Chromosomal Sil system contributes to silver resistance in E. coli ATCC 8739.

The rise of antibiotic resistance in pathogenic bacteria is endangering the efficacy of antibiotics, which consequently results in greater use of silver as a biocide. Chromosomal mapping of the Cus system or plasmid encoded Sil system and their relationship with silver resistance was studied for several gram-negative bacteria. However, only few reports investigated silver detoxification mediated by the Sil system integrated in Escherichia coli chromosome. Accordingly, this work aimed to study the Sil system in E. coli ATCC 8739 and to produce evidence for its role in silver resistance development. Silver resistance was induced in E. coli ATCC 8739 by stepwise passage in culture media containing increasing concentrations of AgNO3. The published genome of E. coli ATCC 8739 contains a region showing strong homology to the Sil system genes. The role of this region in E. coli ATCC 8739 was assessed by monitoring the expression of silC upon silver stress, which resulted in a 350-fold increased expression. De novo sequencing of the whole genome of a silver resistant strain derived from E. coli ATCC 8739 revealed mutations in ORFs putative for SilR and CusR. The silver resistant strain (E. coli AgNO3R) showed constitutive expression of silC which posed a cost of fitness resulting in retarded growth. Furthermore, E. coli AgNO3R exhibited cross-resistance to ciprofloxacin and a slightly increased tolerance to ampicillin. This study demonstrates that E. coli is able to develop resistance to silver, which may pose a threat towards an effective use of silver compounds as antiseptics.

Two-Incision Laparoscopic Cholecystectomy: Reducing Scars in a Simple Way.

BACKGROUND: About 20% of the population has cholelithiasis and this is the main abdominal cause of hospitalization in developed countries. Considering that only in the United States about 700,000 cholecystectomies are done each year, it is possible to estimate the importance of the problem for public health. OBJECTIVE: To describe a two-incision laparoscopic cholecystectomy (TILC) technique using only conventional material, without increasing complications or operative time. MATERIALS AND METHODS: A consecutive and prospective case series compared to another historical operated by conventional laparoscopic cholecystectomy (LC). The TILC was performed with three trocars in two incisions, two trocars in umbilical incision, and one in epigastrium. RESULTS: A total of 72 patients were operated on by the same surgeon (36 in each group). There were no significant differences between groups for gender, mean age, body mass index, or length of hospital stay. The procedures were classified by the surgeon according to surgical difficulty and 58.3% (n = 42) were considered low grade, 9.7% (n = 7) difficult, and the other were intermediaries, with no difference between the series (P < .05). There were minor complications in 6.94% (n = 5) procedures. There were no differences between mean operative time (P = .989), which was 49 (95% confidence interval [CI] 42-56) minutes in LC and 40 (95% CI 35-44) min in TILC. There was no need for additional trocars in any case or for conversion to open surgery. CONCLUSIONS: TILC is feasible, safe, and with good aesthetic result, using the same instruments of LC, without increasing operative time.

Single incision cholecystectomy using a clipless technique with LigaSure in a resource limited environment: The Bahamas experience.

BACKGROUND: Scarless/single-incision laparoscopic cholecystectomy (SILC) is a new procedure. It affords a superior cosmetic outcome when compared to conventional laparoscopic cholecystectomy. We examine the application of this technique using LigaSure via a clipless method. The present study looks at the experience of a single surgeon using this method with initial evaluation of the safety, feasibility, affordability, and benefits of this procedure. METHODS: Twenty-eight patients underwent transumbilical SILC at Doctors Hospital from January to December, 2014. The cohort included both emergency and elective patients. There was no difference in the preoperative work-up as indicated. To perform the operation, a 2-2.5-cm linear incision was made through the umbilicus and the single port platform utilized. A 10mm 30-degree laparoscope, a 5mm LigaSure and straight instruments were used to perform the laparoscopic cholecystectomy procedure. RESULTS: All patients except two were operated on successfully. Conversion was considered the placement of an additional epigastric/Right upper quadrant (RUQ) port. The conversion rate to standard LC was 7%. No patient was converted to open cholecystectomy. In the 28 successfully completed patients, the median duration of the operation was 38.5min and estimated operative blood loss was 24ml. Patients were commenced on liquid diet immediately on being fully conscious and after return to the ward with an estimated time of 6h. The mean postoperative hospital stay was 1.4 days. Follow-up visits were conducted for all patients at 2-weeks intervals and continued for 6 weeks after surgery where possible. Two patients developed wound infections. All patients were satisfied with the good cosmetic effect of the surgery. The total satisfaction rate was 100%. CONCLUSIONS: SILC is a safe and feasible technique for operating with scarless outcomes and reducing perioperative discomfort at the same time. The GelPOINTTM is a safe and feasible platform to be used. The procedure can be accomplished using regular instruments and laparoscope. Curved instruments and a bariatric length laparoscope may make the procedure easier and result in greater time saving. The addition of LigaSure™ decreases the complexity of the operation, decreases operative time and blood loss. The technique is economical in a resource-limited environment.

Colecistectomía por laparoscopia de puerto único a través de un guante quirúrgico / Single site cholecystectomy utilizing a surgical glove

Introducción. La cirugía por laparoscopia se enfoca hacia el desarrollo de técnicas cada vez menos invasivas. Actualmente, es posible introducir a la cavidad abdominal múltiples instrumentos a través de un mismo puerto, y la colecistectomía transumbilical apunta a una cirugía que no deje cicatrices visibles. Materiales y métodos. Se describe una modificación de la técnica laparoscópica de puerto único para el manejo microinvasivo de la vesícula biliar, utilizando un guante quirúrgico. Se practicó una colecistectomía laparoscópica de puerto único, utilizando instrumentos básicos de laparoscopia más un separador sencillo (Alexis; Applied Medical, Rancho Santa Margarita, CA) y un guante quirúrgico. Resultados. Se practicó de forma exitosa una colecistectomía por laparoscopia por puerto único en una paciente de 40 años de edad. La paciente padecía de cólico biliar de varios meses de evolución y acudió al servicio de urgencias por un episodio agudo de colecistitis. Se confirmó el diagnóstico mediante ecografía hepatobiliar. La cirugía se practicó en 50 minutos y no hubo ninguna complicación intraoperatoria o posoperatoria. Discusión. La colecistectomía por laparoscopia de puerto único utilizando un guante quirúrgico, es una técnica segura, asequible y de bajos costos para la práctica de cirugía mínimamente invasiva, especialmente en países en desarrollo.

Introduction: Contemporary focus in laparoscopic surgery has been the development of less invasive techniques. With recent advancements in this area, it is currently possible to introduce several instruments via one single transumbilical incision. Materials and Methods: We describe a technique in which a laparoscopic cholecystectomy is performed via a single transumbilical incision with the novel use of a wound retractor (Alexis®; Applied Medical, Rancho Santa Margarita, CA) and a surgical glove. Results: We successfully performed a single site laparoscopic cholecystectomy in a 40 year old female who presented with an episode of acute cholecystitis. The patient had a history of biliary colic for several months prior to admission. The diagnosis of acute cholecystitis was confirmed by ultrasound. The procedure took 50 minutes and there were no intra or post operative complications. Discussion: Single site laparoscopic cholecystectomy using a surgical glove is a safe, easily accessible and economical technique that can be applied especially in developing countries in which comparable but much more expensive ports of access are not obtainable.

Colecistectomía transvaginal híbrida y por incisión umbilical única asistida con imanes: serie de casos / Magnet assisted transvaginal hybrid approach cholecystectomy and magnet assisted single umbilical incision cholecystectomy

Introducción. Describimos nuestra experiencia inicial en pacientes con diagnóstico de colelitiasis a quienes se les practicó colecistectomía por vía híbrida transvaginal y, en otro grupo, por incisión umbilical única. En ambos grupos se utilizaron imanes durante la disección y extracción de la vesícula biliar. Pacientes y métodos. Se presenta una serie clínica de casos intervenidos por colelitiasis, divididos en dos grupos. Uno se intervino por abordaje a través de una incisión umbilical única (single incision laparoscopic cholecystectomy) y, otro, por vía transvaginal híbrida, en ambos casos con la ayuda de imanes. Se reportan la duración de las cirugías, el tiempo de hospitalización, las complicaciones y el seguimiento posoperatorio durante tres meses. Resultados. Se operaron 23 pacientes, 10 por vía transvaginal híbrida y 13 por incisión umbilical única. No hubo conversiones a colecistectomía laparoscópica de cuatro puertos o abierta. Para la disección y extracción de la vesícula, se utilizaron un clip imantado de 2.500 gauss y un imán externo de 15.000 gauss. Fue mayor la duración de la cirugía en el grupo de abordaje por incisión umbilical única. No hubo complicaciones posoperatorias mayores. No se presentaron complicaciones abdominales ni ginecológicas asociadas al acceso transvaginal, durante el seguimiento posoperatorio. Conclusión. En la colecistectomía por laparoscopia, tanto el abordaje transvaginal híbrido como por incisión umbilical única fueron tan seguros, eficaces y reproducibles como la técnica tradicional, en manos de cirujanos con experiencia en cirugía laparoscópica. En el grupo de abordaje transvaginal híbrido, el tiempo quirúrgico fue menor que en el grupo de incisión umbilical única, pero ambas técnicas tienen tiempos quirúrgicos aceptables. Es más fácil adaptar la técnica transvaginal híbrida, por lo menos, inicialmente pues no requiere instrumental especial. El uso de imanes brinda una excelente exposición del triángulo...

Introduction. Report of our initial experience with hybrid transvaginal cholecystectomy and with single incision transumbilical cholecystectomy in patients with the diagnosis of uncomplicated cholelithiasis using anchor magnetic device in both types of approach. Patients and methods. Prospective clinical case series. Patients were divided into two groups: Single Incision Transumbilical Laparoscopic Cholecystectomy (SILC) and Hybrid Transvaginal Cholecystectomy. An anchor magnetic device for intraoperative manipulation of the gallbladder was used in both groups. Operating time, length of hospital stay, complications, and postoperative course are reported. Results. A total of 23 patients were included, 10 by the hybrid transvaginal approach and 13 by the single incision umbilical approach. A magnetic retraction system was used for retraction, dissection and extraction of the gallbladder. Operating time was longer for the umbilical approach. There were no major complications. None of the patients registered abdominal or gynecological complaints, including discomfort at sexual intercourse. Conclusion. Both approaches are safe and comparable to the traditional technique at centers where laparoscopy is performed regularly. Although the umbilical approach registered shorter operating time, both types of procedure recorded acceptable operating times. The use of the magnetic device allows excellent exposure of Calot's triangle and facilitates traction and retraction during the procedure. The good cosmetic result is evident for both approaches. Further prospective trials should be done in order to determine the clinical applicability of these two types of cholecystectomy.