A Novel Four-port-sharing Approach for Concomitant Cholecystectomy With Laparoscopic Sleeve Gastrectomy

BackgroundGallbladder disease is very common in obese patients. Concomitant cholecystectomy with laparoscopic sleeve gastrectomy (CC-LSG) may be necessary in such cases, and it has been proven safe when indicated. Herein, we developed a novel four-port-sharing technique for CC-LSG that can substitute the conventional trocar placement (6–7 ports).MethodsA retrospective cohort study was conducted between January 2017 and March 2021 using a prospective database. Out of 159 patients who underwent LSG, 10 also received CC-LSG. The patients’ demographic characteristics, intraoperative outcomes, and postoperative outcomes were examined.ResultsOf a total of 159 patients, 18 had cholelithiasis (11.3%). Eight symptomatic and 2 asymptomatic patients (6 men and 4 women) with cholelithiasis underwent CC-LSG. No postoperative complications, including hemorrhage, bile leakage, staple leakage, incisional hernia, and wound infection, were noted.ConclusionsIn CC-LSG, the application of a four-port-sharing technique is safe and feasible, and it provides satisfying cosmetic outcomes for obese patients with symptomatic or asymptomatic cholelithiasis.

Laparoscopic cholecystectomy in patients with liver cirrhosis: review of intraoperative measures and recommendations

Symptomatic biliary stones are related with higher morbidity and mortality rates in patients with liver cirrhosis, especially when patients undergo surgery. The difficulty of cholecystectomy is worsened by liver cirrhosis, especially in patients with extensive liver fibrosis and portal hypertension.Laparoscopic cholecystectomy can be performed safely in selected patients with cirrhosis. However, it can be challenging in many aspects and poses a greater degree of difficulty and thus should be performed by experienced surgical teams, who follow the recommendations and take in mined the special precautions which requested to increase safety of the operation and avoid or reduce the morbidity and mortality , and also who able to tackle the more frequent intraoperative incidents or complications.In this review, we focus on of the technical difficulties and intraoperative recommendations that could be used to approach laparoscopic cholecystectomy in this patient population (trocar placement, intraabdominal pressure, visualization, gallbladder dissection, adjunct for hemostasis, intraperitoneal drains, and conversion to open surgery), and the alternative which can be used in advanced cases

Anatomical Reasoning for Atraumatic Trocar Placement during Implantation of a Transobturator Suburethral Sling

The aimof this research was to study the variant anatomy of the obturator complex in terms of surgical treatment of stress urinary incontinence, as well as to determine the most atraumatic technique for conducting a surgical trocar for a transobturator suburethral sling.Material and methods.A suburethral sling was implanted on 40 sagittally dissected samples of the female pelvis with preserved soft tissues using two techniques: the conventional one based on the use of external landmarks and the technique of the trocar rotation around the lower branch of the pubic bone developed at the University Clinic of St. Petersburg. After implantation of a transobturator suburethral sling, the probability of injury to the branches of the obturator nerve was assessed by precision preparation for each of the presented techniques using 40 samples. It was also suggested to develop a protocol for atraumatic placement ofa sling for stress urinary incontinence.Results. Based on the results obtained and study of the topographic relationships of the trocar and branches of the obturator nerve, it is concluded that the obturator complex has significant anatomical variability. This relates to both the muscular component –the internal and external obturator muscles, and neurovascular structures. The obturator nerve has two types of branching: joint and separate. The latter is a risk factor for intraoperative nerve injury. The technique of suburethral sling implantation by rotating the surgical trocar around the inferior branch of the pubic bone is atraumatic and safe.Conclusions.Variant anatomy of the obturator complex influences the probability of trauma in a transobturator suburethral sling implantation. In particular, the separate branching of the obturator nerve is a risk factor for its intraoperative injury. Further clinical studies are required to assess the outcomes of surgical t reatment of stress urinary incontinence taking into account the variant anatomy of the true pelvis.

Complicated acute appendicitis in a child with left atrial isomerism: a case report

Background Heterotaxy syndrome is a rare clinical entity that is characterized by abnormal visceral organ arrangement in the chest and abdomen. Left atrial isomerism is a subcategory of heterotaxy syndrome characterized by the presence of multiple spleens with or without cardiac anomalies. Patients may remain asymptomatic their whole lives until they are diagnosed incidentally. Given that patients with left atrial isomerism might demonstrate atypical presentations of acute intrabdominal pathologies, it is important to keep a high index of suspicion when encountering such cases. Case presentation In this report, we present a case of a 9-year-old boy with a known history of left atrial isomersim who presented with left lower quadrant pain and positive McBurney, psoas, and obturator signs on the left side. A computed tomography scan of the abdomen confirmed the diagnosis of perforated acute appendicitis on the left, which prompted an emergent laparoscopic appendectomy. Conclusion Our case highlights the importance of keeping a high index of suspicion for a heterotaxy syndrome that is complicated by acute appendicitis in pediatric patients presenting with vague abdominal pain. Planning the location of trocar placement in patients with situs anomalies is of paramount importance to avoid technical difficulties in laparoscopic procedures.

A novel “three-port” trocar placement technique for laparoscopic radical prostatectomy

Background To introduce a novel “three-port” trocar placement technique for laparoscopic radical prostatectomy (LRP) in prostate cancer (PCa) patients. Methods We retrospectively reviewed 300 patients with PCa who received surgical treatment between November 2010 and June 2015 at our institution. They were divided into group A, three-port LRP; group B, conventional four-five-port LRP; group C, open RP (ORP); and group D, robotic-assisted RP (RARP). A learning curve was analyzed by dividing patients of group A into the early and late stages. Results All groups were comparable with regard to the preoperative characteristics except for the relatively smaller prostate volume in group A. The three-port LRP operations were performed successfully with only 8 cases of conversion to the conventional LRP. None of any severe complications or conversion to ORP occurred. In group A, the mean operative time (OT) duration was 113.8 min, the mean estimated blood loss (EBL) was 94.2 ml, the mean drainage days was 4.0 days, the mean hospitalization was 5.1 days, and 27.8% of the prostate specimen margins (PSM) were positive. The differences of OT, EBL, drainage days, hospitalization, and transfusion in group A were statistically significant among the majority of the other groups (p < 0.05). After undergoing the early stages of a learning curve analysis in three-port LRP, the EBL was obviously decreased. Conclusions Three-port LRP is a novel technique that exhibits superior intraoperative advantages to the conventional LRP. Due to its less OT, EBL, drainage days, hospitalization, and transfusion with a shorter learning curve, it should be recommended and popularized in the clinical practice.

A novel “Three-port” trocar placement technique for laparoscopic radical prostatectomy

Background: To introduce a novel “three-port” trocar placement technique for laparoscopic radical prostatectomy (LRP) in prostate cancer (PCa) patients.Methods: We retrospectively reviewed 300 patients with PCa who received surgical treatment between November 2010 and June 2015 at our institution. They were divided into group A: three-port LRP, group B: conventional four-five port LRP, group C: open RP (ORP) and group D: robotic-assisted RP (RARP). A learning curve was analyzed by dividing patients of group A into the early and late stages.Results: All groups were comparable with regard to the preoperative characteristics except for the relatively smaller prostate volume in group A. The three-port LRP operations were performed successfully with only 8 cases conversion to the conventional LRP. None of any severe complications or conversion to ORP occurred. In group A, the mean operative time (OT) duration was 113.8min, the mean estimated blood loss (EBL) was 94.2ml, the mean drainage days was 4.0d, the mean hospitalization was 5.1d, and 27.8% of the prostate specimen margins (PSM) were positive. The differences of OT, EBL, drainage days, hospitalization and transfusion in group A were statistically significant among the majority of the other groups (p<0.05). After undergoing the early stages of a learning curve analysis in three-port LRP, the EBL was obviously decreased.Conclusions: Three-port LRP is a novel technique that exhibits superior intraoperative advantages to the conventional LRP. Due to its less OT, EBL, drainage days, hospitalization and transfusion with a shorter learning curve, it should be recommended and popularized in the clinical practice!

A Novel “Three-Port” Trocar Placement Technique for Laparoscopic Radical Prostatectomy

Background: To introduce a novel “three-port” trocar placement technique for laparoscopic radical prostatectomy (LRP) in prostate cancer (PCa) patients.Methods: We retrospectively reviewed 300 patients with PCa who received surgical treatment between November 2010 and June 2015 at our institution. They were divided into group A: three-port LRP, group B: conventional four-five port LRP, group C: open RP (ORP) and group D: robotic-assisted RP (RARP). A learning curve was analyzed by dividing patients of group A into the early and late stages.Results: All groups were comparable with regard to the preoperative characteristics except for the relatively smaller prostate volume in group A. The three-port LRP operations were performed successfully with only 8 cases conversion to the conventional LRP. None of any severe complications or conversion to ORP occurred. In group A, the mean operative time (OT) duration was 113.8 min, the mean estimated blood loss (EBL) was 94.2 ml, the mean drainage days was 4.0d, the mean hospitalization was 5.1 d, and 27.8% of the prostate specimen margins (PSM) were positive. The differences of OT, EBL, drainage days, hospitalization and transfusion in group A were statistically significant among the majority of the other groups (p<0.05). After undergoing the early stages of a learning curve analysis in three-port LRP, the EBL was obviously decreased.Conclusions: Three-port LRP is a novel technique that exhibits superior intraoperative advantages to the conventional LRP. Due to its less OT, EBL, drainage days, hospitalization and transfusion with a shorter learning curve, it should be recommended and popularized in the clinical practice!

Special type trocar-site hernia with evisceration of the appendix following laparoscopic repair of a perforated duodenal ulcer

Trocar-site hernia is an uncommon complication of laparoscopic surgery and can be classified as early-onset, late-onset or special type. Special type hernias usually occur in the early postoperative period and result in evisceration of intra-abdominal contents through all layers of the abdominal wall without an overlying hernia sac. We present a case of special type herniation of the appendix through a 5-mm trocar site in the right iliac fossa following laparoscopic repair of a perforated duodenal ulcer. In this case, herniation occurred after removal of a drain inserted through the trocar site intraoperatively and was treated with emergent open appendicectomy. A number of patient and technical factors may be associated with an increased risk of trocar-site herniation including increasing age, elevated body mass index, increasing trocar size, longer procedure duration and absence of fascial closure. These factors must be borne in mind when planning trocar placement and number to reduce the risk of herniation.

A Novel “Three-port” Trocar Placement Technique for Laparoscopic Radical Prostatectomy

Background: To introduce a novel “three-port” trocar placement technique for laparoscopic radical prostatectomy (LRP) in prostate cancer (PCa) patients.Methods: We retrospectively reviewed 300 patients with PCa who received surgical treatment between November 2010 and June 2015 at our institution. They were divided into group A: three-port LRP, group B: conventional four-five port LRP, group C: open RP (ORP) and group D: robotic-assisted RP (RARP). A learning curve was analyzed by dividing patients of group A into the early and late stages.Results: All groups were comparable with regard to the preoperative characteristics except for the relatively smaller prostate volume in group A. The three-port LRP operations were performed successfully with only 8 cases conversion to the conventional LRP. None of any severe complications or conversion to ORP occurred. In group A, the mean operative time (OT) duration was 113.8 min, the mean estimated blood loss (EBL) was 94.2 ml, the mean drainage days was 4.0d, the mean hospitalization was 5.1 d, and 27.8% of the prostate specimen margins (PSM) were positive. The differences of OT, EBL, drainage days, hospitalization and transfusion in group A were statistically significant among the majority of the other groups (p<0.05). After undergoing the early stages of a learning curve analysis in three-port LRP, the EBL was obviously decreased.Conclusions: Three-port LRP is a novel technique that exhibits superior intraoperative advantages to the conventional LRP. Due to its less OT, EBL, drainage days, hospitalization and transfusion with a shorter learning curve, it should be recommended and popularized in the clinical practice!