Conventional Laparoscopic Instruments Research Articles

Laparoscopy training of novices with complex curved instruments using 2D- and 3D-visualization

PurposeBeside many advantages, disadvantages such as reduced degrees of freedom and poorer depth perception are still apparent in laparoscopic surgery. 3D visualization and the development of complex instruments are intended to counteract the disadvantages. We want to find out whether the use of complex instruments and 3D visualization has an influence on the performance of novices.Methods48 medical students with no experience in laparoscopic surgery or simulator-based laparoscopy training were included. They were randomized in four groups according to a stratification assessment. During a structured training period they completed the FLS-Tasks “PEG Transfer”, “Pattern Cut” and “Intracorporeal Suture” and a transfer task based on these three. Two groups used conventional laparoscopic instruments with 3D or 2D visualization, two groups used complex curved instruments. The groups were compared in terms of their performance.ResultsIn 2D laparoscopy there was a better performance with straight instruments vs. curved instruments in PEG Transfer and Intracorporeal Suture. In the transfer task, fewer errors were made with straight instruments. In 2D vs. 3D laparoscopy when using complex curved instruments there was an advantage in Intracorporeal Suture and PEG Transfer for 3D visualization. Regarding the transfer exercise, a better performance was observed and fewer errors were made in 3D group.ConclusionWe could show that learning laparoscopic techniques with complex curved instruments is more difficult with standard 2D visualization and can be overcome using 3D optics. The use of curved instruments under 3D vision seems to be advantageous when working on more difficult tasks.

Retracted: Outcome of Gynecologic Laparoendoscopic Single-Site Surgery with a Homemade Device and Conventional Laparoscopic Instruments in a Chinese Teaching Hospital.

[This retracts the article DOI: 10.1155/2020/5373927.].

Myomectomy with ArtiSential fully articulating laparoscopic instruments: A prospective multicenter study.

ArtiSential, a class of innovative laparoscopic instrument, has been developed to overcome the limitations of conventional laparoscopic surgery by enabling free, 360°-unrestricted movement of the wrist joint, as in robotic surgery. The aim of the present study was to describe the initial experiences with these devices in myomectomy and to report the surgical outcomes. A total of 77 women undergoing laparoscopic or robotic myomectomy between January 2021 and June 2022 were included in this multicenter prospective study. The ArtiSential instruments used by the surgeons were those chosen according to their respective preferences. The baseline characteristics, surgical outcomes, trocar placement options, and operator survey results were scrutinized. The mean age of the patients was 39.9 ± 6.3, and the mean body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) was 22.4 ± 3.4 kg/m2 ; 46.8% of the patients underwent robotic surgery, while 53.2% underwent laparoscopic surgery. The number of removed myomas was 3.3 ± 3.0, the size of the largest myoma was 7.1 ± 2.3 cm, and the operative time was 130.0 ± 54.0 min. No transfusions or laparotomy conversions were required. Other than one case of ileus, there were no postoperative complications. In most cases, the instruments were inserted through the umbilicus trocar, and the fenestrated forceps, needle holder, and bipolar fenestrated forceps, in that order, were frequently employed. According to a surgeon survey, 29.9% moderately or strongly agreed that the ArtiSential devices utilized were more convenient than conventional laparoscopic instruments, while only 9.7% moderately or strongly agreed that they were more convenient than robotic instruments. Myomectomy as performed with an ArtiSential instrument seems to be feasible and safe. Further studies are necessary in order to comparatively assess the outcomes and potential benefits of ArtiSential, robotic, and conventional laparoscopic myomectomy.

Laparoscopic transabdominal preperitoneal herniorrhaphy performed using an articulating laparoscopic instrument is feasible and more efficient.

Ipsilateral left-sided-approach laparoscopic transabdominal preperitoneal herniorrhaphy (LA-TAPP) is a procedure used for inguinal hernia. However, conventional laparoscopic instruments may limit the operator's ability to approach certain areas during the procedure. This study aims to assess the feasibility of using an articulating bipolar grasper (ArtiSential®). Between January 2017 and May 2022, 184 patients with inguinal hernia underwent LA-TAPP and were divided into an articulating group (AG) and a conventional group (CG). The two groups were compared for clinical characteristics, surgical outcomes, and recurrence rates. Learning curve analysis was also performed using the CUSUM score. The AG and CG included 72 and 112 patients, respectively. Both groups had similar age, sex, BMI, hernia location, and hernia type. The AG had a significantly shorter operation time (59.2 ± 29.4 vs. 77.8 ± 22.4 min, p < 0.001) than the CG. The duration of hospitalization was slightly shorter in the AG (2.2 ± 0.5 vs. 2.5 ± 1.4 days, p = 0.056). Postoperative complications were lower in the AG (5.6%) than in the CG (9.8%). Scrotal neuralgic pain was observed in 1.4% of patients in the AG and 3.6% of patients in the CG. Learning curve analysis revealed that 24 cases were needed to overcome the learning curve for using an articulating device. IP-TAPP with an articulating instrument is a safe and efficient procedure. The operation time can be reduced by improving the surgeon's procedural autonomy and reducing collisions between the instruments and the patient's ribs.

Single incision laparoscopic heminephroureterectomy in the management of ureteral duplication in children

ObjectivesWe present our technique and results of single incision laparoscopic heminephroureterectomy (SILH) in the management of ureteral duplication (UD) in children. MethodsMedical records of all patients with UD undergoing SILH in our center from July 2018 to March 2023 were reviewed. For SILH, a single 15 mm umbilical skin incision was made and two 6 mm ports and one 4 mm port were placed at different points at the same incision. Conventional 3–5 mm straight laparoscopic instruments were used without any abdominal drain. Results8 children (6 girls and 2 boys, aged 3–45 months) with symptomatic UD were enrolled. Five patients had UD on the left and three on the right side. The operative duration was 100 - 140 min. There was no need for an additional port or conversion to open surgery and no intraoperative complications. All the patients recovered well, resumed oral feeding on POD 1 day, and were discharged on POD 3–6. At a follow-up of 8 – 30 months, all patients were asymptomatic. Postoperative cosmesis was excellent as all patients were virtually scarless. ConclusionsOur technique of SILH with conventional laparoscopic instruments for ureteral duplication in children is feasible, safe, with excellent cosmesis.

Comparison between single incision laparoscopic cholecystectomy using conventional laparoscopic instruments vs. four port laparoscopic cholecystectomy in patients of symptomatic cholelithiasis: a prospective randomised study

Background: The desire to reduce invasiveness, pain, discomfort and improve cosmesis and early return of patient to normal activities is the basis for single incision laparoscopic surgery. The primary aim was to compare post-operative pain and the secondary aim to compare duration of surgery, intraoperative bile spill or stone spill, duration of hospital stay, any postoperative complications and cosmetic outcome between SILC and the gold standard for symptomatic gall stone disease, FPLC (Four port laparoscopic cholecystectomy). Methods: A total of 150 patients were randomized into two groups, A (SILC) and B (FPLC). Post-operative pain and other intra-operative and post -operative parameters were compared. Results: The age ranged between 20 years to 76 years most of them being females with body mass index ranging between 19 and 35 kg/m2. Comparison of pain score was done using MEWS scale; which was found to be statistically significantly SILC at 6 hours, mean difference (MD)-0.833 while at 24 hours the difference was not significant (MD- 0.234). Duration of surgery was significantly more (MD-12.17 minutes) in SILC. No addition of port or conversion to open cholecystectomy was required. There were no significant difference between post-operative complications between the two groups. Cosmesis was significantly better in terms of look of the scar (MD-0.867) and recommending it to their relatives (MD-0.700) in SILC group. Conclusions: SILC is a safe and easily learnable procedure which can be safely be done using conventional laparoscopic instruments in low risk patients. Duration of surgery even after expertise is gained remains to be more than FPLC.

Single-incision laparoscopic transabdominal preperitoneal hernioplasty: 1,054 procedures and experience

PurposeAlthough there have been numerous studies on single-incision laparoscopic inguinal hernia repair (SIL-IHR), the short- and long-term outcomes in patients from a large single institution who underwent single-incision laparoscopic transabdominal preperitoneal hernioplasty (SIL-TAPP) have rarely been reported. The purpose of this study is to evaluate the short- and long-term outcomes of SIL-TAPP and its safety and feasibility in patients from a large single institution.MethodsThe details of 1,054 procedures in 966 patients who underwent SIL-TAPP at the Affiliated Hospital of Nantong University from January 2015 to October 2022 were retrospectively analysed. SIL-TAPP was performed completely through the umbilicus using conventional laparoscopic instruments. Short-term and long-term outcomes of SIL-TAPP were collected by outpatient and telephone follow-ups. In addition, we further compared the operation time, length of postoperative hospital stay, and postoperative complications of patients with simple and complicated unilateral inguinal hernias.ResultsA total of 1,054 procedures were performed for 878 unilateral inguinal hernias and 88 bilateral inguinal hernias. In total, there were 803 (76.2%) indirect inguinal hernias, 192 (18.2%) direct inguinal hernias, 51 (4.8%) femoral hernias and 8 (0.8%) combined hernias. The mean operative time was 35.5 ± 17.0 min for unilateral inguinal hernias and 51.9 ± 25.5 min for bilateral inguinal hernias. There was one (0.1%) conversion to two-incision laparoscopic transabdominal preperitoneal hernioplasty. No intraoperative haemorrhages, inferior epigastric vessel injury or nerve damage occurred. Postoperative complications were minor and could be resolved without surgical intervention. The mean length of hospital stay was 1.3 ± 0.8 days. The median follow-up was 44 months, no trocar hernia occurred, and there was one (0.1%) recurrence. The operation time in the complicated inguinal hernia group was significantly higher than that in the simple inguinal hernia group (38.9 ± 22.3 vs. 35.0 ± 15.6, p = 0.025). The length of postoperative hospital stay and complication rate of the complicated inguinal hernia group were slightly higher than those of the simple inguinal hernia group, but the difference was not statistically significant.ConclusionSIL-TAPP is safe and technically feasible, and both short- and long-term outcomes are acceptable.

Initial experience with 3D laparoscopic choledochal cyst (CDC) excision and hepatico-duodenostomy (HD) in 21 children.

Minimal access surgery has gradually become the standard of care in the management of choledochal cysts (CDC). Laparoscopic management of CDC is a technically challenging procedure that requires advanced intracorporeal suturing skills, and hence, has a steep learning curve. Robotic surgery has the advantages of 3D vision, articulating hand instruments making suturing easy and thusis ideal. However, the non-availability, high costs and necessity for large-size ports are the major limiting factors for robotic procedures in the paediatric population. Use of 3D laparoscopy incorporates the advantage of 3D vision and at the same time allows the use of small-sized conventional laparoscopic instruments. With this background, we discuss our initial experience with the use of 3D laparoscopy using conventional hand instruments in CDC management. To study our initial experience in the management of CDC in paediatric patients with 3D laparoscopy in terms of feasibility and peri-operative details. All patients under 12years of age treated for choledochal cyst in a period of initial 2years were retrospectively analysed. Demographic parameters, clinical presentation, intra-operative time, blood loss, post-operative events and follow-up were studied. The total number of patients were 21. The mean age was 5.3years with female preponderance. Abdominal pain was the most common presenting symptom. All patients could be completed laparoscopically. No patient needed conversion to open procedure or re-exploration. The average blood loss was 26.67ml. None of the patients required a blood transfusion. One patient developed a minor leak postoperatively and was managed conservatively. 3D laparoscopic management of CDC in the paediatric age group is safe and feasible. It offers the advantages of depth perception aiding intracorporeal suturing, with the use of small-sized instruments. It is thus a 'bridging the gap' asset between conventional laparoscopy and robotic surgery. Treatment study level IV.

The merging of dual umbilical port-incisions for contained morcellation in laparoscopic myomectomy

Uncontained power morcellation during laparoscopic myomectomy may spread tissue fragments or malignant cells into the abdominal cavity. Recently, various approaches to contained morcellation, have been adopted to retrieve the specimen. However, each of these methods has its own drawbacks. Intraabdominal bag-contained power morcellation adopts a complex isolation system, which prolongs the operation and increases medical costs. Contained manual morcellation via colpotomy or mini-laparotomy increases the trauma and the risk of infection. Contained manual morcellation via umbilical incision during single-port laparoscopic myomectomy may be the most minimally invasive and cosmetic approach. But the popularization of single-port laparoscopy is challenging because of technical difficulties and high costs. We have therefore, developed a surgical technique using 2 umbilical port-incisions (5 mm and 10 mm), which are merged into 1 large umbilical incision (25-30mm) for contained manual morcellation during specimen retrieval, and one 5mm incision in the lower left abdomen for an ancillary instrument. As demonstrated in the video, this technique significantly facilitates surgical manipulation using conventional laparoscopic instruments while still keeping the incisions minimal. It is also economical because the use of an expensive single-port platform and special surgical instruments is avoided. In conclusion, the merging of dual umbilical port-incisions for contained morcellation adds a minimally invasive, cosmetic, and economical option to laparoscopic specimen retrieval that would enrich a gynecologist's skill set, which is particularly relevant in a low-resource settings.

Construct Validity of a Novel Assessment System for Laparoscopic Suture Accuracy Based on Stereoscopy.

An accurate and objective measuring tool is lacking for laparoscopic suture accuracy assessment in simulation training. We designed and developed the suture accuracy testing system (SATS) and aimed to determine its construct validity in this study. Twenty laparoscopic experts and 20 novices were recruited to perform a suturing task in three sessions using traditional laparoscopic instruments (Tra. session), a handheld multi-degree-of-freedom (MDoF) laparoscopic instrument (MDoF session) and a surgical robot (Rob. session), respectively. The needle entry and exit errors were calculated using the SATS and compared between the two groups. No significant difference of the needle entry error was found in all comparisons. As for the needle exit error, the value of the novice group was significantly higher than that of the expert group in Tra. session (3.48 ± 0.61mm vs. 0.85 ± 0.14mm; p = 1.451e-11) and MDoF session (2.65 ± 0.41mm vs. 1.06 ± 0.17mm; p = 1.451e-11) but not in Rob. session (0.51 ± 0.12mm vs. 0.45 ± 0.08mm; p = 0.091). The SATS demonstrates construct validity. Surgeons' experience in conventional laparoscopic instruments could be transferred to the MDoF instrument. Surgical robot helps to improve suture accuracy and may bridge the experience gap between laparoscopic experts and novices in basic exercises.

Multicenter clinical trial for the resection of rectal polyps using a new laparoendoscopic hybrid transanal access device

IntroductionComplex polyps require the use of advanced endoscopic techniques or minimally invasive surgery for their approach. In rectal polyps it is of special relevance to reach a consensus on the best approach to avoid under- or overtreatment that increases unnecessary morbidity and mortality. MethodsWe describe a prospective, multicenter, pilot clinical trial with a first-in-human medical device. It is hypothesized that UNI-VEC® facilitates transanal laparoendoscopic surgery for the removal of early rectal tumors. The primary objective is to evaluate that it is safe and meets the established functional requirements. Secondary objectives are to evaluate results, complications and level of satisfaction. Results16 patients were recruited in 12 months with a minimum follow-up of 2 months. The mean size was 3.4 cm with the largest polyp being 6 cm. Regarding location, the mean was 6.6 cm from the anal margin. Endoscopic Mucosal Resection (EMR) (6.3%), Endoscopic Submucosal Dissection ESD (43.8%), REC (6.3%) and TAMIS (43.8%) were performed. The mean time was 73.25 min. The 56.3% used a 30° camera and 43.8% used the flexible endoscope as a viewing instrument. The 56.3% were benign lesions and 43.8% malignant. Complete resection is achieved in 87.5%. Regarding complications, mild bleeding (Clavien I) occurred in 25%, 6.3% and 21.4% at 24 h, 48 h and 7 days respectively. Continence was assessed according to the Wexner scale. At 7 days, 60% showed perfect continence, 26.7% mild FI and 13.3% moderate FI. At 30 days, 66.7% had perfect continence, 20% mild FI and 13.3% moderate FI. At 2 months, 4 patients were reviewed who at 30 days had a Wexner's degree higher than preoperative and perfect continence was demonstrated in 25% of the patients, 50% mild and 25% moderate. In no case did rectal perforation or major complications requiring urgent reintervention occur. As for the level of reproducibility, safety, level of satisfaction with the device and evaluation of the blister, the evaluation on a scale of 0–10 (9.43, 9.71, 9.29 and 9.50 respectively). All the investigators have previous experience with transanal devices. ConclusionsThe study demonstrates the efficacy and safety of UNI-VEC® for the treatment of rectal lesions. It will facilitate the implementation of hybrid procedures that seek to solve the limitations of pure endoscopic techniques by allowing the concomitant use of conventional laparoscopic and robotic instrumentation with the flexible endoscope.

Usefulness of the new articulating laparoscopic instrument in laparoscopic pancreaticoduodenectomy.

Minimally invasive pancreaticoduodenectomy has been developed in two tracts of robotic and laparoscopic surgeries. Laparoscopic approach remains a frequently performed surgical method that accounts for a significant portion of minimally invasive pancreaticoduodenectomy. However, biliary and pancreatic reconstruction stages are still demanding procedures because of the inherent limitations of conventional laparoscopic instruments. Therefore, recently developed articulating laparoscopic instruments have greater dexterity similar to robotic instruments seem to be able to compensate for the weak points of conventional laparoscopic instruments. In this article, we demonstrate the hepaticojejunostomy and duct-to-mucosa pancreaticojejunostomy technique using the new articulating laparoscopic instrument.

Ensayo clínico multicéntrico para la resección de pólipos rectales mediante un nuevo dispositivo de acceso transanal híbrido laparoendoscópico

IntroductionComplex polyps require the use of advanced endoscopic techniques or minimally invasive surgery for their approach. In rectal polyps it is of special relevance to reach a consensus on the best approach to avoid under- or overtreatment that increases unnecessary morbidity and mortality. MethodsWe describe a prospective, multicenter, pilot clinical trial with a first-in-human medical device. It is hypothesized that UNI-VEC® facilitates transanal laparoendoscopic surgery for the removal of early rectal tumors. The primary objective is to evaluate that it is safe and meets the established functional requirements. Secondary objectives are to evaluate results, complications and level of satisfaction. ResultsSixteen patients were recruited in 12 months with a minimum follow-up of 2 months. The mean size was 3.4 cm with the largest polyp being 6 cm. Regarding location, the mean was 6.6 cm from the anal margin. Endoscopic mucosal resection (EMR) (6.3%), endoscopic submucosal dissection (ESD) (43.8%), REC (6.3%) and TAMIS (43.8%) were performed. The mean time was 73.25 min. The 56.3% used a 30° camera and 43.8% used the flexible endoscope as a viewing instrument. The 56.3% were benign lesions and 43.8% malignant. Complete resection is achieved in 87.5%. Regarding complications, mild bleeding (Clavien I) occurred in 25%, 6.3% and 21.4% at 24 h, 48 h and 7 days, respectively. Continence was assessed according to the Wexner scale. At 7 days, 60% showed perfect continence, 26.7% mild FI and 13.3% moderate FI. At 30 days, 66.7% had perfect continence, 20% mild FI and 13.3% moderate FI. At 2 months, 4 patients were reviewed who at 30 days had a Wexner's degree higher than preoperative and perfect continence was demonstrated in 25% of the patients, 50% mild and 25% moderate. In no case did rectal perforation or major complications requiring urgent reintervention occur. As for the level of reproducibility, safety, level of satisfaction with the device and evaluation of the blister, the evaluation on a scale of 0–10 (9.43, 9.71, 9.29 and 9.50, respectively). All the investigators have previous experience with transanal devices. ConclusionsThe study demonstrates the efficacy and safety of UNI-VEC® for the treatment of rectal lesions. It will facilitate the implementation of hybrid procedures that seek to solve the limitations of pure endoscopic techniques by allowing the concomitant use of conventional laparoscopic and robotic instrumentation with the flexible endoscope.

Conventional three-port laparoscopic appendectomy versus transumbilical and suprapubic single-incision laparoscopic appendectomy using only conventional laparoscopic instruments

PurposeSingle-incision laparoscopic appendectomy (SILA) is usually performed using single-port instruments, which may restrict its development and application. This study explored the performance of transumbilical SILA (TSILA) and suprapubic SILA (SSILA) using only conventional laparoscopic instruments and compared them with conventional three-hole/port laparoscopic appendectomy (CLA).MethodsThis retrospective study included 174 patients who underwent CLA, TSILA, or SSILA for acute appendicitis at our hospital between June 2019 and July 2021. Demographic data and clinical outcomes were compared among the three groups.ResultsCompared with CLA, TSILA was associated with significant reductions in postoperative pain, length of hospital stay, and hospital cost, while SSILA was associated with significant reductions in length of hospital stay and hospital cost (all P < 0.05). Significantly more patients in the two SILA groups were cosmetically satisfied than those in the CLA group (all P < 0.05). However, compared with CLA, SSILA required a significantly longer operative time (65.3 ± 24.1 vs 56.5 ± 20.9, P = 0.039). Besides, compared with TSILA, SSILA showed significantly higher postoperative pain score (2 ± 2 vs 3 ± 2, P = 0.006). Mild incisional or intraabdominal infections were noticed in 2 (3.0%) patients in the CLA group, 3 (5.1%) in the TSILA group, and 3 (6.3%) in the SSILA group (P = 0.69).ConclusionSILA performed with only conventional laparoscopic instruments was associated with reduced hospital stay and cost and higher cosmetic satisfaction in comparison to CLA. However, it is technically demanding and may increase operative time.

Surgical Training for Bowel Endometriosis: A New Wet-lab Model

To demonstrate a new wet-lab model for training in conservative bowel endometriosis surgery (shaving and discoid resection). Video demonstration. (1) Modeling deep infiltrating endometriosis using cryopreserved porcine rectum. (2) Conservative resection (shaving and discoid resection) using cold scissor and carbon dioxide laser (free beam and fiber). (3) Discoid resection. In this video, we present a new training model for improving the surgical management of bowel endometriosis. After dissection of the serosa and muscular layers, a modified biological glue is injected into the porcine rectum to accurately simulate an infiltrating bowel endometriosis lesion. Once dried, the simulated lesion can be resected using conventional laparoscopic instruments (cold scissors) or using more advanced techniques such as carbon dioxide laser, free beam and fiber (Storz and Lumenis). In case of bowel perforation during resection, this model enables realistic suturing. This new and highly realistic model allows the next generation of endometriosis surgeons to acquire adequate training to make bowel surgery safer and more effective.

Transanal minimally invasive surgery (TAMIS) for rectal cancer

Transanal minimally invasive surgery (TAMIS) is a technique that allows high quality local excision of benign rectal neoplasms and early-stage rectal cancers. These lesions can be located more proximal that those treated with conventional transanal excision. Operative costs are minimized and access to the technique is expanded with utilization of conventional laparoscopic instruments. Good oncologic outcomes can be achieved for local excision of early rectal cancers, but its role in the surgical treatment of more advanced tumors is still being evaluated. As with all surgical techniques, appropriate training must be ensured and continued assessment of oncologic outcomes maintained.

Laparoendoscopic two-site myomectomy (LETS-M) using conventional laparoscopic instruments and the glove-port technique

To evaluate the perioperative outcome of laparoendoscopic two-site myomectomy (LETS-M). The medical records of 204 women receiving LETS-M in a tertiary referral center, including 183 surgeries performed by the experienced surgeon and 21 surgeries performed by 3 well-supervised trainees were retrospectively reviewed. The age of the participants was 39.3±6.4 years. The mean diameter of the largest myoma and the mean number of myomas were 8.5±2.2cm and 1.7±1.1, respectively. Thirty-one (15%) operations removed more than 2 myomas larger than 5cm in diameter. The mean weight of the myomas was 281.1±183.1g. The operation time was 97.6±40.2min, and the intraoperative blood loss was 99.3±115.2mL. There were 3 (1%) cases of excessive blood loss (more than 500mL) and 2 (1%) of postoperative hematoma. The only significant difference between the experienced surgeon and trainees was the operation time (92.3±32.2min vs. 141.2±54min, p<.001), while the myoma number, myoma diameter, myoma weight, and intraoperative blood loss were not significantly different. The operation time did not differ among different myoma locations. In multivariate analysis, virginity, myoma number, more than 2 large myomas, and myoma size were independent variables for longer operation times. No patient experienced any major complications. LETS-M using conventional laparoscopic equipment is a minimally invasive surgical method that is safe, effective, and easy to learn for managing uterine myoma. It is useful to achieve a favorable perioperative outcome with acceptable operation time.

Application of a custom-made single-incision sealing device in laparoscopic surgery for totally extraperitoneal herniorrhaphy: initial experience.

BackgroundIn this research, the safety and feasibility of single-incision laparoscopic surgery for total intraperitoneal herniorrhaphy (SILS-TEP) was clarified through a customized single-port device.MethodsA 2.5 cm curved incision was made along the lower umbilical margin. The subcutaneous fatty tissue was removed by electrotomy or blunt dissection to form a 5.0 cm preperitoneal space under the posterior sheath. The Iconport single-hole device silicone sealing sleeve was wedged under the posterior rectus sheath and inflated with CO2 to dilate the anterior peritoneal space toward the lower abdomen. According to the standard method of laparoscopic total peritoneal hernia repair, conventional laparoscopic instruments were used to complete the operation.ResultsSuccessful SILS-TEP hernia repair was performed in 63 patients. The mean operative times for unilateral indirect hernia were 65.5 [40–110] minutes. The mean operative times for unilateral direct hernia, and femoral were 51.3 [36–83] minutes, respectively. Six seroma cases were seen during the 1- to 32-month follow-up periods, and all patients recovered after conservative treatment. No other major complications were observed. The mean postoperative hospital stay was 3.3 days.ConclusionsWith the assistance of a suitable single-port laparoscopic device, SILS-TEP umbilical incision under the posterior rectus sheath is a safe and feasible method.

Endoscopic surgery suturing techniques: a randomized study on learning

BackgroundSurgeons have widely adopted endoscopic suturing techniques using conventional laparoscopic instruments and the more advanced robotic systems. The FlexDex is a novel articulating laparoscopic needle driver providing enhanced dexterity in laparoscopic surgery. This study evaluates and compares the learning curve of endoscopic suturing with conventional laparoscopy, the FlexDex and robotic suturing in novices.MethodsParticipants performed a minimal invasive suturing task in three different ways in a randomized order: with a conventional laparoscopic needle driver, using the FlexDex needle driver and third, using the Da Vinci Si surgical system. Primary outcome was suturing task time. Secondary outcome parameters were assessment of suturing quality and workload perception.ResultsA total of 10 novice participants were included and completed a total of 300 sessions. Median (IQR) suturing time of the first 5 sessions was 231 s (188–291) in the laparoscopic group versus 378 s (282–471) in the FlexDex group versus 189 s (160–247) in the DaVinci Si group. The last 5 sessions showed significant reduction of median suturing time of 143 s (120–190), 232 s (180–265) and 172 s (134–199) respectively. Analysis identified that the learning curve for the laparoscopic needle driver and Da Vinci Si was reached in 5 sessions, compared to 8 sessions for the Flexdex. The laparoscopic needle driver and Da Vinci Si showed a significant shorter median suturing time compared to the FlexDex (p = 0.00). The FlexDex quality assessment scores were significantly lower compared to the laparoscopic (p = 0.00) and robotic (p = 0.00) scores and perceived workload remains high for the FlexDex users.ConclusionsEx vivo endoscopic suturing with the FlexDex demonstrated a prolonged learning curve compared to laparoscopic and robotic suturing. The learning curve of the FlexDex is fundamentally different from conventional laparoscopic and robotic instruments. This study provides further insights in the implementation and training of endoscopic suturing techniques.

MP10-03 SUPER TRANSURETHRAL BLADDER TUMOR RESECTION

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (MP10)1 Sep 2021MP10-03 SUPER TRANSURETHRAL BLADDER TUMOR RESECTION Shengkun Sun, Yong Xu, Weijun Fu, Guangfu Chen, and Xu Zhang Shengkun SunShengkun Sun More articles by this author , Yong XuYong Xu More articles by this author , Weijun FuWeijun Fu More articles by this author , Guangfu ChenGuangfu Chen More articles by this author , and Xu ZhangXu Zhang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001983.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The existing TURBT technology has a history of more than 80 years. The fragmented resection of tumors are inherent defects of traditional TURBT. The objective of this study was to explore a safe and effective method of TURBT. We performed a novel transurethral bladder tumor resection under air cystoscope. Since the depth of resection is limitless under pneumocystoscope, and there is no previous report, we named this novel operation as “Super Transurethral Resection of Bladder Tumor” (STURBT). METHODS: The operation was performed under general or epidural anesthesia. The Super Scope (S-Scope) was inserted through the urethra, and the bladder was filled with carbon dioxide, and the pressure was set as 12 mmHg. The novel S-Scope has a channel to accommodate conventional laparoscopic surgical instruments, such as supersonic scalpel, bipolar scissors, forceps, and suctions. First the normal bladder mucosa 1 cm from the tumor was marked with a supersonic scalpel. Blunt separation and sharp resection were performed from periphery to the central base of the tumor to achieve en bloc resection. The β basket, a bladder tumor retrieving device, was inserted through the channel, and the tumor was removed in whole or by dividing into 2 to 3 parts. The urethral stent was placed, and the bladder was flushed with normal saline. RESULTS: 5 patients underwent STURBT, and 6 tumors were resected with the largest diameter of 3∼5cm. The average resection time was 28±16.4 minutes, and the tumor was retrieved en bloc or sub-en bloc. There was no obturator nerve reflex or bleeding during operation. Pathological diagnosis showed 1 case of pheochromocytoma and 4 cases of high grade urothelial carcinoma with stage T1∼T2a. Bladder muscle layer was visible in all cases. 3 cases of bladder cancer with muscle invasion received adjuvant intravenous chemotherapy. 4 cases with high grade urothelial carcinoma also received intravesical irragation of BCG periodically. Cystoscopy 3 months post-operation showed well healing of the bladder. There was no tumor recurrence during a mean follow-up of 11.8 (3-18) months. CONCLUSIONS: STURBT is a novel surgical method to treat bladder tumor, which has several advantages over traditional TURBT. No fluid irrigation was needed, and no urine extravasation developed. The supersonic scalpel will not stimulate the obturator nerve. The en bloc tumor resection decreased tumor dissemination and an accurate pathological TNM stage could be obtained. S-Scope assisted STURBT could make full use of the current laparoscopic surgical instruments, which had obvious advantages in transurethral treatment of bladder tumors. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e169-e169 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shengkun Sun More articles by this author Yong Xu More articles by this author Weijun Fu More articles by this author Guangfu Chen More articles by this author Xu Zhang More articles by this author Expand All Advertisement Loading ...