A Retrospective Comparative Study Between Transumbilical Single-incision and Traditional Three-port Laparoscopic ;Appendectomy / 中国微创外科杂志

Objective To discuss the safety and feasibility of single-incision laparoscopic appendectomy ( SILA ) . Methods A retrospective analysis was made on clinical data of patients diagnosed as having appendicitis by clinical manifestations , ultrasound or computer tomography at our department from June 2009 to December 2014.There were 189 cases of transumbilical SILA ( transumbilical group ) and 123 cases of traditional three-port laparoscopic appendectomy ( three-port group ) .Patients with incomplete records, combination with other surgery , pregnancy appendicitis , acute appendicitis over 72 hours were excluded .Intraoperative and postoperative data of two groups were compared . Results No conversion to open surgery was required in both groups .The operation time, postoperative exhaust time , and postoperative hospital stay had no significant differences between the transumbilical group and the three-port group [(45.5 ±12.7) min vs.(46.3 ±17.8) min, t=-0.461, P=0.650; (1.4 ±0.5) d vs.(1.5 ±0.6) d, t=-1.588, P=0.112;(3.8 ±1.6) d vs.(4.1 ±1.9) d, t=-1.554, P=0.121].The cosmetic scores at 3 months after surgery was higher in the transumbilical group than that in the three-port group [(4.5 ±0.6) points vs.(4.2 ±0.5) points, t=4.585, P=0.000].No significant differences were identified in the incidence of complications and pathological types between the two groups . Conclusion SILA is technically feasible and safe with better cosmetic effects .

Gastrectomía en manga transumbilical con técnica simplificada: técnica y resultados quirúrgicos en 100 pacientes / Simplifi ed transumbilical sleeve gastrectomy: technique and surgical results in 100 patients

Background: The use of transumbilical approach for sleeve gastrectomy has been recently reported, using different technique variations. Aim: To report the technique and surgical results of a transumbilical approach simplified sleeve gastrectomy, using rigid instruments. Material and Methods: Ninety four women and six men, selected by a multidisciplinary team, underwent transumbilical sleeve gastrectomy. The operative technique involved a transumbilical incision, introduction of a SILS® or GelPoint® multiport, and a 5mm metallic accessory trocar laterally in the left flank. Rigid instruments were used in all patients. The greater curvature was dissected from 4-5 cm above the pylorus to the angle of His. Gastric transection was completed with a stapler, and calibrated with a 36 French tube advanced through the pylorus. Hemostasis of the staple line was carried out with metallic clips. A barium swallow was performed in ten randomly chosen patients, confirming the correct tubular shape of the stomach. Results: Body mass index of operated patients ranged from 30 to 43 kg/m². Mean operative time was 56.4 +/- 16.7 minutes. During the early postoperative period, two patients had a hemoperitoneum, one had an antral leak and one had an intestinal perforation. No conversion to conventional laparoscopy or open technique was required. No patient died. The mean length of hospital stay was 2.3 +/- 0.5 days. The cosmetic result was satisfactory for all patients. Conclusions: Transumbilical sleeve gastrectomy is a safe and feasible procedure with the reported technique. The insertion of an accessory 5mm trocar in the left flank simplifies the procedure, allowing the use of rigid instruments.

Introducción: El abordaje transumbilical, ha demostrado ser seguro en diferentes procedimientos. Se han reportado series de casos de gastrectomía en manga transumbilical (GMTU), con diferentes variaciones. Objetivo: Es presentar la técnica y resultados quirúrgicos de una técnica de GMTU simplificada, utilizando instrumental rígido. Material y Métodos: 94 mujeres y seis hombres, fueron sometidos a GMTU, seleccionados por un equipo multidisciplinario. La técnica quirúrgica consiste en una incision transumbilical, introducción de dispositivo SILS® o GelPoint®, y un trocar de 5 mm metálico en el flanco izquierdo. Se utilizó instrumental rígido en todos los pacientes. La disección de la curvatura mayor se realiza desde 4-5 cm proximal al píloro, hasta el pilar izquierdo. La sección gástrica se completa con stapler, calibrando con una sonda de 36 fr transpilórica. Se realiza hemostasia selectiva con clips metálicos. Se realizó estudio baritado a diez pacientes aleatorios, confirmando forma tubular adecuada. Resultados: El rango de IMC preoperatorio fue de 30-43 kg/m². El tiempo operatorio promedio fue de 56,4 +/- 16,7 min. No se requirió conversión a técnica multitrocar o laparotómica. Cuatro pacientes presentaron complicaciones precoces: dos hemoperitoneos, una filtración antral y una enterotomía inadvertida. Se reintervino a dos pacientes. No hubo mortalidad. El tiempo de hospitalización fue de 2,3 +/- 0,5 días. El resultado cosmético fue satisfactorio para todos los pacientes. Conclusión: La GMTU es un procedimiento factible y seguro con la técnica expuesta. La inserción del trocar de 5 mm accesorio, simplifica el procedimiento, permite el uso de instrumental rígido, y lo convierte en un procedimiento reproducible.

Colecistectomía laparoscópica por puerto umbilical asistido / Transumbilical laparoscopic cholecystectomy assisted with a second port: experience in 60 patients

Background: Transumbilical laparoscopic surgery offers substantial esthetic benefits. The use of a second port to introduce a second trocar, reduces the need of special or articulated instruments. Aim: To report the experience with transumbilical cholecystectomy, assisted using a second port, to reduce technical complexity. Patients and Methods: The surgical technique was prospectively evaluated in 60 patients aged 18 to 77 years (39 women), that required a cholecystectomy. All had a surgical risk classified according to the American Society of Anesthesiologists (ASA) as I or II. Patients with gallbladder cancer, choledocholithiasis, were excluded. Two trocar (10 and 5 mm) were introduced by transumbilical incision and other one 5 mm trocar was introduced in the right iliac fossa for 0° frontal optics. Results: The mean operative time was 72 minutes (range 35-165). Fifty seven patients had a 24 h hospital stay. Two patients had to be converted to open surgery due to a complex pedicle dissection and one patient required an additional trocar. There were three complications. An umbilical seroma, a bile leakage through a Luschka duct, that was managed conservatively and one bile tract stenosis, that appeared four months after the operation and required surgical repair. Conclusions: Transumbilical cholecystectomy using a second additional port was a successful procedure, with similar esthetic results as single port surgery, but less costly.

Introducción: La cirugía laparoscópica evoluciona hacia técnicas menos invasivas, entre ellas la cirugía por puerto único umbilical, con mayor beneficio estético. El objetivo del presente trabajo es presentar los resultados de una técnica en colecistectomías laparoscópicas por puerto umbilical asistido por segundo puerto. La hipótesis planteada es que la técnica descrita es sencilla, segura y con beneficio estético similar al puerto único umbilical. Pacientes y Métodos: Técnica quirúrgica realizada prospectivamente en una serie de 60 pacientes ASA I y ASA II con consentimiento informado. Se incluye colecistolitiasis, pólipos, colecistitis aguda y crónica. Se excluye cáncer vesicular y coledocolitiasis. No se excluyeron casos por complejidad técnica o IMC. Se insertan 2 trocares de trabajo de 10 y 5 mm por incisión transumbilical y trocar de 5 mm en fosa iliaca derecha para óptica frontal de 0°. Resultados: Tiempo operatorio promedio de 72 minutos, mediana de 60 y extremos de 35 y 165. Tuvieron hospitalización de 24 horas 57 pacientes (95 por ciento). Hubo 2 conversiones a cirugía abierta por difícil disección del pedículo y un caso requirió trocar adicional. Hubo 3 complicaciones: un seroma de ombligo, una bilirragia por conducto de Luschka manejado conservadoramente y 1 estenosis de vía biliar postoperatoria a 4 meses, con reparación quirúrgica. Conclusiones: La colecistectomía lapa-roscópica por puerto umbilical asistida, logra resultados exitosos y con similares ventajas estéticas que el puerto único. El bajo costo de nuestra técnica permite realizarla en hospitales públicos y centros privados con menores recursos.

Laparoendoscopic pfannenstiel nephrectomy using conventional laparoscopic instruments - preliminary experience

PURPOSE: To confirm the feasibility of the laparoendoscopic Pfannenstiel nephrectomy using conventional laparoscopic instruments. MATERIALS AND METHODS: Since March 2009, laparoscopic nephrectomy through a Pfannenstiel incision has been performed in selected patients in our service. The Veress needle was placed through the umbilicus which allowed carbon dioxide inflow. One 5 mm (or 10 mm) trocar was placed at the umbilicus for the laparoscope, to guide the placement of three trocars over the Pfannenstiel incision. Additional trocars were placed as follows: a 10 mm in the midline, a 10 mm ipsilateral to the kidney to be removed (2 cm away from the middle one), and a 5 mm contralateral to the kidney to be removed (2 cm away from the middle one). The entire procedure was performed using conventional laparoscopic instruments. At the end of the surgery, trocars were removed and all three incisions were united into a single Pfannenstiel incision for specimen retrieval. RESULTS: Five nephrectomies were performed following this technique: one atrophic kidney, one kidney donation, two renal cancers and one bilateral renal atrophy. Median operative time was 100 minutes and median intraoperative blood loss was 100 cc. No intraoperative complications occurred and no patients required blood transfusion. Median length of hospital stay was 1 day (range 1 to 2 days). CONCLUSIONS: The use of the Pfannenstiel incision for laparoscopic nephrectomy seems to be feasible even when using conventional laparoscopic instruments, and can be considered a potential alternative for traditional laparoscopic nephrectomy.

Colecistectomía laparoscópica transumbilical: una técnica reproducible / Transumbilical laparoscopic cholecystectomy: experience in 12 patients

Background: A new laparoscopic cholecystectomy technique uses a single umbilical port, to reduce trauma. Aim: To evaluate prospectively the feasibility of performing single incision laparoscopic cholecystectomies. Material and Methods: Patients with cholelithiasis or gallbladder polyps, without recent acute biliary episodes and a normal biliary tract were considered eligible for the study. An optical device with a working channel was introduced through a single umbilical incisión. A second smaller trocar was also introduced through the same incisión. Results: Between May 2008 and February 2009, twelve women aged 14 to 64 years (nine with cholelitiasis and three with gallbladder polyps) fulfilled inclusion criteria. The procedure lasted 160 minutes at the beginning of the series to 45 minutes in the latest cases. Abdominal pain and hospital stay (12-48 hours) do not differ from patients subjected conventional laparoscopy cases. No complication was recorded and no patient had to be converted to conventional surgery. Conclusions: Single umbilical incisión laparoscopic cholecystectomy is similar to conventional laparoscopy procedures in terms of surgical pain and hospital stay and offers a better esthetic outcome.

Introducción: Con el objetivo de disminuir el trauma quirúrgico, se diseña un protocolo para evaluar la factibilidad de realizar en nuestro medio una colecistectomía laparoscópica utilizando un único punto de ingreso al abdomen. Material y Método: Se incluye pacientes con colelitiasis o pólipos vesiculares, sin antecedentes de cólicos biliares recientes y con vía biliar fina. A través de una incisión umbilical se introduce una óptica con canal de trabajo y por la misma incisión un segundo trocar. Resultados: Entre mayo de 2008 y febrero de 2009, 12 mujeres cumplen los criterios de inclusión, 9 con colelitiasis y 3 con pólipos vesiculares. No hubo conversión a cirugía laparoscópica tradicional, el tiempo operatorio varió de 160 minutos al comienzo a 45 minutos en los últimos casos; el dolor fue similar a la cirugía laparoscópica tradicional. No hubo complicaciones intra ni post operatorias, el tiempo de estadía post operatoria fue de 12 a 48 horas. Conclusión: La colecistectomía laparoscópica transumbilical con mínimo trauma, es comparable a la cirugía laparoscópica tradicional en relación a dolor post operatorio y estadía hospitalaria, sin embargo, ofrece mejores resultados estéticos.

Preliminary Clinical Report on Transumbilical Endoscopic Surgery / 中国微创外科杂志

Objective To discuss the clinical value of transluminal endoscopic surgery (TUES), and to find a simple and safe no-scar surgical approach. Methods A total of 13 cases of TUES, including 1 case of hepatic abscess fenestration, 1 abdominal exploration, 5 appendicectomy, and 6 cholecystectomy, were carried out in our hospital. Among the cases, 3 were accomplished using upper-digestive endoscopy, and 10 were performed using triple-channel catheter technique by modified instruments.Results All the operations were completed successfully without conversion to routine laparoscopic surgery or open surgery. The operation time was 90-150 min in the 6 cases of cholecystectomy, 15-40 min in the 5 cases of appendectomy, 90 min in the hepatic abscess fenestration, and 50 min in the abdominal exploration. The abdominal exploration showed peritoneal abrasion around the bladder, and the hemorrhage was controlled by electric coagulation. No complications including hemorrhage and biliary fistula occurred in this series. No abdominal scar was found after the operation except in the skinfolds around the hilum. Conclusions The TUES is a simple, safe, and feasible technique. Since the TUES for cholecystectomy is difficult, the patients should be selected carefully.