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Wang C, Su C, Chen C, Tang X, Wang H, Li W, Li Y, Liu Q, Chen P, Li Y, Luo Y. Single-incision laparoscopic splenectomy in children with massive splenomegaly: A prospective, monocentric pilot study. Front Pediatr 2022; 10:1097416. [PMID: 36704139 PMCID: PMC9871812 DOI: 10.3389/fped.2022.1097416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Single-incision laparoscopic splenectomy (SILS) remains a challenging procedure because of the technical difficulty. In this prospective study, we aimed to evaluate the efficacy and safety of SILS in children with massive splenomegaly. METHODS Pediatric patients with massive splenomegaly were recruited for SILS in a university-affiliated hospital. The data on patient demographics, clinical features, operative variables, and perioperative outcomes were collected prospectively and analyzed. According to the different surgical instruments, the patients were randomly assigned into two groups: the SILS with straight surgical instrument (SILS-S) group and the SILS with curved surgical instrument (SILS-C) group. A two-group comparative analysis was conducted using perioperative data from the different surgical instrumentation systems. RESULTS A total of 120 patients were included, of which 103 patients (success group, 85.83%) had complete SILS, the other 17 (failure group, 14.17%) patients were converted to open (n = 4, 3.33%) or multi-incision laparoscopic surgery (n = 13, 10.83%). The major cause for surgical failure is uncontrollable bleeding (n = 14, 82.35%), and age, height, and weight were the risk factors for failure of SILS, but none of the parameters were independent risk factors. The blood loss in the success group was less than that in the failure group, but no significant differences in other operative and outcome indicators. For SILS, the mean (±SD) operative time was 188 (±48.70) minutes, the median intraoperative blood loss (min, max) was 20 (5, 290) ml, the mean (±SD) time of first anal exhaust was 23.9 (±7.73) hours, and the mean (±SD) postoperative hospital stay was 4.72 (±1.03) days. The median pain score was 3 on 1 day, and 1 on 3 days after the operation. Postoperative complications were identified in 8 (7.77%) cases. However, there were no peri-operative deaths in this series. The SILS-C group had a significantly shorter operation time than the SILS-S group (mean ± SD, 172 ± 44.21 vs. 205 ± 47.90 min). There were no significant differences between the two groups in other perioperative data (P < 0.05). CONCLUSION SILS is a safe and feasible treatment in pediatric patients with massive splenomegaly, and curved surgical instrumentation has contributed to developing surgical manipulation.
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Affiliation(s)
- Congjun Wang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Cheng Su
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Chao Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Xianming Tang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Hong Wang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Wei Li
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Yanqiang Li
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Qiang Liu
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Peng Chen
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Yong Li
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
| | - Yige Luo
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Medical University, Nanning, China
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Enhanced Laparoscopic Vision Improves Detection of Intraoperative Adverse Events During Laparoscopy. Ing Rech Biomed 2020. [DOI: 10.1016/j.irbm.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Shang Y, Guo H, Zhang D, Xue F, Yan X, Shi A, Dong D, Wang S, Ma F, Wang H, Li J, Liu X, Luo R, Wu R, Lv Y. An application research on a novel internal grasper platform and magnetic anchoring guide system (MAGS) in laparoscopic surgery. Surg Endosc 2016; 31:274-280. [PMID: 27177955 DOI: 10.1007/s00464-016-4968-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 05/03/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Laparoendoscopic single-site surgery and natural orifice transluminal endoscopic surgery attempt to reduce transabdominal port sites. These require all instruments to pass through a single access point, leading to instruments collide or work at unfamiliar angles. Thus, we designed an internal grasper under magnetic anchoring guide system (MAGS) platform and investigated its utility and operability. METHODS We measured the configuration for magnetic force decay over distance using a standardized, ex vivo laboratory testing apparatus. An electronic balance was used to measure the force of the gallbladder pull in ten patients with gallbladder stones. One pig (11 mm abdominal wall thickness) underwent a compressed trial of MAGS platform. The device was left in place for 20 min before tissue sections were harvested, and histologic assessment was performed. The utility and operability were investigated in four pigs (38-280 kg weight). RESULTS The magnetic attraction force decayed exponentially over distance; the force of pulling gallbladder was 7.46 ± 0.54 N. This pairing of components allowed for coupling to a theoretical distance of 10 mm. No gross tissue damage was observed. H-E stain showed no necrosis in all specimens. One failed due to wall thickness of 45 mm. Others showed the critical view, triangulation of instruments was obtained, and instrument collision or "sword fighting" was reduced. CONCLUSIONS The MAGS platform overcomes limitations such as collisions and lack of triangulation, reduces transabdominal port sites, and is easy to operate. However, our internal grasper requires the abdominal wall thickness below 10 mm.
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Affiliation(s)
- Yafei Shang
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.,Department of General Surgery, Xi'an Central Hospital, Xi'an, Shaanxi, China
| | - Hongjun Guo
- Department of General Surgery, Xi'an Hospital of Traditional Chinese Medicine, Xi'an, Shaanxi, China
| | - Da Zhang
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.,Department of General Surgery, Xi'an Central Hospital, Xi'an, Shaanxi, China
| | - Fei Xue
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Xiaopeng Yan
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Aihua Shi
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Dinghui Dong
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Shanpei Wang
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Feng Ma
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Haohua Wang
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Jianhui Li
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.,Department of Surgical Oncology, Shaanxi Province People's Hospital, Xi'an, Shaanxi, China
| | - Xuemin Liu
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Ruixue Luo
- Northwest Nonferrous Metal Research Institute, Xi'an, Shaanxi, China
| | - Rongqian Wu
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, Institute of Advanced Surgical Technology and Engineering, Shaanxi Center for Regenerative Medicine and Surgical Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
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Tugwell J, Brennan P, OShea C, ODonoghue K, Power T, OShea M, Griffiths J, Cahill R, Cantillon-Murphy P. Electropermanent Magnetic Anchoring for Surgery and Endoscopy. IEEE Trans Biomed Eng 2015; 62:842-8. [DOI: 10.1109/tbme.2014.2366032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Han WK, Tan YK, Olweny EO, Yin G, Liu ZW, Faddegon S, Scott DJ, Cadeddu JA. Comparison Between Magnetic Anchoring and Guidance System Camera-Assisted Laparoendoscopic Single-Site Surgery Nephrectomy and Conventional Laparoendoscopic Single-Site Surgery Nephrectomy in a Porcine Model: Focus on Ergonomics and Workload Profiles. J Endourol 2013; 27:490-6. [PMID: 23067039 DOI: 10.1089/end.2012.0484] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Woong Kyu Han
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yung K. Tan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ephrem O. Olweny
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Gang Yin
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Zhuo-Wei Liu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Stephen Faddegon
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Daniel J. Scott
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey A. Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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Simi M, Pickens R, Menciassi A, Herrell SD, Valdastri P. Fine Tilt Tuning of a Laparoscopic Camera by Local Magnetic Actuation. Surg Innov 2012; 20:385-94. [DOI: 10.1177/1553350612462458] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background. The magnetic surgical camera is an emerging technology having the potential to improve visualization without taking up port site space. However, tilting the point of view downward/upward can be done only by constantly applying a pressure on the abdomen. This study aims to test the hypothesis that the novel concept of local magnetic actuation (LMA) is able to increase the tilt range available for a magnetic camera without the need for deforming the abdominal wall. The hypothesis that 2-port laparoscopic nephrectomy in fresh tissue human cadavers could be performed by using the LMA camera is also tested. Methods. First, the 2 cameras were separately inserted, anchored, and moved inside the inflated abdomen. Tilting angles were quantified by image analysis while intra-abdominal pressure changes were monitored. Then, 5 two-port nephrectomies were performed by using the LMA camera while collecting quantitative outcomes. Results. The magnetic camera required a constant pressure on the magnetic handle to achieve an average ±20° tilt from the horizontal position, with an average of 7 mm Hg loss of intra-abdominal pressure. The LMA camera allowed for 75° of tilt from the horizontal position with a resolution of ±1°, without any need to deform the abdomen. All the nephrectomies were completed successfully within an average time of 11 minutes. Conclusion. LMA is an effective strategy to provide magnetic cameras with wide-range and high-resolution vertical motion without the need to deform the abdominal wall.
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Affiliation(s)
- Massimiliano Simi
- The Biorobotics Institute of Scuola Superiore Sant’Anna, Pisa, Italy
- STORM Lab, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Ryan Pickens
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Arianna Menciassi
- The Biorobotics Institute of Scuola Superiore Sant’Anna, Pisa, Italy
| | | | - Pietro Valdastri
- The Biorobotics Institute of Scuola Superiore Sant’Anna, Pisa, Italy
- STORM Lab, Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
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Arain NA, Rondon L, Hogg DC, Cadeddu JA, Bergs R, Fernandez R, Scott DJ. Magnetically anchored camera and percutaneous instruments maintain triangulation and improve cosmesis compared with single-site and conventional laparoscopic cholecystectomy. Surg Endosc 2012; 26:3457-66. [PMID: 22648118 DOI: 10.1007/s00464-012-2354-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 04/17/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study evaluated operative outcomes and ergonomics for a magnetic camera (MAGS) used in conjunction with percutaneous instruments [percutaneous surgical set (PSS)] compared with single-site laparoscopic (SSL) and conventional laparoscopic (LAP) cholecystectomy techniques. METHODS Four surgical trainees each performed three porcine cholecystectomies using three randomized techniques including MAGS/PSS, SSL, and LAP. The operative outcomes, procedure-specific ratings (1-5 scale; 1 = superior), workload (1-10 scale; 1 = superior), and global impressions (1-10 scale; 10 = superior) were recorded. Comparisons used analysis of variance (ANOVA) on ranks (Kruskal-Wallis), and p values lower than 0.05 were considered significant. RESULTS The operative outcomes were similar except for significantly higher blood loss with SSL (16.3 ± 10.3) versus LAP (2.8 ± 1.5; p < 0.05) but not with MAGS/PSS (4.8 ± 3.8). Several inadvertent tissue-damaging events occurred with SSL but not with MAGS/PSS or LAP. The incision was significantly shorter with MAGS/PSS (29.3 ± 2.8 mm) and SSL (29.3 ± 2.5 mm) than with LAP (48.0 ± 3.6 mm; p < 0.05). Compared with SSL (3.6 ± 0.5), the procedure-specific ratings significantly favored MAGS/PSS (2.8 ± 0.4) and LAP (1.7 ± 0.2; p < 0.05). Ergonomics and technical challenges both were rated significantly inferior with SSL (4.3 ± 1.0 and 3.8 ± 0.5, respectively) versus LAP (1.5 ± 0.6 and 2.0 ± 0.8, respectively; p < 0.05) but not with MAGS/PSS (2.5 ± 1.0 and 3.0 ± 0.8, respectively). Both MAGS/PSS (4.5 ± 0.5) and SSL (4.8 ± 1.0) were associated with a significantly greater workload than LAP (2.5 ± 0.6; p < 0.05). Global impression ratings were significantly higher for LAP (8.7 ± 1.3) versus SSL (5.8 ± 2.0; p < 0.05) but not for MAGS/PSS (7.1 ± 1.8). Cosmesis was significantly better with MAGS/PSS (9.5 ± 0.6) versus LAP (6.5 ± 2.4; p < 0.05) but not with SSL (8.8 ± 1.3). CONCLUSION The MAGS/PSS technique allows better triangulation and fewer technical difficulties than SSL and better cosmesis than LAP. Further development of these devices is warranted.
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Affiliation(s)
- Nabeel A Arain
- Department of Surgery, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9156, USA.
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