Conventional Laparoscopic Group Research Articles

Laparoscopic dissection and division of distal fistula in boys with rectourethral fistula

BackgroundCongenital rectourethral fistula (RUF) is the most common form of anorectal malformations found in boys. The aim of this study is to review our experience with dissection and division of distal fistula using laparoscopic surgery in the management of RUF, especially rectourethral bulbar fistula. MethodsOne hundred and two consecutive boys with congenital RUF who underwent conventional or single-incision laparoscopic surgery between July 2008 and June 2015 were enrolled in the study. The dissection of the distal fistula was performed along submucosal layer to a level 0.5 cm proximal to the urethra. Rectal mucosa of the fistula was dissected to the distal most point and completely transected flush with the posterior urethra. The residual muscular cuff was ligated with Hem-o-Lock clip or 5-0 PDS suture. Voiding cystourethrography and pelvic magnetic resonance imaging were performed at 3 mo, 6 mo, and 1 y postoperatively. ResultsAll patients successfully underwent laparoscopic surgery without conversion. The mean age at the time of operation was 4.3 ± 2.9 mo. The operative times for the rectoprostatic fistula and rectobulbar fistula were similar (118.2 versus 119.4 min, P = 0.082). There was no significant difference in average operative time between conventional laparoscopic surgery group and single-incision laparoscopic surgery group (118.8 versus 119.1 min, P = 0.281). There was no injury to the urethra or vas deferens. The urethral catheter was removed on postoperative day 10. All patients were followed up. The median follow-up period was 3.3 ± 1.8 y. No recurrent fistula or urethral diverticulum was detected on voiding cystourethrography and pelvic MRI at 1 y. ConclusionsSubmucosal dissection and division of distal fistula using a laparoscopic approach is safe, feasible, and effective for congenital RUF, especially bulbar fistula, in boys.

The clinical experience of robot-assisted surgery in gynecologic cancer

The comparison of robotic and conventional laparoscopic hysterectomy and pelvic lymphadenectomy in gynecologic cancer still needs to be studied. In all, 98 consecutive cases of patients with gynecologic cancer undergoing robot-assisted hysterectomy and pelvic lymphadenectomy, and another 98 consecutive cases of conventional laparoscopic hysterectomy and pelvic lymphadenectomy during the same period in the Obstetrics and Gynecology Hospital of Fudan University were included. The duration of the operation, blood loss, drainage during the first 24 h after the operation, total hospital stay, hospital stay after the operation, lymph nodes collected, perioperative complications, and the cost of each operation for both procedures were recorded. The duration of the operation was longer, and the cost of each operation was almost seven times higher in the robot group than that in the conventional laparoscopy group. But the differences with regard to blood loss, drainage during the first 24 h after the operation, total hospital stay, hospital stay after operation, the lymph nodes collected, and the rate of perioperative complications were not statistically significant. Robot-assisted surgery (RAS) in gynecologic cancer is as feasible as conventional laparoscopic surgery. We recommend further studies about the cost and effect of RAS in gynecologic cancer.

Laparoendoscopic single-site retroperitoneoscopic adrenalectomy compared with conventional laparoscopy and open surgery

ObjectiveLaparoendoscopic single-site surgery (LESS) is a new laparoscopy development that avoids the use of multiple ports and minimizes morbidity. Combined with retroperitoneoscopy, LESS is suitable for adrenalectomy. We compared open, conventional laparoscopic, and LESS-retroperitoneoscopic adrenalectomy (LESS-RA) surgeries for adrenal tumor removal. Furthermore, we analyzed the conventional retroperitoneoscopic adrenalectomy (CRA) and LESS-RA outcomes. Materials and MethodsWe examined 178 patients who underwent adrenalectomy: 43 by open surgery, 72 by conventional laparoscopy, and 63 by LESS-RA. We analyzed the outcomes of operative time, estimated blood loss (EBL), complications, postoperative convalescence, time to resuming oral intake, analgesics on demand, and hospital stay. ResultsWe found that the open surgery group had a significantly greater mean EBL than the conventional laparoscopy or LESS-RA group (353.1±313.6 mL vs. 62.3±76.9 mL vs. 60.9±64.3 mL, respectively; p<0.0001). Open surgery was lengthier than LESS-RA. Both hospital stay and time to resuming oral intake were shortest in the LESS-RA group, followed by conventional laparoscopy and open surgery. CRA and LESS-RA did not differ significantly in mean tumor size, operation time, or EBL. However, there were significant differences in postoperative hospital stay length (6.4±3.4 days vs. 3.6±1.3 days, respectively; p<0.0001), time to resuming oral intake (1.2±0.5 days vs. 0.4±0.5 days, respectively; p<0.0001), and number of on-demand intravenous or intramuscular analgesics needed (0.5±0.8 ampoules/vial vs. 0.3±0.6 ampoules/vial, respectively; p=0.0484). ConclusionThe standard approach to adrenalectomy recently improved from open to laparoscopic surgery, transperitoneal to retroperitoneal access, and multiple ports to a single port. Here we found that laparoscopic surgery had better intra- and postoperative outcomes than open surgery. Furthermore, patients treated with LESS-RA required less postoperative recovery time and less analgesic use than those treated with CRA.

Étude comparative : laparoscopie robot assistée versus cœlioscopie chez les patientes avec une endométriose vésicale

ObjectivesTo compare robot-assisted laparoscopy (RL) and conventional laparoscopy (CL) in surgery for bladder endometriosis. MethodsA retrospective study was conducted between January 2007 and December 2013, including patients with bladder endometriosis receiving at least a partial cystectomy by RL or CL. The primary endpoint was the presence of a radiological recurrence at bladder level. ResultsWe included 15 patients in the RL group and 22 in the CL group. The median age was 29 years±7 years. The symptoms were similar in the 2 groups. Pre-surgical mapping of the lesions was carried out with MRI. Sixty percent of patients in the RL group vs 91% in the CL group had other associated endometriosis lesions, P=0.04. The median size of the bladder lesion was 30±8mm in the RL group vs 23±7mm in the CL group, P=0.03. The median operative time was 210 vs 225min, P=0.8. We did not find any significant difference in intraoperative and early and late postoperative complications between the 2 groups. The median length of stay was 5 days vs 6 days. The proportion of relapse was 20 vs 23%, P>0.05. Clinical improvement was similar between the groups, i.e. 93 vs 86%, P=0.6 and the pregnancy rate was 93 vs 86%, P=0.6. ConclusionsRobot-assisted laparoscopy in the surgical treatment of bladder endometriosis as compared to traditional laparoscopy does not seem to have an adverse effect neither on the risk of recurrence nor on the occurrence of intra- and postoperative complications.

Robotic Single-Site and Conventional Laparoscopic Surgery in Gynecology: Clinical Outcomes and Cost Analysis of a Matched Case-Control Study

Study ObjectiveTo assess the clinical outcomes and costs associated with robotic single-site (RSS) surgery compared with those of conventional laparoscopy (CL) in gynecology. DesignRetrospective case-control study (Canadian Task Force classification II-2). SettingUniversity-affiliated community hospital. PatientsFemale patients undergoing RSS or CL gynecologic procedures. InterventionsComparison of consecutive RSS gynecologic procedures (cases) undertaken between October 2013 and March 2014 with matched CL procedures (controls) completed during the same time period by the same surgeon. Measurements and Main ResultsPatient demographic data, operative data, and hospital financial data were abstracted from the electronic charts and financial systems. An incremental cost analysis based on the use of disposable equipment was performed. Total hospital charges were determined for matched RSS cases vs CL cases. RSS surgery was completed in 25 out of 33 attempts; 3 cases were aborted before docking, and 5 were converted to a multisite surgery. There were no intraoperative complications or conversions to laparotomy. The completed cases included 11 adnexal cases and 14 hysterectomies, 3 of which included pelvic lymph node dissection. Compared with the CL group, total operative times were higher in the RSS group; however, there were no significant between-group differences in estimated blood loss, length of hospital stay, or complication rates. Disposable equipment cost per case, direct costs, and total hospital charges were evaluated. RSS was associated with an increased disposable cost per case of $248 to $378, depending on the method used for vaginal cuff closure. The average total hospital charges for matched outpatient adnexal surgery were $15,450 for the CL controls and $18,585 for the RSS cases (p < .001), and the average total hospital charges for matched outpatient benign hysterectomy were $14,623 for the CL controls and $21,412 for the RSS cases (p < .001). ConclusionAlthough RSS surgery and CL have comparable clinical outcomes in selected patients, RSS surgery remains associated with increased incremental disposable cost per case and total hospital charges. Careful case selection and judicious use of equipment are necessary to maximize cost-effectiveness in RSS gynecologic surgery.

Efficacy and safety of a new single-port model for appendectomy: Experimental study on swine.

CONTEXT:With the cooperation of surgeons and the engineering division of the company Bhio supply© (Esteio-RS, Brazil), a permanent single port was developed.AIMS:An experimental study assessed the safety and efficacy of the device using a swine laparoscopic appendectomy model (right salpingo-oophorectomy).SETTINGS AND DESIGN:Experimental randomised study.MATERIALS AND METHODS:A total of 20 pigs were randomised for the conventional laparoscopic (CL) three-trocar technique or the single Centry port (CPort) with two working channels, aided by a transparietal thread. Operative times, surgical complications, CO2 use, and pneumoperitoneal pressure were checked. Pressure and chromopertubation tests assessed the ligatures.STATISTICAL ANALYSIS USED:For quantitative outcomes, the Fisher's exact test analysed the samples to compare the surgeons in each group, the ANOVA test for parametric data (volume and pressure) and the Student's t-test for analysis of the fascial incision length. The binaries and isolated occurrence events were described in percentages.RESULTS:For all cases, pneumoperitoneum was maintained. The CPort group, however, resulted in higher CO2 use (26.18 l; standard deviation [SD] ± 11.09) than CL group (5.69 l; SD ± 2.44) (P < 0.01). The mean pressure in CPort group (6.604 mmHg, SD ± 1.793) was comparatively lower than in CL group (7.382 mmHg, SD ± 1.833) (P = 0.363). There was no statistical difference between operative times, ligature safety or adverse surgical events between the different groups and surgeons.CONCLUSION:The surgical technique used with the single port showed no differences in safety and efficacy. Though it does require more CO2 use, its working dynamics did not lead to increased operative times. The results were similar between the two surgeons in the study, suggesting that they can be reproduced.

Oral Presentation I

ABSTRACT BACKGROUND AND AIMS Minimally invasive surgery of the adrenal gland is widespread. Although reports demonstrate the safety and feasibility of robot-assisted adrenalectomy, the objective benefits are still unclear, compared to those of conventional laparoscopy. Recently, robot-assisted approach has also become possible for pheochromocytoma resection. Since cardiopulmonary changes during robot-assisted dissection of the pheochromocytoma patient has not been studied in detail, we aimed to assess these concerns, compared to the routine laparoscopic technique. METHODS In this case-control study, 19 consecutive robot-assisted adrenal resections were compared with a control group consisting of 14 conventional laparoscopic adrenalectomy. Patient characteristics and intraoperative hemodynamic and respiratory parameters were assessed. Groups were compared using the χ2 test for categorical variables and Student's t-test for continuous variables. Significance was considered p &lt; 0.05. RESULTS The robot-assisted procedure was performed successfully in all patients, except one. The duration of the robot-assisted procedure, compared to the conventional laparoscopy group, was significantly longer (p &lt; 0.05). Intraoperative blood loss was significantly less in the robot-assisted group (p &lt; 0.05). Dissection of pheochromocytoma showed a significant difference between the groups, according to the incidence of intraoperative blood pressure fluctuations (p &lt; 0.05). The robot-assisted approach resulted in less incidents. Other hemodynamic and respiratory parameters did not differ between groups significantly. There were no perioperative deaths. Complication rates and postoperative hospital stays were not significantly different. CONCLUSION Robot-assisted adrenalectomy is a safe and technically feasible procedure for a pheochromocytoma patient. Robot-assisted resection of pheochromocytoma minimized the occurrence of intraoperative blood pressure fluctuations and blood loss.

Two-port vs. conventional (three-port) laparoscopic appendicectomy: a new technique in laparoscopic appendicectomy

&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Background: &lt;/span&gt;&lt;/strong&gt;Three-port laparoscopic appendicectomy has proven its worth in the management of appendicitis. From a cosmesis, the umbilical and suprapubic portsites are hidden by natural camouflages, the Right Iliac Fossa (RIF) port is the only visible external sign of surgery. The two-port technique avoids even this marker of abdominal invasion. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Methods: &lt;/span&gt;&lt;/strong&gt;58 patients were studied for this study. Data was collected prospectively. The two port appendicectomy was performed with 10 mm umbilical working port and 5 mm supra-pubic camera port. A stitch was taken transparietaly in RIF which was under camera guidance passed through the tip of appendix and held with suture to retract the appendix. The base was ligated with an intra-corporeal knot and appendix cut and delivered out. Three port appendicectomy was performed via the 10 mm umbilical, 5 mm supra-pubic and 5mm right iliac fossa ports. The appendicular stump was ligated with an endoloop or an intra-corporeal knot, appendix cut and delivered out&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Results:&lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-US"&gt; 58 patients underwent surgery over the one year period for appendicitis. Out of 26 cases attempted, the two port appendicectomy was successful in 21 cases, with conversion to the three-port technique in 4 and conversion to open in 1 case. The complication rates, return to work were comparable between the two groups. Duration of operation was more whereas length of hospital stay was less in two port appendicectomy group as compared to conventional laparoscopic group.&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Conclusions: &lt;/span&gt;&lt;/strong&gt;Patients who underwent two port appendicectomy had a cosmetically better appearing scar than compared to three port appendicectomy cases.&lt;/p&gt;

Comparison of Single-Incision and Conventional Laparoscopic Cyst Excision and Roux-en-Y Hepaticojejunostomy for Children with Choledochal Cysts.

The purpose of this study was to elucidate the potential benefits of single-incision laparoscopic Roux-en-Y hepaticojejunostomy comparing the conventional laparoscopic procedures. From January 2013 to July 2013, 17 consecutive children with choledochal cysts received single-incision laparoscopic Roux-en-Y hepaticojejunostomies by a single surgeon at our institution. Seventeen standard laparoscopic hepaticojejunostomies of consecutive children with choledochal cysts from July 2012 to December 2012 were employed as control. Demographic and perioperative information was identified retrospectively using clinic and hospital records including gender, age, total operating time, estimated blood loss, time to oral intake, drainage removal time, postoperative complications, and postoperative hospital stay. One patient was converted to open surgery and another 8-year-old boy conversed to conventional four-port laparoscopic procedure. There were no significant differences between the conventional laparoscopic group and the single-incision laparoscopic group with regard to preoperative variables including age (P = 0.697) and sex distribution (P = 1.000). For mean operative time (209.9 ± 7.5 vs 204.1 ± 6.9min, P = 0.951), estimated blood loss (10.7 ± 1.1 vs 13.4 ± 1.7ml, P = 0.103), time to oral intake (3.73 ± 0.21 vs 3.77 ± 0.20days, P = 0.889), drainage removal time (4.20 ± 0.45 vs 4.06 ± 0.23days, P = 0.067), and postoperative hospital stay (7.60 ± 0.25 vs 7.41 ± 0.21days, P = 0.627), the differences were also nonsignificant. Nevertheless, this technique demonstrated improved cosmetic outcomes comparing with the conventional laparoscopic group. The results showed better cosmetic results and comparable postoperative outcomes. However, well-designed prospective studies are warranted to better address this issue.

Initial experience of reduced port surgery using a two-surgeon technique for colorectal cancer.

BackgroundWith the decreasing number of surgeons on surgical teams, reduced port surgery (RPS) operations have become popular. We herein present our initial experience with RPS, which was successfully performed using a two-surgeon technique. A retrospective analysis was performed to compare the two-surgeon technique with conventional laparoscopic colectomy and evaluate its efficacy.MethodsA total of 535 patients were eligible among 749 registered patients. Conventional multiport laparoscopic colectomy with three surgeons and RPS using the two-surgeon technique with a surgeon and surgeon’s assistant were performed in 429 and 106 cases, respectively. The patient characteristics, short-term outcomes (including intraoperative and postoperative findings) and pathological results were recorded and analyzed.ResultsThe two groups were similar with respect to age, gender, BMI, history of abdominal surgery, depth of tumor invasion and TNM classification. Reconstruction via extracorporeal functional end-to-end anastomosis was performed in a significantly higher number of patients in the two-surgeon technique group (74 %) than in the conventional laparoscopic colectomy group (57 %). Furthermore, the mean operative time in the two-surgeon technique group (117.9 min) was significantly shorter than that observed in the conventional laparoscopic colectomy group (170 min), and the median postoperative hospital stay was significantly shorter in the two-surgeon technique group (6 days) than in the conventional laparoscopic colectomy group (7 days). There were no major postoperative complications. The final TNM stage was similar in both procedures.ConclusionRPS using the two-surgeon technique compares favorably with conventional laparoscopic colectomy and is considered to be a safe and successful procedure.

Robot assisted adrenalectomy: a handy tool or glorified obsession?

Robotic surgery has recently expanded its horizon in urology apart from radical prostatectomy, one of them being adrenalectomy. Till now, laparoscopic adrenalectomy has established itself as the procedure of choice for benign adrenal disorders. Brandao et al. have recently accomplished a thorough systematic review and meta-analysis of nine trials comparing laparoscopic and robotic adrenalectomy. There was no significant difference between the two groups in terms of conversion rate [odds ratio (OR): 0.82; 95% CI, 0.39-1.75; P=0.61] and operative time (WMD: 5.88; 95% CI, -6.02 to 17.79; P=0.33). There was a significantly longer hospital stay in the conventional laparoscopic group (WMD: -0.43; 95% CI, -0.56 to -0.30; P<0.00001), as well as a higher estimated blood loss (WMD: -18.21; 95% CI, -29.11 to -7.32; P=0.001). There was also no statistically significant difference in terms of postoperative complication rate. The authors seem to support the use of robot for adrenalectomy. However, robotic surgery suffers from cost issues and some technical drawbacks that limit its use in routine practice. Larger and appropriately powered randomized controlled trials are needed to establish and justify its use for performing adrenalectomy.

Transumbilical laparoendoscopic single‐site surgery versus conventional laparoscopy for the resection of retroperitoneal paragangliomas

To compare transumbilical laparoendoscopic single-site surgery with conventional laparoscopy for the resection of retroperitoneal paragangliomas. In the present case-control study, we compared 11 transumbilical laparoendoscopic single-site surgery procedures with 22 conventional laparoscopy procedures carried out to treat retroperitoneal paragangliomas between June 2004 and October 2013 at Peking Union Medical Hospital, Beijing, China. Operative time, estimated intraoperative blood loss, blood transfusions, intraoperative hypertension, intraoperative hypotension, highest intraoperative systolic blood pressure, lowest intraoperative systolic blood pressure, postoperative fatigue time, postoperative systematic inflammation reaction syndrome, 24-h postoperative visual analog scale scores, postoperative hospital stay duration, and postoperative complications were recorded and analyzed. There were no significant differences in patient characteristics. All surgical procedures were successfully completed in both groups. Minor complications occurred in one case in the laparoendoscopic single-site surgery group and in two cases in the conventional laparoscopy group. In the laparoendoscopic single-site surgery group, the operative time was longer than that in the conventional laparoscopy group (P = 0.001). There were no significant differences in terms of intraoperative hypertension, intraoperative hypotension, highest intraoperative systolic blood pressure, lowest intraoperative systolic blood pressure, estimated blood loss, postoperative fatigue time, postoperative hospital stay or systematic inflammation reaction syndrome between the two groups. The 24-h postoperative visual analog scale score was lower in the laparoendoscopic single-site surgery group (P = 0.002). No recurrence or metastases were observed over the duration of the postoperative follow up. In properly selected patients, transumbilical laparoendoscopic single-site surgery is a feasible, safe and effective procedure for the surgical treatment of retroperitoneal paragangliomas.

Surgical technique of endometrioma excision impacts on the ovarian reserve. Single-port access laparoscopy versus multiport access laparoscopy: a case control study

Several recent studies report the detrimental effect of endometrioma excision on the ovarian reserve. Surgical technique and the excessive use of bipolar coagulation could be the key factors. Single-port access laparoscopy (SPAL) ovarian cystectomy has been reported as a comparable procedure to conventional laparoscopy in terms of operative outcomes. The aim of this study was to evaluate whether the single-port surgery affects the ovarian reserve whilst performing laparoscopic ovarian cystectomy for unilateral endometrioma. This was a prospective, case-control study of 99 women with unilateral endometrioma. Forty-nine women underwent single-port cystectomy and 50 women underwent multiport laparoscopic (MPL) conventional cystectomy. The primary outcome was the assessment of the ovarian reserve. We evaluated the serum anti-Mullerian hormone (AMH) levels before, 4–6 weeks and 3 months after surgery. At T2 we performed an ultrasound assessment of the antral follicular count (AFC). We have drawn attention to a statistically significant decrease of the mean AMH value and AFC in the SPAL group at the 4–6-week and 3-month follow-up compared to the conventional laparoscopy group. In conclusion, our results suggest that SPAL cystectomy should not be recommended to patients undergoing surgery for endometrioma excision who want to preserve their fertility.

Comparison with open conventional laparoscopic and robotic assisted laparoscopic radical cystectomy with urinary diversion method— 3 years experience of single team

Comparison with open conventional laparoscopic and robotic assisted laparoscopic radical cystectomy with urinary diversion method— 3 years experience of single team

Perioperative and Oncologic Outcomes of Single-incision Laparoscopy Compared with Conventional Laparoscopy for Colon Cancer: An Observational Propensity Score-matched Study

Single-incision laparoscopic (SIL) surgery is a recent advance in minimally invasive surgical techniques. From May 2011 to August 2012, 77 patients underwent primary SIL surgery for colon cancer by one colorectal surgeon. Among them, 61 patients were one-to-one-matched to control patients who had undergone conventional laparoscopic (CL) surgery with a propensity-matched score, and the outcomes were compared. Two hundred forty-seven patients with colon cancer underwent radical colectomy. Of these, 77 patients underwent SIL colectomy. After matching, there were no significant differences in the general characteristics between the patients undergoing the two types of surgery. Operation time was significantly longer in SIL surgery (139 vs 121 minutes, P = 0.001), but procedure time (107 vs 99 minutes, P = 0.069) was not significantly longer than CL surgery after eliminating closure time (31 vs 22 minutes, P < 0.001) from the operation time. There was no significant difference in postoperative complications between the two groups (3.3 vs 1.6%, P = 1.000). The mean number of harvested lymph nodes was 23 and 22 for SIL and CL surgery, respectively (P = 0.332). The mean follow-up period was 15.7 for the SIL group and 21.4 months for the CL group (P < 0.001) with two recurrences in the SIL group (3.3%) and three recurrences in the CL group (4.9%, P = 1.000). Disease-free survival at 20 months did not differ significantly between the two groups (93.3 vs 94.7%, P = 0.939). SIL for colonic malignancy can be safely applied for various types of operations and can provide equivalent oncologic resection and perioperative outcomes compared with CL surgery.

Learning curves for single incision and conventional laparoscopic right hemicolectomy: a multidimensional analysis.

PurposeThis study aimed to compare the learning curves and early postoperative outcomes for conventional laparoscopic (CL) and single incision laparoscopic (SIL) right hemicolectomy (RHC).MethodsThis retrospective study included the initial 35 cases in each group. Learning curves were evaluated by the moving average of operative time, mean operative time of every five consecutive cases, and cumulative sum (CUSUM) analysis. The learning phase was considered overcome when the moving average of operative times reached a plateau, and when the mean operative time of every five consecutive cases reached a low point and subsequently did not vary by more than 30 minutes.ResultsSix patients with missing data in the CL RHC group were excluded from the analyses. According to the mean operative time of every five consecutive cases, learning phase of SIL and CL RHC was completed between 26 and 30 cases, and 16 and 20 cases, respectively. Moving average analysis revealed that approximately 31 (SIL) and 25 (CL) cases were needed to complete the learning phase, respectively. CUSUM analysis demonstrated that 10 (SIL) and two (CL) cases were required to reach a steady state of complication-free performance, respectively. Postoperative complications rate was higher in SIL than in CL group, but the difference was not statistically significant (17.1% vs. 3.4%).ConclusionThe learning phase of SIL RHC is longer than that of CL RHC. Early oncological outcomes of both techniques were comparable. However, SIL RHC had a statistically insignificant higher complication rate than CL RHC during the learning phase.

Single-port laparoscopic left adrenalectomy (SILS): 3 years' experience of a single institution.

Laparoscopic adrenalectomy by 3 or 4 trocars is a well-established procedure. This report describes the initial experience with single-incision laparoscopic surgery (SILS) using the transperitoneal approach for left adrenalectomy. Between April 2010 and January 2013, all consecutive patients with adrenal masses who agreed to undergo SILS adrenalectomy were included in a prospective study. The left 2.5 cm subcostal incision was the sole point of entry. Data of patients undergoing SILS adrenalectomy were compared with those from an uncontrolled group of patients undergoing conventional laparoscopic adrenalectomy during the same study period. There were 40 patients in each study group. SILS was successfully performed and none of the patients required conversion to an open procedure. In 1 case of SILS procedure, an additional lateral 5 mm port was needed for retraction of the kidney. The mean (SD) duration of the operation was 80 (20) minutes in the SILS group and 75 (8) minutes in the conventional laparoscopic adrenalectomy group (P=0.150). No intraoperative or postoperative complications occurred. Differences between the 2 study groups in postoperative pain, number of patients resuming oral intake within the first 24 hours, final pathologic diagnosis (Conn syndrome, Cushing adenomas, nonfunctioning adrenal tumors), and length of hospital stay were not observed. SILS left adrenalectomy is a technically feasible and safe procedure in carefully selected patients and seems to have results similar to a conventional approach in our initial comparison.

Robotic-Assisted Laparoscopy vs Conventional Laparoscopy for the Treatment of Advanced Stage Endometriosis

Study ObjectiveTo compare robotic-assisted laparoscopy with conventional laparoscopy for treatment of advanced stage endometriosis insofar as operative time, estimated blood loss, complication rate, and length of hospital stay. Study DesignRetrospective cohort study (Canadian Task Force classification II2). All procedures were performed by one surgeon between January 2004 and July 2012. Data was collected via chart review. SettingTertiary referral center for treatment of endometriosis. PatientsFour hundred twenty women with advanced endometriosis. InterventionsFertility-sparing surgery to treat advanced endometriosis, either via conventional or robotic-assisted laparoscopy. Measurements and Main ResultsPatient demographic data, operative time, estimated blood loss, complication rate, and length of hospital stay were compared between the 2 groups. Two hundred seventy-three patients underwent conventional laparoscopy and 147 patients underwent robotic-assisted laparoscopy for fertility-sparing treatment of advanced stage endometriosis. Patients in both groups had similar characteristics insofar as age, body mass index, and previous abdominal surgeries. There were no significant differences in blood loss or complication rate between the 2 groups. Mean operative time in the conventional laparoscopy group was 135 minutes (range, 115–156 minutes), and in the robotic-assisted laparoscopy group was 196 minutes (range, 185–209 minutes), with a mean difference in operative time of 61 minutes (p < .001). Length of hospital stay was also significantly increased in the robotic-assisted laparoscopy group. Most patients who underwent conventional laparoscopy were discharged to home on the day of surgery. Of 273 patients in the conventional laparoscopy group, only 63 remained in the hospital overnight, and all 147 patients in the robotic-assisted laparoscopy group were discharged on postoperative day 1. ConclusionConventional laparoscopy and robotic-assisted laparoscopy are excellent methods for treatment of advanced stages of endometriosis. However, use of the robotic platform may increase operative time and might also be associated with longer hospital stay.

Single-Port (Octoport) Assisted Extracorporeal Ovarian Cystectomy for the Treatment of Large Ovarian Cysts: Compare to Conventional Laparoscopy and Laparotomy

Study ObjectiveTo evaluate single-port assisted extracorporeal cystectomy for treatment of large ovarian cysts and to compare its surgical outcomes, complications, and cystic content spillage rates with those of conventional laparoscopy and laparotomy. DesignRetrospective study (Canadian Task Force classification II-2). SettingUniversity teaching hospital. PatientsTwenty-five patients who underwent single-port assisted extracorporeal cystectomy (group 1), 33 patients who underwent conventional laparoscopy (group 2), and 25 patients who underwent laparotomy (group 3). InterventionsSurgical outcomes, complications, and spillage rates in group 1 were compared with those in groups 2 and 3. Measurements and Main ResultsPatients characteristics and tumor histologic findings were similar in the 3 groups. The mean (SD) largest diameter of ovarian cysts was 11.4 (4.2) cm in group 1, 9.7 (2.3) cm in group 2, and 12.0 (3.4) cm in group 3. Operative time in groups 1 and 2 was similar at 69.3 (26.3) minutes vs 73.1 (36.3) minutes (p = .66); however, operative time in group 1 was shorter than in group 3, at 69.3 (26.3) minutes vs 87.5 (26.6) minutes (p =.02). Blood loss in group 1 was significantly lower than in groups 2 and 3, at 16.0 (19.4) mL vs 36.1 (20.7) mL (p < .001) and 16.0 (19.4) mL vs 42.2 (39.7) mL (p = .005). The spillage rate in group 1 was profoundly lower than in group 2, at 8.0% vs 69.7% (p < .001). ConclusionSingle-port assisted extracorporeal cystectomy offers an alternative to conventional laparoscopy and laparotomy for management of large ovarian cysts, with comparable surgical outcomes. Furthermore, cyst content spillage rate in single-port assisted extracorporeal cystectomy was remarkably lower than that in conventional laparoscopy.

Single incision versus conventional laparoscopic resection in gastrointestinal stromal tumors: a retrospective cohort analysis at a single tertiary care center.

BackgroundSingle-incision laparoscopic surgery (SILS), an advanced form of minimally invasive surgery, has recently been used for surgical management of gastrointestinal stromal tumors (GIST). The literature comparing SILS to conventional laparoscopic surgery for treatment of this disease is limited. This study aimed to evaluate the feasibility and effectiveness of SILS compared with conventional laparoscopic resection for GIST.MethodsA retrospective case-cohort study compared the benefits and outcomes of SILS and conventional laparoscopic partial gastrectomy for GIST. Between April 2008 and December 2012, 39 patients underwent laparoscopic gastrectomy for gastric stromal tumors in our department. All operations were performed by a single experienced surgeon. The medical records of these patients were reviewed retrospectively with regard to tumor size, operating time, and other clinical features.ResultsSILS resection was performed on 19 patients, whereas 20 patients had conventional laparoscopic resection. Compared with the conventional laparoscopic group, the operative time for the SILS group was shorter, but the time for recovery of gastrointestinal function and postoperative hospital stay for the SILS group was similar to that of the conventional laparoscopic group. No intraoperative or postoperative complications were recorded in either group.ConclusionCompared with the conventional laparoscopic procedure, SILS in gastric stromal tumors is as feasible and safe when performed by experienced surgeons.