1
|
Aziret M, Çetinkünar S, Erdem H, Kahramanca Ş, Bozkurt H, Dülgeroğlu O, Yıldırım AC, İrkörücü O, Gölboyu EB. Comparison of open appendectomy and laparoscopic appendectomy with laparoscopic intracorporeal knotting and glove endobag techniques: A prospective observational study. Turk J Surg 2017; 33:258-266. [PMID: 29260130 DOI: 10.5152/turkjsurg.2017.3583] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 09/26/2016] [Indexed: 01/07/2023]
Abstract
Objective Despite the recent increase in the use of laparoscopic appendectomy procedures to treat acute appendicitis, laparoscopic appendectomy is not necessarily the best treatment modality. The aim of this study is to examine the value of laparoscopic intracorporeal knotting and glove endobag in terms of various parameters and in terms of reducing the costs related to laparoscopic appendectomy procedures. Material and Methods Seventy-two acute appendicitis patients who underwent laparoscopic appendectomy and open appendectomy surgery were enrolled in the study and were evaluated prospectively. The patients were divided into two groups: group 1 was treated with laparoscopic appendectomy using laparoscopic intracorpreal knotting and glove endobag (n=36) and group 2 was treated with open appendectomy (n=36). The two groups were statistically compared in terms of preoperative symptoms and signs, laboratory and imaging findings, operation time and technique, pain score, gas and stool outputs, duration of hospital stay, return to normal activity, and complications. Results No statistically significant differences were found between the groups in relation to gender, age, body mass index, or pre-operation findings, which included loss of appetite, vomiting, time when pain started, displacement of pain, defense, rebound, imaging methods, and laboratory and pathology examinations (p>0.05). Moreover, there were no differences between the groups with respect to drain usage, hospital stay time, or complications (p>0.05). In contrast, a statistically significant difference was found between the groups in terms of operation time, pain scores, gas-stool outputs, and return to normal activity in the laparoscopic appendectomy group (p=0.001). Conclusion Laparoscopic appendectomy can be performed in a facile, safe, and cost-effective manner with laparoscopic intracorporeal knotting and glove endobag. By using these techniques, the use of expensive instruments can be avoided when performing laparoscopic appendectomy.
Collapse
Affiliation(s)
- Mehmet Aziret
- Department of General Surgery, Sakarya Univesity School of Medicine, Sakarya, Turkey
| | - Süleyman Çetinkünar
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Hasan Erdem
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Şahin Kahramanca
- Department of General Surgery, Kars State Hospital, Kars, Turkey
| | - Hilmi Bozkurt
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Onur Dülgeroğlu
- Department of General Surgery, Kars State Hospital, Kars, Turkey
| | | | - Oktay İrkörücü
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Emre Birzad Gölboyu
- Department of Anesthesiology and Reanimation, Kars State Hospital, Kars, Turkey
| |
Collapse
|
2
|
Cuendis-Velázquez A, E. Trejo-Ávila M, Rosales-Castañeda E, Cárdenas-Lailson E, E. Rojano-Rodríguez M, Romero-Loera S, A. Sanjuan-Martínez C, Moreno-Portillo M. Colédoco-duodeno anastomosis laparoscópica. Cir Esp 2017; 95:397-402. [DOI: 10.1016/j.ciresp.2017.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/22/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
|
3
|
Xu AA, Zhu JF, Su Y. Towards a better knot: Using mechanics methods to evaluate three knot-tying techniques in laparo-endoscopic single-site surgery. J Minim Access Surg 2015; 11:241-5. [PMID: 26622113 PMCID: PMC4640022 DOI: 10.4103/0972-9941.147366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION: Knot tying is difficult but important for laparo-endoscopic single-site surgery (LESS). There are several techniques for LESS knot-tying. However, objective assessment of these skills has not yet been established. The aim of this study was to assess three different knot-tying techniques in LESS using mechanical methods. MATERIALS AND METHODS: The subject tied 24 knots, eight knots with each of the three techniques in an inanimate box laparoscopic trainer while the movements of their instruments were evaluated using a LESS mechanical evaluation platform. The operations were assessed on the basis of the time, average load of the dominant hand. Then, forces caused the knots to rupture were measured using a material testing system and used to compare the knots's strength. RESULTS: The intracorporeal one-hand knot-tying technique presented significantly better time and average load scores than the extracorporeal knot-tying technique (P < 0.01), and the intracorporeal side winding technique was more time and average load consuming in comparison to other techniques during the performance of knot-tying (P < 0.01). The intracorporeal one-handed knot-tying knots can tolerate better distraction forces compared with the intracorporeal side winding knot-tying knots and the extracorporeal knot-tying knots (P < 0.05). CONCLUSIONS: The intracorporeal one-hand knot-tying technique and knots showed better results than the intracorporeal “side winding” technique and the extracorporeal knot-tying technique in terms of the time, average load taken and the force caused the knot to rupture.
Collapse
Affiliation(s)
- An An Xu
- Department of Minimally Invasive Surgery, East Hospital, Tongji University, School of Medicine, Shanghai 200120, China
| | - Jiang Fan Zhu
- Department of Minimally Invasive Surgery, East Hospital, Tongji University, School of Medicine, Shanghai 200120, China
| | - Yuantao Su
- Department of Minimally Invasive Surgery, East Hospital, Tongji University, School of Medicine, Shanghai 200120, China
| |
Collapse
|
4
|
Ay N, Dinç B, Alp V, Kaya Ş, Sevük U. Comparison of outcomes of laparoscopic intracorporeal knotting technique in patients with complicated and noncomplicated acute appendicitis. Ther Clin Risk Manag 2015; 11:1213-6. [PMID: 26316765 PMCID: PMC4542476 DOI: 10.2147/tcrm.s88479] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and aim In our study we aimed to compare laparoscopic intracorporeal knotting technique (base of the appendix was ligated with 20 cm of 2.0 silk) in patients with complicated acute appendicitis (CAA) and noncomplicated acute appendicitis. Patients and methods Ninety patients (female/male: 40/50, age ranging from 16 to 60 years, median age and interquartile range [IQR]: 25 [20; 32] years) who underwent laparoscopic appendectomy were included in the study. The patients were evaluated for the type of acute appendicitis, duration of operation, duration of hospital stay, and postoperative complications. Results The number of cases diagnosed as CAA was 28 (31.1%), and the number of noncomplicated cases was 62 (68.9%). We found that there was no significant difference in postoperative complication rates between complicated and noncomplicated appendicitis cases. Incision site infection was seen in seven cases (7.8%) and ileus was seen in two cases (2.2%). Bleeding, intra-abdominal abscess, and appendix stump leakage were not observed in any of the cases. Median and IQR duration of operation were 42 (35; 52) minutes and median and IQR duration of hospital stay were detected as 2 (1; 2) (range 1–10) days. Conclusion Laparoscopic intracorporeal knotting technique may be a safe, effective, and reliable technique as the materials needed for closing the appendix stumps are easily available for both CAA cases and noncomplicated cases.
Collapse
Affiliation(s)
- Nurettin Ay
- Department of General Surgery, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Bulent Dinç
- Department of General Surgery, Ataturk State Hospital, Antalya, Turkey
| | - Vahhac Alp
- Department of General Surgery, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Şafak Kaya
- Department of Infectious Disease, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Utkan Sevük
- Department of Cardiovascular Surgery, Diyarbakır Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| |
Collapse
|
5
|
YS knot: A new technique for a tension-controlled slip knot using a trocar. Obstet Gynecol Sci 2015; 58:171-4. [PMID: 25798432 PMCID: PMC4366871 DOI: 10.5468/ogs.2015.58.2.171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/08/2014] [Accepted: 11/03/2014] [Indexed: 11/25/2022] Open
Abstract
The Yoon Soon (YS) knot is a laparoscopic extracorporeal slip knot that is easy to learn and apply. Our new technique, which uses the trocar as a knot pusher, is simpler, faster, and has more tension than conventional knot methods. The YS knot will help surgeons save operative time and perform tension-controlled knot-tying during laparoscopic surgery.
Collapse
|
6
|
Crisanto-Campos BA, Rojano-Rodríguez ME, Cárdenas-Lailson LE, Gallardo-Ramírez MA, Arrieta-Joffe P, Márquez-Ugalde MA, Moreno-Portillo M. [Laparoscopic drainage of a pancreatic pseudocyst: a case report]. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2012; 77:148-52. [PMID: 22951042 DOI: 10.1016/j.rgmx.2012.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 03/25/2012] [Accepted: 04/30/2012] [Indexed: 11/24/2022]
Abstract
Pancreatic pseudocysts are defined as homogeneous pancreatic or peripancreatic collections that are not associated with necrotic tissue and are surrounded by granulated or fibrous tissue with no epithelium. Management has been classified as surgical (conventional and laparoscopic) and nonsurgical (endoscopic and radiologic). The aim of this report is to describe our initial experience in the management of a pancreatic pseudocyst by means of laparoscopic posterior cyst-gastrostomy anastomosis, performed at the Pancreas Clinic of the Hospital General "Dr. Manuel Gea González" in Mexico City. New techniques and instrumentation have contributed to the relatively recent development of laparoscopic pancreatic surgery. Our technique has practical advantages that have been confirmed by other authors, such as simple hemostasis, a wide viewing angle enabling adequate necrosectomy, anastomosis that does not require the use of staples, and the possibility of resolving other associated intra-abdominal pathologies, as in this case.
Collapse
Affiliation(s)
- B A Crisanto-Campos
- Clínica de Páncreas, Departamento de Cirugía General, Departamento de Cirugía Endoscópica y Endoscopia Gastrointestinal, Hospital General Dr Manuel Gea González, México DF, México.
| | | | | | | | | | | | | |
Collapse
|
7
|
Novel surgical concept in antireflux surgery: long-term outcomes comparing 3 different laparoscopic approaches. Surgery 2011; 151:84-93. [PMID: 21943634 DOI: 10.1016/j.surg.2011.06.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 06/15/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND The Nissen fundoplication procedure is the most widely used type of antireflux surgery. The results are not always as good as expected, and several modifications to the original technique have been proposed. Long-term effectiveness studies comparing different techniques of antireflux surgery are limited. Our group developed a new concept in antireflux surgery (complete fixed "nondeformable" fundoplication) in order to improve its outcome; we present the long-term comparative results of this novel concept/technique. METHODS Overall, 512 patients were included in the study and assigned into 1 of 3 fundoplications groups: partial (131), Nissen (133), and fixed "nondeformable" (121). We compared the groups with each other and with a group who chose to receive medical treatment (MT) (127). All patients underwent clinical evaluation, upper gastrointestinal endoscopy, esophageal manometry, 24-hour esophageal pH monitoring, and the SF-36 health status survey prior to operation and at 1, 5, 10, and 15 years of follow-up. RESULTS At the 15-year follow-up, we were able to complete the protocol in 319 patients: 103 patients from the partial group, 102 patients from the Nissen group, 97 patients from the fixed "nondeformable" group, and 17 patients from the medical treatment group. A lower prevalence of erosive gastroesophageal reflux disease (GERD) was observed in the fixed "nondeformable" group (7.20%) versus 21.56% for Nissen, 39.80% for partial, and 47.05% for MT (P < .01). Lower esophageal sphincter (LES) pressure and LES length were more constant in the fixed "nondeformable" group (14.7 mm Hg/2.2 cm) compared with the Nissen (9 mm Hg/0.7 cm), partial (7 mm Hg/2 cm), and MT (5.64 mm Hg/1.3 cm) groups (P < .01). Reflux recurrence was observed in 168 patients (13 in fixed "nondeformable," 41 in Nissen, and 98 in partial (P < .01). CONCLUSION The complete fixed "nondeformable" fundoplication showed best results in studied parameters and had a lower long-term recurrence compared with Nissen and partial techniques.
Collapse
|
8
|
Bhattacharjee HK, Buess GF, Becerra Garcia FC, Storz P, Sharma M, Susanu S, Kirschniak A, Misra MC. A novel single-port technique for transanal rectosigmoid resection and colorectal anastomosis on an ex vivo experimental model. Surg Endosc 2010; 25:1844-57. [PMID: 21136108 DOI: 10.1007/s00464-010-1476-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 10/22/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND In the context of natural orifice translumenal endoscopic surgery (NOTES), we developed a new set of rigid instruments according to the principles of transanal endoscopic microsurgery (TEM).These instruments are long, curved, and steerable by rotating two wheels near its handle. Our success in transvaginal cholecystectomy in human with these instruments motivated us to explore the feasibility of rectosigmoid resection through the anus. METHODS The young bovine large bowel with attached organs is collected en bloc and reintegrated into an anatomically designed trainer to reproduce the human anatomy. The technique comprises the following: (1) closure of the rectal lumen by an endolumenal pursestring suture; (2) transection of the rectal wall 1 cm distal to the pursestring suture and continuation of the dissection toward the fascia and upward excising the mesorectal tissue; (3) inferior mesenteric artery is divided near its origin; (4) the colon is mobilized up to the splenic flexure; (5) the mobilized colon is brought down to the pelvis, ligated twice at the intended proximal resection site, and divided between the ligatures; (6) specimen is delivered transanally; and (7) intestinal continuity is restored by stapled or hand-sutured anastomosis. RESULTS Twelve rectosigmoid resections, 20 stapled, and 27 hand-sutured anastomoses were performed in two experimental setups. Mean operation time for the resection part was 78.6 min (standard deviation (SD)=9.9). The average specimen length was 37.2 cm. During dissection in the pelvis, as the specimen was pushed upward and toward abdomen, an "empty pelvis" view of the working field was achieved, facilitating dissection. The mean operation time for hand-sutured and stapled anastomoses were 47.7 (SD=6.9) and 43.3 (SD=7.1) min, respectively. Both groups had one anastomotic leak. CONCLUSIONS Transanal rectosigmoid resection is feasible with TEM technology. The unobstructed "empty pelvis" view is likely to enhance the quality of mesorectal dissection.
Collapse
Affiliation(s)
- Hemanga K Bhattacharjee
- Section of Minimally Invasive Surgery, University Hospital Tuebingen, Waldhoernlestrasse 22, 72072, Tuebingen, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Brown JV, Tinnerman-Minailo EJ, Rettenmaier MA, Micha JP, Goldstein BH. The Minailo knot: a time-saving and cost-saving technique. J Robot Surg 2010; 3:219-21. [PMID: 27628633 DOI: 10.1007/s11701-009-0168-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Accepted: 12/11/2009] [Indexed: 11/24/2022]
Abstract
Endoscopic knot tying during minimally invasive surgery can be complicated, time consuming, and associated with a protracted learning curve. The Minailo knot seems to be a reasonable option because the technique does not require any specialized instrumentation or skill to perform. In particular, vaginal closure is obtained with the placement of a single intra-corporeal knot. Our initial and successful experience with this knot-tying technique during robotic hysterectomy for treatment of gynecologic disease suggests that the method is safe and feasible.
Collapse
Affiliation(s)
- John V Brown
- Gynecologic Oncology Associates, 351 Hospital Road, Suite 507, Newport Beach, CA, 92663, USA
| | | | - Mark A Rettenmaier
- Gynecologic Oncology Associates, 351 Hospital Road, Suite 507, Newport Beach, CA, 92663, USA
| | - John P Micha
- Gynecologic Oncology Associates, 351 Hospital Road, Suite 507, Newport Beach, CA, 92663, USA
| | - Bram H Goldstein
- Gynecologic Oncology Associates, 351 Hospital Road, Suite 507, Newport Beach, CA, 92663, USA.
| |
Collapse
|
10
|
Deng M, Chen G, Burkley D, Zhou J, Jamiolkowski D, Xu Y, Vetrecin R. A study on in vitro degradation behavior of a poly(glycolide-co-L-lactide) monofilament. Acta Biomater 2008; 4:1382-91. [PMID: 18442954 DOI: 10.1016/j.actbio.2008.03.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2007] [Revised: 02/07/2008] [Accepted: 03/20/2008] [Indexed: 11/29/2022]
Abstract
The in vitro degradation behaviors of a poly(glycolide-co-l-lactide) 90/10 monofilament were investigated in phosphate buffer solution at pH 7.4 over a temperature range of 27.5-47.5 degrees C. The property changes of the monofilament with time at different temperatures were evaluated by tensile mechanical test, gel permeation chromatography analysis, and image techniques (optical microscopy, scanning electron microscopy and atomic force microscopy). The interrelationships among material properties, in vitro time and experimental conditions were explored. The results showed that the polymer monofilament gradually lost its tensile strength and molecular weight with increasing in vitro time. The hydrolytic degradation of the monofilaments followed a first order behavior. Higher temperatures accelerated the degradation process significantly. It was found that for a given tensile breaking strength retention (BSR), the dependence of degradation time on temperature could be illustrated by an Arrhenius-type equation, from which the activation energy was derived. Further analysis indicated that there are well-defined relationships between molecular weight and tensile strength, which could be illustrated mathematically. Finally, the microscopic evaluation of the monofilament samples revealed visible changes in morphology on the surface and cross-section area during degradation process. The results from atomic force microscopy showed that the surface roughness of the monofilament tended to increase with the in vitro time.
Collapse
Affiliation(s)
- Meng Deng
- R&D Division, ETHICON, Inc., Johnson & Johnson Company, P.O. Box 151, Somerville, NJ 08876, USA.
| | | | | | | | | | | | | |
Collapse
|
11
|
On the origin and evolution of the Roeder knot and loop--a geometrical review. Surg Laparosc Endosc Percutan Tech 2008; 18:1-7. [PMID: 18287974 DOI: 10.1097/sle.0b013e3181572b00] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The first laparoscopic sliding knot to be described was the Roeder knot; it has been used for a variety of procedures in all surgical disciplines. It was surmised that the introduction of new modifications in the geometry of the knot paralleled the introduction of its new indications, and that not all modifications improved its security. Therefore, a geometrical review was made of all modifications and all data on knot security and loop security of the knot were analyzed. The introduction of the original knot and its 14 applicable modifications paralleled the increase in minimally invasive techniques and the spread of these techniques in all the medical specialties. Roeder loop security depends predominantly on the number of initial turns around the standing part. Its knot security depends on the additional half hitches used to backup the knot after it has been tightened. Only a few of the modifications improved the security of the knot or its previous modifications.
Collapse
|
12
|
Arcovedo R, Barrera H, Reyes HS. Securing the appendiceal stump with the Gea extracorporeal sliding knot during laparoscopic appendectomy is safe and economical. Surg Endosc 2007; 21:1764-7. [PMID: 17353987 DOI: 10.1007/s00464-007-9239-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2006] [Accepted: 01/22/2007] [Indexed: 12/22/2022]
Abstract
BACKGROUND Laparoscopic appendectomy (LA) has become very popular. One criticism of this approach is the high cost of the disposable equipment such as the linear stapler. An alternative would be suture ligation of the appendiceal base. To prove the safety of the Gea extracorporeal sliding knot (GESK) for closure of the stump after LA, a retrospective study was conducted. METHODS For this study, 63 LA procedures performed by one surgeon using the Gea knot (group A) were reviewed and compared with 63 LA procedures performed by two other surgeons (group B) using the linear stapler. The GESK is created with 0-prolene in the manner already described. The main variable was the presence or absence of blowout, leak, or fistula from the appendiceal stump. The secondary variables were abdominal abscess, wound infection, and need for readmission or reoperation. The results were analyzed using the appropriate statistical methods. RESULTS Both groups were similar in terms of age, gender, and pathologic diagnosis. No patient in group A or B experienced a colonic fistula, stump blowout, or leak. In group A, one patient experienced interloop abscesses. There were two wound infections. In group B, one patient experienced a wound infection, and another patient had a wound dehiscence of the umbilical port, which required reoperation. No statistical differences were noted between the two groups. CONCLUSIONS There are surgeons who routinely use sutures to secure the stump of the appendectomy. This study aimed to demonstrate that the GESK is as secure as the stapler for closure of the appendiceal stump. The GESK could be passed through a 5-mm trocar, potentially avoiding complications of a larger trocar site. The GESK seems to be an economic and safe alternative to the stapler.
Collapse
Affiliation(s)
- R Arcovedo
- Department of General Surgery, Coast Surgical Group, 855 Third Avenue, Suite 3340, Chula Vista, CA, 91911, USA.
| | | | | |
Collapse
|
13
|
Yang Q, Shen X, Tan Z. Investigations of the preparation technology for polyglycolic acid fiber with perfect mechanical performance. J Appl Polym Sci 2007. [DOI: 10.1002/app.26392] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
14
|
Pereira-Graterol F, Moreno-Portillo M. Distal Esophageal Perforation Repair During Laparoscopic Esophagomyotomy: Evaluation of Outcomes and Review of Surgical Technique. J Laparoendosc Adv Surg Tech A 2006; 16:587-92. [PMID: 17243875 DOI: 10.1089/lap.2006.16.587] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the technique employed and our experience with primary laparoscopic repair of distal esophageal perforations produced during laparoscopic esophagomyotomy, as well as to evaluate the outcomes. MATERIALS AND METHODS We analyzed six cases of patients with primary achalasia in whom distal esophageal mucosal perforations were caused during laparoscopic esophagomyotomy. A primary repair and fundoplication was performed in five cases; in the sixth patient, the perforation could not be recognized during the surgical procedure. The postoperative follow-up included clinical evaluation, upper gastrointestinal endoscopy, esophageal manometry, and ambulatory 24-h esophageal pH monitoring. RESULTS Five patients reported dysphagia relief and were highly satisfied with the final surgical outcome. In one case we observed an altered postoperative 24-h esophageal pH. Two patients developed esophageal leakage, one with a fatal outcome. CONCLUSION The primary repair of distal esophageal perforations during laparoscopic esophagomyotomy is a valid therapeutic option and does not alter the surgical purpose. However, if the perforation is not recognized early on, the prognosis can change.
Collapse
|
15
|
Chung SY, Chon CH, Ng CS, Fuchs GJ. Newly designed laparoscopic retractable dissector and suture passer. Urology 2005; 65:374-7. [PMID: 15708056 DOI: 10.1016/j.urology.2004.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Accepted: 09/07/2004] [Indexed: 11/19/2022]
Abstract
We introduce a novel laparoscopic instrument that performs as a dissector and retractable suture passer in preparation for intracorporeal knot tying. The newly designed instrument was developed at our institution to duplicate techniques of vessel ligation in open surgery.
Collapse
Affiliation(s)
- Steve Y Chung
- Endourology Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
| | | | | | | |
Collapse
|
16
|
Pereira-Graterol RA, Moreno-Portillo M. A New Technique for Tying the Gea Extracorporeal Knot for Endoscopic Surgery. J Laparoendosc Adv Surg Tech A 2004; 14:403-6. [PMID: 15684791 DOI: 10.1089/lap.2004.14.403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The development of minimally invasive surgery has promoted new knot elaboration techniques. The Gea extracorporeal knot was described in our institution for use in laparoscopic surgery and has demonstrated to be excellent for endoscopic surgical procedures. Our experience has provided some changes in the technique to facilitate the elaboration of the Gea knot. Here we present an alternative tying technique for the Gea knot and slip loop.
Collapse
Affiliation(s)
- Reddy A Pereira-Graterol
- Department of Minimally Invasive Surgery, Dr. Manuel Gea González General Hospital, México City, México.
| | | |
Collapse
|