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Edwards A, Ramirez AC, Scime NV, Kim-Fine S, Brennand EA. Does size matter? Opioid use after laparoscopy for apical pelvic organ prolapse using an 8mm versus 10-12mm accessory port. J Minim Invasive Gynecol 2021; 29:528-534. [PMID: 34929399 DOI: 10.1016/j.jmig.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To determine if a change in lateral accessory port (LAP) size from 10-12mm to 8mm among women undergoing laparoscopic native tissue pelvic organ prolapse (POP) surgery was effective at reducing opioid use after surgery. DESIGN Prospective cohort of women taking part in a POP surgical registry. SETTING Tertiary academic hospital in Calgary, Canada. PATIENTS Women undergoing laparoscopic uterosacral ligament apical suspensions for stage ≥2 POP with either uterine preservation or concomitant hysterectomy. 92 women were included during a 15-month study period from June 2020 to September 2021. INTERVENTIONS Laparoscopic apical suspension using either a 10-12mm or 8mm LAP, with the change occurring at the mid-point of the study period. Fascial defects from 10-12mm ports were closed with a fascial closure device. Perioperative care and technique were otherwise unchanged. MEASUREMENTS AND MAIN RESULTS Post-operative opioid use was measured by mean morphine equivalent daily dose (MEDD), accounting for all oral and intravenous opioids used in the first 24-hours post-surgery. 50 cases (54.3%) used a 10-12mm LAP, 42 cases (45.7%) used an 8mm LAP. Mean MEDD after surgery with a 10-12mm LAP was significantly higher than with an 8mm LAP (35.3 (95% CI 24.9-45.6) vs. 13.6 (95% CI 8.0-19.2), p<0.001). Proportion of women who did not require opioids post-operatively was higher in the 8mm group (45.2%, n=19) than the 10-12mm group (18.0%, n=9) (cOR 3.76, 95% CI 1.47-9.66). Similarly, the proportion of women who did not fill an opioid prescription after discharge was higher in the 8mm group (35.7%, n=15) than the 10-12mm group (16.0%, n=8) (cOR 2.92, 95% CI 1.09-7.81). These results remained statistically significant after adjustment for age, body mass index, race/ethnicity, length of procedure, and concomitant procedures performed. CONCLUSION Compared to 10-12mm port, use of an 8mm LAP during laparoscopic native-tissue apical POP surgery is associated with decreased opioid use in the first 24 hours after surgery.
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Affiliation(s)
- Allison Edwards
- From the Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.
| | - Alison Carter Ramirez
- From the Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Natalie V Scime
- From the Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Shunaha Kim-Fine
- From the Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Erin A Brennand
- From the Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
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2
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Incidence and risk factors for trocar-site incisional hernia detected by clinical and ultrasound examination: a prospective observational study. BMC Surg 2020; 20:330. [PMID: 33317503 PMCID: PMC7737369 DOI: 10.1186/s12893-020-01000-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/03/2020] [Indexed: 01/12/2023] Open
Abstract
Background Trocar site incisional hernia (TSIH) is the most frequent complication associated with laparoscopic surgery. Few studies currently describe its incidence or risk factors. The aim of this report is to determine the real incidence of TSIH and to identify risk factors. Methods A cross-sectional prospective study was performed including consecutive patients who underwent a laparoscopic procedure during a 4 months period. All the patients were assessed both clinically (TSIHc) and by an ultrasonographic examination (TSIHu). The main variable studied was the incidence of TSIH. A multivariate analysis was performed to identify risk factors. Results 76 patients were included. 27.6% of patients were clinically diagnosed as having TSIH (TSIHc) but only 23.7% of those cases were radiologically confirmed (TSIHu). In the logistic regression analysis, age > 70 years (OR 3.462 CI 1.14–10.515, p = 0.028) and body mass index (BMI) ≥ 30 kg/m2 (OR 3.313 CI 1.037–10.588, p = 0.043) were identified as risk factors for TSIH. The size of the trocar also showed statistically significant differences (p < 0.001). Mean follow-up time was 34 months. Conclusions TSIH is under-diagnosed due to the lack of related symptomatology and the inadequacy of the postoperative follow-up period. We detected discrepancies between the clinical and ultrasonographic examinations. TSIHu should be considered as the gold standard for the diagnosis of TSIH. Risk factors such as age, BMI and size of the trocar were confirmed. Patients should be followed-up for a minimum of 2 years. Trial registration The study has been retrospectively registered in Clinicaltrials.gov on June 4, 2020 under registration number: NCT04410744
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Chongxi R, Hongqiao W, Fengying L, Xin W, Hongxia Q, Lijun X. Single-incision approach for bilateral inguinal hernia repair in children: A retrospective study. Medicine (Baltimore) 2020; 99:e19376. [PMID: 32118783 PMCID: PMC7478388 DOI: 10.1097/md.0000000000019376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 01/12/2020] [Accepted: 01/29/2020] [Indexed: 11/25/2022] Open
Abstract
To introduce the use of a new surgical approach named single-incision bilateral inguinal herniorrhaphy (SBIH) in pediatric surgical population.This was a STROBE-compliant retrospective cohort study using data from 101 patients who had undergone bilateral inguinal herniorrhaphy in our institution. Children with bilateral inguinal hernias without contraindications for surgery, ranging in age from 6 months to 12 years, were included. Fifty-six children with bilateral inguinal hernias underwent SBIH (SBIH group) and 45 patients underwent laparoscopic bilateral inguinal herniorrhaphy (LBIH) (LBIH group). Differences in operative time, postoperative pain, recurrence, and complications between the 2 groups were analyzed. Patient satisfaction with cosmetic result was also investigated using questionnaires.There were no statistically significant differences in operative time (P = .2257), postoperative pain (P = .0607), recurrence (P = .8756), and complications (P = .7467) between the 2 groups. Interestingly, the operation time of girls in SBIH group was significantly shorter than that of the boys in this group (P < .0001), but also shorter than that of girls in LBIH group (P = .0038). Postoperative pain for boys was lower in SBIH group than in the LBIH group (P = .0340). No ascending testis, testicular atrophy, and hydrocele occurred in either group. According to the questionnaire, both procedures had equally high levels of satisfaction for cosmetic results (P = .7531).Initial results show that SBIH for pediatric patients, regardless of gender, is a safe and feasible procedure compared with LBIH with an equally low recurrence rate, few complication, and satisfactory cosmetic outcomes.
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4
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Kim JS, Park EY, Park DJ, Kim GY. Modified Book Binding Technique (MBBT) for Intracorporeal Gastroduodenostomy in Totally Laparoscopic Distal Gastrectomy: Initial Experience. J Gastric Cancer 2019; 19:355-364. [PMID: 31598377 PMCID: PMC6769362 DOI: 10.5230/jgc.2019.19.e30] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 08/06/2019] [Accepted: 08/18/2019] [Indexed: 12/16/2022] Open
Abstract
Totally laparoscopic distal gastrectomy (TLDG) frequently involves the use of delta shaped gastroduodenostomy (DSG) for intracorporeal anastomosis. However, DSG has some drawbacks, and the book binding technique (BBT) was developed as a new technique to overcome these drawbacks. Subsequently, this technique was further improved with the development of modified book binding technique (MBBT). This study evaluated the safety and feasibility of MBBT in patients undergoing TLDG. Thirty-three patients who underwent TLDG with MBBT were retrospectively evaluated. The mean operation time was 277.6±37.1 minutes, including 51.9±15.7 minutes for reconstruction. Two patients had anastomosis-related complications, one patient with stricture after leakage and 1 patient with stenosis. The former patient was treated with endoscopic balloon dilatation, and the latter was managed conservatively; neither required re-operation. MBBT is a safe and feasible technique, with acceptable surgical outcomes. It may be a good alternative option for the treatment of intracorporeal anastomosis in patients undergoing TLDG.
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Affiliation(s)
- Jin Sung Kim
- Department of Surgery, Ulsan University Hospital, Ulsan, Korea
| | - Eun Young Park
- Department of Surgery, Ulsan University Hospital, Ulsan, Korea
| | - Dong Jin Park
- Department of Surgery, Ulsan University Hospital, Ulsan, Korea.,Department of Surgery, University of Ulsan College of Medicine, Ulsan, Korea
| | - Gyu Yeol Kim
- Department of Surgery, Ulsan University Hospital, Ulsan, Korea.,Department of Surgery, University of Ulsan College of Medicine, Ulsan, Korea
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5
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Zattoni D, Popeskou GS, Christoforidis D. Left colon resection with transrectal specimen extraction: current status. Tech Coloproctol 2018; 22:411-423. [PMID: 29948523 DOI: 10.1007/s10151-018-1806-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/25/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Full laparoscopic left colectomy with transrectal specimen extraction is proposed as an improvement of the minimally invasive surgical technique. This paper reviews in detail the current status of left-sided colectomy and upper rectum resection with transrectal specimen extraction. METHODS A systematic review was performed of all types of publications on colorectal resection with natural orifice specimen extraction (NOSE). We only included studies reporting on left colectomy, sigmoidectomy, and high anterior resection with transrectal specimen extraction (TRSE), excluding transanal (TASE), transvaginal, or transcolonic specimen extraction. Surgical techniques, patient characteristics, and outcomes were reviewed in detail. RESULTS Thirty-five papers reported on TRSE (2 randomized clinical trials, 7 case-matched series, 19 case series, 5 case reports, and 2 articles on surgical technique). We found a wide variety of innovative anastomotic and specimen extraction techniques. After excluding duplicates and papers reporting mixed TRSE and TASE results, outcomes in patients undergoing TRSE from 23 publications showed a conversion rate to conventional laparoscopy of 3.7% (21/559), overall morbidity 9.5% (53/559) [major in 2.9% (16/559), intra-abdominal infection in 2.1% (12/559)]. No mortality was reported. Postoperative anal incontinence was rarely reported. Several studies showed a decrease in postoperative pain and some in length of hospital stay. CONCLUSIONS Colectomy with TRSE is feasible and seems safe in selected patients. Reported outcomes seem in general similar to conventional laparoscopic colectomy with a possible benefit in postoperative pain and length of hospital stay. Obvious selection bias and lack of high quality trials do not allow firm conclusions to be drawn.
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Affiliation(s)
- D Zattoni
- Department of General Surgery, Ospedale per gli Infermi di Faenza, 48018, Faenza, Italy.
| | - G S Popeskou
- Department of General Surgery, Queen Elisabeth University Hospital, Birmingham, UK
| | - D Christoforidis
- Department of General Surgery, Ospedale Civico di Lugano, 6900, Lugano, Switzerland
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6
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Husain FA, Hollis HW, Pottorf BJ, Rogers JL, Golembeski SM, Johnson JM. The Effect of Transoral Gastric Remnant Extraction on Prescription Opioid Refills and Surgical Site Infections in Patients Undergoing Sleeve Gastrectomy. Bariatr Surg Pract Patient Care 2018. [DOI: 10.1089/bari.2017.0051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Farah A. Husain
- Department of Metabolic-Surgical Weight Management, Colorado Permanente Medical Group, Denver, Colorado
- Department of Surgery, Bariatric Surgery Oregon Health and Science University, Portland, Oregon
| | - Harris W. Hollis
- Department of Graduate Medical Education General Surgery, Saint Joseph Hospital, Denver, Colorado
- Department of Vascular Therapy, Colorado Permanente Medical Group, Denver, Colorado
| | - Brian J. Pottorf
- Attending General Surgeon, Longmont United Hospital, Longmont, Colorado
| | | | - Scott M. Golembeski
- Attending General Surgeon, Rocky Mountain Surgical Associates Denver, Colorado
| | - Jason M. Johnson
- Department of Graduate Medical Education General Surgery, Saint Joseph Hospital, Denver, Colorado
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Popeskou SG, Panteleimonitis S, Christoforidis D, Figueiredo N, Parvaiz A. Port Placement for Laparoscopic Colonic Resections - Video Vignette. Colorectal Dis 2017; 20:259-261. [PMID: 29178273 DOI: 10.1111/codi.13974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 11/09/2017] [Indexed: 02/08/2023]
Abstract
Laparoscopic colonic resections often require manipulation and surgical action in all abdominal quadrants. Port placement, a fundamental part of a successful procedure, often varies widely among surgeons and is currently dictated by individual experience and preference. This variability may be suboptimal for the operation at hand, can be confusing for trainees and many times provide inadequate working posture for the surgeons, resulting in discomfort due to muscular fatigue in the hands, arms, shoulders and cervical spine. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- S-G Popeskou
- Department of Surgery, Poole Hospital NHS Foundation Trust, Poole, UK
| | - S Panteleimonitis
- Department of Surgery, Poole Hospital NHS Foundation Trust, Poole, UK
| | - D Christoforidis
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, BH 15 Bugnon 46, Lausanne, 1011, Switzerland
| | - N Figueiredo
- Department of Colorectal Surgery, Fundacao, Champalimaud, Lisbon, Portugal
| | - A Parvaiz
- Minimally Invasive Colorectal Unit (MICU)Department of Surgery, Queen Alexandra Hospital, Portsmouth, UK
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8
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Lyapis A, Ulrich A, LaMonica R, Kuo CL, Kaye L, Luciano D. Does the Difference in Fascial Closure Technique Affect Postoperative Pain? J Minim Invasive Gynecol 2017; 24:1190-1194. [PMID: 28757438 DOI: 10.1016/j.jmig.2017.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/06/2017] [Accepted: 07/23/2017] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE To compare postoperative incisional pain on postoperative days (PODs) 1 and 14 when using a fascial closure device (FCD) versus a traditional fascial closure (TFC) of the 12-mm upper quadrant port during robotic surgery. Time required to close the incision was also compared. DESIGN Randomized controlled trial (Canadian Task Force classification I). SETTING Two academic affiliated hospitals, The Hospital of Central Connecticut and The University of Connecticut. PATIENTS Women undergoing robotic surgery for benign indications by minimally invasive gynecologists at our institutions between November 2012 and October 2014 were enrolled in the study at their preoperative visit. INTERVENTIONS Patients were randomized to either an FCD or TFC immediately before closure of the fascial incision. Pain score using a 10-point analog pain scale was recorded on POD 1 and POD 14. Time to close the fascial incision, length of surgery, and body mass index were also recorded. MEASUREMENTS AND MAIN RESULTS Sixty-seven patients were enrolled, and 65 were randomized at the time of the fascial closure, whereas 2 enrolled patients converted to laparotomy. Statistical analysis demonstrated that pain scores differed by fascial closure technique. Mean pain scores on POD 1 were 3.43 ± 2.48 and 2.06 ± 2.03 for the FCD and TFC, respectively (p = .028). On POD 14 the mean pain scores were 1.97 ± 2.48 and .83 ± 1.42 for the FCD and TFC, respectively (p = .102). Times to close fascia were 106.5 ± 102.28 seconds and 141.97 ± 102.85 seconds for the FCD and TFC, respectively (p = .138). CONCLUSION Our study demonstrates that at POD 1 the use of the fascia closure device results in higher pain scores without a significant difference in closure time.
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Affiliation(s)
- Anna Lyapis
- Obstetrics & Gynecology, Fremont, California
| | - Amanda Ulrich
- Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut.
| | - Rachel LaMonica
- Women's Health CT, Progressive Women's Health, Farmington, Connecticut
| | | | - Leah Kaye
- Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut
| | - Danielle Luciano
- Department of Obstetrics and Gynecology, University of Connecticut, Farmington, Connecticut
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9
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Amano H, Tanaka Y, Kawashima H, Deie K, Fujiogi M, Suzuki K, Morita K, Iwanaka T, Uchida H. Comparison of single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) and open repair for pediatric inguinal hernia: a single-center retrospective cohort study of 2028 cases. Surg Endosc 2017; 31:4988-4995. [PMID: 28597284 PMCID: PMC5715036 DOI: 10.1007/s00464-017-5472-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 02/15/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUD Recently, laparoscopic percutaneous extraperitoneal closure (LPEC) has gained increased popularity for pediatric inguinal hernia repair. To improve cosmesis, we developed single incision LPEC (SILPEC). The aim of this study was to assess the safety and feasibility of SILPEC compared with traditional open repair (OR). METHODS This was a single-center retrospective cohort study of 2028 children who underwent inguinal hernia repair between April 2005 and August 2014. Nine hundred and ninety-five patients underwent OR and 1033 patients underwent SILPEC. Medical records were reviewed with respect to operative time, recurrence, incidence of contralateral metachronous inguinal hernia (CMIH), and complications. Patient satisfaction with cosmetic result was also investigated using questionnaires sent by mail. RESULTS All SILPEC procedures were completed without conversion. Operative time was longer in the SILPEC group than in the OR group for both unilateral and bilateral surgery regardless of sex (unilateral male: p = 0.0006, unilateral female: p < 0.0001, bilateral male: p < 0.0001, bilateral female: p < 0.0001). There was no statistically significant difference in recurrence rate (p = 0.43). The incidence of CMIH was significantly higher in the OR than in the SILPEC group (p < 0.0001). No postoperative testicular atrophy was found in either group. There was no statistically significant difference in ascending testis (p = 0.09), but the frequency of surgical site infection was higher in the SILPEC than in the OR group (p = 0.0013). According to the questionnaire, operative scar was more invisible in the SILPEC than in the OR group (p < 0.0001), but both procedures had equally high levels of satisfaction for cosmetic results (p = 0.58). CONCLUSION SILPEC proved to be a safe and feasible procedure compared with OR with an equally low recurrence rate, more effectiveness for preventing CMIH, and more invisible scar.
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Affiliation(s)
- Hizuru Amano
- Department of Pediatric Surgery, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama-city, Saitama, 330-8777, Japan.,Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yujiro Tanaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan
| | - Hiroshi Kawashima
- Department of Pediatric Surgery, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama-city, Saitama, 330-8777, Japan
| | - Kyoichi Deie
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Michimasa Fujiogi
- Department of Pediatric Surgery, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama-city, Saitama, 330-8777, Japan
| | - Keisuke Suzuki
- Department of Pediatric Surgery, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama-city, Saitama, 330-8777, Japan
| | - Kaori Morita
- Department of Pediatric Surgery, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama-city, Saitama, 330-8777, Japan
| | - Tadashi Iwanaka
- Department of Pediatric Surgery, Saitama Children's Medical Center, 1-2, Shintoshin, Chuo-ku, Saitama-city, Saitama, 330-8777, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan.
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10
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Wang Q, Huang L, Zeng W, Chen L, Zhao X. Assessment of Port-Specific Pain After Gynecological Laparoscopy: A Prospective Cohort Clinical Trial. J Laparoendosc Adv Surg Tech A 2017; 27:597-604. [PMID: 27935740 DOI: 10.1089/lap.2016.0340] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Qianqian Wang
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Lu Huang
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Wenjie Zeng
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Lifeng Chen
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Xiaofeng Zhao
- Department of Gynecology, Zhejiang Provincial People's Hospital, Hangzhou, China
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11
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Balaphas A, Buchs NC, Naiken SP, Hagen ME, Zawodnik A, Jung MK, Varnay G, Bühler LH, Morel P. Incisional hernia after robotic single-site cholecystectomy: a pilot study. Hernia 2017; 21:697-703. [PMID: 28488073 DOI: 10.1007/s10029-017-1621-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/01/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE Robotic LaparoEndoscopic Single-Site Surgery Cholecystectomy has been performed for 5 years using a dedicated platform (da Vinci® Single-Site®) with the da Vinci® Surgical System (Intuitive Surgical Inc., Sunnyvale, CA, USA). While short-term feasibility has been described, long-term assessment of this method is currently outstanding. The aim of this study was to assess long-term parietal complications of this technique. METHODS In this retrospective study, patients operated between 2011 and 2013 were evaluated. Parietal incision was assessed with ultrasonography and patients screened for residual pain from scar tissue. Demographic and perioperative data were also collected. RESULTS We evaluated 48 patients [38 female, 79.2%; median age 49 years (range: 24-81 years)]; mean BMI 25.9 kg/m2 [±SD 4.1 kg/m2]. After a median follow-up of 39 months (range: 25-46 months), six incisional hernias (two patients had a positive echography but a negative clinical examination) were found (12.5%, 95% CI 7.5-30.2), and two patients had a surgical repair. The overall rate of incisional hernia was 16.7% (95% CI 7.5-30.2). Residual pain was observed in 5 of 48 patients. CONCLUSION This preliminary study suggests that a clinically significant rate of incisional hernias can occur after R-LESS-C. Larger studies comparing R-LESS-C to alternative methods with long-term follow-up are necessary.
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Affiliation(s)
- A Balaphas
- Division of Digestive and Transplantation Surgery, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland.
| | - N C Buchs
- Division of Digestive and Transplantation Surgery, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - S P Naiken
- Division of Digestive and Transplantation Surgery, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - M E Hagen
- Division of Digestive and Transplantation Surgery, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - A Zawodnik
- Division of Digestive and Transplantation Surgery, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - M K Jung
- Division of Digestive and Transplantation Surgery, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - G Varnay
- Division of Radiology, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - L H Bühler
- Division of Digestive and Transplantation Surgery, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - P Morel
- Division of Digestive and Transplantation Surgery, University Hospitals Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
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12
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Amano H, Uchida H, Kawashima H, Deie K, Murase N, Makita S, Yokota K, Tanaka Y. The umbilical Benz incision for reduced port surgery in pediatric patients. JSLS 2016; 19:e2014.00238. [PMID: 25848185 PMCID: PMC4376218 DOI: 10.4293/jsls.2014.00238] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: For reduced port surgery in pediatric patients, the initial umbilical incision plays an important role in both functional ability and cosmetic impact. Larger umbilical incisions enable better manipulation of forceps, extraction of larger surgical specimens, and easier exteriorization of the intestine for anastomosis. We have pursued an incision of the small pediatric umbilicus that allows for enlargement of the orifice of the abdominal opening with preservation of the natural umbilical profile. This article aims to present a new umbilical incision technique and describe the outcomes. Methods: We devised a new umbilical incision technique for reduced port surgery in pediatric patients. Our incision is made in an inverted Y shape (Benz incision), allowing for access port device insertion. The Benz incision technique was applied between November 2010 and May 2014 and was retrospectively studied. Results: Seventy-five patients underwent Benz incisions. The median age of all patients was 6 years 6 months (range, 26 days to 18 years), and the median body weight was 21.7 kg (range, 3.1–54.3 kg). Benz incisions were applied for various procedures, including reduced port surgery with hepaticojejunostomy for congenital biliary dilatation, portojejunostomy for biliary atresia, Meckel diverticulectomy, tumor resection, varicocelectomy, cholecystectomy, splenectomy, ileus surgery, ileocecal resection, and total colectomy. All patients were successfully treated, without a significant increase in operating time or severe complications. The cosmetic profile of the umbilicus was maintained after surgery. Conclusion: The Benz incision is a feasible, effective, and scarless approach for reduced port surgery in pediatric patients whose umbilical rings are too small for the conventional approach.
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Affiliation(s)
- Hizuru Amano
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Kawashima
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kyoichi Deie
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Naruhiko Murase
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuki Yokota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yujiro Tanaka
- Department of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
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Multi-institutional Experience in Laparoendoscopic Single-site Surgery (LESS): For Major Extirpative and Reconstructive Procedures in Pediatric Urology. Urology 2016; 88:173-8. [DOI: 10.1016/j.urology.2015.11.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 12/19/2022]
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