-
Efficacy of the over-the-scope clip (OTSC) for treatment of colorectal postsurgical leaks and fistulas
Abstract
Background Colorectal postsurgical leaks and fistulas are severe complications that dramatically increase morbidity and mortality. The
aim of this study was to evaluate the clinical impact of over-the-scope clip (OTSC) closure to seal the visceral wall in the
management of acute and chronic colorectal postsurgical leaks and fistulas.
Methods We reviewed our prospective series of acute and chronic colorectal postsurgical leaks and fistulas observed between April
2008 and September 2011 and treated by OTSC. Indications were all cases with an orifice <15 mm in maximum diameter with no
extraluminal abscess and luminal stenosis.
Results Endoscopic OTSC closure was performed in 14 consecutive patients (mean defect = 9.1 mm in diameter) by means of 10.5- or 12-mm
clips, depending on the wall defect diameter. In eight cases, the indication was an acute leak and in six cases a chronic
leak, mainly after anterior rectal resection; two cases were complicated by a rectovaginal fistula and in two other cases
by a colocutaneous fistula. OTSC treatment was used to complete endoscopic vacuum-assisted closure of a large defect in three
cases. The overall success rate was 86 % (12/14): 87 % (7/8) in acute and 83 % (5/6) in chronic cases. No OTSC-related complications
occurred. Further surgery was required in one case.
Conclusion Endoscopic OTSC closure of colorectal postsurgical leaks and fistulas is a safe technique, with a high success rate in both
acute and chronic cases, including rectovaginal and colocutaneous fistulas.
- Content Type Journal Article
- Category New Technology
- Pages 1-4
- DOI 10.1007/s00464-012-2340-2
- Authors
- Alberto Arezzo, Digestive, Colorectal and Minimal Invasive Surgery, University of Turin, corso Dogliotti 14, 10126 Torino, Italy
- Mauro Verra, Digestive, Colorectal and Minimal Invasive Surgery, University of Turin, corso Dogliotti 14, 10126 Torino, Italy
- Rossella Reddavid, Digestive, Colorectal and Minimal Invasive Surgery, University of Turin, corso Dogliotti 14, 10126 Torino, Italy
- Francesca Cravero, Digestive, Colorectal and Minimal Invasive Surgery, University of Turin, corso Dogliotti 14, 10126 Torino, Italy
- Marco Augusto Bonino, Digestive, Colorectal and Minimal Invasive Surgery, University of Turin, corso Dogliotti 14, 10126 Torino, Italy
- Mario Morino, Digestive, Colorectal and Minimal Invasive Surgery, University of Turin, corso Dogliotti 14, 10126 Torino, Italy
-
Intrahepatic choledochoscopy during trans-cystic common bile duct exploration; technique, feasibility and value
Abstract
Background Transcystic laparoscopic common bile duct exploration (TC-LCBDE) is advantageous for exploring the bile duct. Choledochoscopy,
however, may be quite challenging to perform transcystically because the cystic duct is usually narrow, duct anatomy may be
unfavorable, and not all stones are amenable to transcystic extraction. Convention suggests that it is technically very difficult
to visualize the intrahepatic bile ducts with transcystic choledochoscopy, due to the angle of insertion of the cystic into
the common bile duct (CBD). However, we have performed intrahepatic choledochoscopy successfully, moving the choledochoscope
from the CBD into the common hepatic duct by using what we have termed a “wiper blade maneuver”. The purpose of this study
was to confirm how often this was possible.
Methods A search of a prospectively collected database of patients undergoing routine intraoperative cholangiography (IOC) and laparoscopic
CBD exploration under the care of a single consultant surgeon was performed.
Results A total of 592 LCBDEs were performed between September 1992 and January 2011; 325 were transcystic explorations. Of these,
72.5 % were female and 56 % were admitted acutely. Exploration and duct clearance was performed by blind Dormia basket trawling
in 63 %. The choledochoscope was utilized in 120 cases (37 %). The 3-mm choledochoscope was used in 66 (55 %) and the 5-mm
scope in 54 (45 %). Intrahepatic choledochoscopy was performed in 49 patients (40.8 %). Length of surgery was 40–350 min (median
90 min; standard deviation 49 min).
Conclusions It is technically challenging to perform intrahepatic choledochoscopy with a 3-mm choledochoscope due to its narrow gauge.
The more rigid 5-mm scope is thus preferred, but is limited in TCE because its effective use depends on the presence of a
dilated cystic duct. Despite the technical limitations of both caliber scopes, we have demonstrated that intrahepatic choledochoscopy
during TCE is possible, with each, in 40 % of cases.
- Content Type Journal Article
- Pages 1-5
- DOI 10.1007/s00464-012-2315-3
- Authors
- Vivienne Gough, Department of Surgery, Monklands Hospital, Airdrie, Lanarkshire ML6 0JS, Scotland, UK
- Nathan Stephens, Department of Surgery, Monklands Hospital, Airdrie, Lanarkshire ML6 0JS, Scotland, UK
- Zubir Ahmed, Department of Surgery, Monklands Hospital, Airdrie, Lanarkshire ML6 0JS, Scotland, UK
- Ahmad H. M. Nassar, Department of Surgery, Monklands Hospital, Airdrie, Lanarkshire ML6 0JS, Scotland, UK
-
Laparoscopic splenectomy: experience of a single center in a series of 300 cases
Abstract
Background Laparoscopic splenectomy (LS) has gradually become the technique of choice for surgical removal of the spleen. The aim of
this study was to evaluate the efficacy of LS in a large cohort of patients from a single center.
Methods From March 1992 to June 2010, 300 patients underwent LS at our hospital for predominantly hematologic disorders. The first
92 cases were performed using an anterior approach, whereas in the remaining 208 cases a lateral approach with a four-trocar
technique was used. Patient demographics, diagnosis, and outcomes were reviewed.
Results Spleen volume was similar between the anterior (350 ml) and the lateral (370 ml) approaches. The lateral approach was associated
with shorter operative time (60 vs. 80 min), less blood loss (30 vs. 110 ml), and no conversion (0 vs. 2.2 %) compared to
the anterior approach. Reoperations were required in three patients (1.0 %) because of bleeding, subphrenic abscess, and intestinal
ischemia. Postoperative complications were significantly fewer for the lateral (4.8 %) than for the anterior (31.5 %) approach
and the hospital stay was shorter (3.1 vs. 5.2 days) and there was less postoperative pain. Splenectomy for hematologic malignancies
resulted in a higher morbidity rate, more postoperative pain, and longer hospital stay. Overall mortality rate was 0.3 %.
No late complications were observed during the 1–5-year follow-up.
Conclusions LS using the lateral approach with the placement of four trocars can be considered the procedure of choice for both benign
and malignant diseases affecting the spleen. Extensive experience and technical standardization help to avoid surgical pitfalls,
providing an adequate control of hemostasis, the excision of accessory spleens (AS), and the avoidance of parenchymal rupture.
- Content Type Journal Article
- Pages 1-7
- DOI 10.1007/s00464-012-2272-x
- Authors
- Francesco Corcione, Department of Laparoscopic and Robotic Surgery, “Azienda Ospedaliera dei Colli”—Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, NA, Italy
- Felice Pirozzi, Department of Laparoscopic and Robotic Surgery, “Azienda Ospedaliera dei Colli”—Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, NA, Italy
- Giuseppe Aragiusto, Department of Hepatobiliary Surgery and Liver Transplantation, “A. Cardarelli” Hospital, Naples, NA, Italy
- Francesco Galante, Department of Laparoscopic and Robotic Surgery, “Azienda Ospedaliera dei Colli”—Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, NA, Italy
- Antonio Sciuto, Department of Laparoscopic and Robotic Surgery, “Azienda Ospedaliera dei Colli”—Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, NA, Italy
-
Description of a novel approach for intraperitoneal drug delivery and the related device
Abstract
Background Two significant limitations of intraperitoneal drug therapy are limited drug distribution and poor penetration into peritoneal
nodules. A possible solution is the application of the so-called “therapeutic pneumoperitoneum,” taking advantage of the gaseous
nature and the pressure of capnoperitoneum during laparoscopy. Our objective was to develop a device able to apply such therapeutic
pneumoperitoneum.
Methods The technology presented here is a spraying device and can be introduced through a trocar. It is driven by mechanical pressure
and consists of an injector, a line, and a nozzle. An in vivo experimental study was performed in five pigs. A transvaginal
cholecystectomy was performed. At the end of the procedure, a standard dose of methylene blue was sprayed/infused into the
abdominal cavity for 30 min (4 test animals w/therapeutic pneumoperitoneum (12 mmHg CO2) and 1 control animal w/conventional lavage (2 l intra-abdominal volume with extracorporeal circulation)). At the end of
the procedure, all animals were autopsied and the peritoneum was analyzed. Outcome criteria were: (1) drug distribution (as
assessed by the stained peritoneal surface at autopsy), and (2) diffusion into the peritoneum (presence or not of macroscopic
staining of the outer aspect of the peritoneum immediately after surgery).
Results Stained peritoneal surface was larger after aerosol application compared with peritoneal lavage, and staining more intense.
Hidden peritoneal surfaces and the anterior abdominal wall were stained only in the aerosol group. In contrast to peritoneal
lavage, the outer aspect of peritoneal membrane was immediately stained after pressurized spraying.
Conclusions This device and the related approach significantly improve both distribution and penetration of a test substance into the
peritoneal cavity in a large animal model. This might be a significant progress in treating intraperitoneal disease, in particular
peritoneal carcinomatosis.
- Content Type Journal Article
- Pages 1-7
- DOI 10.1007/s00464-012-2148-0
- Authors
- Wiebke Solaß, Department of Surgery, Otto-von-Guericke University, Magdeburg, Germany
- Alexander Hetzel, Reger Medizintechnik, Rottweil, Germany
- Giorgi Nadiradze, Department of Surgery, Otto-von-Guericke University, Magdeburg, Germany
- Emil Sagynaliev, Department of Surgery, Otto-von-Guericke University, Magdeburg, Germany
- Marc A. Reymond, Department of Surgery, Otto-von-Guericke University, Magdeburg, Germany
-
Retraction Note: Reduction of postoperative nausea, vomiting, and analgesic requirement with dexamethasone for patients undergoing laparoscopic cholecystectomy
Retraction Note: Reduction of postoperative nausea, vomiting, and analgesic requirement with dexamethasone for patients undergoing laparoscopic cholecystectomy
- Content Type Journal Article
- Category Retraction Note
- Pages 1-1
- DOI 10.1007/s00464-012-2321-5
- Authors
- Y. Fujii, Department of Anesthesiology, Ushiku Aiwa General Hospital, Ibaraki, Japan
- M. Itakura, Department of Anesthesiology, Ushiku Aiwa General Hospital, Ibaraki, Japan
-
Is it worthwhile to preserve adult spleen in laparoscopic distal pancreatectomy? Perioperative and patient-reported outcome analysis
Abstract
Background Despite the emphasis on its role, the spleen has commonly been removed in distal pancreatectomy. We designed this study to
evaluate the efficacy of spleen salvage during laparoscopic distal pancreatectomy for patients with benign and borderline
malignant tumors.
Materials and methods From February 2005 to December 2010, 40 patients underwent spleen-preserving laparoscopic distal pancreatectomy (Sp-Lap DP)
and 32 patients underwent laparoscopic distal pancreatosplenectomy (Lap DPS). Medical records were retrospectively reviewed,
and a specially designed questionnaire was administered to the patients for the follow-up study.
Results The demographics and final diagnoses were similar between the two groups. The operative time was significantly longer in the
Sp-Lap DP group (303.9 ± 136.0 versus 239.0 ± 94.9 min, p = 0.024). Patients in the Lap DPS group had more postoperative pancreatic fistulas of higher grade (p = 0.026). A higher grade of postoperative complications occurred more frequently in the Lap DPS group (p = 0.003). Consequently, postoperative hospital stay was significantly shorter for Sp-Lap DP than for Lap DPS patients (7.1 ± 2.3
versus 12.5 ± 10.8 days, p = 0.004). On the follow-up survey, episodes of common cold or flu were apparently more frequent in the Lap DPS group (p = 0.026). Despite the similar recovery period between the two groups, significantly more patients who underwent Lap DPS felt
fatigue (p = 0.014) and poorer health condition (p = 0.042).
Conclusions In addition to frequent higher-grade complications and prolonged hospital stays, Lap DPS appeared to impair patient quality
of life based on follow-up survey. Even an effort to preserve adult spleen in distal pancreatectomy is worthwhile.
- Content Type Journal Article
- Pages 1-8
- DOI 10.1007/s00464-012-2306-4
- Authors
- Sung Hoon Choi, Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Ludlow Faculty Research Building #204, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Korea
- Mi Ae Seo, Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Ludlow Faculty Research Building #204, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Korea
- Ho Kyoung Hwang, Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Ludlow Faculty Research Building #204, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Korea
- Chang Moo Kang, Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Ludlow Faculty Research Building #204, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Korea
- Woo Jung Lee, Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Ludlow Faculty Research Building #204, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Korea
-
Short-term outcomes of laparoscopic intersphincteric resection from a phase II trial to evaluate laparoscopic surgery for stage 0/I rectal cancer: Japan Society of Laparoscopic Colorectal Surgery Lap RC
Abstract
Background Laparoscopic intersphincteric resection (Lap ISR) is not yet an established technique and its safety and feasibility are unclear.
Our aim was to clarify the safety and feasibility of Lap ISR for clinical stage 0/I rectal cancer (Lap RC) in a prospective
multicenter study of laparoscopic surgery in Japan.
Methods To examine the technical and oncological feasibility of laparoscopic surgery for rectal cancer, we conducted a confirmatory
phase II trial to evaluate laparoscopic surgery for preoperative clinical stage 0/I rectal cancer. Eligibility criteria included
histologically proven carcinoma, size ≤ 8 cm, age 20–75 years, no bowel obstruction, and no prior chemotherapy or radiotherapy.
Between February 2008 and September 2010, 495 patients with rectal cancer underwent laparoscopic surgery at 43 institutions.
Patients’ background characteristics and operative and postoperative outcomes were recorded prospectively.
Results Seventy-seven patients (15.6 %) underwent Lap ISR. A diverting stoma was created in 69 patients (89.6 %). Conversion to open
surgery occurred in 4 patients (5.2 %): 2 patients were converted because of uncontrollable bleeding, and the other 2 patients
because of the need for pelvic side wall lymphadenectomy. There was no mortality. Median operative time was 345 min (range = 198–565),
median amount of blood loss was 100 ml (range = 0–1760), and three patients (3.9 %) were transfused intraoperatively. The
median number of dissected lymph nodes was 14 (range = 3–33), and all (proximal, distal, and vertical) pathological cut margins
were negative. Postoperative complications of grade 2 or more were detected in 17 patients (22.1 %), including anastomotic
leakage in 5 (6.4 %), bowel obstruction in 5 (6.5 %), and surgical site infection in 2 (2.6 %). Abdominal drainage and diverting
stoma were necessary in two patients (2.6 %) due to anastomotic leakage. Median length of postoperative hospital stay was
13 days (range = 7–167).
Conclusion Lap ISR was feasible and safe for clinical stage 0/I rectal cancer with favorable short-term outcome.
- Content Type Journal Article
- Pages 1-10
- DOI 10.1007/s00464-012-2317-1
- Authors
- Shoichi Fujii, Department of Surgery, Gastroenterological Centre, Yokohama City University, 4-57 Urafunecho, Minami-ku, Yokohama, 232-0024 Japan
- Seiichiro Yamamoto, Division of Colorectal Surgery, National Cancer Centre Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
- Masaaki Ito, Colorectal Surgery Division, National Cancer Centre Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577 Japan
- Shigeki Yamaguchi, Department of Gastroenterological Surgery, Saitama Medical University International Medical Centre, 1397-1 Yamane, Hidaka, Saitama, 350-1298 Japan
- Kazuhiro Sakamoto, Department of Coloproctological Surgery, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
- Yusuke Kinugasa, Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777 Japan
- Yukihito Kokuba, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kmikyo-ku, Kyoto, 602-8566 Japan
- Junji Okuda, Department of General and Gastroenterological Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686 Japan
- Kenichi Yoshimura, Translational Research Centre, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
- Masahiko Watanabe, Department of Surgery, Kitasato University Hospital, 1-15-1 Kitasato, Sagamihara, Kanagawa, 228-8555 Japan
-
Trends in adolescent bariatric surgery evaluated by UHC database collection
Abstract
Background With increasing childhood obesity, adolescent bariatric surgery has been increasingly performed. We used a national database
to analyze current trends in laparoscopic bariatric surgery in the adolescent population and related short-term outcomes.
Methods Discharge data from the University Health System Consortium (UHC) database was accessed using International Classification
of Disease codes during a 36 month period. UHC is an alliance of more than 110 academic medical centers and nearly 250 affiliate
hospitals. All adolescent patients between 13 and 18 years of age, with the assorted diagnoses of obesity, who underwent laparoscopic
adjustable gastric banding (LAGB), sleeve gastrectomy (SG), and laparoscopic Roux-en-Y gastric bypass (LRYGB) were evaluated.
The main outcome measures analyzed were morbidity, mortality, length of hospital stay (LOS), overall cost, intensive care
unit (ICU) admission rate, and readmission rate. These outcomes were compared to those of adult bariatric surgery.
Results Adolescent laparoscopic bariatric surgery was performed on 329 patients. At the same time, 49,519 adult bariatric surgeries
were performed. One hundred thirty-six adolescent patients underwent LAGB, 47 had SG, and 146 patients underwent LRYGB. LAGB
has shown a decreasing trend (n = 68, 34, and 34), while SG has shown an increasing trend (n = 8, 15, and 24) over the study years. LRYGB remained stable (n = 44, 60, and 42) throughout the study period. The individual and summative morbidity and mortality rates for these procedures
were zero. Compared to adult bariatric surgery, 30 day in-hospital morbidity (0 vs. 2.2 %, p < 0.02), the LOS (1.99 ± 1.37 vs. 2.38 ± 3.19, p < 0.03), and 30 day readmission rate (0.30 vs. 2.02 %, p < 0.05) are significantly better for adolescent bariatric surgery, while the ICU admission rate (9.78 vs. 6.30 %, p < 0.02) is higher and overall cost ($9,375 ± 6,452 vs. $9,600 ± 8,016, p = 0.61) is comparable.
Conclusion Trends in adolescent laparoscopic bariatric surgery reveal the increased use of sleeve gastrectomy and adjustable gastric
banding falling out of favor.
- Content Type Journal Article
- Pages 1-5
- DOI 10.1007/s00464-012-2318-0
- Authors
- Pradeep Pallati, General Surgery, University of Nebraska Medical Center, Omaha, 985126 NE, USA
- Shelby Buettner, General Surgery, University of Nebraska Medical Center, Omaha, 985126 NE, USA
- Anton Simorov, General Surgery, University of Nebraska Medical Center, Omaha, 985126 NE, USA
- Avishai Meyer, General Surgery, University of Nebraska Medical Center, Omaha, 985126 NE, USA
- Abhijit Shaligram, General Surgery, University of Nebraska Medical Center, Omaha, 985126 NE, USA
- Dmitry Oleynikov, General Surgery, University of Nebraska Medical Center, Omaha, 985126 NE, USA
-
Endoscopic muscularis dissection for upper gastrointestinal subepithelial tumors originating from the muscularis propria
Abstract
Background and aims Based on our experience with endoscopic submucosal dissection (ESD) and new endoscopic techniques for endoscopic closure of
iatrogenic upper gastrointestinal (upper-GI) perforations, we developed methods to remove upper-GI subepithelial tumors (SETs)
originating from the muscularis propria by endoscopic muscularis dissection (EMD). The aim of this study is to evaluate the
clinical feasibility and safety of EMD.
Methods 31 patients with upper-GI SETs originating from the muscularis propria were treated by EMD. The EMD differed from ESD in (1)
precutting the overlying mucosa above the lesion by using snare or longitudinal incision instead of circumferential incision,
(2) dissecting the complete tumors away from submucosal and muscularis propria tissue by electrical dissection combined with
blunt dissection, and (3) closing the wound with clips. Perforations occurring during dissection were closed by endoscopic
methods.
Results 30 of 31 tumors were resected completely (96.8 %). One esophageal lesion was resected partially because of severe adhesions
with surrounding tissue. Mean resected tumor size was 22.1 mm × 15.5 mm, and mean operation time was 76.8 min (range 15–330 min).
Histological diagnosis was gastrointestinal stromal tumor (GIST) in 16 lesions [6 esophageal, 3 cardial, 7 gastric; 6 very
low risk and 10 low risk according to the National Institutes of Health (NIH) risk classification] and leiomyoma in 15 lesions
(8 esophageal, 4 cardial, 3 gastric). No patient developed delayed hemorrhage. Perforation occurred in four patients (12.9
%), all of which were managed successfully by endoscopic techniques. The mean follow-up time was 17.7 months (range 7–35 months).
Follow-up found no tumor recurrence in any patient.
Conclusions In this early experience, EMD appears to be a feasible and minimally invasive treatment for some patients with upper-GI SETs
originating from the muscularis propria. Although there is a higher risk of perforation than with ESD, this will improve with
extended practice, and perforations have become manageable endoscopically.
- Content Type Journal Article
- Pages 1-8
- DOI 10.1007/s00464-012-2305-5
- Authors
- Bing-Rong Liu, Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150086 People’s Republic of China
- Ji-Tao Song, Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150086 People’s Republic of China
- Bo Qu, Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150086 People’s Republic of China
- Ji-Feng Wen, Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150086 People’s Republic of China
- Ji-Bin Yin, Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150086 People’s Republic of China
- Wei Liu, Department of Gastroenterology and Hepatology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin, 150086 People’s Republic of China
-
High incidence of symptomatic incisional hernia after midline extraction in laparoscopic colon resection
Abstract
Background The incidence of incisional hernia has not decreased despite the use of laparoscopy for colon resections. The objective of
this study is to evaluate the impact of the incision used for specimen extraction on the incidence of incisional hernia after
laparoscopic colectomy.
Methods Patients who underwent laparoscopic colectomy without stoma at a single university tertiary-care centre from 2003 to 2009
were identified from an operating room database. Patients were contacted by telephone for participation, and underwent physical
examination ± ultrasonography for incisional hernia at the specimen extraction site and completed the Body Image Questionnaire.
Specimen extraction incisions were classified into midline, transverse and Pfannenstiel groups.
Results Out of a total of 251 patients, 99 patients agreed to participate (68 midline, 7 transverse, 24 Pfannenstiel), while 73 patients
refused consent and 79 patients could not be contacted. Patients who refused consent were older (69.8 vs 62.4 years, p = 0.001) but otherwise were similar to participants with respect to gender, malignant disease, postoperative complications
and extraction site. Mean length of follow-up was 37.0 months. The overall incidence of incisional hernia was 21% (21/99),
being 29 % (20/68) after midline incision compared with 14 % (1/7) after transverse and 0 % (0/24) after Pfannenstiel incisions
(p = 0.002). Of patients with incisional hernia, 47 % (10/21) were symptomatic. Patients with incisional hernia had lower cosmetic
score (14.4 vs 17.7, p = 0.02) compared with those without, but there was no difference in body image score. There were no differences in body image
or cosmesis between the three incisions.
Conclusions There is a high incidence of symptomatic incisional hernia after midline specimen extraction in laparoscopic colectomy, which
negatively impacts cosmesis. The risk of hernia may be lower with the use of a transverse or Pfannenstiel incision for specimen
extraction.
- Content Type Journal Article
- Pages 1-6
- DOI 10.1007/s00464-012-2311-7
- Authors
- Lawrence Lee, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, QC, Canada
- Benjamin Mappin-Kasirer, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, QC, Canada
- Alexander Sender Liberman, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, QC, Canada
- Barry Stein, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, QC, Canada
- Patrick Charlebois, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, QC, Canada
- Melina Vassiliou, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, QC, Canada
- Gerald M. Fried, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, QC, Canada
- Liane S. Feldman, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, QC, Canada
-
Laparoscopic splenectomy for massive splenomegaly in benign hematological diseases
Abstract
Background Laparoscopic splenectomy has become the standard of care for benign hematological disease affecting the spleen; its role in
massive splenomegaly remains controversial. In this study, we evaluated the outcome of laparoscopic splenectomies in terms
of spleen size in a group of 83 patients of benign hematological diseases.
Methods From July 2003 to December 2009, 83 patients underwent laparoscopic splenectomy for various benign hematological diseases.
The data were recorded and analyzed in a retrospective manner. The patients were divided in to two groups according to the
spleen weight; group I < 2,000 g (n = 54) and group II > 2,000 g (n = 29). Age, sex, hematological condition, operative time, estimated blood loss, conversion to open surgery, splenic weight,
length of hospital stay, time to liquid diet, and morbidity were all recorded.
Results Laparoscopic splenectomy was completed in 79 patients (95.2 %). Operative time (p = 0.01) and estimated blood loss (p = 0.001) was more in group II. The length of hospital stay (p = 0.05) and the postoperative morbidity (p = 0.001) also were significantly more in the second group. There was no mortality.
Conclusions Laparoscopic splenectomy is possible and safe for massive splenomegaly in hematological disease (>2,000 g), but it needs longer
operative time and hospital stay.
- Content Type Journal Article
- Pages 1-4
- DOI 10.1007/s00464-012-2314-4
- Authors
- Abdulrahman Saleh Al-Mulhim, Department of Surgery, Medical College, King Faisal University, P.O. Box 1164, Hofuf, Al-Hassa 31982, Kingdom of Saudi Arabia
-
Radiofrequency versus ultrasonic energy in laparoscopic colorectal surgery: a metaanalysis of operative time and blood loss
Abstract
Background Various energy sources are available for tissue dissection and vessel sealing in laparoscopic colorectal surgery. The electrothermal
bipolar vessel sealing system (EBVS) and ultrasonic energy (UE) devices are widely used to provide hemostatic dissection in
laparoscopic procedures. Nevertheless, available evidenced-based data comparing their operative results still are scarce.
This study conducted a metaanalysis of controlled clinical trials comparing EBVS and UE in terms of operative time and intraoperative
blood losses in laparoscopic colorectal surgery
Methods The MEDLINE and Embase databases were searched using medical subject headings and free text words. All randomized controlled
trials (RCTs) and controlled clinical trials using EBVS and UE in laparoscopic colorectal surgery were considered for inclusion
in the study. Random effects models were used in case of heterogeneity to obtain summary statistics for the overall difference
in operating time and blood loss between instruments.
Results Four studies comparing EBVS with UE for 397 patients (200 EBVS vs. 197 UE patients) were included in the study. The findings
showed that EBVS was associated with a significantly shorter operative time and less intraoperative blood loss than UE (p < 0.05).
Conclusions The metaanalysis indicated that EBVS is associated with a shorter operative time and less blood loss than UE in laparoscopic
colorectal surgery. However, these results should be interpreted with caution due to the high heterogeneity of the included
trials and the limited number of studies with a high level of evidence. More adequately designed RCTs with a larger number
of patients are required to confirm the results of this metaanalysis.
- Content Type Journal Article
- Pages 1-8
- DOI 10.1007/s00464-012-2285-5
- Authors
- Nicola Di Lorenzo, Department of Surgical Sciences, University of Rome Tor Vergata, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
- Luana Franceschilli, Department of Surgical Sciences, University of Rome Tor Vergata, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
- Marco Ettore Allaix, Department of Digestive Surgery and Centre for Minimally Invasive Surgery, University of Turin, Turin, Italy
- Anastasios Asimakopoulos, Division of Urology, Department of Surgical Sciences, University of Rome, Tor Vergata, Italy
- Pierpaolo Sileri, Department of Surgical Sciences, University of Rome Tor Vergata, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
- Achille L. Gaspari, Department of Surgical Sciences, University of Rome Tor Vergata, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
-
Three-dimensional vision enhances task performance independently of the surgical method
Abstract
Background Within the next few years, the medical industry will launch increasingly affordable three-dimensional (3D) vision systems
for the operating room (OR). This study aimed to evaluate the effect of two-dimensional (2D) and 3D visualization on surgical
skills and task performance.
Methods In this study, 34 individuals with varying laparoscopic experience (18 inexperienced individuals) performed three tasks to
test spatial relationships, grasping and positioning, dexterity, precision, and hand–eye and hand–hand coordination. Each
task was performed in 3D using binocular vision for open performance, the Viking 3Di Vision System for laparoscopic performance,
and the DaVinci robotic system. The same tasks were repeated in 2D using an eye patch for monocular vision, conventional laparoscopy,
and the DaVinci robotic system.
Results Loss of 3D vision significantly increased the perceived difficulty of a task and the time required to perform it, independently
of the approach (P < 0.0001–0.02). Simple tasks took 25 % to 30 % longer to complete and more complex tasks took 75 % longer with 2D than with
3D vision. Only the difficult task was performed faster with the robot than with laparoscopy (P = 0.005). In every case, 3D robotic performance was superior to conventional laparoscopy (2D) (P < 0.001–0.015).
Conclusions The more complex the task, the more 3D vision accelerates task completion compared with 2D vision. The gain in task performance
is independent of the surgical method.
- Content Type Journal Article
- Pages 1-8
- DOI 10.1007/s00464-012-2295-3
- Authors
- O. J. Wagner, Department of Visceral and Transplantation Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
- M. Hagen, Department of Visceral and Transplantation Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
- A. Kurmann, Department of Visceral and Transplantation Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
- S. Horgan, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, CA, USA
- D. Candinas, Department of Visceral and Transplantation Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
- S. A. Vorburger, Department of Visceral and Transplantation Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
-
Comparative treatment and literature review for laparoscopic splenectomy alone versus preoperative splenic artery embolization splenectomy
Abstract
Background Although laparoscopic splenectomy has been gradually regarded as an acceptable therapeutic approach for patients with massive
splenomegaly, intraoperative blood loss remains an important complication. In an effort to evaluate the most effective and
safe treatment of splenomegaly, we compared three methods of surgery for treating splenomegaly, including open splenectomy,
laparoscopic splenectomy, and a combination of preoperative splenic artery embolization plus laparoscopic splenectomy.
Methods From January 2006 to August 2011, 79 patients underwent splenectomy in our hospital. Of them, 20 patients underwent a combined
treatment of preoperative splenic artery embolization and laparoscopic splenectomy (group 1), 30 patients had laparoscopic
splenectomy alone (group 2), and 29 patients underwent open splenectomy (group 3). Patients’ demographics, perioperative data,
clinical outcome, and hematological changes were analyzed.
Results Preoperative splenic artery embolization plus laparoscopic splenectomy was successfully performed in all patients in group
1. One patient in group 2 required an intraoperative conversion to traditional open splenectomy because of severe blood loss.
Compared with group 2, significantly shorter operating time, less intraoperative blood loss, and shorter postoperative hospital
stay were noted in group 1. No marked significant differences in postoperative complications of either group were observed.
Compared with group 3, group 1 had less intraoperative blood loss, shorter postoperative stay, and fewer complications. No
significant differences were found in operating time. There was a marked increase in platelet count and white blood count
in both groups during the follow-up period.
Conclusions Preoperative splenic artery embolization with laparoscopic splenectomy reduced the operating time and decreased intraoperative
blood loss when compared with laparoscopic splenectomy alone or open splenectomy. Splenic artery embolization is a useful
intraoperative adjunctive procedure for patients with splenomegaly because of the benefit of perioperative outcomes.
- Content Type Journal Article
- Pages 1-9
- DOI 10.1007/s00464-012-2270-z
- Authors
- Zhong Wu, Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041 China
- Jin Zhou, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, 610041 China
- Prasoon Pankaj, Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041 China
- Bing Peng, Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041 China
-
A comparative study of surgery and endoscopy for the treatment of bile duct stricture in patients with chronic pancreatitis
Abstract
Background This study aimed to compare the outcomes of endoscopic treatment (ET) and surgical treatment (ST) for common bile duct (CBD)
stricture in patients with chronic pancreatitis (CP).
Methods From 2004 to 2009, 39 patients (35 men and 4 women; median age, 52 years; range, 38–66 years) were referred for CBD stricture
in CP. Of these 39 patients, 33 (85 %) underwent primary ET, and 6 underwent primary ST. Treatment success was defined in
both groups as the absence of signs denoting recurrence, with normal serum bilirubin and alkaline phosphatase levels after
permanent stent removal in ET group. The follow-up period was longer than 12 months for all the patients.
Results For the patients treated with ET, the mean number of biliary procedures was 3 (range, 1–10) per patient including extractible
metallic stents in 35 % and multiple plastic stents in 65 % of the patients. The mean duration of stent intubation was 11 months.
The surgical procedure associated with biliary drainage (4 choledochoduodenostomies, 1 choledochojejunostomy, and 1 biliary
decompression within the pancreatic head) was a Frey procedure for five patients and a pancreaticojejunostomy for one patient.
The overall morbidity rate was higher in the ST group. The total hospital length of stay was similar in the two groups (16
vs 24 days, respectively; p = 0.21). In terms of intention to treat, the success rates for ST and ET did not differ significantly (83 % vs 76 %; p = 0.08). Due to failure, 17 patients required ST after ET. Event-free survival was significantly longer in the ST group (16.9
vs 5.8 months; p = 0.01). The actuarial success rates were 74 % at 6 months, 74 % at 12 months, and 65 % at 24 months in the ST group and
respectively 75 %, 69 %, and 12 % in the ET group (p = 0.01). After more than three endoscopic procedures, the success rates were 27 % at 6 months and 18 % at 18 months.
Conclusion For bile duct stricture in CP, surgery is associated with better long-term outcomes than endoscopic therapy. After more than
three endoscopic procedures, the success rate is low.
- Content Type Journal Article
- Pages 1-7
- DOI 10.1007/s00464-012-2283-7
- Authors
- Jean-Marc Regimbeau, Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardy, Place Victor Pauchet, 80054 Amiens Cedex 01, France
- David Fuks, Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardy, Place Victor Pauchet, 80054 Amiens Cedex 01, France
- Eric Bartoli, Department of Hepatogastroenterology, Amiens University Hospital and Jules Verne University of Picardy, Place Victor Pauchet, 80054 Amiens Cedex 01, France
- Mathurin Fumery, Department of Hepatogastroenterology, Amiens University Hospital and Jules Verne University of Picardy, Place Victor Pauchet, 80054 Amiens Cedex 01, France
- Adina Hanes, Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardy, Place Victor Pauchet, 80054 Amiens Cedex 01, France
- Thierry Yzet, Department of Radiology, Amiens University Hospital and Jules Verne University of Picardy, Place Victor Pauchet, 80054 Amiens Cedex 01, France
- Richard Delcenserie, Department of Hepatogastroenterology, Amiens University Hospital and Jules Verne University of Picardy, Place Victor Pauchet, 80054 Amiens Cedex 01, France
-
Radiofrequency energy antenna coupling to common laparoscopic instruments: practical implications
Abstract
Background Electromagnetic coupling can occur between the monopolar “Bovie” instrument and other laparoscopic instruments without direct
contact by a phenomenon termed antenna coupling. The purpose of this study was to determine if, and to what extent, radiofrequency
energy couples to other common laparoscopic instruments and to describe practical steps that can minimize the magnitude of
antenna coupling.
Methods In a laparoscopic simulator, monopolar radiofrequency energy was delivered to an L-hook. The tips of standard, nonelectrical
laparoscopic instruments (either an unlit 10 mm telescope or a 5 mm grasper) were placed adjacent to bovine liver tissue and
were never in contact with the active electrode. Thermal imaging quantified the change in tissue temperature nearest the tip
of the telescope or grasper at the end of a 5 s activation of the active electrode.
Results A 5 s activation (30 watts, coagulation mode, 4 cm separation between instruments) increased tissue temperature compared with
baseline adjacent to the grasper tip (2.2 ± 2.2 °C; p = 0.013) and telescope tip (38.2 ± 8.0 °C; p < 0.001). The laparoscopic telescope tip increased tissue temperature more than the laparoscopic grasper tip (p < 0.001). Lowering the generator power from 30 to 15 Watts decreased the heat generated at the telescope tip (38.2 ± 8.0
vs. 13.5 ± 7.5 °C; p < 0.001). Complete separation of the camera/light cords and the active electrode cord decreased the heat generated near the
telescope tip compared with parallel bundling of the cords (38.2 ± 8.0 vs. 15.7 ± 11.6 °C; p < 0.001).
Conclusions Commonly used laparoscopic instruments couple monopolar radiofrequency energy without direct contact with the active electrode,
a phenomenon that results in heat transfer from a nonelectrically active instrument tip to adjacent tissue. Practical steps
to minimize heat transfer resulting from antenna coupling include reducing the monopolar generator power setting and avoiding
of parallel bundling of the telescope and active electrode cords.
- Content Type Journal Article
- Pages 1-5
- DOI 10.1007/s00464-012-2312-6
- Authors
- Edward L. Jones, Department of Surgery, University of Colorado School of Medicine, 12631 East 17th Ave., MS C313, Aurora, CO 80045, USA
- Thomas N. Robinson, Department of Surgery, University of Colorado School of Medicine, 12631 East 17th Ave., MS C313, Aurora, CO 80045, USA
- Jennifer R. McHenry, Covidien Electrosurgery, Boulder, CO, USA
- Christina L. Dunn, Department of Surgery, University of Colorado School of Medicine, 12631 East 17th Ave., MS C313, Aurora, CO 80045, USA
- Paul N. Montero, Department of Surgery, University of Colorado School of Medicine, 12631 East 17th Ave., MS C313, Aurora, CO 80045, USA
- Henry R. Govekar, Department of Surgery, University of Colorado School of Medicine, 12631 East 17th Ave., MS C313, Aurora, CO 80045, USA
- Greg V. Stiegmann, Department of Surgery, University of Colorado School of Medicine, 12631 East 17th Ave., MS C313, Aurora, CO 80045, USA
-
Deep sedation in natural orifice transluminal endoscopic surgery (NOTES): a comparative study with dogs
Abstract
Background Natural orifice transluminal endoscopic surgery (NOTES) has been mostly performed with the animal under general and inhalational
anesthesia (IA-NOTES). To date, NOTES using propofol sedation (PS-NOTES) has not been investigated. This study aimed to assess
the feasibility and safety of PS-NOTES for transgastric oophorectomy with carbon dioxide insufflation and to compare its success
rates with those of conventional IA-NOTES.
Methods In this prospective randomized study, NOTES oophorectomy was performed for 19 female dogs randomized to two conditions: PS
(study group) and IA (control group). Sedation success rates (ability to visualize and resect ovaries without converting to
IA), operative success rates (ability to resect and retrieve both ovaries in full using only NOTES), and vital parameters
including hemodynamic and respiratory changes were documented.
Results In the PS-NOTES group (n = 9), the sedation success rate was 100 %. The operative success rate was 67 % (6 of 9 animals) compared with 80 % (8 of
10 animals) in the IA-NOTES group. No purposeful movement occurred during surgical manipulation and no respiratory or cardiovascular
complications in occured the PS group. Heart rate (HR) and end-tidal carbon dioxide (ETCO2) were significantly higher in the PS group than in the IA group. Blood pressure (BP) was significantly higher in the PS group
only during the middle part of the procedure. Only mild respiratory depression was noted in the PS group, as indicated by
elevated but acceptable ETCO2. Elevations in BP and HR are thought to be related to elevated CO2 but did not appear to have an adverse impact on the course of the procedure. Recovery was uneventful for all the animals.
Conclusion The use of PS-NOTES appears to be feasible, resulting in outcomes comparable with those for IA in dogs. Further studies are
needed to determine the applicability of this concept in human NOTES.
- Content Type Journal Article
- Pages 1-11
- DOI 10.1007/s00464-012-2309-1
- Authors
- Mohammad Al-Haddad, Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, 550 N University Boulevard, UH 4100, Indianapolis, IN 46202, USA
- Daniel McKenna, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Jeff Ko, Purdue University School of Veterinary Medicine, West Lafayette, IN, USA
- Stuart Sherman, Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, 550 N University Boulevard, UH 4100, Indianapolis, IN 46202, USA
- Don J. Selzer, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Samer G. Mattar, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Thomas F. Imperiale, Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, 550 N University Boulevard, UH 4100, Indianapolis, IN 46202, USA
- Douglas K. Rex, Department of Medicine, Division of Gastroenterology, Indiana University School of Medicine, 550 N University Boulevard, UH 4100, Indianapolis, IN 46202, USA
- Attila Nakeeb, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
- Seong Mok Jeong, Purdue University School of Veterinary Medicine, West Lafayette, IN, USA
- Cynthia S. Johnson, Division of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
- Lynetta J. Freeman, Purdue University School of Veterinary Medicine, West Lafayette, IN, USA
-
Laparoscopic retrosternal bypass for corrosive stricture of the esophagus
Abstract
Introduction Surgical management of corrosive stricture of the esophagus entails replacement of the scarred esophagus with a gastric or
colonic conduit. This has traditionally been done using the conventional open surgical approach. We herein describe the first
ever reported minimally invasive technique for performing retrosternal esophageal bypass using a stomach conduit.
Methods Patients with corrosive stricture involving the esophagus alone with a normal stomach were selected. The surgery was performed
with the patient in supine position using four abdominal ports and a transverse skin crease neck incision. Steps included
mobilization of the stomach and division of the gastroesophageal junction, creation of a retrosternal space, transposition
of stomach into the neck (via retrosternal space), and a cervical esophagogastric anastomosis.
Results Four patients with corrosive stricture of the esophagus underwent this procedure. The average duration of surgery was 260
(240–300) min. All patients could be ambulated on the first postoperative day and were allowed oral liquids between the fifth
and seventh day. At mean follow-up of 6.5 (3–9) months, all are euphagic to solid diet and have excellent cosmetic results.
Conclusions Laparoscopic bypass for corrosive stricture of the esophagus using a gastric conduit is technically feasible. It results in
early postoperative recovery, effective relief of dysphagia, and excellent cosmesis in these young patients.
- Content Type Journal Article
- Category Technique
- Pages 1-6
- DOI 10.1007/s00464-012-2307-3
- Authors
- Amit Javed, Department of Gastrointestinal Surgery, GB Pant Hospital and Maulana Azad Medical College, Delhi University, New Delhi, India
- Anil K. Agarwal, Department of Gastrointestinal Surgery, GB Pant Hospital and Maulana Azad Medical College, Delhi University, New Delhi, India
-
Personalized medicine for laparoscopic gastrectomy in gastric cancer
Personalized medicine for laparoscopic gastrectomy in gastric cancer
- Content Type Journal Article
- Category Letter to the Editor
- Pages 1-2
- DOI 10.1007/s00464-012-2316-2
- Authors
- Christof Hottenrott, Chirurgische Klinik, St. Elisabethenkrankenhaus, Ginnheimer Straße 3, 60487 Frankfurt, Germany
-
Transvaginal cholecystectomy versus single-incision laparoscopic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective cohort study
Abstract
Objective This report describes the first prospective cohort study comparing transvaginal cholecystectomies (TVC) with single incision
laparoscopic cholecystectomies (SILC) and four-port laparoscopic cholecystectomies (4PLC).
Methods Between May 2009 and August 2010, 14 patients underwent a TVC. These patients were compared with patients who underwent SILC
(22 patients) or 4PLC (11 patients) in a concurrent, randomized, controlled trial. Demographic data, operative time, numerical
pain scales, complications, and return to work were recorded.
Results Mean age (TVC: 33.5 ± 3.0 year; SILC: 38.4 ± 3.3 year; 4PLC: 35.5 ± 4.1 year; p = 0.58) and mean BMI (TVC: 28.8 ± 1.5 kg/m2; SILC: 31.8 ± 1 kg/m2; 4PLC: 31.4 ± 2.2 kg/m2; p = 0.35) were not statistically significant. However, mean operative time (TVC: 67 ± 3.9 min; SILC: 48.9 ± 2.6 min; 4PLC:
42.3 ± 3.9 min; p < 0.001) was significantly longer for TVC. Numerical pain scales showed significantly lower pain scores on POD 1 and 3 for
TVC compared with SILC and 4PLC (TVC: 4.1 ± 0.5 and 2.9 ± 0.7; SILC: 6.1 ± 0.5 and 5.3 ± 0.5; 4PLC: 5.7 ± 0.4 and 4.7 ± 0.3;
p = 0.02) with equilibration of pain scores by days 14 and 30. Return to work (TVC: 6.4 ± 1.5 days; SILC: 13.1 ± 1.3 days;
4PLC: 14.1 ± 1.4 days; p < 0.001) also was significantly faster for patients in the TVC group. One conversion in the TVC group to a 4PLC was necessary
due to adhesions within the pelvis. One dislodged IUD was seen and immediately replaced in the TVC group. One hernia was observed
in the SILC group.
Conclusions Transvaginal cholecystectomy is a safe and well-tolerated procedure with statistically significantly less pain at 1 and 3 days
after surgery, with a faster return to work but longer operative times compared with single incision and four-port laparoscopic
cholecystectomy.
- Content Type Journal Article
- Pages 1-5
- DOI 10.1007/s00464-012-2253-0
- Authors
- Daniel Solomon, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA
- Amir H. Shariff, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA
- Dan-Arin Silasi, Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, CT 06510, USA
- Andrew J. Duffy, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA
- Robert L. Bell, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA
- Kurt E. Roberts, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA
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