Validación de la histerectomía laparoscópica por un solo puerto quirúrgico como una nueva técnica en Cuba / Validation of the laparoscopic hysterectomy through an only surgical approach as a new technique in Cuba

Introducción: disminuir la agresión a la biología del paciente y minimizar el acceso al área quirúrgica, ha sido una preocupación y una ambición permanente del cirujano. La cirugía a través de orificios naturales implica ganar el acceso a la cavidad abdominal a través del estómago, colon, vagina, útero o vejiga; y elimina, de hecho, los puertos de entrada en la pared abdominal, lo cual la incluye en un nuevo paradigma quirúrgico: la cirugía sin huellas. En el año 2007 se propone una nueva técnica de cirugía endoscópica transumbilical, acorde con los principios técnicos de la cirugía a través de orificios naturales. Su uso en ginecología comienza desde la década de los años setenta cuando se realizaron ligaduras tubarias, y recientemente se han introducido innovadoras técnicas de un solo puerto en procedimientos más complejos. Objetivos: demostrar la factibilidad y seguridad de la histerectomía laparoscópica por un solo puerto quirúrgico mediante una nueva técnica. Métodos: estudio prospectivo de serie de casos. Se realizó la técnica de histerectomía totalmente laparoscópica mediante un solo puerto quirúrgico y con instrumentos diseñados para tal efecto. Resultados: se realizó esta técnica a 10 pacientes con diagnóstico de fibroma uterino. El tiempo quirúrgico fue de 115 minutos (75-160) y la media de sangrado de 75 mL (20-400), y no se observaron complicaciones intraoperatorias ni posoperatorias en los casos estudiados. Conclusiones: la histerectomía laparoscópica por un solo puerto es una técnica factible, segura y reproducible a otros servicios de cirugía de mínimo acceso del país(AU)

Introduction: to decrease the act of aggression to patient's biology and to minimize the access to surgical area has been a concern and also a permanent ambition of surgeon. Surgery thorough natural orifices involves to access to abdominal cavity through stomach, colon, vagina, uterus or bladder and in fact eliminates the approaches to abdominal wall including it in a new surgical paradigm: the surgery without traces. In 2007, it was proposed a new technique of trans-umbilical endoscopic surgery in keeping with the technical principles of surgery through natural orifices. Its use in gynecology begins from the decade of 70s when the tubal ligatures and recently the only approach innovative techniques of one only port have been introduced in procedures more complex. Objectives: to demonstrate the feasibility and safety of the laparoscopic hysterectomy through an only approach by means of a new technique. Methods: a prospective study of cases-series was conducted as well as a hysterectomy technique completely laparoscopic by means of an only approach and using instruments designed to that end. Results: this technique was applied in 10 patients diagnosed with uterine fibroma. The surgical time was of 115 min (75-160) and bleeding mean was of 75 mL (20-400); there were not intraoperative and postoperative complications in study cases. Conclusions: laparoscopic hysterectomy through an only approach is a feasible, safe and reproducible technique for other minimal access surgery services of our country(AU)

Natural orifice transluminal endoscopic surgery in non-survival porcine models: access and technique / 中华消化内镜杂志

Objective To evaluate the feasibility, advantages and pitfalls of trans-gastric, trans-colonic and trans-umbilical peritoneoscopy, and to compare pure natural orifice transluminal endoscopic surgery (NOTES) with hybrid NOTES. Methods Two female pigs of 30kg were used in the study, one for pure NOTES, the other for hybrid NOTES. Each pig received trans-gastric, trans-colonic and trans-umbilical peritoneoscopy, respectively, followed by postmortem examination for organic lesions and closure of incisions.The two approaches were compared in terms of intra-operative situation and manipulation. Results The vital signs of the pigs were stable during the procedures, with no peri-incision organic lesions. There were blind areas in trans-gastric as well as in trans-colonic peritoneoscopy. It was easier to close the colonic incision than the gastric one. The situation in trans-umbilical peritoneoscopy was similar to laparoscopic surgery. Hybrid NOTES seemed superior to pure NOTES with regard to safe access, stable pneumo-peritoneum and adequate visualization. Conclusion Three routes for NOTES appear to be reasonable and feasible. Hybrid NOTES is more effective and safer than pure NOTES with current instruments.

Laparoscopic vs Transumbilical Single-Port Laparoscopic Appendectomy; Results of Prospective Randomized Trial

PURPOSE: Conventional three-port laparoscopic appendectomy (LA) is more commonly performed than transumbilical single port laparoscopic appendectomy (TUSPLA). In this report, we performed a prospective randomized study comparing the outcomes of LA and TUSPLA. METHODS: Between April 14, 2009 and June 10, 2009, 40 patients who required laparoscopic appendectomies were randomly selected to receive either a TUSPLA or a LA. None of these patients had perforation or abscess. Twenty of the patients received a LA and the other 20 received a TUSPLA. The clinical outcomes and visual analog pain scores (VAS) were compared between the groups. RESULTS: The TUSPLA procedures were performed successfully in every indicated patient. Clinical outcomes were similar in both study groups. The TUSPLA group showed a significantly higher VAS score 24 hours postoperatively than the LA group. CONCLUSION: Compared with LA, TUSPLA was technically feasible and safe in patients with non-complicated appendicitis. However, the patients in the TUSPLA group reported more postoperative pain than those in the LA group.

Trans-umbilical Single Port Laparoscopic Appendectomy: Initial Experience / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic appendectomy is one of the most commonly performed minimally invasive surgeries worldwide. In recent years, successful attempts to reduce the number of conventionally-used three ports have been reported. Specifically, two-port techniques, hybrid approaches and single-port assisted techniques have been described. In this article, we report on the feasibility, safety and cosmesis of trans-umbilical single port laparoscopic appendectomy. METHODS: The procedure was performed using a single 15-mm-diameter umbilical incision. Under general anesthesia, an Alexis O wound retractor (Applied medical resources Co., Ltd., rancho Santa Margarita) was inserted through the umbilicus. After the appendix and meso-appendix were dissected with a Harmonic scalpel (Ethicon Endo-Surgery, Inc., USA), the base of the appendix was ligated with two Endo-loops (SEOJONG medical Co., Ltd., Korea). The appendix was withdrawn into the wound protector and removed from the abdominal cavity. RESULTS: This retrospective study enrolled 70 patients (36 females and 34 males with a mean age of 29.0+/-15.0 years). The mean operative time was 49.0+/-13.9 min. There was no mortality. There were five complications in five patients (7.1%) and the median hospital stay was 3.5+/-1.4 days. CONCLUSION: This is a safe, minimally invasive procedure with excellent cosmetic results. Compared with other trans-umbilical appendectomy techniques, single port laparoscopic appendectomy has the advantages of feasibility without extensive endoscopic skills and an acceptable operative time. Technical refinements and accumulated experience probably will enable its wider use for more patients with acute appendicitis.

Single Port Laparoscopic Appendectomy: Retrospective and Comparative Analysis of 55 Consecutive Cases: Report of Initial Experience / 대한내시경복강경외과학회지

PURPOSE: With the big increase in laparoscopic skills and technology, many surgeons have recently began to adopt single port laparoscopic surgery for treating appendicitis due to the increased patient satisfaction and improved cosmesis. We determined if conventional appendectomy or single port laparoscopic appendectomy is the better treatment modality figure out which one will be. METHODS: The data was prospectively collected and retrospectively analyzed for all the patients who underwent single port laparoscopic appendectomy at our institute and this data was compared with that of the patients who had undergone conventional laparoscopic appendectomy. RESULTS: 55 patients underwent single port laparoscopic appendectomy and we collected the data of 76 patients who underwent conventional laparoscopic appendectomy. There were few differences between single port laparoscopic appendectomy and conventional laparoscopic appendectomy for the operation results. CONCLUSION: Single port laparoscopy appendectomy is feasible and safe with several benefits. It can be a good treatment modality for the management of appendicitis. Surgeons familiar with conventional laparoscopy can switch to single port laparoscopy for performing appendectomy without need of special skills or training to get over the learning curve.