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Harada H, Hayami M, Makuuchi R, Ida S, Kumagai K, Ohashi M, Nunobe S. A sandwiching method that simplifies hepatic left lateral segment inversion to secure an optimal surgical view around the esophageal hiatus in laparoscopic and robotic gastrectomy for upper gastric and esophagogastric junction cancers. Langenbecks Arch Surg 2023; 408:159. [PMID: 37093285 DOI: 10.1007/s00423-023-02901-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE In laparoscopic surgery for upper gastric and esophagogastric junction (EGJ) cancer, it is important to achieve optimal exposure of the esophageal hiatus to secure an appropriate workspace. In recent years, hepatic left lateral segment (HLLS) inversion has been used to achieve an optimal surgical field. We present a simple technique to perform a modified HLLS inversion. METHODS As a simple modified method, suturing a 2-0 straight needle to the peritoneum of the round ligament and pulling it to the outside of the abdominal cavity, the falciform, left triangular, and coronary ligaments were dissected. The HLLS was inverted by moving it to the right through the space of the transected falciform ligament. By ligating the thread through the round ligament, the HLLS was sandwiched between the rest of the liver and abdominal wall. The short-term surgical outcomes of patient who underwent simple modified HLLS inversion were retrospectively reviewed. RESULTS This study investigated consecutive 24 patients who underwent laparoscopic proximal and total gastrectomies using the simple modified HLLS inversion technique between June 2021 and April 2022. This series of procedures could be completed in approximately 16 min. A Nathanson liver retractor was used in three patients due to difficulties in completing the HLLS inversion in our institution. Postoperative serum liver enzyme levels indicated there was a small effect on the liver. CONCLUSIONS The simple modified HLLS inversion technique may be a safe and useful procedure and can provide an enhanced surgical field during laparoscopic surgery for upper gastric and EGJ cancers.
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Affiliation(s)
- Hiroki Harada
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Masaru Hayami
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Rie Makuuchi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Satoshi Ida
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Koshi Kumagai
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Manabu Ohashi
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Souya Nunobe
- Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
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Jenner DC, Klimovskij M, Nicholls M, Bates T. Occlusion of the cystic duct with cyanoacrylate glue at laparoscopic subtotal fenestrating cholecystectomy for a difficult gallbladder. Acta Chir Belg 2022; 122:23-28. [PMID: 33210557 DOI: 10.1080/00015458.2020.1846937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
BACKGROUND Subtotal cholecystectomy is occasionally the management of choice in the patient with a hostile Calot's triangle but when it is not considered safe to close the cystic duct this often leads to a biliary fistula. In order to reduce this morbidity a novel strategy to seal the cystic duct with cyanoacrylate glue was introduced. The outcome of the two strategies have been compared. METHODS Patients who had a laparoscopic subtotal cholecystectomy where the cystic duct was left open, the Unsecured group, were compared with those where the duct orifice was occluded with cyanoacrylate glue, the Glued group. The outcome of the two strategies have been compared by duration of biliary drainage, whether a leak was shown on ERCP, time to removal of the drain, length of hospital stay, the re-operation and readmission rates. RESULTS In 78 cases of laparoscopic subtotal cholecystectomy it was considered unsafe to close the cystic duct. 36 patients were managed without closure of the cystic duct, the Unsecured group and bile drainage continued for more than 3 days in 9 cases (25%) compared with 3 of 42 cases (7%) treated with glue, the Glued group (NS). Postoperative ERCP demonstrated a leak more frequently in the Unsecured group (p < 0.02). The length of stay was reduced in the Glued group. (0.9 compared with 3.0 days, p < 0.01). CONCLUSION The results suggest that glue may be a safe option to occlude the cystic duct orifice and reduce hospital stay when this cannot safely be closed at subtotal cholecystectomy.
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Affiliation(s)
| | | | | | - Tom Bates
- Centre for Professional Practice, University of Kent, Kent, UK
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Zhang J, Zheng X, Li W, Lu Y, Sun Z, Zhang N, Zhu B. A Trocar-Free and Low-cost Method for Liver Retraction in Laparoscopic Gastric Surgery. Obes Surg 2021; 32:550-552. [PMID: 34406597 DOI: 10.1007/s11695-021-05665-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Jianlu Zhang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian District, Beijing, 100038, China
| | - Xuejing Zheng
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian District, Beijing, 100038, China
| | - Weiqing Li
- Department of Thoracic Surgery, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian District, Beijing, 100038, China
| | - Yi Lu
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, China
| | - Zhipeng Sun
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian District, Beijing, 100038, China.
| | - Nengwei Zhang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian District, Beijing, 100038, China.
| | - Bin Zhu
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian District, Beijing, 100038, China.
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Zheng X, Sang Q, Wang L, Chen G, Guo Y, Fan Q, Du D, Xu G, Lian D, Zhu B, Zhang N, Sun Z. K-Wire Retractor, a Trocar-Free Liver Retraction Technique in Bariatric Surgery. Obes Surg 2020; 31:1113-1119. [PMID: 33136262 DOI: 10.1007/s11695-020-05091-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Liver retractor helps in the provision of an adequate operative field in bariatric surgery. Though several retractors have been introduced, an optimal retraction method is yet to be desired. We have developed a K-wire retractor, a simple trocar-free liver retractor used in our bariatric surgery. The efficacy and safety of the K-wire retractor were examined. METHODS A retrospective review was performed on patients undergoing laparoscopic bariatric surgery from January 2016 to April 2019. Based on the application of liver retractors during surgery, patients were divided into the K-wire retractor group and the suture-based retractor group for comparative analyses. Patients with severe liver injury or missing data, or treated with other types of retractors were excluded. RESULTS A total of 317 patients were included in our study and there was no conversion to open surgery. There were no significant differences in patient demographics (age, gender, BMI) and types of bariatric surgery between the two groups. The time taken for placement of retractor was significantly shorter in the K-wire retractor group, in addition to higher operative view score and lesser ALT/AST elevation compared with the suture-based retractor group. Although the K-wire retractor group was less inclined to require additional retraction techniques, patients with BMI ≥ 50 Kg/m2 were associated with higher risk (OR:3.8; 95% CI: 1.2, 12.8) of requiring additional retractors. There were no severe K-wire retractor-related complications observed. CONCLUSION The trocar-free K-wire liver retractor is safe, simple, and effective as a standard liver retraction method in bariatric surgery.
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Affiliation(s)
- Xuejing Zheng
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Qing Sang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Liang Wang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Guanyang Chen
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Yifan Guo
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Qing Fan
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Dexiao Du
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Guangzhong Xu
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Dongbo Lian
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Bin Zhu
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian Distinct, Beijing, 100038, China
| | - Nengwei Zhang
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian Distinct, Beijing, 100038, China.
| | - Zhipeng Sun
- Surgery Centre of Diabetes Mellitus, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Tieyi Road, Haidian Distinct, Beijing, 100038, China.
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Sweeny A, Buglino L, La Vella E, Yarbrough D. Comparison of a Novel, Trocar-Free Internal Liver Retractor to Standard Liver Retraction in Bariatric Surgery. Obes Surg 2019; 29:3071-3075. [DOI: 10.1007/s11695-019-04049-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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A Simple Method of Intracorporeal “W-shaped” Liver Retraction Technique for Minimally Invasive Gastric Cancer Surgery. Surg Laparosc Endosc Percutan Tech 2019; 29:e24-e28. [DOI: 10.1097/sle.0000000000000648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Perivoliotis K, Sarakatsianou C, Tepetes K, Baloyiannis I. Single incision laparoscopic fundoplication: A systematic review of the literature. World J Gastrointest Surg 2019; 11:179-190. [PMID: 31057702 PMCID: PMC6478600 DOI: 10.4240/wjgs.v11.i3.179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/12/2019] [Accepted: 03/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Fundoplication, was first introduced as a surgical treatment method of gastroesophageal reflux disease. Consequently, several modifications of this method have been described, whereas laparoscopic fundoplication was recently introduced. Although single incision (SI) fundoplication was considered as an alternative to the conventional laparoscopic approach, several studies reported an increased operation duration, and high rates of multiport conversion and incisional hernia.
AIM To provide a current overview of the technical variations and the postoperative outcomes of patients submitted to SI fundoplication.
METHODS The present systematic review of the literature was designed and conducted on the basis of the PRISMA guidelines. A systematic screening of the electronic scholar databases (Medline, Scopus and Web of Science) was performed.
RESULTS Literature search resulted in the identification of 19 studies. Overall, 266, 137 and 110 SI Nissen, Dor and Toupet fundoplications were reported, respectively. In the majority of the trials, standard laparoscopic instruments were used. The left liver lobe was displayed through the use of forceps, graspers, retractors, drains or even glue. Both intra-corporeal and extracorporeal suturing was described. Mean operative time was 136.3 min. Overall complication rate was 5.2% and the rate of incisional hernia was 0.9%. No mortality was reported.
CONCLUSION Due to the methodological heterogeneity and the lack of high quality studies comparing multi to single access techniques and the several variations, we conclude that further well designed studies are necessary, in order to evaluate the role of SI fundoplication.
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Affiliation(s)
| | | | | | - Ioannis Baloyiannis
- Department of Surgery, University Hospital of Larissa, Larissa 41110, Greece
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Liver Retraction Using n-Butyl-2-Cyanoacrylate (NBCA) Glue during Laparoscopic Splenectomy and Azygoportal Disconnection in Cirrhotic Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3064046. [PMID: 30211218 PMCID: PMC6120335 DOI: 10.1155/2018/3064046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/08/2018] [Indexed: 12/26/2022]
Abstract
Background Although liver retraction using n-butyl-2-cyanoacrylate (NBCA) glue has been applied to laparoscopic upper abdominal surgery in noncirrhotic patients, there is still no consensus on its safety and feasibility for cirrhotic patients. In this study, we aimed to investigate the safety and effectiveness of liver retraction using NBCA glue during laparoscopic splenectomy and azygoportal disconnection (LSD) for gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension. Methods Thirty-nine gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension patients were included in our study. We performed LSD in the presence of NBCA glue (n = 22, NBCA group) and absence of NBCA glue (n = 17, n-NBCA group), respectively. The operation time, blood loss, postoperative hospitalization, and liver function were compared between the two groups. Results There was no mortality during the operation. One patient in non-NBCA group received open surgery due to parenchyma hemorrhage. Postoperative pleural effusion occurred in 2 cases of the NBCA group and 1 of the non-NBCA group. One showed left subphrenic abscess in the non-NBCA group. No postoperative bleeding occurred after 9-30 months of follow-up. The time of operation in NBCA group was significantly shorter than those in n-NBCA group (198.86±17.86 versus 217.81±20.25min, P<0.01). Blood loss in NBCA group was significantly lower than non-NBCA group (159.09±56.98 versus 212.50±88.51 ml, P<0.05). The levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were increased on day 1 after LSD and decreased to normal level on day 7 after LSD in both groups. There was no significant difference in postoperative hospitalization and liver function between the two groups. Conclusion Liver retraction using NBCA glue during LSD for gastroesophageal varices and hypersplenism secondary to liver cirrhosis and portal hypertension is safe, effective, and feasible.
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Yoshikawa K, Shimada M, Higashijima J, Nakao T, Nishi M, Takasu C, Kashihara H, Eto S. Combined liver mobilization and retraction: A novel technique to obtain the optimal surgical field during laparoscopic total gastrectomy. Asian J Endosc Surg 2016; 9:111-5. [PMID: 26679094 DOI: 10.1111/ases.12271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 11/14/2015] [Accepted: 11/24/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION During laparoscopic gastrectomy, it is important to establish a good operative field and ensure an adequate working space. The combined liver mobilization and retraction method is used to get a safe and optimal view. METHODS We retrospectively analyzed 32 consecutive patients who underwent laparoscopic total gastrectomy for gastric cancer. The patients were divided into two groups: the mobilization (+) group (n = 12) and the mobilization (-) group (n = 20). Hepatic function tests were performed in all patients. RESULTS Mobilization provided a satisfactory view of the working field, especially the gastroesophageal junction and the angle of His during laparoscopic total gastrectomy, and no complications were observed during liver retraction. On postoperative hepatic function testing, there was no significant difference between the two groups on any day. CONCLUSIONS Combined liver mobilization and retraction may be helpful in laparoscopic total gastrectomy.
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Affiliation(s)
- Kozo Yoshikawa
- The Department of Surgery, The University of Tokushima, Tokushima, Japan
| | - Mitsuo Shimada
- The Department of Surgery, The University of Tokushima, Tokushima, Japan
| | - Jun Higashijima
- The Department of Surgery, The University of Tokushima, Tokushima, Japan
| | - Toshihiro Nakao
- The Department of Surgery, The University of Tokushima, Tokushima, Japan
| | - Masaaki Nishi
- The Department of Surgery, The University of Tokushima, Tokushima, Japan
| | - Chie Takasu
- The Department of Surgery, The University of Tokushima, Tokushima, Japan
| | - Hideya Kashihara
- The Department of Surgery, The University of Tokushima, Tokushima, Japan
| | - Syohei Eto
- The Department of Surgery, The University of Tokushima, Tokushima, Japan
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Kang R, Li H, Lysdahl H, Quang Svend Le D, Chen M, Xie L, Bünger C. Cyanoacrylate medical glue application in intervertebral disc annulus defect repair: Mechanical and biocompatible evaluation. J Biomed Mater Res B Appl Biomater 2015; 105:14-20. [PMID: 26372292 DOI: 10.1002/jbm.b.33524] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 05/24/2015] [Accepted: 08/30/2015] [Indexed: 12/15/2022]
Abstract
In an attempt to find an ideal closure method during annulus defect repair, we evaluate the use of medical glue by mechanical and biocompatible test. Cyanoacrylate medical glue was applied together with a multilayer microfiber/nanofiber polycaprolactone scaffold and suture in annulus repair. Continuous axial loading and fatigue mechanical test was performed. Furthermore, the in vitro response of mesenchymal stem cell (MSC) to the glue was evaluated by cell viability assay. The in vivo response of annulus tissue to the glue and scaffold was also studied in porcine lumbar spine; histological sections were evaluated after 3 months. Cyanoacrylate glue significantly improved the closure effect in the experimental group with failure load 2825.7 ± 941.6 N, compared to 774.1 ± 281.3 N in the control group without glue application (p < 0.01). The experimental group also withstood the fatigue test. No toxic effect was observed by in vitro cell culture and in vivo implantation. On the basis of this initial evaluation, the use of cyanoacrylate medical glue improves closure effect with no toxicity in annulus defect repair. This method of annulus repair merits further effectiveness study in vivo. © 2015 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 14-20, 2017.
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Affiliation(s)
- Ran Kang
- Orthopaedic Research Lab, Aarhus University Hospital, Aarhus, C 8000, Denmark.,Department of Orthopedic Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, 210028, China
| | - Haisheng Li
- Orthopaedic Research Lab, Aarhus University Hospital, Aarhus, C 8000, Denmark
| | - Helle Lysdahl
- Orthopaedic Research Lab, Aarhus University Hospital, Aarhus, C 8000, Denmark
| | - Dang Quang Svend Le
- Orthopaedic Research Lab, Aarhus University Hospital, Aarhus, C 8000, Denmark
| | - Menglin Chen
- Interdisciplinary Nanoscience Center, Aarhus University, Aarhus, C 8000, Denmark
| | - Lin Xie
- Department of Orthopedic Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, 210028, China
| | - Cody Bünger
- Orthopaedic Research Lab, Aarhus University Hospital, Aarhus, C 8000, Denmark
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Gan P, Bingham J. A clinical study of the LiVac laparoscopic liver retractor system. Surg Endosc 2015; 30:789-796. [PMID: 26092007 PMCID: PMC4735244 DOI: 10.1007/s00464-015-4272-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/27/2015] [Indexed: 12/19/2022]
Abstract
Background All retractors for laparoscopic operations on the gallbladder or stomach apply an upward force to the under-surface of the liver or gallbladder, most requiring an additional skin incision. The LiVac laparoscopic liver retractor system (LiVac retractor) comprises a soft silicone ring attached to suction tubing and connected to a regulated source of suction. The suction tubing extends alongside existing ports. When placed between the liver and diaphragm, and suction applied, a vacuum is created within the ring, keeping these in apposition. Following successful proof-of-concept animal testing, a clinical study was conducted to evaluate the performance and safety of the retractor in patients. Methods The study was a dual-centre, single-surgeon, open-label study and recruited ten patients scheduled to undergo routine upper abdominal laparoscopic surgery including cholecystectomy, primary gastric banding surgery or fundoplication. The study was conducted at two sites and was approved by the institutions’ ethics committees. The primary objective of the study was to evaluate the performance of the LiVac retractor in patients undergoing upper abdominal single- or multi-port laparoscopic surgery. Performance was measured by the attainment of milestones for the retractor and accessory bevel, where used, and safety outcomes through the recording of adverse events, physical parameters, pain scales, blood tests and a post-operative liver ultrasound. Results The LiVac retractor achieved both primary and secondary performance and safety objectives in all patients. No serious adverse events and no device-related adverse events or device deficiencies were reported. Conclusion The LiVac retractor achieved effective liver retraction without clinically significant trauma and has potential application in multi- or single-port laparoscopic upper abdominal surgery. As a separate incision is not required, the use of the LiVac retractor in multi-port surgery therefore reduces the number of incisions.
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Affiliation(s)
- Philip Gan
- St John of God Hospital, Suite 7, 136 Botanic Road, Warrnambool, VIC, 3280, Australia.
| | - Judy Bingham
- Easington Pty Ltd, P.O. Box 1201, Camberwell, VIC, 3124, Australia
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Yu H, Wu S, Yu X, Han J, Yao D. Single-incision laparoscopic biliary bypass for malignant obstructive jaundice. J Gastrointest Surg 2015; 19:1132-8. [PMID: 25700838 DOI: 10.1007/s11605-015-2777-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 02/09/2015] [Indexed: 01/31/2023]
Abstract
Biliary bypass is a major management of resolution to malignant obstructive jaundice. Laparoscopic approach is an ideal alternative to open surgery with the less recurrence compared with endoscopic stenting. Single incision surgery approach has not been applied to biliary bypass due to technical challenge. The aim of this study is to evaluate the safety and feasibility of single-incision laparoscopic biliary bypass. Eighteen patients with periampulla tumor underwent single-incision laparoscopic cholecystojejunostomy. The preoperation and postoperation data were retrospectively analyzed. All the cases underwent surgery successfully without conversion to open or traditional laparoscopic surgery. The operation time and blood loss were 172.8 min and 101.1 ml, respectively. The postoperative hospital stay was 9.9 days. The jaundice was released, and the liver function was improved after the surgery. The mean survival of the patients was 9.5 months. The single-incision laparoscopic cholecystojejunostomy is safe and feasible with acceptable short-term outcomes in selected patients. The benefits still need to be evaluated in comparative study.
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Affiliation(s)
- Hong Yu
- Shengjing Hospital of China Medical University, 36 Sanhao street, Heping District, Shenyang City, 110004, China
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Scognamiglio F, Travan A, Rustighi I, Tarchi P, Palmisano S, Marsich E, Borgogna M, Donati I, de Manzini N, Paoletti S. Adhesive and sealant interfaces for general surgery applications. J Biomed Mater Res B Appl Biomater 2015; 104:626-39. [PMID: 25891348 DOI: 10.1002/jbm.b.33409] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 01/15/2015] [Accepted: 02/26/2015] [Indexed: 12/16/2022]
Abstract
The main functions of biological adhesives and sealants are to repair injured tissues, reinforce surgical wounds, or even replace common suturing techniques. In general surgery, adhesives must match several requirements taking into account clinical needs, biological effects, and material features; these requirements can be fulfilled by specific polymers. Natural or synthetic polymeric materials can be employed to generate three-dimensional networks that physically or chemically bind to the target tissues and act as hemostats, sealants, or adhesives. Among them, fibrin, gelatin, dextran, chitosan, cyanoacrylates, polyethylene glycol, and polyurethanes are the most important components of these interfaces; various aspects regarding their adhesion mechanisms, mechanical performance, and resistance to body fluids should be taken into account to choose the most suitable formulation for the target application. This review aims to describe the main adhesives and sealant materials for general surgery applications developed in the past decades and to highlight the most important aspects for the development of future formulations.
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Affiliation(s)
| | - Andrea Travan
- Department of Life Sciences, University of Trieste, Italy
| | | | - Paola Tarchi
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
| | - Silvia Palmisano
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
| | - Eleonora Marsich
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
| | | | - Ivan Donati
- Department of Life Sciences, University of Trieste, Italy
| | - Nicolò de Manzini
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
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