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Li N, Shen H, Zhang J, Dong B, Wang Y, Li T. A New Transoral Vestibulum Single Incision Endoscopic-Assisted Thyroidectomy with Gasless. Laryngoscope 2024; 134:2976-2984. [PMID: 37987235 DOI: 10.1002/lary.31197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/18/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE We developed a novel method for thyroidectomy using a single-incision oral vestibular approach. To assess its advantages and disadvantages, we compared the perioperative parameters of this approach with those of transoral three-incision thyroidectomy and trans-areolar thyroidectomy. METHODS In a study of 136 papillary thyroid carcinoma patients (2016-2018), precise thyroidectomy and neck dissection were conducted. Among them, 52 chose single-incision oral vestibular approach, 33 chose three-incision variant, and 51 underwent trans-areolar thyroidectomy. Perioperative aspects of the transoral single-incision group were compared with those of transoral three-incision group, and transthoracic group. RESULTS In the cohort, meticulous tumor level VI lymph node dissection was performed, achieving intended resection extent with one case requiring a switch from transoral to transthoracic approach. No nerve palsy occurred in the transoral group. Thyroidectomy duration varied significantly across groups. Transoral single-incision had a shorter duration than transoral three-incision and longer than transthoracic. Minor differences were observed in blood loss and drainage. Perioperative factors like hematoma, infection, hypocalcemia, et al., remained consistent. Notably, no tumor recurrence was observed in this study. CONCLUSIONS This new transoral video-assisted neck surgery (TOVANS) method for thyroidectomy without gas insufflation approach did not increase the surgical complexity compared with the transoral vestibular three-incision thyroidectomy and the trans-areolar thyroidectomy. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2976-2984, 2024.
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Affiliation(s)
- Nian Li
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Hong Shen
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Junbo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Bingwan Dong
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Yong Wang
- Department of Thyroid Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tiancheng Li
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Zheng H, Tong W, Tian Y, Huang F, Huang B. Laparoscopic-assisted transvaginal radical sigmoidectomy for sigmoid colon cancer-A video vignette. Colorectal Dis 2023; 25:2115-2117. [PMID: 37641213 DOI: 10.1111/codi.16727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Huichao Zheng
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Weidong Tong
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yue Tian
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Feifei Huang
- Department of Anesthesiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Bin Huang
- Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China
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Fu T, Ren J, Yao H, Huang B, Sun L, Li X, Tong W. Feasibility and safety of hybrid transvaginal natural orifice transluminal endoscopic surgery for colon cancer: Protocol for a multicenter, single-arm, phase II trial (vNOTESCA). Heliyon 2023; 9:e20187. [PMID: 37780770 PMCID: PMC10539939 DOI: 10.1016/j.heliyon.2023.e20187] [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] [Received: 05/06/2023] [Revised: 09/04/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction It has been a decade since the first patient with colon cancer underwent colectomy by hybrid transvaginal natural orifice transluminal endoscopic surgery (hvNOTES). However, the efficacy and safety of this procedure is not well established. Methods This study is an open-label, multicenter, single-arm, phase 2 trial undertaken at six centers in China. Female patients aged over 18 years and below 80 years old with an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, with pathologically proven, resectable, cT1-3N0-2M0 disease who have previously untreated colon cancer are eligible for inclusion. The primary endpoint is a composite of major intraoperative and postoperative complications (greater than grade III, the Common Terminology Criteria for Adverse Events [CTCAE], version 5.0). Secondary endpoints include conversion to laparoscopic or open surgery, postoperative concentration of C-Reactive Protein and procalcitonine, complete pathological assessment of complete mesocolic excision specimens, postoperative pain, amount of narcotic pain medication administered, time to first flatus after surgery, number of harvested lymph nodes, R0 resection rate, length of hospital stay, sexual function assessment, quality of recovery, satisfaction with surgical scars, quality of life, postoperative recurrence patterns, relapse-free survival, and overall survival. Ethics and dissemination The study was approved by the Research Ethics Committee, Renmin Hospital of Wuhan University, China, number: WDRY2022-K053. All patients will receive written information of the trial and provide informed consent before enrollment. The results of this trial will be disseminated in academic conferences and peer-reviewed medical journals.Trial registration number NCT04048421.
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Affiliation(s)
- Tao Fu
- Department of General Surgery, Qingdao Hospital, University of Health and Rehabilitation Sciences, Qingdao Municipal Hospital, China
- Department of Gastrointestinal Surgery II, Renmin Hospital of Wuhan University, China
| | - Jun Ren
- Department of Gastrointestinal Surgery II, Renmin Hospital of Wuhan University, China
| | - Hongwei Yao
- Department of Colorectal Surgery, Beijing Friendship Hospital of Capital Medical University, China
| | - Bin Huang
- Department of Gastrointestinal Surgery, Daping Hospital of Army Medical University, China
| | - Lifeng Sun
- Department of Colorectal Surgery, The Second Affiliated Hospital of Zhejiang University, China
| | - Xiaorong Li
- Department of Colorectal Surgery, The Third Xiangya Hospital of Central South University, China
| | - Weidong Tong
- Department of Gastrointestinal Surgery, Daping Hospital of Army Medical University, China
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Ullah S, Zhang JY, Liu D, Zhao LX, Liu BR. Transgastric versus transrectal: Which access route is the best for NOTES gallbladder-preserving gallstone therapy? J Dig Dis 2023; 24:491-496. [PMID: 37596857 DOI: 10.1111/1751-2980.13221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 07/31/2023] [Accepted: 08/16/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES To compare the effectiveness and safety of transgastric and transrectal pure natural orifice transluminal endoscopic surgery (NOTES) for cholecystolithotomy. METHODS This was a single-center retrospective comparative study of consecutive patients who underwent pure NOTES for either transrectal or transgastric gallbladder-preserving cholecystolithotomy between September 2017 and April 2020. Patients with symptomatic cholelithiasis were assigned for transrectal or transgastric NOTES based on the patients' choice. Treatment success, postoperative pain, peritonitis, time to resume normal diet, and duration of hospitalization were compared. RESULTS The technical success rate was 100%. Forty-eight patients underwent successful NOTES cholecystolithotomy via the transrectal (n = 26) or transgastric route (n = 22). One (3.8%) patient in the transrectal NOTES group experienced postoperative abdominal pain compared to 6 (27.3%) in the transgastric NOTES group (P = 0.04). Fever and bile peritonitis developed in one (3.8%) patient in the transrectal NOTES group versus 8 (36.4%) in the transgastric NOTES group (P = 0.005). A postoperative fluid diet was commenced at 6 h with the transrectal approach versus on day 3 for the transgastric NOTES group. The mean postoperative hospitalization for transrectal and transgastric NOTES groups was 4.5 days versus 7 days (P = 0.001). Three patients in the transgastric NOTES group developed postoperative gastric fistula. CONCLUSIONS Transrectal NOTES has advantages over transgastric NOTES, including preserved spatial orientation, relatively easier removal of specimens, early food intake, shorter hospitalization, fewer postoperative complications and less pain. Multicenter clinical trials with long-term follow-up are needed to confirm the safety and efficacy of both approaches.
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Affiliation(s)
- Saif Ullah
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Ji Yu Zhang
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Dan Liu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Li Xia Zhao
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Bing Rong Liu
- Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- State Key Laboratory of Esophageal Cancer Prevention and Treatment, Zhengzhou University, Zhengzhou, Henan Province, China
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Progress in Control-Actuation Robotic System for Gastrointestinal NOTES Development. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7047481. [PMID: 36349314 PMCID: PMC9637469 DOI: 10.1155/2022/7047481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 09/19/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022]
Abstract
Purpose Natural orifice transluminal endoscopic surgery (NOTES) is a minimally invasive surgical procedure that reduces patient trauma, infection probability, and rehabilitation time. This paper reviews the progress made in the control-actuation robotic systems for gastrointestinal NOTES development. Material and Methods. A survey on both existing and state-of-the-art control-actuation robotic systems for gastrointestinal NOTES was conducted in December 2021. Results Nine control-actuation robotic systems for gastrointestinal NOTES were identified. The structures and specifications of these robotic systems were reported. The technical parameters were also discussed. Special attention was directed to systems using a control-actuation structure and tendon-driven mechanism. The control-actuation robotic systems typically deploy a control-actuation structure and tendon-driven mechanism. Control-actuation robotic systems for gastrointestinal NOTES show great ability to improve operational accuracy and flexibility and flatten the learning curve of procedures. These characteristics suggest that the use of control-actuation robotic systems is worth exploring in future development.
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Laparoscopic Single-Incision Triangulated Umbilical Surgery Adrenalectomy for Large (>5 cm) Tumors of the Adrenal Gland: Initial Experience with 16 Cases. JOURNAL OF ONCOLOGY 2022; 2022:5966530. [PMID: 36213839 PMCID: PMC9534670 DOI: 10.1155/2022/5966530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/03/2022] [Indexed: 12/01/2022]
Abstract
Background and ObjectivesLaparoscopic single-incision triangulated umbilical surgery (SITUS), which enables the extraction of intraabdominal specimens through a single umbilical incision, has yet to be used to perform adrenalectomy. We have modified SITUS to enable extraction of large (>5 cm) adrenal masses with optimal cosmetic outcomes and investigated efficacy and safety. Methods. In this retrospective study, we analyzed data of 16 patients with adrenal tumors >5 cm who had undergone adrenalectomy by SITUS between October 2015 and April 2018. Two C-shaped incisions were made around the umbilicus and sutured centripetally. After extracting the specimen, we evaluated these patients' operative/postoperative data. Results. SITUS was performed in all 16 patients without conversion to laparoscopic or open surgery. The mean operation time was 75.31 ± 21.54 min (intraperitoneal time 41.94 ± 17.57 min; incision suturing time 33.38 ± 6.34 min). The estimated median blood loss was 57.5 mL (range 30–610 mL). Drainage time and duration of hospital stay were 55.69 ± 12.92 h and 3.94 ± 0.90 d, respectively. After surgery, all incisions were hidden under the umbilicus. Three patients developed keloid diathesis, resulting in enlargement of their scars. Conclusions. SITUS is a safe and feasible procedure for removing large adrenal tumors. In addition to its cosmetic advantages, SITUS facilitates functional recovery, particularly in patients with large adrenal tumors.
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Hu B, Ding H. Evolution of Endoscopic Thyroidectomy: Will a Novel Single Channel Flexible Endoscopic Approach Change the Treatment Paradigm? Int J Gen Med 2022; 15:2795-2798. [PMID: 35300143 PMCID: PMC8922313 DOI: 10.2147/ijgm.s360138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/28/2022] [Indexed: 12/04/2022] Open
Abstract
Endoscopic thyroidectomy has evolved from a hybrid approach utilizing a laparoscopic assistant and robotic-assistance to pure flexible endoscopic thyroidectomy without laparoscopic assistance. However, all the hybrid approaches are complicated and results in scar somewhere on the body surface. Current experimental and clinical studies focus on the implementation of new minimally invasive approaches such as flexible endoscopic thyroidectomy which leaves no scar on the body surface and easier to perform. Flexible endoscopic thyroidectomy is seeming to be a relatively safe and feasible technique with good outcomes. However, more research, particularly using newly developed tools to further improve this technique, and large scaled practice is needed to make it more available to patients worldwide. This article summarizes established endoscopic thyroidectomy techniques and highlight the pros and cons of different available endoscopic approaches to thyroid resection, and discussed how flexible endoscopic thyroidectomy compares to the well establish techniques and future perspective.
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Affiliation(s)
- Bowen Hu
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People’s Republic of China
- Correspondence: Bowen Hu, Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou, 450052, Henan, People’s Republic of China, Tel +86-15286819833, Email
| | - Huanfei Ding
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People’s Republic of China
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Kim M, Bareket R, Reja M, Sarkar A, Shahid H, Tyberg A, Kahaleh M. Ultimate salvation: feasibility of NOTES for complications of ERCP and endoscopic ultrasound-guided procedures. Endoscopy 2022; 54:E100-E101. [PMID: 33784748 DOI: 10.1055/a-1394-5872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Marina Kim
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Romy Bareket
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Mishal Reja
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Avik Sarkar
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Haroon Shahid
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Amy Tyberg
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
| | - Michel Kahaleh
- Department of Gastroenterology & Hepatology, Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA
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Gulaydin N. Laparoscopic cholecystectomy by the modified bikini line approach as a simple and safe technique. Rev Assoc Med Bras (1992) 2021; 67:1172-1176. [PMID: 34669865 DOI: 10.1590/1806-9282.20210589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/15/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The gold standard technique for laparoscopic cholecystectomy (LC) is using four ports in the upper abdomen. However, this operative approach may not provide aesthetic satisfaction for some patients because of visible incision marks. This study sought to demonstrate that these incision marks can be hidden by safely changing the port locations. METHODS For patients with symptomatic cholelithiasis undergoing LC between March 2019 and March 2020, the modified bikini line approach was used. With the patient in the supine position with open legs, the first trocar (10 mm) was inserted into the abdomen through an 11-mm incision in the umbilicus. The other three trocars were placed in the abdomen at the bikini line with the help of a camera. The standard equipment for LC was then used to perform the surgery. RESULTS The modified bikini line approach to LC was used for 38 patients. Average operative time was 28.65 min, and the average hospital stay was 1.07 days. No perioperative or postoperative complications occurred. Follow-up was at 1 week, 1 month, and 6 months. Cosmetic results were satisfactory for all patients. CONCLUSIONS As an alternative to the standard LC approach, the modified bikini line technique is safe and useful in patients for whom postoperative aesthetic appearance is important. The modified approach is simple to learn and use and is effective to hide the incision marks well.
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Affiliation(s)
- Nihat Gulaydin
- Istanbul Atlas University Medical Faculty - Istanbul, Turkey
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Yuan Y, Jian J, Jing H, Yan R, You F, Fu X, Du L, Li W. Single-Incision vs. Conventional Laparoscopic Surgery for Colorectal Cancer: An Update of a Systematic Review and Meta-Analysis. Front Surg 2021; 8:704986. [PMID: 34497828 PMCID: PMC8419430 DOI: 10.3389/fsurg.2021.704986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/19/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Although the advantages of single-incision laparoscopic surgery have been reported in several meta-analyses, the low quality of studies included in the meta-analyses limits the reliability of such a conclusion. In recent years, the number of randomized controlled trials on the efficacy of SILS in colorectal cancer has been on the rise. This update systematic review and meta-analysis of RCTs aims to compare efficacy and safety of SILS and CLS in the patients with colorectal cancer. Methods: Relevant data was searched on the CNKI, Wanfang, VIP, Sinomed, PubMed, Embase, and Cochrane CENTRAL databases from inception until February 5th, 2021. All RCTs comparing SILS and CLS were included. The main outcomes were 30 days of mortality, postoperative complications, intraoperative complications, whereas secondary outcomes were the number of lymph nodes removed, duration of hospital stay, intraoperative blood loss, abdominal incision length, reoperation, readmission, conversion to laparotomy, operation time and anastomotic leakage. Results: A total of 10 RCTs were included, involving 1,133 participants. The quality of the included studies was generally high. No significant difference was found between SILS and CLS in the 30 days mortality rate. The results showed that SILS group had a lower rate of postoperative complications (RR = 0.67, 95% CI: 0.49-0.92), higher rate of intraoperative complications (RR = 2.26, 95%CI: 1.00-5.10), shorter length of abdominal incision (MD = -2.01, 95% CI:-2.42-1.61) (cm), longer operation time (MD = 11.90, 95% CI: 5.37-18.43) (minutes), shorter hospital stay (MD = -1.12, 95% CI: -1.89-0.34) (days) compared with CLS group. However, intraoperative blood loss (MD = -8.23, 95% CI: -16.75-0.29) (mL), number of lymph nodes removed (MD = -0.17, 95% CI: -0.79-0.45), conversion to laparotomy (RR=1.31, 95% CI: 0.48-3.60), reoperation (RR = 1.00, 95% CI: 0.30-3.33) and readmission (RR =1.15, 95% CI: 0.12-10.83) and anastomotic leakage were not significantly different between the two groups. Conclusion: These results indicate that SILS did not has a comprehensive and obvious advantage over the CLS. Surgeons and patients should carefully weigh the pros and cons of the two surgical procedures. Further RCTs are needed to prove long-term outcomes of SILS in colorectal cancer.
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Affiliation(s)
- Ye Yuan
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jianing Jian
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hailiang Jing
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ran Yan
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fengming You
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xi Fu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Linke Du
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenyuan Li
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Sichuan Evidence-Based Medicine Center of Traditional Chinese Medicine, Chengdu, China.,TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Song ZJ, Shi YQ, Jiang YM, Liu K, Li Y, Wang CG, Zhao R. Pure transvaginal natural orifice transluminal endoscopic surgery right hemicolectomy for colon cancer: A case report. World J Clin Cases 2021; 9:1714-1719. [PMID: 33728316 PMCID: PMC7942039 DOI: 10.12998/wjcc.v9.i7.1714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pure natural orifice transluminal endoscopic surgery (NOTES) for colorectal cancer is a complex procedure and rarely used in clinical practice because of the ethical concerns and technical challenges, including loss of triangulation, in-line orientation, and instrument collision. Transvaginal (v) NOTES, however, can overcome these technical challenges. We report a case of pure vNOTES right hemicolectomy for colon cancer, attached with surgical video.
CASE SUMMARY A 65-year-old woman with a 2-year history of intermittent diarrhea was diagnosed with ascending colon adenocarcinoma by colonoscopy and biopsy. Pure vNOTES right hemicolectomy was performed with complete mesocolic excision by well-experienced surgeons. The operative time was 200 min and the estimated blood loss was 30 mL. No intraoperative or postoperative complications occurred within 30 d after the surgery. The visual analog scale pain score on postoperative day 1 was 1 and dropped to 0 on postoperative days 2 and 3. The patient was discharged at postoperative day 6. The pathologic specimen had sufficient clear resection margins and 14 negative harvested lymph nodes.
CONCLUSION vNOTES right hemicolectomy, performed by well-experienced surgeons, overcomes the technical challenges of pure NOTES and may be feasible for colon cancer.
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Affiliation(s)
- Zi-Jia Song
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
| | - Yi-Qing Shi
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
| | - Yi-Mei Jiang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
| | - Kun Liu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
| | - You Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
| | - Chang-Gang Wang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
| | - Ren Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 201801, China
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Alshiek J, Marroquin J, Shobeiri SA. Vaginal ultrasound-guided Pouch of Douglas robotic entry in a live ovine model and human female cadaveric specimens. J Robot Surg 2021; 16:73-79. [PMID: 33576913 DOI: 10.1007/s11701-021-01203-w] [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: 06/05/2020] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
We aimed to determine whether intraoperative ultrasound is a feasible tool for visualization of the pouch of Douglas (POD) to facilitate a safe vaginal entry for direct robotic vaginal trocar insertion for pelvic floor surgery. Endovaginal ultrasound-guided needle insertion of a trocar into the POD was performed in six fresh frozen female cadavers and a live sheep animal model. Using an endovaginal probe the POD was identified as a fluid-filled space clear of bowel or adhesions, then a Veress needle was also used to confirm POD localization. Access to the POD was achieved using a robotic trocar designed for this purpose. The animal study was approved by the Ethics Committee of Asaf-Harofe hospital. Direct visualization during laparoscopy in cadavers and open cadaveric dissections confirmed safe POD entry and accurate trocar placement. This method was found feasible in the development of a safe vaginal entry in both the animal and cadaveric model, possibly negating the need for laparoscopic umbilical observation.
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Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics and Gynecology, Hillel Yafe Hospital, Hadera, Israel.,Department of Obstetrics and Gynecology, INOVA Women's Hospital, Virginia Commonwealth University, Professor, Biomedical Engineering, George Mason University, 3300 Gallows Road, Second Floor South Tower, Falls Church, VA, 22042-3307, USA.,Department of Bioengineering, George Mason University, Fairfax, VA, USA
| | - Joanna Marroquin
- Department of Obstetrics and Gynecology, INOVA Women's Hospital, Virginia Commonwealth University, Professor, Biomedical Engineering, George Mason University, 3300 Gallows Road, Second Floor South Tower, Falls Church, VA, 22042-3307, USA
| | - S Abbas Shobeiri
- Department of Obstetrics and Gynecology, INOVA Women's Hospital, Virginia Commonwealth University, Professor, Biomedical Engineering, George Mason University, 3300 Gallows Road, Second Floor South Tower, Falls Church, VA, 22042-3307, USA. .,Department of Bioengineering, George Mason University, Fairfax, VA, USA.
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Zhang G, Zou X, Liu Q, Xie T, He Z, Yuan Y, Xiao R, Xu H, Li Y, Zou Y, Chen H, Zhang Z, Guo G, Yang Z, Liu L. Suprapubic-assisted laparoendoscopic single-site surgery versus standard laparoscopic nephrectomy: A propensity score-based analysis. Int J Urol 2020; 28:196-201. [PMID: 33230942 DOI: 10.1111/iju.14429] [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: 02/09/2020] [Accepted: 10/07/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare suprapubic-assisted laparoendoscopic single-site surgery nephrectomy with standard laparoscopic nephrectomy. METHODS A retrospective case-control study comparing three surgeons' experience with 122 suprapubic-assisted laparoendoscopic single-site surgery nephrectomy and 107 standard laparoscopic nephrectomy was carried out. Operative time, estimated blood loss, intraoperative complications, intraoperative conversion, postoperative bowel recovery, postoperative analgesics, postoperative visual analog pain scale score, postoperative length of stay, days before going back to work, postoperative complications and Patient Scar Assessment Questionnaire were compared after propensity score matching. RESULTS A total of 97 matched pairs were obtained after propensity score matching. There were no statistically significant differences between the suprapubic-assisted laparoendoscopic single-site surgery nephrectomy and standard laparoscopic nephrectomy groups with respect to operative time, estimated blood loss, intraoperative complications, intraoperative conversion, postoperative bowel recovery, length of stay and postoperative complications. Suprapubic-assisted laparoendoscopic single-site surgery nephrectomy group had decreased postoperative analgesics (20.9 vs 23.5, P = 0.04), visual analog pain scale score at 24 h (4.28 vs 5.28, P = 0.000), visual analog pain scale score at discharge (1.01 vs 1.47, P = 0.000), days before going back to work (28.4 vs 31.9, P = 0.000) and Patient Scar Assessment Questionnaire score (34.0 vs 42.0, P = 0.000), compared with the standard laparoscopic nephrectomy group. CONCLUSIONS Suprapubic-assisted laparoendoscopic single-site surgery nephrectomy and standard laparoscopic nephrectomy are equivalent in terms of the safety and efficacy. However, suprapubic-assisted laparoendoscopic single-site surgery nephrectomy confers less postoperative pain, fewer days before going back to work and better cosmetic result when compared with standard laparoscopic nephrectomy.
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Affiliation(s)
- Guoxi Zhang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Xiaofeng Zou
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Quanliang Liu
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Tianpeng Xie
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Zhihua He
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Yuanhu Yuan
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Rihai Xiao
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Hui Xu
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Yanmin Li
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Yuhua Zou
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Hanmin Chen
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Zhaolin Zhang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Guijun Guo
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Zengxiang Yang
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Linwei Liu
- Department of Urology, First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
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Chen H, Yin C, Zhang X, Zhu Y. Preparation and characterisation of bifunctional surface-modified silicone catheter in lumen. J Glob Antimicrob Resist 2020; 23:46-54. [PMID: 32795517 DOI: 10.1016/j.jgar.2020.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/08/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the coating of antimicrobial peptides (AMPs) and polyvinylpyrrolidone (PVP) to the surface of a silicone catheter to reduce bacterial growth and to increase hydrophilicity, respectively. METHODS Surface characterisation was performed on bare silicone, AMP-coated, PVP-coated and AMP + PVP-coated silicone catheters using attenuated total reflectance-infrared (ATR-IR) spectroscopy, X-ray photoelectron spectroscopy (XPS) and water contact angle. Antibacterial activity, antibacterial biofilm growth and XTT assay were performed on bare silicone, AMP-coated, PVP-coated and AMP + PVP-coated silicone catheters. Statistical analysis was performed by one-way ANOVA. RESULTS The water contact angle of the AMP + PVP-coated silicone catheter was 21.37 ± 2.17° compared with 107.23 ± 0.96°, 74.40 ± 1.76° and 20.77 ± 0.32° for bare silicone, AMP-coated and PVP-coated silicone catheters. Based on in vitro antimicrobial tests, the AMP + PVP-coated silicone catheter had 6.2, 2.2 and 2.5 greater antibacterial activity than that of the bare silicone catheter against Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa, respectively. Moreover, bacterial biofilm growth on the surface of the AMP + PVP-coated silicone catheter was minimal as characterised by scanning electron microscopy. MTT assay showed that bare silicone, AMP-coated, AMP + PVP-coated and PVP-coated silicone catheters were non-cytotoxic to 3T3 and human colon cancer (Caco-2) cells. CONCLUSIONS This work demonstrates that AMP + PVP-coated silicone catheters have potential clinical application prospects with improved hydrophilicity, excellent biocompatibility, antibacterial activity and a certain antibacterial biofilm effect.
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Affiliation(s)
- Haiyan Chen
- College of Pharmaceutical Sciences, Nanjing Tech University, Nanjing 211816, China
| | - Caiyun Yin
- College of Pharmaceutical Sciences, Nanjing Tech University, Nanjing 211816, China
| | - Xin Zhang
- College of Pharmaceutical Sciences, Nanjing Tech University, Nanjing 211816, China
| | - Yishen Zhu
- College of Biotechnology and Pharmaceutical Engineering, Nanjing Tech University, Nanjing 211816, China.
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Duque-Galán M, Hidalgo-Cardona A, López-Girón MC, Nieto-Calvache AJ. Natural Orifice Transluminal Endoscopic Surgery for Correction of Vesicovaginal Fistulas after Hysterectomy Due to Morbidly Adherent Placenta. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 43:237-241. [PMID: 32978084 DOI: 10.1016/j.jogc.2020.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Vesicovaginal fistula (VVF) is a difficult-to-treat complication of obstetric hysterectomy. There are multiple management options, with a preference for surgical repair via abdominal or vaginal approach. We describe a transurethral natural orifice transluminal endoscopic surgery (NOTES) using barbed suture, in 3 cases of VVF after hysterectomy due to morbidly adherent placenta (MAP). CASES Three patients with VVFs after hysterectomy due to MAP underwent a transurethral endoscopic suture repair. Two patients had complete resolution of the fistula, and the third required additional repair by laparotomy; however, a decrease was observed in the size of the VVF after the initial endoscopic repair. CONCLUSION The transurethral NOTES approach for VVF after MAP hysterectomy is a minimally invasive procedure that is valid as an initial approach for this type of complication.
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Affiliation(s)
- Manuel Duque-Galán
- Fundación Valle del Lili, Abnormally Invasive Placenta Clinic, Cali, Colombia
| | | | | | - Albaro José Nieto-Calvache
- Fundación Valle del Lili, Abnormally Invasive Placenta Clinic, Cali, Colombia; Clinic Postgraduate Department, Universidad Icesi, Cali, Colombia.
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Alshiek J, Marroquin J, Shobeiri SA. The Fresh Frozen Cadaveric Study of Direct Pouch of Douglas Laparoscopic and Robotic Trocar Insertion for Vaginal Natural Orifice Transluminal Endoscopic Surgery. J Minim Invasive Gynecol 2020; 28:320-324. [PMID: 32540501 DOI: 10.1016/j.jmig.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/02/2020] [Accepted: 06/06/2020] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To determine the distances and angles that assure a safe entry into the pouch of Douglas (POD) during blind laparoscopic and robotic trocar entry. DESIGN Trocars were inserted into the POD of 4 intact fresh frozen female pelves. Cadaveric dissection was performed, and the distance from the POD to the sacrum at rest and with maximal pressure to POD with the trocar was measured. In addition, the optimal angle for trocar insertion and entry was evaluated. SETTING Inova Advanced Simulation and Technology Evaluation Center. PATIENTS Fresh frozen cadavers with intact reproductive organs. INTERVENTIONS Vaginal POD trocar insertion. MEASUREMENTS AND MAIN RESULTS Measurements were recorded from the sacrum to the POD at rest and from the sacrum to the hymen with trocar pressure. The dissection demonstrated correct trocar placement in the POD of human cadaveric specimens. The mean distances from the sacrum to the hymen, the sacrum to the POD, and the sacrum to the POD with pressure were 18.75 cm, 9.75 cm, and 7.25 cm, respectively. After the deployment of the trocar, the tip was observed to be 2 cm below the cervix in the POD. The mean trocar angle to clear the sacral promontory and the neurovascular structures without injury to the uterus was 25° to 40° from the horizontal plane and 15° to 30° from the coronal plane. CONCLUSION A direct trocar entry into the POD has been found to be feasible in fresh frozen cadaveric specimens. This study provided valuable information for the angle of entry into the POD to facilitate vaginal and robotic trocar entry for minimally invasive gynecologic procedures.
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Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics & Gynecology, Inova Women's Hospital, Falls Church (all authors); Department of Bioengineering, George Mason University, Fairfax (Drs. Alshiek and Shobeiri), Virginia; Department of Obstetrics & Gynecology, Hillel Yafe Hospital, Technion Medical School, Hadera, Israel (Dr. Alshiek)
| | - Joanna Marroquin
- Department of Obstetrics & Gynecology, Inova Women's Hospital, Falls Church (all authors)
| | - S Abbas Shobeiri
- Department of Obstetrics & Gynecology, Inova Women's Hospital, Falls Church (all authors); Department of Bioengineering, George Mason University, Fairfax (Drs. Alshiek and Shobeiri), Virginia.
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17
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Sun T, Cao Z, Zhang Y, Li B, Huang Y, Zou G, Yin X, Yuan X, Zhang C, Ning S. Transanal total mesorectal excision (TaTME) using flexible endoscope with laparoscopic assistance: a pilot study in porcine models. Updates Surg 2020; 72:845-850. [PMID: 32399596 DOI: 10.1007/s13304-020-00768-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/11/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Transanal total mesorectal excision (TaTME) is routinely performed to excise low rectal tumors. TaTME often relies on transanal endoscopic microsurgery (TEM) or transanal minimally invasive surgery (TAMIS) platform, all using rigid endoscopes. Our study reported a novel approach to TaTME which was completed using flexible endoscope, and we named it F-TaTME. METHODS The feasibility of rectum resection using F-TaTME was evaluated in five pigs. Firstly, the superior rectal artery and vein were managed under the assistance of laparoscopy. Secondly, the flexible endoscope was used to complete the full-thickness rectotomy and rectal mobilization. Finally, the specimen was removed and the manual colon-rectal anastomosis was performed under direct vision. RESULTS F-TaTME was accomplished in all 5 pigs. The mean procedure time was 136.6 min (97-162 min). The mean length from the lower edge of the lesion to circumferential dissection line was 1.4 cm (1.0-1.8 cm) and mean length of exteriorized rectum was 12.6 cm (11-14 cm). No injury to colorectal wall, adjacent pelvic or abdominal organs was found. CONCLUSIONS Our preliminary data suggested that F-TaTME may be a feasible method for TaTME.
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Affiliation(s)
- Tao Sun
- Department of Gastroenterology, Air Force Medical Center PLA, Fucheng Road 30, Beijing, 100142, China
| | - Zhen Cao
- Department of General Surgery, The 6th Medical Center, Chinese PLA General Hospital, Fucheng Road 6, Beijing, 100048, China
| | - Yan Zhang
- Department of General Surgery, The 6th Medical Center, Chinese PLA General Hospital, Fucheng Road 6, Beijing, 100048, China
| | - Bairong Li
- Department of Gastroenterology, Air Force Medical Center PLA, Fucheng Road 30, Beijing, 100142, China
| | - Yun Huang
- Department of General Surgery, The 6th Medical Center, Chinese PLA General Hospital, Fucheng Road 6, Beijing, 100048, China
| | - Guijun Zou
- Department of General Surgery, The 6th Medical Center, Chinese PLA General Hospital, Fucheng Road 6, Beijing, 100048, China
| | - Xin Yin
- Department of Gastroenterology, Air Force Medical Center PLA, Fucheng Road 30, Beijing, 100142, China
| | - Xinpu Yuan
- Department of General Surgery, The 6th Medical Center, Chinese PLA General Hospital, Fucheng Road 6, Beijing, 100048, China
| | - Chaojun Zhang
- Department of General Surgery, The 6th Medical Center, Chinese PLA General Hospital, Fucheng Road 6, Beijing, 100048, China.
| | - Shoubin Ning
- Department of Gastroenterology, Air Force Medical Center PLA, Fucheng Road 30, Beijing, 100142, China.
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18
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Liu BR, Ullah S, Li DL, Liu D, Zhao LX, Yang W, Kong LJ, Zhang JY. A snare-assisted pure NOTES retrograde cholecystectomy using a single channel flexible endoscope: a pilot experiment in a porcine model. Surg Endosc 2020; 34:3706-3710. [DOI: 10.1007/s00464-020-07561-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/10/2020] [Indexed: 02/07/2023]
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19
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Alfa MJ, Singh H. Impact of wet storage and other factors on biofilm formation and contamination of patient-ready endoscopes: a narrative review. Gastrointest Endosc 2020; 91:236-247. [PMID: 31521779 DOI: 10.1016/j.gie.2019.08.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/31/2019] [Indexed: 02/07/2023]
Abstract
The 2019 U.S. Food and Drug Administration report indicates that the clinical studies undertaken by the 3 main GI endoscope manufacturers demonstrate 5.4% of patient-ready duodenoscopes remain culture positive for high-concern organisms. The root causes of this persistent contamination are poorly understood. The objectives of this review include summarizing (1) the impact of inadequate manual cleaning and inadequate drying during storage on the formation of build-up biofilm in endoscope channels, (2) the impact of defoaming agents used during patient procedures on drying efficacy, (3) the data showing the importance of build-up biofilm on persistent microbial survival, and (4) the potential impact of implementation of a quality systems approach in GI endoscopy reprocessing.
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Affiliation(s)
- Michelle J Alfa
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Harminder Singh
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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20
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Li Y, Han S. Transgastric endoscopic gallbladder polypectomy and cholecystolithiasis: A case report. Exp Ther Med 2019; 19:95-98. [PMID: 31853277 PMCID: PMC6909710 DOI: 10.3892/etm.2019.8195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/11/2019] [Indexed: 12/14/2022] Open
Abstract
As the most common digestive-system disease, cholelithiasis and gallbladder polyps have a high incidence. The most common treatment is laparoscopic cholecystectomy, but there are numerous drawbacks, including stump syndrome. In the present study, a novel treatment, namely transgastric endoscopic gallbladder polypectomy and cholecystolithiasis, was applied. To the best of our knowledge, the present study is the first to report on this application, which can potentially avoid open surgery and associated scars and allows for rapid recovery after surgery, and may therefore be worthy of further development and implementation in clinical practice. It is esteemed that in the future, transgastric endoscopy gallbladder polypectomy and cholecystolithiasis will be considered as a treatment option for certain patients and is subjected to constant improvements.
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Affiliation(s)
- Yang Li
- Gastroenterology Endoscopy Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
| | - Shutang Han
- Gastroenterology Endoscopy Center, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, Jiangsu 210029, P.R. China
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21
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Park JH, Bilegsaikhan SE, Suh YJ. A Novel Technique for Performing Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA): A Single-port Platform. Surg Laparosc Endosc Percutan Tech 2019; 30:e4-e7. [PMID: 31790081 DOI: 10.1097/sle.0000000000000739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
During transoral endoscopic thyroidectomy vestibular approach (TOETVA), the mental nerve can be injured by the lateral ports. Mental nerve injury is a worrisome complication, which can be minimized by using the single-port platform. A 56-year-old woman was diagnosed with a 5-mm sized papillary thyroid carcinoma on the isthmus. A horizontal 21-mm incision was made on the mucosa at the lower lip, followed by vertical dissection from the mentalis muscles down to the mandibular area. Subsequent hydrodissection widened the working space. For the single-port procedure, the KeyPort system was applied. After inserting the endoscopic instruments, the thyroid isthmus was resected as usual. The patient was discharged without any complications. To our knowledge, this is the first report of single-port TOETVA. Although the indications are limited, a single-port platform can be utilized for TOETVA. This will minimize the risk of mental nerve injury.
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Affiliation(s)
- Jung Ho Park
- Department of Breast and Endocrine Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
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22
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Du B, Fan YJ, Zhao LX, Geng XY, Li DL, Wu XW, Zhang DK, Liu BR. A reliable detachable balloon that prevents abdominal cavity contamination during transrectal natural orifice transluminal endoscopic surgery. J Dig Dis 2019; 20:383-390. [PMID: 31069947 DOI: 10.1111/1751-2980.12757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 04/20/2019] [Accepted: 05/06/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of a detachable endoluminal balloon in the prevention of abdominal cavity contamination during transrectal natural orifice transluminal endoscopic surgery (NOTES). METHODS The efficacy and safety of a detachable endoluminal balloon to maintain disinfection in the distal colon of the pigs were evaluated. The bacterial loads and colonic cleanliness were monitored. Additionally, the device was applied to another nine pigs that underwent a cholecystotomy by transrectal NOTES. Necropsy and pathological examination were performed after 28-day follow-up. RESULTS All animals exposed to the device and one of the seven pigs not exposed to the device scored three points on the bowel cleanliness scale (P < 0.001). After 30 min bacterial loads of the test (with balloon occlusion) and control (without balloon occlusion) groups showed a significant difference (0.8 × 103 CFU/mL vs 186.8 × 103 CFU/mL, P < 0.01). Cholecystotomy by transrectal NOTES with the device was successfully performed. The mean intraperitoneal procedure time was 102.9 ± 37.7 min. There were no procedure-related adverse events. During the follow-up, all animals presented normal behavior and appetite. No peritoneal infection or adhesion was detected at autopsy. Cholecystotomy and rectal incision were histologically healed and no histological abnormalities were detected in the colon related to balloon placement. CONCLUSIONS The detachable balloon provides a reliable solution for preventing peritoneal contamination during transluminal operations. The technique may assist in future transrectal NOTES.
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Affiliation(s)
- Bing Du
- Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Yu Jing Fan
- Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Li Xia Zhao
- Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.,Department of Gastroenterology and Hepatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xin Yu Geng
- Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - De Liang Li
- Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.,Department of Gastroenterology and Hepatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Xiu Wen Wu
- Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - De Kai Zhang
- Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Bing Rong Liu
- Department of Gastroenterology and Hepatology, Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China.,Department of Gastroenterology and Hepatology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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23
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Balla A, Quaresima S, Paganini AM. Ectopic air localizations after transanal procedures: A systematic literature review. Int J Surg 2018; 56:167-173. [PMID: 29936199 DOI: 10.1016/j.ijsu.2018.05.743] [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: 04/14/2018] [Accepted: 05/24/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Aim of this study is to report and to analyze the incidence, clinical impact and treatment options of ectopic air localizations after transanal procedures. METHODS A systematic literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research was carried out using the PubMed database, identifying 40 articles with the following keywords: "transanal" AND "emphysema"; "transanal" AND "subcutaneous emphysema"; "transanal" AND "pneumomediastinum"; "transanal" AND "pneumothoraces"; "transanal" AND "pneumopericardium"; "transanal" AND "retropneumoperitoneum". RESULTS Nineteen articles, published between 1993 and 2017, were included in the study for a total of 29 patients. The most frequent air localization was in the retroperitoneum, followed by subcutaneous tissues, mediastinum and neck. This condition was treated conservatively in 20 patients, with colostomy in 4 patients, with bowel resection and negative diagnostic laparoscopy in one patient each. In three cases the treatment was not specified. Ectopic air location resolved in all cases. CONCLUSIONS Pneumo-mediastinum and pneumo-retroperitoneum after transanal procedures are unusual complications with a dramatic radiological appearance but can be managed successfully with a completely benign course in most cases. Initially, a conservative approach is recommended. Surgical treatment should be reserved only in case of fluid collection or suture dehiscence.
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Affiliation(s)
- Andrea Balla
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Silvia Quaresima
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Alessandro M Paganini
- Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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