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Hayashi Y, Akai K, Fujii S, Ueda T, Maeda I, Takahashi T, Yamashita K, Saito T, Tanaka K, Yamamoto K, Makino T, Kurokawa Y, Eguchi H, Doki Y, Nakajima K. Ultra-thin surgical swab: its development and clinical application. MINIM INVASIV THER 2022; 31:887-893. [DOI: 10.1080/13645706.2021.2025402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yoshinori Hayashi
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Graduate School of Medicine, Osaka University, Suita, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | | | | | | | | | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kiyokazu Nakajima
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Graduate School of Medicine, Osaka University, Suita, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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Juo YY, Park C, Yoo J, Guerron D, Sudan R, Friedman K, Portenier D, Seymour KA. Technical Feasibility, Outcomes, and Patient Satisfaction After Needlescopic and Laparoscopic Bariatric Surgery: a Randomized Study. Obes Surg 2021; 31:5085-91. [PMID: 34480720 DOI: 10.1007/s11695-021-05675-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/15/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Needlescopic instruments create a 3-mm incision and may result in less pain and superior cosmesis. There is limited understanding of the effectiveness of needlescopic instruments in patients with a body mass index (BMI) > 35 kg/m2. We report perioperative outcomes and perception of body image with use of needlescopic instruments after bariatric surgery. METHODS Laparoscopic bariatric procedures were performed on 30 adults at a single academic medical center from January to December 2017. Patients were randomized to conventional laparoscopy (LAP) or needlescopic (NEED) surgery. The Multidimensional Body-Self Relations Questionnaire (MBSRQ) and Patient Scar Assessment Questionnaire (PSAQ) were completed at 6 months and 1 year. Univariate analysis was performed on perioperative outcomes and survey scores. RESULTS Surgery was completed on patients in the LAP group (N = 13) and compared to the NEED group (N = 17). The mean BMI was 41.4 kg/m2 LAP and 41.1 kg/m2 NEED. The most common procedure was Roux-en-Y gastric bypass (RYGB), with 13 RYGB in LAP and 12 RYGB in NEED (P = 0.76).The operative time was not significantly different between the LAP and the NEED group (209.5 ± 66.1 vs 181.9 ± 58.1 min, P = 0.48). There was no leak or mortality in the 30-day follow-up period. Within MBSRQ, the patient's appearance self-evaluation score was similar between LAP and NEED (2.5 ± 0.6 vs 2.4 ± 0.6, P = 0.61). Within PSAQ, the mean satisfaction score for incision appearance was also similar between LAP and NEED (16.1± 2.9 vs 15.4 ± 4.6, P = 0.85). Incision-related perceptions remained consistent at 6 months and 1 year after bariatric surgery. CONCLUSIONS Needlescopic instruments are safe and a viable alternative to use during bariatric surgery. Appearance and perception of scar were similar between groups. Further studies with needlescopic instruments should include patients with a BMI > 35 kg/m2 and compare additional factors associated with body image.
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Matsushita K, Tagaya N, Nakajima R, Yagi M, Obana Y, Nakano Y, Suzuki J, Mizoguchi M, Yoshimura Y, Arai T, Hasegawa Y, Suzuki J, Haku K, Arai T, Kurosaki T, Saito K. Three millimeter needlescopic splenectomy using three-port technique: report of three cases. J Surg Case Rep 2021; 2021:rjab305. [PMID: 34394911 PMCID: PMC8359901 DOI: 10.1093/jscr/rjab305] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022] Open
Abstract
We report our experience with needlescopic splenectomy (NS) for the surgical treatment of idiopathic thrombocytopenic purpura using a 3-mm needlescope with three ports. One patient was male and two were females, and their mean age was 58 years. The patient was placed in the right lateral decubitus position. The first 12-mm port was introduced through the lateral margin of the left rectus abdominis muscle, and the other two 3-mm ports were inserted in the left upper quadrant. NS was performed by a standard technique under the observation of 3.3-mm needlescope. The surgical procedure was successfully completed in all the patients. The mean duration of surgery, intra-operative bleeding volume and post-operative hospital stay were 176 min, 70 ml and 4.7 days, respectively. There were no particular peri-operative complications in spite of dense adhesions or simultaneous laparoscopic procedures. Our method is safe and feasible with low morbidity and without impairing cosmetic benefits.
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Affiliation(s)
- Koji Matsushita
- Department of Surgery, Digestive Disease Center, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Nobumi Tagaya
- Department of Surgery, Digestive Disease Center, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Ryuichirou Nakajima
- Department of Surgery, Digestive Disease Center, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Masayuki Yagi
- Department of Surgery, Digestive Disease Center, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Yuichi Obana
- Department of Surgery, Digestive Disease Center, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Yuhei Nakano
- Department of Surgery, Digestive Disease Center, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Junpei Suzuki
- Department of Surgery, Digestive Disease Center, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Masako Mizoguchi
- Department of Surgery, Digestive Disease Center, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Yukino Yoshimura
- Department of Surgery, Digestive Disease Center, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Takashi Arai
- Department of Surgery, Digestive Disease Center, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Yako Hasegawa
- Department of Surgery, Digestive Disease Center, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Junichi Suzuki
- Department of Surgery, Digestive Disease Center, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Kyokun Haku
- Department of Surgery, Digestive Disease Center, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Toshifumi Arai
- Department of Surgery, Digestive Disease Center, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Tetsuya Kurosaki
- Department of Surgery, Digestive Disease Center, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Kazuyuki Saito
- Department of Surgery, Saitama Medical Center, Dokkyo Medical University, Saitama, Japan
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Abstract
The word "minilaparoscopy" refers to laparoscopic surgical procedures performed using <5-mm trocars, with the exception of the umbilical access. The aim of this review is to explore the feasibility of minilaparoscopy in gynecologic surgery, focusing on instruments, surgical techniques, application and limits of this approach. In this review the authors discussed the positive features and limitation of 3-mm laparoscopy for gynecologic surgery. Using smaller trocars decreases incisional and postoperative pain, and shortens hospitalization, and provides a better cosmetic outcome. Transvaginal specimen extraction can be used to maximize the aesthetic outcomes. A minilaparoscopic surgical procedure is accomplished with lower carbon dioxide pressures, reducing pneumoperitoneum related complications. Accurate patient selection is critical in order to offer the best laparoscopic approach, considering that obesity and endometriosis may represent a challenge for 3-mm surgical tools, which are more flexible and have lower grasping ability. Minilaparoscopy has been shown as a valid alternative to conventional laparoscopy both for diagnostic purpose, major surgical procedures and oncological surgery. Minilaparoscopy in gynecologic surgery represents an option for selected patients, for both benign and malignant indications. The aesthetic outcome represents the main benefit of this approach. Surgeons must be aware of few limitations of this technique such as severe obesity and endometriosis.
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Affiliation(s)
- Jvan Casarin
- Department of Gynecology and Obstetrics, F. Del Ponte Hospital, University of Insubria, Varese, Italy -
| | - Chiara Cimmino
- Department of Gynecology and Obstetrics, F. Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Valeria Artuso
- Department of Gynecology and Obstetrics, F. Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Antonella Cromi
- Department of Gynecology and Obstetrics, F. Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Department of Gynecology and Obstetrics, F. Del Ponte Hospital, University of Insubria, Varese, Italy
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Hoshino M, Omura N, Yano F, Tsuboi K, Yamamoto SR, Akimoto S, Masuda T, Sakashita Y, Fukushima N, Kashiwagi H. Comparison of Needlescopic and Conventional Laparoscopic Fundoplication for Gastroesophageal Reflux Disease-Related Diseases: A Propensity Score-Matched Analysis. J Laparoendosc Adv Surg Tech A 2020; 31:1114-1117. [PMID: 33124946 DOI: 10.1089/lap.2020.0701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background: Recently, in pursuit of minimal invasion, needlescopic surgery (NS) using forceps thinner than the previous standard has garnered attention as a surgical approach to various diseases. Objective: We compared the outcomes of NS for gastroesophageal reflux disease (GERD)-related diseases with the conventional method using propensity score-matched analysis. Subjects and Methods: Among 205 of 328 cases who underwent laparoscopic fundoplication for the first time from June 2008 to December 2019, excluding 115 cases using mesh and 8 cases undergoing reduced port surgery, 25 subjects in the NS group and 25 subjects in the conventional group were extracted upon propensity score matching for six factors: age, gender, body mass index, degree of esophageal hiatal hernia, duration of intraesophageal acid reflux, and severity of reflux esophagitis. Results: The NS group used the Toupet method, whereas the conventional group used the Nissen method for 2 cases and the Toupet method for 23 cases. There were no significant differences between them (P = .490). Although the operative time (143 versus 112 minutes, P = .038) was longer in the NS group, there were no differences in the bleeding volume (nearly equal at 0 mL in both groups), laparotomy conversion rate, intraoperative complications, and postoperative complications (P = .588, P = 1.000, P = 1.000, P = 1.000, respectively). There was also no significant difference in recurrence: 2 cases in the conventional group (8%) and 1 case in the NS group (4%) (P = 1.000). Moreover, the degree of esophageal hiatal hernia, the severity of reflux esophagitis, and the duration of intraesophageal acid reflux all improved after the surgery in both groups (NS group: P = .001, P < .001, P = .002; conventional group: P = .007, P < .001, P = .003). Conclusions: The short-term outcomes of NS for GERD-related diseases were good, with a longer operative time but no difference in terms of safety or outcomes compared with the conventional method. This study was approved by the Institutional Review Board of the Jikei University School of Medicine [30-238 (9259)].
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Affiliation(s)
- Masato Hoshino
- Department of Surgery, Jikei University School of Medicine, Minato-ku, Japan
| | - Nobuo Omura
- Department of Surgery, Jikei University School of Medicine, Minato-ku, Japan.,Department of Surgery, National Hospital Organization, Nishisaitama-Chuo National Hospital, Tokyo, Japan
| | - Fumiaki Yano
- Department of Surgery, Jikei University School of Medicine, Minato-ku, Japan
| | - Kazuto Tsuboi
- Department of Surgery, Jikei University School of Medicine, Minato-ku, Japan
| | - Se Ryung Yamamoto
- Department of Surgery, Jikei University School of Medicine, Minato-ku, Japan
| | - Shunsuke Akimoto
- Department of Surgery, Jikei University School of Medicine, Minato-ku, Japan
| | - Takahiro Masuda
- Department of Surgery, Jikei University School of Medicine, Minato-ku, Japan
| | - Yuki Sakashita
- Department of Surgery, Jikei University School of Medicine, Minato-ku, Japan
| | - Naoko Fukushima
- Department of Surgery, Jikei University School of Medicine, Minato-ku, Japan
| | - Hideyuki Kashiwagi
- Department of Surgery, Jikei University School of Medicine, Minato-ku, Japan
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Fukuoka H, Fukunaga Y, Minami H, Miyanari S, Suzuki S, Nagasaki T, Akiyoshi T, Konishi T, Fujimoto Y, Nagayama S, Ueno M. Needlescopic surgery for very low rectal cancer with no abdominal skin incision. Asian J Endosc Surg 2020; 13:180-185. [PMID: 31282070 DOI: 10.1111/ases.12730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/20/2019] [Accepted: 06/02/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Needlescopic surgery (NS) is a minimally invasive operation beyond traditional laparoscopic surgery. This study aimed to describe NS for intersphincteric resection (ISR) and abdominoperineal resection (APR) for low rectal cancer without a small abdominal skin incision for extracting the specimen and to evaluate the safety and feasibility of the operation. METHODS From January 2011 to April 2016, 36 patients underwent NS for either ISR or APR. By definition, NS for ISR or APR at our institution uses three 3-mm ports and two 5-mm ports at the umbilicus and in the right lower quadrant. The specimen was extracted through the anus or the perineal wound. The feasibility of this operation was determined based on short-term outcomes and pathological findings. RESULTS No patients required conversion to open surgery. The mean operation time was 299 minutes, and the mean estimated blood loss was 30 mL. Postoperative complications higher than Clavien-Dindo grade III occurred in 2.8% of patients (n = 1). The median number of harvested lymph nodes was 16 (range, 0-30), and in no case was there a positive circumferential resection margin. CONCLUSIONS Needlescopic surgery for ISR or APR is technically safe and feasible for low rectal cancer based on the short-term outcomes and the oncological quality, particularly when compared to conventional laparoscopic surgery as described in previous reports.
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Affiliation(s)
- Hironori Fukuoka
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Fukunaga
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hironori Minami
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shun Miyanari
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinsuke Suzuki
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Toshiya Nagasaki
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Akiyoshi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tsuyoshi Konishi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshiya Fujimoto
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoshi Nagayama
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masashi Ueno
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Hoshino M, Omura N, Yano F, Tsuboi K, Yamamoto SR, Akimoto S, Masuda T, Kashiwagi H, Yanaga K. Needlescopic versus conventional laparoscopic Heller–Dor procedure for achalasia: a propensity score-matched analysis. Surg Today 2020; 50:721-725. [DOI: 10.1007/s00595-019-01945-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/03/2019] [Indexed: 12/28/2022]
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8
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Tsuruta M, Hasegawa H, Okabayashi K, Shigeta K, Ishida T, Yahagi M, Ishii Y, Kitagawa Y. Needlescopic versus conventional laparoscopic surgery for colorectal cancer ~a comparative study~. J Anus Rectum Colon 2018; 1:45-49. [PMID: 31583300 PMCID: PMC6768669 DOI: 10.23922/jarc.2016-007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/31/2017] [Indexed: 12/11/2022]
Abstract
Objectives: This study set out to determine whether Needlescopic surgery (NS) produces comparable surgical outcomes for patients with colorectal cancer (CRC) compared to conventional multi-port laparoscopic surgery (MPS). Methods: We used the five-port method with a 3.5 cm umbilical incision for extraction and reconstruction during MPS for CRC. One or two 5 mm ports were exchanged for needle forceps and all surgical procedures were as for previous MPS since July 2012. We investigated the short-term outcomes of 138 consecutive patients who underwent curative resection of CRC by NS (July 2012-August 2014) and 130 consecutive patients with CRC treated with MPS during a previous period (January 2010-June 2012). Results: Operative time in the NS group was comparable to that of MPS (p=0.467); the NS group had significantly less estimated blood loss (p=0.002) and a shorter postoperative hospital stay (p<0.001). The mean number of dissected lymph nodes was 27 in both groups (p=0.730). No mortality occurred in either group, and similar morbidity rates were observed (p=0.454). Conclusions: NS using Endo Relief needle forceps is a safe and feasible option compared to conventional MPS for CRC.
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Affiliation(s)
| | | | | | - Kohei Shigeta
- Department of Surgery, Keio University School of Medicine
| | - Takashi Ishida
- Department of Surgery, Keio University School of Medicine
| | - Masashi Yahagi
- Department of Surgery, Kitasato University Kitasato Institute Hospital
| | - Yoshiyuki Ishii
- Department of Surgery, Kitasato University Kitasato Institute Hospital.,Department of Surgery, Kitasato University School of Medicine
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine
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9
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LeCompte MT, Baucom RB, Beck WC, Holzman MD, Sharp KW, Nealon WH, Poulose BK. Identifying Barriers to Microlaparoscopy in the Performance of Surgical Procedures. Am Surg 2017. [DOI: 10.1177/000313481708301130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Michael T. LeCompte
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rebeccah B. Baucom
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William C. Beck
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Surgery, Memorial Herman Texas Medical Center, Houston, Texas
| | - Michael D. Holzman
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kenneth W. Sharp
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William H. Nealon
- Yale University School of Medicine and New Haven Health System, New Haven, Connecticut
| | - Benjamin K. Poulose
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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10
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Schmidt J. [Minilaparoscopy with 5 mm optics and 3 mm trocars]. Chirurg 2017; 88:647-655. [PMID: 28484787 DOI: 10.1007/s00104-017-0437-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Minilaparoscopy was introduced already 20 years ago. In spite of reduced diameter, technical performance of modern trocars and instruments has improved substantially. While carrying out a minilaparoscopic procedure, the required position of the trocars and the surgical strategy remain the same. The most important step towards minilaparoscopy is reduction of the diameter of the laparoscopes from 10 to 5 mm. The 5 mm laparoscopes show high resolution and transport enough energy to properly illuminate the surgical field. Minilaparoscopic procedures help to improve cosmetic results and reduce postoperative pain, but postoperative complication rates are not affected. Use of one 5 mm trocar causes higher tissue tension than two 3 mm trocars and an additionally placed 3 mm trocar will not increase the complication rate. Therefore, a reduced risk of trocar hernia formation may be expected when a minilaparoscopic approach is used. Efficiency has been proven for minilaparoscopic cholecystectomy, appendectomy, and hernioplasty (TAPP/TEP) whereas overall available evidence across the literature remains poor. Further miniaturization is linked directly to video editing: physical limitations in classic optic systems have already been reached; therefore, reduction of optical chip systems could be a possible alternative.
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Affiliation(s)
- J Schmidt
- Klinik für Allgemein‑, Viszeral- und Thoraxchirurgie, Krankenhaus Landshut-Achdorf, Akademisches Lehrkrankenhaus TU München, Achdorfer Weg 3, 84036, Landshut, Deutschland.
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11
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Keheila M, Shen JK, Faaborg D, Yang P, Cheriyan S, Abourbih S, Khater N, Hill M, Baldwin DD. Percutaneous Externally Assembled Laparoscopic vs Laparoendoscopic Single-Site Nephrectomy in a Porcine Model: A Prospective, Randomized, Blinded, Study. J Endourol 2016; 31:185-190. [PMID: 27917649 DOI: 10.1089/end.2016.0615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To compare the outcomes between laparoendoscopic single-site (LESS) and a novel percutaneous externally assembled laparoscopic (PEAL) nephrectomy in an in vivo porcine model. MATERIALS AND METHODS Ten female farm pigs were randomized to LESS nephrectomy (5) or PEAL nephrectomy (5). Operative times, estimated blood loss, and intraoperative and postoperative complications were compared. The surgeons used a Likert scale to grade difficulty of peritoneal access, port placement, tool assembly, hilar dissection, closure, and overall difficulty of surgery. Scar assessment was performed by a blinded plastic surgeon using the Vancouver Scar Scale. Descriptive statistics were reported as median and range. The Mann-Whitney U test was used for continuous and ordinal variables. A p value <0.05 was considered significant. RESULTS Median operative time was significantly shorter in the PEAL group vs the LESS group (85 minutes vs 127 minutes, p = 0.03). Median Likert scores showed overall hilar dissection and nephrectomy to be significantly easier using PEAL compared with LESS (2 vs 9, p < 0.01 for both). The PEAL instruments left no visible scar at 5 feet in any animal, and only 1 out of 10 scars could be identified on physical examination. CONCLUSIONS The PEAL surgical paradigm demonstrates nearly scarless outcomes while providing shorter operative times and easier performance than LESS nephrectomy in a porcine model.
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Affiliation(s)
- Mohamed Keheila
- 1 Department of Urology, Loma Linda University Medical Center , Loma Linda, California
| | - Jim K Shen
- 1 Department of Urology, Loma Linda University Medical Center , Loma Linda, California
| | - Daniel Faaborg
- 1 Department of Urology, Loma Linda University Medical Center , Loma Linda, California
| | - Patrick Yang
- 1 Department of Urology, Loma Linda University Medical Center , Loma Linda, California
| | - Salim Cheriyan
- 1 Department of Urology, Loma Linda University Medical Center , Loma Linda, California
| | - Samuel Abourbih
- 1 Department of Urology, Loma Linda University Medical Center , Loma Linda, California
| | - Nazih Khater
- 1 Department of Urology, Loma Linda University Medical Center , Loma Linda, California
| | - Michael Hill
- 2 Department of Plastic Surgery, Loma Linda University Medical Center , Loma Linda, California
| | - D Duane Baldwin
- 1 Department of Urology, Loma Linda University Medical Center , Loma Linda, California
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12
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Abstract
Background: Mini-laparoscopy, or needlescopy, is an emerging minimally invasive technique that aims to improve on standard laparoscopy in the areas of tissue trauma, pain, and cosmesis. The objective of this study was to determine if there was a difference in functionality between 2 novel mini-laparoscopic instruments when compared to standard laparoscopic tools. Differences were assessed in a simulated surgical environment. Methods: Twenty participants (5 novices, 10 intermediate, 5 expert) were recruited for this institutional review board–approved study in a surgical simulation training center. Group A tools were assembled intracorporeally, and Group B tools were assembled extracorporeally. Using standard laparoscopic graspers, mini-laparoscopic graspers, or a combination of both, each participant performed 3 basic laparoscopic training tasks: a Peg Transfer, Rubber Band Stretch, and Tootsie Roll Unwrapping. Following each round of tasks, participants completed a survey evaluating the mini-laparoscopic graspers with respect to standard laparoscopic graspers. Data were analyzed using Kruskal-Wallis test with Dunn’s test for post hoc comparisons. Results: When comparing task times, both mini tools performed at the level of standard laparoscopic graspers in all participant groups. Group A tools were quicker to assemble and disassemble versus Group B tools. According to posttask surveys, all participant groups indicated that both sets of mini-laparoscopic graspers were comparable to the standard graspers. Conclusion: In a nonclinical setting, mini-laparoscopic instruments perform at the level of standard laparoscopic tools. Based on these results, clinical trials would be a reasonable next step in assessing feasibility and safety.
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Affiliation(s)
| | | | | | | | - Ryota Tanaka
- NorthShore University HealthSystem, Evanston, IL, USA
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13
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Ferreira H, Ferreira C, Nogueira-Silva C, Tomé A, Guimarães S, Correia-Pinto J. Minilaparoscopic Versus Conventional Laparoscopic Sacrocolpopexy: A Comparative Study. J Laparoendosc Adv Surg Tech A 2016; 26:386-92. [DOI: 10.1089/lap.2015.0381] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hélder Ferreira
- Department of Obstetrics and Gynecology, Centro Hospitalar do Porto, Porto, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
| | - Carlos Ferreira
- Department of Urology, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Cristina Nogueira-Silva
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
- Department of Obstetrics and Gynecology, Hospital de Braga, Braga, Portugal
| | - Antonio Tomé
- Department of Obstetrics and Gynecology, Centro Hospitalar do Porto, Porto, Portugal
| | - Serafim Guimarães
- Department of Obstetrics and Gynecology, Centro Hospitalar do Porto, Porto, Portugal
| | - Jorge Correia-Pinto
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
- Department of Pediatric Surgery, Hospital de Braga, Braga, Portugal
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Paradiso FV, Nanni L. Pediatric laparoscopic cholecystectomy with 2.3 mm Percutaneous Surgical System (MiniLap®): A new frontier for pediatric mini laparoscopy? Journal of Pediatric Surgery Case Reports 2016. [DOI: 10.1016/j.epsc.2016.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Firme WA, Carvalho GL, Lima DL, Lopes VGDP, Montandon ID, Santos Filho F, Shadduck PP. Low-Friction Minilaparoscopy Outperforms Regular 5-mm and 3-mm Instruments for Precise Tasks. JSLS 2016; 19. [PMID: 26390530 PMCID: PMC4558417 DOI: 10.4293/jsls.2015.00067] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: Therapeutic laparoscopy was incorporated into surgical practice more than 25 y ago. Several modifications have since been developed to further minimize surgical trauma and improve results. Minilaparoscopy, performed with 2- to 3-mm instruments was introduced in the mid 1990s but failed to attain mainstream use, mostly because of the limitations of the early devices. Buoyed by a renewed interest, new generations of mini instruments are being developed with improved functionality and durability. This study is an objective evaluation of a new set of mini instruments with a novel low-friction design. Method: Twenty-two medical students and 22 surgical residents served as study participants. Three designs of laparoscopic instruments were evaluated: conventional 5 mm, traditional 3 mm, and low-friction 3 mm. The instruments were evaluated with a standard surgical simulator, emulating 4 exercises of various complexities, testing grasping, precise 2-handed movements, and suturing. The metric measured was time to task completion, with 5 replicates for every combination of instrument–exercise–participant. Results: For all 4 tasks, the instrument design that performed the best was the same in both the medical student and surgical resident groups. For the gross-grasping task, the 5-mm conventional instruments performed best, followed by the low-friction mini instruments. For the 3 more complex and precise tasks, the low-friction mini instruments outperformed both of the other instrument designs. Conclusion: In standard surgical simulator exercises, low-friction minilaparoscopic instruments outperformed both conventional 3- and 5-mm laparoscopic instruments for precise tasks.
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Arenas JL, Alsyouf M, Jang M, Myklak K, Faaborg D, Khater N, Baldwin DD. Percutaneous Externally Assembled Laparoscopic Instruments: Creation of a New Surgical Paradigm. J Endourol 2016; 30:433-40. [PMID: 26732739 DOI: 10.1089/end.2015.0240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) produce excellent cosmetic outcomes, but are technically challenging. The objective of this study was to test the functionality and feasibility of a novel minimally invasive surgical paradigm, which maintains triangulation but uses special externally assembled instruments to minimize the postoperative cosmetic impact. METHODS Percutaneous Externally Assembled Laparoscopic (PEAL) instruments have specialized 2.96-mm shafts with interchangeable 5-mm working tips that are assembled externally. First, 5-mm laparoscopic, PEAL, and 2-mm needlescopic instruments were tested to determine piercing force on fresh human cadaver organs. In a bench-top study, 20 subjects assembled and used PEAL instruments in five different skills tests that were also compared with the same tasks using conventional laparoscopic instruments. Finally, PEAL instrument functionality was tested in a four-porcine nephrectomy feasibility study. RESULTS PEAL (2.80 lbF) and 5-mm laparoscopic instruments (2.28 lbF) had a significantly higher mean organ piercing perforation force compared with needlescopic instruments (1.39 lbF, p < 0.05). Average assembly time of PEAL instruments was 31.08 seconds (range: 19.83-43.85). There were no significant differences in the amount of time needed for completion of the bench-top tasks between laparoscopic and PEAL instruments (p > 0.05 for all tasks). Four-porcine PEAL nephrectomies were completed with no complications and minimal blood loss (mean 7.5 mL). Mean operative time was 98.25 minutes (range 79-116). CONCLUSION PEAL tools are easily assembled, have similar safety and efficacy compared with standard laparoscopic tools, and are less likely to injure organs compared with needlescopic instruments. They function well during laparoscopic nephrectomy and may decrease the invasiveness of conventional laparoscopic instrumentation.
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Affiliation(s)
- Javier L Arenas
- Department of Urology, Loma Linda University Medical Center , Loma Linda, California
| | - Muhannad Alsyouf
- Department of Urology, Loma Linda University Medical Center , Loma Linda, California
| | - Michael Jang
- Department of Urology, Loma Linda University Medical Center , Loma Linda, California
| | - Kristene Myklak
- Department of Urology, Loma Linda University Medical Center , Loma Linda, California
| | - Daniel Faaborg
- Department of Urology, Loma Linda University Medical Center , Loma Linda, California
| | - Nazih Khater
- Department of Urology, Loma Linda University Medical Center , Loma Linda, California
| | - D Duane Baldwin
- Department of Urology, Loma Linda University Medical Center , Loma Linda, California
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David G, Boni L, Rausei S, Cassinotti E, Dionigi G, Rovera F, Spampatti S, Colombo EM, Dionigi R. Use of 3 mm percutaneous instruments with 5 mm end effectors during different laparoscopic procedures. Int J Surg 2014; 11 Suppl 1:S61-3. [PMID: 24380556 DOI: 10.1016/s1743-9191(13)60019-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE With a recent focus on minimizing the visibility of scars, new techniques have been developed. Minilaparoscopy reemerged as an attractive option for surgery as it limits tissue trauma, reduces post-operative pain and improves cosmesis. This study was designed to describe our experience with percutaneous trocarless 3 mm instruments used in combination with standard 5 mm and 10 mm laparoscopic instruments in different general surgery procedures. METHODS We used the PSS (Percutaneous Surgical Set, Ethicon Endo surgery, Cincinnati, OH, USA) in different surgical procedures as accessory instruments in combination with standard 5 mm and 10 mm standard laparoscopic instruments. MAIN FINDINGS The use of percutaneous instruments was safe and feasible in all performed procedures. The surgical technique was not modified. The percutaneous instruments can assure a good grip and can be used for traction and counter-traction. No complications have been described. No pain at the site of insertion has been reported. The skin, muscle and peritoneal defects were smaller than with the 3 mm laparoscopic traditional instruments. CONCLUSIONS Percutaneous approach seems to be a good option in general surgery in terms of efficiency, offering better cosmetic results and good pain control.
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Affiliation(s)
- Giulia David
- Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Luigi Boni
- Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Stefano Rausei
- Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Elisa Cassinotti
- Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Gianlorenzo Dionigi
- Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Francesca Rovera
- Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Sebastiano Spampatti
- Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Elisabetta Marta Colombo
- Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Renzo Dionigi
- Department of Surgical and Morphological Sciences Insubria, University of Insubria Varese, 1st Division of Surgery Ospedale di Circolo e Fondazione Macchi, Varese, Italy
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Zuo S, Iijima K, Tokumiya T, Masamune K. Variable stiffness outer sheath with “Dragon skin” structure and negative pneumatic shape-locking mechanism. Int J Comput Assist Radiol Surg 2014; 9:857-65. [DOI: 10.1007/s11548-014-0981-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 01/24/2014] [Indexed: 12/20/2022]
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Ghezzi F, Cromi A, Uccella S, Bogani G, Sturla D, Serati M, Bolis P. Nerve-sparing minilaparoscopic versus conventional laparoscopic radical hysterectomy plus systematic pelvic lymphadenectomy in cervical cancer patients. Surg Innov 2013; 20:493-501. [PMID: 23339145 DOI: 10.1177/1553350612472986] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 09/19/2023]
Abstract
AIM To present our preliminary experience with nerve-sparing minilaparoscopic radical hysterectomy plus pelvic lymphadenectomy for the surgical treatment of cervical cancer and to compare outcomes with those of the conventional laparoscopic approach. METHODS Data of 87 consecutive women who underwent minimally invasive surgery for early and locally advanced stage cervical cancer were prospectively collected. Ten women who underwent laparoscopic surgery using a nerve-sparing technique performed through 3-mm ancillary ports were compared with the 77 patients who had standard laparoscopic surgery previously with 3 sovrapubic 5-mm trocars. RESULTS Minilaparoscopic radical hysterectomy was successfully accomplished in every case with no conversion to standard laparoscopy or open surgery. Two (2.6%) conversions to open surgery occurred in the conventional laparoscopy group. Surgical characteristics (operative time, estimated blood loss, and length of stay) and complication rate were similar between the 2 groups. No differences in the amount of parametrial and vaginal tissue removed were observed. The number of lymph nodes retrieved through minilaparoscopy was higher than conventional laparoscopy (30 [range = 26-38] vs 22 [range = 8-49]; P = .002). However, no difference was observed when the analysis was restricted to the last 10 conventional procedures (30 [range = 26-38] vs 29 [range = 24-49]; P = .81). CONCLUSIONS Our data show that minilaparoscopic radical hysterectomy with pelvic lymphadenectomy is a feasible procedure if performed by skilled surgeons.
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Affiliation(s)
- Fabio Ghezzi
- 1University of Insubria, Del Ponte Hospital, Varese, Italy
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Dimbarre D, de Loureiro PM, Claus C, Carvalho G, Trauczynski P, Elias F. Minilaparoscopic fundoplication: technical adaptations and initial experience. Arq Gastroenterol 2012; 49:223-6. [PMID: 23011247 DOI: 10.1590/s0004-28032012000300011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 06/05/2012] [Indexed: 11/22/2022]
Abstract
CONTEXT Gastroesophageal reflux disease (GERD) is a highly prevalent disease. Treatment is divided into lifestyle modifications, medical and surgical treatment. Surgical laparoscopy is the gold standard treatment. In the last decade, there were an extensive research on procedures, less aggressive than laparoscopy and with better esthetic results. Minilaparoscopy is "reemerging" as a safe, effective and with excellent cosmetic results in selected patients treated for gastroesophageal reflux disease. We present a serie of 27 patients treated for GERD by minilaparoscopic laparoscopy. MATERIAL Between October 2009 July 2011 a total of 27 patients underwent fundoplication by minilaparoscopy. It is used one 10mm trocar, a telescope of 30 degrees and four 3 mm trocars at regular positions. Regular surgical steps are done with no modifications. Cardiac tape, suture needles, and eventually extracting bag, gauze, are placed and taken out through the umbilical port. With these technical adjustments, we can perform the procedure safely and effectively, similarly to standard laparoscopic technique. RESULTS Of the 27 patients, 22 were female and 5 male. The average body mass index was 25.5 kg/m². Hiatal hernias were small (<3 cm) in 24 patients. Mean operative time was 60 minutes. In all cases the hiatoplasty was performed with simple or 'x' stitches of 2.0 Ethibond. There was no need for conversion to standard laparoscopy or open surgery. The length of hospital stay was less than or equal to 24 hours in all patients. In this series of patients there were no postoperative complications. We did not observe any complication of the surgical wound. There were no evidence of recurrence of symptoms or endoscopic changes. CONCLUSION Hiatoplasty associated with fundoplication using minilaparoscopic instruments is safe, feasible and effective. If compared to other "new access", has a spectacular esthetic results. Can be done with only minor technical adjustments, for any experienced laparoscopic surgeon, and is perfectly adaptable to our financial reality.
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Affiliation(s)
- Daniellson Dimbarre
- Minimally Invasive Surgery Department, Jacques Perissat Institute, Positivo University, Curitiba, PR, Brazil.
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Abstract
The authors suggest that minilaparoscopy should be considered as the most sophisticated evolution of laparoscopic surgery at the present time.
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Abstract
BACKGROUND We propose that needlescopic surgery (NS) should be considered as a way of improving the esthetic result and post-operative quality of life of patients and of reducing costs and stress on surgeons, and we have evaluated the results of NS. METHODS We used NS in 157 patients between May 1998 and December 2010: cholecystectomy in 150 patients, marsupialization of splenic and hepatic cysts in 4 and splenectomy in 3, respectively. Under general anesthesia, one 12-mm and two or three 2- or 3-mm ports were introduced into the operative field. The specimen was retrieved from the 12-mm wound using a plastic bag. RESULTS The procedures were successfully completed in all patients without conversion to an open procedure. In eight (5.3%) of 150 cholecystectomies a change to 5-mm instruments was required. The mean operation times and postoperative hospital stays for cholecystectomy, splenectomy, and marsupialization of splenic and hepatic cysts were 80.2 min and 3.2 days, 167 min and 5.6 days, 170 min and 7 days, and 120 min and 7 days, respectively. There were a few perioperative complications. The most important factor for reducing operation time and achieving a low conversion rate is the use of at least one 3- or 5-mm port for the grasping instruments in cholecystectomy. We recognized a residual cyst requiring splenectomy 62 months after marsupialization in one case. Technical points for performing safe procedures on solid organs were: no direct organ mobilization to avoid organ injuries, the rotation of the operating table and the utilization of organ gravity to create a better operative field, the minimum use of the needlescope to perform a safe maneuver and the improvement of bi-manual technique. CONCLUSIONS NS is a safe and feasible procedure for achieving minimal invasive surgery. We should consider NS as a first choice to treat operable diseases in this laparoscopic era.
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Affiliation(s)
- Nobumi Tagaya
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.
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Agresta F, Bedin N. Is there still any role for minilaparoscopic-cholecystectomy? A general surgeons' last five years experience over 932 cases. Updates Surg 2011; 64:31-6. [PMID: 22076602 DOI: 10.1007/s13304-011-0123-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 11/05/2011] [Indexed: 11/26/2022]
Abstract
Laparoscopy has rapidly emerged as the preferred surgical approach in a number of different diseases because it ensures correct diagnoses and appropriate treatment. The use of mini-instruments (5 mm or less in diameter) and, when possible, the reduction of the number of trocars used might be its natural evolution. Laparoscopic cholecystectomy is a gold standard technique. The aim of the present work is to illustrate the results of the prospective experience of minilaparoscopic cholecystectomy (5 mm MLC) performed at our institution. Between August 2005 and July 2010 a total of 932 patients (mean age 45 years) underwent a laparoscopic cholecystectomy. Amongst them, 887 (95.1%) were operated on with a 5 mm-three trocar approach and in the remaining 45 cases (4.8%) a 3 mm trocar was used. The primary endpoint was the feasibility rate of the techniques. Secondary endpoints were safety and the impact of the techniques on duration of laparoscopy. In two cases conversion to laparotomy was necessary. We needed to add a fourth-5 mm trocar in the 10.7% of the cases (95 patients) in the 5 mm MLC. There were two cases of redo-laparoscopy in this group due to bile leakage from the cystic duct in one case, and to bleeding from the gallbladder bed in the other. Minor occurrence ranged as high as 2.1% in the 5 mm-MLC group, while it was nil in the 3 mm-MLC patients. The present experience shows that the 5 mm-three trocars MLC is a safe, easy, effective and reproducible approach to gallbladder diseases. Such features make the technique a challenging alternative to conventional laparoscopy both in the acute and the scheduled setting. We consider the 3 mm-MLC approach suitable only in selected cases, young and thin patients, due to the fragility of the smaller instruments.
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She WH, Lo OSH, Fan JKM, Poon JTC, Law WL. Needlescopic totally extraperitoneal hernioplasty for unilateral inguinal hernia in adult patients. Asian J Surg 2011; 34:23-7. [PMID: 21515209 DOI: 10.1016/s1015-9584(11)60014-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 11/06/2010] [Accepted: 01/31/2011] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Totally extraperitoneal (TEP) inguinal hernioplasty for inguinal hernia is associated with less postoperative pain, shorter hospital stays, less chronic pain, and increased patient satisfaction when compared with the open Lichtenstein approach‥ However, only few studies to date have compared conventional with needlescopic TEP hernioplasty for treating unilateral inguinal hernias in adult patients. We report our prospective study that compared the postoperative outcomes of these two approaches over a 2-year period. METHODS From July 2007 to June 2009, a total of 32 patients underwent attempted unilateral needlescopic TEP hernioplasty. All data were prospectively collected and analysed, including demographic features, types of hernia, and postoperative outcome. The results were compared with those of an agematched cohort of 32 patients who underwent conventional TEP hernioplasty in the same period. RESULTS Needlescopic TEP hernioplasty was successfully performed in 24 patients. The other eight procedures were completed with conventional TEP approaches after changing one or two 5-mm ports. The most common hernia type was Nyhus type III (38/64, 59.3%). There was no significant difference in the mean operative time, hospital stay, and postoperative pain scores between the needlescopic and conventional approaches. There was no major complication detected on the first visit, except seroma formation (9 patients in the needlescopic group and 11 in the conventional group), all of which was resolved with conservative management. No recurrence of hernia was noted in either group during the mean follow-up period of 88.0 weeks. CONCLUSION Needlescopic TEP hernioplasty was a feasible technique in selected patients for inguinal hernia repair. Postoperative recovery following both approaches was similar. However, because this was a small cohort study, larger prospective, randomized controlled trials are required to establish the longterm benefit, safety and complications of needlescopic surgery.
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Affiliation(s)
- Wong-Hoi She
- Division of Colorectal Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
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Abstract
BACKGROUND Although the use of single-incision laparoscopic surgery (SILS) has spread rapidly, most procedures employ additional needlescopic instruments to ensure safety and shorten the operation time. Therefore, on the basis of results obtained in our department, the present study was conducted to reevaluate the current state of needlescopic surgery (NS) to improve the cosmetic results and postoperative quality of life of patients and to reduce cost and degree of stress on surgeons. METHODS Between May 1998 and February 2011, we performed NS in 202 patients. The diagnoses included gallbladder diseases in 151 patients, spontaneous pneumothorax in 11, thyroid tumor and axillary lymph node metastases in 10 patients each, splenic cyst and appendicitis in 4 patients each, idiopathic thrombocytopenic purpura and postoperative abdominal wall hernia in 3 patients each, primary aldosteronism and hepatic cyst in 2 patients each, and adhesional bowel obstruction and gastric stromal tumor in 1 patient each. Under general anesthesia, one 12-mm and tow or three 2- or 3-mm ports were introduced into the operative field. The specimen was retrieved via the 12-mm wound using a plastic bag. RESULTS The operations were completed in all patients without the need to convert to an open procedure. In 8 (5.3%) of the 151 cholecystectomies, a change to 5-mm instruments was required. There were no perioperative complications. Pertinent technical points included avoidance of direct organ mobilization to minimize injury, rotation of the operating table and utilization of organ gravity to create a better operative field, minimum use of needlescope to ensure safe maneuvering, and improvement of the bi-hand technique. CONCLUSIONS NS is a safe and feasible procedure that allows experienced surgeons to achieve minimally invasive surgery with low morbidity, without the need to convert to a conventional or open procedure.
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Affiliation(s)
- Nobumi Tagaya
- First Department of Surgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan.
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Ghezzi F, Cromi A, Siesto G, Uccella S, Boni L, Serati M, Bolis P. Minilaparoscopic versus conventional laparoscopic hysterectomy: results of a randomized trial. J Minim Invasive Gynecol 2011; 18:455-61. [PMID: 21640669 DOI: 10.1016/j.jmig.2011.03.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 03/26/2011] [Accepted: 03/31/2011] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To compare operative outcomes and postoperative pain of laparoscopic hysterectomy (LH) versus minilaparoscopic hysterectomy (MLH). DESIGN Randomized controlled trial (Canadian Task Force Classification I). SETTING Tertiary care center. PATIENTS Seventy-six women scheduled to undergo a hysterectomy for a supposed benign gynecologic condition. INTERVENTIONS Participants were randomly assigned to LH (n = 38) or MLH (n = 38). MLH was performed with use of 3-mm ports. Both patients and assessors of the postoperative outcomes were blinded to the size of port used, and patients' wounds were concealed by standard-size nontransparent dressings. MEASUREMENTS Primary outcome was postoperative pain (both rest and incident on coughing and abdominal pain, as well as shoulder pain) by use of a 100-mm visual analogue scale. MAIN RESULTS The two groups were similar in terms of operative outcomes. No intraoperative conversion from MLH to both LH and open surgery occurred. No significant difference in pain scores at 1, 3, 8, and 24 hours after surgery between groups was found. Rescue analgesic requirement was similar in the MLH and LH groups (21.1% vs 13.2%, p =.54). CONCLUSIONS Ports can safely be reduced in size without a negative impact on the surgeon's ability to perform LH. MLH appears to have no advantage over LH in terms of postoperative pain.
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Affiliation(s)
- Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
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Karahasanoglu T, Hamzaoglu I, Baca B, Aytac E. Hybrid laparo-endoscopic single port transperitoneal right adrenalectomy. MINIM INVASIV THER 2011; 21:59-62. [PMID: 21395462 DOI: 10.3109/13645706.2010.543423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Laparoscopic surgery is a preferable technique for adrenalectomy. Laparo-endoscopic single port surgery (LESS) is one of the newest areas in minimally invasive surgery. The development of the technology has made many surgical procedures less invasive. In this paper, we report hybrid laparo-endoscopic single port transperitoneal right adrenalectomy for a non-functional adrenal mass.
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Affiliation(s)
- Tayfun Karahasanoglu
- Department of Surgery, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.
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Carvalho GL, Silva FW, Silva JS, de Albuquerque PP, Coelho Rde M, Vilaça TG, Lacerda CM. Needlescopic clipless cholecystectomy as an efficient, safe, and cost-effective alternative with diminutive scars: the first 1000 cases. Surg Laparosc Endosc Percutan Tech. 2009;19:368-372. [PMID: 19851262 DOI: 10.1097/SLE.0b013e3181b7d3c7] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The advent of natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS), surgery without skin scarring, is now challenging every surgeon to improve the esthetic results for patients. Minilaparoscopic cholecystectomy (MLC) represents a refinement in laparoscopic surgery, potentially as cosmetically effective as NOTES. Nevertheless, because of the increased cost and difficulty in managing the equipment, it has not been widely accepted among surgeons. OBJECTIVE To report modifications of the minilaparoscopic technique that make it possible to conduct needlescopic procedures safely and effectively, thereby, considerably reducing costs and promoting the dissemination of this operation. METHOD One thousand consecutive patients who underwent MLC were analyzed, from January 2000 to May 2009 (78.7% women; average age 45.9 y). SURGICAL TECHNIQUE after performing the pneumoperitoneum at the umbilical site, 4 trocars were inserted; 2 of 2 mm, 1 of 3 mm, and 1 of 10 mm in diameter, through which a laparoscope was inserted. Neither the 3-mm laparoscope, nor clips, nor manufactured endobags were used. The cystic artery was safely sealed by electrocautery near the gallbladder neck and the cystic duct was sealed with surgical knots. Removal of the gallbladder was carried out, in an adapted bag made with a glove wrist, through the 10-mm umbilical site. RESULTS The operative time was 43 minutes. The average hospital stay was 16 hours. There was no conversion to open surgery; 2.8% of patients underwent conversion to standard (5 mm) laparoscopic cholecystectomy because of difficulties with the procedure; there were 1.9% minor umbilical site infections and 1.0% umbilical herniations. There was no mortality; no bowel injury, no bile duct injury, and no postoperative hemorrhage, only 1 patient with Luschka's duct bile leakage needed a reoperation. CONCLUSIONS The MLC technique shows no differences in risks as compared with other laparoscopic cholecystectomy procedures. It also entails a considerable reduction in cost, and, as it does not use the 3-mm laparoscope or disposable materials, it is possible to perform MLC on a larger number of patients. Owing to the near invisibility of scars, MLC may also be considered as cosmetically effective as NOTES and SILS.
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Gagner M. Needlescopic splenectomy: a safer alternative to single incision laparoscopic splenectomy (SILS). J Gastrointest Surg 2010; 14:1473. [PMID: 20596787 DOI: 10.1007/s11605-010-1266-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 06/15/2010] [Indexed: 01/31/2023]
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Abstract
BACKGROUND Laparoscopic umbilical herniorrhaphy is preferred when abdominal wall defects exceed 3 cm. The authors describe a novel single-port laparoscopic technique for umbilical hernia repair. METHODS A total of 10 patients underwent single-port laparoscopic umbilical hernia repair. A 10-mm endoscope with a working channel was placed in the left upper quadrant. The abdominal wall defect was covered with a circular mesh with pretied sutures and needles attached. The mesh was secured to the abdominal wall with intraabdominal sutures without the need for transfascial suture fixation. RESULTS The average age of the patients was 43 years, and the average BMI was 34 kg/m(2). All procedures were completed laparoscopically. The mean operative time was 73 minutes. No major intraoperative or postoperative complications were encountered. CONCLUSIONS Single-port laparoscopic umbilical hernia repair is a safe and easily reproducible novel technique. It can help reduce possible complications from multiple-port sites.
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Affiliation(s)
- Kurt E Roberts
- Section of Gastrointestinal Surgery, Yale School of Medicine, New Haven, CT 06510, USA.
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Abstract
SUMMARYDeveloped minimally invasive surgical (MIS) robots are large multi-arm, multipurpose systems requiring significant investments that limit their availability in hospitals. A larger distribution of MIS robots with benefit for patients might be achieved improving their modularity and scalability so that smaller hospitals or medical centers could decide for a simpler and lower cost setup for a limited number of treatments only, while centers with higher funding could have more systems dedicated to different classes of operations. In line with this statement the paper proposes the paradigm of lean MIS system comprising a scalable set of modular, agile, small size single-instrument robots with limited life cycle cost. Miniaturization of instruments can further reduce invasiveness of procedures and one promising research direction is needle laparoscopic surgery, which can be applied to classes of operations on small regions requiring small force interaction with the patient. In the paper the development of a lean single-instrument manipulator for needlescopic surgery is presented and a new master concept for accurate restitution of surgical force proposed and discussed.
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Ghezzi F, Cromi A, Siesto G, Zefiro F, Franchi M, Bolis P. Microlaparoscopy: A further development of minimally invasive surgery for endometrial cancer staging — Initial experience. Gynecol Oncol 2009; 113:170-5. [DOI: 10.1016/j.ygyno.2009.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 01/11/2009] [Accepted: 01/17/2009] [Indexed: 10/21/2022]
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Cabral PHO, Silva ITDCE, Melo JV, Gimenez FS, Cabral CRB, Lima APCD. Needlescopic versus laparoscopic cholecystectomy: a prospective study of 60 patients. Acta Cir Bras 2008; 23:543-50. [DOI: 10.1590/s0102-86502008000600012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 08/18/2008] [Indexed: 11/22/2022] Open
Abstract
PURPOSE: To test the hypothesis that needlescopic cholecystectomies (NC) offer superior outcomes in comparison to common laparoscopic cholecystectomies (LC). METHODS: Sixty consecutive patients with gallbladder disease undergoing either LC or NC were evaluated with respect to differences in operative time, frequency of per-operative incidents, post-operative pain, late postoperative symptoms, length of scars and level of postoperative satisfaction. RESULTS: Mean operative time was similar in both groups. Most of the patients, irrespective of the technique, informed mild postoperative pain. NC patients had lower levels of pain on the 7th postoperative day (PO7) (p<0.01) and decreased need for additional analgesia. Less frequency of epigastric wound pain was observed in NC patients until PO4 (p<0.01). Aesthetic result was far superior after NC (total length of scars less than half after LC). No differences regarding postoperative satisfaction with the operation were observed between the studied groups. CONCLUSIONS: Both techniques were safe and effective, presenting similar operative times and low levels of postoperative pain. Downsizing the ports to 2-3 mm was associated with significantly less frequency of postoperative pain only in the epigastric wound until PO4. Aesthetic outcome of NC was significantly superior to LC, although this advantage did not influence patient level of satisfaction.
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Nadu A. Is Smaller Actually Better? Needlescopic Surgery — A Step Towards (Virtually) Incisionless Surgery. Eur Urol 2008; 54:493-5; author reply 495-7. [DOI: 10.1016/j.eururo.2008.01.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 01/21/2008] [Indexed: 11/15/2022]
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Ghezzi F, Cromi A, Siesto G, Boni L, Uccella S, Bergamini V, Bolis P. Needlescopic hysterectomy: incorporation of 3-mm instruments in total laparoscopic hysterectomy. Surg Endosc 2008; 22:2153-7. [DOI: 10.1007/s00464-008-0010-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Revised: 04/27/2008] [Accepted: 05/26/2008] [Indexed: 12/26/2022]
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Chung WJ, Jo WM, Lee SH, Son HS, Kim KT. Effects of additional pleurodesis with dextrose and talc-dextrose solution after video assisted thoracoscopic procedures for primary spontaneous pneumothorax. J Korean Med Sci 2008; 23:284-7. [PMID: 18437013 PMCID: PMC2526449 DOI: 10.3346/jkms.2008.23.2.284] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Recurrence after thoracoscopic surgery for primary spontaneous pneumothorax is a lingering problem, and many intraoperative methods to induce pleural symphysis have been introduced. We analyzed the effects of chemical pleurodesis during thoracoscopic procedures. Between August 2003 and July 2005, 141 patients among indicated surgical treatment for primary spontaneous pneumothorax in two hospitals of our institution allowed this prospective study. The patients were randomly assigned to 3 groups: thoracoscopic procedure only (group A, n=50), thoracoscopic procedure and pleurodesis with dextrose solution (group B, n=49), and thoracoscopic procedure and pleurodesis with talc-dextrose mixed solution (group C, n=42). There was no significant difference in demographic data among the three groups. The two groups that underwent intraoperative pleurodesis had significantly longer postoperative hospital stays (A/B/C: 2.50+/-1.85/4.49+/-2.10/6.00+/-2.58 days; p=0.001) and a higher incidence of postoperative fever (A/B/C: 10.0/22.45/52.38%; chi(2)= 21.598, p=0.00). No significant differences were found for recurrence rates or the number of postoperative days until chest tube removal. Therefore, the results of our study indicate that intraoperative chemical pleurodesis gives no additional advantage to surgery alone in deterring recurrence for patients with primary spontaneous pneumothorax. Thus, the use of such scarifying agents in the operating room must be reconsidered.
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Affiliation(s)
- Won Jae Chung
- Department of Thoracic and Cardiovascular Surgery, Ansan Hospital, Korea University, 516 Gojan-1-dong, Ansan, Korea
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Liao CH, Lai MK, Li HY, Chen SC, Chueh SC. Laparoscopic adrenalectomy using needlescopic instruments for adrenal tumors less than 5cm in 112 cases. Eur Urol 2007; 54:640-6. [PMID: 18164803 DOI: 10.1016/j.eururo.2007.12.028] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Accepted: 12/14/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine the safety and efficacy of laparoscopic adrenalectomy with needlescopic instruments for most adrenal tumors less than 5cm. METHODS Transperitoneal laparoscopic adrenalectomy with needlescopic instruments for 112 patients with presumptively benign adrenal tumors < 5cm were enrolled from July 2000 to February 2005. Operative time, blood loss, conversion and complication rates, and postoperative data were analyzed by appropriate statistical methods. RESULTS All 112 operations were completed without any mortality or reoperation. Mean operative time was 151min and mean blood loss was 30ml. Only one patient required a blood transfusion and application of a hand-assisted device. Conversion to conventional laparoscopic instruments was necessary in another five patients (4.5%). The operative time of the latter 100 cases (147+/-5.1min, mean+/-standard error of mean) was significantly shorter than that of the initial 12 cases (183+/-8.8min, p=0.001). Larger tumors, previous abdominal surgery, and pheochromocytoma group were independent risk factors of a longer operative time. Except for one leiomyosarcoma, all other tumors were benign adrenal pathologies (57 aldosterone-producing adenomas, 23 Cushing's adenomas, 12 pheochromocytomas, and 20 incidentalomas). CONCLUSION The safety and effectiveness of laparoscopic adrenalectomy employing needlescopic instruments for most adrenal tumors less than 5cm was feasible with acceptable operative time. Pheochromocytomas can also be managed with a longer operative time. Patients with previous upper midline or ipsilateral upper quadrant open surgery might not be suitable candidates for such a technique.
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Affiliation(s)
- Chun-Hou Liao
- Division of Urology, Department of Surgery, Cardinal Tien Hospital, Taipei, Taiwan
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Santoro E, Agresta F, Veltri S, Mulieri G, Bedin N, Mulieri M. Minilaparoscopic colorectal resection: a preliminary experience and an outcomes comparison with classical laparoscopic colon procedures. Surg Endosc 2008; 22:1248-54. [PMID: 17943359 DOI: 10.1007/s00464-007-9601-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 06/29/2007] [Accepted: 07/26/2007] [Indexed: 01/24/2023]
Abstract
BACKGROUND Laparoscopy has rapidly emerged as the preferred surgical approach for a number of different diseases because it allows for a correct diagnosis and proper treatment. However, it is not being applied in a widespread manner for the management of benign or malignant colorectal disease. Its natural evolution seems to be the development of mini-instruments and optics (diameter, </=5 mm). This study aimed to illustrate retrospectively the results of an initial minilaparoscopic colorectal surgery experience at two different institutions. METHODS Between January 2001 and December 2006, a total of 517 patients underwent a laparoscopic colon procedure. Among them, 161 (31.1%) underwent surgery with mini-instruments. The primary end point was the feasibility rate for minilaparoscopic colon resection. The secondary end points were safety and the impact of the technique on the duration of laparoscopy. RESULTS No conversion to classical laparoscopy and eight cases converted to the open approach were registered. The rate for major complications was 3.1%, whereas the rate for minor complications ranged as high as 11.8%. CONCLUSIONS Even if limited by its retrospective design, the reported experience shows that minilaparoscopic surgery may be a safe and effective approach to colon pathology. The described features make minilaparoscopy a challenging alternative to laparoscopy for colon disease. If proven to be cost effective without undue risk, as long as adequate training is obtained and proper preparation is observed, minilaparoscopy may become a standard surgical approach for selected patients.
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Liao CH, Chueh SC, Wu KD, Hsieh MH, Chen J. Laparoscopic partial adrenalectomy for aldosterone-producing adenomas with needlescopic instruments. Urology 2006; 68:663-7. [PMID: 16979699 DOI: 10.1016/j.urology.2006.04.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 11/04/2005] [Revised: 03/29/2006] [Accepted: 04/28/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Laparoscopic total adrenalectomy is the treatment of choice for aldosterone-producing adenomas (APAs). There have not been many reports of laparoscopic partial adrenalectomy, although this procedure offers benefits to patients with suspected bilateral APAs or an APA in a solitary adrenal gland. We describe the feasibility of a novel technique of laparoscopic partial adrenalectomy for APA solely using 2-mm working instruments and a 5 to 10-mm telescope. TECHNICAL CONSIDERATIONS Six unilateral and two bilateral partial adrenalectomies were performed laparoscopically. Only one umbilical 12-mm port for the telescope and two (for left adenomas) or three (for right adenomas) subcostal 2-mm working ports were used. Hemostasis and transection of adrenal tissues were performed using a 2-mm mini-bipolar coagulator and 2-mm scissors. RESULTS All laparoscopic operations were successfully performed using only 2-mm working instruments and a 5 or 10-mm 30 degree telescope with no intraoperative or postoperative complications. Blood loss was minimal, and the operative times were comparable to those of previous reports. All patients had low pain scores, required minimal amounts of narcotics postoperatively, and reported excellent cosmetic results for the wounds. The pathologic examinations confirmed complete excision of all adenomas with intact capsules. The plasma aldosterone concentrations and renin activities returned to normal ranges postoperatively in all patients. At a mean follow-up of 25 months (range 13 to 48), 7 (87.5%) were cured of their hypertension and 1 had the hypertensive medications significantly reduced. CONCLUSIONS Laparoscopic partial adrenalectomy for APAs using 2-mm working instruments and a 5 to 10-mm telescope is a safe and effective treatment alternative.
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Affiliation(s)
- Chun-Hou Liao
- Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Chang YC, Chen CW, Huang SH, Chen JS. Modified needlescopic video-assisted thoracic surgery for primary spontaneous pneumothorax : the long-term effects of apical pleurectomy versus pleural abrasion. Surg Endosc 2006; 20:757-62. [PMID: 16437271 DOI: 10.1007/s00464-005-0275-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [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: 04/18/2005] [Accepted: 08/09/2005] [Indexed: 01/10/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the feasibility and safety of modified needlescopic video-assisted thoracic surgery (VATS) for treating primary spontaneous pneumothorax. The efficacy between apical pleurectomy and pleural abrasion through this technique was also compared. METHODS Between 2001 and 2003, 65 patients with primary spontaneous pneumothorax underwent modified needlescopic VATS procedures. The blebs were resected with endoscopic linear staplers. Pleurodesis was achieved by apical pleurectomy before September 2002 (n = 30) and by pleural abrasion for the remainder of the study period (n = 35). RESULTS Mean operation time was 103 min in the pleurectomy group and 78 min in the abrasion group (p = 0.001). Complications developed in four patients (6.2%): prolonged air leaks in three patients and wound infection in one patient. The mean postoperative hospital stay was 3.8 +/- 1.8 days. The two groups had comparable doses of requested analgesics, complication rates, postoperative chest tube and hospital stays, and postoperative pulmonary function test. Ipsilateral recurrence did not occur in any of the pleurectomy group patients after a mean follow-up of 31 months, but it occurred in three patients (8.6%) in the abrasion group after a mean follow-up of 19 months. CONCLUSIONS Modified needlescopic VATS provides a feasible and safe procedure for treating primary spontaneous pneumothorax. In terms of efficacy, apical pleurectomy is more effective in preventing ipsilateral recurrence than pleural abrasion.
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Affiliation(s)
- Y-C Chang
- Department of Surgery, Far Eastern Memorial Hospital, No. 21, Nan-ya South Road, Sec 2, Banciao City, Taipei, 220, Taiwan
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Santoro E, Agresta F, Aloisi P, Caravani A, Mancini R, Mulieri G, Ciardo LF, Bedin N, Mulieri M. Is minilaparoscopic inguinal hernia repair feasible? A preliminary experience. J Laparoendosc Adv Surg Tech A 2005; 15:294-7. [PMID: 15954832 DOI: 10.1089/lap.2005.15.294] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Laparoscopy has rapidly emerged as the preferred surgical approach to a number of different diseases because it allows for a correct diagnosis and proper treatment. It seems to be moving toward the use of mini-instruments (5 mm or less in diameter). The aim of this paper is to illustrate retrospectively the results of an initial experience of minilaparoscopic transabdominal preperitoneal (miniTAPP) repair of groin hernia defects performed at two institutions. MATERIALS AND METHODS Between February 2000 and December 2003, a total of 303 patients (mean age, 45 years) underwent a miniTAPP procedure: 213 patients (70.2%) were operated on bilaterally and 90 (28.7%) for a unilateral defect, with a total of 516 hernia defects repaired. The primary endpoint was the feasibility rate for miniTAPP. The secondary endpoint was the incidence of mini-TAPP-related complications. RESULTS No conversions to laparoscopy or an anterior open approach were required. There were no major complications, while minor complications ranged as high as 0.3%. CONCLUSION While limited by its retrospective design, the present study indicates that the minilaparoscopic approach to groin hernia repair is safe and effective, making miniTAPP a challenging alternative to laparoscopy in the approach to groin hernia repair.
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Affiliation(s)
- Emanuele Santoro
- Department of General and Laparoscopic Surgery, Nuovo Regina Margherita Hospital, Rome, Italy
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Chen JS, Hsu HH, Kuo SW, Tsai PR, Chen RJ, Lee JM, Lee YC. Needlescopic versus conventional video-assisted thoracic surgery for primary spontaneous pneumothorax: a comparative study. Ann Thorac Surg 2003; 75:1080-5. [PMID: 12683541 DOI: 10.1016/s0003-4975(02)04649-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.0] [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: 11/21/2022]
Abstract
BACKGROUND Management of primary spontaneous pneumothorax by needlescopic video-assisted thoracic surgery (VATS) has rarely been attempted and no comparison study with conventional VATS is available. In this study, we compared the clinical outcomes of needlescopic VATS with conventional VATS in treating primary spontaneous pneumothorax. The technique and our experience with needlescopic VATS are reported. METHODS Between April 2001 and April 2002, a total of 63 patients with recurrent, persistent, or contralateral primary spontaneous pneumothorax were recruited for this study. Operative procedures included needlescopic VATS in 28 patients and conventional VATS in 35 patients. We used a modified operative technique to improve the poor and narrower vision of the needle-videothoracoscope. RESULTS There was no mortality or major complications in either of the two groups. Needlescopic and conventional VATS groups had comparable operation times, postoperative pain, requested doses of meperidine hydrochloride, durations of postoperative chest drainage, and length of hospital stay. After a mean follow-up of 8 months, the needlescopic VATS group had less residual neuralgia (p = 0.021) and better wound satisfaction (p = 0.043) than the conventional VATS group. Ipsilateral recurrence of pneumothorax occurred in 1 patient (3.6%) in the needlescopic VATS group but not in any patients in the conventional VATS group. CONCLUSIONS Our experience showed that needlescopic VATS is technically feasible and can be a satisfactory alternative to conventional VATS in treating primary spontaneous pneumothorax. Limited vision of needlescopic VATS can be improved by the modified technique we used. However, conversion to conventional VATS or minithoracotomy is suggested in selected patients to prevent early recurrence.
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Affiliation(s)
- Jin-Shing Chen
- Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Adrales GL, Mastrangelo MJ, Schwartz RW. The minimally invasive surgical approach to achalasia: a new standard of care? Curr Surg 2002; 59:554-62. [PMID: 16093193 DOI: 10.1016/s0149-7944(02)00673-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Gina L Adrales
- Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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