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Ross SB, Sucandy I, Vasanthakumar P, Christodoulou M, Pattilachan TM, Syblis C, Rosemurgy A. Is the robotic approach the future of distal pancreatectomy with splenectomy? A propensity score matched analysis. J Robot Surg 2024; 18:148. [PMID: 38564045 DOI: 10.1007/s11701-024-01906-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024]
Abstract
Our study provides a comparative analysis of the Laparo-Endoscopic Single Site (LESS) and robotic surgical approaches for distal pancreatectomy and splenectomy, examining their cosmetic advantages, patient outcomes, and operative efficiencies through propensity score matching (PSM). We prospectively followed 174 patients undergoing either the LESS or robotic procedure, matched by cell type, tumor size, age, sex, and BMI from 2012 to 2023. Propensity score matching (PSM) was utilized for data adjustment, with results presented as median (mean ± SD). Post-PSM analysis showed no significant differences in age or BMI between the two groups. LESS approach exhibited a shorter operative duration (180(180 ± 52.0) vs. 248(262 ± 78.5) minutes, p = 0.0002), but increased estimated blood loss (200(317 ± 394.4) vs. 100 (128 ± 107.2) mL, p = 0.04). Rates of intraoperative and postoperative complications, length of hospital stay, readmissions within 30 days, in-hospital mortalities, and costs were comparably similar between the two procedures. While the robotic approach led to lower blood loss, LESS was more time-efficient. Patient outcomes were similar in both methods, suggesting that the choice between these surgical techniques should balance cosmetic appeal with technical considerations.
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Affiliation(s)
- Sharona B Ross
- Digestive Health Institute AdventHealth Tampa, Tampa, FL, USA.
| | - Iswanto Sucandy
- Digestive Health Institute AdventHealth Tampa, Tampa, FL, USA
| | - Prakash Vasanthakumar
- Digestive Health Institute AdventHealth Tampa, Tampa, FL, USA
- University of South Florida Morsani College of Medicine Tampa, Tampa, FL, USA
| | | | | | - Cameron Syblis
- Digestive Health Institute AdventHealth Tampa, Tampa, FL, USA
- University of South Florida Morsani College of Medicine Tampa, Tampa, FL, USA
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Ross SB, Sucandy I, Trotto M, Christodoulou M, Pattilachan TM, Jattan J, Rosemurgy AS. A decade of experience with minimally invasive anti-reflux operations: robot vs. LESS. Surg Endosc 2024:10.1007/s00464-024-10771-5. [PMID: 38503903 DOI: 10.1007/s00464-024-10771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/24/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND The increasing use of robotic systems for anti-reflux operations prompted this study to evaluate and compare the efficacy of robotic and Laparo-Endoscopic Single-Site (LESS) approaches. METHODS From 2012, 228 robotic fundoplication and 518 LESS fundoplication patients were prospectively followed, analyzing perioperative metrics. Data are presented as median (mean ± SD); significance at p ≤ 0.05. RESULTS Patients undergoing a robotic vs. LESS fundoplication were 67 (64 ± 13.7) vs. 61 (59 ± 15.1) years-old with BMIs of 25 (25 ± 3.2) vs. 26 (25 ± 3.9) kg/m2 (p = 0.001 and 1.00, respectively). 72% of patients who underwent the robotic approach had a previous abdominal operation(s) vs 44% who underwent the LESS approach (p = 0.0001). 38% vs. 8% had a re-operative fundoplication (p = 0.0001), 59% vs. 45% had a type IV hiatal hernia (p = 0.0004). Operative duration was 160 (176 ± 76.7) vs. 130 (135 ± 50.5) min (p = 0.0001). There were 0 (robotic) vs. 5 (LESS) conversions to a different approach (p = 0.33). 5 Patients vs. 3 patients experienced postoperative complications (p = 0.06), and length of stay (LOS) was 1 (2 ± 2.6) vs. 1 (1 ± 3.2) days (p = 0.0001). Patient symptomatic dysphagia preoperatively for the robotic vs. LESS approach was scored as 2 (2.4 ± 1.9) vs. 1 (1.9 ± 1.6). Postoperatively, symptomatic dysphagia was scored as 1 (1.5 ± 1.6) vs. 1 (1.7 ± 1.7). The change in these scores was - 1 (- 1 ± 2.2) vs. 0 (- 0.5 ± 2.2) (p = 0.004). CONCLUSION Despite longer operative times and LOS in older patients, the robotic approach is efficient in undertaking very difficult operations, including patients with type IV or recurrent hiatal hernias. Furthermore, preoperative anti-reflux operations were more likely to be undertaken with the robotic approach than the LESS approach. The patient's postoperative symptomatic dysphagia improved relatively more than after the LESS approach. The vast majority of patients who underwent the LESS approach enjoyed improved cosmesis, thus, making LESS a stronger candidate for more routine operations. Despite patient selection bias, the robotic and LESS approaches to anti-reflux operations are safe, efficacious, and should be situationally utilized.
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Affiliation(s)
- Sharona B Ross
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite #500, Tampa, FL, 33613, USA.
| | - Iswanto Sucandy
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite #500, Tampa, FL, 33613, USA
| | - Michael Trotto
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite #500, Tampa, FL, 33613, USA
| | - Maria Christodoulou
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite #500, Tampa, FL, 33613, USA
| | - Tara M Pattilachan
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite #500, Tampa, FL, 33613, USA
| | - Jenna Jattan
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite #500, Tampa, FL, 33613, USA
| | - Alexander S Rosemurgy
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite #500, Tampa, FL, 33613, USA
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Vazquez-Martul D, Ponce Diaz-Reixa JL, Barbagelata-Lopez A, Chantada-Abal V. Single-port robot-assisted retroperitoneal surgery: A feasible approach. Actas Urol Esp 2022; 46:653-7. [PMID: 36272961 DOI: 10.1016/j.acuroe.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/30/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The concept of surgery through a single incision has been pursued in the field of minimal invasion for the treatment of different pathologies. This, added to a retroperitoneal approach, implies less aggression for the patient at different levels. We describe the first cases of single-port robot-assisted retroperitoneal surgery (SP-RARS) in our country using the da Vinci Xi® system. MATERIAL AND METHODS We present two cases of patients with right adrenal masses larger than 4 cm. The first case was a 55-year-old woman with an incidental diagnosis of angiomyolipoma, and the second case was a 62-year-old man with a non-functioning adrenal adenoma. Both cases were operated through a single 4-cm subcostal incision using the da Vinci Xi® system, annulling arm 4 without reallocating laterality on the surgeon's console. RESULTS Both surgeries were performed with console times of 75 and 150 min, respectively, with access and docking times below 30 min. Bleeding was less than 100 cc in both surgeries without the need to make accessory incisions or leave a drainage tube. The surgical specimens were removed through the same initial incision without the need for enlargement. Postoperative intravenous analgesia was not necessary in any case (VAS 0) and hospital stay was less than 24 h in both patients without reporting any complications. CONCLUSIONS SP-RARS is a feasible approach using the da Vinci Xi® system.
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Xu J, Zhou Z, Chen K, Ding Y, Hua Y, Ren M, Shen Y. How to minimize the impact of COVID-19 on laparoendoscopic single-site surgery training? ANZ J Surg 2022; 92:2102-2108. [PMID: 35594058 PMCID: PMC9347803 DOI: 10.1111/ans.17819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 05/05/2022] [Accepted: 05/15/2022] [Indexed: 11/28/2022]
Abstract
Background Because of special technical challenges, laparoendoscopic single‐site surgery (LESS) has been introduced into surgical practice, with surgeons required to have adequate training. The COVID‐19 pandemic has significantly affected every aspect of healthcare systems, including LESS training, which must be modified to minimize the impact of the COVID‐19 pandemic. Methods A 3‐session training programme was designed in 2020 during the epidemic, which was modified in 2019 before the pandemic. Session 1 was an online study on LESS knowledge. Session 2 involved the trainees' self‐directed simulator‐training. Task performance was evaluated using the fundamentals of laparoscopic surgery (FLS) scoring. Session 3 was practical training, including trainers' live surgical video demonstrations and trainees' surgical video feedback after training. Video feedback performance was evaluated using the modified global rating scale (GRS). Furthermore, trainees completed a general self‐efficacy (GSE) instrument. Forty‐two gynaecology trainees were allocated into two groups: novices (n = 32) and experts (n = 10). Results Compared with pre‐training, FLS scores improved in peg transfer (P < 0.001 and P = 0.01) and pattern cutting (P = 0.02 and P < 0.001) for novices and experts, respectively. Participants (81% versus 67%) provided first and second video feedback, respectively. Compared to the first feedback, the GRS scores of both groups improved significantly in the second feedback. All trainees showed an increase in GSE after training (P < 0.001). Conclusion The modified LESS training programme is a practical and effective option that allows trainees to continue training during the epidemic.
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Affiliation(s)
- Jingyun Xu
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zhihao Zhou
- Department of Emergency, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Kai Chen
- Section of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Howard University Hospital, Howard University College of Medicine, Washington, District of Columbia, USA
| | - Yue Ding
- Department of Obstetrics and Gynecology, School of Medicine, Southeast University, Nanjing, China
| | - Yue Hua
- Department of Obstetrics and Gynecology, School of Medicine, Southeast University, Nanjing, China
| | - Mulan Ren
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yang Shen
- Department of Obstetrics and Gynecology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Arroyo Tristán A. Splitting the imaging system from the laparoendoscopic single site surgery device in endoscopic uniportal surgery: ZEUS project. Cir Esp 2022; 100:161-170. [PMID: 35219645 DOI: 10.1016/j.cireng.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/10/2021] [Indexed: 06/14/2023]
Abstract
The use of a rigid tube endoscope (RTE) through a laparoendoscopic single site surgery device for intracavitary visualization during endoscopic uniportal surgery (EUS) is directly related to the fulcrum effect and physical competition (externally between surgeons and on instrumentation through the single port). These facts may have precluded a wider spread of EUS. In an attempt to separate the imaging system from the laparoendoscopic single site surgery device, a tiered project (3 models) that can help overcome these drawbacks is detailed. ZEUS1, a new non-RTE imaging system device for EUS was successfully tested in EUS surgery in a pig model. Still under investigation, ZEUS2 becomes a wired structure that serves as the basis for an endoscopic microcamera with intracavitary pan-tilt-zoom functions. ZEUS3 uses the inner ring of the surgical wound protector as a microchamber crown. Further studies are needed to materialize the ZEUS2 and ZEUS3 models and confirm their efficacy and safety.
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Affiliation(s)
- Andrés Arroyo Tristán
- Servicio de Cirugía de Tórax, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
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Vazquez-Martul D, García-Expósito MA, Rodríguez-Rey S, García-Sobrino R, Barbagelata-López A, Ponce Díaz-Reixa JL, Chantada-Abal V. Single-port retroperitoneoscopic adrenalectomy: Initial experience and standardization of the technique. Actas Urol Esp 2021; 45:609-614. [PMID: 34764053 DOI: 10.1016/j.acuroe.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/18/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION AND OBJECTIVE The minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain. MATERIAL AND METHODS We collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3-4 cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment. RESULTS From December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6 ± 16.3 min, with <150 mL bleeding, mean length of stay of 35.8 ± 13.3 h and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8 ± 18 mm. No complications were reported according to the Clavien-Dindo scale. CONCLUSIONS Even in initially adverse cases, SPORS adrenalectomy is a feasible and safe technique with good cosmetic and perioperative results.
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Affiliation(s)
- D Vazquez-Martul
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
| | - M A García-Expósito
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - S Rodríguez-Rey
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - R García-Sobrino
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - A Barbagelata-López
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J L Ponce Díaz-Reixa
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - V Chantada-Abal
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
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Arroyo Tristán A. Splitting the imaging system from the laparoendoscopic single site surgery device in endoscopic uniportal surgery: ZEUS project. Cir Esp 2021; 100:S0009-739X(21)00246-3. [PMID: 34493374 DOI: 10.1016/j.ciresp.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/30/2021] [Accepted: 07/10/2021] [Indexed: 11/29/2022]
Abstract
The use of a rigid tube endoscope (RTE) through a laparoendoscopic single site surgery device for intracavitary visualization during endoscopic uniportal surgery (EUS) is directly related to the fulcrum effect and physical competition (externally between surgeons and on instrumentation through the single port). These facts may have precluded a wider spread of EUS. In an attempt to separate the imaging system from the laparoendoscopic single site surgery device, a tiered project (3 models) that can help overcome these drawbacks is detailed. ZEUS1, a new non-RTE imaging system device for EUS was successfully tested in EUS surgery in a pig model. Still under investigation, ZEUS2 becomes a wired structure that serves as the basis for an endoscopic microcamera with intracavitary pan-tilt-zoom functions. ZEUS3 uses the inner ring of the surgical wound protector as a microchamber crown. Further studies are needed to materialize the ZEUS2 and ZEUS3 models and confirm their efficacy and safety.
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Affiliation(s)
- Andrés Arroyo Tristán
- Servicio de Cirugía de Tórax, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
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8
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Vazquez-Martul D, García-Expósito MA, Rodríguez-Rey S, García-Sobrino R, Barbagelata-López A, Ponce Díaz-Reixa JL, Chantada-Abal V. Single-port retroperitoneoscopic adrenalectomy: Initial experience and standardization of the technique. Actas Urol Esp 2021; 45:S0210-4806(21)00086-3. [PMID: 34127287 DOI: 10.1016/j.acuro.2021.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/10/2021] [Accepted: 04/18/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVE The minimally invasive surgical approach to adrenal gland pathology is the most widely used nowadays, and retroperitoneoscopy occupies a relevant place. However, the evolution of these techniques towards even less invasive surgery through single-port access is anecdotal. The aim of this work is to describe our initial experience in single-port retroperitoneoscopic surgery (SPORS) of the adrenal gland focusing on perioperative data and postoperative pain. MATERIAL AND METHODS We collected and analyzed the demographic and operative data of a series of patients undergoing adrenalectomy through SPORS. All procedures were performed through a single 3-4cm subcostal incision with a multichannel port. Surgical data such as operative time, bleeding, length of stay and presence of complications were collected. We used the visual analog scale (VAS) for postoperative pain assessment. RESULTS From December 2018 to August 2020, 6 patients with different types of adrenal pathology underwent consecutive surgeries in our Department by the same surgeon using SPORS. All surgeries were performed without requiring accessory trocar placement or reconversion to open surgery. The mean operative time was 91.6±16.3minutes, with <150mL bleeding, mean length of stay of 35.8±13.3hours and postoperative pain of VAS ≤3 (median 0.5). The mean size of specimens was 57.8±18mm. No complications were reported according to the Clavien-Dindo scale. CONCLUSIONS Even in initially adverse cases, SPORS adrenalectomy is a feasible and safe technique with good cosmetic and perioperative results.
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Affiliation(s)
- D Vazquez-Martul
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, España.
| | - M A García-Expósito
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - S Rodríguez-Rey
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - R García-Sobrino
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - A Barbagelata-López
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - J L Ponce Díaz-Reixa
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
| | - V Chantada-Abal
- Servicio de Urología, Complejo Hospitalario Universitario A Coruña, A Coruña, España
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Garisto J, Bertolo R, Reese SW, Bove P, Kaouk J. Minimizing minimally invasive surgery: Current status of the single-port robotic surgery in Urology. Actas Urol Esp 2021; 45:345-52. [PMID: 34088433 DOI: 10.1016/j.acuroe.2021.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/07/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The novel da Vinci Single-Port (SP) robotic platform received the US FDA approval in 2018. The device, specifically conceived for single-site approach, is pushing through the limits of minimally invasive surgery. We sought to provide a comprehensive overview of the current status of the clinical experiences accomplished by the da Vinci SP in urology, and to discuss future perspectives. METHODS A non-systematic literature review was performed focusing on single port articles in urological surgery using Medline/PubMed and Embase search electronic engines. The authors analyzed findings and a brief report of the clinical experience for surgical procedures completed by the SP platform was described. RESULTS The current data available from single-port robotic established the safety and feasibility of urologic procedures using this novel platform. However, the results come from single-center case series, small cohorts and retrospective studies that need to be cautiously interpreted. Additional evidence is required to determine the asset of the SP platform in the urological community. CONCLUSIONS The SP robotic system opens new frontiers on the surgical scenery facilitating the completion of urological surgeries through a single incision. Further comparative studies will be required to assess perioperative and long-term oncological and functional outcomes among SP, multi-arm robotic and open approaches.
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Kaneko G, Hattori S, Shirotake S, Kanao K, Hara S, Oyama M. Laparoendoscopic single-site simple nephrectomy and reduced port procedure for inflammatory nonfunctioning kidney. IJU Case Rep 2021; 4:184-187. [PMID: 33977255 PMCID: PMC8088899 DOI: 10.1002/iju5.12278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION To describe laparoendoscopic single-site simple nephrectomy and reduced port simple nephrectomy for inflammatory nonfunctioning kidney. CASE PRESENTATION Case 1: a 58-year-old female with fever was referred to our hospital. Computed tomography demonstrated a markedly atrophic right kidney and mild hydronephrosis. Case 2: a 64-year-old male with a history of several intra-abdominal surgeries visited our hospital with a complaint of left back pain and fever. Computed tomography demonstrated left marked hydronephrosis, thinning of renal parenchyma, and duplicated inferior vena cava. After antibiotic treatment, transperitoneal reduced port simple nephrectomy and retroperitoneal laparoendoscopic single-site simple nephrectomy were performed in Case 1 and 2, respectively, because the function of the affected kidney was almost lost on renography. Although adhesion was slightly noted around the renal hilum in Case 1, neither conversion to laparotomy nor placement of additional ports was needed. CONCLUSION Laparoendoscopic single-site simple nephrectomy and reduced port simple nephrectomy for inflammatory nonfunctioning kidney may be options for experienced laparoscopic surgeons.
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Affiliation(s)
- Go Kaneko
- Department of Uro‐OncologySaitama Medical University International Medical CenterHidakaSaitamaJapan
| | - Seiya Hattori
- Department of UrologyKawasaki Municipal HospitalKawasakiKanagawaJapan
| | - Suguru Shirotake
- Department of Uro‐OncologySaitama Medical University International Medical CenterHidakaSaitamaJapan
| | - Kent Kanao
- Department of Uro‐OncologySaitama Medical University International Medical CenterHidakaSaitamaJapan
| | - Satoshi Hara
- Department of UrologyKawasaki Municipal HospitalKawasakiKanagawaJapan
| | - Masafumi Oyama
- Department of Uro‐OncologySaitama Medical University International Medical CenterHidakaSaitamaJapan
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Li CC, Chien TM, Lee MR, Lee HY, Ke HL, Wen SC, Chou YH, Wu WJ. Extraperitoneal Robotic Laparo-Endoscopic Single-Site Plus1-Port Radical Prostatectomy Using the da Vinci Single-Site Platform. J Clin Med 2021; 10:jcm10081563. [PMID: 33917705 PMCID: PMC8068145 DOI: 10.3390/jcm10081563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022] Open
Abstract
Currently, over 80% of radical prostatectomies have been performed with the da Vinci Surgical System. In order to improve the aesthetic outlook and decrease the morbidity of the operation, the new da Vinci Single Port (SP) system was developed in 2018. However, one major problem is the SP system is still not available in most countries. We aim to present our initial experience and show the safety and feasibility of the single-site robotic-assisted radical prostatectomy (LESS-RP) using the da Vinci Single-Site platform. From June 2017 to January 2020, 120 patients with localized prostate cancer (stage T1–T3b) at Kaohsiung Medical University Hospital were included in this study. We describe our technique and report our initial results of LESS-RP using the da Vinci Si robotic system. Preoperative, intraoperative and postoperative patient variables were recorded. Prostate-specific antigen (PSA)-free survival was also analyzed. A total of 120 patients were enrolled in the study. The median age of patients was 68 years (IQR 63–71), with a median body mass index of 25 kg/m2 (IQR 23–27). The median PSA value before operation was 10.7 ng/mL (IQR 7.9–21.1). The median setup time for creat-ing the extraperitoneal space and ports document was 25 min (IQR 18–34). The median robotic console time and operation time were 135 min (IQR 110–161) and 225 min (IQR 197–274), respectively. Median blood loss was 365 mL (IQR 200–600). There were 11 (9.2%) patients who experienced complications (Clavien–Dindo classification Gr II). The me-dian catheter duration was 8 days (IQR 7–9), with a median of 10 days (IQR 7–11) of hospital stay. The PSA free-survival rate was 86% at a median 19 months (IQR 6–28) of follow up. Robotic radical prostatectomy using the da Vinci Single-Site platform system is safe and feasible, with acceptable outcomes.
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Affiliation(s)
- Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-C.L.); (M.-R.L.); (H.-L.K.); (S.-C.W.); (Y.-H.C.)
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80756, Taiwan;
| | - Tsu-Ming Chien
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-C.L.); (M.-R.L.); (H.-L.K.); (S.-C.W.); (Y.-H.C.)
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Correspondence: (T.-M.C.); (W.-J.W.); Tel.: +886-7-320-8212 (T.-M.C. & W.-J.W.)
| | - Ming-Ru Lee
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-C.L.); (M.-R.L.); (H.-L.K.); (S.-C.W.); (Y.-H.C.)
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Hsiang-Ying Lee
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung 80756, Taiwan;
| | - Hung-Lung Ke
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-C.L.); (M.-R.L.); (H.-L.K.); (S.-C.W.); (Y.-H.C.)
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Sheng-Chen Wen
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-C.L.); (M.-R.L.); (H.-L.K.); (S.-C.W.); (Y.-H.C.)
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Yii-Her Chou
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-C.L.); (M.-R.L.); (H.-L.K.); (S.-C.W.); (Y.-H.C.)
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan; (C.-C.L.); (M.-R.L.); (H.-L.K.); (S.-C.W.); (Y.-H.C.)
- Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Correspondence: (T.-M.C.); (W.-J.W.); Tel.: +886-7-320-8212 (T.-M.C. & W.-J.W.)
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Huang Y, Duan K, Koythong T, Patil NM, Fan D, Liu J, Guan Z, Guan X. Application of robotic single-site surgery with optional additional port for endometriosis: a single institution's experience. J Robot Surg 2021. [PMID: 33651315 DOI: 10.1007/s11701-021-01217-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022]
Abstract
To evaluate the safety and feasibility of treating stage I-IV endometriosis patients with robotic single-site surgery (RSSS). A retrospective chart review was conducted on 334 patients with endometriosis treated by a single surgeon at a university hospital from January 2015 to November 2019. Surgeries were performed in a single institution between 2015 and 2019. All patients presented with pelvic pain and underwent surgical resection of the lesion. American Society of Reproductive Medicine (ASRM) standards were used to classify endometriosis. The primary goal of this study is to investigate the feasibility and safety of RSSS for surgical resection of stage I-IV endometriosis patients. We will compare patient characteristics and surgical parameters, such as blood loss, operating time, and postoperative complications, across different endometriosis stages to evaluate the effectiveness of this novel technique. RSSS was used for all cases, with no conversions to laparotomy or traditional laparoscopy. One to two additional ports were placed in 41 patients with deeply infiltrating endometriosis (DIE) involving the colorectal and urinary tract and/or extensive pelvic adhesions. Across patient groups, there were no significant differences in age, BMI, fertility history, abdominal surgery history, and hysterectomy ratio (P > 0.05). The median operation time was 140.25 min (range: 85.50-260.00 min, P < 0.05) and median blood loss was 31.25 mL (range: 15-100 mL, P < 0.05). Histopathology supported the diagnosis in 259/334 patients. The undiagnosed patients were associated with lower ASRM scores. For 83.3% of patients (295/334), the length of hospital stay was < 24 h. The postoperative complication rate was 6.0% (20/334), although only two cases were severe. Our results indicate that RSSS is an alternative, safe, and acceptable platform for the surgical treatment of all stages of endometriosis.
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Marchand GJ, Azadi A, Anderson S, Ruther S, Hopewell S, Brazil G, Sainz K, Wolf H, King A, Vallejo J, Ware K, Cieminski K, Galitsky A. LESS hysterectomy through a bluntly created 11 mm incision. J Turk Ger Gynecol Assoc 2021; 22:76-79. [PMID: 33146476 PMCID: PMC7944236 DOI: 10.4274/jtgga.galenos.2020.2020.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In the field of minimally invasive surgery, there is a constant drive to devise and execute the most minimally invasive surgeries possible. By the very nature of laparoscopy and robotic surgery, what one can accomplish with several ports of a given size will invariably be studied and attempted with fewer ports and with ports of smaller sizes. After researching the literature, we were not able to find any single port hysterectomies performed through a port size of smaller than 15 mm. We were able to perform, described here, a technique for performing laparoscopic hysterectomy through a single port of only 11 mm in diameter. We illustrate the technique in the accompanying video and believe the technique to be safe and reproducible.
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Affiliation(s)
- Greg J. Marchand
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Ali Azadi
- Department of Urogynecology, Star Urogynecology Advanced Pelvic Health Institute for Women, Arizona, United States of America
| | - Sienna Anderson
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Stacy Ruther
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Sophia Hopewell
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Giovanna Brazil
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Katelyn Sainz
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America,Washington University of Health and Science School of Medicine, San Pedro, Belize
| | - Hannah Wolf
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Alexa King
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Jannelle Vallejo
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America,Washington University of Health and Science School of Medicine, San Pedro, Belize
| | - Kelly Ware
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America,International University of Health Sciences School of Medicine, Basseterre, Saint Kitts and Nevis
| | - Kaitlynne Cieminski
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
| | - Anthony Galitsky
- Department of Minimally Invasive Surgery, The Marchand Institute for Minimally Invasive Surgery, Mesa, United States of America
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Garisto J, Bertolo R, Reese S, Bove P, Kaouk J. Minimizing minimally invasive surgery: Current status of the single-port robotic surgery in Urology. Actas Urol Esp 2021. [PMID: 33612358 DOI: 10.1016/j.acuro.2020.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The novel da Vinci Single-Port (SP) robotic platform received the US FDA approval in 2018. The device, specifically conceived for single-site approach, is pushing through the limits of minimally invasive surgery. We sought to provide a comprehensive overview of the current status of the clinical experiences accomplished by the da Vinci SP in urology, and to discuss future perspectives. METHODS A non-systematic literature review was performed focusing on single port articles in urological surgery using Medline/PubMed and Embase search electronic engines. The authors analyzed findings and a brief report of the clinical experience for surgical procedures completed by the SP platform was described. RESULTS The current data available from single-port robotic established the safety and feasibility of urologic procedures using this novel platform. However, the results come from single-center case series, small cohorts and retrospective studies that need to be cautiously interpreted. Additional evidence is required to determine the asset of the SP platform in the urological community. CONCLUSIONS The SP robotic system opens new frontiers on the surgical scenery facilitating the completion of urological surgeries through a single incision. Further comparative studies will be required to assess perioperative and long-term oncological and functional outcomes among SP, multi-arm robotic and open approaches.
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Sortino G, Giannubilo W, Di Biase M, Marconi A, Diambrini M, Ferrara V. Laparoscopic single port radical prostatectomy in the 2020: Why not? Our experience. Urologia 2021; 88:212-217. [PMID: 33550922 DOI: 10.1177/0391560321993555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To analyze the feasibility, safety and advantages of Laparo-Endoscopic Single-site Surgery radical prostatectomy (LESS-RP) based on our personal experience. PATIENTS AND METHODS Details of 520 patients were retrospectively analyzed, from 2009 to 2019. Extraperitoneal approach, with only two accesses (2.5 cm and 5 mm respectively) was used to perform radical prostatectomy. Perioperative characteristics and postoperative oncologic and functional outcomes are reported. RESULTS The mean age was 66.6 ± 5.6 years. Mean PSA level was 9 ± 3.5 ng/ml. According to D'Amico classification, the percentage of patients with low-, intermediate-, and high-risk disease cases were 116 (22.4%), 275 (52.8%), and 129 (24.8%) respectively. Mean operative time was 156 ± 43 min. Mean estimated blood loss was 214 ± 93 ml. Positive surgical margins (PSMs) were detected in 110 (21.2%) patients. PSM rates in pT2 and pT3 stages were 20.1% and 22.9%, respectively. The overall complication rate was 9.2%, based on the modified Clavien classification. The 12 months continence and potency rates were 90.9% and 49.1%, respectively. The biochemical recurrence rate was 6.8%, at the median follow-up time of 26.7 months (IQR 12-32). CONCLUSIONS Our analyses show that LESS-RP is a safe procedure, if performed by surgeons with adequate experience and skills. Unlike the classic laparoscopic prostatectomy, this technique allows better aesthetic and psychological results, reduced postoperative pain, and a faster return to normal daily activity with the same functional and oncological results.
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Affiliation(s)
- Giuseppe Sortino
- Department of Urology, Carlo Urbani Hospital, Jesi, Ancona, Italy
| | - Willy Giannubilo
- Department of Urology, Carlo Urbani Hospital, Jesi, Ancona, Italy
| | - Manuel Di Biase
- Department of Urology, Carlo Urbani Hospital, Jesi, Ancona, Italy
| | - Andrea Marconi
- Department of Urology, Carlo Urbani Hospital, Jesi, Ancona, Italy
| | | | - Vincenzo Ferrara
- Department of Urology, Carlo Urbani Hospital, Jesi, Ancona, Italy
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Michener CM, Lampert E, Yao M, Harnegie MP, Chalif J, Chambers LM. Meta-analysis of Laparoendoscopic Single-site and Vaginal Natural Orifice Transluminal Endoscopic Hysterectomy Compared with Multiport Hysterectomy: Real Benefits or Diminishing Returns? J Minim Invasive Gynecol 2020; 28:698-709.e1. [PMID: 33346073 DOI: 10.1016/j.jmig.2020.11.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/16/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Because minimally invasive hysterectomy has become increasingly performed by gynecologic surgeons, strategies to further improve outcomes have emerged, including innovations in surgical approach. We sought to evaluate the intraoperative and perioperative outcomes and success rates of laparoendoscopic single-site surgery (LESS) and vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy in comparison with those of conventional multiport laparoscopic (MPL) hysterectomy. DATA SOURCES A librarian-led search of PubMed, Scopus, CINAHL, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials was performed for case-control, retrospective cohort, and randomized controlled trials through May 2020. METHODS OF STUDY SELECTION The inclusion criterion was publications comparing LESS or vNOTES hysterectomy with conventional MPL hysterectomy for the management of benign or malignant gynecologic disease. Four authors reviewed the abstracts and selected studies for full-text review. The manuscripts were reviewed, separately, by 2 authors for final inclusion and assessment of bias using either the risk-of-bias assessment tool or the Newcastle-Ottawa scale. Any disagreement was resolved by discussion with, or arbitration by, a third reviewer. The titles of 2259 articles were screened, and 108 articles were chosen for abstract screening. Full-text screening resulted in 29 studies eligible for inclusion. TABULATION, INTEGRATION, AND RESULTS Extracted data were placed into REDCap (Vanderbilt University, Nashville, TN), and MPL hysterectomy was compared with single-port hysterectomy using meta-analysis models. The outcomes included estimated blood loss (EBL); operative (OP) time; transfusion; length of hospital stay (LOS); conversion to laparotomy; visual analog scale pain scores at 12 hours, 24 hours, and 48 hours; any complications; and 7 subcategories of complications. Random-effects models were built for continuous outcomes and binary outcomes, and the results are reported as standardized mean difference (SMD) or odds ratio (OR) and their corresponding 95% confidence intervals, respectively. Meta-analysis could not be performed for vNOTES vs MPL, given that only 3 studies met the eligibility criteria. When LESS and MPL were compared, there was a shorter OP time for MPL (SMD = -0.2577, p <.001) and lower rate of transfusion (OR = 0.1697, p <.001), without a significant difference in EBL (SMD = -0.0243, p = .689). There was a nonsignificant trend toward higher risk of conversion to laparotomy in the MPL group (OR = 2.5871, p = .078). Pain scores were no different 12 or 24 hours postoperatively but were significantly higher at 48 hours postoperatively (SMD = 0.1861, p = .035) in the MPL group. There were no differences in overall or individual complications between the LESS and MPL groups. In the vNOTES comparison, 2 studies demonstrated shorter OP times, with reduced LOS and no difference in complications. CONCLUSION In this meta-analysis, we identified that LESS hysterectomy has comparable and low overall rates of complications and conversion to laparotomy compared with MPL. Notably, the OP time seems longer, and the pain scores at 48 hours may be lower with LESS hysterectomy than with MPL hysterectomy. Limited data suggest that vNOTES hysterectomy may have shorter OP times and improved EBL, transfusion rates, LOS, and pain scores compared with MPL hysterectomy, but further study is needed. There remains a deficit in high-quality data to understand the differences in cosmesis among these surgical approaches. The quality of data for this analysis seems to be low to moderate.
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Affiliation(s)
- Chad M Michener
- Division of Gynecologic Oncology (Drs. Michener and Chambers).
| | - Erika Lampert
- Department of Obstetrics and Gynecology (Drs. Lampert and Chalif) Obstetrics, Gynecology and Women's Health Institute
| | - Meng Yao
- Department of Quantitative Health Sciences (Mr. Yao)
| | - Mary Pat Harnegie
- Department of Library Services (Ms. Harnegie), Cleveland Clinic, Cleveland, Ohio
| | - Julia Chalif
- Department of Obstetrics and Gynecology (Drs. Lampert and Chalif) Obstetrics, Gynecology and Women's Health Institute
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Wang Q, Guan Z, Guo X, Chen B, Li L, Liu J, Guan X. Stepwise Laparoendoscopic Single-site Pectopexy for Pelvic Organ Prolapse. J Minim Invasive Gynecol 2020; 28:1142-1143. [PMID: 33096264 DOI: 10.1016/j.jmig.2020.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
STUDY OBJECTIVE To demonstrate stepwise techniques for the successful use of the laparoendoscopic single-site surgery (LESS) technique for safely performing pectopexy. DESIGN Stepwise demonstration with narrated video footage (Canadian Task Force classification III). SETTING An academic tertiary care hospital. INTERVENTIONS Patient was a 48-year-old, gravida 2 para 2, having had 2 normal spontaneous vaginal deliveries, with stage III anterior vaginal prolapse and stage III uterine prolapse and posterior vaginal prolapse. The preoperative vaginal length was 6 cm. Laparoscopic sacrocolpopexy is the current gold standard for pelvic organ prolapse demonstrating a low recurrence rate; however, it can be technically challenging to perform, particularly in women with obesity or in the event of an anatomic variation. The pectineal ligament, also known as Cooper's ligament, is familiar to surgeons and can be used for a tension-free mesh suspension in patients with prolapse. Integration of LESS and pectopexy is a novel alternative, minimally invasive approach that is more cosmetic, simpler, and effective. The key steps in LESS pectopexy include the following: MEASUREMENTS AND MAIN RESULTS: The procedure was performed successfully in approximately 80 minutes with a postoperative vaginal length of 6 cm. Postoperative pelvic organ prolapse quantification was stage 0. CONCLUSION LESS is a feasible technique for pectopexy in patients with pelvic organ prolapse. A LESS pectopexy results in better cosmesis and offers an alternative for patients with challenging pelvic organ prolapse, such as those with obesity.
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Affiliation(s)
- Qianqing Wang
- Xinxiang Central Hospital, Henan (Drs. Wang, Guo, Chen, Li, and Liu,)
| | - Zhenkun Guan
- Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong (Dr. Liu and Mr. Z. Guan), China
| | - Xiangcui Guo
- Xinxiang Central Hospital, Henan (Drs. Wang, Guo, Chen, Li, and Liu,)
| | - Beibei Chen
- Xinxiang Central Hospital, Henan (Drs. Wang, Guo, Chen, Li, and Liu,)
| | - Li Li
- Xinxiang Central Hospital, Henan (Drs. Wang, Guo, Chen, Li, and Liu,)
| | - Juan Liu
- Xinxiang Central Hospital, Henan (Drs. Wang, Guo, Chen, Li, and Liu,); Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong (Dr. Liu and Mr. Z. Guan), China.
| | - Xiaoming Guan
- Division of Minimally Invasive Gynecology, Baylor College of Medicine, Houston, Texas (Dr. X. Guan)
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Wilfong C, Ross S, Musumeci M, Spence J, Gravetz A, Sucandy I, Rosemurgy A. Doing more with less: our decade of experience with laparo-endoscopic single site Heller myotomy supports its application. Surg Endosc 2020; 34:4481-5. [PMID: 32180003 DOI: 10.1007/s00464-019-07232-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/28/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Achalasia is a rare esophageal motility disorder that affects 1 in 100,000 individuals. Currently, laparoscopic Heller myotomy with anterior fundoplication is the 'gold standard' therapy for achalasia, alleviating symptoms by de-functionalizing the lower esophageal sphincter mechanism. The advent of the Laparo-Endoscopic Single Site (LESS) technique provides a more minimally invasive approach to Heller myotomy. METHODS With IRB approval, 179 patients who underwent LESS Heller myotomy with anterior fundoplication since 2007 have been prospectively followed. Patients self-assessed symptom frequency and severity preoperatively and postoperatively using a Likert scale (0 = never/not bothersome to 10 = always/very bothersome). Patients scored their scar satisfaction (1 = revolting to 10 = beautiful). Data are presented as median (mean ± SD). Significance was accepted with 95% probability. RESULTS Fifty-one percent of patients were men, of age 55 (53 ± 17) years and BMI of 25 (25 ± 6.1) kg/m2. Patients had an operative time of 134 (135 ± 34.3) minutes with an estimated blood loss (EBL) of 50 mL. Postoperative complications occurred in 18% of patients (e.g., urinary retention, capnothorax). Length of stay was 1 (2 ± 2.1) day. Preoperatively, symptoms (e.g., dysphagia, regurgitation) were frequent and severe; following myotomy, all symptoms queried were significantly less frequent and severe with follow-up of 28 (34 ± 18.4) months (p < 0.0001 for all, paired Student's t test). Eighty-seven percent of patients reported they were 'very satisfied' or 'satisfied' with their experience and 95% of patients would undergo the operation again knowing what they know now. Patients scored their satisfaction with their scar as 10 (9 ± 1.6). CONCLUSION Heller myotomy with anterior fundoplication undertaken via the LESS approach provides efficacious, satisfactory, and durable amelioration of symptoms. Patients reported significant symptom resolution as well as satisfaction with their overall experience. Our decade of experience documenting the salutary benefits of LESS Heller myotomy should be more than enough to encourage surgeons to incorporate the approach into their armamentarium.
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Wei Y, Tang J, Yuan L, Su J, Zhang Y, Deng Z, Zhu C, Shen L, Wang N, Xu G, Yang Y, Zhu Q. Laparoendoscopic radical prostatectomy (LRP): stepwise transition from multi-site to single-site with the aid of the transurethral port. Int Urol Nephrol 2020; 53:249-255. [PMID: 32902797 DOI: 10.1007/s11255-020-02638-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe our initial experience with laparoendoscopic radical prostatectomy (LRP) and a stepwise transition towards transurethral assisted laparoendoscopic single-site RP (TU-LESS RP). PATIENTS AND METHODS From Jan. 2007 to Dec. 2016, 195 patients underwent RP, of which 89 patients were performed by LRP (Group A), 106 by TU-LESS RP (Group B). The peri-operative data were collected and analyzed. All data referring to patient demographics, surgery, pathology, and peri-operative outcomes were recorded. The cosmetic result was investigated by the Patient Scar Assessment Questionnaire (PSAQ). Analysis of variance or Chi squared test were adopted to analyze the data. RESULTS 195 procedures were completed successfully. The operation time (109.6 ± 31.9 vs. 151.5 ± 87.3, P = 0.025) and anastomosis time (10.1 ± 4.8 vs. 21.8 ± 9.9, P < 0.001) of Group B was significantly reduced compared with Group A. Estimated blood loss in Group B was significantly lower than that in Group A (95.9 ± 11.1 vs. 180.2 ± 99.7, P = 0.006). About perioperative complications, Group B was also less compared with Group A (1.9% vs. 7.9%, P = 0.047). As to the usage of postoperative analgesics, Group B apparently used less than that in Group A (6.6% vs. 62.9%, P < 0.001), which is consistent with the visual analogue scale (VAS) of the two groups (1.7 ± 1.3 vs. 7.8 ± 1.1, P < 0.001). Patients in Group B were significantly more satisfied with incision healing than in group A (74.9 ± 9.3 vs. 49.7 ± 5.8, P < 0.001). There was no significant difference both in BCR rate and time between Group B and Group A. In urination control, more patients in Group B did not have urinary incontinence 3 month after RP compared with Group A (81.1% vs. 67.4%, P = 0.028). CONCLUSIONS LESS RP is proved to be feasible for the proper patients, but it is difficult to popularized due to inconvenient operation. While by means of TU-LESS, operating difficulty can be significantly decreased. TU-LESS RP will be wildly accepted by surgeons and patients because of cosmetic satisfaction and quicker recovery.
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Affiliation(s)
- Yunfei Wei
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Jingyuan Tang
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Lin Yuan
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Jian Su
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Yang Zhang
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Zhonglei Deng
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Chen Zhu
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Luming Shen
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Ninghong Wang
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Guojiang Xu
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Yong Yang
- Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China
| | - Qingyi Zhu
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China.
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Yamada M, Raisbeck LD. The Effects of Attentional Focus Instructions Specific to Body Movements on Movement Quality and Performance. J Sport Rehabil 2020; 30:422-9. [PMID: 32820133 DOI: 10.1123/jsr.2019-0344] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 04/28/2020] [Accepted: 06/06/2020] [Indexed: 11/18/2022]
Abstract
Contexts: Directing an individual's attention to the effect of the movements (external focus) has been shown to improve performance than directing attention to body movements (internal focus). However, the effect of attentional focus instructions specific to movement quality has not been investigated thoroughly. OBJECTIVE To compare the effects of internal and external focus instructions specific to body movements. DESIGN Mixed design, 2 (sex) × 2 (instructions). SETTINGS Laboratory setting. PARTICIPANTS A total of 40 participants (males, n = 20; mean [SD]; age = 22.0 [2.19] y; height = 179.33 [5.90] cm; mass = 77.7 [13.04] kg; females, n = 20; age = 22.0 [3.87] y; height = 164.84 [5.80] cm; mass = 71.48 [20.66] kg) were recruited. INTERVENTION Participants completed 2 consecutive jumps (ie, a forward jump from a height and then a maximal vertical jump) with internal focus and external focus instructions. External focus was elicited by placing pieces of tape on the participants' legs. MAIN OUTCOME MEASURES Landing quality was measured by the Landing Error Scoring System to assess movement quality, and the vertical jump height was measured by Vertec. RESULTS The performance results showed that the external focus condition resulted in superior vertical jump height compared with the internal focus condition (P < .05). Although landing quality did not show significant differences between 2 conditions, the effect size (η2 = .09) indicated that landing quality was better when participants adopted an external, rather than an internal focus of attention (P = .07). CONCLUSIONS The body-oriented instructions can be provided externally by adding artificial external cues and directing attention to them. Importantly, the findings were evident in a qualitative assessment that can be adopted by practitioners. The results suggest that practitioners should adopt an external focus cue for performance and also consider using an external focus for movement quality.
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Xiao J, Fu K, Duan K, Wang J, Sunkara S, Guan X. Pregnancy-preserving Laparoendoscopic Single-site Surgery for Gynecologic Disease: A Case Series. J Minim Invasive Gynecol 2020; 27:1588-1597. [PMID: 32126300 DOI: 10.1016/j.jmig.2020.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 02/13/2020] [Accepted: 02/22/2020] [Indexed: 01/05/2023]
Abstract
STUDY OBJECTIVE The study objective was to assess the feasibility of laparoendoscopic single-site surgery (LESS) for the management of nonobstetric, gynecologic disease processes in pregnant patients. DESIGN A retrospective case series of 13 pregnant women aged 21 to 42 years who underwent LESS for various gynecologic pathology. If able to be contacted, the patients were followed up until the delivery of the fetus. SETTING The surgeries were performed in a single institution between January 2015 and June 2019. PATIENTS The patients were selected if a laparoscopic intervention was indicated. INTERVENTIONS The cases included 6 ovarian cystectomies and 2 salpingo-oophorectomies for adnexal masses; 1 myomectomy for a degenerated myoma; 1 salpingectomy for a heterotopic pregnancy; 2 cerclage placements for recurrent pregnancy loss and cervical insufficiency; and 1 paratubal cystectomy. The patients underwent LESS through a 2.5-cm umbilical incision. The masses were exteriorized using a laparoscopic specimen retrieval bag, with the exception of 2 large adnexal masses, which were aspirated at the incision site, exteriorized after content drainage, and cystectomies performed extracorporeally. The fascial incision was repaired with a permanent suture. MEASUREMENTS AND MAIN RESULTS Various data were collected from patients, including age, surgical and obstetric history, gestational age at surgery, and ultrasonic imaging results. The outcomes measured were operative duration, intraoperative bleeding, postoperative symptoms, fetal monitoring before and after surgery, pathologic findings, conversions, intraoperative complications, and pregnancy outcomes. Eight cases were performed in the first trimester, 4 in the second trimester, and 1 in the third trimester, with the surgeries lasting between 45 minutes and 298 minutes. The blood loss ranged from 5 mL to 300 mL, and postoperative symptoms of mild pelvic or abdominal pain were reported. There were 2 conversions to traditional multiport laparoscopic surgery for the 2 cerclage cases, and there were no open surgery conversions or intraoperative complications. The fetal heart rate ranged between 130 beats per minute and 167 beats per minute postoperatively. Of the 9 patients who were able to be contacted for follow-up, all had successful deliveries. One patient was healthy at 31 weeks and 5 days without complication at the time of her last follow-up. CONCLUSION LESS may be performed by experienced surgeons on gravid patients in any trimester for adnexal masses, myomas, heterotopic pregnancy, and cervical incompetence. Future multiple-center studies may provide further evidence that LESS is a feasible and safe option for gynecologic surgery during pregnancy.
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Affiliation(s)
- Jing Xiao
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (Drs. Xiao, Fu, Duan, Sunkara, and Guan); Department of Gynecology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China (Drs. Xiao and Wang)
| | - Kristi Fu
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (Drs. Xiao, Fu, Duan, Sunkara, and Guan); Department of Gynecology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China (Drs. Xiao and Wang)
| | - Kristina Duan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (Drs. Xiao, Fu, Duan, Sunkara, and Guan); Department of Gynecology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China (Drs. Xiao and Wang)
| | - Junling Wang
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (Drs. Xiao, Fu, Duan, Sunkara, and Guan); Department of Gynecology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China (Drs. Xiao and Wang)
| | - Sowmya Sunkara
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (Drs. Xiao, Fu, Duan, Sunkara, and Guan); Department of Gynecology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China (Drs. Xiao and Wang)
| | - Xiaoming Guan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas (Drs. Xiao, Fu, Duan, Sunkara, and Guan); Department of Gynecology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China (Drs. Xiao and Wang)..
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Tran AA, Shen J, Wernecke C, Gatewood CT, Harris AHS, Dragoo JL. A comparison of the Functional Movement Screen TM and the Landing Error Scoring System: A cohort study. Curr Orthop Pract 2020; 31:8-12. [PMID: 32454929 DOI: 10.1097/BCO.0000000000000822] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Functional Movement Screen (FMSTM) is a nonspecific movement pattern assessment while the Landing Error Scoring System (LESS) is a screen for movement patterns associated with lower extremity injury. The purpose of this study was to determine if the LESS and FMSTM are correlated or if they can be used as complementary assessments of preseason injury risk for anterior cruciate ligament injury.
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Kim MS, Choi CH, Lee JW, Kim BG, Bae DS, Kim TJ. Comparison between Laparoendoscopic Single-Site and Conventional Laparoscopic Surgery in Mature Cystic Teratoma of the Ovary. Gynecol Minim Invasive Ther 2019; 8:155-159. [PMID: 31741840 PMCID: PMC6849097 DOI: 10.4103/gmit.gmit_3_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/11/2019] [Accepted: 05/28/2019] [Indexed: 01/03/2023] Open
Abstract
Objective: The objective of the study is to compare the intra- and post-operative outcomes of laparoendoscopic single-site surgery (LESS) and conventional laparoscopic surgery (CLS) in mature cystic teratoma (MCT) of the ovary. Methods: We reviewed 254 patients who underwent surgery (cystectomy) for ovarian MCT from March 1, 2014, to August 31, 2016. During the study period, 216 patients underwent LESS and 38 patients underwent CLS. The outcome measures included operation time, estimated blood loss, changing hemoglobin (Hb) level, postoperative pain, and complications. Statistical analysis was performed using SPSS 24. Results: There was no statistically significant difference in age, body mass index, sexual experience, cyst size, operative time, adhesiolysis, preoperative Hb, Hb changes, postoperative pain scores (visual analog scale), hospital days, and complications between the two groups. In emergent situation, the frequency of CLS was high as three cases (7.9%) versus one case (0.5%, P = 0.007) with LESS. As the year progressed, the frequency of LESS increased. There were one case of re-operation for bleeding control and transfusion, one case of postoperative peritonitis and transfusion, and one case of postoperative transfusion in LESS. During LESS, additional port(s) was/were created in 13 cases (6.0%, P = 0.249). Conclusions: LESS is not inferior to CLS in MCT surgery, and LESS is useful for the surgery of MCT. Our study demonstrates that LESS confers feasibility, convenience, and safety regarding cystectomy of MCT.
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Affiliation(s)
- Myeong Seon Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chel Hun Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong-Won Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byoung-Gie Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk-Soo Bae
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Tranchart H, Rebibo L, Gaillard M, Dhahri A, Lainas P, Regimbeau JM, Dagher I. Short-term outcomes of single-port versus conventional laparoscopic sleeve gastrectomy: a propensity score matched analysis. Surg Endosc 2019; 34:3978-3985. [PMID: 31595402 DOI: 10.1007/s00464-019-07175-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 09/26/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Sleeve gastrectomy (SG) has become a frequent bariatric procedure. Single-port sleeve gastrectomy (SPSG) could reduce parietal aggression however its development has been restrained due to fear of a complex procedure leading to increased morbidity and suboptimal sleeve construction. The aim of this study was to compare the short-term outcomes of SPSG versus conventional laparoscopic sleeve gastrectomy (CLSG) with regards to morbidity, weight loss, and co-morbidity resolution. METHODS Between January 2015 and December 2016, data from all consecutive patients that underwent SPSG and CLSG in two institutions performing exclusively one or the other approach were retrospectively analyzed. Propensity score adjustment was performed on the factors known to influence the choice of approach. RESULTS During the study period, 1122 patients underwent SG in both institutions (610 SPSG and 512 CLSG). From each group, 314 patients were successfully matched. A 15-min increase in operative time was observed during SPSG (P < 0.001). Postoperative morbidity was similar with a minor increase after SPSG (8.6 vs. 6.7%, P = 0.453). No differences in incisional hernia rates were observed (1.6 (SPSG) vs. 0.3% (CLSG), P = 0.216). Percentage of total weight loss was 31.1% and 28.2% in the CLSG and SPSG 12 months after surgery, respectively (P = 0.321). Co-morbidities resolution 12 months following the procedure was similar. CONCLUSIONS SPSG can be performed safely with similar intraoperative and postoperative morbidity compared to CLSG. Weight loss and co-morbidities resolution at 1 year are equivalent. A 15-min longer operative time was the only negative side of SPSG.
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Affiliation(s)
- Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, 92140, Clamart, France.
- Paris-Saclay University, 91405, Orsay, France.
| | - Lionel Rebibo
- Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, 80054, Amiens, France
- Research Unit BQR SSPC « Simplification of Surgical Patient Care », Jules Verne University of Picardie, 80054, Amiens, France
| | - Martin Gaillard
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, 92140, Clamart, France
- Paris-Saclay University, 91405, Orsay, France
| | - Abdennaceur Dhahri
- Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, 80054, Amiens, France
- Research Unit BQR SSPC « Simplification of Surgical Patient Care », Jules Verne University of Picardie, 80054, Amiens, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, 92140, Clamart, France
- Paris-Saclay University, 91405, Orsay, France
| | - Jean-Marc Regimbeau
- Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardie, 80054, Amiens, France
- Research Unit BQR SSPC « Simplification of Surgical Patient Care », Jules Verne University of Picardie, 80054, Amiens, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, 157 rue de la Porte de Trivaux, 92140, Clamart, France
- Paris-Saclay University, 91405, Orsay, France
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Everard E, Lyons M, Harrison AJ. Examining the Reliability of the Landing Error Scoring System With Raters Using the Standardized Instructions and Scoring Sheet. J Sport Rehabil 2020; 29:519-25. [PMID: 31586431 DOI: 10.1123/jsr.2018-0387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 07/04/2019] [Accepted: 08/04/2019] [Indexed: 11/18/2022]
Abstract
CONTEXT Dynamic movement-based screens, such as the Landing Error Scoring System (LESS), are becoming more widely used in research and practical settings. Currently, 3 studies have examined the reliability of the LESS. These studies have reported good interrater and intrarater reliability. However, all 3 studies involved raters, who were founders of the LESS. Therefore, it is unclear whether the reliability reported reflects that which would be observed with practitioners without such specialized and intimate knowledge of the screen and only using the standardized set of instructions. OBJECTIVE To investigate the interrater and intrarater reliability of the final score and the individual scoring criteria of the LESS. DESIGN Reliability protocol. SETTING Controlled laboratory. PARTICIPANTS Two raters scored 30 male participants (age = 21.8 [3.9] y; height = 1.75 [0.46] m; mass = 75.5 [6.6] kg) involved in a variety of college sports. MAIN OUTCOME MEASURE Two raters using only the standardized scoring sheet assessed the interrater reliability of the total score and individual scoring criteria independently of each other. The principal author scored the videos again 6 weeks later for the intrarater reliability component of the study. INTERVENTION Participants performed a drop box landing from a 30-cm box was recorded with a video camera from the front and side views. RESULTS The intraclass coefficients interrater and intrarater reliability for the total scores were excellent (intraclass coefficients range = .95 and .96; SEM = 1.01 and 1.02). The individual scoring criteria of the LESS had between moderate and perfect agreement using kappa statistics (κ = .41-1.0). CONCLUSION The final score and individual scoring criteria of the LESS have acceptable reliability with raters using the standardized scoring sheet. Practitioners using only the standardized scoring sheet should feel confident that the LESS is a reliable tool.
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Gaboardi F, Pini G, Suardi N, Montorsi F, Passaretti G, Smelzo S. Robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) with daVinci Single-Site® platform. Concept and evolution of the technique following an IDEAL phase 1. J Robot Surg 2018; 13:215-226. [PMID: 30019228 DOI: 10.1007/s11701-018-0839-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/04/2018] [Indexed: 11/28/2022]
Abstract
To describe the evolution of robotic laparoendoscopic single-site radical prostatectomy (R-LESS-RP) performed with the daVinci Single-Site Platform® and a home-made multiport aimed to overcome classical drawbacks of LESS, still present with this platform. Between 09/2015 and 06/2017 12 patients underwent R-LESS RP for clinical localized prostate cancer. Following a "phase 1 (development-stage)" innovation, development, exploration, assessment, long-term study (IDEAL) framework, different solutions were drawn to overcome drawbacks of daVinci Single-Site Platform®, included 3 (A, B, and C) multi-ports developed and evaluated in term of advantages/drawbacks concerning ergonomy. The end points of this study were: feasibility, safety, efficacy, by reporting rational description of multiports configuration, demographics, perioperative variables, functional and oncological results. Semi-flexible robotic 5-mm needle-holder instead of Maryland forceps, 30° lenses up and barbed-suture allowed overcoming limits of robotic-platform. Multiport-C (GelPOINT Advanced-Access® and an extra 8-mm robotic trocar outside the multiport) showed the best compromise to ensure both surgeon and bed-side assistant to reproduce a standard robotic procedure. No conversion to either standard robotic or open technique or intraoperative complications occur in any case. Two patients experienced "high-grade" Clavien-Dindo complications. After 12.4 months follow-up, all patients were continent without any sign of biochemical relapse and among 5 preoperative potent patients submitted to nerve-sparing dissection, 4 reported good erectile-function. R-LESS-RP is feasible and safe in the hands of experienced minimally-invasive surgeons. Do date, we recommend a hybrid solution with a home-made multiport and use of an additional standard robotic trocar which allows the use endowrist® technology instruments.
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Affiliation(s)
- Franco Gaboardi
- Department of Urology, IRCCS San Raffaele Turro Hospital, Via Stamira d'Ancona 20, 20127, Milan, Italy.
| | - Giovannalberto Pini
- Department of Urology, IRCCS San Raffaele Turro Hospital, Via Stamira d'Ancona 20, 20127, Milan, Italy.,Scientific Working Group, EAU Section of Uro-Technology (ESUT), Arnhem, The Netherlands.,Robotic Group, EAU Section of Young Academic Urologist (YAU), Arnhem, The Netherlands
| | - Nazareno Suardi
- Department of Urology, IRCCS San Raffaele Turro Hospital, Via Stamira d'Ancona 20, 20127, Milan, Italy.,Robotic Group, EAU Section of Young Academic Urologist (YAU), Arnhem, The Netherlands.,Department of Urology, University "Vita Salute" San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, University "Vita Salute" San Raffaele, Milan, Italy
| | - Giovanni Passaretti
- Department of Urology, IRCCS San Raffaele Turro Hospital, Via Stamira d'Ancona 20, 20127, Milan, Italy
| | - Salvatore Smelzo
- Department of Urology, IRCCS San Raffaele Turro Hospital, Via Stamira d'Ancona 20, 20127, Milan, Italy
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Abdel-Karim AM, El Tayeb MM, Yahia E, Elmissiry M, Hassouna M, Elsalmy S. Evaluation of the Role of Laparoendoscopic Single-Site Surgery vs Minilaparoscopy for Treatment of Upper Urinary Tract Pathologies: Prospective Randomized Comparative Study. J Endourol 2018; 31:1237-1242. [PMID: 29020831 DOI: 10.1089/end.2017.0363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To present the first prospective randomized comparison between laparoendoscopic single-site surgery (LESS) and minilaparoscopy (ML) for treatment of upper urinary tract pathologies. PATIENTS AND METHODS Between January 2013 and June 2015, patients with different upper urinary pathologies were blindly randomized to both LESS and ML. All procedures were done by single experienced surgeon. Both cohorts were compared regarding demographic data, peri and postoperative characteristics, and visual analog pain scale (VAS). Cosmetic outcome was assessed after 12 months using patient scar assessment scale (PSAS) and observer scar assessment scale (OSAS). RESULTS Sixty patients were randomized into two equal groups with comparable demographic and preoperative characteristics. Indications included nephrectomy, pyeloplasty, cyst marsupialization, adrenalectomy, and repair of retrocaval ureter. Operative time was 167 ± 24 and 145 ± 39 minutes in LESS and ML groups, respectively (p = 0.09). Estimated blood loss was 59 ± 34 and 43 ± 42 mL in both groups, respectively (p = 0.2). VAS was 1.7 ± 0.6 and 2.8 ± 0.5 in both groups, respectively (p = 0.02). PSAS and OSAS were 5.9 ± 0.85 and 10.6 ± 1.98 vs 8.9 ± 0.9 and 13.5 ± 6.3 in both groups, respectively (p > 0.05). There were no intraoperative complications, conversions to open surgery, or conventional laparoscopy in both groups. Mean postoperative Diclofenac Na was 151.7 ± 35.6 and 169.7 ± 47.3 mg in both groups, respectively (p = 0.04). Postoperative complications rate and hospital stay were comparable between both groups. CONCLUSION Both LESS and ML have comparable operative time, blood loss, complication rate, and hospital stay in treatment of upper urinary tract pathologies. However, LESS is associated with less analgesic requirement and better cosmetic outcome.
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Affiliation(s)
- Aly M Abdel-Karim
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Marawan M El Tayeb
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Elsaid Yahia
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Mostafa Elmissiry
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Mohamed Hassouna
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Salah Elsalmy
- Urology Department, Faculty of Medicine, Alexandria University , Alexandria, Egypt
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Kaouk J, Garisto J, Bertolo R. Different approaches to the prostate: The upcoming role of a purpose-built single-port robotic system. Arab J Urol 2018; 16:302-306. [PMID: 30147958 PMCID: PMC6105340 DOI: 10.1016/j.aju.2018.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 03/27/2018] [Accepted: 04/11/2018] [Indexed: 02/07/2023] Open
Abstract
With the aim of minimising the patient’s postoperative pain, expediting recovery and improving cosmesis, the idea of performing a laparoscopic procedure through a single abdominal incision was introduced. In the present report, we describe five different access routes to the prostate that may be at the surgeon’s disposal with the potential of decreasing patient’s perioperative morbidity. Robotic radical prostatectomy has been refined and became a standard of care in surgery for localised prostate cancer. The advent of single-port robotic surgery has prompted the re-discovery of different access routes to the prostate and ideally all of them are feasible. The potential for avoiding the abdominal cavity will decrease the surgical morbidity and minimise the surgical dissection. In the near future, each of the described approaches could be chosen on the basis of the patient’s preoperative comorbidities, body habitus, anatomy, and disease characteristics and location.
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Affiliation(s)
- Jihad Kaouk
- Corresponding author at: Glickman Urology and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH 44195, USA.
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Habicher M, Tokas T, Herrmann TR, Nagele U; Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group. Laparoscopic single-incision triangulated umbilical surgery (SITUS) pyeloplasty: a description of the first 32 cases. World J Urol 2018; 36:1883-8. [PMID: 29754252 DOI: 10.1007/s00345-018-2308-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/24/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Transumbilical laparoendoscopic (LESS) procedures reduce access trauma. Laparoendocopic single-incision triangulated umbilical surgery (SITUS) utilizes straight instruments in a triangulated fashion, via three trocars placed through a single umbilical incision. METHODS Thirty-two consecutive patients underwent an SITUS pyeloplasty. Access is performed by incision of the umbilical fold by 3/4 of its circumference, a 5-mm camera port, and consequently, cranial and caudal 3 or 5 mm working trocars are placed at a distance of 3-6 cm, thus allowing triangulation. SITUS laparoscopy utilizes the standard straight instruments with a length of 43 cm. RESULTS All procedures were successfully performed and no conversion to open, or conventional laparoscopic approach was deemed necessary. Thirty patients underwent a dismembered and two a Fenger pyeloplasty. A crossing vessel was identified in 68.75% of the cases. The median laparoscopic and suturing times were 130 and 30 min, respectively; median blood loss was 50 ml. The median duration of hospitalization was 4 days. The visual analogue scores (VAS) reported were 1 on the first and 0 on the third postoperative day. The indwelling double-J or mono-J stents were removed after a median time of 5 weeks and 4 days, respectively. The overall success rate was 96.8%. CONCLUSIONS The SITUS technique for pyeloplasty is an attractive alternative to conventional laparoscopy and a viable competitor to LESS surgery. It combines the common principles of traditional laparoscopy, such as conventional instrumentation and triangulation, with the benefits of single-port surgery.
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Yu G, Zhang K, Li W, Li L, Zhao Y, Wang Y, Xu M, Da J, Dong G, Wang Z, Xu B. Unilateral Renal Tumor Cryoablation and Contralateral Radical Nephrectomy of Bilateral Renal Tumors by Transumbilical 3D Multichannel Laparoendoscopic Single-Site Surgery. J Endourol Case Rep 2018; 4:53-58. [PMID: 29682611 PMCID: PMC5908421 DOI: 10.1089/cren.2017.0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Unilateral renal tumor cryoablation and contralateral radical nephrectomy of bilateral renal tumors were performed by transumbilical three-dimensional (3D) multichannel laparoendoscopic single-site (LESS) surgery, in an attempt to verify the feasibility and safety of the procedure, sum up the operational experience, and evaluate the surgical outcome. Case Presentation: This was a 47-year-old female patient with a body mass index of 27.34 kg/m2 without backache, low back pain, hematuria, urinary urgency, frequent urination, dysuria, and other symptoms. Contrast-enhanced CT scan of the kidney on admission showed four masses in the left kidney and two masses in the right kidney. Preoperative serum creatinine (SCr) was 87 μmol/L. Operation was performed under general anesthesia by first laying the patient in a left lateral position. A 2-cm longitudinal transumbilical skin incision was made to expose the right kidney for complete dissection of the two tumors. First, puncture biopsy was performed, and then two freeze–thaw cryoablation cycles for the two tumors were performed. At last, the patient was laid in a right lateral position for radical nephrectomy of the left kidney. The operative duration, cryoablation time, and estimated blood loss were 200 minutes, 40 minutes, and 100 mL, respectively. Postoperative pathological examination revealed clear-cell renal cell carcinoma. The right glomerular filtration rate tested was 42.36 mL/minute and SCr was 131 μmol/L at day 5 after surgery. There was no evidence of contrast enhancement at the cryoablative region as shown by renal contrasted CT scan performed 4 days after surgery and renal contrasted MRI scan performed 6 weeks after surgery, indicating that there was no tumor remnant or recurrence. Conclusion: Our preliminary experience shows that the treatment of bilateral renal tumors with unilateral renal tumor cryoablation and contralateral radical nephrectomy by transumbilical 3D LESS is safe, feasible, and effective. It may prove to be a viable option for patients with significant comorbidities and an insensitive treatment intention.
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Affiliation(s)
- Guopeng Yu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Urology, The People's Hospital of Xiangyun, Dali Bai Autonomous Prefecture, Yunnan, China
| | - Ke Zhang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenzhi Li
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Long Li
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanliang Zhao
- Department of Urology, The People's Hospital of Xiangyun, Dali Bai Autonomous Prefecture, Yunnan, China
| | - Yiwei Wang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mingxi Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Da
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoqin Dong
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhong Wang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Abstract
PURPOSE OF REVIEW In this review, we summarize research that has evaluated the role of laparoendoscopic single-site (LESS) and robotic surgery in pediatric urology, highlighting new and/or controversial ideas. RECENT FINDINGS The newest research developments over the last several years are studies that address generalizability of these techniques, ideal patient factors, extrapolation to more complex surgeries, and comparative studies to more traditional techniques to define the associated costs and benefits, as well as patient-centered outcomes. Specifically in the field of LESS, addressing the limitations of suboptimal vision, instrument crowding, and loss of triangulation have been a focus. The literature is now replete with new applications for robotic surgery as well as descriptions of the specific technical challenges inherent to pediatrics. Robotic surgery and LESS are areas of growth in pediatric urology that allow continual innovation and expansion of technology within a surgeon's armamentarium.
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Di Stasi LL, Díaz-Piedra C, Ruiz-Rabelo JF, Rieiro H, Sanchez Carrion JM, Catena A. Quantifying the cognitive cost of laparo-endoscopic single-site surgeries: Gaze-based indices. Appl Ergon 2017; 65:168-174. [PMID: 28802436 DOI: 10.1016/j.apergo.2017.06.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 04/14/2017] [Accepted: 06/10/2017] [Indexed: 05/10/2023]
Abstract
BACKGROUND Despite the growing interest concerning the laparo-endoscopic single-site surgery (LESS) procedure, LESS presents multiple difficulties and challenges that are likely to increase the surgeon's cognitive cost, in terms of both cognitive load and performance. Nevertheless, there is currently no objective index capable of assessing the surgeon cognitive cost while performing LESS. We assessed if gaze-based indices might offer unique and unbiased measures to quantify LESS complexity and its cognitive cost. We expect that the assessment of surgeon's cognitive cost to improve patient safety by measuring fitness-for-duty and reducing surgeons overload. METHODS Using a wearable eye tracker device, we measured gaze entropy and velocity of surgical trainees and attending surgeons during two surgical procedures (LESS vs. multiport laparoscopy surgery [MPS]). None of the participants had previous experience with LESS. They performed two exercises with different complexity levels (Low: Pattern Cut vs. High: Peg Transfer). We also collected performance and subjective data. RESULTS LESS caused higher cognitive demand than MPS, as indicated by increased gaze entropy in both surgical trainees and attending surgeons (exploration pattern became more random). Furthermore, gaze velocity was higher (exploration pattern became more rapid) for the LESS procedure independently of the surgeon's expertise. Perceived task complexity and laparoscopic accuracy confirmed gaze-based results. CONCLUSION Gaze-based indices have great potential as objective and non-intrusive measures to assess surgeons' cognitive cost and fitness-for-duty. Furthermore, gaze-based indices might play a relevant role in defining future guidelines on surgeons' examinations to mark their achievements during the entire training (e.g. analyzing surgical learning curves).
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Affiliation(s)
- Leandro L Di Stasi
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain; College of Nursing and Health Innovation, Arizona State University, 85004 Phoenix, AZ, USA.
| | - Carolina Díaz-Piedra
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain; College of Nursing and Health Innovation, Arizona State University, 85004 Phoenix, AZ, USA
| | | | - Héctor Rieiro
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain
| | - Jose M Sanchez Carrion
- IAVANTE, Line of Activity of the Andalusian Public Foundation for Progress and Health, Ministry of Equality, Health and Social Policy of the Regional Government of Andalusia, 18016 Granada, Spain
| | - Andrés Catena
- Mind, Brain, and Behavior Research Center, University of Granada, 18071 Granada, Spain
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Matsumoto K, Miyajima A, Fukumoto K, Komatsuda A, Niwa N, Hattori S, Takeda T, Kikuchi E, Asanuma H, Oya M. Factors influencing the operating time for single-port laparoscopic radical nephrectomy: focus on the anatomy and distribution of the renal artery and vein. Jpn J Clin Oncol 2017; 47:976-980. [PMID: 28981738 DOI: 10.1093/jjco/hyx105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/29/2017] [Indexed: 11/12/2022] Open
Abstract
Objective It is considered that laparoscopic single-site surgery should be performed by specially trained surgeons because of the technical difficulty in using special instruments through limited access. We investigated suitable patients for single-port laparoscopic radical nephrectomy, focusing on the anatomy and distribution of the renal artery and vein. Methods This retrospective study was conducted in 52 consecutive patients who underwent single-port radical nephrectomy by the transperitoneal approach. In patients undergoing right nephrectomy, a 2-mm port was added for liver retraction. We retrospectively re-evaluated all of the recorded surgical videos and preoperative computed tomography images. The pneumoperitoneum time (PT) was used as an objective index of surgical difficulty. Results The PT was significantly shorter for right nephrectomy than left nephrectomy (94 vs. 123 min, P = 0.004). With left nephrectomy, dissection of the spleno-renal ligament to mobilize the spleen medially required additional time. Also, the left renal vein could only be divided after securing the adrenal, gonadal and lumbar veins. In patients whose renal artery was located cranial to the renal vein, PT tended to be longer than in the other patients (131 vs. 108 min, P = 0.070). In patients with a superior renal artery, the inferior renal vein invariably covered the artery and made it difficult to ligate the renal artery via the umbilical approach at the first procedure. Conclusions These findings indicate that patients undergoing right nephrectomy in whom the renal artery is not located cranial to the renal vein are suitable for single-port laparoscopic radical nephrectomy.
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Affiliation(s)
| | - Akira Miyajima
- Keio University School of Medicine, Department of Urology, Tokyo, Japan
| | - Keishiro Fukumoto
- Keio University School of Medicine, Department of Urology, Tokyo, Japan
| | - Akari Komatsuda
- Keio University School of Medicine, Department of Urology, Tokyo, Japan
| | - Naoya Niwa
- Keio University School of Medicine, Department of Urology, Tokyo, Japan
| | - Seiya Hattori
- Keio University School of Medicine, Department of Urology, Tokyo, Japan
| | - Toshikazu Takeda
- Keio University School of Medicine, Department of Urology, Tokyo, Japan
| | - Eiji Kikuchi
- Keio University School of Medicine, Department of Urology, Tokyo, Japan
| | - Hiroshi Asanuma
- Keio University School of Medicine, Department of Urology, Tokyo, Japan
| | - Mototsugu Oya
- Keio University School of Medicine, Department of Urology, Tokyo, Japan
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Kim H, Nakajima S, Kawamura Y, Shoji S, Hoshi A, Uchida T, Terachi T, Miyajima A. Three-flap umbilicoplasty: a novel and preliminary method of laparoendoscopic single-site transumbilical surgical approach for urachal remnants. Int Urol Nephrol 2017; 49:1965-71. [PMID: 28828600 DOI: 10.1007/s11255-017-1678-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/09/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Symptomatic urachal remnants are rare benign anomalies affecting young adults. For these patients, both curative treatment and acceptable postoperative aesthetic outcomes are important. Here, we describe a novel transumbilical approach, using Y-shaped incisions and three-flap umbilicoplasty techniques, to improve repair and aesthetic outcomes. MATERIALS AND METHODS The clinical and perioperative data of 16 patients (11 men; median age, 25 years; range 16-46 years) who underwent LESS surgery and three-flap umbilicoplasty (LESS group) between December 2013 and March 2017 were analyzed. For comparison, the perioperative data of those who underwent conventional laparoscopic surgery (CL group) between May 2010 and November 2013 at the same institutions were investigated. RESULTS The median operative time of the LESS group was longer than that of the CL group (146.5 vs 107 min; p = 0.009). The estimated blood loss and postoperative hospital stay were not significantly different between the two groups. The two perioperative complications were injury to the transverse colon serosa and minor surgical site infection. Both complications were resolved with appropriate management. CONCLUSIONS This novel umbilical approach is useful for patients with symptomatic urachal remnants, with the reduction in port-site scarring resulting in good postoperative cosmesis.
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Su J, Zhu Q, Yuan L, Zhang Y, Zhang Q, Wei Y. Transumbilical laparoendoscopic single-site radical prostatectomy and cystectomy with the aid of a transurethral port: a feasibility study. BJU Int 2017; 121:111-118. [PMID: 28734080 DOI: 10.1111/bju.13965] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the surgical technique and report early outcomes of transurethral assisted laparoendoscopic single-site (LESS) radical prostatectomy (RP) and LESS radical cystectomy (RC) in a single institution. MATERIALS AND METHODS Between December 2014 and March 2016, a total of 114 LESS RPs and RCs were performed, comprising 68 LESS RPs, 38 LESS RCs with cutaneous ureterostomy (CU) and eight LESS RCs with orthotopic ileal neobladder (OIN). Access was achieved via a single-port, with four channels placed through a transumblical incision. After the apex of prostate was separated from the urethra, a self-developed port ('Zhu's port') was inserted through the urethra to facilitate resection of prostate and urethrovesical anastomosis. The peri-operative and postoperative data were collected and analysed retrospectively. Patients were followed up postoperatively for evidence of long-term side effects. RESULTS All the procedures were completed successfully. No conversion to conventional laparoscopic surgery was necessary. For LESS RP, the average operating time was 152 min. Estimated blood loss was 117 mL. The mean hospital stay was 16.4 days after surgery. For LESS RC with CU and LESS RC with OIN, the mean operating times were 215 and 328 min, mean estimated blood loss was 175 and 252 mL, and mean hospital stay was 9.4 and 18.2 days, respectively. Six patients required blood transfusion (5.26%). Intra-operative complications occurred in two patients (1.75%), and postoperative complications in nine (7.89%). Fourteen out of 68 (20.6%) patients who underwent LESS RP had positive surgical margins. Follow-up ranged from 10 to 30.6 months. In the prostate cancer cases, good urinary control was observed in 35.3%, 97.1% and 100% of patients at 1, 6 and 12 months after the operation, respectively, while biochemical recurrence was observed in 11.8% patients. In the bladder cancer cases, two patients had local recurrence and two patients had distant metastasis. CONCLUSION Our results showed that LESS RP and LESS RC are feasible and safe with the aid of a transurethral port. Operating through the transurethral port might overcome the challenges posed by the single-port laparoscopic approach.
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Affiliation(s)
- Jian Su
- Department of Urology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Qingyi Zhu
- Department of Urology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Lin Yuan
- Department of Urology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Yang Zhang
- Department of Urology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Qingling Zhang
- Department of Urology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Yunfei Wei
- Department of Urology, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, Nanjing, China
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Abdel-Karim AM, Elhenawy IM, Eid AA, Yahia E, Elsalmy SA. Laparoendoscopic single-site surgery for the treatment of different urological pathologies: Defining the learning curve of an experienced laparoscopist. Arab J Urol 2017; 15:187-193. [PMID: 29071150 PMCID: PMC5651930 DOI: 10.1016/j.aju.2017.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/25/2017] [Accepted: 06/06/2017] [Indexed: 12/02/2022] Open
Abstract
Objectives To define the learning curve of laparoendoscopic single-site surgery (LESS) of an experienced laparoscopist. Patients and methods Patients who had LESS, since its implementation in December 2009 until December 2014, were retrospectively analysed. Procedures were divided into groups of 10 and scored according to the European Scoring System for Laparoscopic Operations in Urology. Different LESS indications were done by one experienced laparoscopist. Technical feasibility, surgical safety, outcome, as well as the number of patients required to achieve professional competence were assessed. Results In all, 179 patients were included, with mean (SD) age of 36.3 (17.5) years and 25.4% of the patients had had previous surgeries. Upper urinary tract procedures were done in 65.9% of patients and 54.7% of the procedures were extirpative. Both transperitoneal and retroperitoneal LESS were performed in 92.8% and 7.2% of the patients, respectively. The intraoperative and postoperative complication rates were 2.2% and 5.6% (Clavien–Dindo Grade II 3.9% and IIIa 1.7%), respectively. In all, 75% of intraoperative complications and all conversions were reported during the first 30 LESS procedures; despite the significantly higher difficulty score in the subsequent LESS procedures. One 5-mm extra port, conversion to conventional laparoscopy and open surgery was reported in 14%, 1.7%, and 1.1% of the cases, respectively. At mean (SD) follow-up of 39.7 (11.4) months, all the patients that underwent reconstructive LESS procedures but one were successful. Conclusion In experienced hands, at least 30 LESS procedures are required to achieve professional competence. Although difficult, both conversion and complication rates of LESS are low in experienced hands.
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Affiliation(s)
| | | | - Ahmed A Eid
- Urology Department, Alexandria University, Alexandria, Egypt
| | - Elsayed Yahia
- Urology Department, Alexandria University, Alexandria, Egypt
| | - Salah A Elsalmy
- Urology Department, Alexandria University, Alexandria, Egypt
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Hallbeck MS, Lowndes BR, McCrory B, Morrow MM, Kaufman KR, LaGrange CA. Kinematic and ergonomic assessment of laparoendoscopic single-site surgical instruments during simulator training tasks. Appl Ergon 2017; 62:118-130. [PMID: 28411722 DOI: 10.1016/j.apergo.2017.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 12/22/2016] [Accepted: 02/02/2017] [Indexed: 06/07/2023]
Abstract
While laparoendoscopic single-site surgery (LESS) appears to be feasible and safe, instrument triangulation, tissue handling, and other bimanual tasks are difficult even for experienced surgeons. Novel technologies emerged to overcome LESS' procedural and ergonomic difficulties of "tunnel vision" and "instrument clashing." Surgeon kinematics, self-reported workload and upper body discomfort were used to compare straight, bent and two articulating instruments while performing two basic surgical tasks in a LESS simulator. All instruments resulted in bilateral elevation and rotation of the shoulders, excessive forearm motion and flexion and ulnar deviation of wrists. Surgeons' adopted non-neutral upper extremity postures and performed excessive joint excursions to compensate for reduced freedom of movement at the single insertion site and to operate the instrument mechanisms. LESS' cosmetic benefits continue to impact laparoscopic surgery and by enabling performance through improved instruments, ergonomic improvement for LESS can reduce negative impact on surgeon well-being and patient safety.
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Affiliation(s)
- M Susan Hallbeck
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA; Department of Surgery, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Department of Mechanical and Materials Engineering, College of Engineering, University of Nebraska, Lincoln, NE 68588, USA.
| | - Bethany R Lowndes
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA; Department of Mechanical and Materials Engineering, College of Engineering, University of Nebraska, Lincoln, NE 68588, USA
| | - Bernadette McCrory
- Department of Mechanical and Materials Engineering, College of Engineering, University of Nebraska, Lincoln, NE 68588, USA; Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Melissa M Morrow
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
| | - Kenton R Kaufman
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Chad A LaGrange
- Department of Surgery, Division of Urology, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Redondo C, Esquinas C, Meilán E, García-Tello A, Arance I, Angulo JC. Comparative study of hybrid laparoendoscopic single-site ( LESS) partial nephrectomy and conventional multiport laparoscopy. Actas Urol Esp 2017; 41:242-248. [PMID: 27825746 DOI: 10.1016/j.acuro.2016.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/02/2016] [Accepted: 10/03/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the surgical and oncological outcomes of hybrid laparoendoscopic single-site (LESS) in partial nephrectomy with reusable components compared with multiport laparoscopy. MATERIAL AND METHOD Hybrid LESS technique with auxiliary 3.5mm trocar (n=20) was compared with conventional multiport laparoscopy (n=26) by a prospective, paired, nonrandomized, and comparative study in partially nephrectomized patients. RESULTS Follow-up average was 31±18.6 months. In one case, LESS was converted to laparoscopy. No differences were found regarding age, sex, body mass index, laterality, localization, tumor size or use of double J stent. Dominance of Loop-I (P=0.09) and benign histology (P=0.05) were observed in the LESS group. Neither there were differences regarding operating time, ischemia time, use of hemostatic materials, estimated blood loss, postoperative hemoglobin levels, transfusion or other complications. In any case, to extend the skin incision for specimen extraction was not necessary. Drainage time (P=0.006) and hospital stay (P=0.003) were better in LESS patients. Concerning complications, no significant differences were observed according Clavien-Dindo scale. In laparoscopic group one patient died of pulmonary embolism after hospital discharge. No positive margins were observed in any case. During follow-up neither tumor recurrence nor disease progression were observed. CONCLUSIONS Regarding surgical outcomes, partial nephrectomy by LESS technique does not imply improvements, excepting shorter hospital stay, probably due to accurate surgical hemostasis and/or selection of cases. No surgical and oncological risks are involved, as well as no improvement in ischemia time, blood loss or transfusion rate. We find no significant difference in cosmetic outcomes.
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Affiliation(s)
- C Redondo
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, España
| | - C Esquinas
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, España
| | - E Meilán
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, España
| | - A García-Tello
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, España
| | - I Arance
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, España
| | - J C Angulo
- Servicio de Urología, Hospital Universitario de Getafe, Getafe, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, España.
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Sandberg EM, la Chapelle CF, van den Tweel MM, Schoones JW, Jansen FW. Laparoendoscopic single-site surgery versus conventional laparoscopy for hysterectomy: a systematic review and meta-analysis. Arch Gynecol Obstet 2017; 295:1089-103. [PMID: 28357561 DOI: 10.1007/s00404-017-4323-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/06/2017] [Indexed: 02/07/2023]
Abstract
Purpose To assess the safety and effectiveness of LESS compared to conventional hysterectomy. Methods The systematic review and meta-analysis was performed according to the MOOSE guideline, and quality of evidence was assessed using GRADE. Different databases were searched up to 4th of August 2016. Randomized controlled trials and cohort studies comparing LESS to the conventional laparoscopic hysterectomy were considered for inclusion. Results Of the 668 unique articles, 23 were found relevant. We investigated safety by analyzing the complication rate and found no significant differences between both groups [OR 0.94 (0.61, 1.44), I2 = 19%]. We assessed effectiveness by analyzing conversion risk, postoperative pain, and patient satisfaction. For conversion rates to laparotomy, no differences were identified [OR 1.60 (0.40, 6.38), I2 = 45%]. In 3.5% of the cases in the LESS group, an additional port was needed during LESS. For postoperative pain scores and patient satisfaction, some of the included studies reported favorable results for LESS, but the clinical relevance was non-significant. Concerning secondary outcomes, only a difference in operative time was found in favor of the conventional group [MD 11.3 min (5.45–17.17), I2 = 89%]. The quality of evidence for our primary outcomes was low or very low due to the study designs and lack of power for the specified outcomes. Therefore, caution is urged when interpreting the results. Conclusion The single-port technique for benign hysterectomy is feasible, safe, and equally effective compared to the conventional technique. No clinically relevant advantages were identified, and as no data on cost effectiveness are available, there are currently not enough valid arguments to broadly implement LESS for hysterectomy. Electronic supplementary material The online version of this article (doi:10.1007/s00404-017-4323-y) contains supplementary material, which is available to authorized users.
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Machado MT, Nunes-Silva I, da Costa EF, Hidaka AK, Faria EF, Zampolli H, Bezerra CA. Laparoendoscopic single-site retroperitoneoscopic adrenalectomy: bilateral step-by-step technique. Surg Endosc 2017; 31:3351-3352. [PMID: 28233094 DOI: 10.1007/s00464-016-5400-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/19/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Laparoscopic adrenalectomy is the gold standard surgical approach for small benign adrenal tumors [1]. Several surgical approaches were developed in order to overcome the difficulty to access the adrenal glands, located in the upper retroperitoneum space [2-4]. Laparoendoscopic single-site posterior retroperitoneoscopic adrenalectomy (LESS-PRA) is an emerging technique that reduced the multiple trocar-related trauma and improved cosmetic outcomes while minimizing postoperative morbidity [5-8]. The aim of this study was to describe our step-by-step technique for LESS-PRA and to compare our perioperative outcomes with the conventional 3-port lateral retroperitoneoscopic adrenalectomy (LRA). METHODS A retrospective review was carried out from February 2008 to January 2016 that included 100 patients with adrenal tumors smaller than 4 cm. Study exclusion criteria were defined as tumor size greater than 4 cm, patients older than 80 years, and body mass index (BMI) greater than 40. A total of 20 patients underwent LESS-PRA and 80 patients underwent 3-port lateral retroperitoneoscopic laparoscopic adrenalectomy. Patient's demographic data and perioperative outcomes were compared and statistically analyzed. The cosmetic satisfaction was evaluated with a visual analog scale. RESULTS Estimated blood loss was higher in LRA (100 vs. 50 ml; p = 0.35). Operative time was longer in LESS-PRA than LRA (100.0 vs. 60 min; p < 0.001). Analgesic time necessary for LRA was longer than LESS-PRA (40 vs. 24 h; p < 0.001). Cosmetic satisfaction score was higher in LESS-PRA (9.5 vs. 8.6; p = 0.03). There were no significant differences in perioperative complications and length of hospital stay. No conversion to conventional laparoscopic or open surgery was necessary. CONCLUSION LESS-PRA presented comparable functional and perioperative outcomes to LRA for small adrenal tumors. Although LESS-PRA was associated with longer operative time, it provided inferior estimated blood loss, analgesic time, and improved cosmetic satisfaction.
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Affiliation(s)
| | - Igor Nunes-Silva
- Urology Division, Arnaldo Vieira de Carvalho Cancer Institute- IAVC, São Paulo, SP, Brazil
| | | | | | | | - Hamilton Zampolli
- Urology Division, Arnaldo Vieira de Carvalho Cancer Institute- IAVC, São Paulo, SP, Brazil
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Chantada C, García-Tello A, Esquinas C, Moraga A, Redondo C, Angulo JC. Comparative study of multiport laparoscopy and umbilical laparoendoscopic single-site surgery with reusable platform for treating renal masses. Actas Urol Esp 2017; 41:39-46. [PMID: 27365267 DOI: 10.1016/j.acuro.2016.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Umbilical laparoendoscopic single-site (LESS) surgery is an increasingly used modality for treating renal masses. We present a prospective comparison between LESS renal surgery and conventional laparoscopy. MATERIAL AND METHOD A comparative paired study was conducted that evaluated the surgical results and complications of patients with renal neoplasia treated with LESS surgery (n=49) or multiport laparoscopy (n=53). The LESS approach was performed with reusable material placed in the navel and double-rotation curved instruments. An additional 3.5-mm port was employed in 69.4% of the cases. We assessed demographic data, the type of technique (nephrectomy, partial nephrectomy and nephroureterectomy), surgical time, blood loss, haemoglobin, need for transfusion, number and severity of complications (Clavien-Dindo), hospital stay, histological data and prognosis. RESULTS There were no differences in follow-up, age, sex, body mass index, preoperative haemoglobin levels or type of surgery. Conversion occurred in 2 cases (1 in each group). The surgical time was equivalent (P=.6). Intraoperative transfusion (P=.03) and blood loss (P<.0001) was lower with LESS, postoperative haemoglobin levels were higher (P<.0001) and haemostatic agents were used more frequently (P<.0001). There were no differences in the number (P=.6) or severity (P=.47) of complications. The length of stay (P<.0001), the proportion of patients with drainage (P=.04) and the number of days with drainage (P=.0004) were lower in LESS. Twenty-five percent of the lesions operated on with LESS were benign, but the mean size was similar in the 2 groups (P=.5). Tumour recurrence and/or progression were more frequent in multiport laparoscopy (P=.0013). CONCLUSIONS Umbilical LESS surgery with reusable platform enables various surgical techniques to be performed when treating renal masses, with time consumption and safety comparable to conventional laparoscopy. The LESS approach is advantageous in terms of blood loss and hospital stay.
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Affiliation(s)
- C Chantada
- Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, España
| | - A García-Tello
- Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, España
| | - C Esquinas
- Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, España
| | - A Moraga
- Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, España
| | - C Redondo
- Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, España
| | - J C Angulo
- Servicio de Urología, Hospital Universitario de Getafe, Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Madrid, España.
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Rosemurgy AS, Downs D, Swaid F, Ross SB. Laparoendoscopic Single-Site ( LESS) Nissen Fundoplication: How We Do It. J Gastrointest Surg 2016; 20:2093-9. [PMID: 27730403 DOI: 10.1007/s11605-016-3290-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/27/2016] [Indexed: 01/31/2023]
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Scarneo SE, Root HJ, Martinez JC, Denegar C, Casa DJ, Mazerolle SM, Dann CL, Aerni GA, DiStefano LJ. Landing Technique Improvements After an Aquatic-Based Neuromuscular Training Program in Physically Active Women. J Sport Rehabil 2017; 26:8-14. [PMID: 27632861 DOI: 10.1123/jsr.2015-0052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
CONTEXT Neuromuscular training programs (NTPs) improve landing technique and decrease vertical ground-reaction forces (VGRFs), resulting in injury-risk reduction. NTPs in an aquatic environment may elicit the same improvements as land-based programs with reduced joint stress. OBJECTIVE To examine the effects of an aquatic NTP on landing technique as measured by the Landing Error Scoring System (LESS) and VGRFs, immediately and 4 mo after the intervention. DESIGN AND SETTING Repeated measures, pool and laboratory. PARTICIPANTS Fifteen healthy, recreationally active women (age 21 ± 2 y, mass 62.02 ± 8.18 kg, height 164.74 ± 5.97 cm) who demonstrated poor landing technique (LESS-Real Time > 4). INTERVENTIONS All participants completed an aquatic NTP 3 times/wk for 6 wk. MAIN OUTCOME MEASURES Participants' landing technique was evaluated using a jump-landing task immediately before (PRE), immediately after (POST), and 4 mo after (RET) the intervention period. A single rater, blinded to time point, graded all videos using the LESS, which is a valid and reliable movement-screening tool. Peak VGRFs were measured during the stance phase of the jump-landing test. Repeated-measure analyses of variance with planned comparisons were performed to explore differences between time points. RESULTS LESS scores were lower at POST (4.46 ± 1.69 errors) and at RET (4.2 ± 1.72 errors) than at PRE (6.30 ± 1.78 errors) (P < .01). No significant differences were observed between POST and RET (P > .05). Participants also landed with significantly lower peak VGRFs (P < .01) from PRE (2.69 ± .72 N) to POST (2.23 ± .66 N). CONCLUSIONS The findings introduce evidence that an aquatic NTP improves landing technique and suggest that improvements are retained over time. These results show promise of using an aquatic NTP when there is a desire to reduce joint loading, such as early stages of rehabilitation, to improve biomechanics and reduce injury risk.
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Abstract
INTRODUCTION While autonomous surgical robotic systems exist primarily at the research level, recently these systems have made a strong push into clinical settings. The autonomous or semi-autonomous control of surgical robotic platforms may offer significant improvements to a diverse field of surgical procedures, allowing for high precision, intelligent manipulation of these systems and opening the door to advanced minimally invasive surgical procedures not currently possible. AREAS COVERED This review highlights those experimental systems currently under development with a focus on in vivo modeling and control strategies designed specifically for the complex and dynamic surgical environment. Expert review: Novel methods for state estimation, system modeling and disturbance rejection, as applied to these devices, continues to improve the performance of these important surgical tools. Procedures such as Natural Orifice Transluminal Endoscopic Surgery and Laparo-Endoscopic Single Site surgery, as well as more conventional procedures such as Colonoscopy, serve to benefit tremendously from the development of these automated robotic systems, enabling surgeons to minimize tissue damage and shorten procedure times while avoiding the consequences of laparotomy.
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Affiliation(s)
- J Micah Prendergast
- a Department of Mechanical Engineering , University of Colorado , Boulder , CO , USA
| | - Mark E Rentschler
- a Department of Mechanical Engineering , University of Colorado , Boulder , CO , USA
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Symeonidis EN, Nasioudis D, Economopoulos KP. Laparoendoscopic single-site surgery ( LESS) for major urological procedures in the pediatric population: A systematic review. Int J Surg 2016; 29:53-61. [PMID: 27000720 DOI: 10.1016/j.ijsu.2016.03.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 03/06/2016] [Accepted: 03/12/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Improvements in laparoscopic surgery have led to the introduction of laparoendoscopic single-site surgery (LESS) as an alternative to conventional laparoscopy conferring a number of possible advantages. In this review, we aim to elucidate the aspects of LESS for major urological procedures in the pediatric population. MATERIALS AND METHODS An in-depth search of the literature was performed in the databases of PubMed and Scopus, for studies investigating the technical aspects and clinical outcomes of partial nephrectomies, nephrectomies, nephroureterectomies, varicocelectomies and pyeloplasties in children. Data on parameters such as operation time, instrumentation, perioperative complications, hospital stay and follow up period were collected and further analyzed cumulatively. RESULTS Twenty nine studies met the inclusion criteria incorporating 386 patients who underwent 401 procedures. There were no major intraoperative complications, with only 19 patients (4.73%) facing postoperative complications. No perioperative deaths were reported. CONCLUSIONS In the hands of experienced surgeons LESS seems a feasible, efficient and less invasive alternative to standard laparoscopy in the field of pediatric urology. There is an eminent need of well-designed randomized controlled trials comparing the two techniques.
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Affiliation(s)
- Evangelos N Symeonidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, Greece; Surgery Working Group, Society of Junior Doctors, Athens, Greece
| | | | - Konstantinos P Economopoulos
- Surgery Working Group, Society of Junior Doctors, Athens, Greece; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Yang J, Na YJ, Song YJ, Choi OH, Lee SK, Kim HG. The effectiveness of laparoendoscopic single-site surgery ( LESS) compared with conventional laparoscopic surgery for ectopic pregnancy with hemoperitoneum. Taiwan J Obstet Gynecol 2016; 55:35-9. [PMID: 26927245 DOI: 10.1016/j.tjog.2015.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2015] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare clinical outcomes of conventional laparoscopic surgery and laparoendoscopic single-site surgery (LESS) in the surgical treatment of tubal ectopic pregnancy. MATERIAL AND METHODS A total of 156 patients were diagnosed with ectopic pregnancies by ultrasonography and serum β-human chorionic gonadotrophin (β-hCG) levels at Pusan National University Yangsan Hospital from January 2009 through December 2013. We excluded 28 patients who only received medical treatment, 15 patients who underwent surgery by laparotomy for severe hypovolemic shock, and 30 patients who presented with less than 1 L of hemoperitoneum. Of the 83 patients with massive hemoperitoneum, 38 patients had LESS performed while the remaining 45 patients underwent conventional laparoscopic surgery. RESULTS In this study, there were no statistically significant differences in clinical outcomes in either surgical method except for operative time. Operative time of LESS was significantly shorter than conventional surgery for patients with more than 500 mL of hemoperitoneum. CONCLUSION LESS is a safe and feasible surgical approach in the treatment of tubal ectopic pregnancy. At the same time, LESS has been shown to be more effective than conventional laparoscopic surgery in handling massive hemoperitoneum of more than 1 L, which is a common complication of ectopic pregnancy.
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Affiliation(s)
- Juseok Yang
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea
| | - Yong Jin Na
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea
| | - Yong Jung Song
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea
| | - Ook Hwan Choi
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea
| | - Sun Kyung Lee
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea
| | - Hwi Gon Kim
- Department of Obstetrics and Gynecology, Pusan National University Yangsan Hospital, Yangsan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea.
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Pavan N, Autorino R, Lee H, Porpiglia F, Sun Y, Greco F, Jeff Chueh S, Han DH, Cindolo L, Ferro M, Chen X, Branco A, Fornara P, Liao CH, Miyajima A, Kyriazis I, Puglisi M, Fiori C, Yang B, Fei G, Altieri V, Jeong BC, Berardinelli F, Schips L, De Cobelli O, Chen Z, Haber GP, He Y, Oya M, Liatsikos E, Brandao L, Challacombe B, Kaouk J, Darweesh I. Impact of novel techniques on minimally invasive adrenal surgery: trends and outcomes from a contemporary international large series in urology. World J Urol 2016; 34:1473-9. [PMID: 26923920 DOI: 10.1007/s00345-016-1791-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/12/2016] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To evaluate contemporary international trends in the implementation of minimally invasive adrenalectomy and to assess contemporary outcomes of different minimally invasive techniques performed at urologic centers worldwide. METHODS A retrospective multinational multicenter study of patients who underwent minimally invasive adrenalectomy from 2008 to 2013 at 14 urology institutions worldwide was included in the analysis. Cases were categorized based on the minimally invasive adrenalectomy technique: conventional laparoscopy (CL), robot-assisted laparoscopy (RAL), laparoendoscopic single-site surgery (LESS), and mini-laparoscopy (ML). The rates of the four treatment modalities were determined according to the year of surgery, and a regression analysis was performed for trends in all surgical modalities. RESULTS Overall, a total of 737 adrenalectomies were performed across participating institutions and included in this analysis: 337 CL (46 % of cases), 57 ML (8 %), 263 LESS (36 %), and 80 RA (11 %). Overall, 204 (28 %) operations were performed with a retroperitoneal approach. The overall number of adrenalectomies increased from 2008 to 2013 (p = 0.05). A transperitoneal approach was preferred in all but the ML group (p < 0.001). European centers mostly adopted CL and ML techniques, whereas those from Asia and South America reported the highest rate in LESS procedures, and RAL was adopted to larger extent in the USA. LESS had the fastest increase in utilization at 6 %/year. The rate of RAL procedures increased at slower rates (2.2 %/year), similar to ML (1.7 %/year). Limitations of this study are the retrospective design and the lack of a cost analysis. CONCLUSIONS Several minimally invasive surgical techniques for the management of adrenal masses are successfully implemented in urology institutions worldwide. CL and LESS seem to represent the most commonly adopted techniques, whereas ML and RAL are growing at a slower rate. All the MIS techniques can be safely and effectively performed for a variety of adrenal disease.
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Affiliation(s)
- Nicola Pavan
- University Hospitals Urology Institute, Case Western Reserve University, 27100 Chardon Rd, Richmond Heights, OH, 44143, USA.,Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Trieste, Italy
| | - Riccardo Autorino
- University Hospitals Urology Institute, Case Western Reserve University, 27100 Chardon Rd, Richmond Heights, OH, 44143, USA.
| | - Hak Lee
- Department of Urology, University of California San Diego Health System, La Jolla, CA, USA
| | - Francesco Porpiglia
- Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy
| | - Yinghao Sun
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Francesco Greco
- Department of Urology, Romolo Hospital, Rocca di Neto, Italy
| | - S Jeff Chueh
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Deok Hyun Han
- Department of Urology, Samsung Medical Center, Seoul, Italy
| | - Luca Cindolo
- Department of Urology, S. Pio Da Pietralcina Hospital, Vasto, Italy
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Xiang Chen
- Xiangya Hospital Central South University, Changsha, China
| | - Anibal Branco
- Department of Urology, Cruz Vermelha Hospital, Curitiba, Brazil
| | - Paolo Fornara
- Department of Urology, Martin-Luther-University, Halle Saale, Germany
| | - Chun-Hou Liao
- Department of Urology, Medical College, National Taiwan University, Taipei City, Taiwan
| | - Akira Miyajima
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Iason Kyriazis
- Department of Urology, University of Patras, Patras, Greece
| | | | - Cristian Fiori
- Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy
| | - Bo Yang
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | - Guo Fei
- Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China
| | | | | | | | - Luigi Schips
- Department of Urology, S. Pio Da Pietralcina Hospital, Vasto, Italy
| | | | - Zhi Chen
- Xiangya Hospital Central South University, Changsha, China
| | | | - Yao He
- Xiangya Hospital Central South University, Changsha, China
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | | | - Luis Brandao
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ithaar Darweesh
- Department of Urology, University of California San Diego Health System, La Jolla, CA, USA
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Lee S, Ahn KH, Park HT, Hong SC, Lee YJ, Kim IS, Kim T. Paratubal Borderline Malignancy: A Case of a 17-Year-Old Adolescent Female Treated with Laparo-Endoscopic Single-Site Surgery and a Review of the Literature. J Pediatr Adolesc Gynecol 2016; 29:74-6. [PMID: 26026220 DOI: 10.1016/j.jpag.2014.07.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 07/18/2014] [Accepted: 07/25/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although paratubal cysts are common, borderline paratubal cysts are extremely rare. We describe the case of a large borderline paratubal cyst in a 17-year-old adolescent female treated with laparo-endoscopic single-site surgery (LESS), and review the literature. CASE A 17-year-old female was referred due to a large right adnexal cyst on pelvic sonogram. A CT scan showed a 19-cm cystic lesion with enhancing papillary projection along the wall. Laparo-endoscopic single-site surgery confirmed a large cystic mass that originated from the right salpinx. Right salpingectomy and right ovarian wedge resection were performed, and intraoperative frozen section analysis was conducted. The result of the frozen section analysis and final pathologic review indicated that the cyst was a serous papillary-type borderline tumor in a paratubal cyst. SUMMARY AND CONCLUSION To the best of our knowledge, this is the first case report of a BPC treated with LESS. We suggest that minimally invasive, fertility-preserving surgery should be considered as a standard treatment of borderline paratubal cysts if patients desire future fertility.
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Affiliation(s)
- Sanghoon Lee
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Hyun Tae Park
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea.
| | - Soon Cheol Hong
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Yoo Jin Lee
- Department of Pathology, Korea University College of Medicine, Seoul, Korea
| | - In Sun Kim
- Department of Pathology, Korea University College of Medicine, Seoul, Korea
| | - Tak Kim
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
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Abdel-Karim AM, Yahia E, Hassouna M, Missiry M. Laparoscopic Single Site Surgery for Repair of Retrocaval Ureter in a Morbidly Obese Patient. Urol Case Rep 2016; 4:61-3. [PMID: 26793585 PMCID: PMC4719792 DOI: 10.1016/j.eucr.2015.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 10/13/2015] [Indexed: 11/30/2022] Open
Abstract
This is to describe a case of a morbidly obese (BMI = 40) female with retrocaval ureter treated with laparoendoscopic single-site surgery. A JJ stent was positioned. A 2 cm umbilical access was created. A single port platform was positioned. The entire ureter was mobilized posterior to the vena cava and transected where the dilated portion ended. The distal ureter was repositioned lateral to the inferior vena cava. Anastomosis was done. A 3 mm trocar was used to assist suturing. At 4-month follow-up, CT revealed no evidence of obstruction of the right kidney and the patient was symptomless. Although challenging, in a morbidly obese patient, LESS repair for retrocaval ureter is feasible.
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Affiliation(s)
| | - Elsayed Yahia
- Urology Department, Alexandria University, Alexandria 21411, Egypt
| | - M Hassouna
- Urology Department, Alexandria University, Alexandria 21411, Egypt
| | - M Missiry
- Urology Department, Alexandria University, Alexandria 21411, Egypt
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Bowman TA, Sadowitz BD, Ross SB, Boland A, Luberice K, Rosemurgy AS. Heller myotomy with esophageal diverticulectomy: an operation in need of improvement. Surg Endosc 2015; 30:3279-88. [PMID: 26659233 DOI: 10.1007/s00464-015-4655-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 10/28/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study was undertaken to evaluate the outcomes after laparoscopic Heller myotomy with anterior fundoplication and diverticulectomy for patients with achalasia and esophageal diverticula. METHODS 634 patients undergoing laparoscopic Heller myotomy and anterior fundoplication from 1992 to 2015 are prospectively followed up; patients were stratified for those undergoing concomitant diverticulectomy. Patients graded symptom frequency and severity before and after myotomy, using a Likert scale (0 = never/not bothersome to 10 = always/very bothersome). Median data are presented (mean ± SD). RESULTS Forty-four patients, age 70 years (65 ± 14.2), underwent laparoscopic Heller myotomy, anterior fundoplication, and diverticulectomy. Operative time was 182 min (183 ± 54.6). Fifty percentage of patients had a postoperative complication: Most notable were leaks at the diverticulectomy site (n = 8) and pulmonary complications (n = 11; 10 effusion, 1 empyema). Length of stay (LOS) was 3 days (5 ± 8.3). All leaks occurred after discharge and resolved without sequelae using transthoracic catheter drainage and parenteral nutrition; two patients received endoscopic esophageal stents. Median follow-up is 39 months. Symptoms amelioration was significant postoperatively, including severity of dysphagia [6 (6 ± 3.9) to 2(4 ± 3.6)]. Seventy-six percentage of patients rated their symptoms at last follow-up as satisfying/very satisfying. Seventy-seven percentage of patients had symptoms once per week or less. Eighty-one percentage would have the operation again knowing what they know now. CONCLUSIONS Laparoscopic Heller myotomy, anterior fundoplication, and diverticulectomy well palliate the symptoms of achalasia with accompanying esophageal diverticulum. The operations are generally longer than those without diverticulectomy and are accompanied by a relatively longer LOS. Complications are relatively frequent and severe (e.g., leaks and pneumonia). In particular, leaks at the diverticulectomy site are unpredictable, occur after discharge, and remain vexing. Nevertheless, for this advanced form of achalasia, long-term symptom relief and patient satisfaction are high after anterior fundoplication with concomitant diverticulectomy. New and innovative techniques are needed to decrease the frequency of leaks at the diverticulectomy site.
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Affiliation(s)
- Ty A Bowman
- Southeastern Center for Digestive Disorders and Pancreatic Cancer, Florida Hospital Tampa, 3000 Medical Park Drive, Suite 310, Tampa, FL, 33613, USA
| | - Benjamin D Sadowitz
- Southeastern Center for Digestive Disorders and Pancreatic Cancer, Florida Hospital Tampa, 3000 Medical Park Drive, Suite 310, Tampa, FL, 33613, USA
| | - Sharona B Ross
- Southeastern Center for Digestive Disorders and Pancreatic Cancer, Florida Hospital Tampa, 3000 Medical Park Drive, Suite 310, Tampa, FL, 33613, USA.
| | - Andrew Boland
- Southeastern Center for Digestive Disorders and Pancreatic Cancer, Florida Hospital Tampa, 3000 Medical Park Drive, Suite 310, Tampa, FL, 33613, USA
| | - Kenneth Luberice
- Southeastern Center for Digestive Disorders and Pancreatic Cancer, Florida Hospital Tampa, 3000 Medical Park Drive, Suite 310, Tampa, FL, 33613, USA
| | - Alexander S Rosemurgy
- Southeastern Center for Digestive Disorders and Pancreatic Cancer, Florida Hospital Tampa, 3000 Medical Park Drive, Suite 310, Tampa, FL, 33613, USA
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