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Sample records for intraoperative mr-guided laparoscopic

  1. Intraoperative MR-guided DBS implantation for treating PD and ET

    NASA Astrophysics Data System (ADS)

    Liu, Haiying; Maxwell, Robert E.; Truwit, Charles L.

    2001-05-01

    Deep brain stimulator (DBS) implantation is a promising treatment alternative for suppressing the motor tremor symptoms in Parkinson disease (PD) patient. The main objective is to develop a minimally invasive approach using high spatial resolution and soft-tissue contrast MR imaging techniques to guide the surgical placement of DBS. In the MR-guided procedure, the high spatial resolution MR images were obtained intra-operatively and used to target stereotactically a specific deep brain location. The neurosurgery for craniotomy was performed in the front of the magnet outside of the 10 Gauss line. Aided with positional registration assembly for the stereotactic head frame, the target location (VIM or GPi or STN) in deep brain areas was identified and measured from the MR images in reference to the markers in the calibration assembly of the head frame before the burrhole prep. In 20 patients, MR- guided DBS implantations have been performed according to the new methodology. MR-guided DBS implantation at high magnetic field strength has been shown to be feasible and desirable. In addition to the improved outcome, this offers a new surgical approach in which intra-operative visualization is possible during intervention, and any complications such as bleeding can be assessed in situ immediately prior to dural closure.

  2. Intraoperative laparoscopic complications for urological cancer procedures

    PubMed Central

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

    2015-01-01

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

  3. Intraoperative laparoscopic complications for urological cancer procedures.

    PubMed

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

    2015-05-16

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

  4. Intraoperative pneumothorax during laparoscopic cholecystectomy.

    PubMed

    Tai, Yu-Pin; Wei, Chang-Kuo; Lai, Yu-Yung

    2006-12-01

    Anesthesiologists currently view laparoscopic cholecystectomy resemblant to other laparoscopic procedures with respect to the necessity of inducing a pneumoperitoneum via abdominal insufflation of carbon dioxide (CO2). The present case report describes a healthy 63-year-old man who while undergoing elective laparoscopic cholecystectomy under general anesthesia, developed hypoxemia in the course in consequence of pneumothorax. This complication, although rare, can be catastrophic if prompt diagnosis and rapid intervention and management do not come in the nick of time.

  5. [Intra-operative cholangiography in laparoscopic cholecystectomy].

    PubMed

    Neufeld, D; Jessel, J; Freund, U

    1994-01-16

    Intraoperative cholangiography (IC) in laparoscopic cholecystectomy is a controversial issue. According to traditional teaching, the purpose of cholangiography in gallbladder surgery is to discover previously undiscovered common bile duct stones. This examination was extremely important in the era before ERCP. IC enabled surgeons to find stones and remove them at the same operation. With progress in ERCP, the importance of intraoperative cholangiography has diminished. A stone missed during surgery can most often be dealt with by the less invasive ERCP and papillotomy. There has been a difference of opinion in the literature as to whether to perform cholangiography routinely during gallbladder operations or only in cases in which there is a specific indication, such as an enlarged common bile duct, a history of pancreatitis, or elevated enzymes. Routine operative cholangiography prolongs operative time and carries its own inherent risks, such as injury to the bile ducts. The likelihood of stones is not high and over-diagnosis of stones would result in unwarranted common bile duct exploration and the danger of complications from the procedure. The tendency today is towards a more selective approach. In this era of laparoscopic gallbladder surgery, the controversy has come to the fore again, and there is now an additional aspect. In laparoscopic gallbladder surgery there is greater significance to the "road map" provided by X-rays. We rely mainly on the visual sense and have forgone the tactile sense. Therefore, any added visual input in this operation helps avoid the danger of injuring the main bile ducts. It is our contention that the indications for operative cholangiography in laparoscopic cholecystectomy should again be broadened.

  6. Quantitative analysis of intraoperative communication in open and laparoscopic surgery.

    PubMed

    Sevdalis, Nick; Wong, Helen W L; Arora, Sonal; Nagpal, Kamal; Healey, Andrew; Hanna, George B; Vincent, Charles A

    2012-10-01

    Communication is important for patient safety in the operating room (OR). Several studies have assessed OR communications qualitatively or have focused on communication in crisis situations. This study used prospective, quantitative observation based on well-established communication theory to assess similarities and differences in communication patterns between open and laparoscopic surgery. Based on communication theory, a standardized proforma was developed for assessment in the OR via real-time observation of communication types, their purpose, their content, and their initiators/recipients. Data were collected prospectively in real time in the OR for 20 open and 20 laparoscopic inguinal hernia repairs. Assessors were trained and calibrated, and their reliability was established statistically. During 1,884 min of operative time, 4,227 communications were observed and analyzed (2,043 laparoscopic vs 2,184 open communications). The mean operative duration (laparoscopic, 48 min vs open, 47 min), mean communication frequency (laparoscopic, 102 communications/procedure vs open, 109 communications/procedure), and mean communication rate (laparoscopic, 2.13 communications/min vs open, 2.23 communications/min) did not differ significantly across laparoscopic and open procedures. Communications were most likely to be initiated by surgeons (80-81 %), to be received by either other surgeons (46-50%) or OR nurses (38-40 %), to be associated with equipment/procedural issues (39-47 %), and to provide direction for the OR team (38-46%) in open and laparoscopic cases. Moreover, communications in laparoscopic cases were significantly more equipment related (laparoscopic, 47 % vs open, 39 %) and aimed significantly more at providing direction (laparoscopic, 46 % vs open, 38 %) and at consulting (laparoscopic, 17 % vs open, 12 %) than at sharing information (laparoscopic, 17 % vs open, 31 %) (P < 0.001 for all). Numerous intraoperative communications were found in both

  7. Laparoscopic caecal wedge resection with intraoperative endoscopic assistance.

    PubMed

    Giavarini, Luisa; Boni, Luigi; Cortellezzi, Camillo Claudio; Segato, Sergio; Cassinotti, Elisa; Rausei, Stefano; Dionigi, Gianlorenzo; Rovera, Francesca; Marzorati, Alessandro; Spampatti, Sebastiano; Sambucci, Daniele; Dionigi, Renzo

    2013-01-01

    Cancer is a potential evolution of adenomatous polyps, that is why nowadays screening programs for colorectal cancer are widely diffused. Colonoscopy is the gold standard procedure for identifying and resecting polyps; however, for some polyps resection during colonoscopy is not possible. The aim of the present study is to identify a fast and safe procedure for endoscopically resecting unresectable polyps. Patients with endoscopically unresectable polyps were scheduled for laparoscopic wedge resection under colonoscopic assistance. From November 2010 to November 2012 we treated 15 patients with endoscopically unresectable adenomatous polyps. All patients underwent a laparoscopic caecal wedge resection with intraoperative endoscopic assistance. All procedures were completed without complications and in all cases complete resection of the polyps was achieved. Laparoscopic wedge caecal resection with intraoperative colonoscopy is a fast and safe procedure that can be performed for large polyps that could not be treated endoscopically. Copyright © 2013 Elsevier Ltd and Surgical Associates Ltd. All rights reserved.

  8. The usefulness of intraoperative drip infusion cholangiography during laparoscopic cholecystectomy.

    PubMed

    Nagai, K; Matsumoto, S; Kanemaki, T; Ooshima, T; Mori, K; Funabiki, T

    1992-12-01

    Intraoperative cholangiography during laparoscopic cholecystectomy has been considered to be a necessary examination because incidental injury to the common bile duct must be avoided. We performed 93 intraoperative drip infusion cholangiographies among 103 laparoscopic cholecystectomized patients as simple examinations by using iotroxic acid. The best drip infusion time was determined to be 20 min and good pictures were obtained from 10 to 60 min after the end of the drip. Nine patients with liver dysfunction and a poor radiograph had poor cholangiograms. Clear cholangiograms were obtained in 79 patients: four had a long remnant cystic duct and, in one case, a common bile duct stenosis was found by endoclip. The findings in these five cases helped us to correct failures during operation.

  9. Intraoperative monitoring of laparoscopic skill development based on quantitative measures.

    PubMed

    Cristancho, Sayra M; Hodgson, Antony J; Panton, O N M; Meneghetti, Adam; Warnock, Garth; Qayumi, Karim

    2009-10-01

    Methods for evaluating standard skills in the operating room typically are based on direct observation and checklists, but such evaluations are time consuming and can be subject to bias. It often is possible to acquire more objective measurements using surgical simulators. However, motor performance in simulators can differ significantly from that in the operating room. Intraoperative assessment is particularly challenging because of the significant variability between procedures related to differences in the patients, the surgical setup, and the team. This study aimed to evaluate the feasibility of using a new framework for interpreting quantitative measures acquired in the operating room to distinguish between levels of laparoscopic skill development. Two levels of surgical skill development were observed, namely, those of three fourth-year residents and three attending surgeons performing three laparoscopic cholecystectomies each. Electromagnetic position sensors were attached by the surgeons to a 5-mm curved dissector and a 5-mm atraumatic grasper. From the tools' position histories and video recordings, time, kinematics, and movement transition measures were extracted. Various measures such as the Kolmogorov-Smirnov statistic and the Jensen-Shanon Divergence were used to provide intuitive dimensionless difference measures ranging from 0 to 1. These scores were used to compare residents and expert surgeons executing two surgical tasks: exposure of Calot's triangle and dissection of the cystic duct and artery. The two groups could be clearly differentiated in both tasks during monitoring for the dominant hand (analysis of variance [ANOVA] and Mann-Whitney; p < 0.05) but not for the nondominant hand. It is practical to acquire time, kinematic, and movement transition measures intraoperatively using video and electromagnetic position-sensing technologies. Principal component analysis proved to be a useful technique for presenting differences between skill levels

  10. [Laparoscopic intraoperative differential diagnosis of adnexal tumors. A pilot study of 20 premenopausal patients].

    PubMed

    Grab, D; Kühn, T; Flock, F; Terinde, R

    2000-12-01

    The purpose of the study was to determine the feasibility and potential clinical value of laparoscopic intraoperative sonography in the female genital tract. Intraoperative ultrasound was performed in 20 consecutive premenopausal patients with adnexal masses during laparoscopy using a 7.5 MHz semiflexible transducer. Laparoscopic ultrasound of the female genital tract improves image resolution. Furthermore, this new method allows accurate localisation of early tubal pregnancy and may be helpful if laparoscopic evaluation of the inner genital tract is impaired by severe adhesions. In 7 out of 20 patients, the therapeutical procedure was clearly influenced by the laparoscopic ultrasound findings, resulting in a benefit for the patients in all seven cases. Intraoperative laparoscopic ultrasound may improve minimal invasive management of adnexal masses.

  11. MR-Guided Prostate Interventions

    PubMed Central

    Tempany, Clare; Straus, Sarah; Hata, Nobuhiko; Haker, Steven

    2009-01-01

    In this article the current issues of diagnosis and detection of prostate cancer are reviewed. The limitations for current techniques are highlighted and some possible solutions with MR imaging and MR-guided biopsy approaches are reviewed. There are several different biopsy approaches under investigation. These include transperineal open magnet approaches to closed-bore 1.5T transrectal biopsies. The imaging, image processing, and tracking methods are also discussed. In the arena of therapy, MR guidance has been used in conjunction with radiation methods, either brachytherapy or external delivery. The principles of the radiation treatment, the toxicities, and use of images are outlined. The future role of imaging and image-guided interventions lie with providing a noninvasive surrogate for cancer surveillance or monitoring treatment response. The shift to minimally invasive focal therapies has already begun and will be very exciting when MR-guided focused ultrasound surgery reaches its full potential. PMID:18219689

  12. MR-guided prostate interventions.

    PubMed

    Tempany, Clare; Straus, Sarah; Hata, Nobuhiko; Haker, Steven

    2008-02-01

    In this article the current issues of diagnosis and detection of prostate cancer are reviewed. The limitations for current techniques are highlighted and some possible solutions with MR imaging and MR-guided biopsy approaches are reviewed. There are several different biopsy approaches under investigation. These include transperineal open magnet approaches to closed-bore 1.5T transrectal biopsies. The imaging, image processing, and tracking methods are also discussed. In the arena of therapy, MR guidance has been used in conjunction with radiation methods, either brachytherapy or external delivery. The principles of the radiation treatment, the toxicities, and use of images are outlined. The future role of imaging and image-guided interventions lie with providing a noninvasive surrogate for cancer surveillance or monitoring treatment response. The shift to minimally invasive focal therapies has already begun and will be very exciting when MR-guided focused ultrasound surgery reaches its full potential. (Copyright) 2008 Wiley-Liss, Inc.

  13. Laparoscopic repair for intraoperative injury of the right hepatic artery during cholecystectomy.

    PubMed

    Fujioka, Shuichi; Fuke, Azusa; Funamizu, Naotake; Nakayoshi, Tomoko; Okamoto, Tomoyoshi; Yanaga, Katsuhiko

    2015-02-01

    Right hepatic artery (RHA) injury is a complication that occurs during laparoscopic cholecystectomy, which can sometimes cause hepatic artery pseudoaneurysm or ischemic hepatic necrosis. Therefore, RHA should be managed carefully. Herein, we report a case of intraoperative RHA injury that was successfully repaired during laparoscopic cholecystectomy. Bleeding was controlled prior to the cholecystectomy with vascular clamp forceps that had been inserted through an additional trocar, and repair of the RHA injury was then performed laparoscopically. The postoperative course was uneventful, and patency of the RHA and its sectional arteries were confirmed by CT arteriography. Laparoscopic repair of minor RHA injuries can be managed safely if bleeding is adequately controlled.

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

    PubMed Central

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

    2011-01-01

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

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

    PubMed

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

    2015-02-21

    To determine the efficacy and safety benefits of performing intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) to treat symptomatic cholelithiasis. Patients admitted to the Minimally Invasive Surgery Center of Tianjin Nankai Hospital between January 2012 and January 2014 for management of symptomatic cholelithiasis were recruited for this prospective randomized trial. Study enrollment was offered to patients with clinical presentation of biliary colic symptoms, radiological findings suggestive of gallstones, and normal serum biochemistry results. Study participants were randomized to receive either routine LC treatment or LC+IOC treatment. The routine LC procedure was carried out using the standard four-port technique; the LC+IOC procedure was carried out with the addition of meglumine diatrizoate (1:1 dilution with normal saline) injection via a catheter introduced through a small incision in the cystic duct made by laparoscopic scissors. Operative data and postoperative outcomes, including operative time, retained common bile duct (CBD) stones, CBD injury, other complications and length of hospital stay, were recorded for comparative analysis. Inter-group differences were statistically assessed by the χ2 test (categorical variables) and Fisher's exact test (binary variables), with the threshold for statistical significance set at P<0.05. A total of 371 patients were enrolled in the trial (late-adolescent to adult, age range: 16-70 years), with 185 assigned to the routine LC group and 186 to the LC+IOC group. The two treatment groups were similar in age, sex, body mass index, duration of symptomology, number and size of gallstones, and clinical symptoms. The two treatment groups also showed no significant differences in the rates of successful LC (98.38% vs 97.85%), CBD stone retainment (0.54% vs 0.00%), CBD injury (0.54% vs 0.53%) and other complications (2.16% vs 2.15%), as well as in duration of hospital stay (5.10±1.41 d vs 4.99±1

  16. MR guided breast interventions: role in biopsy targeting and lumpectomies

    PubMed Central

    Jagadeesan, Jayender; Richman, Danielle M; Kacher, Daniel F

    2015-01-01

    Synopsis Contrast enhanced breast MRI is increasingly being used to diagnose breast cancer and to perform biopsy procedures. The American Cancer Society has advised women at high risk for breast cancer to have breast MRI screening as an adjunct to screening mammography. This article places special emphasis on biopsy and operative planning involving MRI and reviews utility of breast MRI in monitoring response to neoadjuvant chemotherapy. We describe peer-reviewed data on currently accepted MR-guided therapeutic methods for addressing benign and malignant breast diseases, including intraoperative imaging. PMID:26499274

  17. AAGL Practice Report: Practice guidelines for intraoperative cystoscopy in laparoscopic hysterectomy.

    PubMed

    2012-01-01

    Lower urinary tract injuries are a serious potential complication of laparoscopic hysterectomy. The risk of such injuries may be as high as 3%, and most, but not all, are detected at intraoperative cystoscopy. High-quality published data suggest a sensitivity of 80% to 90% for ureteral trauma. Among the injuries that may be missed are those related to the use of energy-based surgical tools that include ultrasound and radiofrequency electricity. Cystoscopic evaluation of the lower urinary tract should be readily available to gynecologic surgeons performing laparoscopic hysterectomy. To this end, it is essential that a surgeon with appropriate education, training, and institutional privileges be available without delay to perform this task. Currently available evidence supports cystoscopy at the time of laparoscopic hysterectomies. The rate of detectable but unsuspected lower urinary tract injuries is enough to suggest that surgeons consider cystoscopic evaluation following laparoscopic total hysterectomy as a routine procedure.

  18. Intraoperative fluorescent cholangiography using indocyanine green for laparoscopic fenestration of nonparasitic huge liver cysts.

    PubMed

    Kitajima, Toshihiro; Fujimoto, Yasuhiro; Hatano, Etsuro; Mitsunori, Yusuke; Tomiyama, Koji; Taura, Kojiro; Mizumoto, Masaki; Uemoto, Shinji

    2015-02-01

    Bile duct injury is one of the known serious complications of laparoscopic fenestration for nonparasitic liver cysts. Herein, we report the case of a huge liver cyst for which we performed laparoscopic fenestration using intraoperative fluorescent cholangiography with indocyanine green. A 71-year-old woman with abdominal distention was referred to our hospital. CT demonstrated a 17 × 11.5-cm simple cyst replacing the right lobe of the liver, so laparoscopic fenestration was performed. Although the biliary duct could not be detected because of compression by the huge cyst, fluorescent cholangiography with indocyanine green through endoscopic naso-biliary drainage tube clearly delineated the intrahepatic bile duct in the remaining cystic wall. The patient had no complications at 3 months after surgery. Fluorescent cholangiography using indocyanine green is a safe and effective procedure to avoid bile duct injury during laparoscopic fenestration, especially in patients with a huge liver cyst.

  19. Registration-free laparoscope augmentation for intra-operative liver resection planning

    NASA Astrophysics Data System (ADS)

    Feuerstein, Marco; Mussack, Thomas; Heining, Sandro M.; Navab, Nassir

    2007-03-01

    In recent years, an increasing number of liver tumor indications were treated by minimally invasive laparoscopic resection. Besides the restricted view, a major issue in laparoscopic liver resection is the enhanced visualization of (hidden) vessels, which supply the tumorous liver segment and thus need to be divided prior to the resection. To navigate the surgeon to these vessels, pre-operative abdominal imaging data can hardly be used due to intraoperative organ deformations mainly caused by appliance of carbon dioxide pneumoperitoneum and respiratory motion. While regular respiratory motion can be gated and synchronized intra-operatively, motion caused by pneumoperitoneum is individual for every patient and difficult to estimate. Therefore, we propose to use an optically tracked mobile C-arm providing cone-beam CT imaging capability intraoperatively. The C-arm is able to visualize soft tissue by means of its new flat panel detector and is calibrated offline to relate its current position and orientation to the coordinate system of a reconstructed volume. Also the laparoscope is optically tracked and calibrated offline, so both laparoscope and C-arm are registered in the same tracking coordinate system. Intra-operatively, after patient positioning, port placement, and carbon dioxide insufflation, the liver vessels are contrasted and scanned during patient exhalation. Immediately, a three-dimensional volume is reconstructed. Without any further need for patient registration, the volume can be directly augmented on the live laparoscope video, visualizing the contrasted vessels. This augmentation provides the surgeon with advanced visual aid for the localization of veins, arteries, and bile ducts to be divided or sealed.

  20. Intraoperative laparoscope augmentation for port placement and resection planning in minimally invasive liver resection.

    PubMed

    Feuerstein, Marco; Mussack, Thomas; Heining, Sandro M; Navab, Nassir

    2008-03-01

    In recent years, an increasing number of liver tumor indications were treated by minimally invasive laparoscopic resection. Besides the restricted view, two major intraoperative issues in laparoscopic liver resection are the optimal planning of ports as well as the enhanced visualization of (hidden) vessels, which supply the tumorous liver segment and thus need to be divided (e.g., clipped) prior to the resection. We propose an intuitive and precise method to plan the placement of ports. Preoperatively, self-adhesive fiducials are affixed to the patient's skin and a computed tomography (CT) data set is acquired while contrasting the liver vessels. Immediately prior to the intervention, the laparoscope is moved around these fiducials, which are automatically reconstructed to register the patient to its preoperative imaging data set. This enables the simulation of a camera flight through the patient's interior along the laparoscope's or instruments' axes to easily validate potential ports. Intraoperatively, surgeons need to update their surgical planning based on actual patient data after organ deformations mainly caused by application of carbon dioxide pneumoperitoneum. Therefore, preoperative imaging data can hardly be used. Instead, we propose to use an optically tracked mobile C-arm providing cone-beam CT imaging capability intraoperatively. After patient positioning, port placement, and carbon dioxide insufflation, the liver vessels are contrasted and a 3-D volume is reconstructed during patient exhalation. Without any further need for patient registration, the reconstructed volume can be directly augmented on the live laparoscope video, since prior calibration enables both the volume and the laparoscope to be positioned and oriented in the tracking coordinate frame. The augmentation provides the surgeon with advanced visual aid for the localization of veins, arteries, and bile ducts to be divided or sealed.

  1. Retroperitoneoscopic drainage of bilateral psoas abscesses under intraoperative laparoscopic ultrasound guidance.

    PubMed

    Kodama, Koichi; Takase, Yasukazu; Motoi, Isamu; Mizuno, Hideki; Goshima, Kenichi; Sawaguchi, Takeshi

    2014-05-01

    Despite improved diagnostic modalities for psoas abscesses, the optimum management strategy is not uniform. A 67-year-old man presented with bilateral psoas abscesses secondary to L1-L2 pyogenic discitis. On contrast-enhanced CT, the largest of these abscesses measured 13 × 14 × 33 mm on the right. The patient developed sepsis caused by Klebsiella pneumonia. There were no signs of improvement after 3 weeks of systematic antibiotic administration. We performed surgical drainage of bilateral psoas abscesses by retroperitoneoscopy. Intraoperative laparoscopic ultrasound was useful to determine abscess location in the muscles prior to drainage and confirm no residual abscesses after drainage. The patient was afebrile 3 days later, and his clinical symptoms resolved. Retroperitoneoscopic drainage may represent a feasible minimally invasive therapeutic option for psoas abscess, and intraoperative laparoscopic ultrasound has the potential to increase the safety and efficacy of this surgical procedure.

  2. Intraoperative circulatory management using the FloTrac™ system in laparoscopic liver resection.

    PubMed

    Kitaguchi, Kazuhiko; Gotohda, Naoto; Yamamoto, Hiroyuki; Kato, Yuichiro; Takahashi, Shinichiro; Konishi, Masaru; Hayashi, Ryuichi

    2015-05-01

    Several studies have shown that maintenance of the central venous pressure at a low level during liver surgery is effective for intraoperative management. However, others have suggested that stroke volume variation (SVV) may be a better predictor of fluid responsiveness than central venous pressure. The purpose of this study is to conduct a new type of circulatory management using the FloTrac(TM) system in laparoscopic liver resection and to evaluate specific fluctuations in SVV. Of the laparoscopic liver resections that we performed between March 2012 and December 2013, we used the FloTrac system for intraoperative circulatory management in 21 cases. We analyzed the data, mainly the average value of SVV. The average SVV value during liver transection was 5.2%-24.6% (mean, 17.0%), and 18 cases (86%) exceeded the conventional cut-off value (13%). The average SVV value was 4.3%-18.2% (mean, 9.7%) when pneumoperitoneum was not in effect, whereas it was 7.3% greater on average during liver transection (mean, 17.0%). No perioperative complications developed. The average SVV value during laparoscopic liver transection (mean, 17.0%) exceeded the conventional cut-off value, but in this study, no perioperative complications developed, which enabled safe management. We might be able to manage appropriate fluid control using FloTrac system in patients with laparoscopic liver resection. Therefore, it is necessary to set the target SVV and conduct prospective trials to verify the safety margin for intraoperative management in the future. © 2014 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

  3. Intraoperative endoscopy and leaks after laparoscopic Roux-en-Y gastric bypass.

    PubMed

    Alaedeen, Diya; Madan, Atul K; Ro, Charles Y; Khan, Khurram A; Martinez, Jose M; Tichansky, David S

    2009-06-01

    Postoperative leaks after laparoscopic Roux-en-Y gastric bypass (LRYGB) are a source of morbidity and mortality. Any intervention that would decrease leak rates after LRYGB would be useful. This investigation tested the hypothesis that postoperative leak rates are lower after LRYGB with the routine use of intraoperative endoscopy (EN). Consecutive patients who underwent LRYGB were included. Intraoperative leak testing with air and methylene blue through an orogastric tube (OG) was used in the first 200 patients. Intraoperative endoscopy was used after the first 200 patients. There were 400 patients in this study. Preoperative demographics did not differ between groups. The intraoperative leak rate of the EN group was double the OG group (8 vs 4%; P = not significant), although the difference was not statistically significant. The OG group had a postoperative leak rate of 4 per cent with a mortality rate of 1 per cent. The EN group had a postoperative leak rate of 0.5 per cent with a mortality rate of 0 per cent. The difference in leak rates was statistically significant (P < 0.04). Despite the issues of learning curve, EN demonstrates more intraoperative leaks than OG, indicating EN may be a more sensitive test than OG. Routine use of EN is associated with less postoperative leaks after LRYGB.

  4. Intraoperative ketorolac and bleeding after laparoscopic Roux-en-Y gastric by-pass surgery.

    PubMed

    Klein, M; Støckel, M; Rosenberg, J; Gögenur, I

    2012-01-01

    The unspecific non-steroidal anti-inflammatory drug (NSAID) ketorolac is used during surgery as a single dose regimen to reduce immediate postoperative pain. Many studies have shown an increased risk of bleeding in patients treated with NSAIDs. We wanted to investigate whether intraoperative ketorolac administered at the end of surgery resulted in increased bleeding assessed by reduction in haemoglobin and need for blood transfusion. This was a retrospective review including all patients undergoing laparoscopic Roux-en-Y gastric bypass in the period between January 1st and March 1st, 2010. Haemoglobin levels, time of surgery, fluid treatment and the need for blood transfusion or reoperation were registered. A total of 162 patients were operated in the given period. Of these, the first 47 received intraoperative ketorolac. For the remaining 115 patients, ketorolac was withdrawn. The reduction in haemoglobin in patients receiving intraoperative ketorolac was higher compared with the patients who did not receive ketorolac (-11.3(7.6) % vs. -8.4(6.4) %; p = 0.018). No significant difference was found between the two groups with respect of transfusion requirements (2 out of 47 patients in the ketorolac group versus 0 patients out of 115 in the control group (p = 0.08)). Ketorolac given during surgery may increase the risk of postoperative haemorrhage after laparoscopic Roux-en-Y gastric by-pass.

  5. Impact of radiofrequency energy on intraoperative outcomes of laparoscopic colectomy for cancer in obese patients.

    PubMed

    Cassini, Diletta; Miccini, Michelangelo; Gregori, Matteo; Manoochehri, Farshad; Baldazzi, Gianandrea

    2017-05-04

    Nowadays laparoscopic approach is accepted as a valid alternative to open surgery for the treatment of colorectal cancer. Several studies consider this approach to be safe and feasible also in obese patients, even if dissection in these patients may require a longer operative time and involve higher blood loss. To facilitate laparoscopic approach, more difficult in these patients, several energy sources for laparoscopic dissection and sealing, has been adopted recently. The aim of this study is to investigate the possible intraoperative advantages of radiofrequency energy in terms of blood loss and operative time in obese patients undergoing laparoscopic resection for cancer. All patients who underwent laparoscopic surgery for colorectal cancer from January 2010 to December 2015 were registered in a prospective database. Patients with a body mass index BMI (kg/m(2)) ≥30 were defined as obese, and patients with a BMI (kg/m(2)) <30 were defined as non-obese. All 136 obese patients observed were divided retrospectively into 2 groups according to the devices used for dissection: 83 patients (Historical group: B) on whom dissection and coagulation were performed using other energy sources (monopolar electrocautery scissors, bipolar electrical energy, ultrasonic coagulating shears) and 53 patients who were treated with electrothermal bipolar vessel sealing (Caiman group: A). In group A, the Laparoscopic Caiman 5 (Aesculap AG, Tuttlingen, Germany) was the only instrument employed in the whole procedure. The study examined only three types of operation: right colectomy (RC), left colectomy (LC), and anterior resection (AR). Preoperative data were similar for RC, LC, and AR in both groups (A and B). The mean operative time was statistically shorter in the Caiman group than in the Historical group [104 vs 124 min (p 0.004), 116 vs 140 min (p 0.004), and 125 vs 151 min (p 0.003) for RC, LC, and AR between group A and B, respectively]. Also intraoperative blood loss

  6. Intraoperative augmented reality for laparoscopic colorectal surgery by intraoperative near-infrared fluorescence imaging and optical coherence tomography.

    PubMed

    Cahill, R A; Mortensen, N J

    2010-08-01

    Advances in imaging quality and capability have been the major driver of the laparoscopic revolution that has dramatically impacted upon operative strategies and surgical patient care in recent years. Increasingly now the technological capacity is becoming available to supraselect or extend the useful clinical range of the electromagnetic spectrum beyond visible or white light. This has markedly broadened the intraprocedural optical information available at intraluminal endoscopy and there is likely to be considerable similar benefit for laparoscopy. Rather than narrow band or ultraviolet imaging however, it is the near infrared (NIR) spectrum that seems of most potential to exploit during intra-abdominal endoscopy in particular as this energy range is capable of penetrating relatively deeply into tissues such as the mesentery and bowel wall without inducing thermal damage due to heat dissipation or indeed the intracellular effects associated with higher energy, shorter wavelength energies. By incorporating the NIR spectrum alongside more conventional laparoscopic imaging, a greater appreciation of tissue architecture, character and quality is possible in particular with respect to lymphatic and vascular channel anatomy and flow dynamics and also real-time optical histology (by NIR optical coherence tomography). Such a facility may significantly aid critical intraoperative decision making during colorectal operations by informing the surgeon regarding the most biologically relevant lymphatic basin and lymph nodes for any target area of interest (especially important if considering tailored operative extent for colorectal neoplasia), the sufficiency and quality of arterial supply (and hence inform re the perfusion of stapled intestinal ends prior to reanastomosis) and perhaps even in situ pathological assessment. This article provides a state of art overview of the fascinating potential of this emergent technological capability.

  7. Expert Intraoperative Judgment and Decision-Making: Defining the Cognitive Competencies for Safe Laparoscopic Cholecystectomy.

    PubMed

    Madani, Amin; Watanabe, Yusuke; Feldman, Liane S; Vassiliou, Melina C; Barkun, Jeffrey S; Fried, Gerald M; Aggarwal, Rajesh

    2015-11-01

    Bile duct injuries from laparoscopic cholecystectomy remain a significant source of morbidity and are often the result of intraoperative errors in perception, judgment, and decision-making. This qualitative study aimed to define and characterize higher-order cognitive competencies required to safely perform a laparoscopic cholecystectomy. Hierarchical and cognitive task analyses for establishing a critical view of safety during laparoscopic cholecystectomy were performed using qualitative methods to map the thoughts and practices that characterize expert performance. Experts with more than 5 years of experience, and who have performed at least 100 laparoscopic cholecystectomies, participated in semi-structured interviews and field observations. Verbal data were transcribed verbatim, supplemented with content from published literature, coded, thematically analyzed using grounded-theory by 2 independent reviewers, and synthesized into a list of items. A conceptual framework was created based on 10 interviews with experts, 9 procedures, and 18 literary sources. Experts included 6 minimally invasive surgeons, 2 hepato-pancreatico-biliary surgeons, and 2 acute care general surgeons (median years in practice, 11 [range 8 to 14]). One hundred eight cognitive elements (35 [32%] related to situation awareness, 47 [44%] involving decision-making, and 26 [24%] action-oriented subtasks) and 75 potential errors were identified and categorized into 6 general themes and 14 procedural tasks. Of the 75 potential errors, root causes were mapped to errors in situation awareness (24 [32%]), decision-making (49 [65%]), or either one (61 [81%]). This study defines the competencies that are essential to establishing a critical view of safety and avoiding bile duct injuries during laparoscopic cholecystectomy. This framework may serve as the basis for instructional design, assessment tools, and quality-control metrics to prevent injuries and promote a culture of patient safety. Copyright

  8. Intraoperative Computed Tomography Imaging for Navigated Laparoscopic Renal Surgery: First Clinical Experience.

    PubMed

    Simpfendörfer, Tobias; Gasch, Claudia; Hatiboglu, Gencay; Müller, Michael; Maier-Hein, Lena; Hohenfellner, Markus; Teber, Dogu

    2016-10-01

    Laparoscopic partial nephrectomy (LPN) remains challenging in endophytic and complex kidney tumors as the clear understanding of tumor location and spreading depends on a precise analysis of available imaging. The purpose of this study was to investigate navigated kidney surgery using intraoperative cone-beam computed tomography (CBCT) images in conjunction with a previously proposed method for augmented reality (AR) guidance for safe LPN. The concept proposed is based on using an intraoperative CBCT scan for (1) marker-based AR guidance for fast and reliable tumor access and (2) enhancement of real-time fluoroscopy images for accurate tumor resection. Workflow and accuracy of the system were assessed using a porcine kidney model. Ten patients with complex or endophytic tumor localization and R.E.N.A.L. Nephrometry Score of at least nine scheduled for LPN were included in this study. Patients received an intraoperative CBCT after marker placement. Defining the resection line was assisted by AR. In addition, fluoroscopy imaging for depth perception was used for assistance during dissection. Feasibility and performance were assessed by histopathological results, peri- and postoperative data. Surgery was performed successfully and negative margins were found in all cases. Segmental branches of the renal artery shifted as much as 10 mm in the vertical and 11 mm in the sagittal axis intraoperatively compared to preoperative imaging. Fluoroscopy to intraoperative computed tomography image fusion enabled enhanced depth perception during dissection in all cases. Radiation dose area product was 4.8 mGym(2). The application of the navigation system is feasible and allows for safe and direct access to complex or endophytic renal masses. Radiation limits the application to selected indications.

  9. Intraoperative and postoperative complications of laparoscopic pyeloplasty: a single surgical team experience with 236 cases.

    PubMed

    Fedelini, Paolo; Verze, Paolo; Meccariello, Clemente; Arcaniolo, Davide; Taglialatela, Domenico; Mirone, Vincenzo G

    2013-10-01

    To describe and analyze a single surgical team's experience with intraoperative and postoperative complications arising from the Anderson-Hynes transperitoneal laparoscopic pyeloplasty (LP) procedure in the treatment of patients with ureteropelvic junction obstruction (UPJO). There were 236 consecutive patients who underwent transperitoneal LP over a period of 8 years (2004-2012). These patients' records were retrospectively analyzed for intraoperative and postoperative complications. Of the 236 patients, 111 (47.0%) were males and 125 (53%) were females. In 226 patients, surgical indication was primary UPJO, and in 10 patients, recurrent obstruction. Two hundred and eleven patients (89.4%) were symptomatic. Mean operative time was 96.5 minutes (range 45-360 min). The mean blood loss was 20 mL (range 5-500 mL), and no blood transfusions were necessary. The overall success rate was 97% (229 patients) with a mean follow-up of 38 months (range 6-84 mos). In 86 of the 94 patients who presented with a crossing vessel (91.5%), the anomalous crossing vessel was transposed to the ureteropelvic junction (UPJ) dorsally because of evident obstruction. The mean postoperative hospital stay was 4.2 days (range 3-14 days). All 211 preoperative symptomatic patients reported a complete resolution of symptoms after the procedure. Intraoperative incidents occurred in nine (3.8%) patients, while postoperative complications occurred in 32 (13.5%) patients. Our retrospective analysis confirms that LP is an efficacious and safe procedure resulting in a reported success rate of 97% and a concomitant low level of intraoperative (3.8%) and postoperative complications (13.6%). Major complications necessitating active management occur in a low percentage of cases (5.9% of patients). The most frequent and severe intraoperative complications are related to the Double-J stent insertion. The most common postoperative complication is urine leakage.

  10. Intraoperative measurement of bowel oxygen saturation using a multispectral imaging laparoscope

    PubMed Central

    Clancy, Neil T.; Arya, Shobhit; Stoyanov, Danail; Singh, Mohan; Hanna, George B.; Elson, Daniel S.

    2015-01-01

    Intraoperative monitoring of tissue oxygen saturation (StO2) has potentially important applications in procedures such as organ transplantation or colorectal surgery, where successful reperfusion affects the viability and integrity of repaired tissues. In this paper a liquid crystal tuneable filter-based multispectral imaging (MSI) laparoscope is described. Motion-induced image misalignments are reduced, using feature-based registration, before regression of the tissue reflectance spectra to calculate relative quantities of oxy- and deoxyhaemoglobin. The laparoscope was validated in vivo, during porcine abdominal surgery, by making parallel MSI and blood gas measurements of the small bowel vasculature. Ischaemic conditions were induced by local occlusion of the mesenteric arcade and monitored using the system. The MSI laparoscope was capable of measuring StO2 over a wide range (30-100%) with a temporal error of ± 7.5%. The imager showed sensitivity to spatial changes in StO2 during dynamic local occlusions, as well as tracking the recovery of tissues post-occlusion. PMID:26504664

  11. Intraoperative measurement of bowel oxygen saturation using a multispectral imaging laparoscope.

    PubMed

    Clancy, Neil T; Arya, Shobhit; Stoyanov, Danail; Singh, Mohan; Hanna, George B; Elson, Daniel S

    2015-10-01

    Intraoperative monitoring of tissue oxygen saturation (StO2 ) has potentially important applications in procedures such as organ transplantation or colorectal surgery, where successful reperfusion affects the viability and integrity of repaired tissues. In this paper a liquid crystal tuneable filter-based multispectral imaging (MSI) laparoscope is described. Motion-induced image misalignments are reduced, using feature-based registration, before regression of the tissue reflectance spectra to calculate relative quantities of oxy- and deoxyhaemoglobin. The laparoscope was validated in vivo, during porcine abdominal surgery, by making parallel MSI and blood gas measurements of the small bowel vasculature. Ischaemic conditions were induced by local occlusion of the mesenteric arcade and monitored using the system. The MSI laparoscope was capable of measuring StO2 over a wide range (30-100%) with a temporal error of ± 7.5%. The imager showed sensitivity to spatial changes in StO2 during dynamic local occlusions, as well as tracking the recovery of tissues post-occlusion.

  12. Esophageal Doppler (ODM II) improves intraoperative hemodynamic monitoring during laparoscopic surgery.

    PubMed

    Koliopanos, Alexander; Zografos, George; Skiathitis, Sotirios; Stithos, Dionisios; Voukena, Vasiliki; Karampinis, Andreas; Papastratis, George

    2005-12-01

    Minimally invasive laparoscopic surgery has been expanded to the elderly and high-risk surgical patients with underlying cardiac and pulmonary disease. However, possible cardiovascular changes during CO2 pneumoperitoneum necessitate close intraoperative monitoring. In this prospective study, 55 patients (mean age 62.52 years, range 26-82) undergoing laparoscopic surgery were included. Patients were categorized into 3 groups of low (group A: 12 patients, mean age 55.5 years), moderate (group B: 22 patients, mean age 59.5 years), and high (group C: 21 patients, mean age 69.71 years) surgical risk according to ASA physical status classification. Similar anesthetic agents and anesthetic techniques were used in the above cases. An esophageal Doppler (ODM II, Abbott Laboratories) was used to measure aortic blood flow velocity and thereby estimating stroke volume (SVe) and cardiac output (COe) throughout anesthesia, in addition to traditional monitoring. After abdominal insufflation (peak intra-abdominal pressure: 13-15 mm Hg) COe values decreased from the initial value after induction of anesthesia by 22%, 20%, and 18% for groups A, B, and C, respectively (P < 0.05). The above values further deteriorated (25%, 28%, and 30% for groups A, B, and C, respectively) in the anti-Trendelenburg positioning of the patient. The peak aortic blood flow velocity (PV) followed the changes, thus indicating that heart muscle contractility is affected during the procedure. Stabilization of the above values was achieved after 20 minutes of CO(2) pneumoperitoneum and improvement was noted only after deflation of the abdomen. Heart rate and blood pressure essentially remained unchanged throughout the procedure, although the final values were increased compared with initial. Insufflation of the abdomen with CO(2) produces measurable effects on the cardiovascular system that require reappraisal of hemodynamic monitoring during anesthesia. ODM II offers a reliable, relatively noninvasive, cost

  13. Intraoperative ventilatory strategies for prevention of pulmonary atelectasis in obese patients undergoing laparoscopic bariatric surgery.

    PubMed

    Talab, Hesham F; Zabani, Ibrahim Ali; Abdelrahman, Hassan Saad; Bukhari, Waleed L; Mamoun, Irfan; Ashour, Majed A; Sadeq, Bakr Bin; El Sayed, Sameh Ibrahim

    2009-11-01

    Atelectasis occurs regularly after induction of general anesthesia, persists postoperatively, and may contribute to significant postoperative morbidity and additional health care costs. Laparoscopic surgery has been reported to be associated with an increased incidence of postoperative atelectasis. It has been shown that during general anesthesia, obese patients have a greater risk of atelectasis than nonobese patients. Preventing atelectasis is important for all patients but is especially important when caring for obese patients. We randomly allocated 66 adult obese patients with a body mass index between 30 and 50 kg/m(2) scheduled to undergo laparoscopic bariatric surgery into 3 groups. According to the recruitment maneuver used, the zero end-expiratory pressure (ZEEP) group (n = 22) received the vital capacity maneuver (VCM) maintained for 7-8 s applied immediately after intubation plus ZEEP; the positive end-expiratory pressure (PEEP) 5 group (n = 22) received the VCM maintained for 7-8 s applied immediately after intubation plus 5 cm H(2)O of PEEP; and the PEEP 10 group (n = 22) received the VCM maintained for 7-8 s applied immediately after intubation plus 10 cm H(2)O of PEEP. All other variables (e.g., anesthetic and surgical techniques) were the same for all patients. Heart rate, noninvasive mean arterial blood pressure, arterial oxygen saturation, and alveolar-arterial Pao(2) gradient (A-a Pao(2)) were measured intraoperatively and postoperatively in the postanesthesia care unit (PACU). Length of stay in the PACU and the use of a nonrebreathing O(2) mask (100% Fio(2)) or reintubation were also recorded. A computed tomographic scan of the chest was performed preoperatively and postoperatively after discharge from the PACU to evaluate lung atelectasis. Patients in the PEEP 10 group had better oxygenation both intraoperatively and postoperatively in the PACU, lower atelectasis score on chest computed tomographic scan, and less postoperative pulmonary

  14. Computed tomography, endoscopic, laparoscopic, and intra-operative sonography for assessing resectability of pancreatic cancer.

    PubMed

    Long, Eliza E; Van Dam, Jacques; Weinstein, Stefanie; Jeffrey, Brooke; Desser, Terry; Norton, Jeffrey A

    2005-08-01

    Pancreas cancer is the fourth leading cancer killer in adults. Cure of pancreas cancer is dependent on the complete surgical removal of localized tumor. A complete surgical resection is dependent on accurate preoperative and intra-operative imaging of tumor and its relationship to vital structures. Imaging of pancreatic tumors preoperatively and intra-operatively is achieved by pancreatic protocol computed tomography (CT), endoscopic ultrasound (EUS), laparoscopic ultrasound (LUS), and intra-operative ultrasound (IOUS). Multi-detector CT with three-dimensional (3-D) reconstruction of images is the most useful preoperative modality to assess resectability. It has a sensitivity and specificity of 90 and 99%, respectively. It is not observer dependent. The images predict operative findings. EUS and LUS have sensitivities of 77 and 78%, respectively. They both have a very high specificity. Further, EUS has the ability to biopsy tumor and obtain a definitive tissue diagnosis. IOUS is a very sensitive (93%) method to assess tumor resectability during surgery. It adds little time and no morbidity to the operation. It greatly facilitates the intra-operative decision-making. In reality, each of these methods adds some information to help in determining the extent of tumor and the surgeon's ability to remove it. We rely on pancreatic protocol CT with 3-D reconstruction and either EUS or IOUS depending on the tumor location and operability of the tumor and patient. With these modern imaging modalities, it is now possible to avoid major operations that only determine an inoperable tumor. With proper preoperative selection, surgery is able to remove tumor in the majority of patients.

  15. Massive right hemothorax as the source of hemorrhagic shock after laparoscopic cholecystectomy - case report of a rare intraoperative complication.

    PubMed

    Cristian, Rapicetta; Massimiliano, Paci; Tommaso, Ricchetti; Sara, Tenconi; Federico, Biolchini; Emilio, Belluzzi; Giorgio, Sgarbi

    2011-05-19

    A 62-year old man was referred to our institution in hemorrhagic shock after a laparoscopic cholecystectomy for acute cholecystitis, performed at an outside hospital. A chest X-ray revealed a right-sided massive pleural effusion. Urgent surgical exploration was performed through a video-assisted mini-thoracotomy which revealed active bleeding from a pleural adherence. Successful hemostasis was achieved intraoperatively and the patient had an uneventful recovery. In absence of intra-abdominal hemorrhage, a hemothorax should be considered as a potential source of major bleeding in patients who develop symptoms of hypovolemia after laparoscopic surgery.

  16. Routine versus selective intraoperative cholangiography during laparoscopic cholecystectomy: a survey of 2,130 patients undergoing laparoscopic cholecystectomy.

    PubMed

    Nickkholgh, A; Soltaniyekta, S; Kalbasi, H

    2006-06-01

    Routine use of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is a matter of debate. Data from 2,130 consecutive LCs and patients' follow-up during 9 years were collected and analyzed. During the first 4 years of the study, 800 patients underwent LC, and IOC was performed selectively (SIOC). Thereafter, 1,330 patients underwent LC, and IOC was routinely attempted (RIOC) for all. In the IOC group, 159 patients met the criteria for SIOC, which was completed successfully in 141 cases (success rate, 88.6%). Bile duct calculi were found in nine patients. All other patients with no criteria or failed SIOC were followed, and in nine patients retained stones were documented. Thus, the incidence of ductal stones was 1.1% and sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for the detection of ductal stones were 50, 100, 98.6, and 100%, respectively. In the RIOC group, IOC was routinely attempted in 1,330 patients and was successful in 1,133 (success rate, 90.9%; p = 0.015). Bile duct stones were detected in 37 patients (including 14 asymptomatic stones). In two cases, IOC failed to reveal ductal stones (false negative). There was no false-positive IOC. Therefore, with RIOC policy, the incidence of ductal stones, sensitivity, specificity, NPV, and PPV were 3.3, 97.4, 100, 99.8, and 100%, respectively (significantly higher for success rate, incidence, sensitivity, and NPV; p < 0.05). Abnormal IOC findings were also significantly higher in the RIOC group. Common bile duct injury occurred only in the SIOC group [two cases of all 2,130 LCs (0.09%)]. RIOC during LC is a safe, accurate, quick, and cost-effective method for the detection of bile duct anatomy and stones. A highly disciplined performance of RIOC can minimize potentially debilitating and hazardous complications of bile duct injury.

  17. Evaluation of cardiac function during laparoscopic gastrostomy in pediatric patients with hypoplastic left heart syndrome using intraoperative transesophageal echocardiography.

    PubMed

    Knott, E Marty; Fraser, Jason D; Alemayahu, Hanna; Drake, William B; St Peter, Shawn D; Perryman, Kathy M; Juang, David

    2014-10-01

    Patients with single ventricle physiology (SVP)--specifically, hypoplastic left heart syndrome (HLHS)--frequently need long-term enteral access; however, they are at an extremely high operative risk. Nothing has been published on the physiologic impact on single ventricle function during laparoscopy in this patient population. Therefore, we performed intraoperative transesophageal echocardiography (TEE) to study the physiologic effects of laparoscopic surgery in these patients. After Internal Review Board approval, patients with SVP undergoing laparoscopic gastrostomy were studied with intraoperative TEE, and fractional shortening was determined. Patients were separated into those with HLHS and others with SVP. Data are reported as mean ± standard deviation values. Analysis of variance was used for continuous variables. From August 2011 to February 2013, in total, 11 patients with SVP underwent laparoscopic gastrostomy, including 6 with HLHS. One of the 6 HLHS patients and 1 of the SVP patients underwent concurrent fundoplication. All patients were post-first-stage palliation; two had completed post-second stage. Fractional shortening tended to decrease during insufflation and return to baseline after desufflation. There was no 30-day mortality. Pneumoperitoneum associated with laparoscopic gastrostomy tube placement results in a reversible decrease in fractional shortening in patients with HLHS and SVP. Overall, the children tolerated pneumoperitoneum. TEE allows for real-time assessment of ventricular function and volume and may improve safety during longer procedures.

  18. Laparoscopic diverticulectomy with the aid of intraoperative gastrointestinal endoscopy to treat epiphrenic diverticulum

    PubMed Central

    Yu, Lei; Wu, Ji-xiang; Chen, Xiao-hong; Zhang, Yun-Feng; Ke, Ji

    2016-01-01

    OBJECTIVE: Most researchers believe that the presence of large epiphrenic diverticulum (ED) with severe symptoms should lead to the consideration of surgical options. The choice of minimally invasive techniques and whether Heller myotomy with antireflux fundoplication should be employed after diverticulectomy became points of debate. The aim of this study was to describe how to perform laparoscopic transhiatal diverticulectomy (LTD) and oesophagomyotomy with the aid of intraoperative gastrointestinal (GI) endoscopy and how to investigate whether the oesophagomyotomy should be performed routinely after LTD. PATIENTS AND METHODS: From 2008 to 2013, 11 patients with ED underwent LTD with the aid of intraoperative GI endoscopy at our department. Before surgery, 4 patients successfully underwent oesophageal manometry: Oesophageal dysfunction and an increase of the lower oesophageal sphincter pressure (LESP) were found in 2 patients. RESULTS: There were 2 cases of conversion to an open transthoracic procedure. Six patients underwent LTD, Heller myotomy and Dor fundoplication; and 3 patients underwent only LTD. The dysphagia and regurgitation 11 patients experienced before surgery improved significantly. Motor function studies showed that there was no oesophageal peristalsis in 5 patients during follow-up, while 6 patients showed seemingly normal oesophageal motility. The LESP of 6 patients undergoing LTD, myotomy and Dor fundoplication was 16.7 ± 10.2 mmHg, while the LESPs of 3 patients undergoing only LTD were 26 mmHg, 18 mmHg and 21 mmHg, respectively. In 4 cases experiencing LTD, myotomy and Dor fundoplication, the gastro-oesophageal reflux occurred during the sleep stage. CONCLUSIONS: LTD constitutes a safe and valid approach for ED patients with severe symptoms. As not all patients with large ED have oesophageal disorders, according to manometric and endoscopic results, surgeons can categorise and decide whether or not myotomy and antireflux surgery after LTD will

  19. Single-stage laparoscopic cholecystectomy and intraoperative endoscopic retrograde cholangiopancreatography: is this strategy feasible in Australia?

    PubMed

    March, Brayden; Burnett, David; Gani, Jon

    2016-11-01

    Currently in Australasia, concomitant cholecystolithiasis and choledocholithiasis are usually managed with two procedures: laparoscopic cholecystectomy (LC) and pre or postoperative endoscopic retrograde cholangiopancreatography (ERCP). This approach exposes the patient to the risk of complications from the common bile duct stone(s) while awaiting ERCP, the risks of the ERCP itself (particularly pancreatitis) and the need for a second anaesthetic. This article explores the evidence for a newer hybrid approach, single stage LC and intraoperative ERCP (SSLCE) and compares this approach with the commonly used alternatives. SSLCE offers reduced rates of pancreatitis, reduced length of hospital stay and reduced cost compared with the two-stage approach and requires only one anaesthetic. There is a reduced risk of bile leak compared with procedures that involve a choledochotomy, and ductal clearance rates are superior to trans-cystic exploration and equivalent to the standard two-stage approach. Barriers to widespread implementation relate largely to operating theatre logistics and availability of appropriate endoscopic expertise, although when bile duct stones are anticipated these issues are manageable. There is compelling justification in the literature to gather prospective evidence surrounding SSLCE in the Australian Healthcare system.

  20. Hemorrhage control for laparoscopic hepatectomy: technical details and predictive factors for intraoperative blood loss.

    PubMed

    Kawaguchi, Yoshikuni; Nomi, Takeo; Fuks, David; Mal, Frederic; Kokudo, Norihiro; Gayet, Brice

    2016-06-01

    Controlling bleeding during laparoscopic hepatectomy (LH) is technically demanding, but reportedly associated with less estimated blood loss (EBL) than open surgery. The present study aimed to describe and evaluate hemorrhage control techniques during LH and identify predictors of high intraoperative EBL. The data of 438 consecutive patients undergoing LH between 1995 and 2012 were reviewed. Bleeding control was facilitated by the proper use of hemostatic devices and surgical maneuvers unique to LH and by preserving intra-abdominal pressure. EBL was evaluated among three groups of 146 patients in each group: 1995-2006 (group A), 2006-2009 (group B), and 2009-2012 (group C). We also sought factors that predicted EBL ≥800 mL. Mean EBL decreased overtime from groups A to C: group A, 378 ± 619 mL; group B, 293 ± 391 mL; groups C, 257 ± 366 mL; P = 0.127. Transfusion rate was 6.7 % in group A, 5.5 % in group B, and 4.8 % in group C (P = 0.743). Hypertension (odds ratio (OR) 2.82, 95 % confidence interval CI 1.37-5.78; P = 0.006), preoperative chemotherapy (OR 2.55, 95 % CI 1.26-5.31; P = 0.009), resection of posterosuperior segments (OR 3.73, 95 % CI 1.33-12.17; P = 0.012), and major hepatectomy (OR 4.21, 95 % CI 1.64-13.02; P < 0.001) independently predicted high EBL. Improvements in bleeding control techniques over time have reduced EBL during LH. The use of these techniques and an understanding of the predictive factors for high EBL will help surgeons improve outcomes after LH.

  1. TU-A-BRF-01: MR Guided Radiation Therapy

    SciTech Connect

    Stanescu, T; Balter, J; Nyholm, T; Lagendijk, J

    2014-06-15

    In recent years, there has been an increasing interest in the development of new technologies focused on the deeper integration of MR in radiotherapy. The innovations span from image data acquisition and post-processing to clinical implementation of MR-guided RT systems and workflow development. The session is intended to provide a review of the key and most recent advancements. Targeted discussions will cover topics which currently define the concept of MR-guided radiotherapy including a) system commissioning, quality control and safety, b) MR data manipulation for dose computations and treatment simulation, c) quantification/management of organ motion and treatment delivery guidance. Learning Objectives: Understand the concept and specifics of MR-guided radiotherapy; Understand the requirements for system integration in clinical workflow; Become familiar with the proposed strategies for system commissioning, RT planning and delivery guidance.

  2. Does laparoscopic simulation predict intraoperative performance? A comparison between the Fundamentals of Laparoscopic Surgery and LapVR evaluation metrics.

    PubMed

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

    2015-01-01

    Considerable resources have been invested in low- and high-fidelity simulators in surgical training. To our knowledge, no investigation has compared the 2 head to head for operative assessment purposes. The purpose of this study was to assess the Fundamentals of Laparoscopic Surgery (FLS) low-fidelity video trainer and LapVR (high-fidelity virtual-reality simulator) for (1) construct and (2) predictive validity using a human cholecystectomy model. Twenty-six participants performed tasks from the FLS program and the LapVR simulator as well as a human laparoscopic cholecystectomy. Performance was evaluated using FLS and LapVR metrics and the Objective Structured Assessment of Technical Skills previously validated rating scale. Construct and predictive validity were strongly demonstrated for FLS tasks but only incompletely for LapVR. Efforts should be focused on using the well-validated lower-cost FLS video trainer for assessment of laparoscopic skills. The high-cost LapVR remains experimental in resource-constrained training programs. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Laparoscopic ureteroureterostomy with an intraoperative retrograde ureteroscopy-assisted technique for distal ureteral injury secondary to gynecological surgery: a retrospective comparison with laparoscopic ureteroneocystostomy.

    PubMed

    Wang, Zhaohui; Chen, Zhi; He, Yao; Li, Bingsheng; Wen, Zhiqiang; Chen, Xiang

    2017-08-01

    The aim of this study was to compare the operative and postoperative outcomes of laparoscopic ureteroureterostomy (LAP-UU) using a retrograde ureteroscopy-assisted technique with laparoscopic ureteroneocystostomy (LAP-UNC) in treating ureteral injury after gynecological surgery. The study analyzed 60 ureteral injury repairs performed between May 2010 and February 2016 in patients who underwent either LAP-UU using the retrograde ureteroscopy-assisted technique (n = 26) or LAP-UNC (n = 34). Demographic parameters, operative variables and perioperative outcomes were retrospectively analyzed. The chi-squared test, Fisher's exact test and Student's t test were used for statistical analyses. Demographic and clinical data revealed no significant differences between patients in each group in terms of age, body mass index, length of obstruction, incidence of postoperative urinary leakage, incidence of urinary tract infection during hospitalization, oral antibiotics, mean hospital stay, incidence of recurrent obstruction, rate of conversion to open surgery and mean operative time. The LAP-UU group had significantly less estimated blood loss (85 ± 40 vs 120 ± 35 ml, p = .0006) and a significantly lower incidence of vesicoureteral reflux (grade I) on cystography (0/26 vs 6/34, p = .031) during a mean follow-up of 36.5 months (range 7-71 months). Compared with LAP-UNC, LAP-UU is also a technically feasible and safe option for repairing distal ureteral injury secondary to gynecological surgery. The intraoperative retrograde ureteroscopy-assisted technique during LAP-UU contributes to precise localization of the lesion, reduces intraoperative bleeding, enables sufficient dissection of the intramural ureter and preserves its natural antireflux mechanism.

  4. Methylene blue: a simple marker for intraoperative detection of gastroduodenal perforations during laparoscopic pyloromyotomy.

    PubMed

    Vegunta, Ravindra K; Rawlings, Arthur L; Jeziorczak, Paul M

    2010-03-01

    We studied the feasibility of using methylene blue (MB) as a marker to detect mucosal perforations during laparoscopic pyloromyotomy using in vitro and in vivo animal models. MB was initially tested in pig stomachs in vitro. Information gathered from these experiments was then used to test the marker during experimental live piglet laparoscopic surgery. MB stained the gastric mucosa blue; this tint could be seen through the intact mucosal layer exposed via myotomy. Dye extravasation was seen during laparoscopic surgery with mucosal perforations of 1.2 mm and greater with or without air insufflation of the stomach. Air extravasation was seen with perforations of 2.0 mm and greater. Full strength 1% MB dye instilled into the gastric lumen can potentially be used as a marker for detection of mucosal perforations of 1.2 mm or greater during laparoscopic pyloromyotomy.

  5. Comparison of effects of intraoperative nefopam and ketamine infusion on managing postoperative pain after laparoscopic cholecystectomy administered remifentanil

    PubMed Central

    Choi, Sung Kwan; Choi, Jung Il; Kim, Woong Mo; Heo, Bong Ha; Park, Keun Seok; Song, Ji A

    2016-01-01

    Background Although intraoperative opioids provide more comfortable anesthesia and reduce the use of postoperative analgesics, it may cause opioid induced hyperalgesia (OIH). OIH is an increased pain response to opioids and it may be associated with N-methyl-D-aspartate (NMDA) receptor. This study aimed to determine whether intraoperative nefopam or ketamine, known being related on NMDA receptor, affects postoperative pain and OIH after continuous infusion of intraoperative remifentanil. Methods Fifty-four patients undergoing laparoscopic cholecystectomy were randomized into three groups. In the nefopam group (N group), patients received nefopam 0.3 mg/kg at the induction of anesthesia followed by a continuous infusion of 0.065 mg/kg/h. In the ketamine group (K group), patients received ketamine 0.3 mg/kg at the induction of anesthesia followed by a continuous infusion of 3 µg/kg/min. The control group did not received any other agents except for the standard anesthetic regimen. Postoperative pain score, first time and number of demanding rescue analgesia, OIH and degrees of drowsiness/sedation scale were examined. Results Co-administrated nefopam or ketamine significantly reduced the total amount of intraoperative remifentanil and postoperative supplemental morphine. Nefopam group showed superior property over control and ketamine group in the postoperative VAS score and recovery index (alertness and respiratory drive), respectively. Nefopam group showed lower morphine consumption than ketamine group, but not significant. Conclusions Both nefopam and ketamine infusion may be useful in managing in postoperative pain control under concomitant infusion of remifentanil. However, nefopam may be preferred to ketamine in terms of sedation. PMID:27703629

  6. Update on Clinical MR-guided Focused Ultrasound Applications

    PubMed Central

    McDannold, Nathan

    2015-01-01

    SYNOPSIS Focused ultrasound (FUS) can be used to thermally ablate tissue. The performance of FUS under magnetic resonance (MR) guidance enables aiming the focus at the target, accurate treatment planning, real-time temperature mapping, and evaluation of the treatment. This review updates several clinical applications of MR-guided FUS. MR-guided FUS has a CE mark and FDA approval for thermal ablation for uterine fibroids and bone metastases related pain management. Thousands of uterine fibroid patients have successfully been treated with minor side effects. Technical improvements, increased experience, and the use of a screening MRI examination should further improve treatment outcome. When used for bone metastases and other bone diseases, thermal ablation leads to pain relief due to denervation, and debulking of the tumor. The use of a hemi-spherical multi-element transducer and phase corrections have enabled application of FUS through the skull. Transcranial MR-guided FUS has received CE certification for ablation of deep, central locations in the brain such as the thalamus. Thermal ablation of specific parts of the thalamus can result in relief of the symptoms in neurological disorders such as essential tremor, Parkinson’s, and neuropathic pain. No CE mark or FDA approval has been obtained as yet for treatment of prostate cancer or breast cancer, but several approaches have been proposed and clinical trials should show the potential of MR-guided FUS for these and other applications. PMID:26499282

  7. Effect of intraoperative intravenous lidocaine on postoperative pain and return of bowel function after laparoscopic abdominal gynecologic procedures.

    PubMed

    Grady, Philip; Clark, Nathaniel; Lenahan, John; Oudekerk, Christopher; Hawkins, Robert; Nezat, Greg; Pellegrini, Joseph E

    2012-08-01

    Abdominal surgery has a high incidence of postoperative pain and dysfunctional gastrointestinal motility. This study investigated the effect of a continuous intraoperative infusion of lidocaine on patients undergoing laparoscopic gynecologic surgery. In this double-blind, placebo-controlled investigation, 50 subjects were randomly assigned to control and experimental groups. Both groups received an intravenous lidocaine bolus of 1 mg/kg on induction. The experimental group received a continuous lidocaine infusion of 2 mg/kg/h, initiated following induction and discontinued 15 to 30 minutes before skin closure. Controls received a placebo infusion. Patients in the experimental group had lower postoperative day 3 pain scores using a verbal analog scale (P = .02). Morphine equivalent dose at second request for pain treatment in the postoperative anesthesia care unit was lower in the experimental group (P = .02). There was a statistically significant difference in time interval from surgical start to return of first flatus between the groups (P = .02). Data were analyzed using descriptive and inferential statistics. A P value less than .05 was considered significant. These study results are consistent with previous research suggesting that intraoperative lidocaine infusion may improve postoperative pain levels and may shorten the time to return of bowel function.

  8. Navigation of a robot-integrated fluorescence laparoscope in preoperative SPECT/CT and intraoperative freehand SPECT imaging data: a phantom study

    NASA Astrophysics Data System (ADS)

    van Oosterom, Matthias Nathanaël; Engelen, Myrthe Adriana; van den Berg, Nynke Sjoerdtje; KleinJan, Gijs Hendrik; van der Poel, Henk Gerrit; Wendler, Thomas; van de Velde, Cornelis Jan Hadde; Navab, Nassir; van Leeuwen, Fijs Willem Bernhard

    2016-08-01

    Robot-assisted laparoscopic surgery is becoming an established technique for prostatectomy and is increasingly being explored for other types of cancer. Linking intraoperative imaging techniques, such as fluorescence guidance, with the three-dimensional insights provided by preoperative imaging remains a challenge. Navigation technologies may provide a solution, especially when directly linked to both the robotic setup and the fluorescence laparoscope. We evaluated the feasibility of such a setup. Preoperative single-photon emission computed tomography/X-ray computed tomography (SPECT/CT) or intraoperative freehand SPECT (fhSPECT) scans were used to navigate an optically tracked robot-integrated fluorescence laparoscope via an augmented reality overlay in the laparoscopic video feed. The navigation accuracy was evaluated in soft tissue phantoms, followed by studies in a human-like torso phantom. Navigation accuracies found for SPECT/CT-based navigation were 2.25 mm (coronal) and 2.08 mm (sagittal). For fhSPECT-based navigation, these were 1.92 mm (coronal) and 2.83 mm (sagittal). All errors remained below the <1-cm detection limit for fluorescence imaging, allowing refinement of the navigation process using fluorescence findings. The phantom experiments performed suggest that SPECT-based navigation of the robot-integrated fluorescence laparoscope is feasible and may aid fluorescence-guided surgery procedures.

  9. Comparison between intraoperative cholangiography and choledochoscopy for ductal clearance in laparoscopic CBD exploration: a prospective randomized study.

    PubMed

    Vindal, Anubhav; Chander, Jagdish; Lal, Pawanindra; Mahendra, Balu

    2015-05-01

    Laparoscopic CBD exploration (LCBDE) is an accepted treatment modality for single stage management of CBD stones in fit patients. A transcholedochal approach is preferred in patients with a dilated CBD and large impacted stones in whom ductal clearance remains problematic. There are very few studies comparing intraoperative cholangiography (IOC) with choledochoscopy to determine ductal clearance in patients undergoing transcholedochal LCBDE. This series represents the first of those comparing the two from Asia. Between April 2009 and October 2012, 150 consecutive patients with CBD stones were enrolled in a prospective randomized study to undergo transcholedochal LCBDE on an intent-to-treat basis. Patients with CBD diameter of less than 9 mm on preoperative imaging were excluded from the study. Out of the 132 eligible patients, 65 patients underwent IOC (Group A), and 67 patients underwent intraoperative choledochoscopy (Group B) to determine CBD clearance. There were no differences between the two groups in the demographic profile and the preoperative biochemical findings. There was no conversion to open procedures, and complete stone clearance was achieved in all the 132 cases. The mean CBD diameter and the mean number of CBD stones removed were comparable between the two groups. Mean operating time was 170 min in Group A and 140 min in Group B (p < 0.001). There was no difference in complications between the two groups. Nine patients in Group A (13.8%) showed non-passage of contrast into the duodenum on IOC which resolved after administration of i.v. glucagon, suggesting a transient spasm of sphincter of Oddi. Two patients (3%) showed a false-positive result on IOC which had to be resolved with choledochoscopy. The present study showed that intraoperative choledochoscopy is better than IOC for determining ductal clearance after transcholedochal LCBDE and is less cumbersome and less time-consuming.

  10. Effect of intraoperative amino acids with or without glucose infusion on body temperature, insulin, and blood glucose levels in patients undergoing laparoscopic colectomy: a preliminary report.

    PubMed

    Fujita, Yasuki; Tokunaga, Chiharu; Yamaguchi, Sayo; Nakamura, Kayo; Horiguchi, Yuu; Kaneko, Michiko; Iwakura, Takeo

    2014-09-01

    Amino acid administration helps to prevent intraoperative hypothermia but may enhance thermogenesis when combined with glucose infusion. The aim of this study was to examine the effect of intraoperative amino acid administration, with or without glucose infusion, on temperature regulation during laparoscopic colectomy. Twenty-one patients whose physical status was classified I or II by the American Society of Anesthesiologists, and who were undergoing elective laparoscopic colectomy were enrolled. The exclusion criteria were a history of diabetes and/or obesity, preoperative high levels of C-reactive protein, high blood glucose and/or body temperature after anesthesia induction, and surgical time >500 minutes. Each patient received an acetate ringer solution and was randomly assigned to one of three groups. Group A patients were given only amino acids. Group AG patients were given amino acids and glucose. Group C patients were given neither amino acids nor glucose. Tympanic membrane temperatures and blood glucose and insulin levels were measured intraoperatively. Intraoperative amino acid infusion significantly increased body temperature during surgery as compared with either Group AG or C. The blood glucose levels in Group AG were significantly higher than those in Groups A and C. However, there were no significant differences between Groups A and C. Two hours after anesthesia induction, serum insulin levels in Groups A and AG significantly increased compared with Group C. No significant differences in the postoperative complications or patient hospitalization lengths were detected between the groups. Intraoperative amino acid infusion without glucose administration maintains body temperature more effectively than combined amino acid and glucose infusion in patients undergoing laparoscopic colectomy, despite unaltered intraoperative insulin levels. Copyright © 2014. Published by Elsevier B.V.

  11. MR sequences and rapid acquisition for MR guided interventions

    PubMed Central

    Campbell-Washburn, Adrienne E; Faranesh, Anthony Z; Lederman, Robert J; Hansen, Michael S

    2015-01-01

    Synopsis Interventional MR uses rapid imaging to guide diagnostic and therapeutic procedures. One of the attractions of MR-guidance is the abundance of inherent contrast mechanisms available. Dynamic procedural guidance with real-time imaging has pushed the limits of MR technology, demanding rapid acquisition and reconstruction paired with interactive control and device visualization. This article reviews the technical aspects of real-time MR sequences that enable MR-guided interventions. PMID:26499283

  12. 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.

  13. Laparoscopic ultrasound: a surgical "must" for second line intra-operative evaluation of pancreatic cancer resectability.

    PubMed

    Piccolboni, P; Settembre, A; Angelini, P; Esposito, F; Palladino, S; Corcione, F

    2015-01-01

    Advanced laparoscopy for pancreatic cancer surgery should include laparoscopic ultrasound (LUS), in order to accurately evaluate resectability and rule out the presence of undetected metastases and/or vascular infiltration. LUS should be done as a preliminary step whenever pre-operative imaging casts doubts on resectability. We hereby report our experience of 18 consecutive patients, aged 43-76, coming to our attention during a six months period (Jan-Jun 2013), with a diagnosis of pancreas head or body cancer. LUS allowed to rule out undetected metastases or mesenteric vessels infiltration in 11 patients (61.1%), who were submitted, as previously scheduled, to radical duodeno-pancreatectomy (9 cases) and spleno-caudal pancreatectomy (2 cases). Among the remaining patients, three had been correctly evaluated as non resectable radically at pre-operative work out, and confirmed at LUS, while LUS detected non resectable disease in further 4 patients (22.2%), who underwent palliative procedures. In 2 patients of this group liver micro-metastases were found, while 2 were excluded because of mesenteric vessels infiltration. LUS provided a higher level of diagnostic accuracy, allowing in our experience to exclude 4 patients from radical surgery (22.2%). The evaluation of surgical resectability is an issue of crucial importance to decide surgical strategy in pancreas tumor surgery. In our opinion LUS should be considered a mandatory step in laparoscopic approach to pancreatic tumors, to better define disease staging and evaluate resectability.

  14. Improved Intraoperative Visualization of Nerves through a Myelin-Binding Fluorophore and Dual-Mode Laparoscopic Imaging.

    PubMed

    Cotero, Victoria E; Kimm, Simon Y; Siclovan, Tiberiu M; Zhang, Rong; Kim, Evgenia M; Matsumoto, Kazuhiro; Gondo, Tatsuo; Scardino, Peter T; Yazdanfar, Siavash; Laudone, Vincent P; Tan Hehir, Cristina A

    2015-01-01

    The ability to visualize and spare nerves during surgery is critical for avoiding chronic morbidity, pain, and loss of function. Visualization of such critical anatomic structures is even more challenging during minimal access procedures because the small incisions limit visibility. In this study, we focus on improving imaging of nerves through the use of a new small molecule fluorophore, GE3126, used in conjunction with our dual-mode (color and fluorescence) laparoscopic imaging instrument. GE3126 has higher aqueous solubility, improved pharmacokinetics, and reduced non-specific adipose tissue fluorescence compared to previous myelin-binding fluorophores. Dosing and kinetics were initially optimized in mice. A non-clinical modified Irwin study in rats, performed to assess the potential of GE3126 to induce nervous system injuries, showed the absence of major adverse reactions. Real-time intraoperative imaging was performed in a porcine model. Compared to white light imaging, nerve visibility was enhanced under fluorescence guidance, especially for small diameter nerves obscured by fascia, blood vessels, or adipose tissue. In the porcine model, nerve visualization was observed rapidly, within 5 to 10 minutes post-intravenous injection and the nerve fluorescence signal was maintained for up to 80 minutes. The use of GE3126, coupled with practical implementation of an imaging instrument may be an important step forward in preventing nerve damage in the operating room.

  15. Internal Hernia Following Laparoscopic Roux-en-Y Gastric Bypass: Prevention and Tips for Intra-operative Management.

    PubMed

    Nimeri, Abdelrahman A; Maasher, Ahmed; Al Shaban, Talat; Salim, Elnazeer; Gamaleldin, Maysoon M

    2016-09-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the golden standard for bariatric surgery. However, the potential risk for internal hernia after LRYGB remains a significant concern to both patients and surgeons. In addition, patients presenting with abdominal pain after LRYGB warrant careful attention to avoid missing or delaying the diagnosis of internal hernia. The aim of this study was to describe our technique to prevent internal hernia after LRYGB, intra-operative findings, and our management strategies for patients with internal hernia after LRYGB. In this video, we review different technical tips and tricks to explore patients with suspected internal hernia after RYGB, how to reduce obstructed small bowel, and effectively close mesenteric defects to prevent internal hernia after LRYGB. A high index of suspicion and evaluation of the CT scan of the patient by an experienced bariatric surgeon is essential to avoid missing cases of internal hernia after LRYGB. In addition, patients presenting with incarcerated small bowel due to an internal hernia are best managed by standing on the left side of the patient with the left arm tucked and starting at the ileocecal valve and running the small bowel backwards towards the ligament of Treitz. Furthermore, patients with bowel obstruction due to internal hernia may need to have a gastrostomy placed at the remnant of the stomach. Recurrent abdominal pain is not uncommon after LRYGB. Systematic closure of mesenteric defects, the use of diagnostic laparoscopy, and high index of suspicion are all necessary to avoid delay in diagnosis.

  16. Improved Intraoperative Visualization of Nerves through a Myelin-Binding Fluorophore and Dual-Mode Laparoscopic Imaging

    PubMed Central

    Cotero, Victoria E.; Kimm, Simon Y.; Siclovan, Tiberiu M.; Zhang, Rong; Kim, Evgenia M.; Matsumoto, Kazuhiro; Gondo, Tatsuo; Scardino, Peter T.; Yazdanfar, Siavash; Laudone, Vincent P.; Tan Hehir, Cristina A.

    2015-01-01

    The ability to visualize and spare nerves during surgery is critical for avoiding chronic morbidity, pain, and loss of function. Visualization of such critical anatomic structures is even more challenging during minimal access procedures because the small incisions limit visibility. In this study, we focus on improving imaging of nerves through the use of a new small molecule fluorophore, GE3126, used in conjunction with our dual-mode (color and fluorescence) laparoscopic imaging instrument. GE3126 has higher aqueous solubility, improved pharmacokinetics, and reduced non-specific adipose tissue fluorescence compared to previous myelin-binding fluorophores. Dosing and kinetics were initially optimized in mice. A non-clinical modified Irwin study in rats, performed to assess the potential of GE3126 to induce nervous system injuries, showed the absence of major adverse reactions. Real-time intraoperative imaging was performed in a porcine model. Compared to white light imaging, nerve visibility was enhanced under fluorescence guidance, especially for small diameter nerves obscured by fascia, blood vessels, or adipose tissue. In the porcine model, nerve visualization was observed rapidly, within 5 to 10 minutes post-intravenous injection and the nerve fluorescence signal was maintained for up to 80 minutes. The use of GE3126, coupled with practical implementation of an imaging instrument may be an important step forward in preventing nerve damage in the operating room. PMID:26076448

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

    NASA Astrophysics Data System (ADS)

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

    2015-03-01

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

  18. Feasibility of using intraoperatively-acquired quantitative kinematic measures to monitor development of laparoscopic skill.

    PubMed

    Cristancho, Sayra M; Hodgson, Antony J; Panton, Neely; Meneghetti, Adam; Qayumi, Karim

    2007-01-01

    The objective of this paper is to present the initial results of a study aimed at showing the feasibility of using kinematic measures to distinguish skill levels in manipulating surgical tools. Through a simulated surgical task (dissection of a mandarin orange), we acquired motor performance data from three sets of subjects representing different stages of surgical training. We computed the average lateral, axial and vertical tooltip velocities for each of the two main subtasks ('Peel Skin' and 'Detach Segment'). For each subject, we defined a 6-element vector to describe the kinematic measures extracted from the two tasks and used Principal Components Analysis (PCA) to extract the two dominant contributors to overall variability to simplify the presentation of the data to the trainer. We found that the first two principal components accounted for approximately 90% of the variance across all subjects and tasks. Moreover, the PCA plot showed good intrasubject repeatability, consistency within subjects with similar levels of training, and good separation between the subject groups. The results of this pilot study will allow us to design a future intraoperative study.

  19. Development of a novel handheld intra-operative laparoscopic Compton camera for 18F-Fluoro-2-deoxy-2-D-glucose-guided surgery

    NASA Astrophysics Data System (ADS)

    Nakamura, Y.; Shimazoe, K.; Takahashi, H.; Yoshimura, S.; Seto, Y.; Kato, S.; Takahashi, M.; Momose, T.

    2016-08-01

    As well as pre-operative roadmapping by 18F-Fluoro-2-deoxy-2-D-glucose (FDG) positron emission tomography, intra-operative localization of the tracer is important to identify local margins for less-invasive surgery, especially FDG-guided surgery. The objective of this paper is to develop a laparoscopic Compton camera and system aimed at use for intra-operative FDG imaging for accurate and less-invasive dissections. The laparoscopic Compton camera consists of four layers of a 12-pixel cross-shaped array of GFAG crystals (2× 2× 3 mm3) and through silicon via multi-pixel photon counters and dedicated individual readout electronics based on a dynamic time-over-threshold method. Experimental results yielded a spatial resolution of 4 mm (FWHM) for a 10 mm working distance and an absolute detection efficiency of 0.11 cps kBq-1, corresponding to an intrinsic detection efficiency of  ˜0.18%. In an experiment using a NEMA-like well-shaped FDG phantom, a φ 5× 10 mm cylindrical hot spot was clearly obtained even in the presence of a background distribution surrounding the Compton camera and the hot spot. We successfully obtained reconstructed images of a resected lymph node and primary tumor ex vivo after FDG administration to a patient having esophageal cancer. These performance characteristics indicate a new possibility of FDG-directed surgery by using a Compton camera intra-operatively.

  20. [The variation of hepatic duct confluence and asymptomatic common bile duct stone with routine intraoperative cholangiogram during laparoscopic cholecystectomy].

    PubMed

    Kim, Se Young; Kim, Ki Ho; Kim, Il Dong; Suh, Byung Sun; Shin, Dong Woo; Kim, Sang Wook; Park, Jin Soo; Lim, Hye In

    2011-12-01

    Intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy (LC) has been used to evaluate bile duct stone. But, the routine use of IOC remains controversial. With routine IOC during LC, we reviewed the variation of hepatic duct confluence and try to suggest the diagnostic criteria of asymptomatic common bile duct (CBD) stone. We reviewed the medical record of 970 consecutive patients who underwent LC with IOC from January 1999 to December 2009, retrospectively. Nine hundered seventy patients were enrolled. IOC were successful in 957 (98.7%) and unsuccessful in 13 (1.3%). Eighty two of 957 patients (8.2%) were excluded because of no or poor radiologic image. According to Couinaud's classification, 492 patients (56.2%) had type A hepatic duct confluence, 227 patients (26.1%) type B, 15 patients (17%) type C1, 43 patients (4.9%) type C2, 72 patients (8.2%) type D1, 21 patients (2.4%) type D2, 1 patient (0.1%) type E1, 1 patient (0.1%) type E2, 2 patients (0.2%) type F, and 1 patient (0.1%) no classified type. The CBD stone was found in 116 of 970 (12.2%) patients. In 281 patients, preoperative serologic and radiologic tests did not show abnormality. When preoperative findings were not remarkable, there was no difference of clinical features between patients with or without CBD stones. Although IOC during LC has some demerits, it is a safe and accurate method for the detection of CBD stone and the anatomic variation of intrahepatic duct.

  1. A three-arm (laparoscopic, hand-assisted, and robotic) matched-case analysis of intraoperative and postoperative outcomes in minimally invasive colorectal surgery.

    PubMed

    Patel, Chirag B; Ragupathi, Madhu; Ramos-Valadez, Diego I; Haas, Eric M

    2011-02-01

    Robotic-assisted laparoscopic surgery is an emerging modality in the field of minimally invasive colorectal surgery. However, there is a dearth of data comparing outcomes with other minimally invasive techniques. We present a 3-arm (conventional, hand-assisted, and robotic) matched-case analysis of intraoperative and short-term outcomes in patients undergoing minimally invasive colorectal procedures. Between August 2008 and October 2009, 70 robotic cases of the rectum and rectosigmoid were performed. Thirty of these were organized into triplets with conventional and hand-assisted cases based on the following 6 matching criteria: 1) surgeon; 2) sex; 3) body mass index; 4) operative procedure; 5) pathology; and 6) history of neoadjuvant therapy in malignant cases. Demographics, intraoperative parameters, and postoperative outcomes were assessed. Pathological outcomes were analyzed in malignant cases. Data were stratified by postoperative diagnosis and operative procedure. There was no significant difference in intraoperative complications, estimated blood loss (126.1 ± 98.5 mL overall), or postoperative morbidity and mortality among the groups. Robotic technique required longer operative time compared with conventional laparoscopic (P < .01) and hand-assisted (P < .001) techniques; however, this difference was not maintained in cases with low pelvic anastomoses. The overall mean length of stay was 3.3 ± 1.8 days with no significant difference between the groups. Pathological analysis of malignant cases revealed a median lymph node extraction of 17 with no significant difference among the 3 modalities. In this 3-arm case-matched series, the robotic approach results in short-term outcomes comparable to conventional and hand-assisted laparoscopic approaches for benign and malignant diseases of the rectum and rectosigmoid. With 3-dimensional visualization, additional freedom of motion, and improved ergonomics, this enabling technology may play an important role when

  2. A simple effective method for generation of a permanent record of the Critical View of Safety during laparoscopic cholecystectomy by intraoperative "doublet" photography.

    PubMed

    Sanford, Dominic E; Strasberg, Steven M

    2014-02-01

    The Critical View of Safety (CVS) is an established method for identifying the cystic duct during laparoscopic cholecystectomy. Its goal is to prevent misidentification of the bile ducts and avoid biliary injury. However, a visual record of CVS is not usually made. Intraoperative photography has the potential to record CVS and increase the safety of laparoscopic cholecystectomy. The objective of this study was to develop a simple and effective technique for recording CVS during laparoscopic cholecystectomy. Techniques for photographing and rating photographs of CVS were developed. Surgeons were trained in methods of photographing both anterior and posterior views of CVS during laparoscopic cholecystectomy. Independent observers scored these views individually and together. The term doublet view was used when both anterior and posterior views of CVS were used for rating. Three criteria for CVS were used for scoring photographs. A total score of ≥ 5 of 6 points was considered satisfactory, and a total score <5 of 6 points was considered unsatisfactory. Photographs of 28 patients were obtained. Critical View of Safety photographs were satisfactory in either anterior or posterior single images in 43 of 56 (76.8%) instances, and doublet photographs were satisfactory in 27 of 28 (96.4%) instances (p = 0.02). Body mass index >40 predicted a higher likelihood of unsatisfactory individual CVS photos (p = 0.02); however, there was no correlation between patient or pathologic factors and the scores of doublet views. With training and adherence to straightforward photographic techniques, intraoperative doublet photography can record CVS accurately. This method is performed easily, and could be used for recording of CVS in the medical record. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Primary Closure Following Laparoscopic Common Bile Duct Exploration Combined with Intraoperative Choledochoscopy and D-J Tube Drainage for Treating Choledocholithiasis.

    PubMed

    Yu, Miao; Xue, Huanzhou; Shen, Quan; Zhang, Xiao; Li, Ke; Jia, Meng; Jia, Jiangkun; Xu, Jian

    2017-09-19

    BACKGROUND This study aimed to assess the clinical short-term results of a primary closure following laparoscopic common bile duct exploration (LCBDE) combined with intraoperative choledochoscopy and D-J tube drainage for choledocholithiasis treatment. MATERIAL AND METHODS Twenty-five patients (14 women and 11 men) who underwent LCBDE with primary duct closure and D-J tube drainage for choledocholithiasis were retrospectively enrolled. The D-J tube (4.7F×14 cm) was removed using a duodenoscope if there was no bile leakage. Before discharge, patients were examined for blood amylase. After discharge or D-J tube removal, all patients were routinely assessed for complications. RESULTS Mean operating time was 135±46 min (range, 78-195 min). Mean intraoperative blood loss was 71±24 mL (range, 25-110 mL). Total hospital stay was 6-9 days (mean, 8.04±1.37 days). Two patients experienced intraoperative bile leakage, which was stopped with re-suturing. None of these patients experienced postoperative bile leaks. Three patients had slight elevation of serum amylase before discharge but without pancreatitis signs. The successful clearance rate of stones was 100%. During 1-year follow-up, no recurrence or severe complications occurred. CONCLUSIONS A primary closure following LCBDE combined with intraoperative choledochoscopy and D-J tube drainage is safe and feasible for choledocholithiasis treatment.

  4. Remotely operated MR-guided neurosurgical device in MR operating room

    NASA Astrophysics Data System (ADS)

    Liu, Haiying; Hall, Walter A.; Truwit, Charles L.

    2001-05-01

    A robust near real-time MRI based surgical guidance and navigation scheme has been developed, validated and used. The key concept of the method is to use intra-operative MRI to facilitate the trajectory alignment process of a biopsy needle in neurobiopsy. Since the trajectory corresponding to the biopsy needle pivoted at an entry point on patient skull has two degrees of freedom, the orientation of the needle can be tracked using a 2D imaging plane placed perpendicular to the desired trajectory. Using a near real- time visual feedback during the adjustment of an alignment guidance device, the required trajectory alignment was translated into a simple in-plane targeting task on computer monitor. The orientation adjustment was achieved remotely via a set of MR-compatible strings, which were connected to a joystick. The concept of MR-guided targeting was successfully validated on a phantom set-up. This MR based guidance technique has practically allowed neurosurgeons to accomplish the required needle alignment to an arbitrary trajectory remotely in a straight forward procedure on any conventional MR scanner. Before needle insertion, the trajectory can be validated. Two successful biopsy cases using the new methodology and device have shown that the remotely operated device under MR-guidance is both effective and accurate for neurosurgery.

  5. Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis

    PubMed Central

    Kawada, Kenji; Sakai, Yoshiharu

    2016-01-01

    Anastomotic leakage (AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low anterior resection (LAR). Risk factor analyses for AL after open LAR have been widely reported. However, a few studies have analyzed the risk factors for AL after laparoscopic LAR. Laparoscopic rectal surgery provides an excellent operative field in a narrow pelvic space, and enables total mesorectal excision surgery and preservation of the autonomic nervous system with greater precision. However, rectal transection using a laparoscopic linear stapler is relatively difficult compared with open surgery because of the width and limited performance of the linear stapler. Moreover, laparoscopic LAR exhibits a different postoperative course compared with open LAR, which suggests that the risk factors for AL after laparoscopic LAR may also differ from those after open LAR. In this review, we will discuss the risk factors for AL after laparoscopic LAR. PMID:27433085

  6. Comparison of laparoscopic versus conventional open cryptorchidectomies on intraoperative and postoperative complications and duration of surgery, anesthesia, and hospital stay in horses.

    PubMed

    Cribb, Nicola C; Koenig, Judith; Sorge, Ulrike

    2015-04-15

    Objective-To compare surgical preparation time, surgery and anesthesia times, hospitalization duration, and intra- and postoperative complications between laparoscopic and conventional open cryptorchidectomy in horses. Design-Retrospective cohort study. Animals-60 horses that underwent cryptorchidectomy. Procedures-Medical records were reviewed to identify horses that had undergone cryptorchidectomy from 1991 to 2012. Thirty horses that underwent laparoscopic cryptorchidectomy (case horses) were matched with 30 control horses that had undergone open cryptorchidectomy (ie, inguinal and parainguinal surgical approaches). Horses were matched according to history of previous surgery, testicle location, and type of closure following removal of an undescended unilateral testicle. Duration of surgery, surgical preparation and anesthesia times, hospitalization duration, and number of intra- and postoperative complications were compared between horses that underwent laparoscopic cryptorchidectomy versus open cryptorchidectomy. Comparisons were also made between horses in terms of whether there was a history of previous failed cryptorchidectomy or unknown location of testicle prior to surgery. Results-Horses that underwent laparoscopic cryptorchidectomy had significantly longer surgery and anesthesia times overall, compared with horses that underwent open cryptorchidectomy. No difference in surgery time was found between case and control horses that had a previous surgical attempt to remove an undescended testicle or in which the testicle location was unknown prior to surgery. Overall, horses undergoing laparoscopy had a nonsignificant increase in intraoperative complications, compared with control horses, and had significantly more postoperative complications. Conclusions and Clinical Relevance-Horses undergoing laparoscopic cryptorchidectomy had increased surgical preparation time, increased surgery and anesthesia times, and more postoperative complications, compared with

  7. MR-guided focused ultrasound: a potentially disruptive technology.

    PubMed

    Bradley, William G

    2009-07-01

    A disruptive technology is a technological innovation that overturns the existing dominant technologies in a market. Magnetic resonance (MR)-guided focused ultrasound (MRgFUS) is a noninvasive procedure based on the combination of real-time MR anatomic guidance, MR thermometry, and high-intensity focused ultrasound. Several hundred transducer elements become convergent at a point under MR guidance, leading to heating and coagulation necrosis. Outside the focal point, there is no significant heating. There is no need to break the skin for procedures in the body or to perform a craniotomy for procedures in the brain. This lack of invasiveness is what makes MRgFUS so disruptive compared with surgery. At present, MRgFUS has been used for the ablation of uterine fibroids, breast tumors, painful bony metastases, and liver tumors. In the brain, it has been used for the ablation of glioblastomas and for functional neurosurgery. Phantom and animal studies suggest future applications for prostate cancer and acute stroke treatment.

  8. MR-guided focused ultrasound surgery, present and future

    SciTech Connect

    Schlesinger, David; Benedict, Stanley; Diederich, Chris; Gedroyc, Wladyslaw; Klibanov, Alexander; Larner, James

    2013-08-01

    MR-guided focused ultrasound surgery (MRgFUS) is a quickly developing technology with potential applications across a spectrum of indications traditionally within the domain of radiation oncology. Especially for applications where focal treatment is the preferred technique (for example, radiosurgery), MRgFUS has the potential to be a disruptive technology that could shift traditional patterns of care. While currently cleared in the United States for the noninvasive treatment of uterine fibroids and bone metastases, a wide range of clinical trials are currently underway, and the number of publications describing advances in MRgFUS is increasing. However, for MRgFUS to make the transition from a research curiosity to a clinical standard of care, a variety of challenges, technical, financial, clinical, and practical, must be overcome. This installment of the Vision 20/20 series examines the current status of MRgFUS, focusing on the hurdles the technology faces before it can cross over from a research technique to a standard fixture in the clinic. It then reviews current and near-term technical developments which may overcome these hurdles and allow MRgFUS to break through into clinical practice.

  9. MR-guided focused ultrasound surgery, present and future

    PubMed Central

    Schlesinger, David; Benedict, Stanley; Diederich, Chris; Gedroyc, Wladyslaw; Klibanov, Alexander; Larner, James

    2013-01-01

    MR-guided focused ultrasound surgery (MRgFUS) is a quickly developing technology with potential applications across a spectrum of indications traditionally within the domain of radiation oncology. Especially for applications where focal treatment is the preferred technique (for example, radiosurgery), MRgFUS has the potential to be a disruptive technology that could shift traditional patterns of care. While currently cleared in the United States for the noninvasive treatment of uterine fibroids and bone metastases, a wide range of clinical trials are currently underway, and the number of publications describing advances in MRgFUS is increasing. However, for MRgFUS to make the transition from a research curiosity to a clinical standard of care, a variety of challenges, technical, financial, clinical, and practical, must be overcome. This installment of the Vision 20/20 series examines the current status of MRgFUS, focusing on the hurdles the technology faces before it can cross over from a research technique to a standard fixture in the clinic. It then reviews current and near-term technical developments which may overcome these hurdles and allow MRgFUS to break through into clinical practice. PMID:23927296

  10. 3T MR-Guided Brachytherapy for Gynecologic Malignancies

    PubMed Central

    Kapur, Tina; Egger, Jan; Damato, Antonio; Schmidt, Ehud J.; Viswanathan, Akila N.

    2012-01-01

    Gynecologic malignancies are a leading cause of death in women worldwide. Standard treatment for many primary and recurrent gynecologic cancer cases includes a combination of external beam radiation, followed by brachytherapy. Magnetic Resonance Imaging (MRI) is benefitial in diagnostic evaluation, in mapping the tumor location to tailor radiation dose, and in monitoring the tumor response to treatment. Initial studies of MR-guidance in gynecologic brachtherapy demonstrate the ability to optimize tumor coverage and reduce radiation dose to normal tissues, resulting in improved outcomes for patients. In this article we describe a methodology to aid applicator placement and treatment planning for 3 Tesla (3T) MR-guided brachytherapy that was developed specifically for gynecologic cancers. This has been used in 18 cases to date in the Advanced Multimodality Image Guided Operating suite at Brigham and Women’s Hospital. It is comprised of state of the art methods for MR imaging, image analysis, and treatment planning. An MR sequence using 3D-balanced steady state free precession in a 3T MR scan was identified as the best sequence for catheter identification with ballooning artifact at the tip. 3D treatment planning was performed using MR images. Item in development include a software module designed to support virtual needle trajectory planning that includes probabilistic bias correction, graph based segmentation, and image registration algorithms. The results demonstrate that 3T MR has a role in gynecologic brachytherapy. These novel developments improve targeted treatment to the tumor while sparing the normal tissues. PMID:22898699

  11. MR-Guided Ultrasonic Brain Therapy: High Frequency Approach

    NASA Astrophysics Data System (ADS)

    Aubry, J. F.; Marsac, L.; Pernot, M.; Tanter, M.; Robert, B.; Brentnall, M.; Annic, P.; La Greca, R.; de Charentenay, A.; Pomatta, F.; Martin, Y.; Cohen-Bacrie, C.; Souquet, J.; Fink, M.

    2010-03-01

    A novel MR-guided brain therapy device operating at 1 MHz has been designed and constructed. The system has been installed and tested in a clinical 1.5 T Philips Achieva MRI. Three dimensional time domain finite differences simulations were used to compute the propagation of the wave field through three human skulls. The simulated phase distortions were used as inputs for transcranial correction and the corresponding pressure fields were scanned in the focal plane. At half of the maximum power (10 W/cm2 on the surface of the transducers), necroses were induced 2 cm deep in turkey breasts placed behind a human skull. In vitro experiments on human skulls show that simulations restore more than 85% of the pressure level through the skull bone when compared to a control correction performed with an implanted hydrophone. Finally, high power experiments are performed though the skull bone and a MR-Thermometry sequence is used to map the temperature rise in a brain phantom every 3 s in two orthogonal planes (focal plane and along the axis of the probe).

  12. Application of open source image guided therapy software in MR-guided therapies.

    PubMed

    Hata, Nobuhiko; Piper, Steve; Jolesz, Ferenc A; Tempany, Clare M C; Black, Peter McL; Morikawa, Shigehiro; Iseki, Horoshi; Hashizume, Makoto; Kikinis, Ron

    2007-01-01

    We present software engineering methods to provide free open-source software for MR-guided therapy. We report that graphical representation of the surgical tools, interconnectively with the tracking device, patient-to-image registration, and MRI-based thermal mapping are crucial components of MR-guided therapy in sharing such software. Software process includes a network-based distribution mechanism by multi-platform compiling tool CMake, CVS, quality assurance software DART. We developed six procedures in four separate clinical sites using proposed software engineering and process, and found the proposed method is feasible to facilitate multicenter clinical trial of MR-guided therapies. Our future studies include use of the software in non-MR-guided therapies.

  13. Transcranial MR-Guided Focused Ultrasound: A Review of the Technology and Neuro Applications

    PubMed Central

    Ghanouni, Pejman; Pauly, Kim Butts; Elias, W. Jeff; Henderson, Jaimie; Sheehan, Jason; Monteith, Stephen; Wintermark, Max

    2015-01-01

    MR guided focused ultrasound is a new, minimally invasive method of targeted tissue thermal ablation that may be of use to treat central neuropathic pain, essential tremor, Parkinson tremor, and brain tumors. The system has also been used to temporarily disrupt the blood-brain barrier to allow targeted drug delivery to brain tumors. This article reviews the physical principles of MR guided focused ultrasound and discusses current and potential applications of this exciting technology. PMID:26102394

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

    PubMed

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

    2014-03-01

    Remifentanil is a short-acting drug with a rapid onset that is useful in general anesthesia. Recently, however, it has been suggested that the use of opioids during surgery may cause opioid-induced hyperalgesia (OIH). Researchers have recently reported that esmolol, an ultra-short-acing β1 receptor antagonist, reduces the postoperative requirement for morphine and provides more effective analgesia than the administration of remifentanil and ketamine. Hence, this study was conducted to determine whether esmolol reduces early postoperative pain in patients who are continuously infused with remifentanil for anesthesia during laparoscopic cholecystectomy. Sixty patients scheduled to undergo laparoscopic cholecystectomy were randomly divided into three groups. Anesthesia was maintained with sevoflurane and 4 ng/ml (target-controlled infusion) of remifentanil in all patients. Esmolol (0.5 mg/kg) was injected and followed with a continuous dosage of 10 µg/kg/min in the esmolol group (n = 20). Ketamine (0.3 mg/kg) was injected and followed with a continuous dosage of 3 µg/kg/min in the ketamine group (n = 20), while the control group was injected and infused with an equal amount of normal saline. Postoperative pain score (visual analog scale [VAS]) and analgesic requirements were compared for the first 6 hours of the postoperative period. The pain score (VAS) and fentanyl requirement for 15 minutes after surgery were lower in the esmolol and ketamine groups compared with the control group (P < 0.05). There were no differences between the esmolol and ketamine groups. Intraoperative esmolol infusion during laparoscopic cholecystectomy reduced opioid requirement and pain score (VAS) during the early postoperative period after remifentanil-based anesthesia.

  15. An intraoperative technique to reduce superficial surgical site infections in circular stapler-constructed laparoscopic Roux-en-Y gastric bypass.

    PubMed

    Zhang, Yang; Serrano, Oscar K; Scott Melvin, W; Camacho, Diego

    2016-06-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been established as one of the most effective treatments for morbid obesity. Surgical site infections are the most common complication after LRYGB surgery. To compare the superficial surgical site infections (sSSI) rate before and after the implementation of our intraoperative technique. Academic medical center. Our intraoperative technique relies on sterile coverage of the circular stapler, sterile specimen-bag retrieval of the gastrojejunostomy enteric remnant, and port site Penrose drainage. We analyzed our sSSI outcomes before and after implementation of our technique in all LRYGBs performed by a single surgeon from 2009 to 2015. We took into account patient age; sex; baseline body mass index (BMI); smoking status; and co-morbidities such as diabetes, hypertension, and hyperlipidemia. χ(2) and multivariate analysis were performed. We performed 486 LRYGBs in 2009-2015. The cohort before implementation of our technique (group 1) included 164 patients (33.7%) and the cohort after implementation (group 2) included 322 patients (66.3%). Both groups were similar in age, sex, smoking status, and rates of diabetes and hyperlipidemia but differed in BMI, operative time, and prevalence of hypertension. Hypertension was not a confounder for sSSI (P = .35). The sSSI rate was 9.15% for group 1 and 3.42% for group 2 (P = .0079). Controlling for BMI and operative time, multivariate analysis revealed a significant reduction in sSSI (odds ratio 2.98 [95% CI 1.33-6.69]) with our technique. We describe a reproducible intraoperative technique that significantly reduces sSSI in LRYGB procedures. Our technique has the potential of hastening postoperative recovery. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  16. Clinical implementation of MR-guided vaginal cylinder brachytherapy.

    PubMed

    Owrangi, Amir M; Jolly, Shruti; Balter, James M; Cao, Yue; Maturen, Katherine E; Young, Lisa; Zhu, Tong; Prisciandaro, Joann I

    2015-11-08

    We present an institutional experience on the clinical implementation of magnetic resonance (MR)-guided vaginal brachytherapy using commercially available solid applicator models. To test the fidelity of solid applicator models to digitize vaginal cylinder applicators, three datasets were evaluated. The first included 15 patients who were simulated with CT alone. Next, a water phantom was used to evaluate vaginal cylinders ranging from 20 to 35 mm in diameter with CT and MR. Finally, three patients undergoing HDR brachytherapy with vaginal cylinders that were simulated with both CT and MR were evaluated. In these assessments, the solid applicator models were aligned based on the outline of the applicators on the corresponding volumetric image, and deviations between the central source positions defined based on X-ray markers (on CT) and solid applicator models (on CT and MR), and the percent dose difference between select reference points were calculated. The mean central source deviation defined based on X-ray markers (on CT) and solid applicator models (on CT and MR) for the 15-patient cohort, the phantom, and the 3-patient cohort is 0.6 mm, 0.6 mm, and 1.2 mm, respectively. The average absolute percent dose difference for the bladder, rectum, prescription, and inferior reference points were 2.2%, 2.3%, 2.2%, and 2.4%, respectively, for the 15 patient cohort. For the phantom study, the average, absolute percent dose difference for the prescription and inferior reference points are 2.0% and 2.1% for the CT, 2.3% and 2.2% for the T1W, and 2.8% and 3.0% for the T2W images. For the three patient cohort, the average absolute percent dose difference for the bladder, rectum, prescription, and inferior reference points are 2.9%, 2.6%, 3.0%, and 4.2% for the CT, 6.5%, 1.6%, 2.5%, and 4.7% for the T1W, and 6.0%, 7.4%, 2.6, and 2.0% for the T2W images. Based on the current study, aligning the applicator model to MR images provides a practical, efficient approach to perform

  17. Automatic localization of endoscope in intraoperative CT image: A simple approach to augmented reality guidance in laparoscopic surgery.

    PubMed

    Bernhardt, Sylvain; Nicolau, Stéphane A; Agnus, Vincent; Soler, Luc; Doignon, Christophe; Marescaux, Jacques

    2016-05-01

    The use of augmented reality in minimally invasive surgery has been the subject of much research for more than a decade. The endoscopic view of the surgical scene is typically augmented with a 3D model extracted from a preoperative acquisition. However, the organs of interest often present major changes in shape and location because of the pneumoperitoneum and patient displacement. There have been numerous attempts to compensate for this distortion between the pre- and intraoperative states. Some have attempted to recover the visible surface of the organ through image analysis and register it to the preoperative data, but this has proven insufficiently robust and may be problematic with large organs. A second approach is to introduce an intraoperative 3D imaging system as a transition. Hybrid operating rooms are becoming more and more popular, so this seems to be a viable solution, but current techniques require yet another external and constraining piece of apparatus such as an optical tracking system to determine the relationship between the intraoperative images and the endoscopic view. In this article, we propose a new approach to automatically register the reconstruction from an intraoperative CT acquisition with the static endoscopic view, by locating the endoscope tip in the volume data. We first describe our method to localize the endoscope orientation in the intraoperative image using standard image processing algorithms. Secondly, we highlight that the axis of the endoscope needs a specific calibration process to ensure proper registration accuracy. In the last section, we present quantitative and qualitative results proving the feasibility and the clinical potential of our approach. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. MR-guided biopsy of the prostate: an overview of techniques and a systematic review.

    PubMed

    Pondman, Kirsten M; Fütterer, Jurgen J; ten Haken, Bennie; Schultze Kool, Leo J; Witjes, J Alfred; Hambrock, Thomas; Macura, Katarzyna J; Barentsz, Jelle O

    2008-09-01

    Systematic transrectal ultrasound-guided biopsy (TRUSBx) is the gold standard for detecting prostate cancer. This systematic approach is characterized by low sensitivity (39-52%) and high specificity (81-82%). Magnetic resonance (MR)-guided biopsy techniques are becoming more and more available, but there is no current consensus on the optimal technique. This review presents an overview of MR-guided biopsy techniques for prostate cancer detection. Current literature was reviewed regarding MR-guided biopsy for prostate cancer detection. A literature search was performed using the commercially available MedLine online search engine. Combinations of the following search and Medical Subject Headings terms were applied to retrieve relevant articles: "magnetic resonance," "prostatic neoplasms," and "biopsy." Review articles and studies describing techniques other than MR-guided biopsy were excluded. Biopsy of the prostate is an essential procedure for determining optimal treatment. Systematic TRUSBx is the gold standard, but it fails to detect numerous tumors. Diagnostic MR imaging provides more accurate selection of regions in which tumors are suspected. Using these diagnostic images during an MR-directed biopsy procedure improves quality of the biopsy. In open MR scanners, the prebiopsy images often must be registered to the real-time biopsy images because open MR scanners do not provide optimal tissue contrast; thus, the patient must first be examined in a closed MR scanner and then biopsied in an open scanner. The advantage of open MR over closed MR is that the physician has easy patient access. With special equipment, prostate MR-guided biopsy is also possible in a closed system. Closed MR scanners can be used for the prebiopsy scan as well as for the biopsy procedure. The combination of a diagnostic MR examination and MR-guided biopsy is a promising tool and may be used in patients with previous negative TRUSBx.

  19. Intraoperative prognostic factors and atypical patterns of recurrence in patients with upper urinary tract urothelial carcinoma treated with laparoscopic radical nephroureterectomy.

    PubMed

    Carrion, Albert; Huguet, Jorge; García-Cruz, Eduard; Izquierdo, Laura; Mateu, Laura; Musquera, Mireia; Ribal, Maria José; Alcaraz, Antonio

    2016-08-01

    Objective The aims of this study were to identify clinical, intraoperative and pathological prognostic factors for predicting extraurothelial recurrence and cancer-specific survival (CSS) in patients with upper urinary tract urothelial carcinoma (UTUC) who had undergone laparoscopic radical nephroureterectomy (LRNU), and to investigate the site-specific patterns of recurrence and the associated outcomes. Materials and methods A retrospective revision was undertaken of 117 consecutive patients who had undergone transperitoneal LRNU for UTUC between 2007 and 2012. Univariate and multivariate Cox regression analyses were used to identify prognostic factors and Kaplan-Meier was used to estimate CSS. Results With a median follow-up of 20 months, 36 patients (30%) developed extraurothelial recurrence (local and/or distant). In the multivariate analysis, entering the urinary tract during LRNU was related to local recurrence (p = 0.04), management of the distal ureter to CSS (p = 0.003), pathological stage and positive margins to local (p = 0.001, p = 0.013), distant (p = 0.028, p = 0.009) and global recurrence (p = 0.05, p = 0.012) and CSS (p = 0.011, p = 0.042), and multifocality to distant recurrence (p = 0.024). Median time to recurrence was 11.4 months after LRNU. Of 36 patients with progression, 23 (64%) had simultaneous local and distant recurrence and eight had atypical metastases: two port-site metastases, five peritoneal, two subcutaneous and two abdominal wall implants. The 5 year CSS was 61% for all patients with UTUC and 9% for those with recurrence. Conclusions Intraoperative events could have a negative impact on the oncological outcomes of patients with UTUC treated with LRNU. The use of laparoscopy for advanced UTUC may be related to atypical ways of spreading.

  20. Refining the intraoperative measurement of the distal intrapancreatic part of a choledochal cyst during laparoscopic repair allows near total excision.

    PubMed

    Koga, Hiroyuki; Okawada, Manabu; Doi, Takashi; Miyano, Go; Lane, Geoffrey J; Yamataka, Atsuyuki

    2015-10-01

    During surgery for choledochal cyst (CC), any intrapancreatic CC (IPCC) must also be excised to prevent postoperative pancreatitis and stone formation. We report our technique for laparoscopic total IPCC excision (n = 16; mean age 6.0 years). We insert a fine ureteroscope with a light source into the opened CC through an extra 3.9-mm trocar placed in the epigastrium through a minute incision to identify the pancreatic duct orifice. By pulling the end of the ureteroscope emerging from the trocar gently to withdraw the tip from the pancreatic duct to where distal dissection was ceased under laparoscopic view, the IPCC can be measured. If longer than 5 mm, the distal CC is dissected further caudally until it is less than 5 mm. For accuracy, the distal CC is elevated with a suture that is exteriorized and clamped to provide constant traction. The IPCC was able to be measured in 11/16 (68 %). Initial lengths measured were 3-10 mm (5.2 ± 2.7 mm). Final IPCC were all 5 mm or less. Surgery was uncomplicated without any pancreatic duct injury and postoperative recovery was unremarkable. Follow-up MRI at 32 months showed no IPCC in any case. Measuring the IPCC enables total CC excision, thus reducing the potential for postoperative complications.

  1. An approach for preoperative planning and performance of MR-guided interventions demonstrated with a manual manipulator in a 1.5T MRI scanner.

    PubMed

    Seimenis, Ioannis; Tsekos, Nikolaos V; Keroglou, Christoforos; Eracleous, Eleni; Pitris, Constantinos; Christoforou, Eftychios G

    2012-04-01

    The aim of this work was to develop and test a general methodology for the planning and performance of robot-assisted, MR-guided interventions. This methodology also includes the employment of software tools with appropriately tailored routines to effectively exploit the capabilities of MRI and address the relevant spatial limitations. The described methodology consists of: (1) patient-customized feasibility study that focuses on the geometric limitations imposed by the gantry, the robotic hardware, and interventional tools, as well as the patient; (2) stereotactic preoperative planning for initial positioning of the manipulator and alignment of its end-effector with a selected target; and (3) real-time, intraoperative tool tracking and monitoring of the actual intervention execution. Testing was performed inside a standard 1.5T MRI scanner in which the MR-compatible manipulator is deployed to provide the required access. A volunteer imaging study demonstrates the application of the feasibility stage. A phantom study on needle targeting is also presented, demonstrating the applicability and effectiveness of the proposed preoperative and intraoperative stages of the methodology. For this purpose, a manually actuated, MR-compatible robotic manipulation system was used to accurately acquire a prescribed target through alternative approaching paths. The methodology presented and experimentally examined allows the effective performance of MR-guided interventions. It is suitable for, but not restricted to, needle-targeting applications assisted by a robotic manipulation system, which can be deployed inside a cylindrical scanner to provide the required access to the patient facilitating real-time guidance and monitoring.

  2. An Approach for Preoperative Planning and Performance of MR-guided Interventions Demonstrated With a Manual Manipulator in a 1.5T MRI Scanner

    SciTech Connect

    Seimenis, Ioannis; Tsekos, Nikolaos V.; Keroglou, Christoforos; Eracleous, Eleni; Pitris, Constantinos; Christoforou, Eftychios G.

    2012-04-15

    Purpose: The aim of this work was to develop and test a general methodology for the planning and performance of robot-assisted, MR-guided interventions. This methodology also includes the employment of software tools with appropriately tailored routines to effectively exploit the capabilities of MRI and address the relevant spatial limitations. Methods: The described methodology consists of: (1) patient-customized feasibility study that focuses on the geometric limitations imposed by the gantry, the robotic hardware, and interventional tools, as well as the patient; (2) stereotactic preoperative planning for initial positioning of the manipulator and alignment of its end-effector with a selected target; and (3) real-time, intraoperative tool tracking and monitoring of the actual intervention execution. Testing was performed inside a standard 1.5T MRI scanner in which the MR-compatible manipulator is deployed to provide the required access. Results: A volunteer imaging study demonstrates the application of the feasibility stage. A phantom study on needle targeting is also presented, demonstrating the applicability and effectiveness of the proposed preoperative and intraoperative stages of the methodology. For this purpose, a manually actuated, MR-compatible robotic manipulation system was used to accurately acquire a prescribed target through alternative approaching paths. Conclusions: The methodology presented and experimentally examined allows the effective performance of MR-guided interventions. It is suitable for, but not restricted to, needle-targeting applications assisted by a robotic manipulation system, which can be deployed inside a cylindrical scanner to provide the required access to the patient facilitating real-time guidance and monitoring.

  3. [Effect of intraoperative esmolol infusion on anesthetic, analgesic requirements and postoperative nausea-vomitting in a group of laparoscopic cholecystectomy patients].

    PubMed

    Dereli, Necla; Tutal, Zehra Baykal; Babayigit, Munire; Kurtay, Aysun; Sahap, Mehmet; Horasanli, Eyup

    2015-01-01

    Postoperative pain and nausea/vomitting (PNV) are common in laparoscopic cholecystectomy patients. Sympatholytic agents might decrease requirements for intravenous or inhalation anesthetics and opioids. In this study we aimed to analyze effects of esmolol on intraoperative anesthetic-postoperative analgesic requirements, postoperative pain and PNV. Sixty patients have been included. Propofol, remifentanil and vecuronium were used for induction. Study groups were as follows; I - Esmolol infusion was added to maintenance anesthetics (propofol and remifentanil), II - Only propofol and remifentanil was used during maintenance, III - Esmolol infusion was added to maintenance anesthetics (desflurane and remifentanil), IV - Only desflurane and remifentanil was used during maintenance. They have been followed up for 24h for PNV and analgesic requirements. Visual analog scale (VAS) scores for pain was also been evaluated. VAS scores were significantly lowest in group I (p=0.001-0.028). PNV incidence was significantly lowest in group I (p=0.026). PNV incidence was also lower in group III compared to group IV (p=0.032). Analgesic requirements were significantly lower in group I and was lower in group III compared to group IV (p=0.005). Heart rates were significantly lower in esmolol groups (group I and III) compared to their controls (p=0.001) however blood pressures were similar in all groups (p=0.594). Comparison of esmolol groups with controls revealed that there is a significant decrease in anesthetic and opioid requirements (p=0.024-0.03). Using esmolol during anesthetic maintenance significantly decreases anesthetic-analgesic requirements, postoperative pain and PNV. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  4. Augmented reality system for MR-guided interventions: phantom studies and first animal test

    NASA Astrophysics Data System (ADS)

    Vogt, Sebastian; Wacker, Frank; Khamene, Ali; Elgort, Daniel R.; Sielhorst, Tobias; Niemann, Heinrich; Duerk, Jeff; Lewin, Jonathan S.; Sauer, Frank

    2004-05-01

    We developed an augmented reality navigation system for MR-guided interventions. A head-mounted display provides in real-time a stereoscopic video-view of the patient, which is augmented with three-dimensional medical information to perform MR-guided needle placement procedures. Besides with the MR image information, we augment the scene with 3D graphics representing a forward extension of the needle and the needle itself. During insertion, the needle can be observed virtually at its actual location in real-time, supporting the interventional procedure in an efficient and intuitive way. In this paper we report on quantitative results of AR guided needle placement procedures on gel phantoms with embedded targets of 12mm and 6mm diameter; we furthermore evaluate our first animal experiment involving needle insertion into deep lying anatomical structures of a pig.

  5. Noninvasive MR-Guided HIFU Therapy of TSC-Associated Renal Angiomyolipomas

    DTIC Science & Technology

    2014-09-01

    therapy and a new Ingenia 1.5 Tesla MRI scanner from Philips HealthCare. Using the new instrumentation, we established a large animal MR-guided HIFU... Tesla multi-channel MR imaging system. 1b. Software development. Dynamic parallel imaging and motion correction methods will be developed on...Philips 3.0 Tesla multi-channel MR imaging system. Real-time reconstruction will be implemented. Four major imaging methods, T1 weighted imaging, T2

  6. Diagnostic Performance of MR-guided Vacuum-Assisted Breast Biopsy: 8 Years of Experience.

    PubMed

    Ferré, Romuald; Ianculescu, Victor; Ciolovan, Laura; Mathieu, Marie-Christine; Uzan, Catherine; Canale, Sandra; Delaloge, Suzette; Dromain, Clarisse; Balleyguier, Corinne

    2016-01-01

    Breast magnetic resonance imaging (MRI) has demonstrated increased sensitivity over conventional imaging in identifying and characterizing in situ and invasive, multifocal, and multicentric disease. A histologic diagnosis is required for any enhancing lesion displaying suspicious features, especially in the presence of lower and often variable reported specificity values. Breast MRI findings occult on mammography and ultrasound should undergo an MR-guided biopsy. We retrospectively evaluate our 8 years' experience with this procedure. Our study included 259 lesions in 255 consecutive patients referred for MR-guided breast biopsy. MRI screening of women at a high risk for developing breast cancer accounted for 84 lesions, 54 lesions were detected on MRI staging for multifocal and multicentric disease, and 115 were incidental findings or lesions that presented diagnosis related issues on conventional imaging. Six procedures were cancelled due to lack of visualization. MR-guided breast biopsy was performed for 100 mass and 153 nonmass enhancements. Pathology results were classified into benign (113 lesions), high risk (47 lesions), and malignant (40 ductal carcinoma in situ, 38 invasive ductal carcinoma, 15 invasive lobular carcinoma). Subsequent surgery for high risk and malignant findings revealed an underestimation rate of 34% (16/47) for high risk lesions and of 7.5% for ductal carcinoma in situ (3/40). The overall positive predictive value (PPV) was calculated at 43.1% (33.3% for high-risk women, 70.3% for cancer staging, and 37.4% for incidental/undetermined lesions). The PPV was higher for mass (57%) versus nonmass enhancements (34%). MR-guided breast biopsy proved to be a reliable procedure for the diagnosis and management of occult breast MRI findings, or lesions that preclude biopsy under conventional guidance. The PPV displayed significant variation between patient subgroups, correlating higher values with a higher associated breast cancer prevalence.

  7. Osteoid osteoma: MR-guided focused ultrasound for entirely noninvasive treatment.

    PubMed

    Napoli, Alessandro; Mastantuono, Marco; Cavallo Marincola, Beatrice; Anzidei, Michele; Zaccagna, Fulvio; Moreschini, Oreste; Passariello, Roberto; Catalano, Carlo

    2013-05-01

    To determine the preliminary feasibility, safety, and clinical efficacy of magnetic resonance (MR)-guided focused ultrasound for the treatment of painful osteoid osteoma. This prospective institutional review board-approved study involved six consecutive patients (five males and one female; mean age, 21 years) with a diagnosis of osteoid osteoma based on clinical and imaging findings. All patients underwent MR-guided focused ultrasound ablation after providing informed consent. Lesions located in the vertebral body were excluded. The number of sonications and the energy deposition were recorded. Treatment success was determined at 1, 3, and 6 months after treatment. A visual analog scale (VAS) score for pain was used to assess changes in symptoms. MR imaging features of osteoid osteoma (edema, hyperemia, and nidus vascularization) were considered at baseline and at imaging follow-up. Treatment was performed with a mean of 4 sonications ± 1.8 (standard deviation), with a mean energy deposition of 866 J ± 211. No treatment- or anesthesia-related complications occurred. The pre- and posttreatment mean VAS scores significantly differed (7.9 ± 1.4 and 0.0 ± 0.0, respectively). At imaging, the edema and hyperemia associated with osteoid osteoma gradually disappeared in all lesions. However, nidus vascularization still persisted after treatment in four of six patients. This limited series demonstrated that MR-guided focused ultrasound treatment of osteoid osteoma can be performed safely with a high rate of success and without apparent treatment-related morbidity.

  8. TU-B-210-00: MR-Guided Focused Ultrasound Therapy in Oncology

    SciTech Connect

    2015-06-15

    MR guided focused ultrasound (MRgFUS), or alternatively high-intensity focused ultrasound (MRgHIFU), is approved for thermal ablative treatment of uterine fibroids and pain palliation in bone metastases. Ablation of malignant tumors is under active investigation in sites such as breast, prostate, brain, liver, kidney, pancreas, and soft tissue. Hyperthermia therapy with MRgFUS is also feasible, and may be used in conjunction with radiotherapy and for local targeted drug delivery. MRI allows in situ target definition and provides continuous temperature monitoring and subsequent thermal dose mapping during HIFU. Although MRgHIFU can be very precise, treatment of mobile organs is challenging and advanced techniques are required because of artifacts in MR temperature mapping, the need for intercostal firing, and need for gated HIFU or tracking of the lesion in real time. The first invited talk, “MR guided Focused Ultrasound Treatment of Tumors in Bone and Soft Tissue”, will summarize the treatment protocol and review results from treatment of bone tumors. In addition, efforts to extend this technology to treat both benign and malignant soft tissue tumors of the extremities will be presented. The second invited talk, “MRI guided High Intensity Focused Ultrasound – Advanced Approaches for Ablation and Hyperthermia”, will provide an overview of techniques that are in or near clinical trials for thermal ablation and hyperthermia, with an emphasis of applications in abdominal organs and breast, including methods for MRTI and tracking targets in moving organs. Learning Objectives: Learn background on devices and techniques for MR guided HIFU for cancer therapy Understand issues and current status of clinical MRg HIFU Understand strategies for compensating for organ movement during MRgHIFU Understand strategies for strategies for delivering hyperthermia with MRgHIFU CM - research collaboration with Philips.

  9. A novel adaptive needle insertion sequencing for robotic, single needle MR-guided high-dose-rate prostate brachytherapy

    NASA Astrophysics Data System (ADS)

    Borot de Battisti, M.; de Senneville, B. Denis; Hautvast, G.; Binnekamp, D.; Lagendijk, J. J. W.; Maenhout, M.; Moerland, M. A.

    2017-05-01

    MR-guided high-dose-rate (HDR) brachytherapy has gained increasing interest as a treatment for patients with localized prostate cancer because of the superior value of MRI for tumor and surrounding tissues localization. To enable needle insertion into the prostate with the patient in the MR bore, a single needle MR-compatible robotic system involving needle-by-needle dose delivery has been developed at our institution. Throughout the intervention, dose delivery may be impaired by: (1) sub-optimal needle positioning caused by e.g. needle bending, (2) intra-operative internal organ motion such as prostate rotations or swelling, or intra-procedural rectum or bladder filling. This may result in failure to reach clinical constraints. To assess the first aforementioned challenge, a recent study from our research group demonstrated that the deposited dose may be greatly improved by real-time adaptive planning with feedback on the actual needle positioning. However, the needle insertion sequence is left to the doctor and therefore, this may result in sub-optimal dose delivery. In this manuscript, a new method is proposed to determine and update automatically the needle insertion sequence. This strategy is based on the determination of the most sensitive needle track. The sensitivity of a needle track is defined as its impact on the dose distribution in case of sub-optimal positioning. A stochastic criterion is thus presented to determine each needle track sensitivity based on needle insertion simulations. To assess the proposed sequencing strategy, HDR prostate brachytherapy was simulated on 11 patients with varying number of needle insertions. Sub-optimal needle positioning was simulated at each insertion (modeled by typical random angulation errors). In 91% of the scenarios, the dose distribution improved when the needle was inserted into the most compared to the least sensitive needle track. The computation time for sequencing was less than 6 s per needle track. The

  10. MR-guided microwave ablation in hepatic tumours: initial results in clinical routine.

    PubMed

    Hoffmann, Rüdiger; Rempp, Hansjörg; Keßler, David-Emanuel; Weiß, Jakob; Pereira, Philippe L; Nikolaou, Konstantin; Clasen, Stephan

    2017-04-01

    Evaluation of the technical success, patient safety and technical effectiveness of magnetic resonance (MR)-guided microwave ablation of hepatic malignancies. Institutional review board approval and informed patient consent were obtained. Fifteen patients (59.8 years ± 9.5) with 18 hepatic malignancies (7 hepatocellular carcinomas, 11 metastases) underwent MR-guided microwave ablation using a 1.5-T MR system. Mean tumour size was 15.4 mm ± 7.7 (7-37 mm). Technical success and ablation zone diameters were assessed by post-ablative MR imaging. Technique effectiveness was assessed after 1 month. Complications were classified according to the Common Terminology Criteria for Adverse Events (CTCAE). Mean follow-up was 5.8 months ± 2.6 (1-10 months). Technical success and technique effectiveness were achieved in all lesions. Lesions were treated using 2.5 ± 1.2 applicator positions. Mean energy and ablation duration per tumour were 37.6 kJ ± 21.7 (9-87 kJ) and 24.7 min ± 11.1 (7-49 min), respectively. Coagulation zone short- and long-axis diameters were 31.5 mm ± 10.5 (16-65 mm) and 52.7 mm ± 15.4 (27-94 mm), respectively. Two CTCAE-2-complications occurred (pneumothorax, pleural effusion). Seven patients developed new tumour manifestations in the untreated liver. Local tumour progression was not observed. Microwave ablation is feasible under near real-time MR guidance and provides effective treatment of hepatic malignancies in one session. • Planning, applicator placement and therapy monitoring are possible without using contrast enhancement • Energy transmission from the generator to the scanner room is safely possible • MR-guided microwave ablation provides effective treatment of hepatic malignancies in one session • Therapy monitoring is possible without applicator retraction from the ablation site.

  11. Laparoscopic Management of Large Myomas

    PubMed Central

    Sinha, Rakesh; Sundaram, Meenakshi

    2009-01-01

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

  12. An MR-compatible stereoscopic in-room 3D display for MR-guided interventions.

    PubMed

    Brunner, Alexander; Groebner, Jens; Umathum, Reiner; Maier, Florian; Semmler, Wolfhard; Bock, Michael

    2014-08-01

    A commercial three-dimensional (3D) monitor was modified for use inside the scanner room to provide stereoscopic real-time visualization during magnetic resonance (MR)-guided interventions, and tested in a catheter-tracking phantom experiment at 1.5 T. Brightness, uniformity, radio frequency (RF) emissions and MR image interferences were measured. Due to modifications, the center luminance of the 3D monitor was reduced by 14%, and the addition of a Faraday shield further reduced the remaining luminance by 31%. RF emissions could be effectively shielded; only a minor signal-to-noise ratio (SNR) decrease of 4.6% was observed during imaging. During the tracking experiment, the 3D orientation of the catheter and vessel structures in the phantom could be visualized stereoscopically.

  13. In-Bore MR-Guided Biopsy Systems and Utility of PI-RADS.

    PubMed

    Fütterer, Jurgen J; Moche, Michael; Busse, Harald; Yakar, Derya

    2016-06-01

    A diagnostic dilemma exists in cases wherein a patient with clinical suspicion for prostate cancer has a negative transrectal ultrasound-guided biopsy session. Although transrectal ultrasound-guided biopsy is the standard of care, a paradigm shift is being observed. In biopsy-naive patients and patients with at least 1 negative biopsy session, multiparametric magnetic resonance imaging (MRI) is being utilized for tumor detection and subsequent targeting. Several commercial devices are now available for targeted prostate biopsy ranging from transrectal ultrasound-MR fusion biopsy to in bore MR-guided biopsy. In this review, we will give an update on the current status of in-bore MRI-guided biopsy systems and discuss value of prostate imaging-reporting and data system (PIRADS).

  14. MR-guided focused ultrasound for the novel and innovative management of osteoarthritic knee pain

    PubMed Central

    2013-01-01

    Background Severe knee pain associated with osteoarthritis (OA) is one of the most common and troublesome symptoms in the elderly. Recently, local bone denervation by MR-guided focused ultrasound (MRgFUS) has been demonstrated as a promising tool for pain palliation of bone metastases. The purpose of this study was to develop a novel treatment for knee OA using MRgFUS, and to validate its safety and efficacy. Methods Eight patients with medial knee pain and eligible for total knee arthroplasty were included. MR-guided focused sonication treatments were applied to bone surface just below the rim osteophyte of medial tibia plateau with real-time monitoring of the temperature in the target sites. The pain intensity during walking was assessed on a 100 mm visual analog scale (VAS) before and after treatment. Pressure pain thresholds (PPTs) were also evaluated over several test sites adjacent to the sonication area and control sites one month after treatment. Results Six patients (75%) showed immediate pain alleviation after treatment, and four of them demonstrated long-lasting effect at 6-month follow up (mean VAS reduction; 72.6%). In responders, PPTs in medial knee were significantly increased after treatment (Median; pre- 358 kpa vs post- 534 kpa, p?

  15. MR-Guided Laser-Induced Thermotherapy of the Infratemporal Fossa and Orbit in Malignant Chondrosarcoma via a Modified Technique

    SciTech Connect

    Vogl, Thomas J.; Mack, Martin G.; Straub, Ralf; Eichler, Katrin; Zangos, Stephan

    2001-12-15

    A 76-year-old patient presented with a recurrent mass of a malignant chondrosarcoma in the right infratemporal fossa and in the left maxillary sinus with orbital invasion. The patient was treated with a palliative intention with MR-guided laser-induced thermotherapy using a modified applicator technique. Following treatment clinical symptoms improved and MRI revealed complete laser-induced tumor necrosis.

  16. Comparison of postoperative analgesic efficacy of intraoperative single-dose intravenous administration of dexketoprofen trometamol and diclofenac sodium in laparoscopic cholecystectomy.

    PubMed

    Anıl, Ali; Kaya, Fatma Nur; Yavaşcaoğlu, Belgin; Mercanoğlu Efe, Esra; Türker, Gürkan; Demirci, Abdurrahman

    2016-08-01

    The aim of this study is to compare the effects of intravenous single-dose dexketoprofen trometamol and diclofenac sodium 30 minutes before the end of the surgery on relief of postoperative pain in patients undergoing laparoscopic cholecystectomy. A randomized fashion. Sixty (American Society of Anesthesiologist class I-II) patients undergoing laparoscopic cholecystectomy were divided into 2 groups Patients in group DT received 50 mg dexketoprofen trometamol, whereas patients in group DS received 75 mg diclofenac sodium, intravenously 30 minutes before the end of surgery. Postoperative pain intensity, morphine consumption with patient-controlled analgesia, time to first analgesic requirement, complications, rescue analgesic (intravenous tenoxicam 20 mg) requirement, and duration of hospital stay were recorded. Postoperative pain visual analog scale scores were similar in the follow-up periods (P > .05). Patient-controlled analgesia morphine consumption was significantly less in group DT compared with group DS in all postoperative follow-up periods (2 and 4 hours: P < .01; 8, 12, 18, and 24 hours: P < .001). In the postoperative period, the first analgesic requirement time was significantly longer in group DT compared with group DS (P < .01). In addition, the number of patients requiring rescue analgesic was higher in group DS compared with group DT (P < .01). Other follow-up parameters were similar. In our study, administration of intravenous single-dose dexketoprofen trometamol 30 minutes before the end of surgery provided effective analgesia with reduced consumption of opioids and requirement for rescue analgesic compared with diclofenac sodium in patients undergoing laparoscopic cholecystectomy. For this reason, we believe that, as a part of multimodal analgesia, dexketoprofen trometamol provides more effective analgesia than diclofenac sodium in patients undergoing laparoscopic cholecystectomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Laparoscopic Heller Myotomy for Non-Dilated Esophageal Achalasia in Children with Intraoperative Stepped Dilation Under Image Guidance: Attempting Complete Myotomy.

    PubMed

    Miyano, Go; Miyake, Hiromu; Koyama, Mariko; Morita, Keiichi; Kaneshiro, Masakatsu; Nouso, Hiroshi; Yamoto, Masaya; Fukumoto, Koji; Urushihara, Naoto

    2016-05-01

    This study presents a modified surgical approach to laparoscopic myotomy for achalasia using stepped dilation with a Rigiflex balloon and contrast medium under image guidance. A 10-year-old boy with persistent dysphagia and vomiting had ingested only liquids for 3 months, losing >10 kg in body weight. Barium swallow and esophageal manometry diagnosed esophageal achalasia with mild esophageal dilatation. After failed pneumatic dilatation, laparoscopic Heller myotomy with Dor fundoplication was performed. Prior to surgery, a Rigiflex balloon dilator was placed within the esophagus near the diaphragmatic hiatus. A four-port technique was used, and mobilization of the esophagus was limited to the anterior aspect. A 5-cm Heller myotomy was performed, extending another 2 cm onto the anterior gastric wall. During myotomy, the Rigiflex balloon was serially dilated from 30 to 50 mL, and filled with contrast medium under fluoroscopic image guidance in order to maintain appropriate tension on the esophagus to facilitate myotomy, and to confirm adequate myotomy with sufficient release of lower esophageal sphincter by resecting residual circular muscle fibers. Residual circular muscle fibers can be simultaneously visualized under both fluoroscopic image guidance and direct observation through the laparoscope, and they were cut precisely until the residual notch fully disappeared. Dor fundoplication was completed. The operative time was 180 minutes, and oral intake was started after esophagography on postoperative day 1. As of the 12-month follow-up, the patient has not shown any symptoms, and his postoperative course appeared satisfactory.

  18. MR-guided breast radiotherapy: feasibility and magnetic-field impact on skin dose

    NASA Astrophysics Data System (ADS)

    van Heijst, Tristan C. F.; den Hartogh, Mariska D.; Lagendijk, Jan J. W.; Desirée van den Bongard, H. J. G.; van Asselen, Bram

    2013-09-01

    The UMC Utrecht MRI/linac (MRL) design provides image guidance with high soft-tissue contrast, directly during radiotherapy (RT). Breast cancer patients are a potential group to benefit from better guidance in the MRL. However, due to the electron return effect, the skin dose can be increased in presence of a magnetic field. Since large skin areas are generally involved in breast RT, the purpose of this study is to investigate the effects on the skin dose, for whole-breast irradiation (WBI) and accelerated partial-breast irradiation (APBI). In ten patients with early-stage breast cancer, targets and organs at risk (OARs) were delineated on postoperative CT scans co-registered with MRI. The OARs included the skin, comprising the first 5 mm of ipsilateral-breast tissue, plus extensions. Three intensity-modulated RT techniques were considered (2× WBI, 1× APBI). Individual beam geometries were used for all patients. Specially developed MRL treatment-planning software was used. Acceptable plans were generated for 0 T, 0.35 T and 1.5 T, using a class solution. The skin dose was augmented in WBI in the presence of a magnetic field, which is a potential drawback, whereas in APBI the induced effects were negligible. This opens possibilities for developing MR-guided partial-breast treatments in the MRL.

  19. A numerical study on the oblique focus in MR-guided transcranial focused ultrasound

    NASA Astrophysics Data System (ADS)

    Hughes, Alec; Huang, Yuexi; Pulkkinen, Aki; Schwartz, Michael L.; Lozano, Andres M.; Hynynen, Kullervo

    2016-11-01

    Recent clinical data showing thermal lesions from treatments of essential tremor using MR-guided transcranial focused ultrasound shows that in many cases the focus is oblique to the main axis of the phased array. The potential for this obliquity to extend the focus into lateral regions of the brain has led to speculation as to the cause of the oblique focus, and whether it is possible to realign the focus. Numerical simulations were performed on clinical export data to analyze the causes of the oblique focus and determine methods for its correction. It was found that the focal obliquity could be replicated with the numerical simulations to within 23.2+/- {{13.6}\\circ} of the clinical cases. It was then found that a major cause of the focal obliquity was the presence of sidelobes, caused by an unequal deposition of power from the different transducer elements in the array at the focus. In addition, it was found that a 65% reduction in focal obliquity was possible using phase and amplitude corrections. Potential drawbacks include the higher levels of skull heating required when modifying the distribution of power among the transducer elements, and the difficulty at present in obtaining ideal phase corrections from CT information alone. These techniques for the reduction of focal obliquity can be applied to other applications of transcranial focused ultrasound involving lower total energy deposition, such as blood-brain barrier opening, where the issue of skull heating is minimal.

  20. A system for advanced real-time visualization and monitoring of MR-guided thermal ablations

    NASA Astrophysics Data System (ADS)

    Rothgang, Eva; Gilson, Wesley D.; Hornegger, Joachim; Lorenz, Christine H.

    2010-02-01

    In modern oncology, thermal ablations are increasingly used as a regional treatment option to supplement systemic treatment strategies such as chemotherapy and immunotherapy. The goal of all thermal ablation procedures is to cause cell death of disease tissue while sparing adjacent healthy tissue. Real-time assessment of thermal damage is the key to therapeutic efficiency and safety of such procedures. Magnetic resonance thermometry is capable of monitoring the spatial distribution and temporal evolution of temperature changes during thermal ablations. In this work, we present an advanced monitoring system for MR-guided thermal ablations that includes multiplanar visualization, specialized overlay visualization methods, and additional methods for correcting errors resulting from magnetic field shifts and motion. To ensure the reliability of the displayed thermal data, systematic quality control of thermal maps is carried out on-line. The primary purpose of this work is to provide clinicians with an intuitive tool for accurately visualizing the progress of thermal treatment at the time of the procedure. Importantly, the system is designed to be independent of the heating source. The presented system is expected to be of great value not only to guide thermal procedures but also to further explore the relationship between temperature-time exposure and tissue damage. The software application was implemented within the eXtensible Imaging Platform (XIP) and has been validated with clinical data.

  1. MR-guided thermotherapy of abdominal organs using a robust PCA-based motion descriptor.

    PubMed

    de Senneville, Baudouin Denis; Ries, Mario; Maclair, Grégory; Moonen, Chrit

    2011-11-01

    Thermotherapies can now be guided in real-time using magnetic resonance imaging (MRI). This technique is rapidly gaining importance in interventional therapies for abdominal organs such as liver and kidney. An accurate online estimation and characterization of organ displacement is mandatory to prevent misregistration and correct for motion related thermometry artifacts. In addition, when the ablation is performed with an extracorporal heating device such as high intensity focused ultrasound (HIFU), the continuous estimation of the organ displacement is the basis for the dynamic adjustment of the focal point position to track the targeted pathological tissue. In this paper, we describe the use of an optimized principal component analysis (PCA)-based motion descriptor to characterize in real-time the complex organ deformation during the therapy. The PCA was used to detect, in a preparative learning step, spatio-temporal coherences in the motion of the targeted organ. During hyperthermia, incoherent motion patterns could be discarded, which enabled improvements in motion estimation robustness, the compensation of motion related errors in thermal maps, and the adjustment of the beam position. The suggested method was evaluated for a moving phantom, and tested in vivo in the kidney and the liver of 12 healthy volunteers under free breathing conditions. The ability to perform a MR-guided thermotherapy in vivo during HIFU intervention was finally demonstrated on a porcine kidney.

  2. WE-D-BRD-01: New Linac Designs for MR-Guided Therapy Systems

    SciTech Connect

    Baillie, D.

    2015-06-15

    The advantages that make MR highly desirable for in-room treatment guidance, i.e. soft-tissue visualization and physiological assessment of healthy/tumor tissues, are largely recognized in the research community. However, the MR absorption in practical clinical workflows is still hindered by lack of sufficient technological infrastructure. Recent advances have been made towards filling that gap such as the development of integrated therapy systems relying on an MR scanner and a radiation source (linac, Co-60) and/or brachytherapy. The session is intended to present new efforts and methods aimed at facilitating the adoption of MR guidance for treatment delivery. Specifically, the discussion will focus on a) linac designs for reduced footprint and seamless integration with MR/linac systems, b) tracking coils for brachytherapy applications, and c) procedures for the commissioning and monitoring of MR and MR/linac performance. Learning Objectives: Understand limitations and proposed solutions for linac designs and associated integration with MR/linac systems; Understand current issues with MR-guided brachytherapy procedures Understand the issues and needs for new MR commissioning and QC. License agreement with Modus Medical Devices to develop a phantom for the quantification of MR image distortions.

  3. MR-guided focused ultrasound robot for performing experiments on large animals

    NASA Astrophysics Data System (ADS)

    Mylonas, N.; Damianou, C.

    2011-09-01

    Introduction: In this paper an experimental MRI-guided focused ultrasound robot for large animals is presented. Materials and methods: A single element spherically focused transducer of 4 cm diameter, focusing at 10 cm and operating at 1 MHz was used. A positioning device was developed in order to scan the ultrasound transducer for performing MR-guided focused ultrasound experiments in large animals such as pig, sheep and dog. The positioning device incorporates only MRI compatible materials such as piezoelectric motors, Acrylonitrile Butadiene Styrene (ABS) plastic, brass screws, and brass pulleys. The system is manufactured automatically using a rapid prototyping system. Results: The system was tested successfully in a number of animals for various tasks (creation of single lesions, creation of overlapping lesions, and MR compatibility). Conclusions: A simple, cost effective, portable positioning device has been developed which can be used in virtually any clinical MRI scanner since it can be sited on the scanner's table. The propagation of HIFU can be via a lateral or superior-inferior approach. This system has the potential to be marketed as a cost effective solution for performing experiments in small and large animals.

  4. MR-guided Periarterial Ethanol Injection for Renal Sympathetic Denervation: A Feasibility Study in Pigs

    SciTech Connect

    Streitparth, F. Walter, A.; Stolzenburg, N.; Heckmann, L.; Breinl, J.; Rinnenthal, J. L.; Beck, A.; De Bucourt, M.; Schnorr, J.; Bernhardt, U.; Gebauer, B.; Hamm, B.; Guenther, R. W.

    2013-06-15

    Purpose. To evaluate the feasibility and efficacy of image-guided periarterial ethanol injection as an alternative to transluminal radiofrequency ablation. Methods. Unilateral renal periarterial ethanol injection was performed under general anesthesia in 6 pigs with the contralateral kidney serving as control. All interventions were performed in an open 1.0 T MRI system under real-time multiplanar guidance. The injected volume was 5 ml (95 % ethanol labelled marked MR contrast medium) in 2 pigs and 10 ml in 4 pigs. Four weeks after treatment, the pigs underwent MRI including MRA and were killed. Norepinephrine (NE) concentration in the renal parenchyma served as a surrogate parameter to analyze the efficacy of sympathetic denervation. In addition, the renal artery and sympathetic nerves were examined histologically to identify evidence of vascular and neural injury. Results. In pigs treated with 10 ml ethanol, treatment resulted in neural degeneration. We found a significant reduction of NE concentration in the kidney parenchyma of 53 % (p < 0.02) compared with the untreated contralateral kidney. In pigs treated with 5 ml ethanol, no significant changes in histology or NE were observed. There was no evidence of renal arterial stenosis in MRI, macroscopy or histology in any pig. Conclusion. MR-guided periarterial ethanol injection was feasible and efficient for renal sympathetic denervation in a swine model. This technique may be a promising alternative to the catheter-based approach in the treatment of resistant arterial hypertension.

  5. MR-guided cholecystostomy: Assessment of biplanar, real-time needle tracking in three pigs

    SciTech Connect

    Goehde, Susanne C.; Pfammatter, Thomas; Steiner, Paul; Erhart, Peter; Romanowski, Benjamin J.; Debatin, Joerg F.

    1997-07-15

    Purpose. To demonstrate the feasibility of magnetic resonance (MR)-guided cholecystostomy using active, real-time, biplanar MR tracking in animal experiments. Methods. Experiments were performed on three fully anesthetized pigs in an interventional MR system (GE open). The gallbladder was displayed in two orthogonal planes using a heavily T2-weighted fast spin-echo sequence. These 'cholangio roadmaps' were displayed on LCD monitors positioned in front of the interventionalist. A special coaxial MR-tracking needle, equipped with a small receive-only coil at its tip, was inserted percutaneously into the gallbladder under continuous, biplanar MR guidance. The MR-tracking sequence allowed sampling of the coil (needle tip) position every 120 msec. The position of the coil was projected onto the two orthogonal 'cholangio roadmap' images. Results. Successful insertion of the needle was confirmed by aspiration of bile from the gallbladder. The process of aspiration and subsequent instillation of Gd-DTPA into the gallbladder was documented with fast gradient-recalled echo imaging. Conclusion. Biplanar, active, real-time MR tracking in combination with 'cholangio roadmaps' allows for cholecystostomies in an interventional MRI environment.

  6. Application of MR-guided focused pulsed ultrasound for destroying clots in vitro using thrombolytic drugs

    NASA Astrophysics Data System (ADS)

    Hadjisavvas, V.; Ioannides, K.; Damianou, C.

    2011-09-01

    In this paper an MR-guided focused pulsed ultrasound system for the treatment of stroke using thrombolytic drugs in a model in vitro is presented. A single element spherically focused transducer of 5 cm diameter; focusing at 10 cm and operating at 0.5 MHz or 1 MHz was used. The transducer was mounted in an MR compatible robot. The artery was modelled using a silicone tube. Tissue was modelled using polyaclylimide gel. Coagulated blood was used to model thrombus. A thermocouple was placed in the thrombus in order to measure the thrombus temperature. The effect of power, beam, and frequency was investigated. The goal was to maintain a temperature increase of less than 1 °C during the application of pulse ultrasound (called safe temperature). With the application of ultrasound alone there was no notable destruction of the thrombus. With the combination of ultrasound and thrombolytic drugs destruction occurred after 60 mins of pulse exposure (PRF = 1 s, duty factor = 10%, and with thrombus placed at 1 cm deep in the tissue). This simple in vitro model was proven very successful for evaluating MRgFUS as a modality for treating stroke. In the future we plan to apply this treatment protocol in live animals and humans.

  7. Real-time active MR-tracking of metallic stylets in MR-guided radiation therapy

    PubMed Central

    Wang, Wei; Dumoulin, Charles L.; Viswanathan, Akila N.; Tse, Zion T. H.; Mehrtash, Alireza; Loew, Wolfgang; Norton, Isaiah; Tokuda, Junichi; Seethamraju, Ravi T.; Kapur, Tina; Damato, Antonio L.; Cormack, Robert A.; Schmidt, Ehud J.

    2014-01-01

    Purpose To develop an active MR-tracking system to guide placement of metallic devices for radiation therapy. Methods An actively tracked metallic stylet for brachytherapy was constructed by adding printed-circuit micro-coils to a commercial stylet. The coil design was optimized by electromagnetic simulation, and has a radio-frequency lobe pattern extending ~5 mm beyond the strong B0 inhomogeneity region near the metal surface. An MR-tracking sequence with phase-field dithering was used to overcome residual effects of B0 and B1 inhomogeneities caused by the metal, as well as from inductive coupling to surrounding metallic stylets. The tracking system was integrated with a graphical workstation for real-time visualization. 3T MRI catheter-insertion procedures were tested in phantoms and ex-vivo animal tissue, and then performed in three patients during interstitial brachytherapy. Results The tracking system provided high-resolution (0.6 × 0.6 × 0.6 mm3) and rapid (16 to 40 frames per second, with three to one phase-field dithering directions) catheter localization in phantoms, animals, and three gynecologic cancer patients. Conclusion This is the first demonstration of active tracking of the shaft of metallic stylet in MR-guided brachytherapy. It holds the promise of assisting physicians to achieve better targeting and improving outcomes in interstitial brachytherapy. PMID:24903165

  8. Feasibility of Respiratory Triggering for MR-Guided Microwave Ablation of Liver Tumors Under General Anesthesia

    SciTech Connect

    Morikawa, Shigehiro Inubushi, Toshiro; Kurumi, Yoshimasa; Naka, Shigeyuki; Sato, Koichiro; Demura, Koichi; Tani, Tohru; Haque, Hasnine A

    2004-08-15

    We obtained clear and reproducible MR fluoroscopic images and temperature maps for MR image-guided microwave ablation of liver tumors under general anesthesia without suspending the artificial ventilation. Respiratory information was directly obtained from air-way pressure without a sensor on the chest wall. The trigger signal started scanning of one whole image with a spoiled gradient echo sequence. The delay time before the start of scanning was adjusted to acquire the data corresponding to the k-space center at the maximal expiratory phase. The triggered images were apparently clearer than the nontriggered ones and the location of the liver was consistent, which made targeting of the tumor easy. MR temperature images, which were highly susceptible to the movement of the liver, during microwave ablation using a proton resonance frequency method, could be obtained without suspending the artificial ventilation. Respiratory triggering technique was found to be useful for MR fluoroscopic images and MR temperature monitoring in MR-guided microwave ablation of liver tumors under general anesthesia.

  9. [Effort, accuracy and histology of MR-guided vacuum biopsy of suspicious breast lesions--retrospective evaluation after 389 interventions].

    PubMed

    Fischer, U; Schwethelm, L; Baum, F T; Luftner-Nagel, S; Teubner, J

    2009-08-01

    The aim of this study was to evaluate the effort, accuracy, histological diagnoses and value of MR-guided vacuum biopsy (10-gauge, 9-gauge) as the diagnostic procedure for suspicious breast lesions visible on MRI alone. 389 MR-guided vacuum biopsies of suspicious MRM findings were performed in 365 patients either with a Vacora system (10G, Bard Company) or an ATEC system (9G, Suros Company). The retrospective study included the number of specimens, the table time, the complication rate, and the histopathological results for open biopsy and the findings after follow-up. The study included 341 unilateral unilocular, 12 unilateral bilocular and 12 bilateral unilocular MR-guided vacuum biopsies. In 27 patients (3.9%) the planned intervention was canceled because the lesion could not be reproduced. The average number of specimens was 15.1 (range 4 - 75) with the 10G technique and 14.6 (range 4 - 38) with the 9G technique. The table time was 43.2 min (range 17 - 95 min). Histology revealed concordant benign lesions in 231 cases (59.4%), borderline lesions in 50 cases (12.8%), malignant tumors in 106 cases (DCIS 30 [7.7%], invasive carcinoma 76 [19.5%]), and discordant findings in 2 cases (0.5%). The complication rate was less than 1%. MR-guided vacuum biopsy of the breast is an effective method for the minimally invasive percutaneous evaluation of suspicious breast lesions seen on MRI alone. As a consequence, primary open biopsy can be avoided and the rate of unnecessary surgical interventions reduced. There were no major differences between 10G and 9G vacuum biopsy systems.

  10. Multicenter study for the evaluation of a dedicated biopsy device for MR-guided vacuum biopsy of the breast.

    PubMed

    Perlet, C; Heinig, A; Prat, X; Casselman, J; Baath, L; Sittek, H; Stets, C; Lamarque, J; Anderson, I; Schneider, P; Taourel, P; Reiser, M; Heywang-Köbrunner, S H

    2002-06-01

    The purpose of this multicenter study was to determine the accuracy and clinical value of a dedicated breast biopsy system which allows for MR-guided vacuum biopsy (VB) of contrast-enhancing lesions. In five European centers, MR-guided 11-gauge VB was performed on 341 lesions. In 7 cases VB was unsuccessful. This was immediately realized on postinterventional images or direct follow-up combined with histopathology-imaging correlation; thus, a false-negative diagnosis was avoided. Histology of 334 successful biopsies yielded 84 (25%) malignancies, 17 (5%) atypical ductal hyperplasias, and 233 (70%) benign entities. Verification of malignant or borderline lesions included reexcision of the biopsy cavity. Benign histologic biopsy results were verified by retrospective correlation with the pre- and postinterventional MRI and by subsequent follow-up. Our results indicate that MR-guided VB, in combination with the dedicated biopsy coil, offers the possibility to accurately diagnose even very small lesions that can only be visualized or localized by MRI.

  11. Catheter tip tracking for MR-guided interventions using discrete Kalman filter and mean shift localization.

    PubMed

    Eldirdiri, Abubakr; Courivaud, Frédéric; Palomar, Rafael; Hol, Per Kristian; Elle, Ole Jakob

    2014-03-01

    This paper presents and evaluates stochastic computer algorithms used to automatically detect and track marked catheter tip during MR-guided catheterization. The algorithms developed employ extraction and matching of regional features of the catheter tip to perform the localization. To perform the tracking, a probability map that indicates the possible locations of the catheter tip in the MR images is first generated. This map is generated from the similarity to a given marker template. The method to assess the similarity between the marker template image and the different positions on each MR frame is based on speeded-up robust features extracted from the gradient image. The probability map is then used in two different stochastic localization frameworks mean shift (MS) localization and Kalman filter (KF) to track the position of the catheter using pairs of orthogonal projection of 2D MR images. The algorithm developed was tested on catheter tip marked with LC resonant circuit (of size 2 mm x 2 cm) tuned to the Larmor frequency of the MRI scanner and for different image resolutions (1, 3, 5 and 7 mm squared pixel). The tracking performance was very robust for the two algorithms MS and KF with image resolution as low as 3 mm where the localization error was about 1 mm for KF and 0.9 mm for MS. For the 5-mm resolution images, the error was 2.2 mm for both KF and MS, and for the 7-mm resolution images, the error was 3.6 and 3.7 mm for KF and MS, respectively. Both KF and MS gave comparable results when it comes to accuracy for the different image resolutions. The results showed that the two tracking algorithms tracked the catheter tip with high robustness for image resolution of 3 mm and with acceptable reliability for image resolution as poor as 5 mm with the resonant marker configuration used.

  12. Quantification of intraventricular blood clot in MR-guided focused ultrasound surgery

    NASA Astrophysics Data System (ADS)

    Hess, Maggie; Looi, Thomas; Lasso, Andras; Fichtinger, Gabor; Drake, James

    2015-03-01

    Intraventricular hemorrhage (IVH) affects nearly 15% of preterm infants. It can lead to ventricular dilation and cognitive impairment. To ablate IVH clots, MR-guided focused ultrasound surgery (MRgFUS) is investigated. This procedure requires accurate, fast and consistent quantification of ventricle and clot volumes. We developed a semi-autonomous segmentation (SAS) algorithm for measuring changes in the ventricle and clot volumes. Images are normalized, and then ventricle and clot masks are registered to the images. Voxels of the registered masks and voxels obtained by thresholding the normalized images are used as seed points for competitive region growing, which provides the final segmentation. The user selects the areas of interest for correspondence after thresholding and these selections are the final seeds for region growing. SAS was evaluated on an IVH porcine model. SAS was compared to ground truth manual segmentation (MS) for accuracy, efficiency, and consistency. Accuracy was determined by comparing clot and ventricle volumes produced by SAS and MS, and comparing contours by calculating 95% Hausdorff distances between the two labels. In Two-One-Sided Test, SAS and MS were found to be significantly equivalent (p < 0.01). SAS on average was found to be 15 times faster than MS (p < 0.01). Consistency was determined by repeated segmentation of the same image by both SAS and manual methods, SAS being significantly more consistent than MS (p < 0.05). SAS is a viable method to quantify the IVH clot and the lateral brain ventricles and it is serving in a large-scale porcine study of MRgFUS treatment of IVH clot lysis.

  13. Biomechanical modeling constrained surface-based image registration for prostate MR guided TRUS biopsy.

    PubMed

    van de Ven, Wendy J M; Hu, Yipeng; Barentsz, Jelle O; Karssemeijer, Nico; Barratt, Dean; Huisman, Henkjan J

    2015-05-01

    Adding magnetic resonance (MR)-derived information to standard transrectal ultrasound (TRUS) images for guiding prostate biopsy is of substantial clinical interest. A tumor visible on MR images can be projected on ultrasound (US) by using MR-US registration. A common approach is to use surface-based registration. The authors hypothesize that biomechanical modeling will better control deformation inside the prostate than a regular nonrigid surface-based registration method. The authors developed a novel method by extending a nonrigid surface-based registration algorithm with biomechanical finite element (FE) modeling to better predict internal deformations of the prostate. Data were collected from ten patients and the MR and TRUS images were rigidly registered to anatomically align prostate orientations. The prostate was manually segmented in both images and corresponding surface meshes were generated. Next, a tetrahedral volume mesh was generated from the MR image. Prostate deformations due to the TRUS probe were simulated using the surface displacements as the boundary condition. A three-dimensional thin-plate spline deformation field was calculated by registering the mesh vertices. The target registration errors (TREs) of 35 reference landmarks determined by surface and volume mesh registrations were compared. The median TRE of a surface-based registration with biomechanical regularization was 2.76 (0.81-7.96) mm. This was significantly different than the median TRE of 3.47 (1.05-7.80) mm for regular surface-based registration without biomechanical regularization. Biomechanical FE modeling has the potential to improve the accuracy of multimodal prostate registration when comparing it to a regular nonrigid surface-based registration algorithm and can help to improve the effectiveness of MR guided TRUS biopsy procedures.

  14. MR-Guided Percutaneous Angioplasty: Assessment of Tracking Safety, Catheter Handling and Functionality

    SciTech Connect

    Wildermuth, Simon; Dumoulin, Charles L.; Pfammatter, Thomas; Maier, Stephan E.; Hofmann, Eugen; Debatin, Joerg F.

    1998-09-15

    Purpose: Magnetic resonance (MR)-guided percutaneous vascular interventions have evolved to a practical possibility with the advent of open-configuration MR systems and real-time tracking techniques. The purpose of this study was to assess an MR-tracking percutaneous transluminal angioplasty (PTA) catheter with regard to its safety profile and functionality. Methods: Real-time, biplanar tracking of the PTA catheter was made possible by incorporating a small radiofrequency (RF) coil in the catheter tip and connecting it to a coaxial cable embedded in the catheter wall. To evaluate potentially hazardous thermal effects due to the incorporation of the coil, temperature measurements were performed within and around the coil under various scanning and tracking conditions at 1.5 Tesla (T). Catheter force transmission and balloon-burst pressure of the MR-tracking PTA catheter were compared with those of a standard PTA catheter. The dilatative capability of the angioplasty balloon was assessed in vitro as well as in vivo, in an isolated femoral artery segment in a swine. Results: The degree of heating at the RF coil was directly proportional to the power of the RF pulses. Heating was negligible with MR tracking, conventional spin-echo and low-flip gradient-echo sequences. Sequences with higher duty cycles, such as fast spin echo, produced harmful heating effects. Force transmission of the MR-tracking PTA catheter was slightly inferior to that of the standard PTA catheter, while balloon-burst pressures were similar to those of conventional catheters. The MR-tracking PTA catheter functioned well both in vitro and in vivo. Conclusion: The in vivo use of an MR-tracking PTA catheter is safe under most scanning conditions.

  15. MR-guided focused ultrasound: enhancement of intratumoral uptake of [3H]-docetaxel in vivo

    NASA Astrophysics Data System (ADS)

    Chen, Lili; Mu, Zhaomei; Hachem, Paul; Ma, C.-M.; Wallentine, Annie; Pollack, Alan

    2010-12-01

    The purpose of this study is to quantify the enhancement of [3H]-docetaxel in implanted prostate tumors treated with MR-guided pulsed focused ultrasound (MRgFUS). Human prostate cancer, LNCaP cells in 25 µl, were implanted into the prostates of male nude mice. The tumor growth was directly monitored on MRI. When the tumor reached a designated size, MRgFUS treatment was performed using a focused ultrasound treatment system (InSightec ExAblate 2000) with a 1.5 T GE MR scanner. The tumor-bearing animals were randomly divided into three groups: group 1, MRgFUS treatment + [3H]-docetaxel; group 2, [3H]-docetaxel only and group 3, as a control. Animals in group 1 were treated with MRgFUS non-invasively. Immediately after the treatment, the animals received a single dose of tail vein injection of docetaxel at 15 mg kg-1 mixed with [3H]-docetaxel at 50 uCi kg-1 in a total volume of 150 µl. Animals in group 2 were treated the same as in group one, however without MRgFUS treatment. Animals in group 3 were treated as a control. Animals were sacrificed 30 min after i.v. injections regardless of whether or not they received focused ultrasound. Tumors were removed and processed. The radioactivity of [3H]-docetaxel in the tumor tissue was quantitatively measured by a liquid scintillation counter. Our study showed that all animals tolerated the MRgFUS treatment well. Our data showed increased 3H-docetaxel concentration in the tumor in the MRgFUS-treated group (1079 ± 132 cmp/75 mg) versus those without MRgFUS treatment (524 ± 201 cmp/75 mg) with P = 0.037.

  16. Image-driven, model-based 3D abdominal motion estimation for MR-guided radiotherapy

    NASA Astrophysics Data System (ADS)

    Stemkens, Bjorn; Tijssen, Rob H. N.; de Senneville, Baudouin Denis; Lagendijk, Jan J. W.; van den Berg, Cornelis A. T.

    2016-07-01

    Respiratory motion introduces substantial uncertainties in abdominal radiotherapy for which traditionally large margins are used. The MR-Linac will open up the opportunity to acquire high resolution MR images just prior to radiation and during treatment. However, volumetric MRI time series are not able to characterize 3D tumor and organ-at-risk motion with sufficient temporal resolution. In this study we propose a method to estimate 3D deformation vector fields (DVFs) with high spatial and temporal resolution based on fast 2D imaging and a subject-specific motion model based on respiratory correlated MRI. In a pre-beam phase, a retrospectively sorted 4D-MRI is acquired, from which the motion is parameterized using a principal component analysis. This motion model is used in combination with fast 2D cine-MR images, which are acquired during radiation, to generate full field-of-view 3D DVFs with a temporal resolution of 476 ms. The geometrical accuracies of the input data (4D-MRI and 2D multi-slice acquisitions) and the fitting procedure were determined using an MR-compatible motion phantom and found to be 1.0-1.5 mm on average. The framework was tested on seven healthy volunteers for both the pancreas and the kidney. The calculated motion was independently validated using one of the 2D slices, with an average error of 1.45 mm. The calculated 3D DVFs can be used retrospectively for treatment simulations, plan evaluations, or to determine the accumulated dose for both the tumor and organs-at-risk on a subject-specific basis in MR-guided radiotherapy.

  17. Experimental investigations of an endoluminal ultrasound applicator for MR-guided thermal therapy of pancreatic cancer

    NASA Astrophysics Data System (ADS)

    Adams, Matthew; Salgaonkar, Vasant; Jones, Peter; Plata, Juan; Chen, Henry; Pauly, Kim Butts; Sommer, Graham; Diederich, Chris

    2017-03-01

    An MR-guided endoluminal ultrasound applicator has been proposed for palliative and potential curative thermal therapy of pancreatic tumors. Minimally invasive ablation or hyperthermia treatment of pancreatic tumor tissue would be performed with the applicator positioned in the gastrointestinal (GI) lumen, and sparing of the luminal tissue would be achieved with a water-cooled balloon surrounding the ultrasound transducers. This approach offers the capability of conformal volumetric therapy for fast treatment times, with control over the 3D spatial deposition of energy. Prototype endoluminal ultrasound applicators have been fabricated using 3D printed fixtures that seat two 3.2 or 5.6 MHz planar or curvilinear transducers and contain channels for wiring and water flow. Spiral surface coils have been integrated onto the applicator body to allow for device localization and tracking for therapies performed under MR guidance. Heating experiments with a tissue-mimicking phantom in a 3T MR scanner were performed and demonstrated capability of the prototype to perform volumetric heating through duodenal luminal tissue under real-time PRF-based MR temperature imaging (MRTI). Additional experiments were performed in ex vivo pig carcasses with the applicator inserted into the esophagus and aimed towards liver or soft tissue surrounding the spine under MR guidance. These experiments verified the capacity of heating targets up to 20-25 mm from the GI tract. Active device tracking and automated prescription of imaging and temperature monitoring planes through the applicator were made possible by using Hadamard encoded tracking sequences to obtain the coordinates of the applicator tracking coils. The prototype applicators have been integrated with an MR software suite that performs real-time device tracking and temperature monitoring.

  18. In vivo MR guided boiling histotripsy in a mouse tumor model evaluated by MRI and histopathology.

    PubMed

    Hoogenboom, Martijn; Eikelenboom, Dylan; den Brok, Martijn H; Veltien, Andor; Wassink, Melissa; Wesseling, Pieter; Dumont, Erik; Fütterer, Jurgen J; Adema, Gosse J; Heerschap, Arend

    2016-06-01

    Boiling histotripsy (BH) is a new high intensity focused ultrasound (HIFU) ablation technique to mechanically fragmentize soft tissue into submicrometer fragments. So far, ultrasound has been used for BH treatment guidance and evaluation. The in vivo histopathological effects of this treatment are largely unknown. Here, we report on an MR guided BH method to treat subcutaneous tumors in a mouse model. The treatment effects of BH were evaluated one hour and four days later with MRI and histopathology, and compared with the effects of thermal HIFU (T-HIFU). The lesions caused by BH were easily detected with T2 w imaging as a hyper-intense signal area with a hypo-intense rim. Histopathological evaluation showed that the targeted tissue was completely disintegrated and that a narrow transition zone (<200 µm) containing many apoptotic cells was present between disintegrated and vital tumor tissue. A high level of agreement was found between T2 w imaging and H&E stained sections, making T2 w imaging a suitable method for treatment evaluation during or directly after BH. After T-HIFU, contrast enhanced imaging was required for adequate detection of the ablation zone. On histopathology, an ablation zone with concentric layers was seen after T-HIFU. In line with histopathology, contrast enhanced MRI revealed that after BH or T-HIFU perfusion within the lesion was absent, while after BH in the transition zone some micro-hemorrhaging appeared. Four days after BH, the transition zone with apoptotic cells was histologically no longer detectable, corresponding to the absence of a hypo-intense rim around the lesion in T2 w images. This study demonstrates the first results of in vivo BH on mouse tumor using MRI for treatment guidance and evaluation and opens the way for more detailed investigation of the in vivo effects of BH. Copyright © 2016 John Wiley & Sons, Ltd.

  19. Laparoscopic surgery - series (image)

    MedlinePlus

    ... performed laparoscopically, including gallbladder removal (laparoscopic cholecystectomy), esophageal surgery (laparoscopic fundoplication), colon surgery (laparoscopic colectomy), and surgery on ...

  20. First experience with MR-guided focused ultrasound in the treatment of Parkinson's disease

    PubMed Central

    2014-01-01

    Background Radiofrequency (RF) subthalamotomies have been proposed since the 1960s to treat patients suffering from Parkinson's disease (PD). Recently, the magnetic resonance (MR)-guided focused ultrasound technology (MRgFUS) offers the possibility to perform subthalamic thermocoagulations with reduced risks and optimized accuracy. We describe here the initial results of the MRgFUS pallidothalamic tractotomy (PTT), an anatomical and physiological update of the earlier subthalamotomies. Methods Thirteen consecutive patients suffering from chronic (mean disease duration 9.7 years) and therapy-resistant PD were treated unilaterally with an MRgFUS PTT. Primary relief assessment indicators were the score reduction of the Unified Parkinson Disease Rating Scale (UPDRS) and the patient estimation of global symptom relief (GSR) taken at 3 months follow-up. Final temperatures at target were between 52°C and 59°C. The MR examinations were performed before the treatment, 2 days and 3 months after it. The accuracy of the targeting was calculated on 2 days post-treatment MR pictures for each PTT lesion. Results The first four patients received a PTT using the lesional parameters applied for thalamotomies. They experienced clear-cut recurrences at 3 months (mean UPDRS relief 7.6%, mean GSR 22.5%), and their MR showed no sign of thermal lesion in T2-weighted (T2w) images. As a consequence, the treatment protocol was adapted for the following nine patients by applying repetition of the final temperatures 4 to 5 times. That produced thermocoagulations of larger volumes (172 mm3 against 83 mm3 for the first four patients), which remained visible at 3 months on T2w images. These nine patients enjoyed a mean UPDRS reduction of 60.9% and a GSR of 56.7%, very close to the results obtained with radiofrequency lesioning. The targeting accuracy for the whole patient group was 0.5, 0.5, and 0.6 mm for the anteroposterior (AP), mediolateral (ML), and dorsoventral (DV) dimensions

  1. MR-Guided PTA in Experimental Bilateral Rabbit Renal Artery Stenosis and MR Angiography Follow-Up Versus Histomorphometry

    SciTech Connect

    Le Blanche, Alain-Ferdinand; Rossert, Jerome; Wassef, Michel; Levy, Bernard; Bigot, Jean-Michel; Boudghene, Frank

    2000-09-15

    Purpose: To assess in vivo 1) MR-guided percutaneous transluminal renal angioplasty (PTRA) in experimental bilateral rabbit renal artery stenosis (RAS); 2) postprocedural follow-up by gadolinium-enhanced MR angiography versus histomorphometry.Methods: Fifteen male NZW rabbits of mean weight 4.0 kg (range 3.5-4.2 kg) underwent bilateral RAS induction by combined overdilation-deendothelialization with a gadolinium-filled balloon, passively MR-guided by the artifact of a 0.014-inch guidewire. After 4 weeks the rabbits were randomized into two groups: group A (n = 8) underwent right-sided PTRA for treatment of RAS, group B (n = 7) underwent left-sided PTRA. After another 4 weeks the rabbits were killed to assess by histomorphometry recurrent stenosis and contralateral induction injury stenosis lesions. Each step was preceded by gadolinium-enhanced three-dimensional MR angiography, and the cortex-to-aorta (C/A) signal intensity ratio was calculated.Results: RAS induction was successful in all cases. Fourteen arteries developed restenosis and 13 only initial stenosis. MR-guided PTRAs were feasible in 22 arteries (73%). For a successful catheterization of the ostium (20 arteries, 66% success rate), 10-25 steps were required. Five to eight steps were required for balloon localization and inflation for each PTRA. The restenosis effect was reflected by a 16% (12%-27%) decrease in C/A values on MR angiograms (p < 0.05).Conclusion: MR guidance and MR angiography represent a feasible, less invasive alternative for performing and assessing experimental PTRA in RAS.

  2. Laparoscopic cholecystectomy: new indications.

    PubMed

    Nowzaradan, Y; Westmoreland, J C

    1991-06-01

    Laparoscopic cholecystectomy was performed on 65 unselected and consecutive patients, regardless of age, weight, history of abdominal surgery or presence of acute cholecystitis. All procedures were completed successfully, with only two patients converted to an open cholecystectomy. There were no intra-abdominal intraoperative complications; n o intraoperative transfusions were required. There were no intra-abdominal injuries, and no patient required repeat surgery for postoperative complications. Hospital stays averaged 30 hours, and the average time until patients resumed normal activities was 6 days.

  3. Laparoscopic Distal Pancreatectomy

    PubMed Central

    Melotti, Gianluigi; Butturini, Giovanni; Piccoli, Micaela; Casetti, Luca; Bassi, Claudio; Mullineris, Barbara; Lazzaretti, Maria Grazia; Pederzoli, Paolo

    2007-01-01

    Objective: To describe the clinical characteristics, indications, technical procedures, and outcome of a consecutive series of laparoscopic distal pancreatic resections performed by the same surgical team. Summary Background Data: Laparoscopic distal pancreatic resection has increasingly been described as a feasible and safe procedure, although accompanied by a high rate of conversion and morbidity. Methods: A consecutive series of patients affected by solid and cystic tumors were selected prospectively to undergo laparoscopic distal pancreatectomy performed by the same surgical team. Clinical characteristics as well as diagnostic preoperative assessment and intra- and postoperative data were prospectively recorded. A follow-up of at least 3 months was available for all patients. Results: Fifty-eight patients underwent laparoscopic resection between May 1999 and November 2005. All procedures were successfully performed laparoscopically, and no patient required intraoperative blood transfusion. Splenic vessel preservation was possible in 84.4% of spleen-preserving procedures. There were no mortalities. The overall median hospital stay was 9 days, while it was 10.5 days for patients with postoperative pancreatic fistulae (27.5% of all cases). Follow-up was available for all patients. Conclusions: Our experience in 58 consecutive patients was characterized by the lack of conversions and by acceptable rates of postoperative pancreatic fistulae and morbidity. Laparoscopy proved especially beneficial in patients with postoperative complications as they had a relatively short hospital stay. Solid and cystic tumors of the distal pancreas represent a good indication for laparoscopic resection whenever possible. PMID:17592294

  4. Laparoscopic Total Mesorectum Excision

    PubMed Central

    Quilici, F.A.; Cordeiro, F.; Reis, J.A.; Kagohara, O.; Simões Neto, J.

    2002-01-01

    The main controversy of colon-rectal laparoscopic surgery comes from its use as a cancer treatment. Two points deserve special attention: the incidence of portsite tumor implantation and the possibility of performing radical cancer surgery, such as total mesorectum excision. Once these points are addressed, the laparoscopic approach will be used routinely to treat rectal cancer. To clarify these points, 32 patients with cancer of the lower rectum participated in a special protocol that included preoperative radiotherapy and laparoscopic total mesorectum excision. All data were recorded. At the same time, all data recorded from the experience of a multicenter laparoscopic group (Brazilian Colorectal Laparoscopic Surgeons – 130 patients with tumor of the lower rectum) were analyzed and compared with the data provided by our patients. Analysis of the results suggests that a laparoscopic approach allows the same effective resection as that of conventional surgery and that preoperative irradiation does not influence the incidence of intraoperative complications. The extent of lymph nodal excision is similar to that obtained with open surgery, with an average of 12.3 lymph nodes dissected per specimen. The rate of local recurrence was 3.12%. No port site implantation of tumor was noted in this series of patients with cancer of the lower rectum. PMID:12113422

  5. Endoluminal MR-guided ultrasonic applicator embedding cylindrical phased-array transducers and opposed-solenoid detection coil.

    PubMed

    Rata, Mihaela; Birlea, Vlad; Murillo, Adriana; Paquet, Christian; Cotton, François; Salomir, Rares

    2015-01-01

    MR-guided high-intensity contact ultrasound (HICU) was suggested as an alternative therapy for esophageal and rectal cancer. To offer high-quality MR guidance, two prototypes of receive-only opposed-solenoid coil were integrated with 64-element cylindrical phased-array ultrasound transducers (rectal/esophageal). The design of integrated coils took into account the transducer geometry (360° acoustic window within endoluminal space). The rectal coil was sealed on a plastic support and placed reversibly on the transducer head. The esophageal coil was fully embedded within the transducer head, resulting in one indivisible device. Comparison of integrated versus external coils was performed on a clinical 1.5T scanner. The integrated coils showed higher sensitivity compared with the standard extracorporeal coil with factors of up to 7.5 (rectal applicator) and 3.3 (esophageal applicator). High-resolution MR images for both anatomy (voxel 0.4 × 0.4 × 5 mm(3)) and thermometry (voxel 0.75 × 0.75 × 8 mm(3), 2 s/image) were acquired in vivo with the rectal endoscopic device. The temperature feedback loop accurately controlled multiple control points over the region of interest. This study showed significant improvement of MR data quality using endoluminal integrated coils versus standard external coil. Inframillimeter spatial resolution and accurate feedback control of MR-guided HICU thermotherapy were achieved. © 2014 Wiley Periodicals, Inc.

  6. Sampling strategies for subsampled segmented EPI PRF thermometry in MR guided high intensity focused ultrasound

    SciTech Connect

    Odéen, Henrik Diakite, Mahamadou; Todd, Nick; Minalga, Emilee; Payne, Allison; Parker, Dennis L.

    2014-09-15

    Purpose: To investigate k-space subsampling strategies to achieve fast, large field-of-view (FOV) temperature monitoring using segmented echo planar imaging (EPI) proton resonance frequency shift thermometry for MR guided high intensity focused ultrasound (MRgHIFU) applications. Methods: Five different k-space sampling approaches were investigated, varying sample spacing (equally vs nonequally spaced within the echo train), sampling density (variable sampling density in zero, one, and two dimensions), and utilizing sequential or centric sampling. Three of the schemes utilized sequential sampling with the sampling density varied in zero, one, and two dimensions, to investigate sampling the k-space center more frequently. Two of the schemes utilized centric sampling to acquire the k-space center with a longer echo time for improved phase measurements, and vary the sampling density in zero and two dimensions, respectively. Phantom experiments and a theoretical point spread function analysis were performed to investigate their performance. Variable density sampling in zero and two dimensions was also implemented in a non-EPI GRE pulse sequence for comparison. All subsampled data were reconstructed with a previously described temporally constrained reconstruction (TCR) algorithm. Results: The accuracy of each sampling strategy in measuring the temperature rise in the HIFU focal spot was measured in terms of the root-mean-square-error (RMSE) compared to fully sampled “truth.” For the schemes utilizing sequential sampling, the accuracy was found to improve with the dimensionality of the variable density sampling, giving values of 0.65 °C, 0.49 °C, and 0.35 °C for density variation in zero, one, and two dimensions, respectively. The schemes utilizing centric sampling were found to underestimate the temperature rise, with RMSE values of 1.05 °C and 1.31 °C, for variable density sampling in zero and two dimensions, respectively. Similar subsampling schemes

  7. Sampling strategies for subsampled segmented EPI PRF thermometry in MR guided high intensity focused ultrasound

    PubMed Central

    Odéen, Henrik; Todd, Nick; Diakite, Mahamadou; Minalga, Emilee; Payne, Allison; Parker, Dennis L.

    2014-01-01

    Purpose: To investigate k-space subsampling strategies to achieve fast, large field-of-view (FOV) temperature monitoring using segmented echo planar imaging (EPI) proton resonance frequency shift thermometry for MR guided high intensity focused ultrasound (MRgHIFU) applications. Methods: Five different k-space sampling approaches were investigated, varying sample spacing (equally vs nonequally spaced within the echo train), sampling density (variable sampling density in zero, one, and two dimensions), and utilizing sequential or centric sampling. Three of the schemes utilized sequential sampling with the sampling density varied in zero, one, and two dimensions, to investigate sampling the k-space center more frequently. Two of the schemes utilized centric sampling to acquire the k-space center with a longer echo time for improved phase measurements, and vary the sampling density in zero and two dimensions, respectively. Phantom experiments and a theoretical point spread function analysis were performed to investigate their performance. Variable density sampling in zero and two dimensions was also implemented in a non-EPI GRE pulse sequence for comparison. All subsampled data were reconstructed with a previously described temporally constrained reconstruction (TCR) algorithm. Results: The accuracy of each sampling strategy in measuring the temperature rise in the HIFU focal spot was measured in terms of the root-mean-square-error (RMSE) compared to fully sampled “truth.” For the schemes utilizing sequential sampling, the accuracy was found to improve with the dimensionality of the variable density sampling, giving values of 0.65 °C, 0.49 °C, and 0.35 °C for density variation in zero, one, and two dimensions, respectively. The schemes utilizing centric sampling were found to underestimate the temperature rise, with RMSE values of 1.05 °C and 1.31 °C, for variable density sampling in zero and two dimensions, respectively. Similar subsampling schemes

  8. Performance of a Multi Leaf Collimator System for MR-Guided Radiation Therapy.

    PubMed

    Cai, Bin; Li, Harold; Yang, Deshan; Rodriguez, Vivian; Curcuru, Austen; Wang, Yuhe; Wen, Jie; Kashani, Rojano; Mutic, Sasa; Green, Olga

    2017-09-09

    To investigate and characterize the performance of a Multi Leaf Collimator (MLC) designed for Cobalt-60 based MR-guided radiation therapy system in a 0.35T magnetic field. The MLC design and unique assembly features in the ViewRay MRIdian system were first reviewed. The RF cage shielding of MLC motor and cables were evaluated using ACR phantoms with real time imaging and quantified by signal-to-noise ratio. The dosimetric characterizations, including the leaf transmission, leaf penumbra, tongue and groove effect, were investigated using radiosensitive films. The output factor of MLC-defined fields were measured with ionization chambers for both symmetric fields from 2.1 ×2.1 cm(2) to 27.3 × 27.3 cm(2) and asymmetric fields from 10.5 × 10.5 cm(2) to 10.5 × 2.0 cm(2) . MLC positional accuracy was assessed by delivering either a picket fence (PF) style pattern on radiochromic films with wire-jig phantom or double and triple-rectangular patterns on ArcCheck-MR (Sun Nuclear, Melbourne, FL) with gamma analysis as the pass/fail indicator. Leaf speed tests were performed to assess the capability of full range leaf travel within manufacture's specifications. MLC plan delivery reproducibility were tested by repeatedly delivering both open fields and fields with irregular shaped segments over one-month period. Comparable SNRs within 4% were observed for MLC moving and stationary plans on vendor-reconstructed images, and the direct k-space reconstructed images showed that the three SNRs are within 1%. The maximum leaf transmission for all three MLCs was less than 0.35% and the average leakage was 0.153±0.006%, 0.151±0.008%, and 0.159±0.015% for head 1, 2 and 3, respectively. Both the leaf edge and leaf end penumbra showed comparable values within 0.05 cm, and the measured values are within 0.1 cm with TPS values. The leaf-edge TG effect indicated a 10% underdose and the leaf end TG showed a shifted dose distribution with 0.3cm shift. The leaf positioning test showed a 0

  9. Pitfalls in laparoscopic cholecystectomy.

    PubMed

    Yvergneaux, J P; Kint, M; Kuppens, E

    1994-01-01

    On the basis of literature and of 475 laparoscopic cholecystectomies of the authors, some pitfalls are reviewed. The circumstances, the mechanism and the prevention of injuries were detailed together with the connected problem of postoperative bile leakage. Among the cholangiographic pitfalls the importance of detection of congenital and acquired anomalies of the biliary tree by means of preoperative ERCP or intraoperative trans-cystic cholangiograms was emphasized. A particular study was made of 3 pictures: Mirizzi syndrome; stone impaction in Vater's papilla; no retrograde flow of the common hepatic duct on intraoperative cholangiograms. Biliodigestive fistulas were briefly commented. The problems with cystic duct stones, particularly the treatment of stones in a long, low inserted cystic duct with retroduodenal course and the closing of thick-walled or wide cystic stumps, were explained. In patients with intraoperative residual common bile duct stones and with failed preoperative catheterization of the papilla, the authors advocate their double approach technique. This combined intraoperative laparoscopic and postoperative endoscopic procedure is carried out via the same transcystic polythene catheters as used for cholangiography and external biliary drainage of the common bile duct.

  10. History of intraoperative ultrasound.

    PubMed

    Makuuchi, M; Torzilli, G; Machi, J

    1998-11-01

    Intraoperative ultrasound (IOUS) using A-mode or non-real-time B-mode imaging started in the 1960s; however, it was not widely accepted mainly because of difficulty in image interpretation. In the late 1970s, IOUS became one of the topics in the surgical communities upon the introduction of high-frequency real-time B-mode ultrasound. Special probes for operative use were developed. In the 1980s, all over the world the use of IOUS spread to a variety of surgical fields, such as hepatobiliary pancreatic surgery, neurosurgery, and cardiovascular surgery. IOUS changed hepatic surgery dramatically because IOUS was the only modality that was capable of delineating and examining the interior of the liver during surgery. After 1990, color Doppler imaging and laparoscopic ultrasound were incorporated into IOUS. Currently, IOUS is considered an indispensable operative procedure for intraoperative decision-making and guidance of surgical procedures. For better surgical practice, education of surgeons in the use of ultrasound is the most important issue.

  11. The roles of functional MRI in MR-guided neurosurgery in a combined 1.5 Tesla MR-operating room.

    PubMed

    Liu, H; Hall, W A; Truwit, C L

    2003-01-01

    During MR-guided neurosurgical procedures performed in a combined 1.5 Tesla MR-operating room (MR-OR), we have successfully implemented and validated a functional MRI (fMRI) scheme for efficiently localizing eloquent functional areas and assessing their proximity to a lesion volume immediately prior to the craniotomy. The fMRI examination consists of a dynamical blood oxygenation level dependent (BOLD) MR imaging technique and a task paradigm that is designed to activate the brain area of interest. The functional imaging technique was based on gradient-echo (GE) echo-planar imaging (EPI) (TR/TE = 2000-3000/40-50 msec). The motor task paradigm involves a periodic movement task, such as alternating between thumb and the other four fingers as a finger-tapping task, while the language involved a covert repeat of a series of words given as a task stimulus. While patient is performing the task, a dynamical fMRI was performed concurrently covering the volume of interest every 2 or 3 sec. Also, we have used a temporal series averaging (TSA) method for correcting the background drift in the raw fMRI signal, and developed a scheme for presenting fMRI results to neurosurgeons in an intuitive 3-dimensional volume-rendered display format. By using the fMRI scheme, we have successfully performed sixteen fMRI examinations immediately prior to neurosurgery in the combined MR-OR on the same surgical table to localize various eloquent functional areas of interests. TSA was successful in reducing the background drift in the fMRI time course data, and the 3-dimensional volume-rendered display was proven effective in presenting the resulting brain activations to neurosurgeons. More importantly, in three representative cases (one biopsy and two tumor resections) presented, the information provided by fMRI have indeed contributed significantly in making the optimal surgical decisions prior to craniotomy. Intra-operative fMRI can be an indispensable tool for determining the location of a

  12. Focal therapy for localized unifocal and multifocal prostate cancer: A prospective development study using real time MR guided focused ultrasound

    NASA Astrophysics Data System (ADS)

    Napoli, A.; Caliolo, G.; Boni, F.; Anzidei, M.; Catalano, C.

    2017-03-01

    To assess safety and feasibility of non-invasive high intensity 3T MR guided focused ultrasound (MRgFUS) treatment of localized prostate cancer in an exploratory designed study. Men aged 45-80 years were eligible for this prospective study if they had low-risk localized prostate cancer (prostate specific antigen [PSA] ≤10 ng/mL, Gleason score ≤ 3 + 3), with no previous androgen deprivation or treatment for prostate cancer, and who could safely undergo multiparametric MRI (Discovery 750, GE; Gd-Bopta, Bracco) and have a spinal anesthetic. Patients underwent focal therapy using real time MR guided high intensity focused ultrasound (MRgFUS), delivered to all known cancer lesions, with a margin of normal tissue. Primary endpoints were adverse events (serious and otherwise) and urinary symptoms and erectile function assessed using patient questionnaires. 8 men were recruited between June 2011 and June 2012. After treatment, one man was admitted to hospital for acute urinary retention. Another patient had self-resolving, mild, intermittent dysuria (median duration 5.0 days). Urinary tract infection was not reported. Urinary debris occurred in 6 men (75%), with a median duration of 12 days. Median overall International Index of Erectile Function-15 (IIEF-15) scores were similar at baseline and at 6 to 12 months (p=0.060), as were median IIEF-15 scores for intercourse satisfaction (p=0.433), sexual desire (p=0.622), and overall satisfaction (p=0.256). There was an improvement in lower urinary tract symptoms, assessed by International Prostate Symptom Score (IPSS), between baseline and 6 to 12 months (p=0.026). All 8 men with no baseline urinary incontinence were leak-free and pad-free by 9 months. No histological evidence of cancer was identified in 7 of 8 men biopsied at 6 months (87,5%); overall, the entire population (8 patients) was free of clinically significant cancer and had no evidence of disease on multi-parametric MRI at 6 to 12 months. MR guided Focused

  13. MR-Guided High-Intensity Focused Ultrasound: Current Status of an Emerging Technology

    SciTech Connect

    Napoli, Alessandro Anzidei, Michele Ciolina, Federica Marotta, Eugenio Cavallo Marincola, Beatrice Brachetti, Giulia Mare, Luisa Di Cartocci, Gaia Boni, Fabrizio Noce, Vincenzo Bertaccini, Luca Catalano, Carlo

    2013-10-15

    The concept of ideal tumor surgery is to remove the neoplastic tissue without damaging adjacent normal structures. High-intensity focused ultrasound (HIFU) was developed in the 1940s as a viable thermal tissue ablation approach. In clinical practice, HIFU has been applied to treat a variety of solid benign and malignant lesions, including pancreas, liver, prostate, and breast carcinomas, soft tissue sarcomas, and uterine fibroids. More recently, magnetic resonance guidance has been applied for treatment monitoring during focused ultrasound procedures (magnetic resonance-guided focused ultrasound, MRgFUS). Intraoperative magnetic resonance imaging provides the best possible tumor extension and dynamic control of energy deposition using real-time magnetic resonance imaging thermometry. We introduce the fundamental principles and clinical indications of the MRgFUS technique; we also report different treatment options and personal outcomes.

  14. MR-guided high-intensity focused ultrasound: current status of an emerging technology.

    PubMed

    Napoli, Alessandro; Anzidei, Michele; Ciolina, Federica; Marotta, Eugenio; Cavallo Marincola, Beatrice; Brachetti, Giulia; Di Mare, Luisa; Cartocci, Gaia; Boni, Fabrizio; Noce, Vincenzo; Bertaccini, Luca; Catalano, Carlo

    2013-10-01

    The concept of ideal tumor surgery is to remove the neoplastic tissue without damaging adjacent normal structures. High-intensity focused ultrasound (HIFU) was developed in the 1940s as a viable thermal tissue ablation approach. In clinical practice, HIFU has been applied to treat a variety of solid benign and malignant lesions, including pancreas, liver, prostate, and breast carcinomas, soft tissue sarcomas, and uterine fibroids. More recently, magnetic resonance guidance has been applied for treatment monitoring during focused ultrasound procedures (magnetic resonance-guided focused ultrasound, MRgFUS). Intraoperative magnetic resonance imaging provides the best possible tumor extension and dynamic control of energy deposition using real-time magnetic resonance imaging thermometry. We introduce the fundamental principles and clinical indications of the MRgFUS technique; we also report different treatment options and personal outcomes.

  15. MR-Guided Focused Ultrasound: A New Generation Treatment of Parkinson's Disease, Essential Tremor and Neuropathic Pain

    PubMed Central

    Dobrakowski, Pawel Piotr; Machowska-Majchrzak, Agnieszka Kamila; Łabuz-Roszak, Beata; Majchrzak, Krzysztof Grzegorz; Kluczewska, Ewa

    2014-01-01

    Summary The application of high intense focused ultrasound (HIFU) is currently the subject of many experimental and clinical trials. The combination of HIFU with MRI guidance known as MR-guided focused ultrasound (MRgFUS) appears to be particularly promising to ablate tissues located deep in the brain. The method can be the beginning of interventional neurology and an important alternative to neurosurgery. Studies conducted to date show the effectiveness of the method both in chronic diseases and in emergency cases. The safety and effectiveness of this method have been observed in parkinsonian and essential tremor as well as in neuropathic pain. The procedure does not require anaesthesia. Ionizing radiation is not used and there is no risk of cumulative dose. Such advantages may result in low complication rates and medical justification for further development of MRgFUS. PMID:24976088

  16. MR-guided PET motion correction in LOR space using generic projection data for image reconstruction with PRESTO

    NASA Astrophysics Data System (ADS)

    Scheins, J.; Ullisch, M.; Tellmann, L.; Weirich, C.; Rota Kops, E.; Herzog, H.; Shah, N. J.

    2013-02-01

    The BrainPET scanner from Siemens, designed as hybrid MR/PET system for simultaneous acquisition of both modalities, provides high-resolution PET images with an optimum resolution of 3 mm. However, significant head motion often compromises the achievable image quality, e.g. in neuroreceptor studies of human brain. This limitation can be omitted when tracking the head motion and accurately correcting measured Lines-of-Response (LORs). For this purpose, we present a novel method, which advantageously combines MR-guided motion tracking with the capabilities of the reconstruction software PRESTO (PET Reconstruction Software Toolkit) to convert motion-corrected LORs into highly accurate generic projection data. In this way, the high-resolution PET images achievable with PRESTO can also be obtained in presence of severe head motion.

  17. A framework for the correction of slow physiological drifts during MR-guided HIFU therapies: Proof of concept

    SciTech Connect

    Zachiu, Cornel Moonen, Chrit; Ries, Mario; Denis de Senneville, Baudouin

    2015-07-15

    Purpose: While respiratory motion compensation for magnetic resonance (MR)-guided high intensity focused ultrasound (HIFU) interventions has been extensively studied, the influence of slow physiological motion due to, for example, peristaltic activity, has so far been largely neglected. During lengthy interventions, the magnitude of the latter can exceed acceptable therapeutic margins. The goal of the present study is to exploit the episodic workflow of these therapies to implement a motion correction strategy for slow varying drifts of the target area and organs at risk over the entire duration of the intervention. Methods: The therapeutic workflow of a MR-guided HIFU intervention is in practice often episodic: Bursts of energy delivery are interleaved with periods of inactivity, allowing the effects of the beam on healthy tissues to recede and/or during which the plan of the intervention is reoptimized. These periods usually last for at least several minutes. It is at this time scale that organ drifts due to slow physiological motion become significant. In order to capture these drifts, the authors propose the integration of 3D MR scans in the therapy workflow during the inactivity intervals. Displacements were estimated using an optical flow algorithm applied on the 3D acquired images. A preliminary study was conducted on ten healthy volunteers. For each volunteer, 3D MR images of the abdomen were acquired at regular intervals of 10 min over a total duration of 80 min. Motion analysis was restricted to the liver and kidneys. For validating the compatibility of the proposed motion correction strategy with the workflow of a MR-guided HIFU therapy, an in vivo experiment on a porcine liver was conducted. A volumetric HIFU ablation was completed over a time span of 2 h. A 3D image was acquired before the first sonication, as well as after each sonication. Results: Following the volunteer study, drifts larger than 8 mm for the liver and 5 mm for the kidneys prove that

  18. TE-switched double-contrast enhanced visualization of vascular system and instruments for MR-guided interventions.

    PubMed

    Nanz, D; Weishaupt, D; Quick, H H; Debatin, J F

    2000-05-01

    A visualization principle for MR-guided vascular interventions based on the concerted use of two contrast agents is introduced. The first contrast agent, consisting of small paramagnetic iron oxide particles, was administered intravenously to shorten T(1), and even more so T *(2), of the blood for extended time periods. The second agent, a monomeric gadolinium complex, was added to a solution in an interventional device, such as a percutaneous-transluminal-angioplasty (PTA) balloon, to reduce T(1) with only minor additional effects on T *(2). With appropriate T(1)- and T *(2)-weighting the vascular tree (TE <3 ms) and the device (TE > or =8 ms) could be selectively imaged (TR <20 ms). Potentially, both images could be simultaneously updated in the subsecond range. Whereas a visualization of thin structures like guidewires was found to require pulse-sequence optimization, a successful visualization of a PTA balloon in a swine aorta in vivo was possible with standard sequences.

  19. A new motorized MR-guided ultrasound system for the delivery of large molecules to the rodent brain

    NASA Astrophysics Data System (ADS)

    Magnin, R.; Mériaux, S.; Le Bihan, D.; Dumont, E.; Larrat, B.

    2017-03-01

    Focused ultrasound combined with microbubbles injection has shown its potential to transiently disrupt the Blood Brain Barrier (BBB), allowing the delivery of large molecules to the Central Nervous System (CNS). However, the phenomenon has still to be investigated as the optimal parameters remain unknown up to date. To do so, we developed a new MR-guided motorized system, allowing the displacement of the transducer within preclinical magnets in order to choose the location of the opening. We demonstrated the capabilities of our system by opening the BBB along arbitrary trajectories. We also show the existence of an acoustic pressure threshold for BBB disruption estimated at about 0.3 MPa at 1.5 MHz by testing different acoustic conditions on the same animal. Finally, we investigated the BBB opening efficiency with the duty cycle. We proved that the disruption was greater with higher duty cycle.

  20. An improved optical flow tracking technique for real-time MR-guided beam therapies in moving organs

    NASA Astrophysics Data System (ADS)

    Zachiu, C.; Papadakis, N.; Ries, M.; Moonen, C.; de Senneville, B. Denis

    2015-12-01

    Magnetic resonance (MR) guided high intensity focused ultrasound and external beam radiotherapy interventions, which we shall refer to as beam therapies/interventions, are promising techniques for the non-invasive ablation of tumours in abdominal organs. However, therapeutic energy delivery in these areas becomes challenging due to the continuous displacement of the organs with respiration. Previous studies have addressed this problem by coupling high-framerate MR-imaging with a tracking technique based on the algorithm proposed by Horn and Schunck (H and S), which was chosen due to its fast convergence rate and highly parallelisable numerical scheme. Such characteristics were shown to be indispensable for the real-time guidance of beam therapies. In its original form, however, the algorithm is sensitive to local grey-level intensity variations not attributed to motion such as those that occur, for example, in the proximity of pulsating arteries. In this study, an improved motion estimation strategy which reduces the impact of such effects is proposed. Displacements are estimated through the minimisation of a variation of the H and S functional for which the quadratic data fidelity term was replaced with a term based on the linear L1norm, resulting in what we have called an L2-L1 functional. The proposed method was tested in the livers and kidneys of two healthy volunteers under free-breathing conditions, on a data set comprising 3000 images equally divided between the volunteers. The results show that, compared to the existing approaches, our method demonstrates a greater robustness to local grey-level intensity variations introduced by arterial pulsations. Additionally, the computational time required by our implementation make it compatible with the work-flow of real-time MR-guided beam interventions. To the best of our knowledge this study was the first to analyse the behaviour of an L1-based optical flow functional in an applicative context: real-time MR

  1. The feasibility of using a conventional flexible RF coil for an online MR-guided radiotherapy treatment

    NASA Astrophysics Data System (ADS)

    Hoogcarspel, Stan J.; Crijns, Sjoerd P. M.; Lagendijk, Jan J. W.; van Vulpen, Marco; Raaymakers, Bas W.

    2013-03-01

    The purpose of this paper is to evaluate the impact of a flexible radiofrequency coil on the treatment delivery of an online MR-guided radiotherapy treatment. For this study, we used a Synergy MR body coil (Philips, Best) in combination with the current MRL prototype of the UMC Utrecht. The compatibility of the coil is evaluated in two steps. First, we evaluated the dosimetric impact of the MR coil on both a simple and a complex irradiation strategy for treating spinal bone metastases. This tumor site will likely be chosen for the first in-man treatments with the UMC Utrecht MRL system. Second, we investigated the impact of the treatment beam on the MRI performance of the body coil. In case a single posterior-anterior rectangular field was applied, dose to the target volume was underestimated up to 2.2% as a result of beam attenuation in the MR coil. This underestimation however, decreased to 1% when a stereotactic treatment strategy was employed. The presence of the MR coil in or near the distal site of the treatment beam decreased the exit dose when a magnetic field was present. The MRI performance of the coil was unaffected as the result of the radiation. It is feasible to use the Synergy MR body coil for an online MR-guided radiotherapy treatment without any modification to the coil or attenuation correction methods in the planning stage. The effect of the MRI coil on the dose delivery is minimal and there is no effect of the treatment beam on the SNR of the acquired MRI data.

  2. Value of Intraoperative Sonography in Pancreatic Surgery.

    PubMed

    Weinstein, Stefanie; Morgan, Tara; Poder, Liina; Shin, Lewis; Jeffrey, R Brooke; Aslam, Rizwan; Yee, Judy

    2015-07-01

    The utility of intraoperative sonography for pancreatic disease has been well described for detection and evaluation of neoplastic and inflammatory pancreatic disease. Intraoperative sonography can help substantially reduce surgical time as well as decrease potential injury to tissues and major structures. Imaging with sonography literally at the point of care--the surgeon's scalpel--can precisely define the location of pancreatic lesions and their direct relationship with surrounding structures in real time during surgery. This article highlights our experience with intraoperative sonography at multiple institutional sites for both open and laparoscopic surgical procedures. We use intraoperative sonography for a wide range of pancreatic disease to provide accurate localization and staging of disease, provide guidance for enucleation of nonpalpable, nonvisible tumors, and in planning the most direct and least invasive surgical approach, avoiding injury to the pancreatic duct or other vital structures. © 2015 by the American Institute of Ultrasound in Medicine.

  3. [Laparoscopic radical cystectomy: initial experience].

    PubMed

    Núñez Mora, C; García Mediero, J Ma; Cáceres Jiménez, F; Cabrera Castillo, P M

    2007-09-01

    To review our initial experience with laparoscopic radical cystectomy. Between September 2004 and June 2006 we performed 16 laparoscopic radical cystectomies (14 males and 2 females) with a median age of 63.8 y.o. (51-85). 12 ileal neobladder (with laparoscopic ileal-urethra anastomosis), 3 cutaneous ureteroileostomies and 1 cutaneous ureterostomy were performed as derivation techniques. Median follow up was 12.4 months Mean operation time was 340 minutes. Estimated blood loss was 350 ml. and 3 cases required intra-op blood transfusion. Mean hospitalization discharged was at 7.6 days. Median linph node dissection was 22.9 finding node metastasis in 6 cases. Most frequent complication was ileo in two cases. No local recurrentes in trocar placement was achieved. Laparoscopic Radical cystectomy is a challenged long-lasting procedure but with the advantage of a less transfusion rate and short hospital stay. Oncologycal outcomes are similar as tose from open surgery.

  4. Laparoscopic Operative Technique for Adrenal Tumors

    PubMed Central

    Szostek, Grzegorz; Nazarewski, Slawomir; Borkowski, Tomasz; Chudzinski, Witold; Tolloczko, Tadeusz

    2000-01-01

    Background and Objectives: Laparoscopy has acquired an unquestionable position in surgical practice as a diagnostic and operative tool. Recently, the laparoscopic approach has become a valuable option for adrenalectomy. This paper reports, in detail, our experience of laparoscopic adrenalectomy performed for adrenal tumors. Methods: We performed 12 laparoscopic adrenalectomies from October 29, 1997 to October 31, 1998. The technique of laparoscopic adrenalectomy is described thoroughly in all relevant details for either left or right-sided adrenal lesions. Results: The presented technique of laparoscopic adrenalectomy in all 12 cases provided good and relatively simple exposure of the immediate operative area. All relevant vascular elements were safely controlled, adrenal tumors could be successfully removed, and adequate hemostasis was achieved. No intraoperative or postoperative complications were observed. Conclusions: Laparoscopic adrenalectomy is a safe alternative to open surgery and is preferred for most patients because of shorter postoperative hospital stay and less postoperative discomfort. PMID:10917119

  5. Hysterectomy - laparoscopic - discharge

    MedlinePlus

    Supracervical hysterectomy - discharge; Removal of the uterus - discharge; Laparoscopic hysterectomy - discharge; Total laparoscopic hysterectomy - discharge; TLH - discharge; Laparoscopic supracervical ...

  6. Laparoscopic and open surgery for pheochromocytoma

    PubMed Central

    Edwin, Bjørn; Kazaryan, Airazat M; Mala, Tom; Pfeffer, Per F; Tønnessen, Tor Inge; Fosse, Erik

    2001-01-01

    Backround Laparoscopic adrenalectomy is a promising alternative to open surgery although concerns exist in regard to laparoscopic treatment of pheocromocytoma. This report compares the outcome of laparoscopic and conventional (open) resection for pheocromocytoma particular in regard to intraoperative hemodynamic stability and postoperative patient comfort. Methods Seven patients laparoscopically treated (1997–2000) and nine patients treated by open resection (1990–1996) at the National Hospital (Rikshospitalet), Oslo. Peroperative hemodynamic stability including need of vasoactive drugs was studied. Postoperative analgesic medication, complications and hospital stay were recorded. Results No laparoscopic resections were converted to open procedure. Patients laparoscopically treated had fewer hypertensive episodes (median 1 vs. 2) and less need of vasoactive drugs peroperatively than patients conventionally operated. There was no difference in operative time between the two groups (median 110 min vs. 125 min for adrenal pheochromocytoma and 235 vs. 210 min for paraganglioma). Postoperative need of analgesic medication (1 vs. 9 patients) and hospital stay (median 3 vs. 6 days) were significantly reduced in patients laparoscopically operated compared to patients treated by the open technique. Conclusion Surgery for pheochromocytoma can be performed laparoscopically with a safety comparable to open resection. However, improved hemodynamic stability peroperatively and less need of postoperative analgesics favour the laparoscopic approach. In experienced hands the laparoscopic technique is concluded to be the method of choice also for pheocromocytoma. PMID:11580870

  7. An improved optical flow tracking technique for real-time MR-guided beam therapies in moving organs.

    PubMed

    Zachiu, C; Papadakis, N; Ries, M; Moonen, C; Denis de Senneville, B

    2015-12-07

    Magnetic resonance (MR) guided high intensity focused ultrasound and external beam radiotherapy interventions, which we shall refer to as beam therapies/interventions, are promising techniques for the non-invasive ablation of tumours in abdominal organs. However, therapeutic energy delivery in these areas becomes challenging due to the continuous displacement of the organs with respiration. Previous studies have addressed this problem by coupling high-framerate MR-imaging with a tracking technique based on the algorithm proposed by Horn and Schunck (H and S), which was chosen due to its fast convergence rate and highly parallelisable numerical scheme. Such characteristics were shown to be indispensable for the real-time guidance of beam therapies. In its original form, however, the algorithm is sensitive to local grey-level intensity variations not attributed to motion such as those that occur, for example, in the proximity of pulsating arteries.In this study, an improved motion estimation strategy which reduces the impact of such effects is proposed. Displacements are estimated through the minimisation of a variation of the H and S functional for which the quadratic data fidelity term was replaced with a term based on the linear L(1)norm, resulting in what we have called an L(2)-L(1) functional.The proposed method was tested in the livers and kidneys of two healthy volunteers under free-breathing conditions, on a data set comprising 3000 images equally divided between the volunteers. The results show that, compared to the existing approaches, our method demonstrates a greater robustness to local grey-level intensity variations introduced by arterial pulsations. Additionally, the computational time required by our implementation make it compatible with the work-flow of real-time MR-guided beam interventions.To the best of our knowledge this study was the first to analyse the behaviour of an L(1)-based optical flow functional in an applicative context: real-time MR

  8. Augmented reality visualization using image overlay technology for MR-guided interventions: cadaveric bone biopsy at 1.5 T.

    PubMed

    Fritz, Jan; U-Thainual, Paweena; Ungi, Tamas; Flammang, Aaron J; McCarthy, Edward F; Fichtinger, Gabor; Iordachita, Iulian I; Carrino, John A

    2013-06-01

    The purpose of this study was to prospectively test the hypothesis that image overlay technology facilitates accurate navigation for magnetic resonance (MR)-guided osseous biopsy. A prototype augmented reality image overlay system was used in conjunction with a clinical 1.5-T MR imaging system. Osseous biopsy of a total of 16 lesions was planned in 4 human cadavers with osseous metastases. A loadable module of 3D Slicer open-source medical image analysis and visualization software was developed and used for display of MR images, lesion identification, planning of virtual biopsy paths, and navigation of drill placement. The osseous drill biopsy was performed by maneuvering the drill along the displayed MR image containing the virtual biopsy path into the target. The drill placement and the final drill position were monitored by intermittent MR imaging. Outcome variables included successful drill placement, number of intermittent MR imaging control steps, target error, number of performed passes and tissue sampling, time requirements, and pathological analysis of the obtained osseous core specimens including adequacy of specimens, presence of tumor cells, and degree of necrosis. A total of 16 osseous lesions were sampled with percutaneous osseous drill biopsy. Eight lesions were located in the osseous pelvis (8/16, 50%) and 8 (8/16, 50%) lesions were located in the thoracic and lumbar spine. Lesion size was 2.2 cm (1.1-3.5 cm). Four (2-8) MR imaging control steps were required. MR imaging demonstrated successful drill placement inside 16 of the 16 target lesions (100%). One needle pass was sufficient for accurate targeting of all lesions. One tissue sample was obtained in 8 of the 16 lesions (50%); 2, in 6 of the 16 lesions (38%); and 3, in 2 of the 16 lesions (12%). The target error was 4.3 mm (0.8-6.8 mm). Length of time required for biopsy of a single lesion was 38 minutes (20-55 minutes). Specimens of 15 of the 16 lesions (94%) were sufficient for pathological

  9. Monitoring of hemodynamic changes induced in the healthy breast through inspired gas stimuli with MR-guided diffuse optical imaging

    PubMed Central

    Carpenter, C. M.; Rakow-Penner, R.; Jiang, S.; Pogue, B. W.; Glover, G. H.; Paulsen, K. D.

    2010-01-01

    Purpose: The modulation of tissue hemodynamics has important clinical value in medicine for both tumor diagnosis and therapy. As an oncological tool, increasing tissue oxygenation via modulation of inspired gas has been proposed as a method to improve cancer therapy and determine radiation sensitivity. As a radiological tool, inducing changes in tissue total hemoglobin may provide a means to detect and characterize malignant tumors by providing information about tissue vascular function. The ability to change and measure tissue hemoglobin and oxygenation concentrations in the healthy breast during administration of three different types of modulated gas stimuli (oxygen∕carbogen, air∕carbogen, and air∕oxygen) was investigated. Methods: Subjects breathed combinations of gases which were modulated in time. MR-guided diffuse optical tomography measured total hemoglobin and oxygen saturation in the breast every 30 s during the 16 min breathing stimulus. Metrics of maximum correlation and phase lag were calculated by cross correlating the measured hemodynamics with the stimulus. These results were compared to an air∕air control to determine the hemodynamic changes compared to the baseline physiology. Results: This study demonstrated that a gas stimulus consisting of alternating oxygen∕carbogen induced the largest and most robust hemodynamic response in healthy breast parenchyma relative to the changes that occurred during the breathing of room air. This stimulus caused increases in total hemoglobin and oxygen saturation during the carbogen phase of gas inhalation, and decreases during the oxygen phase. These findings are consistent with the theory that oxygen acts as a vasoconstrictor, while carbogen acts as a vasodilator. However, difficulties in inducing a consistent change in tissue hemoglobin and oxygenation were observed because of variability in intersubject physiology, especially during the air∕oxygen or air∕carbogen modulated breathing protocols

  10. Splenic artery embolization using contour emboli before laparoscopic or laparoscopically assisted splenectomy.

    PubMed

    Iwase, Kazuhiro; Higaki, Jun; Yoon, Hyung-Eun; Mikata, Shoki; Miyazaki, Minoru; Nishitani, Akiko; Hori, Shinichi; Kamiike, Wataru

    2002-10-01

    The present study assessed preoperative splenic artery embolization using spherical embolic material, super absorbent polymer microspheres (SAP-MS), before laparoscopic or laparoscopically assisted splenectomy. Distal splenic artery embolization using 250 to 400 microm SAP-MS was performed in nine cases with ITP and in seven cases with the other diseases with splenomegaly. Laparoscopic or laparoscopically assisted splenectomies, including a hand-assisted procedure and the procedure involving left upper minilaparotomy, were done 2 to 4 hours after embolization. Conversion to traditional laparotomy was not required in any of the 16 cases, while conversion to 12-cm laparotomy was required in one case with massive splenomegaly. Mean operating time was 161 minutes, and mean intraoperative blood loss was 290 mL. No major postoperative complications were identified, and only one patient reported postembolic pain before surgery. Preoperative splenic artery embolization using painless embolic material, SAP-MS, would be effective for easy and safe laparoscopic or laparoscopically assisted splenectomy.

  11. Adaptation of antenna profiles for control of MR guided hyperthermia (HT) in a hybrid MR-HT system

    SciTech Connect

    Weihrauch, Mirko; Wust, Peter; Weiser, Martin; Nadobny, Jacek; Eisenhardt, Steffen; Budach, Volker; Gellermann, Johanna

    2007-12-15

    A combined numerical-experimental iterative procedure, based on the Gauss-Newton algorithm, has been developed for control of magnetic resonance (MR)-guided hyperthermia (HT) applications in a hybrid MR-HT system BSD 2000 3D-MRI. In this MR-HT system, composed of a 3-D HT applicator Sigma-Eye placed inside a tunnel-type MR tomograph Siemens MAGNETOM Symphony (1.5 T), the temperature rise due to the HT radiation can be measured on-line in three dimensions by use of the proton resonance frequency shift (PRFS) method. The basic idea of our iterative procedure is the improvement of the system's characterization by a step-by-step modification of the theoretical HT antenna profiles (electric fields radiated by single antennas). The adaptation of antenna profiles is efficient if the initial estimates are radiation fields calculated from a good a priori electromagnetic model. Throughout the iterative procedure, the calculated antenna fields (FDTD) are step-by-step modified by comparing the calculated and experimental data, the latter obtained using the PRFS method. The procedure has been experimentally tested on homogeneous and inhomogeneous phantoms. It is shown that only few comparison steps are necessary for obtaining a dramatic improvement of the general predictability and quality of the specific absorption rate (SAR) inside the MR-HT hybrid system.

  12. In vivo evaluation of a MR-guided 980nm laser interstitial thermal therapy system for ablations in porcine liver.

    PubMed

    Garcia-Medina, Oscar; Gorny, Krzysztof; McNichols, Roger; Friese, Jeremy; Misra, Sanjay; Amrami, Kimberly; Bjarnason, Haraldur; Callstrom, Matthew; Woodrum, David

    2011-04-01

    To evaluate the use of a 980-nm diode laser for magnetic resonance-guided laser interstitial thermal therapy (MR-guided LITT) ablations in liver tissue in an in vivo porcine model. MR-guided guided LITT was performed on nine juvenile pigs placed under general anesthesia. Target ablation sites were selected in the left and right lobes of the liver. Laser applicators were placed in the liver using intermittent MR guidance. Up to four separate ablations were performed in each animal using a 15 or 30 W laser generator using one or two applicators. During the ablations, continuous MR-based temperature mapping (MR-thermal mapping), using a proton resonance frequency technique, was performed to monitor the size of the ablation in real-time. Extent of thermal tissue damage was continuously estimated based on Arrhenius model. Two-minute ablations were performed at each site. MR-thermal mapping of ablations within the posteroinferior liver were accomplished with continuous breathing at low tidal volume. In the mid right lobe of the liver, due to motion artefacts, MR-thermometry was performed intermittently during breath hold periods. In the left lobe of the liver, ablations were performed with ventilation using positive end expiratory pressure (PEEP) of 10 cm of water. Upon completion, MR imaging with gadolinium contrast was performed to assess the extent of treatment. Thermal lesions were subsequently measured using both, MR-thermal dose and MR gadolinium images, for comparison. Following the animal euthanasia, the liver was harvested and subjected to formalin fixation and paraffin embedding for histological examination. Between one and four focal liver ablations (total 24 ablations) were successfully performed in nine animals with either a 15 or 30 W laser generator. For the 15-W laser generator, the average single applicator ablation size was (2.0 ± 0.5) × (2.6 ± 0.4) cm(2) , as measured by magnetic resonance (MR) thermometry, or (1.7 ± 0.4)

  13. 3T MR Guided in bore transperineal prostate biopsy: A Comparison of robotic and manual needle-guidance templates

    PubMed Central

    Tilak, Gaurie; Tuncali, Kemal; Song, Sang-Eun; Tokuda, Junichi; Olubiyi, Olutayo; Fennessy, Fiona; Fedorov, Andriy; Penzkofer, Tobias; Tempany, Clare; Hata, Nobuhiko

    2014-01-01

    Purpose To demonstrate the utility of a robotic needle-guidance template device as compared to a manual template for in-bore 3T transperineal MR-guided prostate biopsy. Materials and Methods This two-arm mixed retrospective-prospective study included 99 cases of targeted transperineal prostate biopsies. The biopsy needles were aimed at suspicious foci noted on multiparametric 3T MRI using manual template (historical control) as compared with a robotic template. The following data was obtained: the accuracy of average and closest needle placement to the focus, histologic yield, percentage of cancer volume in positive core samples, complication rate, and time to complete the procedure. Results 56 cases were performed using the manual template, and 43 cases were performed using the robotic template. The mean accuracy of the best needle placement attempt was higher in the robotic group (2.39 mm) than the manual group (3.71 mm, p<0.027). The mean core procedure time was shorter in the robotic (90.82min) than the manual group (100.63min, p<0.030). Percentage of cancer volume in positive core samples was higher in robotic group (p<0.001). Cancer yields and complication rates were not statistically different between the two sub-groups (p = 0.557 and p=0.172 respectively). Conclusion The robotic needle-guidance template helps accurate placement of biopsy needles in MRI-guided core biopsy of prostate cancer. PMID:25263213

  14. Laparoscopic cholecystectomy: report of 82 cases.

    PubMed

    Meador, J H; Nowzaradan, Y; Matzelle, W

    1991-02-01

    In our initial experience with 82 patients, laparoscopic cholecystectomy has shown numerous advantages over open cholecystectomy. Both intraoperative blood loss and postoperative need for pain medication have been minimal. Most patients were discharged within 24 to 36 hours and resumed normal activities within 3 to 5 days. The aesthetic aspect is also an obvious advantage, since the laparoscopic procedure avoids disfiguring abdominal scars. Previous abdominal surgery is not a contraindication to attempting this procedure. Based on our experience, laparoscopic cholecystectomy can be done safely on most patients who are candidates for open cholecystectomy, including the elderly, the obese, and those with acute gangrenous cholecystitis.

  15. Pure laparoscopic and robot-assisted laparoscopic reconstructive surgery in congenital megaureter: a single institution experience.

    PubMed

    Fu, Weijun; Zhang, Xu; Zhang, Xiaoyi; Zhang, Peng; Gao, Jiangping; Dong, Jun; Chen, Guangfu; Xu, Axiang; Ma, Xin; Li, Hongzhao; Shi, Lixin

    2014-01-01

    To report our experience of pure laparoscopic and robot-assisted laparoscopic reconstructive surgery in congenital megaureter, seven patients (one bilateral) with symptomatic congenital megaureter underwent pure laparoscopic or robot-assisted laparoscopic surgery. The megaureter was exposed at the level of the blood vessel and was isolated to the bladder narrow area. Extreme ureter trim and submucosal tunnel encapsulation or papillary implantations and anti-reflux ureter bladder anastomosis were performed intraperitoneally by pure laparoscopic or robot-assisted laparoscopic surgery. The clinical data of seven patients after operation were analyzed, including the operation time, intraoperative complications, intraoperative bleeding volumes, postoperative complications, postoperative hospitalization time and pathological results. All of the patients were followed. The operation was successfully performed in seven patients. The mean operation times for pure laparoscopic surgery and robotic-assistant laparoscopic surgery were 175 (range: 150-220) and 187 (range: 170-205) min, respectively, and the mean operative blood loss volumes were 20 (range: 10-30) and 28.75 (range: 15-20) ml, respectively. There were no intraoperative complications. The postoperative drainage time was 5 (range: 4-6) and 5.75 (range: 5-6) d, respectively, and the indwelling catheter time was 6.33 (range: 4-8) d and 7 (range: 7-7) d, respectively. The postoperative hospitalization time was 7.67 (range: 7-8) d and 8 (range: 7-10) d, respectively. There was no obvious pain, no secondary bleeding and no urine leakage after the operation. Postoperative pathology reports revealed chronic urothelial mucosa inflammation. The follow-up results confirmed that all patients were relieved of their symptoms. Both pure laparoscopic and robot-assisted laparoscopic surgery using different anti-reflux ureter bladder anastomoses are safe and effective approaches in the minimally invasive treatment of congenital

  16. Technical Note: Radiological properties of tissue surrogates used in a multimodality deformable pelvic phantom for MR-guided radiotherapy

    SciTech Connect

    Niebuhr, Nina I. Johnen, Wibke; Güldaglar, Timur; Runz, Armin; Echner, Gernot; Mann, Philipp; Möhler, Christian; Pfaffenberger, Asja; Greilich, Steffen; Jäkel, Oliver

    2016-02-15

    Purpose: Phantom surrogates were developed to allow multimodal [computed tomography (CT), magnetic resonance imaging (MRI), and teletherapy] and anthropomorphic tissue simulation as well as materials and methods to construct deformable organ shapes and anthropomorphic bone models. Methods: Agarose gels of variable concentrations and loadings were investigated to simulate various soft tissue types. Oils, fats, and Vaseline were investigated as surrogates for adipose tissue and bone marrow. Anthropomorphic shapes of bone and organs were realized using 3D-printing techniques based on segmentations of patient CT-scans. All materials were characterized in dual energy CT and MRI to adapt CT numbers, electron density, effective atomic number, as well as T1- and T2-relaxation times to patient and literature values. Results: Soft tissue simulation could be achieved with agarose gels in combination with a gadolinium-based contrast agent and NaF to simulate muscle, prostate, and tumor tissues. Vegetable oils were shown to be a good representation for adipose tissue in all modalities. Inner bone was realized using a mixture of Vaseline and K{sub 2}HPO{sub 4}, resulting in both a fatty bone marrow signal in MRI and inhomogeneous areas of low and high attenuation in CT. The high attenuation of outer bone was additionally adapted by applying gypsum bandages to the 3D-printed hollow bone case with values up to 1200 HU. Deformable hollow organs were manufactured using silicone. Signal loss in the MR images based on the conductivity of the gels needs to be further investigated. Conclusions: The presented surrogates and techniques allow the customized construction of multimodality, anthropomorphic, and deformable phantoms as exemplarily shown for a pelvic phantom, which is intended to study adaptive treatment scenarios in MR-guided radiation therapy.

  17. SU-E-J-162: Quality Assurance Procedures for MR Guided Focused Ultrasound Treatment of Bone Metastasis

    SciTech Connect

    Chen, L; Chen, X; Wang, B; Gupta, R; Ma, C

    2014-06-01

    Purpose: The purpose of this work is to develop and verify our quality assurance (QA) procedures to ensure the safety and efficacy of MR-guided focused ultrasound (MRgFUS) treatment of bone metastases. Methods: A practical QA program was developed. Monthly and daily QA (DQA) procedures were performed. The major QA items included the checks of the machine hardware, software and patient safety features. Briefly, these checks/tests include: 1) the cooling system reservoir and treatment table; 2) power to the treatment table; 3) the MR coil; 4) the transducer position with MRI; 5) image display on the treatment work station; 6) the effective focal spot in 3 directions using MR thermometry; and 7) all the safety devices including a sonication lamp, and the emergency stop-sonication switches. In order to avoid patient skin burn, it is important to remove gas bubbles in the interfaces between the treatment table and the gel pad, and the gel pad and patients skin during the patient setup. Our QA procedures have been verified and evaluated through patient treatments. Seven patients with scapula, humeral head, sacrum, ilium, pubic ramus and acetabular bone metastases were treated using MRgFUS. Results: Our study showed that all seven patients tolerated the MRgFUS treatment well. No skin toxicity or other complications were observed. The pain score (0–10) using the visual analog scale (VAS) was significantly reduced from 8.0 ± 1.1 before treatment to 4.7 ± 3.0, 3.0 ± 1.5, 3.2 ± 2.8 and 3.4 ± 1.5 at one day, one month, two months and three months after the MRgFUS treatment, respectively. Conclusion: We demonstrated that with the appropriate QA procedures, MRgFUS is a safe, effective and noninvasive treatment modality for palliation of bone metastases.

  18. Targeted hyperthermia in prostate with an MR-guided endorectal ultrasound phased array: patient specific modeling and preliminary experiments

    NASA Astrophysics Data System (ADS)

    Salgaonkar, Vasant A.; Prakash, Punit; Plata, Juan; Holbrook, Andrew; Rieke, Viola; Kurhanewicz, John; Hsu, I.-C.; Diederich, Chris J.

    2013-02-01

    Feasibility of hyperthermia delivery to the prostate with a commercially available MR-guided endorectal ultrasound (ERUS) phased array ablation system (ExAblate 2100, Insightec, LTD) was assessed through computer simulations and ex vivo experiments. The simulations included a 3D FEM-based biothermal model, and acoustic field calculations for the ExAblate phased array (2.3 MHz, 2.3x4.0 cm2) using the rectangular radiator method. Array beamforming strategies were investigated to deliver 30-min hyperthermia (<41 °C) to focal regions of prostate cancer, identified from MR images in representative patient cases. Constraints on power densities, sonication durations and switching speeds imposed by ExAblate hardware and software were incorporated in the models. T<41 °C was calculated in 14-19 cm3 for sonications with planar or diverging beam patterns at 0.9-1.2 W/cm2, and in 3-10 cm3 for curvilinear (cylindrical) or multifocus beam patterns at 1.5-3.3 W/cm2, potentially useful for treating focal disease in a single posterior quadrant. Preliminary experiments included beamformed sonications in tissue mimicking phantom material under MRI-based temperature monitoring at 3T (GRE TE=7.0 ms, TR=15 ms, BW=10.5 kHz, FOV=15 cm, matrix 128x128, FA=40°). MR-temperature rises of 2-6 °C were induced in a phantom with the ExAblate array, consistent with calculated values and lower power settings (~0.86 W/cm2, 3 min.). Conformable hyperthermia may be delivered by tailoring power deposition along the array length and angular expanse. MRgERUS HIFU systems can be controlled for continuous hyperthermia in prostate to augment radiotherapy and drug delivery. [FUS Foundation, NIH R01 122276, 111981].

  19. SU-E-T-245: MR Guided Focused Ultrasound Increased PARP Related Apoptosis On Prostate Cancer in Vivo

    SciTech Connect

    Chen, L; Chen, X; Cvetkovic, D; Gupta, R; Yang, D; Ma, C

    2014-06-01

    Purpose: Our previous study demonstrated that significant tumor growth delay was observed in the mice treated with pulsed high intensity focused ultrasound (pHIFU). The purpose of this study is to understand the cell killing mechanisms of pHIFU. Methods: Prostate cancer cells (LNCaP), were grown orthotopically in 17 nude mice. Tumor-bearing mice were treated using pHIFU with an acoustic power of 25W, pulse width 100msec and 300 pulses in one sonication under MR guidance. Mutiple sonications were used to cover the whole tumor volume. Temperature (less than 40 degree centigrade in the focal spot) was monitored using MR thermometry. Animals were euthanized at pre-determined time points (n=2) after treatment: 0 hours; 6 hrs; 24 hrs; 48 hrs; 4 days and 7 days. Two tumorbearing mice were used as control. Three tumor-bearing mice were treated with radiation (RT, 2 Gy) using 6 MV photon beams. RT treated mice were euthanized at 0 hr, 6 hrs and 24 hrs. The tumors were processed for immunohistochemical (IHC) staining for PARP (a surrogate of apoptosis). A multispectral imaging analysis system was used to quantify the expression of PARP staining. Cell apoptosis was calculated based on the PARP expression level, which is the intensity of the DAB reaction. Results: Our data showed that PARP related apoptosis peaked at 48 hrs and 7 days in pHIFU treated mice, which is comparable to that for the RT group at 24 hrs. The preliminary results from this study were consistent with our previous study on tumor growth delay using pHIFU. Conclusion: Our results demonstrated that non-thermal pHIFU increased apoptotic tumor cell death through the PARP related pathway. MR guided pHIFU may have a great potential as a safe, noninvasive treatment modality for cancer therapy. This treatment modality might be able to synergize with PARP inhibitors to achieve better result.

  20. Laparoscopic adrenalectomy for phaeochromocytoma: a case series.

    PubMed

    Hotu, Cheri; Harman, Richard; Cutfield, Richard; Hodges, Nicola; Taylor, Eletha; Young, Simon

    2015-10-16

    To describe our 13-year experience in laparoscopic adrenalectomy for phaeochromocytoma. We performed a retrospective analysis of case notes of 29 patients who underwent laparoscopic adrenalectomy for phaeochromocytoma between 2000 and 2013. Twenty-nine patients (16 female), aged 16 to 67 years, underwent laparoscopic adrenalectomy for phaeochromocytoma. All patients were treated preoperatively with alpha-blocking agents. 80% were prescribed additional preoperative antihypertensive agents. 90% received antihypertensive agents intraoperatively. All patients received intraoperative magnesium sulphate for haemodynamic stabilisation. The mean operative time was 160 minutes. Nearly all of the patients experienced haemodynamic stability during surgery. Two patients required conversion to open adrenalectomy, due to severe intraoperative hypertension during tumour handling, and due to extensive intra-abdominal adhesions. Postoperative complications were minimal, and included blood loss, superior epigastric artery damage, and cellulitis at the laparoscopic port site. There was no perioperative mortality. The median length of stay postoperatively was 4 days. 24% were prescribed antihypertensive medication on discharge. In our experience, favourable perioperative outcomes were achieved, demonstrating that laparoscopic adrenalectomy for phaeochromocytoma is a safe and effective procedure in the setting of experienced and skilled surgical, anaesthetic and medical teams delivering the perioperative care.

  1. Laparoscopic radical trachelectomy.

    PubMed

    Rendón, Gabriel J; Ramirez, Pedro T; Frumovitz, Michael; Schmeler, Kathleen M; Pareja, Rene

    2012-01-01

    The standard treatment for patients with early-stage cervical cancer has been radical hysterectomy. However, for women interested in future fertility, radical trachelectomy is now considered a safe and feasible option. The use of minimally invasive surgical techniques to perform this procedure has recently been reported. We report the first case of a laparoscopic radical trachelectomy performed in a developing country. The patient is a nulligravid, 30-y-old female with stage IB1 adenocarcinoma of the cervix who desired future fertility. She underwent a laparoscopic radical trachelectomy and bilateral pelvic lymph node dissection. The operative time was 340 min, and the estimated blood loss was 100mL. There were no intraoperative or postoperative complications. The final pathology showed no evidence of residual disease, and all pelvic lymph nodes were negative. At 20 mo of follow-up, the patient is having regular menses but has not yet attempted to become pregnant. There is no evidence of recurrence. Laparoscopic radical trachelectomy with pelvic lymphadenectomy in a young woman who desires future fertility may also be an alternative technique in the treatment of early cervical cancer in developing countries.

  2. Laparoscopic Radical Trachelectomy

    PubMed Central

    Rendón, Gabriel J.; Ramirez, Pedro T.; Frumovitz, Michael; Schmeler, Kathleen M.

    2012-01-01

    Introduction: The standard treatment for patients with early-stage cervical cancer has been radical hysterectomy. However, for women interested in future fertility, radical trachelectomy is now considered a safe and feasible option. The use of minimally invasive surgical techniques to perform this procedure has recently been reported. Case Description: We report the first case of a laparoscopic radical trachelectomy performed in a developing country. The patient is a nulligravid, 30-y-old female with stage IB1 adenocarcinoma of the cervix who desired future fertility. She underwent a laparoscopic radical trachelectomy and bilateral pelvic lymph node dissection. The operative time was 340 min, and the estimated blood loss was 100mL. There were no intraoperative or postoperative complications. The final pathology showed no evidence of residual disease, and all pelvic lymph nodes were negative. At 20 mo of follow-up, the patient is having regular menses but has not yet attempted to become pregnant. There is no evidence of recurrence. Conclusion: Laparoscopic radical trachelectomy with pelvic lymphadenectomy in a young woman who desires future fertility may also be an alternative technique in the treatment of early cervical cancer in developing countries. PMID:23318085

  3. MR-Guided Delivery of Hydrophilic Molecular Imaging Agents Across the Blood-Brain Barrier Through Focused Ultrasound

    PubMed Central

    Airan, Raag D.; Foss, Catherine A.; Ellens, Nicholas P. K.; Wang, Yuchuan; Mease, Ronnie C.; Farahani, Keyvan; Pomper, Martin G.

    2016-01-01

    Purpose A wide variety of hydrophilic imaging and therapeutic agents are unable to gain access to the central nervous system (CNS) due to the blood-brain barrier (BBB). In particular, unless a particular transporter exists that may transport the agent across the BBB, most agents that are larger than 500 Da or that are hydrophilic will be excluded by the BBB. Glutamate carboxypeptidase II (GCPII), also known as the prostate-specific membrane antigen (PSMA) in the periphery, has been implicated in various neuropsychiatric conditions. As all agents that target GCPII are hydrophilic and thereby excluded from the CNS, we used GCPII as a platform for demonstrating our MR-guided focused ultrasound (MRgFUS) technique for delivery of GCPII/PSMA-specific imaging agents to the brain. Procedures Female rats underwent MRgFUS-mediated opening of the BBB. After opening of the BBB, either a radio- or fluorescently labeled ureido-based ligand for GCPII/PSMA was administered intravenously. Brain uptake was assessed for 2-(3-{1-carboxy-5-[(6-[18F]fluoropyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid ([18F]DCFPyL) and YC-27, two compounds known to bind GCPII/PSMA with high affinity, using positron emission tomography (PET) and near-infrared fluorescence (NIRF) imaging, respectively. Specificity of ligand binding to GCPII/PSMA in the brain was determined with co-administration of a molar excess of ZJ-43, a compound of the same chemical class but different structure from either [18F]DCFPyL or YC-27, which competes for GCPII/PSMA binding. Results Dynamic PET imaging using [18F]DCFPyL demonstrated that target uptake reached a plateau by ~1 h after radiotracer administration, with target/background ratios continuing to increase throughout the course of imaging, from a ratio of ~4:1 at 45 min to ~7:1 by 80 min. NIRF imaging likewise demonstrated delivery of YC-27 to the brain, with clear visualization of tracer in the brain at 24 h. Tissue uptake of both ligands was greatly

  4. Alginate Microspheres Containing Temperature Sensitive Liposomes (TSL) for MR-Guided Embolization and Triggered Release of Doxorubicin

    PubMed Central

    van Elk, Merel; Ozbakir, Burcin; Barten-Rijbroek, Angelique D.; Storm, Gert; Nijsen, Frank; Hennink, Wim E.; Vermonden, Tina; Deckers, Roel

    2015-01-01

    Objective The objective of this study was to develop and characterize alginate microspheres suitable for embolization with on-demand triggered doxorubicin (DOX) release and whereby the microspheres as well as the drug releasing process can be visualized in vivo using MRI. Methods and Findings For this purpose, barium crosslinked alginate microspheres were loaded with temperature sensitive liposomes (TSL/TSL-Ba-ms), which release their payload upon mild hyperthermia. These TSL contained DOX and [Gd(HPDO3A)(H2O)], a T1 MRI contrast agent, for real time visualization of the release. Empty alginate microspheres crosslinked with holmium ions (T2* MRI contrast agent, Ho-ms) were mixed with TSL-Ba-ms to allow microsphere visualization. TSL-Ba-ms and Ho-ms were prepared with a homemade spray device and sized by sieving. Encapsulation of TSL in barium crosslinked microspheres changed the triggered release properties only slightly: 95% of the loaded DOX was released from free TSL vs. 86% release for TSL-Ba-ms within 30 seconds in 50% FBS at 42°C. TSL-Ba-ms (76 ± 41 μm) and Ho-ms (64 ± 29 μm) had a comparable size, which most likely will result in a similar in vivo tissue distribution after an i.v. co-injection and therefore Ho-ms can be used as tracer for the TSL-Ba-ms. MR imaging of a TSL-Ba-ms and Ho-ms mixture (ratio 95:5) before and after hyperthermia allowed in vitro and in vivo visualization of microsphere deposition (T2*-weighted images) as well as temperature-triggered release (T1-weighted images). The [Gd(HPDO3A)(H2O)] release and clusters of microspheres containing holmium ions were visualized in a VX2 tumor model in a rabbit using MRI. Conclusions In conclusion, these TSL-Ba-ms and Ho-ms are promising systems for real-time, MR-guided embolization and triggered release of drugs in vivo. PMID:26561370

  5. Magnetic-field-induced dose effects in MR-guided radiotherapy systems: dependence on the magnetic field strength

    NASA Astrophysics Data System (ADS)

    Raaijmakers, A. J. E.; Raaymakers, B. W.; Lagendijk, J. J. W.

    2008-02-01

    Several institutes are currently working on the development of a radiotherapy treatment system with online MR imaging (MRI) modality. The main difference between their designs is the magnetic field strength of the MRI system. While we have chosen a 1.5 Tesla (T) magnetic field strength, the Cross Cancer Institute in Edmonton will be using a 0.2 T MRI scanner and the company Viewray aims to use 0.3 T. The magnetic field strength will affect the severity of magnetic field dose effects, such as the electron return effect (ERE): considerable dose increase at tissue air boundaries due to returning electrons. This paper has investigated how the ERE dose increase depends on the magnetic field strength. Therefore, four situations where the ERE occurs have been simulated: ERE at the distal side of the beam, the lateral ERE, ERE in cylindrical air cavities and ERE in the lungs. The magnetic field comparison values were 0.2, 0.75, 1.5 and 3 T. Results show that, in general, magnetic field dose effects are reduced at lower magnetic field strengths. At the distal side, the ERE dose increase is largest for B = 0.75 T and depends on the irradiation field size for B = 0.2 T. The lateral ERE is strongest for B = 3 T but shows no effect for B = 0.2 T. Around cylindrical air cavities, dose inhomogeneities disappear if the radius of the cavity becomes small relative to the in-air radius of the secondary electron trajectories. At larger cavities (r > 1 cm), dose inhomogeneities exist for all magnetic field strengths. In water-lung-water phantoms, the ERE dose increase takes place at the water-lung transition and the dose decreases at the lung-water transition, but these effects are minimal for B = 0.2 T. These results will contribute to evaluating the trade-off between magnetic field dose effects and image quality of MR-guided radiotherapy systems.

  6. Alginate Microspheres Containing Temperature Sensitive Liposomes (TSL) for MR-Guided Embolization and Triggered Release of Doxorubicin.

    PubMed

    van Elk, Merel; Ozbakir, Burcin; Barten-Rijbroek, Angelique D; Storm, Gert; Nijsen, Frank; Hennink, Wim E; Vermonden, Tina; Deckers, Roel

    2015-01-01

    The objective of this study was to develop and characterize alginate microspheres suitable for embolization with on-demand triggered doxorubicin (DOX) release and whereby the microspheres as well as the drug releasing process can be visualized in vivo using MRI. For this purpose, barium crosslinked alginate microspheres were loaded with temperature sensitive liposomes (TSL/TSL-Ba-ms), which release their payload upon mild hyperthermia. These TSL contained DOX and [Gd(HPDO3A)(H2O)], a T1 MRI contrast agent, for real time visualization of the release. Empty alginate microspheres crosslinked with holmium ions (T2* MRI contrast agent, Ho-ms) were mixed with TSL-Ba-ms to allow microsphere visualization. TSL-Ba-ms and Ho-ms were prepared with a homemade spray device and sized by sieving. Encapsulation of TSL in barium crosslinked microspheres changed the triggered release properties only slightly: 95% of the loaded DOX was released from free TSL vs. 86% release for TSL-Ba-ms within 30 seconds in 50% FBS at 42°C. TSL-Ba-ms (76 ± 41 μm) and Ho-ms (64 ± 29 μm) had a comparable size, which most likely will result in a similar in vivo tissue distribution after an i.v. co-injection and therefore Ho-ms can be used as tracer for the TSL-Ba-ms. MR imaging of a TSL-Ba-ms and Ho-ms mixture (ratio 95:5) before and after hyperthermia allowed in vitro and in vivo visualization of microsphere deposition (T2*-weighted images) as well as temperature-triggered release (T1-weighted images). The [Gd(HPDO3A)(H2O)] release and clusters of microspheres containing holmium ions were visualized in a VX2 tumor model in a rabbit using MRI. In conclusion, these TSL-Ba-ms and Ho-ms are promising systems for real-time, MR-guided embolization and triggered release of drugs in vivo.

  7. Fast temperature estimation from undersampled k-space with fully-sampled center for MR guided microwave ablation.

    PubMed

    Wang, Fuyixue; Dong, Zijing; Chen, Shuo; Chen, Bingyao; Yang, Jiafei; Wei, Xing; Wang, Shi; Ying, Kui

    2016-10-01

    presence of motion with relatively short computation time, which may make real time imaging for MR-guided microwave ablation possible. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Automated real-time needle-guide tracking for fast 3-T MR-guided transrectal prostate biopsy: a feasibility study.

    PubMed

    Zamecnik, Patrik; Schouten, Martijn G; Krafft, Axel J; Maier, Florian; Schlemmer, Heinz-Peter; Barentsz, Jelle O; Bock, Michael; Fütterer, Jurgen J

    2014-12-01

    To assess the feasibility of automatic needle-guide tracking by using a real-time phase-only cross correlation ( POCC phase-only cross correlation ) algorithm-based sequence for transrectal 3-T in-bore magnetic resonance (MR)-guided prostate biopsies. This study was approved by the ethics review board, and written informed consent was obtained from all patients. Eleven patients with a prostate-specific antigen level of at least 4 ng/mL (4 μg/L) and at least one transrectal ultrasonography-guided biopsy session with negative findings were enrolled. Regions suspicious for cancer were identified on 3-T multiparametric MR images. During a subsequent MR-guided biopsy, the regions suspicious for cancer were reidentified and targeted by using the POCC phase-only cross correlation -based tracking sequence. Besides testing a general technical feasibility of the biopsy procedure by using the POCC phase-only cross correlation -based tracking sequence, the procedure times were measured, and a pathologic analysis of the biopsy cores was performed. Thirty-eight core samples were obtained from 25 regions suspicious for cancer. It was technically feasible to perform the POCC phase-only cross correlation -based biopsies in all regions suspicious for cancer in each patient, with adequate biopsy samples obtained with each biopsy attempt. The median size of the region suspicious for cancer was 8 mm (range, 4-13 mm). In each region suspicious for cancer (median number per patient, two; range, 1-4), a median of one core sample per region was obtained (range, 1-3). The median time for guidance per target was 1.5 minutes (range, 0.7-5 minutes). Nineteen of 38 core biopsy samples contained cancer. This study shows that it is feasible to perform transrectal 3-T MR-guided biopsies by using a POCC phase-only cross correlation algorithm-based real-time tracking sequence. © RSNA, 2014.

  9. Initial experiences with MR Image-guided laparoscopic microwave coagulation therapy for hepatic tumors.

    PubMed

    Murakami, Koichiro; Naka, Shigeyuki; Shiomi, Hisanori; Akabori, Hiroya; Kurumi, Yoshimasa; Morikawa, Shigehiro; Tani, Tohru

    2015-09-01

    Percutaneous thermal ablation is used for treating hepatic tumors. Recent advances in laparoscopy and imaging modalities have led to the development of a novel image-guided minimally invasive loco-regional treatment. The aim of this trial was to apply laparoscopic assistance to magnetic resonance (MR) image-guided thermoablation instead of ultrasonography, because of its various advantages. Patients with hepatic tumors and liver cirrhosis underwent magnetic resonance (MR) image-guided laparoscopic microwave coagulation therapy using a borescope and endoscopic forceps. Six cases of laparoscopic microwave coagulation treatment using MR image guidance were successfully performed between January 2000 and December 2008. Tumors were detected, punctured, and ablated in an open-configured MR scanner. A total of nine hepatocellular carcinoma nodules were preoperatively identified in S3, S5 and S6 (mean diameter = 20.8 ± 5.4 mm). MR-guided microwave coagulation was laparoscopically achieved in all patients without any significant complications that required invasive treatment. The mean length of the operation was 275.3 ± 60.5 min, and the mean postsurgical hospital stay was 10.0 ± 2.3 days. Postoperative confirmation scanning was performed without moving the patients. MR-guided laparoscopic microwave coagulation therapy is an effective treatment for hepatic tumors adjacent to other organs, as it allows for more accurate detection of lesions and for tumors to be treated safely while avoiding adjacent organs. It is less invasive than conventional procedures, because the MR real-time guidance enabled continuous monitoring throughout the procedure.

  10. MR-Guided Pulsed High-Intensity Focused Ultrasound Enhancement of Gene Therapy Combined With Androgen Deprivation and Radiotherapy for Prostate Cancer Treatment

    DTIC Science & Technology

    2009-09-01

    ultrasound . J. Acoust. Soc.Am. 72 1926-1932, (1982) (7) Neppiras E A. Acoustic cavitation . Physics reports 61(3): 159-251, (1980) (8) ter Haar G R, Daniels...Guided Pulsed High-Intensity Focused Ultrasound Enhancement of 5b. GRANT NUMBER W81XWH-08-1-0469 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT...failing to This work is aimed to study MR guided high intensity focused ultrasound (MRgHIFU) enhancement of gene therapy for Prostate Cancer. The

  11. MR-guidance – a clinical study to evaluate a shuttle- based MR-linac connection to provide MR-guided radiotherapy

    PubMed Central

    2014-01-01

    Background The purpose of this clinical study is to investigate the clinical feasibility and safety of a shuttle-based MR-linac connection to provide MR-guided radiotherapy. Methods/Design A total of 40 patients with an indication for a neoadjuvant, adjuvant or definitive radiation treatment will be recruited including tumors of the head and neck region, thorax, upper gastrointestinal tract and pelvic region. All study patients will receive standard therapy, i.e. highly conformal radiation techniques like CT-guided intensity-modulated radiotherapy (IMRT) with or without concomitant chemotherapy or other antitumor medication, and additionally daily short MR scans in treatment position with the same immobilisation equipment used for irradiation for position verification and imaging of the anatomical and functional changes during the course of radiotherapy. For daily position control, skin marks and a stereotactic frame will be used for both imaging modalities. Patient transfer between the MR device and the linear accelerator will be performed with a shuttle system which uses an air-bearing patient platform for both procedures. The daily acquired MR and CT data sets will be digitally registrated, correlated with the planning CT and compared with each other regarding translational and rotational errors. Aim of this clinical study is to establish a shuttle-based approach for realising MR-guided radiotherapy for certain clinical situations. Second objectives are to compare MR-guided radiotherapy with the gold standard of CT image guidance for quality assurance of radiotherapy, to establish an appropiate MR protocol therefore, and to assess the possibility of using MR-based image guidance not only for position verification but also for adaptive strategies in radiotherapy. Discussion Compared to CT, MRI might offer the advantage of providing IGRT without delivering an additional radiation dose to the patients and the possibility of optimisation of adaptive therapy

  12. Total laparoscopic reversal of Hartmann's procedure.

    PubMed

    Masoni, Luigi; Mari, Francesco Saverio; Nigri, Giuseppe; Favi, Francesco; Pindozzi, Fioralba; Dall'Oglio, Anna; Pancaldi, Alessandra; Brescia, Antonio

    2013-01-01

    Hartmann's procedure is still performed in those cases in which colorectal anastomosis might be unsafe. Reversal of Hartmann's procedure (HR) is considered a major surgical procedure with a high morbidity (55 to 60%) and mortality rate (0 to 4%). To decrease these rates, laparoscopic Hartmann's reversal procedure was successfully experienced. We report our totally laparoscopic Hartmann's reversal technique. Between 2004 and 2010 we performed 27 HRs with a totally laparoscopic approach. The efficacy and safety of this technique were demonstrated evaluating the operative data, postoperative complications, and the outcome of the patients. There were no open conversions or major intraoperative complications. Anastomotic leaking occurred in one patient requiring an ileostomy; one patient needed a blood transfusion and one had a nosocomial pneumonia. The mean postoperative hospitalization was 5.7 days. Laparoscopic HR is a feasible and safe procedure and can be considered a valid alternative to open HR.

  13. Laparoscopic approach to common duct pathology.

    PubMed

    Petelin, J B

    1993-04-01

    The author reviews his experience with the laparoscopic management of common duct pathology and compares it with the experience of others as reported in the literature. Routine intraoperative cholangiography is advocated. A variety of methods of managing common duct stones laparoscopically is presented. These include balloon-catheter manipulation, fluoroscopically guided basket extraction, and choledochoscopic evaluation and removal of stones. The accumulated experience indicates that more than 90% of common duct stones can be removed laparoscopically via the cystic duct. This approach significantly reduces the need for either preoperative or postoperative endoscopic retrograde cholangiopancreatography. Although laparoscopic choledochotomy has been employed in a number of cases and can be performed with a high degree of safety and efficacy, it is needed only infrequently. This form of management results in decreased dependence upon T-tubes, thereby reducing postoperative morbidity and the length of hospitalization. A rational protocol for the management of common duct pathology is presented.

  14. Laparoscopic management of post-cholecystectomy sectoral artery pseudoaneurysm

    PubMed Central

    Panda, Nilanjan; Narasimhan, Mohan; Gunaraj, Alwin; Ardhanari, Ramesh

    2014-01-01

    Vascular injuries during laparoscopic cholecystectomy can occur similar to biliary injuries and mostly represented by intraoperative bleeding. Hepatic artery system pseudoaneurysm are rare. It occurs in the early or late postoperative course. Patients present with pallor, signs of haemobillia and altered liver function. We report a case of right posterior sectoral artery pseudoaneurysm detected 2 weeks after laparoscopic cholecystectomy and successfully repaired laparoscopically. We also describe how laparoscopic pringle clamping saved the conversion. The actively bleeding right posterior sectoral artery pseudoaneurysm was diagnosed by CT angiogram. Embolisation, usually the treatment of choice, would have risked liver insufficiency as hepatic artery proper was at risk because the origin the bleeding artery was just after its bifurcation. Isolated right hepatic artery embolisation can also cause hepatic insufficiency. To our knowledge this is the first reported case of laparoscopic repair of post-laparoscopic cholecystectomy bleeding sectoral artery pseudoaneurysm. PMID:24501508

  15. Intraoperative carbon dioxide management and outcomes.

    PubMed

    Wax, David B; Lin, Hung-Mo; Hossain, Sabera; Porter, Steven B

    2010-09-01

    Intraoperative hyperventilation to induce hypocapnia has historically been common practice and has physiological effects that may be detrimental. In contrast, hypercapnia has effects that may be beneficial. As these effects may influence postoperative recovery, we investigated the association between variations in intraoperative carbon dioxide and length of hospital stay in patients who had elective colon resections and hysterectomies. Data were extracted from electronic records for elective colon resections and hysterectomies done from 2002 to 2008. Patients were divided into four groups based on surgical procedure and use of laparoscopic technique. Parameters extracted for analysis included mean end-tidal carbon dioxide (EtCO2) during the surgical procedure as well as others previously purported to affect postoperative outcomes. In-hospital length of stay (LOS) was determined from administrative records and was used as the independent outcome variable. For each group, Poisson regression analysis was performed to find factors that were independently associated with the outcome. A total of 3421 case records in our database met inclusion criteria. Median EtCO2 was 31 mmHg. Median LOS was 7 and 5 days for open and laparoscopic colon resections, and 3 and 2 days for open and laparoscopic hysterectomies, respectively. Regression analysis revealed a statistically significant independent association between higher EtCO2 and reduced LOS for colon resection and open hysterectomy. There is a significant association between higher intraoperative EtCO2 and shorter LOS after colon resection and open hysterectomy. The common practice of inducing hypocapnia may be deleterious, and maintaining normocapnia or permitting hypercapnia may improve clinical outcomes.

  16. Influence of 1.5-Tesla intraoperative MR imaging on surgical decision making.

    PubMed

    Hall, W A; Liu, H; Maxwell, R E; Truwit, C L

    2003-01-01

    To determine the frequency that high-field magnetic resonance (MR) imaging sequences influenced surgical decision making during intraoperative MR-guided surgery. From January 1997 to February 2001, 346 MR-guided procedures were performed using a 1.5-Tesla MR system (NT-ACS, Philips Medical Systems). This system can perform functional MR imaging (fMRI), diffusion weighted imaging (DWI), MR spectroscopy (MRS), MR angiography (MRA), and MR venography (MRV) in addition to T1-weighted, T2-weighted, and turbo FLAIR (fluid-attenuated inversion recovery) imaging. FMRI was used to determine areas of brain activation for language, motor function, and memory. DWI was utilized after tumor resection to exclude cerebral ischemia or infarction. MRS was obtained to identify areas of elevated choline that were suspected to correlate with tumor presence. MRA and MRV localized vascular structures adjacent to tumors prior to resection. The intraoperative procedures performed included 140 brain biopsies of which 82 utilized a trajectory guide and prospective stereotaxy. MRS was used in 42 biopsies (30%), of which 29 had turbo spectroscopic imaging (TSI) and 21 had single voxel spectroscopy (SVS). In all biopsy cases, diagnostic tissue was obtained. There were 103 tumor resections of which 18 (17%) had MRS. Functional MRI was used in 17 cases; 3 biopsies (2%) and 14 planned resections (14%). Speech function was localized in 3 cases, memory function in 3, and motor function in 11. In one case where the motor function of the tongue was intimately involved with a low-grade glioma, resection was not attempted. DWI was used in less than 10% of tumor resections. MRA and MRV were performed in 3 (3%) and 2 (2%) of tumor resections, respectively. The imaging capabilities (i.e., fMRI, DWI, MRA, MRV) associated with high-field intraoperative MR influenced surgical decision making primarily for tumor resections. MRS influenced target selection during brain biopsy.

  17. MR-guided Neurolytic Celiac Plexus Ablation: An Evaluation of Effect and Injection Spread Pattern in Cancer Patients with Celiac Tumor Infiltration

    SciTech Connect

    Akural, Etem; Ojala, Risto O.; Jaervimaeki, Voitto; Kariniemi, Juho; Tervonen, Osmo A.; Blanco Sequeiros, Roberto

    2013-04-15

    ObjectiveThe purpose of this study was to evaluate the feasibility, the initial accuracy, and the effects of the MR-guided neurolytic celiac plexus ablation as a method to treat cancer-induced chronic abdominal pain. Thirteen celiac plexus ablations were performed for 12 patients. A 0.23-T open MRI scanner with optical navigation was used for procedural guidance. As an adjunct to the MR-guided needle positioning, the needle location was confirmed with saline injection and consequent MR imaging (STIR sequence). The spread of the ablative injection material (alcohol-lidocaine mix) was observed by repeating this sequence after the therapeutic injection. Pain scores from seven patients (eight ablations) were used to assess the therapy effect. MR guidance allowed adequate needle positioning and visualization of injection material in all cases. The rest pain scores significantly decreased from 4 (median) at baseline to 1 (median) at 2 weeks (p < 0.05). Average and worst pain experienced during the past week were significantly lower at the 2-week time point compared with the baseline (p < 0.05). However, the intervention did not result in reduction of opioid use at 2 weeks.MR guidance is an accurate and safe method for celiac plexus ablation with positive therapeutic effect.

  18. Model-based feasibility assessment and evaluation of prostate hyperthermia with a commercial MR-guided endorectal HIFU ablation array

    PubMed Central

    Salgaonkar, Vasant A.; Prakash, Punit; Rieke, Viola; Ozhinsky, Eugene; Plata, Juan; Kurhanewicz, John; Hsu, I-C. (Joe); Diederich, Chris J.

    2014-01-01

    Purpose: Feasibility of targeted and volumetric hyperthermia (40–45 °C) delivery to the prostate with a commercial MR-guided endorectal ultrasound phased array system, designed specifically for thermal ablation and approved for ablation trials (ExAblate 2100, Insightec Ltd.), was assessed through computer simulations and tissue-equivalent phantom experiments with the intention of fast clinical translation for targeted hyperthermia in conjunction with radiotherapy and chemotherapy. Methods: The simulations included a 3D finite element method based biothermal model, and acoustic field calculations for the ExAblate ERUS phased array (2.3 MHz, 2.3 × 4.0 cm2, ∼1000 channels) using the rectangular radiator method. Array beamforming strategies were investigated to deliver protracted, continuous-wave hyperthermia to focal prostate cancer targets identified from representative patient cases. Constraints on power densities, sonication durations and switching speeds imposed by ExAblate hardware and software were incorporated in the models. Preliminary experiments included beamformed sonications in tissue mimicking phantoms under MR temperature monitoring at 3 T (GE Discovery MR750W). Results: Acoustic intensities considered during simulation were limited to ensure mild hyperthermia (Tmax < 45 °C) and fail-safe operation of the ExAblate array (spatial and time averaged acoustic intensity ISATA < 3.4 W/cm2). Tissue volumes with therapeutic temperature levels (T > 41 °C) were estimated. Numerical simulations indicated that T > 41 °C was calculated in 13–23 cm3 volumes for sonications with planar or diverging beam patterns at 0.9–1.2 W/cm2, in 4.5–5.8 cm3 volumes for simultaneous multipoint focus beam patterns at ∼0.7 W/cm2, and in ∼6.0 cm3 for curvilinear (cylindrical) beam patterns at 0.75 W/cm2. Focused heating patterns may be practical for treating focal disease in a single posterior quadrant of the prostate and diffused heating patterns may be

  19. Model-based feasibility assessment and evaluation of prostate hyperthermia with a commercial MR-guided endorectal HIFU ablation array

    NASA Astrophysics Data System (ADS)

    Salgaonkar, Vasant A.; Prakash, Punit; Rieke, Viola; Ozhinsky, Eugene; Plata, Juan; Kurhanewicz, John; Hsu, I.-C. Joe; Diederich, Chris J.

    2017-03-01

    Here, operational modifications to a commercial MR-guided ultrasound phased array designed for prostate ablation (part of ExAblate 2100, InSightec Ltd) are presented for the delivery of protracted mild (40 - 45°C) hyperthermia to large contiguous target volumes in the prostate. This high-intensity focused ultrasound phased array is already in clinical trials for prostate ablation, and can be potentially fast-tracked for clinical hyperthermia treatments. As a part of this preliminary feasibility study, patient-specific numerical simulations were performed using Pennes bioheat model and acoustic field calculations were conducted using the rectangular radiator method for the ExAblate prostate array (2.3 MHz, 2.3×4.0 cm2, ˜1000 channels). Thermal solutions were computed using 3D finite element methods (FEM) implemented using Comsol Multiphysics (Comsol Inc). The patient-specific geometries were created through manual segmentation of anatomical structures from representative patient MRIs and 3D rendering (Mimics 15.01, Materialise) and generation of finite element meshes (3-Matic 7.01, Materialise). Array beamforming was employed and acoustic fields were synthesized (Matlab 2010a, MathWorks) to deliver protracted continuous wave hyperthermia to focal prostate cancer targets identified in the patient-specific models. Constraints on power densities, sonication durations and switching speeds imposed by ExAblate hardware and software were incorporated in the models. Sonication strategies explored during modeling were implemented on the ExAblate prostate array and preliminary experiments were conducted in tissue mimicking phantoms under MR temperature monitoring at 3 T (GE Discovery MR750W). Therapeutic temperatures (40 - 45 °C) could be established conformably in focal cancer volumes in a single prostate quadrant using focused heating patterns and hemi-gland heating was possible using diffused heating patterns (iso-phase or diverging). T>41 °C was calculated in 13

  20. Model-based feasibility assessment and evaluation of prostate hyperthermia with a commercial MR-guided endorectal HIFU ablation array

    SciTech Connect

    Salgaonkar, Vasant A. Hsu, I-C.; Diederich, Chris J.; Prakash, Punit; Rieke, Viola; Ozhinsky, Eugene; Kurhanewicz, John; Plata, Juan

    2014-03-15

    Purpose: Feasibility of targeted and volumetric hyperthermia (40–45 °C) delivery to the prostate with a commercial MR-guided endorectal ultrasound phased array system, designed specifically for thermal ablation and approved for ablation trials (ExAblate 2100, Insightec Ltd.), was assessed through computer simulations and tissue-equivalent phantom experiments with the intention of fast clinical translation for targeted hyperthermia in conjunction with radiotherapy and chemotherapy. Methods: The simulations included a 3D finite element method based biothermal model, and acoustic field calculations for the ExAblate ERUS phased array (2.3 MHz, 2.3 × 4.0 cm{sup 2}, ∼1000 channels) using the rectangular radiator method. Array beamforming strategies were investigated to deliver protracted, continuous-wave hyperthermia to focal prostate cancer targets identified from representative patient cases. Constraints on power densities, sonication durations and switching speeds imposed by ExAblate hardware and software were incorporated in the models. Preliminary experiments included beamformed sonications in tissue mimicking phantoms under MR temperature monitoring at 3 T (GE Discovery MR750W). Results: Acoustic intensities considered during simulation were limited to ensure mild hyperthermia (T{sub max} < 45 °C) and fail-safe operation of the ExAblate array (spatial and time averaged acoustic intensity I{sub SATA} < 3.4 W/cm{sup 2}). Tissue volumes with therapeutic temperature levels (T > 41 °C) were estimated. Numerical simulations indicated that T > 41 °C was calculated in 13–23 cm{sup 3} volumes for sonications with planar or diverging beam patterns at 0.9–1.2 W/cm{sup 2}, in 4.5–5.8 cm{sup 3} volumes for simultaneous multipoint focus beam patterns at ∼0.7 W/cm{sup 2}, and in ∼6.0 cm{sup 3} for curvilinear (cylindrical) beam patterns at 0.75 W/cm{sup 2}. Focused heating patterns may be practical for treating focal disease in a single posterior

  1. Virtual Intraoperative Cholangiogram Using WebCL

    PubMed Central

    YU, Alexander; DEMIREL, Doga; HALIC, Tansel; KOCKARA, Sinan

    2016-01-01

    In this paper, we propose a Virtual Intraoperative Cholangiogram (VIC) training platform. Intraoperative Cholangiogram (IC) is an imaging technique of biliary anatomy with using fluorescent fluids sensitive to the X-Rays. The procedure is often employed to diagnose the difficult cases such as abnormal anatomy or choledocholithiasis during the laparoscopic cholecystectomy. The major challenge in cholangiogram is accurate interpretation of the X-Ray image, which requires extensive case training. However, the training platforms that support generation of various IC cases have been lacking. In this study, we developed a web based platform to generate IC images from any virtual bile duct anatomy. As the generation of X-Ray image from 3D scene is a computationally intensive task, we utilized WebCL technology to parallelize the computation for achieving real-time rates. In this work, we present details of our WebCL IC generation algorithm and benchmark results. PMID:27046623

  2. Virtual Intraoperative Cholangiogram Using WebCL.

    PubMed

    Yu, Alexander; Demirel, Doga; Halic, Tansel; Kockara, Sinan

    2016-01-01

    In this paper, we propose a Virtual Intraoperative Cholangiogram (VIC) training platform. Intraoperative Cholangiogram (IC) is an imaging technique of biliary anatomy with using fluorescent fluids sensitive to the X-Rays. The procedure is often employed to diagnose the difficult cases such as abnormal anatomy or choledocholithiasis during the laparoscopic cholecystectomy. The major challenge in cholangiogram is accurate interpretation of the X-Ray image, which requires extensive case training. However, the training platforms that support generation of various IC cases have been lacking. In this study, we developed a web based platform to generate IC images from any virtual bile duct anatomy. As the generation of X-Ray image from 3D scene is a computationally intensive task, we utilized WebCL technology to parallelize the computation for achieving real-time rates. In this work, we present details of our WebCL IC generation algorithm and benchmark results.

  3. Laparoscopic Adrenalectomy.

    PubMed

    Petelin

    1996-06-01

    Adrenal pathology requiring surgical intervention is relatively uncommon. Nevertheless, there are a number of conditions that warrant such consideration. Most surgically correctable diseases of the adrenal glands are associated with excess production of adrenal corticosteroids or catecholamines by an adrenal tumor. Classic open approaches toward adrenalectomy in the past have included an anterior, transabdominal, or posterior route. Laparoscopic adrenalectomy offers the advantages of excellent exposure through minimally damaging portals. This results in an expected very benign postoperative course. It has now been almost 4 years since the first reported laparoscopic adrenalectomy. Since then, numerous small series have been reported and experienced laparoscopic surgeons have proven the merits of a laparoscopic approach to adrenalectomy. This reviews the current state of the art and offers descriptions of selected approaches to both the right and left adrenal glands.

  4. Laparoscopic Surgery

    MedlinePlus

    ... surgeon’s perspective, laparoscopic surgery may allow for easier dissection of abdominal scar tissue (adhesions), less surgical trauma, ... on Facebook About ACG ACG Store ACG Patient Education & Resource Center Home GI Health and Disease Recursos ...

  5. Laparoscopic ureteroneocystostomy for ureteral injuries after hysterectomy.

    PubMed

    Pompeo, Alexandre; Molina, Wilson R; Sehrt, David; Tobias-Machado, Marcos; Mariano Costa, Renato M; Pompeo, Antonio Carlos Lima; Kim, Fernando J

    2013-01-01

    To examine the feasibility of early laparoscopic ureteroneocystostomy for ureteral obstruction due to hysterectomy injury. We retrospectively reviewed a 10-y experience from 2 institutions in patients who underwent early (<30 d) or late (>30 d) laparoscopic ureteroneocystostomy for ureteral injury after hysterectomy. Evaluation of the surgery included the cause of the stricture and intraoperative and postoperative outcomes. A total of 9 patients with distal ureteral injury after hysterectomy were identified. All injuries were identified and treated as early as 21 d after hysterectomy. Seven of 9 patients underwent open hysterectomy, and the remaining patients had vaginal and laparoscopic radical hysterectomy. All ureteroneocystostomy cases were managed laparoscopically without conversion to open surgery and without any intraoperative complications. The Lich-Gregoir reimplantation technique was applied in all patients, and 2 patients required a psoas hitch. The mean operative time was 206.6 min (range, 120-280 min), the mean estimated blood loss was 122.2 cc (range, 25-350 cc), and the mean admission time was 3.3 d (range, 1-7 d). Cystography showed no urine leak when the ureteral stent was removed at 4 to 6 wk after the procedure. Ureteroneocystostomy patency was followed up with cystography at 6 mo and at least 10 y after ureteroneocystostomy. Early laparoscopic ureteral reimplantation may offer an alternative surgical approach to open surgery for the management of distal ureteral injuries, with favorable cosmetic results and recovery time from ureteral obstruction due to hysterectomy injury.

  6. Laparoscopic reversal of Hartmann's procedure.

    PubMed

    Fiscon, Valentino; Portale, Giuseppe; Mazzeo, Antonio; Migliorini, Giovanni; Frigo, Flavio

    2014-12-01

    Reestablishing continuity after a Hartmann's procedure is considered a major surgical procedure with high morbidity/mortality. The aim of this study was to assess the short-/long-term outcome of laparoscopic restoration of bowel continuity after HP. A prospectively collected database of colorectal laparoscopic procedures (>800) performed between June 2005 and June 2013 was used to identify 20 consecutive patients who had undergone laparoscopic reversal of Hartmann's procedure (LHR). Median age was 65.4. Ten patients (50 %) had undergone surgery for perforated diverticulitis, 3 (15 %) for cancer, and 7 (35 %) for other reasons (volvulus, posttraumatic perforation, and sigmoid perforation from foreign body). Previous HP had been performed laparoscopically in only 3 patients. Median operative time was 162.5 min. All the procedures were completed laparoscopically. Intraoperative complication rate was nil. Post-operative mortality and morbidity were respectively 0 and 10 % (1 pneumonia, 1 bowel obstruction from post-anastomotic stenosis which required resection and redo of the anastomosis). Median time to first flatus was 3 days, to normal diet 5 days. Median hospital stay was 9 days without readmissions. We followed up the patients for a median of 44 months: when asked, all 20 (100 %) said they would undergo the operation (LHR) again; 3 (15 %) had been re-operated of laparoscopic mesh repair for incisional hernia. When performed by experienced surgeons, LHR is a feasible, safe, reproducible operation, which allows early return of bowel function, early discharge and fast return to work for the patient. It has a low morbidity rate.

  7. Combined procedures in laparoscopic surgery.

    PubMed

    Wadhwa, Atul; Chowbey, Pradeep K; Sharma, Anil; Khullar, Rajesh; Soni, Vandana; Baijal, Manish

    2003-12-01

    With advancements in minimal access surgery, combined laparoscopic procedures are now being performed for treating coexisting abdominal pathologies at the same surgery. In our center, we performed 145 combined surgical procedures from January 1999 to December 2002. Of the 145 procedures, 130 were combined laparoscopic/endoscopic procedures and 15 were open procedures combined with endoscopic procedures. The combination included laparoscopic cholecystectomy, various hernia repairs, and gynecological procedures like hysterectomy, salpingectomy, ovarian cystectomy, tubal ligation, urological procedures, fundoplication, splenectomy, hemicolectomy, and cystogastrostomy. In the same period, 40 patients who had undergone laparoscopic cholecystectomy and 40 patients who had undergone ventral hernia repair were randomly selected for comparison of intraoperative outcomes with a combined procedure group. All the combined surgical procedures were performed successfully. The most common procedure was laparoscopic cholecystectomy with another endoscopic procedure in 129 patients. The mean operative time was 100 minutes (range 30-280 minutes). The longest time was taken for the patient who had undergone laparoscopic splenectomy with renal transplant (280 minutes). The mean hospital stay was 3.2 days (range 1-21 days). The pain experienced in the postoperative period measured on the visual analogue scale ranged from 2 to 5 with a mean of 3.1. Of 145 patients who underwent combined surgical procedures, 5 patients developed fever in the immediate postoperative period, 7 patients had port site hematoma, 5 patients developed wound sepsis, and 10 patients had urinary retention. As long as the basic surgical principles and indications for combined procedures are adhered to, more patients with concomitant pathologies can enjoy the benefit of minimal access surgery. Minimal access surgery is feasible and appears to have several advantages in simultaneous management of two different

  8. [Intraoperative colonoscopy: current indications].

    PubMed

    Stroppa, I; D'Antini, P; Rossi, L; Farinon, A M

    1993-01-01

    From January 1987 to December 1991, 37 patients underwent intraoperative colonoscopy for several indications; these latter can be summarized in the need to define the site or extension of the lesions treated or detected by endoscopy before surgery. This procedure is therefore necessary in those cases in whom intraoperative endoscopy is likely to be useful in planning the surgical treatment. The use of intraoperative colonoscopy should be however considered complementary, but not substitutive, of the preoperative colonoscopy.

  9. Volumetric MR-guided high-intensity focused ultrasound ablation with a one-layer strategy to treat large uterine fibroids: initial clinical outcomes.

    PubMed

    Kim, Young-Sun; Kim, Jae-Hun; Rhim, Hyunchul; Lim, Hyo Keun; Keserci, Bilgin; Bae, Duk-Soo; Kim, Byoung-Gie; Lee, Jeong-Won; Kim, Tae-Joong; Choi, Chel Hun

    2012-05-01

    To evaluate initial clinical outcomes of volumetric magnetic resonance (MR)-guided high-intensity focused ultrasound (HIFU) ablation by using a one-layer strategy to treat large (>10 cm in diameter) uterine fibroids, with investigation of the correlation between effectiveness of the one-layer strategy and dynamic contrast material-enhanced (DCE) MR parameters. Institutional review board approval and informed consent were obtained. Twenty-seven women (mean age, 44.5 years) with 27 large uterine fibroids (mean diameter, 11.3 cm ± 1.4 [standard deviation] [range, 10.1-16.0 cm]; fibroid volume, 502.5 mL ± 214.3 [range, 253.8-1184.0 mL]) underwent volumetric MR-guided HIFU ablation with a one-layer strategy. (All treatment cells were placed in one coronal plane at a depth of half to anterior two-thirds of the anteroposterior dimension of fibroids.) Treatment time, immediate nonperfused volume (NPV), and effectiveness of a one-layer strategy (ratio of immediate NPV to total volume of treatment cells planned) correlating with baseline DCE MR parameters (volume transfer constant [K(trans)], fractional extravascular extracellular space, and fractional blood plasma volume [Pearson correlation test]), complications, 3-month follow-up volumes, and symptom severity score (SSS) changes (paired t test) were assessed retrospectively. All treatments showed technical success in one session (mean treatment time, 166.2 minutes ± 38.9). NPV was 301.3 mL ± 119.1, which was 64.2% ± 19.9 (<50%, n = 4; ≥ 50%, n = 23) of fibroid volume. Ratio of immediate NPV to total volume of treatment cells (1.79 ± 0.61) negatively correlated with DCE MR imaging K(trans) values (r = -0.426, P = .017). Minor complications occurred in five patients (18.5% [thermal injury of abdominal wall, n = 3; 30-day leg numbness, n = 1; cystitis, n = 1]). At 3-month follow-up (n = 18), mean SSS had decreased from 37.4 at baseline to 24.0 (P < .001), and volume reduction ratio was 0.64 ± 0.15 (P < .001

  10. Intraoperative peripheral nerve injury in colorectal surgery. An update.

    PubMed

    Colsa Gutiérrez, Pablo; Viadero Cervera, Raquel; Morales-García, Dieter; Ingelmo Setién, Alfredo

    2016-03-01

    Intraoperative peripheral nerve injury during colorectal surgery procedures is a potentially serious complication that is often underestimated. The Trendelenburg position, use of inappropriately padded armboards and excessive shoulder abduction may encourage the development of brachial plexopathy during laparoscopic procedures. In open colorectal surgery, nerve injuries are less common. It usually involves the femoral plexus associated with lithotomy position and self-retaining retractor systems. Although in most cases the recovery is mostly complete, treatment consists of physical therapy to prevent muscular atrophy, protection of hypoesthesic skin areas and analgesics for neuropathic pain. The aim of the present study is to review the incidence, prevention and management of intraoperative peripheral nerve injury.

  11. Development of an open source software module for enhanced visualization during MR-guided interstitial gynecologic brachytherapy.

    PubMed

    Chen, Xiaojun; Egger, Jan

    2014-01-01

    In 2010, gynecologic malignancies were the 4th leading cause of death in U.S. women and for patients with extensive primary or recurrent disease, treatment with interstitial brachytherapy may be an option. However, brachytherapy requires precise insertion of hollow catheters with introducers into the tumor in order to eradicate the cancer. In this study, a software solution to assist interstitial gynecologic brachytherapy has been investigated and the software has been realized as an own module under (3D) Slicer, which is a free open source software platform for (translational) biomedical research. The developed research module allows on-time processing of intra-operative magnetic resonance imaging (iMRI) data over a direct DICOM connection to a MR scanner. Afterwards follows a multi-stage registration of CAD models of the medical brachytherapy devices (template, obturator) to the patient's MR images, enabling the virtual placement of interstitial needles to assist the physician during the intervention.

  12. Laparoscopic cholecystectomy in the cardiac patient: a case study.

    PubMed

    Schmelzer, C; Stone, N L

    1995-02-01

    Laparoscopic cholecystectomy has become the standard procedure for the surgical management of cholelithiasis. Compared with open cholecystectomy, this procedure offers shorter hospital stays, shorter recovery time, better cosmetic results, and an overall reduction in health care cost for the patient. As the number of cardiac patients having elective laparoscopic cholecystectomy increases, it is important for the postanesthesia nurse to understand the postoperative assessment and nursing interventions these patients require. Congestive heart failure and acute pulmonary edema are two potential complications resulting from insufflation of the abdomen and intraoperative fluids. This case study of a cardiac patient undergoing laparoscopic cholecystectomy demonstrates important postanesthesia assessment parameters.

  13. Laparoscopic right hemicolectomy in left lateral decubitus position.

    PubMed

    Jager, R M

    1994-10-01

    The laparoscopic surgeon does not have the luxury of manually retracting small-bowel loops during right colonic mobilization and transection. Intraoperative rotation of the table aids gravity-produced displacement of small-bowel loops but is limited because extreme rotation endangers the patient's positional stability. By placing the patient in left lateral decubitus position before sterile draping, gravity-aided displacement of small-bowel loops can be maximized, facilitating safe and swift laparoscopic right colonic dissection and transection. Unlike the supine position, the left lateral decubitus position also permits transoperative colonoscopy, which may be needed to aid laparoscopic identification of nonpalpable intraluminal colonic lesions. Experience with four patients is reported.

  14. In vivo evaluation of multi-echo hybrid PRF/T1 approach for temperature monitoring during breast MR-guided focused ultrasound surgery treatments.

    PubMed

    Todd, Nick; Diakite, Mahamadou; Payne, Allison; Parker, Dennis L

    2014-09-01

    To evaluate the precision of in vivo temperature measurements in adipose and glandular breast tissue using a multi-echo hybrid PRF/T1 pulse sequence. A high-bandwidth, multi-echo hybrid PRF/T1 sequence was developed for monitoring temperature changes simultaneously in fat- and water-based tissues. The multiple echoes were combined with the optimal weightings for magnitude and phase images, allowing for precise measurement of both T1 and the proton resonance frequency (PRF) shift. The sequence was tested during in vivo imaging of 10 healthy volunteers in a breast-specific MR-guided focused ultrasound system and also during focused ultrasound heating of excised breast adipose tissue. The in vivo results indicated that the sequence can measure PRF temperatures with 1.25 × 1.25 × 3.5 mm resolution, 1.9 s temporal resolution, and 1.0°C temperature precision, and can measure T1 values with 3.75 × 3.75 × 3.5 mm resolution, 3.8 s temporal resolution, and 2.5%-4.8% precision. The excised tissue heating experiments demonstrate the sequence's ability to monitor temperature changes simultaneously in water- and fat-based tissues. The addition of a high-bandwidth, multi-echo readout to the hybrid PRF/T1 sequence improves the precision of each measurement, providing a sequence that will be beneficial to several MR-guided thermal therapies. Copyright © 2013 Wiley Periodicals, Inc.

  15. MR-guided percutaneous biopsy of solitary pulmonary lesions using a 1.0-T open high-field MRI scanner with respiratory gating.

    PubMed

    Liu, Ming; Huang, Jie; Xu, Yujun; He, Xiangmeng; Li, Lei; Lü, Yubo; Liu, Qiang; Sequeiros, Roberto Blanco; Li, Chengli

    2017-04-01

    To prospectively evaluate the feasibility, safety and accuracy of MR-guided percutaneous biopsy of solitary pulmonary lesions using a 1.0-T open MR scanner with respiratory gating. Sixty-five patients with 65 solitary pulmonary lesions underwent MR-guided percutaneous coaxial cutting needle biopsy using a 1.0-T open MR scanner with respiratory gating. Lesions were divided into two groups according to maximum lesion diameters: ≤2.0 cm (n = 31) and >2.0 cm (n = 34). The final diagnosis was established in surgery and subsequent histology. Diagnostic accuracy, sensitivity and specificity were compared between the groups using Fisher's exact test. Accuracy, sensitivity and specificity of MRI-guided percutaneous pulmonary biopsy in diagnosing malignancy were 96.9 %, 96.4 % and 100 %, respectively. Accuracy, sensitivity and specificity were 96.8 %, 96.3 % and 100 % for lesions 2.0 cm or smaller and 97.1 %, 96.4 % and 100 %, respectively, for lesions larger than 2.0 cm. There was no significant difference between the two groups (P > 0.05). Biopsy-induced complications encountered were pneumothorax in 12.3 % (8/65) and haemoptysis in 4.6 % (3/65). There were no serious complications. MRI-guided percutaneous biopsy using a 1.0-T open MR scanner with respiratory gating is an accurate and safe diagnostic technique in evaluation of pulmonary lesions. • MRI-guided percutaneous lung biopsy using a 1.0-T open MR scanner is feasibility. • 96.9 % differentiation accuracy of malignant and benign lung lesions is possible. • No serious complications occurred in MRI-guided lung biopsy.

  16. [Decoupling of multi-channel RF coil and its application in the intraoperative MRI].

    PubMed

    Xin, Xuegang; Han, Jijun; Feng, Yanqiu; Chen, Wufan

    2011-04-01

    The coupling from different elements of the multi-channel coil leads to the splitting of the resonance frequency and deviation from the Lamor frequency. Decoupling between different elements is the key technology in the design of the radiofrequency (RF) coil. The electrical decoupling circuits should vary with different arrangements of the elements. A novel method of decoupling for the RF coil used in the intraoperative MR-guided focused ultrasound system is reported in the paper. The prototype RF coil was made according to the proposed decoupling method. The bench test of the prototype showed that the performance of the decoupling of the coil was excellent. The images in vivo were acquired with the designed prototype RF coil.

  17. Laparoscopic CBD Exploration.

    PubMed

    Savita, K S; Bhartia, Vishnu K

    2010-10-01

    Laparoscopic CBD exploration (LCBDE) is a cost effective, efficient and minimally invasive method of treating choledocholithiasis. Laparoscopic Surgery for common bile duct stones (CBDS) was first described in 1991, Petelin (Surg Endosc 17:1705-1715, 2003). The surgical technique has evolved since then and several studies have concluded that Laparoscopic common bile duct exploration(LCBDE) procedures are superior to sequential endolaparoscopic treatment in terms of both clinical and economical outcomes, Cuschieri et al. (Surg Endosc 13:952-957, 1999), Rhodes et al. (Lancet 351:159-161, 1998). We started doing LCBDE in 1998.Our experience with LCBDE from 1998 to 2004 has been published, Gupta and Bhartia (Indian J Surg 67:94-99, 2005). Here we present our series from January 2005 to March 2009. In a retrospective study from January 2005 to March 2009, we performed 3060 laparoscopic cholecystectomies, out of which 342 patients underwent intraoperative cholangiogram and 158 patients eventually had CBD exploration. 6 patients were converted to open due to presence of multiple stones and 2 patients were converted because of difficulty in defining Calots triangle; 42 patients underwent transcystic clearance, 106 patients had choledochotomy, 20 patients had primary closure of CBD whereas in 86 patients CBD was closed over T-tube; 2 patients had incomplete stone clearance and underwent postoperative ERCP. Choledochoduodenosotomy was done in 2 patients. Patients were followed regularly at six monthly intervals with a range of six months to three years of follow-up. There were no major complications like bile leak or pancreatitis. 8 patients had port-site minor infection which settled with conservative treatment. There were no cases of retained stones or intraabdominal infection. The mean length of hospital stay was 3 days (range 2-8 days). LCBDE remains an efficient, safe, cost-effective method of treating CBDS. Primary closure of choledochotomy in select patients is a

  18. Prospective randomized controlled trial comparing standard analgesia with combined intra-operative cystic plate and port-site local anesthesia for post-operative pain management in elective laparoscopic cholecystectomy.

    PubMed

    Protic, Mladjan; Veljkovic, Radovan; Bilchik, Anton J; Popovic, Ana; Kresoja, Milana; Nissan, Aviram; Avital, Itzhak; Stojadinovic, Alexander

    2017-02-01

    Various mechanisms, including somatic and visceral nociceptive stimulation, have been suggested as a cause for pain after laparoscopic cholecystectomy (LC). We therefore conducted a prospective randomized controlled trial (PRCT) to evaluate whether somatovisceral pain blockade reduces pain after LC. Analgesic efficacy of multimodal analgesia is superior to standard analgesia for patients undergoing elective LC for symptomatic cholelithiasis. Specifically, topical cystic plate and port-site injection with 0.25 % bupivacaine significantly reduces pain after LC. This study was designed as single-blinded PRCT. This study was conducted in an academic medical center. Between February and May 2010 we randomly assigned 63 patients with symptomatic cholelithiasis in a 1:1 ratio to non-opioid/opioid analgesic combinations (Control Group, n = 32) and non-opioid/opioid analgesic combinations plus topical 0.25 % bupivacaine onto the cystic plate and local 0.25 % bupivacaine port-site injection, post-LC (Study Group, n = 31). Primary endpoint was patient-reported pain 1, 4, 6, 12, 24 h and 1 week post-LC using the Visual Analog Scale (VAS 0-10). Study groups were comparable clinicopathologically. There were no adverse events. A statistically significant reduction in mean pain score was apparent in Study Group patients in comparison with Control Group (mean VAS 4.83 ± 2.33 vs. 6.80 ± 1.87; p < 0.001) at all early (1-6 h) post-operative time points following LC. This PRCT shows significantly improved pain control with somatovisceral pain blockade over non-opioid/opioid analgesic combinations following LC for symptomatic cholelithiasis. For centers not utilizing adjunctive local anesthetic for LC, this topical use of bupivacaine may improve patient comfort during recovery. This trial was registered on www.ClinicalTrials.gov NCT# 01972620.

  19. Transumbilical approach to intraoperative enteroscopy in a child with intussusception and Peutz-Jeghers syndrome.

    PubMed

    Chui, Chan Hon; Jacobsen, Anette Sundfor

    2006-10-01

    Intraoperative enteroscopy has been known to reduce reoperation rates in complicated Peutz- Jeghers polyposis. It is usually performed during a laparotomy. This case report illustrates the feasibility of performing intraoperative transenterotomy enteroscopy together with extracorporeal ileal resection using the transumbilical approach after successfully reducing an intussusception laparoscopically in a 10-year-old child with Peutz-Jeghers syndrome. This technique obviates the need for a laparotomy.

  20. A novel technique of needle-guided laparoscopic enucleation of insulinomas.

    PubMed

    Laliotis, Aggelos; Martin, Jack; Worthington, Tim R; Marshall, Michele; Isla, Alberto M

    2015-02-01

    Insulinomas are rare, usually benign and solitary neuroendocrine tumors that cause oversecretion of insulin. Surgical excision remains the only treatment modality with the potential for cure. Compared to open extensive pancreatic resections, laparoscopic enucleation of these tumors offers effective treatment, and significantly reduced risks of complications. However, accurate tumor localization is extremely important, especially in cases of lesions deep seated into the head of the pancreas. We present here a novel technique of intraoperative localization of lesions that are not visible on the surface of pancreas. Using laparoscopic intraoperative ultrasound, tumors were located in the parenchyma of the pancreatic head and then an 18-G needle was inserted into the pancreatic lesion intraoperatively under laparoscopic sonographic guidance. The pancreatic parenchyma was then divided until the dome of tumor was visible, minimizing tissue trauma, and enucleation was performed. This technique is a useful tool that substantially improves the chances of successful laparoscopic enucleation of deep-seated small pancreatic insulinomas.

  1. Warm-up on a simulator improves residents' performance in laparoscopic surgery: a randomized trial.

    PubMed

    Chen, Chi Chiung Grace; Green, Isabel C; Colbert-Getz, Jorie M; Steele, Kimberly; Chou, Betty; Lawson, Shari M; Andersen, Dana K; Satin, Andrew J

    2013-10-01

    Our aim was to assess the impact of immediate preoperative laparoscopic warm-up using a simulator on intraoperative laparoscopic performance by gynecologic residents. Eligible laparoscopic cases performed for benign, gynecologic indications were randomized to be performed with or without immediate preoperative warm-up. Residents randomized to warm-up performed a brief set of standardized exercises on a laparoscopic trainer immediately before surgery. Intraoperative performance was scored using previously validated global rating scales. Assessment was made immediately after surgery by attending faculty who were blinded to the warm-up randomization. We randomized 237 residents to 47 minor laparoscopic cases (adnexal/ tubal surgery) and 44 to major laparoscopic cases (hysterectomy). Overall, attendings rated upper-level resident performances (postgraduate year [PGY-3, 4]) significantly higher on global rating scales than lower-level resident performances (PGY-1, 2). Residents who performed warm-up exercises prior to surgery were rated significantly higher on all subscales within each global rating scale, irrespective of the difficulty of the surgery. Most residents felt that performing warm-up exercises helped their intraoperative performances. Performing a brief warm-up exercise before a major or minor laparoscopic procedure significantly improved the intraoperative performance of residents irrespective of the difficulty of the case.

  2. Laparoscopic appendectomy

    NASA Astrophysics Data System (ADS)

    Richards, Kent F.; Christensen, Brent J.

    1991-07-01

    The accurate and timely diagnosis of acute appendicitis remains a difficult clinical dilemma. Misdiagnosis rates of up to 40% are not unusual. Laparoscopic appendectomy provides a definitive diagnosis and an excellent method for routine removal of the appendix with very low morbidity and patient discomfort.

  3. Laparoscopic partial nephrectomy: six degrees of haemostasis.

    PubMed

    Louie, Michael K; Deane, Leslie A; Kaplan, Adam G; Lee, Hak J; Box, Geoffrey N; Abraham, Jose Benito A; Borin, James F; Khan, Farhan; McDougall, Elspeth M; Clayman, Ralph V

    2011-05-01

    • To describe six steps for haemostasis and collecting system closure ('six degrees of haemostasis') that are reproducible and that minimize the two most concerning complications of laparoscopic partial nephrectomy: haemorrhage and urine leakage. • A retrospective study of 23 consecutive laparoscopic partial nephrectomy cases performed by a single surgeon between 2005 and 2008 using the 'six degrees of haemostasis' was carried out. • There were no cases of intraoperative, postoperative or delayed bleeding. • There were no cases of urine leakage. • The 'six degrees of haemostasis' technique for laparoscopic partial nephrectomy described in the present study provides a reliable and reproducible method to reassure the surgeon of haemostasis and provide a decreased risk of urine leakage. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  4. 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

  5. Real-time monitoring and analysis of MR-guided laser ablation in an open-configuration MR system

    NASA Astrophysics Data System (ADS)

    Kettenbach, Joachim; Hata, Nobuhiko; Kuroda, Kagayaki; Silverman, Stuart G.; Wong, Terence Z.; Zientara, Gary P.; Morrison, Paul R.; Kacher, Daniel F.; Gering, Dave; Kikinis, Ron; Jolesz, Ferenc A.

    1998-07-01

    Our goal was to investigate whether an open 0.5T MR-system with integrated frameless stereotactic guidance tools can provide sufficient intraoperative monitoring of interstitial laser therapy (ILT). Temperature-sensitive T1-weighted Fast- Spin-Echo (FSE)- or Spoiled Gradient-Echo sequences (SPGR) were applied and various image processing techniques (pixel- subtraction, phase mapping, optical flow computation) developed in order to control the thermal energy deposition during ILT in patients with brain- and liver tumors. While images from T1-weighted FSE- or SPGR sequences were acquired within 5 - 13 seconds, ILT lasted 2 to 26 minutes. Pixel subtraction or optical flow computation of T1-weighted images was performed within less than 110 msec. Alternating, phase- mapping of real- and imaginary components of SPGR sequences was performed within 220 msec. Pixel subtraction of T1- weighted images identified thermal changes in liver and brain tumors but could not evaluate the temperature values as chemical-shift based imaging, which was however, more affected by susceptibility effects and motion. Optical flow computation displayed the predicted course of thermal changes and revealed that the rate of heat deposition can be anisotropic, which may be related to heterogeneous tumor structure and/or vascularization.

  6. A robotics-based flat-panel ultrasound device for continuous intraoperative transcutaneous imaging.

    PubMed

    Gumprecht, Jan D J; Bauer, Thomas; Stolzenburg, Jens-Uwe; Lueth, Tim C

    2011-01-01

    Laparoscopic partial nephrectomy has become more and more popular in the last decade. Video laparoscopes remain the gold standard of intraoperative imaging during laparoscopic interventions. However, providing only superficial images of the target tissue. In contrast, ultrasound (US) imaging may offer crucial information of the interior of the target tissue that could improve surgical outcome. In this paper, we propose a new concept and prototype system to manipulate an US-probe during laparoscopic partial nephrectomies. Our primary goal was to provide the surgeon with US-images during the intervention in real-time. The prototype system consists of three components: a conventional US-machine, a manipulator to guide the US-probe, and a joystick console to control the manipulator. The results of our experiments show that the concept is feasible for US-imaging during laparoscopic partial nephrectomy.

  7. Anesthetic implications of laparoscopic surgery.

    PubMed Central

    Cunningham, A. J.

    1998-01-01

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

  8. Laparoscopic removal of a perforating intrauterine device mimicking chronic appendicitis.

    PubMed

    Brunner, Stefan M; Comman, Andreas; Gaetzschmann, Peter; Kipf, Bianca; Behrend, Matthias

    2008-08-01

    The intrauterine contraceptive device (IUD) is a common form of reversible birth control. One of the rare, but serious, complications is uterine perforation. In this paper, we report a case of a patient who underwent laparoscopy for presumed chronic appendicitis. Intraoperatively, uterine perforation by the IUD was found. The IUD was removed laparoscopically. The postoperative course was uneventful.

  9. Laparoscopic Biopsies in Pancreas Transplantation.

    PubMed

    Uva, P D; Odorico, J S; Giunippero, A; Cabrera, I C; Gallo, A; Leon, L R; Minue, E; Toniolo, F; Gonzalez, I; Chuluyan, E; Casadei, D H

    2017-08-01

    As there is no precise laboratory test or imaging study for detection of pancreas allograft rejection, there is increasing interest in obtaining pancreas tissue for diagnosis. Pancreas allograft biopsies are most commonly performed percutaneously, transcystoscopically, or endoscopically, yet pancreas transplant surgeons often lack the skills to perform these types of biopsies. We have performed 160 laparoscopic pancreas biopsies in 95 patients. There were 146 simultaneous kidney-pancreas biopsies and 14 pancreas-only biopsies due to pancreas alone, kidney loss, or extraperitoneal kidney. Biopsies were performed for graft dysfunction (89) or per protocol (71). In 13 cases, an additional laparoscopic procedure was performed at the same operation. The pancreas diagnostic tissue yield was 91.2%; however, the pancreas could not be visualized in eight cases (5%) and in 6 cases the tissue sample was nondiagnostic (3.8%). The kidney tissue yield was 98.6%. There were four patients with intraoperative complications requiring laparotomy (2.5%) with two additional postoperative complications. Half of all these complications were kidney related. There were no episodes of pancreatic enzyme leak and there were no graft losses related to the procedure. We conclude that laparoscopic kidney and pancreas allograft biopsies can be safely performed with very high tissue yields. © 2017 The American Society of Transplantation and the American Society of Transplant Surgeons.

  10. SU-F-E-02: A Feasibility Study for Application of Metal Artifact Reduction Techniques in MR-Guided Brachytherapy Gynecological Cancer with Titanium Applicators

    SciTech Connect

    Kadbi, M

    2016-06-15

    Purpose: Utilization of Titanium Tandem and Ring (T&R) applicators in MR-guided brachytherapy has become widespread for gynecological cancer treatment. However, Titanium causes magnetic field disturbance and susceptibility artifact, which complicate image interpretation. In this study, metal artifact reduction techniques were employed to improve the image quality and reduce the metal related artifacts. Methods: Several techniques were employed to reduce the metal artifact caused by titanium T&R applicator. These techniques include Metal Artifact Reduction Sequence (MARS), View Angle Tilting (VAT) to correct in-plane distortion, and Slice Encoding for Metal Artifact Correction (SEMAC) for through-plane artifact correction. Moreover, MARS can be combined with VAT to further reduce the in-plane artifact by reapplying the selection gradients during the readout (MARS+VAT). SEMAC uses a slice selective excitation but acquires additional z-encodings in order to resolve off-resonant signal and to reduce through-plane distortions. Results: Comparison between the clinical sequences revealed that increasing the bandwidth reduces the error in measured diameter of T&R. However, the error is larger than 4mm for the best case with highest bandwidth and spatial resolution. MARS+VAT with isotropic resolution of 1mm reduced the error to 1.9mm which is the least among the examined 2D sequences. The measured diameter of tandem from SEMAC+VAT has the closest value to the actual diameter of tandem (3.2mm) and the error was reduced to less than 1mm. In addition, SEMAC+VAT significantly reduces the blooming artifact in the ring compared to clinical sequences. Conclusion: A higher bandwidth and spatial resolution sequence reduces the artifact and diameter of applicator with a slight compromise in SNR. Metal artifact reduction sequences decrease the distortion associated with titanium applicator. SEMAC+VAT sequence in combination with VAT revealed promising results for titanium imaging and

  11. Differentiation of prostatitis and prostate cancer by using diffusion-weighted MR imaging and MR-guided biopsy at 3 T.

    PubMed

    Nagel, Klaas N A; Schouten, Martijn G; Hambrock, Thomas; Litjens, Geert J S; Hoeks, Caroline M A; ten Haken, Bennie; Barentsz, Jelle O; Fütterer, Jurgen J

    2013-04-01

    To determine if prostatitis and prostate cancer (PCa) can be distinguished by using apparent diffusion coefficients (ADCs) on magnetic resonance (MR) images, with specimens obtained at MR-guided biopsy as the standard of reference. The need for institutional review board approval and informed consent was waived. MR-guided biopsies were performed in 130 consecutive patients with cancer-suspicious regions (CSRs) on multiparametric MR images obtained at 3 T. In this retrospective study, 88 patients met the inclusion criteria. During the biopsy procedure, an axial diffusion-weighted sequence was performed and ADC maps were generated (repetition time msec/echo time msec, 2000/67; section thickness, 4 mm; in-plane resolution, 1.8 × 1.8 mm; and b values of 0, 100, 500, and 800 sec/mm(2)). Subsequently, a confirmation image with the needle left in situ was acquired and projected on the ADC map. The corresponding ADCs at the biopsy location were compared with the histopathologic outcomes of the biopsy specimens. Linear mixed-model regression analyses were used to test for ADC differences between the histopathologic groups. The study included 116 biopsy specimens. Median ADCs of normal prostate tissue, prostatitis, low-grade PCa (Gleason grade components 2 or 3), and high-grade PCa (Gleason grade components 4 or 5) were 1.22 × 10(-3) mm(2)/sec (standard deviation, ± 0.21), 1.08 × 10(-3) mm(2)/sec (± 0.18), 0.88 × 10(-3) mm(2)/sec (± 0.15), and 0.88 × 10(-3) mm(2)/sec (± 0.13), respectively. Although the median ADCs of biopsy specimens with prostatitis were significantly higher compared with low- and high-grade PCa (P < .001), there is a considerable overlap between the tissue types. Diffusion-weighted imaging is a noninvasive technique that shows differences between prostatitis and PCa in both the peripheral zone and central gland, although its usability in clinical practice is limited as a result of significant overlap in ADCs. RSNA, 2013

  12. Analysis of indication for laparoscopic right colectomy and conversion risks.

    PubMed

    Del Rio, Paolo; Bertocchi, Elisa; Madoni, Cristiana; Viani, Lorenzo; Dell'Abate, Paolo; Sianesi, Mario

    2016-01-01

    Laparoscopic surgery developed continuously over the past years becoming the gold standard for some surgical interventions. Laparoscopic colorectal surgery is well established as a safe and feasible procedure to treat benign and malignant pathologies. In this paper we studied in deep the role of laparoscopic right colectomy analysing the indications to this surgical procedure and the factors related to the conversion from laparoscopy to open surgery. We described the different surgical techniques of laparoscopic right colectomy comparing extra to intracorporeal anastomosis and we pointed out the different ways to access to the abdomen (multiport VS single incision). The indications for laparoscopic right colectomy are benign (inflammatory bowel disease and rare right colonic diverticulitis) and malignant diseases (right colon cancer and appendiceal neuroendocrine neoplasm): we described the good outcomes of laparoscopic right colectomy in all these illnesses. Laparoscopic conversion rates in right colectomy are reported as 12-16%; we described the different type of risk factors related to open conversion: patient-related, disease-related and surgeon-related factors, procedural factors and intraoperative complications. We conclude that laparoscopic right colectomy is considered superior to open surgery in the shortterm outcomes without difference in long-term outcomes.

  13. Hematocele After Laparoscopic Appendectomy

    PubMed Central

    Bhullar, Jasneet Singh; Subhas, Gokulakrishna; Mittal, Vijay K.

    2012-01-01

    Background: Laparoscopic appendectomy is one of the most common laparoscopic surgeries performed. We report an unusual complication of hematocele after laparoscopic appendectomy. Case Description: A 48-y-old male presented with swelling and discomfort in his right scrotum 11 d after he underwent laparoscopic appendectomy for acute appendicitis. Before the surgery, he had no scrotal swelling or inguinal hernia. PMID:23484582

  14. 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.

  15. A prospective randomized trial comparing open versus laparoscopic appendectomy.

    PubMed Central

    Frazee, R C; Roberts, J W; Symmonds, R E; Snyder, S K; Hendricks, J C; Smith, R W; Custer, M D; Harrison, J B

    1994-01-01

    OBJECTIVE: The authors determined whether there was an advantage to laparoscopic appendectomy when compared with open appendectomy. SUMMARY/BACKGROUND DATA: The advantages of laparoscopic appendectomy versus open appendectomy were questioned because the recovery from open appendectomy is brief. METHODS: From January 15, 1992 through January 15, 1993, 75 patients older than 9 years were entered into a study randomizing the choice of operation to either the open or the laparoscopic technique. Statistical comparisons were performed using the Wilcoxon test. RESULTS: Thirty-seven patients were assigned to the open appendectomy group and 38 patients were assigned to the laparoscopic appendectomy group. Two patients were converted intraoperatively from laparoscopic appendectomies to open procedures. Thirty-one patients (81%) in the open group had acute appendicitis, as did 32 patients (84%) in the laparoscopic group. Mean duration of surgery was 65 minutes for open appendectomy and 87 minutes for laparoscopic appendectomy (p < 0.001). There were no statistically significant differences in length of hospitalization, interval until resumption of a regular diet, or morbidity. Duration of both parenteral and oral analgesic use favored laparoscopic appendectomy (2.0 days versus 1.2 days, and 8.0 days versus 5.4 days, p < 0.05). All patients were instructed to return to full activities by 2 weeks postoperatively. This occurred at an average of 25 days for the open appendectomy group versus 14 days for the laparoscopic appendectomy group (p < 0.001). CONCLUSIONS: Patients who underwent laparoscopic appendectomies have a shorter duration of analgesic use and return to full activities sooner postoperatively when compared with patients who underwent open appendectomies. The authors consider laparoscopic appendectomy to be the procedure of choice in patients with acute appendicitis. PMID:8203983

  16. Physics-based shape matching for intraoperative image guidance

    SciTech Connect

    Suwelack, Stefan Röhl, Sebastian; Bodenstedt, Sebastian; Reichard, Daniel; Dillmann, Rüdiger; Speidel, Stefanie; Santos, Thiago dos; Maier-Hein, Lena; Wagner, Martin; Wünscher, Josephine; Kenngott, Hannes; Müller, Beat P.

    2014-11-01

    Purpose: Soft-tissue deformations can severely degrade the validity of preoperative planning data during computer assisted interventions. Intraoperative imaging such as stereo endoscopic, time-of-flight or, laser range scanner data can be used to compensate these movements. In this context, the intraoperative surface has to be matched to the preoperative model. The shape matching is especially challenging in the intraoperative setting due to noisy sensor data, only partially visible surfaces, ambiguous shape descriptors, and real-time requirements. Methods: A novel physics-based shape matching (PBSM) approach to register intraoperatively acquired surface meshes to preoperative planning data is proposed. The key idea of the method is to describe the nonrigid registration process as an electrostatic–elastic problem, where an elastic body (preoperative model) that is electrically charged slides into an oppositely charged rigid shape (intraoperative surface). It is shown that the corresponding energy functional can be efficiently solved using the finite element (FE) method. It is also demonstrated how PBSM can be combined with rigid registration schemes for robust nonrigid registration of arbitrarily aligned surfaces. Furthermore, it is shown how the approach can be combined with landmark based methods and outline its application to image guidance in laparoscopic interventions. Results: A profound analysis of the PBSM scheme based on in silico and phantom data is presented. Simulation studies on several liver models show that the approach is robust to the initial rigid registration and to parameter variations. The studies also reveal that the method achieves submillimeter registration accuracy (mean error between 0.32 and 0.46 mm). An unoptimized, single core implementation of the approach achieves near real-time performance (2 TPS, 7–19 s total registration time). It outperforms established methods in terms of speed and accuracy. Furthermore, it is shown that the

  17. MR-guided stereotactic breast biopsy using a mixed ferromagnetic-nonmagnetic coaxial system with 12- to 18-gauge needles: clinical experience and long-term outcome.

    PubMed

    Belloni, Elena; Panizza, Pietro; Ravelli, Silvia; De Cobelli, Francesco; Gusmini, Simone; Losio, Claudio; Sassi, Isabella; Perseghin, Gianluca; Del Maschio, Alessandro

    2013-10-01

    This study investigated the clinical application of a magnetic-resonance (MR)-guided breast biopsy (MRBB) system consisting of a nonmagnetic coaxial needle and a ferromagnetic core biopsy needle. MRBB was performed on 70 breast lesions. The biopsy device consisted of a nonmagnetic 14- to 16-gauge coaxial needle and a ferromagnetic 16- to 18-gauge biopsy needle. Of the 70 lesions, 29 were malignant and 41 nonmalignant. All 29 malignant lesions underwent surgery and were confirmed as malignant at final histology. Of the 41 nonmalignant lesions, 35 underwent follow-up breast MR imaging (mean, 26 ± 19 months), which demonstrated no lesions changes; six lesions underwent surgery because of poor radiological-pathological correlation; of these 6 lesions, 3 were nonmalignant, one was borderline (lobular carcinoma in situ) and two were malignant (well-differentiated tubular carcinoma and infiltrating ductal carcinoma). Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were, respectively, 93.5%, 100%, 100%, 95.1% and 97.1% if the lobular carcinoma in situ was considered a nonmalignant histological result, and 90.6%, 100%, 100%, 92.7% and 95.7% if the lobular carcinoma in situ was considered malignant. MRBB with a ferromagnetic-nonmagnetic coaxial system represented an easy way to perform a biopsy procedure and was easily applicable in the routine clinical setting.

  18. Localized delivery of doxorubicin in vivo from polymer-modified thermosensitive liposomes with MR-guided focused ultrasound-mediated heating

    PubMed Central

    Ta, Terence; Bartolak-Suki, Elizabeth; Park, Eun-Joo; Karrobi, Kavon M.; McDannold, Nathan J.; Porter, Tyrone M.

    2014-01-01

    Thermosensitive liposomes have emerged as a viable strategy for localized delivery and triggered release of chemotherapy. MR-guided focused ultrasound (MRgFUS) has the capability of heating tumors in a controlled manner, and when combined with thermosensitive liposomes can potentially reduce tumor burden in vivo. However, the impact of this drug delivery strategy has rarely been investigated. We have developed a unique liposome formulation modified with p(NIPAAm-co-PAA), a polymer that confers sensitivity to both temperature and pH. These polymer-modified thermosensitive liposomes (PTSL) demonstrated sensitivity to focused ultrasound, and required lower thermal doses and were more cytotoxic than traditional formulations in vitro. A set of acoustic parameters characterizing optimal release from PTSL in vitro was applied in the design of a combined MRgFUS/PTSL delivery platform. This platform more effectively reduced tumor burden in vivo when compared to free drug and traditional formulations. Histological analysis indicated greater tumor penetration, more extensive ECM remodeling, and greater cell destruction in tumors administered PTSL, correlating with improved response to the therapy. PMID:25151982

  19. Laparoscopic nephrectomy using Ligasure system: preliminary experience.

    PubMed

    Leonardo, Costantino; Guaglianone, Salvatore; De Carli, Piero; Pompeo, Vincenzo; Forastiere, Ester; Gallucci, Michele

    2005-10-01

    The advent of laparoscopic surgery has created new technical challenges and problems. Recently, a new commercially available vessel-sealing technology, the Ligasure system, was introduced. The aim of our study was to compare the effectiveness of this new system with earlier methods in a group of patients affected by renal-cell carcinoma. A series of 30 patients underwent laparoscopic radical nephrectomy for clinically localized renal-cell carcinoma. We always used a transperitoneal approach with a three-trocar technique. Patients were randomly divided in two groups: 15 underwent conventional laparoscopic radical nephrectomy, while 15 underwent laparoscopic nephrectomy using the Ligasure system, which is a bipolar radiofrequency generator. Information analyzed included intraoperative blood loss, operative time, conversion rate, and postoperative course. Statistical analysis was performed with commercially available software. The two groups were compared in term of clinical and pathologic variables using Student's t-test. Differences were considered significant at p < 0.05. No statistically significant differences were observed between the two groups for baseline characteristics. No conversion occurred in either group. Statistically significant differences were observed between conventional and Ligasure nephrectomy regarding mean intraoperative blood loss (485 mL and 100 mL, respectively; p < 0.05) and mean operative time (164 minutes and 68 minutes, respectively p < 0.05). No statistically difference was observed in the postoperative discharge time. The Ligasure vessel-sealing system seems to produce a consistent, reliable, permanent seal of veins, arteries, and tissue bundles by fusing the collagen in vessel walls. By reducing sutures and the number of instrument exchanges in the operating theatre, the Ligasure decreases operating time and blood loss. This new energy-based vessel-ligation device appears to be effective in advanced laparoscopic procedures.

  20. Intraoperative Stem Cell Therapy

    PubMed Central

    Coelho, Mónica Beato; Cabral, Joaquim M.S.; Karp, Jeffrey M.

    2013-01-01

    Stem cells hold significant promise for regeneration of tissue defects and disease-modifying therapies. Although numerous promising stem cell approaches are advancing in clinical trials, intraoperative stem cell therapies offer more immediate hope by integrating an autologous cell source with a well-established surgical intervention in a single procedure. Herein, the major developments in intraoperative stem cell approaches, from in vivo models to clinical studies, are reviewed, and the potential regenerative mechanisms and the roles of different cell populations in the regeneration process are discussed. Although intraoperative stem cell therapies have been shown to be safe and effective for several indications, there are still critical challenges to be tackled prior to adoption into the standard surgical armamentarium. PMID:22809140

  1. [Peritoneum and laparoscopic environment].

    PubMed

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

    2007-12-01

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

  2. Acute Intraoperative Pulmonary Aspiration.

    PubMed

    Nason, Katie S

    2015-08-01

    Acute intraoperative aspiration is a potentially fatal complication with significant associated morbidity. Patients undergoing thoracic surgery are at increased risk for anesthesia-related aspiration, largely due to the predisposing conditions associated with this complication. Awareness of the risk factors, predisposing conditions, maneuvers to decrease risk, and immediate management options by the thoracic surgeon and the anesthesia team is imperative to reducing risk and optimizing patient outcomes associated with acute intraoperative pulmonary aspiration. Based on the root-cause analyses that many of the aspiration events can be traced back to provider factors, having an experienced anesthesiologist present for high-risk cases is also critical.

  3. Outcomes of an innovative training course in laparoscopic hernia repair.

    PubMed

    Light, D; Bawa, S; Gallagher, P; Horgan, L

    2017-07-06

    INTRODUCTION The Ethicon™ laparoscopic inguinal groin hernia training (LIGHT) course is an educational course based on three days of teaching on laparoscopic hernia surgery. The first day involves didactic lectures with tutorials. The second day involves practical cadaveric procedures in laparoscopic hernia surgery. The third day involves direct supervision by a consultant surgeon during laparoscopic hernia surgery on a real patient. We reviewed our outcomes for procedures performed on real patients on the final day of the course for early complications and outcomes. METHODS A retrospective study was undertaken of patients who had laparoscopic hernia surgery as part of the LIGHT course from 2013 to 2015. A matched control cohort of patients who had elective laparoscopic hernia surgery over the study period was identified. These patients had their surgery performed by the same consultant general surgeons involved in delivering the course. All patients were followed up at 6 weeks postoperatively. RESULTS A total of 60 patients had a laparoscopic inguinal hernia repair and 23 patients had a laparoscopic ventral hernia repair during the course. The mean operative time for laparoscopic inguinal hernia repair was 48 minutes for trainees (range 22-90 minutes) and 35 minutes for consultant surgeons (range 18-80 minutes). There were no intraoperative injuries or returns to theatre in either group. All the patients operated on during the course were successfully performed as daycase procedures. The mean operative time for laparoscopic ventral hernia repair was 64 minutes for trainees (range 40-120 minutes) and 51 minutes for consultant surgeons (range 30-130 minutes). CONCLUSIONS The outcomes of patients operated on during the LIGHT course are comparable to procedures performed by a consultant. Supervised operating by trainees is a safe and effective educational model in hernia surgery.

  4. Spinal-general anaesthesia decreases neuroendocrine stress response in laparoscopic cholecystectomy.

    PubMed

    Calvo-Soto, P; Martínez-Contreras, A; -Hernández, B Trujillo; And, Fj Peraza-Garay; Vásquez, C

    2012-01-01

    A randomized clinical study to compare the stress response to laparoscopic cholecystectomy during spinal-general anaesthesia and epidural- general anaesthesia. Women undergoing elective laparoscopic chole cystectomy were assigned to receive either spinal anaesthesia (SA group; n = 12) or epidural anaesthesia (EA group; n = 12), in addition to general anaesthesia. Plasma concentrations of cortisol, adrenocorticotrophic hormone (ACTH), noradrenaline, adrenaline and total catecholamines were measured pre- and intraoperatively. Intraoperative cortisol, noradrenaline and total catecholamine levels were significantly lower in the SA group compared with the EA group. When pre- and intraoperative values were compared, the SA group showed a decrease in adrenaline, noradrenaline and total catecholamine levels, and the EA group showed an increase in ACTH and noradrenaline levels. The type of regional anaesthesia significantly affected the stress response: spinal anaesthesia produced a more favourable endocrine response than epidural anaesthesia. Spinal-general anaesthesia may reduce postoperative morbidity in laparoscopic cholecystectomy.

  5. Preliminary experience with laparoscopic surgery in Ile-Ife, Nigeria.

    PubMed

    Adisa, A O; Arowolo, O A; Salako, A A; Lawal, O O

    2009-12-01

    This study presents a pioneer experience with laparoscopic operations in a General Surgical unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Consecutive patients who had laparoscopic operations from April through December 2008 were prospectively studied. Following clinical diagnosis, initial diagnostic laparoscopy was undertaken in all patients, followed by therapeutic open or laparoscopic procedures. All procedures were done under general anaesthesia. Duration of operation and outcome including complications were recorded. In all, there were 12 patients (8 males, 4 females), aged 15 to 50 years. Eight patients had clinical diagnoses of acute appendicitis, one each had undetermined right lower abdominal pain suspected ectopic gestation, adhesive intestinal obstruction and metastatic liver disease. The first 4 patients with inflammed appendix confirmed at laparoscopy had open appendicectomy. Of the next cohort of 5 patients, laparoscopic appendicectomy was completed in four but converted to open procedure in one. Normal findings were noted in the lady with suspected ectopic gestation. Laparoscopic adhesiolysis was done for adhesive intestinal obstruction while a laparoscopic liver biopsy was done for the patient with metastatic liver disease. Operative time ranged from 55-105 minutes with marked reduction in operation time as confidence and experience grew. No intraoperative complication was observed but one patient had superficial port site infection postoperatively. We conclude that with good patient selection and some improvisation, laparoscopic general surgical operations are feasible with acceptable outcome even in a poor resource setting.

  6. Laparoscopic management of cholecystocolic fistula

    PubMed Central

    CONDE, Lauro Massaud; TAVARES, Pedro Monnerat; QUINTES, Jorge Luiz Delduque; CHERMONT, Ronny Queiroz; PEREZ, Mario Castro Alvarez

    2014-01-01

    Introduction Cholecystocolic fistula is a rare complication of gallbladder disease. Its clinical presentation is variable and nonspecific, and the diagnosis is made, mostly, incidentally during intraoperative maneuver. Cholecystectomy with closure of the fistula is considered the treatment of choice for the condition, with an increasingly reproducible tendency to the use of laparoscopy. Aim To describe the laparoscopic approach for cholecystocolic fistula and ratify its feasibility even with the unavailability of more specific instruments. Technique After dissection of the communication and section of the gallbladder fundus, the fistula is externalized by an appropriate trocar and sutured manually. Colonic segment is reintroduced into the cavity and cholecystectomy is performed avoiding the conversion procedure to open surgery. Conclusion Laparoscopy for resolution of cholecystocolic fistula isn't only feasible, but also offers a shorter stay at hospital and a milder postoperative period when compared to laparotomy. PMID:25626940

  7. A simulation model for predicting the temperature during the application of MR-guided focused ultrasound for stroke treatment using pulsed ultrasound

    NASA Astrophysics Data System (ADS)

    Hadjisavvas, V.; Damianou, C.

    2011-09-01

    In this paper a simulation model for predicting the temperature during the application of MR-guided focused ultrasound for stroke treatment using pulsed ultrasound is presented. A single element spherically focused transducer of 5 cm diameter, focusing at 10 cm and operating at either 0.5 MHz or 1 MHz was considered. The power field was estimated using the KZK model. The temperature was estimated using the bioheat equation. The goal was to extract the acoustic parameters (power, pulse duration, duty factor and pulse repetition frequency) that maintain a temperature increase of less than 1 °C during the application of a pulse ultrasound protocol. It was found that the temperature change increases linearly with duty factor. The higher the power, the lower the duty factor needed to keep the temperature change to the safe limit of 1 °C. The higher the frequency the lower the duty factor needed to keep the temperature change to the safe limit of 1 °C. Finally, the deeper the target, the higher the duty factor needed to keep the temperature change to the safe limit of 1 °C. The simulation model was tested in brain tissue during the application of pulse ultrasound and the measured temperature was in close agreement with the simulated temperature. This simulation model is considered to be very useful tool for providing acoustic parameters (frequency, power, duty factor, pulse repetition frequency) during the application of pulsed ultrasound at various depths in tissue so that a safe temperature is maintained during the treatment. This model could be tested soon during stroke clinical trials.

  8. Laparoscopic side-to-side pancreaticojejunostomy for chronic pancreatitis in children

    PubMed Central

    Deie, Kyoichi; Uchida, Hiroo; Kawashima, Hiroshi; Tanaka, Yujiro; Fujiogi, Michimasa; Amano, Hizuru; Murase, Naruhiko; Tainaka, Takahisa

    2016-01-01

    Surgical pancreatic duct (PD) drainage for chronic pancreatitis in children is relatively rare. It is indicated in cases of recurrent pancreatitis and PD dilatation that have not responded to medical therapy and therapeutic endoscopy. We performed laparoscopic side-to-side pancreaticojejunostomy for two paediatric patients with chronic pancreatitis. The main PD was opened easily by electrocautery after locating the dilated PD by intraoperative ultrasonography. The dilated PD was split longitudinally from the pancreatic tail to the pancreatic head by laparoscopic coagulation shears or electrocautery after pancreatography. A laparoscopic side-to-side pancreaticojejunostomy was performed by a one-layered technique using continuous 4-0 polydioxanone (PDS) sutures from the pancreatic tail to the pancreatic head. There were no intraoperative or postoperative complications or recurrences. This procedure has cosmetic advantages compared with open surgery for chronic pancreatitis. Laparoscopic side-to-side pancreaticojejunostomy in children is feasible and effective for the treatment of chronic pancreatitis. PMID:27251846

  9. Posterior Wall Gastric Leiomyoma: Endoscopic Tattooing Facilitates Laparoscopic Resection

    PubMed Central

    Mehta, Dhiren; Zelen, Johnathan; Fogler, Richard

    1998-01-01

    Objective: To demonstrate the application of tattooing for the intraoperative localization of posterior wall gastric leiomyoma during laparoscopic resection. The preoperative injection of Indian ink in the tumor-bearing area of the posterior gastric wall eliminates the need to perform anterior wall gastrostomy or intraoperative upper endoscopic tumor localization. Methods: A patient with posterior wall gastric leiomyoma was marked with Indian ink during preoperative upper endoscopy. The dye was visualized intraoperatively facilitating wedge resection of the tumor-bearing area with the Endo GIA. Results: The patient had an uneventful surgery and recovery. Complete excision of the tumor was accomplished. Conclusion: The preoperative endoscopic marking of gastric lesions, facilitates the intraoperative localization and resection of these lesions. PMID:9876718

  10. Gallbladder removal - laparoscopic

    MedlinePlus

    ... gallbladder using a medical device called a laparoscope. Description Surgery using a laparoscope is the most common ... inserted through one of the cuts. Other medical instruments are inserted through the other cuts. Gas is ...

  11. Laparoscopic Inguinal Hernia Repair

    MedlinePlus

    ... Some hernia repairs are performed using a small telescope known as a laparoscope. If your surgeon has ... in the abdominal wall (muscle) using small incisions, telescopes and a patch (mesh). Laparoscopic repair offers a ...

  12. Laparoscopic Hysterectomy with Automatic Stapling Devices

    PubMed Central

    Tabb, Reese

    1997-01-01

    Purpose: To evaluate outcomes including operating time, blood loss, length of stay (LOS), return to work and complications of laparoscopic hysterectomy performed with automatic stapling devices. Methods: Between 6/11/91 and 11/23/95, 127 laparoscopic hysterectomies were performed with automatic stapling devices. On an average, 6 firings with the stapler were done per case. Postoperative telephone survey and retrospective review of records were done. Results: Data averages for operating time, blood loss, LOS and return to work, respectively, were 90 minutes, 190 cc's, 1.1 day and 2 weeks. Significant complications included delayed postoperative bleeding in 4 patients, all of which occurred within the first 35 cases. One was controlled laparoscopically and 3 others required exploratory laparotomies. Since certain precautionary measures as described were taken, hemorrhagic complications were eliminated. Conclusions: Laparoscopic hysterectomy can be performed safely and effectively with automatic stapling devices in properly selected patients. A potential hazard inherent with this technique includes intraoperative and postoperative bleeding from the staple lines, the incidence of which can be minimized by taking certain precautionary measures such as the use of white cartridges only and bipolar desiccation of staple lines when indicated. PMID:9876650

  13. Laparoscopic adrenalectomy: pathologic features determine outcome

    PubMed Central

    Poulin, Eric C.; Schlachta, Christopher M.; Burpee, Stephen E.; Pace, Kenneth T.; Mamazza, Joseph

    2003-01-01

    Introduction The differential outcomes of laparoscopic adrenalectomy are not well described. Therefore, we evaluated these outcomes in the 3 groups most often seen clinically: bilateral adrenalectomy for Cushing's disease (group 1), pheochromocytoma (group 2) and unilateral adrenalectomy for non-pheochromocytoma (group 3). Methods We reviewed a longitudinal database of 72 consecutive cases of laparoscopic adrenalectomy carried out between 1997 and 2001 at the Centre for Minimally Invasive Surgery, University of Toronto. Results Patients in group 1 tended to be older (median 49 yr) and heavier (median 87 kg). They had a longer operating time (median 255 min), more postoperative complications (15%) and a longer median postoperative stay (4 d). Patients in group 2 had intermediate outcomes: a median operating time of 198 minutes, complication rate of 8.3% and a median postoperative hospital stay of 3 days. However, they had more intraoperative blood loss (median 150 mL). Group 3 patients had the best outcomes with the shortest median operating time (125 min), least blood loss (median 50 mL), fewer complications (6%) and shortest hospital stay (median 2 d). Conclusions Although the outcomes of laparoscopic adrenalectomy are uniformly good, on the basis of the underlying pathologic characteristics, patients can be divided into groups that have different expected outcomes. Patients requiring a unilateral adrenalectomy except for pheochromocytoma have the best recorded outcomes. Surgeons transferring to laparoscopic adrenalectomy would benefit from selecting patients in this group during their learning curve. PMID:14577705

  14. Single-incision laparoscopic total colectomy.

    PubMed

    Paranjape, Charudutt; Ojo, Oluwatosin J; Carne, David; Guyton, Daniel

    2012-01-01

    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. 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. 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. 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.

  15. Laparoscopic Splenectomy Alone for Sickle Cell Disease

    PubMed Central

    Al-Balushi, Zainab N.; Bhatti, Khalid M.; Ehsan, Muhammad T.; Al-Shaqsi, Yousuf; Al-Sharji, Nawal A. R.; Mady, Hatem A. A.; Sherif, Mahmoud H.

    2016-01-01

    Objectives In Oman, the most frequent indication for a splenectomy in children is sickle cell disease (SCD), which is one of the most common haematological disorders in the Gulf region. This study aimed to describe paediatric laparoscopic splenectomies alone for SCD at a tertiary hospital in Oman. Methods This study was conducted between February 2010 and October 2015 at the Sultan Qaboos University Hospital, Muscat, Oman. The medical records of all children aged ≤15 years old undergoing splenectomies during the study period were reviewed. Results A total of 71 children underwent laparoscopic splenectomies during the study period; of these, 50 children (28 male and 22 female) underwent laparoscopic splenectomies alone for SCD. The children’s weight ranged between 11–43 kg. The most common indication for a splenectomy was a recurrent splenic sequestration crisis (92%). Surgically removed spleens weighed between 155–1,200 g and measured between 9–22 cm. Operative times ranged between 66–204 minutes and intraoperative blood loss ranged between 10–800 mL. One patient required conversion to an open splenectomy. Postoperative complications were noted in only four patients. The median hospital stay duration was three days. Conclusion Among this cohort, the mean operating time was comparable to that reported in the international literature. In addition, rates of conversion and postoperative complications were very low. These findings indicate that a laparoscopic splenectomy alone in paediatric patients with SCD is a feasible option. PMID:28003896

  16. 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

  17. [Laparoscopic adrenalectomy in surgery of the adrenal gland diseases].

    PubMed

    Nichitaĭlo, M E; Litvinenko, A N; Gul'ko, O N; Kvacheniuk, A N; Lukecha, I I

    2013-02-01

    In 2002-2012 yrs in The Department of Laparoscopic Surgery and Choledocholithiasis laparoscopic adrenalectomy (LA) for various adrenal gland diseases was done in 94 patients. The operation time while doing right-sided and left-sided LA have had constituted, accordingly, at average (73.6 +/- 12.1) and (121.6 +/- 11.9) min, intraoperative blood loss - (49.3 +/- 9.2) ml. Hemotransfusion was not applied. There was no need for conversion. In 1 (1,1%) patient hemoperitoneum have had occurred as a consequence of traumatic injury of spleen while performing left-sided LA. Nonspeciphic postoperative complications were absent.

  18. Laparoscopic Management of Adhesive Small Bowel Obstruction

    PubMed Central

    Konjic, Ferid; Idrizovic, Enes; Hasukic, Ismar; Jahic, Alen

    2016-01-01

    Introduction: Adhesions are the reason for bowel obstruction in 80% of the cases. In well selected patients the adhesive ileus laparoscopic treatment has multiple advantages which include the shorter hospitalization period, earlier food taking, and less postoperative morbidity rate. Case report: Here we have a patient in the age of 35 hospitalized at the clinic due to occlusive symptoms. Two years before an opened appendectomy had been performed on him. He underwent the treatment of exploration laparoscopy and laparoscopic adhesiolysis. Dilated small bowel loops connected with the anterior abdominal wall in the ileocecal region by adhesions were found intraoperatively and then resected harmonically with scalpel. One strangulation around which a small bowel loop was wrapped around was found and dissected. Postoperative course was normal. PMID:27041815

  19. Laparoscopic cholecystectomy using 2-mm instruments.

    PubMed

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

    1998-10-01

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

  20. Malignant hyperthermia during laparoscopic adjustable gastric banding.

    PubMed

    Chery, Josue; Shintaro, Chiba; Pratt, Ambibola; Kirkley, Ronell; Hearne, Barbara; Beyzman, Andrew; Gorecki, Piotr

    2013-01-01

    We report a rare case of malignant hyperthermia during laparoscopic adjustable gastric banding. A 32-y-old female with no previous history of adverse reaction to general anesthesia underwent laparoscopic adjustable gastric banding. Intraoperative monitoring revealed a sharp increase in end-tidal carbon dioxide, autonomic instability, and metabolic and respiratory acidosis, along with other metabolic and biochemical derangements. She was diagnosed with malignant hyperthermia. Desflurane, the anesthetic agent was discontinued, and the patient was started on intravenous dantrolene. The surgery was completed, and the patient was brought to the surgical intensive care unit for continued postoperative care. She developed muscle weakness and phlebitis that resolved prior to discharge. Prompt diagnosis and treatment of malignant hyperthermia leads to favorable clinical outcome. This clinical entity can occur in the bariatric population with the widely used desflurane. Bariatric surgeons and anesthesiologists alike must be aware of the early clinical signs of this rare, yet potentially fatal, complication.

  1. 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.

  2. Intraoperative endovascular ultrasonography

    NASA Astrophysics Data System (ADS)

    Eton, Darwin; Ahn, Samuel S.; Baker, J. D.; Pensabene, Joseph; Yeatman, Lawrence S.; Moore, Wesley S.

    1991-05-01

    The early experience using intra-operative endovascular ultrasonography (EU) is reported in eight patients undergoing lower extremity revasularization. In four patients, intra-operative EU successfully characterized inflow stenoses that were inadequately imaged with pre- operative arteriography. Two patients were found to have hemodynamically significant inflow stenoses, and were treated with intra-operative balloon angioplasty followed by repeat EU. The other two patients were found to have non-hemodynamically significant inflow stenoses requiring no treatment. Additional outflow procedures were required in all four patients. In the remaining four patients, EU was used to evaluate the completeness of TEC rotary atherectomy, of Hall oscillatory endarterectomy, of thrombectomy of the superficial femoral and popliteal arteries, and of valve lysis during in situ saphenous vein grafting, respectively. In the latter case, the valve leaflets were not clearly seen. In the other cases, EU assisted the surgeon. Angioscopy and angiography were available for comparison. In one case, angioscopy failed because of inability to clear the field while inspecting retrograde the limb of an aorto-bi-femoral graft. EU however was possible. No complications of EU occurred. EU is a safe procedure indicated when characterization of a lesion is needed prior to an intervention or when evaluation of the intervention's success is desired. We did not find it useful in valve lysis for in-site grafting.

  3. Laparoscopic-assisted enterolithotomy for gallstone ileus.

    PubMed

    Gupta, Rahul A; Shah, Chetan R; Balsara, K P

    2013-06-01

    Gallstone ileus is a rare complication of cholelithiasis seen usually in elderly population with comorbidities. Most of the cases present as acute intestinal obstruction with the diagnosis being made intraoperatively. There exists controversy regarding appropriate emergency surgical treatment of gallstone ileus as to whether biliary tract surgery should be done during the first operation. Laparoscopy in recent years is also being used for management of such cases. We report a case of gallstone ileus diagnosed preoperatively and successfully treated by laparoscopic-assisted enterolithotomy.

  4. Laparoscopy Instructional Videos: The Effect of Preoperative Compared With Intraoperative Use on Learning Curves.

    PubMed

    Broekema, Theo H; Talsma, Aaldert K; Wevers, Kevin P; Pierie, Jean-Pierre E N

    Previous studies have shown that the use of intraoperative instructional videos has a positive effect on learning laparoscopic procedures. This study investigated the effect of the timing of the instructional videos on learning curves in laparoscopic skills training. After completing a basic skills course on a virtual reality simulator, medical students and residents with less than 1 hour experience using laparoscopic instruments were randomized into 2 groups. Using an instructional video either preoperatively or intraoperatively, both groups then performed 4 repetitions of a standardized task on the TrEndo augmented reality. With the TrEndo, 9 motion analysis parameters (MAPs) were recorded for each session (4 MAPs for each hand and time). These were the primary outcome measurements for performance. The time spent watching the instructional video was also recorded. Improvement in performance was studied within and between groups. Medical Center Leeuwarden, a secondary care hospital located in Leeuwarden, The Netherlands. Right-hand dominant medical student and residents with more than 1 hour experience operating any kind of laparoscopic instruments were participated. A total of 23 persons entered the study, of which 21 completed the study course. In both groups, at least 5 of 9 MAPs showed significant improvements between repetition 1 and 4. When both groups were compared after completion of repetition 4, no significant differences in improvement were detected. The intraoperative group showed significant improvement in 3 MAPs of the left-nondominant-hand, compared with one MAP for the preoperative group. No significant differences in learning curves could be detected between the subjects who used intraoperative instructional videos and those who used preoperative instructional videos. Intraoperative video instruction may result in improved dexterity of the nondominant hand. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc

  5. Laparoscopic cholecystectomy under spinal anaesthesia: a prospective study.

    PubMed

    Kumar, A

    2014-12-01

    Laparoscopic cholecystectomy under general anaesthesia is the present gold standard in treatment of symptomatic gall bladder disease. This study was conducted to determine the efficacy and safety of laparoscopic cholecystectomy under spinal anaesthesia which could be more cost effective. A prospective study was conducted was over a fourteen month period at a teaching hospital to evaluate efficacy, safety and cost benefit of conducting laparoscopic cholecystectomy under spinal anaesthesia(SA). Patients meeting inclusion criteria were taken up for laparoscopic cholecystectomy under spinal anaesthesia by standardized techniques. They underwent standard four port laparoscopic cholecystectomy. Mean anaesthesia time, pneumoperitoneum time and surgery time defined primary outcome measures. Intraoperative events and post operative pain score were the secondary outcomes measured. All patients underwent laparoscopic cholecystectomy without any major complications. None had to be converted to general anaesthesia in this series. The operation had to be converted to open incision in 3 patients. Commonest complaint was pain in right shoulder and anxiety at the beginning of operation/pneumoperitoneum. All patients were highly or well satisfied during follow up. Laparoscopic cholecystectomy done under spinal anaesthesia as a routine anaesthesia of choice is feasible and safe. In this study spinal anaesthesia for laparoscopic cholecystectomy was found to be safe even in patients with respiratory problems, cost-effective, with minimal postoperative pain and smooth recovery; the disadvantage being occasional right shoulder pain following pneumo-peritoneum (40%). Spinal anaesthesia can be recommended to be the anaesthesia technique of choice for conducting laparoscopic cholecystectomy in hospital setups where cost is a major factor; provided proper backup is present.

  6. MR Guided PET Image Reconstruction

    PubMed Central

    Bai, Bing; Li, Quanzheng; Leahy, Richard M.

    2013-01-01

    The resolution of PET images is limited by the physics of positron-electron annihilation and instrumentation for photon coincidence detection. Model based methods that incorporate accurate physical and statistical models have produced significant improvements in reconstructed image quality when compared to filtered backprojection reconstruction methods. However, it has often been suggested that by incorporating anatomical information, the resolution and noise properties of PET images could be improved, leading to better quantitation or lesion detection. With the recent development of combined MR-PET scanners, it is possible to collect intrinsically co-registered MR images. It is therefore now possible to routinely make use of anatomical information in PET reconstruction, provided appropriate methods are available. In this paper we review research efforts over the past 20 years to develop these methods. We discuss approaches based on the use of both Markov random field priors and joint information or entropy measures. The general framework for these methods is described and their performance and longer term potential and limitations discussed. PMID:23178087

  7. MR-guided laser interventions

    NASA Astrophysics Data System (ADS)

    Bettag, Martin; Ulrich, Frank; Bock, Wolfgang J.; Kahn, Thomas; Schwarzmaier, Hans-Joachim; Hessel, Stefan F. F.

    1992-06-01

    Low-power interstitial thermal therapy using a 1064 nm Nd:YAG laser and a newly designed fiberoptic transmission system, the ITT laser fiber, is a promising therapeutic approach in the treatment of cerebral tumors. After CT-guided stereotactic implantation of an applicator probe, we performed laser-induced interstitial thermal therapy in a patient with an astrocytomas WHO grade II under simultaneous magnetic resonance imaging (MRI) control. In order to assess the effects of the treatment a 2D-Flash sequence with an acquisition time of 15 sec was used. It could be demonstrated that laser-tissue interactions progressed with duration of irradiation depending on laser powers applied. There was a well-defined area of tissue necrosis with a maximum size of 17 mm in diameter in the center of the tumor and a small zone of transient perifocal edema. With regard to experimental studies, it seems to be possible to define between reversible and irreversible laser-tissue effects.

  8. Fusion of intraoperative force sensoring, surface reconstruction and biomechanical modeling

    NASA Astrophysics Data System (ADS)

    Röhl, S.; Bodenstedt, S.; Küderle, C.; Suwelack, S.; Kenngott, H.; Müller-Stich, B. P.; Dillmann, R.; Speidel, S.

    2012-02-01

    Minimally invasive surgery is medically complex and can heavily benefit from computer assistance. One way to help the surgeon is to integrate preoperative planning data into the surgical workflow. This information can be represented as a customized preoperative model of the surgical site. To use it intraoperatively, it has to be updated during the intervention due to the constantly changing environment. Hence, intraoperative sensor data has to be acquired and registered with the preoperative model. Haptic information which could complement the visual sensor data is still not established. In addition, biomechanical modeling of the surgical site can help in reflecting the changes which cannot be captured by intraoperative sensors. We present a setting where a force sensor is integrated into a laparoscopic instrument. In a test scenario using a silicone liver phantom, we register the measured forces with a reconstructed surface model from stereo endoscopic images and a finite element model. The endoscope, the instrument and the liver phantom are tracked with a Polaris optical tracking system. By fusing this information, we can transfer the deformation onto the finite element model. The purpose of this setting is to demonstrate the principles needed and the methods developed for intraoperative sensor data fusion. One emphasis lies on the calibration of the force sensor with the instrument and first experiments with soft tissue. We also present our solution and first results concerning the integration of the force sensor as well as accuracy to the fusion of force measurements, surface reconstruction and biomechanical modeling.

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

    PubMed Central

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

    2015-01-01

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

  10. Two-port laparoscopic management of an autoamputated ovarian cyst in a newborn.

    PubMed

    Visnjic, Stjepan; Domljan, Mislav; Zupancic, Bozidar

    2008-01-01

    A 4-week-old newborn underwent laparoscopic removal of a hemorrhagic cyst measuring 4 cm in diameter. Preoperative diagnostics suggested autoamputation, which is a rare complication of fetal ovarian torsion. The laparoscopic procedure, lasting 26 minutes, was performed, without any major intraoperative complications--bleeding, rupture, or leakage. The modified 2-port technique was used. The identification of all structures was exact. The hemorrhagic cyst was freed of the cyst bed, suctioned to fit the size of the umbilical port, and removed. The presentation of a blind adnexal stump proved autoamputation. The condition of the contralateral ovary was verified. The authors present the laparoscopic procedure with the emphasis on the technique.

  11. MR guided thermal therapy of pancreatic tumors with endoluminal, intraluminal and interstitial catheter-based ultrasound devices: preliminary theoretical and experimental investigations

    NASA Astrophysics Data System (ADS)

    Prakash, Punit; Salgaonkar, Vasant A.; Scott, Serena J.; Jones, Peter; Hensley, Daniel; Holbrook, Andrew; Plata, Juan; Sommer, Graham; Diederich, Chris J.

    2013-02-01

    Image-guided thermal interventions have been proposed for potential palliative and curative treatments of pancreatic tumors. Catheter-based ultrasound devices offer the potential for temporal and 3D spatial control of the energy deposition profile. The objective of this study was to apply theoretical and experimental techniques to investigate the feasibility of endogastric, intraluminal and transgastric catheter-based ultrasound for MR guided thermal therapy of pancreatic tumors. The transgastric approach involves insertion of a catheter-based ultrasound applicator (array of 1.5 mm OD x 10 mm transducers, 360° or sectored 180°, ~7 MHz frequency, 13-14G cooling catheter) directly into the pancreas, either endoscopically or via image-guided percutaneous placement. An intraluminal applicator, of a more flexible but similar construct, was considered for endoscopic insertion directly into the pancreatic or biliary duct. An endoluminal approach was devised based on an ultrasound transducer assembly (tubular, planar, curvilinear) enclosed in a cooling balloon which is endoscopically positioned within the stomach or duodenum, adjacent to pancreatic targets from within the GI tract. A 3D acoustic bio-thermal model was implemented to calculate acoustic energy distributions and used a FEM solver to determine the transient temperature and thermal dose profiles in tissue during heating. These models were used to determine transducer parameters and delivery strategies and to study the feasibility of ablating 1-3 cm diameter tumors located 2-10 mm deep in the pancreas, while thermally sparing the stomach wall. Heterogeneous acoustic and thermal properties were incorporated, including approximations for tumor desmoplasia and dynamic changes during heating. A series of anatomic models based on imaging scans of representative patients were used to investigate the three approaches. Proof of concept (POC) endogastric and transgastric applicators were fabricated and experimentally

  12. MR guided thermal therapy of pancreatic tumors with endoluminal, intraluminal and interstitial catheter-based ultrasound devices: Preliminary theoretical and experimental investigations

    PubMed Central

    Prakash, Punit; Salgaonkar, Vasant A.; Scott, Serena J.; Jones, Peter; Hensley, Daniel; Holbrook, Andrew; Plata, Juan; Sommer, Graham; Diederich, Chris J.

    2014-01-01

    Image-guided thermal interventions have been proposed for potential palliative and curative treatments of pancreatic tumors. Catheter-based ultrasound devices offer the potential for temporal and 3D spatial control of the energy deposition profile. The objective of this study was to apply theoretical and experimental techniques to investigate the feasibility of endogastric, intraluminal and transgastric catheter-based ultrasound for MR guided thermal therapy of pancreatic tumors. The transgastric approach involves insertion of a catheter-based ultrasound applicator (array of 1.5 mm OD x 10 mm transducers, 360° or sectored 180°, ~7 MHz frequency, 13–14G cooling catheter) directly into the pancreas, either endoscopically or via image-guided percutaneous placement. An intraluminal applicator, of a more flexible but similar construct, was considered for endoscopic insertion directly into the pancreatic or biliary duct. An endoluminal approach was devised based on an ultrasound transducer assembly (tubular, planar, curvilinear) enclosed in a cooling balloon which is endoscopically positioned within the stomach or duodenum, adjacent to pancreatic targets from within the GI tract. A 3D acoustic bio-thermal model was implemented to calculate acoustic energy distributions and used a FEM solver to determine the transient temperature and thermal dose profiles in tissue during heating. These models were used to determine transducer parameters and delivery strategies and to study the feasibility of ablating 1–3 cm diameter tumors located 2–10 mm deep in the pancreas, while thermally sparing the stomach wall. Heterogeneous acoustic and thermal properties were incorporated, including approximations for tumor desmoplasia and dynamic changes during heating. A series of anatomic models based on imaging scans of representative patients were used to investigate the three approaches. Proof of concept (POC) endogastric and transgastric applicators were fabricated and

  13. [Laparoscopic versus open surgery for colorectal cancer. A comparative study].

    PubMed

    Arribas-Martin, Antonio; Díaz-Pizarro-Graf, José Ignacio; Muñoz-Hinojosa, Jorge Demetrio; Valdés-Castañeda, Alberto; Cruz-Ramírez, Omar; Bertrand, Martin Marie

    2014-01-01

    Laparoscopic surgery for colorectal cancer is currently accepted and widespread worldwide. However, according tol the surgical experience on this approach, surgical and short-term oncologic results may vary. Studies comparing laparoscopic vs. open surgery in our population are scarce. To determine the superiority of the laparoscopic vs. open technique for colorectal cancer surgery. This retrospective and comparative study collected data from patients operated on for colorectal cancer between 1999 and 2011 at the Angeles Lomas Hospital, Mexico. A total of 82 patients were included in this study; 47 were operated through an open approach and 35 laparoscopically. Mean operative time was significantly lower in the open approach group (p= 0.008). There were no significant difference between both techniques for intraoperative bleeding (p= 0.3980), number of lymph nodes (p= 0.27), time to initiate oral feeding (p= 0.31), hospital stay (p= 0.12), and postoperative pain (p= 0.19). Procedure-related complications rate and type were not significantly different in both groups (p= 0.44). Patients operated laparoscopically required significantly less analgesic drugs (p= 0.04) and less need for epidural postoperative analgesia (p= 0.01). Laparoscopic approach is as safe as the traditional open approach for colorectal cancer. Early oncological and surgical results confirm its suitability according to this indication.

  14. Laparoscopic radical hysterectomy with pelvic lymphadenectomy in early invasive cervical cancer.

    PubMed

    Salicrú, Sabina; Gil-Moreno, Antonio; Montero, Anabel; Roure, Marisa; Pérez-Benavente, Assumpció; Xercavins, Jordi

    2011-01-01

    Laparoscopic radical hysterectomy is one surgical procedure currently performed to treat gynecologic cancer. The objective of this review was to update the current knowledge of laparoscopic radical hysterectomy in early invasive cervical cancer. Articles indexed in the MEDLINE database using the key words "Laparoscopic radical hysterectomy" and "Cancer of the cervix" were reviewed. Studies of laparoscopic radical hysterectomy for treatment of early cervical cancer with a minimum study population of 10 patients were selected. The laparoscopic approach was associated with less surgical morbidity (surgical bleeding) and with shorter length of hospital stay, although the duration of the operation may be longer. Laparoscopic radical hysterectomy with endoscopic pelvic lymphadenectomy, and paraaortic lymphadenectomy if needed, is a safe surgical option for treatment and staging of early invasive cervical cancer considering surgical risk, intraoperative bleeding, intraoperative and postoperative complications, and patient recovery. It is important to respect the learning curve. Surgical advances including new laparoscopic instrumentation and, in particular, use of robotics will contribute to reducing the duration of the operation and to facilitating learning and teaching of the procedure.

  15. Intraoperative virtual brain counseling

    NASA Astrophysics Data System (ADS)

    Jiang, Zhaowei; Grosky, William I.; Zamorano, Lucia J.; Muzik, Otto; Diaz, Fernando

    1997-06-01

    Our objective is to offer online real-tim e intelligent guidance to the neurosurgeon. Different from traditional image-guidance technologies that offer intra-operative visualization of medical images or atlas images, virtual brain counseling goes one step further. It can distinguish related brain structures and provide information about them intra-operatively. Virtual brain counseling is the foundation for surgical planing optimization and on-line surgical reference. It can provide a warning system that alerts the neurosurgeon if the chosen trajectory will pass through eloquent brain areas. In order to fulfill this objective, tracking techniques are involved for intra- operativity. Most importantly, a 3D virtual brian environment, different from traditional 3D digitized atlases, is an object-oriented model of the brain that stores information about different brain structures together with their elated information. An object-oriented hierarchical hyper-voxel space (HHVS) is introduced to integrate anatomical and functional structures. Spatial queries based on position of interest, line segment of interest, and volume of interest are introduced in this paper. The virtual brain environment is integrated with existing surgical pre-planning and intra-operative tracking systems to provide information for planning optimization and on-line surgical guidance. The neurosurgeon is alerted automatically if the planned treatment affects any critical structures. Architectures such as HHVS and algorithms, such as spatial querying, normalizing, and warping are presented in the paper. A prototype has shown that the virtual brain is intuitive in its hierarchical 3D appearance. It also showed that HHVS, as the key structure for virtual brain counseling, efficiently integrates multi-scale brain structures based on their spatial relationships.This is a promising development for optimization of treatment plans and online surgical intelligent guidance.

  16. Effect of aspirin continuation on blood loss and postoperative morbidity in patients undergoing laparoscopic cholecystectomy or colorectal cancer resection.

    PubMed

    Ono, Kazumi; Idani, Hitoshi; Hidaka, Hidekuni; Kusudo, Kazuhito; Koyama, Yusuke; Taguchi, Shinya

    2013-02-01

    No consensus exists whether to continue or withdraw aspirin therapy perioperatively in patients undergoing major laparoscopic abdominal surgery. To investigate whether preoperative continuation of aspirin therapy increases blood loss and associated morbidity during laparoscopic cholecystectomy and colorectal cancer resection, we compared duration of surgical procedures, amount of intraoperative blood loss, rate of blood transfusion, length of postoperative stay, rate of conversion to open surgery, and reoperation within 48 hours between patients with and without aspirin therapy preoperatively. Twenty-nine of 270 patients who underwent laparoscopic cholecystectomy and 23 of 218 patients who underwent laparoscopic colorectal cancer resection, respectively, were on aspirin therapy. We found no significant difference in the investigated outcome between groups with the exception of longer surgical duration of laparoscopic cholecystectomy in aspirin-treated patients. Although underpowered, above findings may suggest that aspirin continuation is unlikely to increase blood loss or postoperative morbidity in patients undergoing laparoscopic cholecystectomy or colorectal cancer resection.

  17. Systematic Video Documentation in Laparoscopic Colon Surgery Using a Checklist: A Feasibility and Compliance Pilot Study.

    PubMed

    O'Mahoney, Paul R A; Trencheva, Koiana; Zhuo, Changhua; Shukla, Parul J; Lee, Sang W; Sonoda, Toyooki; Milsom, Jeffrey W

    2015-09-01

    High-quality images can be readily captured during laparoscopic colon surgery, but there are no guidelines for documentation of these video data or how to best measure surgical quality from an operative video. This study evaluates the feasibility and compliance in documenting key steps during laparoscopic right hemicolectomy and sigmoid colectomy. A retrospective review of previously recorded videos of patients undergoing laparoscopic right hemicolectomy or sigmoid colectomy from September to December 2011 in a single institution was performed. Patients' demographics, intraoperative features, postoperative complications, and variables for video recording and editing were collected. Compliance of key surgical steps was assessed using a checklist by two independent surgeons. Sixteen laparoscopic operations (seven right hemicolectomies and nine sigmoid colectomies) were recorded. Twelve (75%) were laparoscopic-assisted, and four (25%) were hand-assisted laparoscopic operations. Compliance with key surgical steps in laparoscopic right hemicolectomy and sigmoid colectomy was demonstrated in the majority of patients, with steps ranging in compliance from 42.9% to 100% and from 77.8% to 100%, respectively. The edited video had a median duration of 3 minutes 47 seconds (range, 1 minute 44 seconds-5 minutes 38 seconds) with a production time of nearly 1 hour and a resolution of 1440 × 1080 pixels. Key surgical steps during laparoscopic right hemicolectomy and sigmoid colectomy can be documented and edited into a short representative video. Standardization of this process should allow video documentation to improve quality in laparoscopic colon surgery.

  18. Laparoscopic Evaluation of Umbilical Disorders in Calves.

    PubMed

    Robert, Mickaël; Touzot-Jourde, Gwenola; Nikolayenkova-Topie, Olga; Cesbron, Nora; Fellah, Borhane; Tessier, Caroline; Gauthier, Olivier

    2016-11-01

    To describe a laparoscopic technique for evaluating umbilical disorders in calves, including feasibility, visualization of umbilical structures, and related complications. Prospective clinical study. Male calves (15 Holstein, 2 Montbeliard) with umbilical disorders (n=17). Calves <2 months old with obvious umbilical disease were assessed by clinical examination and ultrasonography of the umbilical structures. Laparoscopic evaluation was performed in dorsal recumbency under subarachnoid lumbosacral anesthesia and sedation. An open insertion technique with short 60 mm cannulas was used after creating 2 portals 10 cm cranial to the umbilicus (one 5 cm left of midline for the laparoscope and one 5 cm right of midline as an instrument portal). After laparoscopy, abnormal tissues were resected by laparotomy during the same anesthetic period. Laparoscopic evaluation of umbilical structures was performed quickly (mean surgery time 7.1 ± 2.5 minutes). Umbilical structures could be completely visualized in all calves without intraoperative complications. In addition to abnormalities previously detected on ultrasound, laparoscopy enabled detection of adhesions 7 calves that were not suspected on ultrasound, as well as focal enlargements of the umbilical arteries and urachus close to the bladder in 5 calves. Laparoscopy failed to detect abnormalities observed with ultrasound or laparotomy in 4 calves, including small hernias and omphalitis. Laparoscopic evaluation of umbilical structures was performed safely and quickly in young calves and allowed complete evaluation of intra-abdominal umbilical structures and may, therefore, be a useful adjunct to physical examination and ultrasound to fully assess the abdomen in calves. © Copyright 2016 by The American College of Veterinary Surgeons.

  19. Single-port laparoscopic surgery for sigmoid volvulus

    PubMed Central

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

    2015-01-01

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

  20. Safe laparoscopic surgery: tubal ligation without prior pneumoperitoneum.

    PubMed

    Biojó, R G; Manzi, G B

    1995-04-01

    Twelve years of experience with tubal ligation by the laparoscopic route at two highly specialized centers of female sterilization are discussed; special attention is given to the technique and results achieved. The number of intraoperative and postoperative complications was very low compared with data reported elsewhere. This article attempts to present the knowledge gained by using the laparoscopic technique, at a time when the use of laparoscopic surgery is extending around the world. The direct insertion of trocars without prior pneumoperitoneum has proved to be safe, and the risks of intraabdominal (visceral or vascular) injuries are minimized by observing simple rules, such as clamping of the relaxed abdominal anterior wall with towel clips, maintaining sharpened trocars, and using the extended index finger as a limit to introduce only the tip of the trocars. We consider a medical history of previous laparotomy secondary to peritonitis and open abdominal treatment absolute contraindications for this technique.

  1. Study on an infrared endoscope for energized laparoscopic method

    NASA Astrophysics Data System (ADS)

    Chen, Minghui; Song, Chengli

    2014-11-01

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

  2. Mutual mentoring in laparoscopic urology - a natural progression from laparoscopic fellowship.

    PubMed

    Jones, A; Eden, C; Sullivan, M E

    2007-05-01

    The objective of this study is to report a novel system of 'mutual mentoring' that overcomes the limited availability of laparoscopic mentors and allows progression from laboratory and fellowship experience into independent clinical practice. A total of 88 laparoscopic cases were performed during the fellowship. In the first 2 years as consultants, we (AJ and MS) performed 151 cases with mutual mentoring (simple nephrectomy [n = 28], radical nephrectomy [n = 35], nephro-ureterectomy [n = 19], pyeloplasty [n = 31], pelvic LND [n = 21], others [n = 17]). Mutual mentoring has resulted in the successful introduction of laparoscopic services to two hospitals, allowing an exposure to an average of two cases a week. Complication rates are acceptable and objective measures such as conversion rates, operative time and blood loss appear to be improving. Mutual mentoring allows for a greater through-put of cases, a high level of assistance, advice with intra-operative decisions and the potential to 'share' cases, reducing fatigue and increasing experience. It provides significant moral support in the difficult early days of starting the service. Its disadvantages are that it is time consuming and is geographically restrictive. Mutual mentoring has allowed us to introduce a laparoscopic service at our respective hospitals with high case-load acceptable complication rates.

  3. Laparoscopic injury of the obturator nerve during fertility-sparing procedure for cervical cancer

    PubMed Central

    2012-01-01

    Background Intraoperative injury of the obturator nerve has rarely been reported in patients with gynecological malignancies undergoing extensive radical surgeries. Irreversible damage of this nerve causes thigh paresthesia and claudication. Intraoperative repair may be done by end-to-end anastomosis or grafting when achieving tension-free anastomosis is not possible. Case presentation A 28-year-old woman with stage IB cervical cancer underwent fertility–sparing surgery, including conization and bilateral pelvic lymphadenectomy. The left obturator nerve was damaged intraoperatively during pelvic dissection. Conclusion Immediate laparoscopic repair was successful and there was no functional deficit in the left thigh for six months postoperatively. PMID:22931409

  4. [Value and technique of laparoscopic choledochus revision in choledocholithiasis].

    PubMed

    Czarnetzki, H D; Schulz, S; Jantschulev, M

    1998-01-01

    Despite a large scale indication to ERCP, 5% of unsuspected stones are shown by principally intraoperative cholangiography in our patients. Praeoperative diagnostic makes it possible to select the individual optimal therapy for each patient, the possibility of saving the Papilla vateri gives the large scale indication to laparoscopic common bile duct exploration. Also suspected stones gets a one-time cure therapy by complete laparoscopic operation. After balloon-dilatation of cysticus duct to 6 mm, the laparoscopic choledochoscopy is possible through the cysticus duct. Little stones are flushed into the duodenum or extracted by Segura-basket through the cysticus duct. Big stones needs a Laser- or electrohydraulic lithotripsy, the stonefragments can be flushed into the duodenum or aspirated through the cysticus duct. Multiple big or proximal incarcerated stones gives the indication for laparoscopic choledochotomy. Effective extraction is possible by big Segura-basket, residual stones are taken out under choledochoscopic control by little Segura-basket. Incarcerated stones needs the lithotripsy. Microdrainage of the common bile duct and only in special indication the T-tube saves the gall-flow to restitution of papilla function, the common bile duct is closed by running suture in Lahodny-technique. After the regular postoperative cholangiography on third day after operation, the microdrainage can be taken out. In 96% of all laparoscopic cholecystectomies the intraoperative cholangiography was successful. Only 3 of 103 patients needs a postoperative EPT because of residual fragments after trans cystic duct exploration. 8 laparoscopic choledochotomies shows the successness of endoscopic techniques, the postoperative complications can be the same then in conventional operation.

  5. Advanced laparoscopic fellowship training decreases conversion rates during laparoscopic cholecystectomy for acute biliary diseases: a retrospective cohort study.

    PubMed

    Abelson, Jonathan S; Afaneh, Cheguevara; Rich, Barrie S; Dakin, Gregory; Zarnegar, Rasa; Fahey, Thomas J; Pomp, Alfons

    2015-01-01

    Acute biliary pathology is a risk factor for conversion to open surgery and increased surgical morbidity during laparoscopic cholecystectomy (LC). The purpose of our study was to examine the impact of an advanced laparoscopic fellowship-trained surgeon on risks of conversion, surgical morbidity, and postoperative complications in this patient population. Of 1382 patients who underwent an LC from January 2008 to August 2011, 592 patients were diagnosed with an acute biliary process and were included in the study. Patients were divided into two groups; those operated on by an advanced laparoscopic fellowship-trained surgeon (N=237), and those operated on by a non-laparoscopic fellowship-trained surgeon (N=355). The primary end-points were conversion rates and surgical morbidity. The secondary end-point was operative time. Fellowship-trained surgeons were more likely to perform IOC (57%) versus non-fellowship trained surgeons (20%) (p<0.0001). The conversion rate for the fellowship-trained group was significantly lower than for the non-fellowship trained group (1.7% vs 8.5%, p=0.0004). The intraoperative and postoperative complication rates for the fellowship-trained group were not significantly different. The operative time was slightly longer in the non-fellowship trained group compared to the fellowship-trained group (104 min vs 111 min, p=0.04). Our data demonstrate that advanced laparoscopic fellowship training decreases conversion rates of laparoscopic cholecystectomy for acute biliary pathology. Moreover, given the lower conversion rates, patients may have experienced shorter hospitalizations. Formal advanced laparoscopic fellowship training may decrease length of stay among patients presenting with acute biliary pathology who undergo laparoscopic cholecystectomy. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

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

    PubMed Central

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

    2015-01-01

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

  7. Endoluminal ultrasound applicators for MR-guided thermal ablation of pancreatic tumors: Preliminary design and evaluation in a porcine pancreas model

    PubMed Central

    Adams, Matthew S.; Salgaonkar, Vasant A.; Plata-Camargo, Juan; Jones, Peter D.; Pascal-Tenorio, Aurea; Chen, Hsin-Yu; Bouley, Donna M.; Sommer, Graham; Pauly, Kim Butts; Diederich, Chris J.

    2016-01-01

    Purpose: Endoluminal ultrasound may serve as a minimally invasive option for delivering thermal ablation to pancreatic tumors adjacent to the stomach or duodenum. The objective of this study was to explore the basic feasibility of this treatment strategy through the design, characterization, and evaluation of proof-of-concept endoluminal ultrasound applicators capable of placement in the gastrointestinal (GI) lumen for volumetric pancreas ablation under MR guidance. Methods: Two variants of the endoluminal applicator, each containing a distinct array of two independently powered transducers (10 × 10 mm 3.2 MHz planar; or 8 × 10 × 20 mm radius of curvature 3.3 MHz curvilinear geometries) at the distal end of a meter long flexible catheter assembly, were designed and fabricated. Transducers and circulatory water flow for acoustic coupling and luminal cooling were contained by a low-profile polyester balloon covering the transducer assembly fixture. Each applicator incorporated miniature spiral MR coils and mechanical features (guiding tips and hinges) to facilitate tracking and insertion through the GI tract under MRI guidance. Acoustic characterization of each device was performed using radiation force balance and hydrophone measurements. Device delivery into the upper GI tract, adjacent to the pancreas, and heating characteristics for treatment of pancreatic tissue were evaluated in MR-guided ex vivo and in vivo porcine experiments. MR guidance was utilized for anatomical target identification, tracking/positioning of the applicator, and MR temperature imaging (MRTI) for PRF-based multislice thermometry, implemented in the real-time RTHawk software environment. Results: Force balance and hydrophone measurements indicated efficiencies of 48.8% and 47.8% and −3 dB intensity beam-widths of 3.2 and 1.2 mm for the planar and curvilinear transducers, respectively. Ex vivo studies on whole-porcine carcasses revealed capabilities of producing ablative temperature rise

  8. [Intraoperative floppy iris syndrome].

    PubMed

    Mazal, Z

    2007-04-01

    In the year 2005, Chang and Cambell described unusual reaction of the iris during the cataract surgery in patients treated with tamsulosine. This was named as IFIS, an acronym for the Intraoperative Floppy Iris Syndrome. In its advanced stage, the syndrome is characterized by insufficient mydfiasis before the surgery, narrowing of the pupil during the surgery, its impossible dilatation during the surgery by means of stretching, unusual elasticity of the pupilar margin, surging and fluttering iris with tendency to prolapse. The same manifestations we observed in our patients and we confirm the direct connection with tamsulosine hydrochloride treatment. Tamsulosine is the antagonist of alpha 1A adrenergic receptors whose are present, except in the smooth musculature of the prostate gland and the urinary bladder, in the iris dilator as well. At the same time we observed this syndrome rarely in some patients not using tamsulosine. In most cases, these patients were treated with antipsychotic drugs.

  9. Laparoscopic dissecting instruments.

    PubMed

    Park, A E; Mastrangelo, M J; Gandsas, A; Chu, U; Quick, N E

    2001-03-01

    The authors provide an overview of laparoscopic dissecting instruments and discuss early development, surgical options, and special features. End effectors of different shapes and functions are described. A comparison of available energy sources for laparoscopic instruments includes discussion of thermal dissection, ultrasonic dissection, and water-jet dissection. The ergonomic risks and challenges inherent in the use of current laparoscopic instruments are outlined, as well as ergonomic issues for the design of future instruments. New directions that laparoscopic instrumentation may take are considered in connection with developing technology in robotics, haptic feedback, and MicroElectroMechanical Systems.

  10. Laparoscopic Management of Huge Cervical Myoma.

    PubMed

    Peker, Nuri; Gündoğan, Savaş; Şendağ, Fatih

    . Owing to the anatomic structure of the cervical region, the incision was closed in a monolayer with 0 Vicryl. Total intraoperative blood loss was 300 mL, the total weight of the myoma was 670 g, and the operation lasted approximately 140 minutes. The patient experienced no intraoperative complications. She was discharged on postoperative day 1 and did not exhibit any problems at follow-up. The final histopathological examination confirmed the diagnosis of uterine leiomyoma. Laparoscopic management of huge myomas in difficult locations such as the cervical region seems to be a feasible and safe surgical option, especially in experienced hands. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  11. Laparoscopic Proximal Gastrectomy With Gastric Tube Reconstruction

    PubMed Central

    Shiraishi, Norio; Toujigamori, Manabu; Shiroshita, Hidefumi; Etoh, Tsuyoshi; Inomata, Masafumi

    2016-01-01

    Background and Objectives: There is no standardized method of reconstruction in laparoscopic proximal gastrectomy (LPG). We present a novel technique of reconstruction with a long, narrow gastric tube in LPG for early gastric cancer (EGC). Methods: During the laparoscopic procedure, the upper part of the stomach is fully mobilized with perigastric and suprapancreatic lymphadenectomy, and then the abdominal esophagus is transected. After a minilaparotomy is created, the entire stomach is pulled outside. A long, narrow gastric tube (20 cm long, 3 cm wide) is created with a linear stapler. The proximal part of the gastric tube is formed into a cobra head shape for esophagogastric tube anastomosis, which is then performed with a 45-mm linear stapler under laparoscopic view. The end of the esophagus is fixed on the gastric tube to prevent postoperative esophageal reflux. Results: Thirteen patients with early proximal gastric cancer underwent the procedure. The mean operative time was 283 min, and median blood loss was 63 ml. There were no conversions to open surgery, and no intraoperative complications. Conclusion: This new technique of reconstruction after LPG is simple and feasible. The procedure has the potential of becoming a standard reconstruction technique after LPG for proximal EGC. PMID:27547027

  12. Impact of anesthetic technique on the stress response elicited by laparoscopic cholecystectomy: a randomized trial.

    PubMed

    Sidiropoulou, Irine; Tsaousi, Georgia G; Pourzitaki, Chryssa; Logotheti, Helen; Tsantilas, Dimitrios; Vasilakos, Dimitrios G

    2016-06-01

    The aim of this randomized, double-blind clinical trial was to elucidate the impact of general anesthesia alone (GA) or supplemented with epidural anesthesia (EpiGA) on surgical stress response during laparoscopic cholecystectomy, using stress hormones, glucose, and C-reactive protein (CRP), as potential markers. Sixty-two patients scheduled to undergo elective laparoscopic cholecystectomy were randomly assigned into two groups to receive either GA or EpiGA. Stress hormones [cortisol (COR), human growth hormone (hGH), prolactine (PRL)], glucose, and CRP were determined 1 day before surgery, intraoperatively, and upon first postoperative day (POD1). Plasma COR, hGH, PRL, and glucose levels were maximized intraoperatively in GA and EpiGA groups and reverted almost to baseline on POD1. Significant between-group differences were detected for COR and glucose either intraoperatively or postoperatively, but this was not the case for hGH. PRL was elevated in GA group only intraoperatively. Although, CRP was minimally affected intraoperatively, a notable augmentation on POD1, comparable in both groups, was recorded. These results indicate that hormonal and metabolic stress response is slightly modulated by the use of epidural block supplemented by general anesthesia, in patients undergoing laparoscopic cholecystectomy cholecystectomy. Nevertheless, inflammatory reaction as assessed by CRP seems to be unaffected by the anesthesia regimen.

  13. Intraoperative augmented reality for minimally invasive liver interventions

    NASA Astrophysics Data System (ADS)

    Scheuering, Michael; Schenk, Andrea; Schneider, Armin; Preim, Bernhard; Greiner, Guenther

    2003-05-01

    Minimally invasive liver interventions demand a lot of experience due to the limited access to the field of operation. In particular, the correct placement of the trocar and the navigation within the patient's body are hampered. In this work, we present an intraoperative augmented reality system (IARS) that directly projects preoperatively planned information and structures extracted from CT data, onto the real laparoscopic video images. Our system consists of a preoperative planning tool for liver surgery and an intraoperative real time visualization component. The planning software takes into account the individual anatomy of the intrahepatic vessels and determines the vascular territories. Methods for fast segmentation of the liver parenchyma, of the intrahepatic vessels and of liver lesions are provided. In addition, very efficient algorithms for skeletonization and vascular analysis allowing the approximation of patient-individual liver vascular territories are included. The intraoperative visualization is based on a standard graphics adapter for hardware accelerated high performance direct volume rendering. The preoperative CT data is rigidly registered to the patient position by the use of fiducials that are attached to the patient's body, and anatomical landmarks in combination with an electro-magnetic navigation system. Our system was evaluated in vivo during a minimally invasive intervention simulation in a swine under anesthesia.

  14. Robotics applied in laparoscopic kidney surgery: the Yonsei University experience of 127 cases.

    PubMed

    Lorenzo, Enrique Ian S; Jeong, Wooju; Oh, Cheol Kyu; Chung, Byung Ha; Choi, Young Deuk; Rha, Koon Ho

    2011-01-01

    We report our experience on 127 kidney surgeries with the da Vinci surgical system and show the feasibility of a robotics application in a variety of kidney surgeries by both a laparoscopically-trained and a laparoscopically-naïve surgeon. Clinical data of patients who underwent kidney surgery with the da Vinci surgical system from September 2006 to April 2009 were reviewed. Data acquired from medical records included patient demographics, operative time, estimated blood loss (EBL), incidence of intraoperative complication, duration of hospital stay, blood transfusion rate, oncological outcomes, and follow-up results. One-hundred twenty-seven kidney surgeries have been conducted with the da Vinci surgical system at our institution. Three urologists--1 with formal endourology training, 1 with laparoscopic experience, and 1 laparoscopically naïve--have used it for a variety of procedures involving the kidney. The cases include 65 partial nephrectomies (RPN), 38 radical nephrectomies (RRN), and 24 nephroureterectomies with bladder cuff (RNU). Results on operative time, EBL, incidence of intraoperative injury, duration of hospital stay, and blood transfusion rate are comparable with contemporary studies. Robotics application in kidney surgery is a viable option for various procedures. Our experience shows it can be safely and effectively conducted by both laparoscopically-trained and laparoscopically-naïve surgeons once they are accustomed to the robotics system. Copyright © 2011 Elsevier Inc. All rights reserved.

  15. Safety and Cost Considerations during the Introduction Period of Laparoscopic Radical Hysterectomy.

    PubMed

    Anagnostopoulos, A; Mitra, S; Decruze, B; Macdonald, R; Kirwan, J

    2017-01-01

    Objective. To compare the safety, efficacy, and direct cost during the introduction of laparoscopic radical hysterectomy within an enhanced recovery pathway. Methods. A 1 : 1 single centre retrospective case control study of 36 propensity matched pairs of patients receiving open or laparoscopic surgery for early cervical cancer. Results. There were no significant differences in the baseline characteristics of the two cohorts. Open surgery cohort had significantly higher intraoperative blood loss (189 versus 934 mL) and longer postoperative hospital stay (2.3 versus 4.1 days). Although no significant difference in the intraoperative or postoperative complications was found more urinary tract injuries were recorded in the laparoscopic cohort. Laparoscopic surgery had significantly longer duration (206 versus 159 minutes), lower lymph node harvest (12.6 versus 16.9), and slower bladder function recovery. The median direct hospital cost was £4850 for laparoscopic radical hysterectomy and £4400 for open surgery. Conclusions. Laparoscopic radical hysterectomy can be safely introduced in an enhanced recovery environment without significant increase in perioperative morbidity. The 10% higher direct hospital cost is not statistically significant and is expected to even out when indirect costs are included.

  16. Safety and Cost Considerations during the Introduction Period of Laparoscopic Radical Hysterectomy

    PubMed Central

    Decruze, B.; Macdonald, R.; Kirwan, J.

    2017-01-01

    Objective. To compare the safety, efficacy, and direct cost during the introduction of laparoscopic radical hysterectomy within an enhanced recovery pathway. Methods. A 1 : 1 single centre retrospective case control study of 36 propensity matched pairs of patients receiving open or laparoscopic surgery for early cervical cancer. Results. There were no significant differences in the baseline characteristics of the two cohorts. Open surgery cohort had significantly higher intraoperative blood loss (189 versus 934 mL) and longer postoperative hospital stay (2.3 versus 4.1 days). Although no significant difference in the intraoperative or postoperative complications was found more urinary tract injuries were recorded in the laparoscopic cohort. Laparoscopic surgery had significantly longer duration (206 versus 159 minutes), lower lymph node harvest (12.6 versus 16.9), and slower bladder function recovery. The median direct hospital cost was £4850 for laparoscopic radical hysterectomy and £4400 for open surgery. Conclusions. Laparoscopic radical hysterectomy can be safely introduced in an enhanced recovery environment without significant increase in perioperative morbidity. The 10% higher direct hospital cost is not statistically significant and is expected to even out when indirect costs are included. PMID:28167964

  17. Laparoscopic Surgery - What Is It?

    MedlinePlus

    ... Surgery - What is it? Laparoscopic Surgery - What is it? Laparoscopic Surgery - What is it? | ASCRS WHAT IS LAPAROSCOPIC SURGERY? Laparoscopic or “minimally ... information about the management of the conditions addressed. It should be recognized that these brochures should not ...

  18. Comparative evaluation of conventional and transvaginal laparoscopic ovariohysterectomy in dogs.

    PubMed

    Bakhtiari, Jalal; Khalaj, Ali Reza; Aminlou, Elham; Niasari-Naslaji, Amir

    2012-08-01

    To evaluate the feasibility and safety of a transvaginal approach for laparoscopic ovariohysterectomy (OVH) in dogs and to compare it with conventional laparoscopic OVH. Prospective study. Adult healthy female mixed breed dogs (n = 24). Dogs (weighing 14-17 kg) were anesthetized and positioned in dorsal recumbency for ovariohysterectomy. Dogs were prepared for either conventional (n = 12) or transvaginal (n = 12) laparoscopic OVH. For conventional laparoscopic OVH, 3 midline abdominal portals were used and for the transvaginal approach, 2 midline abdominal portals and one vaginal portal were used. The transected ovarian pedicles, broad ligament, and uterus were removed through the umbilical region in the conventional method and through the vagina in the transvaginal method. Mean surgical time, intraoperative and postoperative complications, clinical and hematologic findings, and wound complications were compared. OVH was successfully performed without complications using both methods. Mean ± SD surgical times were similar between conventional (34.2 ± 4.03 min) and transvaginal (37.0 ± 3.56 min) methods. No significant differences, hematologic and clinical variables, were found between groups. The vaginal port could limit surgical maneuvers ergonomically during manipulation of the uterine body. Transvaginal approach for laparoscopic OVH is a feasible technique with the advantage of requiring one less abdominal portal. © Copyright 2012 by The American College of VeterinarySurgeons.

  19. Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy in Children and Adolescents

    PubMed Central

    Yu, Sherman C.; Petty, John K.; Bensard, Denis D.; Partrick, David A.; Bruny, Jennifer L.

    2005-01-01

    Objective: Pediatric gastric access for long-term enteral feeding may be performed via a laparotomy, laparoscopy, or a percutaneous approach. In children and adolescents, laparoscopic-assisted gastrostomy may be difficult due to a thick abdominal wall. Therefore, if the abdominal wall is estimated to be >2 cm on physical examination, or in children in whom a percutaneous endoscopic gastrostomy was unsuccessfully attempted by a gastroenterologist, we routinely perform a laparoscopic-assisted percutaneous endoscopic gastrostomy. Methods: From January 1998 through February 2003, we retrospectively reviewed 15 cases of a laparoscopic-assisted percutaneous endoscopic gastrostomy. Instruments used to perform this technique are a percutaneous endoscopic gastrostomy kit, an Olympus flexible endoscope, and one 5-mm STEP port placed through an infraumbilical incision for a 5-mm, 30-degree scope. Results: Age range was 2 years to 20 years (mean, 10). Operative time ranged from 20 minutes to 45 minutes. When a concurrent laparoscopic Nissen fundoplication was performed (n = 6), the percutaneous endoscopic gastrostomy was placed after completion of the Nissen fundoplication. No intraoperative complications occurred, and all tubes were successfully placed. Feeds were instituted the following day and advanced to goal. To date, no postoperative complications have occurred, and revision has not been necessary. Conclusions: Laparoscopic-assisted percutaneous endoscopic gastrostomy in children and adolescents is safe and effective. Utilizing laparoscopy permits evaluation of the peritoneum and lysis of adhesions, if necessary. Moreover, laparoscopy provides excellent exposure for accurate placement of the PEG, while avoiding injury to other organs. PMID:16121876

  20. Laparoscopic peritoneal lavage: our experience and review of the literature

    PubMed Central

    Parisi, Amilcare; Desiderio, Jacopo; Petrina, Adolfo; Trastulli, Stefano; Grassi, Veronica; Sani, Marco; Pironi, Daniele; Santoro, Alberto

    2016-01-01

    Introduction Over the years various therapeutic techniques for diverticulitis have been developed. Laparoscopic peritoneal lavage (LPL) appears to be a safe and useful treatment, and it could be an effective alternative to colonic resection in emergency surgery. Aim This prospective observational study aims to assess the safety and benefits of laparoscopic peritoneal lavage in perforated sigmoid diverticulitis. Material and methods We surgically treated 70 patients urgently for complicated sigmoid diverticulitis. Thirty-two (45.7%) patients underwent resection of the sigmoid colon and creation of a colostomy (Hartmann technique); 21 (30%) patients underwent peritoneal laparoscopic lavage; 4 (5.7%) patients underwent colostomy by the Mikulicz technique; and the remaining 13 (18.6%) patients underwent resection of the sigmoid colon and creation of a colorectal anastomosis with a protective ileostomy. Results The 66 patients examined were divided into 3 groups: 32 patients were treated with urgent surgery according to the Hartmann procedure; 13 patients were treated with resection and colorectal anastomosis; 21 patients were treated urgently with laparoscopic peritoneal lavage. We had no intraoperative complications. The overall mortality was 4.3% (3 patients). In the LPL group the morbidity rate was 33.3%. Conclusions Currently it cannot be said that LPL is better in terms of mortality and morbidity than colonic resection. These data may, however, be proven wrong by greater attention in the selection of patients to undergo laparoscopic peritoneal lavage. PMID:27458487

  1. Complications After Laparoscopic and Conventional Cholecystectomy: A Comparative Study

    PubMed Central

    Brune, Iris B.; Schönleben, K.; Omran, S.

    1994-01-01

    The growing popularity of laparoscopic cholecystectomy (LC) has made extensive series comparing laparoscopic and conventional cholecystectomy in a prospective, randomized way nearly impossible. To evaluate LC we compared retrospectively 800 laparoscopic with 748 conventional cholecystectomies (CC). Of the 800 LC, 10 (1.2%) were converted to laparotomy. 6 conversions were related to aberrant anatomical features or features making dissection very difficult, 4 conversions were due to complications. There were 5 (0, 6%) intraoperative complications during LC and 4 (0.5%) during CC. Postoperative morbidity was 2.1% (n = 17) after LC and 3.7% (n = 28) after CC. Particularly the incidence of wound problems was only 0.5% (n = 4) after LC while it was 1.3% (n = 10) after CC. Overall morbidity was 2.7% (n = 22) for LC and 4.2% (n = 32) for CC. Mortality rate after CC was 0.4% (n = 3), there were no deaths after LC. Common bile duct-injury rate was 0.2% (n = 2) for both groups. Complication rates after LC have been rapidly decreasing with growing experience. Laparoscopic cholecystectomy can safely be performed by appropriately trained surgeons in more than 90% of patients suffering from gallbladder disease. The low morbidity and mortality together with the significant advantages to patient recovery makes laparoscopic cholecystectomy the treatment of choice for symptomatic cholecystolithiasis. PMID:7993860

  2. Laparoscopic appendectomy for acute appendicitis: indications and current use.

    PubMed

    Nowzaradan, Y; Westmoreland, J; McCarver, C T; Harris, R J

    1991-10-01

    Laparoscopic evaluation was performed in 43 consecutive patients with right lower abdominal pain and preoperative diagnosis of possible appendicitis. Patients with generalized peritonitis and evidence of perforation of the appendix were not considered for laparoscopy. Visualization was sufficient for making a diagnosis in 97.7% of the cases. In 95%, laparoscopic findings were compatible with the pathology report. Thirty-five patients underwent successful laparoscopic appendectomy with neither intraoperative nor postoperative complications. No further surgery was required; slightly elevated temperatures in 6 patients responded to treatment with antibiotics, and there were no wound infections. Laparoscopic appendectomy is minimally invasive and results in less postoperative pain and morbidity and fewer adhesions and other long-term sequelae than conventional laparotomy. It is associated with superior cosmetic results, a shorter hospital stay, and faster return to normal activities. This experience suggests that if there is no evidence that the appendix is perforated or that generalized peritonitis exists and if qualified physicians and adequate facilities are available, patients presenting with right lower quadrant abdominal pain and possible appendicitis are best evaluated and treated with laparoscopic technique.

  3. Single port laparoscopic right hemicolectomy for ileocolic intussusception

    PubMed Central

    Chen, Jia-Hui; Wu, Jhe-Syun

    2013-01-01

    A 36-year-old male was admitted with right lower abdominal pain and diarrhea for more than 3 mo. Colonoscopy and a barium enema study revealed a submucosal tumor over the cecum, but computed tomography showed an ileal lipoma. There was no definitive diagnosis preoperatively, but ileocolic intussusception was noted during surgery. Single port laparoscopic radical right hemicolectomy was performed because intra-operative reduction failed. The histological diagnosis of the resected tumor was lipoma. Single port laparoscopic surgery has recently been proven to be safe and feasible. There are advantages compared with conventional laparoscopic surgery, such as smaller incision wounds, fewer port site complications, and easier conversion. However, there are some drawbacks which need to be overcome, such as difficulties in triangulation and instrument clashing. If there are no contraindications to laparoscopy, single port laparoscopic surgery can be performed safely and should be considered for diagnosis and treatment of intussusception in adults. Here, we report the first case of ileocolic intussusception successfully treated by single port laparoscopic surgery. PMID:23538552

  4. Single port laparoscopic right hemicolectomy for ileocolic intussusception.

    PubMed

    Chen, Jia-Hui; Wu, Jhe-Syun

    2013-03-07

    A 36-year-old male was admitted with right lower abdominal pain and diarrhea for more than 3 mo. Colonoscopy and a barium enema study revealed a submucosal tumor over the cecum, but computed tomography showed an ileal lipoma. There was no definitive diagnosis preoperatively, but ileocolic intussusception was noted during surgery. Single port laparoscopic radical right hemicolectomy was performed because intra-operative reduction failed. The histological diagnosis of the resected tumor was lipoma. Single port laparoscopic surgery has recently been proven to be safe and feasible. There are advantages compared with conventional laparoscopic surgery, such as smaller incision wounds, fewer port site complications, and easier conversion. However, there are some drawbacks which need to be overcome, such as difficulties in triangulation and instrument clashing. If there are no contraindications to laparoscopy, single port laparoscopic surgery can be performed safely and should be considered for diagnosis and treatment of intussusception in adults. Here, we report the first case of ileocolic intussusception successfully treated by single port laparoscopic surgery.

  5. Laparoscopic proctocolectomy with restorative ileal-anal pouch.

    PubMed

    Gill, T S; Karantana, A; Rees, J; Pandey, S; Dixon, A R

    2004-11-01

    The aim of the study was to analyse the outcome of restorative proctocolectomy carried out by laparoscopic surgery. A prospectively collected electronic database of all colorectal laparoscopic procedures performed between April 2001 and July 2003 has been used to identify surgical outcomes in 14 consecutive patients who have undergone laparoscopic RPC. Fourteen patients (5 male), median BMI 24 kg/m(2) have undergone restorative laparoscopic proctocolectomy over a two year period: 13 (ulcerative colitis, one with cancer) and 1 (FAP). The median operation time was 260 min; time has not decreased with experience. There were no intra-operative surgical complications or deaths. Patient controlled analgesia continued for a median of 36 h. The median time to diet was 48 h and median hospital stay 7 days; three patients required nasogastric aspiration for delayed gastric emptying. Eighteen regional lymph nodes were retrieved local to the carcinoma. There was one anastomotic leak. All covering stomas were closed by 6 months (12 by eight weeks). All 14 patients are fully continent, able to suppress urgency and have a median pouch frequency of 4/24 h. None admit to having problems with potency, orgasm sensation, ejaculation, micturition. One lady reports dysparunia. All are highly satisfied with functional outcome and cosmesis. We are encouraged to continue to offer our patients the option of a laparoscopic resection.

  6. Impact of Scoliosis on Laparoscopic Nissen Fundoplication.

    PubMed

    Ishimaru, Tetsuya; Sugiyama, Masahiko; Arai, Mari; Satoh, Kaori; Uotani, Chizue; Takahashi, Masataka; Takami, Shohei; Fujishiro, Jun; Iwanaka, Tadashi

    2016-11-01

    Scoliosis, which is often associated with neurological impairment in children, sometimes makes it difficult to perform laparoscopic procedures. This study assessed the impact of scoliosis on performing laparoscopic Nissen fundoplication. Medical records and radiographic examinations of patients who underwent laparoscopic Nissen fundoplication at a single institution from 2006 to 2015 were reviewed retrospectively. Patients' data on age at surgery, height, weight, duration of pneumoperitoneum, and amount of bleeding were collected. The Cobb angle was measured using X-rays, and the direction (right or left) of the scoliotic curve was recorded. The chest compression ratio was calculated using computed tomography axial images. Eighty-five patients were included and analyzed in this study, of which 89% were neurologically impaired. Median age, height, and weight were 120 months, 110 cm, and 17 kg, respectively. A positive correlation between age and the Cobb angle (ρ = 0.64) and a negative correlation between age and the chest compression ratio (ρ = -0.56) were observed. The right-curved scoliotic group showed significantly more bleeding than the nonscoliotic (<10°) group (P = .01; nonscoliotic, 0 mL; right curved, 7.5 mL; left curved, 0 mL). The severe scoliotic group (≥45°) showed more bleeding than the nonscoliotic group (P = .02). Neither the direction of the scoliotic curve nor scoliotic severity showed a significant difference in the duration of pneumoperitoneum. The older the patient, the more severe their scoliosis and chest compression were. Right-curved or severe scoliosis could be risk factors for intraoperative bleeding in laparoscopic Nissen fundoplication.

  7. Rapid intraoperative insulin assay: a novel method to differentiate insulinoma from nesidioblastosis in the pediatric patient.

    PubMed

    Strong, Vivian E; Shifrin, Alexander; Inabnet, William B

    2007-10-24

    Hyperinsulinism is the most common cause of recurrent and persistent hypoglycemia in infancy and childhood. Causes can include nesidioblastosis, pancreatic islet cell tumors such as insulinoma, and associations with multiple endocrine neoplasia syndromes. Although new, improved imaging techniques have allowed for more precise preoperative localization of insulinomas, the differentiation of nesidioblastosis and insulinoma, particularly in children, can be challenging. To improve intraoperative localization and confirmation of successful resection of insulinoma, a novel hormonal assay, the rapid intraoperative insulin assay, is reported for the first time in a pediatric patient. This intraoperative radioimmunoassay for insulin yields results within several minutes and confirms complete resection of insulinoma. We present a case of pancreatic insulinoma in a child with symptoms of severe hypoglycemia, causing seizures. The insulinoma was enucleated laparoscopically, and rapid intra-operative insulin assay used to determine the success of the procedure. This rapid intra-operative test provides a valuable adjunct for determining complete excision in complicated cases of recurrent or questionable insulinoma. Although not a common problem, for pediatric patients in whom the diagnosis is not clear, this test may provide a novel approach to confirming disease. We propose the use of this assay in facilitating intra-operative resection and confirmation of complete excision in pediatric patients. This population may especially benefit from this novel assay to confirm complete resection and to differentiate multiple etiologies of hyperinsulinism.

  8. Laparoscopic Resection of Cesarean Scar Ectopic Pregnancy.

    PubMed

    Ades, Alex; Parghi, Sneha

    . Laparoscopic excision of cesarean section scar ectopic pregnancy is an effective procedure for the management of this increasingly more common condition. The use of vasopressin intraoperatively and laparoscopic suturing can prevent hemorrhage and allow for the safe removal of the ectopic pregnancy with multilayer repair of the uterine defect. Copyright © 2016 AAGL. All rights reserved.

  9. Laparoscopic repair of paraesophageal hernias: a Canadian experience

    PubMed Central

    Boushey, Robin P.; Moloo, Husein; Burpee, Stephen; Schlachta, Christopher M.; Poulin, Eric C.; Haggar, Fatima; Trottier, Daniel C.; Mamazza, Joseph

    2008-01-01

    Background The surgical approach to paraesophageal hernias (PEH) has changed with the advent of laparoscopic techniques. Variation in both perioperative outcomes and hernia recurrence rates are reported in the literature. We sought to evaluate the short-and intermediate-term outcomes with laparoscopic PEH repair. Methods We performed a retrospective review of patients having laparoscopic repair of PEH between June 1998 and September 2002. We included patients with more than 120 days of follow-up. Results A total of 58 patients with a mean age of 60.4 (standard deviation [SD] 15.0) years had a laparoscopic procedure to repair a primary PEH, as well as adequate follow-up, during the study period. The types of PEH included type II (n = 13), III (n = 44) and IV (n = 1). The most common symptoms were epigastric pain (57%), dysphagia (40%), heartburn (31%) and vomiting (28%). Associated procedures included 56 (96%) Nissen fundoplications and 2 (4%) gastropexies. We closed all crural defects either with or without pledgets, and 2 patients required the use of mesh. There was 1 conversion to open surgery owing to intraoperative bleeding secondary to a consumptive coagulopathy; we observed no other major intraoperative emergencies. Minor or major complications occurred in 15 patients (26%). Late postoperative complications included 1 umbilical hernia. The mean length of stay in hospital was 3.8 (SD 2.5) days. After surgery, 19 patients were completely asymptomatic, and the majority of the remaining patients (83%) described marked symptom improvement. Upper gastrointestinal series performed in symptomatic patients in the postoperative setting identified 5 recurrent paraesophageal hernias (8.6%) and 5 small sliding hernias (9%). Conclusion Laparoscopic repair of PEH is associated with improved long-term symptom relief, low morbidity and acceptable recurrence rates when performed in an experienced centre. PMID:18841230

  10. Laparoscopic cholecystectomy under spinal anaesthesia: A prospective, randomised study

    PubMed Central

    Tiwari, Sangeeta; Chauhan, Ashutosh; Chaterjee, Pallab; Alam, Mohammed T

    2013-01-01

    CONTEXT: Spinal anaesthesia has been reported as an alternative to general anaesthesia for performing laparoscopic cholecystectomy (LC). AIMS: Study aimed to evaluate efficacy, safety and cost benefit of conducting laparoscopic cholecystectomy under spinal anaesthesia (SA) in comparison to general anaesthesia(GA) SETTINGS AND DESIGN: A prospective, randomised study conducted over a two year period at an urban, non teaching hospital. MATERIALS AND METHODS: Patients meeting inclusion criteria e randomised into two groups. Group A and Group B received general and spinal anaesthesia by standardised techniques. Both groups underwent standard four port laparoscopic cholecystectomy. Mean anaesthesia time, pneumoperitoneum time and surgery time defined primary outcome measures. Intraoperative events and post operative pain score were secondary outcome measure. STATISTICAL ANALYSIS USED: The Student t test, Pearson′s chi-square test and Fisher exact test. RESULTS: Out of 235 cases enrolled in the study, 114 cases in Group A and 110 in Group B analysed. Mean anaesthesia time appeared to be more in the GA group (49.45 vs. 40.64, P = 0.02) while pneumoperitoneum time and corresponding the total surgery time was slightly longer in the SA group. 27/117 cases who received SA experienced intraoperative events, four significant enough to convert to GA. No postoperative complications noted in either group. Pain relief significantly more in SA group in immediate post operative period (06 and 12 hours) but same as GA group at time of discharge (24 hours). No late postoperative complication or readmission noted in either group. CONCLUSION: Laparoscopic cholecystectomy done under spinal anaesthesia as a routine anaesthesia of choice is feasible and safe. Spinal anaesthesia can be recommended to be the anaesthesia technique of choice for conducting laparoscopic cholecystectomy in hospital setups in developing countries where cost factor is a major factor. PMID:23741111

  11. Prospective randomized comparison of transumbilical two-port laparoscopic and conventional laparoscopic varicocele ligation

    PubMed Central

    Zhang, Guo-Xi; Yang, Jun; Long, Da-Zhi; Liu, Min; Zou, Xiao-Feng; Yuan, Yuan-Hu; Xiao, Ri-Hai; Xue, Yi-Jun; Zhong, Xin; Liu, Quan-Liang; Liu, Fo-Lin; Jiang, Bo; Xu, Rui-Quan; Xie, Kun-Lin

    2017-01-01

    We have established a novel method named transumbilical two-port laparoscopic varicocele ligation (TTLVL) for varicocele, which is still needed to evaluate. In this study, 90 patients with left idiopathic symptomatic varicoceles of grades II–III according to the Dubin grading system were randomly assigned to TTLVL (n = 45) and conventional laparoscopic varicocele ligation (CLVL) (n = 45). The demographic, intraoperative, postoperative, and follow-up data were recorded and compared between the two groups. All the procedures in the two groups were completed successfully with no intraoperative complications and no conversions to open surgery. No significant difference was found in the operative time, resuming ambulation, bowel recovery, postoperative hospital stay, and postoperative resolution of scrotal pain between the two groups (P > 0.05). However, the postoperative mean visual analog pain scale scores for TTLVL group were all less at 24 h, 48 h, 72 h, and 7 days postoperatively compared to CLVL (P = 0.001, 0.010, 0.006, and 0.027, respectively). The mean patient scar assessment questionnaire score in postoperative month 3 was 29.7 for TTLVL group compared with 32.1 for CLVL group (P < 0.001). There was no testicular atrophy observed in both groups during the follow-up period. The study shows that TTLVL is a safe, feasible, and effective minimally invasive surgical alternative to CLVL for the treatment of varicocele. Compared with CLVL, TTLVL may decrease postoperative pain and improve the cosmetic outcomes. PMID:26732104

  12. The first laparoscopic cholecystectomy.

    PubMed

    Reynolds, W

    2001-01-01

    Prof Dr Med Erich Mühe of Böblingen, Germany, performed the first laparoscopic cholecystectomy on September 12, 1985. The German Surgical Society rejected Mühe in 1986 after he reported that he had performed the first laparoscopic cholecystectomy, yet in 1992 he received their highest award, the German Surgical Society Anniversary Award. In 1990 in Atlanta, at the Society of American Gastrointestinal Surgeons (SAGES) Convention, Perissat, Berci, Cuschieri, Dubois, and Mouret were recognized by SAGES for performing early laparoscopic cholecystectomies, but Mühe was not. However, in 1999 he was recognized by SAGES for having performed the first laparoscopic cholecystectomy-SAGES invited Mühe to present the Storz Lecture. In Mühe's presentation, titled "The First Laparoscopic Cholecystectomy," which he gave in March 1999 in San Antonio, Texas, he described the first procedure. Finally, Mühe had received the worldwide acclaim that he deserved for his pioneering work. One purpose of this article is to trace the development of the basic instruments used in laparoscopic cholecystectomy. The other purpose is to give Mühe the recognition he deserves for being the developer of the laparoscopic cholecystectomy procedure.

  13. Laparoscopic Nissen fundoplication.

    PubMed Central

    Jamieson, G G; Watson, D I; Britten-Jones, R; Mitchell, P C; Anvari, M

    1994-01-01

    OBJECTIVE: The authors laparoscopic approach for a Nissen fundoplication is presented. SUMMARY BACKGROUND DATA: The technique has been undertaken in 155 patients over 29 months, with 137 patients having been observed for more than 3 months. METHODS: Three hundred sixty degree fundoplication was undertaken using three or four sutures to secure the wrap. Short gastric vessels were not divided, and the anterior wall of the stomach was used to construct the wrap around the esophagus with a large bougie in position. RESULTS: The operation was not completed laparoscopically in 19 patients because a satisfactory wrap could not be achieved. Ten patients undergoing laparoscopic fundoplication underwent a subsequent operation related to the laparoscopic procedure within 6 months, and there was one postoperative death. Seven other patients were readmitted to the hospital several days subsequent to their discharge, four because of pulmonary emboli. Of 137 patients who have been observed for more than 3 months, 133 patients are well and currently are free from reflux symptoms. CONCLUSIONS: In uncomplicated cases, laparoscopic fundoplication has similar advantages to laparoscopic cholecystectomy. In spite of the fact that it has not yet achieved the overall usefulness of open fundoplication, it seems likely that laparoscopic fundoplication will be used increasingly in the treatment of patients with gastroesophageal reflux disease. Images Figure 7. Figure 8. PMID:8053735

  14. Laparoscopic total pancreatectomy

    PubMed Central

    Wang, Xin; Li, Yongbin; Cai, Yunqiang; Liu, Xubao; Peng, Bing

    2017-01-01

    Abstract Rationale: Laparoscopic total pancreatectomy is a complicated surgical procedure and rarely been reported. This study was conducted to investigate the safety and feasibility of laparoscopic total pancreatectomy. Patients and Methods: Three patients underwent laparoscopic total pancreatectomy between May 2014 and August 2015. We reviewed their general demographic data, perioperative details, and short-term outcomes. General morbidity was assessed using Clavien–Dindo classification and delayed gastric emptying (DGE) was evaluated by International Study Group of Pancreatic Surgery (ISGPS) definition. Diagnosis and Outcomes: The indications for laparoscopic total pancreatectomy were intraductal papillary mucinous neoplasm (IPMN) (n = 2) and pancreatic neuroendocrine tumor (PNET) (n = 1). All patients underwent laparoscopic pylorus and spleen-preserving total pancreatectomy, the mean operative time was 490 minutes (range 450–540 minutes), the mean estimated blood loss was 266 mL (range 100–400 minutes); 2 patients suffered from postoperative complication. All the patients recovered uneventfully with conservative treatment and discharged with a mean hospital stay 18 days (range 8–24 days). The short-term (from 108 to 600 days) follow up demonstrated 3 patients had normal and consistent glycated hemoglobin (HbA1c) level with acceptable quality of life. Lessons: Laparoscopic total pancreatectomy is feasible and safe in selected patients and pylorus and spleen preserving technique should be considered. Further prospective randomized studies are needed to obtain a comprehensive understanding the role of laparoscopic technique in total pancreatectomy. PMID:28099344

  15. Fluorescence Ureteral Visualization in Human Laparoscopic Colorectal Surgery Using Methylene Blue.

    PubMed

    Al-Taher, Mahdi; van den Bos, Jacqueline; Schols, Rutger M; Bouvy, Nicole D; Stassen, Laurents P S

    2016-11-01

    Ureteral injury during laparoscopic surgery is rare, but when it occurs, it can be a serious problem. Near-infrared fluorescence (NIRF) with methylene blue (MB) administration is a promising technique for easier and potentially earlier intraoperative visualization of the ureter. Aim of this prospective study was to assess the feasibility of NIRF imaging of the ureter during laparoscopic colorectal surgery, using MB. Patients undergoing laparoscopic colorectal surgery were included and received intravenous injection of MB preoperatively. The ureter was visualized using a laparoscope, which offered both conventional and fluorescence imaging. Intraoperative recognition of the ureter was registered. The precision of ureter distinction with MB imaging was compared to the conventional laparoscopic view. Ten patients were included. All procedures were initially performed using a laparoscopic approach. Dose per injection ranged between 0.125 mg/kg and 1.0 mg/kg bodyweight. There were no adverse effects attributable to MB administration. The ureter was successfully detected in five patients, with highest contrast between ureter and surrounding tissue at an administered dose of 0.75-1.0 mg/kg. The fluorescent signal was only picked up after the ureter was already visible in the conventional white light mode. Ureteral fluorescence imaging using MB proved to be safe and feasible. However, the present technique does not provide practical advantage over conventional laparoscopic imaging for identification of the ureter during laparoscopic colorectal surgery. Future research is necessary to explore more extensive dose finding, alternative fluorescent dyes, or improvement of the imaging system to make this application clinically beneficial.

  16. Clinical outcomes of single incision laparoscopic surgery and conventional laparoscopic transabdominal preperitoneal inguinal hernia repair

    PubMed Central

    Ece, Ilhan; Yilmaz, Huseyin; Yormaz, Serdar; Sahin, Mustafa

    2017-01-01

    BACKGROUND: Laparoscopic surgery has been a frequently performed method for inguinal hernia repair. Studies have demonstrated that the laparoscopic transabdominal preperitoneal (TAPP) approach is an appropriate choice for inguinal hernia repair. Single-incision laparoscopic surgery (SILS) was developed to improve the cosmetic effects of conventional laparoscopy. The aim of this study was to evaluate the safety and feasibility of SILS-TAPP compared with TAPP technique. MATERIALS AND METHODS: A total of 148 patients who underwent TAPP or SILS-TAPP in our surgery clinic between December 2012 and January 2015 were enrolled. Data including patient demographics, hernia characteristics, operative time, intraoperative and postoperative complications, length of hospital stay and recurrence rate were retrospectively collected. RESULTS: In total, 60 SILS-TAPP and 88 TAPP procedures were performed in the study period. The two groups were similar in terms of gender, type of hernia, and American Society of Anesthesiologists (ASA) classification score. The patients in the SILS-TAPP group were younger when compared the TAPP group. Port site hernia (PSH) rate was significantly high in the SILS-TAPP group, and all PSHs were recorded in patients with severe comorbidities. The mean operative time has no significant difference in two groups. All SILS procedures were completed successfully without conversion to conventional laparoscopy or open repair. No intraoperative complication was recorded. There was no recurrence during the mean follow-up period of 15.2 ± 3.8 months. CONCLUSION: SILS TAPP for inguinal hernia repair seems to be a feasible, safe method, and is comparable with TAPP technique. However, randomized trials are required to evaluate long-term clinical outcomes. PMID:27251835

  17. [Intraoperative neuromonitoring in thyroid surgery].

    PubMed

    Motos-Micó, José Jacob; Felices-Montes, Manuel; Abad-Aguilar, Teresa

    Intraoperative neuromonitoring of the recurrent laryngeal nerve in thyroid surgery facilitates the identification of anatomical structures in cervical endocrine surgery reducing the frequency of vocal cord paralysis. To study the normal electrophysiological values of the vague and recurrent laryngeal nerves before and after thyroid surgery. To compare rates of injury of recurrent nerve before and after the introduction of the intraoperative neuromonitoring in thyroid surgery. An observational, descriptive and prospective study in which a total of 490 patients were included. Between 2003-2010, surgery was performed on 411 patients (703 nerves at risk) with systematic identification of recurrent laryngeal nerves. Between 2010-2011 neuromonitorization was also systematically performed on 79 patients. Before the introduction of intraoperative neuromonitoring of 704 nerves at risk, there were 14 recurrent laryngeal nerve injuries. Since 2010, after the introduction of the intraoperative neuromonitoring in thyroid surgery, there has been no nerve injury in 135 nerves at risk. We consider the systematic identification of the recurrent laryngeal nerve is the 'gold standard' in thyroid surgery and the intraoperative neuromonitoring of nerves can never replace surgery but can complement it. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  18. Laparoscopic urorectal fistula repair: value of the salvage prostatectomy and review of current approaches.

    PubMed

    Gözen, Ali Serdar; Malkoc, Ercan; Al-Sudani, Ihsan; Rassweiler, Jens

    2012-09-01

    The surgical approach and repair for urorectal fistula (URF) is a challenging task. A variety of techniques have been described to treat URFs, and the laparoscopic approach has been approved as an efficient tool for even some complex fistulas. We aimed to report our laparoscopic experience for complex URF repair with special emphasis on salvage prostatectomy. The study included four men (59-75 years), with laparoscopic repair for complex URFs. URF developed after transurethral resection of the prostate in patients 2 and 3 and after radical prostatectomy in patient 4. Patient 1 had received combined radiotherapy and chemotherapy for the rectal carcinoma; a prostatic abscess developed that resulted at the end in URF. Laparoscopic salvage prostatectomy was performed for patients 1 and 2. A transvesical laparoscopic approach was performed for patient 3, and a transperitoneal transvesical technique was performed for patient 4. A tunica vaginalis flap was used for patient 1, and peritoneal interposition flaps were developed in patients 2 and 4 mL, and no patients needed intraoperative blood transfusion. Postoperative hospital stay was 12 to 34 days. The urethral catheter was removed on postoperative day 11 to 32, and cystography showed no leakage of contrast except in patient 1. Laparoscopic URF repair is safe and efficacious in experienced hands even in complex cases, and salvage laparoscopic prostatectomy seems like a valuable operative option. The technique requires advanced experience, however, particularly with pelvic surgery and intracorporeal suturing.

  19. Reliable assessment of laparoscopic performance in the operating room using videotape analysis.

    PubMed

    Chang, Lily; Hogle, Nancy J; Moore, Brianna B; Graham, Mark J; Sinanan, Mika N; Bailey, Robert; Fowler, Dennis L

    2007-06-01

    The Global Operative Assessment of Laparoscopic Skills (GOALS) is a valid assessment tool for objectively evaluating the technical performance of laparoscopic skills in surgery residents. We hypothesized that GOALS would reliably differentiate between an experienced (expert) and an inexperienced (novice) laparoscopic surgeon (construct validity) based on a blinded videotape review of a laparoscopic cholecystectomy procedure. Ten board-certified surgeons actively engaged in the practice and teaching of laparoscopy reviewed and evaluated the videotaped operative performance of one novice and one expert laparoscopic surgeon using GOALS. Each reviewer recorded a score for both the expert and the novice videotape reviews in each of the 5 domains in GOALS (depth perception, bimanual dexterity, efficiency, tissue handling, and overall competence). The scores for the expert and the novice were compared and statistically analyzed using single-factor analysis of variance (ANOVA). The expert scored significantly higher than the novice did in the domains of depth perception (p = .005), bimanual dexterity (p = .001), efficiency (p = .001), and overall competence ( p = .001). Interrater reliability for the reviewers of the novice tape was Cronbach alpha = .93 and the expert tape was Cronbach alpha = .87. There was no difference between the two for tissue handling. The Global Operative Assessment of Laparoscopic Skills is a valid, objective assessment tool for evaluating technical surgical performance when used to blindly evaluate an intraoperative videotape recording of a laparoscopic procedure.

  20. Laparoscopic Spine Surgery

    MedlinePlus

    ... the vicinity where the spine surgeon is working. Alternatives to Laparoscopic Surgery What Other Treatment Options are ... questions about your need for spine surgery, your alternatives, billing or insurance coverage, or your surgeon’s training ...

  1. Gallbladder Removal: Laparoscopic Method

    MedlinePlus

    ... say “co-lee-sist-eck-toe-mee”). During traditional surgery, the gallbladder is removed through a 5- ... stay and have a shorter recovery time. Unlike traditional surgery, laparoscopic surgery to remove the gallbladder can ...

  2. Laparoscopic gastric banding

    MedlinePlus

    ... adjustable gastric banding; Bariatric surgery - laparoscopic gastric banding; Obesity - gastric banding; Weight loss - gastric banding ... gastric banding is not a "quick fix" for obesity. It will greatly change your lifestyle. You must ...

  3. Is laparoscopic live donor hepatectomy justified ethically?

    PubMed

    Soubrane, Olivier; Gateau, Valérie; Lefève, Céline

    2016-04-01

    Live donor liver transplant (LDLT) was first reported in the 1990s and quickly raised ethical considerations, mainly related to the risk brought to the donor. The question of donor safety was even more accurate with the occurrence of laparoscopy, a technique which could allegedly increase the risk of severe intraoperative complications. Besides the questions of justice and autonomy, donor safety remains the main ethical debate of LDLT. Considering the lack of comparative assessment of postoperative outcomes, the Jury of the last Consensus meeting held in Japan in 2014 called for the creation of international registries to help to determine the benefit/risk ratio of laparoscopic donor hepatectomy. Since randomized studies are very unlikely to occur, benchmarking comparisons, between liver and kidney donors for instance, may also help to define standard practice. At last, donors' points of view should also be taken into account in the evaluation of those innovative procedures. © 2016 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  4. [The role of intraoperative ultrasonography].

    PubMed

    Matsushita, Yoko; Okayama, Yukinari; Matsuo, Shuji

    2008-06-01

    Intraoperative ultrasonography (US) is able to visualize the inside of the viscera in real time, and is also both noninvasive and simple to perform without influence of the bone or alimentary canal gas disturbing the propagation of the ultrasound. US has recently been widely used for neurosurgery or abdominal surgery, 1) to check the position and size of the tumor, which can not be directly visualized, and to evaluate the relationship between the tumor and blood vessel or tissue, 2) to search for lesions not detected before surgery, 3) to search for residual tumor, 4) to carry out ultrasound-guided biopsy or puncture. For effective intraoperative US, thorough knowledge of the US instrument and the local anatomy is necessary. The medical technologists who routinely perform US are qualified to assist with intraoperative US.

  5. Retraction and triangulation with neodymium magnetic forceps for single-port laparoscopic cholecystectomy.

    PubMed

    Dominguez, Guillermo; Durand, Luis; De Rosa, Julián; Danguise, Eduardo; Arozamena, Carlos; Ferraina, Pedro A

    2009-07-01

    There have been attempts to minimize the invasiveness of laparoscopic cholecystectomy by reducing the size and/or the number of the operating ports and instruments. These attempts create technical challenges related principally to retraction and triangulation necessary to expose the surgical field for a safe surgery. A new technique based on retraction and triangulation with magnetic instruments for single port laparoscopic surgery is presented. Between March 2007 and December 2008, 40 laparoscopic cholecystectomies were performed with single-port laparoscopic surgery with the assistance of magnetic forceps (IMANLAP project). The surgical technique is described, and the intraoperative and postoperative course of the patients is assessed. There were no intraoperative complications, no need to convert to open surgery, and no need to add a second port. Depending on the patient's anatomy, a 1-mm needle was added in some cases. There were no interactions observed between the magnetic devices and the anesthetic monitoring and the rest of the devices of the operation room. This new procedure is feasible and safe. The main goal is control of the magnetic field, allowing enough controlled strength for retraction and sufficient triangulation for adequate exposure of the surgical field. This allows for the use of a single port through which an optic device with a working channel can perform the operation with safety. Finally, the procedure can be performed in a manner similar to the traditional laparoscopic cholecystectomy, and it also appears to be simple to learn.

  6. Single-incision versus hand-assisted laparoscopic colectomy: a case-matched series.

    PubMed

    Gandhi, Dhruvil P; Ragupathi, Madhu; Patel, Chirag B; Ramos-Valadez, Diego I; Pickron, T Bartley; Haas, Eric M

    2010-12-01

    Single-incision laparoscopic colorectal surgery is an emerging modality. We incorporated this technique as an alternative to hand-assisted laparoscopic surgery. We investigated intraoperative and short-term outcomes following single-incision laparoscopic colectomy compared with hand-assisted laparoscopic colectomy. Between July and November 2009, single-incision colorectal procedures were performed and matched to hand-assisted procedures based on five criteria: gender, age, body mass index, pathology, and type of procedure. Demographic, intraoperative, and postoperative data were assessed. Twenty-four pairs of patients with a mean age of 55.1 years and mean body mass index of 28.5 kg/m(2) were matched. The majority of cases (79.2%) were right hemicolectomies. The ranges of incision length were 2-6 cm (single incision) and 5-11 cm (hand-assisted). Mean operating time was significantly longer for single-incision procedures (143.2 min) compared with hand-assisted procedures (112.8 min), p < 0.0004. There was no significant difference in the groups regarding conversions or intraoperative complications (p < 0.083 and p < 1.0, respectively). Mean length of stay for the single-incision approach (2.7 days) was significantly shorter compared with the hand-assisted approach (3.3 days), p < 0.02. Single-incision laparoscopic colectomy is a safe and feasible alternative to hand-assisted laparoscopic surgery. Although the technique required longer operative time, it resulted in smaller incision size and significantly shorter length of hospitalization.

  7. Improving outcomes after laparoscopic appendectomy: a population-based, 12-year trend analysis of 7446 patients.

    PubMed

    Brügger, Lukas; Rosella, Laura; Candinas, Daniel; Güller, Ulrich

    2011-02-01

    Laparoscopic appendectomy for acute appendicitis has become increasingly used over the past decade. The objective of this trend analysis is to assess whether clinical outcomes after laparoscopic appendectomy have improved over the past 12 years. This analysis is based on the prospective database of the Swiss Association of Laparoscopic and Thoracoscopic Surgery. All patients undergoing emergency laparoscopic appendectomy for acute appendicitis from 1995 to 2006 were included. The following outcomes were assessed for each of the 12 years: conversion rates, intraoperative complications, surgical postoperative complications, general postoperative complications, rate of reoperations, and length of hospital stay. Unadjusted and risk-adjusted multivariable analyses were performed. Statistical significance was set at a level of P < 0.05. All statistical tests were 2-sided. Data from 7446 patients undergoing laparoscopic appendectomy for acute appendicitis were prospectively collected. Over the period of observation, the conversion rate decreased significantly from 2.2% to 1.2% (P(trend)< 0.001), as did intraoperative complications (from 3.1% to 0.7%; P(trend)< 0.001), surgical postoperative complications (from 6.1% to 1.9%; P(trend)< 0.001), general postoperative complications (from 4.9% to 1.5%; P(trend)< 0.001), and rates of reoperations (from 3.4% to 0.7%; P(trend)< 0.001). Average postoperative length of hospital stay also significantly decreased from 4.9 to 3.5 days (P(trend)< 0.001). Our investigation provides compelling evidence that intraoperative complications, surgical and general postoperative complications, conversion rates, rates of reoperations, and average length of hospital stay have significantly decreased over the past decade in patients undergoing surgery for acute appendicitis. The present trend analysis is the first one in the literature encompassing more than a decade and reporting clinical outcomes after laparoscopic appendectomy for acute

  8. Technique of sentinel lymph node biopsy and lymphatic mapping during laparoscopic colon resection for cancer

    PubMed Central

    Bianchi, PP; Andreoni, B; Rottoli, M; Celotti, S; Chiappa, A; Montorsi, M

    2007-01-01

    Background: The utility of lymph node mapping to improve staging in colon cancer is still under evaluation. Laparoscopic colectomy for colon cancer has been validated in multi-centric trials. This study assessed the feasibility and technical aspects of lymph node mapping in laparoscopic colectomy for colon cancer. Methods: A total of 42 patients with histologically proven colon cancer were studied from January 2006 to September 2007. Exclusion criteria were: advanced disease (clinical stage III), rectal cancer, previous colon resection and contraindication to laparoscopy. Lymph-nodal status was assessed preoperatively by computed tomography (CT) scan and intra-operatively with the aid of laparoscopic ultrasound. Before resection, 2–3 ml of Patent Blue V dye was injected sub-serosally around the tumour. Coloured lymph nodes were marked as sentinel (SN) with metal clips or suture and laparoscopic colectomy with lymphadenectomy completed as normal. In case of failure of the intra-operative procedure, an ex vivo SN biopsy was performed on the colectomy specimen after resection. Results: A total number of 904 lymph nodes were examined, with a median number of 22 lymph nodes harvested per patient. The SN detection rate was 100%, an ex vivo lymph node mapping was necessary in four patients. Eleven (26.2%) patients had lymph-nodal metastases and in five (45.5%) of these patients, SN was the only positive lymph node. There were two (18.2%) false-negative SN. In three cases (7.1%) with aberrant lymphatic drainage, lymphadenectomy was extended. The accuracy of SN mapping was 95.2% and negative predictive value was 93.9%. Conclusions: Laparoscopic lymphatic mapping and SN removal is feasible in laparoscopic colectomy for colon cancer. The ex vivo technique is useful as a salvage technique in case of failure of the intra-operative procedure. Prospective studies are justified to determine the real accuracy and false-negative rate of the technique. PMID:22275957

  9. Using a laparoscope manipulator (LAPMAN) in laparoscopic gynecological surgery.

    PubMed

    Polet, Roland; Donnez, Jaques

    2008-01-01

    The LAPMAN (Medsys, Gembloux, BELGIUM) is a dynamic laparoscope holder guided by a joystick clipped onto the laparoscopic instruments under the index finger of the operator. It confers optimal control of the visual field while operating, ensures stable and smooth displacement of the laparoscope, and allows the operator to work in conditions of restricted surgical assistance, due to either unavailability of staff or economic constraints. It has been tested successfully in pilot studies in laparoscopic gynecologic surgery.

  10. Surgical site infection rates following laparoscopic urological procedures.

    PubMed

    George, Arvin K; Srinivasan, Arun K; Cho, Jane; Sadek, Mostafa A; Kavoussi, Louis R

    2011-04-01

    Surgical site infections have been categorized by the Centers for Medicare and Medicaid Services as "never events". The incidence of surgical site infection following laparoscopic urological surgery and its risk factors are poorly defined. We evaluated surgical site infection following urological laparoscopic surgery and identified possible factors that may influence occurrence. Patients who underwent transperitoneal laparoscopic procedures during a 4-year period by a single laparoscopic surgeon were retrospectively reviewed. Surgical site infections were identified postoperatively and defined using the Centers for Disease Control criteria. Clinical parameters, comorbidities, smoking history, preoperative urinalysis and culture results as well as operative data were analyzed. Nonparametric testing using the Mann-Whitney U test, multivariable logistic regression and Spearman's rank correlation coefficient were used for data analysis. In 556 patients undergoing urological laparoscopic procedures 14 surgical site infections (2.5%) were identified at mean postoperative day 21.5. Of the 14 surgical site infections 10 (71.4%) were located at a specimen extraction site. Operative time, procedure type and increasing body mass index were significantly associated with the occurrence of surgical site infections (p = 0.007, p = 0.019, p = 0.038, respectively), whereas history of diabetes mellitus (p = 0.071) and intraoperative transfusion (p = 0.053) were found to trend toward significance. Age, gender, positive urine culture, steroid use, procedure type and smoking history were not significantly associated with surgical site infection. Body mass index and operative time remained significant predictors of surgical site infection on multivariate logistic regression analysis. Surgical site infection is an infrequent complication following laparoscopic surgery with the majority occurring at the specimen extraction site. Infection is associated with prolonged operative time and

  11. Laparoscopic access overview: Is there a safest entry method?

    PubMed

    Bianchi, G; Martorana, E; Ghaith, A; Pirola, G M; Rani, M; Bove, P; Porpiglia, F; Manferrari, F; Micali, S

    2016-01-01

    Laparoscopy is a minimally invasive technique to access the abdominal cavity, for diagnostic or therapeutic applications. Optimizing the access technique is an important step for laparoscopic procedures. The aim of this study is to assess the outcomes of different laparoscopic access techniques and to identify the safest one. Laparoscopic access questionnaire was forwarded via e-mail to the 60 centers who are partners in working group for laparoscopic and robotic surgery of the Italian Urological Society (SIU) and their American and European reference centers. The response rate was 68.33%. The total number of procedures considered was 65.636. 61.5% of surgeons use Veress needle to create pneumoperitoneum. Blind trocar technique is the most commonly used, but has the greatest number of complications. Optical trocar technique seems to be the safest, but it's the less commonly used. The 28,2% of surgeons adopt open Hasson's technique. Total intra-operative complications rate was 3.3%. Open conversion rate was 0.33%, transfusion rate was 1.13%, and total post-operative complication rate was 2.53%. Laparoscopic access is a safe technique with low complication rate. Most of complications can be managed conservatively or laparoscopically. The choice of access technique can affect the rate and type of complications and should be planned according to surgeon experience, safety of each technique and patient characteristics. All access types have perioperative complications. According with our study, optical trocar technique seems to be the safest. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Intraoperative fracture of phacoemulsification tip.

    PubMed

    Angmo, Dewang; Khokhar, Sudarshan K; Ganguly, Anasua

    2014-01-01

    Phacoemulsification (phaco) is an established procedure for cataract extraction and has undergone a significant advances in techniques, machines and phaco tips. The Aspiration Bypass System (ABS) phaco tip was introduced for phacoemulsification in 1998. The ABS tip allows fluid to be drawn through the opening when the phaco tip is occluded by nuclear material. The ABS tip allowed the safe use of high vacuum and flow rates and improved chamber stability by decreasing surge and therefore reducing intraoperative complications. To date, no disadvantages of ABS tips have been reported. We report a unique case of an intraoperative break of an ABS phaco tip during routine cataract surgery.

  13. Intraoperative Fracture of Phacoemulsification Tip

    PubMed Central

    Angmo, Dewang; Khokhar, Sudarshan K.; Ganguly, Anasua

    2014-01-01

    Phacoemulsification (phaco) is an established procedure for cataract extraction and has undergone a significant advances in techniques, machines and phaco tips. The Aspiration Bypass System (ABS) phaco tip was introduced for phacoemulsification in 1998. The ABS tip allows fluid to be drawn through the opening when the phaco tip is occluded by nuclear material. The ABS tip allowed the safe use of high vacuum and flow rates and improved chamber stability by decreasing surge and therefore reducing intraoperative complications. To date, no disadvantages of ABS tips have been reported. We report a unique case of an intraoperative break of an ABS phaco tip during routine cataract surgery. PMID:24669153

  14. Single site multiport umbilical laparoscopic appendicectomy versus conventional multiport laparoscopic appendicectomy in acute settings

    PubMed Central

    Yadav, SP

    2014-01-01

    Introduction Although conventional multiport laparoscopic appendicectomy (CMLA) is preferred for managing acute appendicitis, the recently developed transumbilical laparoscopic approach is rapidly gaining popularity. However, its wide dissemination seems restricted by technical/technological issues. In this regard, a newly developed method of single site multiport umbilical laparoscopic appendicectomy (SMULA) was compared prospectively with CMLA to assess the former’s efficacy and the technical advantages in acute scenarios. Methods Overall, 430 patients were studied: 212 in the SMULA group and 218 in the CMLA group. The same surgeon performed all the procedures using routine laparoscopic instruments. The SMULA technique entailed three ports inserted directly at the umbilical mound through three distinct strategically placed mini-incisions without raising the umbilical flap. The CMLA involved the traditional three-port technique. Results Both groups were comparable in terms of demographic criteria, indications for surgery, intraoperative blood loss, time to ambulation, length of hospital stay and umbilical morbidity. Although the mean operative time was marginally longer in the SMULA group (43.35 minutes, standard deviation [SD]: 21.16 minutes) than in the CMLA group (42.28 minutes, SD: 21.41 minutes), this did not reach statistical significance. Conversely, the mean pain scores on day 0 and the cosmetic outcomes differed significantly and favoured the SMULA technique. None of the patients developed port site hernias over the follow-up period (mean 2.9 years). Conclusions The favourable outcomes for the SMULA technique are likely to be due to the three small segregated incisions at one place and better trocar ergonomics. The SMULA technique is safe in an acute setting and may be considered of value among the options for transumbilical appendicectomy. PMID:25198978

  15. Intraoperative localization of early-stage gastrointestinal tumors using a marking clip detector system.

    PubMed

    Ohdaira, Takeshi; Nagai, Hideo; Shibusawa, Hiroyuki

    2005-01-01

    Intraoperative Tumor site recognition is extremely difficult during laparoscopic surgical treatment of early-stage gastrointestinal carcinoma. A novel marking method that uses both metallic clips and a marking clip detector system (MCDS, Olympus Optical Co., Tokyo, Japan) modified from a metal detector system, was designed by the authors. Metallic clips were applied to the tumor site during preoperative endoscopy, and the clip site was identified intraoperatively using the MCDS. In a basic ex vivo study, three metallic clips were detected easily (100% detection). In a clinical study, the marking site was detected in all gastric cancer patients who underwent laparoscopic subtotal gastrectomy. The mean distance between detected site and clip along the longitudinal bowel axis was 6.4 +/- 2.9 mm. Mean detection time was 18.1 +/- 5.7 seconds. None of the patients in this study experienced complications from this marking technique. MCDS allows accurate identification of tumor sites. This method may be useful for tumor-site identification during laparoscopic gastrectomy.

  16. Costs and Outcomes of Abdominal, Vaginal, Laparoscopic and Robotic Hysterectomies

    PubMed Central

    Jonsdottir, Gudrun M.; Jorgensen, Selena; Shah, Neel; Einarsson, Jon I.

    2012-01-01

    Background and Objectives: To estimate the incidence of operative complications and compare operative cost and overall cost of different methods of benign hysterectomy including abdominal, vaginal, laparoscopic, and robotic techniques. Methods: We performed a retrospective cohort analysis (Canadian Task Force classification II-2) of all patients who underwent a hysterectomy for benign reasons in 2009 at a single urban academic tertiary care center using the χ2 test and Student t test. A multivariate regression analysis was also performed for predictors of costs. Cost data were gathered from the hospital's billing system; the remainder of data was extracted from patient's medical records. Results: In 2009, 688 patients underwent a benign hysterectomy; 185 (26.9%) hysterectomies were abdominal, 135 (19.6%) vaginal, 352 (51.5%) laparoscopic, and 14 (2.0%) robotic. The rate of intraoperative complication was 1.7% for abdominal, 0.8% for vaginal, 0.3% for laparoscopic, and 0 for robotic. Mean total patient costs were $43,622 for abdominal, $31,934 for vaginal, $38,312 for laparoscopic, and $49,526 for robotic hysterectomies. Costs were significantly influenced by method of hysterectomy, operative time, and length of stay. Conclusion: Though complication rates did not vary significantly among minimally invasive methods of hysterectomy, patient costs were significantly influenced by the method of hysterectomy. PMID:23484557

  17. Costs and outcomes of abdominal, vaginal, laparoscopic and robotic hysterectomies.

    PubMed

    Wright, Kelly N; Jonsdottir, Gudrun M; Jorgensen, Selena; Shah, Neel; Einarsson, Jon I

    2012-01-01

    To estimate the incidence of operative complications and compare operative cost and overall cost of different methods of benign hysterectomy including abdominal, vaginal, laparoscopic, and robotic techniques. We performed a retrospective cohort analysis (Canadian Task Force classification II-2) of all patients who underwent a hysterectomy for benign reasons in 2009 at a single urban academic tertiary care center using the χ(2) test and Student t test. A multivariate regression analysis was also performed for predictors of costs. Cost data were gathered from the hospital's billing system; the remainder of data was extracted from patient's medical records. In 2009, 688 patients underwent a benign hysterectomy; 185 (26.9%) hysterectomies were abdominal, 135 (19.6%) vaginal, 352 (51.5%) laparoscopic, and 14 (2.0%) robotic. The rate of intraoperative complication was 1.7% for abdominal, 0.8% for vaginal, 0.3% for laparoscopic, and 0 for robotic. Mean total patient costs were $43,622 for abdominal, $31,934 for vaginal, $38,312 for laparoscopic, and $49,526 for robotic hysterectomies. Costs were significantly influenced by method of hysterectomy, operative time, and length of stay. Though complication rates did not vary significantly among minimally invasive methods of hysterectomy, patient costs were significantly influenced by the method of hysterectomy.

  18. Multiple Layer Closure of Myoma Bed in Laparoscopic Myomectomy

    PubMed Central

    Jain, Nutan

    2011-01-01

    Objective: To assess the feasibility and outcome of laparoscopic myomectomy and multiple layer closure of the myoma bed, for management of myomas, at a tertiary care hospital. Materials and Methods: From September 2005 to September 2010, 417 patients, with large and moderate size myomas, were managed by laparoscopic myomectomy. Indications were subfertility, menorrhagia, and abdominal mass. Preoperative evaluation included history, clinical examination, and sonographic mapping. The myomas were enucleated and retrieved laparoscopically. Myoma beds were sutured in multiple layers by endoscopic intracorporeal suturing. Results: Three hundred and fifteen patients presented with subfertility, 45 with menorrhagia, and 57 with abdominal mass. The average maximum diameter of a myoma was 9 cm. The mean duration of surgery was 120 minutes. The mean postoperative stay was 24 hours. No intraoperative complication occurred and the hospital course was uncomplicated. In one case, a minilap incision was performed for retrieval of the myoma with suturing of the bed. Two patients had minor delayed wound healing of the morcellator port site. The patients did not report any complaints during the follow-up, except one patient who developed omental hernia at the morcellator port site. There was no rupture of the scar and very low adhesion scores in the subsequent cesarean sections or second-look scopies. Conclusion: With proper multilayer closure of the myoma bed, laparoscopic myomectomy was feasible for moderate and even large myomas and had excellent outcomes. PMID:22442535

  19. Multiple Layer Closure of Myoma Bed in Laparoscopic Myomectomy

    PubMed Central

    Jain, Nutan; Sahni, Priyanka

    2011-01-01

    Objective: To assess the feasibility and outcome of laparoscopic Myomectomy and multiple layer closure of myoma bed for management of myomas at a tertiary care hospital. Materials and Methods: Four hundred and seventeen patients from September 2005 to September 2010 with large and moderate size myomas were managed by laparoscopic Myomectomy. Indications were subfertility, menorrhagia and abdominal mass. Pre-operative evaluation included history, clinical examination and sonographic mapping. Myomas were enucleated and retrieved laparoscopically. Myoma beds were sutured in multiple layers by endoscopic intracorporeal suturing. Results: Three hundred and fifteen patients presented with subfertility, 45 with menorrhagia and 57 with abdominal mass. The average maximum diameter of myoma was 9 cm. The mean duration of surgery was 120 min. The mean post-operative stay was 24 h. No intra-operative complication occurred and hospital course was uncomplicated. In one case, minilap incision was given for retrieval of myoma and suturing of the bed. Two patients had minor delayed wound healing of the morcellator port site. The patients did not report any complaints during follow-up except one patient who developed omental hernia at morcellator port site. There was no rupture of scar and very low adhesion scores in subsequent caesarian sections or second look scopies. Conclusion: With proper multilayer closure of the myoma bed, laparoscopic Myomectomy is feasible for moderate and even large myomas and has excellent outcomes. PMID:26085750

  20. LAHRI: Laparoscopic-Assisted Hydrostatic Reduction of Intussusception.

    PubMed

    Geltzeiler, Cristina B; Sims, Thomas L; Zigman, Andrew F

    2015-09-01

    Intussusception is the most common cause of bowel obstruction in children from 3 months to 3 years of age. In the absence of peritonitis, initial treatment is either hydrostatic or pneumatic reduction. If these measures fail, operative intervention is required. In nonreducible cases, we propose the use of intraoperative hydrostatic enema to achieve or confirm reduction. In this study we describe a cohort of patients who have undergone laparoscopic-assisted hydrostatic reduction of intussusception (LAHRI). This is a retrospective cohort study of all patients undergoing LAHRI from the years 2011 to 2013. We performed LAHRI in seven children 4 months to 2 years of age. All patients had ileocolic intussusception that failed initial reduction by radiographic enema. With the patient under general anesthesia, saline enema reduction was facilitated by direct laparoscopic visualization. In 2 of the 7 cases, intussusception reduction was visually confirmed in real time, and only a laparoscopic camera port was required. In 1 patient, the bowel was extensively dilated, requiring mini-laparotomy for visualization. The enema, however, reduced the intussusception without any need for manual reduction. In the remaining 4 cases, minimal laparoscopic manipulation was required after the enema failed to completely reduce the intussusceptum, but enema was used to confirm reduction. No child required bowel resection. In cases of failed reduction by contrast enema, we have demonstrated LAHRI to be a successful treatment modality. The technique has the advantage of little to no bowel manipulation and has evolved into one performed via a single umbilical port.

  1. Transvaginal specimen removal after laparoscopic distal pancreatic resection.

    PubMed

    Mofid, Hamid; Emmermann, Alice; Alm, Margret; Zornig, Carsten

    2013-10-01

    Transvaginal specimen removal has been introduced 20 years ago but then abandoned. With the advent of transvaginal interventions following the introduction of natural orifice transluminal endoscopic surgery, renewed interest was generated for hybrid procedures with minimal access for the intervention and use of transvaginal (TV) specimen removal. We present the first such series after laparoscopic distal pancreatectomy. In seven subsequent women (median age 48 years) with body and tail pancreatic tumors undergoing laparoscopic distal pancreatectomy, the new method of TV specimen removal was applied. The patients' data and the technical successes as well as intra- and postprocedural complications were recorded prospectively. The patients were followed after discharge for gynecological examination. Specimen removal consisting of the pancreas and spleen in five and the pancreas only in two cases was technically successful; no intraoperative complications were encountered. Postoperative complications consisted of one case of intra-abdominal hemorrhage and one case of pancreatic fistula, attributable to the resection and not to TV specimen removal. Gynecological follow-up was normal in all seven patients. The technique of TV specimen removal is feasible and safe also after laparoscopic distal pancreatectomy. It may help to further diminish the access trauma of laparoscopic pancreatic surgery.

  2. Laparoscopic treatment of mesenteric cysts. Report of two cases.

    PubMed

    Ciulla, Antonio; Tomasello, Giovanni; Castronovo, Gioacchino; Genova, Gaspare; Maiorana, Alfonso Maurizio

    2008-01-01

    Mesenteric cysts are rare intraabdominal tumors. Since the first report by Benevial in 1507, approximately 800 cases of mesenteric cysts have been described in the literature. Clinical presentation is variable and depends on the size and location of the cyst. This lesion are often asymptomatic or can present as an abdominal palpable mass or with abdominal pain, nausea, vomiting, diarrhea or constipation. Laboratory tests are usually helpless. Ultrasonography and CT scan are the best diagnostic tools. In the past the treatment of choice was totally resection performed by open surgery. With the advent of laparoscopic surgery same authors report mesenteric cysts excised laparoscopically. The Authors report two cases of mesenteric cysts that were excised by laparoscopic surgery using. The cysts of both patients were located in the mesenterium of colon. There were no intraoperative of postoperative complications and the postoperative course was uneventful and both patients returned to full activity within a short time. The follow-up period ranged from 6 to 36 months and there were no recurrences. The laparoscopic surgery is a minimally invasive techniques and represent an alternative safe and less invasive operation for these abdominal cysts.

  3. 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

  4. A case report of laparoscopic ipsilateral ureteroureterostomy in children with renal duplex

    PubMed Central

    Wong, Yuen Shan; Tam, Yuk Him; Pang, Kristine Kit Yi

    2016-01-01

    We report on two children aged 2 and 6 years, who underwent laparoscopic ipsilateral ureteroureterostomy for their renal duplex anomalies. Both patients had complete duplex and were investigated by ultrasound, micturating cystourethrogram, magnetic resonance urography, and radioisotope scan. One patient had high-grade vesicoureteral reflux to lower moiety complicated with recurrent urinary tract infections, while the other had obstruction to upper moiety due to ectopic ureter. The pathological moieties of both patients were functional. Both patients underwent laparoscopic ipsilateral ureteroureterostomy uneventfully without any intraoperative complications. Postoperative imagings confirmed successful outcomes after surgery. PMID:27014651

  5. Laparoscopic debridement of recurrent pancreatic abscesses in the hostile abdomen.

    PubMed

    Haan, James M; Scalea, Thomas M

    2006-06-01

    Recurrent necrotizing pancreatitis in the frozen or hostile abdomen remains a challenge. Percutaneous drainage is useful in these cases but often fails if there is significant pancreatic necrosis. We describe a technique for laparoscopic drainage of necrotic pancreas. The preexisting percutaneous drainage tract was sequentially dilated and a working thoracoscope was placed via a Hasson cannula. A pulsatile irrigation system was used to open the cavity for visualization and to wash away obvious necrotic debris. Working sequentially using the irrigation jet flow for debridement and visualization, we opened the entire tract and debrided a majority of the necrotic tissue. A large drainage tube was placed to allow the egress of any residual infection. Three patients to date have been treated with the above technique with no intraoperative complications. All three patients did well initially postoperatively and had adequate drainage. One patient developed a delayed pancreatic pseudocyst. Laparoscopic debridement via percutaneous drainage tract is a useful technique in the hostile abdomen.

  6. [Laparoscopic surgery: from clinic to legal medicine].

    PubMed

    Chisari, M G; Finocchiaro, A; Lo Menzo, E; Rosato, V; Basile, G

    2004-12-01

    The laparoscopic technique introduced a new way of operating but inevitably causing new problems for the surgeon. After a comprehensive review of the history and the evolution of laparoscopic surgery from its beginning, the technical aspects of minimally invasive surgery and its fields of application are described. The close dependence on instruments and technology is emphasized. A detailed analysis of the advantages and limitations of laparoscopy is made with emphasis on the importance of a risk-benefit evaluation by the health care provider. Of key importance is to obtain a detailed and clear informed consent. The medico legal aspects of intraoperative complications and the liability of the surgical team in case of patients' injury or death are examined. However, it is always necessary to consider if the potential complications are predictable and/or preventable in accordance to the parameters of negligence, imprudence and lack of knowledge. The same criteria have to be applied to assure compliance with the preventive sanitary rules and that the conversion to laparotomy has been promptly carried out.

  7. [Perioperative managment of laparoscopic sleeve gastrectomy].

    PubMed

    Chang, Xu-sheng; Yin, Kai; Wang, Xin; Zhuo, Guang-zuan; Ding, Dan; Guo, Xiang; Zheng, Cheng-zhu

    2013-10-01

    To summarize the surgical technique and perioperative management of laparoscopic sleeve gastrectomy (LSG). A total of 57 morbid obesity patients undergoing LSG surgery from May 2010 to December 2012 were enrolled in the study, whose clinical data in perioperative period were analyzed retrospectively. These patients had more than 1 year of follow-up. All the patients received preoperative preparation and postoperative management, and postoperative excess weight loss(EWL%) and improvement of preoperative complications was evaluated. All the cases completed the operation under laparoscopy, except 1 case because of the abdominal extensive adhesion. The average operation time was(102.0±15.2) min and the mean intraoperative blood loss (132.3±45.6) ml. Of 2 postoperative hemorrhage patients, 1 case received conservative treatment, and another one underwent laparoscopic exploration. The EWL% at 3 months, 6 months and 1 year after procedure was (54.9±13.8)%, (79.0±23.6)% and (106.9±25.1)% respectively. The preoperative complications were improved in some degree. There were no operative death, and anastomotic leak, anastomotic stenosis, or surgical site infection occurred. LSG is a safe and effective surgical technique, whose safety and efficacy may be increased by improving the perioperative management.

  8. [Intraoperative staging of colorectal tumors].

    PubMed

    Abdurakhmonov, Iu B; Mel'nikov, O R; Egorenkov, V V; Moiseenko, V M

    2007-01-01

    The effectiveness of intraoperative staging of tumor by sentinel node staining with lymphotropic dyes was evaluated in 60 patients with colorectal tumors (colon carcinoma -39, rectal cancer- 21). High sensitivity (84.6% and 87.5%, respectively) and specificity (100% and 100%, respectively) for regional lymph node assessment were identified for both colonic and rectal cancer.

  9. Intraoperative transfusion practices in Europe

    PubMed Central

    Meier, J.; Filipescu, D.; Kozek-Langenecker, S.; Llau Pitarch, J.; Mallett, S.; Martus, P.; Matot, I.

    2016-01-01

    Background. Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods. We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results. The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl−1 and increased to 9.8 (1.8) g dl−1 after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusion. Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7–9 g dl−1), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold. Clinical trial registration. NCT 01604083. PMID:26787795

  10. Single-port laparoscopic salpingectomy for surgical treatment of tubal pregnancy: comparison with multi-port laparoscopic salpingectomy.

    PubMed

    Kim, Yong-Wook; Park, Byung-Joon; Kim, Tea-Eung; Ro, Duck-Yeong

    2013-01-01

    This study investigates the safety and feasibility of transumbilical single-port laparoscopic salpingectomy (SPLS) using conventional laparoscopic instruments compared to conventional multi-port laparoscopic salpingectomy (MPLS) for surgical treatment of tubal pregnancy. We conducted a retrospective analysis of 63 patients with tubal pregnancy who underwent SPLS and 71 patients who underwent conventional MPLS between January 2008 and December 2010. All patients in the SPLS group had a drainage tube placed through the umbilicus, and, in the MPLS group, through a 5-mm trocar site in one side of the lower abdomen. No significance difference was discovered between the groups with regard to adjusted hemoglobin values (SPLS, 1.9 ± 1.0 g/dL versus MPLS, 1.7 ± 1.0 g/dL, P = 0.335). Additionally, there was also no significant difference in clinical characteristics, intraoperative findings, or operative outcomes. Our study demonstrated that transumbilical SPLS using conventional laparoscopic instruments has operative outcomes comparable to MPLS for the surgical treatment of tubal pregnancy. Transumbilical SPLS may therefore be offered as a feasible alternative to MPLS.

  11. Single-Port Laparoscopic Salpingectomy for Surgical Treatment of Tubal Pregnancy: Comparison with Multi-Port Laparoscopic Salpingectomy

    PubMed Central

    Kim, Yong-Wook; Park, Byung-Joon; Kim, Tea-Eung; Ro, Duck-Yeong

    2013-01-01

    BackgroundThis study investigates the safety and feasibility of transumbilical single-port laparoscopic salpingectomy (SPLS) using conventional laparoscopic instruments compared to conventional multi-port laparoscopic salpingectomy (MPLS) for surgical treatment of tubal pregnancy. Material and methods We conducted a retrospective analysis of 63 patients with tubal pregnancy who underwent SPLS and 71 patients who underwent conventional MPLS between January 2008 and December 2010. All patients in the SPLS group had a drainage tube placed through the umbilicus, and, in the MPLS group, through a 5-mm trocar site in one side of the lower abdomen. Results No significance difference was discovered between the groups with regard to adjusted hemoglobin values (SPLS, 1.9 ± 1.0 g/dL versus MPLS, 1.7 ± 1.0 g/dL, P = 0.335). Additionally, there was also no significant difference in clinical characteristics, intraoperative findings, or operative outcomes. Conclusions Our study demonstrated that transumbilical SPLS using conventional laparoscopic instruments has operative outcomes comparable to MPLS for the surgical treatment of tubal pregnancy. Transumbilical SPLS may therefore be offered as a feasible alternative to MPLS. PMID:23801896

  12. Laparoscopic Imaging Techniques in Endometriosis Therapy: A Systematic Review.

    PubMed

    Vlek, Stijn L; Lier, M C I; Ankersmit, M; Ket, Johannes C F; Dekker, J J M L; Mijatovic, V; Tuynman, J B

    2016-01-01

    Endometriosis is a common disease associated with pelvic pain and subfertility. Laparoscopic surgical treatment has proven effective in endometriosis, but is hampered by a high rate of recurrence. The aim of this systematic review was to evaluate the intraoperative identification of endometriosis by enhanced laparoscopic imaging techniques, focusing on sensitivity and specificity. A systematic review was conducted according to PRISMA guidelines in PubMed, Embase, Cochrane Library, and Web of Science. Published prospective studies reporting on enhanced laparoscopic imaging techniques during endometriosis surgery were included. General study characteristics and reported outcomes, including sensitivity and specificity, were extracted. Nine studies were eligible for inclusion. Three techniques were described: 5-ALA fluorescence (5-ALA), autofluorescence (AFI), and narrow-band imaging (NBI). The reported sensitivity of 5-ALA and AFI for identifying endometriosis ranged from 91% to 100%, compared with 48% to 69% for conventional white light laparoscopy (WL). A randomized controlled trial comparing NBI + WL with WL alone reported better sensitivity of NBI (100% vs 79%; p < .001). All 9 studies reported an enhanced detection rate of endometriotic lesions with enhanced imaging techniques. Enhanced imaging techniques are a promising additive for laparoscopic detection and treatment of endometriosis. The 5-ALA, AFI, and NBI intraoperative imaging techniques had a better detection rate for peritoneal endometriosis compared with conventional WL laparoscopy. None of the studies reported clinical data regarding outcomes. Future studies should address long-term results, such as quality of life, recurrence, and need for reoperation. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  13. Impact of conversion on surgical outcomes after laparoscopic operation for rectal carcinoma: a retrospective study of 1,073 patients.

    PubMed

    Yamamoto, Seiichiro; Fukunaga, Masaki; Miyajima, Nobuyoshi; Okuda, Junji; Konishi, Fumio; Watanabe, Masahiko

    2009-03-01

    In laparoscopic operations for rectal carcinoma, only a few multicenter studies of a large number of patients have examined the impact of conversion on outcomes and determined risk factors for conversion. This study was designed to evaluate short-term outcomes and risk factors for conversion to open operation in laparoscopic operations for rectal carcinoma. A total of 1,073 patients with carcinoma of the rectum and anus who underwent laparoscopic operations were reviewed retrospectively. Patients were collected from 28 institutions. Patients who required conversion during laparoscopic operation were compared with those with completed laparoscopic resection. Conversion rate was 7.3% (n = 78), and patients requiring conversion were considerably heavier (mean body mass index 24.6 versus 22.7) and had a substantially higher rate of low anterior resection (94.9% versus 83.5%). Conversion was also associated with longer operation time (median 295 minutes versus 270 minutes), greater blood loss (median 265 mL versus 80 mL), longer median postoperative hospital stay (20 days versus 14 days), and higher rates of intraoperative (32.1% versus 3.5%) and postoperative (43.6% versus 21.1%) complications. In multivariate analysis, body mass index and rate of low anterior resection were predictive of conversion. Conversion to open operation is associated with greater morbidity than completed laparoscopic resection. Body mass index and the particular laparoscopic procedure are risk factors for conversion, indicating that appropriate patient selection is essential in laparoscopic operations for rectal carcinoma.

  14. Successful Management of a Positive Air Leak Test during Laparoscopic Colorectal Surgery.

    PubMed

    Sasaki, Kazuhito; Ishihara, Soichiro; Nozawa, Hiroaki; Kawai, Kazushige; Hata, Keisuke; Kiyomatsu, Tomomichi; Tanaka, Toshiaki; Nishikawa, Takeshi; Otani, Kensuke; Yasuda, Koji; Murono, Koji; Watanabe, Toshiaki

    2017-09-22

    Anastomotic leakage remains the most serious complications of colorectal surgery. To prevent colorectal anastomotic leakage (CAL), an air leak test (ALT) with intraoperative colonoscopy (IOCS) is performed to detect mechanically insufficient colorectal anastomoses. The approaches to an intraoperative anastomotic air leak (IOAL) have not been fully investigated. This study aimed to clarify the safe management of an IOAL in laparoscopic colorectal surgery. One hundred forty-eight consecutive patients who underwent laparoscopic resection with double-stapling technique (DST) anastomosis for left-sided colorectal cancer between April 2015 and June 2016 were included and retrospectively reviewed. Intraoperative anastomotic ALT yielded positive results in 7 patients. In all 7 patients, reanastomoses were performed, and diverting stomas were constructed to protect the anastomosis in 2 patients whose reanastomosis sites were close to the anus. Three of the revised DST anastomoses showed air leakage on the repeat ALT; these sites underwent suturing repair and were confirmed to be airtight. None of the patients with a positive intraoperative ALT had postoperative CAL. The overall CAL rate was 1.4%. Combination management using DST revision, direct suturing repair, and a diverting stoma is recommended for intraoperative repair of anastomotic defects detected by IOCS. © 2017 S. Karger AG, Basel.

  15. Laparoscopic repair of abdominal wall hernia: one-year experience

    NASA Astrophysics Data System (ADS)

    Kavic, Michael S.

    1993-05-01

    In this study, 101 consecutive laparoscopic transabdominal preperitoneal hernia repairs (LTPR) were performed in 62 patients by a single surgeon. The series was begun in April 1991, and involved repair of 49 direct, 41 indirect, 4 femoral, 3 umbilical, 3 sliding, and 1 incisional hernias. Twelve cases were bilateral, eleven hernias were incarcerated, and fifteen hernias were recurrent. There were no intraoperative complications, and none of the procedures required conversion to open surgery. Patients experienced the following postoperative complications: transient testicular pain (1), transient anterior thigh paresthesias (2), urinary retention requiring TURP (1), and hernia recurrences (2). Follow up has ranged from 4 - 15 months and initial results have been encouraging.

  16. Laparoscopic cortical sparing adrenalectomy for pediatric bilateral pheochromocytoma: anesthetic management.

    PubMed

    Rajappa, Geetha Chamanhalli; Anandaswamy, Tejesh Channasandra

    2014-05-01

    Pheochromocytoma is a catecholamine-secreting tumor, which is seen rarely in children. These tumors predominantly secrete norepinephrine and epinephrine. They might be familial and associated with hereditary tumors such as Von Hippel-Lindau syndrome and multiple endocrine neoplasia type II. The child might present with a spectrum of clinical manifestation including hypertension, headache, visual disturbances, and behavioral problems. A meticulous preoperative preparation is essential for a stable intraoperative and postoperative outcome. We described successful perioperative management of a child who underwent bilateral laparoscopic cortical sparing adrenalectomy and a repeated surgery for the residual tumor removal.

  17. Context-aware Augmented Reality in laparoscopic surgery.

    PubMed

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

    2013-03-01

    Augmented Reality is a promising paradigm for intraoperative assistance. Yet, apart from technical issues, a major obstacle to its clinical application is the man-machine interaction. Visualization of unnecessary, obsolete or redundant information may cause confusion and distraction, reducing usefulness and acceptance of the assistance system. We propose a system capable of automatically filtering available information based on recognized phases in the operating room. Our system offers a specific selection of available visualizations which suit the surgeon's needs best. The system was implemented for use in laparoscopic liver and gallbladder surgery and evaluated in phantom experiments in conjunction with expert interviews. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Visual tracking of da Vinci instruments for laparoscopic surgery

    NASA Astrophysics Data System (ADS)

    Speidel, S.; Kuhn, E.; Bodenstedt, S.; Röhl, S.; Kenngott, H.; Müller-Stich, B.; Dillmann, R.

    2014-03-01

    Intraoperative tracking of laparoscopic instruments is a prerequisite to realize further assistance functions. Since endoscopic images are always available, this sensor input can be used to localize the instruments without special devices or robot kinematics. In this paper, we present an image-based markerless 3D tracking of different da Vinci instruments in near real-time without an explicit model. The method is based on different visual cues to segment the instrument tip, calculates a tip point and uses a multiple object particle filter for tracking. The accuracy and robustness is evaluated with in vivo data.

  19. Prototype of a single probe Compton camera for laparoscopic surgery

    NASA Astrophysics Data System (ADS)

    Koyama, A.; Nakamura, Y.; Shimazoe, K.; Takahashi, H.; Sakuma, I.

    2017-02-01

    Image-guided surgery (IGS) is performed using a real-time surgery navigation system with three-dimensional (3D) position tracking of surgical tools. IGS is fast becoming an important technology for high-precision laparoscopic surgeries, in which the field of view is limited. In particular, recent developments in intraoperative imaging using radioactive biomarkers may enable advanced IGS for supporting malignant tumor removal surgery. In this light, we develop a novel intraoperative probe with a Compton camera and a position tracking system for performing real-time radiation-guided surgery. A prototype probe consisting of Ce :Gd3 Al2 Ga3 O12 (GAGG) crystals and silicon photomultipliers was fabricated, and its reconstruction algorithm was optimized to enable real-time position tracking. The results demonstrated the visualization capability of the radiation source with ARM = ∼ 22.1 ° and the effectiveness of the proposed system.

  20. [Results of routine intraoperative cholangiography].

    PubMed

    Klima, S; Schyra, B

    1999-01-01

    Most bile duct injuries result from an incorrect interpretation of bile duct anatomy. In 500 laparoscopic cholecystectomies we used a modified technique of cholecystcholangiography. This method is very easy and needs only 5 minutes. We found variants of bile duct anatomy in 74 cases and occult bile duct stones in 20 patients. We recommend this method which decreases the risk of bile duct injuries and gives the opportunity to approximate the golden standard of conventional cholecystectomy.

  1. Cardiac arrest during laparoscopic Roux-en-Y gastric bypass in a bariatric patient with drug-associated long QT syndrome.

    PubMed

    Woodard, Gavitt; Brodsky, Jay B; Morton, John M

    2011-01-01

    Obese patients often may demonstrate an acquired prolonged QTc interval due to alteration in cardiac physiology, electrolyte disturbances, and/or medication use. Intraoperatively, bariatric surgery may further contribute additional cardiac stressors to obese patients with long QT syndrome (LQTS). We present a case report of an obese woman with LQTS who underwent laparoscopic Roux-en-Y gastric bypass surgery and sustained an intraoperative cardiac arrest. We discuss identification, prevention, and treatment strategies for LQTS in the bariatric surgery patient.

  2. Laparoscopic surgery in weightlessness

    NASA Technical Reports Server (NTRS)

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

    1996-01-01

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

  3. Laparoscopic surgery in weightlessness

    NASA Technical Reports Server (NTRS)

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

    1996-01-01

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

  4. Laparoscopic treatment of intussusception.

    PubMed

    Vilallonga, Ramon; Himpens, Jacques; Vandercruysse, Femke

    2015-01-01

    The success of laparoscopic approach in children has encouraged the application of this technique in young (<2 years) children with non-complicated intussusception. A retrospective analysis of our database provided a total of 4 patients who underwent laparoscopic reduction of intestinal intussusception between 8/2008 and 4/2013. A comprehensive review of each case was done including the video description of the laparoscopic technique of one of them. Four patients (2 boys) were treated by laparoscopy for intestinal intussusception. Mean age was 9 months (5-20 months). Delay time between initial symptoms and diagnosis and between diagnosis and surgery were 3.5 days and 6h respectively. Mean operative time was 35min. There were no conversions. There were no complications. Patients were discharged after 2.5 days (2-4 days). We herein report (video) the laparoscopic approach in a 5 month male child who suffered from a ileocecal intussusception. A 10mm trocar was placed in the left lower quadrant and two 5mm trocars were placed in the upper left quadrant and suprapubic just to the right midline. The cause of the intussusception was identified and the bowel was reduced. A concomitant appendectomy was performed. Laparoscopic reduction of intussusception appears to be a safe procedure, in young children with uncomplicated intussusception. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  5. Laparoscopic treatment of intussusception

    PubMed Central

    Vilallonga, Ramon; Himpens, Jacques; Vandercruysse, Femke

    2014-01-01

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

  6. Laparoscopic pancreatic resection.

    PubMed

    Harrell, K N; Kooby, D A

    2015-10-01

    Though initially slow to gain acceptance, the minimally invasive approach to pancreatic resection grew during the last decade and pancreatic operations such as the distal pancreatectomy and pancreatic enucleation are frequently performed laparoscopically. More complex operations such as the pancreaticoduodenectomy may also confer benefits with a minimally invasive approach but are less widely utilized. Though most research to date comparing open and laparoscopic pancreatectomy is retrospective, the current data suggest that compared with open, a laparoscopic procedure may afford postoperative benefits such as less blood loss, shorter hospital stay, and fewer wound complications. Regarding oncologic considerations, despite initial concerns, laparoscopic resection appears to be non-inferior to an open procedure in terms of lymph node retrieval, negative margin rates, and long-term survival. New technologies, such as robotics, are also gaining acceptance. Data show that while the laparoscopic approach incurs higher cost in the operating room, the resulting shorter hospital stay appears to be associated with an equivalent or lower overall cost. The minimally invasive approach to pancreatic resection can be safe and appropriate with significant patient benefits and oncologic non-inferiority based on existing data.

  7. Laparoscopic repair of femoral hernia

    PubMed Central

    Yang, Xue-Fei

    2016-01-01

    Laparoscopic repair of inguinal hernia is mini-invasive and has confirmed effects. Femoral hernia could be repaired through the laparoscopic procedures for inguinal hernia. These procedures have clear anatomic view in the operation and preoperatively undiagnosed femoral hernia could be confirmed and treated. Lower recurrence ratio was reported in laparoscopic procedures compared with open procedures for repair of femoral hernia. The technical details of laparoscopic repair of femoral hernia, especially the differences to laparoscopic repair of inguinal hernia are discussed in this article. PMID:27826574

  8. Complication rate of uterine morcellation in laparoscopic supracervical hysterectomy: a retrospective cohort study.

    PubMed

    Smits, Roos M; De Kruif, Jan H; Van Heteren, Cathelijne F

    2016-04-01

    Over the last decades minimally invasive surgical techniques are increasingly used to treat symptomatic leiomyomas, providing the patient decreased morbidity and more rapid return to daily activities. Morcellation is the fragmentation of a large mass into smaller pieces to make resection through port incisions possible. Over the last year there has been a discussion worldwide about the safety of morcellation. The aim of our study was to identify the complication rate of power morcellation at our institution. We performed a retrospective chart analysis of patients undergoing laparoscopic supracervical hysterectomy with morcellation. We compared the outcomes of patients undergoing laparoscopic supracervical hysterectomy with the use of power morcellation with a control group of women who underwent laparoscopic-assisted vaginal hysterectomy without morcellation. Women who underwent hysterectomy because of suspected malignancy were excluded. A total of 358 patients underwent laparoscopic hysterectomy between 2004 and 2013; 186 laparoscopic supracervical hysterectomies and 172 laparoscopic-assisted vaginal hysterectomies. The main indication for laparoscopic supracervical hysterectomy was heavy menstrual bleeding and pelvic pressure or pain (94.5%). Baseline characteristics were not significantly different except for body mass index, with a mean of 25.7 in laparoscopic supracervical hysterectomy and 27.0 in laparoscopic-assisted vaginal hysterectomy. There was a significant greater uterine weight in the laparoscopic supracervical hysterectomy group (260g vs. 202g). The overall conversion rate was 5.3% (n=19), with no significant difference between the two groups and 79% of conversions being performed for strategic reasons. There was no statistical difference in intra-operative complication rate (2.1% vs. 1.2%). Pathology reports showed no unexpected malignancies. There was no statistical difference in the complication rate post-operatively (2.2% vs. 2.9%). The overall

  9. Simulation in laparoscopic surgery.

    PubMed

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

    2015-01-01

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

  10. Training system for laparoscopic fundoplication.

    PubMed

    Yokoyama; Mailaender; Raestrup; Buess

    2003-07-01

    Laparoscopic fundoplication is widely used today as a surgical standard for gastro-esophageal reflux disease (GERD). However, the procedures are complicated and require advanced laparoscopic skills. In addition, surgical complications correlate with the surgeon's technique and experience. Thus, a training course in laparoscopic fundoplication should be attended before performing surgery. This paper reports on a training course for laparoscopic Nissen fundoplication developed by our group. This course involves practice in suture knotting as part of the laparoscopic operation, practical experience in fundoplication using a porcine organ training model, and observation of a live operation in the operating room. The course improves laparoscopic skills via practical experience and contributes to the learning curve for laparoscopic fundoplication.

  11. "Knotless" laparoscopic extraperitoneal adenomectomy.

    PubMed

    Garcia-Segui, A; Verges, A; Galán-Llopis, J A; Garcia-Tello, A; Ramón de Fata, F; Angulo, J C

    2015-03-01

    Laparoscopic adenomectomy is a feasible and effective surgical procedure. We have progressively simplified the procedure using barbed sutures and a technique we call "knotless" laparoscopic adenomectomy. We present a prospective, multicenter, descriptive study that reflects the efficacy and safety of this technique in an actual, reproducible clinical practice situation. A total of 26 patients with benign prostatic hyperplasia of considerable size (>80cc) underwent "knotless" laparoscopic adenomectomy. This is an extraperitoneal laparoscopic technique with 4 trocars based on the controlled and hemostatic enucleation of the adenoma using ultrasonic scalpels, precise urethral sectioning under direct vision assisted by a urethral plug, trigonization using barbed suture covering the posterior wall of the fascia, capsulorrhaphy with barbed suture and extraction of the morcellated adenoma through the umbilical incision. The median patient age was 69 (54-83)years, the mean prostate volume was 127 (89-245)cc, the mean operative time was 136 (90-315)min, the mean estimated bleeding volume was 200 (120-500)cc and the hospital stay was 3 (2-6)days. All patients experienced improved function in terms of uroflowmetry and International Prostate Symptom Score and quality of life questionnaires. There were complications in 6 patients, 5 of which were minor. "Knotless" laparoscopic adenomectomy is a procedure with low complexity that combines the advantages of open surgery (lasting functional results and complete extraction of the adenoma) with laparoscopic procedures (reduced bleeding and need for transfusions, shorter hospital stays and reduced morbidity and complications related to the abdominal wall). The use of ultrasonic scalpels and barbed sutures simplifies the procedure and enables a safe and hemostatic technique. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Laparoscopic versus conventional appendectomy.

    PubMed Central

    Vallina, V L; Velasco, J M; McCulloch, C S

    1993-01-01

    OBJECTIVE: The goal of this study was to prospectively define the impact of laparoscopy on the management of patients with a presumed diagnosis of appendicitis. SUMMARY BACKGROUND DATA: While the role of laparoscopy in the management of cholelithiasis is well established, its impact on the management of acute appendicitis needs to be objectively defined and compared to that of conventional management. Several authors have predicted that laparoscopic appendectomy will become the preferred treatment for appendicitis. METHODS: Two groups of consecutive patients with similar clinical characteristics of acute appendicitis were compared. Data on the laparoscopic group were compiled prospectively on standardized forms; data on the conventional group were collected retrospectively. Operative time, hospital stay, analgesia, cost, and return to normal activities were noted. RESULTS: Seventeen consecutive patients who underwent appendectomy were compared to 18 consecutive patients who underwent laparoscopy (16 of these 18 had laparoscopic appendectomy). There was no significant difference between the two groups in terms of clinical characteristics and appendiceal histopathology. The mean operative times were 61 +/- 4.1 minutes and 46 +/- 2.9 minutes for the laparoscopy and conventional groups, respectively (p < 0.01). Hospital stay was significantly shorter in the laparoscopic appendectomy group, with 81% of patients being discharged on their first postoperative day (p < 0.001). The laparoscopic appendectomy patients required significantly less narcotic analgesia (p < 0.02). Return to normal activity was not significantly different between the two groups. The average total cost of laparoscopic appendectomy was 30% greater than that of conventional appendectomy. CONCLUSIONS: Laparoscopy is a useful adjunct to the management of patients with a presumed clinical diagnosis of acute appendicitis. PMID:8239785

  13. Robotic versus laparoscopic liver resection: a comparative study from a single center.

    PubMed

    Yu, Young-Dong; Kim, Ki-Hun; Jung, Dong-Hwan; Namkoong, Jung-Man; Yoon, Sam-Youl; Jung, Sung-Won; Lee, Sang-Kyung; Lee, Sung-Gyu

    2014-12-01

    The significant advantages of robotic surgery have expanded the scope of surgical procedures that can be performed through minimally invasive techniques. The aim of this study was to compare the perioperative outcomes between robotic and laparoscopic liver surgeries at a single center. From July 2007 to October 2011, a total of 206 patients underwent laparoscopic or robotic liver surgery at the Asan Medical Center, Seoul, Korea. We compared the surgical outcomes between robotic liver surgery and laparoscopic liver surgery during the same period. Only patients who underwent left hemihepatectomy or left lateral sectionectomy were included in this study. The robotic group consisted of 13 patients who underwent robotic liver resection including 10 left lateral sectionectomies and three left hemihepatectomies. The laparoscopic group consisted of 17 patients who underwent laparoscopic liver resection during the same period including six left lateral sectionectomies and 11 left hemihepatectomies. The groups were similar with regard to age, gender, tumor type, and tumor size. There were no significant differences in perioperative outcome such as operative time, intraoperative blood loss, postoperative liver function tests, complication rate, and hospital stay between robotic liver resection and laparoscopic liver resection. However, the medical cost was higher in the robotic group. Robotic liver resection is a safe and feasible option for liver resection in experienced hands. The authors suggest that since the robotic surgical system provides sophisticated advantages, the retrenchment of medical cost for the robotic system in addition to refining its liver transection tool may substantially increase its application in clinical practice in the near future.

  14. Laparoscopic repair of voluminous symptomatic hiatal hernia using absorbable synthetic mesh.

    PubMed

    Berselli, Mattia; Livraghi, Lorenzo; Latham, Lorenzo; Farassino, Luca; Rota Bacchetta, Gian Luca; Pasqua, Noemi; Ceriani, Ileana; Segato, Sergio; Cocozza, Eugenio

    2015-01-01

    Hiatal hernia is a common disorder and a controversial topic. In symptomatic voluminous hernias laparoscopic surgery and use of mesh can be considered. An initial experience in voluminous hiatal hernia laparoscopic repair using absorbable glycolic acid/trimethylene carbonate synthetic mesh is reported. Retrospective study from an institutional database was performed to analyze laparoscopic hiatal hernia repair using absorbable synthetic mesh from January 2010 to December 2013. All preoperative symptoms and exams were collected and a standardized procedure was performed. Clinical and radiological follow-up was performed. Eight patients underwent laparoscopic repair of hiatal hernia performed by two highly skilled laparoscopic surgeons. One Toupet and seven Nissen fundoplications were tailored. No conversions into laparotomy, neither intraoperative complications nor mortality occurred. After a median follow-up of 23.5 months (range 14 - 44) no mesh complications occurred and all patients are asymptomatic. Two radiological recurrences (25%) were detected. Voluminous symptomatic hiatal hernias can be successfully treated in a high-volume and long-term experienced laparoscopic surgical center by the use of an absorbable synthetic mesh. Further studies and a longer-term follow-up are necessary to confirm this preliminary report.

  15. Safety and Efficacy of Single Incision Laparoscopic Surgery for Total Extraperitoneal Inguinal Hernia Repair

    PubMed Central

    2011-01-01

    Almost 20 years after the first laparoscopic inguinal hernia repair was performed, single incision laparoscopic surgery (SILS™) is set to revolutionize minimally invasive surgery. However, the loss of triangulation must be overcome before the technique can be popularized. This study reports the first 100 laparoscopic total extraperitoneal hernia repairs using a single incision. The study cohort comprised 68 patients with a mean age of 44 (range, 18 to 83): 36 unilateral and 32 bilateral hernias. Twelve patients also underwent umbilical hernia repair with the Ventralex patch requiring no additional incisions. A 2.5-cm to 3-cm crescentic incision within the confines of the umbilicus was performed. Standard dissecting instruments and 52-cm/5.5-mm/300 laparoscope were used. Operation times were 50 minutes for unilateral and 80 minutes for bilateral. There was one conversion to conventional 3-port laparoscopic repair and none to open surgery. Outpatient surgery was achieved in all (except one). Analgesic requirements were minimal: 8 Dextropropoxyphene tablets (range, 0 to 20). There were no intraoperative or postoperative complications with a high patient satisfaction score. Single-incision laparoscopic hernia repair is safe and efficient simply by modifying dissection techniques (so-called “inline” and “vertical”). Comparable success can be obtained while negating the risks of bowel and vascular injuries from sharp trocars and achieving improved cosmetic results. PMID:21902942

  16. [Laparoscopic ventriculoperitoneal shunt with temporary external drainage for hydrocephalus: a comparison with conventional ventriculoperitoneal shunt].

    PubMed

    Chen, Jianfa; Liu, Changxu; Zhu, Hongsheng; Fu, Ming; Lin, Fulu; Liu, Jun; Xie, Kuilong; Li, Ping

    2012-12-01

    To investigate the clinical efficacy of laparoscopic ventriculoperitoneal shunt with temporary external drainage in the treatment of hydrocephalus. Fifty-two cases of hydrocephalus randomized into two groups to receive laparoscopic assisted ventriculoperitoneal shunt with temporary external drainage (19 male and 7 female patients) and conventional ventriculoperitoneal shunt (20 male and 6 female patients). The catheterization time in the abdominal cavity, release time of intracranial hypertension, average hospital stay, postoperative pains, and postoperative complications were compared between the two groups. Laparoscopic ventriculoperitoneal shunt with temporary external drainage was performed successfully in all the cases without intraoperative conversion to open surgery. Compared with the conventional ventriculoperitoneal shunt, laparoscopic ventriculoperitoneal shunt with temporary external drainage was associated with significantly shortened catheterization time in the abdominal cavity, release time of intracranial hypertension, and average hospital stay (P<0.01) as well as lowered postoperative pain score at 4, 8, 16, and 24 h after the operation. The pain scores at 48 and 72 h postoperatively were comparable between the two groups. During the follow-up 3 months, the patients receiving laparoscopic ventriculoperitoneal shunt were found to have significantly lower rates of peritoneal end obstruction and abdominal cavity infection than those having conventional shunt (3.8% vs 19.2%, P<0.01; 1.0% vs 23.1%, P<0.01). Laparoscopic ventriculoperitoneal shunt with temporary external drainage is feasible and produces better clinical therapeutic effect for management of hydrocephalus.

  17. Numerical optimization of a three-channel radiofrequency coil for open, vertical-field, MR-guided, focused ultrasound surgery using the hybrid method of moment/finite difference time domain method.

    PubMed

    Xin, Xuegang; Wang, Di; Han, Jijun; Feng, Yanqiu; Feng, Qianjin; Chen, Wufan

    2012-07-01

    The numerical optimization of a three-channel radiofrequency (RF) coil with a physical aperture for the open, vertical-field, MR-guided, focused ultrasound surgery (MRgFUS) system using the hybrid method of moment (MoM)/finite difference time domain (FDTD) method is reported. The numerical simulation of the current density distribution on an RF coil with a complicated irregular structure was performed using MoM. The electromagnetic field simulation containing the full coil-tissue interactions within the region of interest was accomplished using the FDTD method. Huygens' equivalent box with six surfaces smoothly connected the MoM and FDTD method. An electromagnetic model of the human pelvic region was reconstructed and loaded in the FDTD zone to optimize the three-channel RF coil and compensate for the lower sensitivity at the vertical field. In addition, the numerical MoM was used to model the resonance, decoupling and impedance matching of the RF coil in compliance with engineering practices. A prototype RF coil was constructed to verify the simulation results. The results demonstrate that the signal-to-noise ratio and the homogeneity of the B(1) field were both greatly improved compared with previously published results.

  18. Laparoscopic Management of Huge Myoma Nascendi.

    PubMed

    Peker, Nuri; Gündoğan, Savas; Şendağ, Fatih

    extending to the isthmus uteri and cervical channel. A myomectomy was performed using standard technique as described elsewhere. A vertical incision was made using a harmonic scalpel. The myoma was fixed with a corkscrew manipulator and enucleated. During the procedure, the endometrial cavity was torn and was closed with 2-0 Vicryl separately. Total intraoperative blood loss was 250 mL, the total weight of the myoma was 245 g, and the operation lasted about 120 minutes. The patient experienced no intraoperative complications. She was discharged on postoperative day 1 and did not exhibit any problems at follow-up. The final histopathological examination confirmed the diagnosis of uterine leiomyoma. Laparoscopic management of huge myomas in difficult locations appears to be a feasible and safe surgical option, especially in experienced hands. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  19. J-tube technique for double-j stent insertion during laparoscopic upper urinary tract surgical procedures.

    PubMed

    Kim, Hyung Suk; Lee, Byung Ki; Jung, Jin-Woo; Lee, Jung Keun; Byun, Seok-Soo; Lee, Sang Eun; Jeong, Chang Wook

    2014-11-01

    Double-J stent insertion has been generally performed during laparoscopic upper urinary tract (UUT) surgical procedures to prevent transient urinary tract obstruction and postoperative flank pain from ureteral edema and blood clots. Several restrictive conditions that make this procedure difficult and time consuming, however, include the coiled distal ends of the flexible Double-J stent and the limited bending angle of the laparoscopic instruments. To overcome these limitations, we devised a Double-J stent insertion method using the new J-tube technique. Between July 2011 and May 2013, Double-J stents were inserted using the J-tube technique in 33 patients who underwent a laparoscopic UUT surgical procedure by a single surgeon. The mean stent placement time was 4.8±2.7 minutes, and there were no intraoperative complications. In conclusion, the J-tube technique is a safe and time-saving method for Double-J stent insertion during laparoscopic surgical procedures.

  20. Intraoperative transfusion practices in Europe.

    PubMed

    Meier, J; Filipescu, D; Kozek-Langenecker, S; Llau Pitarch, J; Mallett, S; Martus, P; Matot, I

    2016-02-01

    Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl(-1) and increased to 9.8 (1.8) g dl(-1) after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl(-1)), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold. NCT 01604083. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.

  1. Laparoscopic approach in complicated diverticular disease

    PubMed Central

    Rotholtz, Nicolás A; Canelas, Alejandro G; Bun, Maximiliano E; Laporte, Mariano; Sadava, Emmanuel E; Ferrentino, Natalia; Guckenheimer, Sebastián A

    2016-01-01

    AIM: To analyze the results of laparoscopic colectomy in complicated diverticular disease. METHODS: This was a retrospective cohort study conducted at an academic teaching hospital. Data were collected from a database established earlier, which comprise of all patients who underwent laparoscopic colectomy for diverticular disease between 2000 and 2013. The series was divided into two groups that were compared: Patients with complicated disease (abscess, perforation, fistula, or stenosis) (G1) and patients undergoing surgery for recurrent diverticulitis (G2). Recurrent diverticulitis was defined as two or more episodes of diverticulitis regardless of patient age. Data regarding patient demographics, comorbidities, prior abdominal operations, history of acute diverticulitis, classification of acute diverticulitis at index admission and intra and postoperative variables were extracted. Univariate analysis was performed in both groups. RESULTS: Two hundred and sixty patients were included: 28% (72 patients) belonged to G1 and 72% (188 patients) to G2. The mean age was 57 (27-89) years. The average number of episodes of diverticulitis before surgery was 2.1 (r 0-10); 43 patients had no previous inflammatory pathology. There were significant differences between the two groups with respect to conversion rate and hospital stay (G1 18% vs G2 3.2%, P = 0.001; G1: 4.7 d vs G2 3.3 d, P < 0.001). The anastomotic dehiscence rate was 2.3%, with no statistical difference between the groups (G1 2.7% vs G2 2.1%, P = 0.5). There were no differences in demographic data (body mass index, American Society of Anesthesiology and previous abdominal surgery), operative time and intraoperative and postoperative complications between the groups. The mortality rate was 0.38% (1 patient), represented by a death secondary to septic shock in G2. CONCLUSION: The results support that the laparoscopic approach in any kind of complicated diverticular disease can be performed with low morbidity and

  2. Laparoscopic treatment of intussusception in children: a systematic review.

    PubMed

    Apelt, Nadja; Featherstone, Neil; Giuliani, Stefano

    2013-08-01

    Idiopathic intussusception is one of the most common causes of small bowel obstruction in children. In the event of failed radiological reduction, laparotomy remains the treatment of choice. There is still no agreement in pediatric surgery about safety and effectiveness of the use of minimally invasive surgery in this common pediatric condition. By reviewing available data we aimed to establish whether laparoscopy should be the primary technique in the surgical reduction of intussusception. A systematic review of all publications on the laparoscopic treatment of pediatric intussusception from January 1990 to April 2012 was performed. The following variables were analyzed: age, laparoscopic success rate, reason for conversion, enterotomy rate, operative time, complications, and length of stay (LOS). Ten retrospective studies treating 276 cases of laparoscopically reduced intussusception were identified. A total of 80 conversions corresponded to a 71.0% laparoscopic success rate. Only one case of intraoperative iatrogenic intestinal perforation was reported (0.4%). Postoperative complications occurred in 8 patients (2.9%), and adhesive small bowel obstruction was reported in 1 case (0.4%). Recurrence rate after laparoscopy was 3.6%. Three of 10 papers compared results between laparoscopic and open reduction of intussusception showing a shorter mean LOS in the former group (4.0 vs. 7.1 days, p<0.01). Laparoscopy is safe and effective in the treatment of pediatric intussusception. Tertiary centers with adequate minimally invasive skills should establish laparoscopy as the primary surgical technique in the treatment of this condition. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Risk Factors for Perioperative Anxiety in Laparoscopic Surgery

    PubMed Central

    Ulucanlar, Haluk; Ay, Ahmet; Ozden, Mustafa

    2014-01-01

    Background and Objectives: Our aim is to investigate the anxiety status of the patient before elective cholecystectomy and to analyze the relation between the level of anxiety for a given operation type (laparoscopic and open cholecystectomy) and the corresponding demographic and social data. Methods: A total of 333 patients undergoing cholecystectomy due to cholelithiasis were included in the study; 218 patients (66.1%) received laparoscopic cholecystectomy and 115 patients (33.9%) were treated with open cholecystectomy. The Beck Anxiety Inventory was given to all patients to be completed. We evaluated levels of anxiety in 3 groups as follows: 0 to 15, low to mild anxiety; 16 to 25, moderate anxiety; 26 to 63, severe anxiety. The following patient information remained confidential and was recorded: age and sex, associated disease, civil status, educational status, having open/laparoscopic cholecystectomy, previous knowledge of the operation, job status, economic status, health insurance, and having a child in need of care. Results: The following criteria were determined: the most determinant factors in differentiating between the score groups were having a low level of education, being of the female sex, being single, and having laparoscopic operation; the factors of being a homemaker and over the age of 25 years were determined to have significant effects. Conclusions: When analyzing the results that may appear during the intraoperative and postoperative period, understanding preoperative anxiety, analyzing the risk factors in depth, and taking the necessary precautions are all considerations that need to be the primary objectives of operators who are involved with laparoscopic, endoscopic, and robotic surgery. PMID:25392610

  4. Emulation of the laparoscopic environment for image-guided liver surgery via an abdominal phantom system with anatomical ligamenture

    NASA Astrophysics Data System (ADS)

    Heiselman, Jon S.; Collins, Jarrod A.; Clements, Logan W.; Weis, Jared A.; Simpson, Amber L.; Geevarghese, Sunil K.; Jarnagin, William R.; Miga, Michael I.

    2017-03-01

    In order to rigorously validate techniques for image-guided liver surgery (IGLS), an accurate mock representation of the intraoperative surgical scene with quantifiable localization of subsurface targets would be highly desirable. However, many attempts to reproduce the laparoscopic environment have encountered limited success due to neglect of several crucial design aspects. The laparoscopic setting is complicated by factors such as gas insufflation of the abdomen, changes in patient orientation, incomplete organ mobilization from ligaments, and limited access to organ surface data. The ability to accurately represent the influences of anatomical changes and procedural limitations is critical for appropriate evaluation of IGLS methodologies such as registration and deformation correction. However, these influences have not yet been comprehensively integrated into a platform usable for assessment of methods in laparoscopic IGLS. In this work, a mock laparoscopic liver simulator was created with realistic ligamenture to emulate the complexities of this constrained surgical environment for the realization of laparoscopic IGLS. The mock surgical system reproduces an insufflated abdominal cavity with dissectible ligaments, variable levels of incline matching intraoperative patient positioning, and port locations in accordance with surgical protocol. True positions of targets embedded in a tissue-mimicking phantom are measured from CT images. Using this setup, image-to-physical registration accuracy was evaluated for simulations of laparoscopic right and left lobe mobilization to assess rigid registration performance under more realistic laparoscopic conditions. Preliminary results suggest that non-rigid organ deformations and the region of organ surface data collected affect the ability to attain highly accurate registrations in laparoscopic applications.

  5. A Novel Ultrasound-Based Registration for Image-Guided Laparoscopic Liver Ablation.

    PubMed

    Fusaglia, Matteo; Tinguely, Pascale; Banz, Vanessa; Weber, Stefan; Lu, Huanxiang

    2016-08-01

    Background Patient-to-image registration is a core process of image-guided surgery (IGS) systems. We present a novel registration approach for application in laparoscopic liver surgery, which reconstructs in real time an intraoperative volume of the underlying intrahepatic vessels through an ultrasound (US) sweep process. Methods An existing IGS system for an open liver procedure was adapted, with suitable instrument tracking for laparoscopic equipment. Registration accuracy was evaluated on a realistic phantom by computing the target registration error (TRE) for 5 intrahepatic tumors. The registration work flow was evaluated by computing the time required for performing the registration. Additionally, a scheme for intraoperative accuracy assessment by visual overlay of the US image with preoperative image data was evaluated. Results The proposed registration method achieved an average TRE of 7.2 mm in the left lobe and 9.7 mm in the right lobe. The average time required for performing the registration was 12 minutes. A positive correlation was found between the intraoperative accuracy assessment and the obtained TREs. Conclusions The registration accuracy of the proposed method is adequate for laparoscopic intrahepatic tumor targeting. The presented approach is feasible and fast and may, therefore, not be disruptive to the current surgical work flow.

  6. [Combined endoscopic-laparoscopic techniques for one-stage treatment of concomitant cholelithiasis and choledocholithiasis].

    PubMed

    Wu, Junzheng; Xu, Xiaofei; Liu, Hao; Li, Guoxin

    2013-11-01

    To assess the clinical effects of combined endoscopic-laparoscopic technique for one-stage treatment of cholelithiasis with concomitant choledocholithiasis. A retrospective analysis was conducted of the clinical data of 30 patients (Group A) with cholelithiasis and choledocholithiasis receiving one-stage laparoscopic cholecystectomy (LC) combined with intraoperative encoscopic retrograde cholangio-pancreatography (ERCP) and 32 patients (Group B) receiving LC combined with 1aparoscopic common bile duct exploration. The operative time, blood loss, conversion to open surgery rate, time to postoperative ambulation, calculi residual rate, hospitalization cost and length of hospital stay were analyzed comparatively. There were statistically differences between the two groups in hospitalization cost and length of hospital stay (P<0.05) but not in the other indices (P>0.05). Combined endoscopic-laparoscopic techniques can be a safe and feasible option for one-stage treatment of concomitant cholelithiasis and choledocholithiasis to allow rapid postoperative recovery with a shortened hospital stay.

  7. Cost is not a drawback to perform laparoscopic appendectomy in an academic hospital.

    PubMed

    Lasses-Martínez, Bibiana; Ortiz-Oshiro, Elena; Cabañas-Ojeda, Juan L; Benito-Expósito, Patricia; Fernández-Pérez, Cristina; Alvarez Fernández-Represa, Jesus

    2014-08-01

    Appendectomy is the most frequently performed emergent surgical procedure in western countries. There is still controversy about which alternative is clinically and economically superior: open or laparoscopic appendectomy (LA). Our aim was to determine clinical outcomes and cost of both procedures in our academic institution. A retrospective comparative study was performed including patients undergoing appendectomy from January to December 2011. Demographic data, operating room occupancy time, hospital length of stay, complications, and economic data were obtained. A total of 116 appendectomies were performed along the time of study, 23.27% laparoscopic and 76.72% open. Groups were similar in terms of demographics and intraoperative findings. Operating room occupancy time was longer in laparoscopic group and hospital stay was shorter. No significant differences were found respecting to postoperative complications rate. Cost minimization analysis showed that LA saved 1561.08&OV0556; per patient. In our teaching setting, LA may have clinical and economic advantages over open appendectomy.

  8. Carbon dioxide embolism during laparoscopic cholecystectomy due to a patent paraumbilical vein.

    PubMed

    Mattei, Peter; Tyler, Donald C

    2007-03-01

    Carbon dioxide embolism is a rare but potentially fatal complication of laparoscopic surgery. The most common cause is inadvertent injection of carbon dioxide into a large vein or solid organ during initial peritoneal insufflation. We describe a case of carbon dioxide embolism in a 13-year-old boy during an elective laparoscopic cholecystectomy, caused by injection of carbon dioxide into a large paraumbilical vein. The clinical manifestations of carbon dioxide embolism were hypotension, bradycardia, and an abrupt drop in end-tidal CO2. He subsequently did well and had no sequelae. Carbon dioxide embolism is a recognized complication of laparoscopic surgery, although the risk to the patient may be minimized by the surgical team's awareness of the problem, continuous intraoperative monitoring of end-tidal CO2, and using an open technique for initial access to the peritoneum.

  9. Laparoscopic-assisted cystotomy for urolith removal in dogs and cats — 23 cases

    PubMed Central

    Pinel, Cory B.; Monnet, Eric; Reems, Michael R.

    2013-01-01

    This report describes the outcomes of a modified laparoscopic-assisted cystotomy for urolith removal in dogs and cats. Modifications of the original techniques included a temporary cystopexy to the abdominal wall, utilization of a laparoscope instead of cystoscope, and retrograde flow of saline in the bladder with pressurized saline. The medical records of 23 client-owned animals for which laparoscopic-assisted cystotomy was used for urolith extraction were reviewed. Twenty-six procedures were performed in 23 animals. There were intraoperative complications in 19.2% of cases leading to open conversion in 11.5%. Rate of complications directly related to the procedure was 11.5%. Four cases had documented urolith recurrence with a mean time to recurrence of 335 days. PMID:23814299

  10. The impact of feedback of intraoperative technical performance in surgery: a systematic review.

    PubMed

    Trehan, Abhishek; Barnett-Vanes, Ashton; Carty, Matthew J; McCulloch, Peter; Maruthappu, Mahiben

    2015-06-15

    Increasing patient demands, costs and emphasis on safety, coupled with reductions in the length of time surgical trainees spend in the operating theatre, necessitate means to improve the efficiency of surgical training. In this respect, feedback based on intraoperative surgical performance may be beneficial. Our aim was to systematically review the impact of intraoperative feedback based on surgical performance. MEDLINE, Embase, PsycINFO, AMED and the Cochrane Database of Systematic Reviews were searched. Two reviewers independently reviewed citations using predetermined inclusion and exclusion criteria. 32 data-points per study were extracted. The search strategy yielded 1531 citations. Three studies were eligible, which comprised a total of 280 procedures by 62 surgeons. Overall, feedback based on intraoperative surgical performance was found to be a powerful method for improving performance. In cholecystectomy, feedback led to a reduction in procedure time (p=0.022) and an improvement in economy of movement (p<0.001). In simulated laparoscopic colectomy, feedback led to improvements in instrument path length (p=0.001) and instrument smoothness (p=0.045). Feedback also reduced error scores in cholecystectomy (p=0.003), simulated laparoscopic colectomy (p<0.001) and simulated renal artery angioplasty (p=0.004). In addition, feedback improved balloon placement accuracy (p=0.041), and resulted in a smoother learning curve and earlier plateau in performance in simulated renal artery angioplasty. Intraoperative feedback appears to be associated with an improvement in performance, however, there is a paucity of research in this area. Further work is needed in order to establish the long-term benefits of feedback and the optimum means and circumstances of feedback delivery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. Indocyanine green for intraoperative localization of ureter.

    PubMed

    Siddighi, Sam; Yune, Junchan Joshua; Hardesty, Jeffrey

    2014-10-01

    Intraurethral injection of indocyanine green (ICG; Akorn, Lake Forest, IL) and visualization under near-infrared (NIR) light allows for real-time delineation of the ureter. This technology can be helpful to prevent iatrogenic ureteral injury during pelvic surgery. Patients were scheduled to undergo robot-assisted laparoscopic sacrocolpopexy. Before the robotic surgery started, the tip of a 6-F ureteral catheter was inserted into the ureteral orifice. Twenty-five milligrams of ICG was dissolved in 10-mL of sterile water and injected through the open catheter. The same procedure was repeated on the opposite side. The ICG reversibly stained the inside lining of the ureter by binding to proteins on urothelial layer. During the course of robotic surgery, the NIR laser on the da Vinci Si surgical robot (Intuitive Surgical, Inc, Sunnyvale, CA) was used to excite ICG molecules, and infrared emission was captured by the da Vinci filtered lens system and electronically converted to green color. Thus, the ureter fluoresced green, which allowed its definitive identification throughout the entire case. In all cases of >10 patients, we were able to visualize bilateral ureters with this technology, even though there was some variation in brightness that depended on the depth of the ureter from the peritoneal surface. For example, in a morbidly obese patient, the ureters were not as bright green. There were no intraoperative or postoperative adverse effects attributable to ICG administration for up to 2 months of observation. In our experience, this novel method of intraurethral ICG injection was helpful to identify the entire course of ureter and allowed a safe approach to tissues that were adjacent to the urinary tract. The advantage of our technique is that it requires the insertion of just the tip of ureteral catheter. Despite our limited cohort of patients, our findings are consistent with previous reports of the excellent safety profile of intravenous and intrabiliary ICG

  12. Real-time Intraoperative Fluorescent Lymphography: A New Technique for Lymphatic Sparing Surgery.

    PubMed

    Ietto, G; Amico, F; Soldini, G; Chiappa, C; Franchin, M; Iovino, D; Romanzi, A; Saredi, G; Cassinotti, E; Boni, L; Tozzi, M; Carcano, G

    2016-11-01

    Many surgical procedures can produce persistent lymphorrhea, lymphoceles, and lymphedema after lymph node and lymph vessel damage. Appropriate visualization of the lymphatic system is challenging. Indocyanine green (ICG) is a well-known nontoxic dye for lymphatic flow evaluation. ICG fluorescence-guided lymphography has emerged as a promising technique for intraoperative lymphatic mapping. Our goal was to develop a high spatial resolution, real-time intraoperative imaging technique to avoid or recognize early deep lymphatic vessel damage. We intraoperatively performed ICG fluorescence-guided lymphography during a kidney transplant. ICG was injected in the subcutaneous tissue of the patient's groin in the Scarpa's triangle. A dedicated laparoscopic high-definition camera system was used. Soon after ICG injection, the lymphatic vessels were identified in the abdominal retroperitoneal compartment as fluorescent linear structures running side by side to the iliac vessels. Surgical dissection was therefore performed, avoiding iatrogenic damage to major lymphatic structures. Another ICG injection at the end of the procedure confirmed that the lymphatic vessels were intact without lymph spread. Intraoperative lymphatic mapping with an ICG fluorescence-sensitive camera system is a safe and feasible procedure. ICG real-time fluorescence lymphography can be used to avoid or recognize early deep lymphatic vessel damage and reduce postoperative complications related to the lymphatic system. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Laparoscopic Pyeloplasty and Flexible Nephroscopy: Simultaneous Treatment of Ureteroplevic Junction Obstruction and Nephrolithiasis

    PubMed Central

    Ball, Adam J.; Patel, Vipul R.; Wong, Carson

    2004-01-01

    Background and Objective: Ureteropelvic junction obstruction and concomitant calculus disease may coexist. Therapeutic controversy exists regarding their ideal management. We report our use of flexible nephroscopy during laparoscopic pyeloplasty for caliceal stone removal. Methods: From August 1998 through May 2002, 50 laparoscopic pyeloplasties were performed. Seven patients had documented ureteropelvic junction obstruction and ipsilateral nephrolithiasis. Preoperative stone burden and location were assessed. After pyelotomy, a 16 Fr flexible endoscope was passed through the uppermost trocar under direct laparoscopic guidance into the collecting system. Stone extraction was performed with a 2.4 Fr Nitinol basket. Postoperative imaging was assessed. Results: Complete stone-free status confirmed by postoperative imaging was achieved in 6 of 7 patients. The longest individual stone diameter ranged from 4 mm to 13 mm (mean, 10.3 mm), and an average of 2.5 stones per patient was removed (range, 1 to 4 stones). Neither intraoperative fluoroscopy nor lithotripsy was required. No intraoperative or delayed complications were noted during a mean follow-up of 8.5 months (range, 2 to 17 months). Conclusions: Laparoscopic pyeloplasty and concomitant flexible nephroscopy with basket extraction is a simple, attractive alternative for the simultaneous treatment of ureteropelvic junction obstruction presenting with coexisting nephrolithiasis. It appears more efficacious when the stone number is limited and diameters measure from 5 mm to 20 mm. PMID:15347108

  14. Lighted ureteral stents in laparoscopic colorectal surgery; a five-year experience

    PubMed Central

    Lavy, Daniel; Dinallo, Anthony; Otero, Javier; Roding, Annelie; Hanos, Dustin; Dressner, Roy; Arvanitis, Michael

    2017-01-01

    Background Ureteral injuries during colorectal surgery are a rare event, ranging in the literature from 0.28–7.6%. Debate surrounds the use of prophylactic lighted ureteral stents to help protect the ureter during laparoscopic surgery. It has been suggested that they help to identify injuries but do not prevent them. The authors look to challenge this. Methods Over 66 months, every laparoscopic or colectomy involving ureteral stents was recorded. Researchers documented any injury to the ureter intraoperatively. The chart was also reviewed for the complications of urinary tract infection (UTI) and urinary retention post-operatively. Results During the 66 months, 402 laparoscopic colon resections were done. There were no ureteral injuries. The lighted ureteral stent was identified during every case in the effort to prevent injury during dissection and resection. No catheter associated UTIs were identified, while 14 (3.5%) suffered from post-operative urinary retention. Conclusions The authors of this study present a large series of colon resections with no intraoperative ureteral injuries. In addition, these catheters were not associated with any UTIs and a rate of urinary retention similar to that of the at large data. This series provides compelling data to use lighted ureteral stents during laparoscopic colon surgery. PMID:28251123

  15. Single port access laparoscopic surgery for large adnexal tumors: Initial 51 cases of a single institute

    PubMed Central

    Cho, Bo Ra; Han, Jae Won; Kim, Tae Hyun; Han, Ae Ra; Hur, Sung Eun; Lee, Sung Ki

    2017-01-01

    Objective Investigation of initial 51 cases of single port access (SPA) laparoscopic surgery for large adnexal tumors and evaluation of safety and feasibility of the surgical technique. Methods We retrospectively reviewed the medical records of the first 51 patients who received SPA laparoscopic surgery for large adnexal tumors greater than 10 cm, from July 2010 to February 2015. Results SPA adnexal surgeries were successfully completed in 51 patients (100%). The mean age, body mass index of the patients were 43.1 years and 22.83 kg/m2, respectively. The median operative time, median blood loss were 73.5 (range, 20 to 185) minutes, 54 (range, 5 to 500) mL, and the median tumor diameter was 13.6 (range, 10 to 30) cm. The procedures included bilateral salpingo-oophorectomy (n=18, 36.0%), unilateral salpingo-oophorectomy (n=14, 27.45%), and paratubal cystectomy (n=1, 1.96%). There were no cases of malignancy and none were insertion of additional ports or conversion to laparotomy. The cases with intraoperative spillage were 3 (5.88%) and benign cystic tumors. No other intraoperative and postoperative complications were observed during hospital days and 6-weeks follow-up period after discharge. Conclusion Our results suggest that SPA laparoscopic surgery for large adnexal tumors may be a safe and feasible alternative to conventional laparoscopic surgery. PMID:28217669

  16. Laparoscopic and laparoscopic-assisted cryptorchidectomy in dogs and cats.

    PubMed

    Mayhew, Phillip

    2009-06-01

    There are many applications for laparoscopy in small animal surgery. A relatively simple one is abdominal cryptorchid castration. Laparoscopic examination of the peritoneal cavity can both aid in the diagnosis of abdominal cryptorchidism and allow treatment using either a totally laparoscopic or a laparoscopic-assisted technique. Minimally invasive cryptorchid castration obviates the need for "open" celiotomy and may thereby reduce postoperative discomfort and wound-related complications in these patients.

  17. Non-invasive monitoring of tissue oxygenation during laparoscopic donor nephrectomy

    PubMed Central

    Crane, Nicole J; Pinto, Peter A; Hale, Douglas; Gage, Frederick A; Tadaki, Doug; Kirk, Allan D; Levin, Ira W; Elster, Eric A

    2008-01-01

    Background Standard methods for assessment of organ viability during surgery are typically limited to visual cues and tactile feedback in open surgery. However, during laparoscopic surgery, these processes are impaired. This is of particular relevance during laparoscopic renal donation, where the condition of the kidney must be optimized despite considerable manipulation. However, there is no in vivo methodology to monitor renal parenchymal oxygenation during laparoscopic surgery. Methods We have developed a method for the real time, in vivo, whole organ assessment of tissue oxygenation during laparoscopic nephrectomy to convey meaningful biological data to the surgeon during laparoscopic surgery. We apply the 3-CCD (charge coupled device) camera to monitor qualitatively renal parenchymal oxygenation with potential real-time video capability. Results We have validated this methodology in a porcine model across a range of hypoxic conditions, and have then applied the method during clinical laparoscopic donor nephrectomies during clinically relevant pneumoperitoneum. 3-CCD image enhancement produces mean region of interest (ROI) intensity values that can be directly correlated with blood oxygen saturation measurements (R2 > 0.96). The calculated mean ROI intensity values obtained at the beginning of the laparoscopic nephrectomy do not differ significantly from mean ROI intensity values calculated immediately before kidney removal (p > 0.05). Conclusion Here, using the 3-CCD camera, we qualitatively monitor tissue oxygenation. This means of assessing intraoperative tissue oxygenation may be a useful method to avoid unintended ischemic injury during laparoscopic surgery. Preliminary results indicate that no significant changes in renal oxygenation occur as a result of pneumoperitoneum. PMID:18419819

  18. Carcinoma of the pancreatic head and periampullary region. Tumor staging with laparoscopy and laparoscopic ultrasonography.

    PubMed Central

    John, T G; Greig, J D; Carter, D C; Garden, O J

    1995-01-01

    OBJECTIVE: The authors performed a prospective evaluation of staging laparoscopy with laparoscopic ultrasonography in predicting surgical resectability in patients with carcinomas of the pancreatic head and periampullary region. SUMMARY BACKGROUND DATA: Pancreatic resection with curative intent is possible in a select minority of patients who have carcinomas of the pancreatic head and periampullary region. Patient selection is important to plan appropriate therapy and avoid unnecessary laparotomy in patients with unresectable disease. Laparoscopic ultrasonography is a novel technique that combines the proven benefits of staging laparoscopy with high resolution intraoperative ultrasound of the liver and pancreas, but which has yet to be evaluated critically in the staging of pancreatic malignancy. METHODS: A cohort of 40 consecutive patients referred to a tertiary referral center and with a diagnosis of potentially resectable pancreatic or periampullary cancer underwent staging laparoscopy with laparoscopic ultrasonography. The diagnostic accuracy of staging laparoscopy alone and in conjunction with laparoscopic ultrasonography was evaluated in predicting tumor resectability (absence of peritoneal or liver metastases; absence of malignant regional lymphadenopathy; tumor confined to pancreatic head or periampullary region). RESULTS: "Occult" metastatic lesions were demonstrated by staging laparoscopy in 14 patients (35%). Laparoscopic ultrasonography demonstrated factors confirming unresectable tumor in 23 patients (59%), provided staging information in addition to that of laparoscopy alone in 20 patients (53%), and changed the decision regarding tumor resectability in 10 patients (25%). Staging laparoscopy with laparoscopic ultrasonography was more specific and accurate in predicting tumor resectability than laparoscopy alone (88% and 89% versus 50% and 65%, respectively). CONCLUSIONS: Staging laparoscopy is indispensable in the detection of "occult" intra

  19. Laparoscopic Management of Bleeding After Laparoscopic or Vaginal Hysterectomy

    PubMed Central

    Jabor, Antonin

    2004-01-01

    Objective: To assess the results and contributions of laparoscopy in the management of postoperative bleeding following laparoscopic (LH) or vaginal hysterectomy (VH). Methods: A retrospective study of a 5-year period was carried out on 1167 women who underwent laparoscopic or vaginal hysterectomy. Ten women with postoperative bleeding following laparoscopic or vaginal hysterectomy were identified. Results: The overall incidence of bleeding after laparoscopic or vaginal hysterectomy was 0.85% (10 of 1167). Over the 5-year study period, the incidence fluctuated between 1.1% and 0.4%. Surgical revision was primarily vaginal in 1 woman, followed by laparoscopic control. In 6 patients, laparoscopy was performed immediately. The patients profited from the prompt laparoscopic treatment, because intraabdominal hemorrhage was found and stopped. Of 6 cases of intraperitoneal bleeding, 1 resulted from a blood disorder. The collagen-fibrin agent TachoComb was applied locally, and the patient was postoperatively treated with blood products and coagulation factors. Only bipolar coagulation, TachoComb, and Foley catheter were used to achieve local hemostasis during laparoscopy. The remaining 3 cases where the vaginal cuff was bleeding were managed by vaginal repair and packing without laparoscopy. Conclusion: The laparoscopic approach to postoperative bleeding following laparoscopic or vaginal hysterectomy is an attractive alternative to the abdominal surgical approach. Bleeding following laparoscopic or vaginal hysterectomy can be managed by laparoscopy in the majority of patients. Because the abdominal incision is avoided, the recovery time is reduced. PMID:15347110

  20. Laparoscopic management of bleeding after laparoscopic or vaginal hysterectomy.

    PubMed

    Holub, Zdenek; Jabor, Antonin

    2004-01-01

    To assess the results and contributions of laparoscopy in the management of postoperative bleeding following laparoscopic (LH) or vaginal hysterectomy (VH). A retrospective study of a 5-year period was carried out on 1167 women who underwent laparoscopic or vaginal hysterectomy. Ten women with postoperative bleeding following laparoscopic or vaginal hysterectomy were identified. The overall incidence of bleeding after laparoscopic or vaginal hysterectomy was 0.85% (10 of 1167). Over the 5-year study period, the incidence fluctuated between 1.1% and 0.4%. Surgical revision was primarily vaginal in 1 woman, followed by laparoscopic control. In 6 patients, laparoscopy was performed immediately. The patients profited from the prompt laparoscopic treatment, because intraabdominal hemorrhage was found and stopped. Of 6 cases of intraperitoneal bleeding, 1 resulted from a blood disorder. The collagen-fibrin agent TachoComb was applied locally, and the patient was postoperatively treated with blood products and coagulation factors. Only bipolar coagulation, TachoComb, and Foley catheter were used to achieve local hemostasis during laparoscopy. The remaining 3 cases where the vaginal cuff was bleeding were managed by vaginal repair and packing without laparoscopy. The laparoscopic approach to postoperative bleeding following laparoscopic or vaginal hysterectomy is an attractive alternative to the abdominal surgical approach. Bleeding following laparoscopic or vaginal hysterectomy can be managed by laparoscopy in the majority of patients. Because the abdominal incision is avoided, the recovery time is reduced.

  1. An external audit of laparoscopic cholecystectomy performed in medical treatment facilities of the department of Defense.

    PubMed Central

    Wherry, D C; Rob, C G; Marohn, M R; Rich, N M

    1994-01-01

    OBJECTIVE: This study provided an objective survey by an outside auditing group of a large, complete patient population undergoing laparoscopic cholecystectomies, determined the frequency of complications, especially bile duct injuries, and presented a system for classifying and comparing the severity of bile duct injuries. SUMMARY BACKGROUND DATA: This is the first study of laparoscopic cholecystectomy to encompass a large and complete patient population and to be based on objectively collected data rather than self-reported data. The Civilian External Peer Review Program (CEPRP) of the Department of Defense health care system conducted a retrospective study of 5642 patients who underwent laparoscopic cholecystectomies at 89 military medical treatment facilities from July 1990 through May 1992. METHODS: The study sample consisted of the complete records of 5607 (99.38%) of the 5642 laparoscopic cholecystectomy patients. RESULTS: Of the sample, 6.87% of patients experienced complications within 30 days of surgery, 0.57% sustained bile duct injuries, and 0.5% sustained bowel injuries. Among 5154 patients whose procedures were completed laparoscopically, 5.47% experienced complications. Laparoscopic procedures were converted to open cholecystectomies in 8.08% of cases. Intraoperative cholangiograms were attempted in 46.5% of cases and completed in 80.59% of those attempts. There were no intraoperative deaths; 0.04% of the patients died within 30 days of surgery. CONCLUSIONS: The frequency of complications found in this study is comparable to the frequency of complications reported in recent large civilian studies and earlier, smaller studies. The authors present a system for classifying bile duct injuries, which is designed to standardize references to such injuries and allow for accurate comparison of bile duct injuries in the future. Images Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Figure 6. PMID:7979610

  2. Laparoscopic bilateral transperitoneal adrenalectomy for Cushing syndrome: surgical challenges and lessons learnt.

    PubMed

    Aggarwal, Sandeep; Yadav, Kunal; Sharma, Aditya P; Sethi, Vrishketan

    2013-06-01

    Laparoscopic adrenalectomy is well established for treatment of adrenal lesions. However, bilateral adrenalectomy for Cushing syndrome is a challenging and time-consuming operation. We report our experience of laparoscopic bilateral adrenalectomy for this disease in 19 patients. From September 2009 to August 2012, we have operated 19 patients with Cushing syndrome and performed bilateral laparoscopic adrenalectomy using the transperitoneal approach; synchronous in 15 patients and staged in 4 patients. In 15 patients, the surgery was carried out sequentially on both the sides in lateral position with intraoperative change in position. Complete adrenalectomy including periadrenal fat was carried out on both the sides. Nineteen patients were referred from Department of Endocrinology for bilateral adrenalectomy for adrenocorticotropin hormone (ACTH)-dependent and ACTH-independent Cushing syndrome. The indications for surgery were Cushing disease in 15 patients, occult/ectopic source of ACTH in 2 patients, and primary adrenal hyperplasia in 2 patients. Fifteen patients underwent bilateral adrenalectomy during the same operation. Four patients underwent staged procedures. All procedures were completed laparoscopically with no conversions. The mean operating time for simultaneous bilateral adrenalectomy was 210 minutes (range, 150 to 240 min). This included the repositioning and reprepping time. There were no major intraoperative complications. The average blood loss was 100 mL (range, 50 to 200 mL). None of the patients required blood transfusions in the postoperative period. The postoperative complications included minor port-site infection in 2 patients. One severely debilitated patient died on the 14th postoperative day because of hospital-acquired pneumonia. The remaining 18 patients have done well in terms of impact on the disease. Laparoscopic bilateral adrenalectomy for Cushing syndrome is feasible and safe. It confers all the advantages of minimally invasive

  3. Laparoscopic Resection and End-to-End Ureteroureterostomy for Midureteral Obstruction in Children.

    PubMed

    Lu, Liangsheng; Bi, Yunli; Wang, Xiang; Ruan, Shuangsui

    2017-02-01

    Midureteral obstruction is an extremely rare condition. This retrospective study assessed the outcomes of laparoscopic ureteroureterostomy (UU) in 13 children with midureteral obstructions. Records of patients with midureteral obstruction who underwent laparoscopic end-to-end UU between July 2011 and August 2015 were reviewed. The medical records comprised patient demographic data, intraoperative details, postoperative outcomes, and related complications. Renal ultrasound, magnetic resonance urography, and radioisotope renography were used for pre- and postoperative assessment. Success was defined as removal of symptomatic obstruction or improvement of hydronephrosis. Thirteen patients from 3.0 months to 12 years old were identified: 6 patients presented with asymptomatic hydronephrosis (according to the renal ultrasonography), 3 with intermittent abdominal pain, and 2 with gross hematuria. The remaining 2 patients presented with urinary extravasation after inguinal hernia repair and the Soave procedure, respectively. All patients underwent laparoscopic end-to-end UU. Procedures were performed using either the laparoscopic transperitoneal approach or laparoscopic retroperitoneal approach. All surgeries were performed successfully except for one case that required open surgery because of difficult anastomosis. There were no intraoperative or immediate postoperative complications. The etiology of the midureteral obstruction included congenital midureteral stricture, ureteral polyp, retrocaval ureter, and iatrogenic injury. The mean surgical time was 148.4 min, and postoperative hospital stay was 4.0-9.0 d. Postoperative outcomes were successful in all 13 patients (100%); median follow-up was 19.1 months. Laparoscopic UU was found to be feasible and safe for the management of midureteral obstruction in children.

  4. 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.

  5. Preliminary experience with laparoscopic cholecystectomy in a nigerian teaching hospital.

    PubMed

    Afuwape, O O; Akute, O O; Adebanjo, A T

    2012-01-01

    Presently many centers have facilities for laparoscopic surgery in Nigeria, but the practice is just evolving in most of these centers. This article presents the preliminary experience of the endoscopic surgery unit (general surgery) at the University College Hospital Ibadan Nigeria. The University College Hospital is the premier Nigerian teaching hospital and is located in the south-western part of the country. All the patients who had laparoscopic cholecystectomy at the University College Hospital between June 2009 and January 2011 were included in this study. The patients' demographic data, diagnosis, results of investigations and intra-operative findings were obtained from the records. Additional information extracted from the records was the duration of surgery, complications, outcome and discharge periods. There were thirteen patients over the twenty month period consisting of twelve females and one male. The age range was twenty six to sixty seven years with a mean of 44.6 years. The duration of surgery ranged from 90 to 189 minutes with a mean of 124 minutes. There were two complications. These were adhesive bowel obstruction and common bile duct injury. The duration of admission ranged from four to thirty two days with a mean of 7.53SD ± 8.5 days. There was one conversion to open surgery due to intra-operative gallbladder perforation with consequent dispersal of multiple gall stones within the peritoneal cavity. The common bile duct injury was diagnosed four days following surgery for which a choledochojejunostomy was done after initial conservative treatment. There was no mortality. Laparoscopic surgery is feasible in Nigeria and is likely to show increasing popularity among patients and surgeons. A careful patient selection protocol is necessary for an acceptable success rate with minimal complications. Our protocol of patient selection eliminated the need for intra-operative common bile duct exploration which requires expensive instruments. However, to

  6. Laparoscopic versus Open Ladd's Procedure for Intestinal Malrotation in Adults

    PubMed Central

    Frasier, Lane L.; Leverson, Glen; Gosain, Ankush; Greenberg, Jacob

    2014-01-01

    Background Intestinal malrotation results from errors in fetal intestinal rotation and fixation. While most patients are diagnosed in childhood, some present as adults. Laparoscopic Ladd's procedure is an accepted alternative to laparotomy in children but has not been well-studied in adults. This study was designed to investigate outcomes for adults undergoing laparoscopic Ladd's repair for malrotation. Methods We performed a single-institution retrospective chart review over eleven years. Data collected included: patient age, details of pre-operative work-up and diagnosis, surgical management, complications, rates of re-operation, and symptom resolution. Patients were evaluated on an intent-to-treat basis based on their planned operative approach. Categorical data were analyzed using Fisher's exact test. Continuous data were analyzed using Student's T-test. Results Twenty-two patients were identified (age range 18-63). Fifteen were diagnosed pre-operatively; of the remaining seven patients, four received an intra-operative malrotation diagnosis during elective surgery for another problem. Most had some type of pre-operative imaging, with Computed Tomography being the most common (77.3%). Comparing patients on an intent-to-treat basis, the two groups were similar with respect to age, operative time, and estimated blood loss. Six patients underwent successful laparoscopic repair; three began laparoscopically but were converted to laparotomy. There was a statistically significant difference in length of stay (LOS) (5.0±2.5d vs 11.6±8.1d, p=0.0148) favoring the laparoscopic approach. Three patients required re-operation: 2 underwent side-to-side duodeno-duodenostomy and 1 underwent a re-do Ladd's procedure. Ultimately, 3 (2 laparoscopic, 1 open) had persistent symptoms of bloating (n=2), constipation (n=2), and/or pain (n=1). Conclusion Laparoscopic repair appears to be safe and effective in adults. While a small sample size limits the power of this study, we found

  7. Comparison of two laparoscopic peritoneal vaginoplasty techniques in patients with Mayer-Rokitansky-Küster-Hauser syndrome.

    PubMed

    Zhao, Xiwa; Wang, Ruixue; Wang, Yanxiu; Li, Li; Zhang, Haibo; Kang, Shan

    2015-08-01

    The aim of this study was to compare the technical feasibility and long-term anatomical and functional outcomes of a novel laparoscopic vaginoplasty using single peritoneal flap (SPF) and Davydov's laparoscopic technique in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. From September 2004 to September 2013, a comparative study was conducted of 98 patients with MRKH syndrome who underwent either laparoscopic vaginoplasty using SPF (SPF group, 62 cases) or Davydov's laparoscopic technique (Davydov group, 36 cases) in a university-based tertiary care hospital. Intraoperative and postoperative parameters and anatomical examination findings of the two groups were compared. Functional results were assessed using the Female Sexual Function Index (FSFI). All surgical procedures were performed successfully, with no intraoperative complications in either group. Patients in the SPF group had a significantly shorter operative time and less intraoperative blood loss than patients in the Davydov group. The postoperative course was identical for all patients in the two groups. The mean length and width of the neovagina in the two groups at hospital discharge, the 6-month follow-up, and the 12-month follow-up did not differ significantly. There were no significant differences between the groups with regard to the postoperative FSFI scores at 12 months after surgery. Although the long-term anatomical and functional outcomes of the two laparoscopic peritoneal vaginoplasty techniques are similar, laparoscopic vaginoplasty using SPF, which has many advantages and is easily performed by the gynecologist, is a more feasible and effective approach to creating a neovagina in patients with MRKH syndrome.

  8. Virtual reality in laparoscopic surgery.

    PubMed

    Uranüs, Selman; Yanik, Mustafa; Bretthauer, Georg

    2004-01-01

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

  9. Laparoscopic radical and partial cystectomy

    PubMed Central

    Challacombe, Ben J.; Rose, Kristen; Dasgupta, Prokar

    2005-01-01

    Radical cystectomy remains the standard treatment for muscle invasive organ confined bladder carcinoma. Laparoscopic radical cystoprostatectomy (LRC) is an advanced laparoscopic procedure that places significant demands on the patient and the surgeon alike. It is a prolonged procedure which includes several technical steps and requires highly developed laparoscopic skills including intra-corporeal suturing. Here we review the development of the technique, the indications, complications and outcomes. We also examine the potential benefits of robotic-assisted LRC and explore the indications and technique of laparoscopic partial cystectomy. PMID:21206662

  10. [Laparoscopic cholecystectomy in acute cholecystitis].

    PubMed

    Neufeld, D; Sivak, G; Jessel, J; Freund, U

    1996-04-01

    We performed 417 laparoscopic cholecystectomies, including 58 for acute cholecystitis, between September 1991 and April 1995,. All operations were successful, with no mortality or complications. In about 10%, the laparoscopic approach failed and we converted to open cholecystectomy. Average post-operative hospitalization was 24 hours. We also performed primary open cholecystectomies in 55 patients with acute cholecystitis, because of limitations of operating room and staff availability for unscheduled laparoscopic surgery. In these patients, hospital stay was longer and rate of complications higher. In our opinion laparoscopic cholecystectomy is safe and the preferred approach in acute cholecystitis.

  11. Single-incision laparoscopic myomectomy

    PubMed Central

    Jackson, Tiffany R; Einarsson, Jon I

    2011-01-01

    Laparoscopic myomectomy is a minimally invasive surgical option for the treatment of uterine leiomyomas. Single-incision laparoscopy is a relatively new concept that has potential in gynaecological surgery although the technical challenges of single-incision access have limited the widespread use of the technique. The use of intracorporeal suturing is a significant component of the learning curve for laparoscopic myomectomy and presents an even greater challenge with single-incision laparoscopic myomectomy. This article describes a surgeon’s approach to single-incision laparoscopic myomectomy. PMID:21197249

  12. [The treatment of laparoscopic cholecystectomy for acute cholecystitis].

    PubMed

    Liguori, G; Bortul, M; Castiglia, D

    2003-01-01

    The aim of the study is to evaluate the results of early laparoscopic cholecystectomy for acute cholecystitis and to analyse the problems related to patients' selection and surgical timing. The authors report their personal experience of 45 laparoscopic cholecystectomies for acute cholecystitis. The diagnosis was based on clinical, blood test and US scan analyse findings. Technical surgical details were decompression of the gallbladder, use of endobag and abdominal dranage. We didn't perform and intraoperative cholangiography in absence of predictive factor for common bile duct stones. The mean time required for surgery was 120 minutes, conversion rate was 15% in early operations and 23.8% in operations delaied more than 72 h. Dissection difficulty is the main cause of conversion. Four patients underwent postoperative complications: one subphrenic abscess, one bile leakage (both recovered with nonsurgical therapy and two wound infections). In conclusion laparoscopic cholecystectomy is safe and effective as early treatment of acute cholecystitis in the first 72 hours due to easier dissection of the inflammed and oedematous tissue. This approach allows a reduction of the operative risk and the conversion rate with medical and economic advantages. Presence of bile duct stones is still now indication to conversion in open surgery.

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

    PubMed Central

    Bates, Andrew T.; Divino, Celia

    2015-01-01

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

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

    NASA Astrophysics Data System (ADS)

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

    2016-03-01

    Laparoscopic surgery is a minimally invasive surgical technique. The benefit of small incisions has a disadvantage of limited visualization of subsurface tissues. Image-guided surgery (IGS) uses pre-operative and intra-operative images to map subsurface structures. One particular laparoscopic system is the daVinci-si robotic surgical system. The video streams generate approximately 360 megabytes of data per second. Real-time processing this large stream of data on a bedside PC, single or dual node setup, has become challenging and a high-performance computing (HPC) environment may not always be available at the point of care. To process this data on remote HPC clusters at the typical 30 frames per second rate, it is required that each 11.9 MB video frame be processed by a server and returned within 1/30th of a second. We have implement and compared performance of compression, segmentation and registration algorithms on Clemson's Palmetto supercomputer using dual NVIDIA K40 GPUs per node. Our computing framework will also enable reliability using replication of computation. We will securely transfer the files to remote HPC clusters utilizing an OpenFlow-based network service, Steroid OpenFlow Service (SOS) that can increase performance of large data transfers over long-distance and high bandwidth networks. As a result, utilizing high-speed OpenFlow- based network to access computing clusters with GPUs will improve surgical procedures by providing real-time medical image processing and laparoscopic data.

  15. Use of augmented reality in laparoscopic gynecology to visualize myomas.

    PubMed

    Bourdel, Nicolas; Collins, Toby; Pizarro, Daniel; Debize, Clement; Grémeau, Anne-Sophie; Bartoli, Adrien; Canis, Michel

    2017-03-01

    To report the use of augmented reality (AR) in gynecology. AR is a surgical guidance technology that enables important hidden surface structures to be visualized in endoscopic images. AR has been used for other organs, but never in gynecology and never with a very mobile organ like the uterus. We have developed a new AR approach specifically for uterine surgery and demonstrated its use for myomectomy. Tertiary university hospital. Three patients with one, two, and multiple myomas, respectively. AR was used during laparoscopy to localize the myomas. Three-dimensional (3D) models of the patient's uterus and myomas were constructed before surgery from T2-weighted magnetic resonance imaging. The intraoperative 3D shape of the uterus was determined. These models were automatically aligned and "fused" with the laparoscopic video in real time. The live fused video made the uterus appear semitransparent, and the surgeon can see the location of the myoma in real time while moving the laparoscope and the uterus. With this information, the surgeon can easily and quickly decide on how best to access the myoma. We developed an AR system for gynecologic surgery and have used it to improve laparoscopic myomectomy. Technically, the software we developed is very different to approaches tried for other organs, and it can handle significant challenges, including image blur, fast motion, and partial views of the organ. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  16. Laparoscopic surgery of esophageal hiatus hernia – single center experience

    PubMed Central

    Piątkowski, Jacek; Jackowski, Marek

    2014-01-01

    Introduction Esophageal hiatal hernias are the most frequent types of internal hernias. This condition involves disturbance of normal functioning of the stomach cardiac mechanism and reflux of the gastric contents to the esophagus. Aim: To evaluate postoperative results in our Clinic and the comparison of these results to data from the literature. Material and methods One hundred and seventy-eight patients underwent surgery due to esophageal hiatal hernia at the Clinic of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Bydgoszcz, Nicolaus Copernicus University, Torun, Poland, from 2006 to 2011. All operations were performed using laparoscopy. Fundoplication by means of the Nissen-Rossetti method was carried out in 172 patients while Toupet's and Dor's methods were applied in 4 and 2 patients, respectively. Results Average time of the surgery was 82 min (55–140 min). Conversion was performed in 4 cases. No serious intraoperative complications were noted. In the postoperative period, dysphagia was reported in 20 patients (11.2%). Postoperative wound infection was observed in 1 patient (0.56%). Hernias in the trocar insertion area were reported in 3 patients (1.68%). Ailments recurred in 6 patients. The recurrence of esophageal hiatal hernia was confirmed in 2 patients. Patients with recurrent hernia were re-operated using a laparoscopic approach. Conclusions Laparoscopic surgery is a simple and effective approach for patients with gastroesophageal reflux symptoms due to diaphragmatic esophageal hiatus hernia. The number of complications is lower after laparoscopic procedures than after “open” operations. PMID:24729804

  17. Comparison of laparoscopic vs. open surgery for rectal cancer

    PubMed Central

    Ding, Zihai; Wang, Zheng; Huang, Shijie; Zhong, Shizhen; Lin, Jianhua

    2017-01-01

    This study was conducted to evaluate the safety of laparoscopic radical resection for rectal cancer. A total of 64 cases of rectal cancer patients undergoing radical surgery between January, 1998 and March, 2010 were collected. The patients were divided into the laparoscopic rectal surgery group (LS group, n=31) and the open surgery group (OS group, n=33). Operation time, postoperative recovery, complications and tumor-free survival rate were compared between the two groups. The inclusion criteria were as follows: Standard Karnofsky score >70 prior to surgery, definitive pathological diagnosis and complete clinical data. The exclusion criteria were concomitant tumors affecting survival. With the Dixon operation, the LS group had a longer operation time compared with the OS group (271.2±56.2 vs. 216.0±62.7 min, respectively; P=0.036), and an earlier time of oral intake (3.0±0.9 vs. 4.7±1.0 days, respectively; P=0.000). There were no significant differences between the LS and OS groups in terms of intraoperative blood loss, number of lymph nodes retrieved, duration of postoperative hyperthermia and hospitalization time (P>0.05). With the Miles operation, there were no obvious differences between the LS and OS groups regarding operation time, intraoperative blood loss, number of lymph nodes retrieved, time of oral intake, duration of postoperative hyperthermia and hospitalization time (P>0.05). Furthermore, there were no significant differences between the LS and OS groups with the Dixon or Miles operation in terms of 3-year tumor-free survival rate (P>0.05). Thus, laparoscopic surgery appears to be a safe and feasible option for the treatment of rectal cancer. PMID:28357087

  18. Use of Cystoscopic Tattooing in Laparoscopic Partial Cystectomy

    PubMed Central

    Kim, Bong Ki; Song, Mi Ho; Yang, Hee Jo; Kim, Doo Sang; Lee, Nam Kyu

    2012-01-01

    Purpose During laparoscopic partial cystectomy (LPC), lesion identification is essential to help to determine the appropriate bladder incisions required to maintain adequate resection margins. The inability to use tactile senses makes it difficult for surgeons to locate lesions during laparoscopic surgery. Endoscopic India ink marking techniques are often used in laparoscopic gastroenterological surgery. We present our experience with performing LPC with India ink during the surgical resection of various bladder lesions. Materials and Methods LPC with cystoscopic fine needle tattooing was performed on 10 patients at our institute. Tattooing was performed at 1- to 2-cm intervals approximately 1 cm away from the outer margin of the lesion with enough depth (the deep muscle layer) under cystoscopic guidance. LPC was performed by the transperitoneal approach. The clinical courses and pathologic results were analyzed. Results All LPC with cystoscopic tattooing cases were performed successfully. The mean patient age was 39.1 years. The mean operative time was 130.5 minutes, and the mean estimated blood loss was 93 ml. The mean hospital stay was 13.1 days, and the mean duration of indwelling Foley catheterization was 10.7 days. There were no significant intraoperative or postoperative complications except 1 case of delayed urinary leak and 1 case of delayed wound healing. The pathological diagnosis included 1 urachal cancer, 1 urachal remnant, 4 urachal cysts, 2 pheochromocytomas, and 2 inflammatory masses. All specimens showed adequate surgical margins. Conclusions Cystoscopic tattooing in LPC is a simple and effective technique to assist in locating pathological bladder lesions intraoperatively. This technique can help to determine appropriate resection margins during LPC without incurring additional complicated procedures. PMID:22741048

  19. Bilateral Laparoscopic Totally Extraperitoneal Repair Without Mesh Fixation

    PubMed Central

    Woodward, Brandon; Johna, Samir; Yamanishi, Frank

    2014-01-01

    Background and Objectives: Mesh fixation during laparoscopic totally extraperitoneal repair is thought to be necessary to prevent recurrence. However, mesh fixation may increase postoperative chronic pain. This study aimed to describe the experience of a single surgeon at our institution performing this operation. Methods: We performed a retrospective review of the medical records of all patients who underwent bilateral laparoscopic totally extraperitoneal repair without mesh fixation for inguinal hernia from January 2005 to December 2011. Demographic, operative, and postoperative data were obtained for analysis. Results: A total of 343 patients underwent simultaneous bilateral laparoscopic totally extraperitoneal repair of 686 primary and recurrent inguinal hernias from January 2005 to December 2011. The mean operative time was 33 minutes. One patient was converted to an open approach (0.3%), and 1 patient had intraoperative bladder injury. Postoperative hematoma/seroma occurred in 5 patients (1.5%), wound infection in 1 (0.3%), hematuria in 2 (0.6%), and acute myocardial infarction in 1 (0.3%). Chronic pain developed postoperatively in 9 patients (2.6%); 3 of them underwent re-exploration. All patients were discharged home a few hours after surgery except for 3 patients. Among the 686 hernia repairs, there were a total of 20 recurrences (2.9%) in 18 patients (5.2%). Two patients had bilateral recurrences, whereas 16 had unilateral recurrences. Twelve of the recurrences occurred after 1 year (60%). Fourteen recurrences occurred among direct hernias (70%). Conclusion: Compared with the literature, our patients had fewer intraoperative and postoperative complications, less chronic pain, and no increase in operative time or length of hospital stay but had a slight increase in recurrence rate. PMID:25392633

  20. Localization of liver tumors in freehand 3D laparoscopic ultrasound

    NASA Astrophysics Data System (ADS)

    Shahin, O.; Martens, V.; Besirevic, A.; Kleemann, M.; Schlaefer, A.

    2012-02-01

    The aim of minimally invasive laparoscopic liver interventions is to completely resect or ablate tumors while minimizing the trauma caused by the operation. However, restrictions such as limited field of view and reduced depth perception can hinder the surgeon's capabilities to precisely localize the tumor. Typically, preoperative data is acquired to find the tumor(s) and plan the surgery. Nevertheless, determining the precise position of the tumor is required, not only before but also during the operation. The standard use of ultrasound in hepatic surgery is to explore the liver and identify tumors. Meanwhile, the surgeon mentally builds a 3D context to localize tumors. This work aims to upgrade the use of ultrasound in laparoscopic liver surgery. We propose an approach to segment and localize tumors intra-operatively in 3D ultrasound. We reconstruct a 3D laparoscopic ultrasound volume containing a tumor. The 3D image is then preprocessed and semi-automatically segmented using a level set algorithm. During the surgery, for each subsequent reconstructed volume, a fast update of the tumor position is accomplished via registration using the previously segmented and localized tumor as a prior knowledge. The approach was tested on a liver phantom with artificial tumors. The tumors were localized in approximately two seconds with a mean error of less than 0.5 mm. The strengths of this technique are that it can be performed intra-operatively, it helps the surgeon to accurately determine the location, shape and volume of the tumor, and it is repeatable throughout the operation.

  1. Prostate cancer gene 3 (PCA3) is of additional predictive value in patients with PI-RADS grade III (intermediate) lesions in the MR-guided re-biopsy setting for prostate cancer.

    PubMed

    Kaufmann, S; Bedke, J; Gatidis, S; Hennenlotter, J; Kramer, U; Notohamiprodjo, M; Nikolaou, K; Stenzl, A; Kruck, S

    2016-04-01

    Multiparametric magnetic resonance imaging (mpMRI) improves diagnostic accuracy in re-biopsies of men with prostate cancer (PC) suspicion, but predictive value is limited despite the use of the new Prostate Imaging Reporting and Data System (PI-RADS). Prognostic value of the PC-specific biomarker prostate cancer gene 3 (PCA3) added to the PI-RADS score was evaluated. The study was a retrospective analysis of the institutional database for men with MR-guided biopsy (MR-GB) for suspicious lesion in mpMRI and who had an additional pre-MR-GB PCA3 testing for ongoing PC suspicion. All men had ≥ 1 negative ultrasound GB. Lesions were retrospectively scored by PI-RADS in three MRI sequences (T2w, DCE, and DWI). PCA3 was analyzed with cutoffs of 25 and 35. The prognostic value of mpMRI and PCA3 and the additional value of both were explored. Tumor detection rate (49 men, mean PSA 10 ng/ml, lesion size 40 mm(2)) was 45 % (22/49 patients). In the subgroup of PI-RADS IV°, 17/17 patients had PC; in PI-RADS III° (intermediate) 5/15 had PC, and all 5 had a PCA3 > 35. PCA3 > 35 had no additional prognostic value in the whole cohort. Out of the 10/15 PC negative patients (PI-RADS III°), PCA3 was < 35 in 6. The inclusion of PCA3 value in PI-RADS III° patients improved predictive accuracy to 91.8 %. MpMRI and subsequent grading to PI-RADS significantly improves PC detection in the re-biopsy setting. The diagnostic uncertainty in the PI-RADS intermediate group can be ameliorated by the addition of PCA3 cutoff of 35 to avoid potential unnecessary biopsies.

  2. Self-gripping mesh versus fibrin glue fixation in laparoscopic inguinal hernia repair: a randomized prospective clinical trial in young and elderly patients

    PubMed Central

    Bindi, Marco; Rivelli, Matteo; Solej, Mario; Enrico, Stefano; Martino, Valter

    2016-01-01

    Abstract Laparoscopic transabdominal preperitoneal inguinal hernia repair is a safe and effective technique. In this study we tested the hypothesis that self-gripping mesh used with the laparoscopic approach is comparable to polypropylene mesh in terms of perioperative complications, against a lower overall cost of the procedure. We carried out a prospective randomized trial comparing a group of 30 patients who underwent laparoscopic inguinal hernia repair with self-gripping mesh versus a group of 30 patients who received polypropylene mesh with fibrin glue fixation. There were no statistically significant differences between the two groups with regard to intraoperative variables, early or late intraoperative complications, chronic pain or recurrence. Self-gripping mesh in transabdominal hernia repair was found to be a valid alternative to polypropylene mesh in terms of complications, recurrence and postoperative pain. The cost analysis and comparability of outcomes support the preferential use of self-gripping mesh. PMID:28352842

  3. Laparoscopic resection vs laparoscopic radiofrequency ablation for the treatment of small hepatocellular carcinomas: A single-center analysis

    PubMed Central

    Casaccia, Marco; Santori, Gregorio; Bottino, Giuliano; Diviacco, Pietro; Andorno, Enzo

    2017-01-01

    AIM To compare survival and recurrence after laparoscopic liver resection (LLR) and laparoscopic radiofrequency ablation (LRFA) for the treatment of small hepatocellular carcinoma (HCC). METHODS Between June 1, 2005 and November 30, 2010, 46 patients (62.26 ± 8.55 years old; female/male: 12/34) treated for small HCC were enrolled following strict criteria. Patients with better liver function and larger tumors were referred for LLR (n = 24), while those with poorer liver function and multiple tumors were referred for LRFA (n = 22), and they were then followed for similar durations (44.74 ± 21.3 mo for LLR vs 40.27 ± 30.8 mo for LRFA). RESULTS The LLR and LRFA groups were homogeneous with regard to age, sex, etiology of liver cirrhosis, and AFP levels. The overall survival (OS) and disease-free survival (DFS) probability was 0.354 and 0.260, respectively. A significantly higher OS was observed in the LLR group (LLR: 0.442; LRFA: 0.261; P = 0.048), whereas no statistical difference was found for DFS (LLR: 0.206; LRFA: 0.286; P = 0.205). In the LRFA group was treated a greater number of nodules (LLR: 1.41 ± 0.77; LRFA: 2.72 ± 1.54; P < 0.001). Cox regression analysis found the number of intraoperative HCC nodules as the unique variable statistically significant for OS (hazard ratio: 2.225; P < 0.001). The rank-hazard plot showed a steeper increase of relative hazard for intraoperative nodules > 2. CONCLUSION Our preliminary results confirm the superiority of hepatic resection on thermoablation in the treatment of small HCC in selected patients, when both approaches are made laparoscopically. LLR showed better results compared to LRFA in terms of OS. These data need to be confirmed by further studies on a larger number of patients. PMID:28216972

  4. Laparoscopic power morcellation of presumed fibroids.

    PubMed

    Brolmann, Hans A; Sizzi, Ornella; Hehenkamp, Wouter J; Rossetti, Alfonso

    2016-06-01

    Uterine leiomyoma is a highly prevalent benign gynecologic neoplasm that affects women of reproductive age. Surgical procedures commonly employed to treat symptomatic uterine fibroids include myomectomy or total or sub-total hysterectomy. These procedures, when performed using minimally invasive techniques, reduce the risks of intraoperative and postoperative morbidity and mortality; however, in order to remove bulky lesions from the abdominal cavity through laparoscopic ports, a laparoscopic power morcellator must be used, a device with rapidly spinning blades to cut the uterine tissue into fragments so that it can be removed through a small incision. Although the minimal invasive approach in gynecological surgery has been firmly established now in terms of recovery and quality of life, morcellation is associated with rare but sometimes serious adverse events. Parts of the morcellated specimen may be spread into the abdominal cavity and enable implantation of cells on the peritoneum. In case of unexpected sarcoma the dissemination may upstage disease and affect survival. Myoma cells may give rise to 'parasitic' fibroids, but also implantation of adenomyotic cells and endometriosis has been reported. Finally the morcellation device may cause inadvertent injury to internal structures, such as bowel and vessels, with its rotating circular knife. In this article it is described how to estimate the risk of sarcoma in a presumed fibroid based on epidemiologic, imaging and laboratory data. Furthermore the first literature results of the in-bag morcellation are reviewed. With this procedure the specimen is contained in an insufflated sterile bag while being morcellated, potentially preventing spillage of tissue but also making direct morcellation injuries unlikely to happen.

  5. [Laparoscopic surgery: planning program].

    PubMed

    Sarli, L; Pietra, N; Carreras, F; Longinotti, E

    1992-01-01

    Performing laparoscopic surgery requires an initial training program. A well-planned organization is essential and the surgeon has to become first familiar with the new procedures; the choice of the necessary equipment is the second step. Upkeep of surgical instruments and a careful consideration of legal aspects are the next important steps. Several areas of a planning program are evaluated on the basis of the authors' experience.

  6. Registration of liver images to minimally invasive intraoperative surface and subsurface data

    NASA Astrophysics Data System (ADS)

    Wu, Yifei; Rucker, D. C.; Conley, Rebekah H.; Pheiffer, Thomas S.; Simpson, Amber L.; Geevarghese, Sunil K.; Miga, Michael I.

    2014-03-01

    Laparoscopic liver resection is increasingly being performed with results comparable to open cases while incurring less trauma and reducing recovery time. The tradeoff is increased difficulty due to limited visibility and restricted freedom of movement. Image-guided surgical navigation systems have the potential to help localize anatomical features to improve procedural safety and achieve better surgical resection outcome. Previous research has demonstrated that intraoperative surface data can be used to drive a finite element tissue mechanics organ model such that high resolution preoperative scans are registered and visualized in the context of the current surgical pose. In this paper we present an investigation of using sparse data as imposed by laparoscopic limitations to drive a registration model. Non-contact laparoscopicallyacquired surface swabbing and mock-ultrasound subsurface data were used within the context of a nonrigid registration methodology to align mock deformed intraoperative surface data to the corresponding preoperative liver model as derived from pre-operative image segmentations. The mock testing setup to validate the potential of this approach used a tissue-mimicking liver phantom with a realistic abdomen-port patient configuration. Experimental results demonstrates a range of target registration errors (TRE) on the order of 5mm were achieving using only surface swab data, while use of only subsurface data yielded errors on the order of 6mm. Registrations using a combination of both datasets achieved TRE on the order of 2.5mm and represent a sizeable improvement over either dataset alone.

  7. Intraoperative ultrasound control of surgical margins during partial nephrectomy.

    PubMed

    Alharbi, Feras M; Chahwan, Charles K; Le Gal, Sophie G; Guleryuz, Kerem M; Tillou, Xavier P; Doerfler, Arnaud P

    2016-01-01

    To evaluate a simple and fast technique to ensure negative surgical margins on partial nephrectomies, while correlating margin statuses with the final pathology report. This study was conducted for patients undergoing partial nephrectomy (PN) with T1-T2 renal tumors from January 2010 to the end of December 2015. Before tumor removal, intraoperative ultrasound (US) localization was performed. After tumor removal and before performing hemostasis of the kidney, the specimens were placed in a saline solution and a US was performed to evaluate if the tumor's capsule were intact, and then compared to the final pathology results. In 177 PN(s) (147 open procedures and 30 laparoscopic procedures) were performed on 147 patients. Arterial clamping was done for 32 patients and the mean warm ischemia time was 19 ± 6 min. The mean US examination time was 41 ± 7 s. The US analysis of surgical margins was negative in 172 cases, positive in four, and in only one case it was not possible to conclude. The final pathology results revealed one false positive surgical margin and one false negative surgical margin, while all other margins were in concert with US results. The mean tumor size was 3.53 ± 1.43 cm, and the mean surgical margin was 2.8 ± 1.5 mm. The intraoperative US control of resection margins in PN is a simple, efficient, and effective method for ensuring negative surgical margins with a small increase in warm ischemia time and can be conducted by the operating urologist.

  8. Intraoperative ultrasound control of surgical margins during partial nephrectomy

    PubMed Central

    Alharbi, Feras M.; Chahwan, Charles K.; Le Gal, Sophie G.; Guleryuz, Kerem M.; Tillou, Xavier P.; Doerfler, Arnaud P.

    2016-01-01

    Aims: To evaluate a simple and fast technique to ensure negative surgical margins on partial nephrectomies, while correlating margin statuses with the final pathology report. Subjects and Methods: This study was conducted for patients undergoing partial nephrectomy (PN) with T1–T2 renal tumors from January 2010 to the end of December 2015. Before tumor removal, intraoperative ultrasound (US) localization was performed. After tumor removal and before performing hemostasis of the kidney, the specimens were placed in a saline solution and a US was performed to evaluate if the tumor's capsule were intact, and then compared to the final pathology results. Results: In 177 PN(s) (147 open procedures and 30 laparoscopic procedures) were performed on 147 patients. Arterial clamping was done for 32 patients and the mean warm ischemia time was 19 ± 6 min. The mean US examination time was 41 ± 7 s. The US analysis of surgical margins was negative in 172 cases, positive in four, and in only one case it was not possible to conclude. The final pathology results revealed one false positive surgical margin and one false negative surgical margin, while all other margins were in concert with US results. The mean tumor size was 3.53 ± 1.43 cm, and the mean surgical margin was 2.8 ± 1.5 mm. Conclusions: The intraoperative US control of resection margins in PN is a simple, efficient, and effective method for ensuring negative surgical margins with a small increase in warm ischemia time and can be conducted by the operating urologist. PMID:28057986

  9. Toward a Model of Human Information Processing for Decision-Making and Skill Acquisition in Laparoscopic Colorectal Surgery.

    PubMed

    White, Eoin J; McMahon, Muireann; Walsh, Michael T; Coffey, J Calvin; O Sullivan, Leonard

    2017-10-03

    To create a human information-processing model for laparoscopic surgery based on already established literature and primary research to enhance laparoscopic surgical education in this context. We reviewed the literature for information-processing models most relevant to laparoscopic surgery. Our review highlighted the necessity for a model that accounts for dynamic environments, perception, allocation of attention resources between the actions of both hands of an operator, and skill acquisition and retention. The results of the literature review were augmented through intraoperative observations of 7 colorectal surgical procedures, supported by laparoscopic video analysis of 12 colorectal procedures. The Wickens human information-processing model was selected as the most relevant theoretical model to which we make adaptions for this specific application. We expanded the perception subsystem of the model to involve all aspects of perception during laparoscopic surgery. We extended the decision-making system to include dynamic decision-making to account for case/patient-specific and surgeon-specific deviations. The response subsystem now includes dual-task performance and nontechnical skills, such as intraoperative communication. The memory subsystem is expanded to include skill acquisition and retention. Surgical decision-making during laparoscopic surgery is the result of a highly complex series of processes influenced not only by the operator's knowledge, but also patient anatomy and interaction with the surgical team. Newer developments in simulation-based education must focus on the theoretically supported elements and events that underpin skill acquisition and affect the cognitive abilities of novice surgeons. The proposed human information-processing model builds on established literature regarding information processing, accounting for a dynamic environment of laparoscopic surgery. This revised model may be used as a foundation for a model describing robotic

  10. Robust augmented reality guidance with fluorescent markers in laparoscopic surgery.

    PubMed

    Wild, Esther; Teber, Dogu; Schmid, Daniel; Simpfendörfer, Tobias; Müller, Michael; Baranski, Ann-Christin; Kenngott, Hannes; Kopka, Klaus; Maier-Hein, Lena

    2016-06-01

    Laparoscopic interventions require the precise navigation of medical instruments through the patient's body, while taking critical structures into account. Although numerous concepts have been proposed for displaying subsurface anatomical detail using augmented reality, clinical translation of these methods has suffered from a lack of robustness as well as from cumbersome integration into the clinical workflow. The purpose of this study was to investigate the feasibility of a new approach to intra-operative registration based on fluorescent markers. The proposed approach to augmented reality visualization relies on metabolizable fluorescent markers that are attached to the target organ to guide a 2D/3D intra-operative registration algorithm. In an ex vivo porcine study, marker tracking performance is evaluated in the presence of smoke, blood, and tissue in the field of view of the endoscope. In contrast to state-of-the-art needle-shaped fiducial markers, the fluorescent markers can be reliably tracked when occluded by smoke, blood or tissue. This makes the new 2D/3D intra-operative registration approach considerably more robust than state-of-the-art marker-based methods. As the concept can be smoothly integrated into the clinical workflow, its potential for application in clinical laparoscopy is high.

  11. A simple method for ensuring resection margins during laparoscopic partial nephrectomy: the intracorporeal ultrasonography.

    PubMed

    Doerfler, Arnaud; Oitchayomi, Abeni; Tillou, Xavier

    2014-11-01

    To describe a simple method for ensuring surgical margins during laparoscopic partial nephrectomy (PN). A study was done at our institution from October 2013 to March 2014 for all patients undergoing laparoscopic PN for T1 renal tumors. Before tumor removal, intraoperative ultrasonography (US) localization was performed. The tumor was then removed with a standardized minimal healthy tissue margin technique. Immediately after removal and before performing hemostasis of the kidney, the specimen was placed into a laparoscopic endobag filled with saline solution. The laparoscopic probe was then placed into the endobag and a sequential ultrasonographic scan was performed to evaluate if the tumor's pseudocapsule was respected. Twelve patients were included in our study. Mean warm ischemia time was 19 ± 3 minutes. Mean US examination was 42 ± 9 seconds. US analysis of surgical margins was negative in all except 1 patient. The final histologic examination of all specimens confirmed US results with a 100% correlation. We describe an original, simple, and cost-effective method for ensuring surgical margins during laparoscopic PN with a moderate increase in warm time ischemia. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Laparoscopic splenectomy and porto-azygos disconnection: clinical research in the treatment of portal hypertension

    PubMed Central

    Fengyong, Wang; Yuanshui, Sun; Zhangbing; Yuewu, Wu; Weihua, Zhan; Jianfeng, Shi; Qi, Wu; Jinming, Liu; Ji, Xu; Zaiyuan, Ye

    2015-01-01

    To investigate the safety and efficacy of laparoscopic splenectomy and portaazygous devascularization, we studied laparoscopic splenectomy and porto-azygos devascularization patients within the peri-operative period. Clinical data and curative effect are detailed alongside statistical analysis. The laparoscopic splenectomy and porto-azygos devascularization operation time was 2.56 + 0.62 hours. The intraoperative bleeding and anal exhaust time was 149.5 + 32.7ml 3.47 + 1.32 days, and the hospitalization time was 5.05 + 1.22 days. When the spleen volume was greater than or equal to 1.5 liters, the rate of open abdominal surgery increased significantly. After 1, 2, 3, and 4 years of follow-up, cumulative recurrence bleeding rates were 0, 5.20%, 9.98%, and 15.83%, respectively. Laparoscopic splenectomy and pericardial devascularization is safe, effective, and feasible, and it can be confirmed by enhanced spiral computed tomography (CT). Whether spleen volume greater than 1.5L is suited to laparoscopic surgery requires further research.

  13. Plastic suction curette as uterine manipulator at combined laparoscopic sterilization: a prospective study of 531 cases.

    PubMed

    Banerjee, Asok Kumar; Emembolu, J O

    2006-12-01

    To determine the efficacy and safety of a plastic suction curette (PSC) as uterine manipulator during combined surgical abortion and laparoscopic sterilization. This prospective observational study was conducted between January 1996 and December 2003 in a university teaching hospital and a district hospital. All cases of combined first trimester surgical abortion and laparoscopic sterilization were performed under general anaesthesia in the day surgery unit. A straight or curved PSC with a diameter of 7-12 mm was used for surgical abortion and, afterwards, to manipulate the uterus at laparoscopic sterilization. The negative pressure of 600 mmHg or -80 kPa was maintained during manipulation. Any intra-operative trauma or difficulties in identifying the tubes and blood loss during sterilization were noted. A total of 531 cases of combined abortion and laparoscopic sterilization were performed. There was no failure to identify the tubes nor any uterine perforation; blood loss was minimal. No patient required hospital admission because of direct surgical complications. The plastic suction curette is a safe and efficient uterine manipulator at combined laparoscopic sterilization procedure.

  14. Laparoscopic Adrenalectomy for Removal of Unilateral Noninvasive Pheochromocytomas in 10 Dogs.

    PubMed

    Pitt, Kathryn A; Mayhew, Philipp D; Steffey, Michele A; Culp, William T N; Fuller, Mark C; Della Maggiore, Ann; Nelson, Richard W

    2016-11-01

    To report the surgical technique and outcome of dogs undergoing laparoscopic adrenalectomy for removal of unilateral noninvasive pheochromocytoma. Retrospective case series. Dogs with unilateral noninvasive adrenal tumors (n=10). Medical records of dogs that underwent laparoscopic adrenalectomy for histologically confirmed pheochromocytoma were reviewed. Dogs were positioned in lateral recumbency with the table tilted up to create a semi-sternal position. Three or 4 ports were used and dissection of the mass proceeded using a combination of laparoscopic instrumentation, bipolar vessel-sealing devices, and in some cases monopolar electrosurgical probes. Conversion rate, complications, surgical time, hospitalization time, and long-term follow-up were recorded. The procedure was completed without the need for conversion in 9 of 10 dogs. In 1 dog, hemorrhage obscured the visual field and conversion to an open approach was elected. In 5 cases, a 3-port approach was used, and in 5 cases, a 4th port was placed. Median surgical time was 105 minutes (range, 65-250). Intraoperative complications included 1 splenic laceration. Postoperatively, 1 dog developed gastric dilatation-volvulus. All dogs were discharged from the hospital. Median follow-up time was 16.0 months (range, 6.9-38.0). With careful case selection, laparoscopic adrenalectomy for resection of pheochromocytoma was feasible and could be performed efficiently by experienced laparoscopic surgeons. © Copyright 2016 by The American College of Veterinary Surgeons.

  15. Prevention and acute management of biliary injuries during laparoscopic cholecystectomy: Expert consensus statement

    PubMed Central

    Abbasoğlu, Osman; Tekant, Yaman; Alper, Aydın; Aydın, Ünal; Balık, Ahmet; Bostancı, Birol; Coker, Ahmet; Doğanay, Mutlu; Gündoğdu, Haldun; Hamaloğlu, Erhan; Kapan, Metin; Karademir, Sedat; Karayalçın, Kaan; Kılıçturgay, Sadık; Şare, Mustafa; Tümer, Ali Rıza; Yağcı, Gökhan

    2016-01-01

    Gallstone disease is very common and laparoscopic cholecystectomy is one of the most common surgical procedures all over the world. Parallel to the increase in the number of laparoscopic cholecystectomies, bile duct injuries also increased. The reported incidence of bile duct injuries ranges from 0.3% to 1.4%. Many of the bile duct injuries during laparoscopic cholecystectomy are not due to inexperience, but are the result of basic technical failures and misinterpretations. A working group of expert hepatopancreatobiliary surgeons, an endoscopist, and a specialist of forensic medicine study searched and analyzed the publications on safe cholecystectomy and biliary injuries complicating laparoscopic cholecystectomy under the organization of Turkish Hepatopancreatobiliary Surgery Association. After a series of e-mail communications and two conferences, the expert panel developed consensus statements for safe cholecystectomy, management of biliary injuries and medicolegal issues. The panel concluded that iatrogenic biliary injury is an overwhelming complication of laparoscopic cholecystectomy and an important issue in malpractice claims. Misidentification of the biliary system is the major cause of biliary injuries. To avoid this, the “critical view of safety” technique should be employed in all the cases. If biliary injury is identified intraoperatively, reconstruction should only be performed by experienced hepatobiliary surgeons. In the postoperative period, any deviation from the expected clinical course of recovery should alert the surgeon about the possibility of biliary injury. PMID:28149133

  16. [Laparoscopic hysterectomy -- indications, technic, complications].

    PubMed

    Bechev, Bl; Kornovski, J; Kostov, I; Lazarov, I

    2013-01-01

    In recent decades, interest in laparoscopic gynecological practice increase. This technic applied first as a diagnostic tool in women with infertility. Subsequently starts to be used to perform surgery in small region of the fallopian tubes and ovaries, being increasingly developed and today, it is considered that any gynecological operation can be performed laparoscopically.

  17. Laparoscopic hernioplasty of hiatal hernia

    PubMed Central

    Yang, Xuefei; Hua, Rong; He, Kai; Shen, Qiwei

    2016-01-01

    Laparoscopic surgery is a good choice for surgical treatment of hiatal hernia because of its mini-invasive nature and intraperitoneal view and operating angle. This article will talk about the surgical procedures, technical details, precautions and complications about laparoscopic hernioplasty of hiatal hernia. PMID:27761447

  18. [Comparison study between Vecchietti's and Davydov's laparoscopic vaginoplasty in Mayer-Rokitansky-Küster-Hauser syndrome].

    PubMed

    Dong, Xiaochao; Xie, Zhenwei; Jin, Hangmei

    2015-04-01

    To compare Vecchietti's and Davydov's laparoscopic techniques for vaginoplasty in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. From January 2010 to December 2013, 13 patients underwent the Vecchietti's laparoscopic procedure (Vecchietti group), and 15 patients underwent the Davydov's laparoscopic procedure (Davydov group). Intraoperative parameters and postoperative results were compared. Both of the two groups were successfully treated. The neovagina in both groups were wide with good elasticity, softness and smoothness. The operation time [(39±7) versus (73±11) minutes], the intraoperative blood loss [(21±6) versus (63±10) ml], the anal exsufflation time after surgery [(19±5) versus (28±6) hours] and the recovery period of body temperature after surgery [(35±10) versus (46±10) hours] of the Vecchietti group were less than those of the Davydov group (all P<0.05). But the neovagina length [(8.8±0.5) versus (9.6±0.5) cm] was shorter and the Female Sexual Function Index scale score [26.8±2.0 versus 28.5±1.7] was lower in the Vecchietti group than those in the Davydov group (all P<0.05). The postoperation hospital duration didn't reached statistical difference between the two groups [(7.5±0.9) versus (7.1±0.7) days, P>0.05]. No intraoperative complication occurred. After surgery, 2 patients were found vaginal polyps and 8 patients were suffered from pain in the Davydov group, while all patients were suffered from pain in the Vecchietti group. Both Vecchietti's and Davydov's laparoscopic techniques are simple, safe and effective surgical methods for vaginal reconstruction. In contrast, the Vecchietti's procedure is more time efficient and minimally invasive, while the Davydov's procedure can get less pain, longer vagina and higher sexual satisfaction.

  19. Selective versus Non-Selective Alpha-Blockade prior to Laparoscopic Adrenalectomy for Pheochromocytoma

    PubMed Central

    Randle, Reese W.; Balentine, Courtney J.; Pitt, Susan C.; Schneider, David F.; Sippel, Rebecca S.

    2016-01-01

    Background The optimal pre-operative alpha-blockade strategy is debated for patients undergoing laparoscopic adrenalectomy for pheochromocytomas. We evaluated the impact of selective versus non-selective alpha-blockade on intra-operative hemodynamics and post-operative outcomes. Methods We identified patients having laparoscopic adrenalectomy for pheochromocytomas from 2001-2015. As a marker of overall intra-operative hemodynamics, we combined systolic blood pressure (SBP) >200, SBP <80, SBP <80 AND >200, pulse >120, vasopressor infusion, and vasodilator infusion into a single variable. Similarly, the combination of vasopressor infusion in the post-anesthesia care unit (PACU) and need for intensive care unit (ICU) admission provided an overview of post-operative support. Results We identified 52 patients undergoing unilateral laparoscopic adrenalectomy for pheochromocytoma. Selective alpha-blockade (i.e. Doxazosin) was performed in 35% (n=18), and non-selective blockade with Phenoxybenzamine was performed in 65% (n=34). Demographics and tumor characteristics were similar between groups. Patients blocked selectively were more likely to have a SBP <80 (67%) than those blocked with phenoxybenzamine (35%) (p=0.03), but we found no significant difference in overall intra-operative hemodynamics between patients blocked selectively and non-selectively (p=0.09). Post-operatively, however, patients blocked selectively were more likely to require additional support with vasopressor infusions in the PACU or ICU admission (p=0.02). Hospital stay and complication rates were similar. Conclusion Laparoscopic adrenalectomy for pheochromocytoma is safe regardless of the pre-operative alpha-blockade strategy employed, but patients blocked selectively may have a higher incidence of transient hypotension during surgery and a greater need for post-operative support. These differences did not result in longer hospital stay or increased complications. PMID:27561909

  20. Immunological response in laparoscopic surgery.

    PubMed

    Smit, M J; Beelen, R H; Eijsbouts, Q A; Meijer, S; Cuesta, M A

    1996-01-01

    Immunological response to surgical trauma may be protected during laparoscopic surgery. A less surgical trauma, in comparison with conventional surgery, may explained these important advantages. Plasma and macrophages studies have demonstrated that laparoscopic cholecystectomy causes less depression of cell mediated immunity than open cholecystectomy. What will be the impact of this immunological protection in laparoscopic advanced and oncological surgery? Experimental studies have showed that laparoscopic techniques in advanced and oncological surgery may have important advantages concerning the "preservation of the immune status" of the patient. That will imply in the future a lower percentage of infections, local recurrence and even a lower percentage of distant metastases. On the other hand, the appearance of tumor implants in the port sites after laparoscopic resection for cancer is a significant drawback of this procedure. Proper investigations have to be carried out in order to find the cause and the solution of this dilemma.

  1. Laparoscopically guided bilateral pelvic lymphadenectomy

    NASA Astrophysics Data System (ADS)

    Gershman, Alex; Danoff, Dudley; Chandra, Mudjianto; Grundfest, Warren S.

    1991-07-01

    Pelvic node dissection has gained widespread acceptance as the final staging procedure in patients with normal acid phospatase and bone scan free of metastatic disease prior to definitive therapy for cure. However, the procedure has had a high morbidity (20-34%) and a major economic impact on the patient due to lengthy hospitalization and recuperative time. The development of laparoscopic biopsy techniques suggests that the need for open surgical lymphadenectomy may be reduced by a laparoscopically performed lymphadenectomy. The goal of this report is to investigate the possibility of laparoscopic pelvic lymphadenectomy in an animal model. Our interest in laparoscopy is based on the ability of this technique to permit tissue removal without the need for major incisions. In laparoscopic cholecystectomy and laparoscopic appendectomy, the surgical procedure is essentially unaltered. The diseased organ is removed and there is no need for a large abdominal incision.

  2. Laparoscopic liver resection for hepatocellular carcinoma: korean experiences.

    PubMed

    Han, Ho-Seong; Yoon, Yoo-Seok; Cho, Jai Young; Hwang, Dae Wook

    2013-01-01

    The development of laparoscopic liver resection (LLR) has been slow due to technical difficulties. Therefore, LLR has been limited to easily accessible lesions. Recently, this procedure has been well applied to hepatocellular carcinoma. However, until now, the indications for LLR have been tumors in the peripheral portion of the anterolateral segments of the liver (segments II, III, V and VI and the inferior part of IV according to the classification of Couinaud). Due to the growing interest in LLR, there have been many attempts to apply this technique in difficult locations. The lesions in the posterior or superior part of the liver (segments I, VII, VIII and the superior part of IV), which are considered to be poor indications for LLR, have been reported to be successfully operated on by laparoscopic surgery. Accordingly, this laparoscopic approach has become similar to open surgery in many ways. One of the major advancements of LLR is anatomic liver resection including major and minor resection. Laparoscopic mono- and bisegmentectomies have also become possible with growing experience. There are a variety of monosegmentectomies and bisegmentectomies. The common representatives of bisegmentectomies are left lateral sectionectomy, right anterior sectionectomy and right posterior sectionectomy. The common operative types of monosegmentectomies are S4, S5, and S6 monosegmentectomies, etc. Central bi-sectionectomy will also be discussed. The Glissonian approach has been useful for these types of anatomic liver resection. The difficulty of controlling hemorrhage has been overcome by performing meticulous surgical techniques with newly developed instruments, and intraoperative sonography has been used to locate the lesions and guide the resection plane even for deep-seated or invisible lesions. Further accumulation of experience and technical refinements will make theses challenging procedures more reproducible and safer.

  3. Laparoscopic management of CBD stones: an Indian experience.

    PubMed

    Chander, Jagdish; Vindal, Anubhav; Lal, Pawanindra; Gupta, Nikhil; Ramteke, Vinod Kumar

    2011-01-01

    Common bile duct stones (CBDS) that are seen in the Asian population are very different from those seen in the west. It is not infrequent to see multiple, large, and impacted stones and a hugely dilated CBD. Many of these patients have been managed by open CBD exploration (OCBDE), even after the advent of laparoscopic cholecystectomy (LC), because these large stones pose significant challenges for extraction by endoscopic retrograde cholangiopancreatography. This series presents the largest experience of managing CBDS using a laparoscopic approach from Indian subcontinent. Between 2003 and 2009, 150 patients with documented CBDS were treated laparoscopically at a tertiary care hospital in New Delhi. Of these, 4 patients were managed through transcystic route and 140 through the transcholedochal route. There were 34 men and 116 women patients with age ranging from 15 to 72 years. The mean size of the CBD on ultrasound was 11.7 ± 3.7 mm and on MRCP 13.8 ± 4.7 mm. The number of stones extracted varied from 1 to 70 and the size of the extracted stones from 5 to 30 mm. The average duration of surgery was 139.9 ± 26.3 min and the mean intraoperative blood loss was 103.4 ± 85.9 ml. There were 6 conversions to open procedures, 1 postoperative death (0.7%), and 23 patients (15%) had nonfatal postoperative complications. Three patients had retained stones (2%) and one developed recurrent stone (0.7%). Even in patients with multiple, large, and impacted CBDS, there is scope for a minimally invasive procedure with its attendant benefits in the form of laparoscopic CBD exploration (LCBDE).

  4. General stress response to conventional and laparoscopic cholecystectomy.

    PubMed Central

    Glaser, F; Sannwald, G A; Buhr, H J; Kuntz, C; Mayer, H; Klee, F; Herfarth, C

    1995-01-01

    OBJECTIVE: In many retrospective and prospective observational studies, laparoscopic cholecystectomy (LC) compares favorably with conventional cholecystectomy (CC), with respect to length of hospital stay, postoperative pain, and pulmonary function, indicating a diminished operative trauma. Comparison of laboratory findings (stress hormones, blood glucose, interleukins) are a possibility to objectify stress and tissue trauma of laparoscopic and conventional cholecystectomy. SUMMARY BACKGROUND DATA: Major body injury, surgical or accidental, evokes reproducible hormonal and immunologic responses. The magnitude of many of these changes essentially is proportional to the extent of the injury. METHODS: In a prospective study, biochemical stress parameters were measured in the blood of patients undergoing elective cholecystectomy because of symptomatic cholecystolithiasis. Patients with acute cholecystitis, pancreatitis, choledocholithiasis, or malignant disease were excluded. Values from 40 patients after LC and from 18 patients after CC were compared. Both groups had similar patient characteristics, baseline values, and perioperative care, except for deeper anesthesia during CC. RESULTS: On postoperative day 1, epinephrine (p = 0,05), norepinephrine (p = 0.02), and glucose (p = 0.02) responses were higher after CC. Two days postoperatively, norepinephrine remained higher after CC (p < 0.01). Interleukin-1 beta responses were higher during (p < 0.01) and 6 hours after CC (p = 0.03). Interleukin-6 responses were higher 6 hours (p = 0.03), 1 day (p = 0.02), and 2 days (p < 0.01) after CC. CONCLUSIONS: The results show significant lower values of intraoperatively and postoperatively measured epinephrine, norepinephrine, interleukin-1 beta, and interleukin-6 in patients with laparoscopic cholecystectomy, indicating a minor stress response and tissue trauma in this group of patients. The results correspond to the favorable results of most other trials evaluating clinical

  5. Intravenous methylene blue venography during laparoscopic paediatric varicocelectomy.

    PubMed

    Keene, David J B; Cervellione, Raimondo M

    2014-02-01

    One of the challenges of varicocele surgery is to prevent hydrocele formation while still ensuring success. Methylene blue has been used to identify and preserve lymphatic vessels, and venography has been a standard component of sclerotherapy and percutaneous retrograde techniques. The authors have combined both approaches during laparoscopic varicocelectomy and report their experience. A prospective study was performed of adolescents with idiopathic varicocele and spontaneous venous reflux on Doppler ultrasound. A pampiniform plexus vein was cannulated via scrotal incision before creating the pneumoperitoneum. A mixture of methylene blue and Omnipaque™ was injected into the pampiniform plexus with fluoroscopic screening. Laparoscopic selective vein ligation was then performed using 5mm endoscopic clips or a bipolar vessel sealing device such as Plasmakinetic™ or Ligasure™. Venography was repeated to confirm complete ligation of the internal testicular veins. Patients were followed-up at 3, 6, and 9 months post-surgery with clinical examination and Doppler ultrasound. Data are presented as median (interquartile range). Twenty-four patients underwent laparoscopic selective vein ligation with venography and methylene blue injection. The median age was 14.7 (14.6-15.7) years. The recurrence rate was 12%. No patients developed a hydrocele. The length of surgery was 120 (100-126) minutes. Intra-operative intra-venous methylene blue injection and venography helps to identify venous duplications of the internal testicular veins and enhances the success rate of laparoscopic selective vein ligation. This approach prevents hydrocele formation but has a 12% recurrence rate, which appears to be higher than some techniques described in the literature. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. The feasibility of laparoscopic management of incarcerated obturator hernia.

    PubMed

    Liu, Jing; Zhu, Yilin; Shen, Yingmo; Liu, Sujun; Wang, Minggang; Zhao, Xuefei; Nie, Yusheng; Chen, Jie

    2017-02-01

    Obturator hernia (OH), a rare cause of acute small bowel obstruction, requires immediate surgical intervention to prevent serious complications and mortality. We assessed the safety and efficacy of laparoscopic surgery in patients with incarcerated OH presenting with acute abdomen in an emergency setting. Data pertaining to patients diagnosed with incarcerated OH between 2011 and April 2015 at our hospital were reviewed. Patients' characteristics, operation details and postoperative outcomes were retrospectively analyzed. All ten patients diagnosed with incarcerated obturator hernia during the reference period were females (average age 72.1 ± 11.8 years; average weight 44.1 ± 6.9 kg; average body mass index 17.8 ± 2.1 kg/m(2); average operating time 63 ± 15 min; average hospital stay 6.2 ± 6.6 days). Twelve occult hernias, including six contralateral OHs, two ipsilateral femoral hernias and two bilateral femoral hernias were detected in six patients (60 %), which were simultaneously repaired after laparoscopic exploration. Nine patients (90 %) were successfully treated with synthetic mesh by laparoscopic technique. Only one case required intraoperative conversion to open surgery due to strangulated intestine with perforation. Wound infection was reported in one patient who had undergone bowel resection, but with an eventual complete recovery. Postoperative period was uneventful in the other nine patients. No recurrence or complications were reported on follow-up (mean duration of follow-up: 6-54 months). In this study, laparoscopic technique was associated with a reduced duration of hospital stay and fewer complications. In addition to being a safe and minimally invasive strategy, it allowed for simultaneous diagnosis and treatment of occult hernias during the same procedure. The approach may be a better option for the treatment of incarcerated OH and occult hernias in selected patients.

  7. Intraoperative management of critical arrhythmia

    PubMed Central

    2017-01-01

    The incidence of intraoperative arrhythmia is extremely high, and some arrhythmias require clinical attention. Therefore, it is essential for the anesthesiologist to evaluate risk factors for arrhythmia and understand their etiology, electrophysiology, diagnosis, and treatment. Anesthetic agents reportedly affect normal cardiac electrical activity. In the normal cardiac cycle, the sinoatrial node initiates cardiac electrical activity through intrinsic autonomous pacemaker activity. Sequential atrial and ventricular contractions result in an effective cardiac pumping mechanism. Arrhythmia occurs due to various causes, and the cardiac pumping mechanism may be affected. A severe case may result in hemodynamic instability. In this situation, the anesthesiologist should eliminate the possible causes of arrhythmia and manage the condition, creating hemodynamic stability under proper electrocardiographic monitoring. PMID:28367281

  8. Intraoperative OCT in Surgical Oncology

    NASA Astrophysics Data System (ADS)

    South, Fredrick A.; Marjanovic, Marina; Boppart, Stephen A.

    The global incidence of cancer is rising, putting an increasingly heavy burden upon health care. The need to effectively detect and treat cancer is one of the most significant problems faced in health care today. Effective cancer treatment typically depends upon early detection and, for most solid tumors, successful removal of the cancerous tumor tissue via surgical procedures. Difficulties arise when attempting to differentiate between normal and tumor tissue during surgery. Unaided visual examination of the tissue provides only superficial, low-resolution information and often with little visual contrast. Many imaging modalities widely used for cancer screening and diagnostics are of limited use in the operating room due to low spatial resolution. OCT provides cellular resolution allowing for more precise localization of the tumor tissue. It is also relatively inexpensive and highly portable, making it well suited for intraoperative applications.

  9. Intraoperative magnification: Who uses it?

    PubMed

    Jarrett, Paul Max

    2004-01-01

    Surgeons over recent decades have made increasing use of intraoperative magnification to enhance the outcome of surgical procedures, yet no published information exists regarding the extent of magnification use within surgical specialties. A sample of surgeons consisting of 148 specialists and senior surgical trainees in the west of Scotland was surveyed by postal questionnaire regarding their frequency and types of magnification use. Patterns of use were similar within each specialty, but varied markedly between specialties. Otolaryngologists and plastic, maxillofacial, and ophthalmic surgeons use both loupes and microscopes frequently. Cardiothoracic and pediatric surgeons tend only to utilize loupes, whereas neurosurgeons tend only to use microscopes. General surgeons, urologists, orthopedic surgeons, and gynecologists are infrequent users or nonusers of magnification, and when required will utilize loupes rather than microscopes. As a clear pattern of magnification use exists, it should be possible to anticipate the equipment needs of surgeons when providing theater services.

  10. Intraoperative radiotherapy for breast cancer

    PubMed Central

    Williams, Norman R.; Pigott, Katharine H.; Brew-Graves, Chris

    2014-01-01

    Intra-operative radiotherapy (IORT) as a treatment for breast cancer is a relatively new technique that is designed to be a replacement for whole breast external beam radiotherapy (EBRT) in selected women suitable for breast-conserving therapy. This article reviews twelve reasons for the use of the technique, with a particular emphasis on targeted intra-operative radiotherapy (TARGIT) which uses X-rays generated from a portable device within the operating theatre immediately after the breast tumour (and surrounding margin of healthy tissue) has been removed. The delivery of a single fraction of radiotherapy directly to the tumour bed at the time of surgery, with the capability of adding EBRT at a later date if required (risk-adaptive technique) is discussed in light of recent results from a large multinational randomised controlled trial comparing TARGIT with EBRT. The technique avoids irradiation of normal tissues such as skin, heart, lungs, ribs and spine, and has been shown to improve cosmetic outcome when compared with EBRT. Beneficial aspects to both institutional and societal economics are discussed, together with evidence demonstrating excellent patient satisfaction and quality of life. There is a discussion of the published evidence regarding the use of IORT twice in the same breast (for new primary cancers) and in patients who would never be considered for EBRT because of their special circumstances (such as the frail, the elderly, or those with collagen vascular disease). Finally, there is a discussion of the role of the TARGIT Academy in developing and sustaining high standards in the use of the technique. PMID:25083504

  11. Rapid intraoperative zygoma fracture imaging.

    PubMed

    Czerwinski, Marcin; Parker, Wendy L; Beckman, Lorne; Williams, H Bruce

    2009-09-01

    A fractured zygoma frequently results in an aesthetically displeasing facial asymmetry. Open reduction and internal fixation may accurately realign the facial skeleton but often with undesirable sequelae. The authors' objective was to develop a precise technique of intraoperative zygoma fracture imaging using a C-arm to permit anatomical fracture realignment while reducing the extent of skeletal exposure required. The simplicity and accessibility of this method should allow its widespread clinical application. First, using a model skull, the relative positions of the C-arm required to adequately depict zygoma projection, width, arch contour, and zygoma rotation were defined. Second, diverse zygoma fracture types were created in six cadaver heads with a Mini Bionix machine and were repaired using C-arm guidance; accuracy was confirmed with postoperative computed tomography. Third, after defining optimal operating room setup, the accuracy in a clinical case was assessed. Two C-arm views were defined. The zygoma projection view (C-arm at 70 to 90 degrees to the skull's coronal plane) allows visualization of projection, width, and contour. The rotation view (C-arm at 70 to 90 degrees to the skull's sagittal plane) allows visualization of zygoma rotation. Postoperative computed tomographic imaging confirmed anatomical repair in all cases. Average operating room duration was less than 30 minutes, with operating room times decreasing progressively. The authors have developed an accurate technique of intraoperative zygoma fracture imaging and reduction guidance. This technique may decrease the risks of open access by potentially limiting direct skeletal exposure to buttresses where skeletal stabilization is required. In addition, this method is simple, can be learned and used rapidly, and is readily accessible.

  12. Practicality of intraoperative teamwork assessments.

    PubMed

    Phitayakorn, Roy; Minehart, Rebecca; Pian-Smith, May C M; Hemingway, Maureen W; Milosh-Zinkus, Tanya; Oriol-Morway, Danika; Petrusa, Emil

    2014-07-01

    High-quality teamwork among operating room (OR) professionals is a key to efficient and safe practice. Quantification of teamwork facilitates feedback, assessment, and improvement. Several valid and reliable instruments are available for assessing separate OR disciplines and teams. We sought to determine the most feasible approach for routine documentation of teamwork in in-situ OR simulations. We compared rater agreement, hypothetical training costs, and feasibility ratings from five clinicians and two nonclinicians with instruments for assessment of separate OR groups and teams. Five teams of anesthesia or surgery residents and OR nurses (RN) or surgical technicians were videotaped in simulations of an epigastric hernia repair where the patient develops malignant hyperthermia. Two anesthesiologists, one OR clinical RN specialist, one educational psychologist, one simulation specialist, and one general surgeon discussed and then independently completed Anesthesiologists' Non-Technical Skills, Non-Technical Skills for Surgeons, Scrub Practitioners' List of Intraoperative Non-Technical Skills, and Observational Teamwork Assessment for Surgery forms to rate nontechnical performance of anesthesiologists, surgeons, nurses, technicians, and the whole team. Intraclass correlations of agreement ranged from 0.17-0.85. Clinicians' agreements were not different from nonclinicians'. Published rater training was 4 h for Anesthesiologists' Non-Technical Skills and Scrub Practitioners' List of Intraoperative Non-Technical Skills, 2.5 h for Non-Technical Skills for Surgeons, and 15.5 h for Observational Teamwork Assessment for Surgery. Estimated costs to train one rater to use all instruments ranged from $442 for a simulation specialist to $6006 for a general surgeon. Additional training is needed to achieve higher levels of agreement; however, costs may be prohibitive. The most cost-effective model for real-time OR teamwork assessment may be to use a simulation technician

  13. Prevalence of Adverse Intraoperative Events during Obesity Surgery and Their Sequelae

    PubMed Central

    Greenstein, Alexander J; Wahed, Abdus S; Adeniji, Abidemi; Courcoulas, Anita P; Dakin, Greg; Flum, David R; Harrison, Vincent; Mitchell, James E; O'Rourke, Robert; Pomp, Alfons; Pender, John; Ramanathan, Ramesh; Wolfe, Bruce M

    2013-01-01

    BACKGROUND Adverse intraoperative events (AIEs) during surgery are a well-known entity. A better understanding of the incidence of AIEs and their relationship with outcomes is helpful for surgeon preparation and preoperative patient counseling. The goals of this study are to describe the incidence of AIEs during bariatric surgery and examine their impact on major adverse complications. STUDY DESIGN The study included 5,882 subjects who had bariatric surgery in the Longitudinal Assessment of Bariatric Surgery study between March 2005 and April 2009. Prospectively collected AIEs included organ injuries, anesthesia-related events, anastomotic revisions, and equipment failure. The relationship between AIEs and a composite end point of 30-day major adverse complications (ie, death, venous thromboembolism, percutaneous, endoscopic, or operative reintervention and failure to be discharged from the hospital within 30 days from surgery) was evaluated using a multivariable relative risk model adjusting for factors known to influence their risk. RESULTS There were 1,608 laparoscopic adjusted gastric banding, 3,770 laparoscopic Roux-en-Y gastric bypass operations, and 504 open Roux-en-Y gastric bypass operations. Adverse intraoperative events occurred in 5% of the overall sample and were most frequent during open Roux-en-Y gastric bypass (7.3%), followed by laparoscopic Roux-en-Y gastric bypass (5.5%) and laparoscopic adjusted gastric banding (3%). The rate of composite end point was 8.8% in the AIE group compared with 3.9% among those without an AIE (p < 0.001). Multivariable analysis revealed that patients with an AIE were at 90% greater risk of composite complication than those without an event (relative risk = 1.90; 95% CI, 1.26–2.88; p = 0.002), independent of the type of procedure (open or laparoscopic). CONCLUSIONS Incidence of an AIE is not infrequent during bariatric surgery and is associated with much higher risk of major complication. Additional study is needed to

  14. A novel 3-dimensional electromagnetic guidance system increases intraoperative microwave antenna placement accuracy.

    PubMed

    Sastry, Amit V; Swet, Jacob H; Murphy, Keith J; Baker, Erin H; Vrochides, Dionisios; Martinie, John B; McKillop, Iain H; Iannitti, David A

    2017-09-13

    Failure to locate lesions and accurately place microwave antennas can lead to incomplete tumor ablation. The Emprint™ SX Ablation Platform employs real-time 3D-electromagnetic spatial antenna tracking to generate intraoperative laparoscopic antenna guidance. We sought to determine whether Emprint™ SX affected time/accuracy of antenna-placement in a laparoscopic training model. Targets (7-10 mm) were set in agar within a laparoscopic training device. Novices (no surgical experience), intermediates (surgical residents), and experts (HPB-surgeons) were asked to locate and hit targets using a MWA antenna (10-ultrasound only, 10-Emprint™ SX). Time to locate target, number of attempts to hit the target, first-time hit rate, and time from initiating antenna advance to hitting the target were measured. Participants located 100% of targets using ultrasound, with experts taking significantly less time than novices and intermediates. Using ultrasound only, successful hit-rates were 70% for novices and 90% for intermediates and experts. Using Emprint™ SX, successful hit rates for all 3-groups were 100%, with significantly increased first-time hit-rates and reduced time required to hit targets compared to ultrasound only. Emprint™ SX significantly improved accuracy and speed of antenna-placement independent of experience, and was particularly beneficial for novice users. Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

  15. The Effect of Vertical Versus Horizontal Vaginal Cuff Closure on Vaginal Length After Laparoscopic Hysterectomy.

    PubMed

    Hill, Amanda Marie; Davis, K Meryl; Clark-Donat, Lindsay; Hammons, Lee Marvin; Azodi, Masoud; Silasi, Dan-Arin

    2017-01-01

    STUDY OBJECTIVE: To determine whether vertical versus horizontal closure of the vaginal cuff during laparoscopic hysterectomy has an effect on postoperative vaginal length and pelvic organ prolapse. A prospective randomized controlled trial. Subjects were randomly assigned to vertical or horizontal vaginal cuff closure at the time of total laparoscopic hysterectomy. Pelvic organ prolapse quantization (POP-Q) tests were performed before surgery, 2 to 4 weeks after surgery, and 3 to 4 months after surgery (Canadian Task Force classification I). An academic university-affiliated community hospital. Patients undergoing laparoscopic or robotic-assisted laparoscopic total hysterectomy for benign or malignant disease, excluding those undergoing radical hysterectomy or concomitant pelvic floor procedure. Subjects were randomized into the vertical or horizontal vaginal cuff closure group. Total hysterectomy was completed with traditional laparoscopic techniques or with robotic assistance. A colpotomy ring was used in each subject. Vaginal cuff closure was performed with barbed suture in a running fashion according to the group assignment. A total of 43 subjects were enrolled and randomized. One patient was excluded because the vaginal cuff was closed vaginally, 1 cancelled surgery, and 1 was completed without a uterine manipulator. The mean change in vaginal length was -0.89 cm (standard deviation [SD] = 1.03) in the horizontal group and -0.86 cm (SD = 1.19) in the vertical group (p = .57). POP-Q evaluation revealed no differences between groups and an overall trend toward improved POP-Q measurements. The average duration of vaginal cuff closure did not differ (p = .45), and there were no intraoperative complications related to vaginal cuff closure. Horizontal and vertical laparoscopic closure of the vaginal cuff after laparoscopic hysterectomy results in similar changes in vaginal length and other POP-Q scores. Copyright © 2016 AAGL. Published by Elsevier Inc

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

    PubMed

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

    2015-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  18. Fusion of stereoscopic video and laparoscopic ultrasound for minimally invasive partial nephrectomy

    NASA Astrophysics Data System (ADS)

    Cheung, Carling L.; Wedlake, Christopher; Moore, John; Pautler, Stephen E.; Ahmad, Anis; Peters, Terry M.

    2009-02-01

    The development of an augmented reality environment that combines laparoscopic video and ultrasound imaging for image-guided minimally invasive abdominal surgical procedures, such as partial nephrectomy and radical prostatectomy, is an ongoing project in our laboratory. Our system overlays magnetically tracked ultrasound images onto endoscopic video to create a more intuitive visualization for mapping lesions intraoperatively and to give the ultrasound image context in 3D space. By presenting data in a common environment, this system will allow surgeons to visualize the multimodality information without having to switch between different images. A stereoscopic laparoscope from Visionsense Limited enhances our current system by providing surgeons with additional visual information through improved depth perception. In this paper, we develop and validate a calibration method that determines the transformation between the images from the stereoscopic laparoscope and the 3D locations of structures represented by a tracked laparoscopic ultrasound probe. We first calibrate the laparoscope with a checkerboard pattern and measure how accurate the transformation from image space to tracking space is. We then perform a target localization task using our fused environment. Our initial experience has demonstrated an RMS registration accuracy in 3D of 2.21mm for the laparoscope and 1.16mm for the ultrasound in a working volume of 0.125m3, indicating that magnetically tracked stereoscopic laparoscope and ultrasound images may be appropriately combined using magnetic tracking as long as steps are taken to ensure that the magnetic field generated by the system is not distorted by surrounding objects close to the working volume.

  19. Laparoscopic management of gastrointestinal stromal tumours: review at a Canadian centre

    PubMed Central

    Daigle, Carl; Meneghetti, Adam T.; Lam, Jasmine; Panton, Ormond N.M.

    2012-01-01

    Background Laparoscopic wedge resection has been widely accepted for small benign gastric tumours. Large gastrointestinal stromal tumours (GISTs), however, can be difficult to manipulate laparoscopically and are at risk for capsule disruption, which can then result in peritoneal seeding. Some authors have suggested that large GISTs (> 8 cm) are best approached using an open technique. However, there has been no consensus as to what the cut-off size should be. We conducted one of the largest Canadian series to date to assess outcomes and follow-up of the laparoscopic management of GISTs. Methods All patients with gastric GISTs presenting to Vancouver General Hospital and University of British Columbia Hospital between 2000 and 2008 were reviewed. Most lesions were resected using a wedge technique with closure of the stomach facilitated by an endoscopic linear stapling device. Results In all, 23 patients presented with GISTs; 19 patients underwent laparoscopic resection and, of these, 15 had a purely laparoscopic operation and 4 had a hand-assisted laparoscopic resection. Mean tumour size was 3.2 cm, with the largest tumour measuring 6.8 cm. There were no episodes of tumour rupture or spillage and no major intraoperative complications. All margins were negative. Mean follow-up was 13.3 (range 1–78) months. There was no evidence of recurrence or metastasis. Conclusion The laparoscopic management of gastric GISTs is safe and effective with short hospital stays and good results over a mean follow-up of 13.3 months. We believe that it should be the preferred technique offered to patients. PMID:22269221

  20. Laparoscopic anatrophic nephrolithotomy: feasibility study in a chronic porcine model.

    PubMed

    Kaouk, Jihad H; Gill, Inderbir S; Desai, Mihir M; Banks, Kevin L W; Raja, Shanker S; Skacel, Marek; Sung, Gyung Tak

    2003-02-01

    PURPOSE Anatrophic nephrolithotomy performed via open surgery involves incising the renal parenchyma along an avascular plane to remove a large, complex renal stone. We determined the feasibility of performing laparoscopic anatrophic nephrolithotomy in a survival porcine model. Furthermore, we present a novel technique of creating a staghorn calculus in the porcine model. MATERIALS AND METHODS After developing the technique in 3 pigs the survival study was performed in 10 consecutive animals. The procedure comprised 2 aspects. 1) We developed an animal model for staghorn calculi by retrograde injection of polyurethane (Fomo Products, Inc., Norton, Ohio) into the renal pelvis through a ureteral catheter. For a 2-week period the staghorn calculus was allowed to create hydronephrosis. 2) Laparoscopic anatrophic nephrolithotomy was done, involving control of the renal artery and vein, in situ renal hypothermia with ice slush in 1 animal, lateral renal parenchymal incision, stone extraction and suture repair of the incised collecting system and renal parenchyma. RESULTS Synthetic stone formation and laparoscopic anatrophic nephrolithotomy were successful in all 10 animals, including 1 that underwent staged bilateral anatrophic nephrolithotomy. Mean operative time for anatrophic nephrolithotomy was 125 minutes. Mean blood loss was 68 cc and mean warm ischemia time was 30 minutes (range 23 to 39). A residual small pelvicaliceal calculus was noted postoperatively in the initial 3 cases only. Thereafter, routine intraoperative ultrasonography and flexible endoscopy were done for stone localization, resulting in a stone-free rate of 100% in all 7 remaining animals. Diethylenetriamine pentaacetic acid renal scans documented improvement in the glomerular filtration rate from a mean of 26.4 ml. per minute after stone creation and hydronephrosis to 54.8 ml. per minute 4 to 5 weeks after laparoscopic anatrophic nephrolithotomy. CONCLUSIONS Laparoscopic techniques can be applied

  1. Magnetic Resonance (MR)-Guided Breast Biopsy

    MedlinePlus

    ... guided breast biopsy uses a powerful magnetic field, radio waves and a computer to help locate a breast ... which contain wire coils that send and receive radio waves to help create the MR images. One of ...

  2. Magnetic Resonance (MR)-Guided Breast Biopsy

    MedlinePlus

    ... any medications you’re taking, including aspirin and herbal supplements, and whether you have any allergies – especially to ... doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to ...

  3. Left- and right-sided laparoscopic-assisted nephrectomy in standing horses with unilateral renal disease.

    PubMed

    Röcken, Michael; Mosel, Gesine; Stehle, Christiane; Rass, Julia; Litzke, Lutz F

    2007-08-01

    To describe a technique for, and outcome after, left- or right-sided laparoscopic-assisted nephrectomy in standing horses with unilateral renal disease. Clinical report. Horses (n=3) with unilateral renal disease. Horses were sedated with detomidine (0.01 mg/kg intravenously [IV]) and levomethadone (0.05 mg/kg IV). Paravertebral anesthesia and infiltration-anesthesia with 2% lidocaine were used to create a surgical field incorporating the 17th intercostal space and paralumbar fossa. Two separate, ipsilateral portals and a mini-laparotomy were used. The perirenal peritoneum was horizontally incised (10-15 cm) using endoscissors and the incision digitally enlarged for manual dissection of the perirenal fat and kidney mobilization. The renal vessels and ureter were individually dissected, ligated, and transected under laparoscopic observation and the kidney removed. The perirenal and laparotomy peritoneal defects were not closed; and the laparotomy was closed in a multilayered fashion. The transverse abdominal muscle was apposed in a continuous pattern using 1 polyglactin 910, the subcutaneous tissue (simple continuous pattern) and skin (simple interrupted pattern) with 2-0 polyglactin 910. Left (2) and right (1) sided laparoscopic-assisted nephrectomy (1 nephrolithiasis, 2 hydronephrosis) was performed successfully. Sedation and local anesthesia was adequate for intraoperative immobilization and analgesia. No intraoperative complications occurred. Incisional seroma formation and fever occurred on days 3 and 4 in 1 horse and resolved with medical management. Laparoscopic-assisted nephrectomy can be used for removal of the left or right kidney in standing horses with unilateral kidney disease. To avoid risks associated with general anesthesia and to reduce surgical trauma, laparoscopic-assisted nephrectomy can be performed in the standing sedated horse using a 2 portal technique and a mini-laparotomy.

  4. Total Laparoscopic Hysterectomy and Laparoscopic-Assisted Vaginal Hysterectomy.

    PubMed

    King, Cara R; Giles, Dobie

    2016-09-01

    Vaginal hysterectomy has been shown to have the lowest complication rate, better cosmesis, and decreased cost compared with alternate routes of hysterectomy. However, there are times when a vaginal hysterectomy is not feasible and an open abdominal hysterectomy should be avoided. Minimally invasive surgery has evolved over the last several decades; with the improvement in optics and surgical instruments, laparoscopic hysterectomy is becoming increasingly common. A total laparoscopic hysterectomy is possible with proper training, including sound technique in laparoscopic suturing for closure of the vaginal cuff. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Laparoscopic anatomic liver resection

    PubMed Central

    Vibert, Eric; Kouider, Ali

    2004-01-01

    Background Liver resection is reputed to be one of the most difficult procedures embraced in laparoscopy. This report shows that with adequate training, anatomical liver resection including major hepatectomies can be performed. Methods This is a retrospective study. Results From 1995 to 2004, among 84 laparoscopic liver resections, 46 (54%) anatomical laparoscopic hepatectomies were performed in our institution by laparoscopy. Nine (20%) patients had benign disease while 37 (80%) had malignant lesions. Among those with malignant lesions, 14 patients had hepatocellular carcinoma (HCC), 18 had colorectal metastasis (CRM), while 5 had miscellaneous tumours. For benign disease, minor (two Couinaud's segments or less) and major anatomic hepatectomies were performed in five and four patients, respectively. For malignant lesions, minor and major anatomic hepatectomies were performed in 15 and 22 patients, respectively. Overall, conversion to laparotomy was necessary in 7 (15%) patients. Blood transfusion was required in five (10%) patients. One patient died of cerebral infarction 8 days after a massive peroperative haemorrhage. The overall morbidity rate was 34% whatever the type of resection. Three patients required reoperation, either for haemorrhage (n=1) and/or biliary leak (n=2). For CRM (n=18), overall and disease-free survival at 24 months (mean follow-up of 17 months) were 100% and 56%, respectively. For HCC (n=14), overall and disease-free survival at 36 months (mean follow-up of 29 months) were 91% and 65%, respectively. No port site metastasis occurred in patients with malignancy. Conclusions After a long training with limited liver resection in superficial segments, laparoscopic anatomical minor and major resections are feasible. Short-term carcinological results seem to be similar to those obtained with laparotomy. PMID:18333079

  6. Prostate tissue ablation with MRI guided transurethral therapeutic ultrasound and intraoperative assessment of the integrity of the neurovascular bundle

    NASA Astrophysics Data System (ADS)

    Sammet, Steffen; Partanen, Ari; Yousuf, Ambereen; Wardrip, Craig; Niekrasz, Marek; Antic, Tatjana; Razmaria, Aria; Sokka, Sham; Karczmar, Gregory; Oto, Aytekin

    2017-03-01

    OBJECTIVES: Evaluation of the precision of prostate tissue ablation with MRI guided therapeuticultrasound by intraoperative objective assessment of the neurovascular bundle in canines in-vivo. METHODS: In this ongoing IACUC approved study, eight male canines were scanned in a clinical 3T Achieva MRI scanner (Philips) before, during, and after ultrasound therapy with a prototype MR-guided ultrasound therapy system (Philips). The system includes a therapy console to plan treatment, to calculate real-time temperature maps, and to control ultrasound exposures with temperature feedback. Atransurethral ultrasound applicator with eight transducer elements was used to ablate canine prostate tissue in-vivo. Ablated prostate tissue volumes were compared to the prescribed target volumes to evaluate technical effectiveness. The ablated volumes determined by MRI (T1, T2, diffusion, dynamic contrast enhanced and 240 CEM43 thermal dose maps) were compared to H&E stained histological slides afterprostatectomy. Potential nerve damage of the neurovascular bundle was objectively assessed intraoperativelyduring prostatectomy with a CaverMap Surgical Aid nerve stimulator (Blue Torch Medical Technologies). RESULTS: Transurethral MRI -guided ultrasound therapy can effectively ablate canine prostate tissue invivo. Coronal MR-imaging confirmed the correct placement of the HIFU transducer. MRI temperature maps were acquired during HIFU treatment, and subsequently used for calculating thermal dose. Prescribed target volumes corresponded to the 240 CEM43 thermal dose maps during HIFU treatment in all canines. Ablated volumes on high resolution anatomical, diffusion weighted, and contrast enhanced MR images matched corresponding histological slides after prostatectomy. MRI guidance with realtime temperature monitoring showed no damage to surrounding tissues, especially to the neurovascular bundle (assessed intra-operatively with a nerve stimulator) or to the rectum wall. CONCLUSIONS: Our study

  7. Comparative financial analysis of laparoscopic pelvic lymph node dissection performed in 1990-1992 v 1993-1994.

    PubMed

    Troxel, S A; Winfield, H N

    1996-08-01

    In 1994, it was reported that laparoscopic pelvic lymph node dissection (L-PLND) was US $1350 more expensive than open pelvic lymph node dissection (O-PLND) for the staging of prostate cancer. Despite the lower postoperative expenses associated with L-PLND, the intraoperative expenditures were 52% higher, primarily because of the prolonged operating time and the cost of disposable instrumentation. The objective of the present study was to determine if, with increasing laparoscopic experience and a more competitive surgical supply market, the intraoperative as well as the overall hospital expenses would diminish. The study population consisted of 105 men who underwent staging L-PLND for cancer of the prostate. Group I was composed of 50 patients who underwent surgery between 1990 and 1992, and Group II consisted of 55 patients operated on in 1993 and 1994. All hospital-related expenses were reorganized into preoperative, intraoperative, and postoperative and subsequently corrected for inflationary changes to a base year of 1993-1994. The total overall expenses of the two groups were similar, differing by only $65. Despite a lowering of preoperative and postoperative expenses in the 1993-1994 group by 112% and 31%, respectively, the intraoperative expenses were still $571 higher. The operative time decreased by 19 minutes in the contemporary group, but the expense of surgical supplies continued to increase up to $910 (104%) more than the 1990-1992 group. It is hoped that the use of "laparoscopic kits" as well hospital equipment consortiums will help slow the escalating costs of surgical care. However, it is the responsibility of the laparoscopic surgeon to demonstrate that these procedures are as safe, efficient, and cost-effective as their open counterpart.

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

    PubMed Central

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

    2015-01-01

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

  9. Predictive factors for postoperative morbidity after laparoscopic adrenalectomy for pheochromocytoma: a multicenter retrospective analysis in 225 patients.

    PubMed

    Brunaud, Laurent; Nguyen-Thi, Phi-Linh; Mirallie, Eric; Raffaelli, Marco; Vriens, Menno; Theveniaud, Pierre-Etienne; Boutami, Myriam; Finnerty, Brendan M; Vorselaars, Wessel M C M; Rinkes, Inne Borel; Bellantone, Rocco; Lombardi, Celestino; Fahey, Thomas; Zarnegar, Rasa; Bresler, Laurent

    2016-03-01

    Since the 1950s, preoperative medical preparation has been widely applied in patients with pheochromocytoma to improve intraoperative hemodynamic instability and postoperative complications. However, advancements in preoperative imaging, laparoscopic surgical techniques, and anesthesia have considerably improved management in patients with pheochromocytoma. In consequence, there is no validated consensus on current predictive factors for postoperative morbidity. The aim of this study was to determine perioperative factors which are predictive for postoperative morbidity in patients undergoing laparoscopic adrenalectomy for pheochromocytoma. It is a retrospective analysis of prospectively maintained databases in five medical centers from 2002 to 2013. Inclusion criteria were consecutive patients who underwent non-converted laparoscopic unilateral total adrenalectomy for pheochromocytoma. Two-hundred and twenty-five patients were included. All-cause and cardiovascular postoperative morbidity rates were 16% (n = 36) and 4.8% (n = 11), respectively. Preinduction blood pressure normalization after preoperative medical preparation had no impact on postoperative morbidity. However, past medical history of coronary artery disease (OR [CI95%] = 3.39; [1.317-8.727]) and incidence of intraoperative hemodynamic instability episodes (both SBP ≥ 160 mmHg and MAP < 60 mmHg) (OR [CI95%] = 3.092; [1.451-6.587]) remained independent predictors for postoperative all-cause morbidity. Similarly, past medical history of coronary artery disease (OR [CI95%] = 14.41; [3.119-66.57]), female sex (OR [CI95%] = 12.05; [1.807-80.31]), and incidence of intraoperative hemodynamic instability episodes (both SBP ≥ 200 mmHg and MAP < 60 mmHg) (OR [CI95%] = 4.13; [1.009-16.90]) remained independent predictors for postoperative cardiovascular morbidity. This study identifies risk factors for cardiovascular and all-cause postoperative morbidity after laparoscopic adrenalectomy in current clinical

  10. [Actual status of laparoscopic cholecystectomy].

    PubMed

    Chousleb Mizrahi, Elias; Chousleb Kalach, Alberto; Shuchleib Chaba, Samuel

    2004-08-01

    Since the first laparoscopic cholecystectomy in 1988, the management of gall-bladder disease has changed importantly. This technique was rapidly popularized in the U.S. as well as in Europe. Multiple studies have proved its feasibility, safeness and great advantages. Analyze usefulness and recent advances of endoscopic surgery in the management of gallbladder disease. We did a review of the recent medical literature to determine the actual status of laparoscopic cholecystectomy. Laparoscopic cholecystectomy is the most common surgical procedure performed in the digestive tract. During the year 2001, 1,100,000 cholecystectomies were done in the U.S., 85% were done laparoscopically. In Mexico cholecystectomy in government hospitals is done laparoscopically in 50% of the cases, while in private hospitals it reaches 90%. There are multiple prospective controlled studies showing superiority of laparoscopic cholecystectomy in times of recovery, costs, return to normal activity, pain, morbidity, esthetics among other advantages. Laparoscopic cholecystectomy is the gold standard for the treatment of the great majority of cases of gallbladder disease, nevertheless in developing countries open cholecystectomy is still done frequently.

  11. Could laparoscopic colon and rectal surgery become the standard of care? A review and experience with 750 procedures

    PubMed Central

    Schlachta, Christopher M.; Mamazza, Joseph; Gregoire, Roger; Burpee, Stephen E.; Poulin, Eric C.

    2003-01-01

    Introduction The benefits of the laparoscopic approach to colon and rectal surgery do not seem as great as for other laparoscopic procedures. To study this further we decided to review the current literature and the 10-year experience of a surgical group from university teaching hospitals in Montréal, Québec and Toronto in performing laparoscopic colon and rectal surgery. Methods The prospectively designed case series comprised all patients having laparoscopic colon and rectal surgery. The procedures were carried out by a group of 4 surgeons between April 1991 and November 2001. We noted intraoperative complications, any conversions to open surgery, operating time, postoperative complications and postoperative length of hospital stay. Results The group attempted 750 laparoscopic colon and rectal procedures of which 669 were completed laparoscopically. Malignant disease was the indication for surgery in 49.6% of cases. Right hemicolectomy and sigmoid colectomy accounted for 54.5% of procedures performed. Intraoperative complications occurred in 8.3%, with 29.0% of these resulting in conversion to open surgery. The overall rate of conversion to open surgery was 10.8%, most commonly for oncologic concerns. Median operating time was 175 minutes for all procedures. Postoperative complications occurred in 27.5% of procedures completed laparoscopically but were mostly minor wound complications. Pulmonary complications occurred in only 1.0%. The anastomotic leak rate was 2.5%. The early reoperation rate was 2.4%. Postoperative mortality was 2.2%. No port site metastases have yet been detected. The median postoperative length of stay was 5 days. Conclusions The clinical outcomes of laparoscopic colon and rectal surgery in this 10-year experience are consistent with numerous cohort studies and randomized clinical trials. Laparoscopic colon and rectal surgery in the hands of well-trained surgeons can be performed safely with short hospital stay, low analgesic requirements

  12. Intraoperative scintigraphy for active small intestinal bleeding

    SciTech Connect

    Biener, A.; Palestro, C.; Lewis, B.S.; Katz, L.B. )

    1990-11-01

    Localizing active sites of bleeding within the small intestine remains a difficult task. Endoscopic, angiographic or scintigraphic studies may point to the small intestine as the site of blood loss, but at operation, without a palpable lesion, the exact site of bleeding remains elusive. Patients are managed at laparotomy with intraoperative endoscopy, angiography, multiple enterotomies, blind resections, or placement of an enterostomy. We describe two patients in whom intraoperative scintigraphy accurately identified active sites of bleeding in the small intestine when other modalities failed. Intraoperative scintigraphy is rapid, easy to perform and is an effective means of identifying active sites of bleeding within the small intestine.

  13. The basics of intraoperative diagnosis in neuropathology.