Third-generation three-dimensional display system for laparoscopic radical nephrectomy reduced surgical complications compared to a two-dimensional display system

Objective: Compared with two-dimensional (2D) laparoscope systems, conventional three-dimensional (3D) systems provide a superior understanding of depth. However, they are operator limited due to difficulties with resolution and illumination. A novel third-generation (3G) 3D system may resolve these problems. We prospectively compared the operative performance and perioperative safety results of 2D and 3G 3D systems in laparoscopic radical nephrectomy (LRN). Patients and methods: A single experienced surgeon performed 3G 3D LRN for 19 patients and 2D LRN for 16 patients. After the insertion of the access ports, the execution times of each step in the surgical procedure in the two groups were measured and compared, along with the perioperative complications. Results: Patients in the 3D group were associated with fewer complications than those in the 2D group. In particular, no peritoneal injury was observed in the 3D group (0% vs. 25%, p=0.04). Logistic regression analysis showed no significant differences between the times of each surgical step and the amount of bleeding. Conclusions: The 3G 3D laparoscope system provided a detailed anatomical view for the operator during LRN and may reduce laparoscopic complications. Level of evidence: III.

Laparoscopic Entry via the DE-ALWIS METHOD

Despite the rapid advances in laparoscopic surgery in the past 2 decades the initial entry still accounts for approximately 40% to 50% of laparoscopic complications and should be considered the most dangerous step of a laparoscopic procedure. In this review, the authors share a technique for initial umbilical entry, and provide alternative entry sites in cases where umbilical entry is comtraindicated. Rev Obstet Gynecol. 2009; 2(3):193-198 doi; 10.3909/riog0088. Laparoscopy for diagnostic purposes to a modality for minor and major surgical procedures, had been advancing rapidly over the last 3 decades. The initial entry still accounts for about 40-50% of laparoscopic complications and is the most dangerous step of this surgical procedure [1, 2]. Laparoscopic entry using a veres needle followed by a blind insertion of a sharp trocar is the common method used by gynaecologists [3-5]. There is no concensious as to which laparascopic entry is superior and the common recommendation is use the entry methods with which the surgeons feel comfortable [6]. Umbilical entry is not suitable in certain instances, such as previous midline abdominal incision, previous umbilical hernia surgery, previous pelvic peritonitis and so forth, due to the presence of pelvic adhesions. An open surgery does not guarantee against a visceral injury [7].

Hirschsprung Disease

Hirschsprung disease is characterized by the absence of ganglion cells in the enteric nervous system. Inability to pass meconium in the neonatal period, enterocolitis, bowel obstruction, or chronic constipation in older infants and children may be the presenting symptoms. Once diagnosed, surgical intervention is always required. Successful resection of all portions of aganglionic intestine may be accomplished through multiple surgical techniques. Depending upon the surgical approach required, regional anesthesia may be indicated to assist with pain control postoperatively. This chapter describes Hirschsprung disease and considers a variety of questions related to its diagnosis and treatment, as well as risks related to surgery, including anaphylaxis, laparoscopic complications, vascular injury, epidural complications, and issues related to neuraxial analgesia.

The Effectiveness of a Systematic Algorithm for the Management of Vascular Injuries during the Laparoscopic Surgery

Objectives: Currently, there is no standardized training protocol to teach surgeons how to deal with vascular injuries during laparoscopic procedures. The purpose of this study is to develop and evaluate the effectiveness of a standardized algorithm for managing vascular injury during laparoscopic nephrectomies. Materials and Methods: The performance of 6 surgeons was assessed during 10 laparoscopic nephrectomies in a porcine model. During the first and tenth operations, an injury was made in the renal vein without warning the surgeon. After the first procedure, the surgeons were instructed on how to proceed in dealing with the vascular injury, according to an algorithm developed by the designers of this study. The performance of each surgeon before and after learning the algorithm was assessed. Results: After learning the algorithm there was a decreased blood loss from 327 ± 403.11 ml to 37 ± 18.92 ml (p = 0.031) and decreased operative time from 43 ± 14.53 min to 27 ± 8.27 min (p = 0.015). There was also improvement in the time to start lesion repair from 147 ± 117.65 sec to 51 ± 39.09 sec (p = 0.025). There was a trend toward improvement in the reaction time to the injury (22 ± 21.55 sec vs. 14 ± 6.39, p = 0.188), the time required to control the bleeding (50 ± 94.2 sec vs. 14 ± 6.95 sec, p = 0.141), and the total time required to completely repair of the vascular injury (178 ± 170.4 sec vs. 119 ± 183.87 sec, p = 0.302). Conclusion: A standardized algorithm may help to reduce the potential risks associated with laparoscopic surgery. Further studies will help to refine and determine the benefits of standardized protocols such as that developed in this study for the management of life-threatening laparoscopic complications.