P072 ARTICULATED LAPAROSCOPIC INSTRUMENTS. BENEFITS ON LAPAROSCOPIC HERNIOPLASTY

Abstract Aim To present initial experience using 5 mm articulated laparoscopic instruments in tapp laparoscopic hernioplasty that emulated the benefits attributed to robotic surgery. Material and Methods We report data from the first 42 procedures using 5 mm articulating instruments. A retrospective analysis was performed in patients who underwent tapp laparoscopic hernioplasty using novel articulated graspers, needle holders, and scissors. The surgeons and surgical nurses were trained in the handling and operation of the articulating instruments, before the first surgical procedure. In all cases, articulating instruments were inserted through 5 mm trocars. Data collected included patient demographics, details related to the surgical procedure, postoperative outcomes, and complications. Results Over a period of one month, were repaired 78 inguinal hernias. 36 patients had a bilateral hernia, and the mean age was 45 years (SD 15.1), with a mean BMI of 28.6 (SD 6.1). 32 male and 4 female patients. The mean operative time was 90 min. The articulated head of the clamp allowed traction, dissection, and suture in different directions. In addition, was not detected a significant learning curve due to its intuitive applicability. Surgical complications included two serohematomas. All patients discharge during operation day. The procedures performing without intraoperative complications nor conversion to open surgery occurred. Conclusions The use of an articulated instrument has a promising future. It would meet some benefits of robotics without increasing costs. We need randomized comparative studies for a better conclusion.

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Our Experience with Retroperitoneal Laparoendoscopic Single-Site Ureterolithotomy

Urologia Internationalis ◽

10.1159/000360425 ◽

2014 ◽

Vol 94 (1) ◽

pp. 58-63

Author(s):

Zhonghua Wu ◽

Youming Xu ◽

Jianhua Yu ◽

Jin Liu ◽

Jiushun Chen ◽

...

Keyword(s):

Single Port ◽

Intraoperative Complications ◽

Single Site ◽

Ureteral Stones ◽

Laparoendoscopic Single Site ◽

Laparoscopic Instruments ◽

Costal Arch ◽

Attractive Option ◽

The Mean ◽

Port Device

Aim: To report our experience with retroperitoneal laparoendoscopic single-site (LESS) ureterolithotomy for the management of large proximal ureteral stones. Patients and Methods: From July 2011 to April 2012, 20 patients underwent retroperitoneal LESS ureterolithotomy. The indications for the operation were impacted upper ureteral stones larger than 15 mm. A reusable elastic single-port device with 3 working channels was inserted through the 2.5-cm incision at the midpoint between the costal arch and iliac crest on the mid-axillary line. A rigid 10-mm 30° extra-long laparoscope was introduced for monitoring, and a combination of lengthened pre-bent and conventional laparoscopic instruments was used for handling. The surgical procedure was similar to conventional retroperitoneal laparoscopic ureterolithotomy. Results: Retroperitoneal LESS ureterolithotomy was completed in all of the patients. The mean stone size was 18.8 mm (range 16-28). The mean operative time was 108 min (range 75-140). Significant bleeding was not observed, and no major intraoperative complications occurred in any of the patients. The mean hospital stay was 4.4 days (range 3-7). Conclusions: Retroperitoneal LESS ureterolithotomy, using a reusable elastic single-port device, is technically feasible and safe, and the combination of conventional and pre-bent laparoscopic instruments represents an attractive option for retroperitoneal LESS.

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LAPAROSCOPIC TRANS-ABDOMINAL PRE-PERITONEAL (TAPP) REPAIR FOR TREATMENT INGUINAL HERNIA DISEASE

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.4.11 ◽

2018 ◽

Vol 8 (4) ◽

pp. 76-80

Author(s):

Thao Nguyen Minh ◽

Vu Pham Anh ◽

Tri Nguyen Huu ◽

Phu Nguyen Doan Van ◽

Phuc Nguyen Thanh ◽

...

Keyword(s):

Inguinal Hernia ◽

Operative Time ◽

Bilateral Hernia ◽

Repair Method ◽

Tapp Repair ◽

Post Operation ◽

Average Operative Time ◽

The Mean

Background: Inguinal hernia is one of the commonest surgical diseases and there are many different techniques applied. The laparoscopic trans-abdominal pre-peritoneal (TAPP) repair allows a better view of the inguinal anatomy, evaluation of opposite side and resolve combined peritoneal diseases as well. Patient and method: The study included 60 cases with inguinal hernia that have been treated by laparoscopic transabdominal pre-peritoneal (TAPP) repair. Method: Description, prospective follow-up. Result: The mean age was 58±18.2. 96.7% were males. The average operative time was 45.6±15.1 minutes for one side hernia, 73±25.2 minutes for bilateral hernia. 02 cases have been post-operation inguinal seroma complication (3.3%), 02 cases with hydrocele (3.3%), 01 case with abdominal seroma (1.7%). 04 cases (6.7%) opposite inguinal hernia were detected and 05 cases (8.3%) with combined diseases were resolved. Duration of post-operative stay was 3.9±1.1 days. Conclusion: TAPP is a safe and feasible procedure, allows evaluation of opposite side and resolve combined peritoneal diseases.

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The art of robotic colonic resection: a review of progress in the past 5 years

Updates in Surgery ◽

10.1007/s13304-020-00969-2 ◽

2021 ◽

Author(s):

Hongyi Liu ◽

Maolin Xu ◽

Rong Liu ◽

Baoqing Jia ◽

Zhiming Zhao

Keyword(s):

Robotic Surgery ◽

Hospital Stay ◽

Intraoperative Complications ◽

Intestinal Anastomosis ◽

Length Of Hospital Stay ◽

Colonic Resection ◽

Surgical Performance ◽

Conversion To Open Surgery ◽

Minimal Invasiveness ◽

The Past

AbstractSurgery is developing in the direction of minimal invasiveness, and robotic surgery is becoming increasingly adopted in colonic resection procedures. The ergonomic improvements of robot promote surgical performance, reduce workload for surgeons and benefit patients. Compared with laparoscopy-assisted colon surgery, the robotic approach has the advantages of shorter length of hospital stay, lower rate of conversion to open surgery, and lower rate of intraoperative complications for short-term outcomes. Synchronous robotic liver resection with colon cancer is feasible. The introduction of the da Vinci Xi System (Intuitive Surgical, Inc., Sunnyvale, CA, USA) has introduced more flexibility to colonic operations. Optimization of the suprapubic surgical approach may shorten the length of hospital stay for patients who undergo robotic colonic resection. Single-port robotic colectomy reduces the number of robotic ports for better looking and faster recovery. Intestinal anastomosis methods using totally robotic surgery result in shorter time to bowel function recovery and tolerance to a solid diet, although the operative time is longer. Indocyanine green is used as a tracer to assess blood supplementation in the anastomosis and marks lymph nodes during operation. The introduction of new surgical robots from multiple manufacturers is bound to change the landscape of robotic surgery and yield high-quality surgical outcomes. The present article reviews recent advances in robotic colonic resection over the past five years.

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The Emerging Role of Robotic Single-site Approach for Myomectomy: A Systematic Review of the Literature

Surgical Innovation ◽

10.1177/1553350620988227 ◽

2021 ◽

pp. 155335062098822

Author(s):

Eirini Giovannopoulou ◽

Anastasia Prodromidou ◽

Nikolaos Blontzos ◽

Christos Iavazzo

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Complication Rate ◽

Operative Time ◽

Intraoperative Complications ◽

Single Site ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Robotic Myomectomy ◽

The Mean

Objective. To review the existing studies on single-site robotic myomectomy and test the safety and feasibility of this innovative minimally invasive technique. Data Sources. PubMed, Scopus, Google Scholar (from their inception to October 2019), as well as Clinicaltrials.gov databases up to April 2020. Methods of Study Selection. Clinical trials (prospective or retrospective) that reported the outcomes of single-site robotic myomectomy, with a sample of at least 20 patients were considered eligible for the review. Results. The present review was performed in accordance with the guidelines for Systematic Reviews and Meta-Analyses (PRISMA). Four (4) studies met the inclusion criteria, and a total of 267 patients were included with a mean age from 37.1 to 39.1 years and BMI from 21.6 to 29.4 kg/m2. The mean operative time ranged from 131.4 to 154.2 min, the mean docking time from 5.1 to 5.45 min, and the mean blood loss from 57.9 to 182.62 ml. No intraoperative complications were observed, and a conversion rate of 3.8% was reported by a sole study. The overall postoperative complication rate was estimated at 2.2%, and the mean hospital stay ranged from 0.57 to 4.7 days. No significant differences were detected when single-site robotic myomectomy was compared to the multiport technique concerning operative time, blood loss, and total complication rate. Conclusion. Our findings support the safety of single-site robotic myomectomy and its equivalency with the multiport technique on the most studied outcomes. Further studies are needed to conclude on the optimal minimally invasive technique for myomectomy.

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Phaco-nucleotomy techniques in management of pseudoexfoliation syndrome

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v8i2.17003 ◽

2017 ◽

Vol 8 (2) ◽

pp. 144-150 ◽

Cited By ~ 1

Author(s):

Amol Bansal ◽

K. P.S. Malik ◽

V. K. Malik ◽

Kirti Jain

Keyword(s):

Intraoperative Complications ◽

Divide And Conquer ◽

Pseudoexfoliation Syndrome ◽

Extracellular Material ◽

Ocular Tissues ◽

Operative Complications ◽

Pupil Constriction ◽

The Mean ◽

Almost All ◽

Systemic Condition

Introduction: Pseudoexfoliation syndrome is a common clinically important systemic condition characterized by the pathological production and accumulation of an abnormal fibrillar extracellular material in many intraocular and extra ocular tissues. Many studies have shown that pseudoexfoliation syndrome patients have higher rates of intraoperative complications during cataract surgery compared to the patients without it. Objectives: To compare Phaco-chop and Divide and Conquer techniques of phacoemulsification, in the management of pseudoexfoliation syndrome in terms of intraoperative complications. Materials and methods: It is a hospital based prospective study of 90 patients with cataract and pseudoexfoliation syndrome attending ophthalmology outpatient department in our hospital. Results: The mean age of patients in the study was 61.7 years with equal number of unilateral and bilateral cases. Intra operative complications noted in vertical chopping technique was only pupil constriction in 6.7%, no other complications were seen in this technique, whereas in horizontal chopping, 13.3% had pupil constriction, 6.7% had difficulty in chopping, 3.3% had zonular dehiscence and 3.3% had posterior capsular rent . In divide and conquer technique 16.7% had pupil constriction, 10% had difficulty in trenching, 3.3% had posterior capsular rent. Almost all the patients (97.8%) were implanted with intraocular lens after employment of various surgical modifications. Conclusion: Vertical chopping techniques scores over horizontal chopping and divide and conquer technique of phacoemulsification with good surgical outcome because of less complications.

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Prevalence of cholelithiasis in patients with chagasic megaesophagus

Revista da Sociedade Brasileira de Medicina Tropical ◽

10.1590/s0037-86822011005000043 ◽

2011 ◽

Vol 44 (3) ◽

pp. 324-326 ◽

Cited By ~ 4

Author(s):

Eduardo Crema ◽

Ellen Caroline Rosa Resende Silva ◽

Priscila Melo Franciscon ◽

Virmondes Rodrigues Júnior ◽

Aiodair Martins Júnior ◽

...

Keyword(s):

General Population ◽

Chagas Disease ◽

Biliary Tract ◽

Surgical Procedure ◽

Clinical Findings ◽

Parasympathetic Nerve ◽

Subtotal Esophagectomy ◽

Significant Difference ◽

The Mean ◽

Chagasic Megaesophagus

INTRODUCTION: The prevalence of cholelithiasis in the general population ranges from 9 to 18%. This prevalence is known to be higher in the presence of parasympathetic nerve damage of the biliary tract either due to surgery (vagotomy) or neuronal destruction (Chagas disease). The objective of this study was to evaluate the association of cholelithiasis and chagasic or idiopathic megaesophagus. METHODS: The ultrasound scans of 152 patients with megaesophagus submitted to cardiomyotomy and subtotal esophagectomy surgery were evaluated. The presence of cholelithiasis was compared between chagasic and idiopathic esophagopathy and ultrasound and clinical findings were correlated with age, sex and race. RESULTS: A total of 152 cases of megaesophagus, including 137 with chagasic megaesophagus and 15 with idiopathic megaesophagus, were analyzed. The mean age was 56.7 years (45-67) in the 137 patients with chagasic megaesophagus and 35.6 years (27-44) in the 15 cases of idiopathic megaesophagus, with a significant difference between the two groups (p < 0.0001). The group with chagasic megaesophagus consisted of 59 (43%) women and 78 (56.9%) men, while the group with idiopathic megaesophagus consisted of 8 (53.3%) women and 7 (46.6%) men, showing no significant difference between the groups. Of the 137 patients with confirmed chagasic megaesophagus, 39 (28.4%) presented cholelithiasis versus one case (6.6%) in the 15 patients with idiopathic megaesophagus. CONCLUSIONS: The prevalence of cholelithiasis is high in patients with chagasic megaesophagus and preoperative ultrasound should be performed routinely in these patients in order to treat both conditions during the same surgical procedure.

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Positive patient experience of wide awake local anaesthesia no tourniquet (WALANT) hand surgery in the government setting: a prospective descriptive study

SA Orthopaedic Journal ◽

10.17159/2309-8309/2021/v20n3a1 ◽

2021 ◽

Vol 20 (3) ◽

Author(s):

Jaco J Naude ◽

Odette Koch ◽

Ludwig W Schmidt ◽

Theo LB le Roux

Keyword(s):

Patient Experience ◽

Carpal Tunnel ◽

Local Anaesthesia ◽

Surgical Procedure ◽

Hand Surgery ◽

Descriptive Study ◽

Trigger Finger ◽

The Mean ◽

Wide Awake ◽

No Tourniquet

ABSTRACT BACKGROUND: The purpose of this study was to establish a subjective patient experience with wide awake local anaesthesia no tourniquet (WALANT) procedures performed in the institution from May 2019 to March 2020. WALANT surgery was initiated to improve standard operating procedure and to decrease theatre burden METHODS: This prospective, descriptive study included 100 patients with a mean age of 59 years who required either a carpal tunnel or trigger finger release. The patients' pain experience was documented on the visual analogue scale (VAS) for the local anaesthetic injection and the surgical procedure. Overall experience was assessed on the patient's preference to have the procedure performed by the WALANT method or the conventional method RESULTS: One hundred patients were included, of which 67 had medical comorbidities. The mean VAS score was 1.5 (SD±1.6) with pain on injection. The mean VAS pain score during the surgical procedure was 0.2 (SD±0.7). One hundred per cent of patients (100/100) felt they would do the WALANT outpatient procedure again instead of admission to hospital and surgery in the theatre. Two complications occurred related to wound care problems, and were successfully managed. None of the patients required reoperations for incomplete release of the carpal tunnel or trigger finger surgery CONCLUSION: The results of this study suggest that minor hand surgery using the WALANT protocol can be performed effectively and with high patient satisfaction rates in the orthopaedic outpatient clinic, and is a useful tool in the skillset of a hand surgeon Level of evidence: Level 4 Keywords: WALANT, hand surgery, trigger finger, carpal tunnel release

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VP019 TESAR - TOTALLY ENDOSCOPIC SUBLAY ANTERIOR REPAIR - IN MIDLINE DEFECTS REPAIR

British Journal of Surgery ◽

10.1093/bjs/znab395.155 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Federico Fiori ◽

Feancesco Ferrara ◽

Daniele Gentile ◽

Paolo Boati ◽

Matteo Calì

Keyword(s):

Operative Time ◽

Intraoperative Complications ◽

Endoscopic Approach ◽

Anterior Repair ◽

Exclusion Criteria ◽

Diastasis Recti ◽

Midline Defects ◽

Previously Treated ◽

The Mean ◽

Invasive Techniques

Abstract Aim In recent years, many minimally invasive techniques have been presented in abdominall wall repair. Since 2018 we have been using TESAR techinque, an anterior endoscopic approach with mesh sublay, published in 2019 from our group. Material and Methods From May 2018 to May 2021 58 Patients referred to our Unit for clinical and radiological diagnosis of ventral defect (Midline hernia, Incisional hernia, Diastasis Recti>5 cm). Exclusion criteria were: maximum defeact width 8 cm, and contraindications to general anesthesia Results All the patients underwent midline repair with TESAR technique. Three TAR were performed, with defect of 8 cm width previously treated with botox. No conversion to laparotomy occured, no intraoperative complications were registered. Total mean operative time was 156 +- 21,5 min. No postoperative major complications, 3 subcoutaneous seromas occurred ,all treated conservatively. The mean Hospital stay was 2.7 + 0.8 days. Conclusions TESAR is a feasible technique for extraperitoneal repair of midline defects with a totally endoscopic approach, allowing a safe repair with good outcomes in terms of resolutions of symtoms and postoperative complications. The video shows the main steps of the technique in diastasis recti and complicated ventral hernia repair.

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Our comprehensive experience with tracheostomy in tertiary multi-speciality hospital over four years

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20213900 ◽

2021 ◽

Vol 7 (10) ◽

pp. 1649

Author(s):

Parth B. Kapadia ◽

Manit M. Mandal ◽

Ajay J. Panchal ◽

Rakesh Kumar ◽

Neel Parmar ◽

...

Keyword(s):

Medical Education ◽

Retrospective Study ◽

Surgical Procedure ◽

Case Series ◽

Final Outcome ◽

Patient Age ◽

Significant Case ◽

Surgical Emphysema ◽

The Mean ◽

Mean Time

Background: Tracheostomy is a common surgical procedure used to achieve a secure airway in patients in elective as well as emergency conditions. Our study accounts for our first-hand experience with the procedure in our tertiary multi-speciality hospital.Methods: It is a four year (January 2017 to February 2021) retrospective study in which all the 246 cases of tracheostomies were taken into account which were performed during this study period in the department of otorhinolaryngology (ENT), Surat Municipal Institute of Medical Education and Research (SMIMER), Surat (India). The patients were thoroughly followed up until the final outcome of the tracheostomy was established. Results: A total of 246 tracheostomies were performed, 63.82% of which were in men. The mean patient age was 42 years. The majority (76%) were elective, performed for various indications, while the remaining 24% were emergency tracheostomies. All tracheostomies were performed by otorhinolaryngologists. Complications relating to tracheostomy were documented in 40 patients (16%) intra-operatively and/or post-operatively which included bleeding, surgical emphysema, granulations along the stomal site and rarely shock. The mean time to decannulation was 13.48 days.Conclusions: Our study takes into account and discusses the findings of all the 246 tracheostomies which were performed during the study period of 4 years. Elective cases form the majority although there is a significant case series of emergency tracheostomies performed for a range of pathologies.

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Surgical Treatment of Spinal Extradural Arachnoid Cysts in the Thoracolumbar Spine

Neurosurgery ◽

10.1227/neu.0b013e318257bf74 ◽

2012 ◽

Vol 71 (2) ◽

pp. 278-284 ◽

Cited By ~ 31

Author(s):

Haruki Funao ◽

Masaya Nakamura ◽

Naobumi Hosogane ◽

Kota Watanabe ◽

Takashi Tsuji ◽

...

Keyword(s):

Surgical Treatment ◽

Surgical Procedure ◽

Thoracolumbar Spine ◽

Neurological Recovery ◽

Dural Defect ◽

Total Resection ◽

Duration Of Symptoms ◽

Significant Difference ◽

The Mean ◽

Poor Outcomes

Abstract BACKGROUND: Because an idiopathic spinal extradural arachnoid cyst (SEAC) is rare, its optimal surgical treatment remains controversial. OBJECTIVE: To evaluate the results of surgical treatments for SEACs and to clarify features of the disease associated with poor outcomes. METHODS: Twelve patients with SEACs who underwent surgery at our hospital between 1988 and 2008 were examined retrospectively. The mean follow-up period was 4.7 years. Total resection of the cyst was performed in 7 patients and closure of the dural defect without cyst resection in 5 patients. Surgical outcomes were evaluated with regard to the duration of symptoms, the size of the cyst, and the surgical procedure used. RESULTS: Neurological recovery was observed in all patients, and there was no recurrence. Poor outcomes were observed in patients with a long duration of symptoms (>1 year, P < .01) and large cyst size (>5 vertebrae, P < .05). The surgical procedure had no significant association with the postoperative neurological recovery. However, there was a significant difference in the degree of the mean postoperative kyphotic angle between the patients treated by total resection of the cyst (9.7 degrees) and those treated by closure of the dural defect without cyst resection through selective laminectomy (2.2 degrees) (P < .01). CONCLUSION: There was no significant difference in postoperative neurological recovery between the 2 surgical procedures. However, closure of the dural defect without cyst resection was less invasive, preventing postoperative kyphotic deformity of the thoracolumbar spine.

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