Hysterectomy and Adnexal Procedures by Vaginal Natural Orifice Transluminal Endoscopic Surgery (VNH): Initial Findings From a Korean Surgeon

Objective: To evaluate feasibility and safety of hysterectomy and adnexal procedures by vaginal natural orifice transluminal endoscopic surgery (vNOTES).Study Design: This is a prospective observational study at a tertiary center and teaching University hospital. We enrolled prospectively 34 patients with benign diseases sequentially.Results: We measured baseline characteristics, surgical data, and pain score (VAS) after surgery. We surveyed before/after surgery. The time of port installation and each stage of surgery was measured. The learning curve was assessed through the graph according to the number of operations using linear and logarithmic regression curve estimation. The complications of surgery were investigated. The median age of the patients was 47.5 years (38–73). Median BMI was 22.4 (18.2–30.0). 20 cases of leiomyoma, four cases of adenomyosis, three cases of uterine prolapse, four cases of endometrial hyperplasia, and three cases of CIN were diagnosed. The median uterine weight was 180.0 g. The median port-installation time was 15.0 min (range, 4–35 min) and median total operation time was 85.5 min (range 43.0–132.0). Complications occurred in three patients. Two cases of bladder injury happened during vesicovaginal space dissection before the installation of the Wound Retractor (WR). One patient underwent transumbilical single-port surgery because of late-onset postoperative bleeding on the 13th postoperative day. The mean postoperative VAS scores were 3.36 immediately after surgery and 3.06, 2.79, and 2.45 at 6, 12, and 24 h after surgery, respectively. In continuous variable analysis, we detected a correlation between port-installation time and postoperative VAS ≥4 (pain score as need for medication). Based on a learning curve, port-installation time and total operation time appeared to reach the proficiency level by the 10th case.Conclusions: Although there were three complications, vNOTES offers advantages to patients and surgeons. More surgical techniques will be developed in vNOTES.

Laparoscopic-assisted gastrotomy for foreign body retrieval in four dogs

Four dogs with gastric foreign bodies were treated by laparoscopic-assisted gastrotomy. Techniques included two-port technique (n=two dogs), single-port with Alexis wound retractor (one) and single-port GelSeal cap with three cannulae (one). Foreign bodies retrieved included gravel (n=two dogs), trichobezoar (one) and a ball (one). All dogs had foreign bodies successfully removed, and no complications were encountered associated with the surgical procedures. These results suggest that laparoscopic-assisted gastrotomy is a feasible treatment for dogs with gastric foreign bodies via standard two-port technique, single-port with Alexis wound retractor, or single-port with GelSeal device. The benefits of minimally invasive surgery have been well-established for veterinary patients, and further investigation into additional uses is essential; the findings of this series highlight the importance of considering laparoscopic assistance for procedures such as gastrotomy.

Treatment of Ruptured Giant Omphalocele and Gastroschisis with Liver Herniation using a Wound Retractor as a Novel Approach

Ruptured giant omphaloceles (GO) and gastroschisis with total liver herniation are rare cases of exceptionally large abdominal wall defects. Many of these children have lethal outcome. The surgical and postsurgical management are complex. We report on two cases treated with staged surgical repair using a wound retractor as a silo. With this technique, the liver and intestines could be reduced into the abdomen with secondary closure of the abdominal cavity within the first 1 to 2 weeks of life.

Feasibility of Single-Port Cholecystectomy With Wound Retractor and a Glove in a Rural Hospital in Mexico

Laparoscopic surgery has been established as the standard therapy for symptomatic cholecystolithiasis. Now, single-port cholecystectomy is a surgical option. Due to the need of special laparoscopic instruments and devices, the cost of the surgery is significantly increased, limiting its popularity in most medical centers in developing countries, especially in rural areas. This paper's objective was to show the safety, reproducibility, and feasibility of single-port laparoscopic cholecystectomy using conventional laparoscopic equipment, a wound retractor, and a sterile glove in a rural hospital in Mexico. A prospective study was carried out from July to October 2014. Patients diagnosed with uncomplicated cholecystolithiasis who agreed to participate were operated with this technique. Complications, operative time, bleeding, evolution, and length of hospital stay were recorded. A total of 24 women went onto surgery under this approach. A mean follow-up of 71 days was completed. No incisional hernias, bile duct injuries, wound infection, nor death was presented. Surgical time and cost were not significantly increased compared to conventional laparoscopic approach. Most patient discharge was done the same day of the surgery. Single-port laparoscopic cholecystectomy is a cost-effective procedure, which can be performed in all hospitals where an Alexis retractor and conventional laparoscopic equipment is available. There was no increase of surgical morbidity. The single-port cholecystectomy is a technically feasible and safe surgical option in selected patients and can be easily performed in rural hospitals at a low cost, providing the benefits of the single incision.