Laparoscopic removal of a perforating intrauterine device mimicking chronic appendicitis.

The intrauterine contraceptive device (IUD) is a common form of reversible birth control. One of the rare, but serious, complications is uterine perforation. In this paper, we report a case of a patient who underwent laparoscopy for presumed chronic appendicitis. Intraoperatively, uterine perforation by the IUD was found. The IUD was removed laparoscopically. The postoperative course was uneventful.

Incarcerated femoral Littre's hernia-transperitoneal preperitoneal hernia repair (TAPP) and laparoscopic resection of the necrotic diverticulum.

Littre's hernias in the region of a femoral hernial orifice have been described in numerous cases in the literature. Open inguinal or femoral access was selected for all surgical procedures. We are describing the first case of an incarcerated Littre's hernia in the region of a femoral hernial orifice treated by means of transperitoneal preperitoneal hernia repair with simultaneous laparoscopic resection of the diverticulum. On the basis of the example, it is shown that the laparoscopic procedure is safe and efficient when performed by an experienced laparoscopic surgeon, even for treating incarcerated hernias, including the resection of necrotic tissue.

Hydro-Jet-assisted laparoscopic cholecystectomy: a prospective randomized clinical study.

BACKGROUND: A new dissection technique with high-pressure water stream (Hydro-Jet) has recently been applied for selective dissection during various surgical procedures. The aim of this study was to compare Hydro-Jet with the conventional technique for laparoscopic cholecystectomy. METHODS: Eighty patients were randomized to undergo laparoscopic cholecystectomy with standard (n = 40) or Hydro-Jet-assisted (n = 40) dissection techniques. The rates of intraoperative complications, including blood loss and injury to the adjacent organs, were compared between the groups. The versatility of this technique and the features of surgical dissection were also evaluated and compared. RESULTS: Laparoscopic cholecystectomy was successfully completed in all subjects. The mean operative times were 78 minutes (range, 52-120 minutes) and 81 minutes (range, 45-135 minutes) for Hydro-Jet versus conventional dissection, respectively (P = not significant). Complications included gallbladder perforation in 15% and 30% (P <.1) and liver laceration in 0% and 10% (P <.04) with Hydro-Jet and conventional techniques, respectively. Increased hemorrhage from the gallbladder bed that necessitated fulguration occurred in 12 patients with the conventional technique as compared with none in the Hydro-Jet group (P <.001). Hydro-Jet resulted in a selective dissection of connective tissue preserving blood vessels and the cystic duct. The continuous water flow allowed a clear view for the operator, and the dissection was performed in a relatively bloodless field. The ease of blunt dissection with the bent-tip dissector represents another advantage. CONCLUSION: This study shows that Hydro-Jet dissection represents an excellent alternative to the conventional technique for laparoscopic cholecystectomy. The improved anatomic dissection combined with an almost bloodless operating field as the result of continuous water flow decreased the rate of dissection-related complications.

Hydro-Jet assisted laparroscopic cholecystectomy: initial experience in a porcine model.

BACKGROUND AND OBJECTIVES: Hydro-Jet technology has long been used for cutting various materials like metal and wood in the industrial field. In the medical field, this technology has been applied successfully for selective cutting of the parenchyma of the liver. However, to our knowledge, no data exist on the use of the Hydro-Jet technique for laparoscopic cholecystectomy. The purpose of this study was to evaluate a new dissection technique using a high-pressure water stream (Hydro-Jet) and a new dissection probe for laparoscopic cholecystectomy. METHODS: Thirty pigs underwent laparoscopic cholecystectomy. Pigs were randomized to receive either the conventional or Hydro-Jet assisted dissection technique. The feasibility of this technique and the features of surgical dissection were evaluated and compared between the 2 groups. RESULTS: Laparoscopic cholecystectomy was successful in all animals with no need for conversion to open surgery. The mean operative time was 28 and 36 minutes for Hydro-Jet versus conventional dissection, respectively. Complications using the Hydro-Jet and conventional techniques included 6% and 20% gallbladder perforation and 6.5% and 13% liver laceration, respectively. The use of the Hydro-Jet for cholecystectomy had clear technical advantages over conventional dissection. The Hydro-Jet resulted in a selective dissection of fibrous and connective tissue preserving blood vessels for later ligation. Therefore, the dissection was performed in a relatively bloodless field. The ease of dissection using the new bent tipped dissector represents another advantage. Finally, the continuous water flow allowed a clear view for the operator. CONCLUSIONS: This study shows that Hydro-jet dissection represents an excellent alternative to the conventional technique for laparoscopic cholecystectomy. The improved anatomical dissection combined with an almost bloodless operating field secondary to continuous water flow may decrease dissection-related complications.