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Abstract
Background and Objectives: The authors sought to assess and compare the surgical outcomes of laparoendoscopic single-port surgery (LESS) for totally extraperitoneal (LESS-TEP) hernioplasty and conventional totally extraperitoneal (CTEP) hernioplasty. Methods: From March 2015 through May 2018, a retrospective analysis of postoperative outcomes was conducted that included 81 cases of LESS-TEP and 88 cases of CTEP hernioplasty patients. For postoperative indicator comparisons, a visual-analog pain scale and 5-level cosmesis evaluation sheet were applied. In addition, complications on postoperative outcomes following inguinal hernia repair surgery are discussed based on our analysis and surgical experience. Results: All operations were successfully performed at different hospitals. Compared with the CTEP group, the operative time in the LESS-TEP group increased significantly (P < .05). However, the cosmetic outcome in the LESS-TEP group was rated higher than that in the CTEP group (P < .05). There was no significant difference between the 2 groups in hospitalization time, the incidence of complications, postoperative pain levels, or medical costs (P > .05). Conclusion: LESS-TEP is as feasible and safe as CTEP. The use of LESS-TEP successfully improved the cosmetic outcomes of inguinal hernia repair surgery with smaller and fewer scars for patients. As a new surgical treatment approach for inguinal hernias, the LESS-TEP technique is still not a necessary or efficacious surgical alternative strategy for CTEP, especially for surgeons who are less experienced in the technique.
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Affiliation(s)
- Haifeng Zhang
- Department of General Surgery, The People Hospital of Linyi City, Linyi, Shandong, China
| | - Jinhui Li
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Maosong Gong
- Department of General Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Guangyong Zhang
- Department of General Surgery, The Qi Lu Hospital of Shandong University, Jinan, Shandong, China
| | - Jianing Liu
- Department of General Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Bo Li
- Department of General Surgery, The Second Hospital of Shandong University, Jinan, Shandong, China
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Han YD, Park S, Kim WR, Baek SJ, Hur H, Min BS, Kim NK. Safety and Efficacy of Single-Incision Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair: Comparative Study with Conventional Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair. J Laparoendosc Adv Surg Tech A 2017; 27:253-258. [PMID: 28129040 DOI: 10.1089/lap.2016.0336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Inguinal hernia is a common disease treated with diverse methods. Nowadays, laparoscopic totally extraperitoneal approach is gaining its validity and shows favorable outcomes. However, single-incision laparoscopic surgery is also widening its applicable fields as a new technique. This study aimed to find whether single-incision laparoscopic total extraperitoneal inguinal hernia repair (SILTEP) is applicable compared to conventional laparoscopic total extraperitoneal hernia repair (CLTEP). METHODS We retrospectively reviewed 120 cases of SILTEP and 60 cases of CLTEP in Yonsei University Severance Hospital from January 2012 to December 2013. Each group was compared with patients' characteristics, operative details, and postoperative complications. RESULTS There were no statistical difference in patient age, sex, body mass index, American Society of Anesthesiologists score, hernia type, or location between SILTEP and CLTEP. In operative details, operation time (61.77 ± 16.48 minutes versus 77.83 ± 35.15 minutes, P = .001) was shorter in SILTEP. Postoperative complication rate has shown no statistical difference in SILTEP compared to CLTEP (n = 20, 16.7% versus n = 16, 26.7%, P = .114). CONCLUSIONS SILTEP is feasible and provides comparable postoperative outcomes compared to CLTEP. Although SILTEP has its own challenges for mastering the procedure, with some experiences, it is possible to operate as well as CLTEP.
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Affiliation(s)
- Yoon Dae Han
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine , Seoul, Korea
| | - Seungwan Park
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine , Seoul, Korea
| | - Woo Ram Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine , Seoul, Korea
| | - Se Jin Baek
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine , Seoul, Korea
| | - Hyuk Hur
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine , Seoul, Korea
| | - Byung Soh Min
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine , Seoul, Korea
| | - Nam Kyu Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine , Seoul, Korea
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Sajid MS, Khawaja AH, Sayegh M, Baig MK. A systematic review comparing single-incision versus multi-incision laparoscopic surgery for inguinal hernia repair with mesh. Int J Surg 2016; 29:25-35. [PMID: 26975426 DOI: 10.1016/j.ijsu.2016.02.088] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 02/19/2016] [Accepted: 02/20/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The objective of this article is to evaluate whether the surgical outcomes differ between single incision laparoscopic surgery (SILS) versus multi-incision laparoscopic surgery (MILS) for the repair of inguinal hernia. METHODS A systematic review of the literature on published studies reporting the surgical outcomes following SILS versus MILS for inguinal hernia repair was undertaken using the principles of meta-analysis. RESULTS Fifteen comparative studies on 1651 patients evaluating the surgical outcomes in patients undergoing SILS versus MILS for inguinal hernia repair were systematically analysed. The post-operative recovery time was significantly quicker [odds ratio, -0.35 (CI, -0.57 - 0.14), p = 0.001] following SILS compared to MILS procedure. However, the statistical equivalence was seen in outcomes of length of hospital stay, operative time both for unilateral and bilateral hernias, post-operative pain score, one-week pain score, hernia recurrence [odds ratio, 1.24 (CI, 0.47-3.23), p = 0.66], conversion [odds ratio, 1.07 (CI, 0.37-3.12), p = 0.90], and post-operative complications [odds ratio, 0.95 (CI, 0.66-1.36, p = 0.78] between two approaches. The sub-group analysis of four included randomized, controlled trials showed similarities between outcomes following SILS and MILS except slightly higher postoperative pain score in MILS group. CONCLUSIONS Both SILS and MILS approaches of inguinal hernia repair are feasible, safe and can be offered to patients depending upon the availability of expertise and resources.
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Affiliation(s)
- M S Sajid
- Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK.
| | - A H Khawaja
- Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK
| | - M Sayegh
- Department of General, Upper Gastrointestinal & Hepato-pancreatico-biliary Surgery, Western Sussex Hospitals NHS Foundation Trust, Worthing Hospital Worthing, West Sussex, BN11 2DH, UK
| | - M K Baig
- Department of General, Endoscopic and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK
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Single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP): experience of 512 procedures. Hernia 2014; 19:417-22. [PMID: 25537571 DOI: 10.1007/s10029-014-1337-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 12/10/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Reports have been issued recently on single incision laparoscopic hernioplasty, but no large-scale study has been conducted as yet. This study aimed to assess the safety and feasibility of the single incision laparoscopic totally extraperitoneal hernioplasty (SIL-TEP) on a large number of cases. METHODS 512 SIL-TEPs in 471 patients were performed from June 2010 to January 2014 at Incheon St. Mary's Hospital, The Catholic University of Korea. SIL-TEP was performed using a glove single port device and standard laparoscopic instruments. Short-term outcomes were reviewed. RESULTS Of the 512 hernias, 329 (64.3 %) were indirect, 144 (28.1 %) were direct, 9 (1.8 %) were femoral, and 30 (5.9 %) were combined. There were 3 (0.6 %) conversions to single or three-port laparoscopic transabdominal preperitoneal hernioplasty. Mean operative time was 41.6 min for unilateral hernias and 65.3 min for bilateral hernias. Postoperative complications occurred in 45 cases (9.6 %); 21 were wound seromas, 5 were hematomas, and 18 were urinary retentions. All were successfully treated conservatively. Mean hospital stay was 1.8 days. CONCLUSION The SIL-TEP is safe and technically feasible. Additional studies on long-term recurrence rates are needed to confirm the safety of SIL-TEP.
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de Araújo FBC, Starling ES, Maricevich M, Tobias-Machado M. Single site and conventional totally extraperitoneal techniques for uncomplicated inguinal hernia repair: A comparative study. J Minim Access Surg 2014; 10:197-201. [PMID: 25336820 PMCID: PMC4204263 DOI: 10.4103/0972-9941.141521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 09/10/2013] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE: To demonstrate the feasibility of endoscopic extraperitoneal single site (EESS) inguinal hernia repair and compare it outcomes with the conventional totally extraperitoneal (TEP) technique. BACKGROUND: TEP inguinal hernia repair is a widely accepted alternative to conventional open technique with several perioperative advantages. Transumbilical laparoendoscopic singlesite surgery (LESS) is an emerging approach and has been reported for a number of surgical procedures with superior aesthetic results but other advantages need to be proven. PATIENTS AND METHODS: Thirty-eight uncomplicated inguinal hernias were repaired by EESS approach between January 2010 and January 2011. All procedures were performed through a 25 cm infraumbilical incision using the Alexis wound retractor attached to a surgical glove and three trocars. Body mass index, age, operative time, blood loss, complications, conversion rate, analgesia requirement, hospital stay, return to normal activities and patient satisfaction with aesthetic results were analysed and compared with the last 38 matched-pair group of patients who underwent a conventional TEP inguinal hernia repair by the same surgeon. RESULTS: All procedures were performed successfully with no conversion. In both unilateral and bilateral EESS inguinal repairs, the mean operative time was longer than conventional TEP (55± 20 vs. 40± 15 min, P = 0.049 and 70± 15 vs. 55± 10 min, P = 0.014). Aesthetic result was superior in the EESS group (2.88± 0.43 vs. 2.79± 0.51, P = 0.042). There was no difference between the two approaches regarding blood loss, complications, hospital stay, time until returns to normal activities and analgesic requirement. CONCLUSION: EESS inguinal hernia repair is safe and effective, with superior cosmetic results in the treatment of uncomplicated inguinal hernias. Other advantages of this new technique still need to be proven.
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Affiliation(s)
| | | | - Marco Maricevich
- General Surgery Department, Mayo Clinic, Rochester, Minnesota, United States
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6
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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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Siddiqui MRS, Kovzel M, Brennan SJ, Priest OH, Preston SR, Soon Y. The role of the laparoendoscopic single site totally extraperitoneal approach to inguinal hernia repairs: a review and meta-analysis of the literature. Can J Surg 2014; 57:116-26. [PMID: 24666450 DOI: 10.1503/cjs.010612] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Laparoendoscopic single site (LESS) surgery may have perceived benefits of reduced visible scarring compared to conventional laparoscopic (LAP) totally extraperitoneal (TEP) hernia repairs. We reviewed the literature to compare LESS TEP inguinal hernia repairs with LAP TEP repairs. METHODS We searched electronic databases for research published between January 2008 and January 2012. RESULTS A total of 13 studies reported on 325 patients. The duration of surgery was 40-98 minutes for unilateral hernia and 41-121 minutes for bilateral repairs. Three studies involving 287 patients compared LESS TEP (n = 128) with LAP TEP (n = 159). There were no significant differences in operative duration for unilateral hernias (p = 0.63) or bilateral repairs (p = 0.29), and there were no significant differences in hospital stay (p > 0.99), intraoperative complications (p = 0.82) or early recurrence rates (p = 0.82). There was a trend toward earlier return to activity in the LESS TEP group (p = 0.07). CONCLUSION Laparoendoscopic single site surgery TEP hernia repair is a relatively new technique and appears to be safe and effective. Advantages, such as less visible scarring, mean patients may opt for LESS TEP over LAP TEP. Further studies with clear definitions of outcome measures and robust follow-up to assess patient satisfaction, return to normal daily activities and recurrence are needed to strengthen the evidence.
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Affiliation(s)
| | - Maksym Kovzel
- The Department of Surgery, Royal Surrey County Hospital, Guildford, UK
| | - Steven J Brennan
- The Department of Surgery, Royal Surrey County Hospital, Guildford, UK
| | - Oliver H Priest
- The Department of Surgery, Royal Surrey County Hospital, Guildford, UK
| | - Shaun R Preston
- The Department of Surgery, Royal Surrey County Hospital, Guildford, UK
| | - Y Soon
- The Department of Surgery, Royal Surrey County Hospital, Guildford, UK
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9
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Kim JH, Lee YS, Kim JJ, Park SM. Single port laparoscopic totally extraperitoneal hernioplasty: a comparative study of short-term outcome with conventional laparoscopic totally extraperitoneal hernioplasty. World J Surg 2013; 37:746-51. [PMID: 23358595 DOI: 10.1007/s00268-013-1925-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Recently, single port laparoscopic surgery has begun to develop as an extension of minimally invasive surgery, but there have been only a few reports of single port laparoscopic totally extraperitoneal (SPLTEP) hernioplasty. In addition, there are few comparative studies with conventional laparoscopic totally extraperitoneal (CLTEP) hernioplasty. The aim of the present study was to report our experience with SPLTEP hernioplasty and to compare short-term outcomes for SPLTEP hernioplasty with CLTEP hernioplasty. METHODS Data were prospectively collected for all patients undergoing SPLTEP hernioplasty for inguinal hernia at Incheon St. Mary's Hospital, Incheon, Korea. Data for the SPLTEP group (n = 76 patients enrolled between June 2010 and May 2011) were compared retrospectively with data for the CLTEP group (n = 93 patients enrolled between June 2009 and May 2010). RESULTS There were no significant differences in patient demographics. This study showed no significant difference in terms of operative time between the two groups (SPLTEP group 54.0 min vs. CLTEP group 47.8 min; p = 0.07). There were no conversions to conventional TEP hernioplasty or transabdominal preperitoneal hernioplasty or open surgery in SPLTEP hernioplasty. Morbidity rates were 7.9 % (n = 6) in the SPLTEP group and 10.8 % (n = 10) in the CLTEP group, and the difference was not significant. CONCLUSIONS Single port laparoscopic totally extraperitoneal hernioplasty is technically feasible and the short-term operative outcome is comparable to that of CLTEP hernioplasty. Future large-scale prospective controlled studies and long-term analysis are needed to establish the cosmetic outcomes, quality of life, long-term recurrence rate, and long-term complication rate of SPLTEP hernioplasty.
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Affiliation(s)
- Ji Hoon Kim
- Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Xie XF, Zhu JF, Song CL, Zhang DS, Zou QL. Mechanical evaluation of three access devices for laparoendoscopic single-site surgery. J Surg Res 2013; 185:638-44. [PMID: 23941767 DOI: 10.1016/j.jss.2013.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 07/02/2013] [Accepted: 07/08/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Many access devices have been developed for laparoendoscopic single-site surgery (LESS) during recent years. However, investigations are needed to determine which port is most suitable for this relatively new technique. The aim of this study was to evaluate commonly used ports using mechanical approaches in a training simulator. Any port that required less force and shorter surgery times had superior maneuverability. METHODS The following three commercially available access devices were evaluated: Multi-ports, TriPort, and single-incision laparoscopic surgery (SILS) Port. A LESS mechanical evaluation platform was developed to investigate the forces that acted on the instruments in the ports while moving along horizontal and vertical axes. In addition, a strain-force measurement system was used to compare the average load on the ports when performing standard maneuvers. Additionally, the task completion time was recorded when the maneuvers in these ports were completed. RESULTS During the horizontal displacement of the instrument, the traction forces of the Multi-ports were lower than those of the SILS Port, which were lower than those of the TriPort. The average traction forces were significantly different in pairwise multiple comparisons (P < 0.05). When the instrument was inserted into the ports, the vertical friction forces of the Multi-ports were the lowest and those of the TriPort were the highest. On extraction of the instrument, the friction forces of the Multi-ports remained the lowest, followed by those of the TriPort and SILS Port. There were statistically significant results among all the devices (P < 0.05). The average load required to perform the task was less for the SILS Port than that for the TriPort (P < 0.05). Similarly, the average load for the Multi-ports was significantly less than that for the TriPort (P < 0.001). The participants who used the Multi-ports had significantly faster task times than those who used the SILS Port or TriPort (P < 0.005). CONCLUSIONS Compared with the TriPort and SILS Port, the Multi-ports was associated with the least average load and the shortest task performance times in a training simulator. This study demonstrates that the Multi-ports may offer superior maneuverability for LESS.
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Affiliation(s)
- Xiao-Feng Xie
- Department of General Surgery, East Hospital, Tongji University School of Medicine, Shanghai, China
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Wakasugi M, Akamatsu H, Tori M, Ueshima S, Omori T, Tei M, Masuzawa T, Nishida T. Short-term outcome of single-incision laparoscopic totally extra-peritoneal inguinal hernia repair. Asian J Endosc Surg 2013; 6:143-6. [PMID: 23602002 DOI: 10.1111/ases.12011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 11/05/2012] [Indexed: 12/13/2022]
Abstract
We performed single-incision laparoscopic surgery for totally extra-peritoneal (SILS-TEP) repair using a lightweight mesh fixed by absorbable tacks and without balloon dilation. Thirty-four patients (mean age, 66.5 years) underwent SILS-TEP repair in our hospital between September 2011 and April 2012; 30 patients had unilateral hernia and 4 had bilateral hernias. Mean operative time was 85.6 min for unilateral hernia and 137.7 min for bilateral hernias. All patients underwent successful SILS-TEP repair. Mean hospital stay was 3.4 days. Mean duration of follow-up was 7.1 months. Four seromas were observed, but no recurrences or major complications occurred. SILS-TEP is an economical and useful method for decreasing postoperative complications, such as neuralgia and recurrence, and it could be an attractive approach for inguinal hernia.
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12
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Single-incision laparoscopic herniorrhaphy for inguinal hernia repair. Surg Today 2013; 44:513-6. [DOI: 10.1007/s00595-013-0501-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 01/20/2013] [Indexed: 10/27/2022]
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Gumus II, Surgit O, Kaygusuz I. Laparoscopic single-port Burch colposuspension with an extraperitoneal approach and standard instruments for stress urinary incontinence: early results from a series of 15 patients. MINIM INVASIV THER 2012; 22:116-21. [PMID: 22909022 DOI: 10.3109/13645706.2012.711759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We aimed to investigate the use of single-port laparoscopy in a series of patients undergoing Burch colposuspension with an extraperitoneal approach as an alternative treatment for scarless surgery in stress urinary incontinence. MATERIAL AND METHODS From September 2010 to May 2011 we performed single-port extraperitoneal laparoscopic Burch colposuspension for stress incontinence in 15 patients. Fifteen women who were diagnosed with urodynamic stress incontinence were included in the study. Demographic and clinical data, intraoperative findings, and postoperative course were recorded. RESULTS The mean age was 45,80 ± 9,91 years (range: 38-70 years). The mean body mass index was 25,67 ± 4.06 kg/m2 (range: 22.23-35.38 kg/m(2)). The mean operation time and mean blood loss were 40.80 ± 5.94 minutes (range: 30-50 minutes) and 30.67 ± 11.00 cc (range: 10-50 cc), respectively. The single-port laparoscopic operations were technically completed successfully without placement of additional trocars and there were no complications. The cure and improvement rates following laparoscopic Burch colposuspension via single port were 73.3 % and 20 % respectively. CONCLUSION Single-port laparoscopic Burch can be an alternative treatment for scarless surgery in stress incontinence. Single-incision laparoscopic Burch colposuspension can offer suitable, effective and safe treatment in women with stress incontinence.
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Affiliation(s)
- Ilknur Inegol Gumus
- Department of Obstetric and Gynecology, Fatih University Medical School, Ankara, Turkey.
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Takayama S, Nakai N, Shiozaki M, Ogawa R, Sakamoto M, Takeyama H. Use of barbed suture for peritoneal closure in transabdominal preperitoneal hernia repair. World J Gastrointest Surg 2012; 4:177-9. [PMID: 22905286 PMCID: PMC3420985 DOI: 10.4240/wjgs.v4.i7.177] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 07/23/2012] [Accepted: 07/24/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the use of the V-Loc wound closure device for transabdominal preperitoneal hernia repair.
METHODS: We performed conventional transabdominal preperitoneal hernia repair in 19 patients, including one single incisional case using V-Loc. Except for the use of V-Loc for peritoneal closure, the procedures were the same as those used in conventional techniques.
RESULTS: Although the operators included 2 residents who have no experience in laparoscopic herniorrhaphy and intracorporeal suture, the operations were completed. We believe that V-Loc is especially suitable for inexperienced surgeons and the use of V-Loc reduces the operative time by a small amount but reduces operator stress significantly.
CONCLUSION: We conclude that V-Loc is the ideal peritoneal closure device for transabdominal preperitoneal hernia repair.
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Affiliation(s)
- Satoru Takayama
- Satoru Takayama, Nozomu Nakai, Midori Shiozaki, Ryo Ogawa, Masaki Sakamoto, Hiromitsu Takeyama, Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601 Aichi, Japan
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Single-port endo-laparoscopic surgery (SPES) for totally extraperitoneal inguinal hernia: a critical appraisal of the chopstick repair. Hernia 2012; 17:217-21. [PMID: 22829008 DOI: 10.1007/s10029-012-0968-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 07/12/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Developments in minimal access surgery brought a new concept: single-port endolaparoscopic surgery (SPES). The aim of our study is to verify the safety and feasibility of SPES TEP hernia repair and report our initial clinical outcome. METHODS We prospectively collected data of all patients who underwent SPES TEP repair from May 2009 to December 2010. Data regarding patient demographics, type, size and location of hernia, port devices used, type of mesh and fixation, operative time, complications, length of stay and cosmetic results were collected and analyzed. RESULTS A total of 47 patients (36 M, 11 F) underwent 70 SPES TEP hernia repairs; median age was 53 years (range 22-80). 60 % had indirect hernia, 27.5 % direct, 8.5 % pantaloon, 2 % femoral and 2 % recurrent hernias. Mean hernia size was 1.91 ± 0.67 cm. Port devices used include 33 Triport, 12 SILS and 2 SSL. We used anatomical mesh in 20; flat polypropylene in 10 and titanium-coated polypropylene mesh in 17 patients. Fixation of mesh was achieved in 18 patients with absorbable tacks, 8 with titanium tacks, 1 with fibrin glue, and no tack in 20 with anatomical mesh. No conversions occurred and small seroma was reported in 3 (6.3 %) patients. Mean operative time was 96.48 min (range: 50-150). Average hospital stay was 11.8 h (range: 9-26). Median follow-up was 11 months (range 6-18), and no recurrence was noted. 82.6 % patients were very satisfied, and 17.4 % were satisfied with the procedure. CONCLUSION SPES TEP repair is a safe and feasible technique with good patient satisfaction.
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Abstract
BACKGROUND AND OBJECTIVES Since the introduction of single-incision laparoscopic surgery in 2009, an increasing number of surgical procedures including hernia repair are being performed using this technique. However, its large-scale adoption awaits results of prospective randomized controlled studies confirming its potential benefits. Parallel with single-port surgery development, the issue of the chronic lack of good camera assistants is being addressed by the robotic Freehand® camera controller, which has the potential to replace camera assistants in a large percentage of routine laparoscopic surgery. Although the robotic Freehand has been used in certain operations in urology and gynecology, there have been no published reports in robotic (single-port) hernia surgery. METHODS This study reports the first case and a series of 16 patients who underwent robotic single-port total extraperitoneal inguinal hernia repair compared to 16 consecutive cases of conventional single-port inguinal hernia repair. Patients were matched for age, sex, body mass index, American Society of Anesthesiologists classification, and types of hernia. RESULTS Although operation time was comparable in both, the time wasted for scope cleaning was 8.5 minutes for conventional compared to 1.5 minutes for robotic surgery. CONCLUSION Robotic single-port inguinal hernia repair is feasible and efficient. This represents a further milestone in laparoscopic surgery.
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Affiliation(s)
- Hanh Tran
- The Sydney Hernia Specialists Clinic, Level 2, 195 Macquarie Street, Sydney NSW 2000 Australia.
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Yang GPC, Lai ECH, Chan OCY, Tang CN, Li MKW. Single-incision transabdominal preperitoneal and totally extraperitoneal repair for inguinal hernia: early experience from a single center in Asia. Asian J Endosc Surg 2011; 4:166-70. [PMID: 22776301 DOI: 10.1111/j.1758-5910.2011.00098.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Laparoscopic inguinal hernia repair is currently one of the most commonly performed minimally invasive surgical procedures. In recent years, single-incision operations have been developed to further reduce the invasiveness of the surgery. Herein, we report our early experience with single-incision laparoscopic inguinal hernia repair in Asia, with both the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches. METHODS This is a retrospective review of prospectively collected data on a cohort of consecutive patients with inguinal hernia who underwent single-incision laparoscopic inguinal hernia repair in a minimal access surgical center in Hong Kong between January 2010 and January 2011. RESULTS Our cohort consists of 15 patients who underwent single-incision laparoscopic inguinal hernia; 13 were unilateral and two were bilateral hernias. The mean age was 59.8 years old (range, 28-74 years). The overall mean operative time was 59.53 min (range, 25-120 min). For unilateral hernia repair, the mean operative time was 56 min (range, 25-75 min) and 48.5 min (range, 41-55 min) for TAPP and TEP, respectively. In all cases single-incision laparoscopic hernia repair was successfully performed, no additional trocars were required, and there were no conversions to conventional laparoscopic or open inguinal hernia repair. All patients were discharged on the same day as the procedure. CONCLUSION Single-incision laparoscopic inguinal hernia is feasible in both TEP and TAPP approaches. The procedure should be performed by laparoscopic surgeons with a high level of experience in single-incision surgery. Further randomized trials should be performed to evaluate the full potential and clinical application of single-incision TAPP and TEP.
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Affiliation(s)
- G P C Yang
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong, China.
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Kim JH, Park SM, Kim JJ, Lee YS. Initial experience of single port laparoscopic totally extraperitoneal hernia repair: nearly-scarless inguinal hernia repair. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 81:339-43. [PMID: 22148127 PMCID: PMC3229003 DOI: 10.4174/jkss.2011.81.5.339] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 08/25/2011] [Accepted: 08/31/2011] [Indexed: 11/30/2022]
Abstract
Purpose In the early 1990's laparoscopic hernioplasty gained popularity worldwide. Thereafter, laparoscopic surgeons have attempted to improve cosmesis using single port surgery. This study aims to introduce and assess the safety and feasibility of single port laparoscopic total extraperitoneal (TEP) hernia repair with a nearly-scarless umbilical incision. Methods Sixty three single port laparoscopic TEP hernia repairs were performed in sixty patients from June 2010 to March 2011 at Incheon St. Mary's Hospital, with the use of a glove single-port device and standard laparoscopic instruments. Demographic and clinical data, intraoperative findings, and postoperative course were reviewed. Results Of the 63 hernias treated, 31 were right inguinal hernias, 26 were left inguinal hernias and 3 were both inguinal hernias. There was one conversion to conventional three port laparoscopic transabdominal preperitoneal hernioplasty. Mean operative time was 62 minutes (range, 32 to 150 minutes). There were no intraoperative complications. Postoperative complications occurred in two cases (wound seroma and urinary retension) and were successfully treated conservatively. Mean hospital stay was 2.15 days. Conclusion Single
port laparoscopic TEP hernia repair is safe and feasible. Umbilical incision provides an excellent cosmetic outcome. Prospective randomized studies comparing single port and conventional three port laparoscopic TEP repairs with short-term outcome and long-term recurrence rate are needed for confirmation.
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Affiliation(s)
- Ji Hoon Kim
- Department of Surgery, Incheon St. Mary's Hospital, The Catholic University of Korea School of Medicine, Incheon, Korea
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Tran H. Safety and efficacy of single incision laparoscopic surgery for total extraperitoneal inguinal hernia repair. JSLS 2011; 15:47-52. [PMID: 21902942 PMCID: PMC3134695 DOI: 10.4293/108680811x13022985131174] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Almost 20 years after the first laparoscopic inguinal hernia repair was performed, single incision laparoscopic surgery (SILS™) is set to revolutionize minimally invasive surgery. However, the loss of triangulation must be overcome before the technique can be popularized. This study reports the first 100 laparoscopic total extraperitoneal hernia repairs using a single incision. The study cohort comprised 68 patients with a mean age of 44 (range, 18 to 83): 36 unilateral and 32 bilateral hernias. Twelve patients also underwent umbilical hernia repair with the Ventralex patch requiring no additional incisions. A 2.5-cm to 3-cm crescentic incision within the confines of the umbilicus was performed. Standard dissecting instruments and 52-cm/5.5-mm/30(0) laparoscope were used. Operation times were 50 minutes for unilateral and 80 minutes for bilateral. There was one conversion to conventional 3-port laparoscopic repair and none to open surgery. Outpatient surgery was achieved in all (except one). Analgesic requirements were minimal: 8 Dextropropoxyphene tablets (range, 0 to 20). There were no intraoperative or postoperative complications with a high patient satisfaction score. Single-incision laparoscopic hernia repair is safe and efficient simply by modifying dissection techniques (so-called "inline" and "vertical"). Comparable success can be obtained while negating the risks of bowel and vascular injuries from sharp trocars and achieving improved cosmetic results.
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Affiliation(s)
- Hanh Tran
- The Sydney Hernia Specialists Clinic, Sydney, NSW, Australia.
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SILS Incisional Hernia Repair: Is It Feasible in Giant Hernias? A Report of Three Cases. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2011; 2011:387040. [PMID: 21845023 PMCID: PMC3154386 DOI: 10.1155/2011/387040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 05/01/2011] [Accepted: 06/20/2011] [Indexed: 12/02/2022]
Abstract
Aim. Three incisional ventral abdominal wall hernias were repaired by placing a 20 × 30 cm composite mesh via single incision of 2 cm.
Methods. All three cases had previous operations and presented with giant incisional defects clinically. The defects were repaired laparoscopically via single incision with the placement of a composite mesh of 20 × 30 cm. Nonabsorbable sutures were needed to hang and fix the mesh only in the first case. Double-crown technique was used in all of the cases to secure the mesh to the anterior abdominal wall.
Results. The mean operation time was 120 minutes. The patients were mobilized and led for oral intake at the first postoperative day. No morbidity occurred.
Conclusion. Abdominal incisional hernias can be repaired via single incision with a mesh application in experienced centers.
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Laparoendoscopic single-site totally extraperitoneal adult inguinal hernia repair: initial 100 patients. Surg Endosc 2011; 25:3579-83. [PMID: 21638177 DOI: 10.1007/s00464-011-1761-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Accepted: 04/18/2011] [Indexed: 12/31/2022]
Abstract
BACKGROUND This report aims to describe the authors' initial experience with laparoendoscopic single-site (LESS) totally extraperitoneal (TEP) inguinal hernia repair in 100 patients. METHODS Patients who underwent an elective LESS TEP inguinal hernia repair between December 2008 and September 2010 in a single center were enrolled prospectively in this study. Patient demographic data, hernia characteristics, and operative and postoperative outcomes were analyzed. An Alexis wound retractor was placed through the 2-cm subumbilical incision as a homemade transumbilical access platform after the preperitoneal space was created by a balloon dissector. Standard procedures of TEP all were finished using conventional straight laparoscopic instruments. RESULTS Of the 100 patients in this study, 2 underwent conversion to LESS transabdominal preperitoneal (TAPP) repair. The remaining 98 patients received successful LESS TEP inguinal hernia repair by a single surgeon. No patient required open or conventional laparoscopic conversion. However, one patient did experience recurrence. The mean operative time was 64.2 min, and the hospital stay was 1.54 days. One patient with a history of bladder surgery had a minor intraoperative bladder injury. No major postoperative complication occurred, but 11 patients had seroma or hematoma, 2 had epididymitis, 2 had urinary tract infection, 1 had wound dehiscence, 1 had wound infection, and 1 had urinary retention. This single-arm observational study was limited by the absence of a control cohort. CONCLUSIONS Based on our experience, in the hands of experienced laparoscopic surgeons, LESS TEP repair for adult inguinal hernia using the homemade port as an access platform is feasible and safe and provides acceptable operative outcomes.
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Kwon KH, Son BH, Han WK. Laparoscopic totally extraperitoneal repair without suprapubic port: comparison with conventional totally extraperitoneal repair. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 80:319-26. [PMID: 22066055 PMCID: PMC3204703 DOI: 10.4174/jkss.2011.80.5.319] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Accepted: 03/09/2011] [Indexed: 11/30/2022]
Abstract
Purpose We have treated 24 patients through laparoscopic totally extraperitoneal (TEP) repair without suprapubic port by using reliability and reducing the invasiveness of two surgery. This study is aimed to assess the safety and feasibility of the TEP repair without suprapubic port compared to conventional TEP repair. Methods From September 2007 to 11 May 2010, we compared two groups that suffer from inguinal hernias. One is comprised of 24 patients who were treated without suprapubic port laparoscopic totally extraperitoneal repair (Group A), and the other is comprised of 100 patients who were treated with conventional laparoscopic totally extraperitoneal repair (Group B). Data regarding patient demographics (sex, age, site of hernia, and the type of hernia), operating time, postoperative hospital stay, the use of analgesics, and complications were prospectively collected. Results There was no significant difference noted between two groups in relation to sex, age, site, and the type of hernia. The mean operating time and postoperative hospital stay was longer for the Group B (62.9 minutes, 3.55 days) than for the Group A (59.0 minutes, 2.54 days) (P = 0.389, P < 0.001). Postoperative urinary retention, seroma, wound infection were respectively 4.2%, 8.3%, 0% in Group A, and 12.0%, 8.0%, 7% in group B. There was difference between the two groups, but not statistical significance. Group B used more analgesics than Group A (0.33 vs. 0.48), but it wasn't significant statistically (P = 0.234). Conclusion Although prospective randomized studies with long-term follow-up evaluation are needed to confirm our study between laparoscopic totally extraperitoneal repair without suprapubic-port and conventional laparoscopic totally extraperitoneal repair, our method have some advantages in postoperative pain, urinary retention, operating time, postoperative hospital stay, and cosmetic effect.
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Affiliation(s)
- Ki-Hwak Kwon
- Department of Surgery, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Do M, Liatsikos E, Beatty J, Haefner T, Dunn I, Kallidonis P, Stolzenburg JU. Laparoendoscopic single-site extraperitoneal inguinal hernia repair: initial experience in 10 patients. J Endourol 2011; 25:963-8. [PMID: 21542772 DOI: 10.1089/end.2010.0696] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Recent technical advances and a trend toward laparoscopic single incision surgery have led us to explore the feasibility of laparoendoscopic single-site (LESS) hernia repair. PATIENTS AND METHODS We present our technique and initial experience with LESS extraperitoneal inguinal hernia repair in 10 consecutive men with unilateral inguinal hernias. Age range was 43.7 (28-64) years. Mean body mass index was 28 (range 24-30). Six were left inguinal hernias. There were six indirect and four direct hernias. Three patients had undergone previous open appendectomy. Incarcerated or bilateral hernias were excluded from our initial series. All cases were performed by three surgeons who were experienced in conventional totally extraperitoneal laparoscopic hernia repair as well as experienced in LESS. A literature review of current single-port inguinal hernia repair data is also presented. RESULTS The mean operative time was 53 minutes (range 45-65 min). The average length of skin incision was 2.8 cm (range 2.3-3.2 cm). No drain was necessary in any of the patients, while no recordable bleeding was observed. There were no intraoperative or immediate postoperative complications. Hospitalization period was 2 days for all patients. After a limited follow-up of 1 month, there have been no recurrences and no complaints of testicular pain. The results of the current series compare favorably with those found in a literature review. CONCLUSION LESS extraperitoneal inguinal hernia repair is both feasible and safe, although more technically demanding than its conventional laparoscopic counterpart. Although the cosmetic result with the former approach may prove superior, there are standing questions regarding the complications and long-term outcome. Randomized and if possible blinded trials that compare conventional and single-incision laparoscopic hernia repair may help to distinguish the most advantageous technique.
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Affiliation(s)
- Minh Do
- Department of Urology, University of Leipzig, Leipzig, Germany
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Abstract
In most countries, inguinal hernia repair is the most frequent procedure performed in a surgical practice. Different approaches have been developed during the last decades, with a strong tendency towards tension-free techniques. The laparoscopic approach offers advantages in terms of less postoperative pain and faster recovery with a low incidence in recurrence. In the last few years, single-incision laparoscopic surgery (SILS) has been introduced to further improve surgical outcome and cosmetic results. For SILS inguinal hernia repair, there is little data available so far, but both totally extraperitoneal hernia repair and transabdominal preperitoneal hernia repair have been succesfully performed without complications in a limited number of patients. In our experience, totally extraperitoneal hernia repair seems to be an ideal indication for the application of SILS.
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Affiliation(s)
- A Klaus
- Department of Visceral, Transplant and Thoracic Surgery Center of Operative Medicine, Medical University Innsbruck, Innsbruck, Austria.
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Yoshida M, Furukawa T, Morikawa Y, Kitagawa Y, Kitajima M. The developments and achievements of endoscopic surgery, robotic surgery and function-preserving surgery. Jpn J Clin Oncol 2010; 40:863-9. [PMID: 20736221 DOI: 10.1093/jjco/hyq138] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The breakthrough in laparoscopic surgery has been the development of a charge-coupled device camera system and Mouret performing cholecystectomy in 1987. The short-term benefits of laparoscopic surgery are widely accepted and the long-term benefit of less incidence of bowel obstruction can be expected. The important developments have been the articulating instrumentation via new laparoscopic access ports. Since 2007, single-incision laparoscopic surgery has spread all over the world. Not only single-scar but also no-scar operation is a current topic. In 2004, Kalloo reported the flexible transgastric peritoneoscopy as a novel approach to therapeutic interventions. In 2007, Marescaux reported transvaginal cholecystectomy in a patient. The breakthrough in robotic surgery was the development of the da Vinci Surgical System. It was introduced to Keio University Hospital in March 2000. Precision in the surgery will reach a higher level with the use of robotics. In collaboration with the faculty of technology and science, Keio University, the combined master-slave manipulator has been developed. The haptic forceps, which measure the elasticity of organs, have also been developed. The first possible sites of lymphatic metastasis are known as sentinel nodes. Otani reported vagus-sparing segmental gastrectomy under sentinel node navigation. This kind of function-preserving surgery will be performed frequently if the results of the multicenter prospective trial of the dual tracer method are favorable. Indocyanine green fluorescence-guided method using the HyperEye charge-coupled device camera system can be a highly sensitive method without using the radioactive colloid. 'Minimally invasive, function-preserving and precise surgery under sentinel node navigation in community hospital' may be a goal for us.
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Affiliation(s)
- Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Mita Hospital, Minato-ku, Tokyo, Japan.
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