Disposable device and a minimally invasive technique for rubber band ligation of hemorrhoids.

A disposable syringe-like hemorrhoid ligator was invented to simplify the banding procedure for both patient and surgeon. This single-operator ligator, with its own suction mechanism and easy loading features, was designed for use without the need of an assistant or an anoscope. By pointing the ligator directly toward the appropriate site and by measuring the distance from the anal margin using reference markings on the ligator, the bands can be placed accurately in a blind manner inside the rectum for the treatment of symptomatic internal hemorrhoids. Before the band is discharged, rotating the ligator through 180 degrees while applying suction will cause pain and give warning if the application site is not appropriate. In 480 patients treated to date, this technique was found to be well accepted and accurate, and the final results seem to be comparable to other methods of banding.

Laparoscopic appendectomy: a review of 95 consecutive suspected cases of appendicitis.

OBJECTIVE: To assess the feasibility and efficacy of laparoscopic appendectomy. DESIGN: A review of a case series. SETTING: A single teaching and referral centre in Vancouver. PATIENTS: Ninety-five consecutive patients referred to the Division of General Surgery with suspected appendicitis requiring surgical intervention. The patients ranged in age from 15 to 85 years. INTERVENTIONS: Laparoscopic appendectomy or open appendectomy. MAIN OUTCOME MEASURES: Feasibility of laparoscopic appendectomy, duration of operation, intraoperative and postoperative complications and duration of postoperative hospital stay. RESULTS: Of the 95 patients, 9 had contraindications to laparoscopic appendectomy and underwent an open operation. Of the 86 patients who underwent laparoscopy, the diagnosis of appendicitis was confirmed in 69 (80%). Following this, 61 (88%) patients underwent laparoscopic appendectomy, and in 8 the procedure was converted to open appendectomy because of periappendiceal abscess or an immobile or perforated appendix. The mean duration of operation was 78.5 minutes. There were no intraoperative complications. The mean duration of postoperative hospital stay was 2.8 days. Postoperative complications consisted of ileus in two patients and diarrhea in two patients. There were no wound infections. CONCLUSIONS: Laparoscopic appendectomy can be performed safely, with minimal complications on most patients with appendicitis; hospital stay is reduced. Laparoscopy allows accurate diagnosis.

A pig model for advanced laparoscopic biliary procedures.

Advanced laparoscopic biliary procedures can be undertaken in a pig model, but the small size of the normal common bile duct makes learning difficult. We have developed a prepared pig model of common bile duct ligation on which to practice advanced laparoscopic biliary surgery. The pig's distal common bile duct was occluded using several different methods via a minilaparotomy. Laparoscopic biliary procedures were undertaken 6-21 days later. The common bile duct became dilated to between 2 and 3 cm in diameter in all cases, and this was well tolerated by the animals. All advanced laparoscopic biliary procedures were possible, including choledochoscopy, exploration of the bile duct, and cholecystojejunostomy. Short-term common bile duct ligation is well tolerated in pigs and can be used to create a model for practicing advanced laparoscopic biliary procedures.

Laparoscopic gastrointestinal anastomoses.

In a preliminary study of laparoscopic gastrointestinal anastomosis, a gastric outlet obstruction was created under laparoscopic control in six domestic pigs, weighing an average of 25 kg. A simultaneous gastroenterostomy was formed with an end-stapling device. All animals recovered clinically, and good anastomotic healing was documented 1 week postoperatively. The authors suggest that an end-stapling device could be one method of creating a gastrointestinal anastomosis for humans that is safe and reliable, allows rapid recovery and decreases hospital stay.

Laparoscopy in General Surgery: The pros and cons of endoscopic surgery.

After a period of rather slow initial acceptance by general surgeons, laparoscopy and video endoscopic surgery have suddenly burst on to the surgical scene. Almost overnight many of the surgical procedures once requiring a large incision are now being performed through small punctures. This article describes some of the more common procedures and discusses the merits and difficulties associated with these innovations.

Laparoscopic appendectomy.

In October 1989 the author began a study of laparoscopic appendectomy. This paper presents the preliminary results in 21 patients. Laparoscopy was carried out for diagnosis and 12 patients underwent laparoscopic appendectomy. The morbidity, length of hospital stay and time lost from work was reduced in all 12 patients. The author describes the technique of laparoscopic appendectomy and recommends that only experienced laparoscopists should carry out this procedure.

Laparoscopic jejunostomy.

A laparoscopic jejunostomy was performed in a patient for long-term feeding purposes. The more important details of the surgical technique are described, as well as a description of a new laparoscopic needle holder, for the suturing in the peritoneal cavity.