Acceptable Operative Outcomes Research Articles

Intracorporeal delta-shaped gastroduodenostomy in reduced-port robotic distal subtotal gastrectomy: technical aspects and short-term outcomes.

Gastroduodenostomy is preferred as a method of reconstruction following distal subtotal gastrectomy. However, in initial reports on reduced-port gastrectomy, gastroduodenostomy has rarely been performed therein because of technical difficulties. The present study describes a novel intracorporeal gastroduodenostomy technique applicable during reduced-port robotic distal subtotal gastrectomy. Data were retrospectively reviewed for cases of reduced-port (three-port) robotic distal subtotal gastrectomy with intracorporeal delta-shaped gastroduodenostomy performed from February 2016 to December 2016. The reduced-port approach used a Single-Site™ port via a 25-mm infraumbilical incision and two additional ports. We performed intracorporeal gastroduodenostomy using a 45-mm robotic or laparoscopic endolinear stapler. All staplers were inserted via a port on the left lower abdomen. In our initial experience with intracorporeal gastroduodenostomy, 28 consecutive patients underwent successful surgery with the technique without needing to convert to open, laparoscopic, or conventional five-port robotic surgery. Mean operation time was 201.1min (110-282min), and no major complications, including anastomosis-related problems, were recorded. Intracorporeal delta-shaped gastroduodenostomy was safely and feasibly applied during reduced-port robotic gastrectomy with acceptable operative outcomes and no major complications. Intracorporeal gastroduodenostomy should be considered during reduced-port distal subtotal gastrectomy.

Single-Port Laparoscopic Total Extraperitoneal Inguinal Hernia Repair without Fixation of the Mesh

Purpose: Single-port laparoscopic surgery has been used increasingly in treatment of a variety of conditions, and one recently introduced technique is single-port laparoscopic total extraperitoneal (SPLTEP) hernia repair. The aim of this study was to evaluate the safety and technical feasibility of SPLTEP hernia repair without fixation of the mesh. Methods: From June 2010 to October 2012, 112 consecutive patients underwent SPLTEP hernia repair. Results: We performed 129 inguinal hernia repairs in 112 patients, 17 were bilateral and 95 unilateral. There were 107 indirect hernias (83.0%), 20 direct hernias, and 2 hernias had both of types. Successful SPLTEP hernia repair was performed in 110 patients, with two conversions to an open surgical approach. Median operative times for unilateral and bilateral hernias were 70 minutes (40~145 minutes) and 90 minutes (67~135 minutes), respectively, and the hospital stay was 1 day (1~5 days). Postoperative complications included 10 patients with wound seromas or hematomas, 2 with urinary retention, 4 with groin pain, and 1 with bleeding from the incision site. There were 3 early recurrences (2.4%) during a median follow-up period of 42 months (range, 6~55). Conclusion: SPLTEP inguinal hernia repair without fixation of the mesh is both safe and technically feasible, and provides acceptable operative outcomes. Conduct of a prospective randomized study with long-term follow-up is needed to confirm the benefit of this technique in patients with inguinal hernia.

A Modified Three-Port Laparoscopic Cholecystectomy: Shifting the Third Port to the Umbilicus

Aim: The aim is to shift the 5 mm port from the right upper abdomen to the umbilicus in three-port laparoscopic cholecystectomy to obtain better cosmetic results. Methods: The three ports in conventional three-port laparoscopic cholecystectomy were placed in a 10 mm epigastric incision, a 5 mm umbilical incision and a 5 mm right upper abdominal incision. Our modified method involved movement of the 5 mm incision at the right upper abdomen to the umbilicus. The clinical data of 67 patients undergoing modified three-port laparoscopic cholecystectomy and 82 patients undergoing conventional three-port laparoscopic cholecystectomy in our hospital between February 2013 and April 2015 were collected, including operating time, intra-operative blood loss, need for conversion to open cholecystectomy, postoperative wound infection, length of hospital stay and satisfaction with cosmetic outcome. Results: One patient in the modified group and two in the conventional group were converted to open surgery due to celiac adhesion. There were no significant differences regarding operating time and blood loss between the two groups. Postoperative stay and wound infection were similar in the two groups, however, patients in the modified group were more satisfied with their cosmetic outcome (P = 0.0006). Conclusion: Movement of the 5 mm port from the right upper abdomen to the umbilicus in conventional laparoscopic cholecystectomy can be performed with acceptable operative outcomes and superior cosmetic results.

Retroperitoneal Laparoendoscopic Single-Site Surgery by Single Trocar Technique: Initial Experience with Renal Cyst Decortication

To retrospectively review our initial experience with respect to evaluating the feasibility and safety of retroperitoneal laparoendoscopic single-site surgery (LESS) for renal cyst decortication using the single trocar technique. Between April 2010 and November 2011, 45 patients with symptomatic simple renal cyst have undergone retroperitoneal LESS using the single trocar technique by the same experienced laparoscopic surgeon. A 10-mm 0° laparoscope with a 6-mm working channel and straight conventional laparoscopic instruments were used during all the procedures. Salient demographic and operative data were recorded, including age, body mass index, operative time, estimated blood loss, perioperative complications, analgesic requirement, etc. Forty-three cases were accomplished successfully. In the remaining 2 patients dense adhesions around the renal cyst were encountered, and the operations were completed with an additional 5-mm trocar. The mean operative time was 49 minutes. The mean estimated blood loss was 12 mL. The mean in-hospital analgesic requirement was 2.8 mg of morphine equivalent. The mean time for ambulation postoperatively was 2 days; at the same time the drainage catheter was removed. The mean hospital stay was 3 days. There were no major perioperative complications, but superficial wound infection was noted in 1 patient. Our initial experience with retroperitoneal LESS by the single trocar technique shows the safety and feasibility for renal cyst decortication and provides acceptable operative outcomes.

Laparoendoscopic single-site totally extraperitoneal adult inguinal hernia repair: initial 100 patients

This report aims to describe the authors' initial experience with laparoendoscopic single-site (LESS) totally extraperitoneal (TEP) inguinal hernia repair in 100 patients. Patients who underwent an elective LESS TEP inguinal hernia repair between December 2008 and September 2010 in a single center were enrolled prospectively in this study. Patient demographic data, hernia characteristics, and operative and postoperative outcomes were analyzed. An Alexis wound retractor was placed through the 2-cm subumbilical incision as a homemade transumbilical access platform after the preperitoneal space was created by a balloon dissector. Standard procedures of TEP all were finished using conventional straight laparoscopic instruments. Of the 100 patients in this study, 2 underwent conversion to LESS transabdominal preperitoneal (TAPP) repair. The remaining 98 patients received successful LESS TEP inguinal hernia repair by a single surgeon. No patient required open or conventional laparoscopic conversion. However, one patient did experience recurrence. The mean operative time was 64.2 min, and the hospital stay was 1.54 days. One patient with a history of bladder surgery had a minor intraoperative bladder injury. No major postoperative complication occurred, but 11 patients had seroma or hematoma, 2 had epididymitis, 2 had urinary tract infection, 1 had wound dehiscence, 1 had wound infection, and 1 had urinary retention. This single-arm observational study was limited by the absence of a control cohort. Based on our experience, in the hands of experienced laparoscopic surgeons, LESS TEP repair for adult inguinal hernia using the homemade port as an access platform is feasible and safe and provides acceptable operative outcomes.

Feasibility and safety of retroperitoneoscopic laparoendoscopic single‐site nephrectomy: technique and early outcomes

What's known on the subject? and What does the study add? Laparoendoscopic single-site (LESS) nephrectomy is feasible to remove diseased kidneys. Most of such procedures previously reported were performed through a transperitoneal (trans-abdominal) approach. We report the feasibility, safety, and techniques of performing such operations without disturbing the bowels (a retroperitoneal LESS approach). This approach provides acceptable operative outcomes, and is especially valuable for patients who need to have an intact peritoneal envelope, or those with potentially abnormal or obliterated peritoneal space. • To retrospectively review our experience with respect to evaluating the feasibility and safety of retroperitoneoscopic laparoendoscopic single-site surgery (LESS) nephrectomy. • To present the technical details of such a procedure. • In total, eight retroperitoneoscopic LESS nephrectomies (in seven patients) were completed for a variety of indications in a single centre. • The GelPOINT apparatus (Applied Medical, Rancho Santa Margarita, CA, USA) was used as an access platform through a flank incision (3-5 cm). • Except for a bendable grasper and flexible vascular staplers, all instruments used were conventional straight laparoscopic instruments. • Perioperative data were retrospectively obtained for all patients, including demographic data, operative indications, operative records, length of stay, complications, and pathological analysis. • All retroperitoneoscopic LESS nephrectomy procedures attempted were completed successfully without complications. No extra working port was required for any case. • Median (range) operating time was 164 (87-198) min and median (range) estimated blood loss was 50 (10-200) cm(3) . Median (range) length of hospital stay was 2 (1-3) days. • The median narcotic used was 34 mg of parental morphine sulphate equivalent. The median (range) visual analogue pain scale score at discharge was 2 (0-3) out of 10. • The present single arm observation study is limited by the small patient number and the absence of a control cohort. • Retroperitoneoscopic LESS nephrectomy using the GelPOINT apparatus as an access platform is feasible and safe. • It provides adequate flexibility and spacing of port placements as well as acceptable operative outcomes. • It is especially valuable for those patients who need to maintain peritoneal integrity or those with an abnormal or obliterated peritoneal space.

Laparoscopic Resection of Rectal Cancer: A Comparison of Surgical and Oncologic Outcomes Between Extraperitoneal and Intraperitoneal Disease Locations

The extraperitoneal rectum is anatomically and biologically different from the intraperitoneal rectum, therefore, the surgical outcomes may be different. This study was designed to assess operative outcomes of laparoscopic resection of extraperitoneal (< or = 7 cm from the anal verge) vs. intraperitoneal rectal cancer. Prospective data were collected from 312 patients with rectal cancer who underwent laparoscopic resection. Patients were divided into two groups: extraperitoneal (EP, n = 138) vs. intraperitoneal (IP, n = 174). Mean follow-up was 33 months. Patients with pT3/pT4 accounted for 69.6 percent of EP and 74.1 percent of IP. Circumferential margin was positive in 8.7 percent of EP and 0.6 percent of IP (P = 0.0004). Anastomotic leakage developed in 9.7 percent of EP vs. 4.6 percent of IP (P = 0.1081, overall 6.4 percent). Local recurrence rate at three years was 7.6 percent in EP and 0.7 percent in IP (P = 0.0011, overall 4 percent). By multivariate analysis, extraperitoneal location was a risk factor for local recurrence. Laparoscopic resection of rectal cancer, regardless of EP or IP, provided acceptable operative outcomes. There was an increasing tendency for positive circumferential margin, leakage, and local recurrence in EP vs. IP. A multicenter, prospective study is ongoing to identify the high-risk group for local recurrence who may really benefit from neoadjuvant therapy in the era of laparoscopy.