Usefulness of laparoscopic inguinal hernia repair using the Endoscope Manipulator Robot (EMARO).

PURPOSE: This study aimed to investigate the surgical outcomes of laparoscopic inguinal hernia repair using an Endoscope Manipulator Robot (EMARO). METHODS: This retrospective study included 51 patients who underwent laparoscopic inguinal hernia repairs. The transabdominal preperitoneal approach (TAPP) has been used to treat inguinal hernias. The patients were divided into two groups: one group underwent laparoscopic surgery using EMARO (E-TAPP) and the other group underwent conventional laparoscopic surgery (L-TAPP). The EMARO is a pneumatically driven endoscope-holder robot. The surgical outcomes of laparoscopic inguinal hernia repair were compared between the two groups. RESULTS: Fifteen patients underwent E-TAPP, and 36 underwent L-TAPP. The L-TAPP operation requires two personnel, whereas E-TAPP can be performed by one surgeon. The median operation times of the E-TAPP and L-TAPP groups were 81 min (range, 77-87) and 70 min (range, 60-94), respectively, and the median blood loss was 5 mL (range, 1-5) and 2 mL (range, 1-5). However, these differences were not statistically significant. The setup time for EMARO was approximately 8 min (range, 5-12). No patient experienced recurrence, and the postoperative complication rates were similar between the two groups. The number of patients who used postoperative analgesics in the E-TAPP and L-TAPP groups was four (n = 15) and 22 (n = 36), respectively, with a significant difference between the two groups (p = 0.042). CONCLUSION: Laparoscopic surgery using EMARO can reduce labor costs and postoperative pain. The surgical outcomes of the E-TAPP group were not inferior to those of the L-TAPP group, and E-TAPP could also be safely performed.

Fournier's gangrene treated by simultaneously using colostomy and open drainage.

We report our findings and results on treating a patient with Fournier's gangrene by using colostomy along with open drainage. A 39-year-old male had noticed a swelling and experienced pain in the scrotal sac approximately 1 week before his admission. On admission, his symptoms aggravated and he experienced constipation and difficulty in urination. Local examination of the scrotum circumference revealed a remarkable swelling, and redness and sloughing that had extended to the perianal area. In an emergency operation, incision and drainage of the scrotum, double-barrelled colostomy at the transverse colon, and reconstruction of the percutaneous cystotomy were performed. Postoperative open wound was cleaned twice a day and intravenous infusions of 1g imipenem/cilastatin sodium and 1.2g clindamycin phosphate were administered daily. The patient was discharged 61 days after the operation. Fournier's gangrene has a high mortality rate, and in severe cases that are complicated with infection protracted from defecation, dyschezia and difficulty in urination, we believe that it would be most effective to perform an open drainage and a colostomy simultaneously.