1
|
Storm AC, AbiMansour JP, Bofill-Garcia A, Mahmoud T, Rapaka B, Lescalleet KE, Dayyeh BKA. Use of an intragastric trocar to perform a novel stapling procedure for reflux disease. Endosc Int Open 2022; 10:E1508-E1513. [PMID: 36397862 PMCID: PMC9666069 DOI: 10.1055/a-1933-6573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022] Open
Abstract
Background and study aims A percutaneous intragastric trocar (PIT) enables intraluminal use of laparoscopic tools and helps overcome traditional limitations of endoscopy. The aim of this study was to determine the efficacy of using a PIT to perform an anti-reflux stapling procedure. Materials and methods Trocars were placed in four animals and an articulating stapler was used to perform fundoplication under endoscopic guidance. Animals were monitored for 14 days post-procedure. Functional lumen imaging of the esophagogastric junction (EGJ) was performed at baseline, immediately post-intervention, and at 14 days. Results The procedure was successful in all animals who survived to day 14 without distress or significant adverse events. Baseline EGJ distensibility was 5.0 ± 1.2 mm 2 /mmHg, 2.7 ± 0.7 mm 2 /mmHg post-procedurally, and 3.0 ± 0.8mm 2 /mmHg on day 14. Average change in distensibility pre- and post-procedure was -2.3 ± 1.8 mm 2 /mmHg (95 % confidence interval [CI] -0.5 to 5.1, P = 0.08) while change in pre- and day 14 distensibility was -2.0 ± 1.4 mm 2 /mmHg (95 % CI -0.1 to 4.2, P = 0.06). Conclusions An intragastric trocar allows for use of large-diameter laparoscopic instruments to safely and effectively perform endoluminal fundoplication with anti-reflux properties that persist for at least 14 days.
Collapse
Affiliation(s)
- Andrew C. Storm
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States,Developmental Endoscopy Unit, Mayo Clinic, Rochester, Minnesota, United States
| | - Jad P. AbiMansour
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Aliana Bofill-Garcia
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Tala Mahmoud
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Babusai Rapaka
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Kristin E. Lescalleet
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| | - Barham K. Abu Dayyeh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, United States
| |
Collapse
|
2
|
Laparoscopic Port-Site Hernia: An Underrecognized Iatrogenic Complication of Laparoscopic Surgery. Obstet Gynecol Surv 2021; 76:751-759. [PMID: 34942651 DOI: 10.1097/ogx.0000000000000961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Port-site hernia is an iatrogenic complication with a documented incidence between 0.65% and 2.8%. However, the true incidence could be higher because of delayed onset, asymptomatic nature, and loss to follow-up. Port-site hernia could be further complicated by incarceration or strangulation leading to small bowel obstruction requiring emergent surgical intervention, thus imposing significant financial and emotional burden to patients. Objective This article aims to provide a summary of the available literature concerning port-site hernia and explore preventive strategies for future clinical practice. Evidence Acquisition This review was formulated through electronic literature searches in Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. The reference lists of the included studies were hand searched to identify other relevant articles to capture all available literature in this narrative review. Results Following screening for eligibility based on relevance to the topic under consideration, 28 studies were identified. This included 5 original articles, 1 case series, and 22 review articles, including 4 systematic reviews. Included studies were critically appraised in formulating this review. Conclusions Port-site hernia is an underrecognized yet preventable complication with careful consideration of predisposing technical and host factors, thorough attention to surgical technique, or use of a fascial closure device. Relevance With the widespread and increasing use of laparoscopic methods to treat surgical pathologies, knowledge of this complication is imperative to encourage prevention strategies and facilitate early recognition and management should it occur.
Collapse
|
3
|
Wani AA, Khuroo S, Jain SK, Heer VK, Rajput D, Maqsood S. The "Flip-Flap" Technique for Laparoscopic Port-Site Closure-Description of a Novel, Cost-Effective Technique with Review of Literature. Surg J (N Y) 2021; 7:e168-e171. [PMID: 34295977 PMCID: PMC8289681 DOI: 10.1055/s-0041-1731270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/09/2021] [Indexed: 11/17/2022] Open
Abstract
Overview
Laparoscopic approach has changed the face of surgical care offered to patients. Almost all surgical procedures across specialties are now undertaken by the laparoscopic approach. Closure of port sites to prevent trocar-site hernias (TSHs) forms an integral part of the laparoscopic procedure. TSH is an area of preventable surgical morbidity. We hereby report our technique that is easily applicable, simple, safe, and highly cost-effective. It requires no additional instruments or retractors, is easy to learn, and has a very favorable safety profile.
Materials and Methods
This prospective case series enrolled a total of 454 port-site closures in 255 patients undergoing different laparoscopic procedures over a period of 2 years. The intraperitoneal tissue forceps were used in the reverse direction to lift the fascia up and a right-angled retractor was used to retract back the skin and subcutaneous tissue. The port-site closure is done under vision and no adverse events were reported.
Results
This technique was used in 454 port sites in 255 patients. No intraoperative incidents were noted. There is no requirement of any specialized instruments or retractors. No additional tissue trauma or dissection is required. There is no extension of operative time. The technique is simple to learn and easy to teach. No bowel injuries or TSHs were reported during a follow-up of 26 months.
Conclusion
The described technique is easy, simple, cost-effective, and has a good safety profile.
Collapse
Affiliation(s)
- Ajaz Ahmed Wani
- Department of Surgical Gastroenterology, Shri Mata Vaishno Devi Narayana Superspecialty Hospital, Kakryal, Katra, Jammu and Kashmir, India
| | - Suhail Khuroo
- Department of Surgical Gastroenterology, Shri Mata Vaishno Devi Narayana Superspecialty Hospital, Kakryal, Katra, Jammu and Kashmir, India
| | - Saurabh Kumar Jain
- Department of Clinical Associate Surgical Gastroenterology, Action Cancer Hospital, New Delhi, India
| | - Vikas Kumar Heer
- Department of Surgical Oncology, Shri Mata Vaishno Devi Narayana Superspecialty Hospital, Kakryal, Katra, Jammu and Kashmir, India
| | - Deepak Rajput
- Department of General Surgery, AIIMS Rishikesh, Rishikesh, Uttarakhand, India
| | - Shadab Maqsood
- Department of Radiodiagnosis, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| |
Collapse
|
4
|
Selvaraj N, Dholakia K, Ramani S, Ragavan N. The Chennai port closure method: A novel simple technique for laparoscopic port closure. Surg Open Sci 2021; 4:37-40. [PMID: 33778460 PMCID: PMC7985694 DOI: 10.1016/j.sopen.2021.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/12/2021] [Accepted: 02/05/2021] [Indexed: 11/14/2022] Open
Abstract
Purpose Large-size ports used for laparoscopic and robotic procedures will require appropriate closure to reduce the probability of trocar site complications including hematoma and hernia. Closure of these ports is done by various methods like the open method extending skin incisions, S-retractor, Carter Thomason method, and so on. Chennai port closure (CHC) method, a novel technique that had been in practice in our unit for more than 2 years, ensures direct visualization of the suture placement, and hence, the abdominal wall fascia and peritoneum are secured. Materials and Method We herein describe an easy technique for fascial closure in port size (≥ 10 cm) after minimally invasive surgery, including both laparoscopic and robotic procedures, using a cobbler needle in 151 patients in the study period between February 2017 and March 2020 for various urological procedures. This technique was done before the introduction of the trocar sheath and ensures direct visualization of the abdominal fascial closure. Results There were no major intraoperative events, additional operating time, and need for any costly instruments. No bowel injuries or trocar site hernias were documented during a mean follow-up of 28 months. Presently, this technique is used by many surgeons in our hospital without much difficulty. Conclusion The Chennai port site closure technique is an effective, simple, easy-to-apply, and safe procedure.
Collapse
Affiliation(s)
- Nivash Selvaraj
- Department of Urology, Apollo Main Hospitals, Chennai, India
| | - Kunal Dholakia
- Department of Urology, Apollo Main Hospitals, Chennai, India
| | | | | |
Collapse
|
5
|
Proposed training pathway with initial experience to set up robotic hepatobiliary and pancreatic service. J Robot Surg 2021; 16:65-71. [PMID: 33575862 DOI: 10.1007/s11701-021-01207-6] [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: 11/21/2020] [Accepted: 01/31/2021] [Indexed: 02/07/2023]
Abstract
Although robot-assisted hepatobiliary and pancreatic (HPB) surgery has gained momentum over the last 2 decades, only a handful of units in the world perform major robotic resections. Adaptation of robotic surgery in the UK lags behind its European counterparts and this is mainly because of cost implications in a publicly funded National Health Service (NHS). We describe our experience of setting up a robotic HPB programme with clinical outcomes and propose a training pathway that would help prospective centres in setting up their own robotic HPB service with robust clinical governance oversight. After gaining colleagues' and departmental support, approval from the hospital clinical governance, finance department and new intervention procedure committee was sought. A team of two consultant surgeons, three assistants and three theatre staff went through a structured training programme sponsored mainly by the industry. Surgeon training consisted of online modules, simulation, wet lab, cadaveric training, case observations, proctored procedures followed by independent practice. All major cases were recorded and videos reviewed to improve performance. A total of 111 procedures were successfully completed with robotic assistance between April 2018 and March 2020. The programme started with robot-assisted cholecystectomy as index procedure and progressed on to more complex liver and pancreatic resections including major hepatectomy and Whipple's procedure. The training pathway followed by our team has been effective in setting up a safe robotic HPB programme and could be considered as a roadmap to start new Robotic HPB services.
Collapse
|
6
|
Gao X, Chen Q, Wang C, Yu YY, Yang L, Zhou ZG. Rare case of drain-site hernia after laparoscopic surgery and a novel strategy of prevention: A case report. World J Clin Cases 2020; 8:6504-6510. [PMID: 33392337 PMCID: PMC7760453 DOI: 10.12998/wjcc.v8.i24.6504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/14/2020] [Accepted: 11/02/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Trocar site hernia (TSH) is a rare but potentially dangerous complication of laparoscopic surgery, and the drain-site TSH is an even rarer type. Due to the difficulty to diagnose at early stages, TSH often leads to a delay in surgical intervention and eventually results in life-threatening consequences. Herein, we report an unusual case of drain-site TSH, followed by a brief literature review. Finally, we provide a novel, simple, and practical method of prevention.
CASE SUMMARY A 54-year-old female patient underwent laparoscopic subtotal hysterectomy and bilateral adnexectomy for uterine fibroids 8 d ago in another hospital. She was admitted to our hospital with a 2-d history of intermittent abdominal pain, nausea, vomiting, and abdominal enlargement with an inability to pass stool and flatus. The emergency computed tomography scan revealed the small bowel herniated through a 10 mm trocar incision, which was used as a drainage port, with diffuse bowel distension and multiple air-fluid levels with gas in the small intestines. She was diagnosed with drain-site strangulated TSH. The emergency exploratory laparotomy confirmed the diagnosis. A herniorrhaphy followed by standard intestinal resection and anastomosis were performed. The patient recovered well after the operation and was discharged on postoperative day 8 and had no postoperative complications at her 2-wk follow-up visit.
CONCLUSION TSH must be kept in mind during the differential diagnosis of post-laparoscopic obstruction, especially after the removal of the drainage tube, to avoid the serious consequences caused by delayed diagnosis. Furthermore, all abdomen layers should be carefully closed under direct vision at the trocar port site, especially where the drainage tube was placed. Our simple and practical method of prevention may be a novel strategy worthy of clinical promotion.
Collapse
Affiliation(s)
- Xiang Gao
- Institute of Digestive Surgery, Sichuan University, Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Qun Chen
- Department of Central Transportation, West China School of Nursing, Sichuan University, Chendu 610041, Sichuan Province, China
| | - Cun Wang
- Institute of Digestive Surgery, Sichuan University, Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yong-Yang Yu
- Institute of Digestive Surgery, Sichuan University, Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lie Yang
- Institute of Digestive Surgery, Sichuan University, Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Zong-Guang Zhou
- Institute of Digestive Surgery, Sichuan University, Department of Gastrointestinal Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| |
Collapse
|
7
|
Hulikal N, Singaram NK, Inamdar MB, Niak GR. Early Mechanical Intestinal Obstruction Following Laparoscopic Radical Hysterectomy. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2019.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Narendra Hulikal
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Chittor District, AP, India
| | - Nagesh Kumar Singaram
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Chittor District, AP, India
| | - Md Basheeruddin Inamdar
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Chittor District, AP, India
| | - Guru Raghavendra Niak
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Chittor District, AP, India
| |
Collapse
|
8
|
Kawai H, Misawa T, Sasaya K, Aoyama Y. Dual-hemostat port closure technique with customized surgical suture after laparoscopic cholecystectomy: Single-center experience. Asian J Endosc Surg 2020; 13:83-88. [PMID: 30688041 DOI: 10.1111/ases.12690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/12/2018] [Accepted: 12/16/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Dual-hemostat techniques for port closure have previously been reported, but their safety and efficacy have not been evaluated. Here, we describe the dual-hemostat port closure technique employed at our institution, which uses a customized surgical suture for safe and certain port closure, and we assess the incidence rate of trocar-site hernia (TSH) after laparoscopic cholecystectomy. METHODS From March 1999 to March 2017 at our institution, 316 patients underwent elective laparoscopic cholecystectomy performed by a single experienced surgeon. We routinely used a dual-hemostat technique with a customized surgical suture to achieve safe and certain port closure. We assessed the incidence rate of TSH after laparoscopic cholecystectomy (defined as a reoperation for a TSH or clinical hernia at the port site) based on follow-up data from patient questionnaires and clinical examinations. RESULTS After 67 patients were excluded because of death, unknown address, or conversion to open cholecystectomy, 249 eligible patients received questionnaires, of which 173 were returned (response rate, 69.5%). From these responses, TSH was suspected in three patients, but only one underwent reoperation for TSH after laparoscopic cholecystectomy. Thus, the incidence rate of TSH after laparoscopic cholecystectomy was 0.6% (1/173). CONCLUSIONS Our single-center experience demonstrated that our port closure technique using a dual-hemostat technique with customized surgical suture provides an appropriate option for laparoscopic cholecystectomy, especially given its ease and low incidence of TSH.
Collapse
Affiliation(s)
- Hironari Kawai
- Department of Surgery, Aoyama Hospital, Funabashi, Japan
| | - Takeyuki Misawa
- Department of Surgery, Aoyama Hospital, Funabashi, Japan.,Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Kazuto Sasaya
- Department of Surgery, Aoyama Hospital, Funabashi, Japan
| | | |
Collapse
|
9
|
Kwon HJ, Roh CK, Woo J, Son SY, Han SU, Hur H. Laparoscopic Gastrectomy Using Instruments with a Minimal Diameter for Early Gastric Cancer: A Feasible Alternative to Conventional Laparoscopic Gastrectomy for Experienced Surgeons. J Laparoendosc Adv Surg Tech A 2019; 30:188-195. [PMID: 31742480 DOI: 10.1089/lap.2019.0505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The application of laparoscopic surgery using instruments that are 3 mm or less in diameter for patients with early gastric cancer (EGC) has not yet been established. We aimed to evaluate the feasibility and safety of laparoscopic gastrectomy using instruments with minimal diameter. Methods: We retrospectively analyzed 41 patients who underwent laparoscopic subtotal gastrectomy with D1-positive lymph node dissection for EGC. Among them, 17 patients underwent laparoscopic gastrectomy using instruments with a minimal diameter (experimental group), while 24 patients underwent conventional laparoscopic gastrectomy (control group). In the experimental group, we used two 3-mm trocars, one 5-mm trocar, and the GelPOINT® Advanced Access Platform. We compared operative outcomes between the two groups and assessed the learning curve of laparoscopic gastrectomy using instruments with minimal diameter. Results: The operative outcomes were similar between the two groups. The preoperative-to-postoperative day 2 ratio of neutrophil count in the experimental group was significantly lower than in the control group (2.07 versus 2.65; P = .038). Morbidity was not observed in the experimental group and 3 patients experienced complications in the control group, although it was not significantly different (P = .252). The operation time according to the accumulation of cases was stable without any significant change in the experimental group. Conclusions: Laparoscopic gastrectomy using instruments with minimal diameter is technically feasible and safe for EGC and could also be a good alternative to conventional laparoscopic gastrectomy to minimize the impact of surgical invasiveness when performed by experienced surgeons.
Collapse
Affiliation(s)
- Hyuk-Jae Kwon
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Chul Kyu Roh
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jongsu Woo
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.,Department of Biomedical Science, Graduate School of Ajou University, Suwon, Republic of Korea
| | - Sang-Yong Son
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sang-Uk Han
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea.,Department of Biomedical Science, Graduate School of Ajou University, Suwon, Republic of Korea
| |
Collapse
|
10
|
Prospective Randomized Control Study on the Efficiency and Safety of a Novel Port-site Closure Device, the EZ-close Port-site Closure System. Surg Laparosc Endosc Percutan Tech 2019; 29:335-338. [PMID: 30801390 DOI: 10.1097/sle.0000000000000650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM The efficiency and safety of EZ-close Port-Site Closure System were investigated in comparison with those of the Carter-Thomason CloseSure System (CT) device. METHODS This was a prospective randomized control study. The primary outcome was the time taken to complete the closure of the port site using either the EZ or CT. The suture time (mean±SD) for the EZ group was significantly less than that of the CT group (36.8±10.1 s for the EZ group vs. 48.9±21.5 s for the CT group, P=0.004). There was no need for additional instruments in the EZ group, but in 84.6% of the patients in the CT group, a grasper was required to hold the tie (P<0.05). There was no difference in the complication rates between the 2 groups. CONCLUSIONS The EZ device showed an improved efficiency and similar safety compared with that of the CT device. Its main advantage lied in enabling the surgeon to be totally self-sufficient for the whole port-site closing procedure.
Collapse
|
11
|
Efficacy and reliability of the use of a needle grasper to prevent trocar site hernia. Wideochir Inne Tech Maloinwazyjne 2018; 13:477-484. [PMID: 30524618 PMCID: PMC6280092 DOI: 10.5114/wiitm.2018.75867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 03/19/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction Port site herniation is one of the serious complications of laparoscopic surgery, which decreases its benefits. Closure of a fascia defect at the port site is an important problem of laparoscopic surgery, especially in obese patients. Aim To evaluate needle grasper fascia closure. Material and methods We closed the port site fascia using a percutaneous organ-holding device (needle grasper) in laparoscopic cholecystectomy patients. This study included 334 patients who underwent laparoscopic cholecystectomy between January 2015 and January 2017 in our hospital. Patients were divided into 2 fascia closure groups: group 1 with a standard simple suturing technique and group 2 with a needle grasper to close the port site. Patient demographics, operative details, and postoperative outcomes were collected and evaluated. Results There were 243 female and 91 male (total 334) patients with the mean age of 49.18 ±13.15 years. Only 1 patient in the BMI > 30 kg/m2 group of patients had port site hernia development with the needle grasper technique at the end of the 8-month follow-up period. The port site hernia incidence was higher in group 1 than group 2 (p < 0.001), but there was no significant difference in terms of operation duration between the two groups (p < 0.001, p = 0.709, respectively). In patients with a BMI > 30 kg/m2, both operation duration and port site hernia incidence were higher in simple suture closure than in the needle grasper technique (p < 0.001, p = 0.016, p = 0.005). Conclusions The needle grasper technique is easy, simple, safe, fast, and effective for fascia closure of port sites. This method can also be applied in obese patients easily, safely and in a short time.
Collapse
|
12
|
Li M, Cao B, Gong R, Sun D, Zhang P, Jiang X, Sheng Y. Randomized trial of umbilical incisional hernia in high-risk patients: extraction of gallbladder through subxiphoid port vs. umbilical port after laparoscopic cholecystectomy. Wideochir Inne Tech Maloinwazyjne 2018; 13:342-349. [PMID: 30302147 PMCID: PMC6174159 DOI: 10.5114/wiitm.2018.76001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/27/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Trocar site incisional hernia (TSIH) is one of the most common complications of laparoscopic surgery. Using the umbilical port as a common hole for removing the gallbladder in laparoscopic cholecystectomy is more likely to lead to TSIH than other ports. Thus, extracting the gallbladder through other ports may reduce the incidence of TSIH. AIM To ascertain whether extraction of the gallbladder through the subxiphoid port is more beneficial for reducing umbilical incisional hernia than the umbilical port. MATERIAL AND METHODS From April 2014 to March 2017, a randomized clinical trial was conducted among patients with high risk of incisional hernia and accepted for three-port laparoscopic cholecystectomy (TLC) in our department. 182 patients with indications of cholecystectomy were allocated randomly to group A (subxiphoid port) and group B (umbilical port). Data collection was carried out on operative time, postoperative pain, hospital stay, wound infection and TSIH in the early postoperative course, and at 1, 10, and 24 months after surgery. RESULTS The incidence of TSIH in group A was lower than that in group B (4.9% vs. 14.6%; odds ratio = 8.02; 95% CI: 2.15-47.6; p < 0.001). The mean operative time of group A was significantly shorter than that of group B (35 ±15.16 min vs. 42 ±14.58 min, p < 0.01). There was no significant difference in wound infection rate between group A and group B (p = 0.068). The data of hospital stay (p = 0.428) and postoperative pain (p = 0.349) of all analyzed patients were similar in the two groups. CONCLUSIONS Extraction of the gallbladder through the subxiphoid port can reduce umbilical incisional hernia in high-risk patients effectively.
Collapse
Affiliation(s)
- Min Li
- Department of General Surgery, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Baoqiang Cao
- Department of General Surgery, Anhui Armed Police General Hospital, Hefei, China
| | - Renhua Gong
- Department of General Surgery, Anhui Armed Police General Hospital, Hefei, China
| | - Dengqun Sun
- Department of General Surgery, Anhui Armed Police General Hospital, Hefei, China
| | - Peisong Zhang
- Department of General Surgery, Anhui Armed Police General Hospital, Hefei, China
| | - Xudong Jiang
- Department of General Surgery, Anhui Armed Police General Hospital, Hefei, China
| | - Yanfei Sheng
- Department of Emergency Department, Anhui Armed Police General Hospital, Hefei, China
| |
Collapse
|
13
|
Migliore M, Arezzo A, Arolfo S, Passera R, Morino M. Safety of single-incision robotic cholecystectomy for benign gallbladder disease: a systematic review. Surg Endosc 2018; 32:4716-4727. [PMID: 29943057 DOI: 10.1007/s00464-018-6300-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/18/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Multiport laparoscopic cholecystectomy (MLC) is the gold standard technique for cholecystectomy. In order to reduce postoperative pain and improve cosmetic results, the application of the single-incision laparoscopic cholecystectomy (SILC) technique was introduced, leading surgeons to face important challenges. Robotic technology has been proposed to overcome some of these limitations. The purpose of this review is to assess the safety of single-incision robotic cholecystectomy (SIRC) for benign disease. METHODS An Embase and Pubmed literature search was performed in February 2017. Randomized controlled trial and prospective observational studies were selected and assessed using PRISMA recommendations. Primary outcome was overall postoperative complication rate. Secondary outcomes were postoperative bile leak rate, total conversion rate, operative time, wound complication rate, postoperative hospital stay, and port site hernia rate. The outcomes were analyzed in Forest plots based on fixed and random effects model. Heterogeneity was assessed using the I2 statistic. RESULTS A total of 13 studies provided data about 1010 patients who underwent to SIRC for benign disease of gallbladder. Overall postoperative complications rate was 11.6% but only 4/1010 (0.4%) patients required further surgery. A postoperative bile leak was reported in 3/950 patients (0.3%). Conversion occurred in 4.2% of patients. Mean operative time was 86.7 min including an average of 42 min should be added as for robotic console time. Wound complications occurred in 3.7% of patients. Median postoperative hospital stay was 1 day. Port site hernia at the latest follow-up available was reported in 5.2% of patients. CONCLUSIONS The use of the Da Vinci robot in single-port cholecystectomy seems to have similar results in terms of incidence and grade of complications compared to standard laparoscopy. In addition, it seems affected by the same limitations of single-port surgery, consisting of an increased operative time and incidence of port site hernia.
Collapse
Affiliation(s)
- Marco Migliore
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy.
| | - Simone Arolfo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Roberto Passera
- Division of Nuclear Medicine, University of Torino, Torino, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| |
Collapse
|
14
|
Manigrasso M, Anoldo P, Milone F, De Palma GD, Milone M. Case report of an uncommon case of drain-site hernia after colorectal surgery. Int J Surg Case Rep 2018; 53:500-503. [PMID: 29342445 PMCID: PMC6290395 DOI: 10.1016/j.ijscr.2017.12.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/23/2017] [Indexed: 02/07/2023] Open
Abstract
Trocar site herniation is a rare but potentially serious complication of laparoscopic surgery. We report an uncommon case of drain site hernia. The risk of trocar site hernia in laparoscopy has been known since 1967. Other two cases are described in literature regarding pediatric and gynaecologic patients. Drain should not be positioned through the 10 mm trocar in order to avoid any herniation.
Background trocar site herniation is a rare but potentially serious complication of laparoscopic surgery. Data about drain site hernia after laparoscopic surgery is scarce and anecdotal. Case presentation we report an uncommon case of drain site hernia in a man undergone laparoscopic left colectomy for a colonic adenocarcinoma who developed small bowel herniation in a 10 mm port site, in which a 24 FR drain was inserted leaving a real free space of 2 mm. Discussion laparoscopic approach has gained widespread acceptance in each surgical fields because of the perceived better postoperative outcomes in terms of less pain, faster recovery, and lower risk of incisional hernia. However, the risk of trocar site hernia has been known since 1967. Different risk factors for the development of trocar site hernia are described in literature: the trocar diameter and design, preexisting fascial defects, enlargement of a port site to remove a specimen, high blood glucose levels, obesity, increase intra-abdominal pressure as in chronic obstructive airway disease or extensive manipulation of the trocar during surgical intervention, which may enlarge the trocar site and thus induce small bowel herniation. However, the most important recognized risk factor for trocar site hernia is the size of the trocar. Conclusions waiting for further studies, the lesson to be learnt from this case report is that, even if the free space after drain positioning is minimal, drain should not be positioned through the 10 mm trocar to allow the closure of fascial defect in order to avoid any herniation.
Collapse
Affiliation(s)
- M Manigrasso
- Department of Surgical Specialties and Nephrology, University "Federico II" of Naples, Italy.
| | - P Anoldo
- Department of Surgical Specialties and Nephrology, University "Federico II" of Naples, Italy.
| | - F Milone
- Department of Surgical Specialties and Nephrology, University "Federico II" of Naples, Italy.
| | - G D De Palma
- Department of Surgery and Advanced Technologies, University "Federico II" of Naples, Italy.
| | - M Milone
- Department of Surgical Specialties and Nephrology, University "Federico II" of Naples, Italy.
| |
Collapse
|
15
|
Mohammadhosseini B. Tehran's Tie: A simple trick to fix the trocar to the abdominal wall and close the entry site of first trocar in laparoscopic surgery. Asian J Endosc Surg 2017; 10:216-218. [PMID: 28547929 DOI: 10.1111/ases.12352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 12/01/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Trocar dislodgment can occur frequently during minimally invasive surgery. Closing the entry port at the fascial layer after the end of a long laparoscopic surgery is time-consuming. Here, I introduce Tehran's Tie, a simple trick to overcome these problems. MATERIALS AND SURGICAL TECHNIQUE After the first trocar site has been created with the open technique and before the first port is inserted, the fascial wound is grasped with a loop of nylon thread, similar to a transverse matrix suture. Then, the trocar is inserted through the loop into the abdominal cavity. One thread is tied around the trocar to fix it. Another thread is used to tie and close the fascial defect at the end of laparoscopic surgery. DISCUSSION Tehran's Tie is a simple trick for managing the first trocar site in laparoscopic surgery. It is a very useful and easy trick for fixing the first trocar to the abdominal wall and for closing the port site at the end of the procedure.
Collapse
|
16
|
Shope AJ, Winder JS, Bliggenstorfer JT, Crowell KT, Haluck RS, Pauli EM. Force Comparison of Commercially Available Transfascial Suture Passers. Surg Innov 2017; 24:301-308. [PMID: 28178871 DOI: 10.1177/1553350617691709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Transfascial suture passers (TSPs) are a commonly used surgical tool available in a wide array of tip configurations. We assessed the insertion force of various TSPs in an ex vivo porcine model. METHODS Uniform sections of porcine abdominal wall were secured to a 3D-printed platform. Nine TSPs were passed through the abdominal wall both without and with prolene suture under the following scenarios: abdominal wall only and abdominal wall plus underlay ePTFE or composite ePTFE/polypropylene mesh. Insertion forces were recorded in Newton (N). RESULTS When passed without suture through the abdominal wall, smaller diameter TSPs required less insertional force (1.50 ± 0.17 N vs 9.68 ± 1.50 N [ P = 0.00072]). Through composite mesh, the solid tipped TSPs required less force than hollow tipped ones (3.87 ± 0.25 N vs 7.88 ± 0.20 N [ P = 0.00026]). Overall, smaller diameter TSPs required less force than the larger TSPs when passed through ePTFE empty (Gore 2.95 ± 0.83 N vs Carter-Thomason 16.07 ± 2.10 N [ P = .0005]) or with suture (Gore 8.37 ± 2.59 N vs Carter-Thomason 19.12 ± 1.10 N [ P = .003]). CONCLUSIONS Diameter plays the greatest role in the force required for TSP penetration. However, when passed through underlay mesh or while holding suture, distal tip shape, the mechanism of suture holding, and shaft diameter all contribute to the forces necessary for penetration. These factors should be considered when choosing a TSP for intraoperative use.
Collapse
Affiliation(s)
| | | | | | | | | | - Eric M Pauli
- 1 The Pennsylvania State University, Hershey, PA, USA
| |
Collapse
|
17
|
Lasheen AE, Salem A, Abd Elaal S, Elsheweal AE, Osman G, Alkilany M, Ibrahim A. Percutaneous trans-abdominal external looped needle with two holes in the trocar sheath for port-site closures in difficult obese cases. Asian J Endosc Surg 2016; 9:295-299. [PMID: 27452810 DOI: 10.1111/ases.12302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/05/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Port closure is essential after successful laparoscopic surgery to prevent incisional hernia. However, good fascial closure still represents a problem, especially in obese patients and when the port wound is oblique. We report a novel technique for port-site closures in such cases. METHODS This study involved 67 obese patients who underwent laparoscopic surgery. We used a novel technique for port-site closure that employed a looped needle passed through two holes in the port sheath. RESULTS The method was used in 67 patients (45 laparoscopic cholecystectomies, 22 laparoscopic hernia repairs), with a mean BMI of 35.7 kg/m2 . No intraoperative incidents or port-site hernias were reported during follow-up (mean, 22 months). CONCLUSION Our procedure is safe, easy, and effective for fascial port site closures, especially in cases of difficult obese patients and oblique port wounds.
Collapse
Affiliation(s)
- Ahmed E Lasheen
- General and Laparoscopic Surgery Department, Zagazig University Hospital, Zagazig University, Zagazig, Egypt.
| | - Ayman Salem
- General and Laparoscopic Surgery Department, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Salah Abd Elaal
- General and Laparoscopic Surgery Department, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Abd Elhafez Elsheweal
- General and Laparoscopic Surgery Department, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Gamal Osman
- General and Laparoscopic Surgery Department, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Mohammed Alkilany
- General and Laparoscopic Surgery Department, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| | - Amr Ibrahim
- General and Laparoscopic Surgery Department, Zagazig University Hospital, Zagazig University, Zagazig, Egypt
| |
Collapse
|
18
|
Singal R, Zaman M, Mittal A, Singal S, Sandhu K, Mittal A. No Need of Fascia Closure to Reduce Trocar Site Hernia Rate in Laparoscopic Surgery: A Prospective Study of 200 Non-Obese Patients. Gastroenterology Res 2016; 9:70-73. [PMID: 27785329 PMCID: PMC5040548 DOI: 10.14740/gr715w] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 01/12/2023] Open
Abstract
Background Laparoscopy is widely practiced and offers realistic benefits over conventional surgery. Port closure is important after a laparoscopic procedure to prevent port site incisional hernia. Larger port size and increasing numbers of ports needed to perform more complex laparoscopic procedures are likely to increase the incidence of port site hernias (PSHs). PSHs tend to develop more frequently at umbilical and midline port sites due to the thinness of the umbilical skin and weaknesses in the linea alba. More than 90% of PSHs occur through 10 mm and large ports can occur through 5 mm ports also. The aim was to study the outcomes and complications in laparoscopic surgery without fascial sheath closure of port site. We compared the results with another group in which fascial closure was done by a standard method. Methods This was a prospective study carried out in the Department of Surgery, MMIMSR, Mullana, Ambala, from August 2013 to 2015 in a single unit by a single surgeon. A total of 200 patients were selected randomly for the different laparoscopic procedures. Patients were divided into group A (only skin closure was done without fascia closure) and group B (fascial closure of the port in addition to skin closure). In both groups, we used blunt trocar for the 10 mm port. Skin of the 5 mm port was closed simply. The results in two groups were compared in terms of complications like PSH, bleeding, and wound infection. Results The outcomes in two groups were compared with and without fascia closure of 10 mm trocar port site. Patients operated for lap cholecystectomy were 170 (85%), 10 (5%) for lap appendicectomy, and 20 (10%) for lap hernia. The study compared the results in two groups mainly for PSH formation. The P value was insignificant and Fischer’s exact test result came as 1.00. There were no significant differences between the two groups in terms of PSH, bleeding and infection in non-obese cases. Conclusion In both groups, blunt trocar was introduced into the abdomen. We concluded that this is safe, without visceral injury, and no bleeding was seen in both the groups. We had not encountered any case with PSH formation in follow-up of 6 - 8 months. There was no infection over the port site.
Collapse
Affiliation(s)
- Rikki Singal
- Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Distt-Ambala, Haryana, India
| | - Muzzafar Zaman
- Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Distt-Ambala, Haryana, India
| | - Amit Mittal
- Department of Radiodiagnosis and Imaging, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Distt-Ambala, Haryana, India
| | - Samita Singal
- Department of Radiodiagnosis and Imaging, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Distt-Ambala, Haryana, India
| | - Karamjot Sandhu
- Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Distt-Ambala, Haryana, India
| | - Anshu Mittal
- Department of SPM, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana, Distt-Ambala, Haryana, India
| |
Collapse
|
19
|
Lasheen AE, Safwat K, Elsheweal A, Ibrahim A, Mahmoud R, Alkilany M, Ismaeil A. Effective, simple, easy procedure for laparoscopic port closure in difficult cases. Ann Med Surg (Lond) 2016; 10:36-40. [PMID: 27536351 PMCID: PMC4976136 DOI: 10.1016/j.amsu.2016.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/03/2016] [Accepted: 06/04/2016] [Indexed: 01/31/2023] Open
Abstract
Background Laparoscopic and rebotic surgery is widely practiced in modern medicine. The operative procedure is not complete until the port sites are closed with a fascial closure. Good fascial closure still represents problem, especially in difficult obese patients. This study reported simple technique is suitable in such cases. Material and methods We herein describe a simple technique for fascial closure after Laparoscopic surgery using percutaneous transabdominal approach by using two looped needles in 87 obese patients. This technique was done while the trocar sheath in its position. Results The procedure was used in 87 patients (69 females and 18 males) after laparoscopic cholecystectomy with mean body mass index 35.5 kg/m2 and mean age 47.1 years from May 2013 through June 2015. No intra-operative incidents and no port sites hernias were reported during a mean follow up of 18 months. Conclusion The procedure is easy to perform, safe, and effective for fascial port site closure in difficult obese (thick abdominal wall and oblique port wound) cases. The complete fascial closure of port site is essential for good outcome of laparoscopic surgery. Port site herniation is serious complication leading to loss all mini-invasive surgery advantages. Our technique is done under direct visualization and trocar sheath in its position. Our procedure is effective, easy to produce complete fascial closure at any port site type and in any case.
Collapse
Affiliation(s)
- Ahmed E Lasheen
- General, Laparoscopic Department, Zagazig University Hospital, Zagazig University, 44519, Egypt
| | - Khaled Safwat
- General, Laparoscopic Department, Zagazig University Hospital, Zagazig University, 44519, Egypt
| | - AbdElhafez Elsheweal
- General, Laparoscopic Department, Zagazig University Hospital, Zagazig University, 44519, Egypt
| | - Amr Ibrahim
- General, Laparoscopic Department, Zagazig University Hospital, Zagazig University, 44519, Egypt
| | - Ramadan Mahmoud
- General, Laparoscopic Department, Zagazig University Hospital, Zagazig University, 44519, Egypt
| | - Mohammed Alkilany
- General, Laparoscopic Department, Zagazig University Hospital, Zagazig University, 44519, Egypt
| | - Ashraf Ismaeil
- General, Laparoscopic Department, Zagazig University Hospital, Zagazig University, 44519, Egypt
| |
Collapse
|
20
|
Fascial Repair of Laparoscopic Ports with Allis-Hemostat Technique. Indian J Surg 2016; 77:245-7. [PMID: 26730002 DOI: 10.1007/s12262-012-0784-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 11/21/2012] [Indexed: 10/27/2022] Open
Abstract
Port site hernias are one of the most serious complications associated with laparoscopic surgery. In this study, we present a simple and reliable method for port site closure in laparoscopic surgery. From 2005 to 2011, 500 patients who underwent laparoscopic surgery were enrolled for the study. They were evaluated considering age, sex, indication of laparoscopic surgery, and early and late complications of port site and were followed up at least for 1 year after the surgery. In our study, 180 males and 320 females with mean age of 36 years were enrolled. The most common indication for laparoscopic surgery was cholecystectomy in 320 patients (64 %). There were no early or late complications of port site after surgery. Our method is a new modification of the procedure presented by Spalding. Using Allis forceps and putting it under the fascia seems to be a more suitable technique which facilitates the laparoscopic port repair. We found it to be extremely safe, simple, and easy to teach.
Collapse
|
21
|
Incisional and port-site hernias following robotic colorectal surgery. Surg Endosc 2015; 30:3505-10. [PMID: 26541723 DOI: 10.1007/s00464-015-4639-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 10/19/2015] [Indexed: 01/30/2023]
Abstract
BACKGROUND The association between extraction site location, robotic trocar size, and the incidence of incisional hernias in robotic colorectal surgery remain unclear. Laparoscopic literature reports variable rates of incisional hernias versus open surgery, and variable rates of trocar site hernias. However, conclusions from these studies are confusing due to heterogeneity in closure techniques and may not be generalized to robotic cases. This study evaluates the effect of extraction site location on incisional hernia rates, as well as trocar hernia rates in robotic colorectal surgery. MATERIALS AND METHODS A retrospective review of multiport and single incision robotic colorectal surgeries from a single institution was performed. Patients underwent subtotal, segmental, or proctocolectomies, and were compared based on the extraction site through either a muscle-splitting (MS) or midline (ML) incision. Hernias were identified by imaging and/or physical exam. Demographics and risk factors for hernias were assessed. Groups were compared using a multivariate logistic regression analysis. RESULTS The study included 259 colorectal surgery patients comprising 146 with MS and 113 with ML extraction sites. Postoperative computed tomograms were performed on 155 patients (59.8 %) with a mean follow-up of 16.5 months. The overall incisional hernia rate was 5.8 %. A significantly higher hernia rate was found among the ML group compared to the MS group (12.4 vs. 0.68 %, p < 0.0001). Of the known risk factors assessed, only increased BMI was associated with incisional hernias (OR 1.18). No trocar site hernias were found. CONCLUSION Midline extraction sites are associated with a significantly increased rate of incisional hernias compared to muscle-splitting extraction sites. There is little evidence to recommend fascia closure of 8-mm trocar sites.
Collapse
|
22
|
Bailey CD, Frumovitz M. Preventing Complications in Minimally Invasive Gynecologic Surgery. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2015. [DOI: 10.1007/s13669-015-0123-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
23
|
Rajendiran A, Maruthupandian D, Karunakaran K, Syed MNA. Aneurysm Needle as an Effective Tool in Laparoscopic Port Closure. J Laparoendosc Adv Surg Tech A 2015; 25:744-6. [PMID: 26287316 DOI: 10.1089/lap.2015.0249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The importance of port closure after laparoscopic surgeries is emphasized by the extensive number of techniques being described for the same. Even so, the search for a simple, time-saving, and effective technique still continues. One commonly overlooked factor is the obliquity of laparoscopic ports, which makes direct visualization of the rectus fascia through the skin incision difficult. Also, our patients, mostly of Indian ethnicity, tend to have relatively thick subcutaneous fat that again acts as a constraint during port closure. We have described a simple and effective method of laparoscopic port closure using Moynihan's aneurysm needle and a skin hook. This technique is particularly advantageous in the above-mentioned scenarios. We have been successfully using this technique in our institution for the past 6 years, and we have not encountered any case of port-site hernia. Our technique does not require expensive instruments or the need for visualization via a camera.
Collapse
Affiliation(s)
- Ashwin Rajendiran
- Department of General Surgery, Madurai Medical College , Madurai, Pondicherry, India
| | | | | | | |
Collapse
|
24
|
Sima E, Hedberg J, Ehrenborg A, Sundbom M. Differences in early complications between circular and linear stapled gastrojejunostomy in laparoscopic gastric bypass. Obes Surg 2015; 24:599-603. [PMID: 24323525 DOI: 10.1007/s11695-013-1139-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Laparoscopic gastric bypass (LGBP) is the most common bariatric procedure worldwide. The gastrojejunostomy can be stapled with a circular or linear stapler, each with their own specific advantages. We have evaluated differences in postoperative complications between the two techniques. METHODS We studied operative data and postoperative complications in 560 patients (79.8 % females, median age 42, BMI 42.5) operated with LGBP between 2008 and 2012 at our center. The gastrojejunostomy was initially performed using a circular stapler (CS) in 288 patients and later by linear stapler (LS) in 272. Complications, operative time, and length of stay were retrieved from our database. The risk of developing a port site infection was evaluated with multivariate logistic regression. RESULTS Port site infections were more common with CS than LS, 5.2 and 0.4 %, respectively (p < 0.01). Multivariate analysis demonstrated CS to be an independent risk factor for port site infections (OR 16.3 (2.09-126), p < 0.01), as well as for stomal ulcers (OR 10.1, 1.15-89, p = 0.04). Major postoperative complications remained unchanged (anastomotic leak 1.0 vs. 1.1 %, abscess 0.7 vs. 0.4 %), while operative time and length of stay were found to be shorter using the LS (122 vs. 83 min, p < 0.001 and 4 vs. 3 days, p < 0.001). CONCLUSIONS The linear stapled technique yielded lower incidence of port site infections, probably by avoiding the passage of a contaminated circular stapler through the abdominal wall. No difference in major complications was seen, but operative time was shorter using a linear stapler instead of a circular stapler.
Collapse
Affiliation(s)
- E Sima
- Department of Surgical Sciences, Uppsala University, 75185, Uppsala, Sweden,
| | | | | | | |
Collapse
|
25
|
Coblijn UK, de Raaff CAL, van Wagensveld BA, van Tets WF, de Castro SMM. Trocar Port Hernias After Bariatric Surgery. Obes Surg 2015; 26:546-51. [DOI: 10.1007/s11695-015-1779-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
26
|
Securing the surgical field in laparoscopic pancreatectomy using a Penrose drain and Endo Close. Surg Laparosc Endosc Percutan Tech 2015; 25:e101-3. [PMID: 26039800 DOI: 10.1097/sle.0000000000000116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We adopted the use of Penrose drains and Endo Close to secure a good surgical field during laparoscopic pancreatectomy. METHODS We used a Penrose drain with threads ligated on both ends to suspend the stomach. We then pulled the threads out of the body from the side of the trocar or from besides the xiphisternum by using Endo Close. In most cases, 2 Penrose drains were used to retract the stomach. When the greater omentum on the left side of the cardia still blocks the surgical field, we sewed the posterior wall of the stomach onto the dome of the diaphragm. RESULTS The use of 2 Penrose drains and Endo Close were effective to retract the stomach in most cases. However, in 3 cases, we needed to additionally sew the stomach onto the diaphragm to fully open up the field. CONCLUSION This is a simple and effective method to ensure a good surgical field.
Collapse
|
27
|
Pulle MV, Siddhartha R, Dey A, Mittal T, Malik VK. Port site hernia in laparoscopic surgery: Mechanism, prevention and management. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.cmrp.2015.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
|
28
|
Predictors of incisional hernia after robotic assisted radical prostatectomy. Adv Urol 2015; 2015:457305. [PMID: 25709645 PMCID: PMC4332979 DOI: 10.1155/2015/457305] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/18/2014] [Accepted: 01/12/2015] [Indexed: 01/21/2023] Open
Abstract
Introduction. To explore the long term incidence and predictors of incisional hernia in patients that had RARP. Methods. All patients who underwent RARP between 2003 and 2012 were mailed a survey reviewing hernia type, location, and repair. Results. Of 577 patients, 48 (8.3%) had a hernia at an incisional site (35 men had umbilical), diagnosed at (median) 1.2 years after RARP (mean follow-up of 5.05 years). No statistically significant differences were found in preoperative diabetes, smoking, pathological stage, age, intraoperative/postoperative complications, operative time, blood loss, BMI, and drain type between patients with and without incisional hernias. Incisional hernia patients had larger median prostate weight (45 versus 38 grams; P = 0.001) and a higher proportion had prior laparoscopic cholecystectomy (12.5% (6/48) versus 4.6% (22/480); P = 0.033). Overall, 4% (23/577) of patients underwent surgical repair of 24 incisional hernias, 22 umbilical and 2 other port site hernias. Conclusion. Incisional hernia is a known complication of RARP and may be associated with a larger prostate weight and history of prior laparoscopic cholecystectomy. There is concern about the underreporting of incisional hernia after RARP, as it is a complication often requiring surgical revision and is of significance for patient counseling before surgery.
Collapse
|
29
|
Transvaginal appendectomy in morbidly obese patient. Case Rep Surg 2014; 2014:368640. [PMID: 25506028 PMCID: PMC4258338 DOI: 10.1155/2014/368640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 10/29/2014] [Indexed: 01/17/2023] Open
Abstract
Introduction. Laparoscopic appendectomy has significant benefits in obese patients. However, morbid obesity can be accepted as an exclusion criterion for natural orifice transluminal endoscopic surgery (NOTES). Here, we present a transvaginal appendectomy in a 66-year-old morbidly obese (BMI 36 kg/m2, ASA III) patient. Case and Technique. Acute appendicitis was suspected based on history, physical examination, laboratory tests, and ultrasound findings. During laparoscopic surgery, a 5 mm trocar was inserted through the umbilicus and a 5 mm telescope was placed. A 12 mm trocar and a 5 mm grasper were inserted separately through the posterior fornix of the vagina under laparoscopic guidance. The appendix was divided with an endoscopic stapler through the transvaginal 12 mm trocar and removed from the same trocar. The operating time was 75 minutes with minimal blood loss (<10 mL). The patient was discharged 16 hours after surgery uneventfully and she did not require any analgesic administration. Conclusion. To the best of our knowledge, this is the first clinical case that focuses on the transvaginal appendectomy at morbid obesity. We can say that morbid obesity does not constitute an obstacle for treatment of acute appendicitis by transvaginal endoscopic surgery.
Collapse
|
30
|
Abstract
The author reports on a technique of port site closure that is simple, cost-effective, and quick to apply. Background: Laparoscopic and robotic surgery is widely practiced in modern medicine. The operative procedure is not complete until the port sites are closed with a fascial suture. We report a simple new technique that is easy, cost-effective, and quick to apply using 2 S-retractors for suture placement under direct visualization to secure the abdominal wall fascia and peritoneum. Materials and Methods: As a prospective consecutive case series, this technique was used for fascial closure after laparoscopy ports > 8 mm using 2 S-retractors. One S-retractor is used as a barrier protecting the contents of the abdominal cavity, reducing the risk of visceral injuries. The second S-retractor allows us to directly visualize the different layers, exposing the needle tip during its course through the fascia. Results: This method was used in 100 patients with no intraoperative incidents, additional operative time, or need to access costly instruments. Currently, this technique is also used by many surgeons in our institution without any difficulty. No bowel injuries or port-site hernias were reported during a mean follow-up of 6 wk postoperation and 12-mo annual follow-up. Conclusion: The procedure is simple, easy, cost-effective, and quick to apply.
Collapse
Affiliation(s)
- Homayara Haque Aziz
- Department of Gynecology and Obstetrics, State University of New York, University at Buffalo, Buffalo, NY, USA; Millard Fillmore Suburban Hospital Kaleida Health, Buffalo, NY, USA; Department of Obstetrics and Gynecology, University of Maryland, Baltimore Washington Medical Center, 7556 Teague Rd Suite 430, Hanover MD 21076, USA.
| |
Collapse
|
31
|
Trocar site hernia after bariatric surgery: Our experience without fascial closure. Int J Surg 2014; 12 Suppl 1:S83-6. [DOI: 10.1016/j.ijsu.2014.05.047] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 12/18/2022]
|
32
|
del Junco M, Okhunov Z, Juncal S, Yoon R, Landman J. Evaluation of a Novel Trocar-Site Closure and Comparison with a Standard Carter-Thomason Closure Device. J Endourol 2014; 28:814-8. [DOI: 10.1089/end.2014.0069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Samuel Juncal
- Department of Urology, University of California, Irvine
| | - Renai Yoon
- Department of Urology, University of California, Irvine
| | - Jaime Landman
- Department of Urology, University of California, Irvine
| |
Collapse
|
33
|
Armañanzas L, Ruiz-Tovar J, Arroyo A, García-Peche P, Armañanzas E, Diez M, Galindo I, Calpena R. Prophylactic mesh vs suture in the closure of the umbilical trocar site after laparoscopic cholecystectomy in high-risk patients for incisional hernia. A randomized clinical trial. J Am Coll Surg 2014; 218:960-8. [PMID: 24680572 DOI: 10.1016/j.jamcollsurg.2014.01.049] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 12/23/2013] [Accepted: 01/13/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prosthetic repair has become the standard method for hernia repair. Mesh placement for the prevention of trocar site incisional hernia (TSIH) is still a controversial issue. We tested the hypothesis that closure with an intraperitoneal prophylactic mesh of the umbilical trocar after a laparoscopic cholecystectomy can reduce the incidence of a TSIH in high-risk patients. STUDY DESIGN A randomized clinical trial was conducted among patients undergoing elective laparoscopic cholecystectomy who presented the following high-risk factors for incisional hernia, according to the literature: age 65 years and older, diabetes mellitus, chronic pulmonary disease, and obesity (ie, body mass index ≥30 kg/m(2)). Patients were assigned to have closure of the umbilical trocar site with either nonabsorbable sutures (group A) or intraperitoneal polypropylene omega-3 mesh (group B). Trocar site incisional hernia, pain, and surgical complications were evaluated at the early postoperative course and at 1, 6, and 12 months after surgery. RESULTS A total of 106 patients were randomized into the study and 92 patients were finally analyzed, including 47 in group A and 45 in group B. The TSIH rate was higher in group A (31.9%) than in group B (4.4%) (odds ratio = 10.1; 95% CI, 2.15-47.6; p < 0.001)). The wound infection rate was 4.3%; 8.5% in group A and 0% in group B (odds ratio = 2.04; 95% CI, 1.7-2.5; p = 0.045). Median postoperative pain evaluated by a visual analogue scale was 3 in group A and 2 in group B (p = 0.05). No differences were observed in complication rate, operative time, or hospital stay between the groups. CONCLUSIONS Prosthetic closure of the umbilical trocar site after laparoscopic surgery could become the standard method for preventing TSIH in high-risk patients.
Collapse
Affiliation(s)
- Laura Armañanzas
- Department of Surgery, General University Hospital Elche, Elche, Spain.
| | - Jaime Ruiz-Tovar
- Department of Surgery, General University Hospital Elche, Elche, Spain; Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain
| | - Antonio Arroyo
- Department of Surgery, General University Hospital Elche, Elche, Spain; Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain
| | | | | | - María Diez
- Department of Surgery, General University Hospital Elche, Elche, Spain
| | - Isabel Galindo
- Department of Surgery, General University Hospital Elche, Elche, Spain
| | - Rafael Calpena
- Department of Surgery, General University Hospital Elche, Elche, Spain; Department of Pathology and Surgery, School of Medicine, Miguel Hernandez University, Elche, Spain
| |
Collapse
|
34
|
Jayaraman S, Rao SD. Case Series of Umbilical and Extra-umbilical Port Site Herniae. Indian J Surg 2014; 75:488-91. [PMID: 24426656 DOI: 10.1007/s12262-013-0881-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 01/28/2013] [Indexed: 02/07/2023] Open
Abstract
Trocar site hernia or port site hernia (PSH) is a type of incisional hernia occurring at the trocar sites after laparoscopic surgeries. This is a rare but a potentially dangerous complication, as it can lead to considerable morbidity requiring surgical intervention. Various factors have been implicated for its development and various methods are also suggested for its prevention. We present here five cases of port site herniae.
Collapse
Affiliation(s)
| | - S Devaji Rao
- St. Isabel's Hospital, Chennai, India ; Dhanwanthri Surgical Clinic, 15, Vinayagam Street, Somu Colony, Chennai, 600028 India
| |
Collapse
|
35
|
Abstract
A modified Aptos needle appeared to allow an easy, simple, safe method for fascial closure of trocar sites. Background and Objectives: Trocar-site incisional hernias are the most common complications in laparoscopic surgery. Fascial closure of port sites represents a challenging issue in laparoscopic surgery. Methods: We describe a simple easy technique for fascial closure of port sites using a double-tip needle (Lasheen needle). This study included 100 patients who underwent laparoscopic surgery from January 2009 through August 2011 in the General Surgery Department, Zagazig University Hospital, Zagazig, Egypt. The mean follow-up period was 2 years for any wound complications at these trocar sites. Results: The mean age of the patients was 39.5 years, and the mean time for placement of one suture was 2 minutes. No trocar-site herniation occurred with our technique during the period of follow-up. Infection developed at the trocar site in 3 patients. Conclusion: This technique is easy, simple, safe, fast, inexpensive, and effective for fascial closure of trocar sites.
Collapse
Affiliation(s)
- Ahmed Lasheen
- General Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | | | | | |
Collapse
|
36
|
Vasant DH, Abraham A, Paine PA. Endoscopically assisted suturing of a persistent gastrocutaneous fistula by using a site closure device. Gastrointest Endosc 2013; 78:553-4. [PMID: 23948202 DOI: 10.1016/j.gie.2013.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 04/01/2013] [Indexed: 12/11/2022]
|
37
|
Bunker D, Ilie V, Fisher D. Laparoscopic Tenckhoff catheter insertion: a retrospective study over 6 years. ANZ J Surg 2012; 84:73-7. [PMID: 22985018 DOI: 10.1111/j.1445-2197.2012.06273.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2012] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Peritoneal dialysis via Tenckhoff catheter predisposes to hernia formation due to both local and systemic factors. Another important complication of peritoneal catheter insertion includes infection, which can prompt removal of the catheter. METHODS We performed a retrospective study between January 2005 and July 2011 of 61 patients who underwent laparoscopic placement of a Tenckhoff catheter and peritoneal dialysis at our institution using a single-port technique. We analysed complications of Tenckhoff insertion, specifically infection and the formation of hernias requiring operative management. RESULTS Infections noted in our patients included peritonitis (10%) and exit-site infection (5%). Of the five patients who required re-insertion of Tenckhoff catheter, four were for infective complications. A total of seven hernias developed in five (8%) of patients, mostly inguinal or umbilical near the Hassan port entry site. DISCUSSION With infection and hernia formation being the main contributors to failure of the procedure, actively addressing the entry site and areas predisposed to hernia formation, observing aseptic technique and meticulous attention to early signs of complications during follow-up are vital to improve success rates. The outcomes of the laparoscopic single-port insertion technique shows promise compared with conventional Tenckhoff catheter insertion techniques.
Collapse
Affiliation(s)
- Daniel Bunker
- Surgery Department, Dubbo Base Hospital, Dubbo, New South Wales, Australia
| | | | | |
Collapse
|
38
|
Dotai T, Coker AM, Antozzi L, Acosta G, Michelotti M, Bildzukewicz N, Sandler BJ, Jacobsen GR, Talamini MA, Horgan S. Transgastric large-organ extraction: the initial human experience. Surg Endosc 2012; 27:394-9. [PMID: 22806531 DOI: 10.1007/s00464-012-2473-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 06/17/2012] [Indexed: 12/13/2022]
Abstract
INTRODUCTION In laparoscopy, it often is the case that port sites are enlarged for specimen extraction. This leads to higher risk of trocar site complications, such as infection or incisional hernia. Natural orifice surgery (NOTES) is beneficial for minimizing these complications, and this is emphasized when the extracted specimen is of large volume. We have been using transgastric technique for appendectomy, cholecystectomy, and laparoscopic sleeve gastrectomy (LSG). Of these transgastric operations, we focus on the one with relatively large-organ extraction: LSG with transoral remnant extraction (TORE). We describe the details and feasibility of this procedure and compare the outcomes to conventional LSG. METHODS All patients undergoing LSG were considered candidates for TORE and were consented for this procedure if interested after an informed discussion. Eighteen LSGs with TORE (TORE group) and ten conventional LSGs (non-TORE group) were performed from August 2010 to March 2011. We retrospectively compared these two groups for the age, sex, preoperative body mass index, operating room time, hospital stay, excess weight loss (EWL), and trocar site complications. Laparoscopic sleeve gastrectomy with TORE consists of conventional LSG and transgastric retrieval of the resected stomach. The procedure exceeds exactly the same manner as conventional LSG until the initial stapling of the stomach. For TORE, the gastrectomy is initiated 5 cm proximal to the pylorus than usual LSG to save the space for the gastrotomy used for specimen retrieval. After the gastrectomy is completed, the full thickness of the distal most part of the staple line is incised open as wide as 2 cm by using electric cautery or ultrasonic dissector. A flexible upper endoscope, which has been in the stomach already as a bougie for gastrectomy, is then guided into the peritoneal cavity through the gastrotomy. The specimen is grasped endoscopically with a snare and extracted transorally. Following this, the gastrotomy is closed laparoscopically. The final shape of the gastric sleeve is identical to the one of conventional LSG. RESULTS There was no significant difference between the TORE and the non-TORE group for patients' profile, operating room time, hospital stay, and EWL. Neither group has experienced perioperative complications. All specimens were extracted readily and safely in the TORE group. Of the ten cases in the non-TORE group, four required extension of the trocar site. No trocar site complications were found in the TORE group, whereas the extended trocar site developed panniculitis in two cases of the non-TORE group; one required panniculectomy for refractory induration. CONCLUSIONS TORE can be safely and easily performed by surgeons with laparoscopic and endoscopic skill, and with commonly available instruments. While producing identical outcomes, our initial experience with the TORE technique demonstrates an advantage over traditional LSG, because it minimizes trocar site complications. Transgastric organ extraction is potentially applicable to other large-organ extractions in laparoscopic surgery without excessive risk or resources. Larger case volume and longer follow-up period is awaited.
Collapse
Affiliation(s)
- Takayuki Dotai
- The Center for the Future of Surgery, University of California San Diego, 9500 Gilman Drive, MET Building, CFS, La Jolla, CA 92093, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Trocar site hernia after the use of 12-mm bladeless trocar in robotic colorectal surgery. Surg Laparosc Endosc Percutan Tech 2012; 22:e34-6. [PMID: 22318075 DOI: 10.1097/sle.0b013e3182415320] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bladeless trocar decreases accidental injuries and incisional hernia; further a closure of fascial defect is considered to be unnecessary if a 12-mm bladeless trocar is used at nonmidline. We present a case of bowel herniation after using 12-mm bladeless trocar in robotic colorectal surgery. A 67-year-old woman had rectal cancer and underwent a robot-assisted low anterior resection. The facial defect after using 12-mm bladeless trocar was closed with the routine procedure. On postoperative day 7, her hernia of the trocar site was diagnosed by an abdominal computed tomography. The herniation was reduced with laparoscopic surgery. In conclusion, a trocar site hernia can occur after using a 12-mm bladeless trocar in robotic surgery.
Collapse
|
40
|
Natalin RA, Lima FS, Pinheiro T, Vicari E, Ortiz V, Andreoni C, Landman J. The final stage of the laparoscopic procedure: exploring final steps. Int Braz J Urol 2012; 38:4-16. [DOI: 10.1590/s1677-55382012000100002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2011] [Indexed: 11/21/2022] Open
|
41
|
Williams SB, Greenberger ML, Pearce WF, Tertzakian GM. Alternative technique for laparoscopic port-site closure. J Endourol 2011; 26:311-2. [PMID: 22149146 DOI: 10.1089/end.2011.0383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract 0-polyglactin suture into the abdomen via a puncture through the rectus fascia parallel to the fascia defect under visual guidance. Second, we perform a similar puncture with the tonsil forceps on the opposite side of the fascia defect under direct vision to grasp the suture. This cost-effective maneuver is safe and eliminates the need for ancillary port-site closure devices.
Collapse
Affiliation(s)
- Stephen B Williams
- Associated Urologists of Orange County, 1801 N. Broadway, Santa Ana, CA 92607, USA.
| | | | | | | |
Collapse
|
42
|
Lago J, Serralta D, García A, Martín J, Sanz M, Pérez MD, Turégano F. Randomized prospective trial on the occurrence of laparoscopic trocar site hernias. J Laparoendosc Adv Surg Tech A 2011; 21:775-9. [PMID: 22050610 DOI: 10.1089/lap.2011.0262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Laparoscopy has become the gold standard in an increasing number of procedures. We analyze the incidence of trocar site hernias (TSH) and determine whether closure of the external fascia prevents onset of TSH and possible complications. METHODS We performed a simple-blind randomized trial with two groups, one in which all the orifices were closed by suturing the external fascia of the abdominal wall (group A), and another in which the orifices were left open, closing only the skin (group B). Monitoring for TSH lasted 2 years from the intervention. The trial has been registered at www.clinicaltrials.gov with the clinicaltrials.gov identifier number: NCT01240434. RESULTS A total of 195 patients were randomized. Thirty-three were removed from the study after conversion to open surgery, early open reoperation, or loss to follow-up. The remaining 162 patients comprised the study population, 80 in group A and 82 in group B. We found no differences between the groups regarding basic demographic data, kind of surgery, or topographic distribution of the trocars. Five TSH were diagnosed-four in group A and one in group B (P=.176)-and there was no relation between TSH and trocar size (11 or 12 mm) or location. We found 10 wound infections, 7 in group A and 3 in group B (P=.154). CONCLUSION Our study suggests that the onset of TSH does not depend on trocar size or location. There is no evidence that suture of the fascial defect prevents the onset of TSH. In addition, we found a trend toward a higher incidence of wound infection among patients in whom the fascia had been sutured.
Collapse
Affiliation(s)
- Jesús Lago
- Servicio de Cirugía General II, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
The authors describe a technique that allows suture of the abdominal fascia at sites using a transcurtaneous approach and standard surgical instruments. Background and Objectives: Fascial closure of port sites represents a challenging issue in laparoscopic surgery. The aim of this article is to introduce a procedure that allows the safe suturing of the abdominal fascia in these wounds. Methods: We herein describe a simple technique for fascial closure after laparoscopy using a transcutaneous approach and standard surgical instruments for suture. Results: The method was used in 34 patients with no intraoperative incidents and no port-site hernias during a mean follow-up of 23.9 months (median 20.5, range 5 to 47). Conclusion: The procedure is easy to perform, safe, fast, and inexpensive.
Collapse
Affiliation(s)
- Florin Botea
- Liver Surgery Unit, 3rd Department of General Surgery, University of Milan, Faculty of Medicine, Humanitas Clinical Institute, Milan, Italy.
| | | | | |
Collapse
|
44
|
Pamela D, Roberto C, Francesco LM, Umberto M, Carla M, Vincenzo N, Stefano T, Eriberto F, Daniele G, Angelo D, Diego M, Micol Sole DP, Alessandro S, Maurizio B, Vito S, Nicola A, Francesco S. Trocar site hernia after laparoscopic colectomy: a case report and literature review. ISRN SURGERY 2011; 2011:725601. [PMID: 22084774 PMCID: PMC3200298 DOI: 10.5402/2011/725601] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 03/30/2011] [Indexed: 01/13/2023]
Abstract
Background. Trocar Site Hernia (TSH) is defined as an incisional hernia which occurs after minimally invasive surgery on the trocar incision site.In 2004 Tonouchi classified trocar site hernias into 3 types: Early onset type; Late onset type; Special type. Case Report. We report the case of a 76-year old woman that underwent an emergency explorative laparotomy on the 10th p.o. day after a laparoscopic left hemicolectomy. Surgery showed a small bowel herniation through the 12 mm trocar incision site; the intestinal loop appeared necrotic and had to be resected, and the hernia orifice was repaired. We carried out a review of literature about this topic. Discussion. The clinical onset of a trocar site hernia is usually early, occurring within the 30th post operative day and it is caused by the omentum or small bowel entrapment into the trocar orifice. The clinical presentation is insidious, with progression to an acute abdomen, and an emergency surgical approach is often required. Conclusions. TSH is a severe complication of operative laparoscopy especially with large-bore trocar ports. The incidence of TSH resulting from our review ranges from 0.007% to 22% with an average of 1.85%. Prevention of TSH appears to be more effective when trocar insertion through the abdominal wall is tangential, the closure of both the fascia and the peritoneum is performed if the incision is greater than 7 mm, the suture of extra umbilical port site is performed under laparoscopic vision.
Collapse
Affiliation(s)
- Delmonaco Pamela
- General Surgery Department, St. Maria Hospital, University of Perugia, 05100 Terni, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Owens M, Barry M, Janjua AZ, Winter DC. A systematic review of laparoscopic port site hernias in gastrointestinal surgery. Surgeon 2011; 9:218-24. [PMID: 21672662 DOI: 10.1016/j.surge.2011.01.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 12/23/2010] [Accepted: 01/03/2011] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Port site hernia is an important yet under-recognised complication of laparoscopic surgery, which carries a high risk of strangulation due to the small size of the defect involved. The purpose of this study was to examine the incidence, classification, and pathogenesis of this complication, and to evaluate strategies to prevent and treat it. METHODS Medline was searched using the words "port site hernia", "laparoscopic port hernia" "laparoscopic complications" and "trocar site hernias". The search was limited to articles on cholecystectomy, colorectal, bariatric or anti-reflux surgery published in English. A total of 42 articles were analysed and of these 35 were deemed eligible for review. Inclusion criteria were laparoscopic gastrointestinal surgery in English only with reported incidence of port site herniation. Studies were excluded if insufficient data was provided. Eligible studies were also cross-referenced. RESULTS Analysis of 11,699 patients undergoing laparoscopic gastrointestinal procedures demonstrated an incidence of port site hernias of 0.74% with a mean follow-up of 23.9 months. The lowest incidence of port site herniation was for bariatric surgery with 0.57% in 2644 patients with a mean follow-up of 67.4 months while the highest incidence was for laparoscopic colorectal surgery with an incidence of 1.47% in 477 patients with a mean follow-up of 71.5 months. CONCLUSION All fascial defects larger than or equal to 10mm should be closed with peritoneum, while smaller defects may require closure in certain circumstances to prevent herniation. Laparoscopic port site herniation is a completely preventable cause of morbidity that requires a second surgical procedure to repair.
Collapse
Affiliation(s)
- M Owens
- Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland
| | | | | | | |
Collapse
|
46
|
Rammohan A, Naidu RM. Laparoscopic port site Richter's hernia - An important lesson learnt. Int J Surg Case Rep 2010; 2:9-11. [PMID: 22096675 DOI: 10.1016/j.ijscr.2010.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 11/09/2010] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION We report a case of small bowel obstruction with strangulation caused by a port site hernia following a laparoscopic appendicectomy and the successful management of the problem by employing a laparoscopy assisted technique. The aim of this report is to emphasize the importance of fascial closures of trocar sites in order to significantly decrease postoperative morbidity. CASE REPORT A 31 years old female presented with a classic clinical picture of acute appendicitis. She underwent an uneventful laparoscopic appendicectomy. A 12 mm trocar was used at the umbilical port. On Postoperative day three, the patient developed abdominal distension, crampy abdominal pain, nausea and bilious vomiting. Her white cell count increased to 16,500/mm(3), and CRP was 145. X-ray abdomen showed dilated small bowel with multiple air fluid levels. CT scan showed a herniated loop of small bowel into the trocar site with small bowel obstruction. Laparoscopy was done to confirm the Richter's hernia into trocar site with small bowel obstruction. The bowel loop could not be reduced laparoscopically. Limited exploration of the trocar site confirmed findings with necrosis of the antimesenteric portion of the small bowel. A limited bowel resection and anastomosis was performed. The patient had an uneventful recovery. CONCLUSION Most port site hernias present within 10 days of the primary procedures, delayed hernias have been reported. CT scan is a helpful adjunct to differentiate port site hematoma from incarcerated small bowel. The knowledge of such a complication and its early diagnosis are important to avoid complications.
Collapse
|
47
|
Technical modifications in the robotic-assisted surgical approach for gynaecologic operations. J Robot Surg 2010; 4:253-7. [DOI: 10.1007/s11701-010-0223-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Accepted: 10/11/2010] [Indexed: 10/18/2022]
|
48
|
Laparoscopic cholecystectomy combined using miniaturised instruments in transgastric gall bladder removal: performed on 63 patients. Minim Invasive Surg 2010; 2010:582763. [PMID: 22091353 PMCID: PMC3196865 DOI: 10.1155/2010/582763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Accepted: 12/30/2009] [Indexed: 01/15/2023] Open
Abstract
Background. The laparoscopic cholecystectomy is a perfectly codified surgical procedure. The development of recent innovative and experimental surgical techniques Natural Orifice transluminal endoscopic surger (N.O.T.E.S.) which reduces the abdominal wall trauma leads us to develop a combined procedure of a standard dissection using miniaturised instruments already existing on the market (3 and 5 mm wide) and a gall bladder removal through a short gastrotomy Natural Orifice Specimen Extraction (N.O.S.E.). Methods. Our objective was to evaluate the safety, the feasibility, and the reproducibility of our new approach. After reviewing existing products on the market and a feasibility study, we put in place a protocol in our structure for patients on whom the procedure was performed. We carried out a gall bladder removal by a short gastrotomy, located on the anterior gastric wall, which then reduced the abdominal wall trauma and allowed them to resume normal physical activity quickly without risk of trocar site hernia. Results. We performed the procedure described in this paper on 63 patients, between April 2008 and July 2009. There were 14 men and 49 women with an average age of 46.8 years (ranging from 28 to 77) and an average BMI of 27.2. 30 patients had at least one gallstone larger than 10 mm. There was no postoperative gastric or abdominal wall complication and a fast recovery for all the patients in our study. Conclusions. This procedure is feasible, reproducible, with good results and minimal abdominal wall trauma. It is also safer than N.O.T.E.S. and endoscopic clipping and recovery, allowing normal physical activity, fast and, without risk of incisional hernia.
Collapse
|
49
|
Durai R, Ng PC. Novel Methods of Closing 10-mm Laparoscopic Port-Site Wounds. J Laparoendosc Adv Surg Tech A 2009; 19:791-3. [DOI: 10.1089/lap.2009.0023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rajaraman Durai
- Department of Surgery, University Hospital Lewisham, London, United Kingdom
| | - Philip C.H. Ng
- Department of Surgery, University Hospital Lewisham, London, United Kingdom
| |
Collapse
|
50
|
Su WH, Cheng MH, Tsou TS, Cheung SM, Chang SP, Wang PH. Port wound closure assisted by Foley catheter: An easier way to provide fascia security. J Obstet Gynaecol Res 2009; 35:725-31. [DOI: 10.1111/j.1447-0756.2008.01008.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|