Single-incision laparoscopic appendectomy for acute appendicitis using a 10-mm laparoscope and the glove port technique

Objective: To evaluate the single incision laparoscopic appendectomy [SILA] using existing instruments, the 10-mm laparoscope, and glove port technique

Methods: SILA was performed on 16 patients [8 male cases, 8 female cases] between June 2012 and September 2015. A 20-mm incision was made in the umbilicus and a wound retractor was placed. A 10-mm trocar for the laparoscope and two 5-mm trocars were fixed to the three fingers of the latex gloves and it was attached to the wound retractor. Another thin forceps were inserted from right low abdomen

Results: Average age of patients was 32.6 +/- 17.7 years. Preoperative average white blood cell was 13,325 +/- 4,584 /mm3, and average CRP was 1.81 +/- 3.70 mg/dL. Preoperative body temperature was 36.8 +/- 0.5°C. The mean appendix size was 9.6 +/- 2.3 mm and none of the patients had an abscess on preoperative CT. The CT also revealed a fecal pellet in 5/16 [31%] of patients. Mean operation time was 66.4 +/- 25.4 minutes, and minimal intraoperative bleeding was observed in all patients. Average hospital stay was 5.3 +/- 1.9 days and none of the patients had complications

Conclusion: SILA using the 10-mm laparoscope and glove port technique may be a safe and feasible operation for mild to moderate appendicitis

Influence of Original or Residual Pseudo-lumen on Perioperative Complications in DeBakey Type Aortic Dissection / 日本心臓血管外科学会雑誌

From April 1990 to December 1993, 13 patients (8 males and 5 females; mean age, 62 years) who underwent surgery for DeBakey type I aortic dissection, were studied to determine pre- and postoperative complications due to original dissection and residual dissection. Ascending aortic replacement had been performed in 9 patients and replacement of the ascending aorta and aortic arch in 4. Preoperative complications were aortic regurgitation (AR) in 3 cases, shock in 4, cardiac tamponade in 5, myocardial ischemia in 2 and spinal cord ischemia in 1. Postoperative complications were visceral and limb ischemia in 1 case, left leg ischemia in 1, spinal ischemia in 2 and worsening AR in 1. The postoperative 30-day survival rate was 85% (11/13). Two patients who underwent urgent ascending aortic replacement with simultaneous coronary artery bypass grafting died within 30 days after surgery. One patient with visceral and limb ischemia died in the hospital. Two patients with spinal ischemia survived but became paraplegic. Cardiac, visceral or spinal ischemia was a common problem in this series. All four patients who underwent ascending aortic replacement with simultaneous aortic arch replacement were alive for 30 days after surgery. The incidence of residual dissection may be reduced by replacing the ascending aorta concomitantly with the aortic arch rather than replacing the ascending aorta only. If a patient with DeBakey type I aortic dissection is in fair preoperative condition and elective surgery is possible, replacement of the ascending aorta and the aortic arch should be considered.