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Surgical Endoscopy Dec 2018Complete mesocolic excision is gradually becoming an established oncologic surgical principle for right hemicolectomy. However, the procedure is technically demanding...
BACKGROUND
Complete mesocolic excision is gradually becoming an established oncologic surgical principle for right hemicolectomy. However, the procedure is technically demanding and carries the risk of serious complications, especially when performed laparoscopically. A standardized procedure that minimizes technical hazards and facilitates teaching is, therefore, highly desirable.
METHODS
An expert group of surgeons and one anatomist met three times. The initial aim was to achieve consensus about the surgical anatomy before agreeing on a sequence for dissection in laparoscopic CME. This proposal was evaluated and discussed in an anatomy workshop using post-mortem body donors along with videos of process-informed procedures, leading to a definite consensus.
RESULTS
In order to provide a clear picture of the surgical anatomy, the "open book" model was developed, consisting of symbolic pages representing the corresponding dissection planes (retroperitoneal, ileocolic, transverse mesocolic, and mesogastric), vascular relations, and radicality criteria. The description of the procedure is based on eight preparative milestones, which all serve as critical views of safety. The chosen sequence of the milestones was designed to maximize control during central vascular dissection. Failure to reach any of the critical views should alert the surgeon to a possible incorrect dissection and to consider converting to an open procedure.
CONCLUSION
Combining the open-book anatomical model with a clearly structured dissection sequence, using critical views as safety checkpoints, may provide a safe and efficient platform for teaching laparoscopic right hemicolectomy with CME.
Topics: Anatomy, Regional; Colectomy; Colon, Ascending; Colonic Neoplasms; Germany; Humans; Laparoscopy; Models, Anatomic; Postoperative Complications; Quality Improvement; Reference Standards
PubMed: 30324463
DOI: 10.1007/s00464-018-6267-0 -
JSLS : Journal of the Society of... 2014Subcutaneous emphysema and gas extravasation outside of the peritoneal cavity during laparoscopy has consequences. Knowledge of the circumstances that increase the... (Review)
Review
BACKGROUND
Subcutaneous emphysema and gas extravasation outside of the peritoneal cavity during laparoscopy has consequences. Knowledge of the circumstances that increase the potential for subcutaneous emphysema is necessary for safe laparoscopy.
METHODS
A literature review and a PubMed search are the basis for this review.
CONCLUSIONS
The known risk factors leading to subcutaneous emphysema during laparoscopy are multiple attempts at abdominal entry, improper cannula placement, loose fitting cannula/skin and fascial entry points, use of >5 cannulas, use of cannulas as fulcrums, torque of the laparoscope, increased intra-abdominal pressure, procedures lasting >3.5 hours, and attention to details. New additional risk factors acting as direct factors leading to subcutaneous emphysema risk and occurrence are total gas volume, gas flow rate, valveless trocar systems, and robotic fulcrum forces. Recognizing this spectrum of factors that leads to subcutaneous emphysema will yield greater patient safety during laparoscopic procedures.
Topics: Humans; Laparoscopy; Pneumoperitoneum, Artificial; Risk Factors; Subcutaneous Emphysema
PubMed: 24680136
DOI: 10.4293/108680813X13693422520882 -
The Surgical Clinics of North America Dec 1990Laparoscopic cholecystectomy is a combined endoscopic-operative technique for removing the gallbladder. Patients with symptomatic gallstones are eligible for this...
Laparoscopic cholecystectomy is a combined endoscopic-operative technique for removing the gallbladder. Patients with symptomatic gallstones are eligible for this procedure. Contraindications include pregnancy, acute cholangitis, advanced cholecystitis, acute pancreatitis, peritonitis, significant bleeding disorder, portal hypertension, and a prior major upper abdominal operation. The procedure does require experience and specialized training. It is guided by an endoscope, camera, and video monitor, and is performed through four cannulas. The gallbladder is dissected from the hepatic bed under observation on a monitor. The possible complications are bleeding, injury to the common bile duct, and technical problems, such as perforation of the gallbladder. The length of the hospital stay and the postoperative recovery time are markedly shortened compared with standard cholecystectomy. The procedure has an advantage over stone dissolution and biliary lithotripsy in that the gallbladder is removed, and additional or continued treatment is not necessary. This procedure offers sufficient advantages to the patient that it will likely become a standard for qualified abdominal surgeons.
Topics: Cholecystectomy; Humans; Laparoscopes; Laparoscopy
PubMed: 2147301
DOI: 10.1016/s0039-6109(16)45282-5 -
Journal of Visceral Surgery Feb 2018
Topics: Blood Loss, Surgical; Esophageal Achalasia; Female; Fundoplication; Heller Myotomy; Humans; Laparoscopes; Laparoscopy; Male; Operative Time; Patient Positioning; Treatment Outcome
PubMed: 29475748
DOI: 10.1016/j.jviscsurg.2018.01.006 -
Journal of Cardiothoracic Surgery Aug 2022Mediastinoscope and laparoscope-assisted esophagectomy for esophageal cancer occasionally causes postoperative accumulation of pleural effusion despite the preservation...
BACKGROUND
Mediastinoscope and laparoscope-assisted esophagectomy for esophageal cancer occasionally causes postoperative accumulation of pleural effusion despite the preservation of the mediastinal pleura. Transhiatal chest drainage has been reported to be useful for thoracic esophagectomy; however, its use in mediastinoscope and laparoscope-assisted esophagectomy remains unelucidated. This study aimed to evaluate the effectiveness and safety of transhiatal chest drainage in mediastinoscope and laparoscope-assisted esophagectomy.
METHODS
This retrospective study included patients who underwent mediastinoscope and laparoscope-assisted esophagectomy for esophageal cancer from 2018 to 2021. Transhiatal chest drainage involved the insertion of a 19-Fr Blake® drain from the abdomen to the left thoracic cavity through the hiatus. We assessed its effectiveness and safety by the daily drainage output, accumulation of postoperative pleural effusion, frequency of postoperative thoracentesis, and other complications. The drainage group comprising 24 patients was compared with the non-drainage group comprising 13 patients, in whom a transhiatal chest drainage tube was not placed during mediastinoscope and laparoscope-assisted esophagectomy.
RESULTS
The median daily output of the transhiatal chest drainage was 230 mL on day 1, 385 mL on day 2, and 313 mL on day 3. The number of patients with postoperative pleural effusion was significantly reduced from 10/13 (76.9%) in the non-drainage group to 4/24 (16.7%) in the drainage group (p = 0.001). The frequency of thoracentesis in the drainage group was significantly lower than that in the non-drainage group (p = 0.002). There were no significant differences in the occurrence of other postoperative complications.
CONCLUSIONS
Transhiatal chest drainage could evacuate pleural effusion effectively and safely after mediastinoscope and laparoscope-assisted esophagectomy.
Topics: Esophageal Neoplasms; Esophagectomy; Humans; Laparoscopes; Mediastinoscopes; Pleural Effusion; Postoperative Complications; Retrospective Studies
PubMed: 36002867
DOI: 10.1186/s13019-022-01953-0 -
Scientific Reports Nov 2022Minimally invasive surgery (MIS) is limited in safety and efficiency by the hand-held nature and narrow fields of view of traditional laparoscopes. A multi-resolution...
Minimally invasive surgery (MIS) is limited in safety and efficiency by the hand-held nature and narrow fields of view of traditional laparoscopes. A multi-resolution foveated laparoscope (MRFL) was invented to address these concerns. The MRFL is a stationary dual-view imaging device with optical panning and zooming capabilities. It is designed to simultaneously capture and display a zoomed view and supplemental wide view of the surgical field. Optical zooming and panning capabilities facilitate repositioning of the zoomed view without physically moving the system. Additional MRFL features designed to improve safety and efficiency include its snub-nosed endoscope, tool-tip auto tracking, programmable focus profiles, unique selectable display modalities, foot pedal controls, and independently controlled surgeon and assistant displays. An MRFL prototype was constructed to demonstrate and test these features. Testing of the prototype validates its design architecture and confirms the functionality of its features. The current MRFL prototype functions adequately as a proof of concept, but the system features and performance require further improvement to be practical for clinical use.
Topics: Humans; Laparoscopes; Equipment Design; Minimally Invasive Surgical Procedures; Endoscopes; Surgeons
PubMed: 36323802
DOI: 10.1038/s41598-022-23021-2 -
BioMed Research International 2022Comparing the clinical effect of flexible ureteroscope and laparoscope in the treatment of parapelvic cyst. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Comparing the clinical effect of flexible ureteroscope and laparoscope in the treatment of parapelvic cyst.
METHOD
A total of 82 patients with parapelvic cyst who underwent surgical treatment in our hospital from May 2019 to May 2020 were selected. Patients were randomly divided into a control group and an observation group; the control group underwent laparoscopic parapelvic cyst topical decompression; the observation group underwent transurethral flexible ureteroscope holmium laser incision and drainage of parapelvic cyst. The intraoperative (operative time, intraoperative blood loss, and ventilation time), postoperative (time of getting out of bed, pain score, and length of hospital stay), and recurrence were compared between the two groups.
RESULTS
(1) The operative time and intraoperative blood loss in the observation group were significantly better than those in the control group ( < 0.05), while the ventilation time had no significant difference ( > 0.05). (2) The pain score and length of hospital stay in the observation group were better than those in the control group ( < 0.05). There was no significant difference in the time of getting out of bed ( > 0.05). (3) There was no serious infection or bleeding in either group. The observation group had no recurrence, and the postoperative recurrence rate was 0. There were 11 cases of recurrence in the control group, and the postoperative recurrence rate was 26.83%. The postoperative recurrence rate of the observation group was significantly lower than that of the control group, with statistical significance ( = 4.604, < 0.05).
CONCLUSION
Flexible ureteroscope for the treatment of parapelvic cyst could effectively reduce the operative time, intraoperative blood loss, and pain; in addition, the postoperative recovery was fast and the recurrence is rare, which was worth popularizing.
Topics: Blood Loss, Surgical; Cysts; Humans; Kidney Diseases, Cystic; Laparoscopes; Pain; Retrospective Studies; Treatment Outcome; Ureteroscopes
PubMed: 36246976
DOI: 10.1155/2022/5718923 -
The Canadian Veterinary Journal = La... Sep 2022Two peritoneopericardial hernias (PPDH) repaired laparoscopically are reported. Both PPDHs were approached with the dog in dorsal recumbency. Herniated organs...
Two peritoneopericardial hernias (PPDH) repaired laparoscopically are reported. Both PPDHs were approached with the dog in dorsal recumbency. Herniated organs (gallbladder and 2 liver lobes in Case 1 and omental fat in Case 2) were dissected and reduced. Hernias were closed in a 2-layer horizontal mattress pattern using 2-0 polyester (Case 1), and in a single-layer simple continuous pattern using 0 barbed polyglyconate (Case 2). Reduction and herniorrhaphy were achieved without conversion. Moderate to severe systemic hypotension was observed in both dogs which responded rapidly to reducing abdominal insufflation. Ten- and 7-month follow-up confirmed good clinical outcome in both dogs.
Topics: Animals; Dog Diseases; Dogs; Hernia; Herniorrhaphy; Insufflation; Laparoscopy
PubMed: 36060491
DOI: No ID Found -
Scientific Reports Sep 2023This paper tackles the challenge of accurate depth estimation from monocular laparoscopic images in dynamic surgical environments. The lack of reliable ground truth due...
This paper tackles the challenge of accurate depth estimation from monocular laparoscopic images in dynamic surgical environments. The lack of reliable ground truth due to inconsistencies within these images makes this a complex task. Further complicating the learning process is the presence of noise elements like bleeding and smoke. We propose a model learning framework that uses a generic laparoscopic surgery video dataset for training, aimed at achieving precise monocular depth estimation in dynamic surgical settings. The architecture employs binocular disparity confidence information as a self-supervisory signal, along with the disparity information from a stereo laparoscope. Our method ensures robust learning amidst outliers, influenced by tissue deformation, smoke, and surgical instruments, by utilizing a unique loss function. This function adjusts the selection and weighting of depth data for learning based on their given confidence. We trained the model using the Hamlyn Dataset and verified it with Hamlyn Dataset test data and a static dataset. The results show exceptional generalization performance and efficacy for various scene dynamics, laparoscope types, and surgical sites.
Topics: Laparoscopy; Awareness; Drugs, Generic; Generalization, Psychological; Supervised Machine Learning
PubMed: 37717055
DOI: 10.1038/s41598-023-42713-x -
Surgical Endoscopy Jan 2021Viral particles have been shown to aerosolize into insufflated gas during laparoscopic surgery. In the operating room, this potentially exposes personnel to aerosolized...
BACKGROUND
Viral particles have been shown to aerosolize into insufflated gas during laparoscopic surgery. In the operating room, this potentially exposes personnel to aerosolized viruses as well as carcinogens. In light of circumstances surrounding COVID-19 and a concern for the safety of healthcare professionals, our study seeks to quantify the volumes of gas leaked from dynamic interactions between laparoscopic instruments and the trocar port to better understand potential exposure to surgically aerosolized particles.
METHODS
A custom setup was constructed to simulate an insufflated laparoscopic surgical cavity. Two surgical instrument use scenarios were examined to observe and quantify opportunities for insufflation gas leakage. Both scenarios considered multiple configurations of instrument and trocar port sizes/dimensions: (1) the full insertion and full removal of a laparoscopic instrument from the port and (2) the movement of the scope within the port, recognized as "dynamic interaction", which occurs nearly 100% of the time over the course of any procedure.
RESULTS
For a 5 mm instrument in a 5 mm trocar, the average volume of gas leaked during dynamic interaction and full insertion/removal scenarios were 43.67 and 25.97 mL of gas, respectively. Volume of gas leaked for a 5 mm instrument in a 12 mm port averaged 41.32 mL and 29.47 for dynamic interaction vs. instrument insertion and removal. Similar patterns were shown with a 10 mm instrument in 12 mm port, with 55.68 mL for the dynamic interaction and 58.59 for the instrument insertion/removal.
CONCLUSIONS
Dynamic interactions and insertion/removal events between laparoscopic instruments and ports appear to contribute to consistent leakage of insufflated gas into the OR. Any measures possible taken to reduce OR gas leakage should be considered in light of the current COVID-19 pandemic. Minimizing laparoscope and instrument removal and replacement would be one strategy to mitigate gas leakage during laparoscopic surgery.
Topics: Aerosols; COVID-19; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Insufflation; Laparoscopy; Occupational Diseases; Occupational Exposure; Personnel, Hospital
PubMed: 32974779
DOI: 10.1007/s00464-020-08006-4