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Kim JW, Park JM, Chi KC. Convenience of Adding a Needle Grasper in Single-Incision Laparoscopic Distal Gastrectomy With Billroth I Anastomosis for Clinical Early Gastric Cancer. J Gastric Cancer 2022; 22:248-259. [PMID: 35938370 PMCID: PMC9359886 DOI: 10.5230/jgc.2022.22.e24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To overcome the technical difficulties of single-incision laparoscopic distal gastrectomy (SILDG), needle grasper (Endo ReliefTM)-assisted SILDG (NASILDG) was developed. Here, we compared the operative convenience and postoperative outcomes between SILDG and NASILDG. MATERIALS AND METHODS A needle grasper was inserted into the right upper abdomen and used in the NASILDG. We retrospectively reviewed patients who underwent D1 + dissection and delta-shaped Billroth I anastomosis with SILDG or NASILDG performed by a single surgeon between September 2015 and August 2018. RESULTS The SILDG (male, 50.0%) and NASILDG (male, 60.0%) groups included 10 and 15 patients, respectively. The operative time without combined operation and anastomosis was significantly shorter in the NASILDG group. Early complications and scar characteristics were not significantly different between the two groups. CONCLUSIONS By adding a needle grasper, SILDG became more convenient without decreasing cosmetic results. NASILDG could be a recommended method to reduce the technical difficulty of SILDG.
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Affiliation(s)
- Jong Won Kim
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Joong-Min Park
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyong-Choun Chi
- Department of Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
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2
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Single incision laparoscopic surgery (SILS) versus conventional laparoscopic technique for ileostomy: a retrospective cohort study. Langenbecks Arch Surg 2022; 407:1757-1763. [PMID: 35639135 DOI: 10.1007/s00423-022-02473-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 02/14/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Minimal-invasive surgery has gained wide acceptance in colorectal surgery. Single incision laparoscopic surgery (SILS) was designed to minimize surgical trauma and improve postoperative outcome. However, the role of SILS in ileostomy formation is unclear. METHODS In this retrospective cohort study 26 patients were included. Six patients were operated with SILS and 20 with conventional laparoscopic technique for ileostomy. We retrospectively evaluated patient charts for baseline characteristics including prior abdominal surgeries and combination of surgeries. Our primary efficacy objectives were operation time and postoperative hospitalization days. Our safety objectives included the prevalence of postoperative pain, parastomal hernia, incisional hernia, perforation, wound infection, ileus, and infections in general. RESULTS Baseline characteristics including previous abdominal surgery and concomitant surgeries were comparable in both groups. Total operation time using SILS (37.5 ± 6.2 min [mean ± SD]), compared to laparoscopic surgery (82.2 ± 54.8 min [mean ± SD]) was significantly shorter (p = 0.0002). In a sensitivity analysis excluding patients with combined surgery, ileostomy formation by SILS was shorter (36.5 ± 6.2 min [mean ± SD]), compared to laparoscopy (59.7 ± 28.7 min [mean ± SD]; p = 0.024). Length of postoperative stay was not statistically different between the groups (SILS: 5.5 ± 2.4 days [mean ± SD]; laparoscopic: 13.8 ± 17.3 days [mean ± SD], p = 0.193). Postoperative complication rates were low and comparable in both groups. CONCLUSION Placement of a loop ileostomy using SILS technique not only reduces surgical trauma but also operation time without affecting postoperative hospital stay or postoperative complication rates. Single-incision laparoscopic surgery for ileostomy is an appealing approach for ileostomy in selected patients.
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3
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Fathi A, Saleh MM, Shetiwy M, Elzahaby IA, Farouk O, Shams N, Elghandour MF, Abouzid A. Operative Outcomes of Single-Incision Laparoscopic Hysterectomy vs Conventional Laparoscopic Total Hysterectomy: A Prospective Randomized Controlled Study. Surg Innov 2021; 29:590-599. [PMID: 34465254 DOI: 10.1177/15533506211041892] [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: 11/16/2022]
Abstract
Background. Over time, there was an emerging need to shift from laparotomy to minimally invasive laparoscopic surgery, with the success of laparoscopic surgery in the last decade in gyne-oncology. Patients and Methods. This is a prospective randomized controlled trial conducted in Surgical Oncology Unit, Oncology Centre, Mansoura University, in the period between February 2016 and October 2019. Fifty female patients planned for total hysterectomy were randomized into two equal groups; the first underwent conventional laparoscopic hysterectomy (CLH), while the second underwent single-incision laparoscopic hysterectomy (SILH). Results. The mean operative time in the SILH group was 120.00 ± 28.72 minutes vs 103.20 ± 23.04 minutes in the CLH group (P= .027). Median hospital stay in the SILH group was 1 day (range: 1-3 days), the same as that in the CLH group, with no statistical significance (P= .384). Postoperative pain assessment using the Visual Analogue Scale (VAS) after 6 hours had a median score of 6 (2-8) in the SILH group and 6 (4-7) in the CLH group with significant increase in experienced pain in the SILH group (P= .004), while no significant difference was noted after 12 hours and 24 hours in both SILH and CLH groups. Conclusion. Single-incision laparoscopic hysterectomy (SILH) has similar outcomes when compared to conventional laparoscopic hysterectomy as regard blood loss, hospital stay, conversion to laparotomy, intraoperative and postoperative complications with the disadvantages of longer operative time, increased surgeon's workload, and relatively more postoperative pain.
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Affiliation(s)
- Adel Fathi
- Surgical Oncology Unit, Oncology Center, 243489Mansoura University (OCMU), Egypt
| | - Mahmoud M Saleh
- Surgical Oncology Unit, Oncology Center, 243489Mansoura University (OCMU), Egypt
| | - Mosab Shetiwy
- Surgical Oncology Unit, Oncology Center, 243489Mansoura University (OCMU), Egypt
| | - Islam A Elzahaby
- Surgical Oncology Unit, Oncology Center, 243489Mansoura University (OCMU), Egypt
| | - Omar Farouk
- Surgical Oncology Unit, Oncology Center, 243489Mansoura University (OCMU), Egypt
| | - Nazem Shams
- Surgical Oncology Unit, Oncology Center, 243489Mansoura University (OCMU), Egypt
| | - Mohamed F Elghandour
- Department of general surgery, 243489Mansoura University Hospital, Mansoura, Egypt
| | - Amr Abouzid
- Surgical Oncology Unit, Oncology Center, 243489Mansoura University (OCMU), Egypt
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Yang X, Bu Z, He M, Lin Y, Jiang Y, Chen D, Liu K, Zhou J. Effectiveness and safety of reduced-port laparoscopic surgery vs conventional multi-port laparoscopic surgery in the treatment of gastric diseases: A meta-analysis. Medicine (Baltimore) 2021; 100:e23941. [PMID: 33545969 PMCID: PMC7837851 DOI: 10.1097/md.0000000000023941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/09/2020] [Accepted: 12/01/2020] [Indexed: 12/02/2022] Open
Abstract
ABSTRACT This study aimed to compare the effectiveness and safety of reduced-port laparoscopic surgery (RPLS) and conventional multi-port laparoscopic (CMPLS) surgery in the treatment of gastric diseases.The PubMed, Embase, Cochrane Library, Web of Science, and Chinese Biomedical Literature databases were systematically searched for randomized controlled trials, cohort studies, and case control studies on the use of RPLS vs conventional multi-port laparoscopic surgery in treating gastric diseases from their inception until March 10, 2019. The evaluated outcomes were the operative time, blood loss, length of hospital stay, number of dissected lymph nodes, postoperative complications, and conversions. All of these were compared using Stata software version 12.0.A total of 18 studies were included, which involved 2938 patients. In studies referring to the comparison between RPLS and CMPLS in treating gastric diseases, the former showed significantly inferior in terms of operative time (P = .011) and number of dissected lymph nodes (P = .031); but superior results in terms of the estimated blood loss (P = .000) and length of hospital stay (P = .001) than the latter did; however, the rates of postoperative complications (P = .830) and conversions (P = .102) were not statistically significant between the 2 groups.RPLS and CMPLS showed comparable effectiveness and safety in the treatment of gastric diseases in our meta-analysis. Based on the current evidence, we believe that RPLS is an efficacious surgical alternative to CMPLS in the management of gastric diseases because of the shorter hospital stay and reduced blood loss. However, large-scale, well-designed, multicenter studies are needed to further confirm the results of this study.
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Affiliation(s)
- Xu Yang
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province
| | - Zhaoting Bu
- 22 Shuang Yong Road, Graduate School of Guangxi Medical University, Nanning, Guangxi Autonomous Region
| | - Maoqin He
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province
| | - Yue Lin
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Yuting Jiang
- 22 Shuang Yong Road, Graduate School of Guangxi Medical University, Nanning, Guangxi Autonomous Region
| | - Da Chen
- 22 Shuang Yong Road, Graduate School of Guangxi Medical University, Nanning, Guangxi Autonomous Region
| | - Kaibing Liu
- 22 Shuang Yong Road, Graduate School of Guangxi Medical University, Nanning, Guangxi Autonomous Region
| | - Jun Zhou
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province
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Abdel-Karim AM, El Tayeb MM, Yahia E, Elmissiry M, Hassouna M, Elsalmy S. Evaluation of the Role of Laparoendoscopic Single-Site Surgery vs Minilaparoscopy for Treatment of Upper Urinary Tract Pathologies: Prospective Randomized Comparative Study. J Endourol 2018; 31:1237-1242. [PMID: 29020831 DOI: 10.1089/end.2017.0363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To present the first prospective randomized comparison between laparoendoscopic single-site surgery (LESS) and minilaparoscopy (ML) for treatment of upper urinary tract pathologies. PATIENTS AND METHODS Between January 2013 and June 2015, patients with different upper urinary pathologies were blindly randomized to both LESS and ML. All procedures were done by single experienced surgeon. Both cohorts were compared regarding demographic data, peri and postoperative characteristics, and visual analog pain scale (VAS). Cosmetic outcome was assessed after 12 months using patient scar assessment scale (PSAS) and observer scar assessment scale (OSAS). RESULTS Sixty patients were randomized into two equal groups with comparable demographic and preoperative characteristics. Indications included nephrectomy, pyeloplasty, cyst marsupialization, adrenalectomy, and repair of retrocaval ureter. Operative time was 167 ± 24 and 145 ± 39 minutes in LESS and ML groups, respectively (p = 0.09). Estimated blood loss was 59 ± 34 and 43 ± 42 mL in both groups, respectively (p = 0.2). VAS was 1.7 ± 0.6 and 2.8 ± 0.5 in both groups, respectively (p = 0.02). PSAS and OSAS were 5.9 ± 0.85 and 10.6 ± 1.98 vs 8.9 ± 0.9 and 13.5 ± 6.3 in both groups, respectively (p > 0.05). There were no intraoperative complications, conversions to open surgery, or conventional laparoscopy in both groups. Mean postoperative Diclofenac Na was 151.7 ± 35.6 and 169.7 ± 47.3 mg in both groups, respectively (p = 0.04). Postoperative complications rate and hospital stay were comparable between both groups. CONCLUSION Both LESS and ML have comparable operative time, blood loss, complication rate, and hospital stay in treatment of upper urinary tract pathologies. However, LESS is associated with less analgesic requirement and better cosmetic outcome.
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Affiliation(s)
- Aly M Abdel-Karim
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Marawan M El Tayeb
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Elsaid Yahia
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Mostafa Elmissiry
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Mohamed Hassouna
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Salah Elsalmy
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
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Taniguchi K, Iida R, Ota K, Asakuma M, Uchiyama K, Takasu A. Single-port surgery (SPS) strategy for small bowel obstruction (SBO) caused by postoperative internal hernia: A series case report. Medicine (Baltimore) 2018; 97:e0269. [PMID: 29595689 PMCID: PMC5895389 DOI: 10.1097/md.0000000000010269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Internal hernia due to postoperative adhesions sometimes causes small bowel obstruction (SBO) and requires emergency surgery. The difficulties in the management of SBO with internal hernia include accurate diagnosis and estimation of its ischemic degree and of the risk of SBO recurrences following the surgical procedure. Laparoscopic surgery is a noninvasive to reduce postoperative adhesions and therefore has been widely used recently. However, surgeons often tend to hesitate in applying laparoscopic surgery for SBO because of some situational disadvantages such as poor operating space or iatrogenic bowel injury. Hence, laparoscopic surgery is still not yet the standard procedure for SBO caused by internal hernia. Thus, the establishment of an appropriate procedure for SBO due to internal hernia is required. PATIENT CONCERNS We experienced 3 SBO cases caused by postoperative internal hernia. The first patient was a 59-year-old man who had temporary loop-ileostomy for a perforated sigmoid colon due to diverticulitis. Severe hypogastralgia and vomiting occurred suddenly on the 33rd postoperative day. The second patient was an 81-year-old man who had been hospitalized due to epigastralgia of unknown origin. He had a surgical history of omentum patching for a perforated duodenum 20 years ago. The third patient was a 72-year-old female who presented at our hospital after sudden and severe hypogastralgia. She had a surgical history of sigmoidectomy for her sigmoid colon cancer 22 years ago. DIAGNOSIS A contrast computed tomography (CT) revealed a suspected closed loop obstruction of their bowels and immediate surgical treatments were required. INTERVENTION We tried SPS using the surgical glove method as an initial approach for their SBO caused by postoperative internal hernia. OUTCOMES Two of these 3 cases completely underwent SPS treatment, which afforded accurate diagnosis of SBO. Laparotomy following SPS, which allowed accurate diagnosis, was judged to be appropriate and was performed in the third case. All the patients were discharged without any complications and SBO have not recurred after their discharge. Finally, we established a new strategy using SPS for SBO with internal hernia. LESSONS Our experience suggests that SPS is a promising strategy as an initial surgical approach for SBO with internal hernia.
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Affiliation(s)
- Kohei Taniguchi
- Department of Emergency Medicine
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Ryo Iida
- Department of Emergency Medicine
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | | | - Mitsuhiro Asakuma
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Kazuhisa Uchiyama
- Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
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Di Stasi LL, Díaz-Piedra C, Ruiz-Rabelo JF, Rieiro H, Sanchez Carrion JM, Catena A. Quantifying the cognitive cost of laparo-endoscopic single-site surgeries: Gaze-based indices. APPLIED ERGONOMICS 2017; 65:168-174. [PMID: 28802436 DOI: 10.1016/j.apergo.2017.06.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 04/14/2017] [Accepted: 06/10/2017] [Indexed: 05/10/2023]
Abstract
BACKGROUND Despite the growing interest concerning the laparo-endoscopic single-site surgery (LESS) procedure, LESS presents multiple difficulties and challenges that are likely to increase the surgeon's cognitive cost, in terms of both cognitive load and performance. Nevertheless, there is currently no objective index capable of assessing the surgeon cognitive cost while performing LESS. We assessed if gaze-based indices might offer unique and unbiased measures to quantify LESS complexity and its cognitive cost. We expect that the assessment of surgeon's cognitive cost to improve patient safety by measuring fitness-for-duty and reducing surgeons overload. METHODS Using a wearable eye tracker device, we measured gaze entropy and velocity of surgical trainees and attending surgeons during two surgical procedures (LESS vs. multiport laparoscopy surgery [MPS]). None of the participants had previous experience with LESS. They performed two exercises with different complexity levels (Low: Pattern Cut vs. High: Peg Transfer). We also collected performance and subjective data. RESULTS LESS caused higher cognitive demand than MPS, as indicated by increased gaze entropy in both surgical trainees and attending surgeons (exploration pattern became more random). Furthermore, gaze velocity was higher (exploration pattern became more rapid) for the LESS procedure independently of the surgeon's expertise. Perceived task complexity and laparoscopic accuracy confirmed gaze-based results. CONCLUSION Gaze-based indices have great potential as objective and non-intrusive measures to assess surgeons' cognitive cost and fitness-for-duty. Furthermore, gaze-based indices might play a relevant role in defining future guidelines on surgeons' examinations to mark their achievements during the entire training (e.g. analyzing surgical learning curves).
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Affiliation(s)
- Leandro L Di Stasi
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain; College of Nursing and Health Innovation, Arizona State University, 85004 Phoenix, AZ, USA.
| | - Carolina Díaz-Piedra
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain; College of Nursing and Health Innovation, Arizona State University, 85004 Phoenix, AZ, USA
| | | | - Héctor Rieiro
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain
| | - Jose M Sanchez Carrion
- IAVANTE, Line of Activity of the Andalusian Public Foundation for Progress and Health, Ministry of Equality, Health and Social Policy of the Regional Government of Andalusia, 18016 Granada, Spain
| | - Andrés Catena
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain
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Lee Y, Kim HH. Single-incision Laparoscopic Gastrectomy for Gastric Cancer. J Gastric Cancer 2017; 17:193-203. [PMID: 28970949 PMCID: PMC5620088 DOI: 10.5230/jgc.2017.17.e29] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/22/2017] [Accepted: 08/28/2017] [Indexed: 12/28/2022] Open
Abstract
The implementation of national cancer screening has increased the detection rates of early gastric cancer (EGC) in Korea. Since the successful introduction of laparoscopic gastrectomy for gastric cancer in the early 1990s, this technique has demonstrated improved short-term outcomes without compromising long-term oncologic results. It is associated with reduced pain, shorter hospitalization, reduced morbidity rates, better cosmetic outcomes, and equivalent mortality rates as those for open surgery. Laparoscopic gastrectomy improves patients' quality of life (QOL) and provides favorable prognosis. Single-incision laparoscopic gastrectomy (SILG) is one extremely minimally invasive method, theoretically offering improved cosmetic results, less postoperative pain, and earlier recovery after surgery than conventional multiport laparoscopic gastrectomy. In this context, SILG is thought to be an optimal method to promote and maximize patients' QOL in the acute postoperative phase. However, the technical difficulties of this procedure have limited its use. Since the first report describing single-incision distal gastrectomy in 2011, only 16 studies to date have evaluated SILG. Most of these studies have focused on the technical feasibility and safety of SILG because its long-term outcomes have not been reported. This article reviews the advantages and limitations of SILG.
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Affiliation(s)
- Yoontaek Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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9
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Alekberzade AV, Lipnitsky EM, Krylov NN, Sundukov IV, Badalov DA. [Single-port laparoscopic cholecystectomy: advantages and disadvantages]. Khirurgiia (Mosk) 2016:19-24. [PMID: 27905368 DOI: 10.17116/hirurgia20161119-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To analyze the outcomes of single-port laparoscopic cholecystectomy. MATERIAL AND METHODS Early and long-term postoperative period has been analyzed in 240 patients who underwent laparoscopic cholecystectomy (LCE) including 120 cases of single-port technique and 120 cases of four-port technique. Both groups were compared in surgical time, pain syndrome severity (visual analog scale), need for analgesics, postoperative complications, hospital-stay, daily activity recovery and return to physical work, patients' satisfaction of surgical results and their aesthetic effect. RESULTS It was revealed that single-port LCE is associated with lower severity of postoperative pain, quick recovery of daily activity and return to physical work, high satisfaction of surgical results and their aesthetic effect compared with four-port LCE. Disadvantages of single-port LCE include longer duration of surgery, high incidence of postoperative umbilical hernia. However hernia was predominantly observed during the period of surgical technique development. CONCLUSION Further studies to standardize, evaluate the safety and benefits of single-port LCE are necessary.
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Affiliation(s)
- A V Alekberzade
- Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | - E M Lipnitsky
- Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | - N N Krylov
- Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | - I V Sundukov
- Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | - D A Badalov
- Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
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10
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D'Hondt M, Pottel H, Devriendt D, Van Rooy F, Vansteenkiste F, Van Ooteghem B, De Corte W. SILS sigmoidectomy versus multiport laparoscopic sigmoidectomy for diverticulitis. JSLS 2016; 18:JSLS-D-13-00319. [PMID: 25392639 PMCID: PMC4154429 DOI: 10.4293/jsls.2014.00319] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background and Objectives: In this single-institution study, we aimed to compare the safety, feasibility, and outcomes of single-incision laparoscopic sigmoidectomy (SILSS) with multiport laparoscopic sigmoidectomy (MLS) for recurrent diverticulitis. Methods: Between October 2011 and February 2013, 60 sigmoidectomies were performed by the same surgeon. Forty patients had a MLS and 20 patients had a SILSS. Outcomes were compared. Results: Patient characteristics were similar. There was no difference in morbidity, mortality or readmission rates. The mean operative time was longer in the SILSS group (P = .0012). In a larger proportion of patients from the SILSS group, 2 linear staplers were needed for transection at the rectum (P = .006). The total cost of disposable items was higher in the SILSS group (P < .0001). No additional ports were placed in the SILSS group. Return to bowel function or return to oral intake was faster in the SILSS group (P = .0446 and P = .0137, respectively). Maximum pain scores on postoperative days 1 and 2 were significantly less for the SILSS group (P = .0014 and P = .047, respectively). Hospital stay was borderline statistically shorter in the SILSS group (P = .0053). SILSS was also associated with better cosmesis (P < .0011). Conclusion: SILSS is feasible and safe and is associated with earlier recovery of bowel function, a significant reduction in postoperative pain, and better cosmesis.
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Affiliation(s)
- Mathieu D'Hondt
- Department of Digestive Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Hans Pottel
- Interdisciplinary Research Center, Catholic University Leuven, Kortrijk, Belgium
| | - Dirk Devriendt
- Department of Digestive Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Frank Van Rooy
- Department of Digestive Surgery, Groeninge Hospital, Kortrijk, Belgium
| | | | | | - Wouter De Corte
- Department of Anesthesia, Groeninge Hospital, Kortrijk, Belgium
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11
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Abstract
Single-port laparoscopic cholecystectomy (LC) has been compared with 3- or 4-port LC. To our knowledge, there are no studies comparing the 3-, 2-, and 1-port techniques. Patients were randomized into 3 groups: LC 1-port using SILS, LC 2-port using a laparoscope with a working channel, and LC 3-port using the standard ports. Pain was evaluated at recovery, 4 hours, 24 hours, day 5, and day 8, using an analog visual scale. Homogenous groups in their demographic characteristics; all confirmed gallbladder lithiasis. At recovery, there was less pain in group 1 (P = 0.002); at 4 hours pain was similar in all groups (P = 0.899); at 24 hours there was less pain in groups 2 and 3 (P = 0.031); and at days 5 and 8 there was marginal (P = 0.053) and significant (P = 0.003) relevance. In terms of pain perception, LC performed through 1 port does not offer advantages when compared with 2 or 3 ports. More clinical trials are needed to confirm these data.
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12
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Escobar-Dominguez JE, Garcia-Quintero P, Hernandez-Murcia C, Verdeja JC. Outcomes in laparoscopic cholecystectomy by single incision with SPIDER surgical system are comparable to conventional multiport technique: one surgeon's experience. Surg Endosc 2016; 30:4793-4799. [PMID: 26932549 DOI: 10.1007/s00464-016-4809-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/03/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Single-incision laparoscopic cholecystectomy has emerged as an alternative to conventional multiport laparoscopic cholecystectomy (LC). Technical difficulty, prolonged surgical times and increased complication rates have been reported in single-incision laparoscopic surgery. One of the concerns is lack of triangulation of instruments. The SPIDER® surgical system is a single-incision laparoscopic device that utilizes flexible instruments with the purpose of achieving adequate triangulation. The purpose of this study is to compare the outcomes of SPIDER versus LC. METHODS A retrospective chart review of patients who underwent LC and SPIDER cholecystectomy by a single surgeon during a concurrent 44-month period at Baptist Health South Florida hospitals was performed focusing on demographics, indication for surgery, complications and incisional hernia rates. Exclusion criteria were concomitant surgery and hernia repair at the time of surgery. RESULTS A total of 612 patients underwent minimally invasive cholecystectomy: 279 cases for SPIDER cholecystectomy and 333 for multiport LC. Baseline differences in patient characteristics between the SPIDER and LC groups were statistically significant. The SPIDER group had younger and healthier patients (lower ASA classification scores) with predominant diagnosis of cholelithiasis (69 %) compared to the LC group which had more complex cases. Total complications rate for both SPIDER and LC were 0.4 % (n = 1) and 3 % (n = 10), respectively. Conversion to open cholecystectomy occurred in one patient from the LC group (0.3 %). Conversion rate from SPIDER to additional ports or LC was performed in 5 cases (1.8 %) with no conversions to open surgery. Hemoperitoneum was reported in 2 cases, one for each approach, requiring reoperation. CONCLUSION Single-incision laparoscopic cholecystectomy with SPIDER is a safe and feasible technique with similar outcomes to multiport LC. However, statistical significant difference was reported in baseline characteristics of both groups. No incisional hernias were reported in this case series for either technique.
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Affiliation(s)
| | - Pedro Garcia-Quintero
- Baptist Health Medical Group - General Surgery, Baptist Health South Florida, Miami, FL, USA
| | | | - Juan-Carlos Verdeja
- Baptist Health Medical Group - General Surgery, Baptist Health South Florida, Miami, FL, USA. .,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
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13
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Sharp NE, Vassaur J, Buckley FP. Single-site Nissen fundoplication versus laparoscopic Nissen fundoplication. JSLS 2016; 18:JSLS-D-13-00202. [PMID: 25392613 PMCID: PMC4154403 DOI: 10.4293/jsls.2014.00202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background: Advances in minimally invasive surgery have led to the emergence of single-incision laparoscopic surgery (SILS). The purpose of this study is to assess the feasibility of SILS Nissen fundoplication and compare its outcomes with traditional laparoscopic Nissen fundoplication. Methods: This is a retrospective study of 33 patients who underwent Nissen fundoplication between January 2009 and September 2010. Results: There were 15 SILS and 18 traditional laparoscopic Nissen fundoplication procedures performed. The mean operative time was 129 and 182 minutes in the traditional laparoscopic and single-incision groups, respectively (P = .019). There were no conversions in the traditional laparoscopic group, whereas 6 of the 15 patients in the SILS group required conversion by insertion of 2 to 4 additional ports (P = .0004). At short-term follow-up, recurrence rates were similar between both groups. To date, there have been no reoperations. Conclusions: SILS Nissen fundoplication is both safe and feasible. Short-term outcomes are comparable with standard laparoscopic Nissen fundoplication. Challenges related to the single-incision Nissen fundoplication include overcoming the lengthy learning curve and decreasing the need for additional trocars.
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Affiliation(s)
- Nicole E Sharp
- General Surgery, Scott & White Healthcare, Round Rock, Texas, USA
| | - John Vassaur
- General Surgery, Scott & White Healthcare, Round Rock, Texas, USA
| | - F Paul Buckley
- General Surgery, Scott & White Healthcare, Round Rock, Texas, USA
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Al-Badawi IA, AlOmar O, Albadawi N, Abu-Zaid A. Single-port laparoscopic surgery for benign salpingo-ovarian pathology: a single-center experience from Saudi Arabia. Ann Saudi Med 2016; 36:64-9. [PMID: 26809202 PMCID: PMC6074270 DOI: 10.5144/0256-4947.2016.26.1.1200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are limited data and few solid conclusions on the use of single-port laparoscopic surgery (SPLS) in gynecologic procedures. OBJECTIVE The objective of our descriptive study was to review our single-center experience with benign salpingo-ovarian conditions (feasibility, safety and surgical outcomes). DESIGN A retrospective cross-sectional study from January-2012 to October-2014. SETTING King Faisal Specialist Hospital & Research Center--a referral tertiary healthcare center. PATIENTS AND METHODS All gynecologic patients who underwent SPLS procedures for benign adnexal pathologies were analyzed for pre-, intra-and postoperative details. SPLS was done using a single multi-port trocar and standard laparoscopic instruments. MAIN OUTCOME MEASURES Perioperative complications and conversion rate. RESULTS Eighty (n=80) patients underwent SPLS interventions. the median age and BMi were 37 years and 24.6 kg/m2, respectively. Thirty-one patients (38.8%) had >=1 previous abdominopelvic surgeries. Of 104 SPLS procedures conducted, the three most common procedures were unilateral ovarian cystectomy (n=21/104; 20.2%), bilateral ovarian transposition (n=20/104; 19.2%), and unilateral salpingo-oophorectomy (n=16/104; 15.4%). No patient required addition of extra ports or conversion to conventional multi-port laparoscopy or laparotomy. The median operative time, estimated blood loss and hospital stay were 66 min, 10 mL and 1 day, respectively. No patient experienced major intraoperative or postoperative complications. the median postoperative pain grade using the visual analogue scale was 2 (examined in 74 of 80 patients). At six-weeks postoperatively, the median wound scar length (measured at outpatient clinic) was 1.2 cm. CONCLUSION SPLS in the management of benign salpingo-ovarian conditions is generally feasible, potentially safe, and associated with satisfactory operative and postoperative outcomes. LIMITATIONS Retrospective and non-comparative design. Single-center experience. Subjective scores of the patients' self-reported satisfaction about post-operative pain, subject to recall bias.
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Affiliation(s)
- Ismail A Al-Badawi
- Dr. ismail A. Al-Badawi, Department of Obstetrics and Gynecology,, King Faisal Specialist Hospital and Research Centre,, PO Box 3354 Riyadh 11211, Saudi Arabia, T: +966-011-442-7392, F: +966-011-442-7393,
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Mahdi BD, Rahma C, Mohamed J, Hayet Z, Riadh M. Single port laparoscopic orchidopexy in children using surgical glove port and conventional rigid instruments. Korean J Urol 2015; 56:781-4. [PMID: 26568797 PMCID: PMC4643175 DOI: 10.4111/kju.2015.56.11.781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/21/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We review the literature and describe our technique for laparoendoscopic single-site orchidopexy using a glove port and rigid instruments. We assessed the feasibility and outcomes of this procedure. MATERIALS AND METHODS We retrospectively reviewed the case records of all children who had undergone laparoendoscopic single-site orchidopexy by use of a surgical glove port and conventional rigid instruments for a nonpalpable intraabdominal testis between January 2013 and September 2014. RESULTS Data from a total of 20 patients were collected. The patients' mean age was 18 months. All cases had a nonpalpable unilateral undescended testis. Fourteen patients (70%) had an undescended testis on the right side and six patients (30%) had an undescended testis on the left side. Seventeen patients underwent primary orchidopexy. Three patients underwent single-port laparoscopic Fowler-Stephens orchidopexy for the first and the second stage. Average operating time was 57 minutes (range, 40 to 80 minutes). No patient was lost to follow-up. At follow-up, 2 testes were found to have retracted out of the scrotum and these were successfully dealt with in a second operation. One testis was hypoplastic in the scrotal pouch. There were no signs of umbilical hernia. CONCLUSIONS Single-port laparoscopic orchidopexy using a glove port and rigid instruments is technically feasible and safe for various nonpalpable intraabdominal testes. However, surgical experience and long-term follow-up are needed to confirm the superiority of this technique.
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Affiliation(s)
- Ben Dhaou Mahdi
- Department of Pediatric Surgery, Hedi Chaker Hospital, School of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Chtourou Rahma
- Department of Pediatric Surgery, Hedi Chaker Hospital, School of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Jallouli Mohamed
- Department of Pediatric Surgery, Hedi Chaker Hospital, School of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Zitouni Hayet
- Department of Pediatric Surgery, Hedi Chaker Hospital, School of Medicine of Sfax, University of Sfax, Sfax, Tunisia
| | - Mhiri Riadh
- Department of Pediatric Surgery, Hedi Chaker Hospital, School of Medicine of Sfax, University of Sfax, Sfax, Tunisia
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Caetano Júnior EM, Vieira JP, Moura-Franco RMAM, Fuziy RA, Serra HO, Marcondes GB, Shiraiwa DK, Sousa MGD, Girão MJBC, Lopes-Filho GDJ, Linhares MM. Evaluation of systemic inflammatory responses in cholecystectomy by means of access. Single-port umbilical incision, transvaginal NOTES, laparoscopy and laparotomy. Acta Cir Bras 2015; 30:691-703. [PMID: 26560428 DOI: 10.1590/s0102-86502015010000000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/14/2015] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate and compare clinical and inflammatory responses to the surgical trauma caused by cholecystectomy via several access approaches: single-port umbilical incision (SILS), transvaginal natural orifice transluminal endoscopic surgery (NOTES), laparoscopy, and Laparotomy. METHODS Twenty-eight female pigs were equally divided into four groups and submitted to cholecystectomy by single-port umbilical incision, transvaginal NOTES, laparoscopy, or Laparotomy. An additional five animals served as controls (sham group). Animals were monitored perioperatively regarding anesthesia and surgical procedure times, as well as for the presence of complications. Postoperatively, they were evaluated regarding time to ambulation and feeding, and the presence of clinical events. Procalcitonin, C-reactive protein (CRP), and AQUI feron-gamma (IFN-γ) measurements were performed before surgery and immediately, two days, and seven days after surgery. Animals were sacrificed and necropsied at seven days after surgery. RESULTS All procedures were successfully performed as proposed in each group. Only minor complications, such as gallbladder perforation and bleeding from the liver bed, were observed during surgery in all groups. The vaginal NOTES group showed higher anesthesia and surgical procedure times compared to the other groups (p<0.001). No other between-group differences in perioperative or postoperative times, clinical evolution, or serum inflammatory markers were observed. Only adhesions were found on necropsy, with no differences between groups. CONCLUSION The single-port umbilical and transvaginal NOTES access approaches were feasible and safe compared to laparoscopic and laparotomy for cholecystectomy.
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Affiliation(s)
| | - Josiel Paiva Vieira
- Department of Surgery, Universidade Federal do Maranhão, Sao Luis, MA, Brazil
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A multicenter study of initial experience with single-incision robotic cholecystectomies (SIRC) demonstrating a high success rate in 465 cases. Surg Endosc 2015; 30:2951-60. [PMID: 26541728 DOI: 10.1007/s00464-015-4583-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/19/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recently, the robotic single-site platform has been used to ameliorate the difficulties seen in single-incision laparoscopic surgery (SILC) while preserving the benefits of standard laparoscopic cholecystectomy. The purpose of this study is to describe the clinical outcomes of a large series of single-incision robotic cholecystectomy (SIRC). METHODS Medical records of consecutive patients who underwent SIRC were retrospectively reviewed. All procedures were performed by six surgeons at five different North American centers involved in the study. All patients included in the study underwent a cholecystectomy attempted through single site at the umbilicus, using the da Vinci(®) Surgical System (Intuitive Surgical Inc. Sunnyvale, CA). RESULTS A total of 465 patients met study criteria. Median age was 48 years (range 18-89); 351 (75.5 %) were female and 304 (66.4 %) were overweight or obese. Except for gender, case characteristics differed significantly by surgeon/site. Previous abdominal surgery was reported for 226 (48.6 %) cases. SIRC was successfully completed in 455 (97.8 %) cases, and there were no conversions to open surgery. Median surgical time was 52 min with a decreasing trend after 55-85 cases. Male gender, obesity and diagnoses other than biliary dyskinesia were independent predictors of longer surgical times. The complication rate was 2.6 %. CONCLUSIONS Our large, multicenter study demonstrates that robotic single-site cholecystectomy is safe and feasible in a wide range of patients.
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Matsui Y, Satoi S, Hirooka S, Kon M. Simple Suturing Technique for Umbilical Dimple Wound after Single-Incision Laparoscopic Surgery. J Am Coll Surg 2015; 221:e61-3. [DOI: 10.1016/j.jamcollsurg.2015.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/14/2015] [Accepted: 07/14/2015] [Indexed: 11/15/2022]
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Mahdi BD, Rahma C, Mohamed J, Riadh M. Single-port laparoscopic surgery in children: A new alternative in developing countries. Afr J Paediatr Surg 2015; 12:122-5. [PMID: 26168750 PMCID: PMC4955419 DOI: 10.4103/0189-6725.160354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Single-incision laparoscopic surgery (SILS) is a technique in laparoscopic surgery, which is based on the idea that all the laparoscopic trocars are inserted through a single umbilical incision. This paper documents a single-centre experience, which performed the single-port surgery in children using an improvised trans-umbilical glove-port with conventional rigid instruments. MATERIALS AND METHODS We prospectively studied the outcomes of SILS procedures between January 2013 and June 2014. Materials required making our homemade trans-umbilical port consisted on: A flexible ring, a rigid larger ring, one powder-free surgical glove, a wire-to-skin and standard standards laparoscopic trocars. RESULTS A total of 90 consecutive procedures had been done in our institution: 15 girls and 75 boys (mean age: 7.5 years). We used SILS on 59 appendectomies with an average operative time of 48 minutes. We needed conversion to conventional surgery in three cases (two with perforated appendicitis and one for difficulty to mobilize the appendix). SIL cholecystectomy was performed for four patients with symptomatic cholelithiasis; mean operative time was 60 min. All patients were discharged on postoperative day 2. Eighteen boys with non-palpable testis were explored and treated. Other procedures included: Varicocelectomy (n = 2), intra-abdominal lymph node biopsies (n = 2), ovarian cystectomy (n = 1), ovarian transposition (n = 1), aspiration of renal hydatid cyst (n = 1), explorative laparoscopy in research to Meckel's diverticulum (n = 1) and intestinal intussusceptions (n = 1). No post-operative complications were seen in all cases. CONCLUSIONS SILS in the paediatric population using conventional rigid instruments is feasible, safe and effective. It may be an alternative to the costly commercially available single-port systems especially in a developing country like Tunisia.
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Affiliation(s)
| | - Chtourou Rahma
- Department of Pediatric Surgery, Hedi Chaker Hospital, Sfax, Tunisia
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Yamaguchi T, Abe N, Matsunobu S, Mizuno H, Yanagida O, Takeuchi H, Masaki T, Mori T, Sugiyama M. Single-incision multiport laparoendoscopic surgery using a short-type flexible endoscope and its usefulness in cholecystectomy. Asian J Endosc Surg 2015; 8:48-53. [PMID: 25384706 DOI: 10.1111/ases.12148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 09/12/2014] [Accepted: 09/21/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION We previously demonstrated the advantages of a short-type flexible endoscope as a working scope in laparoscopic surgery through single-incision procedures in animal experiments. In this report, we examined the outcomes of laparoscopic surgery through a single incision using a flexible endoscope in a clinical setting. Specifically, we performed cholecystectomy using single-incision multiport laparoendoscopic (SIMPLE) surgery. METHODS Thirteen patients with cholecystolithiasis or gallbladder polyp underwent SIMPLE cholecystectomy using a newly developed short-type flexible endoscope with a working length of 60 cm. Twenty-seven patients underwent standard single-incision laparoscopic cholecystectomy using a 5-mm rigid laparoscope. We retrospectively compared the surgical outcomes between the two groups. RESULTS SIMPLE cholecystectomy using the short-type flexible endoscope was successfully carried out. No gallbladder perforation occurred, but perforation occurred in four cases in the standard laparoscopic cholecystectomy group; however, the difference was not statistically significant. Although no other surgical outcomes differed between the two groups, the flexible endoscope had several advantages over the standard laparoscope. The scope provided a flexible view of the operating field. The gallbladder dissection using the cutting device via the scope was easier and safer than that in standard single-incision laparoscopic cholecystectomy. The water-jet, suctioning, and self-cleaning lens functions of the scope served the surgery well. CONCLUSIONS SIMPLE cholecystectomy using a short-type flexible endoscope has surgical outcomes equivalent to those of standard single-incision laparoscopic cholecystectomy, but this endoscope with multiple functions may make the surgical procedures less stressful and safer.
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Affiliation(s)
- Takashi Yamaguchi
- Department of Surgery, Nakanokouseikai General Hospital, Tokyo, Japan
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Stauffer JA. Commentary on "single-port laparoscopic distal pancreatectomy: initial experience". J Laparoendosc Adv Surg Tech A 2014; 24:864. [PMID: 25495253 DOI: 10.1089/lap.2014.9995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- John A Stauffer
- Department of Surgery, Mayo Clinic Florida , Jacksonville, Florida
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Abstract
Single-incision laparoscopic Ladd's procedure for symptomatic intestinal malrotation in an adult appears to be feasible and safe with minimal postoperative pain and satisfactory cosmesis. Introduction: The potential of single-incision laparoscopic surgery (SILS) as a less invasive and more cosmetically appealing technique has prompted the expansion of its adoption. SILS has been shown to be a safe and feasible alternative to traditional multiport cholecystectomy, appendectomy, colectomy, and many other laparoscopic procedures. The objective of this study is to provide an initial report of the feasibility of correcting intestinal malrotation via a single-incision laparoscopic transumbilical approach. Case Description: A 29-year-old woman presented with symptomatic congenital intestinal malrotation. She elected to undergo a Ladd's procedure using a single-incision laparoscopic approach with a SILS port and standard laparoscopic instruments. The procedure was accomplished without additional ports or conversion to laparotomy, and no intraoperative or postoperative complications were noted. Total operative time was 106 minutes. The patient had minimal postoperative pain and was satisfied with the cosmetic outcome. Conclusion: When performed by a surgeon experienced in the SILS technique, single-incision laparoscopic Ladd's procedure for symptomatic intestinal malrotation in an adult is feasible and safe, with minimal postoperative pain and favorable cosmetic outcome.
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Affiliation(s)
- John Vassaur
- College of Medicine, Texas A&M Health Science Center, Temple, TX, USA; General Surgery, Scott & White Healthcare, Round Rock, TX, USA
| | - Hannah Vassaur
- General Surgery, Scott & White Healthcare, Round Rock, TX, USA
| | - F Paul Buckley
- General Surgery, Scott & White Healthcare MS-MB-3.019, 302 University Blvd., Round Rock, TX 78665, USA.
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Matsui Y, Ryota H, Sakaguchi T, Nakatani K, Matsushima H, Yamaki S, Hirooka S, Yamamoto T, Kwon AH. Comparison of a Flexible-tip Laparoscope with a Rigid Straight Laparoscope for Single-incision Laparoscopic Cholecystectomy. Am Surg 2014. [DOI: 10.1177/000313481408001227] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This study assessed whether a flexible-tip laparoscope improves operative outcomes including operative length while performing single-incision laparoscopic cholecystectomy (SILC) compared with the use of a conventional straight laparoscope. The flexible-tip laparoscope decreased the operative time compared with the straight laparoscope. Although SILC has potential benefits, surgeons experience problems for in-line viewing through a laparoscope and from contact of instruments with the laparoscope, resulting in longer operative times and the need for additional ports. The aim of this study was to determine whether a flexible-tip laparoscope improves operative outcomes, including operative length and the rate of insertion of additional ports, while performing SILC compared with the use of a conventional rigid straight laparoscope. We reviewed data on patients for whom we performed SILC at the Department of Surgery, Kansai Medical University, for the period from November 1, 2009, to February 28, 2013. The information was assessed with respect to patient characteristics, types of laparoscope used, operative data as well as postoperative outcomes. Operating time for SILC using the flexible-tip laparoscope was significantly shorter than with the straight laparoscope (81.5 ± 23.2 vs 94.4 ± 21.1 minutes) as a result of a better view of the operating field without contact with working instruments. Although a trend was shown toward a reduced rate of the need for extra ports in the flexible-tip laparoscope group, the difference did not reach statistical significance. Using the flexible-tip laparoscope solved the problem of in-line viewing and decreased the operative time for SILC.
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Affiliation(s)
- Yoichi Matsui
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | - Hironori Ryota
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | | | | | | | - So Yamaki
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | - Satoshi Hirooka
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | | | - A-Hon Kwon
- Department of Surgery, Kansai Medical University, Osaka, Japan
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Lianos GD, Rausei S, Ruspi L, Galli F, Mangano A, Roukos DH, Dionigi G, Boni L. Laparoscopic gastrectomy for gastric cancer: Current evidences. Int J Surg 2014; 12:1369-73. [DOI: 10.1016/j.ijsu.2014.10.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 09/25/2014] [Accepted: 10/16/2014] [Indexed: 02/07/2023]
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Shibao K, Sato N, Higure A, Yamaguchi K. A new oval multichannel port to facilitate reduced port distal gastrectomy. MINIM INVASIV THER 2014; 24:135-40. [DOI: 10.3109/13645706.2014.985684] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Joseph SP, Moore BT, Slayden G, Sorensen GB, Boettger C, Potter D, Margolin D, Brown K. Patient perception of single-incision laparoscopic cholecystectomy. JSLS 2014; 17:585-95. [PMID: 24398201 PMCID: PMC3866063 DOI: 10.4293/108680813x13693422520396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Safety and relief of symptoms appeared to be most important to patients with gallbladder disease, whereas postprocedural aesthetics was less important. Background and Objectives: Single-incision laparoscopic cholecystectomy (SILC) is gradually being adopted into general surgical practice. The potential risks and benefits are still being studied, and little is known about how patients perceive this new surgical technique. Methods: After providing patients with basic educational materials on laparoscopic cholecystectomy (LC) and SILC, we administered a questionnaire exploring patients' perspectives of the importance of postoperative pain, scar appearance, risk of complications, and cost regarding their preference for SILC versus LC. Results: Among 100 patients (mean age, 43.3 years), the majority were women (85%), white (85%), college educated (77%), and privately insured (85%). Indications included biliary dyskinesia (43%), biliary colic (48%), and acute cholecystitis (9%). Patients stated that they would be somewhat or very interested in SILC if recommended by their surgeon (89%), although 35% were somewhat or very concerned about the lack of long-term results. The majority would accept no additional risk to undergo SILC. Scar appearance was somewhat or very important to <40% of patients, whereas pain was somewhat or very important to 79%. Only 27% of patients would spend >$100 to undergo SILC. When asked to rank pain, appearance, symptom resolution, personal cost, and risk of complications, 52% ranked symptom resolution, 20% ranked pain, and 19% ranked risk of complications as most important. Conclusions: Safety and relief of symptoms are most important to patients with gallbladder disease, whereas postprocedural esthetics was relatively unimportant and few would be willing to pay more for SILC versus LC. However, if the surgeon recommends SILC, most patients would trust this recommendation.
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Affiliation(s)
- Sigi P Joseph
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA; Saint Luke's Hospital of Kansas City, Kansas City, MO, USA; Bothwell Regional Hospital, 601 E 14th St, Sedalia, MO 65301, USA.
| | - B Todd Moore
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA. Saint Luke's Hospital of Kansas City, Kansas City, MO, USA
| | | | - George B Sorensen
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA. Saint Luke's Hospital of Kansas City, Kansas City, MO, USA
| | | | - David Potter
- Saint Luke's Hospital of Kansas City, Kansas City, MO, USA
| | - Daniel Margolin
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA. Saint Luke's Hospital of Kansas City, Kansas City, MO, USA
| | - Kimberly Brown
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA. Saint Luke's Hospital of Kansas City, Kansas City, MO, USA
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Riggle JD, Miller EE, McCrory B, Meitl A, Lim E, Hallbeck MS, LaGrange CA. Ergonomic comparison of laparoscopic hand instruments in a single site surgery simulator with novices. MINIM INVASIV THER 2014; 24:68-76. [PMID: 25142199 DOI: 10.3109/13645706.2014.946426] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Single-site surgery improves cosmesis but increases procedural difficulty. Enhanced instruments could improve procedural efficiency leading to better patient outcomes. MATERIAL AND METHODS One pair of non-articulating (straight) and two different pairs of articulating laparoscopic instruments were evaluated using a peg-transfer surgical task simulator by premedical college students. The instruments were comparatively tested using task performance measures, ergonomic measures, and participant questionnaires. RESULTS The straight instrument produced significantly higher task performance scores and lower task times compared to both articulating instruments (p < 0.05). The straight instrument required less muscle activation and less wrist deviation than the articulating instruments to perform the same task. Participants rated the straight instrument significantly easier to use and less difficult to complete the task than with either articulating instrument (p < 0.05 for both). CONCLUSIONS This exploratory study suggests that novices have difficulty using articulating instruments and perform better using straight laparoscopic instruments when first attempting LESS surgical tasks. Although a study with post-graduate medical trainees is needed to confirm these results, trainees should initially practice LESS with non-articulating instruments to gain proficiency at basic laparoscopic tasks. Additionally, redesigning articulating instruments to specifically address the spatial constraints and learning curve of LESS may also improve trainee performance and instrument usability.
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Miyauchi Y, Sato M, Hattori K. Comparison of postoperative pain between single-incision and conventional laparoscopic appendectomy in children. Asian J Endosc Surg 2014; 7:237-40. [PMID: 24990256 DOI: 10.1111/ases.12118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 04/17/2014] [Accepted: 04/30/2014] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate differences in postoperative pain between single-incision laparoscopic appendectomy (SLA) and conventional laparoscopic appendectomy (CLA) for uncomplicated appendicitis in children. METHODS In total, 30 patients underwent CLA, and 12 patients underwent SLA. Patients with perforated appendicitis or an abscess were excluded. We evaluated the length of hospital stay, the frequency of postoperative analgesic requirement, and the duration of postoperative pain. RESULTS The mean length of hospital stay was 3.67 ± 0.75 days for the CLA group and 4.0 ± 0.70 days for the SLA group. The mean frequency of postoperative analgesic requirement was 1.93 ± 1.63 times for the CLA group and 2.00 ± 1.00 times for the SLA group. The mean duration of postoperative pain was 52.63 ± 20.82 hours for the CLA group and 55.91 ± 18.45 hours for the SLA group. These postoperative outcomes were similar between the two groups. CONCLUSION Our study suggests that SLA, which results in similar postoperative pain as CLA, is a feasible technique for uncomplicated appendicitis in children.
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Affiliation(s)
- Yuya Miyauchi
- Department of Pediatric Surgery, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
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Ahn SH, Son SY, Jung DH, Park DJ, Kim HH. Pure single-port laparoscopic distal gastrectomy for early gastric cancer: comparative study with multi-port laparoscopic distal gastrectomy. J Am Coll Surg 2014; 219:933-43. [PMID: 25256369 DOI: 10.1016/j.jamcollsurg.2014.07.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 07/16/2014] [Accepted: 07/16/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND The purpose of this study was to show the feasibility and safety of pure single-port laparoscopic distal gastrectomy (SDG) by comparing its short-term outcomes with those of conventional multiport totally laparoscopic distal gastrectomy (TLDG). STUDY DESIGN Prospectively collected data of 50 gastric cancer patients who underwent pure SDG from November 2011 through October 2013 were compared with the matched data of 50 TLDG patients. RESULTS Mean operation time (144.5 vs 140.3 minutes; p = 0.561) and number of harvested lymph nodes (51.7 ± 16.3 vs 52.4 ± 17.9; p = 0.836) were comparable. Estimated blood loss was lower in the SDG patients (50.5 ± 31.5 mL vs 87.5 ± 79.6 mL; p = 0.007). Postoperative recovery was faster in the SDG patients in terms of lower maximum pain score on the operative day (6.1 ± 1.4 vs 6.9 ± 1.5; p = 0.015) and postoperative day 1 (4.6 ± 1.0 vs 5.5 ± 1.4; p < 0.001), less use of parenteral analgesics (0.8 ± 1.0 vs 1.4 ± 1.0; p = 0.020), and less increase in C-reactive protein level on postoperative day 5 (4.57 ± 6.26 mg/L vs 8.51 ± 5.25 mg/L; p = 0.008). Postoperative morbidity occurred in 6 (12%) and 5 (10%) patients in the SDG and TLDG group, respectively. CONCLUSIONS This study showed that pure SDG is both safe and feasible for early gastric cancer, with similar operation time and better short-term outcomes than TLDG in terms of postoperative pain, estimated blood loss, inflammatory reaction, and cosmetic result.
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Affiliation(s)
- Sang-Hoon Ahn
- Department of Surgery, Seoul National University College of Medicine, Seoul and Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Yong Son
- Department of Surgery, Seoul National University College of Medicine, Seoul and Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Do Hyun Jung
- Department of Surgery, Seoul National University College of Medicine, Seoul and Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University College of Medicine, Seoul and Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul and Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Tzanis D, Lainas P, Tranchart H, Pourcher G, Devaquet N, Perlemuter G, Naveau S, Dagher I. Atypical as well as anatomical liver resections are feasible by laparoendoscopic single-site surgery. Int J Surg Case Rep 2014; 5:580-3. [PMID: 25108073 PMCID: PMC4200877 DOI: 10.1016/j.ijscr.2013.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 10/28/2013] [Accepted: 11/15/2013] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Liver surgery was one of the last fields to be conquered by laparoscopy, which has become safe and effective, especially for left lateral sectionectomy (LLS) and limited peripheral resections. However, major hepatectomies remain challenging. Laparoendoscopic single-site (LESS) surgery is being employed for an increasing variety of surgical sites and indications. PRESENTATION OF CASE Three patients underwent LESS hepatectomy. A 36-year-old woman had LLS for a 38-mm adenoma, an 85-year-old woman an atypical resection of segment VI for a 12-mm hepatocellular carcinoma and a 41-year-old woman an atypical right anterior resection for a 9 cm symptomatic FNH. Procedures were performed transperitoneally with a single-port device, via a 20-mm or 30-mm incision. Operative times were 110 min for LLS, 100 min for the atypical segment VI resection and 120 min for the atypical right anterior liver resection. Blood loss was less than 50 ml in the first two patients and 150 ml in the third. Postoperative courses were uneventful. The first two patients were discharged on postoperative day 3 and the third on postoperative day 1. DISCUSSION To date, some case reports and series of LESS liver surgery have been published. We performed the reported hepatectomies after a considerable experience in laparoscopic hepatic surgery and after applying the LESS approach to other procedures. Our hepatectomy technique was not modified by the use of the single-port and results were very encouraging. CONCLUSION We believe that in selected patients, both peripheral resections and LLS are feasible by LESS surgery, with good intra-operative and post-operative results.
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Affiliation(s)
- Dimitrios Tzanis
- Department of General Surgery, Antoine-Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140 Clamart cedex, France; University of Paris-Sud, Orsay F-91405, France
| | - Panagiotis Lainas
- Department of General Surgery, Antoine-Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140 Clamart cedex, France; University of Paris-Sud, Orsay F-91405, France
| | - Hadrien Tranchart
- Department of General Surgery, Antoine-Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140 Clamart cedex, France; University of Paris-Sud, Orsay F-91405, France
| | - Guillaume Pourcher
- Department of General Surgery, Antoine-Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140 Clamart cedex, France; University of Paris-Sud, Orsay F-91405, France
| | - Niaz Devaquet
- Department of General Surgery, Antoine-Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140 Clamart cedex, France
| | - Gabriel Perlemuter
- University of Paris-Sud, Orsay F-91405, France; Department of Gastroenterology, Antoine-Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140 Clamart cedex, France
| | - Sylvie Naveau
- University of Paris-Sud, Orsay F-91405, France; Department of Gastroenterology, Antoine-Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140 Clamart cedex, France
| | - Ibrahim Dagher
- Department of General Surgery, Antoine-Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, F-92140 Clamart cedex, France; University of Paris-Sud, Orsay F-91405, France.
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Yilmaz H, Alptekin H, Acar F, Calisir A, Sahin M. Single-incision laparoscopic cholecystectomy and overweight patients. Obes Surg 2014; 24:123-7. [PMID: 23929313 DOI: 10.1007/s11695-013-1041-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Modifications of minimally invasive laparoscopic cholecystectomy have been achieved, including single-incision laparoscopic cholecystectomy (SILC). In the current literature, the effects of high body mass index (BMI) on the results of the surgical therapy have not been sufficiently investigated after SILC. We evaluated perioperative outcomes and postoperative complications of overweight patients who underwent SILC. METHODS Two hundred two patients who underwent SILC were retrospectively evaluated. The data included demographics and outcomes such as postoperative complications and postoperative hospitalization were obtained. For the outcome analyses, patients were divided into two group according to their BMI (<30 vs ≥ 30 kg/m(2)). RESULTS Of the 202 patients, 157 patients were in normal weight group and 45 patients were in overweight group. Mean operative time was 31.67 ± 6.4 min in overweight group and 26.6 ± 5.3 min in normal weight group. The wound infection rate for overweight and normal weight patients was 13.3 and 7.6 %, respectively. Eleven of the 202 patients (5.4 %) experienced port-site hernia (PSH). CONCLUSIONS This retrospective study comparing overweight and normal weight patient in SILC demonstrates that SILC is associated with the prolonged operative time, high additional port requirement, and increased wound complication rate. PSH occurrence rate was high after SILC irrespective of the body weight.
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Affiliation(s)
- Huseyin Yilmaz
- Department of General Surgery, Faculty of Medicine, Selcuk University, Keykubat Kampusu, 42075, Konya, Turkey,
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Wang D, Ji ZL, Jiang XH, Wang JM, Tan YY, Wang Y, Wen YZ. Laparoendoscopic single-site distal pancreatectomy in pigs. World J Gastroenterol 2014; 20:6878-6883. [PMID: 24944478 PMCID: PMC4051927 DOI: 10.3748/wjg.v20.i22.6878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 02/07/2014] [Accepted: 03/19/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the technique for laparoendoscopic single-site distal pancreatectomy.
METHODS: Laparoendoscopic single-site spleen-preserving distal pancreatectomy was performed in pigs using a novel flexible multichannel port, a curved laparoscopic multifunctional operative device and a fish hook retractor, which provided a favorable operative field.
RESULTS: Six pigs were involved in this study, and five survived the procedure. The first animal died following injury to the superior mesenteric vein and uncontrolled intraoperative bleeding. Except for this failure, the mean operative time was 155 min (range: 102-236 min). A steep learning curve was observed in the study, with a mean operative time of 177 min in the first two operations vs 134 min in the last three operations. The mean blood loss was 50 mL, and the postoperative course was uneventful. The animals were sacrificed three weeks after the procedures, and no pancreatic leakage or abdominal infection was found macroscopically.
CONCLUSION: Laparoendoscopic single-site distal pancreatectomy is a safe and feasible procedure and can be implemented in humans in selected cases at qualified surgical centers.
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Successful laparoscopic gastric resection and safe introduction of a single-incision technique for gastric submucosal tumors located near the esophagogastric junction. Surg Today 2014; 45:209-14. [DOI: 10.1007/s00595-014-0940-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/11/2014] [Indexed: 12/19/2022]
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Single-incision laparoscopic cholecystectomy: a systematic review of methodology and outcomes. Surg Today 2014; 45:537-48. [PMID: 24845737 DOI: 10.1007/s00595-014-0908-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 04/01/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE (1) To survey the dissemination of SILC; (2) to determine which SILC method has become mainstream; (3) to determine whether the characteristic complications vary according to the type of procedure. METHODS An electronic search of PubMed, Databases@Ovid, and SciVerse Scopus between 2003/01/01 and 2012/12/31 was performed. RESULTS The peak number of annually published articles was 70 in 2011. The most common procedures were single skin incision, the use of a SILS Port(®), suture suspension and a 5-mm oblique scope. The intraoperative complications rate was 1.69 %. Postoperative complications occurred in 213/5283 cases. According to the surgical procedure, five factors (approach; P = 0.0017, gallbladder anchorage; P < 0.001, size; P = 0.049 and type; P < 0.001 of the scope, and size of the clip applier; P = 0.074) significantly affected the incidence of wound infection. The incidence of wound seroma/bleeding was significantly influenced by gallbladder anchorage (P = 0.009), the use of curved/articulated instruments (P = 0.048), and the diameter of the clip applier (P < 0.001). CONCLUSION To determine the best operative procedure for SILC, an analysis of uniform operative procedures is needed.
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Porpiglia F, Autorino R, Cicione A, Pagliarulo V, Falsaperla M, Volpe A, Gozen AS, Celia A, De Sio M, Saita A, Damiano R, Zacchero M, Fiori C, Terrone C, Bertolo R, Greco F, Breda A, Lima E, Rassweiler J. Contemporary urologic minilaparoscopy: indications, techniques, and surgical outcomes in a multi-institutional European cohort. J Endourol 2014; 28:951-7. [PMID: 24708491 DOI: 10.1089/end.2014.0134] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To provide an analytical overview of contemporary indications, techniques, and outcomes of urologic minilaparoscopy (ML) in multiple European centers. METHODS Data of patients who had undergone a minilaparoscopic urologic procedure at nine European institutions between 2009 and 2012 were retrospectively gathered. Surgical procedures were classified as upper or lower urinary tract and as ablative or extirpative and reconstructive. The main surgical outcome parameters were analyzed and relevant operative data related to the surgical technique were recorded. RESULTS Overall, 192 patients (mean age 45.25±17.8 years) were included in the analysis. Most of them were nonobese (mean body mass index [BMI] 24.7±3.6 kg/m(2)) at low estimated surgical risk (mean American Society of Anesthesiologists [ASA] 1.69±0.68). Indications for surgery were mostly nononcologic (132 cases, 68.8%). Most of the procedures were done in the upper urinary tract (133 cases, 69.2%) and were mostly with a reconstructive intent (109 cases, 56.7%). Overall operative time was 132.7±52.3 minutes with an estimated blood loss of 60.9±47.6 mL while the mean hospital stay was 5±2.1 days. Most of the postoperative complications were low Clavien grade (1 and 2), with only one (0.5%) grade 3 and one (0.5%) grade 4 complications recorded. CONCLUSIONS A broad range of common procedures can be safely and effectively performed with ML techniques. By duplicating the principles of standard laparoscopy, but potentially offering less surgical scar and trauma, ML can be regarded as a viable option when looking for a virtually "scarless" surgery.
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Abstract
The gold standard for the surgical treatment of symptomatic cholelithiasis is conventional laparoscopic cholecystectomy (LC). Although it has been associated with a slightly higher incidence of bile duct injury (BDI) in comparison with open cholecystectomy (OC), LC is considered a very safe operation. Prevention of BDI should be routinely performed in every LC. Recent trends include the performance of cholecystectomy through a single incision and NOTES (Natural Orifice Transluminal Endoscopic Surgery). However, lack of evidence of clinical advantages prevents their widespread adoption, and more data are needed to assess whether their use is warranted.
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Kim MJ, Kim TS, Kim KH, An CH, Kim JS. Safety and feasibility of needlescopic grasper-assisted single-incision laparoscopic cholecystectomy in patients with acute cholecystitis: comparison with three-port laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2014; 24:523-7. [PMID: 24818559 DOI: 10.1089/lap.2013.0552] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Single-incision laparoscopic cholecystectomy (SILC) has been increasing in use steadily, and many researchers have reported the safety and feasibility of SILC. However, most studies were confined to selected patients and excluded patients with acute inflammation. In this study, we evaluated the safety and feasibility of SILC with our technique in patients with acute cholecystitis. PATIENTS AND METHODS Ninety-six patients with acute cholecystitis undergoing laparoscopic cholecystectomy at Uijeonbu St. Mary's Hospital (Uijeongbu, Korea) between October 2011 and December 2012 were retrospectively reviewed. SILC was performed in 49 patients, and conventional three-port laparoscopic cholecystectomy was performed in 47 patients. Patient demographics and operative outcomes were compared between groups to evaluate the safety and feasibility of SILC using our technique. RESULTS There were no differences between groups in demographics except for the sex ratio. SILC was more often performed in female patients (69% versus 34%, P=.001). There were no statistically significant differences between groups in terms of operation time, critical view of safety identification time, iatrogenic gallbladder perforation, port-site seroma, and postoperative hospital stay, respectively. One patient in each group required conversion to open cholecystectomy because of massive bleeding. CONCLUSIONS This study showed that needlescopic grasper-assisted SILC with our technique is acceptable not only in selected patients but also in patients with acute cholecystitis. Lateral and cephalad retraction using a needlescopic grasper and a snake retractor can make SILC safe and easy in acute cholecystitis through better visualization of the triangle of Calot.
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Affiliation(s)
- Min-Jung Kim
- 1 Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Uijeongbu, Korea
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Internal hernia caused by epiploic appendices successfully treated by single-incision laparoscopic surgery (SILS). Hernia 2014; 19:1011-3. [PMID: 24577739 DOI: 10.1007/s10029-014-1231-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/16/2014] [Indexed: 10/25/2022]
Abstract
Internal hernia is a rare and often overlooked cause of small bowel obstruction. We report a case of internal hernia with an orifice composed of epiploic fat, successfully diagnosed and treated by single-incision laparoscopic surgery. This is the second report of this type of internal hernia and the first reported case addressed laparoscopically. Although the use of laparoscopy for the treatment of small bowel obstruction is not firmly established today, it may be beneficial for both its diagnostic value and as a less invasive treatment.
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Woo Ng Y, Goenadi CJ, Fai Fong Y. Single incision laparoscopic surgery for a large endometriotic cyst. J Surg Tech Case Rep 2014; 5:41-4. [PMID: 24470851 PMCID: PMC3889004 DOI: 10.4103/2006-8808.118628] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a technique for the treatment of large benign ovarian cysts by single port laparoscopic surgery via the umbilical approach. X-cone single port system (Karl Storz) was employed in this surgery. Prebent atraumatic grasping forceps were used in conjunction with the straight laparoscopic instruments. We propose using a "to-fro" peeling technique in the z-axis in SPLS cystectomy. Combined use of prebent and straight laparoscopic instruments enables the cystectomy to be performed in the z-axis, thereby avoiding instruments crossing and hands collision outside the abdomen. The proposed technique proved to be feasible, easy to employ, and safe in SPLS cystectomy, with the additional benefit of superior cosmetic outcome.
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Affiliation(s)
- Ying Woo Ng
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | | | - Yoke Fai Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Ahn SH, Son SY, Lee CM, Jung DH, Park DJ, Kim HH. Intracorporeal uncut Roux-en-Y gastrojejunostomy reconstruction in pure single-incision laparoscopic distal gastrectomy for early gastric cancer: unaided stapling closure. J Am Coll Surg 2013; 218:e17-21. [PMID: 24280449 DOI: 10.1016/j.jamcollsurg.2013.09.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 08/05/2013] [Accepted: 09/04/2013] [Indexed: 01/12/2023]
Affiliation(s)
- Sang-Hoon Ahn
- Department of Surgery, Seoul National University College of Medicine and Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Yong Son
- Department of Surgery, Seoul National University College of Medicine and Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang-Min Lee
- Department of Surgery, Seoul National University College of Medicine and Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Do Hyun Jung
- Department of Surgery, Seoul National University College of Medicine and Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Do Joong Park
- Department of Surgery, Seoul National University College of Medicine and Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyung-Ho Kim
- Department of Surgery, Seoul National University College of Medicine and Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
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Haugvik SP, Røsok BI, Waage A, Mathisen O, Edwin B. Single-incision versus conventional laparoscopic distal pancreatectomy: a single-institution case-control study. Langenbecks Arch Surg 2013; 398:1091-6. [PMID: 24177746 DOI: 10.1007/s00423-013-1133-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 10/11/2013] [Indexed: 12/18/2022]
Abstract
PURPOSE Laparoscopic distal pancreatectomy is becoming increasingly established at specialized surgical institutions worldwide. The purpose of this study was to compare single-incision laparoscopic distal pancreatectomy (panLESS) with conventional laparoscopic distal pancreatectomy (panLAP) to assess feasibility and 30-day morbidity. METHODS Eight consecutive patients who underwent panLESS were matched with patients who underwent panLAP in the same time period. Matching criteria were age, body mass index, and American Society of Anesthesiologists score. Feasibility was based on tumor size, operative time, intraoperative bleeding, resection status, and hospital stay. Thirty-day morbidity was defined by the revised Accordion Classification system and the International Study Group on Pancreatic Fistula definition. RESULTS Over a 19-month period, 8 and 16 patients were identified for panLESS and panLAP, respectively. There were no significant differences in tumor size, operative time, intraoperative bleeding, resection status, and hospital stay between the two groups. Surgical complications developed in four panLESS patients and five panLAP patients, and out of which, two patients from each group developed a postoperative pancreatic fistula (grade B). CONCLUSIONS This study indicates that panLESS is comparable to panLAP in terms of feasibility. More experience is needed to define what role single-incision distal pancreatectomy should have in minimal invasive pancreatic surgery.
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Affiliation(s)
- Sven-Petter Haugvik
- Department of Hepato-Pancreato-Biliary Surgery, Rikshospitalet, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway,
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Wagner MJ, Kern H, Hapfelmeier A, Mehler J, Schoenberg MH. Single-port cholecystectomy versus multi-port cholecystectomy: a prospective cohort study with 222 patients. World J Surg 2013; 37:991-8. [PMID: 23435700 DOI: 10.1007/s00268-013-1946-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of this study was to compare single-port access cholecystectomy (SPA) with the standard laparoscopic technique (LC) regarding the duration of the operation, complications, learning curve, late postoperative quality of life (QoL) and the incidence of incisional hernias. METHODS Between June 2009 and December 2011, a total of 122 SPA cholecystectomies were performed in our hospital. Simultaneously, 310 patients were operated on with the LC technique. In the LC group, 100 patients met the same criteria defined for SPA surgery. The two groups (SPA and LC) were compared by multivariable regression analysis. Endpoints of this study were quality of life (QoL) after 6 months by the EQ-5D questionnaire 5L and the incidence of incisional hernia 1 year after surgery. Operating time, hospital stay, and perioperative complications were also measured and compared. The median follow-up was 9.2 months (3-25 months). RESULTS The patients in the SPA group were younger and more often female. The mean operating time for group SPA was 73 min (35-136 min)-significantly longer than that for group LC with 60 min (33-190 min) (p < 0.001). Additional trocars were used in 8 of 122 (6.5 %) SPA patients. A conversion to open cholecystectomy was not necessary in SPA patients. The conversion rate in the LC group to open cholecystectomy was 2 % (2/100). The perioperative and postoperative complications and incisional hernia (5.5 %) were the same in both groups. QoL was significantly better in the SPA group in terms of mobility (p = 0,002), usual activity (p = 0.036), and overall anxiety (p = 0.026). CONCLUSIONS SPA cholecystectomy is safe, although the operation is significantly longer. No differences in terms of major complications or the incidence of incisional hernia were seen after 1 year. QoL was significantly better in patients operated on with the SPA technique.
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Affiliation(s)
- Markus J Wagner
- Department of Surgery, Rotkreuzklinikum München, Munich, Germany
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Yilmaz H, Arun O, Apiliogullari S, Acar F, Alptekin H, Calisir A, Sahin M. Effect of laparoscopic cholecystectomy techniques on postoperative pain: a prospective randomized study. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2013; 85:149-53. [PMID: 24106680 PMCID: PMC3791356 DOI: 10.4174/jkss.2013.85.4.149] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/30/2013] [Accepted: 06/09/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE Minimally invasive surgical technics have benefits such as decreased pain, reduced surgical trauma, and increased potential to perform as day case surgery, and cost benefit. The primary aim of this prospective, randomized, controlled study was to compare the effects of single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC) procedures regarding postoperative pain. METHODS Ninety adult patients undergoing elective laparoscopic cholecystectomy were included in the study. Patients were randomized to either SILC or CLC. Patient characteristics, postoperative abdominal and shoulder pain scores, rescue analgesic use, and intraoperative and early postoperative complications were recorded. RESULTS A total of 83 patients completed the study. Patient characteristics, postoperative abdominal and shoulder pain scores and rescue analgesic requirement were similar between each group except with the lower abdominal pain score in CLC group at 30th minute (P = 0.04). Wound infection was seen in 1 patient in each group. Nausea occurred in 13 of 43 patients (30%) in the SILC group and 8 of 40 patients (20%) in the CLC group (P > 0.05). Despite ondansetron treatment, 6 patients in SILC group and 7 patients in CLC group vomited (P > 0.05). CONCLUSION In conclusion, in patients undergoing laparoscopic surgery, SILC or CLC techniques does not influence the postoperative pain and analgesic medication requirements. Our results also suggest that all laparoscopy patients suffer moderate and/or severe abdominal pain and nearly half of these patients also suffer from some form of shoulder pain.
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Affiliation(s)
- Huseyin Yilmaz
- Department of General Surgery, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Oguzhan Arun
- Department of Anesthesiology and Reanimation, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Seza Apiliogullari
- Department of Anesthesiology and Reanimation, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Fahrettin Acar
- Department of General Surgery, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Husnu Alptekin
- Department of General Surgery, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Akın Calisir
- Department of General Surgery, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Mustafa Sahin
- Department of General Surgery, Selcuk University Faculty of Medicine, Konya, Turkey
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Romero-Talamás H, Kroh M. Cholecystectomy by using a surgical robotic system. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 21:11-7. [PMID: 24124116 DOI: 10.1002/jhbp.35] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Because of their frequency, hepato-biliary procedures have been the gateway for innovation to permeate into the realm of general surgery. Robotics and single-incision techniques are the latest manifestation in the evolution of minimally invasive surgery. Enthusiasm for the latter has increased due to its inarguably superior cosmetic result. Nevertheless, there are several technical disadvantages associated with this approach that have raised several concerns. The robotic platform may provide a solution to these issues. We analyze the strengths and weaknesses of the robotic system for cholecystectomy and its relation to single site technology. We review all available literature addressing robotic single site cholecystectomy. Due to the advent of specific robotic single site technology, many of the challenges commonly associated with single site cholecystectomy have been alleviated. Although this novel approach has not yet been extensively tested, the available evidence suggests that it is at least equivalent to LC in selected patients. Robotic single site cholecystectomy is safe and feasible and adequately compensates for many of the challenges commonly associated with conventional single site cholecystectomy. Large, high-quality studies are needed to further clarify the role of this procedure and its value as part of the surgeon's armamentarium.
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Affiliation(s)
- Héctor Romero-Talamás
- Digestive Disease Institute, Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA
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Rabischong B, Compan C, Savary D, Bourdel N, Canis M, Mage G, Botchorishvili R. La laparoscopie par incision unique en gynécologie : état des lieux en 2013. ACTA ACUST UNITED AC 2013; 42:445-57. [DOI: 10.1016/j.jgyn.2013.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 03/26/2013] [Accepted: 03/27/2013] [Indexed: 11/16/2022]
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Nomura H, Okuda K, Saito N, Fujiyama F, Nakamura Y, Yamashita Y, Terai Y, Ohmichi M. Mini-laparoscopic surgery versus conventional laparoscopic surgery for patients with endometriosis. Gynecol Minim Invasive Ther 2013. [DOI: 10.1016/j.gmit.2013.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Tranchart H, Ketoff S, Lainas P, Pourcher G, Di Giuro G, Tzanis D, Ferretti S, Dautruche A, Devaquet N, Dagher I. Single incision laparoscopic cholecystectomy: for what benefit? HPB (Oxford) 2013; 15:433-8. [PMID: 23659566 PMCID: PMC3664047 DOI: 10.1111/j.1477-2574.2012.00612.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 09/27/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND A single-incision laparoscopic cholecystectomy (SILC) was developed to improve outcomes as compared with the four-port classic laparoscopic cholecystectomy (CLC). Any potential benefits associated with a SILC have been suggested by previous studies reporting few patients with different surgical techniques. The aim of this study was to describe the experience with a standardized SILC as compared with CLC. METHODS From June 2010 to January 2012, 40 patients underwent a SILC [median age: 47.5 years (25-92)] and operative and peri-operative data were prospectively collected. Over the same period, 37 patients underwent a CLC. A 10-point visual analogue scale (VAS) was used for qualitative data. The costs of SILC and CLC were also compared. RESULTS For those patients undergoing a SILC the median operating time was 70 min (24-110). There were no conversions. An additional trocar was necessary in 16 patients. Four patients developed post-operative complications. The median immediate post-operative pain score was 5 (0-10). The median quality of life and cosmetic satisfaction at the initial post-operative visit were 10 (6-10) and 10 (5-10), respectively (VAS). Although the surgical results of both groups were similar, post-operative complications were exclusively reported in the SILC group (two incisional hernias). CONCLUSION Standardization of SILC is possible but associated with an important rate of additional trocar placement and a disturbing rate of incisional hernias.
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Affiliation(s)
- Hadrien Tranchart
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France
| | - Serge Ketoff
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France
| | - Guillaume Pourcher
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France
| | - Giuseppe Di Giuro
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France
| | - Dimitrios Tzanis
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France
| | - Stefano Ferretti
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France
| | - Antoine Dautruche
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France
| | - Niaz Devaquet
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France,Correspondence Ibrahim Dagher, Department of Minimally Invasive Surgery, Antoine Béclère Hospital, 157 rue de la Porte de Trivaux, 92141 Clamart cedex, France. Tel: +33 1 45 37 45 45. Fax: + 33 1 45 37 49 78. E-mail:
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Ikegami T, Shirabe K, Yoshizumi T, Kayashima H, Maehara Y. Use of the SAND balloon catheter in single-incision laparoscopic cholecystectomy for acute cholecystitis. Asian J Endosc Surg 2013; 6:134-6. [PMID: 23601999 DOI: 10.1111/ases.12005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 08/23/2012] [Accepted: 09/29/2012] [Indexed: 12/13/2022]
Abstract
INTRODUCTION SILS for acute cholecystitis is technically challenging because of the difficulties in obtaining optical surgical field. MATERIALS AND SURGICAL TECHNIQUE A 2-cm incision was made through the umbilicus, a single port and trocars were introduced, and the abdomen was then insufflated. A 5-mm SAND balloon punctured the abdominal wall and then the gallbladder wall. The distal and proximal balloons were inflated to prevent bile leakage, and the bile was aspirated. The collapsed gallbladder was then retracted cephalad, the critical structures were exposed, and the cystic artery and duct were divided. The gallbladder was dissected and removed through the umbilicus, and the abdomen was closed. We performed this procedure in three cases with acute cholecystitis. Operative times were 95, 133 and 244 min, blood loss was 5, 10 and 43 mL, and postoperative hospital stay was 2, 2 and 3 days, respectively. DISCUSSION The single-incision laparoscopic approach with the SAND balloon is a feasible technique for acute cholecystitis.
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Affiliation(s)
- Toru Ikegami
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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A laparoendoscopic single-site surgery approach to mesh sacrohysteropexy. Case Rep Med 2013; 2013:641675. [PMID: 23533434 PMCID: PMC3596949 DOI: 10.1155/2013/641675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 01/29/2013] [Indexed: 11/17/2022] Open
Abstract
Although laparoendoscopic single-site surgery (LESS) has spread across surgical disciplines, this has not been the case for the repair of uterovaginal prolapse. We describe the use of this technique for mesh sacrohysteropexy to correct a global prolapse classified as stage II on the pelvic organ prolapse quantification (POP-Q) system. The procedure involved intraoperative modification of a commercially available single incision port. At the 18 months followup, the patient was free of symptoms and had no objective prolapse.
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Chakravartty S, Murgatroyd B, Ashton D, Patel A. Single and multiple incision laparoscopic adjustable gastric banding: a matched comparison. Obes Surg 2013; 22:1695-700. [PMID: 22911145 DOI: 10.1007/s11695-012-0704-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Single incision laparoscopic bariatric surgery has developed over the last few years, with single incision laparoscopic adjustable gastric banding (SILS-AGB) being performed most commonly. However, there are no randomised controlled trials and few matched studies comparing SILS-AGB to conventional laparoscopic multi-port multiport adjustable gastric banding (LAGB). Our aim was to study any differences in outcome and analgesic requirements between two matched groups of gastric band patients (SILS-AGB and LAGB). METHODS Between June 2009 and September 2010, 111 patients underwent SILS-AGB and 99 patients underwent LAGB performed by a single surgeon (AGP). Patients were matched for age, sex, weight, BMI and co-morbidities. Forty six SILS-AGB and LAGB patients were included for analysis. Their outcomes were compared for operating times, conversions, analgesia requirements, morbidity and mortality. RESULTS Patients characteristics between the SILS-AGB and LAGB groups were similar with no differences in their median age (44 vs 47 years), sex (m:f; 7:39 vs 4:42), body mass index (43.1 vs 44.4 kg/m(2)) or co morbidities respectively. In the SILS-AGB group the median operating time (70 min) was not significantly longer than in LAGB group (61.5 min, p = 0.07). However, SILS-AGB patients used less opiates (p < 0.01) than the LAGB patients. There was no difference in morbidity, mortality or readmission rates. CONCLUSION SILS-AGB is a safe and feasible option and is comparable with LAGB. Post operative demand for analgesia was significantly less in the SILS-AGB group. Further comparisons of post operative pain and long term outcomes are required; however preliminary results are promising.
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Affiliation(s)
- Saurav Chakravartty
- Department of Surgery (Firm 3), King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
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