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Robotic ileocolic resection with mesenteric excision and intracorporeal anastomosis for Crohn's disease complicated with enterocutaneous fistula and stricture-A video vignette. Colorectal Dis 2024. [PMID: 38783540 DOI: 10.1111/codi.17045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
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Short- and mid-term results of diode laser treatment in pilonidal sinus disease and the role of endoscopic camera use on outcomes. Tech Coloproctol 2023; 27:921-928. [PMID: 37356014 DOI: 10.1007/s10151-023-02831-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 06/01/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Nowadays, surgical treatment of pilonidal sinus disease (PSD) with novel techniques is a topic of interest since conventional methods are associated with longer return to daily life and higher complication and recurrence rates. Recently, use of laser as a minimally invasive approach has become popular in the surgical treatment of PSD. In this study, we analyze the short- and mid-term results after laser treatment and the effect of endoscopic camera use on outcomes. METHODS A total of 106 patients with PSD who underwent laser treatment between November 2017 and September 2021 were included in this study. All patients were treated with a 1470-nm diode laser. Endoscopic camera was used in 73 patients and results of these were compared with those in whom camera was not used. Follow-up period was determined as a minimum of 1 year. Data were analyzed retrospectively. RESULTS There were 80 (75%) male and 26 female patients. The median age was 26 (range 13-50) years. On the first postoperative day, 26 (26.5%) patients did not have any pain and 42(42.8%) patients reported low-grade pain. The mean time to return to daily life was 4.5 ± 5.5 (median 2, range 1-30) days. The complication rate was 10.4%. Eighty-six (87.8%) patients completely recovered and the mean complete recovery time was 27.4 ± 15.9 days. The patient satisfaction rate was 99.0%. The recurrence rate was 11.0%. Neither history of previous surgery nor abscess was associated with recurrence. Use of an endoscopic camera had no effect on postoperative pain, complete recovery, complications, patient satisfaction, and recurrence (p < 0.05). CONCLUSION Laser treatment for PSD is a promising approach with the advantages of less postoperative pain, early return to daily life, high patient satisfaction, and acceptable complication and recurrence rates. Nevertheless, further studies are needed to investigate the role of endoscopic camera use in this procedure since its possible advantages could not be clarified.
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Step by step revisiting and standardizing the robotic approach of complete mesocolic excision for right-sided colon cancer. Tech Coloproctol 2022; 26:677-679. [PMID: 35076765 DOI: 10.1007/s10151-022-02575-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
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Does Obesity Impact Surgical and Pathological Outcomes in Robotic Complete Mesocolic Excision for Colon Cancer? J Laparoendosc Adv Surg Tech A 2021; 31:1247-1253. [PMID: 33416432 DOI: 10.1089/lap.2020.0824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Obesity is one of the contributing factors to technical difficulties in minimally invasive colorectal surgery. However, there are no data regarding the outcomes for obese patients undergoing robotic complete mesocolic excision (CME) for colon cancer. In this study, we aimed to investigate whether robotic CME in obese patients can be performed with similar morbidity and pathological results compared with nonobese patients. Methods: Patients who underwent robotic CME between 2014 and 2019 were classified into obese and nonobese groups. Obesity was defined as body mass index ≥30 kg/m2. Demographic data, perioperative outcomes and pathological results were compared between the groups. Results: There were 42 and 105 patients in the obese and nonobese group, respectively. The groups were comparable regarding preoperative characteristics. There were no significant differences with respect to operative times (244 ± 64 versus 304 ± 75 minutes, P = .29), blood loss (median, 50 versus 80 mL, P = .20), intraoperative complications (0% versus 3.8%, P > .99), and conversions (0% versus 1.9%, P > .99). No differences were detected in length of hospital stay (6 ± 1 versus 6 ± 2 days, P = .73), anastomotic leak (2.4% versus 1.9%, P > .99), septic complications, reoperations (2.4% versus 3.8%), and readmissions (2.4% versus 2.9%) (P > .05). The mean number of harvested lymph nodes (33 ± 11 versus 34 ± 13, P = .79), resection margin status, and mesocolic fascia grading were similar. Conclusion: Robotic CME in obese patients can be performed with a similar morbidity and pathological profile compared with nonobese patients. The Clinical Trial Registration number is not applicable for this study.
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Operative and long-term oncological outcomes in patients undergoing robotic versus laparoscopic surgery for rectal cancer. Int J Med Robot 2020; 16:1-10. [PMID: 32920968 DOI: 10.1002/rcs.2168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study aimed to compare short- and long-term outcomes after robotic versus laparoscopic approach in patients undergoing curative surgery for rectal cancer. METHODS Patients undergoing elective robotic and laparoscopic resection for rectal cancer were included. Perioperative clinical characteristics, postoperative short- and long-term outcomes were compared between groups. RESULTS There were 72 and 44 patients in robotic (RG) and laparoscopic (LG) groups respectively. No differences were detected regarding patients' demographics, histopathologic outcomes, conversion rates and 30-day overall postoperative complication rates. Operative time was longer in the RG (341 ± 111.7 vs. 263 ± 97.5 min, p = 0.001) and length of stay was longer in the LG (4.4 ± 1.9 vs. 6.4 ± 2.9 days, p = 0.001). The 5-year overall and disease-free survival rates were similar (97.1% and 94.9%, p = 0.78; 86.2% and 82.7%, p = 0.72) between the groups. CONCLUSION This study showed both short and long-term outcomes of a limited number of included patients between the robotic and laparoscopic surgery were similar. However, future studies and randomized trials are necessary to establish these findings.
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Learning curve analysis of robotic transabdominal preperitoneal inguinal hernia repair. Int J Med Robot 2020; 16:1-5. [PMID: 33289228 DOI: 10.1002/rcs.2150] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/01/2020] [Accepted: 08/11/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND The purpose of this study was to assess the learning curve (LC) for inguinal hernia repair with robotic transabdominal preperitoneal (R-TAPP) approach. METHODS Between April 2016 and October 2019, patients who underwent R-TAPP were retrieved. Patient demographics, operative variables and postoperative outcomes were assessed. The moving average method and cumulative sum of operation times (OT) were used to evaluate the LC. The surgeon (BB) in this study had completed his laparoscopic (Lap) TAPP experience. RESULTS There were 50 (two females) consecutive patients (mean age was 51.7 ± 16.9 years). The first phase (learning phase) included initial 35 operations. The second phase included the next 15 operations. It was observed that, with increasing experience, a statistically significant shortening in the average OT by about 25 min was achieved (p = 0.041). CONCLUSION The LC phase for R-TAPP, for surgeon with previous experience in Lap TAPP, seems to be very quick without compromising the operative morbidity.
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Totally minimally invasive radical gastrectomy with the da Vinci Xi ® robotic system versus straight laparoscopy for gastric adenocarcinoma. Int J Med Robot 2020; 16:1-9. [PMID: 32757483 DOI: 10.1002/rcs.2146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Data regarding the outcomes of pure minimally invasive techniques of radical gastrectomy are scarce. We aimed to compare short-term post-operative outcomes in patients undergoing totally minimally invasive radical gastrectomy with the da Vinci Xi® robotic system versus straight laparoscopy for gastric adenocarcinoma. METHODS Between December 2013 and March 2018, robotic and laparoscopic radical gastrectomy performed in two centres were included. Both groups were compared with respect to perioperative short-term outcomes. RESULTS Ninety-four patients were included in the study. Anticoagulant and neoadjuvant chemotherapy use were higher in the robotic group (p = 0.02, p = 0.02). There were conversions in the laparoscopy group whereas no conversions occurred in the robotic group (p = 0.052). Operating time in the robotic group was longer (p = 0.001). The number of harvested lymph nodes in the laparoscopic group was higher (p = 0.047). CONCLUSION Totally robotic technique with the da Vinci Xi® robotic system provides similar short-term results compared to laparoscopic surgery in radical gastrectomy.
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Impact of Prolonged Neoadjuvant Treatment-surgery Interval on Histopathologic and Operative Outcomes in Patients Undergoing Total Mesorectal Excision for Locally Advanced Rectal Cancer. Surg Laparosc Endosc Percutan Tech 2020; 30:511-517. [PMID: 32694403 DOI: 10.1097/sle.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study primarily aimed to assess the impact of prolonged neoadjuvant treatment-surgery interval (PNSI) on histopathologic and postoperative outcomes. Impacts of the mode of neoadjuvant treatment (NT) and surgery on the outcomes were also evaluated in the same patient population. PATIENTS AND METHODS Between February 2011 and December 2017, patients who underwent NT and total mesorectal excision for locally advanced rectal cancer were included. PNSI was defined as >4 and >8 weeks after short-course and long-course NT modalities, respectively. RESULTS A total of 44 (27%) patients received short-course NT (standard interval: n=28; PNSI: n=16) and 122 (73%) patients received long-course NT (standard interval: n=39; PNSI: n=83). Postoperative morbidity was similar between the standard interval and PNSI in patients undergoing short-course [n=3 (11%) vs. n=3 (19%), P=0.455] and long-course [n=6 (15%) vs. n=16 (19%), P=0.602] NT. PNSI was associated with increased complete pathologic response in patients receiving short-course NT [0 vs. n=5 (31%), P=0.002]. Compared with short-course NT, long-course NT was superior in terms of tumor response based on the Mandard [Mandard 1 to 2: n=6 (21%) vs. 6 (38%), P=0.012] and the College of American Pathologists (CAP) [CAP 0 to 1: n=13 (46%) vs. n=8 (50%), P=0.009] scores. Postoperative morbidity was similar after open, laparoscopic, and robotic total mesorectal excision [n=1 (14.2%) vs. n=21 (21%) vs. n=6 (12.5%), P=0.455] irrespective of the interval time to surgery and the type of NT. CONCLUSIONS PNSI can be considered in patients undergoing short-course NT due to its potential oncological benefits. The mode of surgery performed at tertiary centers has no impact on postoperative morbidity after both NT modalities.
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Totally laparoscopic and totally robotic surgery in patients with left-sided colonic diverticulitis. Int J Med Robot 2020; 16:e2068. [PMID: 31875352 DOI: 10.1002/rcs.2068] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 12/09/2019] [Accepted: 12/18/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Introduction of the da Vinci Xi system has facilitated the use of robotics in colorectal surgery. Nevertheless, data on the outcomes of robotic surgery for the treatment of colonic diverticulitis have remained scarce. METHODS Patient demographics, clinical characteristics, and perioperative outcomes of the patients undergoing totally robotic with the da Vinci Xi system or laparoscopic surgery for left-sided colonic diverticulitis (LCD) were compared. RESULTS Laparoscopic and robotic groups included 22 and 20 patients, respectively. There were no significant differences between the two groups in terms of patient demographics, clinical characteristics, operative time, and postoperative complications. There were three conversions in the laparoscopy group and no conversion in the robotic group (P = 0.23). Conversion to open surgery was associated with postoperative morbidity (P = 0.02). CONCLUSION Robotic surgery is an applicable alternative for the treatment of LCD. Robotic approach may potentially lower the risk of operative morbidity by reducing the requirement of conversion.
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Robotic left colectomy with complete mesocolic excision and intracorporeal side-to-side anastomosis for splenic flexure cancer with the da Vinci Xi robotic platform - a video vignette. Colorectal Dis 2019; 21:1454. [PMID: 31390679 DOI: 10.1111/codi.14813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/24/2019] [Indexed: 02/08/2023]
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Fully robotic total gastrectomy with D2 lymphadenectomy for gastric cancer. Surg Oncol 2019; 32:48. [PMID: 31747635 DOI: 10.1016/j.suronc.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 10/18/2019] [Accepted: 11/02/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Robotic surgery with technical advantages was shown to make complex maneuvers easier and more precise for gastric surgery [1]. This video demonstrates our technique on robotic total gastrectomy with the da Vinci Xi platform for gastric cancer. METHODS 68-year-old female was presented with persistent epigastric abdominal pain and underwent upper endoscopy showed ulcerated mass extended from the cardia to the lesser curvature. Histopathology showed gastric adenocarcinoma. After patient received neoadjuvant chemotherapy, decision was made to proceed with surgery. RESULTS Initially, greater curvature dissection was started by division of the gastrocolic ligament with entering the lesser sac with monopolar scissors and bipolar forceps. The right gastroomental vessels were identified and divided at their root along with lymph nodes. After ligation of the right gastric vessels, dissection was extended to retrieve lymph nodes around the left gastric vessels. Duodenum was circumferentially dissected and transected 2 cm distal to the pylorus. Subsequently, extended lymphadenectomy was started with suprapancreatic lymph node dissection to retrieve lymph nodes around the common hepatic artery and celiac axis. Spleen-preserving dissection of the lymphatic tissue of the distal splenic artery and the splenic hilum was performed. The distal esophagus was divided with robotic stapler. Fully robotic end-to-side esophagojejunal anastomosis was constructed. For the reconstruction of gastrointestinal continuity after total gastrectomy, side-to-side jejuno-jejunal anastomosis was performed. Total operative time was 5 hours and estimated blood loss was 20 cc. DISCUSSION Totally robotic gastrectomy with D2-lymphadenectomy is a safe technique for gastric cancer and provides intracorporeal suturing in reconstructing the anatomy.
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Standardized totally robotic complete mesocolic excision for right-sided colon cancer - a video vignette. Colorectal Dis 2019; 21:1335. [PMID: 31370101 DOI: 10.1111/codi.14800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/23/2019] [Indexed: 02/08/2023]
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Robotic sigmoidectomy for giant diverticula with the da Vinci Xi - a video vignette. Colorectal Dis 2019; 21:977-978. [PMID: 31055864 DOI: 10.1111/codi.14664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/08/2019] [Indexed: 02/08/2023]
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Clinicopathological and prognostic significance of microsatellit instability (MSI) status and PDl-1 expression in Turkish patients with gastric cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e15538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15538 Background: The aim of this study was to evaluate the prognostic role of microsatellite instability (MSI) status and PD-L1 expression in surgically resected gastric cancer and the relationship of these parameters with clinicopathological features. Methods: Eighty six gastric cancer patients which had curative surgical resection at Acibadem Atakent and Maslak Hospitals between 2010 and 2017 were analysed. Tumor samples were evaluated with MSI and PD-L1 antibodies by immunohistochemical (IHC) methods. PD-L1 IHC scoring was performed using the combined positive score (CPS). Survival analysis was accomplished using the Kaplan-Meier method. Cox proportional hazard regression model was used to identify independent risk factors that affect patients' overall survival. Results: The rate of PD-L1 expression in tumor cells was 34.9% (n = 30) and the frequency of PD-L1 expression in immune cells with CPS (≥1%) was 57% (n = 49). MSI-H was detected in 11.6%(n = 10), and more observed in PD-L1 positive cases (p = 0.021). MSI-H status was significantly correlated with older age, increased tumor size, presence of PD-L1 expression, and adenocarcinoma subtype. PD-L1 expression was associated with lymph node metastasis, adenocarcinoma subtype, microsatellite instability, presence of preoperative treatment and improved response to preoperative chemotherapy. In our study, the impact of MSI status on survival was not demonstrated, but PD-L1 expression positivity(≥1%) in both tumor cells (15.7 vs 53.4 months, p = 0.008)and in immune cells (20.4 vs NR; p = 0.027) was associated with short overall survival. PD -L1 expression in tumor cells was an independent prognostic factor for overall survival in multivariate analysis (HR: 2.28, p = 0.047). Conclusions: PD-L1 expression was related to a poor prognosis in patients with gastric cancer and can represent a rational approach for PD-1/PD-L pathway-targeted immunotherapy.
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Robotic Complete Mesocolic Excision Versus Conventional Laparoscopic Hemicolectomy for Right-Sided Colon Cancer. J Laparoendosc Adv Surg Tech A 2019; 29:671-676. [PMID: 30807257 DOI: 10.1089/lap.2018.0348] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Robotic technique has been proposed to overcome the limitations of laparoscopic surgery. In this study, we aimed at determining whether robotic complete mesocolic excision (CME) for right-sided colon cancer can be safe and effective as conventional laparoscopic right hemicolectomy (CLRH). Materials and Methods: Between February 2015 and September 2017, patients undergoing robotic right CME and CLRH with curative intent for right-sided colon cancer were included. Patient characteristics, short-term and histopathological outcomes were compared between the groups. Results: Ninety-six patients (robotic, n = 35) were included in this study. The operative time (286 ± 77 versus 132 ± 40 minutes, P = .0001) was significantly longer in the robotic group. There were no conversions in either group. No significant differences existed between the groups regarding the mean estimated blood loss, time to first flatus, length of hospital stay (6 ± 3 versus 6 ± 3 days, P = .64), and follow-up times (robotic 15 ± 8 versus laparoscopic 16 ± 10 months P = .11). Overall complication rates (n = 10 [29%] versus n = 15 [25%], P = .67) were similar. In the robotic group, vascular injury occurred in 2 patients, and both were repaired robotically. The mean number of harvested lymph nodes was significantly higher (41 ± 12 versus 33 ± 10, P = .04) and length between the vascular tie and colonic wall was longer (13 ± 3.5 versus 11 ± 3, P = .02) in the robotic group. Conclusion: Although robotic right CME seems equally safe to CLRH in terms of short-term morbidity, future prospective randomized trials are needed to define its role for treatment of right colectomy.
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Simultaneous laparoscopic totally extraperitoneal and transabdominal preperitoneal repair for bilateral inguinal hernia in a patient with a history of robotic prostatectomy - a video vignette. Colorectal Dis 2018; 20:1052-1053. [PMID: 30216630 DOI: 10.1111/codi.14421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 08/28/2018] [Indexed: 02/08/2023]
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Laparoscopic management of bowel obstruction due to multiple congenital adhesion bands in pregnancy - a video vignette. Colorectal Dis 2018; 20:1051-1052. [PMID: 30194901 DOI: 10.1111/codi.14407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/13/2018] [Indexed: 12/26/2022]
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Adoption of robotic technology in Turkey
: A nationwide analysis on caseload and platform used. Int J Med Robot 2018; 15:e1962. [DOI: 10.1002/rcs.1962] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/20/2018] [Accepted: 09/21/2018] [Indexed: 01/12/2023]
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"Top down no-touch" technique in robotic complete mesocolic excision for extended right hemicolectomy with intracorporeal anastomosis. Tech Coloproctol 2018; 22:607-611. [PMID: 30083781 DOI: 10.1007/s10151-018-1831-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 07/31/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Proper identification of the mesocolic vessels is essential for achieving complete mesocolic excision (CME) in cases of colon cancer requiring an extended right hemicolectomy. In robotic procedures, we employed a "top down technique" to allow early identification of the gastrocolic trunk and middle colic vessels. The aim of our study was to illustrate the details of this technique in a series of 12 patients. METHODS The top down technique consists of two steps. First, the omental bursa was entered to identify the right gastroepiploic vein. Tracing down this vein as a landmark, the gastrocolic trunk was exposed, branches of this trunk and the middle colic vessels were divided. Second, dissection was directed to the ileocolic region and proceeded in an inferior-to-superior direction along the superior mesenteric vein to divide the ileocolic and right colic vessels consecutively. The ileotranverse anastomosis was created intracorporeally. RESULTS There were 8 males and 4 females with a mean age of 64.8 ± 16.9 years and a mean body mass index of 25.6 ± 3.7 kg/m2. All the procedures were completed successfully. No conversions occurred. The mean operative time and blood loss were 312.1 ± 93.9 min and 110.0 ± 89.9 ml, respectively. The mean number of harvested lymph nodes was 45.2 ± 11.1. The mean length of hospital stay was 7.6 ± 4.7 days. Two patients had intraoperative complications and two had postoperative complications. There was no disease recurrence at a mean follow-up period of 10.4 ± 7.1 months. CONCLUSIONS The top down technique appears to be useful in robotic CME for an extended right hemicolectomy. Early identification of the gastrocolic trunk and middle colic vessels via this technique may prevent inadvertent vascular injury at the mesenteric root of the transverse colon.
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Is Robotic Complete Mesocolic Excision Feasible for Transverse Colon Cancer? J Laparoendosc Adv Surg Tech A 2018; 28:1443-1450. [PMID: 29878855 DOI: 10.1089/lap.2018.0239] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction: Laparoscopic complete mesocolic excision (CME) for transverse colon cancer is technically challenging. Robotic technology has been developed to reduce technical limitations of laparoscopy. Yet, no data are available on the role of robotic approach for CME of transverse colon cancer. The aim of this study is to evaluate the feasibility and short-term outcomes of robotic CME in this subset of colon cancer. Methods: A retrospective review of a prospectively maintained database of 29 consecutive patients undergoing robotic CME for transverse colon adenocarcinoma between December 2014 and December 2017 was performed. Data on demographics, tumor characteristics, postoperative 30-day complications, and oncologic outcomes were analyzed. Results: There were 21 (72%) men and 8 women with a mean age of 62.9 ± 15.6 years and a body mass index of 26.4 ± 4.8 kg/m2. Of the 29 robotic CME procedures, 12 patients underwent extended right colectomy, 10 extended left colectomy, 6 subtotal colectomy, and 1 total colectomy. The mean operative time was 321.7 ± 111.3 minutes and estimated blood loss was 106.9 ± 110.9 mL (median, 50; range, 10-400 mL). The intra- and postoperative complication rates were 7% and 24%, respectively. There were no conversions. The mean time to first bowel movement was 3.5 ± 1.3 and length of hospital stay was 7.1 ± 3.0 days. All the resections were R0. The mean number of harvested lymph nodes in extended and subtotal/total colectomy procedures was 36.6 ± 13.1 and 71.0 ± 30.3, respectively. The rate of mesocolic plane surgery was 79%. There were no statistically significant differences between the mesocolic and the intramesocolic/muscularis propria plane resections with respect to clinical characteristics, operative outcomes, and pathology results (P > .05). Conclusions: Robotic CME for transverse colon cancer is feasible and can be a procedure of choice to achieve a good surgical quality.
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Totally robotic complete mesocolic excision for right-sided colon cancer. J Robot Surg 2018; 13:107-114. [PMID: 29774501 DOI: 10.1007/s11701-018-0817-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/23/2018] [Indexed: 12/12/2022]
Abstract
Complexity and operative risks of complete mesocolic excision (CME) seem to be important drawbacks to generalize this procedure in the surgical treatment of right colon cancer. Robotic systems have been developed to improve quality and outcomes of minimal invasive surgery. The aim of this study was to evaluate the feasibility of robotic right-sided CME and present our initial experience. A retrospective review of 37 patients undergoing totally robotic right-sided CME between February 2015 and November 2017 was performed. All the operations were carried out using the key principles of both CME with intracorporeal anastomosis and no-touch technique. Data on perioperative clinical findings and short-term outcomes were analyzed. There were 20 men and 17 women with a mean age of 64.4 ± 13.5 years and a body mass index of 26.8 ± 5.7 kg/m2. The mean operative time and estimated blood loss were 289.8 ± 85.3 min and 77.4 ± 70.5 ml, respectively. Conversion to laparoscopy occurred in one patient (2.7%). All the surgical margins were clear and the mesocolic plane surgery was achieved in 27 (72.9%) of the cases. The mean number of harvested lymph nodes was 41.8 ± 11.9 (median, 40; range 22-65). The mean length of hospital stay was 6.6 ± 3.7 days. The intraoperative and postoperative complication rates were 5.4 and 21.6%, respectively. We believe that use of robot for right-sided CME is feasible and appears to provide remarkably a high number of harvested lymph nodes with good specimen quality.
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Robotic Versus Laparoscopic Stapler Use for Rectal Transection in Robotic Surgery for Cancer. J Laparoendosc Adv Surg Tech A 2018; 28:501-505. [DOI: 10.1089/lap.2017.0545] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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V-Y advancement flap reconstruction for anal stricture - a video vignette. Colorectal Dis 2018; 20:78-79. [PMID: 29053211 DOI: 10.1111/codi.13931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/14/2017] [Indexed: 02/08/2023]
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Totally robotic total mesorectal excision with high vascular tie for rectal cancer - a video vignette. Colorectal Dis 2017; 19:1121-1122. [PMID: 28941067 DOI: 10.1111/codi.13897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 08/21/2017] [Indexed: 02/08/2023]
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Role of robotic approach for management of complicated jejunoileal diverticulosis - video vignette. Colorectal Dis 2017; 20:259-259. [PMID: 29178438 DOI: 10.1111/codi.13975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 11/09/2017] [Indexed: 02/08/2023]
Abstract
Jejunoileal diverticulosis (JID) is a rare condition with a reported incidence lower than 0.1% (1-3). Surgery is the definitive treatment for JID and can be considered to improve the patient's quality of life and to prevent further occurrence of severe symptoms (3, 4, 5). Minimally invasive approach facilitates postoperative recovery, lowers risks and improves outcomes in JID treatment (6). This article is protected by copyright. All rights reserved.
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Robotic ventral mesh rectopexy technique for rectal intussusception with rectocele - a video vignette. Colorectal Dis 2017; 19:947. [PMID: 28816010 DOI: 10.1111/codi.13847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/01/2017] [Indexed: 02/08/2023]
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Robotic mesocolic excision with a 'top to down no-touch' technique for right colon cancer - a video vignette. Colorectal Dis 2017; 19:866-867. [PMID: 28710846 DOI: 10.1111/codi.13819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 05/24/2017] [Indexed: 02/08/2023]
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Combined laparoscopic-robotic approach in complex re-operative colorectal surgery - a video vignette. Colorectal Dis 2017; 19:598-599. [PMID: 28419688 DOI: 10.1111/codi.13687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 01/23/2017] [Indexed: 02/08/2023]
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Robotic transanal minimally invasive surgery (R-TAMIS) with the da Vinci Xi System - a video vignette. Colorectal Dis 2017; 19:401. [PMID: 28235160 DOI: 10.1111/codi.13638] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/22/2016] [Indexed: 02/08/2023]
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Vascular High Ligation and Embryological Dissection in Laparoscopic Restorative Proctocolectomy for Ulcerative Colitis. J Laparoendosc Adv Surg Tech A 2016; 27:33-35. [PMID: 27626834 DOI: 10.1089/lap.2016.0364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION After its description in 1980, restorative proctocolectomy has become the procedure of choice for ulcerative colitis (UC). The supposed advantages of the laparoscopy have proven beneficial for colorectal operations but a standard technique in laparoscopic restorative proctocolectomy (LRP) is still lacking. In this study, we present our technique of LRP with vascular high ligation (VHL) and embryological dissection (ED). MATERIALS AND METHODS This retrospective study reviewed patients who underwent LRP with VHL for UC from January 2009 to June 2015. Of these, only two-stage LRP patients were included to the study. The LRP technique was performed by five ports through a medial-to-lateral approach. The dissection was carried out between the embryological planes and all the vessel roots were highly divided. A diverting ileostomy was performed in all of the patients. RESULTS Forty-six patients were operated for UC with the laparoscopic approach. Among these patients, there were 19 (8 females) patients who were performed LRP with VHL. The median age was 42 (range 25-62) years. No intraoperative complications occurred. There was no conversion to open procedure. Early postoperative complications were observed in 3 (15.8%) patients, including postoperative mechanical bowel obstruction (n = 1), wound infection (n = 1), and ileal pouch bleeding (n = 1). DISCUSSION High ligation of the vessels is not routinely performed except in the presence of malignancy. In our study, we focus on the importance of high ligation and ED for better observation and preservation of the important anatomical structures. According to our opinion, this approach aids in the preservation of the ureters, nerves, and the duodenum providing better observation of dissection planes.
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Robotic complete mesocolic excision for right-sided colon cancer. Surg Endosc 2016; 30:4624-5. [DOI: 10.1007/s00464-016-4786-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/21/2016] [Indexed: 10/22/2022]
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Vascular high ligation and embryological plane dissection in laparoscopic restorative proctocolectomy for ulcerative colitis - a video vignette. Colorectal Dis 2016; 18:218-9. [PMID: 26558884 DOI: 10.1111/codi.13213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/02/2015] [Indexed: 02/08/2023]
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Robotic total proctocolectomy for ulcerative colitis - a video vignette. Colorectal Dis 2015; 17:736. [PMID: 26047017 DOI: 10.1111/codi.13019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 05/06/2015] [Indexed: 02/08/2023]
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Total laparoscopic approach for the treatment of right colon cancer: a technical critique. Asian J Surg 2012; 36:58-63. [PMID: 23522756 DOI: 10.1016/j.asjsur.2012.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 08/17/2012] [Accepted: 09/06/2012] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND AIMS Total laparoscopic surgery is not a new concept, but it is not preferred generally for right colectomy. The aim of the study is to evaluate the outcomes, which are related with surgical technique after total laparoscopic right colectomy (TLRC) and laparoscopic-assisted right colectomy (LARC) for right colon cancer in 30 consecutive patients. MATERIALS AND METHODS Thirty patients with right colon cancer, half of which were treated with TLRC and half of which were treated with LARC, were compared with regard to patient demographics, operative and postoperative data, histopathologic findings, follow-up data, and the complications related to the surgical technique. RESULTS There were 16 men and 14 women, median age was 63 years (range 41-86) with a body mass index (BMI) of 27 kg/m2 (range 20-33). There were no differences between the groups for BMI, harvested lymph node number, or distal and radial margins. The length of the incision and the length of the postoperative stay was shorter in the TLRC group (p=0.000). Overall complications were higher in the LARC group than in the TLRC group (p=0.014). The median follow-up was 28 months (range 5-99). In the late period, two patients in the LARC group were reoperated on. The cause of reoperation was internal herniation in one patient due to ileal twisting and incisional hernia in the other one. CONCLUSION Our preliminary data indicate that TLRC could result in better outcomes for right colon cancer patients than LARC.
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Evaluation of diverting ileostomy in laparoscopic low anterior resection for rectal cancer. Asian J Surg 2012; 34:63-8. [PMID: 21723468 DOI: 10.1016/s1015-9584(11)60021-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 03/03/2011] [Accepted: 04/14/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diverting ileostomy is believed to mitigate the effects of anastomotic complications in low anterior resections (LAR) for rectal cancer. However, there are no data about the effects of diverting ileostomy on the outcomes of laparoscopic LAR METHODS: We retrospectively reviewed the medical records of 77 consecutive rectal cancer patients who had undergone laparoscopic LAR with (n = 23) or without (n = 54) diverting ileostomy. The patients' data were recorded and supplemented on short-term follow-up visits and included standard demographics, operative procedure, location of the cancer, and final pathologic diagnosis. We noted length of hospitalisation, complications, and time interval from ileostomy creation to closure. Morbidity and mortality were also included. RESULTS Surgical intervention requiring anastomotic leakage occurred in three patients who underwent laparoscopic LAR without diverting ileostomy. The anastomosis level of patients who underwent laparoscopic LAR with diverting ileostomy was significantly lower than that of patients who underwent laparoscopic LAR without diverting ileostomy (p < 0.05). CONCLUSION Anastomosis level and total mesorectal excision are the main factors for creation of diverting ileostomy in laparoscopic LAR Laparoscopic LAR without diverting ileostomy could be selectively performed. Our study provides a basis for further prospective randomised studies on the role of diverting ileostomy in LAR.
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Transvaginal assisted totally laparoscopic single-port right colectomy. J Laparoendosc Adv Surg Tech A 2011; 21:255-7. [PMID: 21457116 DOI: 10.1089/lap.2010.0438] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Operative approach for right colectomy has progressed substantially in last decades, by the application of laparoscopy in colorectal surgery. Single-port (SP) laparoscopic surgery is one of the newest branches of advanced laparoscopy. A 29-year-old woman with ileocecal Crohn's disease underwent a totally laparoscopic transumbilical SP right colectomy, assisted by vaginal access. The operation time was 140 minutes. The blood loss was 20 mL. The patient was allowed to drink fluids and a soft oral diet on the first day postoperatively. Neither intraoperative nor postoperative complications were observed. The patient was discharged on postoperative day 4. The wound size was 2.5 cm. The umbilical scar was almost invisible on postoperative day 7. Totally laparoscopic transumbilical SP right colectomy with vaginal access is a feasible procedure, providing a scarless surgery, ensuring the preservation of the body image.
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Hybrid laparo-endoscopic single port transperitoneal right adrenalectomy. MINIM INVASIV THER 2011; 21:59-62. [PMID: 21395462 DOI: 10.3109/13645706.2010.543423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Laparoscopic surgery is a preferable technique for adrenalectomy. Laparo-endoscopic single port surgery (LESS) is one of the newest areas in minimally invasive surgery. The development of the technology has made many surgical procedures less invasive. In this paper, we report hybrid laparo-endoscopic single port transperitoneal right adrenalectomy for a non-functional adrenal mass.
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Impact of increased body mass index on laparoscopic surgery for rectal cancer. ACTA ACUST UNITED AC 2011; 46:87-93. [PMID: 21228595 DOI: 10.1159/000321360] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 09/21/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Laparoscopy was initially considered to be a risky procedure for rectal cancer patients, especially patients with an increased body weight. The literature is scarce regarding the effects of obesity on laparoscopic rectal surgery. The aim of the current study was to analyze the effect of an increased body mass index (BMI) on outcome of laparoscopic surgery for rectal cancer. METHODS Patients who underwent laparoscopic rectal resection were allocated to one of three groups according to their BMI: normal weight (BMI < 25), overweight (25 ≤ BMI < 30) and obese (BMI ≥ 30). These three groups were compared with each other in terms of patient demographics, postoperative hospital stay, postoperative complications and histopathological data. RESULTS There were 100 patients operated on for rectal cancer. The median BMI of the patients was 27 (range 18.5-40) kg/m(2), and 43, 43 and 14 patients were classified as normal weight, overweight and obese, respectively. The conversion rate was 4.7% in the overweight group and 0% in the other groups. The proportion of complications and oncological outcomes between the groups showed no significant difference (p > 0.05). CONCLUSIONS Apparently, increased BMI is not a contraindication for laparoscopic rectal surgery.
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Single-Port Laparoscopic Sphincter-Saving Mesorectal Excision for Rectal Cancer. ACTA ACUST UNITED AC 2011; 146:75-81. [DOI: 10.1001/archsurg.2010.300] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
BACKGROUND Surgical intervention under concomitant steroid therapy can be complicated by impaired anastomotic healing. The aim of this experimental study was to investigate the effects of a corticosteroid (methylprednisolone) on healing colonic anastomoses in relation to the dose and duration of administration. METHODS Fifty male Spraque-Dawley rats weighing 200-220 g were divided into five groups each containing 10 rats. No treatment was given in the control group. Group HDST: high-dose methylprednisolone (1 mg/kg/day, intramuscular) treatment for a short term of 2 days; group HDLT: high-dose methylprednisolone treatment for a long term of 60 days; group LDST: low-dose methylprednisolone (0.28 mg/kg/day) treatment for a short term of 2 days; and group LDLT: low-dose methylprednisolone treatment for a long term of 60 days. Standard left colonic anastomosis was performed in all rats. Anastomotic bursting pressure, hydroxyproline measurement, and histopathological data were evaluated in all groups on postoperative day 4. RESULTS The mean anastomotic bursting pressure value was significantly lower in the HDLT group (P < 0.05). The mean hydroxyproline levels were significantly lower in all groups (P < 0.05). Histopathological results demonstrated significant changes according to neutrophil infiltration, granulation tissue formation, presence of vascularization, and peritonitis in the HDLT, LDST, and LDLT groups (P < 0.05). CONCLUSIONS High and low doses of the corticosteroid produced adverse effects on the healing of colon anastomosis in rats regardless of whether it was administered over a long or short preoperative period. However, the most prominent negative effect was associated with high-dose, long-term corticosteroid administration.
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Transumbilical totally laparoscopic single-port Nissen fundoplication: a new method of liver retraction: the Istanbul technique. J Gastrointest Surg 2010; 14:1035-9. [PMID: 20306152 PMCID: PMC2872018 DOI: 10.1007/s11605-010-1183-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Accepted: 02/18/2010] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Mustafa Kemal Atatürk, founder of the Turkish Republic, had guarded many German scientists of a Jewish descent before the Second World War. Dr. Rudolf Nissen was one of the outstanding surgeons who had served in the Turkish university hospitals. He had created an antireflux procedure which is named after his own name while he was working in our clinic, the Cerrahpaşa Hospital. From a laparoscopic approach, the Nissen fundoplication was the gold standard intervention for the surgical treatment of gastroesophageal reflux disease (GERD). Currently, video laparoscopic surgery is evolving quickly with the guidance of new technology. Single-port (SP) laparoscopic transumbilical surgery is one of the newest branches of advanced laparoscopy. DISCUSSION Simple or complex manipulations may be performed with SP laparoscopic transumbilical surgery. The advantages, which are gained from conventional laparoscopy, can be invigorated by an SP laparoscopic approach. The retraction technique of the liver and the optical system were the most important factors, which made the Nissen fundoplication possible via single port. Here, we report that totally laparoscopic transumbilical SP Nissen fundoplication procedure was performed in three patients for sliding hiatal hernia with GERD. CONCLUSION Totally laparoscopic transumbilical SP Nissen fundoplication is a safe and feasible technique for the surgical treatment of GERD.
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Restorative caecogastroplasty reconstruction after pylorus-preserving near-total gastrectomy: A preliminary study. Br J Surg 2005. [DOI: 10.1046/j.1365-2168.1997.02465.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
To our knowledge, the association of umbilical flora and infections has not been studied yet. The aim of this study was to identify the causative agents for trocar site infections and to highlight whether there is association between umbilical flora and trocar site infections. One hundred consecutive patients who had undergone laparoscopic surgery were studied. Microbiological samples were taken from the umbilicus before (group 1) and after (group 2) antisepsis with povidone-iodine. Microbiological assessment was done for wounds suspected to be infected, and the wounds with positive cultures were classified as group 3. The incidence of wound infection was 8%. One hundred percent of the infections were associated with the extraction trocar. Eighty-nine percent of all of the infections occurred after laparoscopic cholecystectomy, whereas 11% occurred after laparoscopic appendectomy. The micro-organisms in group 3 did not belong to the skin flora, unlike the micro-organisms in groups 1 and 2, but hospital-acquired pathogens were responsible for the infections. The umbilical flora and the bile are not the source of the surgical site infections after laparoscopic surgery in our study despite the considerations in the literature.
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Spiral tacks may contribute to intra-abdominal adhesion formation. Surg Today 2005; 34:860-4. [PMID: 15449157 DOI: 10.1007/s00595-004-2831-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2003] [Accepted: 01/20/2004] [Indexed: 10/26/2022]
Abstract
PURPOSE With the inception of laparoscopic ventral hernia repair came a novel device not used in conventional hernia repair; the spiral tack. We conducted an experimental study on pigs to determine whether spiral tacks contribute to adhesion formation. METHODS Using a standard laparoscopic technique in pigs, pieces of polypropylene mesh were fixed to the fascia on the upper abdominal wall, with polypropylene sutures on a randomly chosen side (side 1), and with 5-mm spiral tacks on the opposite side (side 2). The extent, type, and tenacity of the adhesions were assessed on postoperative days (PODs) 30 and 90. RESULTS The mesh fixed to the abdominal wall with spiral tacks tended to increase the extent, type, and tenacity of adhesions more than the mesh fixed with polypropylene sutures (P < 0.05). CONCLUSIONS Spiral tacks contributed to the formation of adhesions more than polypropylene mesh did. Although this was a small-scale animal study, our findings suggest that the effect of spiral tacks used in laparoscopic ventral hernia repair should be assessed and the consequences monitored more closely.
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Massive haemorrhage induced by low molecular weight heparin in a patient with steroid refractory ulcerative colitis. Scand J Gastroenterol 2004; 39:613. [PMID: 15223691 DOI: 10.1080/00365520410004622] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Is intraluminal clip application an appropriate treatment for iatrogenic gastric perforation? Eur Surg Res 2003; 35:383-7. [PMID: 12802101 DOI: 10.1159/000070611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2002] [Accepted: 10/15/2002] [Indexed: 11/19/2022]
Abstract
BACKGROUND The standard treatment of iatrogenic perforation has been an urgent operation. Recently, endoscopic clip application was recommended particularly for iatrogenic perforations. This study was designed to investigate the usage of surgical clips for gastric perforations. METHOD Forty male rats were allocated to four groups. Following a midline laparotomy, a 5-mm gastrotomy was made at the fundic part of the stomach and through this ostomy a pre-pyloric perforation was created in all groups. In group I, the perforation site was closed with polypropylene sutures. In group II, the perforation site was closed extraluminally by vascular surgical clips. In group III, the perforation site was closed intraluminally by the same number of clips. In group IV, control group, the perforation site was left open. The animals were sacrificed on the 4th postoperative day. The healing of the perforation site was evaluated by the bursting pressure and the hydroxyproline content of the suture line. RESULTS Measurements revealed no differences in bursting pressure and hydroxyproline levels between the intraluminal clip application group (group III) and the group in which the perforation site was left open (group IV) (p > 0.05). Higher bursting pressures and hydroxyproline levels were observed in groups I and II compared to control group (p < 0.05). CONCLUSIONS These results suggest that gastric perforations are not strengthened by intraluminal clip application. Further detailed clinical studies are necessary in order to conclude that intraluminal clip application is an appropriate treatment for iatrogenic perforation.
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Enteroclysis-guided laparoscopic adhesiolysis in recurrent adhesive small bowel obstructions. Surg Laparosc Endosc Percutan Tech 2002; 12:165-70. [PMID: 12080256 DOI: 10.1097/00129689-200206000-00005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of this study was to point out the efficiency of enteroclysis assay in localization of intraabdominal adhesions that impede small bowel transit in patients with recurrent adhesive small bowel obstruction who underwent laparoscopic partial adhesiolysis. Between January 1998 and June 2001, 15 selected patients with recurrent adhesive small bowel obstructions were treated successfully by medical means and evaluated with enteroclysis to define the pathologic adhesive site that impeded bowel transit. If the results of enteroclysis were indicative, they underwent laparoscopic partial adhesiolysis. The mean duration of the laparoscopic procedure was 99 minutes. In one patient conversion to laparotomy occurred because of excessive adhesions, and in another patient a small bowel injury occurred and enterorrhaphy was performed laparoscopically. Mean postoperative hospital stay was 4 days. During a mean follow-up of 17.2 months (range, 6-39), there was no delayed morbidity or recurrence. Identification of the small bowel site of recurrent obstruction with enteroclysis permits limited laparoscopic adhesiolysis. This approach may be a rational alternative to not only open procedures but also complete laparoscopic adhesiolysis without enteroclysis.
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The influence of omentectomy on the inflammatory phase of anastomotic healing. HEPATO-GASTROENTEROLOGY 2001; 48:1359-63. [PMID: 11677964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND/AIMS Proper wound healing of the alimentary tract is essential for the prevention of the significant mortality and morbidity associated with complications. The effects of omentectomy on the inflammatory phase of anastomotic healing in rats were examined. METHODOLOGY Sixty male Wistar-Albino rats that weighed about 200-220 g were used in this study. Animals were divided into three groups as colon anastomosis, colon anastomosis + partial omentectomy and colon anastomosis + total omentectomy. On the third postoperative day, all animals were sacrificed under anesthesia. Bursting pressure of anastomosis amounts and types of cells in the anastomosis, and nitric oxide, malondialdehyde, superoxide dismutase levels in the anastomosis and serum was examined. RESULTS Bursting pressure values were 102.60 +/- 13.41 mm Hg, 105 +/- 10.80 mm Hg and 102.50 +/- 11.12 mm Hg in the colon anastomosis, colon anastomosis + partial omentectomy and colon anastomosis + total omentectomy groups, respectively (P > 0.05). A significant increase in macrophage count was found in the colon anastomosis + total omentectomy group when compared with the colon anastomosis group (P = 0.02). According to the comparisons with percentages, there was a significant difference in lymphocyte counts between colon anastomosis and colon anastomosis + total omentectomy groups (P = 0.04). The blood level of superoxide dismutase was higher in the colon anastomosis + total omentectomy group than the other two groups, and in the colon anastomosis + partial omentectomy group than the colon anastomoses group (P = 0.0001). There was a significant increase in the blood level of nitric oxide when comparing the colon anastomosis + total omentectomy group with colon anastomosis group (P = 0.02). The tissue level of malondialdehyde was higher in the colon anastomosis + total omentectomy group than the other two groups (P < 0.0001). CONCLUSIONS Omentectomy may influence the outcome of the inflammatory phase of wound healing in rats. But systemic compensatory regulation of body can tolerate these detrimental effects and wound healing continues in its regular manner.
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