ABSTRACT
Objective@#To explore the safety and feasibility of colonoscopy - assisted transanal minimally invasive surgery via glove port (CA-TAMIS-GP) in the treatment of early rectal tumors.@*Methods@#A total of 67 patients evaluated as early rectal tumors (adenoma limited within mucosal layer) with diameter ≤4.0 cm at Department of Anal-Colorectal Surgery, Hangzhou Third People′s Hospital from July 2013 to March 2017 were prospectively enrolled in the study. Benign tumors were diagnosed by preoperative imaging in all the patients with the distance to anal edge of 4 to 20 cm. Patients were randomly divided into treatment group and the control group according to the random number table. The treatment group (n=32) underwent CA-TAMIS-GP, including 19 males and 13 females with mean age of (55.6±11.2) years and mean tumor size of (3.3±0.4) cm, while the control group (n=35) underwent endoscopic submucosal dissection (ESD, control group), including 20 males and 15 females with mean age of (52.9±12.3) years and mean tumor size of (3.4±0.5) cm. Differences of baseline data between two groups were not significant (all P>0.05). The specific method of CA-TAMIS-GP was as follows: a surgical rubber glove sleeve (No.6) was passed through the anal device; the glove was fixed at the anvil device; after fully expanding the anus, the anal sac was placed into the anus with the fingers outside; then, the cuff and the anal sac were sutured and fixed to the perianal; a well-tight glove path was established; the ultrasonic scalpel, grasper and the colonoscopy lens connected to the host platform and the electric negative pressure suction were inserted into the three finger sleeves respectively and fixed by rubber band or silk thread; the laparoscopic instruments such as the grasper and the ultrasonic scalpel were used for pulling, grasping, cutting, electrocoagulation, suturing and other operations to complete the resection of rectal lesions. Efficacy, postoperative complication and operative cost, etc. between two groups were compared using the student′s t test, chi-square tests, and Fisher′s exact test.@*Results@#Operations of two groups were completed successfully without conversion to laparotomy. Histopathologic examination showed all specimens had negative margins with the surgical resection of the layer to the submucosa, and showed no significant differences between two groups (P>0.05). Compared to the control group, the operation time was shorter [(49.5±14.6) minutes vs.(66.1±17.6) minutes, t=-4.235, P<0.001], and the intraoperative hemorrhage was less [(4.2±1.6) ml vs. (6.2±2.1) ml, t=-4.349, P<0.001] in the treatment group with significant differences. In the treatment group, 6 patients had mild anal pain or discomfort after operation, and 1 patient in the control group showed anal foreign body sensation. The difference was statistically significant [18.8% (6/32) vs. 2.9% (1/35), P=0.048]. The incidence of postoperative hematochezia in the treatment group was lower than that in the control group [9.4% (3/32) vs. 20.0% (7/35), P=0.310] without significant difference. The cost of consumables in the treatment group was (1586.9±204.4) yuan, which was lower than (7694.4±1123.2) yuan in control group, and the difference was statistically significant (t=-30.880, P<0.001). All the patients were followed up for 6 to 36 months after operation, and no recurrence or long-term complication occurred in the treatment group, while 1 case developed local recurrence in the control group.@*Conclusion@#CA-TAMIS-GP is a safe and effective method for early rectal tumors with simple and economical characteristics, which broadens the application of colonoscopy.
ABSTRACT
Introduction: Single-incision laparoscopic surgery is an attractive approach for cholecystectomy. However, its widespread application has many limitations. A significant obstacle of application in developing countries is the expensive and non affordable specialized single port systems and roticulating instruments. Objective: To assess the feasibility and effectiveness of the glove port technique of trans-umbilical single incision laparoscopic cholecystectomy (SILC) performed by a single surgeon using the conventional laparoscopic instruments. Methodology: 70 patients with symptomatic gall bladder stone disease were selected and underwent glove port laparoscopic cholecystectomy (GPLC). Patient’s demographic data, operative data, early postoperative complications, patient satisfaction score and wound measurement 3 months later, were documented and statistically analyzed. Results: The mean operative time was 47.75 min. The mean estimated blood loss was 14.5 ml. No conversion of the technique occurred. Overall intra operative complication rate was 5.7%, while post operative complication rate was 4.2%. Conclusion: On technical basis; we consider GPLC in selected cases; a safe, feasible and convenient, and cost effective method of SILC.
ABSTRACT
Single-incision laparoscopic surgery has gained increasing attention due to its potential to improve the benefits of laparoscopic surgery. However, inconvenience remains for inexperienced surgeons during surgery when instruments conflict with each other, and a glove port is used hesitantly for such diagnosis related groups (DRG) because of its high cost. Authors made a new glove port by an odd surgical gloves and one wound protectors. This glove port is ease to make besides being convenient to us, and inexpensive. This new glove port has the benefit of easy utilization and cost effectiveness for surgeons performing single-incision laparoscopic surgery.
Subject(s)
Cost-Benefit Analysis , Diagnosis-Related Groups , Gloves, Surgical , Laparoscopy , Wounds and InjuriesABSTRACT
Objetivo: Presentar nuestra experiencia en apendicectomías laparoscópicas a 2 puertos (15-5mm), utilizando un dispositivo elaborado con material de quirófano: puerto en guante simplificado, en el servicio de Cirugía General del Hospital Dr. Leopoldo Manrique Terrero. Métodos: Estudio prospectivo, observacional. Fueron intervenidos 15 pacientes con la técnica de apendicectomía laparoscópica a 2 puertos (15-5 mm), utilizando un dispositivo puerto en guante simplificado entre septiembre del 2012 y abril del 2013. Se analizó edad, sexo, tiempo quirúrgico, estancia hospitalaria, complicaciones, conversión a otra técnica, y los efectos estéticos. Resultados: Predominó el sexo masculino (73%), la edad promedio fue 29 años, el tiempo quirúrgico promedio fue de 46 min, el tiempo de hospitalización fue de 24 horas, no hubo conversión a otra técnica, no hubo complicaciones, los resultados estéticos fueron valorados en escala subjetiva como muy bueno. Conclusión: La técnica de apendicectomía laparoscópica a 2 puertos constituye una alternativa quirúrgica segura y confiable, perfectamente reproducible en nuestro medio, además de tener similar costo que la laparoscopia tradicional, aportando beneficios adicionales estéticos y sin utilizar instrumental especial(AU)
Objective: To present our experience in two ports laparoscopic appendectomies (15-5 mm), using a device elaborated totally with operating room supplies: simplified glove port. Study performed at General Surgery Service of Hospital Dr. Leopoldo Manrique_Terrero, Caracas. Methods: This is a prospective, observational study. Fifteen patients were operated by two ports laparoscopic appendectomy technique (15-5 mm), using a simplified glove port, between September, 2012 and April, 2013. It was analyzed age, gender, operative time, hospital stay, complications, conversion to other technics and aesthetic purposes. Results: Males were predominated in 73%, the average age was 29 years, surgical time average was 46 min. Hospital stay was 24 hours, without intraoperative complications. The aesthetic results were assessed in very good as subjective scale. Conclusion: The technique two-port laparoscopic appendectomy is a safe and reliable alternative surgical, perfectly reproducible in addition to our average cost similar to traditional laparoscopic, providing additional aesthetic benefits without using instrumental special(AU)
Subject(s)
Humans , Male , Female , Adult , Appendectomy , Laparoscopy , Operating Rooms , Appendicitis , General Surgery , Harbor Sanitation , Equipment and SuppliesABSTRACT
OBJECTIVE: The purpose of this study was to compare clinical and surgical outcomes between laparo-endoscopic single-site (LESS) surgery and traditional multiport laparoscopic (TML) surgery for treatment of adnexal tumors. METHODS: Medical records were reviewed for patients undergoing surgery for benign adnexal tumors between January 2008 and April 2012 at our institution. All procedures were performed by the same surgeon. Clinical and surgical outcomes for patients undergoing LESS surgery using Glove port were compared with those patients undergoing TML surgery. RESULTS: A review of 129 patient cases undergoing LESS surgery using Glove port and 100 patient cases undergoing TML surgery revealed no significant differences in the baseline characteristics of the two groups. The median operative time was shorter in the LESS group using Glove port at 44 minutes (range, 19-126 minutes) than the TML group at 49 minutes (range, 20-196 minutes) (P=0.0007). There were no significant differences between in the duration of postoperative hospital stay, change in hemoglobin levels, pain score or the rate of complications between the LESS and TML groups. CONCLUSION: LESS surgery showed comparable clinical and surgical outcomes to TML surgery, and required less operative time. Future prospective trials are warranted to further define the benefits of LESS surgery for adnexal tumor treatment.