Application value of 'N' shaped Trocar placement in Da Vinci robotic bariatric and metabolic surgery / 中华消化外科杂志

Objective:To investigate the application value of 'N' shaped Trocar placement in Da Vinci robotic bariatric and metabolic surgery.Methods:The retrospective and descriptive study was conducted. The clinical data of 69 patients who underwent Da Vinci robotic bariatric and metabolic surgery in the China-Japan Union Hospital of Jilin University from March to October 2020 were collected. There were 18 males and 51 females, aged from 12 to 67 years, with a median age of 34 years. The surgery was performed with the 'N' shaped Trocar placement by the same team of surgeons. The Da Vinci robotic sleeve gastrectomy, Da Vinci robotic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy or Da Vinci robotic biliopancreatic diversion with duodenal switch was selected according to the patient's condition. Observation indicators: (1) surgical and post-operative conditions; (2) follow-up. Follow-up using the outpatient examination, telephone interview and WeChat to detect the body weight, body mass index, fasting blood glucose, glycosylated hemoglobin, total cholesterol, Trocar-related complications of patients at postoperative 3 months. The follow-up was up to November 2020. Measurement data with normal distribution were represented as Mean± SD, and comparison of general data before and after surgery was analyzed using the paired t test. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Results:(1) Surgical and postoperative conditions: of the 69 patients, 34 cases received Da Vinci robotic sleeve gastrectomy, 34 cases received Da Vinci robotic single-anastomosis duodenal-ileal bypass with sleeve gastrectomy, and 1 case received Da Vinci robotic biliopancreatic diversion with duodenal switch. There was no conversion to open surgery or laparoscopic surgery. The operation time of 69 patients was (161±52)minutes, and the volume of intraoperative blood loss was 30 mL(range, 10-100 mL). Two of 69 patients had post-operative complications. One of them with postoperative abdominal hemorrhage was cured after symptomatic treatment and discharged on the 10th day after surgery. The other one patient with postoperative peritoneal effusion was cured and discharged from hospital after puncture drainage and symptomatic treatment. No Trocar-related complication such as Trocar foramen bleeding and Trocar foramen hernia occurred in the 69 patients. The duration of postoperative hospital stay of 69 patients was (6±3)days. (2) Follow-up: 47 of 69 patients were followed up for 3 months. The body mass, body mass index, fasting blood glucose, glycosylated hemoglobin, and total cholesterol were (86±19)kg, (30±5)kg/m 2, (5.2±0.7)mmol/L, 5.3%±0.6%, (4.3±1.3)mmol/L at postoperative 3 months, which had significant differences compared with the preoperative indicators ( t=6.101, 8.261, 2.973, 2.567, 2.098, P<0.05). All the 47 patients had no Trocar-related complications during the follow-up. Conclusion:The 'N' shaped Trocar placement method is safe and feasible in the Da Vinci robotic bariatric and metabolic surgery, with good efficacy.

Laparoscopic appendectomy versus laparoscopic assisted appendectomy: a hospital based comparative study

Background: Laparoscopic appendectomy is more expensive and time consuming as compared to open technique. On the other hand, laparoscopic assisted appendectomy has the advantages of both the open and laparoscopic methods.Methods: This was a prospective comparative study of patients that underwent appendectomy by laparoscopic or laparoscopic assisted techniques.Results: A total of 40 patients were selected for the study. Standard laparoscopic technique was performed in 20 patients and laparoscopic assisted appendectomy was performed in 20 patients. The average operating time was 25.4±15 minutes in laparoscopic assisted appendectomy while it was 46.20±10.90 minutes in standard laparoscopic appendectomy which was statistically significant. Mean hospital stay in group A was 2.70±0.70 and in group B it was 2.10±0.70 which was not statistically significant.Conclusions: The laparoscopic-assisted method of appendix removal can be performed as efficiently as laparoscopically. It is fast and easy to perform, and it is expected to decrease the overall cost of laparoscopic appendectomy.

Modified three port laparoscopic cholecystectomy versus conventional four port technique

Background: The current  study was undertaken to compare the results of modified three-port laparoscopic cholecystectomy and conventional three or four-port surgery in terms of technical feasibility, safety of the technique, postoperative pain and need of post-operative analgesia, cosmetic satisfaction of the patient and cost effectiveness and were found to be better with the modified technique.Methods: In modified three port laparoscopic cholecystectomy technique, first 10 mm umbilical, second 5 mm epigastric and third 5 mm subcostal ports are made, i.e., "10-5-5" instead of "10-10-5" or "10-10-5-5" of conventional three or four port techniques and finally, gallbladder is extracted through the umbilical port.Results: The pain in the postoperative period and the requirement of postoperative analgesia were significantly less and there was better cosmetic satisfaction of the patients operated by the modified three port laparoscopic cholecystectomy technique as compared to conventional three or four port surgery.Conclusions: The modified three-port laparoscopic cholecystectomy technique is safe and has the same comfort and feasibility to the surgeon along with added advantage of less pain and better cosmetic appearance to the patient in comparison to the conventional three or four-port surgery, with no obvious increase in complications and is definitely a viable alternative procedure for the management of cholelithiasis.

Lesión esplénica accidental en cirugía ginecológica laparoscópica asociada con la técnica de entrada. Reporte de un caso y revisión bibliográfica / Incidental splenic injury during laparoscopic gynecological surgery associated with the entry technique. A case report and literature review

Resumen: ANTECEDENTES: Las lesiones accidentales del bazo durante la cirugía laparoscópica ginecológica son complicaciones raras, con gran repercusión en la morbilidad y mortalidad perioperatoria. La cirugía laparoscópica mediante compresión asistida y administración de hemostáticos es una opción viable en pacientes con lesiones esplénicas derivadas del acceso de los trocares. CASO CLÍNICO: Paciente de 48 años, con síndrome anémico secundario a trastornos (hipermenorrea y metrorragias) menstruales de seis meses de evolución, atendida en el departamento de Ginecología del Hospital General Dr. Manuel Gea González donde se clasificó con P0A0L1M0-C0O1E1I0N0 (FIGO 2011). Se decidió la histerectomía laparoscópica con salpingooforectomía bilateral. Durante el procedimiento quirúrgico tuvo sangrado activo, dependiente de la pared esplénica. Se ejerció compresión del sitio sangrante y se aplicó Surgicel® (producto hemostático absorbible-Ethicon), con adecuada hemostasia. La paciente evolucionó satisfactoriamente y fue dada de alta sin contratiempos. CONCLUSIÓN: Existen pocos reportes de lesiones esplénicas accidentales en cirugía ginecológica laparoscópica. La parte más peligrosa es la introducción de la aguja de Veress y del trócar, que pueden provocar lesiones viscerales o a vasos sanguíneos. Las pacientes con lesiones esplénicas accidentales deben ser tratadas por un equipo multidisciplinario.

Abstract: BACKGROUND: Incidental spleen injuries during gynecological laparoscopic surgery are rare complications that have a major impact on perioperative morbidity and mortality. Laparoscopic management through assisted compression and haemostatic products has been a recommended option in patients who have splenic lesions secondary to the path of laparoscopic trocars. CLINICAL CASE: 48-year-old patient with anemic syndrome secondary to 6-month-old menstrual disorders. It is protocolized in the Department of Gynecology of the Hospital Dr. Manuel Gea González where it is classified P0A0L1M0 - C0O1E1I0N0 (FIGO 2011). It is proposed for laparoscopic hysterectomy with bilateral salpingophrectomia. In the surgical act there is active bleeding dependent on splenic wall. It is compressed from the bleeding site and Surgicel® (absorbable hemostatic product - Ethicon) is applied, presenting hemostasis. The patient evolved successfully and left without incident. CONCLUSION: There are few documented reports of incidental splenic injuries in laparoscopic gynecological surgery. The most dangerous part of laparoscopy is the introduction of the Veress needle and the trocar, where visceral lesions or blood vessels may occur. Timely diagnosis of these complications is important for proper treatment. Incidental splenic injuries should be treated by a multidisciplinary team.

A study on laparoscopic sterilisation using 5mm laparoscope and direct trocar entry method

Background: Laparoscopic sterilization is a widely accepted method of permanent contraception. The techniques of abdominal entry are open direct trocar and veress method. The objectives of this study were to performance and practice of 5mm direct trocar entry techniques in Laparoscopic sterilization. To prepare a list of benefits and complications.Methods: Retrospective analysis of patients who underwent direct 5mm trocar entry for laparoscopic sterilization.  Period: 1st April 2017 to 30th November 2017. Patient came on the day of surgery with empty stomach. Intravenous pethedine 50mg and phenergan 12.5mg and antibiotics were given. Injection lignocaine intraumbilically and incision of 5mm was made. 5mm trocar and canula inserted directly. 5mm scope inserted.  After ensuring peritoneal cavity, pneumoperitonium created. Secondary 7mm port made under vision and ring applicator inserted and fallop ring applied on both tubes. Port closure done by N Butyl 2 cyano accrylate. Patient was observed for 6 hours and discharged with analgesics and antibiotics.Results: We operated 220 interval sterilizations and 31 posts MTP.  In 250 cases, the method was successful.  Only in one woman 5mm trocar was insufficient to make peritoneal entry since the patient was morbidly obese. Hence 10mm trocar was used.Conclusions: Laparoscopic tubal sterilization can be done with 5mm laparoscope and direct trocar entry method is safe and saves time.

Stitch less, clip less, three ports laparoscopic cholecystectomy: experience of 300 cases

Background: 300 cases of cholelithiasis were operated by stitch less, clip less, three ports laparoscopic cholecystectomy at Maxx lyfe Hospital, near Bathindi morh, Sunjwan road, Jammu with effect from August 2017 to May 2019. The outcome measures in the form of safety of the technique, postoperative pain, need of postoperative analgesia, number of OT assistants needed, duration of hospital stay, recovery and return to routine work, cosmetic satisfaction of the patient were taken into consideration and were found to be better than in conventional four ports technique of laparoscopic cholecystectomy.Methods: In three port laparoscopic cholecystectomy, first 10 mm umbilical, second 5 mm subxyphoid and third 5 mm subcostal ports are used and telescope is passed into the peritoneal cavity through the umbilical port. Retraction of the gallbladder is done by the long grasping forceps through the 5 mm subcostal port, whereas dissection is accomplished through the subxyphoid port. The gallbladder is retrieved through the subxyphoid port.Results: Mean operative time was 40 minutes and mean duration of postoperative stay in the hospital was 18 hours. Days to return to normal activity was 4 days at an average.Conclusions: The 3-port laparoscopic cholecystectomy  technique is safe and has better outcomes in the form of less postoperative pain, less duration of hospital stay, early return to routine work and more cosmetic satisfaction as compared to the conventional 4-port technique, with no obvious increase in bile duct injuries and it can be a viable alternative in the field of minimally invasive surgery.

Trocar-site hernia after gynecological laparoscopic surgery: a 20-year, single-center experience / 中华医学杂志(英文版)

Background@#Trocar-site hernia (TSH) is a serious complication after laparoscopic procedures. Although it is a rare entity, it can have life-threatening consequences. This study aimed to retrospectively analyze the potential associated factors for TSH following gynecologic laparoscopy and summarize prevention strategies based on our experience.@*Methods@#We searched for gynecological laparoscopic surgeries in the medical records system of Peking Union Medical College Hospital (PUMCH) from August 1998 to July 2018 and further sifted through the results for cases involving TSH. All included patients were divided into different groups according to patient characteristics, and the rate of TSH was compared among groups. Moreover, the detailed information of all patients with TSH was recorded and analyzed. Statistical analyses were performed with GraphPad Prism 6.@*Results@#The approximate total rate of post-operative TSH among gynecologic laparoscopy procedures performed at PUMCH in the last 20 years was 0.016% (9/55,244). The rate of TSH was significant higher in elder patients (≥60 years old; 3/2686, 0.112%) than in younger patients (<60 years old, 6/52,558; 0.011%, P = 0.008). Moreover, the approximate rate of TSH was significantly higher after single-incision laparoscopic surgery (SILS, 2/534, 0.357%) than conventional laparoscopic surgery (7/54,710, 0.013%, P = 0.003). The average age of patients with TSH was 53.4 years (range, 35.0-79.0 years). Two of the nine patients had late-onset TSH following SILS; the other seven had early-onset TSH following conventional laparoscopy. Five TSH cases occurred at right lateral port sites, and the remaining three occurred at the umbilical port site. All patients underwent repair surgery, and one required small bowel resection.@*Conclusion@#Older age and SILS are potential associated factors for TSH development, while reducing excessive manipulation and improving suturing skills, especially at the umbilical trocar site following SILS and the right lateral trocar site, can avoid herniation.

Intercostal trocars and transthoracic trocars facilitated laparoscopic resection of lesions in liver segments 7 and 8 : a report of 20 cases / 中华肝胆外科杂志

Objective To evaluate the use of intercostal trocars (ICS) and transthoracic trocars in laparoscopic resection of liver segments 7 and 8.Method From November 2015 to June 2017,20 patients who underwent laparoscopic S7 or 8 segmentectomy for liver tumors in the Department of Hepatobiliary Surgery,the First Affiliated Hospital,Guangxi Medical University were analyzed retrospectively.Results Ports were inserted at the 8th or 9th ICS,respectively,in addition to the conventional abdominal ports.The mean operation time was 225.0 min (110.0 ～ 486.0 min).Anatomical resection was completed in 1 patient,and non-anatomical resection in 19 patients.The conversion rate was 0％.Pringle's maneuver was used in 9 patients.The mean blood loss was 85.0 (25.0 ～410.0) ml,and the mean length of hospital stay was 7.0 (5.0 ～ 12.0) days.The complication rate was 10.0％.Pathologic findings revealed that 17,2,1 patient(s) had HCC,hemangioma,and inflammatory nodule,respectively.The mean tumor size and tumor free margin were 33.8 (15.0 ～ 74.0) mm;and 15.0 (1.0 ～ 30.0) mm,respectively.There was no HCC recurrence on follow-up,expect for one patient who developed tumor recurrence at 20 months after laparoscopic liver resection.Conclusions In selected patients,laparoscopic liver resection using intercostal trocars was useful and safe for tumors located in liver segments 7 and 8.The long-term oncologic outcomes need to be further evaluated.

Feasibility of 18G trocar applied in jugular vein puncture for adults / 局解手术学杂志

Objective To investigate the feasibility of 18G trocar for central venous catheterization in adults.Methods Retrospective analyzed the clinical data of 60 patients with central venous catheterization under local anesthesia.These patients were randomly divided into the control group and the observation group.Selected the internal jugular vein as the site of the puncture catheter.The control group was punc-tured by conventional puncture needle while the observation group was punctured by the 18G trocar.Results There was no statistical differ-ence between the two groups in the success rate of final puncture and catheterization(P>0.05).Compared with the control group,the suc-cess rate of guidewire insert was higher,the puncture operation time was shorter,the pain score during puncture operation was lower,and post-operative patient satisfaction was higher in the observation group.The differences of the two groups were statistically significant(P<0.05). Conclusion 18G trocar can perform central venous catheterization successfully.This method has great advantages for awake patients,and it also worked in some cases with difficult wire insertion.

Research report of the clinical application effect of Clampcath trocar in immune adsorption / 重庆医学

Objective To observe the application effect of Clampcath trocar in immune adsorption.Methods A tatol of 40 patients underwent immune adsorption in our hospital were divided into the observation group and the control group according to the random number table method,with 20 cases in each group.In the observation group,20 cases were treated with Clampcath trocar as temporary vascular access for immune adsorption,and in the control group,20 cases were treated with 16 G indwelling needle as temporary vascular access for immune adsorption.The blood flow,tube plugging rate,discount rate,indwelling time of immune adsorption of patients in each group were compared.Results The tube blocking rate and discount rate of the observation group were significantly lower than that of the control group (P＜0.05),the difference wasstatistically significant;in the observation group,the blood flow was significantly higher than that in the control group (P＜ 0.01),the indwelling time of the observation group was longer than that of the control group (P＜0.05),the difference was statistically significant.Conclusion Clampcath trocar could be used as temporary vascular access for immune adsorption,of which the operation is simple,and is cheap and affordable.Meanwhile,it has advantages include low tube plugging rate and discount rate,long indwelling time and sufficient blood flow,thus it could alleviate the suffering of patients and reduce the waste of resources,and it's worthy of clinical promotion.

Application of 23G minimally vitrectomy trocar in acute angle closure glaucoma / 眼科新进展

Objective To evaluate the outcome of 23G minimally vitrectomy trocar on eyes with acute angle closure glaucoma.Methods A retrospective review was performed of patients with acute angle closure glaucoma who underwent combined compound trabeculectomy from September,2014 to June,2015 in Beijing MEM care system.Intraoperative 23G minimally vitrectomy trocar was used in all of the patients.30 eyes of 30 patients were enrolled in the study.All patients were followed up for 12 months.Visual acuity,intraocular pressure and complications were observed.Results No serious complications such as explosive choroid hemorrhage and retinal hemorrhage occurred during operation.All of 30 eyes maintained adequate pressure control.The average postoperative IOP was (15.93 ± 1.35) mmHg (1 kPa =7.5 mmHg),was less than the preoperative (56.34 ± 6.96) mmHg (P =0.00).And the visual acuity in 23 eyes were improved.Conclusion Combined trabeculectomy with 23G minimally vitrectomy trocar in acute angle closure glaucoma patients is a kind of safe and effective operation method,can obviously reduce the intraoperative explosive choroid hemorrhage.

Clinical experience of UOTLA in treatment of complicated appendicitis in children / 中国内镜杂志

Objective To analyze the efficacy of umbilical one trocar laparoscopic appendectomy (UOTLA) in treatment of complicated appendicitis in children. Methods Clinical data of 78 cases of children patients with complicated appendicitis from January 2012 to October 2015 was summarized, including 44 cases as UOTLA group received umbilical one trocar laparoscopic appendectomy, 34 cases as OA group received open appendectomy. Then statistically analyzed all the patients' operation time, postoperative hospital stay, postoperative abdominal abscess, incision infection, early inflammatory intestinal obstruction and pain level. Results The laboratory test results of C reaction protein (CRP) had no significant difference between the two groups, while peripheral white blood cell count decreased more significantly in UOTLA group than that in OA group; the operation time of UOTLA group was shorter than that in OA group with no statistical difference [(66.59 ± 33.24) vs (72.86 ± 30.36) min, P > 0.05], but postoperative hospital stay was shorter [(8.21 ± 1.67) vs (9.21 ± 2.01) d, P 0.05); incision infection: 6 cases in UOTLA group, 9 cases in OA group (P > 0.05); early inflammatory intestinal obstruction: 1 cases in UOTLA group, 5 cases in OA group (P > 0.05); the pain level, postoperative recovery time was significantly shorter in UOTLA group compared with OA group (P 0.05]. Conclusion UOTLA is safe and effective for complicated appendicitis in children due to minimally invasive, less pain and faster recovery without significant increase in the cost and postoperative complications. It can be applied in children with purulent, perforated appendicitis and gangrene, perforated appendicitis and other complicated appendicitis.

Tracheotomy tube as trocar in the electronic bronchoscope instead of thoracoscope / 中国内镜杂志

Objective To investigate the feasibilty of the disposable tracheotomy tube as trocar in the electronic bronchoscope instead of thoracoscope. Methods 86 patients with effusion of unknown origin undergoing medical tho-racoscopy from January 2015 to October 2015, 59 male (68.6%) and 27 female (31.4 %), mean age (49.00 ± 20.00) years (15 ~ 83) years, were randomly divided into two groups, Tracheostomy tube group (group T) and Conventional chest tube group (group C). Group T uses disposable cannula tracheostomy tube as trocar, and group C received conventional medical thoracoscopy chest tube. Then compare the positive rate of pathological diagnosis, operation time, inspection fees, and other adverse reactions between the two groups. Results 40 cases (93.0%) in group T were confirmed diagnosis, including 8 cases of lung pleural metastasis, 31 cases of erculous pleurisy, 1 case of empyema, while 4 cases of unknown diagnosis (7.0%). 33 cases (76.7%) in group C were confirmed diagnosis, in-cluding 4 cases of lung pleural metastasis, 29 cases of tuberculous pleurisy, while 10 cases of unknown diagnosis (23.3 %). The difference was statistically significant between the two groups ( < 0.05). Operative time in group T was (23.86 ± 2.45) minutes, while in group C was (29.88 ± 3.67) minutes, the difference was statistically significant ( <0.05). While the complication rate was no significant difference. Conclusions It is demonstrated that the dispos-able tracheotomy tube as trocar in the electronic bronchoscope instead of thoracoscope which can shorten the opera-tion time, improve the diagnosis rate, reduce costs, worthy of promoting.

Application value analysis of the method cut-open performing umbilicus abdominal access during laparoscopy / 局解手术学杂志

Objective To introduce a new method performing umbilicus abdominal access during laparoscopy. Methods In a prospec-tive,362 patients received laparoscopic appendectomy in October 2012 to October 2014 were oberserved in this study. The clinical data,the time of the progress of making umbilicus abdominal access,complications and the state of the wound were recorded. Results The performing time of the trocar in umbilicus was (42. 3 ± 27. 1)s. Conclusion The method Cut-open,is simple,fast and save,which is worth to promoting in laparoscopic surgery.

Direct trocar insertion using optical trocar in the establishment of the observational passage during trans-peritoneal laparoscopic operation-our initial experience / 中华泌尿外科杂志

Objective To evaluate the clinical significance of direct trocar insertion using optical trocar in the establishment of the primary port during trans-peritoneal laparoscopic surgical procedures.Methods A prospective study was conducted by collecting the data of 120 patients who should be performed abdominal laparoscopic surgery from April 2015 to December 2015.The 120 patients were randomly divided into a research group and a control group.The research group consisted of 34 male patients and 26 female patients,mean age was (52.0 ± 11.9) years and mean BMI was (24.9 ± 2.9) kg/m2.In research group,patients were positioned laterally with the flank padded and elevated.A predetermined position was drawn prior to surgery between the umbilicus and lateral rectus abdominis,for the creation of the primary laparoscopic trocar port.The predetermined point was incised,and then the method of direct trocar insertion using the optical access trocar was used for establishment of the primary port.After this maneuver was completed the surgery continued as indicated.The control group consisted of 36 male patients and 24 female patients,whose mean age was (52.9 ± 11.4) years and mean BMI was (25.2 ± 2.4) kg/m2.This group underwent the traditional method of port construction by incision into the abdomen.The time of constructing the passage,leakage rate,bleeding rate,and injury rate of abdominal organs were compared.Results In research group,the time of building primary port was clearly shorter than that in control group (2.7min vs.15.9min,P ＜ 0.05),the leakage rate was also obviously reduced compared to that in control group (0 vs.30％,P ＜ 0.05).Neither groups observed any significant bleeding nor visceral organ damage throughout the study.Conclusion Direct trocar insertion using optical trocar to establish observation port is a highly efficient and safe method in trans-peritoneal laparoscopic operation,which should be research thoroughly in clinical practice.

The application of trocar position adjustment in posterior laparoscopic in the treatment of retrocaval ureter / 中华泌尿外科杂志

Objective To introduce a new trocar position in the posterior laparoscopic for the treatment of retrocaval ureter.Methods From August 2011 to October 2014,5 cases with retrocaval ureter treated with posterior laparoscopic were retrospectively analyzed,including 3 males and 2 females,aged from 15 to 46 years(mean 34 years).The history of disease ranged from 1 to 10 months,with 3 cases presented with low back pain,and 2 cases being detected uronephrosis by check-up.Results All the operations were successfully completed,with the operation duration ranged from 75-125 min (mean 90min),and blood loss ranged from 20ml to 50 ml(mean 35 ml).The average hospital stay was 6 days(5-7d).There was no wound infection or urine leakage.Ureteral double-J tubes were removed 4 weeks after surgery.Postoperative followup ranged from 2 weeks to 6 months (mean 30 months).There was no anastomotic stricture,and the hydronephrosis relieved.Conclusions Trocar position adjustment of posterior laparoscopic in treatment of retrocaval ureter is convenient to operate,which also shortened the time of operation,reduced the difficulty of operation and the surgeons' fatigue.

Modified Peritoneal Dialysis Catheter Insertion: Comparison with a Conventional Method

PURPOSE: The conventional trocar and cannula method in peritoneal dialysis (PD) catheter insertion has its limitation in clinical setting. The aim of this study was to compare a modified method for percutaneous PD catheter insertion with the conventional method, and demonstrate advantages of the modified method. MATERIALS AND METHODS: Patients at a single center who had percutaneous PD catheters inserted by nephrologists from January 2006 until September 2012, using either a modified method (group M) or the conventional trocar and cannula method (group C), were retrospectively analyzed, in terms of baseline characteristics, complications experienced up to 3 months after the procedure, and the suitability of the procedure for patients. RESULTS: Group M included 82 subjects, while group C included 66 cases. The overall early complication rate in group M (1.2%) was significantly lower than that in group C (19.7%) (p<0.001). The catheter revision rate during timeframe for early complications was significantly lower in group M (0%) than in group C (6.1%) (p=0.024). When comparing Procedure time (1 h 3 min+/-16 min vs. 1 h 36 min+/-19 min, p<0.01), immediate post-procedural pain (2.43+/-1.80 vs. 3.14+/-2.07, p<0.05), and post-procedure days until ambulation (3.95+/-1.13 days vs. 6.17+/-1.34 days, p<0.01), group M was significantly lower than group C. There was no significant difference in total hospitalization period (14.71+/-7.05 days vs. 13.86+/-3.7 days). CONCLUSION: Our modified PD catheter insertion method shows its advantages in early complication rate, early complications revision rate, and the patients' conveniences.

Trocar Size Selection for Trans-Trocar Appendix Removal in Laparoscopic Appendectomy

PURPOSE: Many disposable laparoscopic instruments are used in laparoscopic surgery. There are several disadvantages in use of disposable laparoscopic instruments, including cost ineffectiveness, environmental contamination, and resource recycling. In addition, a disposable specimen bag has been used in laparoscopic appendectomy. Use of the trans-trocar appendix removal technique provides several advantages compared to use of a specimen bag. Therefore, the aim of this study is to analyze the adequate trocar size for trans-trocar appendix removal. METHODS: A total of 62 patients undergoing appendectomy between June 2012 and September 2012 were identified. After appendectomy, we performed a trans-trocar test using removed appendix specimen and trocars. Three different types of trocars were used for the trans-trocar test, 5 mm, 12 mm, and 11 mm Xcel(R) (Ethicon). We analyzed the success rate. RESULTS: Significant relationships were observed between maximal specimen diameter and body mass index. When BMI was below 20, the success rate of the 11 mm trocar was 86% in the trans-trocar appendix removal test. When BMI was between 20 and 25, the success rate of the 12 mm trocar was 71%, but that of 11 mm was 57%. When BMI was above 25, the success rate of the 15 mm trocar was 62%. CONCLUSION: Although this study had many limitations, a large-sized trocar was needed for trans-trocar appendix removal in more body mass index. When BMI is below 20, an 11 mm trocar is recommended in trans-trocar appendix removal. When BMI is between 20 and 25, a 12 mm trocar is. When BMI is above 25, a 15 mm trocar and a disposable specimen bag are recommended. Further continuous study will be needed for analysis of clinical outcome.

A Vessel Injury by Trocar of Closed Suction Drainage after Hip Hemiarthroplasty: A Case Report / 대한고관절학회지

Vascular complication of hip arthroplasty is relatively rare, and usually involves iatrogenic injury or thrombus formation of main vessels. No case of vascular injury associated with closed suction drainage has been reported. The current report describes an injury of a branch from the lateral circumflex femoral artery caused by a trocar of closed suction drainage in a 72-year-old man who had been treated with bipolar hemiarthroplasty because of a femoral neck fracture. We report on this case with a review of the literature in order to avoid similar complications.

Diagnosis of a Trocar Site Mass as Omental Herniation after Laparoscopic Gastrectomy

A trocar site hernia is a rare complication. We report a patient who had an abdominal wall mass at a previous trocar site after laparoscopic distal gastrectomy. It was diagnosed as omental herniation and fat necrosis. We conclude that patients with trocar site masses exhibiting fat density on a computed tomography scan could be followed up without surgery, and that fascial defects located at 10-mm or larger trocar sites should be closed whenever possible to prevent hernia formation.