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Nayak K, Shinde RK, Gattani RG, Thakor T. Surgical Perspectives of Open vs. Laparoscopic Approaches to Lateral Pancreaticojejunostomy: A Comprehensive Review. Cureus 2024; 16:e51769. [PMID: 38322062 PMCID: PMC10844796 DOI: 10.7759/cureus.51769] [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: 11/23/2023] [Accepted: 01/06/2024] [Indexed: 02/08/2024] Open
Abstract
Pancreaticojejunostomy, a critical step in pancreatic surgery, has significantly evolved surgical approaches, including open, laparoscopic, and robotic techniques. This comprehensive review explores open surgery's historical success, advantages, and disadvantages, emphasizing surgeons' accrued experience and familiarity with this approach. However, heightened morbidity and prolonged recovery associated with open pancreaticojejunostomy underscore the need for a nuanced evaluation of alternatives. The advent of robotic-assisted surgery introduces a paradigm shift in pancreatic procedures. Enhanced dexterity, facilitated by wristed instruments, allows intricate suturing and precise tissue manipulation crucial in pancreatic surgery. Three-dimensional visualization augments surgeon perception, improving spatial orientation and anastomotic alignment. Moreover, the potential for a reduced learning curve may enhance accessibility, especially for surgeons transitioning from open techniques. Emerging technologies, including advanced imaging modalities and artificial intelligence, present promising avenues for refining both open and minimally invasive approaches. The ongoing pursuit of optimal outcomes mandates a judicious consideration of surgical techniques, incorporating technological advancements to navigate challenges and enhance patient care in pancreaticojejunostomy.
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Affiliation(s)
- Krushank Nayak
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Raju K Shinde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rajesh G Gattani
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Tosha Thakor
- Pathology, American International Institute of Medical Sciences, Udaipur, IND
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A Study of the Safety and Morbidity Profile of Closed versus Open Technique of Laparoscopic Primary Peritoneal Access Port in Patients Undergoing Routine Laparoscopic Cholecystectomy at a Tertiary Care Hospital in Northeastern India. Minim Invasive Surg 2022; 2022:1017551. [PMID: 35865273 PMCID: PMC9296326 DOI: 10.1155/2022/1017551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/18/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction. Laparoscopic cholecystectomy (LC) is the gold standard operation for gallstone disease. Primary port placement into the abdomen is a blind procedure and is challenging with chances of unforeseen complications. The complication rate has remained the same during the past 25 years. Both closed/Veress and open/Hasson’s techniques are commonly employed and have their typical indications for use. Materials and Methods. This prospective study was carried out in the Department of General Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, from January 2014 to January 2016, with the aim to compare the safety profile of closed/Veress and open/Hasson’s methods of access to the abdomen during laparoscopic cholecystectomy (LC). The study had 400 eligible cases undergoing LC who were randomly allotted into 2 groups with 200 cases each: group A: closed/Veress needle method and group B: open/Hasson’s method. Results. Closed/Veress and open/Hasson’s method of establishing pneumoperitoneum in laparoscopic cholecystectomy is equally safe in terms of major complications. The closed/Veress method gives faster access to the abdomen as compared to the open method (5.62 ± 2.23 minutes and 7.18 ± 2.52 minutes, respectively,
value <0.0001). The open/Hasson’s method is associated with more primary port site complications (9/200 vs. 0/200,
value 0.0036) and troublesome intraoperative gas leaks (39/200 vs. 2/200,
value <0.0001). The open technique for primary peritoneal access port for laparoscopic cholecystectomy does not impart any additional benefits in terms of safety and morbidity profile in patients undergoing LC. Conclusion. The closed/Veress method of establishing pneumoperitoneum in laparoscopic cholecystectomy is equally safe in terms of major complications and gives quicker access to the abdomen as compared to the open method.
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Merh R, Saunders M, Jenner D. The fibers of the circular junction of the linea alba in normal adult anatomy. Clin Anat 2021; 34:842-844. [PMID: 33427342 DOI: 10.1002/ca.23718] [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: 03/07/2020] [Revised: 12/28/2020] [Accepted: 01/04/2021] [Indexed: 11/11/2022]
Abstract
The linea alba (LA) is known to be useful to surgeons for making surgical incisions. Laparoscopic entry into the peritoneal cavity using the open technique may involve identification of a point just above or below the umbilicus where the peritoneum is fused to the LA. This anatomical site is found through superficial dissection to expose the junction between the umbilical stalk (US) and the LA, where distinct fibers seem to form a unique ligament-like structure in normal adult anatomy. This point, in fact, is part of a circular fibrous structure that exists almost like a ring around the remnant US. It is formed by the fusion of oblique and transverse fibers of the LA with circular fibers from proliferation of an encircling band of compact mesoderm to close a patent umbilical ring. We describe and name this anatomical landmark as junctio circularis alba or the "circular junction of the LA" as encountered in normal adult human anatomy. We believe this is crucial for describing key surgical procedures at this site to aid effective surgical training and reduce iatrogenic complications from laparoscopic port site entries.
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Affiliation(s)
- Radhika Merh
- Department of General Surgery, Queen Elizabeth the Queen Mother Hospital, Margate, Kent, United Kingdom
| | - Michael Saunders
- Department of General Surgery, Conquest Hospital, Hastings, United Kingdom
| | - Deborah Jenner
- Department of General Surgery, Conquest Hospital, Hastings, United Kingdom
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Ismaila BO, Alayande BT. A Modified Open Primary Laparoscopic Surgery Port Placement through Umbilical Tube. Niger J Surg 2019; 25:76-79. [PMID: 31007517 PMCID: PMC6452752 DOI: 10.4103/njs.njs_34_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: A safe, reliable technique for primary trocar introduction is important for laparoscopic surgery. In resource-constrained settings where there is paucity of needed equipment and cost is prohibitive, a method utilizing fewer instruments will be useful. Aim: This study aims to describe a method of primary trocar introduction that utilizes any available port. Methods: A supra- or infra-umbilical incision is made into an everted tubular umbilicus. The linear alba is incised and the resultant opening bluntly developed, after which any available port is inserted using the trocar as a guide. The trocar is withdrawn while the sleeve is pushed in. Results: One hundred and three successful insertions were affected in 107 patients with age range of 1–75 years, with no significant gas leaks. Conclusion: This modified open approach is a simple and reliable way of primary port insertion. Access is gained easily in different age groups and umbilicus types.
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Affiliation(s)
| | - Barnabas T Alayande
- Department of Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
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Tröbs RB, Vahdad MR, Cernaianu G. Transumbilical cord access (TUCA) for laparoscopy in infants and children: simple, safe and fast. Surg Today 2016; 46:235-40. [PMID: 26031233 PMCID: PMC4722059 DOI: 10.1007/s00595-015-1191-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 03/16/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE We herein report a case series evaluating the safety and complication rate of transumbilical cord access (TUCA) for pediatric laparoscopic surgery. METHODS Data were collected for 556 infants and children. Access into the abdominal cavity was gained via a transverse infraumbilical stab incision passing the fibrotic umbilical cord remnant. Ninety-two infants underwent laparoscopic pyloromyotomy (LPM), 159 female infants underwent herniorrhaphy (LHR) and 309 infants underwent appendectomy (LAP). Of the total operations, 70 % were performed by board-certified surgeons and 30 % were performed by non-board-certified surgeons. The median time of follow-up was 24 months. RESULTS No cases of acute severe bleeding or organ laceration were noted. TUCA-related complications were observed in nine patients (1.6 %). Omphalitis and persistent wound secretion were detected in eight children and foreign bodies consisting of cyanoacrylate were removed from three of these patients. Meanwhile, umbilical pain leading to surgical revision was observed in one child, and eight umbilical hernias were repaired during the TUCA procedures. No signs of postoperative incisional hernia were recorded. CONCLUSIONS TUCA is a safe and comfortable access method for pediatric laparoscopic surgery in various age groups. This method is easy to learn and can be quickly and safely performed in the vast majority of children.
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Affiliation(s)
- Ralf-Bodo Tröbs
- Department of Pediatric Surgery, Catholic Foundation Marienhospital Herne, Ruhr-University of Bochum, Widumer Str. 8, 44627, Herne, Germany.
| | - M Reza Vahdad
- Department of Pediatric and Adolescent Surgery, Klinikum Der Stadt Köln, Amsterdamer Str. 59, 50735, Cologne, Germany.
| | - Grigore Cernaianu
- Department of Pediatric Surgery, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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Malik AM, Laghari AA, Mallah Q, Hashmi F, Sheikh U, Talpur KAH. [Not Available]. J Minim Access Surg 2013; 4:5-8. [PMID: 19547669 PMCID: PMC2699055 DOI: 10.4103/0972-9941.40990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2007] [Accepted: 01/08/2008] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To deteremine the incidence, nature and management of extra-biliary complications of laparoscopic cholecystectomy. MATERIALS AND METHODS This study presents a retrospective analysis of extra-biliary complications occuring during 1046 laparoscopic cholecystectomies performed from August 2003 to December 2006. The study population included all the patients with symptomatic gallstone disease in whom laparoscopic cholecystectomy was performed. The extra-biliary complications were divided into two distinct categories: (i) Procedure related and (ii) Access related. RESULTS The incidence of access-related complications was 3.77% and that of procedure-related complications was 6.02%. Port-site bleeding was troublesome at times and demanded a re-do laparoscopy or conversion. Small bowel laceration occurred in two patients where access was achieved by closed technique. Five cases of duodenal and two of colonic perforations were the major complications encountered during dissection in the area of Calot's triangle. In 21 (2%) patients the procedure was converted to open surgery due to different complications. Biliary complications occurred in 2.6% patients in the current series. CONCLUSION Major extra-biliary complications are as frequent as the biliary complications and can be life-threatening. An early diagnosis is critical to their management.
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Affiliation(s)
- Arshad M Malik
- Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Hyderabad, Pakistan
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Sundbom M, Hedberg J, Wanhainen A, Ottosson J. Aortic injuries during laparoscopic gastric bypass for morbid obesity in Sweden 2009-2010: a nationwide survey. Surg Obes Relat Dis 2013; 10:203-7. [PMID: 24209880 DOI: 10.1016/j.soard.2013.06.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 06/03/2013] [Accepted: 06/05/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND In Sweden, bariatric surgery has increased more than tenfold in the past decade, from 700 to 8,600 procedures annually, and laparoscopic gastric bypass (LRYGB) dominates (92% of all procedures). This expansion makes safety issues crucial. The aim of this nationwide survey was to identify aortic injuries in LRYGB. METHODS All 41 centers performing LRYGB in Sweden were asked if an aortic injury had occurred during the years 2009-2010. Techniques for entering the first trocar and way of establishing pneumoperitoneum were evaluated. The total number of procedures was collected from the national quality registry, Scandinavian Obesity Surgery Registry (SOReg), and the National Patient Register. RESULTS During the study period, 11,744 LRYGBs were performed. The analysis revealed 5 aortic injuries, all occurring in patients in whom an optical trocar had been placed before establishing pneumoperitoneum. Outcomes varied from no major sequelae to bilateral lower limb amputation and death. Based on the total number of LRYGBs, the risk for an aortic injury was .043% overall and .091% when an optical trocar was used. CONCLUSION Aortic injury is a rare but serious complication in laparoscopic gastric bypass. In this survey, optical trocars constructed to reduce the risk of intraabdominal damage had been used in all 5 cases.
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Affiliation(s)
- Magnus Sundbom
- Section of Gastrointestinal Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Jakob Hedberg
- Section of Gastrointestinal Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Wanhainen
- Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Johan Ottosson
- Department of Surgery, Örebro University, Örebro, Sweden
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Safety of open technique for first-trocar placement in laparoscopic surgery: a series of 6,000 cases. Surg Endosc 2011; 26:182-8. [DOI: 10.1007/s00464-011-1852-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 06/22/2011] [Indexed: 11/25/2022]
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Open port placement through the umbilical cicatrix. Indian J Surg 2009; 71:273-5. [PMID: 23133171 DOI: 10.1007/s12262-009-0069-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2008] [Accepted: 03/23/2009] [Indexed: 10/20/2022] Open
Abstract
Peritoneal access and creation of pneumoperitoneum are the key initial steps of laparoscopic surgery. This is commonly achieved by either introducing Veress needle or by gradual dissection of all the layers of the abdominal wall and then introducing a port under direct vision. The two techniques are extremely safe, but large outcome studies have found slightly increased complications with the Veress needle. Randomized trials do not support such finding and both techniques continue to have their enthusiasts. We hereby describe an open method of initial port placement, wherein the port is introduced through the umbilical cicatrix under direct vision.
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Piccinni G, Merlicco D, Centonze A, Sciusco A, Petrozza D, Testini M, Nacchiero M. The semiopen first umbilical trocar access technique in laparoscopic surgery: easy and safe. J Laparoendosc Adv Surg Tech A 2008; 18:865-8. [PMID: 18922062 DOI: 10.1089/lap.2008.0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND First access in laparoscopy still causes trouble and a small percentage of visceral and vascular injuries. Residents and surgeons-in-training often have doubts about which technique is safer and "friendlier." Semiopen technique (SO) for the first umbilical trocar access was originally described in 2002. We report our retrospective analysis using SO that shows its safety and easiness. METHODS In the period from January 2003 to November 2007, 300 unselected patients, including obese patients (body mass index > 30) were treated with laparoscopy beginning with a periumbilical approach using SO. We usually prefer to enter the cavity with a STEP cannula stiffened by an unarmed Veress needle of 1.9 mm. There were 112 men and 188 women with ages ranging from 16 to 82 years. The procedure was performed by an expert laparoscopic surgeon in 260 cases and by residents or surgeons without expertise in laparoscopy in 40 cases. RESULTS We experienced no injuries of the viscera or vessels (0%). The mean time to enter the abdomen was 180 seconds, including obese patients. CONCLUSIONS After our limited experience with the SO, we believe that every surgeon who tries it will experience safety of the Hasson and the comfort of the Veress.
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Affiliation(s)
- Giuseppe Piccinni
- Department of Application in Surgery of Innovative Technologies, DACTI, Section of General Surgery, Università di Bari, Bari, Italy.
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Moberg AC, Petersson U, Montgomery A. An open access technique to create pneumoperitoneum in laparoscopic surgery. Scand J Surg 2007; 96:297-300. [PMID: 18265857 DOI: 10.1177/145749690709600407] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND An open access technique might reduce severe vascular and visceral injuries. An open access technique through the umbilical cicatrix tube has been developed as a routine method with the goal to be easy, safe and used by all surgeons in patients without a previous midline incision. AIM To evaluate the open technique in a prospective study in 100 consecutive laparoscopic operations regarding time for entrance, surgeons experience and BMI of the patients. METHODS A midline incision from the linea alba up into the inverted umbilicus was performed in the cicatrix tube and the peritoneum was penetrated allowing air to flow into the abdominal cavity followed by a blunt trocar insertion. RESULTS Time for access was median 93 seconds. Entrance time in patients with BMI >30 (n=18) was 100 sec and with BMI <30 it was 90 sec (p = 0.71). The median time for consultants was 88 sec and for residents 120 sec (p = 0.003). No gas leakage was seen. Prolonged time for access was seen in three patients; two equipment failures and one obese patent. CONCLUSION The open access technique is applicable in all patients without a former midline incision. It is fast, easy to learn with very few associated problems.
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Affiliation(s)
- A C Moberg
- Department of Surgery, University Hospital of Malmö, Malmö, Sweden.
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Antevil JL, Bhoyrul S, Brunson ME, Vierra MA, Swadia ND. Safe and rapid laparoscopic access--a new approach. World J Surg 2005; 29:800-3. [PMID: 15895194 DOI: 10.1007/s00268-005-7730-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite numerous recent technical advances in minimally invasive surgical technique, the potential exists for serious morbidity during initial laparoscopic access. Safe access depends on adhering to well-recognized principles of trocar insertion, knowledge of abdominal anatomy, and recognition of hazards imposed by previous surgery. Applying these principles, we describe a safe, rapid, and cost-effective technique for laparoscopic access using readily available instruments. This technique emphasizes identification and incision of the point at which the midline abdominal fascia is fused with the base of the umbilicus, and the importance of the application of countertraction directly at the point of insertion. This method allows penetration under direct vision with minimal controlled axial force, and without the requirement for fascial sutures or other cumbersome aspects of the traditional open technique. While previous reports describe techniques for laparoscopic access entry based on similar anatomic and surgical principles, we describe an alternative method not yet discussed in the surgical literature.
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Affiliation(s)
- Jared L Antevil
- Department of General Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, California 92134, USA
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