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Zhang M, Zhong Q, Ma J, Mao J, Shi A, Lyu Y, Yan X. Feasibility experiment of a novel deformable self-assembled magnetic anastomosis ring (DSAMAR) for gastrointestinal anastomosis through a natural orifice. Sci Rep 2024; 14:10602. [PMID: 38719935 PMCID: PMC11078934 DOI: 10.1038/s41598-024-60887-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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
Although the application of magnetic compression anastomosis is becoming increasingly widespread, the magnets used in earlier studies were mostly in the shape of a whole ring. Hence, a deformable self-assembled magnetic anastomosis ring (DSAMAR) was designed in this study for gastrointestinal anastomosis. Furthermore, its feasibility was studied using a beagle model. The designed DSAMAR comprised 10 trapezoidal magnetic units. Twelve beagles were used as animal models, and DSAMARs were inserted into the stomach and colon through the mouth and anus, respectively, via endoscopy to achieve gastrocolic magnamosis. Surgical time, number of failed deformations, survival rate of the animals, and the time of magnet discharge were documented. A month later, specimens of the anastomosis were obtained and observed with the naked eye as well as microscopically. In the gastrocolic anastomosis of the 12 beagles, the procedure took 65-120 min. Although a deformation failure occurred during the operation in one of the beagles, it was successful after repositioning. The anastomosis was formed after the magnet fell off 12-18 days after the operation. Naked eye and microscopic observations revealed that the anastomotic specimens obtained 1 month later were well-formed, smooth, and flat. DSAMAR is thus feasible for gastrointestinal anastomosis under full endoscopy via the natural orifice.
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Affiliation(s)
- Miaomiao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
- Shaanxi Provincial Key Laboratory of Magnetic Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiuye Zhong
- Zonglian College, Xi'an Jiaotong University, Xi'an, China
| | - Jia Ma
- Department of Surgical Oncology, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Jianqi Mao
- Zonglian College, Xi'an Jiaotong University, Xi'an, China
| | - Aihua Shi
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yi Lyu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, China.
- Shaanxi Provincial Key Laboratory of Magnetic Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| | - Xiaopeng Yan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi, China.
- Shaanxi Provincial Key Laboratory of Magnetic Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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Piazza C, Gennarini F, Montenegro C, Lancini D, Del Bon F, Zigliani G, De Palma G, Lopomo NF, Sala E. Transoral laser exoscopic surgery of the larynx: state of the art and comparison with traditional transoral laser microsurgery. Acta Otorhinolaryngol Ital 2024; 44:S3-S11. [PMID: 38745511 PMCID: PMC11098537 DOI: 10.14639/0392-100x-suppl.1-44-2024-n2850] [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] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/28/2023] [Indexed: 05/16/2024]
Abstract
Objective To evaluate the efficacy of transoral laser exoscopic surgery (TOLES) in a unicentric series of patients affected by benign and malignant glottic and supraglottic lesions, and compare outcomes with those of transoral laser microsurgery (TOLMS). Methods To demonstrate the non-inferiority of TOLES in terms of operative time, margin status and complication rates, we compared outcomes of 93 patients treated by TOLES between July 2021 and July 2023 with those of a match-paired group of 107 historical patients treated by TOLMS. To perform a multiparametric ergonomic evaluation of TOLES vs TOLMS, we used observational methods for biomechanical overload risk assessment and wearable technologies comparing 15 procedures with TOLES vs a paired match of 13 surgeries performed with TOLMS by the same surgeon. Results No significant differences were found in terms of surgical duration, positive margins, or complications between TOLES and TOLMS. Ergonomics assessment by inertial measurement units and electromyographic surface electrodes demonstrated a reduced biomechanical overload with TOLES compared to TOLMS. Conclusions The many advantages of TOLES, such as its superior didactic value, better digital control of light even through small-bored laryngoscopes, improved binocular vision, and increase in surgical performance by 3 or 4-hand techniques, are difficult to be quantified. In contrast, its non-inferiority in terms of oncological results and better ergonomics compared to TOLMS are demonstrated herein.
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Affiliation(s)
- Cesare Piazza
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Francesca Gennarini
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Claudia Montenegro
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, School of Medicine, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Francesca Del Bon
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Zigliani
- Unit of Otorhinolaryngology – Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giuseppe De Palma
- Department of Medical, Surgical and Radiological Sciences and Public Health, University of Brescia, School of Medicine, Brescia, Italy
- Unit of Occupational Health, Occupational Hygiene, Toxicology and Prevention, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Emma Sala
- Unit of Occupational Health, Occupational Hygiene, Toxicology and Prevention, ASST Spedali Civili of Brescia, Brescia, Italy
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Seow-En I, Li KK, Tan EKW. Intracorporeal antimesenteric ancillary trocar: an anastomotic technique facilitating natural orifice specimen extraction in left-sided colorectal surgery. Colorectal Dis 2024; 26:766-771. [PMID: 38302860 DOI: 10.1111/codi.16884] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 01/03/2024] [Accepted: 01/06/2024] [Indexed: 02/03/2024]
Abstract
AIM Natural orifice specimen extraction (NOSE) in left-sided colorectal surgery requires application of the circular stapler anvil to the proximal bowel without exteriorization through an additional abdominal incision. We describe an intracorporeal method to secure the stapler anvil, termed the intracorporeal antimesenteric ancillary trocar (IAAT) technique. METHOD The ancillary trocar is attached to the stapler anvil before introduction into the abdominal cavity through the anal or vaginal orifice. The colon is incised before the trocar spike is brought out through the antimesenteric surface 3-4 cm within the cut edge. A linear stapler is used to seal the bowel end. The ancillary trocar is detached and retrieved via the NOSE conduit. Following the NOSE procedure, a side-to-end colorectal anastomosis is performed with the transanal circular stapler. RESULTS Ten consecutive patients underwent elective left-sided colorectal resection with IAAT for NOSE (seven transanal, three transvaginal) from January to June 2023. Median age and body mass index were 66 (range 47-74) years and 24.3 (range 17.9-30.8) kg/m2 respectively. Two (20%) patients underwent sigmoid colectomy for sigmoid volvulus while eight (80%) underwent anterior resection for colorectal cancer. Median operating time, operative blood loss and postoperative length of hospital stay were 170 (range 140-240) min, 20 (range 10-40) mL and 1 (range 1-3) day respectively. There were no postoperative complications, readmissions or reoperations. Median follow-up duration was 3 (range 1-6) months. CONCLUSION The IAAT double-stapling side-to-end anastomotic technique is safe and feasible for patients undergoing left-sided colorectal resection with NOSE, resulting in good outcomes.
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Affiliation(s)
- Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - Kelvin Kaiwen Li
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
| | - Emile Kwong-Wei Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Singapore
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Chandra A, Rajan P, Gupta V, Ahmad A, Parihar A, Yadav G, Singh U, Rajashekhara M, Patankar SK, Patel R. Natural Orifice Endosonographic Colposuspension With Rectopexy for Combined Pelvic Organ Prolapse: A Feasibility Study. Dis Colon Rectum 2022; 65:e184-e190. [PMID: 34856590 DOI: 10.1097/dcr.0000000000002286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND We describe a natural orifice technique for simultaneous endoluminal lateral suspension of apical vaginal wall and rectal prolapse fixation with ultrasound and fluoroscopic assistance. IMPACT OF INNOVATION The technique is minimally invasive, can be performed under regional anaesthesia, and avoids laparotomy or use of a mesh in addition to preserving the uterus. TECHNOLOGY MATERIALS AND METHODS This technique involves suprapubic transvaginal ventral suture colposuspension, fixation of the anterior rectal wall to the undersurface of the anterior abdominal wall and tack fixation of the posterior rectal wall to the underlying sacral promontory through a submucosal tunnel performed endoscopically with fluoroscopic and ultrasound assistance. PRELIMINARY RESULTS Seven patients with a mean age of 63 years were followed between 3 to 11 months. CONCLUSIONS This is a novel minimally invasive transluminal procedure that repairs concomitant rectal and vaginal prolapse in the same sitting. FUTURE DIRECTIONS Improvement in the instrument design and incorporation of endoluminal robotic systems will enhance the technical ease. The study needs validation in larger series of patients with longer follow-up.
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Affiliation(s)
- Abhijit Chandra
- Department of Surgical Gastroenterology, King George's Medical University, Uttar Pradesh, India
| | - Pritheesh Rajan
- Department of Surgical Gastroenterology, King George's Medical University, Uttar Pradesh, India
| | - Vivek Gupta
- Department of Surgical Gastroenterology, King George's Medical University, Uttar Pradesh, India
| | - Arshad Ahmad
- Department of Surgery, King George's Medical University, Uttar Pradesh, India
| | - Anit Parihar
- Department of Radiodiagnosis, King George's Medical University, Uttar Pradesh, India
| | - Gourav Yadav
- Department of Radiodiagnosis, King George's Medical University, Uttar Pradesh, India
| | - Uma Singh
- Department of Obstetrics and Gynaecology, King George's Medical University, Uttar Pradesh, India
| | - Mahesh Rajashekhara
- Department of Surgical Gastroenterology, King George's Medical University, Uttar Pradesh, India
| | - Sanjiv K Patankar
- BKL Walawalkar Rural Medical College and Hospital, Dervan, Chiplun, Maharashtra, India
| | - Ravi Patel
- Department of Surgical Gastroenterology, King George's Medical University, Uttar Pradesh, India
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Zhao LX, Liu ZZ, Ullah S, Liu D, Yang HY, Liu BR. The detachable balloon: A novel device for safe trans-rectal natural orifice transluminal endoscopic surgery. Dig Liver Dis 2021; 53:931-934. [PMID: 33994130 DOI: 10.1016/j.dld.2021.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Li-Xia Zhao
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou 450052, PR China
| | - Zhen-Zhen Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou 450052, PR China
| | - Saif Ullah
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou 450052, PR China
| | - Dan Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou 450052, PR China
| | - Hui-Yu Yang
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou 450052, PR China
| | - Bing-Rong Liu
- Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Zhengzhou University, No. 1 Eastern Jianshe Road, Zhengzhou 450052, PR China.
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Chene G, Nohuz E, Mansoor A, Cerruto E, Lamblin G, Galea M, Baekelandt J. Easy way to perform salpingectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) (with video). J Gynecol Obstet Hum Reprod 2020; 50:102005. [PMID: 33242679 DOI: 10.1016/j.jogoh.2020.102005] [Citation(s) in RCA: 3] [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: 11/01/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 01/12/2023]
Abstract
The transvaginal natural orifice transluminal endoscopic surgery (vNOTES) is a new minimally invasive and emerging technique. Feasibility and safety profiles of peritoneal access via transvaginal routes have been demonstrated especially for the adnexal surgery. In order to be reproducible and replicable with a standardized procedure, we propose the step-by-step video description of the vNOTES salpingectomy. The advantages of the vNOTES (low postoperative pain, faster postoperative recovery, scarless surgery) could lead to a promising alternative to conventional laparoscopic salpingectomy/adnexectomy.
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Affiliation(s)
- G Chene
- Department of Gynecology, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Hospices civils de Lyon, 69000 Lyon, France; Claude Bernard Lyon 1University, EMR 3738, 69000 Lyon, France.
| | - E Nohuz
- Department of Gynecology, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Hospices civils de Lyon, 69000 Lyon, France
| | - A Mansoor
- Department of Gynecology, Hôpital d'Issoire, 13 rue du Dr Sauvat, 63500 Issoire, France
| | - E Cerruto
- Department of Gynecology, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Hospices civils de Lyon, 69000 Lyon, France
| | - G Lamblin
- Department of Gynecology, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Hospices civils de Lyon, 69000 Lyon, France
| | - M Galea
- Department of Gynecology, Hôpital Femme Mère Enfant, 59 Boulevard Pinel, Hospices civils de Lyon, 69000 Lyon, France
| | - J Baekelandt
- Department of Gynaecology, Imelda Hospital, Bonheiden, Belgium
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Lim J, Roh TH, Kim W, Kim JS, Hong JB, Sung KS, Moon JH, Kim EH, Hong CK. Biportal endoscopic transorbital approach: a quantitative anatomical study and clinical application. Acta Neurochir (Wien) 2020; 162:2119-2128. [PMID: 32440923 DOI: 10.1007/s00701-020-04339-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 02/05/2020] [Accepted: 04/07/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND We devised a biportal endoscopic transorbital approach (BiETOA) to gain surgical freedom by making a port for the endoscope and investigated the benefits and limitations of BiETOA. METHODS A cylindrical port was designed and 3-D printed using biocompatible material. The port was inserted through a keyhole between the superolateral side of the orbital rim and the temporal muscle. An endoscope was inserted through the port, and other instruments were inserted through the conventional transorbital route. BiETOA was used to dissect eight cadaveric heads, and the angle of attack and surgical freedom were assessed. RESULTS The mean maximal angle of attack was significantly different in BiETOA and endoscopic transorbital approach (ETOA) (P < 0.01) but not in BiETOA and ETOA lateral orbital rim (LOR) osteotomy (P = 0.207, P = 0.21). The mean surgical freedom was significantly different in BiETOA and ETOA (P < 0.01) and in BiETOA and ETOA LOR osteotomy (P < 0.01). In the clinical cases, tumors were removed successfully without any complications. CONCLUSIONS BiETOA provided increased surgical freedom and better visibility of deep target lesion and resulted in good surgical and cosmetic outcomes.
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Affiliation(s)
- Jaejoon Lim
- Department of Neurosurgery, Bundang CHA Medical Center, CHA University College of Medicine, Seongnam, Republic of Korea
| | - Tae Hoon Roh
- Department of Neurosurgery, Ajou Univeristy Hospital, Ajou University College of Medicine, Suwon, Republic of Korea
| | - Woohyun Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ju-Seong Kim
- Department of Neurosurgery, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Je Beom Hong
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung Su Sung
- Department of Neurosurgery, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Ju Hyung Moon
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eui Hyun Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang-Ki Hong
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Alshiek J, Marroquin J, Shobeiri SA. The Fresh Frozen Cadaveric Study of Direct Pouch of Douglas Laparoscopic and Robotic Trocar Insertion for Vaginal Natural Orifice Transluminal Endoscopic Surgery. J Minim Invasive Gynecol 2020; 28:320-324. [PMID: 32540501 DOI: 10.1016/j.jmig.2020.06.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/02/2020] [Accepted: 06/06/2020] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE To determine the distances and angles that assure a safe entry into the pouch of Douglas (POD) during blind laparoscopic and robotic trocar entry. DESIGN Trocars were inserted into the POD of 4 intact fresh frozen female pelves. Cadaveric dissection was performed, and the distance from the POD to the sacrum at rest and with maximal pressure to POD with the trocar was measured. In addition, the optimal angle for trocar insertion and entry was evaluated. SETTING Inova Advanced Simulation and Technology Evaluation Center. PATIENTS Fresh frozen cadavers with intact reproductive organs. INTERVENTIONS Vaginal POD trocar insertion. MEASUREMENTS AND MAIN RESULTS Measurements were recorded from the sacrum to the POD at rest and from the sacrum to the hymen with trocar pressure. The dissection demonstrated correct trocar placement in the POD of human cadaveric specimens. The mean distances from the sacrum to the hymen, the sacrum to the POD, and the sacrum to the POD with pressure were 18.75 cm, 9.75 cm, and 7.25 cm, respectively. After the deployment of the trocar, the tip was observed to be 2 cm below the cervix in the POD. The mean trocar angle to clear the sacral promontory and the neurovascular structures without injury to the uterus was 25° to 40° from the horizontal plane and 15° to 30° from the coronal plane. CONCLUSION A direct trocar entry into the POD has been found to be feasible in fresh frozen cadaveric specimens. This study provided valuable information for the angle of entry into the POD to facilitate vaginal and robotic trocar entry for minimally invasive gynecologic procedures.
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Affiliation(s)
- Jonia Alshiek
- Department of Obstetrics & Gynecology, Inova Women's Hospital, Falls Church (all authors); Department of Bioengineering, George Mason University, Fairfax (Drs. Alshiek and Shobeiri), Virginia; Department of Obstetrics & Gynecology, Hillel Yafe Hospital, Technion Medical School, Hadera, Israel (Dr. Alshiek)
| | - Joanna Marroquin
- Department of Obstetrics & Gynecology, Inova Women's Hospital, Falls Church (all authors)
| | - S Abbas Shobeiri
- Department of Obstetrics & Gynecology, Inova Women's Hospital, Falls Church (all authors); Department of Bioengineering, George Mason University, Fairfax (Drs. Alshiek and Shobeiri), Virginia.
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McGoran J, Bennett A, Cooper J, De Caestecker J, Lovat LB, Guha N, Ragunath K, Sami SS. Acceptability to patients of screening disposable transnasal endoscopy: qualitative interview analysis. BMJ Open 2019; 9:e030467. [PMID: 31831531 PMCID: PMC6924752 DOI: 10.1136/bmjopen-2019-030467] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 10/27/2019] [Accepted: 11/01/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Screening in selected high risk populations for Barrett's oesophagus (BO) and oesophageal varices (OVs) has been proposed, but there are obstacles with conventional oesophagogastroduodenoscopy (C-OGD), including patient acceptability. Portable and disposable office-based transnasal endoscopy (TNE) is a feasible and accurate alternative to C-OGD that may have use in primary and secondary care. This article outlines a qualitative analysis of patient experiences of TNE and C-OGD in order to gain an insight into an acceptable delivery of an endoscopic screening service. DESIGN Purposeful sampling identified 23 participants who then underwent semi-structured interviews to determine their experiences of both procedures. Thematic analysis was conducted to derive meaning from their lived experiences. SETTING A secondary care endoscopy unit, clinic room and interview room. PARTICIPANTS Patients referred for BO or OV surveillance and for endoscopy to investigate dyspepsia underwent unsedated TNE using the EG Scan II device followed by C-OGD with or without sedation (patient choice), as part of a clinical trial. RESULTS The themes that arose from our analysis were: inclusivity in one's own healthcare, comfort level and convenience, validity of the procedure and application to a screening population and a sense of altruism and reciprocity. Positive aspects of TNE included participant empowerment, reduced discomfort and avoidance of conscious sedation. Participants felt that if TNE screening was of proven efficacy it would be welcomed, though views on use in a community setting were mixed. CONCLUSIONS Most patients preferred TNE to unsedated C-OGD and the reasons they gave featured strongly in the emerging themes. Preferences between TNE and sedated C-OGD were more subtle, with equivalent comfort scores but merits and drawbacks of both being discussed. This information identifies opportunities and challenges in establishing an endoscopic screening service. Trial registration number ISRCTNregistry identifier: 70595405; Pre-results.
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Affiliation(s)
- John McGoran
- Digestive Diseases Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Andrea Bennett
- National Institute for Health Research (NIHR) Biomedical Research Center in Gastrointestinal and Liver Diseases, Nottingham University Hospitals NHS Trust, Nottingham, Nottingham, UK
| | - Joanne Cooper
- National Institute for Health Research (NIHR) Biomedical Research Center in Gastrointestinal and Liver Diseases, Nottingham University Hospitals NHS Trust, Nottingham, Nottingham, UK
| | - John De Caestecker
- Digestive Diseases Centre, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Laurence B Lovat
- Division of Surgery and Interventional Science, University College London, London, London, UK
| | - Neil Guha
- National Institute for Health Research (NIHR) Biomedical Research Center in Gastrointestinal and Liver Diseases, Nottingham University Hospitals NHS Trust, Nottingham, Nottingham, UK
| | - Krish Ragunath
- National Institute for Health Research (NIHR) Biomedical Research Center in Gastrointestinal and Liver Diseases, Nottingham University Hospitals NHS Trust, Nottingham, Nottingham, UK
| | - Sarmed S Sami
- Division of Surgery and Interventional Science, University College London, London, London, UK
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Feussner H, Krieger Y, Wilhelm D, Brunner S, Ostler D, Meining A, Lueth T. Mechatronic Support System for NOTES and Monoport Surgery - A New Approach. Surg Technol Int 2019; 34:23-29. [PMID: 31034576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
To circumvent the drawbacks of currently available platforms for natural orifice transluminal endoscopic surgery (NOTES) and monoport surgery (MPS), we developed a patient-specific, disposable, surgical soft robotic system. The system (Single-Port Overtube; SPOT) is designed as an overtube for standard surgical equipment. The platform body and the manipulators can be quickly adapted to transmural (monoport), NOTES and endoluminal (endoscopic) applications, and 3D-printed overnight as an individualized system. In addition, practical considerations, such as the predicted "ideal" dimensions of the platform, were evaluated. As a result, we found that preoperatively available biometric data currently provide little support for tailored instrument design. Further work is required to provide engineers / developers with more useful preoperative information.
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Affiliation(s)
- Hubertus Feussner
- Department of General and Visceral Surgery, Technical University of Munich, Munich, Germany
| | - Yannick Krieger
- Department of General and Visceral Surgery, Technical University of Munich, Munich, Germany
| | - Dirk Wilhelm
- Department of General and Visceral Surgery, Technical University of Munich, Munich, Germany
| | - Stephan Brunner
- Department of General and Visceral Surgery, Technical University of Munich, Munich, Germany
| | - Daniel Ostler
- Department of General and Visceral Surgery, Technical University of Munich, Munich, Germany
| | - Alexander Meining
- Clinic for Internal Medicine I, Center for Internal Medicine, Ulm University Hospital, Ulm, Germany
| | - Tim Lueth
- Department of Mechanical Engineering, Technical University of Munich, Munich, Germany
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Suzuki Y, Moritani K, Seo Y, Takahashi T. Comparison of decompression tubes with metallic stents for the management of right-sided malignant colonic obstruction. World J Gastroenterol 2019; 25:1975-1985. [PMID: 31086465 PMCID: PMC6487384 DOI: 10.3748/wjg.v25.i16.1975] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Emergency surgical resection is a standard treatment for right-sided malignant colonic obstruction; however, the procedure is associated with high rates of mortality and morbidity. Although a bridge to surgery can be created to obviate the need for emergency surgery, its effects on long-term outcomes and the most practical management strategies for right-sided malignant colonic obstruction remain unclear.
AIM To determine the appropriate management approach for right-sided malignant colonic obstruction.
METHODS Forty patients with right-sided malignant colonic obstruction who underwent curative resection from January 2007 to April 2017 were included in the study. We compared the perioperative and long-term outcomes of patients who received bridges to surgery established using decompression tubes and those created using self-expandable metallic stents (SEMS). The primary outcome was the overall survival duration (OS) and the secondary endpoints were the disease-free survival (DFS) duration and the preoperative and postoperative morbidity rates. Analysis was performed on an intention-to-treat basis.
RESULTS There were 21 patients in the decompression tube group and 19 in the SEMS group. There were no significant differences in the perioperative morbidity rates of the two groups. The OS rate was significantly higher in the decompression tube group than in the SEMS group (5-year OS rate; decompression tube 79.5%, SEMS 32%, P = 0.043). Multivariate analysis revealed that the bridge to surgery using a decompression tube was significantly associated with the OS (hazard ratio, 17.41; P = 0.004). The 3-year DFS rate was significantly higher in the decompression tube group than in the SEMS group (68.9% vs 45.9%; log-rank test, P = 0.032). A propensity score–adjusted analysis also demonstrated that the prognosis was significantly better in the decompression tube group than in the SEMS group.
CONCLUSION The bridge to surgery using trans-nasal and trans-anal decompression tubes for right-sided malignant colonic obstruction is safe and may improve long-term outcomes.
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Affiliation(s)
- Yoshiyuki Suzuki
- Department of Surgery, Ashikaga Red Cross Hospital, Tochigi 326-0843, Japan
| | - Konosuke Moritani
- Department of Surgery, Ashikaga Red Cross Hospital, Tochigi 326-0843, Japan
| | - Yuki Seo
- Department of Surgery, Ashikaga Red Cross Hospital, Tochigi 326-0843, Japan
| | - Takayuki Takahashi
- Department of Surgery, Ashikaga Red Cross Hospital, Tochigi 326-0843, Japan
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Sato H, Takeuchi M, Hashimoto S, Mizuno KI, Furukawa K, Sato A, Yokoyama J, Terai S. Esophageal diverticulum: New perspectives in the era of minimally invasive endoscopic treatment. World J Gastroenterol 2019; 25:1457-1464. [PMID: 30948909 PMCID: PMC6441918 DOI: 10.3748/wjg.v25.i12.1457] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/28/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
Esophageal diverticula are rare conditions that cause esophageal symptoms, such as dysphagia, regurgitation, and chest pain. They are classified according to their location and characteristic pathophysiology into three types: epiphrenic diverticulum, Zenker’s diverticulum, and Rokitansky diverticulum. The former two disorders take the form of protrusions, and symptomatic cases require interventional treatment. However, the esophageal anatomy presents distinct challenges to surgical resection of the diverticulum, particularly when it is located closer to the oral orifice. Since the condition itself is not malignant, minimally invasive endoscopic approaches have been developed with a focus on alleviation of symptoms. Several types of endoscopic devices and techniques are currently employed, including peroral endoscopic myotomy (POEM). However, the use of minimally invasive endoscopic approaches, like POEM, has allowed the development of new disorder called iatrogenic esophageal diverticula. In this paper, we review the pathophysiology of each type of diverticulum and the current state-of-the-art treatment based on our experience.
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Affiliation(s)
- Hiroki Sato
- Division of Gastroenterology, Niigata University Medical and Dental Hospital, Niigata 951-8510, Japan
| | - Manabu Takeuchi
- Division of Gastroenterology, Nagaoka Red Cross Hospital, Nagaoka 940-2085, Japan
| | - Satoru Hashimoto
- Division of Gastroenterology, Niigata University Medical and Dental Hospital, Niigata 951-8510, Japan
| | - Ken-ichi Mizuno
- Division of Gastroenterology, Niigata University Medical and Dental Hospital, Niigata 951-8510, Japan
| | - Koichi Furukawa
- Division of Gastroenterology, Niigata City General Hospital, Niigata 950-1197, Japan
| | - Akito Sato
- Division of Gastroenterology, Nagaoka Chuo General Hospital, Nagaoka 940-8653, Japan
| | - Junji Yokoyama
- Division of Gastroenterology, Niigata University Medical and Dental Hospital, Niigata 951-8510, Japan
| | - Shuji Terai
- Division of Gastroenterology, Niigata University Medical and Dental Hospital, Niigata 951-8510, Japan
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Paydarfar JA, Wu X, Halter RJ. Initial experience with image-guided surgical navigation in transoral surgery. Head Neck 2018; 41:E1-E10. [PMID: 30556235 DOI: 10.1002/hed.25380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/08/2018] [Accepted: 05/28/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Surgical navigation using image guidance may improve the safety and efficacy of transoral surgery (TOS); however, preoperative imaging cannot be accurately registered to the intraoperative state due to deformations resulting from placement of the laryngoscope or retractor. This proof of concept study explores feasibility and registration accuracy of surgical navigation for TOS by utilizing intraoperative imaging. METHODS Four patients undergoing TOS were recruited. Suspension laryngoscopy was performed with a CT-compatible laryngoscope. An intraoperative contrast enhanced CT scan was obtained and registered to fiducials placed on the neck, face, and laryngoscope. RESULTS All patients were successfully scanned and registered. Registration accuracy within the pharynx and larynx was 1 mm or less. Target registration was confirmed by localizing endoscopic and surface structures to the CT images. Successful tracking was performed in all 4 patients. CONCLUSION For surgical navigation during TOS, although a high level of registration accuracy can be achieved by utilizing intraoperative imaging, significant limitations of the existing technology have been identified. These limitations, as well as areas for future investigation, are discussed.
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Affiliation(s)
- Joseph A Paydarfar
- Section of Otolaryngology, Audiology, and Maxillofacial Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Lebanon, New Hampshire
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
| | - Xiaotian Wu
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
| | - Ryan J Halter
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
- Dartmouth College Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire
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14
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Yamaguchi D, Ikeda K, Takeuchi Y, Kinoshita R, Higuchi T, Fukuda H, Tominaga N, Morisaki T, Ario K, Tsunada S, Yoshida H, Fujimoto K. New insertion method of transnasal ileus tube for small bowel obstruction: Anterior balloon method. PLoS One 2018; 13:e0207099. [PMID: 30462677 PMCID: PMC6248956 DOI: 10.1371/journal.pone.0207099] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/24/2018] [Indexed: 11/20/2022] Open
Abstract
Background Small bowel obstruction (SBO) is usually caused by postoperative adhesions and malignant disease, and decompression is effective for SBO. Our previous case report suggested that a new transnasal ileus tube insertion method, the anterior balloon method (ABM), could achieve decompression for adhesive SBO. Aims The study aimed to investigate the effectiveness of a new method for inserting transnasal ileus tubes in patients with SBO. Methods Altogether, 134 patients with small bowel obstruction treated from January 2011 to December 2017 were reviewed. The patients were categorized into two groups: those with the new method that inserts an anterior balloon (ABM group: 52 patients, 2014–2017) versus those with the ordinary insertion method (OIM group: 82 patients, 2011–2014). Results The patients’ characteristics and symptoms on admission were similar in the ABM and OIM groups. Adhesions were the main cause of ileus in the two groups. The insertion time duration was significantly shorter in the ABM group than in OIM group (28.4 ± 9.1 vs. 33.5 ± 13.0 min; p = 0.01). The ABM group also had significantly longer tubes than OIM group (222.4 ± 32.2 vs. 157.4 ± 31.7 cm; p < 0.001), which resulted in a significantly shorter time until clinical symptoms were relieved in ABM group. There were no significant differences in adverse events between the two groups. Conclusions The ABM group had shorter insertion duration and longer tubes than those of OIM group. The ABM might become a preferred therapeutic choice to achieve decompression in patients with SBO.
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Affiliation(s)
- Daisuke Yamaguchi
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
- Department of Internal Medicine, Saga Medical School, Saga, Japan
- * E-mail:
| | - Kei Ikeda
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Yuki Takeuchi
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Rikako Kinoshita
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Toru Higuchi
- Department of Internal Medicine, Saga Medical School, Saga, Japan
| | - Hiroko Fukuda
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Naoyuki Tominaga
- Department of Internal Medicine, Saga Medical School, Saga, Japan
| | - Tomohito Morisaki
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Keisuke Ario
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Seiji Tsunada
- Department of Gastroenterology, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Hisako Yoshida
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuma Fujimoto
- Department of Internal Medicine, Saga Medical School, Saga, Japan
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15
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Abstract
How robotics could help shape the future of surgical care.
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Affiliation(s)
- Andrew Brodie
- Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital , Stevenage
| | - Nikhil Vasdev
- Hertfordshire and Bedfordshire Urological Cancer Centre, Lister Hospital, Stevenage Clinical Senior Lecturer in Urology, School of Life and Medical Sciences, University of Hertfordshire , Hatfield
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16
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Sow YL, Tang IP, Kho JPY, Prepageran N. Pilot study comparing steroid-impregnated and non-steroid-impregnated absorbable nasal dressing following endoscopic sinus surgery. Med J Malaysia 2018; 73:244-248. [PMID: 30121688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Endoscopic sinus surgery (ESS) is the mainstay for treatment of chronic rhinosinusitis versus maximal medical therapy. We propose a more economical option, by using steroid-impregnated Gelfoam instead of Nasopore post ESS, as it is less expensive and has showed effectiveness in preventing post-operative bleeding. MATERIALS AND METHODS A randomised, double-blinded, placebo-controlled trial was carried out in eight patients with chronic rhinosinusitis or nasal polyposis who were planned for bilateral endoscopic sinus surgery. A Peri-operative Sinus Endoscopy (POSE) Score and Lund-Kennedy Endoscopic Score (LKES) were recorded. The use of hydrocortisone-impregnated Gelfoam dressing versus normal saline-impregnated Gelfoam dressing were compared. Scores were repeated post-operatively at one week, three weeks and three months interval. RESULTS For LKES, at the end of three months, 50% of the patients had the same score difference, 37.5% had better results on the study side while 12.5% had better results on the control side. Meanwhile, for POSE Score, at the end of three months, 75% of the patients had better score difference on the study side while 12.5% had better results on the control side. CONCLUSION Gelfoam can be used as nasal packing material to deliver topical steroid after endoscopic sinus surgery. Steroid-impregnated nasal dressing after endoscopic sinus surgery may not provide better long-term outcome.
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Affiliation(s)
- Y L Sow
- University of Malaya Medical Centre, ENT Department, Lembah Pantai, Kuala Lumpur, Malaysia.
| | - I P Tang
- University of Malaya Medical Centre, ENT Department, Lembah Pantai, Kuala Lumpur, Malaysia
| | - J P Y Kho
- University of Malaya Medical Centre, ENT Department, Lembah Pantai, Kuala Lumpur, Malaysia
| | - N Prepageran
- University of Malaya Medical Centre, ENT Department, Lembah Pantai, Kuala Lumpur, Malaysia
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Labidi M, Watanabe K, Hanakita S, Park HH, Bouazza S, Bernat AL, Froelich S. The Chopsticks Technique for Endoscopic Endonasal Surgery-Improving Surgical Efficiency and Reducing the Surgical Footprint. World Neurosurg 2018; 117:208-220. [PMID: 29886295 DOI: 10.1016/j.wneu.2018.05.229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 01/15/2018] [Revised: 05/29/2018] [Accepted: 05/30/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Variations and additions to the endoscopic endonasal exposure have been proposed around a modular strategy. These extensions are often necessary to provide additional working space and reduce conflict between the instruments and the endoscope. Resection of endonasal structures, which affects negatively the sinonasal quality of life, is thus undertaken not only to obtain tumor exposure but also to improve the maneuverability of the instruments. OBJECTIVE Our objective was to achieve the same skull base exposures and tumor resections and limit the surgical footprint on sinonasal structures and patients' quality of life. METHODS Our team developed a surgical technique in which the endoscope and a malleable rotative aspirator are held by the nondominant hand and the other main instrument in the dominant hand. This modification, which we call the chopsticks technique, allows the surgeon to use minimalistic exposures with an improved dynamic perception of the surgical field and reduced conflicts between the instruments. The endonasal structures that are left intact help support the instruments. The same surgical objectives, in terms of exposure and resection, are achieved. We describe our technique and a series of patients operated with this uninarial 3-instruments technique to discuss relevant operative nuances. CONCLUSIONS We propose a technical modification that allows the surgeons to benefit from the advantages of a bimanual technique while still holding the endoscope. In our opinion, this technique may improve dynamic understanding of the anatomy and surgical efficiency and reduce the footprint of the surgery.
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Affiliation(s)
- Moujahed Labidi
- Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France; Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
| | - Kentaro Watanabe
- Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France
| | - Shunya Hanakita
- Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France
| | - Hun Ho Park
- Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France
| | | | - Anne-Laure Bernat
- Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France
| | - Sébastien Froelich
- Department of Neurosurgery, Hôpital Lariboisière (AP-HP), Paris, France; Paris VII-Diderot University, Paris, France
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18
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Zhou KY, Yang WZ, Cui ZY, Wei RJ, Zhao CL, Ma T, An F. [F4.8 visual miniature nephroscope for the diagnosis and treatment of hematospermia]. Zhonghua Nan Ke Xue 2018; 24:525-528. [PMID: 30173458] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To explore the practicability and safety of the F4.8 visual miniature nephroscope in the diagnosis and treatment of hematospermia. METHODS This study included 12 cases of refractory hematospermia accompanied by perineal or lower abdominal pain and discomfort. All the patients failed to respond to two months of systemic anti-inflammatory medication and local physiotherapy. Seminal vesicle tumor and tuberculosis were excluded preoperatively by rectal seminal vesicle ultrasonography, MRI or CT. Under epidural anesthesia, microscopic examination was performed with the F4.8 miniature nephroscope through the urethra and ejaculatory duct orifice into the seminal vesicle cavity, the blood clots washed out with normal saline, the seminal vesicle stones extracted by holmium laser lithotripsy and with the reticular basket, the seminal vesicle polyps removed by holmium laser ablation and vaporization, and the seminal vesicle cavity rinsed with diluted iodophor after operation. RESULTS Of the 10 patients subjected to bilateral seminal vesiculoscopy, 3 with unilateral and 2 with bilateral seminal vesicle stones were treated by holmium laser lithotripsy, saline flushing and reticular-basket removal, 2 with seminal vesicle polyps by holmium laser ablation and vaporization, and the other 3 with blood clots in the seminal vesicle cavity by saline flushing for complete clearance. The 2 patients subjected to unilateral seminal vesiculoscopy both received flushing of the seminal vesicle cavity for clearance of the blood clots. The operations lasted 10-55 (25 ± 6) minutes. There were no such intra- or post-operative complications as rectal injury, peripheral organ injury, and external urethral sphincter injury. The urethral catheter was removed at 24 hours, anti-infection medication withdrawn at 72 hours, and regular sex achieved at 2 weeks postoperatively. The patients were followed up for 6-20 (7 ± 2.3) months, during which hematospermia and related symptoms disappeared in 10 cases at 3 months and recurrence was observed in the other 2 at 4 months after surgery but improved after antibiotic medication. CONCLUSIONS The F4.8 visual miniature nephroscope can be applied to the examination of the seminal vesicle cavity and treatment of seminal vesicle stones and polyps, with the advantages of minimal invasiveness, safety and reliability.
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Affiliation(s)
- Ke-Yi Zhou
- Department of Urology, Baoding First Central Hospital, Baoding, Hebei 071000, China
| | - Wen-Zeng Yang
- Department of Urology, The Affiliated Hospital of Hebei University, Baoding, Hebei 071000, China
| | - Zhen-Yu Cui
- Department of Urology, The Affiliated Hospital of Hebei University, Baoding, Hebei 071000, China
| | - Ruo-Jing Wei
- Department of Urology, The Affiliated Hospital of Hebei University, Baoding, Hebei 071000, China
| | - Chun-Li Zhao
- Department of Urology, The Affiliated Hospital of Hebei University, Baoding, Hebei 071000, China
| | - Tao Ma
- Department of Urology, The Affiliated Hospital of Hebei University, Baoding, Hebei 071000, China
| | - Feng An
- Department of Urology, The Affiliated Hospital of Hebei University, Baoding, Hebei 071000, China
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Abstract
AIM To overcome the technical difficulty of exteriorizing a specimen through the descending colon stump, we applied laparoscopic-assisted natural orifice specimen extraction (LA-NOSE) using a Cai tube. METHODS From April 2014 to February 2015, we successfully performed total laparoscopic radical surgery with LA-NOSE in six patients with descending colon lesions. The time of operation, blood loss amount, lymph nodes harvested, postoperative recovery, postoperative complications and follow-up were observed. RESULTS Total laparoscopic dissection and anastomosis with natural orifice removal using a Cai tube was successful in all 6 patients; no deaths, anastomotic bleeding, fistulas, infections, or any other complications were recorded. The median operating time was 327.7 ± 73.4 min, and the estimated blood loss was 66.7 ± 69.2 mL. The mean number of lymph nodes harvested was 15.7 ± 4.4. Recovery of gastrointestinal function ranged from 2 to 4 days after the operation. The mean length of postoperative hospital stay was 12.3 ± 3.2 days. The six cases were followed up for 6-16 (12.5 ± 3.6) months, and all patients avoided auxiliary incision which demonstrated potential cosmetic advantages and uneventful recovery with no additional complications or cancer recurrence. CONCLUSION In this pilot study of six patients, LA-NOSE radical descending colectomy using a Cai tube was feasible and safe.
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Affiliation(s)
- Jian-Chun Cai
- Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, No. 201-209, Hubin south Road, Xiamen, 363104, Fujian, China.
- Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin south Road, Xiamen, 363104, Fujian, China.
| | - Xin-Ya Hong
- Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, No. 201-209, Hubin south Road, Xiamen, 363104, Fujian, China
- Institute of Gastrointestinal Oncology, Medical College of Xiamen University, No. 201-209, Hubin south Road, Xiamen, 363104, Fujian, China
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20
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Abstract
The idea to use natural orifices as an access route for operations in the body has inspired many clinicians and researchers worldwide. Some of these expected a continuation of the development from open surgery to laparoscopic surgery finally to a less invasive modality. Others hoped for economic benefits for endoscopists to take over previous surgical patients into gastroenterological departments. The first experimental studies demonstrated that the initial expectations could not be implemented in a short period of time. The available endoscopes could not be proved for advanced procedures. Key problems like sterility, infection control, tissue manipulation, safety of access closure, and specimen retrieval manifested to be too large for routine clinical use. However, the attraction of the natural orifice transluminal endoscopic surgery (NOTES) philosophy has resulted in a reduction of the number and diameters of trocars in laparoscopic surgery. Hybrid NOTES as a combination of classical laparoscopic access with natural orifice instrumentations (mostly transvaginal) have become clinical reality in many hospitals. This development fits into the long-term trend towards less invasive surgery and more effective interventional methods in endolumenal endoscopy.
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Affiliation(s)
- G Kähler
- Zentrale Interdisziplinäre Endoskopie, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
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Mortagy M, Mehta N, Parsi MA, Abe S, Stevens T, Vargo JJ, Saito Y, Bhatt A. Magnetic anchor guidance for endoscopic submucosal dissection and other endoscopic procedures. World J Gastroenterol 2017; 23:2883-2890. [PMID: 28522906 PMCID: PMC5413783 DOI: 10.3748/wjg.v23.i16.2883] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/24/2017] [Accepted: 03/15/2017] [Indexed: 02/07/2023] Open
Abstract
Endoscopic submucosal dissection (ESD) is a well-established, minimally invasive treatment for superficial neoplasms of the gastrointestinal tract. The universal adoption of ESD has been limited by its slow learning curve, long procedure times, and high risk of complications. One technical challenge is the lack of a second hand that can provide traction, as in conventional surgery. Reliable tissue retraction that exposes the submucosal plane of dissection would allow for safer and more efficient dissection. Magnetic anchor guided endoscopic submucosal dissection (MAG-ESD) has potential benefits compared to other current traction methods. MAG-ESD offers dynamic tissue retraction independent of the endoscope mimicking a surgeon’s “second hand”. Two types of magnets can be used: electromagnets and permanent magnets. In this article we review the MAG-ESD technology, published work and studies of magnets in ESD. We also review the use of magnetic anchor guidance systems in natural orifice transluminal endoscopic surgery and the idea of magnetic non-contact retraction using surface ferromagentization. We discuss the current limitations, the future potential of MAG-ESD and the developments needed for adoption of this technology.
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Dargar S, De S, Sankaranarayanan G. Development of a Haptic Interface for Natural Orifice Translumenal Endoscopic Surgery Simulation. IEEE Trans Haptics 2016; 9:333-344. [PMID: 27008674 PMCID: PMC5026958 DOI: 10.1109/toh.2016.2543224] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Natural orifice translumenal endoscopic surgery (NOTES) is a minimally invasive procedure, which utilizes the body's natural orifices to gain access to the peritoneal cavity. The NOTES procedure is designed to minimize external scarring and patient trauma, however flexible endoscopy based pure NOTES procedures require critical scope handling skills. The delicate nature of the NOTES procedure requires extensive training. Thus, to improve access to training while reducing risk to patients, we have designed and developed the VTEST, a virtual reality NOTES simulator. As part of the simulator, a novel decoupled 2-DOF haptic device was developed to provide realistic force feedback to the user in training. A series of experiments were performed to determine the behavioral characteristics of the device. The device was found capable of rendering up to 5.62N and 0.190 Nm of continuous force and torque in the translational and rotational DOF, respectively. The device possesses 18.1 and 5.7 Hz of force bandwidth in the translational and rotational DOF, respectively. A feedforward friction compensator was also successfully implemented to minimize the negative impact of friction during the interaction with the device. In this work, we have presented the detailed development and evaluation of the haptic device for the VTEST.
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Affiliation(s)
- Saurabh Dargar
- Graduate student in the Biomedical Engineering Department and with the Center for Modeling, Simulation and Imaging in Medicine (CeMSIM) at Rensselaer Polytechnic Institute in Troy, NY, USA
| | - Suvranu De
- Director of CeMSIM and Head of the Department of Mechanical, Aerospace and Nuclear Engineering (MANE) at Rensselaer Polytechnic Institute in Troy, NY, USA
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23
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Dorozhkin D, Nemani A, Roberts K, Ahn W, Halic T, Dargar S, Wang J, Cao CGL, Sankaranarayanan G, De S. Face and content validation of a Virtual Translumenal Endoscopic Surgery Trainer (VTEST™). Surg Endosc 2016; 30:5529-5536. [PMID: 27129546 DOI: 10.1007/s00464-016-4917-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 04/02/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Natural orifice translumenal endoscopic surgery (NOTES) is an emerging surgical paradigm, where peritoneal access is achieved through one of the natural orifices of the body. It is being reported as a safe and feasible surgical technique with significantly reduced external scarring. Virtual Translumenal Endoscopic Surgical Trainer (VTEST™) is the first virtual reality simulator for the NOTES. The VTEST™ simulator was developed to train surgeons in the hybrid transvaginal NOTES cholecystectomy procedure. The initial version of the VTEST™ simulator underwent face validation at the 2013 Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) summit. Several areas of improvement were identified as a result, and the corresponding modifications were implemented in the simulator. This manuscript outlines the results of the subsequent evaluation study, performed in order to assess the face and content validity of the latest VTEST™ simulator. METHODS Twelve subjects participated in an institutional review board-approved study that took place at the 2014 NOSCAR summit. Six of the 12 subjects, who are experts with NOTES experience, were used for face and content validation. The subjects performed the hybrid transvaginal NOTES cholecystectomy procedure on VTEST™ that included identifying the Calot's triangle, clipping and cutting the cystic duct/artery, and detaching the gallbladder. The subjects then answered five-point Likert scale feedback questionnaires for face and content validity. RESULTS Overall, subjects rated 12/15 questions as 3.0 or greater (60 %), for face validity questions regarding the realism of the anatomical features, interface, and the tasks. Subjects also highly rated the usefulness of the simulator in learning the fundamental NOTES technical skills (3.50 ± 0.84). Content validity results indicate a high level of usefulness of the VTEST™ for training prior to operating room experience (4.17 ± 0.75).
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Affiliation(s)
- Denis Dorozhkin
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Arun Nemani
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Kurt Roberts
- Gastrointestinal Surgery, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Woojin Ahn
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Tansel Halic
- Computer Science Department, University of Central Arkansas, Conway, AR, USA
| | - Saurabh Dargar
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Jinling Wang
- Biomedical, Industrial and Human Factors Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Caroline G L Cao
- Biomedical, Industrial and Human Factors Engineering, College of Engineering and Computer Science, Wright State University, Dayton, OH, USA
| | - Ganesh Sankaranarayanan
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110, 8th Street, Troy, NY, 12180, USA.
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Dapri G, Guta D, Cardinali L, Mazzetti C, Febres AC, Grozdev K, Sondji SH, Surdeanu I, Cadière GB. A New Reusable Platform for TransAnal Minimally Invasive Surgery: First Experience. Surg Technol Int 2016; 28:85-95. [PMID: 27042793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION TransAnal Minimally Invasive Surgery (TAMIS) has generated interest and attracted research in the last decade. This approach is used to treat primary benign and malignant diseases, but it can also be adopted to resolve colorectal complications, such as leak and fistula, bleeding and stenosis. A new reusable transanal platform formed by a new port and monocurved instruments has been invented and here presented. MATERIALS AND METHODS The first experience included 13 patients submitted to TAMIS for rectal adenocarcinoma (8), immediate colorectal leak (1), early rectovaginal fistula (1), late colorectal fistula (1), immediate colorectal bleeding (1), and benign stenosis (1). Mean age was 62.3 years (38-74), and mean BMI was 25.2 kg/m2 (20.5-32.1). RESULTS Mean operative time for transanal total mesorectal excision (TME) was 149.2 minutes (96-193) and for the other procedures 80.6 minutes (15-163). Mean operative bleeding was 51.1 cc (0-450). Mean hospital stay was 5.0 days (2-8). The 3 patients with coloanal anastomosis presented diarrhea postoperatively. No other early postoperative complications were registered. Pathologic report in the oncologic diseases showed that a mean number of 14.7 nodes (16-20) were removed. After a mean follow-up of 8 months (1-14), there were no late complications in any of the 13 patients treated. CONCLUSION TAMIS is a feasible alternative approach to treat rectal cancer and a completely new technique to manage colorectal complications. Moreover, this new transanal platform offers surgeons a satisfactory working ergonomy, with no increase in cost of the procedures, because entirely reusable materials are adopted.
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Affiliation(s)
- Giovanni Dapri
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium
| | - Daniel Guta
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium
| | - Luca Cardinali
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium
| | - Claudia Mazzetti
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium
| | - Anny Cadenas Febres
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium
| | - Konstantin Grozdev
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium
| | - Sixte-Henry Sondji
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium
| | - Ion Surdeanu
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium
| | - Guy-Bernard Cadière
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium
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Koskinen A, Myller J, Mattila P, Penttilä M, Silvola J, Alastalo I, Huhtala H, Hytönen M, Toppila-Salmi S. Long-term follow-up after ESS and balloon sinuplasty: Comparison of symptom reduction and patient satisfaction. Acta Otolaryngol 2016; 136:532-6. [PMID: 26848855 DOI: 10.3109/00016489.2015.1129553] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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] [Indexed: 12/23/2022]
Abstract
CONCLUSION This is the first controlled study of balloon sinuplasty's long-term efficacy with the follow-up time over 5 years. The results are in accordance with a previous 2-year-follow-up study. Both techniques retained the efficacy and patient satisfaction on average 6 years after the surgery. BACKGROUND Endoscopic sinus surgery (ESS) and balloon sinuplasty are considered as a treatment for chronic rhinosinusitis (CRS) after a failure of conservative therapy. High cost and lack of long-term follow-up studies restrain the use of balloon sinuplasty. OBJECTIVE The aim of this study was to compare long-term efficacy and satisfaction in CRS patients who had undergone maxillary sinus operation with either balloon sinuplasty or ESS technique. Previous or additional sinonasal operations were exclusion criteria. MATERIALS AND METHODS Study patients were recruited from 208 CRS-patients who underwent either ESS or balloon sinuplasty. Patients with nasal polyposis (gradus ≥ 2), previous sinonasal surgery, unilateral disease, or immune deficiency were excluded. Altogether 45 patients in the ESS group and 40 patients in the balloon group were included. Of these, 30 and 28, respectively, answered to a phone interview held on average 6 years after primary surgery. Symptom reduction and long-term satisfaction were evaluated by using symptom scores of 19 parameters altogether. RESULTS Both groups experienced improvement in symptoms and were equally satisfied with the operation. The number of patient-reported acute exacerbations was higher among the balloon dilated patients. Also, the reduction of thick nasal discharge was less evident in the balloon sinuplasty group. Four patients in the balloon sinuplasty group underwent revision surgery. There were no revisions in the ESS group.
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Affiliation(s)
- Anni Koskinen
- a Haartman Institute, University of Helsinki , Finland
- b Department of Otorhinolaryngology , University of Helsinki and Helsinki University Hospital , Finland
- c Department of Otorhinolaryngology , Päijät-Häme Central Hospital , Lahti , Finland
| | - Jyri Myller
- c Department of Otorhinolaryngology , Päijät-Häme Central Hospital , Lahti , Finland
| | - Petri Mattila
- b Department of Otorhinolaryngology , University of Helsinki and Helsinki University Hospital , Finland
| | - Matti Penttilä
- d Department of Otorhinolaryngology , Tampere University Hospital , Finland
- e Terveystalo Healthcare OYJ of Finland, Tampere, Finland
| | - Juha Silvola
- f Department of Otorhinolaryngology , Oslo University Hospital, Rikshospitalet , Norway
| | - Ismo Alastalo
- c Department of Otorhinolaryngology , Päijät-Häme Central Hospital , Lahti , Finland
| | - Heini Huhtala
- g School of Health Sciences, University of Tampere , Finland
| | - Maija Hytönen
- b Department of Otorhinolaryngology , University of Helsinki and Helsinki University Hospital , Finland
| | - Sanna Toppila-Salmi
- a Haartman Institute, University of Helsinki , Finland
- h Department of Allergy , University of Helsinki and Helsinki University Hospital , Finland
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Izzo A, Tortora G, Dario P, Menciassi A. Design, development and characterization of a modular end effector for MIS procedures. Annu Int Conf IEEE Eng Med Biol Soc 2016; 2015:6880-3. [PMID: 26737874 DOI: 10.1109/embc.2015.7319974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Minimally Invasive Surgery (MIS) paradigm is well established in modern surgical procedures. Although MIS is successful from the patient's viewpoint, the use of rigid instruments inserted through small skin incisions leads to dexterity constraints and loss of degree of motion. Robotics has been introduced as support for augmenting dexterity during interventions, restoring hand-eye coordination and providing tools with enhanced degrees of motion. However, surgical robots have high costs and large footprint, pushing the research towards the development of modular robots to be used in Naturally Orifice Trans-luminal Endoscopic Surgery (NOTES) procedures. The main need of having simple and cheap tools able to be interchanged during the surgical procedure became crucial. In this paper an innovative modular end-effector based on a compliant soft actuation system able to provide up to 5.78 N gripping forces is presented.
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Furukawa K, Miyahara R, Funasaka K, Yamamura T, Ohno E, Nakamura M, Kawashima H, Watanabe O, Hirooka Y, Goto H. Endoscopic Closure of Duodenal Perforation with the Over-the-scope-clipping System. Intern Med 2016; 55:3131-3135. [PMID: 27803406 PMCID: PMC5140861 DOI: 10.2169/internalmedicine.55.6793] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Endoscopic treatment for superficial non-ampullary duodenal tumors is technically difficult and challenging due to the anatomical characteristics of the duodenum. It is frequently complicated by procedural accidents, such as perforation. Surgical repair has long been the standard treatment for acute iatrogenic gastrointestinal perforation. However, endoscopic closure has recently emerged as an attractive alternative. In the patient presented herein, the over-the-scope-clipping system (OTSC system) was found to be useful for closing a duodenal perforation that had occurred during endoscopic submucosal dissection. For endoscopists who perform endoscopic treatment of the duodenum, endoscopic closure with the OTSC system is considered to be a technique that is necessary to master.
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Affiliation(s)
- Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Japan
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Ahn W, Dorozhkin D, Schwaitzberg S, Jones DB, De S. Developing Modularized Virtual Reality Simulators for Natural Orifice Translumenal Endoscopic Surgery (NOTES). Stud Health Technol Inform 2016; 220:1-4. [PMID: 27046543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Natural orifice translumenal endoscopic surgery (NOTES) procedures are rapidly being developed in diverse surgical fields. We are developing a Virtual Translumenal Endoscopic Surgery Trainer (VTEST™) built on a modularized platform that facilitates rapid development of virtual reality (VR) NOTES simulators. Both the hardware interface and software components consist of independent reusable and customizable modules. The developed modules are integrated to build a VR-NOTES simulator for training in the hybrid transvaginal NOTES cholecystectomy. The simulator was demonstrated and evaluated by expert NOTES surgeons at the 2015 Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) summit.
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Affiliation(s)
- Woojin Ahn
- Center for Modeling, Simula tion and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY
| | - Denis Dorozhkin
- Center for Modeling, Simula tion and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY
| | - Steven Schwaitzberg
- Department of Surgery, University at Buffalo School of Medicine and Biomedical Sciences, Harvard Medical School, Buffalo, NY
| | - Daniel B Jones
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Suvranu De
- Center for Modeling, Simula tion and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, NY
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Gerboni G, Henselmans PWJ, Arkenbout EA, van Furth WR, Breedveld P. HelixFlex: bioinspired maneuverable instrument for skull base surgery. Bioinspir Biomim 2015; 10:066013. [PMID: 26623568 DOI: 10.1088/1748-3190/10/6/066013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Endoscopic endonasal surgery is currently regarded as the 'gold standard' for operating on pituitary gland tumors, and is becoming more and more accepted for treatment of other skull base lesions. However, endoscopic surgical treatment of most skull base pathologies, including certain pituitary tumors, is severely impaired by current instruments lack of maneuverability. Especially, gaining access to, and visibility of, difficult-to-reach anatomical corners without interference with surrounding neurovascular structures or other instruments, is a challenge. In this context there is the need for instruments that are able to provide a stable shaft position, while both the orientation and the position of the end-effector can be independently controlled. Current instruments that allow for this level of maneuverability are usually mechanically complex, and hence less suitable for mass production. This study therefore focuses on the development of a new actuation technique that allows for the required maneuverability while reducing the construction complexity. This actuation technique, referred to as multi-actuation, integrates multiple cable routings into a single steerable structure. Multi-actuation has been successfully integrated and tested in a handheld prototype instrument called HelixFlex. HelixFlex contains a 4 degrees of freedom maneuverable 5.8 mm (diameter) tip and shows promising results concerning its maneuverability and potential rigidity.
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Affiliation(s)
- Giada Gerboni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
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30
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Kim DK, Yoon YE, Han WK, Rha KH. Roles of NOTES and LESS in management of small renal masses. Int J Surg 2015; 36:574-582. [PMID: 26607854 DOI: 10.1016/j.ijsu.2015.11.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 08/24/2015] [Revised: 10/27/2015] [Accepted: 11/10/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Over the last 2 decades, open surgery has been largely displaced by laparoscopic surgery for the treatment of renal masses. Recently, minimally invasive surgical techniques, such as laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES), have been developed for such purpose. METHODS In the present literature review, the current status of treatment for small renal masses was investigated. The advantages and disadvantages of LESS and NOTES are presented to confirm the feasibility and reproducibility of these techniques. RESULTS LESS significantly reduces pain and offers excellent cosmetic outcomes with comparable oncological and perioperative results, and NOTES offers the potential for surgery by various approach without any transcutaneous abdominal incision in management of small renal masses. CONCLUSION When the technical limitations are overcome, clinical application of LESS and NOTES is expected to increase. Further prospective and comparative studies are needed to clarify the application of these new techniques.
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Affiliation(s)
- Dae Keun Kim
- Department of Urology, CHA Gangnam Hospital, CHA University, CHA Medical School, Seoul, Republic of Korea; Department of Urology, School of Medicine, Graduate School, Hanyang University, Seoul, Republic of Korea.
| | - Young Eun Yoon
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Yonseiro 50-1, Seodaemun-gu, Seoul 120-752, Republic of Korea.
| | - Woong Kyu Han
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Yonseiro 50-1, Seodaemun-gu, Seoul 120-752, Republic of Korea.
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Yonseiro 50-1, Seodaemun-gu, Seoul 120-752, Republic of Korea.
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Vemuri AS, Nicolau S, Sportes A, Marescaux J, Soler L, Ayache N. Interoperative Biopsy Site Relocalization in Endoluminal Surgery. IEEE Trans Biomed Eng 2015; 63:1862-1873. [PMID: 26625405 DOI: 10.1109/tbme.2015.2503981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Barrett's oesophagus, a premalignant condition of the oesophagus has been on a rise in the recent years. The standard diagnostic protocol for Barrett's involves obtaining biopsies at suspicious regions along the oesophagus. The localization and tracking of these biopsy sites "interoperatively" poses a significant challenge for providing targeted treatments and tracking disease progression. This paper proposes an approach to provide guided navigation and relocalization of the biopsy sites using an electromagnetic tracking system. The characteristic of our approach over existing ones is the integration of an electromagnetic sensor at the flexible endoscope tip, so that the endoscopic camera depth inside the oesophagus can be computed in real time, allowing to retrieve and display an image from a previous exploration at the same depth. We first describe our system setup and methodology for interoperative registration. We then propose three incremental experiments of our approach. First, on synthetic data with realistic noise model to analyze the error bounds of our system. The second on in vivo pig data using an optical tracking system to provide a pseudo ground truth. Accuracy results obtained were consistent with the synthetic experiments despite uncertainty introduced due to breathing motion, and remain inside acceptable error margin according to medical experts. Finally, a third experiment designed using data from pigs to simulate a real task of biopsy site relocalization, and evaluated by ten gastro-intestinal experts. It clearly demonstrated the benefit of our system toward assisted guidance by improving the biopsy site retrieval rate from 47.5% to 94%.
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Gunkova P, Gunka I, Zonca P, Dostalik J, Ihnat P. Laparoscopic sleeve gastrectomy for morbid obesity with natural orifice specimen extraction (NOSE). ACTA ACUST UNITED AC 2015; 116:422-5. [PMID: 26286244 DOI: 10.4149/bll_2015_080] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE An experience with laparoscopic sleeve gastrectomy using the natural orifice specimen extraction (NOSE) technique. BACKGROUND Bariatric surgery is nowadays the only long term effective obesity treatment method. METHODS Twenty one consecutive patients underwent laparoscopic sleeve gastrectomy with the use of natural orifice specimen extraction (NOSE) in the Surgical Clinic of Faculty Hospital Ostrava between May 2012 and August 2012. Inclusion criteria were the body mass index (BMI) higher than 35 kg/m2 or higher than 32 kg/m2 accompanied with relevant comorbidities. RESULTS Among 21 patients in this series, there were three men (14.3%) and 18 women (85.7%). Their mean age was 40.9±10.2 years. Their mean preoperative BMI was 40.4±4.6 kg/m2. No patient had previous bariatric surgery, one patient had laparoscopic fundoplication. All operations were completed laparoscopically with no conversions to an open procedure. In two cases, laparoscopic cholecystectomy was performed and the gallbladder was extracted along with the gastric specimen by transgastric approach. CONCLUSION Laparoscopic sleeve gastrectomy is a safe and effective bariatric procedure with low morbidity and mortality. Based on our initial experiences it could be an indication for NOSE with transgastric approach. Obese patients would benefit from this approach due to the elimination of wound complications (Tab. 2, Fig. 3, Ref. 22).
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Chang H, Huang Y, Yao W, Zhang L, Li Y. Improved method of gastrostomy tube replacement using a small-caliber transnasal endoscope. Acta Otolaryngol 2015; 136:195-8. [PMID: 26549728 DOI: 10.3109/00016489.2015.1103382] [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] [Indexed: 11/13/2022]
Abstract
CONCLUSION Gastrostomy tube replacement using a new approach through the abdominal-wall stoma with a small-caliber trans-nasal endoscope is feasible, fast, and safe compared with the trans-oral approach. OBJECTIVES To evaluate the feasibility of a new technique using a trans-nasal endoscope for gastrostomy tube replacement. METHODS Between June 2005 and December 2013 in the Peking University Third Hospital, 69 patients underwent gastrostomy tube replacement using the trans-oral approach (conventional method) or a small-caliber trans-nasal endoscope inserted through the abdominal-wall stoma (new method). A retrospective review was performed of the medical records of those patients, including demography and information about the surgical procedure and any complications. Patients were classified into the conventional group and the new method group. Descriptive statistics for all continuous variables were mean ± standard deviation and for categorical variables were number and percentage. RESULTS Gastrostomy tube replacement was achieved in 69 of 69 cases (100%); 23 of these procedures were performed using the new method. The surgery time with the conventional method (8.3 ± 2.0 min) was significantly longer than with the new method (6.0 ± 0.9 min, p < 0.001). With the conventional method, there was one patient (2%) with post-operative fever and skin infection; no complications occurred with the new method.
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Affiliation(s)
- Hong Chang
- a Department of Gastroenterology , Peking University Third Hospital , Beijing , PR China
| | - Yonghui Huang
- a Department of Gastroenterology , Peking University Third Hospital , Beijing , PR China
| | - Wei Yao
- a Department of Gastroenterology , Peking University Third Hospital , Beijing , PR China
| | - Li Zhang
- a Department of Gastroenterology , Peking University Third Hospital , Beijing , PR China
| | - Yuan Li
- a Department of Gastroenterology , Peking University Third Hospital , Beijing , PR China
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Redan JA, Humphries AR, Farmer B, Paquentin EM, Koh CH, Chung MK, Stringel G, McCarus SD, Carvalho G, Diaz RG, Shadduck PP. "Big Operations Using Mini Instruments": The Evolution of Mini Laparoscopy in the Surgical Realm. Surg Technol Int 2015; 27:19-30. [PMID: 26680376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Laparoscopy using miniature (2-3.5 mm) instruments was introduced in the late 1980s and early 1990s. Though mini laparoscopy (Mini) created new opportunities for surgical diagnosis and therapy, the limitations of early instruments inhibited widespread adoption. This is no longer the case. Mini is enjoying a renaissance, due to several factors: the maturation of minimally invasive surgery (MIS), the failure of laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) platforms to achieve early expectations, and the recent significant improvements in Mini instrument functionality and durability. As a result, Mini is being increasingly applied to pediatric and adult procedures across specialties. To assess the current status of Mini laparoscopy, the Society of Laparoendoscopic Surgeons (SLS) and the Florida Hospital Nicholson Center convened an international symposium in February 2015. This report shares highlights from that symposium, "Big Operations Using Mini Instruments."
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Affiliation(s)
- Jay A Redan
- Minimally Invasive General Surgery, Florida Hospital Celebration Health Celebration, Florida, University of Central Florida College of Medicine, Orlando, Florida
| | | | - Brianne Farmer
- University of Central Florida College of Medicine, Orlando, Florida
| | | | - Charles H Koh
- Columbia Hospital, St. Mary's Hospital, Milwaukee, WI, Mount Alvernia Hospital, Queen Elizabeth Hospital, Singapore
| | - Maurice K Chung
- Department of Obstetrics and Gynecology, University of Toledo School of Medicine, Toledo, Ohio, Department of Surgery, Lima Memorial Hospital, Lima, Ohio
| | - Gustavo Stringel
- New York Medical College, Maria Fareri Children's Hospital, Valhalla, New York
| | - Steven D McCarus
- Department of Obstetrics and Gynecology, University of Central Florida, Florida Hospital Celebration Health, Orlando, Florida
| | - Gustavo Carvalho
- University of Pernambuco, Department of Surgery, Hospital Universitário Oswaldo Cruz, Recife, Brazil
| | - Roberto Gallardo Diaz
- Sanatorio El Pilar in Guatemala City, Mini Invasive Surgical Group of Guatemala, Guatemala City, Guatemala
| | - Phillip P Shadduck
- Duke University, Duke Regional Hospital, TOA Surgical Specialists, North Carolina Specialty Hospital, Durham, North Carolina
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Senft JD, Carstensen B, Mischnik A, Warschkow R, Müller-Stich BP, Linke GR. Endolumenal colon occlusion reduces peritoneal contamination during a transrectal NOTES procedure: a controlled porcine survival study. Surg Endosc 2015; 30:2946-50. [PMID: 26487201 DOI: 10.1007/s00464-015-4582-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 06/02/2015] [Accepted: 09/19/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND To enable an efficient and enduring decontamination of the rectal mucosa during transanal endosocopic procedures, we developed a device for reversible endolumenal colon occlusion (ColoShield). The aim of this study was to assess the value of ColoShield in reducing peritoneal contamination during a transrectal procedure. METHODS Sixteen pigs underwent transrectal hybrid NOTES cholecystectomy after standardized disinfective rectal washout either with endolumenal colon occlusion using ColoShield (N = 8) or without colon occlusion (N = 8). Rectal swab samples were taken before and after rectal washout and at the end of the procedure. Peritoneal biopsies for microbiological evaluation were obtained at the end of the procedure and at necropsy 7 days after surgery. RESULTS Peritoneal contamination at the end of surgery was significantly lower using ColoShield compared to not using colon occlusion [13 (1/8) vs. 75 % (6/8); P = 0.012]. No significant differences were found regarding contamination of rectal swabs and peritoneal contamination at necropsy. CONCLUSION The application of ColoShield may increase the safety of transrectal NOTES and transanal endoscopic procedures by reducing peritoneal contamination and consecutive infectious complications.
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Affiliation(s)
- Jonas D Senft
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Benedict Carstensen
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Alexander Mischnik
- Department of Infectious Diseases, Medical Microbiology and Hygiene, University of Heidelberg, Im Neuenheimer Feld 324, 69120, Heidelberg, Germany
| | - Rene Warschkow
- Institute of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Georg R Linke
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Lamm SH, Zerz A, Efeoglou A, Steinemann DC. Transrectal Rigid-Hybrid Natural Orifice Translumenal Endoscopic Sigmoidectomy for Diverticular Disease: A Prospective Cohort Study. J Am Coll Surg 2015; 221:789-97. [PMID: 26282488 DOI: 10.1016/j.jamcollsurg.2015.07.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/13/2015] [Accepted: 07/13/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Our goal was to evaluate the feasibility of transrectal rigid hybrid natural orifice translumenal endoscopic surgery (NOTES) sigmoidectomy (trNS) in a series of consecutive prospective patients with diverticular disease. The NOTES for left colectomy offers patients reduced pain and easier recovery. Limited data are available for trNS, which is considered safe for various indications. However, the technique is not standardized, and patients in the reported series are highly selected. STUDY DESIGN Patients scheduled for trNS were entered into a prospective registry on an intention-to-treat basis. The primary endpoint was trNS feasibility, and secondary endpoints were morbidity, pain, length of stay, and inflammatory response. A medial-to-lateral dissection with full mobilization of the splenic flexure and total intracorporeal anastomosis was performed. The rectum was covered with a wound protector for transrectal extraction. RESULTS Of 95 elective sigmoidectomies, 81% (n = 77) were enrolled for either transvaginal NOTES resection (n = 37) or trNS (n = 40). There was no difference in body mass index or indication between patients undergoing laparoscopic-assisted sigmoidectomy (LAS), transvaginal resection, or trNS, although trNS patients were younger. Mainly because of a mismatch of bulky specimen and narrow pelvis, 17.5% of trNS were converted to LAS. Major morbidity was 10%, including 2 septic complications. During the study, the anastomosis technique was changed from double stapled end-to-end to side-to-end anastomosis. CONCLUSIONS Transrectal rigid hybrid natural orifice translumenal endoscopic sigmoidectomy is feasible and safe in a high proportion of unselected consecutive patients with diverticular disease undergoing elective treatment. Intracorporeal side-to-end anastomosis is the preferred technique, and trNS should be offered for elective sigmoidectomy presupposing advanced laparoscopic experience.
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Affiliation(s)
- Sebastian H Lamm
- Department of Surgery, Cantonal Hospital Baselland, Bruderholz, Switzerland
| | - Andreas Zerz
- Department of Surgery, Cantonal Hospital Baselland, Bruderholz, Switzerland
| | | | - Daniel C Steinemann
- Department of Surgery, Cantonal Hospital Baselland, Bruderholz, Switzerland.
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Bhardwaj N. Will NOTES ever become noticed? ANZ J Surg 2015; 85:204-5. [PMID: 25996005 DOI: 10.1111/ans.12812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hayashi S, Takayama T, Matsuda M, Ikarashi M, Hagiwara K, Suzuki T. Evaluation of three types of platforms in single-incision laparoscopic surgery for performing transanal endoscopic microsurgery (SILSTEM). Hepatogastroenterology 2014; 61:1931-1937. [PMID: 25713890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS Transanal endoscopic microsurgery using a platform for single-incision laparoscopic surgery (SILSTEM) is safe for excising rectal lesions. We tested three types of platforms. METHODOLOGY Nine patients underwent SILSTEM by one surgeon. Tumors located 5–15 cm from the anal verge were eligible. After measuring their dimensions, length, and trocar channels, the platforms tested were the SILSTM port (SP), EZTM access (EA), and GelPOINTTM Path (GP). Clinicopathology, intraoperative parameters, and postoperative outcomes were recorded. RESULTS Six men and three women (median age 63 years) underwent SILSTEM using platform SP in three patients, EA in four, GP in two. Median operation time was 128 min (range 71–313). Median blood loss was 3 ml (range 1–71). Pathology confirmed adenocarcinoma in five patients, adenoma in three, and carcinoid in one. Patients were discharged within 2–13 days postoperatively. There was no postoperative fecal incontinence or soiling. Overall median follow-up was 13.3 months (range 1.3–27.2). There were no recurrences. CONCLUSION SILSTEM can effectively resect rectal tumors using any of three platforms. Large prospective trials are needed to define the advantages, disadvantages, and indications for each platform and to draw conclusions regarding operation time, anorectal function, and costs.
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Ahn W, Dargar S, Halic T, Lee J, Li B, Pan J, Sankaranarayanan G, Roberts K, De S. Development of a Virtual Reality Simulator for Natural Orifice Translumenal Endoscopic Surgery (NOTES) Cholecystectomy Procedure. Stud Health Technol Inform 2014; 196:1-5. [PMID: 24732469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The first virtual-reality-based simulator for Natural Orifice Translumenal Endoscopic Surgery (NOTES) is developed called the Virtual Translumenal Endoscopic Surgery Trainer (VTESTTM). VTESTTM aims to simulate hybrid NOTES cholecystectomy procedure using a rigid scope inserted through the vaginal port. The hardware interface is designed for accurate motion tracking of the scope and laparoscopic instruments to reproduce the unique hand-eye coordination. The haptic-enabled multimodal interactive simulation includes exposing the Calot's triangle and detaching the gall bladder while performing electrosurgery. The developed VTESTTM was demonstrated and validated at NOSCAR 2013.
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Affiliation(s)
- Woojin Ahn
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute
| | - Saurabh Dargar
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute
| | - Tansel Halic
- Computer Science Department, University of Central Arkansas
| | - Jason Lee
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute
| | - Baichun Li
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute
| | - Junjun Pan
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute
| | - Ganesh Sankaranarayanan
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute
| | - Kurt Roberts
- Gastrointestinal Surgery, Yale School of Medicine, Yale University
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute
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Dargar S, Lam B, Horodyski C, Sankaranarayanan G, De S. A Decoupled 2 DOF Force Feedback Mechanism for the Virtual Translumenal Endoscopic Surgical Trainer (VTEST. Stud Health Technol Inform 2014; 196:86-88. [PMID: 24732486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Natural orifice translumenal endoscopic surgery (NOTES) is a minimally invasive procedure which utilizes the body's natural orifices to gain access to the peritoneal cavity. The VTEST is a virtual reality NOTES cholecystectomy simulator being built at the CeMSIM at RPI. We have developed a 2 DOF decoupled haptic device, which can provide translational and rotational haptic feedback to the user handling the flexible endoscope. Preliminary results indicate the device is capable of providing realistic feedback to the user while operating the device.
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Affiliation(s)
- Saurabh Dargar
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, New York
| | - Benjamin Lam
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, New York
| | - Crystal Horodyski
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, New York
| | - Ganesh Sankaranarayanan
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, New York
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, Troy, New York
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Gorgun IE, Aytac E, Costedio MM, Erem HH, Valente MA, Stocchi L. Transanal endoscopic surgery using a single access port: a practical tool in the surgeon's toybox. Surg Endosc 2013; 28:1034-8. [PMID: 24178864 DOI: 10.1007/s00464-013-3267-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 10/06/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Large polyps and early carcinomas of the rectum may be excised with transanal endoscopic surgery (TES). Single-port techniques are emerging in the field of colorectal surgery and have been adapted to many colorectal procedures so far. In this article, we aimed to present our initial experience with TES using a single access port with its technical details. PATIENTS AND METHODS Patients undergoing TES using a single access port between July 2010 and January 2013 were included in the study. Patient demographics, operative technique, and both operative and postoperative outcomes were evaluated and presented. RESULTS A total of 12 patients (ten males) were included in our study. The median age was 63.5 years (50-84), median American Society of Anesthesiologists (ASA) score was 3 (2-4), and median body mass index was 28.8 kg/m(2) (17.4-55.6). Median operating time was 79 min (43-261). Histopathological diagnoses were as follows: tubulovillous adenoma (n = 6), tubular adenoma (n = 4), adenocarcinoma (n = 1), and neuroendocrine tumor (n = 1). Five patients were sent home on the day of surgery and the median postoperative hospital stay was 1 day (0-38). Median estimated blood loss was 22.5 ml (5-150). A transient urinary retention was developed in one patient postoperatively, and two patients had postoperative bleeding. The first of these patients with a long history of anticoagulant usage had rectal bleeding 13 days after surgery, which was successfully managed with medical treatment. The second patient was morbidly obese, had multiple comorbidities, and had rectal bleeding on postoperative day 7 which was managed with local epinephrine injection. He suffered unrelated cardiac death on postoperative day 38. CONCLUSIONS TES is safe and feasible when using a single port and in the standard laparoscopic setting. The single-port technique may play a major role in the widespread utilization of TES as a treatment for large adenomas and early rectal cancers.
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Jiang SJ, Shi H, Swar G, Wang HX, Liu XJ, Wang YG. Trans-umbilical endoscopic cholecystectomy with a water-jet hybrid-knife: A pilot animal study. World J Gastroenterol 2013; 19:6857-6862. [PMID: 24187461 PMCID: PMC3812485 DOI: 10.3748/wjg.v19.i40.6857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/27/2013] [Accepted: 09/04/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the feasibility and safety of Natural orifice trans-umbilical endoscopic cholecystectomy with a water-jet hybrid-knife in a non-survival porcine model.
METHODS: Pure natural orifice transluminal endoscopic surgery (NOTES) cholecystectomy was performed on three non-survival pigs, by transumbilical approach, using a water-jet hybrid-knife. Under general anesthesia, the following steps detailed the procedure: (1) incision of the umbilicus followed by the passage of a double-channel flexible endsocope through an overtube into the peritoneal cavity; (2) establishment of pneumoperitoneum; (3) abdominal exploration; (4) endoscopic cholecystectomy: dissection of the gallbladder performed using water jet equipment, ligation of the cystic artery and duct conducted using nylon loops; and (5) necropsy with macroscopic evaluation.
RESULTS: Transumbilical endoscopic cholecystectomy was successfully completed in the first and third pig, with minor bleedings. The dissection times were 137 and 42 min, respectively. The total operation times were 167 and 69 min, respectively. And the lengths of resected specimen were 6.5 and 6.1 cm, respectively. Instillation of the fluid into the gallbladder bed produced edematous, distended tissue making separation safe and easy. Reliable ligation using double nylon loops insured the safety of cutting between the loops. There were no intraoperative complications or hemodynamic instability. Uncontrolled introperative bleeding occurred in the second case, leading to the operation failure.
CONCLUSION: Pure NOTES trans-umbilical cholecystectomy with a water-jet hybrid-knife appears to be feasible and safe. Further investigation of this technique with long-term follow-up in animals is needed to confirm the preliminary observation.
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Brooks RJ, Piper H, Looi T, Drake J. NOTES suction grasper for tubular viscera--characterization of gripping force when varying hole size, diameter, and number. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:4726-9. [PMID: 24110790 DOI: 10.1109/embc.2013.6610603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This paper details the design and characterization of a novel suction grasper for Natural Orifice Transesophageal Surgery (NOTES). Axial gripping force was optimized by changing hole size, number, and spacing. A 10 kg pig and a rabbit esophagus were used to simulate a neonatal esophagus. Maximum axial forces of up to 7.2 N were achieved. Hole pattern spacing had little to no impact on force while suction area was very significant. Additionally, there was a preference for a greater number of holes versus larger holes for relatively large hole sizes. Lastly, smaller holes resulted in smoother loss of gripping force when beyond maximum holding force was applied.
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Abstract
Due to the fast spread of laparoscopic cholecystectomy, surgical procedures have been changed essentially. The new techniques applied for both abdominal and thoracic procedures provided the possibility for minimally invasive access with all its advantages. Robots - originally developed for industrial applications - were retrofitted for laparoscopic procedures. The currently prevailing robot-assisted surgery is ergonomically more advantageous for the surgeon, as well as for the patient through the more precise preparative activity thanks to the regained 3D vision. The gradual decrease of costs of robotic surgical systems and development of new generations of minimally invasive devices may lead to substantial changes in routine surgical procedures.
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Affiliation(s)
- József Sándor
- Semmelweis Egyetem Kísérletes és Sebészeti Műtéttani Intézet 1089 Budapest Nagyvárad tér 4
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Nishimura A, Kawahara M, Honda K, Ootani T, Kakuta T, Kitami C, Makino S, Kawachi Y, Nikkuni K. Totally laparoscopic anterior resection with transvaginal assistance and transvaginal specimen extraction: a technique for natural orifice surgery combined with reduced-port surgery. Surg Endosc 2013; 27:4734-40. [PMID: 23949481 PMCID: PMC3830205 DOI: 10.1007/s00464-013-3120-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 07/17/2013] [Indexed: 12/13/2022]
Abstract
Background Natural orifice specimen extraction (NOSE) has been developed as a means of decreasing the incidence of surgical wound complications. However, NOSE performed using a conventional multiport technique has been reported previously. The current authors performed totally laparoscopic anterior resection with transvaginal specimen extraction (TVSE) using the reduced-port surgery (RPS) technique. The Alexis wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA) and Free Access (Top Corporation, Tokyo, Japan) were attached to the transvaginal route for transvaginal assistance and smooth specimen extraction. The authors documented this simple and safe technique and its short-term results. Methods Data were prospectively collected for five patients who underwent totally laparoscopic anterior resection with TVSE for colorectal cancer between June 2012 and December 2012. A multiport access device (GelPOINT advanced-access platform; Applied Medical) was inserted into the navel, and a 5-mm port was inserted into the right lower quadrant to be used as a drain site. Transverse transvaginal posterior colpotomy then was performed. One ring of an Alexis ring pair was inserted into the peritoneal cavity through the vagina. The other white ring was placed outside of the vagina and then covered with a Free Access to maintain the pneumoperitoneum for insertion of a 12-mm port. Lymph node dissection and transection of the distal colon were performed with transvaginal assistance. The specimen then was extracted transvaginally. After the Alexis had been removed, the vaginal incision was closed transvaginally. End-to-end colorectal anastomosis was performed using the double-stapling technique. Results Transvaginal extraction was completed in all five cases. The median operation time was 235 min. One case was complicated by chyloperitoneum. The median hospital stay was 6 days. Only one patient required intravenous analgesics once on postoperative day 1. All the patients remained disease free. Conclusion Totally laparoscopic anterior resection using TVSE with RPS appears to be feasible, safe, and oncologically acceptable for selected cases.
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Affiliation(s)
- Atsushi Nishimura
- Department of Surgery, Institute of Gastroenterology, Nagaoka Chuo General Hospital, 2041 Kawasaki-cho, Nagaoka, Niigata, 940-8653, Japan,
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Song TJ, Seo DW, Kim SH, Park DH, Lee SS, Lee SK, Kim MH. Endoscopic gastrojejunostomy with a natural orifice transluminal endoscopic surgery technique. World J Gastroenterol 2013; 19:3447-3452. [PMID: 23801837 PMCID: PMC3683683 DOI: 10.3748/wjg.v19.i22.3447] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 03/27/2013] [Accepted: 04/19/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the technical feasibility and safety of an endoscopic gastrojejunostomy with a pure natural orifice transluminal endoscopic surgery (NOTES) technique using a T-anchoring device in a porcine survival model.
METHODS: An endoscopic gastrojejunostomy with a pure NOTES technique using a T-anchoring device was performed on 10 healthy female minipigs weighing approximately 40 kg each under general anesthesia. All procedures were performed with a transgastric approach using a 2-channel therapeutic endoscope.
RESULTS: The transgastric gastrojejunostomy was technically successful in all cases. A total of four to six stitched pairs of a T-anchoring device were used to secure the anastomosis. The median time required to enter the peritoneal cavity and pull the small bowel into the stomach was 34 min (range: 19-41 min); the median time required to suture the anastomosis was 67 min (range: 44-78 min). An obstruction of the efferent limb occurred in one case, and a rupture of the anastomosis site occurred in another case. As a result, the functional success rate was 80% (8/10). Small bowel adhesion to the stomach and liver occurred in one case, but the anastomosis was intact without leakage or obstruction.
CONCLUSION: A transgastric gastrojejunostomy with a T-anchoring device may be safe and technically feasible. A T-anchoring device may provide a simple and effective endoscopic suturing method.
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Nishiyama N, Mori H, Kobara H, Rafiq K, Fujihara S, Kobayashi M, Oryu M, Masaki T. Efficacy and safety of over-the-scope clip: Including complications after endoscopic submucosal dissection. World J Gastroenterol 2013; 19:2752-2760. [PMID: 23687412 PMCID: PMC3653149 DOI: 10.3748/wjg.v19.i18.2752] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 01/18/2013] [Accepted: 03/07/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To retrospectively review the results of over-the-scope clip (OTSC) use in our hospital and to examine the feasibility of using the OTSC to treat perforations after endoscopic submucosal dissection (ESD).
METHODS: We enrolled 23 patients who presented with gastrointestinal (GI) bleeding, fistulae and perforations and were treated with OTSCs (Ovesco Endoscopy GmbH, Tuebingen, Germany) between November 2011 and September 2012. Maximum lesion size was defined as lesion diameter. The number of OTSCs to be used per patient was not decided until the lesion was completely closed. We used a twin grasper (Ovesco Endoscopy GmbH, Tuebingen, Germany) as a grasping device for all the patients. A 9 mm OTSC was chosen for use in the esophagus and colon, and a 10 mm device was used for the stomach, duodenum and rectum. The overall success rate and complications were evaluated, with a particular emphasis on patients who had undergone ESD due to adenocarcinoma. In technical successful cases we included not only complete closing by using OTSCs, but also partial closing where complete closure with OTSCs is almost difficult. In overall clinical successful cases we included only complete closing by using only OTSCs perfectly. All the OTSCs were placed by 2 experienced endoscopists. The sites closed after ESD included not only the perforation site but also all defective ulcers sites.
RESULTS: A total of 23 patients [mean age 77 years (range 64-98 years)] underwent OTSC placement during the study period. The indications for OTSC placement were GI bleeding (n = 9), perforation (n = 10), fistula (n = 4) and the prevention of post-ESD duodenal artificial ulcer perforation (n = 1). One patient had a perforation caused by a glycerin enema, after which a fistula formed. Lesion closure using the OTSC alone was successful in 19 out of 23 patients, and overall success rate was 82.6%. A large lesion size (greater than 20 mm) and a delayed diagnosis (more than 1 wk) were the major contributing factors for the overall unsuccessful clinical cases. The location of the unsuccessful lesion was in the stomach. The median operation time in the successful cases was 18 min, and the average observation time was 67 d. During the observation period, none of the patients experienced any complications associated with OTSC placement. In addition, we successfully used the OTSC to close the perforation site after ESD in 6 patients. This was a single-center, retrospective study with a small sample size.
CONCLUSION: The OTSC is effective for treating GI bleeding, fistulae as well as perforations, and the OTSC technique proofed effective treatment for perforation after ESD.
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Wendling MR, Melvin WS, Perry KA. Impact of transoral incisionless fundoplication (TIF) on subjective and objective GERD indices: a systematic review of the published literature. Surg Endosc 2013; 27:3754-61. [PMID: 23644835 DOI: 10.1007/s00464-013-2961-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 03/29/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) remains a significant problem for the medical community. Many endoluminal treatments for GERD have been developed with little success. Currently, transoral incisionless fundoplication (TIF) attempts to recreate a surgical fundoplication through placement of full-thickness polypropylene H-fasteners. This, the most recent procedure to gain FDA approval, has shown some promise in the early data. However, questions of its safety profile, efficacy, and durability remain. METHODS The Cochrane Library and MEDLINE through PubMed were searched to identify published studies reporting on subjective and objective GERD indices after TIF. The search was limited to human studies published in English from 2006 up to March 2012. Data collected included GERD-HRQL and RSI scores, PPI discontinuation and patient satisfaction rates, pH study metrics, complications, and treatment failures. Statistical analysis was performed with weighted t tests. RESULTS Titles and abstracts of 214 papers were initially reviewed. Fifteen studies were found to be eligible, reporting on over 550 procedures. Both GERD-HRQL scores (21.9 vs. 5.9, p < 0.0001) and RSI scores (24.5 vs. 5.4, p ≤ 0.0001) were significantly reduced after TIF. Overall patient satisfaction was 72 %. The overall rate of PPI discontinuation was 67 % across all studies, with a mean follow-up of 8.3 months. pH metrics were not consistently normalized. The major complication rate was 3.2 % and the failure rate was 7.2 % across all studies. CONCLUSION TIF appears to provide symptomatic relief with reasonable levels of patient satisfaction at short-term follow-up. A well-designed prospective clinical trial is needed to assess the effectiveness and durability of TIF as well as to identify the patient population that will benefit from this procedure.
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Affiliation(s)
- Mark R Wendling
- Department of Surgery, The Ohio State University, 548 Doan Hall, 410 W. 10th Avenue, Columbus, OH, 43210, USA,
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Jeong CW, Lee S, Oh JJ, Lee SB, Jeong SJ, Hong SK, Byun SS, Kim HH, Lee SE. Pure transvesical NOTES appendectomy using a 5-mm rigid laparoscope: a feasibility and survival study with porcine models. Surg Endosc 2013; 27:2992-9. [PMID: 23389077 DOI: 10.1007/s00464-013-2825-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 12/21/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previously, the authors demonstrated the feasibility of a pure transvesical natural orifice translumenal endoscopic surgery (NOTES) for uterine horn resection (UHR) using a rigid ureteroscope in swine as an appendectomy model. However, visualization was poor, and there was room for improvement. The authors have assessed the feasibility and safety of a revised technique that uses a 5-mm rigid laparoscope. METHODS Eight operations on four female pigs (35-40 kg) were performed as a proof of concept study. Four right-side operations were performed in a survival model. The surgical procedure was similar to the original technique. However, the rigid ureteroscope was replaced by a 5-mm laparoscope after modification of the access system. In addition, the clipped metal threads used for bladder closure were easily placed with a long 13-gauge needle. In the survival model, a Foley catheter was placed for 1 day. RESULTS The new technique provided considerably better visualization and operability than the original technique. The mean total operative time was 96.6 ± 18.2 min, and the mean estimated blood loss was 15.0 ± 13.5 ml. On postoperative day 3, pig 2 in the survival study died of peritonitis resulting from a small bowel injury. The lab results for the other pigs demonstrated no adverse events and tolerable immune responses. Necropsy showed complete healing of the vesicotomy. CONCLUSIONS The revised transvesical NOTES UHR technique improved the outcomes and feasibility of the original technique. This approach may be translatable to human appendectomy procedures in the future.
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Affiliation(s)
- Chang Wook Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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García-Mediero JM, Cabrera PM, Cáceres F, Mateo E, García-Tello A, Angulo JC. [Current state of single-port transumbilical surgery in urology: challenges and applications]. Actas Urol Esp 2013; 37:106-13. [PMID: 22999345 DOI: 10.1016/j.acuro.2012.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 07/20/2012] [Indexed: 02/07/2023]
Abstract
CONTEXT Laparoscopic surgery in urology is considered to be an important advance, although it is not exempt from some morbidity associated to the use of multiple trocars and specifically to the extraction of the specimen. In order to decrease this morbidity and improve esthetics, other techniques are being developed, such as natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). It is aimed to review the current status of laparoendoscopic single site surgery in urology. ACQUISITION OF EVIDENCE A nonsystematic review has been carried out by means of the bibliographic search using the terms LESS and Urology from 2007 to 2012. The current LESS experience in urology is described, and its principal indications and the different single site devices and instruments available on the market are described. SYNTHESIS OF EVIDENCE LESS surgery arose as one more step in the constant evolution of minimally invasive surgery in an attempt to improve esthetics, reduce surgical trauma and decrease pain and the post-operative complications associated to the conventional laparoscopy with multiple trocars. Since it was first described in 2007, the experience has been increasing exponentially and the LESS technique, whether assisted or not by robot, is becoming consolidated for a large spectrum of urological indications (both in oncological and reconstructive surgery) on a much greater scale than the NOTES technique. Even though most of the existing data are not randomized and very rarely comparative, with the selection bias that this represents, it seems clear that the esthetic benefit and analgesic control associated to the LESS surgery is real and reproducible. The complications associated to it are greater in cases of major oncology surgery and are due more to the technique itself then to the approach. CONCLUSIONS Although the real benefit of the LESS surgery in urology cannot be appropriately quantified, the cosmetic improvement, less pain and greater patient satisfaction with their wound are clear. Appropriate training in this type of procedures in centers having large volumes and the continuous technical improvements in the instrumental development by the biomedical industry has resulted in the fact that the transumbilical LESS technique in urology has been born to stay.
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Affiliation(s)
- J M García-Mediero
- Hospital Universitario de Getafe, Fundación para la Investigación Biomédica, Servicio Madrileño de Salud, Universidad Europea de Madrid, Madrid, España
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