Ureteral injury during laparoscopic rectal resection and concurrent laparoscopic repair by uretero-ureterostomy

Iatrogenic ureteral injury is an uncommon but severe complication of laparoscopic colorectal surgery. If it is detected intraoperatively, conversion to open surgery is usually inevitable. Here, we described a complete ureteral transection during laparoscopic low anterior resection, which was simultaneously repaired by laparoscopic uretero-ureterostomy. The most important points during the anastomosis of two tiny tubular tissues are dissecting the tubular organs without trauma, obtaining meticulous hemostasis without causing any necrosis, and achieving accurate approximation of tissues with the sutures. To the best of our knowledge, this is the first report that focused on laparoscopic repair of ureteral injury during laparoscopic colorectal surgery. As there are still few data on laparoscopic repair of ureteral lesions, no firm conclusions can be drawn. But, in appropriate cases, if intracorporeal suture expertise is available, laparoscopic repair can be done during colorectal surgery.

Evaluation of the effectiveness of training the skill of intracorporeal suture in laparoscopy in simulated conditions

Intracorporeal laparoscopic suture (ICS) is an important skill of the surgeon in performing laparoscopic procedures. Simulation training in this skill contributes to the formation of a skill and its implementation in operational practice. There are not enough publications highlighting the effectiveness of simulation training of the skill from the point of view of application in practice. Interviews were conducted with surgeons who underwent such simulation training in order to determine the proportion of doctors who applied the acquired skill in a real operating room. After training 88.9% of surgeons started using Intracorporeal laparoscopic suture; intracorporeal sliding knot — 77.3%.

Learning curve of students of the Bashkir state medical University in the educational process on endovideosimulators.

The article presents a comparative analysis of the learning curve of 40 students of Bashkir State Medical University on the technique of intracorporeal suture on a box simulator developed at the Department of Surgical diseases and new technologies and the "LapSim" simulator. Students who had different levels of manual skills were divided into two groups: the first - trained on a "box simulator", the second - trained on a "LapSim"simulator. To assess the level of development of practical skills, indicators of time spent on performing manipulation (in minutes) and GOALS (Global Operational Assessment of Laparoscopic Skills) were used. To assess the level of development of practical skills, indicators of time spent on performing manipulation (in minutes) and GOALS scores (Global Operational Assessment of Laparoscopic Skills). During analysis of the results there is a significant reduction of the time of performing manipulation in groups with an increase of the experience of students (in the performance of the second and third attempts). Training on a box simulator subjectively turned out to be easier for students than on a virtual laparoscopy simulator "LapSim".

Solo Surgery in Single Incision Laparoscopic Myomectomy

Background The intracorporeal suture during single incision laparoscopic surgery is challengeable. Since laparoscopic myomectomy requires not only one assistant to hold a camera but also other to hold the uterine manipulator, it is difficult to perform solo surgery in single port laparoscopic myomectomy through intracorporeal suture.ResultsThe three patients underwent single incision laparoscopic myomectomy. The size of the largest myoma was 4.8-5.6cm. The operation was performed by the surgeon alone without assistants. The passive camera holder was positioned near the patient's body. Without using uterine manipulator, the uterus was hung from the abdominal wall using a thread. The uterine myoma was enucleated, which was removed from the outside with the umbilicus incision site. The uterine wound was double sutured to avoid any uterine defects. The outer suture of wound was sutured by a method such as simple continuous suture, Lembert suture, or baseball suture. The operation time was 95-105 minutes.There were no specific complications associated with the surgery. The patients were discharged on the second day after surgery.ConclusionsSolo surgery in single incision laparoscopic myomectomy using camera holder was successfully performed without using a uterine manipulator.

Una experiencia de integración de la Formación Sanitaria Especializada con la Universitaria de Posgrado: Entrenamiento por etapas en cirugía laparoscópica.

Antecedentes: Diseño de un modelo de simulación para formación en cirugía laparoscópica. Métodos: Dentro del Máster Anatomía Aplicada a la Clínica se implementaron tres etapas de formación progresiva en médicos residentes. La etapa 1 se realizó en simulador con material no biológico: manejo de objetos, disección con pinza y tijera, y sutura laparoscópica. La etapa 2 utilizó material biológico (tubo digestivo en fresco) en simulador, para la práctica de sección intestinal y anastomosis intracorpórea. En la etapa 3 se realizaron técnicas laparoscópicas en cadáver en fresco (apendicectomía, colecistectomía, apertura de la transcavidad epiploica, hemicolectomías derecha e izquierda). Se añadió una encuesta de satisfacción a los participantes de la actividad. Resultados: El programa se impartió a 6 residentes de Cirugía General. Todos completaron los ejercicios de las etapas 1 y 2. En la etapa 3 se pudo realizar el neumoperitoneo sin dificultad y los tejidos presentaron una textura adecuada. Los residentes de primer año completaron la apendicectomía y la colecistectomía, pero procedimientos más complejos requirieron residentes con más experiencia. Los participantes encuestados reflejaron que el programa es adecuado y útil para el entrenamiento en laparoscopia. Conclusiones: El modelo propuesto es reproducible y adecuado en adquisición de competencias básicas en cirugía laparoscópica. Background: Design of a simulation model training in laparoscopic surgery for surgical residents. Methods: Three stages of progressive training were programmed within a Postgraduate Degree in Clinical Anatomy. Stage 1 was performed in a box-trainer with synthetic materials: managing small objects, dissection with clamp and scissors, and laparoscopic intracorporeal suture. Stage 2 used biological material (fresh digestive tract from a human corpse) in box-trainer, practicing section and intracorporeal anastomosis. In stage 3, laparoscopy was performed on a fresh corpse (appendectomy, cholecystectomy, lesser sac opening, right and left colectomy). A satisfaction survey was carried out to the participants. Results: Some six General and Digestive Surgery residents took the program. All of them completed the stage 1 and 2 exercises. In stage 3, the pneumoperitoneum could be performed without any complications, and tissues presented an adequate texture. First-year residents completed appendectomy and cholecystectomy, but more complex procedures required more experienced residents. The participants reflected that the program is adequate and useful to gain basic skills in laparoscopy. Conclusions: The proposed model is reproducible and adequate in acquisition of basic skills in laparoscopic surgery.

Single-Incision Percutaneous Closure of Pediatric Inguinal Hernia: A New Modification for Intracorporeal Suture Knotting

Background. Single-incision percutaneous closure (SIPC) of pediatric inguinal hernia under laparoscopic guidance is a well-developed feasible technique; however, suture knotting remains a major challenge during this technique. Most laparoscopic surgeons prefer extracorporeal subcutaneous suture knotting, which may be associated with consequent formation of stitch sinus and increased recurrence rate. On the other hand, intracorporeal suture knotting necessitates the availability of special devices or homemade instruments with a long learning curve. Therefore, the present study innovates new and simple modification allowing intracorporeal suture knotting during SIPC of pediatric inguinal hernia that does not require any special operating devices or homemade instruments. Patients and Methods. Four-hundred children suffering from inguinal hernia of congenital type, submitted to SIPC using Epidural needle (EN), under laparoscopic guidance with intracorporeal suture knotting. Results. Children ages were 6 months to 10 years (the range). There were 300 boys and 100 girls, and two-hundred children suffered from left side hernia, 150 with right-side hernia, and 50 children with both left- and right-side hernia. 10 ± 2.2 minutes was the recorded operation time in one side hernia repair, while 14 ± 4.3 minutes was recorded for both side repair. Postoperative results reported recurrent hernia in one child and postoperative hydrocele in 3 children which resolved spontaneously after 3 weeks of follow-up. Conclusion. Intracorporeal suture knotting during SIPC of pediatric inguinal hernia allows for the transformation of a formally extraperitoneal procedure to an intraperitoneal procedure. This new modification for intracorporeal suture knotting does not require any special operating devices or homemade instruments. It seems to be an attractive way during SIPC of pediatric inguinal hernia when intracorporeal suture knotting is considered.

RESULTS OF THE USE OF VARIOUS METHODS OF ENDOSCOPIC INGUINAL HERNIORRHAPHY IN CHILDREN

Introduction. Endoscopic inguinal herniorrhaphy in children has become widespread, but there are no comparative results of using various technologies for its implementation. Material and methods. The results of 1136 laparoscopic herniorrhaphies in children for inguinal hernia throughout the period from 2006 to 2016 were analyzed. The first group (GL1) comprised 812 patients who underwent laparoscopic suturing of an inguinal hernia with intracorporeal purse-string suture. The second group (GL2) included 324 children, who were treated with the subcutaneous endoscopically assisted ligation (SEAL) technology - single-ported transcutaneous herniorrhaphy with laparoscopic assistance. Children were operated most often at the age from 1 year to 7 years. The average age of patients in the first group amounts of 4.6 years, in the second group - 4.5 years. All herniorrhaphies were performed standardly, with the use of the same instrumentation. Results. There were revealed such advantages of the use of the SEAL method as the time of training of beginning surgeons to the technique of endoherniorrhaphy is shorter by 2.5 times at the preclinical stage of training, at the stage of assisting and bringing the independent technique of its implementation to perfection; the duration of the operation is shorter due to the exclusion of the time for the introduction of the second/third port and the imposition of an intracorporeal node that presents the greatest difficulty for beginning surgeons; the number of intra- and early postoperative complications do not differ in both groups. The number of relapses is greater in GL2 children with large inguinal and scrotal hernias. The duration of hospitalization in groups did not differ. Conclusion. The use of SEAL technology is economically more profitable due to the relative simplicity of technique of herniorrhaphy and the minimal use of the number of endoscopic instruments. In large inguinal and scrotal hernias, it is more appropriate to use the traditional technique of imposing intracorporeal suture.