Factors affecting gasless reduced-port laparoscopic myomectomy (GRP-LM) using a subcutaneous abdominal wall lifting method: a retrospective analysis of a large cohort of 966 cases in Japan.

OBJECTIVE: To evaluate the usefulness of gasless reduced-port laparoscopic myomectomy (GRP-LM) using a subcutaneous abdominal wall lifting method. METHODS: In GRP-LM, after lifting the abdominal wall by a subcutaneous abdominal wall lifting method, a 1.5-cm incision is made in the lateral abdomen, Lap Protector® is placed. The operation is performed by two surgeons, one who inserts multiple forceps from the Lap Protector and performs the operation, and an assistant who operates the laparoscope and uterine manipulator. The surgical outcome of GRP-LM and the factors that affect it were investigated. RESULTS: GRP-LM was performed in 966 patients. Complications (0.5%) and blood transfusions (0.3%) were remarkably rare, and there were no cases of conversion to open surgery. With regard to the correlation between the number of fibroids extracted and each factor, the number of fibroids extracted correlated with fibroid weight and operation time, but not with blood loss. The average number of sutures per case was 21, and the average suture and ligation time per suture was 77 s. Comparing the cost of GRP-LM with that of the conventional insufflation LM, a saving of $875 was possible with GRP-LM. CONCLUSION: GRP-LM is a suitable for multiple fibroids, and is cosmetic and economical, because it allows rapid and reliable suture and ligation, despite having only one port for the procedure.

Reduced port laparoscopic rectopexy for full-thickness rectal prolapse.

BACKGROUND: Laparoscopic rectopexy is an established treatment option for full-thickness rectal prolapse. Recently, reduced port surgery (RPS) has emerged as a novel concept, offering reduced postoperative pain and improved cosmetic outcomes compared with conventional multiport surgery (MPS). This study aimed to evaluate the feasibility and safety of RPS for full-thickness rectal prolapse. METHODS: From October 2012 to December 2018, 37 patients (MPS: 10 cases, RPS: 27 cases) underwent laparoscopic rectopexy for full-thickness rectal prolapse. Laparoscopic posterior mesh rectopexy (Wells procedure) is the standard technique for full-thickness rectal prolapse at our hospital. RPS was performed using a multi-channel access device, with an additional 12-mm right-hand port. Short-term outcomes were retrospectively compared between MPS and RPS. RESULTS: No significant differences were observed between MPS and RPS in the median operative time, the median blood loss volume, the postoperative complication rates, and median hospital stay duration after surgery. CONCLUSION: Reduced port laparoscopic posterior mesh rectopexy may serve as an effective therapeutic option for full-thickness rectal prolapse. However, to establish the superiority of RPS over MPS, a prospective, randomized, controlled trial is warranted.

The merging of dual umbilical port-incisions for contained morcellation in laparoscopic myomectomy.

Uncontained power morcellation during laparoscopic myomectomy may spread tissue fragments or malignant cells into the abdominal cavity. Recently, various approaches to contained morcellation, have been adopted to retrieve the specimen. However, each of these methods has its own drawbacks. Intraabdominal bag-contained power morcellation adopts a complex isolation system, which prolongs the operation and increases medical costs. Contained manual morcellation via colpotomy or mini-laparotomy increases the trauma and the risk of infection. Contained manual morcellation via umbilical incision during single-port laparoscopic myomectomy may be the most minimally invasive and cosmetic approach. But the popularization of single-port laparoscopy is challenging because of technical difficulties and high costs. We have therefore, developed a surgical technique using 2 umbilical port-incisions (5 mm and 10 mm), which are merged into 1 large umbilical incision (25-30mm) for contained manual morcellation during specimen retrieval, and one 5mm incision in the lower left abdomen for an ancillary instrument. As demonstrated in the video, this technique significantly facilitates surgical manipulation using conventional laparoscopic instruments while still keeping the incisions minimal. It is also economical because the use of an expensive single-port platform and special surgical instruments is avoided. In conclusion, the merging of dual umbilical port-incisions for contained morcellation adds a minimally invasive, cosmetic, and economical option to laparoscopic specimen retrieval that would enrich a gynecologist's skill set, which is particularly relevant in a low-resource settings.

Survival Outcome after Reduced-Port Laparoscopic Radical Cystectomy for Bladder Cancer: Long-Term Follow-Up Analysis.

INTRODUCTION: This study had two objectives: (i) to evaluate oncological outcomes in a long-term follow-up of patients with bladder cancer after reduced-port laparoscopic radical cystectomy (RP-LRC) and (ii) to assess the effect of modified Glasgow prognostic scores (mGPS) on patient outcomes. METHODS: Consecutive patients (n = 100) who received RP-LRC between March 2012 and December 2018 at our institution and affiliated hospital were retrospectively reviewed. Preoperative serum albumin and C-reactive protein levels were determined. Patients were grouped based on clinical T stage (≤cT2: n = 75, ≥cT3: n = 25) using pooled cumulative data. Oncological outcomes and mGPS as a prognostic biomarker were analyzed retrospectively. Kaplan-Meier curves displayed recurrence and survival rates. Univariate and multivariate Cox regression analyses evaluated potential prognostic factors for recurrence-free survival (RFS) and cancer-specific survival (CSS). RESULTS: Patient characteristics between the two groups were statistically similar for preoperative hematological and mGPS status, blood loss level, rate of allogeneic transfusion, and pneumoperitoneum time. After a median follow-up period of 55 months, 40/100 patients experienced disease relapse. RFS and CSS for ≤cT2 were significantly less than for ≥cT3 (p < 0.001, p < 0.05, respectively). Distant metastasis occurred in 30 patients with similar distributions of relapse sites between T-stage cohorts. Median RFS for mGPS 1/2 were 18.9 (95% confidence interval [CI]: 8.8-not assessed [NA]) and 35.0 (95% CI: 8.7-NA) months, respectively, significantly worse than for mGPS 0 (median NA, 95% CI: NA-NA); CSS was similar. Univariate and multivariate analyses revealed ≥cT3 stage, worse clinical N stage, and poor mGPS status were significant prognostic factors for short RFS and CSS. CONCLUSIONS: A large proportion of bladder cancer patients who undergo RP-LRC experience relapse, with ≥cT3 stage, worse clinical N stage or poor mGPS status identified as significant prognostic factors. Our findings may contribute to improved surgical procedures for such patients.

Totally laparoscopic resection of right-sided colon cancer using transvaginal specimen extraction with a 10-mm-long abdominal incision.

BACKGROUND: Natural orifice specimen extraction (NOSE) has been developed as a means of decreasing the incidence of surgical wound complications. We refined the procedure for totally laparoscopic colectomy with transvaginal specimen extraction using the reduced port surgery technique with the ultimate goal of attenuating damage to the abdominal wall. We herein report this innovative technique and its short- and long-term outcomes. METHODS: We prospectively collected data on seven patients who underwent totally laparoscopic colectomy using transvaginal specimen extraction with a 10-mm-long abdominal incision for right-sided colon cancer from January 2014 to December 2021. Two 5-mm ports were used in the procedure without laparotomy. Transverse transabdominal posterior colpotomy was then performed. We introduced a GelPOINT Mini advanced access platform (Applied Medical, Rancho Santa Margarita, CA, USA) into the transvaginal route for the insertion of a laparoscope, forceps, and stapling device. Lymph node dissection and transection of the ileum and distal colon were performed with transvaginal assistance. A specimen was then extracted transvaginally. Intracorporeal functional end-to-end anastomosis was conducted using a linear stapler through the vagina. After the removal of GelPOINT Mini, the vaginal incision was closed transvaginally. RESULTS: Seven patients successfully underwent this procedure. Median operative time was 219 min (range 174-255 min), median blood loss was 23 ml (range 10-37 ml), median number of harvested lymph nodes was 21 (range 17-35 lymph nodes) and median margins were 17.0 cm (range 9.0-25.0 cm) for the proximal margin and 9.5 cm (range 5.0-13.0 cm) for the distal margin. There were no complications more severe than Clavien-Dindo Grade II and there was no mortality. The median frequency of use intravenous analgesics from postoperative day 1 to discharge was once. Two patients did not require analgesics. A node-positive patient developed recurrence at the lung and paraaortic lymph nodes. CONCLUSIONS: This procedure appears to be feasible, safe, and oncologically acceptable for selected cases.

Ultra-thin surgical swab: its development and clinical application.

INTRODUCTION: Ultra-thin (diameter: 3 mm) surgical swabs have not been in practical use as it is difficult to manufacture these using the pre-existing methods; therefore, a new technology has been adopted. This study aimed to evaluate the safety and efficiency of ultra-thin surgical swabs in bench-top and preclinical settings. MATERIAL AND METHODS: We performed liquid particle counter (LPC) test, cotton strength test, shaft bending comparison and surgical vision test for checking the durability of swabs as bench-top investigation, and laparoscopic surgery in a porcine model as preclinical investigation. All tests were compared with conventional 5-mm swabs. RESULTS: The ultra-thin swabs had fewer eluted particles in the LPC test, endured a 5 kg pulling force in the cotton strength test, their shaft did not break at 100 mm bending in the shaft bend comparison test, and interfered less in the surgical vision test. They were used for manipulating organs with no damage in preclinical investigation. CONCLUSIONS: Three millimeters ultra-thin surgical swabs manufactured with the new manufacturing technology are effective and safe.

Single/reduced port surgery vs. conventional laparoscopic gastrectomy: systematic review and meta-analysis.

INTRODUCTION: The aim is to compare single port surgery (SPS)/reduced port surgery (RPS) versus conventional laparoscopy (CL) for gastrectomy for gastric cancer in terms of intra- and postoperative outcomes. MATERIAL AND METHODS: After a search in Pubmed and Embase, six articles were included. Pooled analysis was used to evaluate the statistically significance for each variable. RESULTS: Two hundred and thirty-three and 230 patients underwent SPS/RPS and CL, respectively. One hundred and eighty-eight patients and 45 patients underwent subtotal and total gastrectomy, respectively, using the SPS/RPS approach. One hundred and eighty-five patients and 45 patients underwent subtotal and total gastrectomy, respectively, by CL. In 85 patients, an extra trocar was systematically placed at the end of surgery. Statistically significant differences were not observed about preoperative staging. The pooled analysis regarding operative time, blood loss, postoperative complications, number of harvested lymph nodes and postoperative hospital stay showed that the only statistically significant difference between the two approaches is the shorter hospital stay in case of SPS/RPS. CONCLUSIONS: SPS/RPS total or subtotal gastrectomy shows a lower postoperative hospital stay, with comparable operative time, blood loss, early postoperative complication rate and number of harvested lymph nodes in comparison to CL, provided extensive experience in minimally invasive gastrectomy is present. Abbreviations: AGC: advanced gastric cancer; BMI: body mass index; CI: confidence interval; CL: conventional laparoscopy; LESS: laparoendoscopic single site; MD: mean difference; NOS: Newcastle-Ottawa Scale; OR: odds ratio; PRISMA: Preferred Reporting Items for Systematic Review and Meta-Analysis; ROBIN-I: Risk Of Bias In Non-randomised Studies - of Interventions; RPS: reduced port surgery; RR: risk ratio; SILS: single incision laparoscopic surgery; SPS: single port surgery; WMD: weighted mean differences.

Dual trocar laparoscopy improves reduced-port surgery of the distal pancreas.

BACKGROUND: The technical feasibility of transumbilical single-incision surgery (SIL) for pancreatic resections has been demonstrated. However, this technique is hampered by the limited degrees of freedom for instrument handling. Dual-incision laparoscopy (DIL) with an additional trocar may simplify dissection and allow drainage. MATERIAL AND METHODS: Between December 2009 and May 2017, 21 patients were treated with SIL (12/2009 to 01/2014) or DIL (02/2014 to 05/2017) pancreatic resection. All data were collected in a database and retrospectively analysed. RESULTS: Demographic parameters of the patients did not differ significantly in the DIL or the SIL group. No conversion to open surgery was required. No intraoperative complication occurred in either group. The surgical difficulty score was significantly higher in the SIL group (4.4 ± 1.56 vs 2.18 ± 1.95; p = .006). Postoperative serum amylase levels were higher (101.9 U/l ± 50.11 vs 48.91 U/l ± 35.20; p = .01) and return to normal levels (6.4 ± 9.66 days vs 2.09 ± 1.98 days; p = .045) was later in the SIL group. Three complications requiring radiological or surgical intervention were witnessed in the SIL group and one complication in the DIL group (p = .42). CONCLUSION: DIL surgery is a safe and feasible alternative to SIL surgery, facilitating key steps of distal pancreatic tail resection.

Long-term outcomes of needlescopic surgery in patients with colon cancer: a retrospective cohort study.

BACKGROUND: Laparoscopic surgery is a minimally invasive and frequently performed surgical procedure that has become the standard surgery for colorectal cancer. Needlescopic surgery (NS) for colon cancer has also been performed and reported as a less invasive technique. In this study, we investigated the long-term outcomes of NS in comparison with those of conventional surgery (CS). METHODS: The data of 1122 patients without distant metastasis who underwent laparoscopic surgery between 2011 and 2014 were retrospectively analyzed. In this study, NS was defined as a laparoscopic procedure performed with the use of 3-mm ports and forceps with one 5-mm port for an energy device, as well as with clips. One 12-mm port was placed in the umbilicus for specimen extraction from the abdominal cavity. RESULTS: A total of 241 patients underwent NS. There was no significant difference between the 5-year recurrence rate and the 5-year total mortality rate (NS: 10.0% and 5.4% vs. CS: 10.3% and 3.5%, p = 0.86/0.23). In the multivariate analysis, NS was not found to be an independent prognostic factor. In terms of the distribution of recurrence sites, there was no significant difference between the two groups. CONCLUSIONS: NS for colon cancer was not inferior to CS in terms of short-term and long-term outcomes.

Experimental evaluation of the fineness of needle forceps: advantages other than minimal access.

PURPOSE: Needle forceps are used to limit damage to the abdominal wall in endoscopic surgery; however, few experimental studies have evaluated the fineness and performance of needle forceps. We conducted this study to identify the advantages of needle forceps over conventional 5 mm forceps, focusing on fine grasping and needle control. METHODS: Twenty physicians executed tasks using 5 mm forceps and 2.1 mm small diameter forceps in a laparoscopic experimental setting. First, we timed the execution and recorded the number of drops in a task of grasping and moving grains of rice and red beans. Next, we measured the execution time, looseness of the knot, and the deviation from the stitching point in a suture and ligation task using suture needles with a diameter of 17 or 26 mm. RESULTS: The needle forceps required a significantly shorter execution time to move the rice grains (37.7 s vs. 45.8 s; p = 0.01) and a significantly higher completion rate (90% vs 20%; p < 0.01). The deviation of the stitching point using the 17 mm needle with needle forceps was significantly smaller than with the 5 mm forceps (0.5 mm vs. 1.0 mm; p < 0.01). CONCLUSION: Needle forceps are better for procedures requiring fine grasping and enable more accurate small diameter needle control than 5 mm forceps.

Robot-assisted surgery with Senhance robotic system for colon cancer: our original single-incision plus 2-port procedure and a review of the literature.

BACKGROUND: The Senhance robotic system provides such advantages as an eye-tracking camera control system, haptic feedback, operator comfort, and reusable endoscopic instruments. The aim of this small study was to assess the feasibility and safety of performing a reduced-port robot-assisted colectomy for colon cancer with the use of a novel robotic system. METHODS: This was a single-center retrospective study of eight patients with colon cancer who underwent single-incision plus 2-port robot-assisted colectomy with the Senhance robotic system (SILS+2-S) between December 2019 and March 2020 at our hospital. Data on perioperative outcomes, which included operative time, operative blood loss, length of hospitalization, postoperative complications, and histopathological results, were collected prospectively. RESULTS: The mean patient age was 70.9 years and the mean body mass index was 24.4 kg/m2. One patient was converted to laparoscopy due to a damaged scope holder. The mean operative and console times were 229.1 and 139.1 min, respectively. The mean intraoperative blood loss was 49.4 ml. The mean length of the umbilical incision was 3.0 cm. The mean number of harvested lymph nodes was 18.3. The surgical margins were negative in all eight patients. There was neither morbidity nor mortality associated with the procedure, and no Clavien-Dindo classification Grade II-IV complications occurred. CONCLUSIONS: SILS+2-S is a safe and feasible approach for patients with colon cancer. Further studies are needed to validate the advantages of SILS+2-S and to evaluate the long-term oncological outcomes.

A novel approach for the complete extraction of large tumours in video-assisted thoracoscopic surgery.

BACKGROUND: Video-assisted thoracoscopic (VATS) lobectomy has recently become the standard for treating lung cancer. However, the complete removal of large tumours from the chest cavity is often difficult. Therefore, we developed a novel approach to extract large tumours from the wound without rib resection or fracture (the eXtraction of resected specimens through the Lower INterCostal route [XLINC] method). SUBJECTS AND METHODS: In XLINC, a skin incision is made on the tenth intercostal space, and the resected lung tissue is extracted. This retrospective study included patients who underwent VATS lobectomy using XLINC in our institution from 2016 to 2018. As a control group, six patients who had undergone thoracotomy during VATS surgery due to a large tumour diameter were included in the conversion group. RESULTS: Four men and six women (median age = 66 years, maximum median tumour diameter = 59 mm) were included in the study. The median length of the wound incision for XLINC was 4.5 (range: 4-8) cm. The median operative time was 183 min, and the estimated blood loss was 50 ml. Rib resection was not required, and no fractures were noted. The median length of hospital stay was 8 days. No patients developed major complications caused by XLINC. There were no significant differences, except in operation time and amount of blood loss, between the two groups. However, the XLINC group used fewer post-operative analgesics. CONCLUSION: Our report suggests that XLINC might be a simpler, less invasive procedure that could be used in patients with large tumours.

Prospective multicenter study of reduced port surgery combined with transvaginal specimen extraction for colorectal cancer resection.

PURPOSE: The relevance of transvaginal specimen extraction (TVSE) combined with reduced port surgery (RPS) remains unknown. This study investigated the feasibility of TVSE with RPS according to short-term outcomes and cosmesis. METHODS: This prospective multicenter study enrolled ten patients at three institutions. For the semi-quantification of each parameter, we administered questionnaires to assess pain (visual analogue scale), subjective/objective wound healing esthetics [photo series questionnaires (PSQ)], and quality of life (QOL). RESULTS: No operative complications occurred, except one case of urinary tract infection, which was promptly cured with antibiotics. On day 0, pain was rated at 2.3 ± 0.67 at rest and 4.9 ± 0.82 during sneezing; these ratings gradually declined over time. The PSQ showed that the patient ratings of wound esthetics after TVSE were not inferior to ratings from patients after conventional laparoscopy or single incision laparoscopic surgery, and they were significantly higher than the patient ratings of wounds after laparotomy (P < 0.05). The QOL scores showed that, in comparison to before surgery, after surgery, patients reported significant deterioration of their physical function (96.67 ± 1.49 vs. 87.33 ± 2.71), emotional function (93.33 ± 2.72 vs. 86.67 ± 2.22), fatigue (7.78 ± 3.72 vs. 26.67 ± 8.31), and pain (6.67 ± 3.69 vs. 18.33 ± 4.61). CONCLUSION: TVSE with RPS for colorectal cancer was feasible and was associated with a low degree of postoperative pain.

Retrospective case-matched study between reduced port laparoscopic rectopexy and conventional laparoscopic rectopexy for rectal prolapse.

INTRODUCTION: Reduced port laparoscopic Well's procedure (RPLWP) is a novel technique used to overcome the limitations of single-incision laparoscopic surgery. The aim of this study was to compare outcomes between RPLWP and conventional laparoscopic Well's procedure (CLWP) and to investigate the learning curve of RPLWP. PATIENTS AND METHODS: From January 2006 to March 2017, a retrospective review of a prospectively maintained laparoscopic surgery database was performed to identify patients had undergone CLWP and RPLWP. From these patients, each of 10 cases were manually matched for age, sex, body mass index. From January 2006 to March 2015, CLWP was used for all procedures whereas, from April 2015, RPLWP was routinely performed as a standard procedure for rectal prolapse. RESULTS: No significant differences were observed between the two groups in terms of operating time, blood loss, intraoperative complications, and conversion to CLWP or open rectopexy. Based on the postoperative outcomes, the hospital stay was significantly shorter in the RPLWP group. The estimated learning curve for RPLWP was fitted and defined as y = 278.47e-0.064x with R2 = 0.838; therefore, a significant decrease in operative time was observed by using the more advanced surgical procedure. CONCLUSIONS: RPLWP is an effective, safe, minimally invasive procedural alternative to CLWP with no disadvantage for patients when a skilled surgeon performs it.

Intracorporeal delta-shaped gastroduodenostomy in reduced-port robotic distal subtotal gastrectomy: technical aspects and short-term outcomes.

BACKGROUND: Gastroduodenostomy is preferred as a method of reconstruction following distal subtotal gastrectomy. However, in initial reports on reduced-port gastrectomy, gastroduodenostomy has rarely been performed therein because of technical difficulties. The present study describes a novel intracorporeal gastroduodenostomy technique applicable during reduced-port robotic distal subtotal gastrectomy. METHODS: Data were retrospectively reviewed for cases of reduced-port (three-port) robotic distal subtotal gastrectomy with intracorporeal delta-shaped gastroduodenostomy performed from February 2016 to December 2016. The reduced-port approach used a Single-Site™ port via a 25-mm infraumbilical incision and two additional ports. We performed intracorporeal gastroduodenostomy using a 45-mm robotic or laparoscopic endolinear stapler. All staplers were inserted via a port on the left lower abdomen. RESULTS: In our initial experience with intracorporeal gastroduodenostomy, 28 consecutive patients underwent successful surgery with the technique without needing to convert to open, laparoscopic, or conventional five-port robotic surgery. Mean operation time was 201.1 min (110-282 min), and no major complications, including anastomosis-related problems, were recorded. CONCLUSIONS: Intracorporeal delta-shaped gastroduodenostomy was safely and feasibly applied during reduced-port robotic gastrectomy with acceptable operative outcomes and no major complications. Intracorporeal gastroduodenostomy should be considered during reduced-port distal subtotal gastrectomy.

Urological laparoendoscopic single-site and reduced port surgery: A nationwide survey in Japan.

OBJECTIVES: To evaluate the current status of urological laparoendoscopic single-site and reduced port surgery in Japan. METHODS: Of the 152 institutions to which councilors of the Japanese Society of Endourology belong, 42 (28%) have carried out laparoendoscopic single-site and reduced port surgery. A total of 32 of these institutions agreed to participate in this survey. Patients who had undergone surgery between January 2008 and March 2014 were included in the present study. RESULTS: Overall, 1145 cases of laparoendoscopic single-site and reduced port surgery were recorded during the study period. The most frequent procedures were adrenalectomy and radical nephrectomy. Laparoendoscopic single-site and reduced port surgery represented 12% (872/7311) of all laparoscopic procedures carried out at participating institutions. The number of patients who underwent pyeloplasty, donor nephrectomy and simple nephrectomy tended to increase, whereas those who underwent adrenalectomy, radical nephrectomy and nephroureterectomy peaked in 2012, and then tended to decrease in 2013. The rates of conversion, perioperative and postoperative complications, were 2.7%, 2.2% and 4.5%, respectively. CONCLUSIONS: The number of laparoendoscopic single-site and reduced port urological surgeries in Japan has increased for benign indications, such as pyeloplasty, donor nephrectomy and simple nephrectomy. In contrast, procedures such as adrenalectomy and radical nephrectomy are trending down after reaching a peak in 2012. Overall, laparoendoscopic single-site and reduced port urological surgery in Japan is being safely carried out when compared with other reported series of laparoendoscopic single-site surgery and conventional laparoscopic surgery.

Comparison of single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) and open repair for pediatric inguinal hernia: a single-center retrospective cohort study of 2028 cases.

BACKGROUD: Recently, laparoscopic percutaneous extraperitoneal closure (LPEC) has gained increased popularity for pediatric inguinal hernia repair. To improve cosmesis, we developed single incision LPEC (SILPEC). The aim of this study was to assess the safety and feasibility of SILPEC compared with traditional open repair (OR). METHODS: This was a single-center retrospective cohort study of 2028 children who underwent inguinal hernia repair between April 2005 and August 2014. Nine hundred and ninety-five patients underwent OR and 1033 patients underwent SILPEC. Medical records were reviewed with respect to operative time, recurrence, incidence of contralateral metachronous inguinal hernia (CMIH), and complications. Patient satisfaction with cosmetic result was also investigated using questionnaires sent by mail. RESULTS: All SILPEC procedures were completed without conversion. Operative time was longer in the SILPEC group than in the OR group for both unilateral and bilateral surgery regardless of sex (unilateral male: p = 0.0006, unilateral female: p < 0.0001, bilateral male: p < 0.0001, bilateral female: p < 0.0001). There was no statistically significant difference in recurrence rate (p = 0.43). The incidence of CMIH was significantly higher in the OR than in the SILPEC group (p < 0.0001). No postoperative testicular atrophy was found in either group. There was no statistically significant difference in ascending testis (p = 0.09), but the frequency of surgical site infection was higher in the SILPEC than in the OR group (p = 0.0013). According to the questionnaire, operative scar was more invisible in the SILPEC than in the OR group (p < 0.0001), but both procedures had equally high levels of satisfaction for cosmetic results (p = 0.58). CONCLUSION: SILPEC proved to be a safe and feasible procedure compared with OR with an equally low recurrence rate, more effectiveness for preventing CMIH, and more invisible scar.

Early experience of duet laparoscopic distal gastrectomy (duet-LDG) using three abdominal ports for gastric carcinoma: surgical technique and comparison with conventional laparoscopic distal gastrectomy.

BACKGROUND: Reduced port laparoscopic surgery may lead to less pain and better cosmetic outcome than conventional surgery. Also, it requires fewer assistants and abdominal ports. Recently, some experts have reported operative techniques and outcomes of reduced port laparoscopic gastrectomy. In this study, we sought to introduce our techniques of duet laparoscopic distal gastrectomy (duet-LDG) using three abdominal ports and surgical outcomes of early experience of this procedure. METHODS: Between 2010 and 2014, 431 patients undergoing LDG for gastric carcinoma were retrospectively reviewed. Among them, 49 patients underwent duet-LDG. During duet-LDG, an operator performed all the procedures using two abdominal ports with an additional umbilical laparoscopy port. Short-term surgical outcomes of duet-LDG were compared with conventional LDG groups. RESULTS: The mean age of the duet-LDG group was 61.1 years with 38 males and 11 females. Forty patients underwent Billroth II, and 9 patients underwent Roux-en-Y reconstruction. The mean operating time was 147 min, and the mean intraoperative blood loss was 49 ml. Duet-LDG was successfully completed without intraoperative complications or open conversion in all patients. After an operation, six patients (12.2 %) developed postoperative complications, and no mortality occurred. The mean hospital stay was 8.6 days. When compared with the conventional LDG groups, patients who underwent duet-LDG showed no significant differences in short-term surgical outcomes including morbidity, mortality, and the duration of hospital stay. CONCLUSIONS: Duet-LDG is a viable alternative to conventional LDG for treating early gastric carcinoma providing comparable surgical outcomes. Less operative pain and scar, reduced medical cost, and requiring fewer assistants may benefit patients as well as surgeons. Finally, the efficacy of duet-LDG needs to be evaluated in diverse clinical aspects.

A feasibility of single-incision laparoscopic percutaneous extraperitoneal closure for treatment of incarcerated inguinal hernia in children: our preliminary outcome and review of the literature.

The purpose of this study is to examine the feasibility of single-incision laparoscopic percutaneous extraperitoneal closure (LPEC) for incarcerated inguinal hernia (IIH) repair. 6 single-incision LPEC procedures were performed for IIH repair and 60 procedures were performed for reducible inguinal hernia (RIH) in the same period of time in one hospital. The laparoscope and one pair of grasping forceps were placed through the same umbilical incision. In IIH repair, the herniated organ was gently pulled using the grasping forceps with external manual pressure. If it was difficult to reduce the herniated organ with one pair of forceps, another pair of forceps were inserted through a multi-channel port without extending the umbilical incidion. Using the LPEC needle, the hernia orifice was closed extraperitoneally. We performed a retrospective analysis to compare the outcomes of single-incision LPEC for IIH repair or reducible inguinal hernia. All procedures were completed by single-incision without open conversion. A multi-channel port with another pair of forceps was needed in three cases. The operation time and the length of stay were significantly longer with IIH repair than with RIH repair. There were no major complications and there was no evidence of early recurrence in any patient. In conclusion, single-incision LPEC with a multi-channel port is feasible and safe for IIH repair.

Development of scar-less laparoscopic hernia repair (TAPP-252) facilitated by new 2mm instruments.

INTRODUCTION: To minimize the invasiveness of laparoscopic transabdominal preperitoneal hernia repair (TAPP) for the treatment of adult inguinal hernia, we developed a new operative technique with the use of only one 5 mm port and two 2 mm punctures (TAPP-252). MATERIAL AND METHODS: To facilitate TAPP-252, we developed seven kinds of new 2 mm instruments, including grasping forceps, hook shaped electrode, mesh pusher, needle driver, scissors, laparoscope and port. RESULTS: TAPP-252 was stably performed in 35 patients with minimal abdominal wall destruction and excellent cosmetic result without any recurrence or morbidity. CONCLUSIONS: The newly developed 2 mm devices showed sufficient performance and durability in TAPP-252. Further investigation is necessary to assess durability and long-term outcomes.