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Xu Z, Pan J, Hu Y, Tong X, Huang L. Effects of single-incision laparoscopic surgery on operative time, blood loss, time to first flatus, pain, abdominal drainage, and complications in acute appendicitis. Minerva Gastroenterol (Torino) 2024; 70:266-268. [PMID: 37310373 DOI: 10.23736/s2724-5985.23.03464-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Zhifeng Xu
- Department of General Surgery, Wenzhou People's Hospital, Wenzhou, China
| | - Jianghua Pan
- Department of General Surgery, Wenzhou People's Hospital, Wenzhou, China
| | - Yiren Hu
- Department of General Surgery, Wenzhou People's Hospital, Wenzhou, China
| | - Xiaochun Tong
- Department of General Surgery, Wenzhou People's Hospital, Wenzhou, China
| | - Lidong Huang
- Department of General Surgery, Wenzhou People's Hospital, Wenzhou, China -
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Wang A, Bian C, Zhou H. Single-incision plus one port laparoscopic low anterior resection for mid-low rectal cancer-a video vignette. Colorectal Dis 2022; 24:674-675. [PMID: 35098636 DOI: 10.1111/codi.16071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/26/2021] [Accepted: 01/18/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Anqi Wang
- Division of Colorectal Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Ce Bian
- Division of Colorectal Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China
| | - Haiyang Zhou
- Division of Colorectal Surgery, Changzheng Hospital, Navy Medical University, Shanghai, China
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Zhou J, Lin S, Sun S, Zheng C, Wang J, He Q. Effect of single-incision laparoscopic distal gastrectomy guided by ERAS and the influence on immune function. World J Surg Oncol 2021; 19:307. [PMID: 34666774 PMCID: PMC8527799 DOI: 10.1186/s12957-021-02422-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/07/2021] [Indexed: 12/20/2022] Open
Abstract
Background To evaluate the immune function of gastric cancer patients after single-incision laparoscopic distal gastrectomy (SIDG) or multiport laparoscopic distal gastrectomy (MLDG) guided by enhanced recovery after surgery (ERAS). Methods A retrospective cohort study was performed on 120 patients who underwent laparoscopic distal gastrectomy for gastric cancer. The patients were divided into two groups according to operation method: group A (MLDG) and group B (SIDG), both guided by ERAS concept. The indicators reflecting immune function and inflammation, such as CD3+, CD4+, CD8+ and NK cell count, CD4+/CD8+ cell ratios, IgA, IgM and IgG levels, C-reactive protein (CRP), total lymphocyte count (TLC) and neutrophil-to-lymphocyte ratio (NLR) were tested 3 days and 7 days after surgery. Results The skin incision length of patients in group B was significantly shorter than that in group A, but the operation time was significantly longer in group B than that in group A (P < 0.05). There were no significant differences in preoperative CD3+, CD4+, CD8+, natural killer (NK) cells, CD4+/CD8+, IgA, IgM and IgG levels between two groups (P < 0.05). Three days after surgery, the immune function indices were decreased in both groups, but with no significant difference between two groups (P > 0.05). On the 7th day after surgery, the immune indexes of both groups recovered somewhat, approaching the preoperative level (P > 0.05). Inflammation indexes increased 3 days after surgery and decreased 7 days after surgery in both groups, among them the CRP level in group A was higher than that in group B (P < 0.05). The 3-year survival rate were 96.7% in group A and 91.7% in group B, respectively, with no statistically significant difference. Conclusion Compared with MLDG guided by ERAS, SIDG under the guidance of the ERAS concept has better cosmetic effect and similar effect on immune function of gastric cancer patients.
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Affiliation(s)
- Junfeng Zhou
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, Fujian, PR China
| | - Sheng Lin
- Department of Pediatric Surgery, Fujian Children's Hospital, Fujian, 350005, Fuzhou, PR China
| | - Sida Sun
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, Fujian, PR China
| | - Chengying Zheng
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, Fujian, PR China
| | - Jiaxing Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, Fujian, PR China
| | - Qingliang He
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, No.20 Chazhong Road, Fuzhou, 350005, Fujian, PR China.
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Hyun IG, Choi Y, Han HS, Yoon YS, Cho JY, Kim KH, Han S. Feasibility of Solo Single-Incision Laparoscopic Surgery in Non-anatomical Minor Liver Resection: a Propensity Score-Matched Analysis. J Gastrointest Surg 2021; 25:681-687. [PMID: 32157607 DOI: 10.1007/s11605-020-04527-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND We introduced solo surgery using a laparoscopic scope holder to wide an operator's activity range and reduce instrument crowding and clashing in single incisional surgery. This study aimed to compare the surgical outcomes of solo single-incision laparoscopic surgery (SILS) and conventional multiport laparoscopic surgery (MULS) for hepatocellular carcinoma (HCC). METHODS Among 477 consecutive patients between January 2004 and December 2017, 214 patients were included. To overcome selection bias, we performed 1:1 match using propensity score matching between SILS and MULS. Baseline characteristics, operative outcomes, and postoperative complications were compared. RESULTS No significant differences in baseline characteristics and pathologic features were found between the two groups. Operation time, estimated blood loss, and postoperative major complication were not significantly different (119.0 min vs 141.6 min, p = 0.275; 200.0 mL min vs 373.3 min, p = 0.222; 0 vs 0, p = 1.000). However, postoperative hospital stay was significantly shorter in SILS (2.73 days vs 7.67 days, p = 0.005). CONCLUSIONS Solo SILS had comparable postoperative complications and feasibility in the aspect of operation time and hospital stay compared with conventional MULS for a favorable located single HCC.
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Affiliation(s)
- In Gun Hyun
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Kil Hwan Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Sunjong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
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Floating docking technique: a simple modification to improve the working space of the instruments during single-port robotic surgery. World J Urol 2020; 39:1299-1305. [PMID: 32601981 DOI: 10.1007/s00345-020-03307-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To compare the range of motion and ergonomic characteristics of single-port robotic instruments in the setting of the "floating" versus "flat" docking technique using the GelPOINT® system. MATERIAL AND METHODS The basic principle of the floating docking technique resides in the GelSeal cap and trocar (s) being 8 cm off the skin level with the Alexis® acting as a conduit between the trocar (s) and the body while preserving insufflation. In the setting of a dry lab study, we measured the range of motion of one robotic instrument with the "floating" and the "flat" docking technique in two different situations depending on whether the distance between the incision and the target was more or less than 10 cm. RESULTS The minimum required distances between the target and the tip of the cannula for activation of the wrist and elbow were 5 and 10 cm, respectively. When the target was near to the cannula (i.e., less than 10 cm), the floating technique was associated with a significant increase in the range of motion of the instrument in all directions. The working space volume of the instrument was increased by more than 390% (from 101 to 497 cm3) when the surgeon switched from flat (standard) to the floating technique in the setting of a target close (i.e., less than 10 cm) to the cannula CONCLUSION: The floating docking technique is a simple and effective way to increase the working surgical space, especially in confined and narrow surgical fields with a target closer than 10 cm from the skin.
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Bydzovsky ND, Bockstahler B, Dupré G. Single-port laparoscopic-assisted ovariohysterectomy with a modified glove-port technique in dogs. Vet Surg 2019; 48:715-725. [PMID: 31161631 PMCID: PMC6618065 DOI: 10.1111/vsu.13242] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 11/09/2018] [Accepted: 11/27/2018] [Indexed: 01/08/2023]
Abstract
Objective To describe a single‐port laparoscopic‐assisted ovariohysterectomy (LOHE) with a modified glove‐port technique in dogs and compare it with previously published laparoscopic techniques for LOHE in dogs. Study design Prospective clinical study and technique description. Animals Forty‐two healthy female dogs. Methods Laparoscopic‐assisted ovariohysterectomy was performed with a custom‐made single‐port device. The total duration of surgery from first incision to skin closure was compared with previously published durations of LOHE in dogs. Short‐term complications were recorded. Results The median total duration of surgery was 24 minutes (range, 17.5–39.5; mean, 25.73; SD, 6.12), which was shorter than that described in most previously reported studies of LOHE in dogs (range, 20.8 ± 4.00–60.0 ± 18.45 minutes; P < .001). Intraoperative complications were minor, but wound complications occurred in 12 of 42 (29%) dogs. Conclusion Single‐port LOHE with the glove‐port technique in combination with a wound retractor and nonarticulated instruments was completed in all dogs. This technique was faster than what has been previously reported for other LOHE, but local wound complications were common. Clinical relevance The glove‐port technique described here offers a low‐cost alternative to other commercially available single‐port devices.
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Affiliation(s)
- Nina D Bydzovsky
- Department for Small Animals and Horses, Small Animal Surgery, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Barbara Bockstahler
- Department for Small Animals and Horses, Small Animal Surgery, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Gilles Dupré
- Department for Small Animals and Horses, Small Animal Surgery, University of Veterinary Medicine Vienna, Vienna, Austria
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Cheng A, Kim Y, Itsarachaiyot Y, Zhang HK, Weiss CR, Taylor RH, Boctor EM. Photoacoustic-based catheter tracking: simulation, phantom, and in vivo studies. J Med Imaging (Bellingham) 2018; 5:021223. [PMID: 29594184 DOI: 10.1117/1.jmi.5.2.021223] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 02/07/2018] [Indexed: 11/14/2022] Open
Abstract
Catheters are commonly used in many procedures and tracking and localizing them is critical to patient safety and surgical success. The standard of care for catheter tracking is with the use of fluoroscopy. Alternatives using conventional tracking technologies such as electromagnetic trackers have been previously explored. This work explores the use of an emerging imaging modality, photoacoustics, as a means for tracking. A piezoelectric (PZT) sensor is placed at the tip of the catheter, allowing it to receive the acoustic signals generated from photoacoustic markers due to the photoacoustic effect. The locations of these photoacoustic markers are determined by a stereo-camera and the received acoustic signals are converted into distances between the PZT element and the photoacoustic markers. The location of the PZT sensor can be uniquely determined following a multilateration process. This work validates this photoacoustic tracking method in phantom, simulation, and in vivo scenarios using metrics including reconstruction precision, relative accuracy, estimated accuracy, and leave-out accuracy. Submillimeter tracking results were achieved in phantom experiments. Simulation studies evaluated various physical parameters relating to the photoacoustic source and the PZT sensor. In vivo results showed feasibility for the eventual deployment of this technology.
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Affiliation(s)
- Alexis Cheng
- Johns Hopkins University, Department of Computer Science, Baltimore, Maryland, United States
| | - Younsu Kim
- Johns Hopkins University, Department of Computer Science, Baltimore, Maryland, United States
| | - Yuttana Itsarachaiyot
- Johns Hopkins University, Department of Mechanical Engineering, Baltimore, Maryland, United States
| | - Haichong K Zhang
- Johns Hopkins University, Department of Computer Science, Baltimore, Maryland, United States
| | - Clifford R Weiss
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States.,Johns Hopkins University, Department of Surgery, Baltimore, Maryland, United States.,Johns Hopkins University, Department of Radiology, Baltimore, Maryland, United States
| | - Russell H Taylor
- Johns Hopkins University, Department of Computer Science, Baltimore, Maryland, United States.,Johns Hopkins University, Department of Mechanical Engineering, Baltimore, Maryland, United States.,Johns Hopkins University, Department of Radiology, Baltimore, Maryland, United States
| | - Emad M Boctor
- Johns Hopkins University, Department of Computer Science, Baltimore, Maryland, United States.,Johns Hopkins University, Department of Radiology, Baltimore, Maryland, United States.,Johns Hopkins University, Department of Electrical Engineering, Baltimore, Maryland, United States
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Cheong C, Kim NK. Minimally Invasive Surgery for Rectal Cancer: Current Status and Future Perspectives. Indian J Surg Oncol 2017; 8:591-599. [PMID: 29203993 PMCID: PMC5705499 DOI: 10.1007/s13193-017-0624-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/31/2017] [Indexed: 02/07/2023] Open
Abstract
Although laparoscopic resection for colon cancer has been proven safe and feasible when compared with open resection, currently no clear evidence is available regarding minimally invasive surgery for rectal cancer. This type of surgery may benefit patients by allowing fast recovery of normal dietary intake and bowel function, reduced postoperative pain, and shorter hospitalization. Therefore, minimally invasive surgeries such as laparoscopic or robot surgery have become the predominant treatment option for colon cancer. Specifically, the proportion of laparoscopic colorectal cancer surgery in Korea increased from 42.6 to 64.7% until 2013. However, laparoscopic surgery for rectal cancer is more difficult and technically demanding. In addition, the procedure requires a prolonged learning curve to achieve equivalent outcomes relative to open surgery. It is very challenging to approach the deep and narrow pelvis using laparoscopic instruments. However, robotic surgery provides better vision with a high definition three-dimensional view, exceptional ergonomics, Endowrist technology, enhanced dexterity of movement, and a lack of physiologic tremor, facilitated by the use of an assistant in the narrow and deep pelvis. Recently, an increasing number of reports have compared the outcomes of laparoscopic and open surgery for colon cancer. Such reports have prompted a discussion of the outcomes of minimally invasive surgery, including robotic surgery, for rectal cancer. The aim of this review is to summarize current data regarding the clinical outcomes, including oncologic outcomes, of minimally invasive surgery for rectal cancer.
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Affiliation(s)
- Chinock Cheong
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752 South Korea
| | - Nam Kyu Kim
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro Seodaemun-gu, Seoul, 120-752 South Korea
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Dressler J, Jorgensen LN. The use of expanding ports in laparo-endoscopic single-site surgery may cause more pain: a meta-analysis of randomized clinical trials. Surg Endosc 2017; 31:4400-4411. [PMID: 28364149 DOI: 10.1007/s00464-017-5487-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 02/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Previous meta-analyses on the clinical outcome after laparo-endoscopic single-site surgery (LESS) versus conventional laparoscopic surgery (CLS) have not revealed any major differences in postoperative pain between the two procedures. This meta-analysis aims to evaluate the difference in postoperative pain between the two procedures, focusing on whether LESS was conducted with a non-expanding port (LESSnonex) or a port expanding (LESSex) within the incision. METHOD EMBASE, Medline, PubMed, Science Citation Index Expanded, and Cochrane Central Register of Controlled Trials were searched for randomized clinical trials (RCTs) on LESS versus CLS for general abdominal procedures. Weighted mean difference (WMD) and Odds ratios (OR) were calculated with 95% confidence intervals (CI). RESULTS A total of 29 RCTs with 2999 procedures were included. Pain (VAS 0-10) 6 h after surgery was significantly lower in the group where LESS was conducted with LESSnonex compared to CLS, WMD=-0.72 (- 1.10 to - 0.33). Pain 18-24 h was significantly higher in the group where LESS was conducted with LESSex compared to CLS, WMD = 0.38 (0.01-0.75). Wound-related complications were significantly more frequent in LESSex procedures compared to CLS, OR = 1.94 (1.03-3.63). CONCLUSION The present meta-analysis indirectly indicates that the type of access device that is used for an abdominal LESS procedure may contribute to the development of early postoperative pain as the use of a non-expanding model was associated with a more advantageous outcome. Direct randomized comparison of LESSnonex and LESSex is warranted to confirm if the use of expanding access devices generates more pain and wound complications.
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Affiliation(s)
- Jannie Dressler
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark.
| | - Lars N Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark
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Kim SJ, Choi BJ, Lee SC. Comparative analysis of outcomes after multiport and single-port laparoscopic colectomy in emergency situations: Is single-port laparoscopic colectomy safe and feasible? Asian J Surg 2016; 41:20-29. [PMID: 27592126 DOI: 10.1016/j.asjsur.2016.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/19/2016] [Accepted: 05/20/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/OBJECTIVE Although consensus has been reached on the superiority of laparoscopy for a majority of conditions underlying acute abdominal pain, the safety and feasibility of single-port laparoscopic colectomy (SPLC) in emergency situations have not been determined. METHODS A prospective electronic database of all emergency patients who underwent either multiport laparoscopic colectomy (MPLC) or SPLC between April 2006 and December 2014 was used to compare the surgical outcomes of these operative methods. RESULTS During the study period, 31 MPLCs and 76 SPLCs were performed. These two operative methods resulted in similar operating times, transfusion amounts, lengths of stay, postoperative complications, attainment of lymph nodes, and proximal and distal cut margins. However, the SPLC group had a shorter time to first flatus (2.8±1.9 days vs. 3.8±1.5 days, p=0.005), earlier reinitiation of free oral fluids (3.2±2.1 days vs. 4.4±1.8 days, p=0.002), and lesser requirement of narcotic analgesics (2.5±3.9 times vs. 4.7±4.8 times, p=0.017). CONCLUSION SPLC could be a safe and effective alternative to MPLC, even in emergency situations when performed by surgeons who have overcome the learning curve associated with single-port laparoscopic techniques. The tendency toward earlier returns to bowel function and decreased incidence of postoperative analgesic use would be potential benefits of SPLC in emergency situations.
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Affiliation(s)
- Say-June Kim
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Byung-Jo Choi
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Sang Chul Lee
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Republic of Korea.
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Yin SY, Yen-Chu, Wu YC, Liu CY, Hsieh MJ, Yuan HC, Ko PJ, Liu YH. Lung resection using transumbilical incision: an animal survival study. JSLS 2016; 19:e2013.00285. [PMID: 25848173 PMCID: PMC4370034 DOI: 10.4293/jsls.2013.00285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Transumbilical single-port surgery is a potentially less invasive approach to many types of abdominal surgeries and offers better cosmetic outcomes than conventional 3-port laparoscopic surgery. It avoids the complication of intercostal neuralgia and may reduce the risk of pulmonary complications after video-assisted thoracic surgery. This study evaluated the feasibility of transumbilical lung wedge resection. METHODS Lung resection was performed in 11 beagle dogs weighing 5.9 to 8.5 kg. A 3-cm umbilical incision and one diaphragmatic incision were made, and an endoscopic stapler was used. The diaphragmatic incisions were repaired under video guidance using a V-Loc knotless suturing device (Covidien, Mansfield, Massachusetts). Animals were monitored daily for signs of postoperative infection. White blood cell count, C-reactive protein level, and IL-6 level were measured in all animals. Animals were euthanized 14 days after surgery and underwent necropsy evaluation. RESULTS Accurate lung resection was achieved in 10 of 11 animals during a median operative time of 98 minutes (range 60-165). In 1 animal, transumbilical lung resection was not possible and was converted to thoracotomy. All animals survived without major postoperative complications. At necropsy, evidence of uneventful healing of the stapled resection margin and diaphragmatic wound were found. There was no evidence of vital organ injury or intrathoracic infection. CONCLUSION A transumbilical approach to thoracic cavity exploration and stapled lung resection is technically feasible. Primary suturing of the diaphragmatic incision is a simple and effective means of diaphragmatic wound closure. This may be an alternative to video-assisted thoracic surgery for the management of simple thoracic disease.
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Affiliation(s)
- Shun-Ying Yin
- Division of Thoracic Surgery and Animal Laboratory Center, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Chu
- Division of Thoracic Surgery and Animal Laboratory Center, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Cheng Wu
- Division of Thoracic Surgery and Animal Laboratory Center, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Ying Liu
- Division of Thoracic Surgery and Animal Laboratory Center, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Ju Hsieh
- Division of Thoracic Surgery and Animal Laboratory Center, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hsu-Chia Yuan
- Division of Thoracic Surgery and Animal Laboratory Center, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Po-Jen Ko
- Division of Thoracic Surgery and Animal Laboratory Center, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Hen Liu
- Division of Thoracic Surgery and Animal Laboratory Center, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Lukovich P, Sionov VB, Kakucs T. Training With Curved Laparoscopic Instruments in Single-Port Setting Improves Performance Using Straight Instruments: A Prospective Randomized Simulation Study. JOURNAL OF SURGICAL EDUCATION 2016; 73:348-354. [PMID: 26868318 DOI: 10.1016/j.jsurg.2015.10.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 10/10/2015] [Accepted: 10/20/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Lately single-port surgery is becoming a widespread procedure, but it is more difficult than conventional laparoscopy owing to the lack of triangulation. Although, these operations are also possible with standard laparoscopic instruments, curved instruments are being developed. The aims of the study were to identify the effect of training on a box trainer in single-port setting on the quality of acquired skills, and transferred with the straight and curved instruments for the basic laparoscopic tasks, and highlight the importance of a special laparoscopic training curriculum. DESIGN A prospective study on a box trainer in single-port setting was conducted using 2 groups. Each group performed 2 tasks on the box trainer in single-port setting. Group-S used conventional straight laparoscopic instruments, and Group-C used curved laparoscopic instruments. Learning curves were obtained by daily measurements recorded in 7-day sessions. On the last day, the 2 groups changed instruments between each other. SETTING 1st Department of Surgery, Semmelweis University of Medicine from Budapest, Hungary, a university teaching hospital. PARTICIPANTS In all, 20 fifth-year medical students were randomized into 2 groups. None of them had any laparoscopic or endoscopic experience. Participation was voluntary. RESULTS Although Group-S performed all tasks significantly faster than Group-C on the first day, the difference proved to be nonsignificant on the last day. All participants achieved significantly shorter task completion time on the last day than on the first day, regardless of the instrument they used. Group-S showed improvement of 63.5%, and Group-C 69.0% improvement by the end of the session. After swapping the instruments, Group-S reached significantly higher task completion time with curved instruments, whereas Group-C showed further progression of 8.9% with straight instruments. CONCLUSIONS Training with curved instruments in a single-port setting allows for a better acquisition of skills in a shorter period. For this reason, there is a need for proficiency-based conventional, but also for a single-port, laparoscopic training curriculum in general surgery residency education.
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Affiliation(s)
- Peter Lukovich
- 1st Department of Surgery, Semmelweis University, Budapest, Hungary.
| | | | - Timea Kakucs
- 1st Department of Surgery, Semmelweis University, Budapest, Hungary
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Chuang SH, Lin CS. Single-incision laparoscopic surgery for biliary tract disease. World J Gastroenterol 2016; 22:736-747. [PMID: 26811621 PMCID: PMC4716073 DOI: 10.3748/wjg.v22.i2.736] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 09/19/2015] [Accepted: 10/20/2015] [Indexed: 02/06/2023] Open
Abstract
Single-incision laparoscopic surgery (SILS), or laparoendoscopic single-site surgery, has been employed in various fields to minimize traumatic effects over the last two decades. Single-incision laparoscopic cholecystectomy (SILC) has been the most frequently studied SILS to date. Hundreds of studies on SILC have failed to present conclusive results. Most randomized controlled trials (RCTs) have been small in scale and have been conducted under ideal operative conditions. The role of SILC in complicated scenarios remains uncertain. As common bile duct exploration (CBDE) methods have been used for more than one hundred years, laparoscopic CBDE (LCBDE) has emerged as an effective, demanding, and infrequent technique employed during the laparoscopic era. Likewise, laparoscopic biliary-enteric anastomosis is difficult to carry out, with only a few studies have been published on the approach. The application of SILS to CBDE and biliary-enteric anastomosis is extremely rare, and such innovative procedures are only carried out by a number of specialized groups across the globe. Herein we present a thorough and detailed analysis of SILC in terms of operative techniques, training and learning curves, safety and efficacy levels, recovery trends, and costs by reviewing RCTs conducted over the past three years and two recently updated meta-analyses. All existing literature on single-incision LCBDE and single-incision laparoscopic hepaticojejunostomy has been reviewed to describe these two demanding techniques.
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Single-incision flexible endoscopy (SIFE) for detection and staging of peritoneal carcinomatosis. Surg Endosc 2015; 30:3808-15. [DOI: 10.1007/s00464-015-4682-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/14/2015] [Indexed: 01/19/2023]
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Kim SJ, Kim KH, An CH, Kim JS. Innovative technique of needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration: A comparative study. World J Gastroenterol 2015; 21:12857-12864. [PMID: 26668510 PMCID: PMC4671041 DOI: 10.3748/wjg.v21.i45.12857] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/22/2015] [Accepted: 09/02/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the safety and feasibility of needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration (nSIL-CBDE) by comparing the surgical outcomes of this technique with those of conventional laparoscopic CBDE (CL-CBDE).
METHODS: We retrospectively analyzed the clinical data of patients who underwent CL-CBDE or nSIL-CBDE for the treatment of common bile duct (CBD) stones between January 2000 and December 2014. For performing nSIL-CBDE, a needlescopic grasper was also inserted through a direct puncture below the right subcostal line after introducing a single-port through the umbilicus. The needlescopic grasper helped obtain the critical view of safety by retracting the gallbladder laterally and by preventing crossing or conflict between laparoscopic instruments. The gallbladder was then partially dissected from the liver bed and used for retraction. CBD stones were usually extracted through a longitudinal supraduodenal choledochotomy, mostly using flushing a copious amount of normal saline through a ureteral catheter. Afterward, for the certification of CBD clearance, CBDE was performed mostly using a flexible choledochoscope. The choledochotomy site was primarily closed without using a T-tube, and simultaneous cholecystectomies were performed.
RESULTS: During the study period, 40 patients underwent laparoscopic CBDE. Of these patients, 20 underwent CL-CBDE and 20 underwent nSIL-CBDE. The operative time for nSIL-CBDE was significantly longer than that for CL-CBDE (238 ± 76 min vs 192 ± 39 min, P = 0.007). The stone clearance rate was 100% (40/40) in both groups. Postoperatively, the nSIL-CBDE group required less intravenous analgesic (pethidine) (46.5 ± 63.5 mg/kg vs 92.5 ± 120.1 mg/kg, P = 0.010) and had a shorter hospital stay than the CL-CBDE group (3.8 ± 2.0 d vs 5.1 ± 1.7 d, P = 0.010). There was no significant difference in the incidence of postoperative complications between the two groups.
CONCLUSION: The results of this study suggest that nSIL-CBDE could be safe and feasible while improving cosmetic outcomes when performed by surgeons trained in conventional laparoscopic techniques.
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Fujiwara H, Shiozaki A, Konishi H, Kosuga T, Komatsu S, Ichikawa D, Okamoto K, Otsuji E. Single-Port Mediastinoscopic Lymphadenectomy Along the Left Recurrent Laryngeal Nerve. Ann Thorac Surg 2015; 100:1115-7. [PMID: 26354650 DOI: 10.1016/j.athoracsur.2015.03.122] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 03/26/2015] [Accepted: 03/30/2015] [Indexed: 11/27/2022]
Abstract
We herein describe a single-port mediastinoscopic method for upper mediastinal dissection in esophageal cancer surgery. After the left cervical incision and lymphadenectomy, a Lap-Protector (Hakko, Tokyo, Japan) was inserted into the wound and an EZ Access port (Hakko) was attached. Esophageal mobilization with en bloc lymphadenectomy along the left recurrent laryngeal nerve was then performed using a port-in-port technique with conventional flexible laparoscopy. Carbon dioxide insufflation expanded the intramediastinal space, and minute structures in the deep mediastinum around the aortic arch, such as nerves, bronchial arteries, and lymphatic vessels, were clearly visualized, allowing lymphadenectomy to be safely and carefully performed along the nerve.
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Affiliation(s)
- Hitoshi Fujiwara
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Atsushi Shiozaki
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hirotaka Konishi
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiyuki Kosuga
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shuhei Komatsu
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Daisuke Ichikawa
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuma Okamoto
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Chen KH, Chen LR, Seow KM. Ovarian Suspension With Adjustable Sutures: An Easy and Helpful Technique for Facilitating Laparoendoscopic Single-Site Gynecologic Surgery. J Minim Invasive Gynecol 2015; 22:767-775. [PMID: 25757814 DOI: 10.1016/j.jmig.2015.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To describe a method of ovarian suspension with adjustable sutures (OSAS) for facilitating laparoendoscopic single-site gynecologic surgery (LESS) and to investigate the effect of OSAS on LESS. DESIGN Prospective cohort study (Canadian Task Force classification: II-2). SETTING University teaching hospital. PATIENTS One hundred seventy-eight patients with benign 5- to 15-cm cystic ovarian tumors who underwent LESS with OSAS (suspension group, n = 90) and without OSAS (control group, n = 88). INTERVENTIONS For patients who underwent OSAS (suspension group), 1 end of double-head straight needles with a polypropylene suture was inserted into the pelvic cavity through the abdominal skin to penetrate the cyst or ovarian parenchyma and puncture outside the abdominal skin. After cutting off the needles, both sides of the remaining suture were held together by a clamp, without knotting, so that the manipulator could "lift," "loosen," or "fix" the stitches to adjust the tension. MEASUREMENTS AND MAIN RESULTS The average time to create OSAS was 2.9 min. For the suspension and control groups, the average blood loss was 81.4 and 131.8 mL (p < .001), and the operative time was 42.0 and 61.3 min (p < .001), respectively. There were no significant differences in the incidence of complications (5.6% vs 9.1%; p = .365), but there were significant differences in conversions to standard non-single-site laparoscopy (5.6% vs 15.9%; p = .025) and laparotomy (1.1% vs 6.8%; p = .040). Logistic regression analysis revealed that the ratios of conversion to standard non-single-site laparoscopy (odds ratio [OR], 0.126; 95% confidence interval [CI], 0.311-0.508) and laparotomy (OR, 0.032; 95% CI, 0.002-0.479) were much lower in the suspension group; the risk of complications was comparable (OR, 0.346; 95% CI, 0.085-1.403). CONCLUSION OSAS is an easy, safe, and feasible method that offers advantages during LESS. Although routine use of OSAS is not necessary, OSAS can be considered during LESS to facilitate the surgery.
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Affiliation(s)
- Kuo-Hu Chen
- Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei, Taiwan, and School of Medicine, Tzu-Chi University, Hualien, Taiwan.
| | - Li-Ru Chen
- Mackay Memorial Hospital, Taipei, Taiwan, and Department of Mechanical Engineering, National Chiao-Tung University, Hsinchu, Taiwan
| | - Kok-Min Seow
- Department of Obstetrics and Gynecology, Shin Kong Wu Ho-Su Memorial Hospital, and Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan
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Fistarol M, Giostri PG, Bechara Noviello M, Silva Santos Filho A, Alencar de Lima Rezende C, Fulgêncio Brandão AH. Single-Port Laparoscopy as a Feasible Technique to Approach Benign Adnexal Mass Surgically. J Gynecol Surg 2015. [DOI: 10.1089/gyn.2014.0095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marina Fistarol
- Hospital da Baleia, Fundação Benjamin Guimarães, Belo Horizonte, MG, Brazil
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Lu HY, Chu Y, Wu YC, Liu CY, Hsieh MJ, Chao YK, Wu CY, Yuan HC, Ko PJ, Liu YH, Liu HP. Hemodynamic and inflammatory responses following transumbilical and transthoracic lung wedge resection in a live canine model. Int J Surg 2015; 16:116-122. [PMID: 25769396 DOI: 10.1016/j.ijsu.2015.02.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 02/14/2015] [Accepted: 02/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Single-port transumbilical surgery is a well-established platform for minimally invasive abdominal surgery. The aim of this study was to compare the hemodynamics and inflammatory response of a novel transumbilical technique with that of a conventional transthoracic technique in thoracic exploration and lung resection in a canine model. METHODS Sixteen dogs were randomly assigned to undergo transumbilical thoracoscopy (n = 8) or standard thoracoscopy (n = 8). Animals in the umbilical group received lung resection via a 3-cm transumbilical incision in combination with a 2.5-cm transdiaphragmatic incision. Animals in the standard thoracoscopy group underwent lung resection via a 3-cm thoracic incision. Hemodynamic parameters (e.g., mean arterial pressure, heart rate, cardiac index, systemic vascular resistance, and global end-diastolic volume index) and inflammatory parameters (e.g., neutrophil count, neutrophil 2',7' -dichlorohydrofluorescein [DCFH] expression, monocyte count, monocyte inducible nitric oxide synthase expression, total lymphocyte count, CD4+ and CD8+ lymphocyte counts, the CD4+/CD8+ratio, plasma Creactive protein level, interleukin-6 level) were evaluated before surgery, during the operation, and on postoperative days 1, 3, 7, and 14. RESULTS Lung resections were successfully performed in all 16 animals. There were 2 surgery-related mortality complications (1 animal in each group). In the transumbilical group, 1 death was caused by early extubation before the animal fully recovered from the anesthesia. In the thoracoscopic group, 1 death was caused by respiratory distress and the complication of sepsis at 5 days after surgery. There was no significant difference between the two techniques with regard to the hemodynamic and immunologic impact of the surgeries. CONCLUSION This study suggests that the hemodynamic and inflammatory changes with endoscopic lung resection performed by the transumbilical approach are comparable to those after using the conventional transthoracic approach. This information is novel and relevant for surgeons interested in developing new surgical techniques in minimally invasive surgery.
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Affiliation(s)
- Hung-Yi Lu
- Department of Thoracic Surgery, Chang Gung Memorial Hospital, Kaohsiung, Chang Gung University, Taiwan
| | - Yen Chu
- Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Cheng Wu
- Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Ying Liu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Ju Hsieh
- Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yin-Kai Chao
- Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Yang Wu
- Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hsu-Chia Yuan
- Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Po-Jen Ko
- Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yun-Hen Liu
- Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
| | - Hui-Ping Liu
- Laboratory Animal Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Rational manipulation of the standard laparoscopic instruments for single-incision laparoscopic right colectomy. Int Surg 2014; 98:205-9. [PMID: 23971771 DOI: 10.9738/intsurg-d-12-00037.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This report clarifies the rational manipulation of standard laparoscopic instruments for single-incision laparoscopic right colectomy (SILRC) using the SILS Port. We classified the manipulations required into 4 techniques. Vertical manipulation was required for medial-to-lateral retroperitoneal dissection. Frontal manipulation was needed for extension and establishment of a retroperitoneal plane. External crossing manipulation was used for dissection or ligation of the ileocolic or right colic vessels. Internal crossing manipulation was required for mobilization from the cecum to ascending colon. We performed SILRC for a series of 30 consecutive patients. One additional port was needed in 5 of the patients (16.7%) because of severe adhesion between the ileum and abdominal wall. No intraoperative complications were encountered. Four rational manipulations of the standard laparoscopic instruments are required for SILRC using the SILS Port. However, more experience and comparative trials are needed to determine the exact role of SILRC.
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Kashiwagi H, Kumagai K, Monma E, Nozue M. Dual-port distal gastrectomy for the early gastric cancer. Surg Endosc 2014; 29:1321-6. [PMID: 25159658 PMCID: PMC4422851 DOI: 10.1007/s00464-014-3827-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 07/08/2014] [Indexed: 01/06/2023]
Abstract
Background Although recent trends in laparoscopic procedures have been toward minimizing the number of incisions, four or five ports are normally required to complete laparoscopic gastrectomy because of the complexity of this procedure. Multi-channel ports, such as the SILS port (Covidien, JAPAN), are now available and are crucial for performing single-incision laparoscopic surgery (SILS) or reduced port surgery (RPS). We carried out reduced port distal gastrectomy (RPDG) using a dual-port method with a SILS port. Methods Ten patients who were diagnosed as early stage gastric cancer were offered the RPDG. Mean age and body mass index (BMI) were 68.1 and 21.4, respectively. No distant metastasis or regional lymph node swelling was seen in any case. A 5-mm flexible scope (Olympus, JAPAN) and SILS port were used and a nylon ligature with a straight needle, instead of a surgical instrument, was available to raise the gastric wall. Results The average operative time was 266.9 ± 38.3 min and blood loss was 37.8 ± 56.8 ml. Patients recovered well and experienced no complications after surgery. All patients could tolerate soft meals on the first day after surgery and the average hospital stay was 8.1 days. Past conventional LAG cases were evaluated to compare the short-term outcome and no difference was seen in the mean operative time or operative blood loss. The length of hospital stay after surgery was shorter for the RPDG group than the conventional operation group (p < 0.0001). Interestingly, the trend of serum CRP elevation after surgery was lower in the RPDG group than the conventional LAG group (p = 0.053). Conclusions
Although the benefits of RPS have not been established, this type of surgery may be expected to have some advantages. Cosmetic benefits and shorter hospital stays are clear advantages. Less invasiveness can be expected according to the trend of serum CRP elevation after RPDG.
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Affiliation(s)
- Hiroyuki Kashiwagi
- Department of Surgery, Shonai Amarume Hospital, Shouyou 1-1-1, Shonai Town, Higashi-Tagawa, 999-7782, Japan,
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Liang HH, Hung CS, Wang W, Tam KW, Chang CC, Liu HH, Yen KL, Wei PL. Single-incision versus conventional laparoscopic appendectomy in 688 patients: a retrospective comparative analysis. Can J Surg 2014; 57:E89-97. [PMID: 24869622 DOI: 10.1503/cjs.023812] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Laparoscopic surgery has become the standard for treating appendicitis. The cosmetic benefits of using single-incision laparoscopy are well known, but its duration, complications and time to recovery have not been well documented. We compared 2 laparoscopic approaches for treating appendicitis and evaluated postoperative pain, complications and time to full recovery. METHODS We retrospectively reviewed the cases of consecutive patients with appendicitis and compared those who underwent conventional laparoscopic appendectomy (CLA) performed using 3 incisions and those who underwent single-incision laparoscopic appendectomy (SILA). During SILA, the single port was prepared to increase visibility of the operative site. RESULTS Our analysis included 688 consecutive patients: 618 who underwent CLA and 70 who underwent SILA. Postsurgical complications occurred more frequently in the CLA than the SILA group (18.1% v. 7.1%, p = 0.018). Patients who underwent SILA returned to oral feeding sooner than those who underwent CLA (median 12 h v. 22 h, p < 0.001). These between-group differences remained significant after controlling for other factors. Direct comparison of only nonperforated cases, which was determined by pathological examination, revealed that SILA was significantly longer than CLA (60 min v. 50 min, p < 0.001). Patients who underwent SILA had longer in-hospital stays than those who underwent CLA (72 v. 55 h, p < 0.001); however, they had significantly fewer complications (3.0% v. 14.4%, p = 0.006). CONCLUSION In addition to its cosmetic advantages, SILA led to rapid recovery and no increase in postsurgical pain or complications.
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Affiliation(s)
- Hung-Hua Liang
- The Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei Medical University, Taipei, Taiwan
| | - Chin-Sheng Hung
- The Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei Medical University, Taipei, Taiwan
| | - Weu Wang
- The Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei Medical University, Taipei, Taiwan
| | - Ka-Wai Tam
- The Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chao Chang
- The Division of Gastroenterology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hui-Hsiung Liu
- The Graduate Institute of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ko-Li Yen
- The Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei Medical University, Taipei, Taiwan
| | - Po-Li Wei
- The Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei Medical University, Taipei, Taiwan
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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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Feasibility of single-port laparoscopic surgery for sigmoid colon and rectal cancers and preoperative assessment of operative difficulty. J Gastrointest Surg 2014; 18:977-85. [PMID: 24470062 DOI: 10.1007/s11605-014-2463-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 01/09/2014] [Indexed: 01/31/2023]
Abstract
PURPOSE Single-port laparoscopic surgery is more difficult for sigmoid colon and rectal cancers than for right-sided colon cancer. We sought to analyze the feasibility of this procedure for sigmoid colon and rectal cancers and to estimate its difficulty. METHODS We analyzed prospectively collected data from 63 consecutive patients with sigmoid colon or rectal cancers who underwent single-port laparoscopic surgery at our institution from June 2009 to December 2011. Patient and tumor characteristics, including patients' pelvic anatomy which was assessed on CT scan imaging, were evaluated to elucidate what factors would affect the difficulty of the procedure and the necessity of using an additional trocar. RESULTS Overall, the median operative duration was 190 min and blood loss was 20 ml, with no postoperative complications. The median number of lymph nodes harvested was 17 and the distal margin was 58 mm. The tumor was located significantly closer to the anus in cases in which an additional trocar was required in the right lower quadrant (9.5 vs 18 cm, p < 0.0001). Procedural difficulty was significantly increased in cases in which the sacral promontory protruded ventrally (odds ratio 0.779 [95% confidence interval 0.613 to 0.945], p = 0.0236). CONCLUSIONS Depending on tumor location and sacral promontory shape, the introduction of an additional trocar might render single-port laparoscopic surgery feasible for sigmoid colon and rectal cancer resection.
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Chuang SH, Chen PH, Chang CM, Tsai YF, Lin CS. Single-incision laparoscopic common bile duct exploration with conventional instruments: an innovative technique and a comparative study. J Gastrointest Surg 2014; 18:737-43. [PMID: 24347312 DOI: 10.1007/s11605-013-2420-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 11/15/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Single-incision laparoscopic surgery developed rapidly in recent years. We introduce an innovative technique: single-incision laparoscopic common bile duct exploration (SILCBDE) with conventional instruments. A retrospective comparison between SILCBDE and standard laparoscopic common bile duct exploration (LCBDE) was analyzed. METHODS Thirty-four patients who underwent LCBDE for choledocholithiasis in a period of 17 months were enrolled. Seventeen standard LCBDEs and 17 SILCBDEs were attempted. Simultaneous cholecystectomies were performed. RESULTS The stone clearance rate was 94.1% (16 patients) in the standard LCBDE group and 100% in the SILCBDE group. There was no statistical difference in demographic distribution, clinical presentations, and operative results between the two groups, except the SILCBDE group had a higher rate of acute cholecystitis than the standard LCBDE group (76.5 vs. 35.3%; p < 0.05). One procedure (5.9%) in the SILCBDE group was converted to a four-incision transcystic LCBDE. The complication rate was 11.8% (two patients) in the standard LCBDE group and 5.9% (one patient) in the SILCBDE group. The average follow-up period was 4.2 months. CONCLUSION SILCBDE is as safe and efficacious as standard LCBDE in experienced hands. Choledochoscope manipulation and bile duct repair are the key skills. Long-term follow-up and further prospective randomized trials are anticipated.
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Affiliation(s)
- Shu-Hung Chuang
- Department of Biological Science and Technology, National Chiao Tung University, No.75 Po-Ai Street, Hsin-Chu, 30068, Taiwan
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Maluenda F, León J, Csendes A, Burdiles P, Giordano J, Molina M. Single-incision laparoscopic sleeve gastrectomy: initial experience in 20 patients and 2-year follow-up. Eur Surg 2014; 46:32-37. [PMID: 24563650 PMCID: PMC3926978 DOI: 10.1007/s10353-013-0246-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 12/17/2013] [Indexed: 11/25/2022]
Abstract
Background The transumbilical route began being clinically feasible with or without unique access devices. Setting The setting for this study was a private practice at Clínica Las Condes, Santiago, Chile. Objective The objective was to describe our experience performing a laparoscopic sleeve gastrectomy (LSG) via transumbilical route using a single-port access device in addition to standard laparoscopic instruments. Method A prospective nonrandomized protocol was applied to patients fulfilling the following inclusion criteria: to have been medically indicated for an LSG, to have a body mass index (BMI) of less than or equal to 40 kg/m2, and the distance between the xiphoid appendix and umbilicus should be less than 22 cm. All patients were female with a median (p50) age of 34.5 (ranging from 21 to 57) years, a median weight of 92 (ranging from 82.5 to 113) kg, and a median BMI of 35.1 (ranging from 30.5 to 40) kg/m2. The device insertion technique, the gastrectomy, and postoperative management are described. Results LSG via transumbilical route was successfully carried out in 19 of the 20 patients in whom the procedure was performed; one patient had to be converted to a conventional laparoscopic procedure. Mean operating time was 127 (ranging from 90 to 170) min. On the second postoperative day, all patients were assessed through an upper gastrointestinal barium-contrasted radiological series. There was neither morbidity nor mortality in this group. Excess weight loss at 25 months after surgery was 114 %. Conclusions Single-port LSG can be successfully performed in selected obese patients with a BMI of less than 40 kg/m2 using traditional laparoscopic instruments. The technique allows performing a safe and effective vertical gastrectomy.
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Affiliation(s)
- F Maluenda
- Department of Surgery, Clínica Las Condes, Lo Fontecilla 441, 7591046 Las Condes, Santiago Chile ; Department of Surgery, University Hospital, University of Chile, Santiago, Chile
| | - J León
- Clínica Alemana, Santiago, Chile
| | - A Csendes
- Department of Surgery, University Hospital, University of Chile, Santiago, Chile
| | - P Burdiles
- Department of Surgery, Clínica Las Condes, Lo Fontecilla 441, 7591046 Las Condes, Santiago Chile
| | - J Giordano
- Department of Surgery, Clínica Las Condes, Lo Fontecilla 441, 7591046 Las Condes, Santiago Chile
| | - M Molina
- Department of Surgery, Clínica Las Condes, Lo Fontecilla 441, 7591046 Las Condes, Santiago Chile
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Liang ZW, Cheng Y, Jiang ZS, Liu HY, Gao Y, Pan MX. Transumbilical single-incision endoscopic splenectomy: Report of ten cases. World J Gastroenterol 2014; 20:258-263. [PMID: 24415880 PMCID: PMC3886017 DOI: 10.3748/wjg.v20.i1.258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 10/10/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the feasibility and clinical application of transumbilical single-incision endoscopic splenectomy using conventional laparoscopic instruments.
METHODS: Between 2010 and 2012, transumbilical single-incision endoscopic splenectomy was performed in 10 patients in our department, of whom 4 had refractory idiopathic thrombocytopenic purpura, 4 had enlarged splenic cyst and 2 had splenic hematoma. A 2.5-cm curved incision was made at the lower umbilicus edge, and a 10 mm laparoscope was inserted into the middle of the incision. A 5-mm harmonic scalpel was placed on the right side, and a 5-mm auxiliary instrument on the left side of the laparoscope. Splenic ligaments were incised with a harmonic scalpel, and the splenic pedicle was cut with an Endo-gastrointestinal anastomosis. The spleen was dissected and placed in a large retrieval bag, blended, and then removed.
RESULTS: All transumbilical single-incision endoscopic splenectomies were performed successfully with mean operative time of 80 ± 5 min and mean blood loss of 150 ± 20 mL. Conversion to laparotomy or multi-port laparoscopic surgery was not required in all cases. All patients were discharged on postoperative days 4-6. During the postoperative hospitalization period, no painkillers were required. No intra-abdominal complications such as infection, ascites, gastric leakage, pancreatic leakage, or wound infection occurred in any case during the 6-mo follow-up.
CONCLUSION: Transumbilical single-incision endoscopic splenectomy using conventional laparoscopic instruments is technically feasible and safe in selected patients.
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Wang D, Hou HW, Ji ZL. An investigation for public acceptance of laparoendoscopic single-site surgery. Pak J Med Sci 2013; 29:719-24. [PMID: 24353615 PMCID: PMC3809289 DOI: 10.12669/pjms.293.3272] [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: 12/17/2012] [Revised: 04/22/2013] [Accepted: 04/23/2013] [Indexed: 11/23/2022] Open
Abstract
Objective: Laparoendoscopic single-site surgery (LESS) is the latest innovation in minimally invasive surgery with unconfirmed advantages. The public perception of LESS is the basis of carrying out the surgery. Methodology: Participants from the outpatient department were invited to rate, on a 5-point Likert scale, the important factors including scar, complications, cost, pain and hospital stay in choosing surgery. In addition, those who preferred LESS would continue to make their choices as the risks of LESS in above mentioned aspects rose. Results: About 85% of the questionnaires were included in the analysis. Complication was the most important factor with an average score of 4.77±0.43, followed by pain (3.84±0.96), scar (3.57±1.17), cost (3.41±0.87) and hospital stay (3.04±0.86). Of the 196 participants, 132 (67%) preferred LESS with younger age (35.3±10.64 versus 40.4 ±9.6, P=0.001). Better cosmesis was the only factor that made the participants choose LESS (3.78±1.11 versus 3.13±1.19, P<0.005). Almost 90% of the participants could accept the hypothesis (incision length of 3.5cm, cost up to 120%, pain up to 120%, hospital stay of 5 days), while only 50% of participants could accept the risk of complications of 6%. Conclusions: Complication is the most important factor that the public are concerned about in choosing surgery. LESS is preferred by young who care more concerned about the cosmesis, even with moderately elevated risks of extending incision and increasing hospital cost, postoperative pain and hospital stay.
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Affiliation(s)
- Dong Wang
- Dong Wang, MD, Southeast University Medical School, Nanjing, Jiangsu210009, China
| | - Hong-Wei Hou
- Hong-Wei Hou, MD, Southeast University Medical School, Nanjing, Jiangsu210009, China
| | - Zhen-Ling Ji
- Zhen-Ling Ji, MD, PhD, Southeast University Medical School, Nanjing, Jiangsu210009, China
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Pan MX, Liang ZW, Cheng Y, Jiang ZS, Xu XP, Wang KH, Liu HY, Gao Y. Learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy. World J Gastroenterol 2013; 19:4786-4790. [PMID: 23922478 PMCID: PMC3732853 DOI: 10.3748/wjg.v19.i29.4786] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/15/2013] [Accepted: 06/20/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy (SILC).
METHODS: The clinical data of 180 consecutive transumbilical suture-suspension SILCs performed by a team in our department during the period from August 2009 to March 2011 were retrospectively analyzed. Patients were divided into nine groups according to operation dates, and each group included 20 patients operated on consecutively in each time period. The surgical outcome was assessed by comparing operation time, blood loss during operation, and complications between groups in order to evaluate the improvement in technique.
RESULTS: A total of 180 SILCs were successfully performed by five doctors. The average operation time was 53.58 ± 30.08 min (range: 20.00-160.00 min) and average blood loss was 12.70 ± 11.60 mL (range: 0.00-100.00 mL). None of the patients were converted to laparotomy or multi-port laparoscopic cholecystectomy. There were no major complications such as hemorrhage or biliary system injury during surgery. Eight postoperative complications occurred mainly in the first three groups (n = 6), and included ecchymosis around the umbilical incision (n = 7) which resolved without special treatment, and one case of delayed bile leakage in group 8, which was treated by ultrasound-guided puncture and drainage. There were no differences in intraoperative blood loss, postoperative complications and length of postoperative hospital stay among the groups. Bonferroni’s test showed that the operation time in group 1 was significantly longer than that in the other groups (F = 7.257, P = 0.000). The majority of patients in each group were discharged within 2 d, with an average postoperative hospital stay of 1.9 ± 1.2 d.
CONCLUSION: Following scientific principles and standard procedures, a team experienced in multi-port laparoscopic cholecystectomy can master the technique of SILC after 20 cases.
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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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Wen CT, Chu Y, Yeh CJ, Liu CY, Yuan HC, Ko PJ, Liu YH, Liu HP. Feasibility and safety of endoscopic transumbilical thoracic surgical lung biopsy: a survival study in a canine model. J Surg Res 2013; 183:47-55. [DOI: 10.1016/j.jss.2012.11.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Revised: 11/22/2012] [Accepted: 11/30/2012] [Indexed: 12/26/2022]
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Healy DA, Murphy SP, Burke JP, Coffey JC. Artificial interfaces (“AI”) in surgery: Historic development, current status and program implementation in the public health sector. Surg Oncol 2013; 22:77-85. [DOI: 10.1016/j.suronc.2012.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 12/04/2012] [Accepted: 12/22/2012] [Indexed: 02/07/2023]
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Sajid MS, Ladwa N, Kalra L, Hutson KK, Singh KK, Sayegh M. Single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: meta-analysis and systematic review of randomized controlled trials. World J Surg 2013; 36:2644-53. [PMID: 22855214 DOI: 10.1007/s00268-012-1719-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The objective of this study was to analyze systematically the randomized, controlled trials that compared single-incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC). METHODS The meta-analysis was conducted according to the Quality of Reporting of Meta-analysis (QUORUM) standards. The included studies were analyzed systematically using the statistical software package RevMan. The summated outcomes were expressed as the risk ratios (RR) for dichotomous variables and standardized mean differences (SMD) for continuous variables. RESULTS Eleven randomized trials encompassing 858 patients were retrieved from the electronic databases. In the random effects model, postoperative pain, postoperative complications, length of hospital stay, cosmesis score, conversion rate, and time to return to normal activities were statistically comparable between the two cholecystectomy techniques. SILC was associated with a longer operating time [SMD 0.71; 95 % confidence interval (CI) 0.38, 1.05; z = 4.18; p < 0.0001) and an increased requirement for additional port insertion (RR 6.54; 95 % CI 2.19, 19.57; z = 3.36; p < 0008). However, there was significant heterogeneity among the trials. CONCLUSIONS SILC does not offer any advantage over CLC for treating benign gallbladder disorders. CLC may be used assiduously for this purpose.
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Affiliation(s)
- Muhammad S Sajid
- Department of Upper Gastrointestinal and Hepatobiliary Surgery, Worthing Hospital, Worthing, Washington Suite, North Wing, West Sussex, BN11 2DH, UK.
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A laparoendoscopic single-site surgery approach to mesh sacrohysteropexy. Case Rep Med 2013; 2013:641675. [PMID: 23533434 PMCID: PMC3596949 DOI: 10.1155/2013/641675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 01/29/2013] [Indexed: 11/17/2022] Open
Abstract
Although laparoendoscopic single-site surgery (LESS) has spread across surgical disciplines, this has not been the case for the repair of uterovaginal prolapse. We describe the use of this technique for mesh sacrohysteropexy to correct a global prolapse classified as stage II on the pelvic organ prolapse quantification (POP-Q) system. The procedure involved intraoperative modification of a commercially available single incision port. At the 18 months followup, the patient was free of symptoms and had no objective prolapse.
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A randomised comparative study evaluating learning curves of novices in a basic single-incision laparoscopic surgery task. J Gastrointest Surg 2013; 17:569-75. [PMID: 23225160 DOI: 10.1007/s11605-012-2113-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 11/22/2012] [Indexed: 01/31/2023]
Abstract
OBJECTIVE There is currently no objective quantification of the temporal changes in performance associated with a novice surgeon learning single-incision laparoscopic surgery (SILS) operative tasks. Analysing learning curves allows us to objectively quantify performance. The aim was to evaluate if the rate of learning and ultimate proficiency level reached in SILS when using straight or articulating instruments is different to conventional laparoscopy and if training in laparoscopy influences learning or proficiency for SILS. DESIGN AND SETTING Thirty-six surgically naive medical students were randomised to complete the validated peg transfer task over 50 repetitions using a conventional laparoscopic set-up, SILS set-up with straight instruments or articulated instruments or SILS set-up after having reached proficiency using a conventional laparoscopy. RESULTS There was a significant increased overall proficiency between the group trained in conventional laparoscopy and all other groups (p < 0.01), with no difference between the other groups. There was no difference in the rate of learning between the groups. There was no difference in the ultimate proficiency level (p = 0.671) or rate of learning (p = 0.63) when using straight or articulating instruments. There was no difference in ultimate proficiency level (p = 0.59) or learning rate (p = 0.219) seen in the SILS group that had prior training on the task with a conventional laparoscopic set-up. CONCLUSIONS The results of this study indicate that the proficiency reached using a conventional laparoscopic set-up cannot be matched using a SILS configuration for the novice surgeon and that the choice of straight or articulated instruments as well as previous laparoscopic training does not confer an advantage in this basic task.
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Kwasnicki RM, Aggarwal R, Lewis TM, Purkayastha S, Darzi A, Paraskeva PA. A comparison of skill acquisition and transfer in single incision and multi-port laparoscopic surgery. JOURNAL OF SURGICAL EDUCATION 2013; 70:172-179. [PMID: 23427960 DOI: 10.1016/j.jsurg.2012.10.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/30/2012] [Accepted: 10/07/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Single incision laparoscopic surgery (SILS) offers a scar-less approach to cholecystectomy. We conducted a cadaveric randomized crossover study to compare the novice learning curves for multiport laparoscopic cholecystectomy (LC) and single incision laparoscopic cholecystectomy (SILC), and to investigate the acquisition of transferable skills. PARTICIPANTS Twenty medical students were randomized into SILS or LC groups. METHODS After baseline assessment and cognitive learning modules, groups completed 5 cadaveric porcine cholecystectomies in their designated modality, followed by one using the other approach. Performance was assessed using a validated surgical assessment device (ICSAD) and by expert video analysis with generic and procedure-specific rating scales [modified global rating scale (mGRS) and procedure-specific rating scales (PSRS)]. RESULTS Analysis of the first case revealed significant differences between LC and SILS groups for time-taken (median 46.00 vs 68.19 min, p = 0.019), and path length (216 vs 348 m, p = 0.034). Intergroup analysis of the remaining group cases showed no difference for any of the performance metrics. Outlying performance of the 4th case in the LC group rendered learning curve comparison unviable. At crossover, performance of the SILS group on their LC compared with the 5th LC performed by the LC group showed no significant difference. However, comparing the LC group's SILC to the 5th SILC performed by the SILS group showed significant difference for all performance metrics (p < 0.05). CONCLUSIONS This study suggests that the difference between novice performance for SILC and LC becomes negligible after the first procedure. Furthermore, dedicated SILC training appears to develop competencies for both SILC and LC, therefore its addition to the early surgical curriculum is likely to extend the access of SILC to patients without reducing multiport laparoscopic skill acquisition.
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Affiliation(s)
- Richard M Kwasnicki
- Department of Biosurgery and Surgical Technology, Imperial College London, London W2 1NY, United Kingdom.
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Henriksen NA, Al-Tayar H, Rosenberg J, Jorgensen LN. Cost assessment of instruments for single-incision laparoscopic cholecystectomy. JSLS 2013; 16:353-9. [PMID: 23318059 PMCID: PMC3535802 DOI: 10.4293/108680812x13427982377021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This study concludes that a modified single-incision procedure for cholecystectomy using 2 regular ports inserted through the umbilicus can be performed at lower cost than a conventional 4-port procedure. Background and Objectives: Specially designed surgical instruments have been developed for single-incision laparoscopic surgery, but high instrument costs may impede the implementation of these procedures. The aim of this study was to compare the cost of operative implements used for elective cholecystectomy performed as conventional laparoscopic 4-port cholecystectomy or as single-incision laparoscopic cholecystectomy. Methods: Two consecutive series of patients undergoing single-incision laparoscopic cholecystectomy were assessed: (1) single-incision cholecystectomy using a commercially available multichannel port (n=80) and (2) a modified single-incision cholecystectomy using 2 regular trocars inserted through the umbilicus (n=20) with transabdominal sutures for gallbladder mobilization (puppeteering technique). Patients who underwent conventional 4-port cholecystectomy during the same time period (n=100) were selected as controls. Results: The instrumental cost of the single-incision cholecystectomy using a commercial port was significantly higher (median, $1123) than the cost for conventional 4-port (median $441, P < .0005) and modified single-incision cholecystectomy (median $342, P < .0005). The cost of the modified single-incision procedure was significantly lower than that for the 4-port cholecystectomy (P < .0005). Conclusion: The modified single-incision procedure using 2 regular ports inserted through the umbilicus can be performed at lower cost than conventional 4-port cholecystectomy.
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Shibao K, Higure A, Yamaguchi K. Laparoendoscopic single-site common bile duct exploration using the manual manipulator. Surg Endosc 2013; 27:3009-15. [PMID: 23436088 DOI: 10.1007/s00464-013-2837-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 01/04/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laparoendoscopic single-site (LESS) surgery has developed as a new surgical modality that has increased cosmetic benefits over conventional endoscopic surgery. However, there are no reports about LESS surgery in common bile duct exploration. This report presents a LESS surgery to manage CBD stones by laparoscopic choledochotomy and C-tube placement with favorable outcomes. METHODS This retrospective review analyzes 13 patients who underwent LESS CBD exploration with C-tube drainage for choledocholithiasis. The technique is herein described and the outcomes measured. The Radius Surgical System (Tübingen Scientific Medical, Tübingen, Germany) is a flexible manual manipulator that was applied for suturing and ligation to overcome the difficulties associated with LESS surgery. RESULTS The diameters of the CBDs ranged from 12 to 20 mm, the median number of stones was 5.8, and the median diameter of stones was 9 mm. All of the routine procedures including choledochotomy, intraoperative ultrasound, choledochoscopy, and intraoperative cholangiography guidance were performed. Stone clearance from the CBD was achieved for all but one of the patients. It was possible to close the common bile duct opening with regular forceps, but this required extra effort compared to conventional laparoscopic surgery. On the other hand, the manual manipulator enabled the optimal penetration angle and was useful for both intracorporeal suturing and ligation for the closure of the common bile duct opening. The manual manipulator also helped to overcome in-line viewing and hand/instruments collisions, which are common problems in LESS surgery. No mortality was associated with this procedure, and two wound infections were drained without anesthesia. No recurrent stones were observed during the follow-up period. CONCLUSIONS LESS surgery was successfully applied to CBD exploration as an available alternative to conventional laparoscopic surgery. This method is technically feasible and produces superior cosmetic results. The manual manipulator may therefore have several advantages for performing LESS surgery.
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Affiliation(s)
- Kazunori Shibao
- Department of Surgery I, School of Medicine, University of Occupational and Environmental Health Japan, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Japan.
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Hartman MJ, Monnet E, Kirberger RM, Venter LJ, Bester L, Schulman ML, Serfontein T, Fourie R, Schoeman JP. Laparoscopic Sterilization of the African Lioness (Panthera leo). Vet Surg 2013; 42:559-64. [DOI: 10.1111/j.1532-950x.2012.01049.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Marthinus J. Hartman
- Department of Companion Animal Clinical Studies; Faculty of Veterinary Science; University of Pretoria; Pretoria; South Africa
| | - Eric Monnet
- Department of Clinical Sciences; Colorado State University; Fort Collins; CO
| | - Robert M. Kirberger
- Department of Companion Animal Clinical Studies; Faculty of Veterinary Science; University of Pretoria; Pretoria; South Africa
| | - Leon J. Venter
- Department of Paraclinical Sciences; Faculty of Veterinary Science; University of Pretoria; Pretoria; South Africa
| | - Lynette Bester
- Department of Companion Animal Clinical Studies; Faculty of Veterinary Science; University of Pretoria; Pretoria; South Africa
| | - Martin L. Schulman
- Department of Production Animal Studies; Faculty of Veterinary Science; University of Pretoria; Pretoria; South Africa
| | - Tania Serfontein
- Department of Companion Animal Clinical Studies; Faculty of Veterinary Science; University of Pretoria; Pretoria; South Africa
| | - Retha Fourie
- Department of Companion Animal Clinical Studies; Faculty of Veterinary Science; University of Pretoria; Pretoria; South Africa
| | - Johan P. Schoeman
- Department of Companion Animal Clinical Studies; Faculty of Veterinary Science; University of Pretoria; Pretoria; South Africa
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Li M, Han Y, Feng YC. Single-port laparoscopic hysterectomy versus conventional laparoscopic hysterectomy: a prospective randomized trial. J Int Med Res 2012; 40:701-8. [PMID: 22613433 DOI: 10.1177/147323001204000234] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To compare transumbilical single-port laparoscopic hysterectomy (TSPLH) with traditional four-port total laparoscopic hysterectomy (TLH). METHODS Patients with benign uterine disease were assigned to receive either TSPLH (n = 52) or TLH (n = 56). Duration of surgery, intraoperative blood loss, conversion rate, time to first flatus, duration of immobilization, post operative analgesia requirement, port site infection, port hernia, duration of hospital stay, postoperative fever rate and percentage patient satisfaction were recorded. RESULTS TSPLH and TLH were both performed successfully. TSPLH was associated with significantly longer duration of surgery, shorter duration of immobilization, lower rate of port site infection and higher patient satisfaction than TLH. There were no other significant differences between the two groups. All subjects recovered fully and no postoperative complications occurred during a 6-month (minimum) follow-up period. CONCLUSIONS TSPLH was found to be a feasible and safe approach for laparoscopic hysterectomy.
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Affiliation(s)
- M Li
- Department of Minimally Invasive Gynaecology, Central Hospital of Fengxian District, Shanghai, China
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Yang GP, Tung KL, Lai EC, Chan OC, Tang CN, Li MK. Scarless needlescopic transabdominal preperiotneal inguinal hernia repair: An alternative to single-incision repair. SURGICAL PRACTICE 2012. [DOI: 10.1111/j.1744-1633.2012.00618.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- George P.C. Yang
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong
| | - Karen L.M. Tung
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong
| | - Eric C.H. Lai
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong
| | - Oliver C.Y. Chan
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong
| | - Chung-Ngai Tang
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong
| | - Michael K.W. Li
- Department of Surgery; Pamela Youde Nethersole Eastern Hospital; Hong Kong
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Iacobone M, Citton M, Nitti D. Laparoscopic distal pancreatectomy: Up-to-date and literature review. World J Gastroenterol 2012; 18:5329-37. [PMID: 23082049 PMCID: PMC3471101 DOI: 10.3748/wjg.v18.i38.5329] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 04/19/2012] [Accepted: 05/13/2012] [Indexed: 02/06/2023] Open
Abstract
Pancreatic surgery represents one of the most challenging areas in digestive surgery. In recent years, an increasing number of laparoscopic pancreatic procedures have been performed and laparoscopic distal pancreatectomy (LDP) has gained world-wide acceptance because it does not require anastomosis or other reconstruction. To date, English literature reports more than 300 papers focusing on LDP, but only 6% included more than 30 patients. Literature review confirms that LDP is a feasible and safe procedure in patients with benign or low grade malignancies. Decreased blood loss and morbidity, early recovery and shorter hospital stay may be the main advantages. Several concerns still exist for laparoscopic pancreatic adenocarcinoma excision. The individual surgeon determines the technical conduction of LDP, with or without spleen preservation; currently robotic pancreatic surgery has gained diffusion. Additional researches are necessary to determine the best technique to improve the procedure results.
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Khalaj A, Bakhtiari J, Niasari-Naslaji A. Comparison between single and three portal laparoscopic splenectomy in dogs. BMC Vet Res 2012; 8:161. [PMID: 22963734 PMCID: PMC3585911 DOI: 10.1186/1746-6148-8-161] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 08/27/2012] [Indexed: 01/25/2023] Open
Abstract
Background Single incision laparoscopic surgery (SILS) is a newly growing technique to replace a more invasive conventional multiple portal laparoscopic surgery. The objective of this study was to compare single (SILS) with three portal (Conventional) laparoscopic splenectomy in dogs. Mongrel dogs (n = 18), weighting 15 ± 3 kg, were selected for this study (n = 12 SILS; n = 6 conventional). The area from xiphoid to pubis was prepared under aseptic conditions in dorsal recumbency with the head down and tilted 30 degree in the right lateral position. Pneumoperitoneum was established by CO2 using an automatic high flow pressure until achieving 12 mm Hg. Instrumentation used consisted of curved flexible-tip 5 mm Maryland forceps and ultracision harmonic scalpel for sealing and cutting of the vessels and splenic attachments. Results All dogs recovered uneventfully. The splenectomy procedure using SILS and conventional methods were significantly different in the respective operative time (29.1 ± 1.65 vs. 42.0 + 2.69 min) and the length of the surgical scar (51.6 ± 1.34 mm vs. 72.0 ± 1.63 mm; P < 0.001). There were no post-operative wound complication including inflammation, infection, hernia formation and dehiscence up to one month after surgery. Meanwhile, the conversion to open surgery or application of additional portals was not required in both approaches. Conclusion This study demonstrated that SILS is a safe and feasible operation and could be used as an alternative approach to three portal (Conventional) for splenectomy in dog.
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Affiliation(s)
- Alireza Khalaj
- Minimally Invasive Surgery Research Centre, Rasool Akram Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Transanal single-port laparoscopic total mesorectal excision in the treatment of rectal cancer. Tech Coloproctol 2012; 17:117-23. [DOI: 10.1007/s10151-012-0882-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 08/12/2012] [Indexed: 12/16/2022]
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Single-port laparoscopic surgery of the distal esophagus: initial clinical experience. Surg Laparosc Endosc Percutan Tech 2012; 22:e118-21. [PMID: 22678329 DOI: 10.1097/sle.0b013e318247c45f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Laparoscopic fundoplication (LF) is considered to be potentially suitable for single-port surgery because of lack of requirements of organ resection, anastomosis, and specimen retrieval. However, its feasibility and safety have not been fully established. The objective of this study was to evaluate the feasibility and safety of single-port LF (sLF) in our institution. sLF was attempted in 11 patients and was completed without the additional ports in 3 patients (27%). The remaining 8 patients required the addition of 1 to 3 ports to complete LF. Median operating time and blood loss were 221 minutes and 20 mL, respectively (intention-to-treat). No major complications were noted. All patients showed uneventful postoperative recovery and clinical improvement of their preoperative symptoms with satisfactory cosmetic outcome. sLF is technically feasible and safe, although the use of extra ports should be positively considered to ensure the safety and quality of LP.
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Rückbeil O, Lewin A, Federlein M, Gellert K. The barrier-free trocar technique in three laparoscopic standard procedures. J Minim Access Surg 2012; 8:9-12. [PMID: 22303082 PMCID: PMC3267336 DOI: 10.4103/0972-9941.91773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 10/13/2010] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND: Numerous technical and surgical innovations took place in laparoscopic surgery in the recent past. It is debatable whether single-access surgery or natural orifice surgery (NOS) will establish for several standard procedures. Most of the NOS-procedures are controversial and single-access surgery still has to prove its equality in controlled trials. In the intention to reduce the ingress incisons and to facilitate instrumentation, we decided to test the barrier-free AirSeal®-trocar in clinical practice. MATERIALS AND METHODS: Laparoscopically we performed a cholecystectomy, gastric wedge-resection and a fundoplication using the barrier-free AirSeal® 12-mm-trocar. This trocar works without any mechanical barrier so that via this trocar the use of two instruments is possible. RESULTS: All three operations were successful. CONCLUSION: Laparoscopic standard procedures are feasible using this barrier-free trocar without a higher degree of difficulty. Because of the facilitated instrumentation, it is possible to work more efficiently and to maintain the focus on the surgical field.
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Affiliation(s)
- Oskar Rückbeil
- Department of Surgery, Sana Klinikum Lichtenberg Berlin, Berlin, Germany
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Morales-Conde S. [Single port, NOTES: a promising future or a passing fashion]. Cir Esp 2012; 91:1-3. [PMID: 22832061 DOI: 10.1016/j.ciresp.2012.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 05/13/2012] [Accepted: 05/27/2012] [Indexed: 10/28/2022]
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Uday SK, Bhargav PRK, Venkata Pavan Kumar CH. Criteria for Laparoscopic Advanced Surgery in Semi-Equipped Setup (CLASS): Feasibility Study Based on Institutional Experience. Indian J Surg 2012; 76:31-7. [PMID: 24799781 DOI: 10.1007/s12262-012-0597-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 06/05/2012] [Indexed: 02/02/2023] Open
Abstract
Laparoscopic and Minimally invasive techniques have become a routine practice for various surgical disorders in present times. Though, advanced laparoscopic procedures are feasible they are largely restricted to fewer centers due to lack of advanced instrumentation, finances and expertise at most of them. In this context, we conducted a feasibility study to evolve definite criteria for performing advanced laparoscopic surgeries in resource restricted set-ups. We present our experience with 25 cases of advanced laparoscopic procedures using conventional laparoscopic instruments. We evaluated the clinico-investigative profile and operative details of all the patients. We classified the surgical expertise, laparoscopic instrumentation, surgical set ups and patient factors systematically to evolve the criteria for feasibility of advanced laparoscopicsurgery. Out of the 22 eligible patients for the study, various laparoscopic surgeries performed were - Fundoplication (4), Cystogastrostomy (3), Endoscopic thyroidectomy (7), Thoracoscopic Thyroidectomy (2), Adrenalectomy (5) and Retroperitoneal paraganglioma excision (1). There was no mortality and two morbidities in the form of hypercarbia and a tracheo-cutaneous fistula in 2 cases of endoscopic thyroidectomy. According to the criteria, we propose our surgical set up falls in to Grade 3, for which this criteria fits in. This study demonstrates the feasibility of advanced laparoscopic procedures in semi-equipped set-up, preferably by employing institute specific criteria of CLASS.
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Affiliation(s)
- S K Uday
- Endocrine and Metabolic Surgery Department, Mamata Medical College and Hospital (MMC/MGH), Khammam, Andhra Pradesh India
| | - P R K Bhargav
- Endocrine and Metabolic Surgery Department, Mamata Medical College and Hospital (MMC/MGH), Khammam, Andhra Pradesh India
| | - C H Venkata Pavan Kumar
- Endocrine and Metabolic Surgery Department, Mamata Medical College and Hospital (MMC/MGH), Khammam, Andhra Pradesh India
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Kikuchi I, Kagawa N, Silber S, Kuwayama M, Takehara Y, Aono F, Kumakiri J, Kato O, Takeda S. Oophorectomy for fertility preservation via reduced-port laparoscopic surgery. Surg Innov 2012; 20:219-24. [PMID: 22696023 DOI: 10.1177/1553350612449074] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND For fertility preservation of women patients scheduled to undergo chemotherapy or radiotherapy, unilateral oophorectomy was performed, and the ovary was cryopreserved. METHODS Two-port surgery was conducted in 3 patients, and single-port surgery using a single-incision laparoscopic surgery port in 3. An 18-G Cathelin needle equipped with a syringe was directly inserted transabdominally to reach the small follicle on the ovarian surface; then, follicular fluid was recovered by aspiration through the syringe as with in vitro fertilization procedures, and immature oocytes were collected from the resulting culture medium under microscopy and cryopreserved. Vitrification of the ovarian tissue was performed using the cryotissue method. RESULTS The operative time and estimated blood loss were 39.7 minutes (17-57) and 8.6 mL (2-20), and the numbers of ovarian cortical tissues and immature oocytes collected were 10.1 (5.5-15) and 16.3 (0-36), respectively. CONCLUSIONS It is suggested that fertility preservation operations before chemotherapy or radiotherapy can be safely done using reduced-port surgery.
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Affiliation(s)
- Iwaho Kikuchi
- Juntendo University Faculty of Medicine, Tokyo, Japan.
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Carbone M, Turini G, Petroni G, Niccolini M, Menciassi A, Ferrari M, Mosca F, Ferrari V. Computer guidance system for single-incision bimanual robotic surgery. ACTA ACUST UNITED AC 2012; 17:161-71. [DOI: 10.3109/10929088.2012.692168] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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