ABSTRACT
OBJECTIVE: To demonstrate the feasibility of endoscopic extraperitoneal single site (EESS) inguinal hernia repair and compare it outcomes with the conventional totally extraperitoneal (TEP) technique. BACKGROUND: TEP inguinal hernia repair is a widely accepted alternative to conventional open technique with several perioperative advantages. Transumbilical laparoendoscopic singlesite surgery (LESS) is an emerging approach and has been reported for a number of surgical procedures with superior aesthetic results but other advantages need to be proven. PATIENTS AND METHODS: Thirty-eight uncomplicated inguinal hernias were repaired by EESS approach between January 2010 and January 2011. All procedures were performed through a 25 cm infraumbilical incision using the Alexis wound retractor attached to a surgical glove and three trocars. Body mass index, age, operative time, blood loss, complications, conversion rate, analgesia requirement, hospital stay, return to normal activities and patient satisfaction with aesthetic results were analysed and compared with the last 38 matched-pair group of patients who underwent a conventional TEP inguinal hernia repair by the same surgeon. RESULTS: All procedures were performed successfully with no conversion. In both unilateral and bilateral EESS inguinal repairs, the mean operative time was longer than conventional TEP (55± 20 vs. 40± 15 min, P = 0.049 and 70± 15 vs. 55± 10 min, P = 0.014). Aesthetic result was superior in the EESS group (2.88± 0.43 vs. 2.79± 0.51, P = 0.042). There was no difference between the two approaches regarding blood loss, complications, hospital stay, time until returns to normal activities and analgesic requirement. CONCLUSION: EESS inguinal hernia repair is safe and effective, with superior cosmetic results in the treatment of uncomplicated inguinal hernias. Other advantages of this new technique still need to be proven.
ABSTRACT
PURPOSE: Demonstrate two alternatives that permit a warm ischemia time reduction during laparoscopic partial nephrectomy. MATERIALS AND METHODS: In this video, two cases of intermediate complexity renal tumors according to the RENAL nephrometry renal scoring system illustrating the techniques and our preliminary experience: a 65 year old man with a 4 cm right, posterior renal tumor. This patient underwent an early unclamping and parenchymal suturing using a greek bar continuous suture with hem-o-lock clips attached to the respective extremities of the suture; The second patient is a 49 year old man with a 3 cm renal tumor. The technique utilized was no clamping resection following the ABC Medical School technique: dissection of renal hilum for eventual clamping if necessary, a frontal 360 degrees visualization of tumor limits, pneumoperitoneum pressure elevated to 25mmHg during tumor resection, spiral excavation of normal parenchyma around the tumor and resection with negative margins. RESULTS: We previously performed 15 cases utilizing the early unclamping technique. The mean clamp time was 15 minutes with a mean blood loss of 285 mL. Only 1 patient had focal positive surgical margins, without recurrence demonstrated at 30 months. Fifteen partial nephrectomies were previously performed with on demand clamping. In 3 cases, clamping was necessary with a mean ischemia time of 11 minutes. The mean blood loss was 390 mL and 2 cases required a perioperative blood transfusion. One case presented with a positive focal margin without recurrence demonstrated at 24 months of follow-up. Renal function was preserved in all cases regardless of the technique applied. CONCLUSION: Warm ischemia time can be reduced and kidney function can be preserved during laparoscopic nephrectomy if either early unclamping or on demand clamping are selectively applied.
Subject(s)
Kidney Neoplasms/surgery , Laparoscopy/methods , Nephrectomy/methods , Warm Ischemia/methods , Aged , Constriction , Humans , Male , Time Factors , Treatment OutcomeABSTRACT
PURPOSE: To report preliminary results of the first case of video-assisted colonic conduit. A 42-year-old woman had undergone external beam radiotherapy for squamous cell carcinoma of the cervix and developed a vesicovaginal fistula with small capacity bladder. Intraoperative option for urinary diversion was colonic conduit. METHODS: A 4 trocar transperitoneal approach was chosen and isolation of both ureters was performed. A 5 cm incision between xiphoid and umbilicus was carried out. A 15 cm colonic segment was isolated with linear stapler maintaining blood supply. Intestinal transit was then reconstructed. Leadbetter ureterointestinal anastomoses were performed with ureteral splints. Drainage, colostomy maturation, and closure of incisions were carried out conventionally. RESULTS: Operative time was 195 minutes; blood loss was 90 mL; no intraoperative or postoperative complications were observed. Length of hospital stay was 7 days and time to full recovery 3 weeks. CONCLUSIONS: Video-assisted colonic conduit is feasible and have promising results concerning reduction of surgical morbidity.