Normal laparoscopic anatomy of the caprine pelvic cavity

Due to the several advantages over conventional procedures, the laparoscopic disease diagnosis and surgery has now started receiving attention in small ruminants. The normal laparoscopic anatomy needs to be described for comparison with the findings in animals with various diseases. The objective of the present study was therefore to describe the laparoscopic anatomy of the caprine pelvic cavity. Adult Bakerwal and Pashmina goats (n=25) of both the sexes were included in this laparoscopy study. All the animals were restrained in dorsal recumbency and Trendelenburg position under lumbosacral epidural anesthesia and sedation. After creating the pneumoperitoneum, the primary port for 5 mm laparoscope was placed at linea alba (3.0 cm cranial to mammary glands in does), and at right paramedian (3.0 cm cranial to the rudimentary teat in the bucks) site. Secondary port was placed under direct laparoscopic observation 5-6 cm away from the primary port in horizontal plane, to allow insertion of the grasping forceps. Scan was performed first at the primary port and subsequently through the secondary port for orientation and exploration of the pelvic cavity. The ventral laparoscopic approach provided satisfactory exposure of the pelvic cavity in goats. Comprehensive description of the pelvic organs could be obtained. However, dorsal aspect of the urinary bladder neck and accessory genital organs of male animals could not be visualized. Major complications were not encountered during or after laparoscopy. Laparoscopy a minimally invasive procedure has several advantages over alternate methods of understanding anatomy, physiology and pathology of most of the intraperitoneal pelvic structures in goats. The technique has high pedagogic value. The procedure is safe in experienced hands.

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P139 LAPAROSCOPIC TRANSABDOMINAL PREPERITONEAL REPAIR FOR SMALL AND MEDIUM PRIMARY UMBILICAL AND MIDLINE HERNIAS

British Journal of Surgery ◽

10.1093/bjs/znab395.131 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Kryspin Mitura

Keyword(s):

Mesh Repair ◽

Laparoscopic Approach ◽

Mesh Size ◽

Complication Rates ◽

Linea Alba ◽

Hernia Defect ◽

Transabdominal Preperitoneal ◽

Open Mesh Repair ◽

Onlay Mesh

Abstract Aim Complications of open mesh repair for primary umbilical and midline hernias (PUMH) may lead to significant re-admissions and follow-up costs. Although laparoscopic intraperitoneal onlay mesh repair reduces infection rates, especially in overweight patients, it’s controversial in these hernias, mainly due to potential adhesions’ formation. Laparoscopic transabdominal preperitoneal technique (lap-TAPP) may address these issues, as it combines advantages of both open and laparoscopic approaches. The aim of this study is to present the initial results of lap-TAPP for PUMH in regard to its feasibility and complication rates. Material and Methods We evaluated 25 consecutive cases of lap-TAPP repair for PUMH. Patients’s characteristics, intraoperative findings, and postoperative complications after 30-days follow-up were analyzed. Results 21 male and 4 female patients were included in analysis (mean BMI 29.8 kg/m2). Surgery time was 82 minutes (55-120). We found 20 umbilical and 11 epigastric linea alba hernias. Mesh size was 144cm2 (120-225); mean hernia defect width was 25mm (10-40). In 9 patients (36%) the peritoneal rents were created which were easily closed with sutures. All patients were discharged on 1 POD with no complications. After 30-days we found no recurrences or bulging, no pain complaints. We found one subcutaneous small hematoma with no need for intervention. Conclusions Laparoscopic TAPP for small and medium PUMH is a safe and feasible technique with low complication rate. However, this method is technically demanding and time consuming while performed with laparoscopic approach as it requires precise and subtle plane dissection, and non-ergonomic closure hernia defect.

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Epidemiological characterization and risk factors associated with lentiviral infection of small ruminants at animal fairs in the semiarid Sertão region of Pernambuco, Brazilian semiarid

Semina Ciências Agrárias ◽

10.5433/1679-0359.2017v38n4p1875 ◽

2017 ◽

Vol 38 (4) ◽

pp. 1875

Author(s):

José Romero Alexandre Alves ◽

Clécio Henrique Limeira ◽

Geilson Manoel de Souza Lima ◽

Raymundo Rizaldo Pinheiro ◽

Francisco Selmo Fernandes Alves ◽

...

Keyword(s):

Risk Factors ◽

Traffic Control ◽

Disease Transmission ◽

Significant Risk ◽

Small Ruminants ◽

Significant Risk Factor ◽

Disease Diagnosis ◽

Serum Samples ◽

Western Blots ◽

Factors Associated

Animal agglomerations at commercial events such as trade fairs represent an important facilitator in infectious disease transmission. Thus, it is crucial to understand the epidemiology of infectious diseases in small ruminants. The objective of this study was to examine lentiviral presence in goats and sheep traded at the animal fair of Tabira city (Sertão region of Pernambuco) and identify possible risk factors associated with infection. We collected serum samples from 233 crossbred goats and 119 crossbred sheep, belonging to 12 breeders, at the Tabira livestock fair from November 2014 to June 2015. An epidemiological questionnaire was used to analyze the risk factors. Agar gel immunodiffusion (AGID) and western blotting (WB) were performed to diagnose small ruminant lentivirus (SRLV) infection. In the AGID test, we used maedi-visna virus (MVV) antigens for sheep and caprine arthritis/encephalitis virus (strain Cork) (CAEV-Co) antigen for goats. The WB analysis used CAEV-Co antigen for both species. Variables from the questionnaire were analyzed with univariate and multivariate statistics. One seropositive goat but no sheep was identified via AGID. According to the WB results, 15/233 goats (6.44%; CI95% = 3.94 - 10.35%) and 8/119 sheep (6.72%; CI95% = 3.45 - 12.71%) were seropositive, totaling 23/352 reactive animals (6.53%; CI95% = 4.39 - 9.61%) from 12 herds. Annual vermifugation of the animals was a significant risk factor (odds ratio = 5.9; CI95% = 1.7-19.8; p = 0.04) for disease in goats, but no variables associated with infection risks were identified in sheep. We concluded that SRLV was present in goats and sheep at the animal fair. Western blots were more sensitive than AGID for SRLV diagnosis. Practices aiming to improve sanitary management may reduce the risk of infection in goats. All studied herds included animals identified as seropositive for SRLV. Therefore, we recommend adopting measures that increase disease diagnosis while intensifying traffic control and surveillance of animal agglomerations.

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Evaluation of Patient Feedback following Laparoscopic Cholecystectomy based on Information Described in the Informed Consent form Developed by the Association of Polish Surgeons

Polish Journal of Surgery ◽

10.1515/pjs-2016-0003 ◽

2015 ◽

Vol 87 (11) ◽

Author(s):

Piotr Misiak ◽

Sławomir Jabłoński ◽

Jerry Lazarek ◽

Katarzyna Malinowska ◽

Edyta Santorek-Strumiłło ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Informed Consent ◽

Surgical Intervention ◽

Small Sample Size ◽

Laparoscopic Approach ◽

Invasive Procedure ◽

Small Sample ◽

Consent Form ◽

Patient Feedback ◽

Informed Consent Form

AbstractThe cholecystectomy procedure is the most routinely performed intervention in general surgery. The current international gold standard is via the laparoscopic approach. It is a safe, minimally-invasive procedure; however, it is associated with complications in 1% of cases.was to analyze patient feedback, by means of a survey, to determine how much knowledge patients possessed about their disease state and proposed surgical intervention, based primarily on information contained within the informed consent form developed by the Association of Polish Surgeons.This study involved the participation of 51 patients who underwent laparoscopic cholecystectomy, indicated by a diagnosis of gallstones, in the years 2014 and 2015.Despite having signed the informed consent form, there was considerable variation among the responses given to the survey by the 51 patients in this study. Some patients’ responses were tangential to the questions asked; many patients did not respond to any of the sub points.Given that this study is based on a small sample size of patients, it must be presumed that the process by which the patient declares his or her informed consent requires further consideration with respect to the means by which it is obtained. The authors of this study thus recommend that multimedia resources be harnessed as part of the process of obtaining the informed consent of patients prior to surgical intervention.

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A 9-year experience study of single-port micro-laparoscopic repair of pediatric inguinal hernia using a simple needle

Hernia ◽

10.1007/s10029-019-02079-4 ◽

2019 ◽

Vol 24 (3) ◽

pp. 639-644

Author(s):

R. Chen ◽

S. Tang ◽

Q. Lu ◽

X. Zhang ◽

W. Zhang ◽

...

Keyword(s):

Inguinal Hernia ◽

Single Port ◽

Average Length ◽

Operating Time ◽

Laparoscopic Approach ◽

Invasive Procedure ◽

High Ligation ◽

Laparoscopic Technique ◽

Inguinal Hernias ◽

Laparoscopic Techniques

Abstract Purpose As laparoscopic techniques and equipments improve, laparoscopic inguinal hernia repair has been gaining popularity. The objective of the study was to summarize 9 years of experience using a single-port micro-laparoscopic approach to repair pediatric inguinal hernias with a simple hernia needle. Methods 1880 children with inguinal hernias were enrolled using micro-laparoscopic surgery between June 2009 and 2018. All patients underwent high ligation surgery using a single-port micro-laparoscopic technique. The clinical data were retrospectively analyzed. Results All micro-laparoscopic surgeries were successfully performed in the 1880 patients, who ranged in age from 2 months to 14 years (3.66 ± 2.96 years) including 1622 males and 258 females. Among them, 1299 cases were unilateral hernias and 581 cases were bilateral hernias. The average operating time was 12.5 ± 3.5 min for a unilateral hernia and 20.5 ± 4.5 min for bilateral hernias. All patients were discharged 1–2 days after surgery, and the average length of their hospital stay was 2–4 days. Complications of knot reaction and pneumoscrotum occurred in 5 cases (0.27%) and 54 cases (2.87%), respectively, but these cases were properly managed, with no major impact on the operational outcomes. All patients were followed up for 3–65 months; there were 13 recurrent cases (0.69%). Conclusions Single-port micro-laparoscopic herniorrhaphy in children using a simple hernia needle is a reliable and minimally invasive procedure.

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The Effects of Repeat Laparoscopic Surgery on the Treatment of Complications Resulting from Laparoscopic Surgery

The American Surgeon ◽

10.1177/000313481207800929 ◽

2012 ◽

Vol 78 (9) ◽

pp. 926-932

Author(s):

Chih-Yuan Fu ◽

Chi-Hsun Hsieh ◽

Chun-Han Shih ◽

Yu-Chun Wang ◽

Ray-Jade Chen ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Laparoscopic Approach ◽

Invasive Procedure ◽

Operative Management ◽

Postoperative Hemorrhage ◽

Biliary Complications ◽

Postoperative Peritonitis ◽

Minimally Invasive Procedure ◽

Management Of Complications ◽

Complications Of Laparoscopic Cholecystectomy

Laparoscopic surgery is frequently applied in the operative management of appendicitis and symptomatic cholelithiasis because it is a minimally invasive procedure. There are, however, some complications of laparoscopic cholecystectomy (LC) and laparoscopic appendectomy (LA) that result in the need for reoperation. In the current study, we examine the effects of repeat laparoscopic surgery on the treatment of complications arising from LC/LA. From April 2005 to March 2011, we examined a cohort of patients who had received LC or LA and experienced complications that required reoperations. We focused on patients with postoperative hemorrhages, postoperative peritonitis, early postoperative small bowel obstructions (EPSBO), and biliary complications (after LC) who were treated through a repeat laparoscopic approach. The general demographics of the patients, their postoperative complications, procedures for selecting the appropriate reoperation method, and repeat laparoscopic findings are described in detail. During the 6-year period examined, 1608 patients received LC and 1486 patients received LA at the hospitals participating in this study. In patients with complications requiring reoperation, the repeat laparoscopic approach was performed successfully (without the need for further laparotomy) in 50 per cent of the patients with postoperative hemorrhage (2 of 4), 50 per cent of the patients with postoperative peritonitis (2 of 4), 75 per cent of the EPSBO patients (3 of 5), and 50 per cent the of patients with biliary complications (1 of 2). The repeat laparoscopic approach is an appropriate method for the management of complications arising from laparoscopic surgery. In patients with postoperative hemorrhage, laparoscopic hemostasis and hematoma evacuations can be performed while maintaining stable hemodynamics. In addition, laparoscopic approaches are also feasible for selective post-LC ductal injuries, EPSBO, and unconfirmed diagnoses of peritonitis after laparoscopic surgery.

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Evaluation of diagnostic factors used to refer children with constipation for rectal biopsies

International Journal of Colorectal Disease ◽

10.1007/s00384-021-04069-4 ◽

2021 ◽

Author(s):

Emilie G. Jaroy ◽

Ragnhild Emblem ◽

Henrik M. Reims ◽

The Tien Mai ◽

Gabriel T. Risa ◽

...

Keyword(s):

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Failure To Thrive ◽

Invasive Procedure ◽

Rectal Biopsy ◽

Functional Constipation ◽

Disease Diagnosis ◽

Abdominal Distention ◽

Tertiary Referral Hospital ◽

Male Sex

Abstract Purpose Children with constipation and suspected Hirschsprung’s disease are referred for rectal biopsy. Since this is an invasive procedure, appropriate indications should be applied to minimize the number of “unnecessary” biopsies. Methods We reviewed all constipated children who underwent a rectal biopsy to diagnose a possible Hirschsprung’s disease at a tertiary referral hospital over a 6-year period (2013–2018). We registered clinical and demographic factors in these children and conducted correlation and multivariate regression analysis to evaluate the relation between these factors and a diagnosis of Hirschsprung’s disease. Results We identified 225 children, aged 0–17 years. In total, Hirschsprung’s disease was diagnosed in only 49/225 (22%). Among the 49 children with Hirschsprung’s disease, 29 (59%) were diagnosed in the neonatal period. Among girls, HD was confirmed in only 10/101 (10%) children, and only 1 of these 10 girls was older than 6 months at the time of the biopsy. The following factors correlated significantly with Hirschsprung’s disease diagnosis in children older than 1 month: “male sex”, “failure to thrive”, “gross abdominal distention plus vomiting” and “fulfils the Rome 4 criteria for functional constipation”. Conclusion In children referred for rectal biopsy, the factors most indicative of Hirschsprung’s disease were “male sex”, “failure to thrive”, “gross abdominal distention plus vomiting” and “fulfils the Rome 4 criteria for functional constipation”. Notably, the prevalence of Hirschsprung’s disease decreased with the increasing age of the children. Girls referred for a biopsy rarely had Hirschsprung’s disease, especially those older than 1 month.

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Single-incision laparoscopic approach for linea alba hernia in children

Journal of Minimal Access Surgery ◽

10.4103/jmas.jmas_211_17 ◽

2019 ◽

Vol 15 (1) ◽

pp. 42

Author(s):

Li Long ◽

Zhang Jun ◽

Jia Na ◽

Chen Zhen ◽

Yang Xuan ◽

...

Keyword(s):

Single Incision ◽

Laparoscopic Approach ◽

Linea Alba

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Insertion Mechanics of 3D Printed Honeybee-Inspired Needle Prototypes for Percutaneous Procedure

2017 Design of Medical Devices Conference ◽

10.1115/dmd2017-3457 ◽

2017 ◽

Cited By ~ 4

Author(s):

Mohammad Sahlabadi ◽

David Gardell ◽

Jonasan Younan Attia ◽

Seyedvahid Khodaei ◽

Parsaoran Hutapea

Keyword(s):

Tissue Damage ◽

Invasive Procedure ◽

Disease Diagnosis ◽

The Body ◽

Medical Community ◽

Design Parameters ◽

Insertion Force ◽

Less Invasive ◽

Cylindrical Component ◽

Needle Trajectory

Surgical needles are commonly used by medical professionals to reach target locations inside of the body for disease diagnosis or other medical interventions — such as biopsy, brachytheraphy, thermal ablation, and drug delivery [1, 2]. The effectiveness of these procedures depends on the accuracy with which the needle tips reach the targets, such as tumors or certain organs/tissues. In procedures, such as deep brain stimulation and prostate brachytheraphy, it is impossible to reach the surgical sites via simple needle trajectory because of anatomical constraints. Although needles are considered minimally invasive devices, needle insertion still causes tissue damage of varying degrees so it is desirable to reach multiple targets, or multiple sites on a single target, to obtain multiple high-quality biopsy samples with each insertion [1, 2]. Recently there has been a substantial and growing interest in the medical community to develop innovative surgical needles for percutaneous interventional procedures. The answer to the challenge of developing advanced surgical needles could be found in nature. Insects such as honeybees (Fig. 1), mosquitos, and horse flies have sophisticated sting mechanics and stinger structures, which they use to steer their stingers to a specific target, such as a human, and to release their venom in a certain path in skin [3]. We are studying these mechanisms, evolved in nature over millions of years, as a basis to develop bioinspired needles. Surgical needles are typically consisted of a hollow cylindrical component (cannula) and an inner solid cylindrical component (stylet). Our hypothesis is that a surgical needle (stylet) that mimics insect stinger mechanics and structures can be easily controlled for sophisticated needle steering during surgery and can result in more effective and less invasive percutaneous procedures. The focus of this work is to mimic honeybee stinger such as shown in Fig. 1 to design innovative surgery needles. One of the critical issues in designing surgery needles is the insertion force required to penetrate and to navigate the needle inside the tissue [2]. Larger insertion forces increase tissue damages thus may result in a more painful procedure [2]. Another consideration is the needle trajectory path (needle tip deflection) and the difficulty to control the needle path. The needle deviates from the target and thus it is very difficult to navigate the needle in the tissue. There is a need to design advanced surgery needles that provide smaller insertion force. This can lead to a less invasive procedure, in other words, less tissue damage and pain [3]. The needle trajectory path of these new needle designs must be understood for the needle design optimization. As stated previously, it is hypothesized that a honeybee-inspired needle can be utilized to reduce the insertion force. In this work, the experimental work to understand the mechanics of bioinspired needles is presented. 3D printing of the needles and their insertion tests are performed to investigate the effect of the needle designs on the insertion force and the needle deflection (trajectory path) curves. Understanding these factors should shed some lights on some design parameters to develop innovative surgery needles.

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249 Laparoscopic Assisted Enterolithotomy: A Viable Option in The Management of Gallstone Ileus

British Journal of Surgery ◽

10.1093/bjs/znab259.605 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

N Angamuthu ◽

S Alagaratnam ◽

R D'Souza ◽

M Varcada

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Gallstone Ileus ◽

Laparoscopic Approach ◽

Invasive Procedure ◽

Distal Ileum ◽

General Surgeon ◽

Bowel Loop ◽

Laparoscopic Assisted

Abstract Introduction Gallstone ileus (GSI) is a rare cause of small bowel obstruction in patients over the age of 65 years. We report a case of GSI treated successfully with a laparoscopic assisted enterolithotomy. Case report A 75-year-old female presented with two days of abdominal distension and vomiting with a non-peritonitic abdomen on examination. A computerised tomography scan demonstrated small bowel obstruction due to an obstructing stone in the distal ileum. Three port laparoscopy and small bowel assessment confirmed a solitary enterolith (4cms) in the distal ileum with upstream dilated loops. An infra-umbilical 6 cm midline incision was made and the localised bowel loop was delivered. An enterotomy was made proximal to the point of obstruction, stone retrieved, and a single layer interrupted closure was performed. Ten weeks post-operatively, patient had a virtual follow-up consultation and is doing well. Conclusions GSI often presents in elderly patients with multiple co-morbidities. A laparotomy with enterolithotomy is the initial treatment of choice with biliary intervention as a second operation, if needed, at a later date. Clearly, a conventional exploratory laparotomy in this cohort of patients carries a high risk and therefore the use of less morbid and less invasive procedure like laparoscopy should be considered. Although a total laparoscopic approach would require advanced laparoscopic skills particularly due to dilated bowel loops limiting the intra-abdominal space for suturing, a laparoscopic assisted approach as described above should be considered as a reasonable option within the remits of an emergency general surgeon.

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Trans-Umbilical Open Port Placement During Laparoscopic Access: A Safe Technique

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v15i1.48647 ◽

2020 ◽

Vol 15 (1) ◽

pp. 67-70

Author(s):

Md Atiqul Haque Sarder ◽

Quazi Sabran Uddin Ahmed

Keyword(s):

Age Groups ◽

Armed Forces ◽

Port Placement ◽

Reliable Technique ◽

Linea Alba ◽

Excellent Outcome ◽

Medical College ◽

Modified Method ◽

Safe Technique ◽

Primary Port

Introduction: Intra-peritoneal access and creation of pneumoperitoneum through a quick, safe and reliable technique is important for Laparoscopic Surgery. Specially in an resource constrained setting where there is paucity of needed equipment and cost is prohibitive, utilization of the fewer instruments available and accompanid by excellent functional and cosmetic outcomes should be the aim of a laparoscopic surgeon. Objectives: To describe a modified method of primary trocar introduction that utelizes fewer available instruments. Materials and Methods: A vertical incision is made in the trans-umblical region at the base of to an everted umblicul scar. The linea alba is incised and the resultant opening bluntly developed after which the 1st port is inserted using tocar as an guide. The trocar is withdrawn while the canula is pushed in. Results: We included total 124 patient (Male-44, Female-80) in the study period, from Jan 2017 to December 2018. In one single surgical unit, with the age limit 18-75 years, With no significant complications. Conclusion: This modified open trans-umblical approach is a simple, quick, and reliable way to primary port insertion. Access is gained easily in different age groups and umblicus types, through a small congenital umblical defect that is almost universally present. It is associated with minimum morbidity and has excellent outcome. Journal of Armed Forces Medical College Bangladesh Vol.15 (1) 2019: 67-70

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