Advantages Of Laparoscopy Research Articles

MISPLACED COPPER T: A COMPREHENSIVE OVERVIEW

Worldwide, the second most popular form of birth control is Cu T because it is a long term, reversible, highly effective and cost effective contraceptive. In an international study sponsored by the WHO, the average annual failure rate of Copper T was 0.4% or less. Uterine perforation is one of the most dreaded complications of Copper T insertion. The frequency of this occurrence is estimated to be between 0.05 and 13 per 1000 insertions (average, 1.2/1000) and appears to depend on the type of device placed, the skill of the operator, position of the uterus, and intensity of follow-up. A detailed study of case was done who were admitted in our hospital. Further imaging was done and patient were diagnosed with misplaced IUD. The misplaced IUD was removed under vision with hysteroscopy or laproscopy. Minimally invasive techniques like hysteroscopy and advanced laparoscopy are ideally suited to the diagnosis and surgical management of the perforated IUD.

Laparoscopic entry in obese patients: Jain point

Objectives: The study aims to analyze the safety of a novel entry port, the Jain Point for first blind laparoscopic entry port in obese patients, which is non umbilical in position, located in mid abdomen, applicable in patients with or without previous surgery. Methods: The study was conducted at an advanced laparoscopy center between January 2011 to December 2023. Total 9715 patients underwent laparoscopy and out of these, 1362 were selected and categorized as per WHO criteria for obesity. The selection criteria were solely based on BMI. All first blind entries were made by Jain point. The entry related complications were compared with other conventional techniques. Results: In the study period, 1362 obese patients were operated. Time spent in establishing the pneumoperitoneum and trocar entry was comparable to other conventional approaches with a short learning curve. Major complications in the form of MRV (major retroperitoneal vessel) injury was not noted in our series. No injury to stomach and any other viscera noted. Minor complications in the form of prepertioneal insufflation and omental emphysema in 2.7% and failed entry were noted in 1% cases. All surgeries were completed laparoscopically and majority of patients were discharged in 24 to 48 hours. Conclusions: Keeping in context the safety of non umbilical entry ports, this study proposes Jain Point a, lateral, non-umbilical, primary blind entry port, as a viable option in obese patients, with or without previous surgeries.

Could "Low Quality of Life" Rather Than "Significant Symptoms" Be Better Criteria for the Selection of Patients for the Repair of a Giant Hiatus Hernia?

Purpose Giant hiatus hernia (GHH) repair is undertaken electively in symptomatic patients, to prevent complications such as gastric volvulus and subsequent mortality. Advances in laparoscopy and perioperative care have reduced the risk of GHHrepair, and improvement in quality of life (QoL) has become an important outcome measure. In our unit, we have been assessing QoL in all the operated as well as non-operated patients with GHH, using the "Quality of Life in Reflux and Dyspepsia" (QOLRAD) questionnaire. We sought to evaluate differences in QoLbetween patients who were managed conservatively for GHHand those who underwent GHH repair over a two-year period. Methods All patients seen in the Upper Gastrointestinal Tertiary Unit in Lancashire Teaching Hospitals NHS Trustwith GHH between January 2015 and December 2022 were identified from a prospectively kept database. QOLRAD scores were analyzed and compared between conservatively and operatively managed patients using the Mann-Whitney U test. Demographic and operative outcome data were also collected. Results Eighty-seven patients with GHH were included. QoL of 51 patients improved significantly after elective surgery. Five out of 36 patients, who were initially treated conservatively, elected to have repair during their follow-up period. These 5 Patients had a lower initial QOLRAD score in comparison to those whose management remained conservative (2.72 vs 5.05, Mann Whitney U testp=0.034), and their QOLRAD scores also improved significantly after the operation. QOLRAD scores in conservatively managed patients remained stable over a two-year follow-up period. Conclusion Objectively calculated low QoL may be a more useful tool than subjective symptoms in selecting patients for elective repair of GHH.

An Indian surgeon's perspective on management of asymptomatic gallstones.

Cholelithiasis is widely prevalent in India, with a majority of patients being asymptomatic while a small proportion experiencing mild complications. In the laparoscopic era, the rate of cholecystectomies has increased owing to early recovery and fewer complications. In asymptomatic patients, the risk of complications must be balanced against the treatment benefit. Recent guidelines suggest no prophylactic cholecystectomy in asymptomatic patients. We aimed to find out the Indian surgeons' perspective on asymptomatic gallstone management. A cross-sectional e-survey was conducted of practicing surgeons, onco-surgeons and gastrointestinal-surgeons in India. The survey had questions regarding their perspective on laparoscopic cholecystectomy and treatment modalities in asymptomatic gallstones. A total of 196 surgeons responded to the survey. Their mean age was 42.3 years. Overall, 111 (57%) respondents worked in the private sector. Most surgeons (164) agreed that the rate of cholecystectomy has increased since the advent of laparoscopy; 137 (70%) respondents agreed that they would not operate on patients without risk factors. Common bile duct stones, chronic hemolytic diseases, transplant recipients, and diabetes mellitus were the risk factors. Majority of the participants agreed on not performing a cholecystectomy in patients with asymptomatic gallstones. There exists a lack of consensus among Indian surgeons on asymptomatic gallstone management in India. Where the majority of cases are asymptomatic and do not require surgery, certain comorbidities can influence the line of treatment in individual patients. Currently, the treatment guidelines for asymptomatic patients need to be established as cholecystectomies may be overperformed due to the fear of development of complications.

Advantages of laparoscopy in gynecologic surgery in elderly patients.

Geriatric patients requiring gynecological surgery is increasing worldwide. However, older patients are at higher risk of postoperative morbidity and mortality, particularly cardiopulmonary complications. Laparoscopic surgery is widely used as a minimally invasive method for reducing postoperative morbidities. We compared the outcomes of open and laparoscopic gynecologic surgeries in patients older than 55 years. We included patients aged >55 years who underwent gynecological surgery at a single tertiary center between 2010 and 2020, excluding vaginal or ovarian cancer surgeries were excluded. Surgical outcomes were compared between the open surgery and laparoscopic groups, with age cutoff was set at 65 years for optimal discriminative power. We performed linear or logistic regression analyses to compare the surgical outcomes according to age and operation type. Among 2,983 patients, 28.6% underwent open surgery and 71.4% underwent laparoscopic surgery. Perioperative outcomes of laparoscopic surgery were better than those of open surgery in all groups. In both the open and laparoscopic surgery groups, the older patients showed worse overall surgical outcomes. However, age-related differences in perioperative outcomes were less severe in the laparoscopic group. In the linear regression analysis, the differences in estimated blood loss, transfusion, and hospital stay between the age groups were smaller in the laparoscopy group. Similar restuls were observed in cancer-only and benign-only cohorts. Although the surgical outcomes were worse in the older patients, the difference between age groups was smaller for laparoscopic surgery. Laparoscopic surgery offers more advantages and safety in patients aged >65 years.

The value of collision feedback in robotic surgical skills training

Collision feedback about instrument and environment interaction is often lacking in robotic surgery training devices. The PoLaRS virtual reality simulator is a newly developed desk trainer that overcomes drawbacks of existing robot trainers for advanced laparoscopy. This study aimed to assess the effect of haptic and visual feedback during training on the performance of a robotic surgical task. Robotic surgery-naïve participants were randomized and equally divided into two training groups: Haptic and Visual Feedback (HVF) and No Haptic and Visual Feedback. Participants performed two basic virtual reality training tasks on the PoLaRS system as a pre- and post-test. The measurement parameters Time, Tip-to-tip distance, Path length Left/Right and Collisions Left/Right were used to analyze the learning curves and statistically compare the pre- and post-tests performances. In total, 198 trials performed by 22 participants were included. The visual and haptic feedback did not negatively influence the time to complete the tasks. Although no improvement in skill was observed between pre- and post-tests, the mean rank of the number of collisions of the right grasper (dominant hand) was significantly lower in the HVF feedback group during the second post-test (Mean Rank = 8.73 versus Mean Rank = 14.27, U = 30.00, p = 0.045). Haptic and visual feedback during the training on the PoLaRS system resulted in fewer instrument collisions. These results warrant the introduction of haptic feedback in subjects with no experience in robotic surgery. The PoLaRS system can be utilized to remotely optimize instrument handling before commencing robotic surgery in the operating room.

Laparoscopic repair of iatrogenic celiac artery injury during median arcuate ligament release: A retrospection and tips at troubleshooting.

Median arcuate ligament (MAL) syndrome or celiac artery (CA) compression syndrome previously treated mainly by vascular surgeons using the open approach is now being increasingly performed by general surgeons with training in advanced laparoscopy. Although this approach has all the advantages of minimal access surgery, the procedure is fraught with serious complications like injury to major vascular structures during dissection. Vascular injury by far is the major cause of conversion to open procedure. Herein, we report a laparoscopic repair of iatrogenic CA injury by intra-corporeal suturing during MAL release. We also elaborate the causes, the preventive measures that can be applied to avoid such catastrophic occurrences in future. To the best of our knowledge, this is the first report of a laparoscopic repair of CA bleed during MAL release.

10526 The World's First Proof of Concept of the Practical Potential in Artificially Intelligent Digital Twins in Advanced Laparoscopic Training

10526 The World's First Proof of Concept of the Practical Potential in Artificially Intelligent Digital Twins in Advanced Laparoscopic Training

Laparoscopic exploration versus conservative treatment in stable blunt abdominal trauma patients

Background: Laparoscopy is now a standard procedure in general surgery, and as technique and equipment advance, more complicated procedures are being carried out using this minimally invasive approach. With less patient morbidity, postoperative complications, and recovery time than open procedures, laparoscopic surgery aims to offer equal or better visualisation. Numerous laparoscopic procedures, such as cholecystectomy, gastroesophageal reflux procedures, and diagnostic laparoscopy, have demonstrably achieved this goal. Despite the advantages of laparoscopy in the trauma population, its complexity and potential hemodynamic instability due to intra-abdominal injury typically prevent its use. This cutting-edge technology may help carefully chosen trauma patients. According to estimates, 10% of all deaths worldwide were due to trauma. Methods: This prospective study included 29 patients with history of blunt abdominal trauma and vitally stable following initial resuscitation admitted to Casualty and Emergency Unit, ainshams university hospitals and Elzhor Hospital port said, during the period from June 2022 to December 2022. Results: The patients in study were 21 males (82 % of total) 10 males in (LE) representing approximately 77 % and 11 males in conservative group representing approximately (87 %), and 8 females (18 % of total) 2 females in (LE) and 6 in conservative group. As Regarding the hospital stay, in this study, the patients managed by (LE) had shorter hospital stay in relation to those managed conservatively, as the patients results revealed that the overall hospital stay for (LE) was significantly shorter, with an average of 5.69 ± 1.887 days. In this study, the group that benefit the most from shortening the hospital stay was the patients with haemoperitonium with no definite injuries, followed by patients with splenic injuries, while differences in hospital stay in patients with hepatic injuries were not significant. All patients had access to follow-up information for three months after discharge. There were no infective or late hemorrhagic complications observed. Conclusion: Laparoscopic exploration was found to be most beneficial in patients with blunt abdominal trauma who had a CT scan that revealed haemoperitonium but no organ injuries., and to less extent in cases with splenic injuries, while there was no significant data favoring (LE) on conservative treatment in patients with hepatic injuries.

Role of diagnostic laparoscopy in comparison with CT scan finding of patients presenting with abdominal trauma-A cross-sectional study

Background: Trauma is a critical and urgent surgical condition that we encounter on a regular basis. Blunt trauma mechanisms account for 78.9–95.6% of all injuries, with the abdomen being affected in 6.0–14.9% of all traumatic injuries. Diagnostic laparoscopy (DL) for blunt abdominal trauma (BAT) is safe and feasible. Prerequisites are the hemodynamic stability of the patient and surgical expertise in advanced laparoscopy. Aims and Objectives: To find out the role of DL in the diagnosis and management of abdominal trauma patients. Effect on the length of hospital stay and rate of reduction of non-therapeutic laparotomy in the patients with trauma abdomen. Materials and Methods: This cross-sectional study was conducted with 50 patients of abdominal trauma with pre-structured pro forma and Written informed consent. A contrast-enhanced computed tomography (CECT) scan of the abdomen was done in hemodynamically stable patient and injury was noted. Patients meeting the inclusion criteria underwent DL. Results: The duration of hospital stay was lower in laparoscopically managed patients than in laparotomy patients. Most of the patients were managed conservatively 37 (74%) and thus by reducing non-therapeutic laparotomy. Overall recovery was 86% which signifies the reduction in mortality rate with the use of DL. In this study, clear diagnosis was obtained in 88% of the cases, so the efficacy is 88%. Conclusion: Laparoscopy and CECT abdomen has an effective diagnostic and management role in patients with BAT. The therapeutic value of DL is also accepted, well appreciated, and it cannot be underestimated.

Laparoscopy versus laparotomy for the management of early-stage endometrial cancer: Effect on oncological outcomes

Background and aim: Endometrial cancer is the most common gynecologic malignancy diagnosed in an early stage in 80% of patients. The standard treatment for this includes hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection. The advancement of laparoscopy has facilitated the use of minimally invasive techniques also in the field of oncologic surgery. Every new approach should be evaluated in terms of oncological outcomes. This study aimed to compare the oncological outcomes among women with early-stage endometrial cancer treated using laparotomy and a laparoscopic approach.
 Methods: We conducted a retrospective analysis of patients with early-stage endometrial cancer treated in the Department of Gynecologic Oncology and Breast Oncology, University Medical Center Maribor. All consecutive patients who underwent laparotomy (from 2001 to 2006) or laparoscopy (from 2008 to 2016) were included. All patients had a standard surgical treatment: hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection. We analyzed the prognostic factors in each group of patients, which could affect our primary and secondary goals. The primary goal (the recurrence rate) and secondary goal (the disease-free survival) were determined during a follow-up of at least 5 years.
 Results: A total of 73 consecutive patients who underwent laparotomy from 2001 to 2006 and 60 consecutive patients who underwent laparoscopy from 2008 to 2016 were included in the analysis. No statistically significant between-group difference was found in the prognostic factors, except the adjuvant radiotherapy being more frequent in the laparotomy group (change in clinical practice). No statistically significant between-group difference was found in the disease recurrence rate [6/73 (8.2%) laparotomy group vs. 2/60 (3.3%) laparoscopy group (P = 0.238)] or in the disease-free survival during at least 5-year follow-up (P = 0.180). 
 Conclusion: No statistically significant difference was found in oncological outcomes during a 5-year follow-up of women with early-stage endometrial cancer treated using laparotomy or laparoscopy. This finding was an important retrospective overview, but future prospective randomized trials should validate this.

V06-06 SINGLE PORT DA VINCI URETEROILEAL CONDUIT REVISION

You have accessJournal of UrologyCME1 Apr 2023V06-06 SINGLE PORT DA VINCI URETEROILEAL CONDUIT REVISION Rogerio Huang, Akhil Saji, Mubashir Billah, Daniel Bassily, Benjamin Rudnick, Michael Stifelman, and Mutahar Ahmed Rogerio HuangRogerio Huang More articles by this author , Akhil SajiAkhil Saji More articles by this author , Mubashir BillahMubashir Billah More articles by this author , Daniel BassilyDaniel Bassily More articles by this author , Benjamin RudnickBenjamin Rudnick More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , and Mutahar AhmedMutahar Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003274.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In the United States, 80,000 new cases of bladder cancer are diagnosed every year. 30% are muscle invasive at the time of diagnosis, requiring radical cystectomy and ileal conduit being the most common type of urinary diversion. A rare complication is a ureteroileal anastomotic stricture (UIS), which occurs in 2-3% of cases. The gold standard treatment is an open repair. The advent of laparoscopy and robotics has allowed these revisions to be done with improved morbidity. In 2018, the single port robotic system has further enabled advances in minimally invasive surgery. There remains a paucity of educational videos on how to perform single port surgery. We aim to demonstrate a single port ureteroileal conduit revision. METHODS: An IRB approval was obtained at our institution and prospective data was collected on all patients undergoing a single port robotic UIS revision from January 2019 - April 2022. This case demonstration involves a 74 year old male who had a radical cystectomy with ileal conduit in June 2021. He subsequently developed bilateral UIS and elected for a single port UIS revision. RESULTS: The total operative time was 155 minutes and estimated blood loss was 25 mL. The patient’s pain was well controlled and his length of stay was 24 hours. There were no postoperative complications. The patient’s pfannenstiel incision healed with excellent cosmetic results. A renal ultrasound done at 3 months showed resolution of hydronephrosis. In a preliminary review, a single surgeon at our institution performed 6 single port UIS revisions. The mean OR time was 152.4 minutes and the mean estimated blood loss was 30.8 mL. The mean length of stay was 2.2 days. The 30-day postoperative complication rate was 0%. CONCLUSIONS: The single port Da Vinci robotic UIS revision is a novel and effective technique. The single port robot offers a superior platform to access tight spaces and excellent precision for dissection and ureteral anastomotic suturing. A single Pfannenstiel incision site allows easy access to the conduit as well as improved cosmesis. Single site surgery can significantly reduce pain and length of stay. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e510 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rogerio Huang More articles by this author Akhil Saji More articles by this author Mubashir Billah More articles by this author Daniel Bassily More articles by this author Benjamin Rudnick More articles by this author Michael Stifelman More articles by this author Mutahar Ahmed More articles by this author Expand All Advertisement PDF downloadLoading ...

Short-term surgical outcomes of laparoscopic and open surgery for rectal cancer: A nationwide retrospective analysis.

Laparoscopy for treatment of rectal cancer is widely used in clinical practice. However, the safety and advantages of laparoscopy over open surgery at the national level remain unclear. We compared the short-term outcomes of laparoscopy and open surgery for rectal cancer. Using a Japanese nationwide inpatient database, this study analyzed data on patients who underwent rectal resection between July 2010 and March 2018. We performed propensity score matching analyses to compare in-hospital mortality, morbidities, blood transfusion, diverting stomas, anastomotic leakages, duration of anesthesia, postoperative length of stay, and readmission within 30 days between the laparoscopy and open surgery groups. Among 99 137 eligible patients, propensity score matching generated 29 717 pairs. Laparoscopy was associated with lower in-hospital mortality (0.4% vs 0.6%, P=.006), overall morbidities (28.7% vs 33.2%, P < .001), and blood transfusion rate (11.5% vs 22.9%, P < .001); shorter postoperative duration of stay (16 days vs 18 days, P < .001); and longer duration of anesthesia (390 vs 310 minutes, P < .001). Grade C anastomotic leakage was not different between the groups. With respect to in-hospital mortality, morbidities, blood transfusion, postoperative length of hospitalization, and readmission within 30 days, laparoscopy is advantageous over open surgery in the treatment of rectal cancer.

Underutilization of laparoscopy for ovarian surgeries in the pediatric population: A nationwide analysis

PurposeOophorectomy and ovarian detorsion are some of the most frequent operations performed in the female pediatric population. Despite the advent of laparoscopy, many surgeons continue to utilize open surgical approaches in these patients. This study sought to compare nationwide trends and postoperative outcomes in laparoscopic and open ovarian operations in the pediatric population. MethodsFemales less than 21 years old who underwent ovarian operations (oophorectomy, detorsion, and/or drainage) from 2016 to 2017 were identified from the Nationwide Readmissions Database. Patients were stratified by surgical approach (laparoscopic or open). Hospital characteristics and outcomes were compared using standard statistical tests. ResultsThere were 13,202 females (age 17 [14–20] years) who underwent open (59%) or laparoscopic (41%) ovarian operations. The most common indications for surgery were ovarian mass (48%), cyst (36%), and/or torsion (19%) for which oophorectomy (88%), detorsion (26%), and drainage (13%) were performed most frequently. The open approach was utilized more frequently for oophorectomy (95% vs. 77% laparoscopic) and detorsion (33% vs. 16% laparoscopic), both p < 0.001. A greater proportion of laparoscopic procedures were performed at large (67% vs. 61% open), teaching (82% vs. 76% open) hospitals in patients with private insurance (47% vs. 42% open), all p < 0.001. Patients undergoing open procedures had significantly higher index length of stay (LOS) and rates of wound infections. Thirty-day and overall readmission rates, as well as overall readmission costs, were higher in patients who received open surgeries. ConclusionsDespite fewer overall complications, decreased cost, fewer readmissions, and shorter LOS, laparoscopic approaches are underutilized for pediatric ovarian procedures. Type of StudyRetrospective Comparative. Level of EvidenceLevel III.

Partial Nephrectomy for Renal CancerA Phoenix Risen from the Ashes: A Case Series on Totally Laparoscopic Partial Nephrectomy with Review of Literature

Partial nephrectomy, also called Kidney-sparing Surgery (KSS) or Nephron-sparing Surgery (NSS), is an operation wherein, only a cancerous renal tumour or diseased renal tissue is surgically removed; leaving behind as much healthy renal tissue as possible. Understandably, it was initially preferred in patients with solitary kidney and those, with concurrent bilateral tumours. Over the first two decades of the 21st century, Partial Nephrectomy (PN) has become the standard procedure for many renal tumours; even in unilateral disease. This is because of early pick up due to significant developments in imaging modalities and also, due to better understanding of the biology of renal tumours. With advances in minimal access surgery, partial nephrectomy too has come under its ambit. In the present case series, it's fascinating journey has been discussed- its exciting rise, subsequent downfall and then its unique rise again; as the preferred surgical therapy for many renal tumours, around the world. The purpose of reporting the present case series on Laparoscopic Partial Nephrectomy (LPN) performed for renal cancer, was to share the authors’ early experience and results on the topic and to compare them with the world literature. Also, the aim was to underscore the fact that, in an advanced laparoscopy set up, with optimum patient selection and availability of advanced laparoscopic skills, it is an effective and feasible operation. Herein, the authors have described three cases of totally LPN and review of literature on the same. Over an average follow-up period of 23 months, all three patients continue to be asymptomatic and disease free.

Minimally Invasive Procedure for Haemorrhoids: A Retrospective Observational Study

Introduction: The Minimally Invasive Procedure for Haemorrhoids (MIPH), also known as Stapled Haemorrhoidopexy (SH), has gained significant recognition and praise within the surgical community due to its speed and minimal postoperative pain. It was initially believed to have superior postoperative outcomes, resulting in reduced morbidity and mortality rates compared to traditional procedures. However, long-term follow-up data has now revealed previously undocumented sequelae and complications associated with SH. Aim: To share authors’ experience with SH, including patient demographics, operative details, recurrence rates, and postoperative complications, in a tertiary corporate teaching hospital. Materials and Methods: The present retrospective observational study was conducted at the Department of General Surgery and Advanced Laparoscopic Surgery, Dr. LH Hiranandani Hospital, Powai, Mumbai, Maharashtra, India. The study utilised data from the outcomes of SH performed by a single surgeon for Grade II and III haemorrhoids over a 15-year period, from December 2007 to December 2022. Data was extracted from the hospital’s Electronic Medical Records (EMR) and supplemented with information obtained through a telephonic questionnaire. A standard, prevalidated, semi-structured case record proforma was used for data collection. The parameters under study included donut completeness, haemorrhage, faecal urgency, urinary retention, anal stenosis, postoperative pain scores, return to work, and recurrence. Proportions, percentages, and means were calculated and reported for different groups. Results: A total of 245 patients were enrolled in the study. The average pain score at 12 hours postoperatively was 4, which decreased to 2 by day 10. Recurrent disease was observed in 16 patients (6%) at three months and in 24 patients (10%) at six months. Conclusion: The SH demonstrated advantages over conventional open surgery by causing significantly lower postoperative morbidity. However, its recurrence rates were slightly higher.

Medial versus lateral camera port placement for robotic nephron-sparing surgery: evaluating surgical complications and outcomes.

As the growing popularity of robotic-assisted laparoscopic procedures for the treatment of renal cancer increases, there exists a variation in surgical technique among institutions and surgeons alike. One variation that exists in robotics is the anatomical placement of the camera port (medial versus lateral camera port placement). The purpose of this study is to evaluate surgical complications and outcomes in comparison to site of camera port placement during nephron-sparing surgery in an academic setting. Over a three-year period, outcomes for all robotic surgeries for renal cancer were examined. A total of 229 cases were discovered. Patient demographics and comorbidities were analyzed along with perioperative surgical data including location of camera port, surgery length, warm ischemia time, blood loss, pathological tumor margins, tumor size, length of stay and laboratory data. 134 patients had surgery performed with lateral camera port placement versus 95 patients with medial camera port placement. Operative time was significantly lower with an average operative time of 165.8min for the lateral group versus 209.1min in the medial group (p < 0. 0001). Warm ischemia time was also less in the lateral group with an average of 11min versus 15.5min for the medial group (p < 0. 0001).Blood loss was less in the lateral camera port group with an average of 158.2mL (± 196.5mL) versus 248.6mL in the medial group (± 252.6) (p = 0.0040). Drain use, positive surgical margin rate, transfusion rate, conversion to radical nephrectomy, change in pre-operative versus postoperative creatinine and glomerular filtration rate and length of hospital stay did not statistically differ. Lateral camera port placement is associated with decreased operative time and warm ischemia time in this series. There may be certain laparoscopic advantages through a better visualization of surgical anatomy, thus allowing for faster extirpation of renal lesions and decrease in surgical time. These advantages may result in better long-term renal function and decreased clinical sequela from chronic kidney disease.

7918 Laparoscopic Repair of Cervico-Vaginal Agenesis in a Previously Failed Attempt of Mcindoe's Vaginoplasty: A Case Report

<h3>Study Objective</h3> A unique Laparoscopic approach for surgical repair of Cervico-vaginal agenesis. <h3>Design</h3> A case report with 6 months follow-up. <h3>Setting</h3> laparoscopy surgery with patient in lithotomy position under anaesthesia. <h3>Patients or Participants</h3> A 23-yrs old female came with primary amenorrhea with lower abdominal pain since 2 years. Her MRI was suggestive of: 1) upper 2/3rd vaginal aplasia with hematoma in the cervical canal 2) b/l hematosalpinx 3) b/l ovarian hemorrhagic cysts. McIndoe's Vaginoplasty was attempted 6months back which had failed. <h3>Interventions</h3> Laparoscopic cervico- vaginal agenesis repair was planned <h3>Measurements and Main Results</h3> The occurrence of cervical agenesis is quite uncommon (1:80 000–1:100 000) and only 39% of these cases simultaneously have vaginal agenesis. Initially, these cases were managed by hysterectomy or abdominal cervicovaginoplasty. Later, a minimally invasive approach came to light with the advent of laparoscopy and surgical expertise. Principles of surgery: 1. Laparoscopic management of Hematosalpinx and hemorrhagic cysts. 2. Dissection of UV fold and pushing the bladder down to expose 3-4 cm length of the vagina. 3. Dissection between cervix and vagina in the right plane. 4. Creating neo-vagina by dissection of the vaginal agenesis. 5. Vertical incision on the cervix and horizontal incision on the vagina Suturing techniques between cervix and vagina and placing a silicon catheter in cervical canal and neo-vagina. <h3>Conclusion</h3> Laparoscopic approach for cervico vaginal agenesis is better than vaginal approach with cutting cervix vertically for patency of cervical canal.

Laparoscopic femoral hernia repair: our experience: a case series with review of literature

Femoral hernia is one of the rare types of groin hernia. Though classical clinical examination findings for its accurate diagnosis are well documented, it very often gets mistaken for the much commoner inguinal hernia. Traditionally, it has been surgically repaired by open approach. However, the advent of laparoscopy has brought femoral hernia repair under its purview. The purpose of this study is to evaluate the incidence of femoral hernia in our series and outcomes of its laparoscopic repair. We retrospectively evaluated the prospectively collected data of all the 796 patients who had undergone laparoscopic repair for groin hernias, performed by a single surgeon at our institution, over 15 years (from 2007 to 2022). There were 7 patients of femoral hernia in our series. All were diagnosed ‘on table’, while operating purportedly for inguinal hernia. Three out of these seven patients had occult femoral hernia. Femoral hernia is a rare entity and is often not accurately diagnosed pre-operatively. Its laparoscopic management is feasible, effective, and safe.

Laparoscopy for Abdominopelvic Emergencies at the Auxerre Hospital: Patients’ Epidemiological Profile, Diagnostic and Therapeutic Contribution

This study aims to investigate the epidemiological profile of patients and the diagnostic and therapeutic contribution of emergency laparoscopy at the Centre Hospitalier Auxerre (CHA) in France. It’s a year-long descriptive retrospective study conducted at the Auxerre Hospital. Out of 1130 laparoscopies, 245 were emergencies, i.e., 21.68% of laparoscopies. The mean age of our study population was 37 ± 22.78 years with patients ranging from 3 to 93-year-old. The sex ratio was 0.96. The main indications for emergency laparoscopies at CHA were acute appendicitis (44.9%) followed by exploratory laparoscopies (18.8%). Eight percent (8%) of the emergency laparoscopies were later converted to laparotomies, for the following reasons: difficult exposure, multiple adhesions, intestinal dilatation, hypercapnia. Regarding the surgical procedures, an appendectomy was performed in 37.1% of cases whereas peritoneal lavage and drainage following appendectomy were performed cavity in 18.4% of cases. We highlight a laparoscopic transdiaphragmatic pericardial fenestration performed to drain pericardial effusion due to cardiac tamponade, an uncommon procedure even in western practice. The mean duration of the procedure was 53 ± 32.52 minutes, ranging from 11 minutes and 214 minutes. The low postoperative morbidity of 6.53% in our study is one of the undeniable advantages of the laparoscopic approach. The other advantage of laparoscopy is the shortened hospital stay, even in the context of an abdominal emergency. Ample evidence of this is the average hospital stay of 5±5.4 days with 60.4% of patients spending less than 5 days in the hospital.