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Eppenga R, Snaauw G, Kuhlmann K, van der Heijden F, Ruers T, Nijkamp J. An improved camera model for oblique-viewing laparoscopes: high reprojection accuracy independent of telescope rotation. Phys Med Biol 2023; 68:185007. [PMID: 37582390 DOI: 10.1088/1361-6560/acf08f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 08/15/2023] [Indexed: 08/17/2023]
Abstract
Objective. Oblique-viewing laparoscopes are popular in laparoscopic surgeries where the target anatomy is located in narrow areas. Their viewing direction can be shifted by telescope rotation without changing the laparoscope pose. This rotation also changes laparoscope camera parameters that are estimated by camera calibration to be able to reproject an anatomical model onto the laparoscopic view, creating augmented reality (AR). The aim of this study was to develop a camera model that accounts for these changes, achieving high reprojection accuracy for any telescope rotation.Approach. Camera parameters were acquired by calibrations encompassing a wide telescope rotation range. For those parameters showing periodic changes upon rotation, interpolation models were created and used to establish an updatable camera model. With this model, corner points of a tracked checkerboard were reprojected onto the checkerboard laparoscopic images, at random rotation angles. Root-mean-square reprojection errors (RMSEs) were calculated between the reprojected and imaged corner points.Main results. Reprojection RMSEs were low and approximately independent on telescope rotation angle, over a wide rotation range of 320°. The mean reprojection RMSE was 2.8±0.7 pixels for a conventional laparoscope and 3.6±0.7 pixels for a chip-on-the-tip (COTT) laparoscope, corresponding to 0.3±0.1 mm and 0.4±0.1 mm in world coordinates respectively. Worst-case reprojection errors were about 9 pixels (0.8 mm) for both laparoscopes.Significance. The camera model developed in this study improves on existing models for oblique-viewing laparoscopes because it provides high reprojection accuracy independent of the telescope rotation angle and is applicable for conventional and chip-on-a-tip oblique-viewing laparoscopes. The work presented here is an important step towards creating accurate AR in image-guided interventions where oblique-viewing laparoscopes are used while simultaneously providing the surgeon the flexibility to rotate the telescope to any desired rotation angle.Acronyms. CC: camera coordinates; CCToolbox: camera calibration toolbox; COTT: chip-on-the-tip; CS: camera sensor; DD: decentering distortion; FL: focal length; OTS: optical tracking system; PP: principal point; RD: radial distortion; SI: supplementary information;tHE:hand-eye translation component.
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Affiliation(s)
- Roeland Eppenga
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gerard Snaauw
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Koert Kuhlmann
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Theo Ruers
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Nanobiophysics Group, Faculty TNW, University of Twente, Enschede, The Netherlands
| | - Jasper Nijkamp
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Jia W, Cheng X, Zhao R. Editorial: Laparoscopic surgery in colorectal cancer. Front Oncol 2022; 12:960730. [PMID: 36119542 PMCID: PMC9477083 DOI: 10.3389/fonc.2022.960730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wenqing Jia
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Digestive surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xi Cheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Digestive surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Xi Cheng, ; Ren Zhao,
| | - Ren Zhao
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Institute of Digestive surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Xi Cheng, ; Ren Zhao,
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Lyu K, Yang L, Song C. Motion Measurement and Analysis of Different Instruments for Single-Incision Laparoscopic Surgery. Appl Bionics Biomech 2022; 2022:3057485. [PMID: 35694278 PMCID: PMC9177342 DOI: 10.1155/2022/3057485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/21/2022] [Accepted: 05/10/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To objectively compare and analyze the range of motion of three types of instruments for single-incision laparoscopic surgery. Material and Methods. Ten experienced participants were recruited. Straight instruments (Group A), straight/articulating instruments (Group B), and precurved instruments (Group C) were used to complete the transferring task through one site in a laparoscopic simulator. Straight instruments via two separate sites (Group D) served as control. The operation time of each group was recorded. Instrument positions were measured by an optical tracking system. The inserted length and pivoting angles were derived via MATLAB. Results There was a significant difference in operation time between groups (D < A < B < C, p < 0.01). The range of motion of instruments was different on instrument types and surgical approaches. A significant difference in the inserted length was found between groups. Instrument conflicts and inadequate triangulation were found in Group A; instrument conflicts were found in Group B; no obvious conflicts and triangulation problems were observed in Group C. The operation in Group C was similar to the operation in Group D but differed on the left/right pivoting angles. Conclusion Different types of instruments have different ranges of motion in single-incision laparoscopic surgery. Working with precurved instruments seems like a compromise to traditional laparoscopic surgery if the transmission property, and shaft curvature of the instruments could be improved. An integrated mechanical platform or robotic system might be the ultimate solution for single-incision laparoscopic surgery to pursue even less trauma.
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Affiliation(s)
- Kunyong Lyu
- School of Information Science and Technology, ShanghaiTech University, Shanghai 201210, China
| | - Lixiao Yang
- Equipment Department, Shanghai Changhai Hospital, Shanghai 200433, China
| | - Chengli Song
- Shanghai Institute for Minimally Invasive Therapy, School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
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Que Son T, Hieu Hoc T, Duc Long V, Thanh Tung T, Minh Tuan N, Minh Hue B, Van Minh N, Toan Thang N. Laparoscopic Appendectomy Using the Surgical-Glove Port Through an Umbilical Incision: A Single-Center Retrospective Study. Cureus 2022; 14:e24512. [PMID: 35497086 PMCID: PMC9042655 DOI: 10.7759/cureus.24512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 11/05/2022] Open
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Wu ZJ, Huang XW, Yu JH, Lin HZ, Zheng FW. Short-term clinical and oncological outcomes after single-incision plus one-port laparoscopic surgery for rectosigmoid cancer: a retrospective clinical analysis of 30 cases. J Int Med Res 2021; 49:3000605211019674. [PMID: 34250822 PMCID: PMC8373150 DOI: 10.1177/03000605211019674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the safety and feasibility of single-incision laparoscopic
surgery+1 (SILS+1) radical resection of sigmoid and upper rectal cancer. Methods The clinical data of 30 consecutive patients with sigmoid and upper rectal
cancer who underwent SILS+1 radical resection between October 2018 and
January 2020 in our hospital were retrospectively analyzed. An initial 5-cm
periumbilical transverse incision was made. Then, a multiport device was
placed in the umbilical incision. Two 10-mm ports were used for laparoscope
insertion, and the other two ports were used for laparoscope device
insertion. A 12-mm trocar was placed in the right lower abdominal quadrant
under laparoscopic view and served as the surgeon’s dominant operating
channel. Results All operations were performed successfully without conversion to conventional
laparoscopic surgery or open operation. Three patients developed
postoperative complications: one patient developed ileus, one developed
postoperative bleeding, and one developed wound infection. There were no
perioperative deaths. Conclusions The safety and feasibility of SILS+1 radical resection of sigmoid and upper
rectal cancer was established by experienced surgeons in our study. However,
further studies are needed to demonstrate the advantages of this procedure
compared with the benefits of conventional laparoscopic surgery.
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Affiliation(s)
| | - Xiang-Wu Huang
- Xiang-Wu Huang, Department of Anorectal
Surgery, the Affiliated Hospital of Putian University, No 999 Dongzhen East
Road, Licheng District, Fujian Province 351100, China.
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Arkenbout EA, de Winter JCF, Ali A, Dankelman J, Breedveld P. A gesture-based design tool: Assessing 2DOF vs. 4DOF steerable instrument control. PLoS One 2018; 13:e0199367. [PMID: 30024885 PMCID: PMC6053136 DOI: 10.1371/journal.pone.0199367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/06/2018] [Indexed: 12/21/2022] Open
Abstract
Iterative prototyping is costly and time-consuming. Particularly when designing medical instruments, human factors related design choices significantly impact performance and safety. A tool is presented that allows for the evaluation of steerable instrument controls before the onset of the prototyping stage. The design tool couples gestural input to virtually simulated instrument motions using hand motion tracking. We performed a human-subject evaluation of two manual control strategies that differed in their degrees of freedom (DOF). 2DOF thumb control was compared to 4DOF thumb-index finger control. Results identified regions within the instrument workspace that are difficult to reach and showed participants to favor using the thumb for gross and fine-tuning motions at both control strategies. Index finger ab/adduction was found to be least functional. A strong learning effect was observed at 4DOF control. Based on the results, gesture-based instrument design is a viable design tool.
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Affiliation(s)
- E. A. Arkenbout
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
- * E-mail:
| | - J. C. F. de Winter
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - A. Ali
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - J. Dankelman
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - P. Breedveld
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
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Isaac-Lowry OJ, Okamoto S, Pedram SA, Woo R, Berkelman P. Compact teleoperated laparoendoscopic single-site robotic surgical system: Kinematics, control, and operation. Int J Med Robot 2017; 13. [PMID: 28345294 DOI: 10.1002/rcs.1811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/26/2016] [Accepted: 12/30/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND To date a variety of teleoperated surgical robotic systems have been developed to improve a surgeon's ability to perform demanding single-port procedures. However typical large systems are bulky, expensive, and afford limited angular motion, while smaller designs suffer complications arising from limited motion range, speed, and force generation. This work was to develop and validate a simple, compact, low cost single site teleoperated laparoendoscopic surgical robotic system, with demonstrated capability to carry out basic surgical procedures. METHODS This system builds upon previous work done at the University of Hawaii at Manoa and includes instrument and endoscope manipulators as well as compact articulated instruments designed to overcome single incision geometry complications. A robotic endoscope holder was used for the base, with an added support frame for teleoperated manipulators and instruments fabricated mostly from 3D printed parts. Kinematics and control methods were formulated for the novel manipulator configuration. RESULTS Trajectory following results from an optical motion tracker and sample task performance results are presented. CONCLUSIONS Results indicate that the system has successfully met the goal of basic surgical functionality while minimizing physical size, complexity, and cost.
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Affiliation(s)
| | - Steele Okamoto
- Department of Mechanical Engineering, University of Hawaii at Manoa, USA
| | | | - Russell Woo
- Department of Mechanical Engineering, University of Hawaii at Manoa, USA
| | - Peter Berkelman
- Department of Mechanical Engineering, University of Hawaii at Manoa, USA
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Tominaga T, Nonaka T, Wakata K, Kunizaki M, Tobinaga S, Sumida Y, Hidaka S, Sawai T, Nagayasu T. Single-incision laparoscopic ileocecal resection using an organ retractor. Int J Surg Case Rep 2017; 33:84-88. [PMID: 28285210 PMCID: PMC5350497 DOI: 10.1016/j.ijscr.2017.02.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/23/2017] [Accepted: 02/23/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Single-incision laparoscopic surgery has been reported to be a safe and feasible technique for colorectal cancer. However, the technique needs skill due to the limitations of the device. An organ retractor is a new grasp device that has the potential to overcome these limitations. PRESENTATION OF CASE A 63-year-old woman with a tumor palpated in the right lower quadrant of the abdomen presented to hospital. Colonoscopy showed a type 2 mass with nearly complete stenosis, and a biopsy specimen showed well-differentiated adenocarcinoma. Single-incision laparoscopic surgery ileocecal resection was performed using an organ retractor. A 3-cm incision was placed in the umbilicus, and three conventional ports were inserted. An organ retractor was used for hepatocolic ligament resection, resection of the ileocolic vessels, and resection of the insertion of the mesentery proper. For each resection, the trailer line's tension was adjusted to provide a good operative view. The patient's postoperative course was good, and she was discharged 7days after surgery. DISCUSSION An organ retractor was effective for single-incision laparoscopic surgery technique not only to maintain a good operative view, but also to change trailer line tension, which enabled safe dissection. CONCLUSION An organ retractor could facilitate single-incision laparoscopic surgery.
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Affiliation(s)
- Tetsuro Tominaga
- Departments of Surgery, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Takashi Nonaka
- Departments of Surgery, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Kouki Wakata
- Departments of Surgery, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Masaki Kunizaki
- Departments of Surgery, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Shuichi Tobinaga
- Departments of Surgery, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Yorihisa Sumida
- Departments of Surgery, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Shigekazu Hidaka
- Departments of Surgery, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Terumitsu Sawai
- Departments of Cardiopulmonary Rehabilitation Science, Division of Surgical Oncology, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
| | - Takeshi Nagayasu
- Departments of Surgery, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
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Olijnyk JG, Ferreira PW, Nácul MP, Cavazzola LT. Efficacy and safety of a new single-port model for appendectomy: Experimental study on swine. J Minim Access Surg 2016; 12:129-34. [PMID: 27073304 PMCID: PMC4810945 DOI: 10.4103/0972-9941.158951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
CONTEXT: With the cooperation of surgeons and the engineering division of the company Bhio supply© (Esteio-RS, Brazil), a permanent single port was developed. AIMS: An experimental study assessed the safety and efficacy of the device using a swine laparoscopic appendectomy model (right salpingo-oophorectomy). SETTINGS AND DESIGN: Experimental randomised study. MATERIALS AND METHODS: A total of 20 pigs were randomised for the conventional laparoscopic (CL) three-trocar technique or the single Centry port (CPort) with two working channels, aided by a transparietal thread. Operative times, surgical complications, CO2 use, and pneumoperitoneal pressure were checked. Pressure and chromopertubation tests assessed the ligatures. STATISTICAL ANALYSIS USED: For quantitative outcomes, the Fisher's exact test analysed the samples to compare the surgeons in each group, the ANOVA test for parametric data (volume and pressure) and the Student's t-test for analysis of the fascial incision length. The binaries and isolated occurrence events were described in percentages. RESULTS: For all cases, pneumoperitoneum was maintained. The CPort group, however, resulted in higher CO2 use (26.18 l; standard deviation [SD] ± 11.09) than CL group (5.69 l; SD ± 2.44) (P < 0.01). The mean pressure in CPort group (6.604 mmHg, SD ± 1.793) was comparatively lower than in CL group (7.382 mmHg, SD ± 1.833) (P = 0.363). There was no statistical difference between operative times, ligature safety or adverse surgical events between the different groups and surgeons. CONCLUSION: The surgical technique used with the single port showed no differences in safety and efficacy. Though it does require more CO2 use, its working dynamics did not lead to increased operative times. The results were similar between the two surgeons in the study, suggesting that they can be reproduced.
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Affiliation(s)
- José Gustavo Olijnyk
- Department of Surgery, Post Graduation Program in Surgical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Education and Research (IEP), Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Paulo Walter Ferreira
- Engineering Division, Nacional Service of Industrial Learning, (SENAI-RS), Porto Alegre, RS, Brazil
| | - Miguel Prestes Nácul
- Department of Surgery, Post Graduation Program in Surgical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Education and Research (IEP), Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Leandro Totti Cavazzola
- Department of Surgery, Post Graduation Program in Surgical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Department of Education and Research (IEP), Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
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Pascual M, Salvans S, Pera M. Laparoscopic colorectal surgery: Current status and implementation of the latest technological innovations. World J Gastroenterol 2016; 22:704-717. [PMID: 26811618 PMCID: PMC4716070 DOI: 10.3748/wjg.v22.i2.704] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
The introduction of laparoscopy is an example of surgical innovation with a rapid implementation in many areas of surgery. A large number of controlled studies and meta-analyses have shown that laparoscopic colorectal surgery is associated with the same benefits than other minimally invasive procedures, including lesser pain, earlier recovery of bowel transit and shorter hospital stay. On the other hand, despite initial concerns about oncological safety, well-designed prospective randomized multicentre trials have demonstrated that oncological outcomes of laparoscopy and open surgery are similar. Although the use of laparoscopy in colorectal surgery has increased in recent years, the percentages of patients treated with surgery using minimally invasive techniques are still reduced and there are also substantial differences among centres. It has been argued that the limiting factor for the use of laparoscopic procedures is the number of surgeons with adequate skills to perform a laparoscopic colectomy rather than the tumour of patients’ characteristics. In this regard, future efforts to increase the use of laparoscopic techniques in colorectal surgery will necessarily require more efforts in teaching surgeons. We here present a review of recent controversies of the use of laparoscopy in colorectal surgery, such as in rectal cancer operations, the possibility of reproducing complete mesocolon excision, and the benefits of intra-corporeal anastomosis after right hemicolectomy. We also describe the results of latest innovations such as single incision laparoscopic surgery, robotic surgery and natural orifice transluminal endoscopic surgery for colon and rectal diseases.
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The quest for precision in transanal total mesorectal excision. Tech Coloproctol 2015; 20:11-8. [PMID: 26611358 DOI: 10.1007/s10151-015-1405-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/20/2015] [Indexed: 12/18/2022]
Abstract
Transanal total mesorectal excision (TME) is an emerging minimally invasive approach to rectal cancer, with encouraging preliminary results. However, the new surgical anatomy of the bottom-up approach complicates surgical understanding and increases the risks of inadvertent injuries to crucial anatomical structures, including nerves. Key elements to improve the safety and stimulate interest in such a complex technique might be robotics and image guidance, to enhance the level of precision. In this editorial, some of the technologies that could be used for precision TME are outlined, in light of the experience of our Institute for Image-Guided Surgery.
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Keller DS, Flores-Gonzalez JR, Sandhu J, Ibarra S, Madhoun N, Haas EM. SILS v SILS+1: a Case-Matched Comparison for Colorectal Surgery. J Gastrointest Surg 2015; 19:1875-9. [PMID: 26282851 DOI: 10.1007/s11605-015-2921-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/10/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Single-incision laparoscopic surgery (SILS) is safe and feasible for benign and malignant colorectal diseases. SILS has comparable or improved outcomes compared to multiport laparoscopy but technical limitations when operating in the pelvis. To address these limitations, we developed an innovative SILS+1 approach using a single Pfannenstiel incision for pelvis access with one additional umbilical port. Our goal was to compare outcomes for SILS and SILS+1 in lower abdominal and pelvic colorectal surgery. METHODS Review of a prospectively maintained database identified patients who underwent an elective reduced port laparoscopic lower abdominal/pelvic colorectal procedure from 2009 to 2014. Cases were stratified by approach: SILS versus SILS+1 then matched 1:2 on age, gender, body mass index (BMI), comorbidity, and procedure. Demographic, perioperative, and postoperative outcome variables were evaluated. The main outcome measures were operative time, conversion rate, length of stay, complication, morbidity, and mortality rates. RESULTS One hundred thirty-two reduced port AR/LAR patients were evaluated-44 SILS and 88 SILS+1. The groups were similar in age, gender, BMI, and ASA class. The primary diagnosis in both cohorts was diverticulitis (90.9 % SILS, 87.5 % SILS+1), and main procedure performed an anterior rectosigmoidectomy (86.4 % SILS, 88.2 % SILS+1). Significantly more SILS+1 patients had previous abdominal surgery (p = 0.01). The operative time was significantly shorter in SILS+1 (mean 166.6 [SD 48.4] vs. 178.0 [SD 70.0], p = 0.03). The conversion rate to multiport or open surgery was also significantly lower with SILS+1 compared to SILS (1.1 vs. 11.4 %, p = 0.02). Postoperatively, the length of stay across the groups was similar. SILS trended towards higher complication and readmission rates (NS). There were no unplanned reoperations or mortality in either group. CONCLUSIONS SILS+1 facilitates pelvic and lower abdominal colorectal surgery, with shorter operative times and lower conversion rates. The additional port improved visualization and outcomes without any impact on length of stay, readmission, or complication rates.
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Affiliation(s)
| | | | | | | | | | - Eric M Haas
- Colorectal Surgical Associates, Houston, TX, USA. .,Houston Methodist Hospital, Houston, TX, USA. .,Minimally Invasive Colorectal Surgery, University of Texas Medical School, Houston, TX, USA.
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Liu YY, Diana M, Halvax P, Cho S, Légner A, Alzaga A, Swanström L, Dallemagne B, Marescaux J. Flexible endoscopic single-incision extraperitoneal implant and fixation of peritoneal dialysis catheter: proof of concept in the porcine model. Surg Endosc 2014; 29:2402-6. [PMID: 25414067 DOI: 10.1007/s00464-014-3951-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 10/11/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) catheters placed in the pelvic space without anchoring present a high rate of migration. We aimed to assess the feasibility of a single-incision approach, using a flexible endoscopic preperitoneal tunneling for catheter implantation and fixation. MATERIALS AND METHODS Eight pigs were involved in this experimental study. A 2/0 Vicryl loop was sutured at the tip of a PD catheter. In 4 pigs, a 1.5 cm incision was made on the left paramedian line and the parietal peritoneal layer was identified by splitting rectal muscles. A gastroscope was inserted in the incision and advanced in the extraperitoneal space. An exit hole was made in the peritoneum over the low pelvic cavity. A guidewire was left in the abdominal cavity, and the PD catheter was inserted over the guidewire. The endoscope was inserted in the tunnel again, and endoscopic clips were deployed over the Vicryl loop to fix the catheter. In 4 pigs, the PD catheter was inserted laparoscopically using a two-port approach. The catheter's tip was fixed with laparoscopic clips on the Vicryl loop. A strain test to assess the force required to detach clips was performed using a digital dynamometer. RESULTS Operative time for flexible endoscopic tunneling was longer when compared to the laparoscopic implant (29.5 ± 4.43 vs. 22.7 ± 2.51 min). Mean force to displace the catheter was similar after flexible endoscopic fixation when compared to laparoscopic clip fixation (5.57 N ± 2.76 vs. 4.15 N ± 1.76). CONCLUSIONS Flexible endoscopic extraperitoneal tunneling allows for minimally invasive single-incision PD catheter placement and fixation.
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Affiliation(s)
- Yu-Yin Liu
- IRCAD, Digestive and Endocrine Surgery, University of Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France
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Arkenbout EA, Henselmans PWJ, Jelínek F, Breedveld P. A state of the art review and categorization of multi-branched instruments for NOTES and SILS. Surg Endosc 2014; 29:1281-96. [PMID: 25249149 DOI: 10.1007/s00464-014-3816-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 08/12/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Since the advent of Natural Orifice Translumenal Endoscopic Surgery (NOTES) and single incision laparoscopic surgery (SILS), a variety of multitasking platforms have been under development with the objective to allow for bimanual surgical tasks to be performed. These instruments show large differences in construction, enabled degrees of freedom (DOF), and control aspects. METHODS Through a literature review, the absence of an in-depth analysis and structural comparison of these instruments in the literature is addressed. All the designed and prototyped multitasking platforms are identified and categorized with respect to their actively controlled DOF in their shafts and branches. Additionally, a graphical overview of patents, bench test experiments, and animal and/or human trials performed with each instrument is provided. RESULTS The large range of instruments, various actuation strategies, and different direct and indirect control methods implemented in the instruments show that an optimal instrument configuration has not been found yet. Moreover, several questions remain unanswered with respect to which DOF are essential for bimanual tasks and which control methods are best suited for the control of these DOF. CONCLUSIONS Considering the complexity of the currently prototyped and tested instruments, future NOTES and SILS instrument development will potentially necessitate a reduction of the available DOF to minimize the control complexity, thereby allowing for single surgeon bimanual task execution.
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Affiliation(s)
- Ewout A Arkenbout
- Bio-Inspired Technology Group, Biomechanical Engineering Dept., Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD, Delft, The Netherlands,
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15
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Dhumane P, Dallemagne B, Barry B, Perretta S, Leroy J, Mutter D, Marescaux J. Clinical Evaluation of an Internal Adjustable Retractor in Laparoscopic Cholecystectomy. Surg Innov 2014; 21:234-239. [DOI: 10.1177/1553350613517945] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
Introduction. Reducing the number of abdominal incisions in laparoscopic cholecystectomy introduces ergonomic challenges while establishing the critical view during dissection of the triangle of Calot (TC). This study investigates the use of a novel internal retracting device in performing cholecystectomy with a reduced number of ports. Methods. A 3-port laparoscopic cholecystectomy was attempted by 4 surgeons unfamiliar with the novel device. Exposure of the TC was obtained using the internal retractor, which comprises 2 clips, linked by an adjustable thread. One clip is fixed on the gallbladder and the other is fixed to the peritoneum. The endpoint was to evaluate the efficacy and reliability of the device in establishing the critical view of safety. Results. Thirteen patients with a mean body mass index of 25.29 kg/m2(standard deviation = 6.24; range = 17.6-36.7 kg/m2) were included in the study. The critical view was obtained in 10 of 13 patients. Application of the device was completed in a median time of 2.25 minutes without injury of the gallbladder or bile leak. Failure occurred in 3 patients, related to wrong manipulation of the device (2 patients), and correct placement of the device but inadequate exposure (1 patient). A conventional 4-port technique was used in these patients. Operators rated their experience with the device as an “easy-to-operate” device with a good safety profile and without any interference with the operative process. Conclusions. Throughout the minimization process specific to minimal access surgery, internal retractors will certainly allow for a reduction in the number of trocars used in laparoscopic procedures.
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Affiliation(s)
- Parag Dhumane
- IRCAD-EITS Institute, University Hospital of Strasbourg, Strasbourg, France
| | - Bernard Dallemagne
- IRCAD-EITS Institute, University Hospital of Strasbourg, Strasbourg, France
| | - Brian Barry
- IRCAD-EITS Institute, University Hospital of Strasbourg, Strasbourg, France
| | - Silvana Perretta
- IRCAD-EITS Institute, University Hospital of Strasbourg, Strasbourg, France
| | - Joel Leroy
- IRCAD-EITS Institute, University Hospital of Strasbourg, Strasbourg, France
| | - Didier Mutter
- IRCAD-EITS Institute, University Hospital of Strasbourg, Strasbourg, France
| | - Jacques Marescaux
- IRCAD-EITS Institute, University Hospital of Strasbourg, Strasbourg, France
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Cianchi F, Staderini F, Badii B. Single-incision laparoscopic colorectal surgery for cancer: State of art. World J Gastroenterol 2014; 20:6073-6080. [PMID: 24876729 PMCID: PMC4033446 DOI: 10.3748/wjg.v20.i20.6073] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 12/05/2013] [Accepted: 02/20/2014] [Indexed: 02/06/2023] Open
Abstract
A number of clinical trials have demonstrated that the laparoscopic approach for colorectal cancer resection provides the same oncologic results as open surgery along with all clinical benefits of minimally invasive surgery. During the last years, a great effort has been made to research for minimizing parietal trauma, yet for cosmetic reasons and in order to further reduce surgery-related pain and morbidity. New techniques, such as natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopy (SIL) have been developed in order to reach the goal of “scarless” surgery. Although NOTES may seem not fully suitable or safe for advanced procedures, such as colectomies, SIL is currently regarded as the next major advance in the progress of minimally invasive surgical approaches to colorectal disease that is more feasible in generalized use. The small incision through the umbilicus allows surgeons to use familiar standard laparoscopic instruments and thus, perform even complex procedures which require extraction of large surgical specimens or intestinal anastomosis. The cosmetic result from SIL is also better because the only incision is made through the umbilicus which can hide the wound effectively after operation. However, SIL raises a number of specific new challenges compared with the laparoscopic conventional approach. A reduced capacity for triangulation, the repeated conflicts between the shafts of the instruments and the difficulties to achieve a correct exposure of the operative field are the most claimed issues. The use therefore of this new approach for complex colorectal procedures might understandingly be viewed as difficult to implement, especially for oncologic cases.
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17
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Gan P. A novel liver retractor for reduced or single-port laparoscopic surgery. Surg Endosc 2013; 28:331-5. [PMID: 24061620 DOI: 10.1007/s00464-013-3178-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 08/08/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Retraction of either lobe of liver is required for surgical access to the respective organ. A novel liver retractor device and technique is described, which applies a vacuum between the liver and diaphragm to lift the liver, and which does not require additional incisions. METHODS A novel liver retractor was tested in two anesthetized sheep at incrementally higher levels of suction from -100 to -700 mmHg (-13 to -93 kPa), and any signs of trauma were recorded. The animals recovered for 5 days, then were humanely killed and postmortem examination of the liver and diaphragms performed. RESULTS Successful liver retraction was achieved from -200 to -600 mmHg (-27 to -80 kPa) suction. An imprint of the retractor was observed on the liver surface, but there was no breach of the liver serosa. Negligible ecchymoses were observed on the corresponding surface of the diaphragms. Both sheep recovered well after surgery. There was no macroscopic evidence of injury to the liver and diaphragm 5 days postoperatively. Histological examination revealed normal liver parenchyma deep to the site where the devices had been placed, and hemorrhagic changes within the serosa only varied between a few microns to a maximum of 1.4-mm depth. CONCLUSIONS The novel liver retractor described achieved an effective liver retraction without trauma. It has potential application in reduced or single-port laparoscopic upper abdominal surgery.
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Affiliation(s)
- Philip Gan
- St John of God Healthcare & Southwest Healthcare, Suite 7, 136 Botanic Road, Warrnambool, VIC, 3280, Australia,
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18
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Endoluminal surgical triangulation: overcoming challenges of colonic endoscopic submucosal dissections using a novel flexible endoscopic surgical platform: feasibility study in a porcine model. Surg Endosc 2013; 27:4130-5. [PMID: 23793807 DOI: 10.1007/s00464-013-3049-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 05/23/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Colonic endoscopic submucosal dissection (ESD) is challenging as a result of the limited ability of conventional endoscopic instruments to achieve traction and exposure. The aim of this study was to evaluate the feasibility of colonic ESD in a porcine model using a novel endoscopic surgical platform, the Anubiscope (Karl Storz, Tüttlingen, Germany), equipped with two working channels for surgical instruments with four degrees of freedom offering surgical triangulation. METHODS Nine ESDs were performed by a surgeon without any ESD experience in three swine, at 25, 15, and 10 cm above the anal verge with the Anubiscope. Sixteen ESDs were performed by an experienced endoscopist in five swine using conventional endoscopic instruments. Major ESD steps included the following for both groups: scoring the area, submucosal injection of glycerol, precut, and submucosal dissection. Outcomes measured were as follows: dissection time and speed, specimen size, en bloc dissection, and complications. RESULTS No perforations occurred in the Anubis group, while there were eight perforations (50 %) in the conventional group (p = 0.02). Complete and en bloc dissections were achieved in all cases in the Anubis group. Mean dissection time for completed cases was statistically significantly shorter in the Anubis group (32.3 ± 16.1 vs. 55.87 ± 7.66 min; p = 0.0019). Mean specimen size was higher in the conventional group (1321 ± 230 vs. 927.77 ± 229.96 mm(2); p = 0.003), but mean dissection speed was similar (35.95 ± 18.93 vs. 23.98 ± 5.02 mm(2)/min in the Anubis and conventional groups, respectively; p = 0.1). CONCLUSIONS Colonic ESDs were feasible in pig models with the Anubiscope. This surgical endoscopic platform is promising for endoluminal surgical procedures such as ESD, as it is user-friendly, effective, and safe.
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Single-access laparoscopic rectal surgery is technically feasible. Minim Invasive Surg 2013; 2013:687134. [PMID: 23577248 PMCID: PMC3615606 DOI: 10.1155/2013/687134] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 02/24/2013] [Indexed: 01/21/2023] Open
Abstract
Introduction. Single-access laparoscopic surgery (SALS) has been successfully introduced for colectomy surgery; however, for mid to low rectum procedures such as total mesorectal excision, it can be technically complicated. In this study, we introduced a single-access technique for rectum cancer operations without the use of other instruments. Aims. To show the short-term results of single-access laparoscopic rectal surgery in terms of pathologic results and immediate complications. Settings and Design. Prospective study. Materials and Methods. We selected middle rectum to anal canal cancer patients to undergo single-access laparoscopic rectal resection for rectal cancer. All patients had total mesorectal excisions. An umbilical incision was made for the insertion of a single multichannel port, and a mesocolic window was created to identify the inferior mesenteric artery and vein. Total mesorectal excision was performed. There were no perioperative complications. The mean operative time was 269 minutes; the median hospital stay was 7 days; the mean wound size was 5.5 cm; the median number of harvested lymph nodes was 15; and all patients had intact mesorectal capsules. Statistical Analysis Used. Mean, minimum–maximum. Conclusion. Single-access laparoscopic surgery for rectal cancer is feasible while oncologic principles and patient safety are maintained.
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Gultepe E, Randhawa JS, Kadam S, Yamanaka S, Selaru FM, Shin EJ, Kalloo AN, Gracias DH. Biopsy with thermally-responsive untethered microtools. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2013; 25:514-9. [PMID: 23047708 PMCID: PMC3832625 DOI: 10.1002/adma.201203348] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 09/13/2012] [Indexed: 05/18/2023]
Abstract
Thermally activated, untethered microgrippers can reach narrow conduits in the body and be used to excise tissue for diagnostic analyses. As depicted in the figure, the feasibility of an in vivo biopsy of the porcine bile duct using untethered microgrippers is demonstrated.
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Affiliation(s)
- Evin Gultepe
- Department of Chemical and Biomolecular Engineering, The Johns Hopkins University, Baltimore, MD 21218, USA
| | - Jatinder S. Randhawa
- Department of Chemical and Biomolecular Engineering, The Johns Hopkins University, Baltimore, MD 21218, USA
| | - Sachin Kadam
- Department of Chemical and Biomolecular Engineering, The Johns Hopkins University, Baltimore, MD 21218, USA
| | - Sumitaka Yamanaka
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA
| | - Florin M. Selaru
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA
| | - Eun J. Shin
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA
| | - Anthony N. Kalloo
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA
| | - David H. Gracias
- Department of Chemical and Biomolecular Engineering, The Johns Hopkins University, Baltimore, MD 21218, USA. Department of Chemistry, The Johns Hopkins University, Baltimore, MD 21218, USA
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Chittawar PB, Magon N, Bhandari S. Laparoendoscopic single-site surgery in gynecology: LESS is actually how much less? J Midlife Health 2013; 4:46-51. [PMID: 23833535 PMCID: PMC3702066 DOI: 10.4103/0976-7800.109638] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Gynecological surgery is evolving continuously. Laparoendoscopic single-site surgery (LESS) is the recent addition in this field that stands to benefit almost 40% of women in midlife who will eventually undergo adnexal surgery or hysterectomy. Carried out through a single umbilical incision, the potential benefit of single site surgery is improvement in operative morbidity and cosmesis. The safety, feasibility and efficacy of laparoendoscopic single site procedures have been established in studies over the last few years. In this article, we will review the nomenclature, instruments, and the evidence around the commonly performed gynecologic surgeries using the LESS procedure.
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Affiliation(s)
- Priya Bhave Chittawar
- Department of Reproductive Medicine, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
| | - Navneet Magon
- Department of Obstetrics and Gynaecology, Air Force Hospital, Kanpur, Uttar Pradesh, India
| | - Shilpa Bhandari
- Department of Reproductive Medicine, Sri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
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Cianchi F, Qirici E, Trallori G, Mallardi B, Badii B, Perigli G. Single-incision laparoscopic colectomy: technical aspects and short-term results. Updates Surg 2012; 64:19-23. [PMID: 21976113 DOI: 10.1007/s13304-011-0112-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 09/16/2011] [Indexed: 02/07/2023]
Abstract
Single-incision laparoscopic surgery (SILS) is currently regarded as the next major advance in the progress of minimally invasive techniques in colorectal surgery. We describe our initial experience using SILS for the management of colorectal disease and present preliminary short-term results. Between February 2010 and April 2011, 7 patients (4 females and 3 males, mean age 55 years, range 32–74) underwent SILS for either benign or malignant colorectal disease. Preoperative diagnosis was diverticular disease of the sigmoid colon in two patients, malignant polyps of the sigmoid colon in two other patients and large villous tumor of the right colon in three patients. Surgical procedures, 4 anterior resections of the rectum and 3 right hemicolectomies, were performed through a 3 cm single umbilical incision using a SILS multi port device with conventional or articulated laparoscopic instruments. There were no intraoperative complications or conversions in the standard laparoscopic procedure. The mean operative time for anterior resections was 160.0 ± 10.6 min, whereas it was 160.6 ± 20 for right hemicolectomies. Blood loss was minimal. No postoperative complications were reported in any of the patients. The overall mean hospital stay was 4.8 ± 0.2 days (range 4–5). For the subset of patients with malignant or pre-malignant disease, the mean number of retrieved lymph nodes was 15.6 ± 4.4 (range 6–31). Cosmetic results were considered excellent by all the patients after 15 days. In conclusion, our preliminary experience shows that SILS for colorectal disease is feasible and safe with potential reproducible oncologic results.
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Affiliation(s)
- Fabio Cianchi
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy.
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23
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Abstract
The authors suggest that minilaparoscopy should be considered as the most sophisticated evolution of laparoscopic surgery at the present time.
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Randall CL, Gultepe E, Gracias DH. Self-folding devices and materials for biomedical applications. Trends Biotechnol 2012; 30:138-46. [PMID: 21764161 PMCID: PMC3288299 DOI: 10.1016/j.tibtech.2011.06.013] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 06/05/2011] [Accepted: 06/16/2011] [Indexed: 01/10/2023]
Abstract
Because the native cellular environment is 3D, there is a need to extend planar, micro- and nanostructured biomedical devices to the third dimension. Self-folding methods can extend the precision of planar lithographic patterning into the third dimension and create reconfigurable structures that fold or unfold in response to specific environmental cues. Here, we review the use of hinge-based self-folding methods in the creation of functional 3D biomedical devices including precisely patterned nano- to centimeter scale polyhedral containers, scaffolds for cell culture and reconfigurable surgical tools such as grippers that respond autonomously to specific chemicals.
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Affiliation(s)
- Christina L Randall
- Department of Biomedical Engineering, The Johns Hopkins University, Baltimore, MD 21205, USA
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