Laparoscopic excision of duodenal tumors.

We present three patients with bleeding duodenal tumors who were managed by laparoscopic excision. This represents the largest study of such an experience. The literature is reviewed, and the various technical approaches are discussed.

Evaluation of a head-mounted display (HMD) in the performance of a simulated laparoscopic task.

BACKGROUND: Head-mounted display (HM) units are used in various industries, but they have been tried only recently in surgery. In this study, we evaluated whether a commercially available HMD would improve or impede a laparoscopic task-in this case, suturing. METHODS: Six participants performed a total of 120 laparoscopic suture knots in an experimental model. The Olympus FMD011 model with a two-dimensional image was used. The order of each task with or without the head display unit was random. The time to complete each knot was recorded, and the results were analyzed. RESULTS: The display unit prolonged the suturing times of the subjects by 10% (p < 0.04). CONCLUSIONS: In this experimental model, the HMD we utilized did not appear to improve laparoscopic suturing. More developments, such as improved depth perception and better resolution, may increase its usefulness for laparoscopic tasks.

Randomized trial of needlescopic versus laparoscopic cholecystectomy.

BACKGROUND: Several studies have reported the feasibility of using 'needlescopic' instruments with a diameter less than 3 mm in minimally invasive surgery. This study reports a comparison of needlescopic cholecystectomy and laparoscopic cholecystectomy. METHODS: Seventy-five patients with symptomatic chronic cholelithiasis were randomized to needlescopic (n = 37) or laparoscopic (n = 38) cholecystectomy. RESULTS: The duration of surgery in the two groups was similar. Patients in the needlescopic group had less pain (mean visual analogue score 2.2 versus 3.6; P < 0.003) and had smaller scars (median length 17.0 versus 25.0 mm; P < 0.001). In addition, patients in the needlescopic group tended to require fewer intramuscular pethidine injections (P = 0.05). However, oral analgesic requirements in the two groups were similar. There were no complications in either group. CONCLUSION: Needlescopic cholecystectomy resulted in less postoperative pain and a smaller surgical scar than laparoscopic cholecystectomy in patients with chronic cholecystitis.

Benign duodenal tumors.

BACKGROUND/AIMS: Benign duodenal tumors are rare and less common than malignant tumors. They comprise a wide variety of pathologies. Treatment is by endoscopic excision or surgical resection. In this report, we aim to review the management of benign tumors located in the proximal duodenum. METHODOLOGY: A retrospective review of 11 patients with benign duodenal tumors treated in a single institution was performed over 10 years. Malignant tumors and periampullary tumors were excluded from the study. RESULTS: The most common presentations were abdominal pain and upper gastrointestinal bleeding. Diagnosis was established by gastroduodenoscopy with biopsy. Seven tumors were located in the first part of the duodenum. The mean size of the tumors was 2.8 cm. Three patients with bleeding tumors were treated with endoscopic hemostasis and underwent surgery because the tumors were larger than 2 cm. Four patients had endoscopic polypectomies and 5 patients had surgical excision. The histological types included 6 adenomas, 3 Brunner's gland adenomas or harmatoma, 1 schwannoma and 1 leiomyoma. The results were good with only 1 case of recurrence. CONCLUSIONS: The presentation of benign duodenal tumors is non-specific. They are diagnosed by gastroduodenoscopy and the tumors can be removed if small and pedunculated. Endoscopic ultrasound is useful in detecting submucosal involvement of sessile tumors. In such cases and large tumors (> 2 cm), surgical excision by laparotomy or laparoscopy should be undertaken.

Telesurgical laparoscopic cholecystectomy between two countries.

Telesurgery is a form of operative videoconferencing in which a remotely located surgeon observes a procedure through a camera and provides visual and auditory feedback to the operative site. With the use of more robotic devices in laparoscopic surgery, various forms of telesurgery have been tried. We describe the first two international telesurgical, telementored, robot-assisted laparoscopic cholecystectomies performed in the world, between the Johns Hopkins Institute, Baltimore, Maryland, USA, and the National University Hospital, Singapore.