Intravenous cannula: an instrument and a port in laparoscopic surgery.

BACKGROUND: An intravenous cannula was used experimentally as a cheap and scarless alternative to an endoloop to provide retraction and lumen occlusion. It is also a miniport for introduction of ligatures and small catheters. METHODS: This possibility was explored during standard procedures such as laparoscopic cholecystectomy and laparoscopic appendectomy. RESULTS: This technique was successfully applied in 89% of laparoscopic cholecystectomies and 86% of laparoscopic appendectomies. CONCLUSIONS: In many instances a standard port for laparoscopic instruments was unnecessary, despite the fact that the authors did not intentionally work towards port number reduction for laparoscopic procedures.

The intravenous catheter at McBurney's point.

The manipulation of the inflamed appendix during laparoscopic surgery and avoiding its disintegration or leakage can be challenging even to experts. A suture loop form through an intravenous catheter may offer the least traumatic handling of the appendix, and it serves the extra benefit of leaving no scar. Furthermore, multiple loops can be formed conveniently and economically by a single long suture material. It can also ensure snaring at the very base of the appendix. We attempted this technique in 15 patients with 14 successful operations; there was great patient satisfaction and there were no surgical complications. Difficulty was encountered only when the surgeon tried to loop the buried appendix tip that cannot be delivered by one-hand manipulation.

Endoscopic surgery of the neck: a new frontier.

Endoscopic dissection and surgical intervention of the neck is a safe and technically feasible option. A cavity for the operation is made by sharp dissection after preliminary CO2 insufflation of the fascial planes to induce surgical emphysema. We successfully performed three endoscopic parathyroidectomies and five endoscopic hemithyroidectomies without any complication. The technical details and factors affecting the result of the operation are described here.

Laparoscopic vagotomy and open pyloroplasty for bleeding duodenal ulcer not controlled endoscopically.

The majority of our patients with bleeding duodenal ulcer responded to endoscopic injection treatment. However, in six patients admitted during a 2 1/2-year period, we were forced to do emergency surgery to control the hemorrhage (three with failed injection and persisting exsanguination from a brisk bleeder and three rebled soon after apparent initial hemostasis). We performed an innovative procedure: pyloroplasty was done after oversewing the arterial bleeder in the duodenum through a small transverse wound in the right upper quadrant. The wound was then closed around a 10-mm trocar sheath. With the addition of three more ports, a truncal vagotomy was completed laparoscopically. Recovery was rapid and uneventful in all six cases; postoperative pain was minimal. The mean operative time was 85 minutes. We believe that, in a selected group of patients, laparoscopic vagotomy and open pyloroplasty through an essentially extended port wound (as described in detail) is an expedient and effective procedure in the emergency setting.

The technique of endoscopic exploration for parathyroid adenoma of the neck.

BACKGROUND: The technical details of endoscopic exploration of parathyroid adenoma are described here, thereby drawing attention to the enormous potential of this new modality of minimal-access surgery. METHODS: Four patients with a parathyroid adenoma that was clearly demonstrated by pre-operative localization imaging techniques were subject to endoscopic exploration using one 11 mm and two 5 mm ports: a technique heretofore undescribed. RESULTS: An adenoma was successfully localized endoscopically in each case and was removed. The postoperative outcome proved most encouraging: no analgesics were required, the hypercalcaemia rapidly corrected and the patients were pleased with the smallness of scars. CONCLUSIONS: The described endoscopic approach is a viable and promising alternative to open surgery for parathyroid adenoma; further study would be fruitful.

Isolated duplications of the cystic duct: case report and implications in laparoscopic cholecystectomy.

During laparoscopic cholecystectomy on an elderly patient, we were alarmed to find another "cystic" duct after division of the cystic duct, and the operation was converted to open laparotomy. This is the first documented case in the English literature of duplication of a cystic duct with two ducts joining the common hepatic duct at the same level. This and other anatomic variations are important considerations in the safe performance of laparoscopic cholecystectomy.