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Gaia G, Sighinolfi MC, Rocco B, Cannoletta M, Sampogna V, Lamarca A, Alboni C. Learning curve of optical trocar access during laparoscopic pelvic surgery: A prospective study. Actas Urol Esp 2023; 47:675-680. [PMID: 37442225 DOI: 10.1016/j.acuroe.2023.07.002] [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: 02/06/2023] [Revised: 05/27/2023] [Accepted: 05/31/2023] [Indexed: 07/15/2023]
Abstract
INTRODUCTION The optical trocar access (OTA) is a modified closed technique that aims to minimize the risk of vascular or bowel injuries while reducing the likelihood of gas leakage. A learning curve (LC) effect for OTA has been invoked with n = 30 procedures being considered as a threshold to define expertise. We aim to evaluate the impact of the LC within the first thirty cases of OTA performed by a trainee. METHODS This is a prospective randomized study on 60 patients elected to laparoscopic gynecological surgery. Patients were randomized to have OTA insertion by a junior surgeon or by an expert. LC was evaluated by: 1) insertion time; number of: 2) corrections by the senior; 3) times the tip of the trocar stopped in the preperitoneal layer; 4) mistakes of skin incision; 5) times the tip of the trocar ends under the omentum; 6) complications. To analyze the LC within the first 30 cases, procedures were stratified in 3 groups (cases 1-10; 11-20; 21-30) for both trainee and expert and LC variables were compared. RESULTS Overall, mean OTA insertion time was 56 s. No major intra- and post-operative complications were recorded. Mean insertion time was statistically significantly longer for the trainee compared to the expert within the first 10 cases (91 vs 33 s respectively, P = .01). For cases 11-20 and 21-30, time advantage of the senior surgeon is less evident (P = .05). The number of times the tip of the trocar stopped in the preperitoneal layer was similar between groups, as well as times the tip of the trocar ends under the omentum. CONCLUSIONS OTA is a fast and simple way to achieve the pneumoperitoneum and first trocar insertion as a single step. The current series confirms the effectiveness of the technique since the beginning of the LC.
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Affiliation(s)
- G Gaia
- Servicio de Obstetricia y Ginecología, ASST Santi Paolo e Carlo, Italy
| | | | - B Rocco
- Servicio de Urología, ASST Santi Paolo e Carlo, Italy
| | - M Cannoletta
- Departamento de Obstetricia y Ginecología, Universidad de Módena y Reggio Emilia, Italy
| | - V Sampogna
- Departamento de Obstetricia y Ginecología, Universidad de Módena y Reggio Emilia, Italy
| | - A Lamarca
- Departamento de Obstetricia y Ginecología, Universidad de Módena y Reggio Emilia, Italy
| | - C Alboni
- Departamento de Obstetricia y Ginecología, Universidad de Módena y Reggio Emilia, Italy
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Miti C, Busuulwa P, Scott R, Bloomfield-Gadelha H. Primary entry trocar design and entry-related complications at laparoscopy in obese patients: meta-analysis. BJS Open 2023; 7:zrad047. [PMID: 37352873 PMCID: PMC10289830 DOI: 10.1093/bjsopen/zrad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/07/2023] [Accepted: 03/19/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Safe primary entry at laparoscopy could present challenges in obese patients. Various techniques have been proposed in previous studies, however, the characteristics of the actual device utilized may be more influential than the technique in achieving successful abdominal entry in patients with increased BMI. METHODS This systematic review and meta-analysis included both randomized and non-randomized studies gathered with no date filters from MEDLINE, Embase, Scopus, Web of Science and Clinicaltrials.gov. PRISMA guidelines underpinned the conduct and reporting of the review. The meta-analysis of proportions was conducted using a generalized linear mixed model and analyses included random-effects models. The primary outcome was the proportion of first access vascular and visceral injuries incurred in the process of laparoscopic abdominal surgery in patients with a BMI >30 kg/m2. Subgroup analysis was performed for optical versus non-optically enabled devices. RESULTS In total, 5403 patients were analysed across 13 observational studies with a mean BMI of 45.93 kg/m2. In 216 patients from two randomized studies, the mean BMI was 39.92 kg/m2. The overall incidence using a random-effects model was 8.1 per 1000 events of visceral and vascular injuries (95 per cent c.i. 0.003 to 0.024). Heterogeneity was statistically significant at I2 = 80.5 per cent (69.6 per cent; 87.5 per cent, P< 0.0001). In a subgroup analysis, a tendency towards reduced injuries when optical devices were employed was observed with one per 100 injuries in these trocars (95 per cent c.i. 0.001 to 0.018) versus four per 100 (95 per cent c.i. -0.019 to -0.102) in non-optically enabled devices. CONCLUSION Injuries during primary laparoscopic entry undertaken in obese patient groups are uncommon. Due to considerable heterogeneity in the small number of examined studies, evidence was insufficient and largely of low quality to ascribe differences in the incidence of injuries to the characteristics of the primary entry trocar utilized.
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Affiliation(s)
- Chimwemwe Miti
- Department of Electrical and Electronic Engineering, EPSRC Centre for Doctoral Training in Digital Health and Care, University of Bristol, Bristol, UK
| | - Paula Busuulwa
- Department of Academic Obstetrics & Gynaecology, Liverpool Women’s Hospital, Liverpool, UK
| | - Richard Scott
- Department of Engineering Mathematics and Bristol Robotics Laboratory, University of Bristol, Bristol, UK
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Amiki M, Ishiyama Y, Harada T, Mochizuki I, Tomizawa Y, Ito S, Oneyama M, Hara Y, Narita K, Tachimori Y, Goto M, Sekikawa K, Kuba M. Initial entry via the left upper quadrant with an optical trocar in laparoscopic bariatric surgery. Asian J Endosc Surg 2022; 15:463-466. [PMID: 34994085 DOI: 10.1111/ases.13019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/24/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Laparoscopic bariatric surgery (BS) is not readily performed in Japan. To facilitate safe initial access to the abdominal cavity, we insert an optical viewing trocar at a unique site in the left upper quadrant (LUQ). Herein, we describe the technique, its advantages, and outcomes. MATERIALS AND SURGICAL TECHNIQUE Briefly, the optical trocar is inserted just below the left subcostal margin, 8 cm from the midline. On insertion, layers of the abdominal wall are visualized on the monitor. Depending on the angle of insertion, five, seven, or eight layers are seen. DISCUSSION In assessing our initial entry technique, used in 21 obese patients undergoing laparoscopic sleeve gastrectomy, we found median insertion time to be 25 seconds. There were no related complications. In nearly all (20/21) patients, the abdominal wall was visualized as seven layers: subcutaneous fat, anterior rectus sheath, rectus abdominis muscle, posterior rectus sheath, transverse abdominis muscle, transversalis fascia, and peritoneum. Understanding the layers of the abdominal wall visualized during optical trocar insertion in the LUQ will provide for safe and rapid initial entry in patients undergoing laparoscopic BS and can further the widespread acceptance of laparoscopic BS.
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Affiliation(s)
| | | | | | | | | | - Shingo Ito
- Kawasaki Saiwai Hospital, Kawasaki City, Japan
| | | | | | | | | | - Manabu Goto
- Kawasaki Saiwai Hospital, Kawasaki City, Japan
| | | | - Motoko Kuba
- AOI Universal Hospital, Kawasaki City, Japan
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The use of optical trocars in abdominal entry among patients with obesity - A case series. Ann Med Surg (Lond) 2021; 69:102698. [PMID: 34484719 PMCID: PMC8390951 DOI: 10.1016/j.amsu.2021.102698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/05/2021] [Accepted: 08/07/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Bariatric and metabolic procedures are becoming more common worldwide and laparoscopic surgery is the primary method to perform these operations. Accessing the peritoneum remains a challenge in obese patients and this study aims to assess the safety of optical trocars in bariatric surgery. Methods A retrospective study was conducted on all patients that have undergone bariatric surgery in our center between the years of 2017–2019 to examine the method by which pneumoperitoneum was established. We studied the incidence and type of complications associated with creating pneumoperitoneum in obese patients, along with the rates of converting to an open procedure. Results A total of 821 patients underwent bariatric surgery in our center over the 3 year period. They had an average age of 34.2 years (range = 13–65) with an average BMI of 45.9 kg/m2. Optical trocars successfully established pneumoperitoneum in all these patients. Complications attributed to optical trocar entry were encountered in 8 patients (0.97%), 3 males and 5 females. The average BMI of these 8 patients is 52.7 kg/m2, 4 of which had a BMI >50 kg/m2. The complications encountered included 3 liver lacerations, 4 mesenteric injuries and 1 omental vessel laceration. Four injuries were caused by 12 mm optical trocars while the other 4 injuries were caused by 5 mm optical trocars. These complications were managed laparoscopically and no patients had to be converted to a laparotomy. Conclusion The use of non-bladed, optical trocar entry into the abdomen can be considered a safe method in the establishment of pneumoperitoneum in patients with obesity. However, more studies are required randomizing the use of optical trocars to the open Hasson technique in order to further validate this method. The establishment of pneumoperitoneum is a challenge in patients with obesity. Optical trocars are thought to facilitate abdominal entry amongst obese patients. The use of optical trocars in the establishment of pneumoperitoneum carries a low complication rate. None of the noted complications caused any mortality with no patients requiring conversion to open surgery. Use of non bladed optical trocars for abdominal entry is a safe method in the establishment of pneumoperitoneum.
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Shimbo M, Endo F, Tominaga K, Sano M, Nishino T, Kyono Y, Komatsu K, Ohyama T, Sakurai M, Narimoto K, Matsushita K, Hattori K. Optimizing first trocar access for robot-assisted radical prostatectomy: Optical trocar access through the upper abdominal quadrant using the Kii Fios First Entry trocar. Asian J Endosc Surg 2021; 14:443-450. [PMID: 33145955 DOI: 10.1111/ases.12889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/01/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES A pre-equipped metal trocar is required to use as a camera trocar due to a specification change in the da Vinci X/Xi system (Intuitive Surgical). We observed slight slippage of a trocar placed by the open method. With optical trocar access (OTA), the initial trocar is viewed directly with a laparoscope during placement. Reports regarding OTA for robotic surgery are limited, particularly for robot-assisted radical prostatectomy (RARP). We modified the OTA procedure such that it was appropriate for RARP. PATIENTS AND METHODS A total of 158 patients were enrolled in this study. The first trocar placement time (FTPT) was compared between the open and OTA groups. In the OTA group, the trocar was mainly placed through the upper abdominal quadrant. We also analyzed the differences between the conventional and modified OTA procedures using the Kii Fios First Entry trocar (Applied Medical). We examined the factors affecting the FTPT using linear regression models. A P value <.05 was considered significant. RESULTS The FTPT was significantly shorter in the OTA group than the open group (P < .0001). The modified method was associated with a shorter FTPT (P = .0001). None of the patient characteristics affected the FTPT in either group. No major complications were observed. CONCLUSIONS OTA was applied successfully during RARP. Use of the Kii Fios First Entry trocar with upper abdominal quadrant placement was suitable for RARP.
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Affiliation(s)
- Masaki Shimbo
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Fumiyasu Endo
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Koki Tominaga
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Masayuki Sano
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Takato Nishino
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Yoko Kyono
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Kenji Komatsu
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Takehiro Ohyama
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Masato Sakurai
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Kazutaka Narimoto
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | | | - Kazunori Hattori
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
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Tanaka C, Fujiwara M, Kanda M, Murotani K, Iwata N, Hayashi M, Kobayashi D, Yamada S, Kodera Y. Optical trocar access for initial trocar placement in laparoscopic gastrointestinal surgery: A propensity score-matching analysis. Asian J Endosc Surg 2019; 12:37-42. [PMID: 29673123 DOI: 10.1111/ases.12484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 02/07/2018] [Accepted: 02/22/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Optical trocar access is a technique to place the initial trocar in laparoscopic surgery. With optical trocar access, each tissue layer can be visualized before insertion, which can help prevent organ injury, and air leaks at the trocar site can be minimized even in obese patients. The aim of this study was to compare the time needed for trocar insertion using optical trocar access and an open method in patients who underwent laparoscopic gastrointestinal surgery. METHODS We reviewed our prospectively collected database and identified 384 patients who underwent laparoscopic gastrointestinal surgery involving initial trocar insertion near the umbilicus by either the optical trocar access or the open method. Before the two methods were compared, propensity score matching was used to adjust for essential variables between the optical trocar access and open groups. RESULTS Patients categorized in the optical trocar access and open groups were matched one-to-one by propensity score matching, and 137 pairs of patients were generated. The time needed for trocar insertion was significantly shorter in the optical trocar access group than in the open group (36.6 vs 209.8 s, P < 0.01). The multivariable analysis identified an inexperienced surgeon as the only independent risk factor for prolonged time for initial trocar insertion using the optical trocar access. CONCLUSIONS This study indicated that optical trocar access may be recommended for inserting the initial trocar in laparoscopic gastrointestinal surgery.
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Affiliation(s)
- Chie Tanaka
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michitaka Fujiwara
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenta Murotani
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Iwata
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masamichi Hayashi
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Daisuke Kobayashi
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Suguru Yamada
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Sun J, Kotaro T. Design of a Handheld Trocar Insertion Device for Laparoscopic Surgery to Avoid Overshooting. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:1841-1844. [PMID: 30440754 DOI: 10.1109/embc.2018.8512667] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Overshooting trocar insertion in Iaparoscopic surgery has been extensively cited as a major cause of surgical injury. The complexity and extensive insertion force required of the current handheld insertion method increases the risk of overshooting and is difficult for novice and female operators. Hence, we developed a trocar insertion device to make the procedure easier and safer. The device is designed so it is easy to handle and assemble. It used negative pressure and pneumatic cylinders to lift the abdominal wall and two motors to drive the trocar insertion. In addition, we interpreted the characteristics of the insertion force and developed an algorithm to detect whether the trocar is properly inserted. By monitoring changes in the insertion force with this device, the trocar insertion can be stopped automatically and immediately. The development of this device has realized the automation of trocar insertion. It reduces the demand on operators and improves the safety of the procedure.
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SUN JUNPENG, TADANO KOTARO. FORCE CHARACTERISTICS AND EFFECTIVE STOPPING UPON THE ABDOMINAL WALL IS PENETRATED OUT BY TROCAR DURING LAPAROSCOPIC SURGERY. J MECH MED BIOL 2018. [DOI: 10.1142/s0219519418500252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Overshooting during trocar insertion may injury patient viscera and arteries or even lead to death. It has been extensively cited as a kind of common medical negligence. Hence, this paper investigated the force characteristics during a trocar inserted into the abdominal wall and developed strategies for effective stopping upon the trocar penetrated out of the abdominal wall. First, an experimental platform with two degrees of freedom was assembled. Second, two insertion methods were compared and the insertion forces using three types of trocars were measured respectively. Subsequently, we interpreted the force characteristics in terms of insertion principle and the abdominal structure. And based on the force characteristics, we generated two algorithms for the two insertion methods, which can be utilized to stop inserting effectively upon the trocar penetrated out of the abdominal wall. Finally, we evaluated the merits and demerits of the two algorithms. This paper proposed the interpretation of force characteristics during trocar insertion and achieved effective stopping to avoid overshooting. It provides foundations for the development of automatic trocar insertion device in the future.
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Affiliation(s)
- JUNPENG SUN
- Department of Mechanical Engineering, Tokyo Institute of Technology, 4259 Nagatsuta-cho, Midori-ku, Yokohama, Kanagawa 226-8503, Japan
| | - KOTARO TADANO
- Department of Mechanical Engineering, Tokyo Institute of Technology, 4259 Nagatsuta-cho, Midori-ku, Yokohama, Kanagawa 226-8503, Japan
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Cisano C, Sapienza P, Crocetti D, de Toma G. Z-entry technique reduces the risk of trocar-site hernias in obese patients. Ann R Coll Surg Engl 2016; 98:340-1. [PMID: 27087329 DOI: 10.1308/rcsann.2016.0114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- C Cisano
- "Sapienza" University of Rome , Rome , Italy
| | - P Sapienza
- "Sapienza" University of Rome , Rome , Italy
| | - D Crocetti
- "Sapienza" University of Rome , Rome , Italy
| | - G de Toma
- "Sapienza" University of Rome , Rome , Italy
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Djokovic D, Gupta J, Thomas V, Maher P, Ternamian A, Vilos G, Loddo A, Reich H, Downes E, Rachman IA, Clevin L, Abrao MS, Keckstein G, Stark M, van Herendael B. Principles of safe laparoscopic entry. Eur J Obstet Gynecol Reprod Biol 2016; 201:179-88. [DOI: 10.1016/j.ejogrb.2016.03.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Affiliation(s)
- S Arnaudov
- Basingstoke and North Hampshire Hospital , Basingstoke , UK
| | - A B Cresswell
- Basingstoke and North Hampshire Hospital , Basingstoke , UK
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Alkatout I, Mettler L, Maass N, Noé GK, Elessawy M. Abdominal anatomy in the context of port placement and trocars. J Turk Ger Gynecol Assoc 2015; 16:241-51. [PMID: 26692776 DOI: 10.5152/jtgga.2015.0148] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/12/2015] [Indexed: 11/22/2022] Open
Abstract
Although the anatomy of the human being has not changed, technical developments in operating materials and methods demand a simultaneous development in operative management. Developments in electronic and optical technologies permit many gynecological operations to be performed laparoscopically. One fundamental distinction between any other operating method and laparoscopy is the hurdle that the initial entry, whether with a needle, cannula, or trocar, is mostly performed blind. However, there is a risk that blind entry may result in vascular or organ damage. One of the difficulties associated with entry complications is that any damage may not be immediately recognized, leading to major abdominal reparative surgery, and at worst, a temporary colostomy. Therefore, the technical and operative quality of laparoscopic surgery begins with port placement and trocars. Visual access systems are available but are not yet widely used. The aim of this review was to introduce the different port placement and trocar systems as well as their correct and professional usage in correlation with the abdominal functional anatomy.
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Affiliation(s)
- Ibrahim Alkatout
- Department of Gynecology and Obstetrics, Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Germany
| | - Liselotte Mettler
- Department of Gynecology and Obstetrics, Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Germany
| | - Nicolai Maass
- Department of Gynecology and Obstetrics, Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Germany
| | - Günter-Karl Noé
- Department of Obstetrics and Gynaecology, University of Witten/Herdecke, Communal Clinics Rhein Kreis Neuss, Witten, Germany
| | - Mohamed Elessawy
- Department of Gynecology and Obstetrics, Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Germany
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Cherian J, Fridley JS, Duckworth EAM. Modern paradigm for peritoneal catheter insertion: single port optical access laparoscopic shunt insertion. Neurosurgery 2015; 11 Suppl 2:205-11; discussion 211-2. [PMID: 25714516 DOI: 10.1227/neu.0000000000000678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ventriculoperitoneal shunting is one of the most commonly performed neurosurgical procedures. Typically, for insertion of the peritoneal catheter, a mini-laparotomy technique is used. Although generally safe, it can be cosmetically undesirable and time consuming. Complications include malpositioning, bowel injury, and delayed hernias. Laparoscopic techniques have been advocated to address these issues, but have been slow to gain traction with neurosurgeons. OBJECTIVE To describe our experience with single port optical access laparoscopy for placement of ventriculoperitoneal shunts. Our technique simplifies adoption of a laparoscopic technique for neurosurgeons looking to incorporate its benefits. METHODS All ventriculoperitoneal shunts placed by the senior author since April 2011 were retrospectively reviewed. Surgical and perioperative complications, length of postoperative stay, and need for revisions were analyzed. RESULTS Fifty-six patients were included in the study. There were no cases of peritoneal catheter misplacement. One intraoperative complication occurred early in the series, in which there was an injury to the gallbladder necessitating cholecystectomy. There were 7 cases followed by shunt revision inclusive of the abdomen. In 3 cases, pseudocysts were noted. CONCLUSION Single port optical access laparoscopy is a fast and minimally invasive technique that allows direct visualization of the layers of the abdominal wall as they are traversed and visualization of the peritoneal catheter during placement. It uses a small cosmetic incision and obviates the need for postoperative abdominal radiographic studies. The procedure has a modest learning curve, but can be safely used without the assistance of an assist surgeon after the skills are acquired.
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Affiliation(s)
- Jacob Cherian
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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Kassir R, Blanc P, Lointier P, Tiffet O, Berger JL, Amor IB, Gugenheim J. Laparoscopic Entry Techniques in Obese Patient: Veress Needle, Direct Trocar Insertion or Open Entry Technique? Obes Surg 2014; 24:2193-4. [DOI: 10.1007/s11695-014-1452-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tinelli A, Malvasi A, Mynbaev OA, Tsin DA, Davila F, Dominguez G, Perrone E, Nezhat FR. Bladeless direct optical trocar insertion in laparoscopic procedures on the obese patient. JSLS 2014; 17:521-8. [PMID: 24398192 PMCID: PMC3866054 DOI: 10.4293/108680813x13693422519398] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Results of the study suggest that direct optical entry technique reduced entry time and blood loss with trends to slightly decrease the occurrence of minor vascular and bowel injuries in obese women. Background: Recently, we have shown advantages of a direct optical entry (DOE) using a bladeless trocar in comparison with the open Hasson technique (OHT) in older reproductive-age women with previous operations, as well as in comparison with Veress needle entry in reproductive-age and postmenopausal women. Objectives: A prospective multicenter randomized study to determine whether the DOE is feasible for establishing safe and rapid entry into the abdomen in comparison with those of the OHT in reproductive-age obese women. Methods: Two types of surgical techniques were blindly applied in 224 obese reproductive-age women with benign neoplastic diseases of ovary and uterus. Namely, laparoscopic entry into the abdomen in 108 patients was performed by DOE and in 116 women by OHT. Following parameters (entry time in seconds needed to establish the intra-abdominal vision after pneumoperitoneum, blood loss, occurrence of vascular and/or bowel injuries) were compared during surgery as main outcomes. Results: Main baseline characteristics of patients, including age (36.1 ± 4.5 vs 35.7 ± 5.8), body mass index (34.9 ± 5.1 vs 35.1 ± 4.9 kg/m2), and parity (2.1 ± 0.4 vs 1.9 ± 0.9), were not significantly different between the DOE and OHT groups (P > .05). While intraoperative parameters such as the entry time (71.9 ± 3.7 vs 215.1 ± 6.2 seconds) and blood loss value (9.7 ± 6.1 vs 12.2 ± 2.9 mL) were significantly reduced in the DOE group in comparison with those of OHT group (respectively, P < .0001 and < .01), there were also trends to slight decrease of the occurrence of the minor injuries, manifested as omental small vessels rupture (0 of 108 vs 4 of 116) and punctures and pinches of jejunal serosa (0 of 108 vs 3 of 116) in patients of the DOE group in comparison with those of OHT group (respectively, P = .0515 and = .0925). Conclusions: DOE reduced entry time and blood loss with trends to slightly decrease of the occurrence of the minor vascular and bowel injuries, thus enabling a possible alternative to OHT in obese women; however, further larger trials need to confirm the possible additional benefits of a DOE.
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Affiliation(s)
- Andrea Tinelli
- Department of Obstetrics and Gynecology, Division of Experimental Endoscopic Surgery, Imaging, Technology and Minimally Invasive Therapy, Vito Fazzi Hospital, Piazza Muratore, 73100 Lecce, Italy.
| | - Antonio Malvasi
- Department of Obstetrics and Gynaecology, Santa Maria Hospital, Bari, Italy
| | - Ospan A Mynbaev
- Experimental Researches and Modeling Division, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Daniel Alberto Tsin
- Department of Gynecology, Division of Minimal Invasive Endoscopy, The Mount Sinai Hospital of Queens, New York, NY, USA
| | - Fausto Davila
- Hospital Regional de Poza Rica, Sesver, Monterrey, Mexico
| | | | - Emanuele Perrone
- Department of Gynecology and Obstetrics, University of Perugia, Perugia, Italy
| | - Farr R Nezhat
- Columbia University College of Physicians and Surgeons, New York, NY, USA, Division of Gynecologic Oncology and the Department of Obstetrics and Gynecology, St. Luke's-Roosevelt Hospital Center, New York, NY, USA
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16
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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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Silay MS, Tepeler A, Sancaktutar AA, Kilincaslan H, Altay B, Erdem MR, Hatipoglu NK, Akcay M, Akman T, Armagan A. The all-seeing needle instead of the Veress needle in pediatric urologic laparoscopy. J Endourol 2013; 27:1376-80. [PMID: 23560687 DOI: 10.1089/end.2013.0054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To investigate the feasibility of the all-seeing needle for safe entry and creation of pneumoperitoneum in pediatric urologic laparoscopy. PATIENTS AND METHODS A total of 14 children underwent various transperitoneal urologic laparoscopic procedures. The all-seeing needle, which is 4.85F in diameter, was used for safe entry into the abdominal cavity at the site of the umblicus in all cases. The microoptic was integrated with the light system and connected via a zoom ocular enabling direct visualization of the layers between the skin and the peritoneal cavity. Once the intraperitoneal access was obtained, CO2 pneumoperitoneum was created from one port of the three-way connector attached to the proximal part of the needle. Then the laparoscopic trocars were placed under vision of the microoptical system. RESULTS Mean age of the children was 4.5 ± 2.9 years. In all children, the all-seeing needle was safely introduced into the abdominal cavity under direct vision. Then, CO2 pneumoperitoneum was succesfully performed. The mean time for optical puncture was calculated as 1.1 ± 0.8 minutes. No complication was encountered during the introduction of the needle, creation of the pneumoperitoneum, and placement of the trocars. CONCLUSIONS The all-seeing needle appears to be beneficial in safe entry and for creating pneumoperitoneum in laparoscopic pediatric urology cases. It eliminates the disadvantages of the Veress needle, which is blunt insertion, and may possibly prevent complications.
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Affiliation(s)
- Mesrur Selcuk Silay
- 1 Department of Urology, Faculty of Medicine, Bezmialem Vakif University , Istanbul, Turkey
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18
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Van Koughnett JAM, Kalaskar SN, Wexner SD. Pitfalls of laparoscopic colorectal surgery and how to avoid them. COLORECTAL CANCER 2013. [DOI: 10.2217/crc.13.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
SUMMARY Laparoscopic surgery is commonly used for colorectal diseases. Recently, laparoscopy for colorectal carcinoma has increased in use, especially by colorectal surgeons. Laparoscopy is associated with potential pitfalls that pose challenges to the surgeon and team. The identification and management of these pitfalls may not directly parallel those during an open approach. As such, it is essential for the surgeon to have a good working knowledge of how to avoid potential problems and how to best manage them when they do occur. This review highlights common pitfalls of laparoscopic colorectal surgery, as well as offering practical approaches to their management. Technical, patient and surgeon factors are all discussed.
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Affiliation(s)
- Julie Ann M Van Koughnett
- Department of Colorectal Surgery, Cleveland Clinic FL, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
| | - Sudhir N Kalaskar
- Department of Colorectal Surgery, Cleveland Clinic FL, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic FL, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
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A safe optically guided entry technique using Endopath Xcel Trocars in laparoscopic surgery: A personal series of 821 patients. Gynecol Minim Invasive Ther 2013. [DOI: 10.1016/j.gmit.2012.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
Ventral hernias, whether naturally occurring or the result of previous surgery, comprise one of the most common problems confronting general surgeons. As many as 25% of laparotomy incisions develop a hernia over long-term follow-up, which is a difficult problem with many treatment algorithms. Laparoscopic ventral hernia repair has improved over the last decade and has proven to be an effective treatment option. With fewer wound complications and low recurrence rates, it is a useful tool in the surgeon's armamentarium. Care should be taken regarding patient selection, operative technique, and mesh size to ensure adequate repair of the hernia, thereby preventing recurrence at a later date. The first attempt at a hernia repair has the highest chance of long-term success, so it is important that the surgeon take all the factors into mind before proceeding with operative repair.
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Affiliation(s)
- W Scott Melvin
- Department of Surgery, The Ohio State University, 395 West 12th Avenue, Columbus, OH 43210-1267, USA
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21
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Use of a No. 11 blade scalpel and reusable blunt trocar to establish pneumoperitoneum: description of a safe and inexpensive technique. J Minim Invasive Gynecol 2010; 17:760-5. [PMID: 20955985 DOI: 10.1016/j.jmig.2010.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Revised: 07/13/2010] [Accepted: 07/15/2010] [Indexed: 11/21/2022]
Abstract
First access is crucial in laparoscopic surgery because of its potentially life-threatening complications. A number of procedures using a variety of instruments have been previously described; however, the safest approach remains uncertain. Herein, we describe a simple and inexpensive method for direct trocar insertion using reusable instruments that was developed over 10 years in a series of 4721 consecutive gynecologic laparoscopic procedures. Observed data revealed that the technique is feasible, rapidly performed, and safe, with a likely cost savings, using a small set of reusable instruments. This procedure should be compared with other access methods in randomized studies to confirm the observed advantages.
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22
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Deguines JB, Qassemyar Q, Dhahri A, Brehant O, Fuks D, Verhaeghe P, Regimbeau JM. Technique of open laparoscopy for supramesocolic surgery in obese patients. Surg Endosc 2010; 24:2053-5. [PMID: 20135178 DOI: 10.1007/s00464-009-0872-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Accepted: 11/29/2009] [Indexed: 01/09/2023]
Abstract
BACKGROUND Incidence of obesity and related diseases are increasing in the world. Visceral surgeons are more often confronted with laparoscopic surgery in obese patients. Besides validated surgery procedures, such as cholecystectomy and gastroesophageal reflux surgery, bariatric procedures are increasingly performed. In obese patients, the thickness of adipose panicle makes open laparoscopy hazardous. METHODS In our department, we use systematically a technique of open laparoscopy in obese patients for supramesocolic surgery, which is safe, reproducible, and permits good closure of the abdominal wall. RESULTS The surgical technique consists of opening the abdominal wall through the rectus abdominis. Helped by specific retractors called Descottes (Medtronic Laboratory), both fascias are charged by sutures separately. Incision in the fascias is made safely by pooling on sutures. Introduction of port-site is made under view control. At the end of laparoscopy, closure of both fascias is easily done. CONCLUSIONS We present a technique of open laparoscopy in obese patients, systematically used, for supramesocolic surgery. This technique is safe, reproducible, and permits an efficient closure of the abdominal wall.
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Affiliation(s)
- Jean Baptiste Deguines
- Federation of Digestive Surgery, North Hospital, Université de Picardie Jules Verne, Place Victor Pauchet, 80054 Amiens Cedex 01, France
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Hagen ME, Wagner OJ, Thompson K, Jacobsen G, Spivack A, Wong B, Talamini M, Horgan S. Supra-pubic single incision cholecystectomy. J Gastrointest Surg 2010; 14:404-7. [PMID: 19908104 PMCID: PMC2809977 DOI: 10.1007/s11605-009-1079-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 10/26/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Surgery is moving towards less invasive and cosmetically superior approaches such as single incision laparoscopy (SIL). While trans-umbilical SIL is gaining popularity, incisions may lead to post-operative deformations of the umbilicus and the possibility of an increased rate of incisional hernias. Access within the pubic hairline allows preservation of the umbilicus and results in a scar which is concealed within the pubic hair. METHODS Supra-pubic single incision cholecystectomy was performed in a 30-year-old patient with symptomatic gallstones. A 2.5-cm transverse incision was placed within the pubic hairline and a subcutaneous tunnel was formed. Three 5-mm ports were introduced into the tunnel and perforated the anterior rectus sheath superior to the skin incision. The surgical procedure was then undertaken with conventional laparoscopic instrumentation. The adjacent 5-mm incisions were merged for gallbladder removal. The entry site was closed under direct vision. RESULTS The above procedure was technically feasible and without complication. Operative time was 45 min, and the patient was discharged 5 h post-operatively. CONCLUSIONS Supra-pubic single incision laparoscopic cholecystectomy may offer a more cosmetically appealing result than standard umbilical access. The operation can be performed by surgeons skilled in single incision techniques with good result.
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Affiliation(s)
- Monika E. Hagen
- Department of Surgery, Center for the Future of Surgery, University of California, 200 West Arbor Drive, San Diego, CA 92108 USA
| | - Oliver J. Wagner
- Department of Surgery, Center for the Future of Surgery, University of California, 200 West Arbor Drive, San Diego, CA 92108 USA
| | - Kari Thompson
- Department of Surgery, Center for the Future of Surgery, University of California, 200 West Arbor Drive, San Diego, CA 92108 USA
| | - Garth Jacobsen
- Department of Surgery, Center for the Future of Surgery, University of California, 200 West Arbor Drive, San Diego, CA 92108 USA
| | - Adam Spivack
- Department of Surgery, Center for the Future of Surgery, University of California, 200 West Arbor Drive, San Diego, CA 92108 USA
| | - Brian Wong
- Department of Surgery, Center for the Future of Surgery, University of California, 200 West Arbor Drive, San Diego, CA 92108 USA
| | - Mark Talamini
- Department of Surgery, Center for the Future of Surgery, University of California, 200 West Arbor Drive, San Diego, CA 92108 USA
| | - Santiago Horgan
- Department of Surgery, Center for the Future of Surgery, University of California, 200 West Arbor Drive, San Diego, CA 92108 USA
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Primary midline peritoneal access with optical trocar is safe and effective in morbidly obese patients. Surg Obes Relat Dis 2009; 5:610-4. [DOI: 10.1016/j.soard.2009.05.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 05/13/2009] [Accepted: 05/13/2009] [Indexed: 11/21/2022]
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Danan D, Winfree CJ, McKhann GM. INTRA-ABDOMINAL VASCULAR INJURY DURING TROCAR-ASSISTED VENTRICULOPERITONEAL SHUNTING. Neurosurgery 2008; 63:E613; discussion E613. [DOI: 10.1227/01.neu.0000325261.29689.fc] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT
OBJECTIVE
Laparoscopic trocar injury is a relatively well-described complication of cholecystectomies and gynecological procedures. However, this type of injury has not been reported in association with adult neurological surgery. To increase awareness of this very serious risk, we report a case of intra-abdominal vascular injury during a shunt procedure involved with a common neurosurgical procedure.
CLINICAL PRESENTATION
A 76-year-old man with no previous abdominal surgical history presented with probable normal pressure hydrocephalus.
INTERVENTION
After an appropriate preoperative workup confirming probable normal pressure hydrocephalus, the patient consented to placement of a ventriculoperitoneal shunt with a programmable valve. During placement of the distal catheter using an abdominal trocar, the aorta was punctured inadvertently, necessitating emergency laparotomy for vascular repair.
CONCLUSION
An abdominal trocar should be used with caution in ventriculoperitoneal shunt surgery. Even with meticulous technique, vascular injury can occur with any trocar-based abdominal procedure. The neurosurgeon who uses this technique must be prepared to initiate emergent vascular access and repair, with a vascular surgery team available should such an injury occur. Alternatively, open placement of peritoneal catheters avoids blind peritoneal instrumentation and is an effective method for minimizing potentially catastrophic vascular injuries.
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Affiliation(s)
- Deepa Danan
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Christopher J. Winfree
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
| | - Guy M. McKhann
- Department of Neurological Surgery, Columbia University Medical Center, New York, New York
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Creation of Pneumoperitoneum Using a Bladed Optical Trocar in Morbidly Obese Patients: Technique and Results. Obes Surg 2008; 18:1043-6. [DOI: 10.1007/s11695-008-9497-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 03/07/2008] [Indexed: 10/22/2022]
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Rabl C, Palazzo F, Aoki H, Campos GM. Initial laparoscopic access using an optical trocar without pneumoperitoneum is safe and effective in the morbidly obese. Surg Innov 2008; 15:126-31. [PMID: 18480084 DOI: 10.1177/1553350608317354] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Obtaining access to the peritoneal cavity in laparoscopic surgery is more difficult in morbidly obese people. The aim of this study was to examine the safety and efficacy of accessing the peritoneal cavity using an optical, bladeless trocar without previous pneumoperitoneum in morbidly obese patients. The patients' characteristics and outcomes with consecutive and preferential use of an optical, bladeless, first trocar insertion without previous pneumoperitoneum in morbidly obese patients (body mass index > 35 kg/m2) was reviewed. A total of 208 morbidly obese patients were included. The trocar insertion technique was used in 196 patients. No bowel or major abdominal vessel injuries occurred. Ninety-eight patients (50%) had previous abdominal operations. Trocar-related injuries occurred in 3 patients: a superficial mesenteric laceration in 2 and a laceration of a greater omentum vessel in 1. The direct first trocar insertion technique provides safe entry into the peritoneal cavity in morbidly obese patients.
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Affiliation(s)
- Charlotte Rabl
- Department of Surgery, University of California San Francisco, CA 94143-0790, USA
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28
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Gilliam AD, Donnelly L, Gopinath B. Avoidance of tattoo disruption: a further benefit of laparoscopic surgery. Surg Endosc 2008; 23:318-20. [PMID: 18437475 DOI: 10.1007/s00464-008-9921-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2007] [Revised: 02/12/2008] [Accepted: 03/04/2008] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Tattoos are increasingly common in both male and female patients. Abdominal skin tattoos may be present at the site of proposed incisions for conventional surgery whereas laparoscopic port site placement can be adjusted to accommodate tattoo constraints. METHODS Patients with tattoos were questioned by face-to-face interview to determine how long ago they had their tattoo, financial cost of the tattoo, and potential degree of distress caused by disruption of their tattoo (on a scale of 1-10). Consultant and higher surgical trainee general surgeons were asked by e-mail survey whether they had encountered a patient with a tattoo at the site of a proposed incision, did they avoid incising the tattoo during surgical intervention, and had they received a complaint from a patient about tattoo distortion. RESULTS Ninety six patients (50 male, median age 29 years) were questioned. Median cost of the tattoos was pound35 ($70). Female patients were more likely to be distressed and complain than men about tattoo disruption (p = 0.0003) and there was a significant inverse correlation between time from tattooing and distress (p = 0.02). Most (79%) of the general surgeons questioned (n = 107, response rate 82%) had encountered tattoos at proposed incision sites; 61% had avoided making an incision through it and 4% had received a complaint about tattoo disruption by a patient. CONCLUSION Tattoo disruption by surgical incision may cause distress especially in female patients who had their tattoo recently. Tattoos should be avoided where possible by alternative port site placement.
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Affiliation(s)
- A D Gilliam
- James Cook University Hospital, Marton Road, Middlesborough, TS4 3BW, UK.
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Current World Literature. Curr Opin Obstet Gynecol 2007; 19:496-501. [PMID: 17885468 DOI: 10.1097/gco.0b013e3282f0ffad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Madan AK, Taddeucci RJ, Harper JL, Tichansky DS. Initial trocar placement and abdominal insufflation in laparoscopic bariatric surgery. J Surg Res 2007; 148:210-3. [PMID: 18262554 DOI: 10.1016/j.jss.2007.08.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 08/22/2007] [Accepted: 08/24/2007] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Initial trocar placement and abdominal insufflation in laparoscopic bariatric surgery can be challenging for the novice. One technique is the use of an optical viewing trocar without prior abdominal insufflation. This investigation tests the hypothesis that this technique can be taught to novice surgeons with good results. METHODS Patients undergoing laparoscopic bariatric surgery were included. Novice surgeons (residents/fellows) with 0-50 initial trocar placements placed the initial trocar and insufflated the abdomen in the presence of an expert surgeon (>300 initial trocar placements in morbidly obese patients). Trocar placement time was defined as the time to place the trocar into the peritoneal cavity (including infiltration of local anesthesia and incision). Insufflation time was defined as the time to insufflate the abdomen to a pressure of 10 to 15 mm Hg (including time to place tubing on trocar). Novice times were compared with expert times. RESULTS There were 81 patients (56 by expert and 25 by novice) in this study. No bowel or vessel injury during initial trocar placement was noted. No correlation was seen between times and BMI or waist/hip circumference (P = NS). Mean expert trocar placement time was shorter than the mean novice time (25 +/- 9 versus 54 +/- 27 s; P < 0.0001); although there was no difference in mean insufflation time (expert versus novice: 16 +/- 5 versus 19 +/- 10; P = NS). The mean total time to place the initial trocar and insufflate the abdomen for the novices was 72 +/- 26 s. CONCLUSIONS Initial trocar placement can be taught safely to novices. The technique using an optical viewing trocar without prior abdominal insufflation is effective and efficient in morbidly obese patients.
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Affiliation(s)
- Atul K Madan
- Minimally Invasive Surgery Section, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
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Sesti F, Melgrati L, Damiani A, Piccione E. Authors’ Response to Comment on “Isobaric (gasless) laparoscopic uterine myomectomy—An overview” [Eur. J. Obstet. Gynecol. Reprod. Biol. 129 (2006) 9–14]. Eur J Obstet Gynecol Reprod Biol 2007. [DOI: 10.1016/j.ejogrb.2006.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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