Hand-assisted laparoscopic surgery for abdominal aortic aneurysm.

There is a trend toward the use of minimally invasive surgery and limited incision for the surgical repair of abdominal aortic aneurysm (AAA). Conventional AAA repair is performed with a large laparotomy wound and uses either a transperitoneal or retroperitoneal approach. Due to the older age of this patient population, they often suffer more from the surgical wound, require prolonged hospital stay and have a slower recovery. We describe the use of hand-assisted laparoscopic surgery for grafting of a 5.5-cm infrarenal AAA identified by computed tomography scan. The operator inserted the left hand with a Pneumo Sleeve device in the abdomen through a 7-cm midline supraumbilical incision for laparoscopic surgery. Using the left hand and laparoscopic instruments to do the surgery provided control over the operation and sensation of touch. At the completion of the laparoscopic dissection, the first Clawford clamp was applied above the aortic bifurcation through the laparoscopic incision. The second Clawford clamp was applied below the renal arteries through the midline laparotomy incision. After cross-clamping the AAA, the aneurysm was incised, the clot removed, and lumbar bleeding points were oversewn with 3-O prolene suture. Then, the aneurysmal segment was grafted with a Dacron prosthesis using conventional suturing technique. The patient was extubated 3 hours after the operation, stayed in the intensive care unit for 1 night and was discharged 7 days later. He resumed oral intake on the postoperative day 1. There were no complications. This case illustrates that hand-assisted laparoscopic surgery for AAA can allow quick recovery of bowel function, quick progression to regular diet, short length of hospital stay, and probably a reduction in the total cost of care.

Functional investigation in children with spina bifida -- measured by the Pediatric Evaluation of Disability Inventory (PEDI).

OBJECT: The purpose of this study was to investigate the functional performance in children with spina bifida, using the Pediatric Evaluation of Disability Inventory (PEDI). A comparison was also made between the functional performance of children with myelomeningocele (MMC) and lipomyelomeningocele (LMC). METHODS AND RESULTS: Twenty-six children with MMC and 37 cases with LMC were enrolled in this study. There was no significant difference in gender, age or method of birth delivery between these two study groups. The normative standard scores of PEDI for children with spina bifida were all below the mean standard scores found in non-disabled children, but still within the average range, with exception of mobility score in the MMC group. Patients' neurological level, walking ability, intelligence, independence in activities of daily living, and bowel function showed significant correlation with the PEDI scores ( P<0.05) in the children with MMC. In comparing these two disease groups, the MMC had higher neurological level, poorer walking ability and poorer bladder and bowel function than did the LMC ( P<.05). The former also had significantly lower PEDI scores in the mobility and social function domains. PEDI provided valuable information regarding overall functional performance in daily life for children with spina bifida. CONCLUSION: This information is extremely important for planning a comprehensive and individualized rehabilitation program.