Segment IV Approach is Useful for Whole-Layer Laparoscopic Cholecystectomy for Gallbladder Polyps

2021 ◽  
Author(s):  
Yoshiaki Tanji ◽  
Shuichi Fujioka ◽  
Hironori Shiozaki ◽  
Yuki Takano ◽  
Naoto Takahashi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Operative Time ◽  
Malignant Neoplasms ◽  
Pathological Findings ◽  
Gallbladder Polyps ◽  
Cystic Plate ◽  
Potentially Malignant ◽  
Proof Procedure ◽  
Median Operative Time

Abstract Background Whole-layer laparoscopic cholecystectomy (W-LC) has recently been advocated as a total biopsy for potentially malignant neoplasms of the gallbladder; however, it is not an injury-proof procedure. This study reports W-LC using the segment IV approach (technique for securing the whole-layer gallbladder at the medial origin of the cystic plate).MethodsTwenty among twenty-five patients diagnosed with potentially malignant gallbladder polyps underwent this technique.ResultsMostly, W-LC was performed successfully (median operative time 135 min) without intraoperative and postoperative complications. Pathological findings indicated that cholesteric polyps was the most common type (n=13), followed by adenomatous polyps (25%) and carcinoma in situ (5%).ConclusionsWe conclude that the segment IV approach is appropriate for performing total biopsy in patients diagnosed with potentially malignant gallbladder polyps.

SINGLE PORT LAPAROSCOPIC CHOLECYSTECTOMY IN HUE CENTRAL HOSPITAL

2012 ◽  
pp. 25-30
Author(s):  
Xuan Dong Pham ◽  
Nhu Hiep Pham ◽  
Huu Thien Ho ◽  
Anh Vu Pham ◽  
Hai Thanh Nguyen ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Single Port ◽  
Operating Time ◽  
Chronic Cholecystitis ◽  
Central Hospital ◽  
Gallbladder Polyp ◽  
Gallbladder Polyps ◽  
Hospital Patients ◽  
Wound Pain ◽  
Initial Results

Purpose: Evaluating the initial results in applying single port laparoscopic cholecystectomy at Hue Central Hospital. Patients and methods: 29 gallbladder polyps, gallstones with symptoms of acute or chronic cholecystitis and surgeried by single port laparoscopic cholecystectomy at Hue Central Hospital from March 2011 to December 2011. Results: Male/female was 0.45/1. Age: 49.24 ± 16.43 (21-81), 40 to 60 years 54.6%. Cholecystitis: 75.9%, 17.3% gallbladder polyp, gallbladder adenomyomatosis 3.4%. Added 1 trocart because difficult dissection surgery 10.2%, bleeding 6.8% difficult to handle, added 2 trocart 3.4%. Bleeding intraoperative 10.3%. Operating time: 76.2 ± 33.5 minutes, hospital stay: 4 - 6 days 51.7%. Wound pain after 2 weeks of hospital discharge 6.9%, with no wound seromas and no wound infection. Conclusions: Single port laparoscopic cholecystestomy is safe, has fewer complications, can be done with experienced surgeons laparoscopic surgery. Keywords: Single port laparoscopic cholecystectomy, gallbladder ston Key words: Single port laparoscopic cholecystectomy, gallbladder stone

scholarly journals Predictors of Incisional Hernia after Robotic Assisted Radical Prostatectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Avinash Chennamsetty ◽  
Jason Hafron ◽  
Luke Edwards ◽  
Scott Pew ◽  
Behdod Poushanchi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Incisional Hernia ◽  
Operative Time ◽  
Patient Counseling ◽  
Incisional Hernias ◽  
Prostate Weight ◽  
History Of ◽  
Robotic Assisted Radical Prostatectomy

Introduction.To explore the long term incidence and predictors of incisional hernia in patients that had RARP.Methods.All patients who underwent RARP between 2003 and 2012 were mailed a survey reviewing hernia type, location, and repair.Results.Of 577 patients, 48 (8.3%) had a hernia at an incisional site (35 men had umbilical), diagnosed at (median) 1.2 years after RARP (mean follow-up of 5.05 years). No statistically significant differences were found in preoperative diabetes, smoking, pathological stage, age, intraoperative/postoperative complications, operative time, blood loss, BMI, and drain type between patients with and without incisional hernias. Incisional hernia patients had larger median prostate weight (45 versus 38 grams;P=0.001) and a higher proportion had prior laparoscopic cholecystectomy (12.5% (6/48) versus 4.6% (22/480);P=0.033). Overall, 4% (23/577) of patients underwent surgical repair of 24 incisional hernias, 22 umbilical and 2 other port site hernias.Conclusion.Incisional hernia is a known complication of RARP and may be associated with a larger prostate weight and history of prior laparoscopic cholecystectomy. There is concern about the underreporting of incisional hernia after RARP, as it is a complication often requiring surgical revision and is of significance for patient counseling before surgery.

Cholestatic Liver Injury: Care of Patients With Primary Biliary Cholangitis or Primary Sclerosing Cholangitis

2016 ◽  
Vol 27 (4) ◽  
pp. 441-452 ◽  
Author(s):  
Laurie Larson ◽  
Michelle James ◽  
Andrea Gossard
Keyword(s):  
Primary Sclerosing Cholangitis ◽  
Sclerosing Cholangitis ◽  
Disease Recurrence ◽  
Outpatient Setting ◽  
Primary Biliary Cholangitis ◽  
Malignant Neoplasms ◽  
Cholestatic Liver Disease ◽  
Gallbladder Polyps ◽  
Increased Risk ◽  
Common Causes

The most common causes of chronic cholestatic liver disease are primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC). Both disease processes are characterized by a destruction of intrahepatic and/or extrahepatic biliary ducts. The etiology is not entirely clear; however, there is an underlying autoimmune component contributing to both disease processes. Although PBC and PSC are often diagnosed and managed in the outpatient setting, in some instances, a patient may have jaundice, fatigue, and pruritus requiring evaluation and determination of the cholestatic cause. Patients with PSC should be monitored for evidence of cholangiocarcinoma, colon cancer, and gallbladder polyps as they are at an increased risk of malignant neoplasms. Liver transplant has the potential for improving quality of life, although disease recurrence is a risk.

scholarly journals Comparative study of standard laparoscopic cholecystectomy and single incision laparoscopic cholecystectomy: outcome and complications

2019 ◽  
Vol 7 (11) ◽  
pp. 4310
Author(s):  
Kirti Savyasacchi Goyal ◽  
Maneshwar Singh Utaal ◽  
Pramod Kumar Bhatia
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Operative Time ◽  
Gall Bladder Disease ◽  
Single Incision ◽  
Intraoperative Complications ◽  
Single Incision Laparoscopic Surgery ◽  
Bladder Disease ◽  
Standard Laparoscopic Cholecystectomy ◽  
Single Incision Laparoscopic Cholecystectomy

Background: Laparoscopic cholecystectomy (LC) has evolved to be as gold standard treatment for gall bladder disease and is the most common laparoscopic procedure performed worldwide. In recent times, the innovative techniques of Natural orifice Transluminal Endoscopic Surgery (NOTES) and Single Incision Laparoscopic Surgery (SILS) have been applied as a step forward towards scar less surgery with added benefits of less pain and less analgesic requirement, shorter hospital stay, quick return to work.Methods: A retrospective study of 50 patients admitted with gall bladder disease through outdoor for laparoscopic cholecystectomy from November 2018 to January 2019 in Maharishi Markandeshwar Institute of Medical Sciences and Research Mullana (AMBALA) were randomized into two groups of  25 each for Single Incision Laparoscopic Cholecystectomy (SILC) and standard laparoscopic cholecystectomy (LC) comparing the operative time, outcome and  complications.Results: 50 patients admitted to MMIMSR Mullana from November 2018 to January 2019 with gall bladder disease were divided into two groups of 25 each who underwent three port SILC and four port laparoscopic cholecystectomy (4PLC). The average intra-operative time in SILC (80.56 mins) was significantly more than standard laparoscopic cholecystectomy. The average length of stay in the hospital for SILC was 1.8 days (1-3 days), was significantly less than in standard four port laparoscopic cholecystectomy. Incidence of Intraoperative complications were more in SILC than standard LC.Conclusions: SILC as the newer novel technique had better outcomes in terms of cosmesis, early discharge, shorter stay at hospital.

Diseases of the Pituitary Gland

2018 ◽  
pp. 373-394
Author(s):  
Vânia Nosé ◽  
Sandro Santagata ◽  
Edward R. Laws
Keyword(s):  
Cell Differentiation ◽  
Infectious Diseases ◽  
Pituitary Gland ◽  
Pituitary Adenomas ◽  
Sella Turcica ◽  
Vascular Lesions ◽  
Malignant Neoplasms ◽  
Systemic Diseases ◽  
Pathological Findings ◽  
Hormone Production

Diseases of the pituitary gland are common, and the most frequently encountered lesions within the sella turcica and pituitary are described and illustrated in details in this chapter. The lesions present within this chapter include cysts and malformations, vascular lesions, inflammatory disorders, infectious diseases, systemic diseases, and both benign and malignant neoplasms. The most common neoplasms of the pituitary are the pituitary adenomas, and these are described in detail including the numerous subtypes depending on the cell differentiation and hormone production. The chapter contains numerous tables and figures illustrating the pathological findings.

scholarly journals The Health Impact of Surgical Techniques and Assistive Methods Used in Cesarean Deliveries: A Systemic Review

2020 ◽  
Vol 17 (18) ◽  
pp. 6894
Author(s):  
Li-Hsuan Wang ◽  
Kok-Min Seow ◽  
Li-Ru Chen ◽  
Kuo-Hu Chen
Keyword(s):  
Blood Loss ◽  
Cesarean Delivery ◽  
Operative Time ◽  
Surgical Techniques ◽  
Systemic Review ◽  
Fetal Head ◽  
Advantages And Disadvantages ◽  
Cesarean Deliveries ◽  
Fundal Pressure

Cesarean delivery is one of the most frequently performed surgeries in women throughout the world. However, the most optimal technique to minimize maternal and fetal morbidities is still being debated due to various clinical situations and surgeons’ preferences. The contentious topics are the use of vacuum devices other than traditional fundal pressure to assist in the delivery of the fetal head and the techniques of uterine repair used during cesarean deliveries. There are two well-described techniques for suturing the uterus: The uterus can be repaired either temporarily exteriorized (out of abdominal cavity) or in situ (within the peritoneal cavity). Numerous studies have attempted to compare these two techniques in different aspects, including operative time, blood loss, and maternal and fetal outcomes. This review provides an overview of the assistive method of vacuum devices compared with fundal pressure, and the two surgical techniques for uterine repair following cesarean delivery. This descriptive literature review was performed to address important issues for clinical practitioners. It aims to compare the advantages and disadvantages of the assistive methods and surgical techniques used in cesarean deliveries. All of the articles were retrieved from the databases Medline and PubMed using the search terms cesarean delivery, vacuum, and exteriorization. The searching results revealed that after exclusion, there were 9 and 13 eligible articles for vacuum assisted cesarean delivery and uterine exteriorization, respectively. Although several studies have concluded vacuum assistance for fetal extraction as a simple, effective, and beneficial method during fetal head delivery during cesarean delivery, further research is still required to clarify the safety of vacuum assistance. In general, compared to the use of in situ uterine repairs during cesarean delivery, uterine exteriorization for repairs may have benefits of less blood loss and shorter operative time. However, it may also carry a higher risk of intraoperative complications such as nausea and vomiting, uterine atony, and a longer time to the return of bowel function. Clinicians should consider these factors during shared decision-making with their pregnant patients to determine the most suitable techniques for cesarean deliveries.

DOZ047.36: Thoracoscopic esophageal internal axial traction for long- gap esophageal atresia

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
M Juricic ◽  
N Panait ◽  
G Podevin ◽  
A Bonnard ◽  
P Lopez ◽  
...  
Keyword(s):  
Esophageal Atresia ◽  
Operative Time ◽  
Median Number ◽  
Ethical Review ◽  
Multicenter Observational Study ◽  
Long Gap ◽  
Esophageal Anastomosis ◽  
Long Gap Esophageal Atresia ◽  
Axial Traction ◽  
Median Operative Time

Abstract Aim of the Study Long-gap esophageal atresia (LGEA) remains a surgical challenge. This study aimed to report the results of thoracoscopic esophageal axial internal traction in LGEA. Methods This multicenter observational study included retrospectively neonates who underwent primary thoracoscopic esophageal axial internal traction for LGEA between June 2017 and July 2018. LGEA was defined as the technical impossibility to perform a primary esophageal anastomosis. The Ethical Review Board of our institution approved the study. Main Results Eight neonates were included with a median gestational age at birth of 35 weeks [25; 37] and a median birth weight of 2266 g [890; 3800], 6 types I and 2 types II according to Ladd's classification. Initial median gap between 2 esophageal ends was 5 vertebral bodies [4.5; 7]. Internal traction was performed at a median age of 5 weeks of life [1; 17] with a median operative time of 87 minutes. Four patients required at least 2 internal traction procedures. After a mean traction time of 1.5 weeks [1; 13.5], esophageal anastomosis was successfully performed in 7 patients (5 thoracoscopies, 2 thoracotomies) with a median operative time of 165 minutes. One patient needed a colonic interposition. Five of these 7 patients required an esophageal endoscopic dilatation (median number: 4 [2; 6]). Median follow-up was 9.75 months [3; 16]. Conclusions Thoracoscopic esophageal axial internal traction for LGEA was a safe and feasible procedure that allowed an esophageal anastomosis in 7 of the 8 patients. Improvement of the procedure requires setting a common protocol concerning the timing of the first internal axial traction and the duration of traction before considering esophageal anastomosis.

PS01.070: EVALUATION OF THE EFFECTIVENESS OF ROBOTIC FUNDOPLICATIONS IN THE TREATMENT OF GERD

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 69-69
Author(s):  
Mikhail Koshkin ◽  
Oleg Vasnev ◽  
Alexandr Belousov ◽  
Mikhail Mikhnevich ◽  
Magomet Baychorov ◽  
...  
Keyword(s):  
Operative Time ◽  
Conflicts Of Interest ◽  
Nissen Fundoplication ◽  
Laparoscopic Approach ◽  
Laparoscopic Group ◽  
Short Term ◽  
Antireflux Operations ◽  
Davinci System ◽  
Invasive Techniques ◽  
Median Operative Time

Abstract Background Surgical treatment is one of the most effective options for treatment of gastroesofageal reflux disease. Laparoscopic approach became is a ‘gold standard’ over the time demonstrating all advantages of minimally invasive techniques over the open procedures. However the utility of robotic antireflux operations still remains controversial. Methods Since the January till the December of 2017 thirty operations were operated on. Mean age was 57,2 (35–76), among them 21 (70%) were female and 9 (30%) were males. Mean BMI was 29,4 (24,1–41,0). Laparoscopic procedures were performed in15 patients (1st group), robotic procedures with DaVinci system were performed in 15 patients of the second group. Chernousov modified Nissen fundoplication was performed in 25 patients, Toupet fundoplication was used for 4 patients, Nissen type was performed in 4 cases. Results The median operative time in laparoscopic group was 125 min (80–200 min), in robotic group - 124 min (90–210 min). There were no statistical differences between two groups (P = 0,93).Blood loss was minimal in both groups. Mean postoperative hospital stay was 4 days (2–7 days) in the 1st group and 4 days (2–6 days) in the second. There were no statistical differences between two groups (P = 0,19). Postoperative course was uneventful in all patients of both groups. Conclusion Robotic antireflux operations are safe and effective in treatment of patients with reflux-esophagitis. There were no statistically significant differences in short-term results of laparoscopic and robotic operations. Disclosure All authors have declared no conflicts of interest.

Prolonged (Longer than 3 Hours) Laparoscopic Cholecystectomy: Reasons and Results

2011 ◽  
Vol 77 (8) ◽  
pp. 981-984 ◽  
Author(s):  
Gokulakkrishna Subhas ◽  
Aditya Gupta ◽  
Jasneet Bhullar ◽  
Linda Dubay ◽  
Lorenzo Ferguson ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Open Cholecystectomy ◽  
Stepwise Logistic Regression ◽  
Intraabdominal Adhesions ◽  
Average Operative Time ◽  
Prolonged Surgery

For the experienced surgeon, the average operative time for a laparoscopic cholecystectomy is less than 1 hour. There has been no study documenting the causes and results of prolonged (longer than 3 hours) surgery. A retrospective study was done of patients who underwent cholecystectomy between January 2003 and December 2007. A total of 3126 cholecystectomies were done. After excluding patients who had a planned open cholecystectomy and patients who had additional laparoscopic surgeries, we identified 70 patients who had a planned laparoscopic cholecystectomy with operative time exceeding 3 hours. Multivariate stepwise logistic regression was performed analyzing the various factors leading to prolonged surgery. Of the 70 patients, ranging in age from 21 to 92 years (mean, 57 years), most (n = 53) were female. Operative time ranged from 3 hours to 6 hours 40 minutes (mean, 3 hours 37 minutes). Emergency:elective admission ratio was 9:5 and acute cholecystitis (n = 40) was the most common indication. Common characteristics were obesity (n = 44, P = 0.031), intraabdominal adhesions (n = 43, P = 0.004), and previous abdominal surgeries (n = 40, P = 0.002). Intraoperative complications included spillage of stones (n = 6), bile duct injury (n = 3), and bleeding (n = 3). The possibility of prolonged laparoscopic cholecystectomy should be anticipated in patients with obesity and previous abdominal operations. Prolonged surgery increases the risk of complications (bile duct injury, bleeding) and prolongs the postoperative hospital stay.

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