1
|
Abstract
Objective: The da Vinci single-port (SP) platform represents the latest innovation in minimally invasive urologic surgery, and the adoption of this technology by urologists is increasing. In this article, we briefly describe the evolution of minimally invasive and single-site surgery, and offer a comprehensive review of the current literature on the SP platform. Materials and Methods: For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until August 15, 2022. The published literature to date within SP robotic surgery in urology will be discussed. Evidence Synthesis: There are relatively few high-quality studies on the SP system, but there are multiple case series describing unique indications and surgical approaches with the SP robot, demonstrating safety and feasibility in the hands of experienced robotic surgeons. There also are an increasing number of prospective, larger cohort studies comparing outcomes between SP and multiport (MP) approaches that show benefits of the SP system regarding improved cosmesis, postoperative pain control, and decreased length of stay. Conclusions: Multiple prospective studies have shown benefits regarding cost and pain control for SP platform procedures compared to the traditional MP robotic approach. While its high cost and learning curve represent barriers to adoption, the SP platform represents a critical development in minimally invasive surgery. As this technology is further implemented at more institutions, long-term, high-quality data should accrue that will demonstrate its true value.
Collapse
Affiliation(s)
- Tuan Thanh Nguyen
- Department of Urology, University of California Irvine, Orange, California, USA
- University of Medicine and Pharmacy at Ho Chi Minh City, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Jacob Basilius
- Department of Urology, University of California Irvine, Orange, California, USA
| | - Sohrab Naushad Ali
- Department of Urology, University of California Irvine, Orange, California, USA
| | - Ryan W Dobbs
- Department of Urology, Cook County Health & Hospitals System, Chicago, Illinois, USA
| | - David I Lee
- Department of Urology, University of California Irvine, Orange, California, USA
| |
Collapse
|
2
|
Franco A, Pellegrino AA, De Nunzio C, Salkowski M, Jackson JC, Zukowski LB, Checcucci E, Vourganti S, Chow AK, Porpiglia F, Kaouk J, Crivellaro S, Autorino R. Single-Port Robot-Assisted Radical Prostatectomy: Where Do We Stand? Curr Oncol 2023; 30:4301-4310. [PMID: 37185441 PMCID: PMC10136812 DOI: 10.3390/curroncol30040328] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/18/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
In 2018, the da Vinci Single Port (SP) robotic system was approved by the US Food and Drug Administration for urologic procedures. Available studies for the application of SP to prostate cancer surgery are limited. The aim of our study is to summarize the current evidence on the techniques and outcomes of SP robot-assisted radical prostatectomy (SP-RARLP) procedures. A narrative review of the literature was performed in January 2023. Preliminary results suggest that SP-RALP is safe and feasible, and it can offer comparable outcomes to the standard multiport RALP. Extraperitoneal and transvesical SP-RALP appear to be the two most promising approaches, as they offer decreased invasiveness, potentially shorter length of stay, and better pain control. Long-term, high-quality data are missing and further validation with prospective studies across different sites is required.
Collapse
Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL 60612, USA
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, 00189 Rome, Italy
| | - Antony A Pellegrino
- Department of Urology, University of Illinois at Chicago, Chicago, IL 60612, USA
- Unit of Urology/Division of Oncology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, 00189 Rome, Italy
| | | | - Jamal C Jackson
- Department of Urology, Rush University, Chicago, IL 60612, USA
| | | | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, 10060 Turin, Italy
| | | | | | - Francesco Porpiglia
- Division of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, 10043 Turin, Italy
| | - Jihad Kaouk
- Department of Urology, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL 60612, USA
| | | |
Collapse
|
3
|
Palacios AR, Morgantini L, Trippel R, Crivellaro S, Abern MR. Comparison of Perioperative Outcomes Between Retroperitoneal Single-Port and Multiport Robot-Assisted Partial Nephrectomies. J Endourol 2022; 36:1545-1550. [PMID: 35856826 DOI: 10.1089/end.2022.0346] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: To report early institutional experience with the single-port robotic platform and compare perioperative outcomes between single-port robot-assisted partial nephrectomies (SP-RAPN) and multiport robot-assisted partial nephrectomies (MP-RAPN) when utilizing a retroperitoneal approach. Methods: A retrospective chart review of patients who underwent SP-RAPN or MP-RAPN at our institution between November 1, 2013 and May 30, 2021 was performed. Surgical platforms were compared through univariate analysis using the Kruskal-Wallis test for continuous variables and χ2 test for categorical variables. Results: A total of 20 SP-RAPN and 42 MP-RAPN were performed utilizing a retroperitoneal approach. Patients who underwent SP-RAPN were more likely to have a lower radius, endophytic/exophytic, nearness, anterior/posterior, location score (4 vs 6; p = 0.0084) and their masses tended to be more exophytic, although this was not statistically significant (p = 0.0535). Patients undergoing SP-RAPN had a shorter postoperative length of hospital stay (1 vs 2 days; p < 0.0001). There were no significant differences in operative time, estimated blood loss, ischemia time, positive margin rate, malignant histology, postoperative complication rate, or Clavien-Dindo complication grade. Conclusion: Retroperitoneal SP-RAPN appear to be safe without compromising perioperative outcomes when compared with MP-RAPN for low-complexity renal masses. Further studies are recommended to assess the role of the SP for higher-complexity renal masses and to characterize variables that influence the observed difference in length of hospital stay.
Collapse
Affiliation(s)
- Arnold R Palacios
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Luca Morgantini
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ryan Trippel
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Michael R Abern
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA.,Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| |
Collapse
|
4
|
Kim CH, Lee J, Lee SY, Heo SH, Jeong YY, Kim HR. Periumbilical Transverse Incision for Reducing Incisional Hernia in Laparoscopic Colon Cancer Surgery. World J Surg 2022; 46:916-924. [PMID: 35076822 DOI: 10.1007/s00268-021-06319-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although off-midline incisions (unilateral low transverse or Pfannenstiel incision) have been reported to have a lower incidence of incisional hernia (IH) than periumbilical vertical incision for the purpose of specimen extraction, it is most commonly used in laparoscopic colon cancer surgery because off-midline incisions are associated with the limitation of colon exteriorization. This study aims to investigate the risk of IH after laparoscopic colectomy and compare midline vertical incision versus transverse incision focusing on the incidence of IH. METHODS Patients who underwent elective laparoscopic colectomy due to colon malignancy from June 2015 to May 2017 were included. All patients had either vertical (n = 429) or muscle splitting periumbilical transverse incisions (n = 125). RESULTS Median duration of the follow-up period was 23.6 months, during which IHs occurred in 12.1% patients. The incidence of hernia was significantly lower in the transverse group (3 vs. 64, 2.4% vs. 14.9%, p < 0.001). On multivariate analysis, BMI ≥ 23 [odds ratio (OR) 2.282, 95% confidence interval (CI) 1.245-4.182, p = 0.008], postoperative surgical site infection (OR 3.780, 95% CI 1.969-7.254, p < 0.001) and vertical incision (OR 7.113, 95% CI 2.173-23.287, p < 0.001) were independently related with increased incidence of IH. CONCLUSIONS A muscle splitting periumbilical transverse incision could significantly reduce the rate of IH in minimally invasive colon cancer surgery.
Collapse
Affiliation(s)
- Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 519-763, Korea
| | - Jaram Lee
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 519-763, Korea
| | - Soo Young Lee
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 519-763, Korea
| | - Suk Hee Heo
- Department of Radiology, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea
| | - Yong Yeon Jeong
- Department of Radiology, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea
| | - Hyeong Rok Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 519-763, Korea.
| |
Collapse
|
5
|
Zaliznyak M, Chen A, Kuhlmann P, Weinberger J, Zhao H, Tobis S, Wu G, Houman J. Optimal instrument length for transumbilical laparoendoscopic single site (U-LESS) surgery. J Robot Surg 2021; 16:53-58. [PMID: 33566275 DOI: 10.1007/s11701-021-01208-5] [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: 12/28/2020] [Accepted: 01/31/2021] [Indexed: 11/24/2022]
Abstract
The aim of our study was to recommend a novel method for measuring the distance from the umbilicus to intra-abdominal organs, as well as recommend an instrument length that would accommodate transumbilical laparoendoscopic single-site (U-LESS) surgeries to these areas. From CT scans of 50 men and 50 women, we calculated the distance from the umbilicus to 11 intra-abdominal points of interest using two triangles oriented perpendicular to each other. Using known lengths of the triangles, we used the Pythagorean theorem to calculate distances with and without insufflation. Distances were measured from the umbilicus to the xyphoid process, superior most aspect of the spleen, neck of the gallbladder, bifurcation of the descending aorta, adrenal glands, superior pole(s) of the kidneys, inferior most aspect of the inguinal canal, suprapubic margin, and the apex of the prostate (or female bladder neck). We found that an instrument working length of 43 cm would be sufficient to facilitate U-LESS surgery for all of our patients to each of the measured points of interest. The technique described in this paper serves as a useful method by which to measure the distance from the umbilicus to any intra-abdominal point of interest. These measurements would allow surgeons to correctly select instruments with adequate length when planning to perform U-LESS surgery.
Collapse
Affiliation(s)
- Michael Zaliznyak
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Andrew Chen
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Paige Kuhlmann
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - James Weinberger
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA, 90095, USA
| | - Hanson Zhao
- Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Scott Tobis
- Sansum Clinic, Santa Barbara, CA, 93102, USA
| | - Guan Wu
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, NY, 14642, USA
| | - Justin Houman
- Tower Urology, 8635 W 3rd Street #1W, Los Angeles, CA, 90048, USA.
| |
Collapse
|
6
|
Kaouk JH, White WM. Single-Port Laparoscopic Surgery in Urology ‘What is Now Proved was Only Once Imagined’. Urology 2020; 145:324-325. [DOI: 10.1016/j.urology.2020.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
7
|
Covas Moschovas M, Bhat S, Rogers T, Thiel D, Onol F, Roof S, Sighinolfi MC, Rocco B, Patel V. Applications of the da Vinci single port (SP) robotic platform in urology: a systematic literature review. Minerva Urol Nephrol 2020; 73:6-16. [PMID: 32993277 DOI: 10.23736/s2724-6051.20.03899-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Robotic surgical technology has evolved to include a new platform specifically designed for the single-port (SP) approach. Benefits of the da Vinci SP are still under investigation. This study aimed to review the urological literature since the first report of the use of the platform. EVIDENCE ACQUISITION We performed a systematic literature review of PubMed, Medline, and Web of Science databases on June 15, 2020 searching for all available articles of da Vinci SP use from December 2014 (date of the first clinical report of da Vinci SP in the urology) until June 1, 2020 following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. EVIDENCE SYNTHESIS A total of 43 articles were eligible for inclusion. Ten studies reported different surgeries and techniques on cadavers while the rest described the clinical experience of different groups. We divided our article and tables into preclinical experience with surgery on cadavers, radical prostatectomy (RP) approach, and multiple types of procedures described in the same study. CONCLUSIONS The application of da Vinci SP in urologic procedures after five years of the first clinical investigation is feasible and safe. Radical prostatectomy is the most common intervention performed with this robot. Some groups described benefits in terms of less postoperative pain and early discharge, especially with the extraperitoneal approach. However, further studies with larger sample sizes and longer follow-up are awaited.
Collapse
Affiliation(s)
| | - Seetharam Bhat
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Travis Rogers
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | | | - Fikret Onol
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Shannon Roof
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | | | | | - Vipul Patel
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| |
Collapse
|
8
|
Single-port robotic-assisted partial nephrectomy: initial clinical experience and lessons learned for successful outcomes. J Robot Surg 2020; 15:293-298. [PMID: 32564222 DOI: 10.1007/s11701-020-01106-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/15/2020] [Indexed: 12/17/2022]
Abstract
The Intuitive Surgical DaVinci SP ("Single Port") robotic platform was approved in 2014, but, recently, there has been a dissemination of the technology with multiple urological procedures successfully adapted to this robot. There are some important differences from prior models. We aimed to share our early outcomes and lessons learned for performing successful single-port robotic-assisted partial nephrectomy (SP-RAPN). This study is a retrospective review of sequential SP-RAPN cases between 7/2019 and 3/2020. We extracted patient characteristics and early surgical outcomes. Surgical tips and tricks were recorded during these cases and compiled. SP-RAPN was successfully completed in 12 patients. Patients mean age was 57.8 ± 11.0 years and median ASA score was 2. Mean tumor size was 3.1 ± 2.2 cm. The average OR Time was 172 ± 41 min and EBL was 68 ± 75 mL. All cases had warm ischemia time < 25 min. Tumor pathology included 8 RCC (6 pT1a, 1 pT1b, 1 pT2a), 2 AML, and 2 oncocytoma. There were no complications. Our top surgical tips involved: (1) patient positioning, (2) port placement, (3) insufflation, (4) air docking, (5) assistant port placement, (6) dynamic arm control, (7) hilar clamping, (8) camera relocation, (9) tumor excision, and (10) extraction and port closure. SP-RAPN is safe and feasible in this series. There are advantages and disadvantages to this platform. As the technology matures and techniques evolve, SP-RAPN may become more appealing. Future studies should focus on long-term outcomes and cost-effectiveness of the SP system.
Collapse
|
9
|
Single-port technique evolution and current practice in urologic procedures. Asian J Urol 2020; 8:100-104. [PMID: 33569276 PMCID: PMC7859361 DOI: 10.1016/j.ajur.2020.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/19/2020] [Accepted: 04/21/2020] [Indexed: 11/21/2022] Open
Abstract
Different groups described the single-port surgery since its first report in laparoscopic procedures. However, the acceptance of this technique among urologists, even after the robotic approach, was reduced in the past years. Therefore, to overcome the challenges related to the single-port surgery, a new robotic platform named da Vinci SP was created with exclusive single port technology. We performed a non-systematic literature review regarding the single port technique in urologic surgeries since the first laparoscopic report until the da Vinci SP robotic platform. Three different periods were described (laparoscopy, robotic, and da Vinci SP), and we focused in our experience with this new single port robot. We selected different articles and summarized the information regarding the use of single-site surgery in laparoscopic procedures and the challenges of this approach. We also reported the experience of different groups using the single port robotic technique and some recent reports of the da Vinci SP approach. In our experience with this new console, we described some critical points related to our radical prostatectomy technique and the lessons learned during the introduction of this novel platform. Previous single-site procedures described some common challenges that limited the technique expansion. However, our experience with the da Vinci SP described feasible and safe procedures with acceptable intraoperative outcomes. The introduction of this platform is recent in the market, and the literature still lacks a high level of evidence describing the long-term outcomes of this new technology.
Collapse
|
10
|
Li C, Hua K. The current status of sacrocolpopexy in the management of apical prolapse. MINERVA GINECOLOGICA 2020; 72:165-170. [PMID: 32315126 DOI: 10.23736/s0026-4784.20.04477-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pelvic organ prolapse (POP) is a prevalent condition that negatively affects women' s quality of life. There is growing recognition that adequate support for the vaginal apex is an important component of a durable surgical repair for women with advanced prolapse, including the anterior and posterior wall prolapse. Surgical treatment options include abdominal and vaginal approaches, the former of which can be performed open, laparoscopically, and robotically. Sacrocolpopexy is a common procedure designed for the treatment of prolapse including uterine or vaginal vault prolapse and multiple-compartment prolapse. Although traditionally performed as an open abdominal procedure, minimally invasive sacrocolpopexy, whether laparoscopic or robotic, has been successfully performed in the clinical practice by many pelvic reconstructive surgeons. In order to require an outstanding cosmetic result, transumbilical/transvaginal single-port sacrocolpopexy has been developed to achieve the goal and initial outcomes have demonstrated their efficacy, safety and feasibility. However, up to date, there are many variations to these procedures, with different levels of evidence to support each of them. Herein we reviewed the current literatures on current surgical choices for women with apical prolapse.
Collapse
Affiliation(s)
- Chunbo Li
- Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Keqin Hua
- Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China -
| |
Collapse
|
11
|
Single versus multiple port laparoscopic left lateral sectionectomy for hepatocellular carcinoma: A retrospective comparative study. Int J Surg 2020; 77:15-21. [PMID: 32179178 DOI: 10.1016/j.ijsu.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Single port laparoscopic hepatectomy has been applied in some surgeries. We aimed to describe our experience with single port laparoscopic left lateral sectionectomy (SPLS) and to compare the safety and feasibility of this technique with those of conventional multi-port laparoscopic left lateral sectionectomy (MPLS) in the treatment of hepatocellular carcinoma (HCC). METHODS A total of 72 consecutive patients who underwent SPLS (n = 33) and MPLS (n = 39) for HCC were enrolled. The peri-operative parameters of safety and feasibility, as well as the short-term oncological outcomes were compared. RESULTS The length of postoperative hospital stay (LOS) was significantly shorter in the SPLS group than in the MPLS group (4.12 vs. 4.59 days, P = 0.043). No significant difference between the two groups was found in the operation time (104.58 vs. 95.69 min in the SPLS group and MPLS group respectively, P = 0.353) or the amount of blood loss (62.73 vs. 68.46 ml, P = 0.595). The 1-year recurrence-free survival rate was 77.9% in the SPLS group and 70.7% in the MPLS group (P = 0.82). Subgroup analysis showed that for patients without cirrhosis, the LOS was shorter in the SPLS group than in the MPLS group (P = 0.033), while for patients with cirrhosis, the LOS was not significantly different between the two groups (P = 0.201), although it was shorter in the SPLS group. CONCLUSIONS SPLS was a feasible and safe surgical approach for the treatment of HCC on left lateral section.
Collapse
|
12
|
Single-port robotic surgery: the next generation of minimally invasive urology. World J Urol 2019; 38:897-905. [DOI: 10.1007/s00345-019-02898-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/28/2019] [Indexed: 01/30/2023] Open
|
13
|
Mustea A, Holthaus B, Elmeligy H, Krüger-Rehberg S, Trojnarska D, Alwafai Z, Sternberg J, Stope MB, Kohlmann T, Meinhold-Heerlein I, Koensgen D. Comparison of laparoscopy-assisted vaginal hysterectomy as endoscopic single-station surgery and conventional laparoscopic hysterectomy—surgical effects on safety and quality of life. ACTA ACUST UNITED AC 2019. [DOI: 10.1186/s10397-019-1062-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Background
To extend the benefits of minimally invasive surgery, an increasing enthusiasm has emerged for the laparo-endoscopic single-site surgery (LESS). The idea of LESS is to allow inserting multiple laparoscopic instruments through only one umbilical incision instead of multiple abdominal incisions.
Methods
Sixty patients from three different centers in Germany were randomized (1:1) to conventional laparoscopic hysterectomy (n = 31) or LESS hysterectomy (n = 29). The study focused in particular on the safety and efficacy of both techniques.
Results
The mean operative time was comparable in both groups (68.2 vs 73.6 min., p = 0.409; 95% CI − 18.69–7.12). No differences were seen regarding estimated blood loss (p = 0.915; 95% CI − 21.02–18.88), intra- and postoperative complications (p = 0.944), and wound infection rates (p = 0.944). Patients within the LESS group experienced significantly less pain in the first 24 h postoperatively (p = 0.006); the pain scores at 3, 5, 7 days and 2 months postoperatively were comparable.
Conclusion
LESS hysterectomy is a reliable and safe option in gynecologic surgery. Compared to conventional laparoscopic hysterectomy, LESS surgery demonstrated comparable surgical properties in regard to blood loss, duration of surgery, and intra-/postoperative complications. Notably, patients undergoing LESS hysterectomy experienced some less pain postoperatively.
Collapse
|
14
|
Ma X, Song C, Chiu PW, Li Z. Autonomous Flexible Endoscope for Minimally Invasive Surgery With Enhanced Safety. IEEE Robot Autom Lett 2019. [DOI: 10.1109/lra.2019.2895273] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
15
|
Lauterbach R, Mustafa-Mikhail S, Matanes E, Amit A, Wiener Z, Lowenstein L. Single-port versus multi-port robotic sacrocervicopexy: Establishment of a learning curve and short-term outcomes. Eur J Obstet Gynecol Reprod Biol 2019; 239:1-6. [PMID: 31154095 DOI: 10.1016/j.ejogrb.2019.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/17/2019] [Accepted: 05/24/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to compare the learning curves, surgical outcomes and complications of multi-port access robotic-assisted laparoscopic sacrocervicopexy (MP-RSC) to single-port robotic access (SP-RSC) for vaginal apex prolapse. METHODS A retrospective study of the first 52 MP-RSC procedures compared with the first 52 SP-RSC procedures performed at one medical center. Primary outcomes were intraoperative bleeding, operative time, and hospitalization. Secondary outcomes were surgical complications. RESULTS There was a statistically significant difference in mean operative times between the MP-RSC and SP-RSC procedures: 206.5 ± 39.4 and 187.8 ± 46.2, respectively, P = 0.028. The mean estimated intraoperative blood loss was 35 [20-87.5] ml and 20 [10-47.5] ml, respectively, P = 0.008. Respective mean operative times decreased from the first 15 to the subsequent 15 cases: in the MP-RSC group from 224.2 ± 43.2 to 198.4 ± 36.3 min, P = 0.088, and in the SP-RSC group from 222.4 ± 53.1 to 161.3 ± 28.2 min, P < 0.001. The subsequent 22 cases showed different trends. Hospitalization (days) and level of pain at 24 h postoperative, according to a 1-10 point visual analogue scale, did not differ. Adverse events were rare in both groups. CONCLUSIONS MP-RSC and SP-RSC are feasible and the short term outcomes and learning curves for both procedures are comparable.
Collapse
Affiliation(s)
- Roy Lauterbach
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Susana Mustafa-Mikhail
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Emad Matanes
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Amnon Amit
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Zeev Wiener
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| |
Collapse
|
16
|
Zouari M, Ben Dhaou M, Ammar S, Jallouli M, Mhiri R. Laparoendoscopic Single-Site (LESS) Surgery in Pediatric Urology: A 4-Year Experience. Curr Urol 2019; 12:153-157. [PMID: 31316324 DOI: 10.1159/000489434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 12/12/2017] [Indexed: 11/19/2022] Open
Abstract
Objective The aim of the study was to assess the feasibility and outcomes of pediatric urological laparoendoscopic single-site (LESS) surgery. Materials and Methods We retrospectively collected charts of all patients who underwent LESS procedures in our department from January 2013 to December 2016. Data included demographic characteristics, type of procedures, intraoperative details, hospital stay, and complications. The umbilicus was used as the surgical site in all cases. All procedures were performed with a homemade glove port and standard straight 3- or 5-mm laparoscopic instruments. Results Seventy-three patients (55 males, 18 females) were identifed. Procedures included 46 orchidop-exies, 21 pyeloplasties, 8 varicocelectomies, 3 nephrecto-mies, 3 nephroureterectomies, 3 orchiectomies, and 1 renal hydatid cyst treatment. Median operative time for the entire cohort was 47 min (range 26-156 min). There was no signifcant intraoperative blood loss. No conversion to conventional laparoscopy or open surgery was needed. All patients required paracetamol postoperatively. The mean follow-up was 18 months. Two patients had testicular atrophy after a Fowler-Stephens procedure and 1 patient had testicular reascension. Cosmetic results were excellent. Forty-five (62.5%) patients were discharged on the day of surgery. Conclusion Our study demonstrated that LESS surgery using our glove port technique and conventional laparoscopic instruments is a feasible and safe technique for the surgical management of various pediatric urological conditions.
Collapse
Affiliation(s)
- Mohamed Zouari
- Department of Pediatric Surgery, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia.,Sfax Medical School, University of Sfax, Sfax, Tunisia
| | - Mahdi Ben Dhaou
- Department of Pediatric Surgery, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia.,Sfax Medical School, University of Sfax, Sfax, Tunisia
| | - Saloua Ammar
- Department of Pediatric Surgery, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia.,Sfax Medical School, University of Sfax, Sfax, Tunisia
| | - Mohamed Jallouli
- Department of Pediatric Surgery, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia.,Sfax Medical School, University of Sfax, Sfax, Tunisia
| | - Riadh Mhiri
- Department of Pediatric Surgery, Hedi Chaker Hospital, University of Sfax, Sfax, Tunisia.,Sfax Medical School, University of Sfax, Sfax, Tunisia
| |
Collapse
|
17
|
Internal hernia after gastrectomy for gastric cancer in minimally invasive surgery era. Gastric Cancer 2019; 22:1009-1015. [PMID: 30758761 PMCID: PMC6694080 DOI: 10.1007/s10120-019-00931-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 01/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The incidence and clinical presentation of internal hernia after gastrectomy have been changing in the minimally invasive surgery era. This study aimed to analyze the clinical features and risk factors for internal hernia after gastrectomy for gastric cancer. METHODS We retrospectively analyzed internal hernia after gastrectomy for gastric cancer in 6474 patients between January 2003 and December 2016 at Seoul National University Bundang Hospital. Multivariable logistic regression was performed to evaluate risk factors. RESULTS Internal hernias identified by computed tomography or surgical exploration were 111/6474 (1.7%) and the median interval time was 450 days after gastrectomy. Fourteen (0.9%) of the 1510 patients who underwent open gastrectomy and 97 (2.0%) of the 4964 patients who underwent laparoscopic gastrectomy developed internal hernia. Of the 6474 patients, internal hernia developed in 0 (0%), 9 (1.1%), 40 (3.1%), 56 (3.3%), 6 (2.3%), and 0 (0%) patients who underwent Billroth I, Billroth II, Roux-en-Y, uncut Roux-en-Y, double tract, and esophagogastrostomy reconstructions, respectively. Fifty-nine (53.2%) of 111 patients with symptomatic hernia underwent surgery. Of the 59 internal hernias, treated surgically, 32 (53.2%), 27 (45.8%), and 0 (0%) were identified in jejunojejunostomy mesenteric, Petersen's, and transverse colon mesenteric defects, respectively. In multivariate analysis, non-closure of mesenteric defects (P < 0.01), laparoscopic approach (P < 0.01), and totally laparoscopic approach (P = 0.03) were independent risk factors for internal hernia. CONCLUSIONS The potential spaces such as Petersen's, jejunojejunostomy mesenteric, and transverse colon mesenteric defects should be closed to prevent internal hernia after gastrectomy for gastric cancer.
Collapse
|
18
|
Oh JR, Park SC, Park SS, Sohn B, Oh HM, Kim B, Kim MJ, Hong CW, Han KS, Sohn DK, Oh JH. Clinical Outcomes of Reduced-Port Laparoscopic Surgery for Patients With Sigmoid Colon Cancer: Surgery With 1 Surgeon and 1 Camera Operator. Ann Coloproctol 2018; 34:292-298. [PMID: 30509018 PMCID: PMC6347336 DOI: 10.3393/ac.2018.04.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/06/2018] [Indexed: 01/08/2023] Open
Abstract
Purpose This study compared the perioperative clinical outcomes of reduced-port laparoscopic surgery (RPLS) with those of conventional multiport laparoscopic surgery (MPLS) for patients with sigmoid colon cancer and investigated the safety and feasibility of RPLS performed by 1 surgeon and 1 camera operator. Methods From the beginning of 2010 until the end of 2014, 605 patients underwent a colectomy for sigmoid colon cancer. We compared the characteristics, postoperative outcomes, and pathologic results for the patients who underwent RPLS and for the patients who underwent MPLS. We also compared the clinical outcomes of single-incision laparoscopic surgery (SILS) and 3-port laparoscopic surgery. Results Of the 115 patients in the RPLS group, 59 underwent SILS and 56 underwent 3-port laparoscopic surgery. The MPLS group included 490 patients. The RPLS group had shorter operating time (137.4 ± 43.2 minutes vs. 155.5 ± 47.9 minutes, P < 0.001) and shorter incision length (5.3 ± 2.2 cm vs. 7.8 ± 1.2 cm, P < 0.001) than the MPLS group. In analyses of SILS and 3-port laparoscopic surgery, the SILS group showed younger age, longer operating time, and shorter incision length than the 3-port surgery group and exhibited a more advanced T stage, more lymphatic invasion, and larger tumor size. Conclusion RPLS performed by 1 surgeon and 1 camera operator appears to be a feasible and safe surgical option for the treatment of patients with sigmoid colon cancer, showing comparable clinical outcomes with shorter operation time and shorter incision length than MPLS. SILS can be applied to patients with favorable tumor characteristics.
Collapse
Affiliation(s)
- Jung Ryul Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sung Chan Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sung Sil Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Beonghoon Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Hyoung Min Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Bun Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Min Jung Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Chang Won Hong
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kyung Su Han
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Dae Kyung Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| |
Collapse
|
19
|
Chang Y, Lu X, Zhu Q, Xu C, Sun Y, Ren S. Single-port transperitoneal robotic-assisted laparoscopic radical prostatectomy (spRALP): Initial experience. Asian J Urol 2018; 6:294-297. [PMID: 31297322 PMCID: PMC6595143 DOI: 10.1016/j.ajur.2018.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/03/2018] [Accepted: 07/17/2018] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the feasibility of single-port transperitoneal robotic-assisted laparoscopic radical prostatectomy (spRALP) and discuss its surgical technique. Methods A 60-year-old male was admitted with an elevated prostate-specific antigen (PSA) level of 13.89 ng/mL and confirmed with prostate cancer on biopsy showing three of 22 positive cores with a Gleason score of 3 + 4 = 7. Multiparametric magnetic resonance (MR) and bone scintigraphy showed organ-confined disease. spRALP was performed using da Vinci Si HD surgical system, with access of a quadri-channel laparoscopic port placed supraumbilically. Two drainage tubes were placed before wound closure. The surgical procedure was largely in consistence with a conventional robotic-assisted laparoscopic radical prostatectomy. Results The surgery was successfully carried out with a duration of 152 min and an estimated blood loss of 100 mL. The patient was discharged on postoperative Day 4 after removal of both pelvic drainage tubes. Foley catheter was removed on postoperative Day 14. No major complications were encountered. Postoperative pathology showed a Gleason score of 3 + 4 = 7 with no extraprostatic extension and negative surgical margins. Conclusion Single-port robotic prostatectomy is feasible using the currently available robotic instruments in most Chinese robotic urological centers. Meticulous preoperative planning and careful patient selection are mandatory. Further studies concerning perioperative complications and pentafecta outcome compared with the conventional multi-port robotic prostatectomy is required.
Collapse
Affiliation(s)
- Yifan Chang
- Department of Urology, Changhai Hospital, Second Military University, Shanghai, China
| | - Xiaojun Lu
- Department of Urology, Changhai Hospital, Second Military University, Shanghai, China
| | - Qingliang Zhu
- Department of Urology, Jiangdu People's Hospital, Yangzhou, China
| | - Chuanliang Xu
- Department of Urology, Changhai Hospital, Second Military University, Shanghai, China
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Second Military University, Shanghai, China
- Corresponding authors.
| | - Shancheng Ren
- Department of Urology, Changhai Hospital, Second Military University, Shanghai, China
- Corresponding authors.
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Yu G, Zhang K, Li W, Li L, Zhao Y, Wang Y, Xu M, Da J, Dong G, Wang Z, Xu B. Unilateral Renal Tumor Cryoablation and Contralateral Radical Nephrectomy of Bilateral Renal Tumors by Transumbilical 3D Multichannel Laparoendoscopic Single-Site Surgery. J Endourol Case Rep 2018; 4:53-58. [PMID: 29682611 PMCID: PMC5908421 DOI: 10.1089/cren.2017.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Unilateral renal tumor cryoablation and contralateral radical nephrectomy of bilateral renal tumors were performed by transumbilical three-dimensional (3D) multichannel laparoendoscopic single-site (LESS) surgery, in an attempt to verify the feasibility and safety of the procedure, sum up the operational experience, and evaluate the surgical outcome. Case Presentation: This was a 47-year-old female patient with a body mass index of 27.34 kg/m2 without backache, low back pain, hematuria, urinary urgency, frequent urination, dysuria, and other symptoms. Contrast-enhanced CT scan of the kidney on admission showed four masses in the left kidney and two masses in the right kidney. Preoperative serum creatinine (SCr) was 87 μmol/L. Operation was performed under general anesthesia by first laying the patient in a left lateral position. A 2-cm longitudinal transumbilical skin incision was made to expose the right kidney for complete dissection of the two tumors. First, puncture biopsy was performed, and then two freeze–thaw cryoablation cycles for the two tumors were performed. At last, the patient was laid in a right lateral position for radical nephrectomy of the left kidney. The operative duration, cryoablation time, and estimated blood loss were 200 minutes, 40 minutes, and 100 mL, respectively. Postoperative pathological examination revealed clear-cell renal cell carcinoma. The right glomerular filtration rate tested was 42.36 mL/minute and SCr was 131 μmol/L at day 5 after surgery. There was no evidence of contrast enhancement at the cryoablative region as shown by renal contrasted CT scan performed 4 days after surgery and renal contrasted MRI scan performed 6 weeks after surgery, indicating that there was no tumor remnant or recurrence. Conclusion: Our preliminary experience shows that the treatment of bilateral renal tumors with unilateral renal tumor cryoablation and contralateral radical nephrectomy by transumbilical 3D LESS is safe, feasible, and effective. It may prove to be a viable option for patients with significant comorbidities and an insensitive treatment intention.
Collapse
Affiliation(s)
- Guopeng Yu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Urology, The People's Hospital of Xiangyun, Dali Bai Autonomous Prefecture, Yunnan, China
| | - Ke Zhang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenzhi Li
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Long Li
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanliang Zhao
- Department of Urology, The People's Hospital of Xiangyun, Dali Bai Autonomous Prefecture, Yunnan, China
| | - Yiwei Wang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingxi Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Da
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoqin Dong
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhong Wang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
22
|
Angioni S, Mereu L, Maricosu G, Mencaglia L, Melis GB. Single Port Access Laparoscopy (SPAL) for Endometrioma Excision. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/228402651000200207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Puropose To evaluate the feasibility of single port access laparoscopy (SPAL) for the treatment of ovarian endometrioma. Case Report Three patients affected by single ovarian endometrioma underwent cyst excision using a laparoendoscopic single port approach with a new multiport, reusable trocar, and flexible, curved and standard laparoscopic instruments. Results No conversion to multi-access standard laparoscopic technique was required and no intraoperative or postoperative complications were observed. The mean operative time was 40 minutes. Conclusions We conclude that single portal access laparoscopy is feasible, safe and effective for the excision of ovarian endometrioma, with good results in terms of cosmesis, postoperative pain and patient satisfaction. This approach may be indicated in patients with single cysts without dense adherences in the bowel and/or deep infiltrating endometriosis.
Collapse
Affiliation(s)
- Stefano Angioni
- Division of Gynecology, Obstetrics and
Pathophysiology of Human Reproduction, University of Cagliari - Italy
| | - Liliana Mereu
- Division of Gynecology, Villanova
Hospital, Firenze - Italy
| | - Giovanni Maricosu
- Division of Gynecology, Obstetrics and
Pathophysiology of Human Reproduction, University of Cagliari - Italy
| | - Luca Mencaglia
- Division of Gynecology, Villanova
Hospital, Firenze - Italy
| | - Gian Benedetto Melis
- Division of Gynecology, Obstetrics and
Pathophysiology of Human Reproduction, University of Cagliari - Italy
| |
Collapse
|
23
|
Narita M, Kageyama S, Okegawa T, Kinoshita H, Sato F, Nakagawa K, Habuchi T, Hoshi A, Matsubara A, Yoshimura K, Terachi T, Mimata H, Kawauchi A. Urological laparoendoscopic single-site and reduced port surgery: A nationwide survey in Japan. Int J Urol 2017; 25:263-268. [DOI: 10.1111/iju.13504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/30/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Mitsuhiro Narita
- Department of Urology; Shiga University of Medical Science; Shiga Japan
| | - Susumu Kageyama
- Department of Urology; Shiga University of Medical Science; Shiga Japan
| | | | - Hidefumi Kinoshita
- Department of Urology and Andrology; Kansai Medical University; Osaka Japan
| | | | - Ken Nakagawa
- Department of Urology; Tokyo Dental College Ichikawa General Hospital; Chiba Japan
| | - Tomonori Habuchi
- Department of Urology; Akita University Graduate School of Medicine; Akita Japan
| | - Akio Hoshi
- Department of Urology; Tokai University School of Medicine; Kanagawa Japan
| | - Akio Matsubara
- Department of Urology; Hiroshima University; Hiroshima Japan
| | - Koji Yoshimura
- Department of Urology; Shizuoka General Hospital; Shizuoka Japan
| | - Toshiro Terachi
- Department of Urology; Tokai University School of Medicine; Kanagawa Japan
| | | | - Akihiro Kawauchi
- Department of Urology; Shiga University of Medical Science; Shiga Japan
| |
Collapse
|
24
|
First case of robotic laparoendoscopic single-site radical prostatectomy with single-site VesPa platform. J Robot Surg 2017; 12:381-385. [DOI: 10.1007/s11701-017-0724-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
|
25
|
Song T, Kim MK, Jung YW, Yun BS, Seong SJ, Choi CH, Kim TJ, Lee JW, Bae DS, Kim BG. Minimally invasive compared with open surgery in patients with borderline ovarian tumors. Gynecol Oncol 2017; 145:508-512. [DOI: 10.1016/j.ygyno.2017.03.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/24/2017] [Accepted: 03/24/2017] [Indexed: 01/12/2023]
|
26
|
Loh AZH, Torrizo MP, Ng YW. Single Incision Laparoscopic Surgery for Surgical Treatment of Tubal Ectopic Pregnancy: A Feasible Alternative to Conventional Laparoscopy. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2016.0103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alvona Zi Hui Loh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Marbee P. Torrizo
- Department of Obstetrics and Gynaecology, Chong Hua Hospital, Cebu City, Philippines
| | - Ying Woo Ng
- Department of Obstetrics and Gynaecology, Division of Benign Gynaecology, National University Hospital, Singapore, Singapore
| |
Collapse
|
27
|
Wang C, Diao M, Li L, Liu S, Chen Z, Li X, Cheng W. Laparoscopic dissection and division of distal fistula in boys with rectourethral fistula. J Surg Res 2016; 211:147-153. [PMID: 28501111 DOI: 10.1016/j.jss.2016.11.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/23/2016] [Accepted: 11/29/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Congenital rectourethral fistula (RUF) is the most common form of anorectal malformations found in boys. The aim of this study is to review our experience with dissection and division of distal fistula using laparoscopic surgery in the management of RUF, especially rectourethral bulbar fistula. METHODS One hundred and two consecutive boys with congenital RUF who underwent conventional or single-incision laparoscopic surgery between July 2008 and June 2015 were enrolled in the study. The dissection of the distal fistula was performed along submucosal layer to a level 0.5 cm proximal to the urethra. Rectal mucosa of the fistula was dissected to the distal most point and completely transected flush with the posterior urethra. The residual muscular cuff was ligated with Hem-o-Lock clip or 5-0 PDS suture. Voiding cystourethrography and pelvic magnetic resonance imaging were performed at 3 mo, 6 mo, and 1 y postoperatively. RESULTS All patients successfully underwent laparoscopic surgery without conversion. The mean age at the time of operation was 4.3 ± 2.9 mo. The operative times for the rectoprostatic fistula and rectobulbar fistula were similar (118.2 versus 119.4 min, P = 0.082). There was no significant difference in average operative time between conventional laparoscopic surgery group and single-incision laparoscopic surgery group (118.8 versus 119.1 min, P = 0.281). There was no injury to the urethra or vas deferens. The urethral catheter was removed on postoperative day 10. All patients were followed up. The median follow-up period was 3.3 ± 1.8 y. No recurrent fistula or urethral diverticulum was detected on voiding cystourethrography and pelvic MRI at 1 y. CONCLUSIONS Submucosal dissection and division of distal fistula using a laparoscopic approach is safe, feasible, and effective for congenital RUF, especially bulbar fistula, in boys.
Collapse
Affiliation(s)
- Chen Wang
- Department of Colorectum Surgery, Qingdao Municipal Hospital, Qingdao, People's Republic of China; Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Mei Diao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Long Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China.
| | - Shuli Liu
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Zheng Chen
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Xu Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Wei Cheng
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China; Department of Surgery, United Family Hospital, Beijing, China; Department of Pediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| |
Collapse
|
28
|
|
29
|
Mahadevappa N, Gudage S, Senguttavan KV, Mallya A, Dharwadkar S. Laparoendoscopic single site surgery for extravesical repair of vesicovaginal fistula using conventional instruments: Our initial experience. Urol Ann 2016; 8:305-11. [PMID: 27453652 PMCID: PMC4944623 DOI: 10.4103/0974-7796.184896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: Vesicovaginal fistula (VVF) is a major complication with psychosocial ramifications. In literature, few VVF cases have been managed by laparoendoscopic single site surgery (LESS) and for the 1st time we report VVF repair by LESS using conventional laparoscopic instruments. We present our initial experience and to assess its feasibility, safety and outcome. Patients and Methods: From March 2012 to September 2015, LESS VVF repair was done for ten patients aged between 30 and 65 (45.6 ± 10.15) years, who presented with supratrigonal VVF. LESS was performed by modified O’Conor technique using regular trocars with conventional instruments. Data were collected regarding feasibility, intra- or post-operative pain, analgesic requirement, complication, and recovery. Results: All 10 cases were completed successfully, without conversion to a standard laparoscopic or open approach. The mean operative time was 182.5 ± 32.25 (150–250) min. The mean blood loss was 100 mL. The respective mean visual analog score for pain on day 1, 2, and 3 was 9.2 ± 1, 5 ± 1, and 1.4 ± 2.3. The analgesic requirement in the form of intravenous tramadol on days 1, 2, and 3 was 160 ± 51.6, 80 ± 63.2, and 30 ± 48.3, mgs respectively. No major intra- or post-operative complications were observed. The mean hospital stay was 2.6 ± 0.7 (2–4) days. Conclusion: In select patients, LESS extravesical repair of VVF using conventional laparoscopic instruments is safe, feasible with all the advantages of single port surgery at no added cost. Additional experience and comparative studies with conventional laparoscopy are warranted.
Collapse
Affiliation(s)
- Nagabhushana Mahadevappa
- Department of Urology, Institute of Nephrourology, Victoria Hospital Campus, Bengaluru, Karnataka, India
| | - Swathi Gudage
- Department of OBG, Victoria Hospital, Bengaluru, Karnataka, India
| | - Karthikeyan V Senguttavan
- Department of Urology, Institute of Nephrourology, Victoria Hospital Campus, Bengaluru, Karnataka, India
| | - Ashwin Mallya
- Department of Urology, Institute of Nephrourology, Victoria Hospital Campus, Bengaluru, Karnataka, India
| | - Sachin Dharwadkar
- Department of Urology, Institute of Nephrourology, Victoria Hospital Campus, Bengaluru, Karnataka, India
| |
Collapse
|
30
|
Maurice MJ, Ramirez D, Kaouk JH. Robotic Laparoendoscopic Single-site Retroperitioneal Renal Surgery: Initial Investigation of a Purpose-built Single-port Surgical System. Eur Urol 2016; 71:643-647. [PMID: 27421824 DOI: 10.1016/j.eururo.2016.06.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 06/06/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND Robotic single-site retroperitoneal renal surgery has the potential to minimize the morbidity of standard transperitoneal and multiport approaches. Traditionally, technological limitations of non-purpose-built robotic platforms have hindered the application of this approach. OBJECTIVE To assess the feasibility of retroperitoneal renal surgery using a new purpose-built robotic single-port surgical system. DESIGN, SETTING, AND PARTICIPANTS This was a preclinical study using three male cadavers to assess the feasibility of the da Vinci SP1098 surgical system for robotic laparoendoscopic single-site (R-LESS) retroperitoneal renal surgery. SURGICAL PROCEDURE We used the SP1098 to perform retroperitoneal R-LESS radical nephrectomy (n=1) and bilateral partial nephrectomy (n=4) on the anterior and posterior surfaces of the kidney. Improvements unique to this system include enhanced optics and intelligent instrument arm control. Access was obtained 2cm anterior and inferior to the tip of the 12th rib using a novel 2.5-cm robotic single-port system that accommodates three double-jointed articulating robotic instruments, an articulating camera, and an assistant port. MEASUREMENTS The primary outcome was the technical feasibility of the procedures, as measured by the need for conversion to standard techniques, intraoperative complications, and operative times. RESULTS AND LIMITATIONS All cases were completed without the need for conversion. There were no intraoperative complications. The operative time was 100min for radical nephrectomy, and the mean operative time was 91.8±18.5min for partial nephrectomy. Limitations include the preclinical model, the small sample size, and the lack of a control group. CONCLUSIONS Single-site retroperitoneal renal surgery is feasible using the latest-generation SP1098 robotic platform. While the potential of the SP1098 appears promising, further study is needed for clinical evaluation of this investigational technology. PATIENT SUMMARY In an experimental model, we used a new robotic system to successfully perform major surgery on the kidney through a single small incision without entering the abdomen.
Collapse
Affiliation(s)
- Matthew J Maurice
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel Ramirez
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jihad H Kaouk
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
31
|
Marchini GS, Fioravanti ID, Horta LV, Torricelli FCM, Mitre AI, Arap MA. Specific training for LESS surgery results from a prospective study in the animal model. Int Braz J Urol 2016; 42:90-5. [PMID: 27136472 PMCID: PMC4811231 DOI: 10.1590/s1677-5538.ibju.2014.0658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 04/07/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to prospectively evaluate the ability of post-graduate students enrolled in a laparoscopy program of the Institute for Teaching and Research to complete single port total nephrectomies. MATERIALS AND METHODS 15 post-graduate students were enrolled in the study, which was performed using the SILStm port system for single-port procedures. All participants were already proficient in total nephrectomies in animal models and performed a left followed by a right nephrectomy. Analyzed data comprised incision size, complications, and the time taken to complete each part of the procedure. Statistical significance was set at p<0.05. RESULTS All students successfully finished the procedure using the single-port system. A total of 30 nephrectomies were analyzed. Mean incision size was 3.61 cm, mean time to trocar insertion was 9.61 min and to dissect the renal hilum was 25.3 min. Mean time to dissect the kidney was 5.18 min and to complete the whole procedure was 39.4 min. Total renal hilum and operative time was 45.8% (p<0.001) and 38% (p=0.001) faster in the second procedure, respectively. Complications included 3 renal vein lesions, 2 kidney lacerations and 1 lesion of a lumbar artery. All were immediately identified and corrected laparoscopically through the single-port system, except for one renal vein lesion, which required the introduction an auxiliary laparoscopic port. CONCLUSION Laparoscopic single-port nephrectomy in the experimental animal model is a feasible but relatively difficult procedure for those with intermediate laparoscopic experience. Intraoperative complications might be successfully treated with the single-port system. Training aids reducing surgical time and improves outcomes.
Collapse
Affiliation(s)
- Giovannni Scala Marchini
- Instituto de Ensino e Pesquisa do Hospital Sírio Libanês, São Paulo, Brasil.,Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - Italo D Fioravanti
- Instituto de Ensino e Pesquisa do Hospital Sírio Libanês, São Paulo, Brasil
| | - Leonardo V Horta
- Instituto de Ensino e Pesquisa do Hospital Sírio Libanês, São Paulo, Brasil
| | - Fabio C M Torricelli
- Instituto de Ensino e Pesquisa do Hospital Sírio Libanês, São Paulo, Brasil.,Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - Anuar Ibrahim Mitre
- Instituto de Ensino e Pesquisa do Hospital Sírio Libanês, São Paulo, Brasil.,Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| | - Marco Antonio Arap
- Instituto de Ensino e Pesquisa do Hospital Sírio Libanês, São Paulo, Brasil.,Hospital das Clínicas da Universidade de São Paulo Faculdade de Medicina de São Paulo, Brasil
| |
Collapse
|
32
|
Liu L, Liu X, Zhang F, Yao X, Xue P, Shen H, Jiang Y, Zhou Z, Shi C, Lin Z. Dual-Channel Minimally Invasive Endoscopic Port for Evacuation of Deep-Seated Spontaneous Intracerebral Hemorrhage with Obstructive Hydrocephalus. World Neurosurg 2016; 91:452-9. [PMID: 27132183 DOI: 10.1016/j.wneu.2016.04.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/17/2016] [Accepted: 04/20/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND In minimally invasive endoscopic port surgery, the medium is air, and the image is clearer than in fluid. The most commonly used port is a single-channel port, which accommodates the rod lens of the endoscope and 2 microsurgical instruments. This setup decreases the freedom of movement of the 3 instruments, making the bimanual procedure difficult. We describe a novel "dual-channel" endoscopic port to facilitate a bimanual refinement procedure for removing deep-seated spontaneous intracerebral hematomas, and we demonstrate the feasibility of this method. METHODS The small channel accommodates a 0° endoscope lens, and the large channel accommodates 2 microsurgical instruments. This method was used in 8 patients with deep-seated spontaneous intracerebral hematomas with obstructive hydrocephalus. It was necessary to evacuate the deep-seated hematomas in these patients as soon as possible to recover the circulation of cerebrospinal fluid. RESULTS Dual-channel port surgery was performed in 8 patients with an average age of 55 years (range, 44-79 years). The time from ictus to surgery ranged from 4 hours to 12 days. The duration of drainage tube placement was 2-5 days. The hematomas in all patients, in the third ventricle or thalamus, were evacuated thoroughly. In each patient, improvements in Glasgow Coma Scale scores were observed from admission to discharge. CONCLUSIONS The dual-channel endoscopic port facilitated bimanual refinement microsurgery during the evacuation of deep-seated intracerebral hematomas, and it prevented the disturbance of the 3 instruments without restraining the scope of the operation during the microsurgical procedure.
Collapse
Affiliation(s)
- Li Liu
- Fourth Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xi Liu
- Fourth Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Fan Zhang
- Department of Anesthesiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xianyi Yao
- Department of Otolaryngology, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Peng Xue
- Fourth Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hong Shen
- Fourth Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yunfeng Jiang
- Fourth Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhisong Zhou
- Fourth Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Changbin Shi
- Sixth Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zhiguo Lin
- Fourth Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
| |
Collapse
|
33
|
Wang C, Li L, Diao M, Liu S, Zhang J, Chen Z, Li X, Cheng W. Single-Incision Laparoscopic-Assisted Anorectoplasty for the Management of Persistent Cloaca. J Laparoendosc Adv Surg Tech A 2016; 26:328-33. [DOI: 10.1089/lap.2015.0296] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Chen Wang
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
- Graduate School of Peking Union Medical College, Beijing, People's Republic of China
| | - Long Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
- Graduate School of Peking Union Medical College, Beijing, People's Republic of China
| | - Mei Diao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Shuli Liu
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Jinshan Zhang
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Zheng Chen
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Xu Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Wei Cheng
- Department of Surgery, United Family Hospital, Beijing, People's Republic of China
- Departments of Pediatrics and Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
34
|
Feng L, Song J, Wu M, Tian Y, Zhang D. Retroperitoneal Laparoendoscopic Single-Incision Radical Nephrectomy Without Special Platforms: A Single-Center Initial Experience. J Laparoendosc Adv Surg Tech A 2016; 26:203-8. [PMID: 26859099 DOI: 10.1089/lap.2015.0483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To describe the initial experience of retroperitoneal laparoendoscopic single-incision radical nephrectomy (LESI-RN) without special platforms and use of conventional laparoscopic instruments and assess the safety and feasibility of LESI-RN. SUBJECTS AND METHODS Twenty patients who underwent LESI-RN were enrolled in this study. A 5-cm arc skin incision was performed at the midpoint between the costal arch and iliac crest on the midaxillary line. Trocars of 10, 5, and 11 mm were placed at the middle, left end, and right end of the arc incision, respectively. Demographic parameters and perioperative data were retrospectively analyzed and compared with the patients who underwent conventional retroperitoneal laparoscopic radical nephrectomy (LRN). RESULTS The LESI-RN patients had a significantly lower visual analogue scale (4.4 ± 1.9 versus 5.6 ± 1.4; P = .031) and analgesic requirement (18.5 ± 11.2 versus 28.6 ± 16.1; P = .026) compared with the conventional LRN group. The operation time in the LESI-RN group was longer than that in the conventional LRN group (P = .001). The two procedures were essentially similar in terms of the time to liquid intake and hospital stay after operation (P > .05). CONCLUSIONS LESI-RN is a safe and feasible surgical strategy, which combines the common principles of using straight instruments and working triangulation in conventional LRN with advantages of cosmesis and minimal invasiveness in laparoendoscopic single-site surgery. The surgical and oncological efficacy of LESI-RN is similar to that of conventional LRN but with significantly improved control of postoperative pain and cosmetic results.
Collapse
Affiliation(s)
- Lang Feng
- Department of Urology, Beijing Friendship Hospital, Capital Medical University , Beijing, China
| | - Jian Song
- Department of Urology, Beijing Friendship Hospital, Capital Medical University , Beijing, China
| | - Menghua Wu
- Department of Urology, Beijing Friendship Hospital, Capital Medical University , Beijing, China
| | - Ye Tian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University , Beijing, China
| | - Daoxin Zhang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University , Beijing, China
| |
Collapse
|
35
|
Cao Y, Miura S, Kobayashi Y, Kawamura K, Sugano S, Fujie MG. Pupil Variation Applied to the Eye Tracking Control of an Endoscopic Manipulator. IEEE Robot Autom Lett 2016. [DOI: 10.1109/lra.2016.2521894] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
36
|
Yu H, Shin JY. Short-term outcomes following reduced-port, single-port, and multi-port laparoscopic surgery for colon cancer: tailored laparoscopic approaches based on tumor size and nodal status. Int J Colorectal Dis 2016; 31:115-22. [PMID: 26410265 DOI: 10.1007/s00384-015-2399-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Surgeons have recently developed more minimally invasive surgical procedures to reduce surgical stress and improve cosmesis. Although single-port laparoscopic colectomy (SPLC) has potential benefits over multi-port laparoscopic colectomy (MPLC), there are concerns about the increased technical difficulties associated with SPLC. Therefore, we attempted reduced-port laparoscopic colectomy (RPLC). The purpose of this study was to evaluate the difference in perioperative outcome following tailored laparoscopic approaches for colon cancer on the basis of tumor characteristics. METHODS The prospectively collected data of 170 patients who underwent only minimally invasive colectomy for colon cancer from July 2010 to June 2013 were reviewed. The MPLC, SPLC, and RPLC groups comprised 92 (54.1 %), 40 (23.5 %), and 38 (22.4 %) patients, respectively. RESULTS The number of harvested lymph nodes was significantly higher in the RPLC group than in the MPLC and SPLC groups (29.9 ± 21.5, 21.9 ± 12.1, and 24.2 ± 13.8, respectively; p = 0.027). The mean operating time was significantly different among the MPLC, SPLC, and RPLC groups (243.5 ± 59.0, 207.2 ± 49.6, and 216.2 ± 53.7 min, respectively; p = 0.001). The time to first flatus was also significantly different among the MPLC, SPLC, and RPLC groups (3.1 ± 1.2, 3.6 ± 1.3, and 3.4 ± 1.1 days, respectively; p = 0.039). No significant differences in the other short-term surgical outcomes were observed among the three groups. CONCLUSIONS SPLC and RPLC according to tailored laparoscopic approaches for colon cancer appear to be beneficial in terms of operative time and lymph node retrieval, and may be considered as surgical options in laparoscopic colectomy for colon cancer patients with favorable tumor characteristics.
Collapse
Affiliation(s)
- Hyeon Yu
- Department of Surgery, Inje University College of Medicine, Inje University Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 612-896, Republic of Korea
| | - Jin Yong Shin
- Department of Surgery, Inje University College of Medicine, Inje University Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan, 612-896, Republic of Korea.
| |
Collapse
|
37
|
Apostolou KG, Orfanos SV, Papalois AE, Felekouras ES, Zografos GC, Liakakos T. Single-Incision Laparoscopic Right Hemi-Colectomy: a Systematic Review. Indian J Surg 2015; 77:301-12. [PMID: 26702238 DOI: 10.1007/s12262-015-1282-z] [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: 02/26/2015] [Accepted: 05/11/2015] [Indexed: 11/26/2022] Open
Abstract
As surgeons became more adept with laparoscopic colon surgery, other less invasive procedures, such as single-incision laparoscopic right hemi-colectomy (SIL-RH), have been applied. The objective of this study was to evaluate the safety of SIL-RH as well as its intraoperative and postoperative outcomes for right-sided colon diseases. A detailed search in PubMed for citations that included SIL-RH from 2000 to 2014 revealed 21 studies fulfilling the criteria of the present review. A total of 684 patients were analyzed. Of the patients, 50.2 % were men. Mean patient age was 64.8 years. Of the patients, 36.1 % had already undergone an abdominal operation before the performance of SIL-RH, while 69 % of the patients underwent SIL-RH for colon cancer. Relatively low rates of overall morbidity (15 %) and mortality (0.75 %) were reported in the included studies. Mean length of postoperative hospital stay (LOS) was 5.5 days. Bowel motility return had a mean value of 2.8 days. Mean number of harvested lymph nodes (LN) was 19.2 LN. All resection margins were tumor-free. SIL-RH was a safe alternative to multiport laparoscopic right hemi-colectomy (ML-RH) in terms of morbidity and mortality, postoperative gastrointestinal function recovery, LOS, as well as oncological radicalness.
Collapse
Affiliation(s)
- K G Apostolou
- 1st Department of Surgery, General Hospital of Athens Laiko, Athens School of Medicine, University of Athens, Agiou Thoma 17, 11527 Athens, Greece
| | - S V Orfanos
- 1st Department of Surgery, General Hospital of Athens Laiko, Athens School of Medicine, University of Athens, Agiou Thoma 17, 11527 Athens, Greece
| | - A E Papalois
- 1st Department of Propaedeutic Surgery, Athens Medical School, Hippocration Hospital of Athens, Athens, Greece
| | - E S Felekouras
- 1st Department of Surgery, General Hospital of Athens Laiko, Athens School of Medicine, University of Athens, Agiou Thoma 17, 11527 Athens, Greece
| | - G C Zografos
- 1st Department of Propaedeutic Surgery, Athens Medical School, Hippocration Hospital of Athens, Athens, Greece
| | - T Liakakos
- 1st Department of Surgery, General Hospital of Athens Laiko, Athens School of Medicine, University of Athens, Agiou Thoma 17, 11527 Athens, Greece
| |
Collapse
|
38
|
Jennings AJ, Spencer RJ, Hanks L, Barroilhet L, Kushner D, Rose S, Rice L, Al-Niaimi A. The Feasibility and Safety of Adopting Single-Incision Laparoscopic Surgery into Gynecologic Oncology Practice. J Minim Invasive Gynecol 2015; 23:358-63. [PMID: 26561374 DOI: 10.1016/j.jmig.2015.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE To determine the complications associated with single-incision laparoscopy in gynecologic oncology surgery. DESIGN A retrospective cohort (Canadian Task Force classification II-3). SETTING A single academic institution. PATIENTS One hundred fifteen consecutive patients undergoing single-incision laparoscopy with suspected gynecologic oncology conditions. INTERVENTIONS Single-incision laparoscopy. MEASUREMENTS AND MAIN RESULTS One hundred fifteen patients underwent single-incision laparoscopy. The mean age was 55.3 ± 13.1 years. For procedures completed via single-incision laparoscopy (102/115 [88.7%]), the mean operative time was 130.7 ± 55.5 minutes. The average blood loss was 63 ± 111 mL. The conversion to open rate was 13 of 115 (12.17%). The conversion rate of the 55 patients with benign conditions was lower (2/55 [3.64%]) compared with the 60 patients with malignant conditions (11/60 [18.33%]). The hernia rate was 2 of 115 (1.80%), 1 of which was a recurrent hernia. The median time for follow-up was 30 days (range, 5-653 days). CONCLUSION Single-incision laparoscopy provides a feasible, safe, and promising minimally invasive modality for treating gynecologic oncology patients.
Collapse
Affiliation(s)
- Ashley J Jennings
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - Ryan J Spencer
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - Laura Hanks
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - Lisa Barroilhet
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - David Kushner
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - Stephen Rose
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - Laurel Rice
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - Ahmed Al-Niaimi
- Division of Gynecology, Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin.
| |
Collapse
|
39
|
Alessimi A, Adam E, Haber GP, Badet L, Codas R, Fehri HF, Martin X, Crouzet S. LESS living donor nephrectomy: Surgical technique and results. Urol Ann 2015; 7:361-5. [PMID: 26229326 PMCID: PMC4518375 DOI: 10.4103/0974-7796.160321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 10/26/2014] [Indexed: 11/25/2022] Open
Abstract
Purpose: We present the findings of 50 patients undergoing pure trans-umbilical laparo-endoscopic single-site surgery (LESS) living donor nephrectomy (LDN), between February 2010 and May 2014. Materials and Methods: Laparo-endoscopic single-site surgery LDN was performed through an umbilical incision. Different trocars were used, namely Gelpoint (Applied Mιdical, Rancho Santa Margarita, CA) SILS port (Covidien, Hamilton, Bermuda), R-port (Olympus Surgical, Orangeburg, NY) and standard trocars, inserted through the same skin incision but using separate fascial punctures. The standard laparoscopic technique was employed. The kidney was pre-entrapped in a retrieval bag and extracted trans-umbilically. Data were collected prospectively including questionnaires containing patient reported oral pain medication duration and time to recovery. Results: LESS LDN was successful in all patients. Mean warm ischemia time was 6.2 min (3–15), mean procedure time was 233.2 min (172–300), and hospitalization stay was 3.94 days (3–7) with a visual analogue pain score at discharge of 1.32 (0–3). No intraoperative complications occurred. The mean time of oral pain medication was 8.72 days (1–20) and final scar length was 4.06 cm (3–5). Each allograft was functional. Conclusion: Although challenging, trans-umbilical LESS LDN seems to be feasible and safe. Hence, LESS has the potential to improve cosmetic results and decrease morbidity.
Collapse
Affiliation(s)
- Abdullah Alessimi
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| | - Emilie Adam
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| | - Georges-Pascal Haber
- Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lionel Badet
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| | - Ricardo Codas
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| | - Hakim Fassi Fehri
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| | - Xavier Martin
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| | - Sébastien Crouzet
- Department of Urology and Transplantation Edouard Herriot Hospital, Lyon, France
| |
Collapse
|
40
|
Mai HX, Liu JLE, Pei SJ, Zhao LI, Qu N, Dong JK, Chen B, Wang YL, Huang C, Chen LJ. Comparison of the short-term efficacy of sequential treatment with intravesical single-port laparoscopic partial cystectomy with bladder preservation or open partial cystectomy in combination with cisplatin plus gemcitabine chemotherapy. Exp Ther Med 2015; 10:74-80. [PMID: 26170915 DOI: 10.3892/etm.2015.2448] [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: 06/25/2014] [Accepted: 03/18/2015] [Indexed: 11/06/2022] Open
Abstract
This study aimed to assess the short-term efficacy of sequential therapy for T2/T3a bladder cancer with intravesical single-port laparoscopic partial cystectomy or open partial cystectomy combined with cisplatin plus gemcitabine (GC) chemotherapy in a prospective randomized controlled study. Thirty patients with bladder cancer who underwent open partial cystectomy (group A) or single-port laparoscopic partial cystectomy (group B) and received standard GC chemotherapy were analyzed. Perioperative functional indicators and tumor recurrence during a 1-year postoperative follow-up were compared between the two groups. The baseline characteristics were comparable between the two groups. The mean operative time, amount of blood loss and duration of hospital stay were 90.3 min, 182.0 ml and 7.3 days, respectively, for group A, and 105.3 min, 49.3 ml and 5.8 days, respectively, for group B. No secondary postoperative bleeding, urine leakage, wound infection or other complications were observed in the two groups. Postoperative scarring was not evident in group B. The overall incidence of surgical complications, tumor recurrence rate and complications during chemotherapy in the postoperative follow-up period of 12 months were similar between the two groups. Single-port laparoscopic partial cystectomy surgery is an idea surgical method for the treatment of invasive bladder cancer, with good surgical effect, minimal invasiveness, rapid recovery and short hospital stay. The data from 1-year postoperative follow-up showed that laparoscopic surgery was superior with regard to perioperative bleeding, postoperative recovery and duration of indwelling urinary catheter use. However, regarding the tumor recurrence rate, long-term comparative details are required to determine the effect of laparoscopic surgery.
Collapse
Affiliation(s)
- Hai-Xing Mai
- Chinese People's Liberation Army General Hospital & Medical School of Chinese People's Liberation Army, Beijing 100853, P.R. China ; Department of Urology, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Jun-LE Liu
- Department of Urology, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - Shu-Jun Pei
- Department of Urology, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| | - L I Zhao
- Chinese People's Liberation Army General Hospital & Medical School of Chinese People's Liberation Army, Beijing 100853, P.R. China
| | - Nan Qu
- Chinese People's Liberation Army General Hospital & Medical School of Chinese People's Liberation Army, Beijing 100853, P.R. China
| | - Jin-Kai Dong
- Chinese People's Liberation Army General Hospital & Medical School of Chinese People's Liberation Army, Beijing 100853, P.R. China
| | - Biao Chen
- Chinese People's Liberation Army General Hospital & Medical School of Chinese People's Liberation Army, Beijing 100853, P.R. China
| | - Ya-Lin Wang
- Chinese People's Liberation Army General Hospital & Medical School of Chinese People's Liberation Army, Beijing 100853, P.R. China
| | - Cheng Huang
- Chinese People's Liberation Army General Hospital & Medical School of Chinese People's Liberation Army, Beijing 100853, P.R. China
| | - Li-Jun Chen
- Department of Urology, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, P.R. China
| |
Collapse
|
41
|
Single-port access versus conventional multi-port access total laparoscopic hysterectomy for very large uterus. Obstet Gynecol Sci 2015; 58:239-45. [PMID: 26023674 PMCID: PMC4444521 DOI: 10.5468/ogs.2015.58.3.239] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Revised: 10/08/2014] [Accepted: 10/10/2014] [Indexed: 12/27/2022] Open
Abstract
Objective The aim of this study was to compare the surgical outcomes of single-port access (SPA) and conventional multi-port access total laparoscopic hysterectomies (TLH) among patients with very large uteri (500 g or more). Methods Fifty consecutive patients who received TLH for large uterine myomas and/or adenomyoses weighing 500 g or more between February 2009 and December 2012 were retrospectively reviewed. SPA and conventional TLH were each performed in 25 patients. Surgical outcomes, including operation time, estimated blood loss, postoperative hemoglobin change, postoperative hospital stay, postoperative pain, and perioperative complications, were compared between the two groups. Results There were no significant demographic differences between the two groups. All operations were completed laparoscopically with no conversion to laparotomy. Total operation time, uterus weight, estimated blood loss, and postoperative hemoglobin change did not significantly differ between the two groups. Postoperative hospital stay was significantly shorter for the SPA-TLH group compared to that of the conventional TLH group (median [range], 3 [2.0-6.0] vs. 4 [3-7] days; P=0.004]. There were no inter-group differences in postoperative pain at 6, 24, and 72 hours after surgery. There was only one complicated case in each group. Conclusion SPA-TLH in patients with large uteri weighing 500 g or more is as feasible as conventional TLH. SPA-TLH is associated with shorter hospital stays compared to that of conventional TLH.
Collapse
|
42
|
Sinha R, Malhotra V, Sikarwar P. Single incision laparoscopic TAPP with standard laparoscopic instruments and suturing of flaps: A continuing study. J Minim Access Surg 2015; 11:134-8. [PMID: 25883454 PMCID: PMC4392487 DOI: 10.4103/0972-9941.142401] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 11/24/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND: Single incision laparoscopic surgery, especially transumbilical, should be the closest to replicate the minimal access results achieved by natural orifice endoscopic surgery (NOTES). This study of single incision transabdominal preperitoneal (SITAPP) inguinal hernia repair is a continuing study exploring the peroperative variables and short and long term complications of this procedure. PATIENTS AND METHODS: All the 183 patients were operated by the same surgeon through a horizontal transumbilical incision positioned across the lower third of the umbilicus. Port access was through three separate transfacial punctures. Routine rigid instruments were used and the peritoneal flaps were either tacked or sutured into place. Patients with irreducible hernia and obstructed hernia were included, while those with strangulated hernia were excluded. RESULTS: All the patients were male with an average age of 41.4 years. Twenty four patients had bilateral hernia, 15 patients had irreducible and 6 patients had obstructed hernia. The mean operating time was 38.3 mins for unilateral hernias completed with tackers and 42.8 mins in those with intracorporeal suturing. The corresponding operating time for bilateral hernias was 53.2 and 62.7 minutes. There was minimal serous discharge from the umbilicus in 8 patients, port site infection in 1 patient and recurrence in 2 patients over a 36 months period. CONCLUSIONS: SITAPP for groin hernias, performed with conventional instruments is feasible, easy to learn, has a very high patient acceptance and is cosmetically superior to conventional TAPP. The use of tackers reduces the operating time significantly.
Collapse
Affiliation(s)
- Rajeev Sinha
- Department of Surgery, Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India
| | - Vivek Malhotra
- Department of Surgery, Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India
| | - Prashant Sikarwar
- Department of Surgery, Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India
| |
Collapse
|
43
|
Khambati A, Wehbi E, Farhat WA. Laparo-endoscopic single site surgery in pediatrics: Feasibility and surgical outcomes from a preliminary prospective Canadian experience. Can Urol Assoc J 2015; 9:48-52. [PMID: 25737756 DOI: 10.5489/cuaj.2379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Laparo-endoscopic single-site surgery (LESS) is becoming an alternative to standard laparoscopic surgery. Proposed advantages include enhanced cosmesis and faster recovery. We assessed the early post-operative surgical outcomes of LESS surgery utilizing different instruments in the pediatric urological population in Canada. METHODS We prospectively captured data on all patients undergoing LESS at our institution between February 2011 and August 2012. This included patient age, operative time, length of stay, complications and short-term surgical outcomes. Different instruments/devices were used to perform the procedures. Access was achieved through a transumbilical incision. RESULTS A total of 16 LESS procedures were performed, including seven pyeloplasties, four unilateral and one bilateral varicocelectomies, two simple nephrectomies, one renal cyst decortication and one pyelolithotomy. There was no statistical difference in the operative times, hospital length of stay and cost (pyeloplasty only) in patients undergoing pyeloplasty and varicocelectomy using the LESS technique when compared to an age matched cohort of patients managed with the traditional laparoscopic approach. One pyeloplasty in the LESS group required conversion to open due to a small intra-renal pelvis. There were no immediate or short term post-operative complications; however, one patient experienced a decrease in renal function status post LESS pyeloplasty. Since all procedures were performed by a vastly experienced surgeon at a tertiary center, the generalizability of the results cannot be assessed. CONCLUSIONS There are only a few series that have assessed the role of LESS in pediatric urological surgery. Although our experience is limited by a heterogeneous group of patients with a short follow-up period, the present cohort demonstrates the safety and feasibility of LESS. Further evaluation with randomized studies is required to better assess the role of LESS in pediatric urology.
Collapse
Affiliation(s)
- Aziz Khambati
- Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, ON
| | - Elias Wehbi
- Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, ON
| | - Walid A Farhat
- Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, ON
| |
Collapse
|
44
|
Wu K, Yang L, Wu A, Wang J, Xu S, Zhao H, Huang Z. Single-site laparoscopic appendectomy in children using conventional instruments: a prospective, randomized, control trial. Pediatr Surg Int 2015; 31:167-71. [PMID: 25381588 DOI: 10.1007/s00383-014-3636-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 01/01/2023]
Abstract
PURPOSE Single-site laparoscopic surgery (SSLS) is still only used in limited situations to treat children with appendicitis. Using conventional laparoscopic (CL) equipment to perform SSLS appendectomy is considered a valuable application in China. This prospective randomized trial aims to evaluate the surgical outcome of SSLS and CL appendectomy using CL equipment. METHODS Sixty patients were recruited and randomly assigned to receive SSLS or 3-port CL appendectomy between February 2011 and June 2013. Each case of SSLS appendectomy was performed using CL instruments. Surgery outcomes, including operative time, conversion rates, postoperative complications, hospital stays, and hospital costs were evaluated. RESULTS Patient characteristics were similar between groups. The SSLS using CL instruments was successful in all the 30 patients and no conversions occurred. Mean operative time was longer in the SSLS group than the CL group (64.3 ± 3.1 vs 53.0 ± 2.9 min, respectively; p = 0.000). Complication rates, lengths of hospital stay, and hospital costs were similar between the two groups. CONCLUSIONS The findings of this study demonstrate that using conventional instruments to perform SSLS is technically feasible and safe in children. Although SSLS appendectomy does increase the operative time, it does not increase the complication rate and hospital cost.
Collapse
Affiliation(s)
- Kai Wu
- Department of Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, Guangdong Province, China
| | | | | | | | | | | | | |
Collapse
|
45
|
Núñez Valera MJ, Padilla Iserte P, Higueras García G, Herraiz S, Rubio JM, Romeu Villarroya M, Pellicer A, Díaz-García C. Single Site Laparoscopy for Fertility Preservation: A Cohort Study. J Minim Invasive Gynecol 2015; 22:291-6. [DOI: 10.1016/j.jmig.2014.10.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 11/25/2022]
|
46
|
|
47
|
Inoue S, Kajiwara M, Teishima J, Matsubara A. Population perception of surgical approach in minimally invasive surgery. Can Urol Assoc J 2015; 9:E1-4. [PMID: 25624959 DOI: 10.5489/cuaj.2116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to better understand the impact that public opinion might have on surgical approaches in urologic minimally invasive surgery (MIS). METHODS We collected surveys from 400 participants, including the general population (n = 220) and paramedical staff (n = 180). Participants were anonymous. The survey included 16 questions on the characteristics and preference for the surgical approach if a urologic MIS were performed on them. RESULTS The responders preferred the transumbilical approach (57.0%) to the subcostal approach (43.0%). In particular, the preference for a transumbilical approach was significantly higher in females (65.1% vs. 49.3%, p = 0.0014). Similarly, when participants were divided into two groups (<50 years and ≥50 years), the preference for the transumbilical approach was significantly higher in the younger group (60.8% vs. 48.0%, p = 0.0187). Logistic regression analysis revealed that preference for this approach was about 2 times more likely to rise in the females (p = 0.032). CONCLUSIONS Preference for the transumbilical approach was significantly higher young female respondents. This patient subset most values the cosmetic benefits of transumbilical approach in urologic MIS.
Collapse
Affiliation(s)
- Shogo Inoue
- Department of Urology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Mitsuru Kajiwara
- Department of Urology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Jun Teishima
- Department of Urology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| | - Akio Matsubara
- Department of Urology, Hiroshima University Institute of Biomedical and Health Sciences, Hiroshima, Japan
| |
Collapse
|
48
|
Bansal D, Cost NG, Bean CM, Minevich EA, Noh PH. Pediatric urological laparoendoscopic single site surgery: single surgeon experience. J Pediatr Urol 2014; 10:1170-5. [PMID: 24993421 DOI: 10.1016/j.jpurol.2014.04.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 04/29/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim was to assess the feasibility and outcomes of pediatric urological laparoendoscopic single site (LESS) surgery. MATERIALS AND METHODS A retrospective review was performed of all children who underwent LESS surgery at a single pediatric institution from September 2010 to July 2013. Patient demographics, intraoperative details, narcotic usage, and complications were reviewed. The umbilicus was used as the surgical site in all cases. All procedures were performed with a flexible tip laparoscope, a multichannel port, standard 3- or 5-mm laparoscopic instrumentation, and articulating instruments. RESULTS Sixty-one patients (50 male, 11 female) were identified. Procedures included 18 orchidopexies, 15 nephrectomies, 11 varicocelectomies, nine nephroureterectomies, four partial nephrectomies, one ureterectomy, one ureterolithotomy, one orchiectomy, and one utricle excision. The ureterolithotomy was converted to open surgery for failure to progress. The utricle excision was converted to conventional laparoscopy by adding one accessory port and one skin puncture because of the close proximity of the vas deferens to the utricle. Intraoperative complications included one vas deferens injury during orchidopexy in a postpubertal male. Postoperative complications occurred in six patients: five grade II and one grade IIIb. CONCLUSIONS Pediatric urological LESS procedures are technically feasible, safe, and effective. Further evaluation is warranted to better define its role in pediatric urological surgery.
Collapse
Affiliation(s)
- Danesh Bansal
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - Nicholas G Cost
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - Christopher M Bean
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - Eugene A Minevich
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA
| | - Paul H Noh
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, ML 5037, Cincinnati, OH 45229, USA.
| |
Collapse
|
49
|
Position of laparo-endoscopic single-site surgery nephrectomy in clinical practice and comparison (matched case-control study) with standard laparoscopic nephrectomy. Wideochir Inne Tech Maloinwazyjne 2014; 9:371-9. [PMID: 25337160 PMCID: PMC4198631 DOI: 10.5114/wiitm.2014.43019] [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: 10/26/2013] [Revised: 11/12/2013] [Accepted: 12/02/2013] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION One way how to reduce morbidity and improve cosmesic of kidney surgery is single site laparoscopy. Relatively well described concept but without defined position in clincal practise. AIM To report of institutional experience with laparoendoscopic single-site surgery (LESS) nephrectomy (NE) and compare (matched case-control study) it with that of standard laparoscopic NE (LNE). MATERIAL AND METHODS In the period 8/2011 to 10/2013, we performed 183 mini-invasive NE (132 tumours, 51 benign aetiology); 45 of them (24.6%) were LESS, the rest LNE. The main but not absolute indications for LESS were: non-obese men, and less advanced tumours. In 13 patients undergoing LESS-NEs (28.9%) there was a transumbilical approach. For the rest, a pararectal incision was performed and an accessory port was added in 31.1% (14) - 2/22 (9.1%) left sided, 12/23 (52.2%) right sided. Twenty-four LESS-NE were performed by a more experienced surgeon (mean operation time (MOT) 73.1 min), 21 LESS-NE by 4 other surgeons (MOT 132.8 min). These 24 were compared with 43 LNE done by the same surgeon before the period of LESS (1/2007-8/2011) and with similar characteristics of cases (body mass index (BMI) ≤ 35 kg/m(2), less advanced tumour). RESULTS We found no statistically significant differences in any of the parameters studied. The MOT 73.1 min vs. 75.0 min (p = 0.78), BMI 27.4 kg/m(2) vs. 29.2 kg/m(2) (p = 0.08), blood loss 54.7 vs. 39.2 (p = 0.47). Complications (4.2% vs. 11.6%) were only of internal character in origin. No conversion in either group. In LESS-NE, staplers were used more frequently (more expensive than clips) for division of renal hilar vessels (70.8% vs. 51.2%). The mean price of LESS-NE was €367 higher. CONCLUSIONS The LESS NE performed by an experienced surgeon is a safe and efficient method for the surgical treatment of both malignant and benign renal conditions in patients with BMI < 30 kg/m(2) and with low-stage tumours. The LESS NE is more expensive compared to LNE.
Collapse
|
50
|
|