Needlescopic surgery for large umbilical hernia in a patient with morbid obesity using intraperitoneal onlay mesh with fascial defect closure: a case report

Needlescopic Laparoscope Sleeve Gastrectomy (NLSG): a Potential Surgical Approach

BACKGROUND

Laparoscopic sleeve gastrectomy has become the most popular weight loss surgery currently, but it inevitably leaves multiple small scars in the abdomen. Although the appearance of single-incision laparoscopic sleeve gastrectomy achieve better cosmetic results, it may lead to postoperative complications such as umbilical hernia and umbilical infection. The author has developed a new surgical approach that can compensate for these deficiencies, which we called needlescopic laparoscope sleeve gastrectomy (NLSG).

METHODS

Four consecutive patients underwent needlescopic laparoscope sleeve gastrectomy between July 2024 and August 2024. A 3-mm trocar located at the lower left abdomen is for the 2.7-mm needlescopic laparoscope to observe. Another 3-mm trocar located at the right upper abdomen is for the 2.7-mm needlescopic intestinal clamp to assist in surgery. The 12-mm trocar at the navel serves as the main operating hole, through which the ultrasonic knife and endoscopic linear cutter stapler enters. All 3-mm incisions are not sutured, and the 12-mm incision at the navel is sutured intradermally to achieve complete invisibility of the wound. All patients used the same surgical instruments, technique, and perioperative protocol.

RESULTS

The procedure was successfully performed in all patients. The average surgical time is 57 ± 9.1 min. There were no mortalities or postoperative complications noted during the 3-month follow-up period.

CONCLUSION

Needlescopic laparoscope sleeve gastrectomy is safe, feasible, and great potential.

Photocurable injectable Janus hydrogel with minimally invasive delivery for all-in-one treatment of gastric perforations and postoperative adhesions

Background: Surgical sutures for sealing gastric perforations (GP) are associated with severe inflammation and postoperative adhesions. Hydrogel bioadhesives offer a potential alternative for sutureless repair of GP; however, their application in minimally invasive surgery is limited due to their prefabricated patch-form, lacking in situ gelation capability. In this study, we emphasized an all-in-one minimally invasive strategy for sutureless repair of acute GP. Methods: an injectable photocurable Janus hydrogel was synthesized, and their ability to seal GP was performed. A rat GP model was used to verify the wound healing and antiadhesion efficiency of hydrogels, and a rabbit GP model was used to verify their laparoscopic feasibility. A fresh human corpse GP model was further employed to verify the user-friendliness of a minimally invasive deliverable (MID) device. A minipig GP model was utilized to evaluate the all-in-one minimally invasive strategy for the treatment of acute GP. Results: Such injectable Janus hydrogel exhibited asymmetric adhesiveness, where the inner-facing side of the hydrogel displays strong sealing and wound healing abilities for GP, while the outward-facing side prevents postoperative adhesion formation. We further developed a minimally invasive deliverable (MID) device integrating hydrogel-delivery parts and photocrosslinking-gelation parts in a laparoscope system. The precise delivery and rapid fluid-tight sealing process of the injectable Janus hydrogel using the MID device for in situ GP repair were demonstrated in a simulated clinical scenario. The in vivo effectiveness of GP sutureless repair was successfully validated in porcine models, with further exploration of the underlying mechanism. Conclusions: Our findings reveal that the injectable Janus hydrogel offers an all-in-one strategy for sutureless GP repair and concurrent prevention of postoperative adhesion formation by incorporating the MID device in minimally invasive surgery, presenting the significant potential to reduce patient surgical complications.

Left paraduodenal hernia treated by single-incision laparoscopic surgery: a case report

Background

Paraduodenal hernia is a rare internal hernia which accounts for only 1% of all intestinal hernias. There have been limited reported cases of paraduodenal hernia treated by laparoscopic surgery. We report a case of left paraduodenal hernia that was successfully treated by single-incision laparoscopic surgery (SILS).

Case presentation

A 17-year-old woman presented with left upper abdominal pain. An abdominal enhanced multi-detector computed tomography demonstrated encapsulated cluster of small bowel loops in the left upper quadrant which passed through the dorsal side of the inferior mesenteric vein, and showed that blood flow of the prolapsed small bowel was preserved. We preoperatively diagnosed left paraduodenal hernia without ischemia or necrosis. We performed elective SILS because she was a young actress training school student and cosmetic benefit was thought to be important. We pulled out the protruded small bowel and closed a defect with a running suture by SILS. The patient was discharged 3 days after the surgery with no complications.

Conclusions

We reported the case of left paraduodenal hernia successfully diagnosed and treated by SILS.