Single-incision laparoscopic cholecystectomy: a new retraction technique.

BACKGROUND: Laparo-endoscopic single site cholecystectomy receives great interest from the surgical community. It has potential for reducing postoperative pain, length of hospital stay and improving cosmesis. Minimally invasive surgeons have been forced to develop techniques for providing adequate retraction of the gallbladder. Herein, we describe a new retraction technique to improve the dissection of Calot's triangle. SURGICAL TECHNIQUE: Twelve patients underwent laparo-endoscopic single site laparoscopic cholecystectomy using this retraction technique. An intra-umbilical skin incision was made by pulling out the umbilicus. A SILS port was placed through an open approach. We inserted a 10-mm 30 degrees camera through the SILS port without using any trocar. One suture was knotted in the middle of the gallbladder. Gallbladder retraction was achieved by the use of an EndoClose needle that was inserted into abdominal cavity at the subcostal border. The floppy knot was held by the notched end of the EndoClose needle. This device provided retraction of the gallbladder in every direction. CONCLUSIONS: Adequate retraction greatly simplifies laparo-endoscopic single site cholecystectomy. New retraction techniques will enable wider use of this novel minimally invasive approach. Further work is needed to investigate the advantages of this new technique.

Bone marrow edema seen in MRI of osteoarthritic knees is a microfracture.

We hypothesize that the bone marrow edema seen in MRI images of osteoarthritic joints are a result of microfractures. These microfractures caused intermittent pain of the osteoarthritis knees. Varus malalignment of the knee with osteoporosis leads loading on the medial compartment, and high pressure on the lateral compartment for valgus malalignment.

Laparoscopic giant parastomal hernia repair with prosthetic mesh.

Laparoscopy is being increasingly used in colorectal surgery interventions. Herein, we present a patient with giant parastomal hernia who underwent laparoscopic repair. A70-year-old man who had undergone abdominoperineal resection and end colostomy for carcinoma of rectum was admitted to our clinic with a giant parastomal hernia. The parastomal hernia was repaired by laparoscopic approach using prosthetic material. The patient was discharged uneventfully on postoperative day 4. Laparoscopic approach is a rational alternative to conventional repair techniques of parastomal hernia and may be a reliable and easily applicable method with the classic benefits of laparoscopic surgery.

Possible role of gangliosides in salivary gland complications of diabetes.

Gangliosides have previously been considered to be possible antigenic sites in Type 1 diabetes. Lymphocytic infiltration of Langerhans islands is the pathologic hallmark of autoimmune diabetes and may also be observed in salivary glands in experimental diabetes. Diabetic complications of parotid and submaxillary glands may therefore be related with an autoimmune process against sialoglycoconjugates of salivary gland tissue.

Intraoperative bowel irrigation improves anastomotic collagen metabolism in the left-sided colonic obstruction but not covering colostomy.

This study investigated the effects of intraoperative colonic irrigation and proximal diverting end colostomy after segmental bowel resection in experimental left-colonic obstruction on anastomotic healing. Simple obstruction of descending colon was performed in male Sprague-Dawley rats. After 24 h we performed segmental colonic resection and anastomosis in the control group (n = 15); resection, anastomosis, and covering colostomy in the colostomy group (n = 14); resection and anastomosis after antegrade colonic lavage through cecum by using isotonic saline solution in the irrigation group (n = 13). In rats that were killed 7 days later anastomotic dehiscence and bursting pressure and tissue hydroxyproline concentration at the anastomosis were measured. No significant differences were observed between groups in terms of anastomotic dehiscence, bursting site, or pressure. The hydroxyproline concentration was significantly higher in the irrigation group than the control group (P = 0.025) and the colostomy group (P = 0.029), but no difference was noted between the control group and the colostomy group. These findings suggest that intraoperative antegrade colonic irrigation in the acute left-sided colonic obstruction positively affects collagen metabolism at the anastomotic site; if the anastomosis is performed without bowel cleansing, covering colostomy does not improve collagen metabolism.

Intracavernosal endothelin levels of impotent men before and after papaverine induced penile erection.

OBJECTIVES: Endothelin and nitric oxide (NO) are modulating factors of vascular tonus. Recent data have given support to the assumption that penile erection is the consequence of competition of vasodilator NO and vasoconstrictor endothelin on penis. Reported that atherosclerotic vascular disease is presented with increased endothelin and decreased NO release, this study was designed to search for a similar endothelin alteration in corpus cavernosum of penis. METHODS: Intracavernosal entothelin levels of 33 important men with arteriogenic impotence before and after papaverine-induced penile erection were examined by using radioimmunoassay kits. RESULTS: The intracavernosal endothelin levels of arteriogenic impotent men in our study were not altered both in the flaccid and papaverine-induced erectile state. CONCLUSIONS: The lack of alteration was concluded to be the possible result of cavernosal damage in arteriogenic impotence leading to diminished release of NO and increased release of endothelin.

The effects of diabetes on penile somato-afferent system.

The direct evaluation of the autonomic nervous system to detect the neurogenic component of erectile dysfunction in men is not possible. Biothesiometry, a vibration perception test, is a simple method for the assessment of the penile somato-afferent system. A nomogram for the evaluation of somato-afferent system has been developed utilizing the biothesiometer in healthy men. This nomogram was used to compare the biothesiometric values of potent and impotent diabetic patients. According to our data, the radix penis is selectively damaged by diabetes mellitus in the first stage of the disease, whereas the glans penis is damaged later on when the disease reaches the stage of impotence.