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Long-term and short-term surgical outcomes of single-incision laparoscopic hepatectomy on anterolateral liver segments. Surg Endosc 2019; 34:2969-2979. [PMID: 31482356 DOI: 10.1007/s00464-019-07080-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/21/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Laparoscopic liver resection yields improved short-term surgical outcomes, whereas the reports about clinical benefits of single-incision laparoscopic hepatectomy (SILH) are scarce. This retrospective study is to compare the surgical outcomes of SILH with those of multi-incision laparoscopic hepatectomy (MILH). METHODS The study included 54 patients who had undergone SILH and 184 patients who had undergone MILH between January 2010 and December 2017. Short-term outcomes were compared in those of patients who underwent left lateral sectionectomy and partial hepatectomy of segment 5-6. A subgroup analysis of hepatocellular carcinoma (HCC) was also performed for long-term outcome comparisons. RESULTS In those of patients who underwent left lateral sectionectomy, SILH group had less chronic hepatitis B (15.2 vs. 45.8%; p = 0.004), less liver cirrhosis (12.1 vs. 50.0%; p = 0.002), less tumor proximal to major vessel (6.1 vs. 29.2%; p = 0.018), shorter surgical time (113.2 ± 37.9 vs. 146.0 ± 50.5 min; p = 0.007), and shorter postoperative hospital stays (4.4 ± 1.1 vs. 5.4 ± 1.3 days; p = 0.002) compared with MILH group. In those of patients with tumor located at segment 5-6, no significant differences were observed in surgical time, blood loss, complications, and mortality. Single-incision laparoscopic partial hepatectomy was only associated with wider surgical margins (11.8 ± 7.0 vs. 5.3 ± 5.2 mm; p = 0.003). In the HCC subgroup, SILH had similar 1-, 3-, and 5-year overall survival and 1-, 3-, and 5-year recurrence-free survival rates compared with patients who had undergone MILH. CONCLUSIONS The study demonstrates the safety and feasibility of single-incision laparoscopic liver resection for left lateral sectionectomy and partial hepatectomy for segment 5-6. In selected patients within the group and by experienced surgical team, the SILH technique results in comparable short-term surgical outcomes and long-term oncological outcomes.
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Gettman MT. Editorial Comment on: The Decline of Laparoendoscopic Single-Site Surgery: A Survey of the Endourological Society to Identify Shortcomings and Guidance for Future Directions by Sorokin et al. (From: Sorokin I, Canvasser NE, Irwin B, et al. J Endourol 2017;31:1049-1055). J Endourol 2017; 31:1343-1344. [PMID: 29048229 DOI: 10.1089/end.2017.0688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Sorokin I, Canvasser NE, Irwin B, Autorino R, Liatsikos EN, Cadeddu JA, Rane A. The Decline of Laparoendoscopic Single-Site Surgery: A Survey of the Endourological Society to Identify Shortcomings and Guidance for Future Directions. J Endourol 2017; 31:1049-1055. [DOI: 10.1089/end.2017.0280] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Igor Sorokin
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Noah E. Canvasser
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Brian Irwin
- Department of Surgery, Division of Urology, The University of Vermont Medical Center, Burlington, Vermont
| | - Riccardo Autorino
- Department of Urology, Case Western Reserve University, Cleveland, Ohio
| | | | - Jeffrey A. Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Abhay Rane
- Department of Urology, East Surrey Hospital, Redhill, United Kingdom
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Pavan N, Autorino R, Lee H, Porpiglia F, Sun Y, Greco F, Jeff Chueh S, Han DH, Cindolo L, Ferro M, Chen X, Branco A, Fornara P, Liao CH, Miyajima A, Kyriazis I, Puglisi M, Fiori C, Yang B, Fei G, Altieri V, Jeong BC, Berardinelli F, Schips L, De Cobelli O, Chen Z, Haber GP, He Y, Oya M, Liatsikos E, Brandao L, Challacombe B, Kaouk J, Darweesh I. Impact of novel techniques on minimally invasive adrenal surgery: trends and outcomes from a contemporary international large series in urology. World J Urol 2016; 34:1473-9. [PMID: 26923920 DOI: 10.1007/s00345-016-1791-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/12/2016] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To evaluate contemporary international trends in the implementation of minimally invasive adrenalectomy and to assess contemporary outcomes of different minimally invasive techniques performed at urologic centers worldwide. METHODS A retrospective multinational multicenter study of patients who underwent minimally invasive adrenalectomy from 2008 to 2013 at 14 urology institutions worldwide was included in the analysis. Cases were categorized based on the minimally invasive adrenalectomy technique: conventional laparoscopy (CL), robot-assisted laparoscopy (RAL), laparoendoscopic single-site surgery (LESS), and mini-laparoscopy (ML). The rates of the four treatment modalities were determined according to the year of surgery, and a regression analysis was performed for trends in all surgical modalities. RESULTS Overall, a total of 737 adrenalectomies were performed across participating institutions and included in this analysis: 337 CL (46 % of cases), 57 ML (8 %), 263 LESS (36 %), and 80 RA (11 %). Overall, 204 (28 %) operations were performed with a retroperitoneal approach. The overall number of adrenalectomies increased from 2008 to 2013 (p = 0.05). A transperitoneal approach was preferred in all but the ML group (p < 0.001). European centers mostly adopted CL and ML techniques, whereas those from Asia and South America reported the highest rate in LESS procedures, and RAL was adopted to larger extent in the USA. LESS had the fastest increase in utilization at 6 %/year. The rate of RAL procedures increased at slower rates (2.2 %/year), similar to ML (1.7 %/year). Limitations of this study are the retrospective design and the lack of a cost analysis. CONCLUSIONS Several minimally invasive surgical techniques for the management of adrenal masses are successfully implemented in urology institutions worldwide. CL and LESS seem to represent the most commonly adopted techniques, whereas ML and RAL are growing at a slower rate. All the MIS techniques can be safely and effectively performed for a variety of adrenal disease.
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Affiliation(s)
- Nicola Pavan
- University Hospitals Urology Institute, Case Western Reserve University, 27100 Chardon Rd, Richmond Heights, OH, 44143, USA.,Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Riccardo Autorino
- University Hospitals Urology Institute, Case Western Reserve University, 27100 Chardon Rd, Richmond Heights, OH, 44143, USA.
| | - Hak Lee
- Department of Urology, University of California San Diego Health System, La Jolla, CA, USA
| | - Francesco Porpiglia
- Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Francesco Greco
- Department of Urology, Romolo Hospital, Rocca di Neto, Italy
| | - S Jeff Chueh
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Deok Hyun Han
- Department of Urology, Samsung Medical Center, Seoul, Italy
| | - Luca Cindolo
- Department of Urology, S. Pio Da Pietralcina Hospital, Vasto, Italy
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Xiang Chen
- Xiangya Hospital Central South University, Changsha, China
| | - Anibal Branco
- Department of Urology, Cruz Vermelha Hospital, Curitiba, Brazil
| | - Paolo Fornara
- Department of Urology, Martin-Luther-University, Halle Saale, Germany
| | - Chun-Hou Liao
- Department of Urology, Medical College, National Taiwan University, Taipei City, Taiwan
| | - Akira Miyajima
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Iason Kyriazis
- Department of Urology, University of Patras, Patras, Greece
| | | | - Cristian Fiori
- Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy
| | - Bo Yang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Guo Fei
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | | | | | | | - Luigi Schips
- Department of Urology, S. Pio Da Pietralcina Hospital, Vasto, Italy
| | | | - Zhi Chen
- Xiangya Hospital Central South University, Changsha, China
| | | | - Yao He
- Xiangya Hospital Central South University, Changsha, China
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | | | - Luis Brandao
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ithaar Darweesh
- Department of Urology, University of California San Diego Health System, La Jolla, CA, USA
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Cabral JF, Braga IC, Branco F, Cavadas V, Ferreira AF, Ramos MS. What about vaginal extraction of the kidney? results of an online survey. Int Braz J Urol 2016; 42:78-82. [PMID: 27136470 PMCID: PMC4811229 DOI: 10.1590/s1677-5538.ibju.2015.0170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/20/2015] [Indexed: 11/22/2022] Open
Abstract
PURPOSE We aimed to characterize surgeons opinion about the vaginal extraction of the kidney after transperitoneal laparoscopic nephrectomy. Matherial and Methods: A 9-item questionnaire was published online (Survey Monkey TM) and publicized via email to a multidisciplinary pool of surgeons in Portugal. Data was collected and statistical analysis was performed using IBM SPSS Statistics, Version 21.0. RESULTS Three hundred and fifty nine inquiries were sent, 154 surgeons completed the questionnaires (response rate of 43.0%). Fifty five point eight percent of the participants would choose the transvaginal approach for themselves or for a close relative. The most stated arguments were a better cosmesis (29.0%) expectancy of lower post operative pain (26.0%) and lower rate of incisional hernias (23.0%). Defenders of the transabdominal procedure justified with an expectancy of lower complication rate (39%), namely impairment of sexual function and fertility (22%). The female gender and the familiarity with transvaginal surgery were the stronger predictors of the option for this approach (70.6% vs 48.5%; p=0,016 and 85.3% vs 46.6%; p <0.001 respectively). CONCLUSIONS Contrasting with similar surveys published on transvaginal NOTES, the vaginal specimen extraction after conventional laparoscopic nephrectomy was fairly accepted by the inquired surgeons.
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Affiliation(s)
| | - Isaac Campos Braga
- Departamento de Urologia, Hospital de Santo António - C.H.P, Porto, Portugal
- Instituto de Investigação em Ciências da Vida e da Saúde - I.C.V.S, Universidade do Minho; ICVS/3B´s - PT Laboratório Associado ao Governo, Braga, Portugal
| | - Frederico Branco
- Departamento de Urologia, Hospital de Santo António - C.H.P, Porto, Portugal
| | - Vitor Cavadas
- Departamento de Urologia, Hospital de Santo António - C.H.P, Porto, Portugal
| | - Avelino Fraga Ferreira
- Departamento de Urologia, Hospital de Santo António - C.H.P, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar - I.C.B.A.S - Universidade do Porto, Porto, Portugal
| | - Miguel Silva Ramos
- Departamento de Urologia, Hospital de Santo António - C.H.P, Porto, Portugal
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Schroeder RPJ, Chrzan RJ, Klijn AJ, Kuijper CF, Dik P, de Jong TPVM. Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre. J Pediatr Urol 2015; 11:271.e1-6. [PMID: 26096439 DOI: 10.1016/j.jpurol.2015.03.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Minimally invasive surgery (MIS) is being utilized more frequently as a surgical technique in general surgery and in paediatric urology. It is associated with a steep learning curve. Currently, the centre does not offer a MIS training programme. It is hypothesized that the number of MIS procedures performed in the low-volume specialty of paediatric urology will offer insufficient training potential for surgeons. OBJECTIVE To assess the MIS training potential of a highly specialized, tertiary care, paediatric urology training centre that has been accredited by the Joint Committee of Paediatric Urology (JCPU). STUDY DESIGN The clinical activity of the department was retrospectively reviewed by extracting the annual number of admissions, outpatient consultations and operative procedures. The operations were divided into open procedures and MIS. Major ablative procedures (nephrectomy) and reconstructive procedures (pyeloplasty) were analysed with reference to the patients' ages. The centre policy is not to perform major MIS in children who are under 2 years old or who weigh less than 12 kg. RESULTS Every year, this institution provides approximately 4300 out-patient consultations, 600 admissions, and 1300 procedures under general anaesthesia for children with urological problems. In 2012, 35 patients underwent major intricate MIS: 16 pyeloplasties, eight nephrectomies and 11 operations for incontinence (seven Burch, and four bladder neck procedures). In children ≥2 years of age, 16/21 of the pyeloplasties and 8/12 of the nephrectomies were performed laparoscopically. The remaining MIS procedures included 25 orchidopexies and one intravesical ureteral reimplantation. DISCUSSION There is no consensus on how to assess laparoscopic training. It would be valuable to reach a consensus on a standardized laparoscopic training programme in paediatric urology. Often training potential is based on operation numbers only. In paediatric urology no minimum requirement has been specified. The number of procedures quoted for proficiency in MIS remains controversial. The MIS numbers for this centre correspond to, or exceed, numbers mentioned in other literature. To provide high-quality MIS training, exposure to laparoscopic procedures should be expanded. This may be achieved by centralizing patients into a common centre, collaborating with other specialities, modular training and training outside the operating theatre. CONCLUSION Even in a high-volume, paediatric urology educational centre, the number of major MIS procedures performed remains relatively low, leading to limited training potential.
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Affiliation(s)
- R P J Schroeder
- Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands.
| | - R J Chrzan
- University Children's Hospitals AMC Amsterdam and UMC Utrecht, AMC Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - A J Klijn
- University Children's Hospitals AMC Amsterdam and UMC Utrecht, UMC (WKZ) Utrecht, Postbus 85090, 3508 AB Utrecht, The Netherlands.
| | - C F Kuijper
- University Children's Hospitals AMC Amsterdam and UMC Utrecht, AMC Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - P Dik
- University Children's Hospitals AMC Amsterdam and UMC Utrecht, UMC (WKZ) Utrecht, Postbus 85090, 3508 AB Utrecht, The Netherlands.
| | - T P V M de Jong
- University Children's Hospitals AMC Amsterdam and UMC Utrecht, UMC (WKZ) Utrecht, Postbus 85090, 3508 AB Utrecht, The Netherlands.
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Gerntke CI, Kersten JF, Schön G, Mann O, Stark M, Benhidjeb T. Women’s Perception of Transvaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES). Surg Innov 2015; 23:201-11. [DOI: 10.1177/1553350615598621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective. Over the past 8 years, natural orifice transluminal endoscopic surgery (NOTES) has developed from preclinical to routine clinical practice. However, there are still concerns regarding the transvaginal approach. In our survey, we were interested in females with a professional medical background, thus having at least a basic medical understanding, which might discriminate between objective and subjective concerns. Material and Methods. A questionnaire with 14 items was distributed among 1895 female physicians and nursing and administration staff of the University Medical Center Hamburg-Eppendorf. In addition, a qualitative literature review was performed. Data analysis was carried out using statistical package R version 2.15.0. Results. The questionnaire was answered anonymously by 553 employees (29%). Fifty-seven percent were nurses, 18.6% belonged to administration, and 17% were physicians. A total of 63.1% of our respondents would choose the transvaginal NOTES technique for an assumed ovariectomy, while only 30.4% would choose this access for cholecystectomy. Doubts regarding transvaginal NOTES were related to sexual dysfunction (44.8%), its experimental nature (43.8%), future pregnancies (36.8%), and ethical reasons (30.3%). The literature review showed that women’s perception of the transvaginal access is documented very heterogeneously and therefore difficult to compare. Conclusions. Despite the good reported results of NOTES and the medical background of the surveyed female employees, our study and the literature review clearly shows that there are fears regarding the transvaginal access, which might be a result of limited information. More accurate explanation of the available methods by the attending surgeon can lead to a better choice of the patient’s preferred method.
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Affiliation(s)
| | | | - Gerhard Schön
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Mann
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Stark
- The New European Surgical Academy (NESA), Berlin, Germany
| | - Tahar Benhidjeb
- Burjeel Hospital, Abu Dhabi, United Arab Emirates
- The New European Surgical Academy (NESA), Berlin, Germany
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Abstract
Objective To investigate the public perception of laparoendoscopic single-site surgery (LESS) according to the age group. Methods An anonymous questionnaire about the desire for cosmesis and the preference for LESS in treatment of benign gynecologic diseases was provided to healthy volunteers (n=102). The survey participants were divided into two age groups (young women ≤40 years and middle-aged women >40 years). The desire for cosmesis was assessed using a validated scale, Body Image Scale. Results All of the participants completed the questionnaire. The Body Image Scale scores were not different between the two age groups (11.5±3.5 vs. 11.8±4.0, P=0.656). The most common fear of surgery was the risk of complications in both age groups (69% in the young age group and 65% in the middle-aged group). Unless the operative risk increased, most of the participants (61% to 67%) in both age groups preferred LESS. Their choice was influenced by reduced scarring (43% to 61%), more safety (20% to 39%), reduced postoperative pain (8% to 10%), and new technology (4% to 6%). Conclusion Based on these results, there was no difference in the desire for cosmesis and perception of LESS according to the age. Therefore, physicians should discuss and consider LESS even in middle-aged women.
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Kaouk JH, Autorino R. Editorial comment. Urology 2014; 84:1528. [PMID: 25475231 DOI: 10.1016/j.urology.2014.06.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
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Friedersdorff F, Aghdassi SJ, Magheli A, Richter M, Stephan C, Busch J, Boehmer D, Miller K, Fuller TF. Staging lymphadenectomy in patients with localized high risk prostate cancer: comparison of the laparoendoscopic single site (LESS) technique with conventional multiport laparoscopy. BMC Urol 2014; 14:92. [PMID: 25412566 PMCID: PMC4247718 DOI: 10.1186/1471-2490-14-92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/30/2014] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND In patients with localized high-risk prostate cancer awaiting radiation therapy, pelvic lymphadenectomy (PL) is a reliable minimally invasive staging procedure. We compared outcomes after laparoendoscopic single site PL (LESSPL) with those after conventional multiport laparoscopic PL (MLPL). METHODS A retrospective case-control study was carried out at the authors' center. For LESSPL the reusable X-Cone single port was combined with straight and prebent laparoscopic instruments and an additional 3 mm needlescopic grasper. MLPL was performed via four trocars of different sizes using standard laparoscopic instruments. RESULTS Patients who underwent either LESSPL (n = 20) or MLPL (n = 97) between January 2008 and July 2013, were included in the study. Demographic data were comparable between groups. Patients in the LESSPL group tended to be older and had a significantly higher ASA-score. The mean operating time was 172.4 ± 34.1 min for LESSPL and 116.6 ± 40.1 min for MLPL (P < .001). During LESSPL, no conversion to MLPL was necessary. An average of 12 lymph nodes per patient was retrieved, with no significant difference between study groups. Postoperative pain scores were similar between groups. The hospital stay was 2.3 ± 0.7 days after LESSPL and 3.1 ± 1.2 days after MLPL (P = .01). Two days postoperatively, significantly more patients after LESSPL than after MLPL recovered their normal physical activity (P < .001). Six months postoperatively, no complications were registered in the LESSPL group and cosmetic results were excellent. CONCLUSIONS In the present study, shorter hospitalization and quicker postoperative recovery were major benefits of LESSPL over MLPL. In patients with localized prostate cancer, staging LESS pelvic lymphadenectomy may be a safe alternative to conventional multiport laparoscopy.
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Affiliation(s)
- Frank Friedersdorff
- Department of Urology, Charité University Hospital, Charitéplatz 1, 10117 Berlin, Germany.
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Retropubic, laparoscopic and mini-laparoscopic radical prostatectomy: a prospective assessment of patient scar satisfaction. World J Urol 2014; 33:1181-7. [DOI: 10.1007/s00345-014-1425-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/19/2014] [Indexed: 10/24/2022] Open
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Gkegkes ID, Iavazzo C. Single incision laparoscopic hepatectomy: A systematic review. J Minim Access Surg 2014; 10:107-12. [PMID: 25013325 PMCID: PMC4083541 DOI: 10.4103/0972-9941.134872] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/10/2013] [Indexed: 12/11/2022] Open
Abstract
Single incision laparoscopic surgery is a rather innovative surgical technique. A systematic literature review was performed with the intention to evaluate the till now clinical evidence regarding the application of single incision technique on liver resections as a method of management in hepatic lesions. Twelve relative studies were found in the field including 30 patients with a age range from 29 to 90 years and a body mass index from 20.1 to 36.5 kg/m2. Primary hepatic carcinoma (40%), metastatic nodules (26.7%), hepatic cysts (16.7%), hepatic haemangiomas (13.3%) and hepatic adenoma (3.3%) were the most common indications of the lesions resected. The types of hepatectomy performed included partial hepatectomy (43.3%), segmentectomy (30%) and lobectomy (26.7%). In the majority of the patients, left lateral segments (II-III-IV) (76.7%) were resected. The median operative time was 110 min (range: 55-235) while the median quantity of blood loss was 50 ml (range: 0-100). No conversion to open surgery and no transfusion were needed. The duration of hospital stay ranged between 2 and 11 days. No complications, no cases of disease recurrence or death of patients were reported. None of the studies included described data on the cosmesis of the application of single incision laparoscopic technique on hepatic resections. Moreover, the surgical technique, as well as the different type of ports used is also presented in this review. Single site port laparoscopic surgery is a promising minimally invasive procedure for liver resections.
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Quality of scar after total thyroidectomy: a single blinded randomized trial comparing octyl-cyanoacrylate and subcuticular absorbable suture. ISRN SURGERY 2013; 2013:270953. [PMID: 24324898 PMCID: PMC3845629 DOI: 10.1155/2013/270953] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 09/26/2013] [Indexed: 12/14/2022]
Abstract
Objective. To compare the quality of resulting scar at 6 weeks after total thyroidectomy with the use of the tissue adhesive octyl-cyanoacrylate or subcuticular absorbable suture for the closure of cervicotomy. Material and Methods. There are 50 patients undergoing a cervicotomy for total thyroidectomy. Twenty-five patients were randomly assigned to closure with tissue adhesive and 25 with subcuticular absorbable suture. At week 6 the scar was evaluated by blinded assessors with the Italian version of POSAS questionnaire, a validated wound scale composed of an observer's and a patient's subscale. Results. Assessment of scar appearance showed a statistically significant difference (p = 0. 038) in favor of subcuticular suture with respect to tissue adhesive on observer's assessment. The difference on patients' self-assessment was not significant. A multivariate analysis of six qualitative features of scars showed a significant influence on assessment for hyperpigmentation and relief of scar. The Italian version of POSAS proved to be reliable. Conclusion. Though tissue adhesive represents a valid method of skin closure, subcuticular absorbable suture provides a better aesthetic outcome in small cervical incisions in the early phase after thyroid surgery.
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Current evidence in gastrointestinal surgery: natural orifice translumenal endoscopic surgery (NOTES). J Gastrointest Surg 2013; 17:1857-62. [PMID: 23860676 DOI: 10.1007/s11605-013-2277-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 06/24/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Natural orifice translumenal endoscopic surgery (NOTES) is a technique that uses transvisceral access to perform surgical procedures entirely through a natural orifice. Despite the increasing awareness of NOTES, there remain obstacles to its technical feasibility and widespread acceptance. Furthermore, with the paucity of high-level supporting evidence, NOTES currently remains an experimental technique. OBJECTIVE This article reviews the goals, applications, technical and practical challenges, and future direction of NOTES in gastrointestinal surgery.
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Tobis S, Houman J, Thomer M, Rashid H, Wu G. Robot-Assisted Transumbilical Laparoendoscopic Single-Site Pyeloplasty: Technique and Perioperative Outcomes from a Single Institution. J Laparoendosc Adv Surg Tech A 2013; 23:702-6. [DOI: 10.1089/lap.2012.0577] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Scott Tobis
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Justin Houman
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Marguerite Thomer
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Hani Rashid
- Department of Urology, University of Rochester Medical Center, Rochester, New York
| | - Guan Wu
- Department of Urology, University of Rochester Medical Center, Rochester, New York
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Yeung PP, Bolden CR, Westreich D, Sobolewski C. Patient preferences of cosmesis for abdominal incisions in gynecologic surgery. J Minim Invasive Gynecol 2013; 20:79-84. [PMID: 23312246 DOI: 10.1016/j.jmig.2012.09.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 09/18/2012] [Accepted: 09/22/2012] [Indexed: 10/27/2022]
Abstract
STUDY OBJECTIVE To estimate patient preferences insofar as the cosmetic appeal of abdominal incisions used for hysterectomy. We hypothesized that the laparoendoscopic single-site surgery (LESS) incision would be preferred cosmetically to traditional multiport laparoscopic incisions and open abdominal incisions via Pfannenstiel, vertical midline, or horizontal mini-laparotomy. DESIGN Prospective comparative study (Canadian Task Force classification II-2). SETTING Two gynecology clinics at Duke University Medical Center in Durham, North Carolina. PATIENTS Seventy-three women including 50 consecutive women from a private specialty clinic and 23 consecutive women from a resident indigent care clinic. INTERVENTIONS A brief questionnaire was distributed that assessed preferences via ranking and by using a visual analog scale. Patients were also asked to rate the importance of 4 factors in their decision making: size, location, and number of incisions, and perceived recovery time. Descriptive statistics, t tests, Wilcoxon rank-sum tests, and χ(2) tests were used to compare continuous or categorical values. MEASUREMENTS AND MAIN RESULTS Overall, the LESS incision was the most preferred incision according to most common choice and visual analog scale scores. In the private clinic, the LESS incision was preferred most often, with 53% of women (39/73) ranking it as their first choice. In the resident clinic, the horizontal mini-laparotomy incision was preferred most often, with 27% of women (20/73) ranking it their first choice. Neither the demographic factors nor any of the factors in decision making explained the difference between the clinics. CONCLUSION The LESS incision was most preferred in this study. However, the horizontal mini-laparotomy incision and the traditional laparoscopic with low lateral incisions were also highly preferred. Patient perception of the "visibility" of abdominal incisions may be the distinguishing issue to explain the difference in the preferences between the clinics and the differences between the present study and previously published studies of cosmetic preferences.
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Affiliation(s)
- Patrick P Yeung
- Department of Obstetrics, Gynecology, and Women's Health, Minimally Invasive Gynecologic Surgery, Saint Louis University, St. Louis, Missouri 63117, USA.
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Rais-Bahrami S, Moreira DM, Hillelsohn JH, George AK, Rane A, Gross AJ, Richstone L. Contemporary Perspectives on Laparoendoscopic Single-Site Surgery in Urologic Training and Practice. J Endourol 2013; 27:727-31. [DOI: 10.1089/end.2012.0652] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Soroush Rais-Bahrami
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York
| | - Daniel M. Moreira
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York
| | - Joel H. Hillelsohn
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York
| | - Arvin K. George
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York
| | - Abhay Rane
- Department of Urology, East Surrey Hospital, Redhill, United Kingdom
| | - Andreas J. Gross
- Department of Urology, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Lee Richstone
- The Arthur Smith Institute for Urology, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, New York
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Laparoendoscopic single-site (LESS) varicocelectomy with reusable components: comparison with the conventional laparoscopic technique. Surg Endosc 2013; 27:3646-52. [PMID: 23549770 DOI: 10.1007/s00464-013-2938-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 03/14/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study aimed to compare laparoendoscopic single-site varicocelectomy (LESSV) with multiport laparoscopic varicocelectomy (MLV) in terms of intraoperative parameters and postoperative outcomes. METHODS A retrospective case-control study investigated 10 male adolescents and 89 adults who underwent either LESSV or MLV at the authors' center. The reusable X-Cone single port was inserted transumbilically. A 5-mm 30° telescope was used together with a straight and a prebent laparoscopic instrument. The MLV procedure was performed using two 5-mm ports and one 10-mm port. RESULTS Between January 2009 and November 2012, 20 patients underwent LESSV and 79 patients underwent MLV. The demographic data were comparable between the two groups. The mean operating time was 59.1 ± 15.5 min for LESSV and 51.2 ± 14.4 min for MLV (P = 0.04). In the LESSV group, no conversion to MLV was necessary. The hospital stay was 1.6 ± 0.7 days in the LESSV group versus 1.8 ± 0.5 days in the MLV group (P = 0.17). The postoperative pain scores did differ between the two groups. By day 2, significantly more patients in the LESSV group than in the MLV group fully recovered their normal physical activity (P = 0.02). Comparison of pre- and postoperative values showed relief of testicular pain and improvement of semen parameters for the majority of the patients. The overall incidence of complications was distributed equally between the two groups as follows: paresthesia of the upper thigh (8 %), wound infection (5 %), epididymitis (3 %) and hydrocele (4 %). All the patients in the LESSV group were fully satisfied with their cosmetic results compared with only 76 % of the patients in the MLV group (P = 0.01). CONCLUSIONS The LESSV procedure performed with the reusable X-Cone is as safe and efficient as MLV. After LESSV, the parameters measuring postoperative patient satisfaction are significantly improved. Given its reusable components, including prebent laparoscopic instruments, the X-Cone platform is a cost-effective alternative to disposable or homemade single ports.
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Laydner H, Autorino R, Isac W, Khalifeh A, Panumatrassamee K, Kassab A, Long JA, Eyraud R, Rizkala E, Stein RJ, Kaouk JH. Reply: To PMID 23541224. Urology 2013; 81:1238. [PMID: 23541228 DOI: 10.1016/j.urology.2012.11.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Humberto Laydner
- Center for Laparoscopic and Robotic Surgery, Department of Urology, Cleveland Clinic, Cleveland, Ohio, USA
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