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Tsuruta M, Hasegawa H, Okabayashi K, Shigeta K, Ishida T, Yahagi M, Ishii Y, Kitagawa Y. Needlescopic versus conventional laparoscopic surgery for colorectal cancer ~a comparative study~. JOURNAL OF THE ANUS RECTUM AND COLON 2018; 1:45-49. [PMID: 31583300 PMCID: PMC6768669 DOI: 10.23922/jarc.2016-007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/31/2017] [Indexed: 12/11/2022]
Abstract
Objectives: This study set out to determine whether Needlescopic surgery (NS) produces comparable surgical outcomes for patients with colorectal cancer (CRC) compared to conventional multi-port laparoscopic surgery (MPS). Methods: We used the five-port method with a 3.5 cm umbilical incision for extraction and reconstruction during MPS for CRC. One or two 5 mm ports were exchanged for needle forceps and all surgical procedures were as for previous MPS since July 2012. We investigated the short-term outcomes of 138 consecutive patients who underwent curative resection of CRC by NS (July 2012-August 2014) and 130 consecutive patients with CRC treated with MPS during a previous period (January 2010-June 2012). Results: Operative time in the NS group was comparable to that of MPS (p=0.467); the NS group had significantly less estimated blood loss (p=0.002) and a shorter postoperative hospital stay (p<0.001). The mean number of dissected lymph nodes was 27 in both groups (p=0.730). No mortality occurred in either group, and similar morbidity rates were observed (p=0.454). Conclusions: NS using Endo Relief needle forceps is a safe and feasible option compared to conventional MPS for CRC.
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Affiliation(s)
| | | | | | - Kohei Shigeta
- Department of Surgery, Keio University School of Medicine
| | - Takashi Ishida
- Department of Surgery, Keio University School of Medicine
| | - Masashi Yahagi
- Department of Surgery, Kitasato University Kitasato Institute Hospital
| | - Yoshiyuki Ishii
- Department of Surgery, Kitasato University Kitasato Institute Hospital.,Department of Surgery, Kitasato University School of Medicine
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine
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Baig MN, Baig U, Tariq A, Din R. A Prospective Study of Distal Metatarsal Chevron Osteotomies with K-Wire Fixations to Treat Hallux Valgus Deformities. Cureus 2017; 9:e1704. [PMID: 29167752 PMCID: PMC5698042 DOI: 10.7759/cureus.1704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Introduction Hallux valgus is one of the most common forefoot deformities worldwide. Females are affected more often than males. The three most common clinical symptoms are the painful bunion, transfer metatarsalgia, and hammer or claw toes. Methods This case series consisted of 20 patients who had chevron osteotomy from January 2015 to January 2016. The clinical assessment was measured by The American Orthopedic Foot and Ankle Score (AOFAS), and radiologic assessment was determined by preoperative and postoperative hallux valgus angle (HVA) and intermetatarsal angle (IMA). Results The patients' mean age was 56 years. Out of 20 patients, 19 were female, and one was male. The mean AOFAS improved from 51 preoperatively to 82 postoperatively. The HVA improved from 26° preoperatively to 14°. There were five complications including four Kirschner (K)-wire complications. Conclusion Distal chevron osteotomy is a reliable and time-tested procedure. The K-wire fixation has a relatively high complication rate. We planned to use other methods of fixation and then compared them with K-wires fixation results for future studies.
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Affiliation(s)
- M N Baig
- Orthopaedics, Galway University Hospital
| | - Usman Baig
- Medicine, Quaid-E-Azam Medical College, Bahawalpur
| | - Ali Tariq
- Trauma & Orthopaedics, Galway University Hospital
| | - Robert Din
- Department of Orthopaedics, Poole Hospital, Poole, United Kingdom
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Aldeghaither S, Zubaidi A, Alkhayal K, Al-Obaid O. Single-incision laparoscopic colorectal surgery: a report of 33 cases in Saudi Arabia. Ann Saudi Med 2016; 36:282-7. [PMID: 27478914 PMCID: PMC6074404 DOI: 10.5144/0256-4947.2016.282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Single-incision laparoscopic surgery (SILS) has gained worldwide acceptance as a minimally invasive technique in colorectal procedures since its introduction in 2008. However, case series on its feasibility and safety in Saudi Arabia are lacking. OBJECTIVE Evaluate the operative results and clinical outcome of single-port laparoscopic procedures in colorectal surgeries. DESIGN Retrospective. SETTING This study was conducted at King Khalid university Hospital, Riyadh, Saudi Arabia. PATIENTS AND METHODS Demographic and clinical data, including pathology, and intraoperative and postoperative outcomes, were prospectively collected in patients undergoing SILS. This study was conducted during the period from January 2010 and October 2014. MAIN OUTCOME MEASURES Demographic and postoperative outcomes in patients undergoing SILS colectomies. RESULTS Thirty-three (33) patients underwent SILS. The mean (SD) age was 51 years (18.2 years), and the average body mass index was 26.6 (6.9) kg/m2. Patients were primarily diagnosed with cancer (n=20/33, 61%), inflammatory bowel disease (n=12/33, 36%) and diverticulitis (n=1/33, 3%). Procedures included anterior resection (n=9/33, 27%), ileocecal resection (n=8/33 24%), hemicolectomy (n=7/33, 21%), extended right hemicolectomy (n=5/33, 15%) and total colectomy (n=4/33, 12%). The mean SD operative time was 212 minutes (76.4 minutes). The mean SD size of the extraction incision was 4.2 (1.7) cm. Six percent of the cases were converted to open (n=2/33), and 9% required placement of an extra port (n=3/33). Four (12%) patients had intraoperative complications, and 30% experienced postoperative complications. The average length of hospital stay was 6.4 (4.3) days. COCNLUSIONS SILS is technically feasible and safe for patients undergoing colorectal surgery with no unusual complications. However, comparative studies are necessary to validate the potential benefits of SILS over conventional colorectal laparoscopic surgery. LIMITATIONS The study lacked a comparison to conventional open procedures. Additionally, some evaluation criteria were not considered, including cosmesis, pain control, patient satisfaction and cost effectiveness.
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Affiliation(s)
- Saud Aldeghaither
- Dr. Saud Aldeghaither, Department of Surgery, King Khaled University Hospital,, PO Box 7805, Riyadh 11472, Saudi Arabia, T: +966-11-467-1585, , ORCID: http://orcid.org/0000-0001-8836-085X
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Huntington JT, Boomer LA, Pepper VK, Diefenbach KA, Dotson JL, Nwomeh BC. Minimally Invasive Ileal Pouch-Anal Anastomosis with Rectal Eversion Allows for Equivalent Outcomes in Continence in Pediatric Patients. J Laparoendosc Adv Surg Tech A 2016; 26:222-5. [DOI: 10.1089/lap.2015.0429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Justin T. Huntington
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Laura A. Boomer
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Victoria K. Pepper
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Karen A. Diefenbach
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Jennifer L. Dotson
- Department of Gastroenterology, Nationwide Children's Hospital, Columbus, Ohio
| | - Benedict C. Nwomeh
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
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Miyata R, Kameyama N, Tomita M, Mitsuhashi H, Baba S, Amemiya R, Amada E. Transumbilical glove port: A cost-effective method for single-incision laparoscopic hepatectomy. SAGE Open Med Case Rep 2015; 3:2050313X14568699. [PMID: 27489679 PMCID: PMC4857323 DOI: 10.1177/2050313x14568699] [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: 10/28/2014] [Accepted: 12/22/2014] [Indexed: 12/07/2022] Open
Abstract
Objectives: Emerging concepts of “reduced port surgery” have gained considerable attention from laparoscopic surgeons, including the field of liver resection. To date, 86 cases of single-incision laparoscopic hepatectomy (SILH) have been reported, with commercially available access devices being used in most of these cases. We report herein a use of homemade transumbilical glove port for SILH. Methods: A 39-year-old woman represented giant hepatic hemangioma (9-cm in size) located at the left lateral segment (S2/3). Partial hepatectomy was performed by the glove method via single port access with conventional laparoscopic bipolar forceps, grasper and scissors without the need of any single-port specific devices. Results: The operative time was 77 minutes, and intraoperative blood loss was 50 mL. The postoperative course was uneventful. Conclusions: Glove method not only has significant advantages in terms of cost, but also is superior in its versatility, allowing wider range of movements compared to conventional access devices. Taking in consideration its cost effectiveness and versatility, glove method may be a good option for SILH.
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Affiliation(s)
| | | | | | | | | | | | - En Amada
- International Goodwill Hospital, Yokohama, Japan
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Naqi SA, Smyth J, Mortensen N, Hompes R, Cahill R. Single-incision laparoscopic ileorectal anastomosis. Colorectal Dis 2014; 16:O297-9. [PMID: 24506165 DOI: 10.1111/codi.12584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 01/02/2014] [Indexed: 02/08/2023]
Abstract
AIM Minimally invasive approaches for stoma closure offer considerable benefits for patients. Single port access via an end ileostomy site after stoma take-down in patients with prior total colectomy and a rectal stump remnant could allow restoration of ileorectal continuity by anastomosis but has not been detailed previously. METHODS After mobilisation of the end ileostomy, the anvil of a circular stapler is secured into the open end of the distal ileum and the intestine returned into the abdominal cavity. A single port access device (in this description, a 'surgical glove port') is placed then into the stoma site and full laparoscopy performed. Once the rectal stump is identified and prepared, an intracorporeal anastomosis can be constructed in a tension-free manner using a Knight-Griffin technique. Leak-testing can also be performed and the operation concluded with closure of the solitary incision. RESULTS In selected cases, adhesiolysis and anastomosis can be safely performed in toto. If the peritoneal environment is challenging, access can be escalated to multiport laparoscopy or even laparotomy. CONCLUSION Initiation of ileorectal anastomosis construction by single port laparoscopy at least allows peritoneal assessment but can provide for the operation's completion. This can confer maximum patient benefit for the most minimally invasive option.
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Affiliation(s)
- Syed Ali Naqi
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
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Shah A, Moftah M, Morrin M, Redmond M, Cahill RA. Single-site laparoscopic excision of mesocolic cystic lymphangioma - a video vignette. Colorectal Dis 2014; 16:566. [PMID: 24617916 DOI: 10.1111/codi.12589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 01/12/2014] [Indexed: 02/08/2023]
Affiliation(s)
- A Shah
- Departments of Colorectal Surgery, Beaumont Hospital, Dublin 9, Dublin, Ireland
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Shah A, Moftah M, Hadi Nahar Al-Furaji H, Cahill RA. Standardized technique for single port laparoscopic ileostomy and colostomy. Colorectal Dis 2014; 16:O248-52. [PMID: 24612317 DOI: 10.1111/codi.12601] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 01/07/2014] [Indexed: 02/08/2023]
Abstract
AIM Single site laparoscopic techniques and technology exploit maximum usefulness from confined incisions. The formation of an ileostomy or colostomy seems very applicable for this modality as the stoma occupies the solitary incision obviating any additional wounds. METHOD Here we detail the principles of our approach to defunctioning loop stoma formation using single port laparoscopic access in a stepwise and standardized fashion along with the salient specifics of five illustrative patients. No specialized instrumentation is required and the single access platform is established table-side using the 'glove port' technique. RESULTS The approach has the intra-operative advantage of excellent visualization of the correct intestinal segment for exteriorization along with direct visual control of its extraction to avoid twisting. Postoperatively, abdominal wall trauma has been minimal allowing convalescence and stoma care education with only one parietal incision. CONCLUSION Single incision stoma siting proves a ready, robust and reliable technique for diversion ileostomy and colostomy with a minimum of operative trauma for the patient.
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Affiliation(s)
- A Shah
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
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Advanced laparoscopic surgery for colorectal disease: NOTES/NOSE or single port? Best Pract Res Clin Gastroenterol 2014; 28:81-96. [PMID: 24485257 DOI: 10.1016/j.bpg.2013.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 11/23/2013] [Indexed: 01/31/2023]
Abstract
Laparoscopic surgery for colorectal disease is an evolving, dynamic subject undergoing constant adaptation. Hence there are significant ongoing advances in technique and technology as has been seen with the emergence of single port and Natural Orifice Transluminal Endoscopic operations with already considerable ramifications for many aspects of minimal access surgery. Most recently single port technologies and expertise have synergized with Transanal Endoscopic (TEM/TEO) experience to allow their convergence out of their respective niches so that pelvic surgery can be laparoendoscopically performed from both its abdominal and perineal aspects. Distinct from wound-related benefits, such capacity for high resolution and multi-dimensional imaging relates significant benefit to the operating team and patient. This state of the art review demonstrates the crucial perspective that advanced practices and performance capabilities are intrinsically complimentary rather than competitive. All surgeons need therefore to participate in adapting their practice styles to allow technical step-advance across the discipline.
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Lin YM, Chen HH, Chen YJ, Chen PH, Lu CC. Single-Incision Laparoscopic Colectomy Using Self-Made Glove Port for Benign Colon Diseases. J Laparoendosc Adv Surg Tech A 2013; 23:932-7. [DOI: 10.1089/lap.2013.0383] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Yueh-Ming Lin
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hong-Hwa Chen
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yun-Ju Chen
- Department of Biological Science & Technology, I-Shou University, Kaohsiung, Taiwan
- Department of Medical Research, E-Da Hospital, Kaohsiung, Taiwan
| | - Pin-Han Chen
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Chang Lu
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Clarke K, Toomey DP, McEntee GP. Gloveport hernioscopy. Hernia 2013; 19:429-31. [PMID: 24096410 DOI: 10.1007/s10029-013-1164-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Abstract
It can be difficult to exclude occult, necrotic bowel in incarcerated herniae that reduce prior to emergent surgical exploration without resorting to further abdominal wall incisions. This case illustrates the Gloveport hernioscopy technique to identify necrotic small intestine that had spontaneously reduced in a man with a strangulated umbilical hernia. This minimally invasive technique allowed a multichannel examination of the peritoneal cavity without any further insult to the abdominal wall.
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Affiliation(s)
- K Clarke
- Department of Surgery, St. Monica's Ward, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland,
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Lv C, Wu S, Wu Y, Shi J, Su Y, Fan Y, Kong J, Yu X. Single-incision laparoscopic versus traditional multiport laparoscopic colorectal surgery--a cumulative meta-analysis and systematic review. Int J Colorectal Dis 2013; 28:611-21. [PMID: 23386215 DOI: 10.1007/s00384-013-1653-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/22/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE The published data on the evaluation of feasibility and safety of single-incision laparoscopic colorectal surgery (SILC) compared with traditional multiport laparoscopic colorectal surgery (MLC) remained controversial. The present cumulative meta-analysis and systematic review were performed to provide a more objective and precise estimate. MATERIALS AND METHODS PubMed, the Cochrane Library, and also, manual searches were employed to identify potentially eligible studies which were published before June 7, 2012. The association was assessed by odds ratio (OR) and means with 95 % confidence intervals (CI). RESULTS A total of 20 comparative studies were included, with 670 patients underwent SILC and 838 patients underwent MLC. For overall pooled estimates, no evidence of between trial differences was found in overall conversion rate (OR, 1.7; 95 % CI, 0.97 to 3.01), overall complication rate (OR, 0.82; 95 % CI, 0.63 to 1.08), and operative time (mean, -3.59; 95 % CI, -10.95 to 3.77); significantly between trial differences were found in estimated blood loss (mean, -18.61; 95 % CI, -31.33 to -5.90) and post-operative hospital stay (mean, -0.54; 95 % CI, -0.95 to -0.12). The cumulative meta-analysis identified a potentially increased conversion rate of SILC compared with MLC with the increased percentage of malignancies, but no significant differences could be identified in overall complication rate. CONCLUSION This meta-analysis suggested the feasibility and safety of SILC performed by experienced hands, though potentially higher overall conversion rate occurred in malignancies. SILC will benefit the patients much more with its superiority over MLC.
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Affiliation(s)
- Chao Lv
- Biliary and Vascular Unit, Department of General Surgery, Shengjing Hospital, China Medical University, Shenyang 110004, People's Republic of China
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Dapri G, Carandina S, Mathonet P, Himpens J, Cadière GB. Suprapubic single-incision laparoscopic right hemicolectomy with intracorporeal anastomosis. Surg Innov 2013; 20:484-92. [PMID: 23325782 DOI: 10.1177/1553350612471208] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Single-incision laparoscopy (SIL) has gained significance recently. The umbilicus has been the preferred access site for SIL. Suprapubic access site (SAS) can be an alternative, especially for a right hemicolectomy (RH). METHODS Between November 2011 and July 2012, 7 consecutive patients underwent suprapubic SIL RH (SSILRH). The median age was 53 years, and the median body mass index was 23.9 kg/m2. Indications for surgery included appendicular tumor (1) and adenocarcinoma of the right colon (6). Three reusable trocars were used, and the resection was performed through the SAS. An intracorporeal linear stapled anastomosis was performed, the mesenteric defect was closed, and the access site was used for specimen extraction. RESULTS No patient required additional trocars or conversion to an open surgery. The median laparoscopic time was 222 minutes, and the median final incision length was 50 mm. The median Visual Analogue Scale score (0-10) at 6, 18, 30, 42, 54, 66, and 78 postoperative hours was 6, 6, 2, 2, 2, 2, and 2, respectively. The median hospital stay was 4 days. CONCLUSIONS SSILRH is useful because the SAS can be enlarged for extraction of the specimen without compromising the cosmetic outcome. The mesocolic and mesenteric dissections are on the same axis as the access site. The intracorporeal anastomosis can be performed without traction. Finally, positioning of the operative table improves exposure of the operative field and allows the surgeon to maneuver the colon and small bowel intracorporeally.
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Ragupathi M, Vande Maele D, Nieto J, Pickron TB, Haas EM. Transanal endoscopic video-assisted (TEVA) excision. Surg Endosc 2012; 26:3528-35. [PMID: 22729706 DOI: 10.1007/s00464-012-2399-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Accepted: 05/15/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Transanal endoscopic video-assisted (TEVA) excision represents an alternative approach for the surgical treatment of middle and upper rectal lesions not amenable to colonoscopic removal. Utilizing principles of single-incision laparoscopic surgery, this novel minimally invasive approach optimizes access for safe and complete removal of these lesions without the need for a formal rectal resection. We describe our technique and early outcomes with TEVA excision. METHODS Between March 2010 and September 2011, TEVA excision was performed for patients presenting for management of rectal lesions not amenable to colonoscopic or standard transanal removal. Patients were selected if they presented with benign disease or superficial adenocarcinoma, and the proximal extent of the lesion extended beyond 8 cm from the anal verge. Demographic, intraoperative, and postoperative data were assessed. A SILS™ port was placed in the anal canal for access in all cases. Standard laparoscopic instruments were utilized for visualization, full-thickness transanal excision, and primary closure. RESULTS Twenty patients (50% male) with a mean age of 64.6 ± 10.9 years, mean body mass index of 28.2 ± 4.9 kg/m(2), and median American Society of Anesthesiologist score of 2 underwent TEVA excision. Fourteen patients (70%) presented with benign disease and six patients (30%) presented with malignant disease. The mean size of the lesions was 3.0 ± 1.4 cm, and the mean distance from the anal verge was 10.6 ± 2.4 cm. All excisions were successfully completed with a mean operative time of 79.8 ± 25.1 (range, 45-135) min. The mean length of hospital stay was 1.1 ± 0.7 (range, 0-3) days. CONCLUSIONS TEVA excision is a safe and feasible approach for local excision of rectal lesions not otherwise amenable to standard techniques. Continued investigation and development will be important to establish its role in minimally invasive colorectal surgery.
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Ali S, Moftah M, Ajmal N, Cahill RA. Single port-assisted fully laparoscopic abdominoperineal resection (APR) with immediate V-RAM flap reconstruction of the perineal defect. Updates Surg 2012; 64:217-21. [DOI: 10.1007/s13304-012-0158-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 04/25/2012] [Indexed: 11/28/2022]
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Single-access laparoscopic surgery for ileal disease. Minim Invasive Surg 2012; 2012:697142. [PMID: 22530116 PMCID: PMC3317071 DOI: 10.1155/2012/697142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Accepted: 12/12/2011] [Indexed: 12/21/2022] Open
Abstract
Aim. Single-access laparoscopic surgery (SALS) can be effective for benign and malignant diseases of the ileum in both the elective and urgent setting. Methods. Ten consecutive, nonselected patients with ileal disease requiring surgery over a twelve month period were included. All had a preoperative abdominopelvic computerized tomogram. Peritoneal access was achieved via a single transumbilical incision and a “surgical glove port” utilized as our preferred access device. With the pneumoperitoneum established, the relevant ileal loop was located using standard rigid instruments. For ileal resection, anastomosis, or enterotomy, the site of pathology was delivered and addressed extracorporeally. Result. The median (range) age of the patients was 42.5 (22–78) years, and the median body mass index was 22 (20.2–28) kg/m2. Procedures included tru-cut biopsy of an ileal mesenteric mass, loop ileostomy and ileotomy for impacted gallstone extraction as well as ileal (n = 3) and ileocaecal resection (n = 4). Mean (range) incision length was 2.5 (2–5) cm. All convalescences were uncomplicated. Conclusions. These preliminary results show that SALS is an efficient and safe modality for the surgical management of ileal disease with all the advantages of minimal access surgery and without requiring a significant increase in theatre resource or cost or incurring extra patient morbidity.
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