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ABSTRACT: The purpose of this study was to assess the use of a homemade multiport for LESS (laparoendoscopic single-site surgery) ovariohysterectomy (OVH) in cats. Intra and postoperative variables of the surgery steps, technical challenges, complications and evolution of surgical time by a surgeon in training were evaluated. Twenty queens were selected for LESS OVH. The multiport device was manufactured of a conical-shaped ethylene polytereftalate (PET) bottle, urethral catheter no. 8, latex balloon no. 11, a 3.5mm and a 6mm laparoscopic trocars. Hemostasis was carried out using bipolar diathermy. Mean total surgical time was 14.54±5.12 minutes. Approach to right and left ovarian pedicles and abdominal access for insertion of the multiport device were the most time consuming surgical steps. LESS ovariohysterectomy using a new homemade multiport device is feasible and safe. Thus, the proposed technique may be considered as a minimally invasive alternative to ovariohysterectomy in the feline specie.
RESUMO: Objetivou-se avaliar o emprego do novo dispositivo multiportal artesanal para realização de ovariohisterectomia por LESS (cirurgia laparoendoscópica por único acesso) em gatas, analisando variáveis intraoperatórias de tempo cirúrgico das diferentes etapas que compõem o procedimento, suas possíveis dificuldades técnicas de execução e complicações trans e pós-operatórias. Avaliou-se ainda a curva de aprendizado deste procedimento, realizado por um cirurgião não proficiente na técnica. Vinte gatas foram submetidas à laparoscopia. Para a confecção do multiportal foi utilizado um recipiente de politereftalato de etileno (PET), uma sonda uretral nº8, um balão de látex nº11, um portal de videocirurgia de 3,5mm, e um de 6mm. O sistema de coagulação foi o bipolar. O tempo cirúrgico médio foi de 14,54±5,12 minutos. A abordagem aos pedículos ovarianos direito e esquerdo e o acesso para introdução do portal foram as etapas que apresentaram maior tempo de execução. A OVH videoassistida empregando o novo dispositivo multiportal é factível, não demonstrando complicações. Acredita-se, portanto, que a técnica proposta torna-se uma alternativa para realização minimamente invasiva de ovariohisterectomia em felinos.
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Objective To investigate the comparative analysis between single-port access laparoscopic Miles surgery with jackknife position and laparoscopic Miles surgery with lithotomy position for low rectal cancer.Methods Retrospectively analyzed 36 patients with low rectal cancer (TNM stage:Ⅱ-Ⅲ) undergoing laparoscopic abdominoperineal excision.Patients were divided into two groups.Lithotomy position group:laparoscopic Miles surgery with lithotomy position.Jackknife position group:single-port access laparoscopic Miles surgery with jackknife position.The operation time,blood loss,postoperative recovery,postoperative complication,postoperative recurrence and survival rate were observed.Results Blood loss of perineal position in jackknife position group was less than that in lithotomy position group [(31.5 ± 22.4) ml vs.(53.5 ± 25.6) ml] (P =0.01),and removal of drainage tube in jackknife position group was earlier than that in lithotomy position group [(6.7 ± 1.9) d vs.(9.8 ± 1.7) d] (P ＜ 0.01).However,the operation time,blood loss in abdomen,blood loss,postoperative out-of-bed activity time,recovery of gastrointestinal function time,dermal sutures out time,postoperative hospital stay,complication,postoperative recurrence in 2 years and survival rate between two groups had no significant difference (P ＞0.05).Conclusions Single-port access laparoscopic Miles surgery is safe and feasible with better surgical outcome and cosmetic benefits.Furthermore,the blood loss and postoperative exudation at perineal region is less than that in traditional lithotomy position.
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Since 2008, various single-port access laparoscopic surgeries in gynecologic diseases have been performed in Korea. Single-port laparoscopic surgery has some advantages. It has less visible scars, less pain, and a faster recovery. Single-port laparoscopic surgery also has a drawback that is hard to handle instruments compared to conventional multi-port laparoscopic surgery. However, single-port laparoscopic surgery can be performed safely by practitioners who have experiences in single-port laparoscopic techniques. Based on experiences of gynecologic single-port laparoscopic surgery for 1000 cases in Incheon St. Mary's Hospital until August 2011, we describe techniques for single-port access laparoscopic surgery.
Subject(s)
Female , Cicatrix , Genital Diseases, Female , Korea , Laparoscopy , UmbilicusABSTRACT
OBJECTIVE: The aim of this study was to estimate the feasibility, safety and surgical outcomes of single port access laparoscopic myomectomy (SPA-M). METHODS: We reviewed the medical records of 29 patients with uterine leiomyoma who underwent SPA-M in Gumi CHA hospital between March 2010 and August 2010. We performed SPA-M with conventional rigid straight laparoscopic instruments in all cases. RESULTS: In this study, the mean of leiomyoma weight, operating time, and estimated blood loss were 55.43 gm(+/-54.79, range 5~220 gm), 69.68 min (+/-32.99, range 20~120 min.), 100 mL (+/-104.26 range minimal~300 mL), respectively. Transfusion was done in the one case. CONCLUSION: SPA-M using conventional rigid straight laparoscopic instruments was feasible and could be an alternative to conventional multi-port access laparoscopic myomectomy (MPA-M).
Subject(s)
Humans , Leiomyoma , Medical RecordsABSTRACT
OBJECTIVE: To evaluate the safety and feasibility of single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH) using conventional laparoscopic instruments compared to multi-port access laparoscopically assisted vaginal hysterectomy (MPA-LAVH). METHODS: We reviewed the medical records of 220 patients with uterine leiomyoma or adenomyosis who underwent 110 SPA-LAVH and 110 MPA-LAVH in Incheon St. Mary's Hospital between April 2007 and November 2009. We performed SPA-LAVH with conventional rigid straight laparoscopic instruments in all cases. We also performed a new vaginal cuff closure method, Kim's Vaginal Vault Suspension Method, named after the operator (Kim, YW) in both SPA-LAVH and MPA-LAVH. RESULTS: There was no significant difference in patients' age, operating time, uterine weight, hemoglobin change, frequency of blood transfusion, and incidence of postoperative fever between the two groups. The patients' mean age was 46.1+/-7.0 years (SPA-LAVH) and 45.5+/-6.3 years (MPA-LAVH). The mean operating time was 87.2+/-21.0 minutes (SPA-LAVH) and 83.3+/-20.3 minutes (MPA-LAVH). The mean uterine weight was 261.4+/-139.7 g (SPA-LAVH) and 257.8+/-132.9 g (MPA-LAVH). The mean hemoglobin change was 1.1+/-0.7 g/dL (SPA-LAVH) and 1.2+/-0.6 g/dL (MPA-LAVH). Neither bowel injury nor urinary tract injury occurred during the operation in the two groups. One of the SPA-LAVH and one of the MPA-LAVH cases were converted to abdominal total hysterectomy. The mean hospital stay time was shorter with SPA-LAVH (2.6+/-0.6 days [SPA-LAVH] and 3.3+/-0.7 days [MPA-LAVH], P<0.05). CONCLUSION: SPA-LAVH using conventional rigid straight laparoscopic instruments can be offered as a safe and feasible alternative to MPA-LAVH.
Subject(s)
Female , Humans , Adenomyosis , Blood Transfusion , Fever , Hemoglobins , Hysterectomy , Hysterectomy, Vaginal , Incidence , Leiomyoma , Length of Stay , Medical Records , Urinary TractABSTRACT
OBJECTIVE: To evaluate the effectiveness of transumbilical single-port access laparoscopic surgery of ectopic pregnancy. METHODS: Retrospective analysis was performed on six patients who underwent transumbilical single-port access laparoscopic management of ectopic pregnancies. RESULTS: The median age of 6 cases was 33.5 years (range, 32 to 36), and the median body mass index was 20.6 kg/m2 (range, 16.5 to 28.7). The median largest diameter of G-sac was 4.8 cm (range, 3.0 to 5.4). Intracorporeal rupture and hemoperitoneum were accompanied in all cases. The median time needed for the surgery was 77.5 minutes (range, 59 to 95). The median estimated blood loss was 40 mL (range, 20 to 50). The median postoperative hospital day was 2 days (range, 1 to 3). There were no complications on postoperative course and follow-up. CONCLUSION: Transumbilical single-port access laparoscopic surgery for ectopic pregnancy was feasible and safe. This approach might be reasonable alternative to conventional laparoscopic surgery using 3 or 4 port in the management of ectopic pregnancy.
Subject(s)
Female , Humans , Pregnancy , Body Mass Index , Follow-Up Studies , Hemoperitoneum , Laparoscopy , Pregnancy, Ectopic , Retrospective Studies , RuptureABSTRACT
Objective: We present our preliminary experience of using a homemade transumbilical single-port access for performing transumbilical single port access (SPA) laparoscopic surgery for gastrointestinal disease and its perioperative nutritional management.Methods: During Nov.2009-Dec.2009,five patients received SPA surgery and nutritional management following the protocol of fast track surgery.A patient with stomach GIST received partial gastrectomy,a patient with ascending colon lymphoma received right hemicolectomy,a patient with rectal cancer received anterior resection,a patient with jejunum GIST received partial small bowel resection,and a patient with early gastric cancer received distal subtotal gastrectomy (D1+α). Results: Transumbilical SPA surgery were successfully done in five patients without conversion.The mean length of incision was 3 cm,the mean time for operation was 138 (60-240)min,and the mean blood loss was 50 (10-100)ml.All patients could mobilize and orally drink on the 1st day after operation,have soft diet the 3st days after operation,their mean postoperative hospital stay was 4 days.No complication occurred.Mean body weight loss was 2.6 kg on discharge compared with at admission.Conclusion: Transumbilical SPA surgery with the protocol of fast-track surgery had advantages including shorter incision,less trauma,faster recovery,and less body weight loss.
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Single port access surgery can be the next generation of minimally invasive surgery. It has been tried in various diseases of surgery, urology, and gynecology. It was introduced in Korea and its field is widening. Total hysterectomy is the most common operation in gynecology. However, single port total laparoscopic hysterectomy (TLH) had been hardly performed due to technical difficulties. Author has successfully performed single port transumbilical TLH and right adnexectomy in a patient who had adenomyosis, uterine myoma, and right ovarian serous cystadenoma. One laparoscope and 2 instruments were inserted in 3 cannulas of the port that was made up with a wound retractor and a surgical glove. Laparoscopic suturing was done after total hysterectomy and right adnexectomy. During the operation, only commonly used laparoscopic instruments (straight and rigid) were used. All the procedures were completed without any complications and there were neither postoperative complications nor visible scars. Author reports the first single port transumbilical TLH case in Korea that showed satisfying results.