P95 LAPAROSCOPIC ASSISTED LEFT THORACOABDOMINAL OESOPHAGECTOMY (LLTA); AN INNOVATIVE APPROACH FOR TUMOURS OF THE GASTRO-OESOPHAGEAL JUNCTION

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
A Reyhani ◽  
J Zylstra ◽  
A Davies ◽  
J Gossage
Keyword(s):  
Operation Time ◽  
Median Number ◽  
National Standards ◽  
Resection Margins ◽  
Novel Approach ◽  
Thoracoabdominal Approach ◽  
Lateral Decubitus ◽  
Lower Oesophagus ◽  
Laparoscopic Assisted ◽  
Median Operation Time

Abstract Aim To report a novel approach for tumours located at the gastro-oesophageal junction (GOJ) using a laparoscopic abdominal phase combined with a left thoracoabdominal approach. Background and Methods The standard left thoracoabdominal approach offers excellent exposure and access to GOJ and lower oesophagus. It also involves a single position for the procedure, shortening the operation time. The disadvantages are a large incision, dividing the costochondral junction, and a low level thoracotomy. Laparoscopic Left Thoracoabdominal Oesophagectomy (LLTA) is performed with the patient in the same right lateral decubitus position, but rolled away from the operator at 45xxx. allowing laparoscopic gastric mobilisation and lymphadenectomy. The thoracic phase uses an anterolateral left thoracotomy through the higher 5th intercostal space, giving a higher intrathoracic anastomosis, just below the aortic arch. No disruption of the costochondral junction is made. Consecutive patients treated for GOJ tumours with LLTA operated on during 2013-2019 were analysed and compared to national standards (NOGCA). Results This series of 70 consecutive patients had a mean age of 63 years. Median operation time was 235 minutes. Median inpatient hospital stay was 10 days (NOGCA 9 (11-17)). The majority were adenocarcinoma; predominantly located in the GOJ (Siewert Type1 (37.14%), Type2 (45.71%), Type3 (2.86%)); 90% of the tumours were T3 or T4. Postoperative morbidity was low (Clavien-Dindo 0 in 50% of the patients). The median number of total lymph nodes excised was 27.77 (NOGCA >15). Positive nodes were predominantly located in the lesser-curve (40%), Para-oesophageal 34.29%; Sub-carinal 2.86%. Positive circumferential resection margins (<1mm) were present in 28.57% of patients (NOGCA 25.1%). In-Hospital and 30 day mortality was 1.43% (NOGCA 2.7%). Recurrence after LLTA was 24.29% at a mean 371 days (local 5.7%, systemic 15.7%, mixed 2.86%). Conclusion This series demonstrates a novel, safe and reproducible left sided approach for cancer of the GOJ. There is good exposure at the hiatus, without the division of the costochondral junction and low thoracotomy.

Laparoscopic-assisted left thoracoabdominal esophagectomy (LLTA): an innovative approach for locally advanced tumors of the gastroesophageal junction

2020 ◽  
Vol 33 (11) ◽  
Author(s):  
A Reyhani ◽  
J Zylstra ◽  
A R Davies ◽  
J A Gossage
Keyword(s):  
Gastroesophageal Junction ◽  
Locally Advanced ◽  
Operation Time ◽  
Lateral Decubitus Position ◽  
Left Thoracotomy ◽  
Thoracoabdominal Approach ◽  
Lateral Decubitus ◽  
Locally Advanced Tumors ◽  
Laparoscopic Assisted ◽  
Advanced Tumors

ABSTRACT Purpose To report a novel approach for locally advanced tumors located at the gastroesophageal junction (GEJ) using a laparoscopic abdominal phase and open left thoracotomy with the patient in a single right lateral decubitus position. Background The standard open left thoracoabdominal approach offers excellent exposure and access to the GEJ and lower esophagus. It also involves a single position for the procedure, shortening the operation time. The disadvantages are a large incision, division of the costochondral junction, and a low-level thoracotomy. The laparoscopic-assisted left thoracoabdominal esophagectomy (LLTA) is performed with the patient in the same right lateral decubitus position, but initially rolled away from the operator at 45° allowing laparoscopic gastric mobilization and lymphadenectomy. The patient is then tilted back to the lateral position for the thoracic phase. An anterolateral left thoracotomy is performed through the higher fifth intercostal space allowing a high intrathoracic anastomosis, just below the aortic arch. No disruption of the costochondral junction is made. Methods Consecutive patients selectively treated for locally advanced GEJ tumors with an LLTA approach between 2013 and 2019 were analyzed and compared to national standards (NOGCA). Results This series of 74 consecutive patients had a mean age of 63 years. The median operation time was 235 minutes. The median inpatient stay was 10 days (NOGCA 9 [11–17]). The tumors were predominantly adenocarcinoma (95%) and located at the GEJ (92%). The majority were locally advanced T3 or T4 tumors. Postoperative morbidity was low, Clavien–Dindo (C–D) 0 in 52.7% patients, C–D1 (1.4%), C–D2 (31.1%), C–D3a (5.4%), C–D4a (9.5%), and C–D5 (1.4%). The median number of total lymph nodes (LN) excised was 28 (NOGCA >15); LN % yield ≥18 was 90% (NOGCA 82.5%). Positive nodes were located at the lesser-curve (40%), paraesophageal (32.4%), and subcarinal regions (2.7%). Positive circumferential resection margins (<1 mm) were present in 28.4% of resected specimens (NOGCA 25.1%). This is reflective of the high proportion T3/T4 tumors selected for this approach. Hospital and 30-day mortality was 1.4% (NOGCA 2.7%). Recurrence after LLTA was 25.7% (local 5.4%, systemic 17.6%, mixed 2.7%) at a median of 311 days (62–1,158). Conclusion This series demonstrates a novel, safe, and reproducible approach for locally advanced cancer of the GEJ. It offers a better exposure of the hiatus than the right-sided approach and avoids division of the costochondral junction and low thoracotomy seen with the open left thoracoabdominal approach.

scholarly journals Peroral endoscopic myotomy using FlushKnife BT: a single-center series

2017 ◽  
Vol 05 (07) ◽  
pp. E663-E669 ◽  
Author(s):  
Shinwa Tanaka ◽  
Takashi Toyonaga ◽  
Fumiaki Kawara ◽  
Ian Grimm ◽  
Namiko Hoshi ◽  
...  
Keyword(s):  
Case Series ◽  
Operation Time ◽  
Acid Reflux ◽  
Median Number ◽  
Peroral Endoscopic Myotomy ◽  
Esophageal Spasm ◽  
Vessel Sealing ◽  
Endoscopic Myotomy ◽  
Needle Knife ◽  
Median Operation Time

Abstract Background and study aims Peroral endoscopic myotomy (POEM) is an evolving new treatment strategy for achalasia. Although several kinds of electrosurgical knives have been used in performing POEM, the best device has yet to be determined. The FlushKnife BT is a waterjet-emitting short needle-knife with a small ball tip (BT) that offers the potential to perform all aspects of POEM with a single device. In this study, we evaluated the safety and efficiency of the FlushKnife BT for POEM. Patients and methods A total of 54 consecutive patients with achalasia and other spastic esophageal motility disorders, such as jackhammer esophagus or distal esophageal spasm, who underwent POEM between January 2016 and August 2016, were included in this retrospective study. Results The median operation time was 73.0 minutes (range 39 – 184 minutes). All procedures were completed using only the FlushKnife BT without changing to any other electrosurgical instrument. The median number of additional submucosal injections with an injection needle was 0 (range 0 – 1). Endoscopic vessel sealing was performed a mean of 3 times (range 0 – 7). The median number of bleeding episodes requiring treatment with hemostatic forceps was 0 (range 0 – 5). There were no significant adverse events. Seven of 52 patients (13.5 %) reported symptoms of gastroesophageal reflux disease such as heartburn or acid reflux at 3 month follow-up. Conclusions The FlushKnife BT enabled POEM to be performed with very few device exchanges, either for re-injection or to control intraoperative bleeding. In this uncontrolled case series, the ability of the FlushKnife BT to perform nearly all aspects of the POEM procedure seems to make it particularly well suited to this procedure.

scholarly journals An Indigenous Method of Securing Ventriculoperitoneal Shunt Tube in Peritoneal Cavity

2021 ◽  
Author(s):  
Samir Kumar Kalra ◽  
Krishna Shah ◽  
Sneyhil Tyagi ◽  
Suviraj John ◽  
Rajesh Acharya
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Operation Time ◽  
Complication Rates ◽  
Effective Technique ◽  
Common Procedure ◽  
Shunt System ◽  
Shunt Tube ◽  
Csf Diversion ◽  
Median Operation Time

Abstract Introduction Ventriculoperitoneal shunt (VPS) is the most common procedure used for cerebrospinal fluid (CSF) diversion in hydrocephalus. Over the years, many technical, procedural, and instrument-related advancements have taken place which have reduced the associated complication rates. Shunt block is a very common complication irrespective of the shunt system used. The abdominal end of the shunt tube gets blocked usually due to plugging of omentum onto the shunt catheter. We describe a technique of catheter fixation and placement under vision coupled with omentopexy done laparoscopically to prevent this complication. Materials and Methods This technique was used in 23 patients (11 female, 12 male; range 16–73 years) afflicted with hydrocephalus from June 2016 and December 2019 after obtaining an informed consent, and the outcomes were noted in terms of shunt patency, complications, if any, and the need for revision. Results The median operation time was 90 minutes (range 35–160 minutes). All shunt catheters were still functional after a mean follow-up of 16.5 months (range 1–34 months) and none required revision. Conclusion Laparoscopic placement of shunt tube along with omental folding is a safe and effective technique for salvaging the abdominal end of VPS and may be helpful in reducing shunt blockage.

Laser Ablation of Posterior Urethral Valves by Fetal Cystoscopy

2015 ◽  
Vol 37 (4) ◽  
pp. 267-273 ◽  
Author(s):  
José María Martínez ◽  
Narcis Masoller ◽  
Roland Devlieger ◽  
Esther Passchyn ◽  
Olga Gómez ◽  
...  
Keyword(s):  
Renal Failure ◽  
Laser Ablation ◽  
Amniotic Fluid ◽  
Gestational Age ◽  
Significant Risk ◽  
Operation Time ◽  
Posterior Urethral Valves ◽  
Consecutive Series ◽  
Urethral Valves ◽  
Median Operation Time

Objective: To report the results of fetal cystoscopic laser ablation of posterior urethral valves (PUV) in a consecutive series in two referral centers. Methods: Twenty pregnant women with a presumptive isolated PUV were treated with fetal cystoscopy under local anesthesia. Identification and fulguration of the PUV by one or several firing-contacts with diode laser were attempted. Perinatal and long-term outcomes were prospectively recorded. Results: The median gestational age at procedure was 18.1 weeks (range 15.0-25.6), and median operation time was 24 min (range 15-40). Access to the urethra was achieved in 19/20 (95%) cases, and postoperative, normalization of bladder size and amniotic fluid was observed in 16/20 (80%). Overall, there were 9 (45%) terminations of pregnancy and 11 women (55%) delivered a liveborn baby at a mean gestational age of 37.3 (29.1-40.2) weeks. No infants developed pulmonary hypoplasia and all were alive at 15-110 months. Eight (40% of all fetuses, 72.7% of newborns) had normal renal function and 3 (27.3%) had renal failure awaiting renal transplantation. Conclusion: Fetoscopic laser ablation for PUV can achieve bladder decompression and amniotic fluid normalization with a single procedure in selected cases with anyhydramnios. There is still a significant risk of progression to renal failure pre or postnatally.

scholarly journals Evaluation of laparoscopic-assisted transanal total mesorectal excision (Ta-TME) for locally advanced distal rectal cancer in men with difficult pelvic conditions after neoadjuvant chemoradiation therapy

2020 ◽  
Author(s):  
Yingjie Li ◽  
Guoli He ◽  
Lin Wang ◽  
Qiushi Dong ◽  
Xinzhi Liu ◽  
...  
Keyword(s):  
Resection Margin ◽  
Operation Time ◽  
Neoadjuvant Chemoradiation ◽  
Sphincter Preservation ◽  
Chemoradiation Therapy ◽  
Pelvic Anatomy ◽  
Mesorectal Excision ◽  
Diverting Ileostomy ◽  
Positive Circumferential Resection Margin ◽  
Laparoscopic Assisted

Abstract Background: To evaluate the use of laparoscopic-assisted transanal and total mesorectal excision (Ta-TME) in men with difficult pelvic anatomy in an attempt to optimize anal sphincteric preservation, determine the completeness of TME, and determine postoperative morbidity and mortality.Methods: Twenty male patients (TA group) with difficult pelvic anatomy (narrow pelvis) who were diagnosed with rectal cancer underwent Ta-TME surgery from January 2017 to January 2018 at Peking University Cancer Hospital. We matched these 20 patients with 2 other groups of patients who underwent either a laparoscopic transabdominal TME (LA group) or an open transabdominal TME (OP group) according to age, sex, BMI, distance of tumour from the anal verge, and diameter of the tumour. All 3 groups of patients had undergone preoperative neoadjuvant chemoradiation therapy. The efficacy and safety of Ta-TME were evaluated according to operative time, blood loss, postoperative hospital stay, and postoperative complications. Outcomes of Ta-TME were evaluated by comparing the rate of a positive circumferential resection margin, the integrity of the TME, and the rate of sphincter preservation among the 3 groups. Results: When comparing Ta-TME (TA group), laparoscopic transabdominal TME (LA group), and open transabdominal TME (OP group), the respective mean blood loss (100 mL, 100 mL, 100 mL, p=0.335), postoperative hospital stay (9 days, 9 days, 7 days), number of harvested lymph nodes (7, 6, 7), positive circumferential resection margin rate (0%, 0%, 5%), rate of pathologic complete response (5%,10%,10%), and integrity of TME showed no significant differences across groups (p>0.5 for all). In contrast, there were significant differences in operation time (302 min, 253 min, 135 min), rate of preservation of the anal sphincter (100%, 30%, 45%), and the creation of a protective diverting ileostomy (100%, 30%, 45%, p<0.05 for all).Conclusion: The rate of anal sphincter preservation in the Ta-TME group was considerably greater than that in the other groups, but the safety of the operation did not differ among the 3 groups. Ta-TME required a diverting ileostomy in all cases, and the total operation time for Ta-TME was greater than that of laparoscopic and open transabdominal TME.

Phase II Activity of Belinostat (PXD-101), Carboplatin, and Paclitaxel in Women With Previously Treated Ovarian Cancer

2012 ◽  
Vol 22 (6) ◽  
pp. 979-986 ◽  
Author(s):  
Don S. Dizon ◽  
Lars Damstrup ◽  
Neil J. Finkler ◽  
Ulrik Lassen ◽  
Paul Celano ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Confidence Interval ◽  
Progression Free Survival ◽  
Complete Response ◽  
Median Number ◽  
Clinical Activity ◽  
Phase 2 ◽  
Resistant Disease ◽  
Novel Approach

BackgroundPreclinical data show that belinostat (Bel) is synergistic with carboplatin and paclitaxel in ovarian cancer. To further evaluate the clinical activity of belinostat, carboplatin, and paclitaxel (BelCaP), a phase 1b/2 study was performed, with an exploratory phase 2 expansion planned specifically for women with recurrent epithelial ovarian cancer (EOC).MethodsThirty-five women were treated on the phase 2 expansion cohort. BelCap was given as follows: belinostat, 1000 mg/m2 daily for 5 days with carboplatin, AUC 5; and paclitaxel, 175 mg/m2 given on day 3 of a 21-day cycle. The primary end point was overall response rate (ORR), using a Simon 2 stage design.ResultsThe median age was 60 years (range, 39–80 years), and patients had received a median of 3 prior regimens (range, 1–4). Fifty-four percent had received more than two prior platinum-based combinations, sixteen patients (46%) had primary platinum-resistant disease, whereas 19 patients (54%) recurred within 6 months of their most recent platinum treatment. The median number of cycles of BelCaP administered was 6 (range, 1–23). Three patients had a complete response, and 12 had a partial response, for an ORR of 43% (95% confidence interval, 26%–61%). When stratified by primary platinum status, the ORR was 44% among resistant patients and 63% among sensitive patients. The most common drug-related adverse events related to BelCaP were nausea (83%), fatigue (74%), vomiting (63%), alopecia (57%), and diarrhea (37%). With a median follow-up of 4 months (range, 0–23.3 months), 6-month progression-free survival is 48% (95% confidence interval, 31%–66%). Median overall survival was not reached during study follow-up.ConclusionsBelinostat, carboplatin, and paclitaxel combined was reasonably well tolerated and demonstrated clinical benefit in heavily-pretreated patients with EOC. The addition of belinostat to this platinum-based regimen represents a novel approach to EOC therapy and warrants further exploration.

Short-Term Outcomes of Laparoscopic Surgery for Colorectal Cancer in Oldest-Old Patients

2015 ◽  
Vol 32 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Tetsuro Tominaga ◽  
Hiroaki Takeshita ◽  
Junichi Arai ◽  
Katsunori Takagi ◽  
Masaki Kunizaki ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Oldest Old ◽  
Operation Time ◽  
Open Group ◽  
Background Characteristics ◽  
Old Patients ◽  
Liquid Intake ◽  
Oral Liquid ◽  
Clinical Background ◽  
Laparoscopic Assisted

Background/Aims: Oldest-old patients generally have several comorbidities, and laparoscopic-assisted colectomy (LAC) has not been performed on these patients. However, the surgical technique of LAC has improved, and its indications have been extended. The aim of this study was to evaluate the safety and effectiveness of LAC for patients over 85 years old. Methods: Fifty-eight patients over 85 years old who underwent colectomy were retrospectively analyzed. The patients were divided into two groups (LAC group n = 15; open surgery group (Open group) n = 43), and clinicopathological features, surgical characteristics, and outcomes were compared. Results: There were no significant differences in clinical background characteristics between the groups. The LAC group had longer operation time and greater lymph node dissection (both p < 0.01). Postoperatively, the use of analgesics (p = 0.01) was less and the start of oral liquid intake (p = 0.03) was faster in the LAC group. Postoperative complications occurred in 3 patients (20%) in the LAC group and 13 patients (30%) in the Open group (p = 0.66); delirium (n = 6) and sub-ileus (n = 4) developed only in the Open group. Conclusion: After LAC, elderly patients tended to have less postoperative pain and started oral liquid intake earlier. LAC can be safe and effective, preventing postoperative complications that occur specifically in oldest-old patients.

scholarly journals General versus general anaesthesia combined with caudal block in laparoscopic-assisted Soave pull-through of Hirschsprung disease: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhixiong Lin ◽  
Yifan Fang ◽  
Lei Yan ◽  
Yu Lin ◽  
Mingkun Liu ◽  
...  
Keyword(s):  
Side Effects ◽  
General Anesthesia ◽  
Operation Time ◽  
Hirschsprung Disease ◽  
Caudal Block ◽  
Hemodynamic Changes ◽  
Significant Difference ◽  
Pull Through ◽  
Laparoscopic Assisted ◽  
Duration Of Operation

Abstract Background Caudal block is one of the most preferred regional anesthesia for sub-umbilical region surgeries in the pediatric population. However, few studies are available on caudal block performed in laparoscopic-assisted Soave pull-through of Hirschsprung disease (HD). We aimed to compare general anesthesia (GA) and general anesthesia combined with caudal block (GA + CA) in laparoscopic-assisted Soave pull-through of HD. Methods A retrospective review was performed in children with HD operated in our hospital between 2017 and 2020. Patients were divided into the GA and GA + CA group. The primary outcome was the duration of operation, and secondary outcomes included intraoperative hemodynamic changes, the Face, Legs, Activity, Cry, Consolability (FLACC) scale, dose of anesthetics, and incidence of side effects. Results A total of 47 children with HD were included in the study, including 20 in the GA group and 27 in the GA + CA Group. The two groups were similar in age, gender, weight and type of HD (P > 0.05). The GA + CA group had significantly shorter duration of operation (especially the transanal operation time) (median 1.20 h vs. 0.83 h, P < 0.01) and recovery time (mean 18.05 min vs. 11.89 min, P < 0.01). The mean doses of sufentanil and rocuronium bromide during the procedure and FLACC scores at 1 h and 6 h after surgery were also lower in the GA + CA group (p < 0.01). The hemodynamic changes in the GA + CA group were more stable at time of t2 (during transanal operation) and t3 (10 min after transanal operation), but there was no significant difference in the incidence of postoperative side effects between the two groups (P = 1.000). Conclusion General anesthesia combined with caudal block can shorten the duration of operation, and provide more stable intraoperative hemodynamics and better postoperative analgesia.

scholarly journals Transumblical Single Incision Two-Port Laparoscopic Assisted Appendectomy: Early Experience in Paediatric Patients

2009 ◽  
Vol 22 (2) ◽  
pp. 289-294
Author(s):  
MA Nowshad ◽  
A Mostaque ◽  
SMA Shahid ◽  
HK Emrul
Keyword(s):  
Acute Appendicitis ◽  
Laparoscopic Appendectomy ◽  
Single Incision ◽  
Open Appendectomy ◽  
Operation Time ◽  
Randomized Controlled ◽  
Safe Technique ◽  
Port System ◽  
Laparoscopic Assisted ◽  
Additional Port

Laparoscopic appendectomy considered as superior alternative to open appendectomy. Usual laparoscopic appendectomy is performed with the three port system. In this study, we performed a unique single transumblical incision two-port laparoscopic assisted appendectomy with the aim to reduce postoperative port site complication as well as improving cosmesis and patients satisfaction. From January 2010, 32 patients were admitted with clinically diagnosed acute appendicitis and were randomly assigned to single transumblical incision two-port laparoscopic assisted appendectomy. Transumblical single incision two-port laparoscopic assisted appendectomy was attempted in all patients (9 males and 23 females) with an average age of 9.2 years. Transumblical single incision two-port laparoscopic assisted appendectomy was successfully completed in 31 patients. In one patient, another additional port required due to severe adhesion of the appendix. Mean operation time was 25.2 minutes (range, 17-38), and mean postoperative hospital stay was 1.Sdays (range 1-2). Postoperative complications (local pericaecal abscess) occurred in one case that was treated conservatively. Transumblical single incision two-port laparoscopic assisted appendectomy appears to be a feasible and safe technique for the treatment of acute appendicitis in the paediatric setting. It allows nearly scar less abdominal surgery. The true benefit of the technique should be assessed by randomized controlled trials.TAJ 2009; 22(1): 289-294

scholarly journals Comparative study of open approach and laparoscopic surgery for emergent groin hernias

2019 ◽  
Vol 6 (4) ◽  
pp. 1047
Author(s):  
Yasuhiro Kurumiya ◽  
Keisuke Mizuno ◽  
Ei Sekoguchi ◽  
Gen Sugawara
Keyword(s):  
Laparoscopic Surgery ◽  
Patient Outcomes ◽  
Groin Hernia ◽  
Operation Time ◽  
Open Group ◽  
Open Approach ◽  
Intraoperative Blood Loss ◽  
Median Operation Time ◽  
Groin Hernias ◽  
Emergent Surgery

Background: The utilization of laparoscopic surgery for groin hernias is rapidly increasing in Japan even though a consensus for the use of the laparoscopic over the open approaches to surgery for emergent cases has yet to be determined. Therefore, we retrospectively examined patient outcomes from both open and laparoscopic surgeries.Methods: Emergent surgery for a strangulated groin hernia was performed on 63 patients at our hospital from January 2013 to December 2017. All laparoscopic surgeries were performed using the transabdominal preperitoneal repair (TAPP) approach. The choice of whether to perform an open approach (open) or laparoscopic surgery with the TAPP approach was made by doctors who were familiar with both surgical techniques.Results: There were 49 patients in the open group and 14 patients in the TAPP group. The median operation time (min) was 78 in the open group and 127 in the TAPP group. The median intraoperative blood loss (ml) was 21.0 in the open group and 3.0 in the TAPP group. There were 12 patients (24.5%) in the open group and 1 patient (7.1%) in the TAPP group who had postoperative complications. Surgical site infection did not occur in the TAPP group.Conclusions: TAPP is a useful technique in emergent surgery for incarcerated hernias.

Sign in / Sign up

Export Citation Format

Share Document