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1.
Ann R Coll Surg Engl ; 103(2): 130-133, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33559548

RESUMO

INTRODUCTION: Laparoscopic pyloromyotomy is now an accepted procedure for the treatment of pyloric stenosis. However, it is clear that during the implementation period there are significantly higher incidences of mucosal perforation and incomplete pyloromyotomy. We describe how we introduced a new laparoscopic procedure without the complications associated with the learning curve. MATERIALS AND METHODS: Five consultants tasked one surgeon to pilot and establish laparoscopic pyloromyotomy before mentoring the others until they were performing the procedure independently; all agreed to use exactly the same instruments and operative technique. This involved a 5mm 30-degree infra-umbilical telescope with two 3mm instruments. Data were collected prospectively. RESULTS: Between 1 January 2013 and 31 December 2017, 140 laparoscopic pyloromyotomies were performed (median age 27 days, range 13-133 days, male to female ratio 121:19). Fifty-five per cent of procedures were performed by trainees. Complications were one mucosal perforation and one inadequate pyloromyotomy. There were no injuries to other organs, problems with wound dehiscence or other significant complications. The median time of discharge was one day (range one to six days). CONCLUSION: Our rate of perforation and incomplete pyloromyotomy was 1.4%, which is equivalent to the best published series of either open or laparoscopic pyloromyotomy. We believe that this resulted from the coordinated implementation of the procedure using a single technique to reduce clinical variability, increase mentoring and improve training. This approach appears self-evident but is rarely described in the literature of learning curves. In this age of increased accountability, new technologies should be incorporated into routine practice without an increase in morbidity to patients.


Assuntos
Laparoscopia/educação , Tutoria/organização & administração , Complicações Pós-Operatórias/epidemiologia , Estenose Pilórica/cirurgia , Piloromiotomia/educação , Consultores , Feminino , Implementação de Plano de Saúde , Humanos , Lactente , Recém-Nascido , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Curva de Aprendizado , Tempo de Internação , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Piloromiotomia/efeitos adversos , Piloromiotomia/instrumentação , Piloromiotomia/métodos , Estudos Retrospectivos , Cirurgiões/educação , Gravação em Vídeo
2.
Medicine (Baltimore) ; 100(3): e23941, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545969

RESUMO

ABSTRACT: This study aimed to compare the effectiveness and safety of reduced-port laparoscopic surgery (RPLS) and conventional multi-port laparoscopic (CMPLS) surgery in the treatment of gastric diseases.The PubMed, Embase, Cochrane Library, Web of Science, and Chinese Biomedical Literature databases were systematically searched for randomized controlled trials, cohort studies, and case control studies on the use of RPLS vs conventional multi-port laparoscopic surgery in treating gastric diseases from their inception until March 10, 2019. The evaluated outcomes were the operative time, blood loss, length of hospital stay, number of dissected lymph nodes, postoperative complications, and conversions. All of these were compared using Stata software version 12.0.A total of 18 studies were included, which involved 2938 patients. In studies referring to the comparison between RPLS and CMPLS in treating gastric diseases, the former showed significantly inferior in terms of operative time (P = .011) and number of dissected lymph nodes (P = .031); but superior results in terms of the estimated blood loss (P = .000) and length of hospital stay (P = .001) than the latter did; however, the rates of postoperative complications (P = .830) and conversions (P = .102) were not statistically significant between the 2 groups.RPLS and CMPLS showed comparable effectiveness and safety in the treatment of gastric diseases in our meta-analysis. Based on the current evidence, we believe that RPLS is an efficacious surgical alternative to CMPLS in the management of gastric diseases because of the shorter hospital stay and reduced blood loss. However, large-scale, well-designed, multicenter studies are needed to further confirm the results of this study.


Assuntos
Equipamentos e Provisões/normas , Laparoscopia/instrumentação , Laparoscopia/normas , Gastropatias/cirurgia , Resultado do Tratamento , Equipamentos e Provisões/efeitos adversos , Humanos , Laparoscopia/métodos , Tempo de Internação/tendências , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Gastropatias/complicações
3.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(1): 35-42, 2021 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-33461250

RESUMO

In the past 30 years, minimally invasive surgery has been greatly improved with the development of the energy platform, instrument platform, and imaging platform. Taking colorectal cancer surgery as an example, the five elements of surgical procedure have developed to a certain extent. The surgical approach has undergone a process from large to small. The range of resection ranges from simple bowel resection to radical resection/extended radical resection, and then to surgery that focuses on preserving organ function. With the recognition of the direction of normal lymphatic drainage and the characteristics of tumor lymphatic metastasis, lymph node dissection has been gradually standardized. The reconstruction of the digestive tract has changed from manual sutures to full endoscopic anastomosis, and then to the concept of functional anastomosis. The removal of the specimen has improved from large incision through the abdominal wall, to small laparoscopic incision, and then to the natural cavity. The evolution of these procedures depends on the advancement of technology platforms and equipment, and the recognition of new concepts. The development of minimally invasive platform must be in the direction of ensuring the implementation of the most optimized surgical approach. The platform is more secure, integrated, multifunctional, and intelligent. In the future, minimally invasive procedures must be aimed at maximizing the benefits of patients. The procedures are more scientific, functional, comfortable and diverse. Surgical innovation has promoted the development of the platform. The platform and the surgical procedure promote each other's development.


Assuntos
Neoplasias Colorretais/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Laparoscopia , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/tendências , Neoplasias Colorretais/patologia , Procedimentos Cirúrgicos do Sistema Digestório/instrumentação , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/tendências , Previsões , Humanos , Laparoscopia/instrumentação , Laparoscopia/métodos , Laparoscopia/tendências , Excisão de Linfonodo , Metástase Linfática , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Técnicas de Sutura/instrumentação , Técnicas de Sutura/tendências
5.
Obstet Gynecol ; 136(5): 908-911, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030861

RESUMO

BACKGROUND: Wireless signal transduction is the future in the field of laparoscopic surgery. Cable-free endoscopic equipment would be the ideal surgical instrument for every laparoscopic surgeon. INSTRUMENT: Our department has developed a new cable-free laparoscopic setup that couples a rigid 0°, 10-mm laparoscope with a wireless camera modified with a special adapter. We used a portable and rechargeable LED cold light source. The signal was wirelessly transmitted from the camera to a tablet computer using the corresponding mobile application. EXPERIENCE: Our team has used this setup in 14 laparoscopic operations with excellent results. Two cases performed exclusively with the new setup are presented in the videos. The image quality obtained was comparable with the conventional laparoscopic setup, and the operations performed were unaffected. CONCLUSION: This report presents the use of a wireless camera throughout the course of a laparoscopic surgery, and the results are promising. The new systems' favorable characteristics, such as wireless signal transmission, cost, flexibility, and size, support this as a feasible new technique for performing laparoscopic surgery.


Assuntos
Procedimentos Cirúrgicos em Ginecologia/instrumentação , Laparoscópios/tendências , Laparoscopia/instrumentação , Tecnologia sem Fio/tendências , Desenho de Equipamento , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/tendências , Humanos , Laparoscopia/métodos , Laparoscopia/tendências
6.
Medicine (Baltimore) ; 99(36): e22057, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899070

RESUMO

INTRODUCTION: Based on existing literature, the juxtaglomerular cell tumor (JGCT) is a rare renal tumor, typically present with hypertension and hypokalemia. Nonfunctioning JGCT, without hypertension or hypokalemia, is extremely rare. PATIENT CONCERNS: Herein, we report a case of nonfunctioning JGCT mimicking renal cell carcinoma. The 29-year-old woman with an unremarkable past medical history presented with a left renal tumor without hypertension or hypokalemia. DIAGNOSIS: Both CT and 18F-FDG-PET/CT suggested a malignancy, possibly renal cell carcinoma. INTERVENTIONS: The tumor was then removed completely via robotic assistant laparoscopic partial nephrectomy; and pathology result was JGCT. Since the patient had no hypertension or hypokalemia, a nonfunctional JGCT was diagnosed. OUTCOMES: The patient recovered uneventfully, and was in good health in 6-months' follow-up period. CONCLUSION: Preoperative identification of JGCT is very difficult due to the lack of specific clinical manifestations. This case teaches us that for young patients with renal tumors whose CT enhancement is not obvious at the early phase, JGCT should be considered as a differential diagnosis. Radical nephrectomy should be avoided for JGCT in consideration of its relatively good prognosis.


Assuntos
Carcinoma de Células Renais/diagnóstico , Sistema Justaglomerular/patologia , Neoplasias Renais/patologia , Neoplasias/cirurgia , Adulto , Assistência ao Convalescente , Diagnóstico Diferencial , Feminino , Fluordesoxiglucose F18/administração & dosagem , Humanos , Neoplasias Renais/diagnóstico por imagem , Laparoscopia/instrumentação , Nefrectomia/métodos , Nefrectomia/tendências , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento
8.
Medicine (Baltimore) ; 99(34): e21787, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846810

RESUMO

Laparoscopic inguinal herniorrhaphy has been well established for the management of primary and recurrent inguinal hernias. Single-incision laparoscopic surgery (SILS) has now been accepted as a less invasive alternative to conventional laparoscopic surgery. However, commercially available access devices for SILS had disadvantages such as rigidness and crowding. This series aimed to analyze the feasibility and safety of single-incision laparoscopic trans-abdominal pre-peritoneal hernioplasty (SILS-TAPP) by applying our self-made device for managing inguinal hernia.We collected and reviewed the medical records of patients who received SILS-TAPP using a self-made glove-port device between January 2014 and January 2016. All operations were performed by the same surgical team. The demographics and intra- and perioperative outcomes were evaluated.SILS-TAPP was successfully performed in 105 patients (131 inguinal hernia repairs). No major intra- and postoperative morbidities were encountered, and no conversion to a conventional 3-port approach or open surgery was required. The mean operative time was 73.5 min and the mean postoperative hospital stay was 2.1 days. Three minor short-term complications were noted, which were resolved without surgical intervention. One recurrence was diagnosed during follow-up and treated using a second TAPP procedure.SILS-TAPP was shown to be a feasible, safe procedure in patients with an inguinal hernia. A simple self-made glove-port device was proven as a practical method of SILS-TAPP.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/instrumentação , Laparoscopia/instrumentação , Adulto , Idoso , Estudos de Viabilidade , Feminino , Luvas Cirúrgicas , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos , Umbigo/cirurgia
9.
Am Surg ; 86(6): 715-720, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32683956

RESUMO

BACKGROUND: Surgeons can help reduce health care spending by selecting affordable and efficient instruments. The laparoscopic appendectomy (LA) is commonly performed and can serve as a model for improving health care cost. METHODS: We retrospectively reviewed all adult patients who underwent LA for non-perforated appendicitis from March 2015 to November 2017. Our objective was to determine which combination of disposable instruments afforded the lowest total operative cost without compromising postoperative outcomes. RESULTS: In total, 1857 consecutive patients were reviewed from 2 hospitals. After determining the 8 most commonly utilized combinations of disposable instruments, 846 patients were ultimately analyzed. The combination of a LigaSure, Endoloop, and an EndoBag (LEB) had the shortest median operative time (25 minutes, P < .001) and lowest median total operative cost ($1893, P < .001). CONCLUSIONS: The LEB instrument combination rendered the shortest operative time, lowest total operative cost, and can be used to maximize surgical value during LA.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Equipamentos Descartáveis/economia , Laparoscopia , Instrumentos Cirúrgicos/economia , Adulto , Apendicectomia/economia , Apendicectomia/instrumentação , Apendicite/economia , Análise Custo-Benefício , Feminino , Humanos , Laparoscopia/economia , Laparoscopia/instrumentação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos
10.
Eur J Trauma Emerg Surg ; 46(4): 731-735, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32488448

RESUMO

BACKGROUND: Surgery in the era of the current COVID-19 pandemic has been curtailed and restricted to emergency and certain oncological indications, and requires special attention concerning the safety of patients and health care personnel. Desufflation during or after laparoscopic surgery has been reported to entail a potential risk of contamination from 2019-nCoV through the aerosol generated during dissection and/or use of energy-driven devices. In order to protect the operating room staff, it is vital to filter the released aerosol. METHODS: The assemblage of two easily available and low-cost filter systems to prevent potential dissemination of Coronavirus via the aerosol is described. RESULTS: Forty-nine patients underwent laparoscopic surgeries with the use of one of the two described tools, both of which proved to be effective in smoke evacuation, without affecting laparoscopic visualization. CONCLUSION: The proposed systems are cost-effective, easily assembled and reproducible, and provide complete viral filtration during intra- and postoperative release of CO2.


Assuntos
Infecções por Coronavirus , Filtração/métodos , Controle de Infecções/métodos , Laparoscopia , Pandemias , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Serviços Médicos de Emergência/métodos , Desenho de Equipamento , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/métodos , Salas Cirúrgicas/métodos , Salas Cirúrgicas/tendências , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumoperitônio Artificial/métodos , Gestão da Segurança/métodos
11.
A A Pract ; 14(7): e01244, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32539283

RESUMO

A novel coronavirus pandemic may be particularly hazardous to health care workers. Airway management is an aerosol-producing high-risk procedure. To minimize the production of airborne droplets, including pathogens such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), from the endotracheal tube during procedures requiring lung deflation, we devised a technique to mitigate the risk of infection transmission to health care personnel.


Assuntos
Infecções por Coronavirus/prevenção & controle , Empiema Pleural/cirurgia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Laparoscopia/instrumentação , Ventilação Monopulmonar/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Cirurgia Torácica Vídeoassistida/métodos , Idoso , Betacoronavirus , Broncoscopia/métodos , Infecções por Coronavirus/transmissão , Humanos , Intubação Intratraqueal/métodos , Masculino , Pneumonia Viral/transmissão
12.
PLoS One ; 15(6): e0234919, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32559223

RESUMO

BACKGROUND: The ribcage and diaphragm are mechanical barriers for laparoscopic access during hepatectomy. Here, we introduce the varied application of intercostal trans-diaphragmatic ports during laparoscopic hepatectomy, and describe the management of intercostal ports with key technical points. METHODS: From January 2013 to December 2017, 180 patients underwent laparoscopic hepatectomy. In 32 of these patients (17.8%), intercostal ports (31 right and one left) were applied, and we analyzed the feasibility and safety of intercostal ports during laparoscopic hepatectomy. RESULTS: The main tumor location was segment VII and VIII (78%). The major type of laparoscopic hepatectomy was partial hepatectomy (91%). In the majority of cases (66%) the number and size of intercostal trocars was a single 5-mm port. The median operative time and blood loss were 232 min and 50 mL, respectively. A chest drain was placed via the hole of the intercostal port on the chest wall in two cases (6.3%). The median duration of the post-operative hospital stay was 6 days. There was no conversion, and a pure laparoscopic hepatectomy was achieved in all cases. There was no mortality. As for complications due to the application of intercostal ports, an asymptomatic pneumothorax was detected in only one case, and it was cured by conservative treatment. CONCLUSIONS: The ribcage and diaphragm could be overcome as barriers to laparoscopic access by the placement of intercostal ports with minimal access during laparoscopic hepatectomy. The use of an intercostal port and proper management allows for a feasible approach and safe resection during laparoscopic hepatectomy.


Assuntos
Hepatectomia/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Cateteres/efeitos adversos , Diafragma/cirurgia , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/instrumentação , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Costelas/cirurgia
13.
Colorectal Dis ; 22(6): 635-640, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32359223

RESUMO

AIM: The rapid spread of the COVID-19 pandemic has created unprecedented challenges for the medical and surgical healthcare systems. With the ongoing need for urgent and emergency colorectal surgery, including surgery for colorectal cancer, several questions pertaining to operating room (OR) utilization and techniques needed to be rapidly addressed. METHOD: This manuscript discusses knowledge related to the critical considerations of patient and caregiver safety relating to personal protective equipment (PPE) and the operating room environment. RESULTS: During the COVID-19 pandemic, additional personal protective equipment (PPE) may be required contingent upon local availability of COVID-19 testing and the incidence of known COVID-19 infection in the respective community. In addition to standard COVID-19 PPE precautions, a negative-pressure environment, including an OR, has been recommended, especially for the performance of aerosol-generating procedures (AGPs). Hospital spaces ranging from patient wards to ORs to endoscopy rooms have been successfully converted from standard positive-pressure to negative-pressure spaces. Another important consideration is the method of surgical access; specifically, minimally invasive surgery with pneumoperitoneum is an AGP and thus must be carefully considered. Current debate centres around whether it should be avoided in patients known to be infected with SARS-CoV-2 or whether it can be performed under precautions with safety measures in place to minimize exposure to aerosolized virus particles. Several important lessons learned from pressurized intraperitoneal aerosolized chemotherapy procedures are demonstrated to help improve our understanding and management. CONCLUSION: This paper evaluates the issues surrounding these challenges including the OR environment and AGPs which are germane to surgical practices around the world. Although there is no single universally agreed upon set of answers, we have presented what we think is a balanced cogent description of logical safe approaches to colorectal surgery during the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Laparoscopia/métodos , Salas Cirúrgicas , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Pneumoperitônio Artificial/métodos , Filtros de Ar , Betacoronavirus , Cirurgia Colorretal , Infecções por Coronavirus/transmissão , Procedimentos Cirúrgicos do Sistema Digestório/instrumentação , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Humanos , Controle de Infecções/instrumentação , Laparoscopia/instrumentação , Pneumonia Viral/transmissão , Campos Cirúrgicos
14.
Khirurgiia (Mosk) ; (4): 37-41, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32352666

RESUMO

OBJECTIVE: To compare the effectiveness of multi-port and single-port laparoscopic surgery in the treatment of hydatid cyst of the liver. MATERIAL AND METHODS: There were 25 children with solitary hydatid cyst of the liver (CL-CE2) who underwent surgery in 2013-2017. Mean age was 10.1±2.05 years. There were 17 boys and 8 girls. Patients were divided into 2 groups: group 1 (multi-port laparoscopy) - 19 patients, group 2 (single-port laparoscopic surgery) - 6 patients. RESULTS: Duration of ultrasound-assisted laparoscopy (G11 generator) was significantly shorter in the group 1 compared with group 2 (62.2±5.4 vs. 85.3±9.7 min, p<0.05). Intraoperative complications were absent. Biliary fistula in postoperative period was observed in 1 (5.3%) patient of the group 1. External drainage was effective. Residual cavity in 6 months after laparoscopic resection was observed in 1 (16.7%) patient of the group 2. Recurrent liver echinococcosis was not recorded. CONCLUSION: Hydatid cyst (CL-CE2) of the liver is an indication for laparoscopic echinococcectomy. Multi-port laparoscopy is characterized by reduced duration of surgery and postoperative morbidity compared with single-port procedures.


Assuntos
Equinococose Hepática/cirurgia , Criança , Feminino , Humanos , Laparoscopia/instrumentação , Laparoscopia/métodos , Masculino , Resultado do Tratamento
16.
Ulus Travma Acil Cerrahi Derg ; 26(3): 384-388, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32436964

RESUMO

BACKGROUND: In this study, we aimed to evaluate the superiority of intracorporeal sutures and Hem-o-lok clips about efficiency, reliability and cost. METHODS: We performed laparoscopic surgery for acute appendicitis in this study. Appendiceal stump was closed by Hem-o-lok clips (Group I) and intracorporeal knotting (Group II) in a randomized manner. Groups were compared for demographic data (age, sex, body mass index, American Society of Anesthesiologists score) operation time, total cost, 2.6.12.24.hours and 7th day pain score. RESULTS: Demographic data, such as age, gender and BMI, were similar between groups (p>0.05). There was no significant difference between the groups concerning peroperative and postoperative complications (p>0.05). No postoperative nausea, vomiting, ileus and intraabdominal abscess were observed in patients. There was no significant difference between the groups about duration of operation, length of hospital stay and cost analysis (p>0.05). There was no significant difference in pain scores of groups. The effect of the operation type on pain scores was not statistically significant (p>0.05). CONCLUSION: This study showed that both intracorporeal knotting and Hem-o-loc clips were effective, reliable and similar cost-effective in laparoscopic appendectomy. The decision should be based on the surgeon's experience.


Assuntos
Apendicectomia , Apêndice/cirurgia , Laparoscopia , Técnicas de Fechamento de Ferimentos , Apendicectomia/efeitos adversos , Apendicectomia/instrumentação , Apendicectomia/estatística & dados numéricos , Apendicite/cirurgia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/instrumentação , Laparoscopia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Instrumentos Cirúrgicos , Suturas , Técnicas de Fechamento de Ferimentos/efeitos adversos , Técnicas de Fechamento de Ferimentos/instrumentação , Técnicas de Fechamento de Ferimentos/estatística & dados numéricos
17.
Ann R Coll Surg Engl ; 102(6): e130-e132, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32326737

RESUMO

Minimally invasive oesophagectomy has become popular, but studies showed a higher rate of postoperative hiatus hernia compared with open oesophagectomy. Our video presents the laparoscopic biosynthetic mesh repair of a symptomatic giant hiatus hernia in a 71-year-old man who had undergone minimally invasive oesophagectomy one year earlier for distal adenocarcinoma of the oesophagus. The operative time was 120 minutes. The patient started oral intake on postoperative day one and was discharged on postoperative day three. Postoperative computed tomography at six months showed no signs of recurrence. In the setting of a symptomatic hiatus hernia post-minimally invasive oesophagectomy, we suggest an initial laparoscopic approach, because of its countless advantages.


Assuntos
Esofagectomia/efeitos adversos , Hérnia Hiatal/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/cirurgia , Toracoscopia/efeitos adversos , Adenocarcinoma/terapia , Idoso , Quimiorradioterapia Adjuvante , Colo Transverso/diagnóstico por imagem , Diafragma/diagnóstico por imagem , Diafragma/cirurgia , Neoplasias Esofágicas/terapia , Hérnia Hiatal/diagnóstico , Hérnia Hiatal/etiologia , Herniorrafia/instrumentação , Humanos , Intestino Delgado/diagnóstico por imagem , Laparoscopia/instrumentação , Masculino , Terapia Neoadjuvante , Readmissão do Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Telas Cirúrgicas , Técnicas de Sutura , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
J Surg Res ; 251: 85-93, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32114213

RESUMO

BACKGROUND: Laparoscopy is the gold standard approach in numerous surgical procedures. A new generation of robotized instruments has been developed to compensate for the ergonomic constraints of conventional instruments. The main objective was to compare the learning curves of novices for intracorporeal suturing on a laparoscopy pelvitrainer, using either a robotized needle holder or conventional needle holders. The post-training performances under ergonomically difficult conditions were also analyzed. MATERIALS AND METHODS: Fifth-year medical students were randomized in group A using a robotized needle holder (JAIMY; Endocontrol, Grenoble, France) and group B using straight conventional needle holders. They undertook four training sessions (intracorporeal knot-tying task) followed by an evaluation session (intracorporeal knots-tying task, frontal suture, and hexagonal suture). RESULTS: Twenty participants were included. The performances of the two groups (n = 10) were not significantly different at baseline. During the training sessions, there was a learning curve with a plateau at the third session for both the groups. At the final evaluation session, there was no significant difference between group A and group B for the intracorporeal knot-tying task (median fundamentals of laparoscopic surgery score: 468 versus 474.5 respectively; P = 0.762). There was a significant difference between group A and group B for the frontal suture (median global score: 15.75 versus 3.75 respectively; P = 0.005) but not for the hexagonal suture (median global score: 18 versus 15 respectively; P = 0.284). CONCLUSIONS: Learning curves were equally fast using the robotized needle holder versus conventional instruments and led to equivalent performances. Under ergonomically difficult conditions, the robotized needle holder provided an advantage relative to conventional instruments.


Assuntos
Laparoscopia/educação , Curva de Aprendizado , Modelos Anatômicos , Procedimentos Cirúrgicos Robóticos/educação , Técnicas de Sutura/educação , Técnicas de Sutura/instrumentação , Competência Clínica , Ergonomia , Feminino , Humanos , Laparoscopia/instrumentação , Masculino , Agulhas , Estudos Prospectivos , Procedimentos Cirúrgicos Robóticos/instrumentação , Estudantes de Medicina , Adulto Jovem
19.
Fertil Steril ; 113(3): 679-680, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32111474

RESUMO

OBJECTIVE: To introduce an effective approach using a self-made retrieval bag during laparoscopic myomectomy to contain tissue extraction. DESIGN: Step-by-step video explanation of the surgical procedure with still pictures and surgical video clips to demonstrate the detailed technique, approved by the Shengjing Hospital of China Medical University. SETTING: University hospital. PATIENT(S): A 32-year-old woman diagnosed with a uterine myoma (diameter, 6 cm). She had endured 5 years of intermittent lower abdominal pain and 2 years of infertility. INTERVENTION(S): A self-made retrieval bag during laparoscopic myomectomy was used (consists of four steps) to contain tissue extraction. 1. Self-made retrieval bag using a sterile medical bag. 2. Inspect the pelvic cavity, evaluate and determine the location and number of myomas. 3. Resect the myoma. 4. Morcellate the myoma into pieces inside the retrieval bag using laparoscopic power morcellation. MAIN OUTCOME MEASURE(S): Value and feasibility of using a self-made retrieval bag in laparoscopic myomectomy. RESULT(S): The myoma was successfully and completely resected by laparoscopy using a self-made retrieval bag to contain tissue extraction. Operative time was 93 minutes. In the follow-up period, the patient did not report any symptom of iatrogenic parasitic myoma. The woman had a pregnancy at month 26 after operation and underwent a cesarean section. This resulted in a full-term baby. CONCLUSION(S): Our surgical approach demonstrated a number of noteworthy advantages. The use of retrieval bag to contain tissue extraction during laparoscopic morcellation can avoid the risk of iatrogenic parasitic myoma. The retrieval bag is self-made using a sterile packing bag, which is cost free and also reduces operative expenses.


Assuntos
Laparoscopia , Leiomioma/cirurgia , Instrumentos Cirúrgicos , Coleta de Tecidos e Órgãos/instrumentação , Miomectomia Uterina , Neoplasias Uterinas/cirurgia , Adulto , Desenho de Equipamento , Feminino , Humanos , Laparoscopia/instrumentação , Laparoscopia/métodos , Leiomioma/patologia , Morcelação/instrumentação , Morcelação/métodos , Coleta de Tecidos e Órgãos/métodos , Miomectomia Uterina/instrumentação , Miomectomia Uterina/métodos , Neoplasias Uterinas/patologia
20.
J Laparoendosc Adv Surg Tech A ; 30(5): 564-568, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32208052

RESUMO

Introduction: Training in laparoscopic surgery seems to be an important aspect in gaining and maintaining professional competency. In experimental settings, camera navigation skills improved after simulation-based training, but the effect of camera work on the surgeon's performance is not well studied. The aim of this study was to investigate whether a fixed camera or an operated camera, as well as the experience of the camera operator has an effect on the performance of the surgeon. Materials and Methods: The study was performed on the LapSim laparoscopic training system. The task was to tie an intracorporal knot in a static surgical environment with three different camera conditions: fixed camera, camera operated by an inexperienced person (inexpert camera), and camera operated by an experienced surgeon (expert camera). The camera conditions were counterbalanced across trials. Performance variables were completion time in seconds and the extend of movements in path length and angular pathway. Gaze behavior was measured with eye-tracking glasses worn by the surgeon as well as the camera operator and was evaluated for performance-harming effects. Results: Completion time varied across conditions, with participants performing significantly longer in the fixed camera condition than in the expert or the inexpert condition. The expert and inexpert conditions did not differ. The performance-harming effect of non-focusing on the tissue was especially visible in the fixed camera condition but disappeared in the expert camera condition. Neither the camera operators' gaze behavior nor the surgeon-camera operator fixation agreement predicted task performance. Discussion: A camera operator can potentially eliminate performance-harming effects of maladaptive gaze behavior and promote optimal visual behavior of a surgeon. In our experimental task, there was no significant difference in whether the camera operator had previous training in laparoscopic surgery or not.


Assuntos
Atenção , Laparoscopia/educação , Laparoscopia/instrumentação , Treinamento por Simulação , Cirurgiões , Análise e Desempenho de Tarefas , Competência Clínica , Computadores , Fixação Ocular , Humanos , Masculino , Projetos Piloto
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