Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.155
Filtrar
1.
J Med Life ; 12(3): 301-307, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31666835

RESUMO

Hysterectomy is the most common gynecological surgical intervention; therefore, there are many technical variations in different healthcare systems around the world. We aimed to review, step by step, the technique of laparoscopic hysterectomy as well as to present the available variety of surgical instruments impartially so that the operative team can decide in an informed manner the model and characteristics of the equipment used. The surgical technique is presented based on the experience of the authors, focusing mainly on intraoperative recommendation and suggestions. Advantages and disadvantages of the available instruments are also extensively detailed. Surgical positioning, as well as inserting the uterine manipulator are essential steps. The open technique is used to create pneumoperitoneum. The utero-ovarian ligament or the infundibulopelvic ligament is identified, coagulated and cut. The round ligament is incised, entering the space between the two layers of the broad ligament and advancing caudally in this space, which, if correctly identified, should be avascular. The uterine vessels located on the posterior sheet of the broad ligament are dissected and coagulated. The vaginal wall is sectioned with the help of the manipulator's cap, making it easier to expose the insertion line of the vagina on the cervix. The uterus is removed through the vagina or through a trans-parietal incision. Thereafter, the vagina is sutured using separate Vicryl sutures. Between 2011 and 2016, laparoscopic hysterectomy had an increasing trend all over Europe. With a reported percentage of 3%, Romania ranks last in hysterectomies performed laparoscopically. The laparoscopic approach offers the advantages of minimal invasiveness: less pain, faster recovery and early social reintegration; therefore, this trend of improvement should become more accepted.


Assuntos
Histerectomia/instrumentação , Laparoscopia/instrumentação , Coagulação Sanguínea , Feminino , Humanos , Pessoa de Meia-Idade , Instrumentos Cirúrgicos , Útero/cirurgia
2.
Medicine (Baltimore) ; 98(44): e17780, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689845

RESUMO

RATIONALE: Foreign bodies related ureteral obstruction and hydronephrosis is rare and usually cause numerous problems for clinical physicians. PATIENT CONCERNS: We report a 36-year-old female who was referred to our hospital due to a 4-year history of dull pain on the left back. DIAGNOSIS: X-ray and abdominal CT revealed a foreign body around the upper part of the left ureter with ureteral obstruction and hydronephrosis. INTERVENTIONS: Laparoscopy was performed and a 3-cm sewing needle was removed successfully. OUTCOMES: After 6 months' follow-up, the patient's ureteral obstruction and hydronephrosis were significantly reduced, and the double-J ureteral stent was removed. LESSONS: This case indicated that ureteral obstruction and hydronephrosis caused by foreign bodies needed to be early diagnosed and located. Invasive therapies rather than conservative treatments are preferred to remove the FBs and relieve obstruction.


Assuntos
Corpos Estranhos/complicações , Hidronefrose/etiologia , Laparoscopia/métodos , Ureter/lesões , Obstrução Ureteral/etiologia , Adulto , Feminino , Corpos Estranhos/cirurgia , Humanos , Hidronefrose/cirurgia , Laparoscopia/instrumentação , Stents , Ureter/cirurgia , Obstrução Ureteral/cirurgia
3.
J Surg Oncol ; 120(8): 1386-1390, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31691288

RESUMO

BACKGROUND AND OBJECTIVES: Laparoscopic access to the posterosuperior and lateral parts of the right liver is difficult for blocked and deep surgical situations. We invented a novel water bag device (WBD) to improve the exposure of the right liver. METHODS: Eighteen consecutive patients with lesions isolated to the posterosuperior or lateral right liver were included in our research. They underwent laparoscopic right hepatectomy with the help of the device and were compared with previous similar laparoscopic cases of our operating surgeon. RESULTS: The device was successfully employed without related complications and provided enhanced and stable surgical exposure. All patients were operated on without the need for blood transfusions or laparotomy conversion. The median operation time and estimated blood loss were 227 minutes (range, 114-568) and 88 mL (range, 25-250), respectively. In all cases, tumor-free surgical margins were confirmed and no major complications were observed. The results were better than those in previous similar laparoscopic cases. CONCLUSIONS: The WBD is safe and effective for laparoscopic exposure when lesions are located in the posterosuperior and lateral parts of the right liver. With the help of the device, laparoscopic right liver resection is easier to perform instead of undergoing open hepatectomy.


Assuntos
Hepatectomia/instrumentação , Laparoscopia/instrumentação , Neoplasias Hepáticas/cirurgia , Adulto , Idoso , Perda Sanguínea Cirúrgica , Feminino , Hepatectomia/métodos , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia
5.
Z Gastroenterol ; 57(10): 1196-1199, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31610582

RESUMO

Many patients with intrahepatic cholelithiasis need surgical treatment during their life. For patients with hepatolithiasis, conventional therapy methods suggest partial hepatectomy or hepatic transplantation, while both kinds of surgery carry a considerable risk and trauma. Under such conditions, percutaneous transhepatic cholangioscopic lithotripsy provides an alternative method for hepatolithiasis treatment. Conventional rigid choledochoscope applied in percutaneous transhepatic cholangioscopic lithotripsy often lack sufficient flexibility for complete intrahepatic bile duct inspection. In this article, we report a case of one patient with complex hepatolithiasis and choledocholithiasis who received percutaneous transhepatic cholangioscopic lithotripsy using the newly-developed soft fiber-optic choledochoscope. This treatment represents a safe and effective outcome. We came to the conclusion that soft fiber-optic choledochoscope guided percutaneous transhepatic cholangioscopic lithotripsy seems a promising treatment option for selected patients with hepatolithiasis, especially for those who cannot accept conventional methods.


Assuntos
Coledocolitíase , Litotripsia , Hepatopatias , Idoso , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/patologia , Ductos Biliares Intra-Hepáticos/cirurgia , Coledocolitíase/diagnóstico por imagem , Coledocolitíase/patologia , Coledocolitíase/cirurgia , Humanos , Laparoscopia/instrumentação , Litotripsia/instrumentação , Fígado/diagnóstico por imagem , Fígado/patologia , Fígado/cirurgia , Hepatopatias/diagnóstico por imagem , Hepatopatias/patologia , Hepatopatias/cirurgia , Masculino , Resultado do Tratamento
6.
Dis Colon Rectum ; 62(12): 1512-1517, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31569096

RESUMO

BACKGROUND: There has been increasing concern and scrutiny in the use of mesh for certain pelvic organ prolapse procedures. However, mesh erosion was often associated with sites of suture fixation of the mesh to the rectum or vagina. Thus, in response to this finding, we replaced our suture material with absorbable monofilament suture. OBJECTIVE: The purpose of this study was to compare the rates of mesh-related complications after laparoscopic ventral mesh rectopexy, according to the type of suture used in fixation of mesh. DESIGN: This was retrospective cohort study. SETTINGS: This study was performed at a high-volume, tertiary care center. It was conducted using a prospective database including patients who underwent laparoscopic ventral mesh rectopexy over a 7-year period. PATIENTS: A total of 495 cases were included; 296 (60%) laparoscopic ventral mesh rectopexies were performed using a nonabsorbable suture compared with 199 (40%) with an absorbable suture in a case-matched analysis. In addition, 151 cases of laparoscopic ventral mesh rectopexy with nonabsorbable were matched based on age, sex, and time of follow-up, with an equal number of patients using absorbable monofilament suture. MAIN OUTCOMES MEASURES: Primary outcome was symptomatic mesh erosion after rectopexy. Secondary outcomes included other mesh-related complications and/or reoperations. RESULTS: The erosion rate was 2% (6/495) in the nonabsorbable suture group, including 4 erosions into the rectum and 2 into the vagina. There was no erosion in the group with absorbable suture. This difference was maintained after matching: after a median follow-up of 6 (12) months, there was no erosion in the absorbable suture group versus 3.3% erosion (n = 5) in the nonabsorbable suture group (p = 0.03). LIMITATIONS: This study was limited by its retrospective design. CONCLUSIONS: Mesh-related complications are reduced using absorbable sutures compared with nonabsorbable sutures when performing laparoscopic ventral mesh rectopexy with synthetic mesh without an increase in rectopexy failures. See Video Abstract at http://links.lww.com/DCR/B49. IMPACTO DEL TIPO DE SUTURA EN LA TASA DE EROSIóN DESPUéS DE LA RECTOPEXIA VENTRAL LAPAROSCóPICA CON MALLA: UN ESTUDIO DE CASOS EMPAREJADOS: Ha habido una creciente preocupación y escrutinio en el uso de la malla para ciertos procedimientos de prolapso de órganos pélvicos. Sin embargo, la erosión de la malla a menudo se asoció con sitios de fijación de sutura de la malla al recto o la vagina. Por lo tanto, en respuesta a este hallazgo, reemplazamos nuestro material de sutura con sutura de monofilamento absorbible.Comparar las tasas de complicaciones relacionadas con la malla después de la rectopexia laparoscópica de malla ventral, de acuerdo al tipo de sutura utilizada en la fijación de la malla.Este fue un estudio de cohorte retrospectivo.Este estudio se realizó en un centro de atención de tercer nivel de alto volumen. Se realizó utilizando una base de datos prospectiva que incluía pacientes que se sometieron a una rectopexia de malla ventral laparoscópica durante un período de 7 años.Se incluyeron un total de 495 casos; 296 (60%) rectopexias de malla ventral laparoscópica utilizando una sutura no reabsorbible en comparación con 199 (40%) con una sutura absorbible en un análisis de casos emparejados. Además, 151 casos de rectopexia ventral laparoscópica con malla no absorbible se emparejaron según la edad, el sexo y el tiempo de seguimiento con un número igual de pacientes que usaban sutura de monofilamento absorbible.La medida de resultado primaria fue la erosión sintomática de la malla después de la rectopexia. La medida de resultado secundarias incluyeron otras complicaciones y/o reoperaciones relacionadas con la malla.La tasa de erosión fue del 2% (6/495) en el grupo de sutura no absorbible; 4 erosiones en el recto y 2 en la vagina. No hubo erosión en el grupo con sutura absorbible. Esta diferencia se mantuvo después del emparejamiento: después de una mediana de seguimiento de 6 (12) meses, no hubo erosión en el grupo de sutura absorbible versus 3.3% de erosión (n = 5) en el grupo de sutura no absorbible (p = 0.03).Este estudio estuvo limitado por su diseño retrospectivo.Las complicaciones relacionadas con la malla se reducen utilizando suturas absorbibles en comparación con las suturas no absorbibles cuando se realiza la rectopexia de malla ventral laparoscópica con malla sintética, sin un aumento en los fracasos de rectopexia. Vea el Resumen del Video en http://links.lww.com/DCR/B49.


Assuntos
Laparoscopia/instrumentação , Prolapso Retal/cirurgia , Telas Cirúrgicas/efeitos adversos , Suturas/classificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais com Alto Volume de Atendimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento
7.
Gynecol Oncol ; 155(2): 220-223, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31488245

RESUMO

OBJECTIVES: To determine if intraperitoneal (IP) ports placed concurrently with bowel resection during surgical treatment of ovarian cancer is associated with more complications than those ports placed without concurrent bowel resection. METHODS: The medical records of all patients who had an IP port placed at our institution between 2005 and 2016 were reviewed. Two groups were analyzed: IP ports placed with bowel resection (IP-BR) and those without (IP). RESULTS: Of 306 patient charts reviewed, 31% had a surgery with IP port placement and concurrent bowel resection (IP-BR). Demographics were similar except for mean BMI (25.6 IP-BR vs 27.4 IP, p = 0.007). More IP-BR patients had stage IIIC disease (83.3% IP-BR vs 56.9% IP, p ≤0.01). Patients were cytoreduced to R0 in 48.7% IP-BR vs 56.4% IP (p = 0.253). For adjuvant treatment, IV chemotherapy was administered before IP chemotherapy in 90.4% IP-BR (median 2 cycles), and 50.3% IP, (median 2 cycles, p < 0.01). Ultimately 80.2% IP-BR (median 4 cycles) and 77.8% IP (median 5 cycles) received IP chemotherapy (p = 0.65). Rates of total IP port complications were similar (19.2% IP-BR vs 23.2% IP, p = 0.397), including IP port infections (0% IP-BR vs 0.7% IP, p = 0.5). Eleven percent of IP-BR patients had a bowel complication (e.g. obstruction or perforation) while IP port was in situ vs 2.7% IP (p = 0.01). Only 2.7% IP-BR and 6% IP discontinued IP chemotherapy due to IP port complication (p = 0.3). CONCLUSIONS: Patients who have IP ports placed concurrently with a bowel resection do not appear to have more complications, nor lower rates of IP chemotherapy administration.


Assuntos
Laparoscopia/instrumentação , Neoplasias Ovarianas/cirurgia , Antineoplásicos/uso terapêutico , Quimioterapia Adjuvante , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/instrumentação , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/etiologia , Neoplasias Ovarianas/tratamento farmacológico , Peritônio/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Instrumentos Cirúrgicos/efeitos adversos , Resultado do Tratamento
8.
Clín. investig. ginecol. obstet. (Ed. impr.) ; 46(3): 102-106, jul.-sept. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-182715

RESUMO

Objetivo: Verificar que la técnica de acceso laparoscópico tras insuflación con aguja de Veress en punto de Palmer a presiones elevadas no produce efectos adversos anestésicos relevantes en pacientes sanas y que, además, es útil para la reducción del riesgo de lesiones mayores, comparada con la técnica clásica de insuflación umbilical a presiones estándar. Material y métodos: Estudio analítico observacional prospectivo de cohortes. La cohorte expuesta al factor estudiado la conforman 150 pacientes intervenidas mediante cirugías laparoscópicas ginecológicas en las que se ha utilizado, para las maniobras de acceso a cavidad abdominal, la insuflación con aguja de Veress en punto de Palmer hasta presiones elevadas de 20-25mmHg (grupo 1). La cohorte no expuesta la conforman 150 pacientes en las que se ha utilizado, para las maniobras de acceso a cavidad abdominal, la técnica clásica de insuflación con aguja de Veress a nivel umbilical hasta presiones estándar de 12-14mmHg (grupo 2). Resultados: En el grupo 1 el porcentaje de complicaciones fue del 5,3%, mientras que en el grupo 2 fue del 6,7% (p=0,62). Por otro lado, el porcentaje de cambios de técnica/localización de acceso y de conversión a laparotomía secundaria a efectos adversos durante las maniobras de insuflación/entrada fue del 2% y del 0% en el grupo 1, y del 2,7% y del 2% en el grupo 2, respectivamente. Conclusión: La insuflación en punto de Palmer a presiones elevadas presenta ventajas comparada con la técnica umbilical clásica respecto a la prevención de complicaciones durante las maniobras de acceso laparoscópico


Objective: To demonstrate that the laparoscopic access technique at Palmer's point at elevated pressures does not cause significant anaesthetic adverse effects in healthy patients, and is also useful for reducing the risk of major injuries compared to the classic umbilical insufflation technique at standard pressures. Material and methods: Prospective observational analytical study of cohorts. The cohort exposed to the studied factor consisted of 150 patients undergoing gynaecological laparoscopic surgery in which insufflation with Veress needle in Palmeŕs point until high pressures of 20-25mmHg (Group 1) has been used for access manoeuvres into the abdominal cavity. The unexposed cohort consisted of 150 patients in whom the classical technique of insufflation has been used for access manoeuvres to the abdominal cavity, with the needle at umbilical level up to standard pressures of 12-14mmHg (Group 2). Results: The percentage of complications in Group 1 was 5.3%, whereas it was 6.7% in Group 2 (p=0.62). On the other hand, the percentage of technique changes/access location and conversion to laparotomy due to adverse effects during insufflation/entry manoeuvres was 2% and 0% in Group 1, and 2.7% and 2% in Group 2, respectively. Conclusion: Palmer's point insufflation at elevated pressures has advantages compared to the classical umbilical technique, as regards the prevention of complications during laparoscopic access manoeuvres


Assuntos
Humanos , Feminino , Adulto , Insuflação/classificação , Insuflação/instrumentação , Laparoscopia/métodos , Estudos Prospectivos , Laparoscopia/instrumentação , Procedimentos Cirúrgicos em Ginecologia/métodos
10.
Yonsei Med J ; 60(9): 864-869, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31433584

RESUMO

PURPOSE: The aim of this study was to evaluate the feasibility and safety of laparoendoscopic single site (LESS) surgery using an angiocatheter needle in patients with huge ovarian cysts (diameter ≥15 cm). MATERIALS AND METHODS: Thirty-one patients with huge ovarian cysts underwent LESS surgery using an angiocatheter needle between March 2011 and August 2016. An intra-umbilical vertical incision (1.5-2.0 cm) was made in the midline. After the cyst wall was punctured using an angiocatheter needle, the fluid contents were aspirated with a connected vacuum aspirator. After placing a Glove port in the umbilical incision, LESS surgery was performed using a rigid 0-degree, 5-mm laparoscope and conventional, rigid, straight laparoscopic instruments. Knife-in-bag morcellation was instituted for specimen collection. RESULTS: The median maximal diameter of ovarian cysts was 18 cm (range, 15-30 cm), the median operation time was 150 minutes (range, 80-520 minutes), and the median volume of blood loss was 100 mL (range, 20-800 mL). Three patients (9.7%) were diagnosed with malignant ovarian cancer using intraoperative frozen examination, and 1 patient was converted to laparotomy due to advanced disease. Thirty patients underwent LESS, and there was no need for an additional laparoscopic port. CONCLUSION: LESS surgery using an angiocatheter needle, with leaving only a small postoperative scar, was deemed feasible for the management of huge ovarian cysts.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/métodos , Laparoscopia/instrumentação , Laparoscopia/métodos , Laparotomia/métodos , Cistos Ovarianos/cirurgia , Neoplasias Ovarianas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Agulhas , Duração da Cirurgia , Estudos Retrospectivos , Instrumentos Cirúrgicos , Resultado do Tratamento , Adulto Jovem
12.
Fertil Steril ; 112(2): 183-196, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31352957

RESUMO

Before the modern era of in vitro fertilization, reproductive surgery to deal with pelvic disease was the key intervention in the management of infertility. A series of clinical observations and animal experiments led to the development of microsurgical principles, which were applicable to all forms of gynecologic surgery. The evolution of endoscopy permitted minimally invasive approaches to most pelvic pathology. Assisted reproductive techniques now have primacy in the management of infertility, but women deserve to have fertility-enhancing or fertility-sparing surgery performed by a surgeon with relevant training. Thus, we have an obligation to maintain formal training programs in reproductive surgery.


Assuntos
Fertilização In Vitro/métodos , Procedimentos Cirúrgicos em Ginecologia , Laparoscopia , Laparotomia , Endoscópios , Tubas Uterinas/cirurgia , Feminino , Fertilização In Vitro/instrumentação , Procedimentos Cirúrgicos em Ginecologia/instrumentação , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/tendências , Humanos , Infertilidade/cirurgia , Infertilidade Feminina/cirurgia , Laparoscopia/instrumentação , Laparoscopia/métodos , Laparoscopia/tendências , Laparotomia/instrumentação , Laparotomia/métodos , Laparotomia/tendências , Microcirurgia/métodos , Técnicas de Reprodução Assistida/tendências
13.
World J Gastroenterol ; 25(26): 3313-3333, 2019 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-31341358

RESUMO

Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy must be performed by a highly experienced endoscopist. The challenges are accessing the afferent limb in different types of reconstruction, cannulating a papilla with a reverse orientation, and performing therapeutic interventions with uncommon endoscopic accessories. The development of endoscopic techniques has led to higher success rates in this group of patients. Device-assisted ERCP is the endoscopic procedure of choice for high success rates in short-limb reconstruction; however, these success rate is lower in long-limb reconstruction. ERCP assisted by endoscopic ultrasonography is now popular because it can be performed independent of the limb length; however, it must be performed by a highly experienced and skilled endoscopist. Stent deployment and small stone removal can be performed immediately after ERCP assisted by endoscopic ultrasonography, but the second session is needed for other difficult procedures such as cholangioscopy-guided electrohydraulic lithotripsy. Laparoscopic-assisted ERCP has an almost 100% success rate in long-limb reconstruction because of the use of a conventional side-view duodenoscope, which is compatible with standard accessories. This requires cooperation between the surgeon and endoscopist and is suitable in urgent situations requiring concomitant cholecystectomy. This review focuses on the advantages, disadvantages, and outcomes of various procedures that are suitable in different situations and reconstruction types. Emerging new techniques and their outcomes are also discussed.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomia/métodos , Laparoscopia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Sistema Biliar/diagnóstico por imagem , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Colecistectomia/instrumentação , Duodenoscópios , Endossonografia , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Derivação Gástrica/instrumentação , Derivação Gástrica/métodos , Humanos , Laparoscopia/instrumentação , Pancreaticoduodenectomia/efeitos adversos , Pancreaticoduodenectomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Stents , Resultado do Tratamento , Ultrassonografia de Intervenção
14.
Urology ; 132: 123-129, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31310768

RESUMO

OBJECTIVES: To demonstrate the clinical feasibility of an articulated laparoscopic needle driver to assist in the performance of laparoscopic partial nephrectomy (LPN). Previous studies have demonstrated under-utilization of minimally invasive techniques for patients undergoing partial nephrectomy (PN). METHODS: Consecutive patients with renal masses amenable to PN underwent LPN with an articulating laparoscopic needle driver. A consecutive cohort of patients who previously underwent robot assisted laparoscopic PN (RALPN) was selected as a comparison cohort. Preoperative, perioperative, and postoperative variables were retrospectively collected. RESULTS: A total of 20 patients underwent PN with 10 patients assigned to each of the LPN and RALPN cohorts. Median R.E.N.A.L. nephrometry scores assigned to the LPN and RALPN cohorts were 7 and 6 respectively (P= .31). Median warm ischemia time for patients in the LPN and RALPN groups was 25.5 and 18.5 minutes respectively (P= .36). Median estimated blood loss for LPN and RALPN was 200 and 50 mL (P= .03). Median operative time for LPN and RALPN was 203 and 194 minutes respectively (P= .76). Median Length of stay after LPN and RALPN was similar (3.0 vs 2.5 nights, P= .26). Following LPN, 3 patients required blood transfusion as compared to 2 patients in the RALPN cohort (P= .61). CONCLUSION: Our initial results demonstrated the clinical safety and feasibility of a new surgical device for performing LPN. Patients who underwent LPN with a novel articulating needle driver demonstrated equivalent results to RALPN across several key outcomes.


Assuntos
Neoplasias Renais/cirurgia , Laparoscopia/instrumentação , Agulhas , Nefrectomia/instrumentação , Nefrectomia/métodos , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Humanos , Masculino , Estudos Retrospectivos
15.
J Minim Invasive Gynecol ; 26(5): 973-976, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256782

RESUMO

The first port entry in patient who underwent previous abdominal surgery. Palmer's point can be used in patients with suspected periumbilical adhesions, a history of an umbilical hernia, or multiple failed attempts of insufflations at the umbilicus. Palmer's point has its limitations in cases of left upper quadrant surgery, splenomegaly, portal hypertension, and improper nasogastric tube placement giving rise to a bloated stomach. In such cases, a new and safe point for laparoscopic entry is needed. In the present case of a patient who underwent previous upper abdominal surgery with the chevron incision obscuring Palmer's point, laparoscopic entry was made through a novel point that was found to be safe in such cases and can be used in similar cases of previously scarred abdomens.


Assuntos
Abdome/cirurgia , Cicatriz/etiologia , Cicatriz/cirurgia , Laparoscopia , Laparotomia/efeitos adversos , Hemorragia Uterina/cirurgia , Abdome/patologia , Cavidade Abdominal/cirurgia , Adulto , Cicatriz/patologia , Equinococose Hepática/cirurgia , Feminino , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/métodos , Instrumentos Cirúrgicos/efeitos adversos , Aderências Teciduais/cirurgia , Hemorragia Uterina/patologia
16.
Ann R Coll Surg Engl ; 101(6): e136-e138, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31155895

RESUMO

Completely endophytic renal tumours pose challenges in laparoscopic nephron-sparing tumour excisions, with the use of intraoperative imaging techniques (e.g. ultrasound) being crucial when managing such tumours. The use of a percutaneous hookwire for tumour localisations are in use in several other surgical fields, such as breast surgery. An asymptomatic 52-year-old man presented with an incidental small right sided solid 33-mm interpolar renal mass identified on computed tomography. A guided insertion of a percutaneous localisation wire was carried out prior to a laparoscopic partial nephrectomy to assist in intraoperative tumour landmark/margins identification. Operative time was 210 minutes with zero ischaemia time, with an estimated blood loss of 200 ml. No perioperative complications were observed and the patient was discharged two days postoperatively. Histology revealed the mass to be a Fuhrman grade 2 clear-cell carcinoma with a 2-mm clear surgical margin. The patient remained free of recurrence at 16 months of follow-up. We have reported our first experience of wire localisation prior to laparoscopic partial nephrectomy for an intrarenal mass, which to our knowledge could be the first of its kind in renal surgery. Percutaneous wire localisation of endophytic renal tumours is potentially safe and effective and can allow nephron-sparing surgery where laparoscopic ultrasound is not available. Longer-term and further evidence should be encouraged.


Assuntos
Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgia , Laparoscopia/métodos , Instrumentos Cirúrgicos , Carcinoma de Células Renais/diagnóstico por imagem , Humanos , Neoplasias Renais/diagnóstico por imagem , Laparoscopia/instrumentação , Masculino , Pessoa de Meia-Idade , Nefrectomia/instrumentação , Nefrectomia/métodos , Radiografia Intervencionista/instrumentação , Radiografia Intervencionista/métodos , Tomografia Computadorizada por Raios X
17.
J Laparoendosc Adv Surg Tech A ; 29(8): 1077-1080, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31161953

RESUMO

Background: Laparoscopic intracorporeal sutures and knots require advanced techniques in children. The JAiMY® needle holder (Endocontrol Company, Grenoble, France), a flexible jaw with both clockwise and anticlockwise revolving functions, enables the placement of sutures in very small working spaces. Using this tool, a novel new ligation method, which we named "twitching technique," can be performed. Methods: To perform the "twitching technique," first grasp the long tail of the thread with the JAiMY and the forceps on the needle side. Then, rotate the tip of the needle holder halfway in either direction and bring the forceps closer to the needle holder to make a ring using the thread. Grasp the thread at the crossing point with the forceps, and then catch the short tail through the ring with the needle holder. Results (Case Presentation): A 1-year-old boy presented with vomiting because of esophageal hiatal hernia. He was being treated for single ventricle and asplenia at our hospital. Laparoscopic esophageal hiatus plication was performed. Although the working space was extremely limited, the JAiMY and the "twitching technique" enabled steady suture placement and ligation. Conclusions: The "twitching technique" is an easy, steady, and safe method for performing ligation in difficult situations and may facilitate the performance of many laparoscopic surgeries in pediatric fields.


Assuntos
Hérnia Hiatal/cirurgia , Laparoscopia/instrumentação , Laparoscopia/métodos , Ligadura/métodos , Instrumentos Cirúrgicos , Técnicas de Sutura , Esôfago/cirurgia , Humanos , Lactente , Masculino , Agulhas
18.
J Laparoendosc Adv Surg Tech A ; 29(10): 1216-1222, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31150305

RESUMO

Background: Laparoscopic duodenal atresia (DA) repair is a demanding procedure that requires performing a watertight anastomosis in a small working space. Drawbacks of the approach have been high leakage rates and long operative times. In this article, we evaluate our initial experience with DA repair using a laparoscopic miniature stapler (LA-MS) and compared outcomes with a historic cohort of laparoscopic hand-sewn (LA-HS) and open repairs (ORs). Materials and Methods: A retrospective analysis of all patients who underwent surgery for DA at our two centers between January 2010 and April 2018 was performed. Demographics, comorbidities, intra- and postoperative data, and outcome parameters were evaluated and statistically analyzed. Results: DA repair was performed in 44 patients. Ten patients underwent laparoscopic DA repair using an MS, 21 patients laparoscopic repair with HS anastomosis, and 13 patients underwent OR. Median age and weight at surgery was 13.5 days (range: 2-173) and 3300 g (range: 1630-5600) in the LA-MS group, 4 days (range: 2-269) and 2750 g (range: 1700-4095) in the LA-HS group and 4 days (range: 1-17) and 2222 g (range: 1520-3590) in the OR group, respectively. Mean operative time was significantly shorter in the laparoscopic stapled group compared with LA-HS group (145 ± 37 minutes (range: 97-217) versus 201 ± 47 minutes (range: 119-275), P < .004). Duodenojejunostomy was performed more frequently in the laparoscopic stapled group compared with the open procedure (P = .008). Overall complication rate was similar between groups. Time to initiation of feeds and time to full feeds were significantly shorter in the laparoscopic stapled group compared with the open approach (5 versus 11.9 days, P = .041 and 14.5 versus 24.4 days, P = .020). Conclusion: Laparoscopic DA repair using an MS is a novel, safe, and feasible technique that was associated with significantly shorter operating times than HS laparoscopic DA repair. Owing to its simplicity, this technique has the potential to become the new standard of care.


Assuntos
Obstrução Duodenal/cirurgia , Atresia Intestinal/cirurgia , Laparoscopia/instrumentação , Grampeadores Cirúrgicos , Grampeamento Cirúrgico/instrumentação , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Laparoscopia/métodos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Grampeamento Cirúrgico/métodos , Resultado do Tratamento
19.
Medicina (Kaunas) ; 55(6)2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31195748

RESUMO

Background and objectives: Single-port laparoscopic appendectomy (SLA) in most previous studies has used intracorporeal excision of the appendix and needed a longer operative time than multi-port laparoscopic appendectomy (MLA), although SLA does have the potential benefit of an almost invisible scar within the umbilicus. Some studies have reported that extracorporeal transumbilical single-incision laparoscopic-assisted appendectomy (TULAA) in children took a considerably reduced operative time compared to MLA. We adopted TULAA in adults, adding routine dissection of the peritoneal attachment of the appendix. The aim was to compare the operative outcomes between TULAA and MLA. Materials and Methods: Between March 2013 and January 2016, 770 patients with acute uncomplicated and complicated appendicitis from 15 to 75 years of age were enrolled retrospectively. The operation was performed as early (EA) and interval appendectomy (IA). Results: Operative time was shorter in the TULAA group than in the MLA group, except for IA. No open conversion occurred in the TULAA group, except one case of ileocecal resection for IA. No intra-abdominal fluid collection was found in the TULAA group. Extended resection (especially partial cecectomy) was performed less frequently in the TULAA group than in the MLA group for IA. Mean postoperative hospital stay was shorter in the TULAA group for uncomplicated appendicitis. When the data of the EA group and the IA group were compared, operative time was significantly shorter in the IA group for both MLA and TULAA. The open conversion rate and the complication rate tended to be lower in the IA group. Confined to IA, the TULAA group tended to have shorter mean initial, postoperative, and total hospital stays. Conclusions: TULAA can be a useful surgical alternative to MLA in adults and young adolescents, because it lacks open conversion and provides both a shorter operative time and a shorter postoperative hospital stay. TULAA is feasible for IA in that it showed a lower rate of extended resection and complications.


Assuntos
Apendicectomia/métodos , Laparoscopia/métodos , Umbigo/cirurgia , Adolescente , Adulto , Apendicectomia/instrumentação , Apendicite/cirurgia , Feminino , Humanos , Laparoscopia/instrumentação , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , República da Coreia , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do Tratamento
20.
Zhongguo Yi Liao Qi Xie Za Zhi ; 43(3): 165-169, 2019 May 30.
Artigo em Chinês | MEDLINE | ID: mdl-31184070

RESUMO

At present, there still exist some limitations in the laparoscopic surgery robot represented by da Vinci surgical robot, such as the lack of force feedback function. Doctor can not feel the force feedback while operating. In this paper, a new minimally invasive laparoscopic surgery robot system is designed. Based on the master side surgeon's console, stereo vision subsystem and the slave side surgical cart, the multi-dimensional instrument force feedback technology and force feedback based safety protection strategy are introduced. The design realizes the force sensing function of full state operation. Besides, a number of different live pig experiments are carried out. The amount of bleeding in these experiments is relatively small compared with the data of the same kind of surgical robots, which effectively validates the force feedback and surgical safety protection strategies of the new robot system.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Robóticos , Robótica , Animais , Desenho de Equipamento , Laparoscopia/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Cirúrgicos Robóticos/instrumentação , Suínos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA