Application Of Laparoscopy Research Articles

Fostering young talents for surgery : Laparoscopy in preclinical education-Too early or exactly right?

Due to the declining interest among medical students in pursuing asurgical career, the impact of demographic changes and the technical challenges, there is an increasing need to attract medical students to the surgical profession. Against this backdrop, ateaching project was developed to familiarize medical students with minimally invasive surgical techniques early in the preclinical education, thereby increasing the interest in surgery. Within the framework of the regular anatomical dissection course the following modules on laparoscopic surgery were integrated: (1)clinical lecture on the technique and application of laparoscopy, (2)exploratory live laparoscopy on abody donor and (3)practical exercises on laparoscopic trainers. The impact of this teaching project on the interest in asurgical career and on the clinical anatomical understanding was evaluated among 295 participating medical students. The evaluation revealed apronounced gender-independent interest in learning surgical skills early in the preclinical study phase. The teaching project led to asignificantly increased interest in pursuing asurgical career. Moreover, the incorporation of laparoscopic teaching modules into the preclinical anatomy course enhanced the learning motivation and understanding of clinically relevant topographic anatomy. The integration of practical surgical content into preclinical anatomical education can increase the attractiveness of surgical disciplines and simultaneously optimize teaching of anatomy. Longitudinal studies are required to examine the sustainability of these clinical teaching modules in career decisions of medical students.

Application of Laparoscopy in the Diagnosis and Treatment of Pregnancy Complicated with Uterine Myomas

Application of Laparoscopy in the Diagnosis and Treatment of Pregnancy Complicated with Uterine Myomas

Retracted: Application of Laparoscopy in Comprehensive Staging Operation of Ovarian Cancer Based on Electronic Medical Blockchain Technology.

[This retracts the article DOI: 10.1155/2021/6649640.].

V-005 A CASE SERIES DEMONSTRATING APPLICABILITY OF LAPAROSCOPIC MANAGEMENT OF STRANGULATED OR INCARCERATED HERNIAS IN EMERGENCY GENERAL SURGERY

Abstract Aims Acute small bowel obstruction secondary to strangulated hernias is a presentation often encountered during the acute surgical take. Despite the widespread use of a minimally invasive approach for elective hernia surgery, there is a significant reduction in use of laparoscopy in the emergency setting. We aim to describe a case series on the applicability of laparoscopy in the management of emergency strangulated or incarcerated hernias. Materials We describe 4 cases of patients who presented with acutely strangulated or incarcerated hernias as an emergency to a single centre in the United Kingdom. The cases demonstrated include inguinal, femoral, obturator and spigelian hernias, each presenting as an acute emergency with concomitant small bowel obstruction. Results The patients underwent emergency surgery using a laparoscopic approach for repair of strangulated or incarcerated hernias and assessment of obstructed small bowel. Where indicated, small bowel resection and primary anastomosis was undertaken when viability of affected segment of bowel was compromised. All procedures were completed laparoscopically, with no recurrence occurring in these patients during the follow-up period. Conclusion Minimally invasive surgery is an important tool in the armamentarium of the acute care surgeon. A laparoscopic approach will reduce the insult of intervention in already physiologically deplete patients. This case series demonstrates the feasibility of laparoscopy in the management of strangulated or incarcerated hernias in the emergent setting, requiring advanced laparoscopic skill as demonstrated in this video.

137: LAPAROSCOPIC DISTAL GASTRECTOMY: JUST AN OPTION OR THE NEW GOLD STANDARD FOR ELDERLY PATIENTS?

Abstract Background and aim The application of laparoscopy in elderly patients with gastric cancer is controversial, especially in Western population. The aim of the study is to evaluate the feasibility of a laparoscopic approach and compare short-term outcomes with results obtained using traditional open surgery. Methods Data concerning 52 elderly patients (≥70 years), who underwent distal gastrectomy at our institution from January 2017 to August 2020, were retrospectively analyzed. We divided the population into two cohorts according to the surgical technique (laparoscopic or open surgery) and we compared the short-term outcomes. The open and laparoscopic cohorts were compared in terms of demographics, ASA score, pTNM stage, the pathological pattern according to Lauren classification, time of surgery, selected type of gastrointestinal reconstruction, the extension of lymphadenectomy and number of lymph nodes resected, postoperative complications classified according to modified Clavien-Dindo system, length of stay (LOS), postoperative mortality within 30 days. Univariate and multivariate analyses were performed for length of stay, including age, sex, duration of surgery, BMI, technique, tumor localization, grading, reconstruction, ASA, Lauren stage, extension of lymphadenectomy, TNM stage, and neoadjuvant chemotherapy as variables. Results Demographics, pathological characteristics and surgical outcomes were comparable in both cohorts, except for the length of hospital stay (LOS) that was significative longer in the open cohort (12,31 vs 8,42 P = 0.02). Number of harvested lymph nodes and complete resection (R0) rate were similar, leading to comparable oncological results. Based on the univariate analysis, in addition to the approach, ASA score was another factor significantly associated to LOS (ASA 2 8,4 ± 2,1 days vs ASA 3 13,5 ± 7,8 days). A multiple regression was run to predict LOS from ASA and surgical approach. The multiple regression model statistically significantly predicted LOS, F(3,44) = 6,906, P < 0,002. The surgical approach showed a certain trend to significance in predicting LOS, P = 0,09. Conclusion Laparoscopic distal gastrectomy is effective and safe in elderly patients with similar short-term outcomes compared to open distal gastrectomy. The main advantage of laparoscopic technique is a shorter length of hospital stay.

Role of laparoscopy in the immediate, intermediate, and long-term management of iatrogenic bile duct injuries during laparoscopic cholecystectomy.

Bile duct injuries (BDI) during a laparoscopic cholecystectomy still remain as one of the most feared complications in surgery. The use of laparoscopy for its management is a controversial subject of discussion. The purpose of this study is to assess the amount of possibilities that a laparoscopic approach allows in its resolution. A retrospective analysis of all the patients diagnosed with BDI at our center was carried out. The analysis was made considering three different scenarios in which laparoscopy can be used: (1) intraoperative management of BDI; (2) postoperative management of bile peritonitis; (3) deferred treatment of BDI. We analyzed 22 patients in total who were divided into three groups according to the different scenarios proposed. In the first group, the applicability of laparoscopy was 45%, some complications occurred in two patients, and primary patency was obtained in seven. In the second group, four of them presented a grade III complication. In the third group, the applicability of laparoscopy was 13.6%. Only one patient presented a IIIa complication and primary patency was obtained in all of them. Laparoscopy plays a more important role in BDI management every day. This approach, in selected cases, is associated with good long-term results and perioperative advantages of a minimally invasive approach.

Pure Laparoscopic Living Donor Hepatectomy With/Without Fluorescence-Assisted Technology and Conventional Open Procedure: A Retrospective Study in Mainland China

Background: The application of laparoscopy in donor liver acquisition for living donor liver transplantation (LDLT) has become increasingly popular in the past decade. Indole cyanide green (ICG) fluorescence technique is a new adjuvant method in surgery. The purpose was to compare the safety and efficacy of laparoscopic and open surgery in living donor left lateral hepatectomy, and to evaluate the application of ICG in laparoscopy.Methods: Donors received LDLT for left lateral lobe resection from November 2016 to November 2020 were selected and divided into pure laparoscopy donor hepatectomy (PLDH) group, fluorescence-assisted pure laparoscopy donor hepatectomy (FAPLDH) group and open donor hepatectomy (ODH) group. We compared perioperative data and prognosis of donors and recipients. Quality of life were evaluated by SF-36 questionnaires.Results: The operation time of PLDH group (169.29 ± 26.68 min) was longer than FAPLDH group (154.34 ± 18.40 min) and ODH group (146.08 ± 25.39 min, p = 0.001). The blood loss was minimum in FAPLDH group (39.48 ± 10.46 mL), compared with PLDH group (52.44 ± 18.44 mL) and ODH group (108.80 ± 36.82 mL, p=0.001). The post-operative hospital stay was longer in PLDH group (5.30 ± 0.98 days) than FAPLDH group (4.81 ± 1.03 days) and ODH group (4.64 ± 1.20 days; p = 0.001). Quality of life of donors undergoing laparoscopic surgery was better.Conclusion: Laparoscopic approaches for LDLT contribute to less blood loss, better cosmetic satisfaction. The fluorescence technique can further reduce bleeding and shorten operation time. In terms of quality of life, laparoscopic surgery is better than open surgery. Laparoscopy procedure for living-donor procurement with/without fluorescence-assist can be performed as safely as open surgery.

Application effects of free transplantation of autologous omentum in treating maxillofacial infection complicated with complex sinus tract

Objective: To investigate the application effects of free transplantation of autologous omentum in treating maxillofacial infection complicated with complex sinus tract. Methods: The retrospective observational study method was used. Four patients with maxillofacial infection complicated with complex sinus tract were admitted to Department of Burns and Plastic Surgery of the Second Affiliated Hospital of Air Force Medical University from July 2017 to the December 2019, including 3 males and 1 female aged 36-60 years. Preoperative facial computed tomography (CT) was performed on patients for calculating the volume of sinus tract. During the operation, the sinus tract was thoroughly debrided, and the volume of the tissue defect was about 5 cm×3 cm×2 cm-10 cm×5 cm×3 cm after debridement. The tissue defect area was filled with omentum of 100-300 mL which was cut under laparoscopy. The artery and vein on the right side of the omentum were reserved as the vascular pedicle of the donor area, which were anastomosed with the facial artery and external jugular vein of the recipient area. The survival of omentum, and the occurrences of reinfection and complication were observed after operation, respectively. On the 10th day and in 1 month after the operation, the blood supply of omentum was examined by colored Doppler ultrasound and CT angiography, and the filling of tissue defect area was examined by head and face CT. During follow-up after the operation, the recoveries of face appearance and function and scar hyperplasia in the donor area. Results: The transplanted omentums in 4 patients survived after the operation with no reinfection and complication. On the 10th day and in 1 month after the operation, the transplanted omentums had good blood supply, and the filled area with omentum was in good shape, without formation of dead cavity. During follow-up of 6-10 months after surgery, the appearance and function of face recovered well, and there was no obvious scar hyperplasia in the donor area. Conclusions: After free transplantation of omentum in treating maxillofacial infection with complex sinus tract, the patients have good facial appearance and function, and the application of laparoscopy results in little damage to the patients and quick postoperative recovery.

Application of laparoscopy in perihilar tumor surgery

With the promotion of the concept of minimally invasive surgery, hepatobiliary surgery has gradually become a mainstream technique; however, for bile duct tumors in the perihilar region, there are few reports on the application of laparoscopy in such tumor due to the complex structure and anatomical variations of the hepatic hilar region. With reference to related reports in China and globally, this article introduces the research advances in the application of laparoscopy in perihilar tumor surgery. The analysis shows that laparoscopy has certain advantages in the surgical treatment of perihilar tumors, especially in the treatment of Bismuth Ⅰ/Ⅱ hilar cholangiocarcinoma and early-stage gallbladder cancer; due to the high requirements of laparoscopic surgery for the surgeon, only a few experts can perform this surgery at present, and strict screening and evaluation of patients are also required. Therefore, laparoscopy used in perihilar tumor surgery is still at the preliminary stage of exploration, with a need for further exploration and learning.

Application of Laparoscopy in Comprehensive Staging Operation of Ovarian Cancer Based on Electronic Medical Blockchain Technology.

Ovarian cancer has always entangled most women. Studies have shown that the prevalence of ovarian cancer ranks third in female reproductive malignancies, and the mortality rate has always been the highest. The reason is mainly because the diagnosis and treatment of preovarian cancer has always been a big problem. However, the emergence of laparoscopy can well solve this problem, especially laparoscopy assisted by blockchain technology, which plays a huge role in the overall staging of ovarian cancer. This article proposes the application research of laparoscopy in the comprehensive staging of ovarian cancer based on electronic medical blockchain technology. First of all, this article uses the literature method to study the clinical characteristics and surgical classification of ovarian cancer, as well as the application status of blockchain technology and laparoscopic technology. Secondly, it designed an application experiment based on electronic medical blockchain technology to assist laparoscopy in the comprehensive staging of ovarian cancer and analyzed the comparison of the laparoscopic group and the control group in the comprehensive staging of ovarian cancer. The results of the study showed that the amount of bleeding in the laparoscopic group was 103.5 ml, while the amount of bleeding in the control group was 141.1 ml; the proportion of tertiary pain in the laparoscopic group was 11.37%, and the proportion of tertiary pain in the control group was 31.82%. From this, it can be seen that, in the comprehensive staging operation for ovarian cancer, the laparoscopic group has less intraoperative blood loss than the control group and lower pain, and the treatment effect is better.

MODERN CONCEPT OF RENDERING AID TO WOMEN WITH OVARIAN HEMORRHAGES

Aim: Analysis of modern medical care for women with ovarian hemorrhage, determination of the main diagnostic criteria that influence the choice of treatment tactics and further prognosis of the outcome of treatment of ovarian apoplexy. Material and methods: The provision of medical care to 888 women with ovarian apoplexy. Depending on the volume of hemoperitoneum, all patients were divided into three groups.: Group I – 480 (54.0%) women in whom intraabdominal bleeding did not exceed 200 ml; Group II – 283 (31.8%) patients with hemoperitoneum ranged from 200 to 500 ml; Group III – 125 (14.1%) patients with hemoperitoneum volume greater than 500 ml. Results: According to the data of the transvaginal US , a linear dependence was observed between the level of free liquid and the volume of hemoperitoneum (r=0.63, p<0.05). In 792 (89.2%) patients the diagnosis of apoplexy of the ovary and intraperitoneal hemorrhage was made to surgical intervention- on the basis of clinical picture and US data. The most frequently performed hemostatic operation was resection of the ovary – 477 (77.2%) interventions. The average volume of hemoperitoneum discovered in patients with AO, in absence of the adhesive process was (273.5±21.3) ml, whereas in patients with the expressed adhesive process of the small pelvis organs it was (141.4±35.5) ml. The cause of AO was the corpus luteum or cyst of the corpus luteum in more than the half of the cases – 348 (56.3%). Conclusions: The manifestation of the clinical symptoms in apoplexy of the ovaries depends on the volume of intraperitoneal hemorrhage. The application of laparoscopy as a main therapeutic and prophylactic method in AO allows to preserve, and sometimes to restore the reproductive function of a woman and to reduce the rate of the disease relapse development.

Laparoscopic management of perforated appendicitis-a study of 90 cases

Introduction: Acute appendicitis is the most common general surgical emergency in the world. It may cause potential risk for patients due to its life threaten complications like burst (perforation). The perforated appendicitis often leads to serious infectious complication like abdominal sepsis, pelvic abscess & etc. There are concerns of using laparoscopic appendectomy to perforated appendicitis. Now a days laparoscopic management of perforated appendicitis is the standard surgical option in many countries. Laparoscopic procedure has tremendous advantages over the open procedure regarding its diagnosis, exclusion of additional pathology, surgical treatment, wound infection (port infection), hospital stay & overall patient’s satisfaction. The aim of this prospective study was to evaluate the role and application of laparoscopy in the management of complicated appendicitis (perforation).
 Methods: It is a prospective study conducting during January 2011 to May 2019 in BSMMU and some private hospitals of Dhaka, Bangladesh. It includes 90 patients in whom laparoscopic appendicectomy & peritoneal lavage was performed. Three ports technique were usual. Sometimes 4th port is required. 10 mm port is telescopic port. The other one is 3/5 mm port and another one is 5/10 mm port.Energy source is unipolar diathermy. Intracorporeal knotting, endoloop and haemoclip are used for haemostosis& ligating appendicular stump.
 Results: Age distribution of the study is 3-90 years, mean 17 years. Male is predominant. Duration varies 10-120 minutes, mean 70 minutes. Duration varies 30-120 minutes, mean 70 minutes. Hospital stay varies from 48-96 hours, mean 64 hours. There were 8 complications- single (5, 5.55%) or multiple (3, 3.33%) port infections, paralytic ileus (2, 2.22%) and diarrhea (1, 1.11%), port TB was identified (3, 3.33%) cases among the port infection. Conversion was 1 (1.11%) for controlling haemorrhage of burst appendicitis. All complications are managed conservatively.
 Conclusion: Total management of perforated appendicitis by laparoscopy is excellent. So it is achievable, feasible & can be done by expert hand in any center. Now it is considered as standard procedure.
 Journal of Surgical Sciences (2019) Vol. 23(2): 59-66

Laparoscopic Splenectomy in the Treatment of Hematological Diseases of the Spleen

Abstract Methods of surgical treatment of hematological diseases of the spleen have changed significantly in the past decade. The introduction of laparoscopic and minimally invasiveprocedures as standard for solving a significant number of conditions in abdominal surgery, has led surgeons toincreasingly use laparoscopic surgery of the spleen. However, some unique anatomical characteristics of the spleen can lead to limitation in the application of laparoscopy. In this study, we investigated the application of laparoscopic splenectomy in the treatment of haematological disorders of the spleen, intraoperative and postoperative characteristics, the presentation ofoperational technique and the evaluation of the success of this procedure. In the treatment of benign hematological diseases, the effectiveness and efficiency of laparoscopy has been proven. The speculation of medical professionals is that laparoscopic splenectomy is an equal, if not the superior way of treating benign hematological diseases of the spleen in relation to the open procedure, and that there is a chance that laparoscopy might completely replace the classical surgery in most of it’s indications.

Applications of Laparoscopic Transperitoneal Surgery of the Pediatric Urinary Tract.

Application of laparoscopy in pediatric urology has evolved over more than 30 years coming from a merely diagnostic use for non-palpable testes to “interventional” laparoscopy to extirpative surgery and finally to the era of reconstructive pediatric laparoscopic urology, when in 1995 Peters described the first laparoscopic pyeloplasty in a child. Laparoscopic surgery in pediatric urology became implemented increasingly in the twenty-first century with now present-day applications including the complete variety of all kind of indications for surgery for pediatric urological pathology. This article aims to provide a comprehensive overview of current indications, techniques, and outcomes of laparoscopic transperitoneal surgery of the upper as well as of the lower urinary tract for urological pathology in the pediatric patient population.

The anatomical study and clinical application of the lateral ligaments of the rectum

The anatomical location and contents of the lateral ligaments of the rectum (LLR) should be identified in the procedure of total mesorectal excision, as well as its relationship with the middle rectal artery and pelvic plexus. However, discovering this relationship is plaguing the existence and composition of the lateral rectal ligament with confusion and misconceptions. The application of laparoscopy in rectal cancer excision is helpful in identifying the existence of the lateral ligament of the rectum. According to the anatomical study and our clinical observations, the traditional anatomical structures of the lateral ligament of the rectum do exist. It is essential for general surgeons to understand the anatomical location, contents and the technique of dissection of the lateral rectal ligament and doing so is helpful in improving the quality of life of post-operative patients.

Application of laparoscopy in acute appendicitis for the elderly: A single center experience

Background and Purpose: Laparoscopic appendectomy for acute appendicitis is gold standard for adult patients in the world. The incidence of appendicitis in the elderly has risen. The aim of this study was to compare post-operatory outcomes in old patients with acute appendicitis approached by laparoscopy versus open surgery. Methods: We retrospectively analysed the data of elderly patients who underwent appendectomy for acute appendicitis from 1st of January 2010 to the 1st of August 2017. We analysed 286 appendectomies in elderly patients: 214 patients were operated by laparoscopic appendectomy (LA) and 72 patient were underwent Open Appendectomy (OA). Results: The operation time was slightly longer in the LA group (P<0.001), but the time of recovery inflammatory response, time for diet and hospital stay were significantly shorter in LA group than that in OA group. Complications: The rate of surgical site infection in LA group was less than that in OA group, and the rate of pneumonia between LA group and OA group was similar. Conclusions: Laparoscopic appendectomy can be recommended as first choice for old patients with appendicitis.

腹腔镜在腹部创伤的临床应用

腹腔镜在腹部创伤的临床应用

Transanal TME - really needed?

In the last decade, thanks to natural orifice translumenal endoscopic surgery, the application of laparoscopy through the anus has gained interest from both research and clinical point of views. Therefore, an increased number of transanal procedures have been reported, from the resection of a large rectal polyp to total mesorectal excision, and for controlling perioperative complications like leak, bleeding, and stenosis. Currently, the most popular surgical trend remains transanal total mesorectal excision. In this article, the technique, advantages, and disadvantages are discussed.

Do acute care surgeons need bariatric surgical training to ensure optimal outcomes in obese patients with nonbariatric emergencies?

IntroductionAcute care surgeons care for the entire breadth of the American adult population, including obese patients. As the population gets heavier, more patients will present to acute case surgeons with nonbariatric surgical emergencies. Do these surgeons need bariatric training to properly care for obese population? ObjectivesTo evaluate our experience in obese population requiring acute surgery and compare outcomes based on surgeon expertise in bariatric surgery. SettingCommunity teaching hospital, United States. MethodsRetrospective review of obese patients requiring acute surgical intervention. Surgeons were classified as bariatric surgeons (B, n = 2) versus nonbariatric surgeons (NB, n = 4). Demographic characteristics, co-morbidities, and outcomes based on surgeon training were compared. ResultsTwo hundred three patients comprised the cohort. The mean body mass index was 37 ±6 kg/m2. The majority of procedures were laparoscopic (cholecystectomies n = 75, appendectomies n = 45). The remaining nonroutine laparoscopic cases were intestinal obstructions (n = 9), incarcerated hernias (n = 17), traumatic injuries (n = 48), and intestinal ischemia or perforation (n = 9). Bariatric surgeons performed 35% of cases, and risk profiles were similar between groups. Operative times were similar for cholecystectomies and appendectomies. Bariatric surgeons performed more nonroutine cases laparoscopically (7% B versus 2% NB, P = .001). Surgical site infections were low (2% B versus 4% NB, P = .4). Hospital length of stay was higher in the NB group at 9 ± 9 days versus 5 ± 4 days for B (P = .05). Mortality was 5%. ConclusionsAcute surgical procedures were performed in obese patients. Bariatric expertise favorably affected length of stay and the application of laparoscopy. Bariatric expertise may improve outcomes in nonbariatric emergencies, but further study is warranted.

Current application and prospect of three-dimensional laparoscopic radical resection of colorectal cancer

Most colorectal surgeries now are carried out as minimally invasive surgery along with the development and application of laparoscopy. However, the surgical imaging system does not meet the progressing requirement of laparoscopic surgeons. Thanks to the advent of three-dimensional (3D) laparo-scopy, a more sophisticated surgical scene with realer images of anatomy is provided to surgeons. It makes identification and manipulation easier, so that to shorten the learning curve. Meanwhile, the 3D laparoscopy is not perfect. But authors believe it will finally be used broadly in colorectal surgery with the improvement of the technology. Key words: Colorectal neoplasms; Radical resection; Minimally invasive surgery; Laparoscopy; Three-dimensional technology