-
Retina (Philadelphia, Pa.) Aug 2020
Topics: Cannula; Surgical Instruments; Vitrectomy
PubMed: 32343099
DOI: 10.1097/IAE.0000000000002828 -
International Journal of Surgery... Jun 2023Conventional laparoscopic sleeve gastrectomy (CLSG) has been conducted in multiple centers for treating morbid obesity, however, there are no standard criteria for (1)... (Meta-Analysis)
Meta-Analysis
Trocar number and placement for laparoscopic sleeve gastrectomy and comparison of single-incision and conventional laparoscopic sleeve gastrectomy: a systematic review and meta-analysis.
BACKGROUND
Conventional laparoscopic sleeve gastrectomy (CLSG) has been conducted in multiple centers for treating morbid obesity, however, there are no standard criteria for (1) placing the trocar; and (2) how many trocars should be used. Single-incision laparoscopic sleeve gastrectomy (SLSG), a newly emerged technique in 2008, has been proposed as an alternative to CLSG in recent years, however, there is no definite evidence for this.
MATERIALS AND METHODS
A systematic literature search was performed using the PubMed, Embase, Web of Science, and Cochrane Library databases for laparoscopic sleeve gastrectomy cases from January 2006 to October 2022. We then summarized the trocar numbers and placement patterns among these studies. A meta-analysis was conducted to compare the difference between SLSG and CLSG in the perioperative and postoperative indices.
RESULTS
A total of 61 studies involving 20 180 patients who underwent laparoscopic sleeve gastrectomy for treating morbid obesity were included in the systematic review, including 11 on SLSG, 35 on CLSG, and 15 studies comparing SLSG and CLSG. A systematic review showed that the trocar number varied in different CLSG studies, mainly using four or five trocars. The trocars were mainly placed in position, presenting an inverted trapezoid pattern and a left-predominant pattern. Meta-analysis showed that the operative time in the SLSG was significantly higher than that in the CLSG, and the pain Visual Analog Scale rating on postoperative day 1 in the CLSG was significantly higher than in the SLSG. There were no statistical significances in the other complications or surgical efficiency.
CONCLUSIONS
In the CLSG, the majority of the trocars were arranged in an inverted trapezoid pattern and were of the left-predominant type. Although SLSG is a feasible technique in selected patients, there is insufficient evidence to recommend its widespread use compared with CLSG. High-quality randomized controlled trials with large study populations and long follow-up periods will be required in the future.
Topics: Humans; Obesity, Morbid; Laparoscopy; Bariatric Surgery; Surgical Instruments; Gastrectomy
PubMed: 37068794
DOI: 10.1097/JS9.0000000000000402 -
CMAJ : Canadian Medical Association... Apr 2023
Topics: Humans; Sweating, Gustatory; Surgical Instruments
PubMed: 37068799
DOI: 10.1503/cmaj.221178-f -
Arquivos Brasileiros de Cirurgia... 2021Trocars position for the Si model (position is similar for the Xi, although trocars stay more in line). Robotic gastrectomy is gaining popularity worldwide. It allows...
BACKGROUND
Trocars position for the Si model (position is similar for the Xi, although trocars stay more in line). Robotic gastrectomy is gaining popularity worldwide. It allows reduced blood loss and lesser pain. However, it widespread use is limited by the extensive learning curve and costs.
AIM
To describe our standard technique with reduced use of robotic instruments.
METHODS
We detail the steps involved in the procedure, including trocar placement, necessary robotic instruments, and meticulous surgical description.
RESULTS
After standardizing the procedure, 28 patients were operated with this budget technique. For each procedure material used was: 1 (Xi model) or 2 disposable trocars (Si) and 4 robotic instruments. Stapling and clipping were performed by the assistant through an auxiliary port, limiting the use of robotic instruments and reducing the cost.
CONCLUSION
This standardization helps implementing a robotic program for gastrectomy in the daily practice or in one`s institution.
Topics: Gastrectomy; Humans; Laparoscopy; Reference Standards; Robotic Surgical Procedures; Stomach Neoplasms; Surgical Instruments
PubMed: 33470372
DOI: 10.1590/0102-672020200003e1542 -
Surgical Endoscopy Jun 2022Laparoscopy is common in abdominal surgery. Trocar site hernia (TSH) is a most likely underestimated complication. Among risk factors, obesity, the use of larger trocars...
BACKGROUND
Laparoscopy is common in abdominal surgery. Trocar site hernia (TSH) is a most likely underestimated complication. Among risk factors, obesity, the use of larger trocars and the umbilical trocar site has been described. In a previous study, CT scan in the prone position was found to be a reliable method for the detection of TSH following gastric bypass (LRYGB). In the present study, our aim was to examine the incidence of TSH after gastric sleeve, and further to investigate the proportion of symptomatic trocar site hernias.
METHODS
Seventy-nine patients subjected to laparoscopic gastric sleeve in 2011-2016 were examined using CT in the prone position upon a ring. Symptoms of TSH were assessed using a digital survey.
RESULTS
The incidence of trocar site hernia was 17 out of 79 (21.5%), all at the umbilical trocar site. The mean follow-up time was 37 months. There was no significant correlation between patient symptoms and a TSH.
CONCLUSIONS
The incidence of TSH is high after laparoscopic gastric sleeve, a finding in line with several recent studies as well as with our first trial on trocar site hernia after LRYGB. Up to follow-up, none of the patients had been subjected to hernia repair. Although the consequence of a trocar site hernia can be serious, the proportion of symptomatic TSH needs to be more clarified.
Topics: Hernia; Humans; Laparoscopy; Retrospective Studies; Surgical Instruments; Thyrotropin
PubMed: 34704151
DOI: 10.1007/s00464-021-08787-2 -
Surgical Endoscopy Jun 2022During laparoscopy, the abdominal cavity is insufflated with carbon dioxide (CO) that could become contaminated with viruses and surgical smoke. Medical staff is...
BACKGROUND
During laparoscopy, the abdominal cavity is insufflated with carbon dioxide (CO) that could become contaminated with viruses and surgical smoke. Medical staff is potentially exposed when this gas leaks into the operating room through the instruments and past trocar valves. No detailed studies currently exist that have quantified these leakage pathways. Therefore, the goal of this study was to quantify the gas leakages through trocars and instruments, during minimally invasive procedures.
METHODS
A model of the surgical environment was created, consisting of a rigid container with an interface for airtight clamping of laparoscopic equipment such as trocars and surgical instruments. The model was insufflated to 15 mm Hg using a pressure generator and a pneumotachograph measured the equipment gas leak. A protocol of several use cases was designed to simulate the motions and forces the surgeon exerts on the trocar during surgery.
RESULTS
Twenty-three individual trocars and twenty-six laparoscopic instruments were measured for leakage under the different conditions of the protocol. Trocar leakages varied between 0 L/min and more than 30 L/min, the instruments revealed a range of leakages between 0 L/min and 5.5 L/min. The results showed that leakage performance varied widely between trocars and instruments and that the performance and location of the valves influenced trocar leakage.
CONCLUSIONS
We propose trocar redesigns to overcome specific causes of gas leaks. Moreover, an international testing standard for CO leakage for all new trocars and instruments is needed so surgical teams can avoid this potential health hazard when selecting new equipment.
Topics: Carbon Dioxide; Equipment Failure; Humans; Laparoscopy; Surgical Instruments
PubMed: 34731302
DOI: 10.1007/s00464-021-08807-1 -
PloS One 2022Climate change is one of the 21st century's biggest public health issues and health care contributes up to 10% of the emissions of greenhouse gases in developed...
INTRODUCTION
Climate change is one of the 21st century's biggest public health issues and health care contributes up to 10% of the emissions of greenhouse gases in developed countries. About 15 million laparoscopic procedures are performed annually worldwide and single-use medical equipment is increasingly used during these procedures. Little is known about costs and environmental footprint of this change in practice.
METHODS
We employed Life Cycle Assessment method to evaluate and compare the environmental impacts of single-use, reusable, and mixed trocar systems used for laparoscopic cholecystectomies at three hospitals in southern Sweden. The environmental impacts were calculated using the IMPACT 2002+ method and a functional unit of 500 procedures. Monte Carlo simulations were used to estimate differences between trocar systems. Data are presented as medians and 2.5th to 97.5th percentiles. Financial costs were calculated using Life Cycle Costing.
RESULTS
The single-use system had a 182% higher impact on resources than the reusable system [difference: 5160 MJ primary (4400-5770)]. The single-use system had a 379% higher impact on climate change than the reusable system [difference: 446 kg CO2eq (413-483)]. The single-use system had an 83% higher impact than the reusable system on ecosystem quality [difference: 79 PDF*m2*yr (24-112)] and a 240% higher impact on human health [difference: 2.4x10-4 DALY/person/yr (2.2x10-4-2.6x10-4)]. The mixed and single-use systems had a similar environmental impact. Differences between single-use and reusable trocars with regard to resource use and ecosystem quality were found to be sensitive to lower filling of machines in the sterilization process. For ecosystem quality the difference between the two were further sensitive to a 50% decrease in number of reuses, and to using a fossil fuel intensive electricity mix. Differences regarding effects on climate change and human health were robust in the sensitivity analyses. The reusable and mixed trocar systems were approximately half as expensive as the single-use systems (17360 € and 18560 € versus 37600 €, respectively).
CONCLUSION
In the Swedish healthcare system the reusable trocar system offers a robust opportunity to reduce both the environmental impact and financial costs for laparoscopic surgery.
Topics: Cholecystectomy, Laparoscopic; Disposable Equipment; Ecosystem; Equipment Reuse; Humans; Surgical Instruments
PubMed: 35839237
DOI: 10.1371/journal.pone.0271601 -
The Veterinary Clinics of North... Jan 2016The diversity implicit in exotic animal surgery requires a tailored approach to optimize successful outcomes. Outlined is information on patient preparation,... (Review)
Review
The diversity implicit in exotic animal surgery requires a tailored approach to optimize successful outcomes. Outlined is information on patient preparation, instrumentation, hemostatic techniques, and magnification as it pertains to the exotic animal. Application of topical antiseptic solutions and judicious removal of pelage and feathers will decrease bacterial load during patient preparation. The use of specific barrier protection ensures proper aseptic technique and enables optimal patient monitoring. Magnification combined with a focal light source enhances visual acuity, allowing for better use of delicate instrumentation and identification of anatomic structures.
Topics: Animals; Animals, Exotic; Anti-Infective Agents, Local; Hemostasis, Surgical; Surgery, Veterinary; Surgical Drapes; Surgical Equipment; Surgical Instruments; Sutures
PubMed: 26611922
DOI: 10.1016/j.cvex.2015.08.011 -
Journal of Neurosurgical Sciences Mar 2016The history of cerebral aneurysm surgery owes a great tribute to the tenacity of pioneering neurosurgeons who designed and developed the clips used to close the... (Review)
Review
The history of cerebral aneurysm surgery owes a great tribute to the tenacity of pioneering neurosurgeons who designed and developed the clips used to close the aneurysms neck. However, until the beginning of the past century, surgery of complex and challenging aneurysms was impossible due to the lack of surgical microscope and commercially available sophisticated clips. The modern era of the spring clips began in the second half of last century. Until then, only malleable metal clips and other non-metallic materials were available for intracranial aneurysms. Indeed, the earliest clips were hazardous and difficult to handle. Several neurosurgeons put their effort in developing new clip models, based on their personal experience in the treatment of cerebral aneurysms. Finally, the introduction of the surgical microscope, together with the availability of more sophisticated clips, has allowed the treatment of complex and challenging aneurysms. However, today none of the new instruments or tools for surgical therapy of aneurysms could be used safely and effectively without keeping in mind the lessons on innovative surgical techniques provided by great neurovascular surgeons. Thanks to their legacy, we can now treat many types of aneurysms that had always been considered inoperable. In this article, we review the basic principles of surgical clipping and illustrate some more advanced techniques to be used for complex aneurysms.
Topics: History, 20th Century; History, 21st Century; Humans; Intracranial Aneurysm; Microsurgery; Neurosurgical Procedures; Surgical Instruments; Vascular Surgical Procedures
PubMed: 26657306
DOI: No ID Found -
BMC Ophthalmology Jan 2021However there have been numerous investigations of intrascleral intraocular lens (IOL) fixation techniques, there is room for improvement in terms of simplifying...
BACKGROUNDS
However there have been numerous investigations of intrascleral intraocular lens (IOL) fixation techniques, there is room for improvement in terms of simplifying complicated techniques and reducing the high levels of skill required. This study aimed to report a novel technique for sutureless intrascleral fixation of the IOL using retinal forceps with a 27-gauge trocar.
METHODS
Nineteen eyes of 18 patients underwent intrascleral fixation of the IOL from July 2018 to September 2019 were enrolled in this study. A 27-gauge trocar formed 3-mm scleral tunnels positioned at 4 and 10 o'clock, 2 mm from the corneal limbus. We used a 3-piece IOL haptic grasped by a 27-gauge retinal forceps and pulled from the 27-gauge trocar. The IOL was fixed by making a flange. Main outcome measures were visual acuity, corneal endothelial cell density, IOL tilt, decentration, predicted error of refraction and complications.
RESULTS
The 19 eyes were followed up for 1 month. The mean pre- and postoperative logMAR uncorrected visual acuity (UCVA) was 1.06 ± 0.63 and 0.40 ± 0.26, respectively (p < 0.01), while the mean pre- and postoperative logMAR best corrected visual acuity (BCVA) was 0.27 ± 0.51 and 0.06 ± 0.15, respectively (p = 0.09). The mean corneal endothelial cell density was 2406 ± 625 to 2004 ± 759 cells/mm at 1 month (p = 0.13). The mean IOL tilt was 3.52 ± 3.00°, and the mean IOL decentration was 0.39 ± 0.39 mm. There was no correlation among IOL tilt, decentration and BCVA (p > 0.05). The mean prediction error of the target refraction was - 0.03 ± 0.93 D. The complications were vitreous hemorrhage (3 eyes), hyphema (1 eye), IOP elevation (1 eye), iris capture of the IOL (1 eye) and hypotony (2 eyes). No IOL dislocation occurred.
CONCLUSIONS
IOL intrascleral fixation with a flange achieved good IOL fixation and visual outcome in the scleral tunnels created with the 27-gauge trocar.
Topics: Humans; Lens Implantation, Intraocular; Lenses, Intraocular; Retrospective Studies; Sclera; Surgical Instruments; Suture Techniques
PubMed: 33407262
DOI: 10.1186/s12886-020-01758-6