Direct Laparoscopic Vision Research Articles

Pre-clinical evaluation of the new veress needle+ mechanism on thiel-embalmed bodies: a controlled crossover study - Experimental research.

Eighteen participants (novices, intermediates, and experts) performed in total of 248 insertions in a systematic way on Thiel-embalmed bodies with wide and small bore versions of the conventional VN (VNc) and the VN+. Insertion depth was measured by recording the graduations on the needle under direct laparoscopic vision. Participants graded the bodies and the procedures as lifelike. Overall, a significant reduction (P<0.001) in average insertion depth was found for the VN+ compared to the VNc of 26.0 SD16 mm versus 46.2 SD15mm. The insertion depth difference in the novice group was higher compared to the intermediates and experts (P<0.001). The average insertion depth for both needle types was less (P<0.001) for female participants compared to male. This study indicated that the VN+ significantly reduced the insertion depth in all tested conditions. Whether the difference between female and male performance can be linked to differences in muscle control or arm mass should be further investigated. Useful technical information was gathered from this study to further improve the VN+.

Management of Cesarean Scar Pregnancy Via Laparoscopic and Transcervical Approaches

<h3>Study Objective</h3> To detail novel management of sequelae of pre-operative uterine artery embolization in the setting of a cesarean scar pregnancy in a patient undergoing laparoscopic uterine wedge resection. <h3>Design</h3> A video case report with follow up at 2- and 6-weeks post-procedure. <h3>Setting</h3> An operative suite at a tertiary care center. <h3>Patients or Participants</h3> A 30-year-old woman with cesarean scar pregnancy in the setting of one prior cesarean section who underwent uterine artery embolization. Following embolization, she developed significant clot in the uterus, consistent with placental abruption, which was unable to be evacuated with uterine wedge resection alone. <h3>Interventions</h3> Uterine artery embolization followed by laparoscopic uterine wedge resection of a cesarean scar pregnancy with hysteroscopy and dilation and aspiration under direct laparoscopic visualization. <h3>Measurements and Main Results</h3> Approximately 100cc of additional products of conception and clot was evacuated from this patient by using a secondary method of uterine evacuation (dilation and aspiration). <h3>Conclusion</h3> Use of both laparoscopic and transcervical resection of cesarean scar ectopic pregnancy resulted in increased evacuation of products of conception. Further study is warranted to determine if this results in overall decreased blood loss in patients.

Evaluation of Sensory Loss and Postoperative Analgesia Obtained by Diaphragmatic Apposition Zone Block Under Direct Laparoscopic Visualization in Patients Undergoing Nephrectomy: A Descriptive Study.

PurposeLocal anesthetics can spread into the subendothoracic fascia compartment via the arcuate ligament and apposition zone of the diaphragm after the anterior quadratus lumborum blocks. Therefore, a new block may be achieved if local anesthetic is administered into the diaphragmatic apposition zone (DAZ) under direct laparoscopic visualization by surgeons. Therefore, we evaluated the sensory loss and postoperative analgesic efficacy of this new block in patients receiving laparoscopic nephrectomy.MethodsA total of 28 patients scheduled to receive elective laparoscopic nephrectomy under general anesthesia were enrolled in this study. The DAZ blocks were performed in patients under direct laparoscopic visualization with 20 mL of 0.5% ropivacaine before the dissected kidneys or renal tumors were taken out from the incision. All patients received the intravenous patient-controlled analgesia after surgery. The dermatomes of sensory loss and the muscle weakness of quadriceps femoris were assessed at 2 h post-surgery in the wards. The postoperative pain was scored. The opioid consumption in the first 24 h after surgery was recorded.ResultsThe average number of dermatomes of sensory block was 8.6 ± 1.2. The highest level of sensory loss was T6 (T5-T6) [median (interquartile range, IQR)], and the lowest level of sensory block was L1 (L1–L2). The postoperative pain scores at rest or on movement at 2 h, 6 h, 12 h, 24 h and 48 h were kept at the low levels (less than 4). The muscle strength of the quadriceps femoris evaluated was 5 (5–5) points [median (IQR)]. Total dose of intravenous morphine equivalent consumption in the first 24 h after surgery was 21.2 ± 4.1 mg.ConclusionThe DAZ block manifests a wide dermatomal coverage of sensory loss and is associated with the low levels of postoperative pain intensity and opioid use. It provides a new postoperative analgesia option for patients undergoing laparoscopic nephrectomy.

Laparoscopic-Assisted Pancreatic Necrosectomy: Technique and Initial Outcomes.

Necrotizing pancreatitis (NP) may result de novo or following procedures such as ERCP or partial pancreatectomy (post-procedural), and may require surgical debridement. Video-assisted retroperitoneal debridement (VARD) is a standard approach for NP that employs a 5cm incision with varying degrees of blind and open debridement. We describe our technique and outcomes of a modified VARD called laparoscopic-assisted pancreatic necrosectomy (LAPN) performed through a single 12mm incision that uses direct laparoscopic visualization during debridement. At one medical center, all LAPN patients (2012-2020) were assessed for demographics, disease factors, and outcomes. Bivariate logistic regression analyses were performed to identify factors independently associated with recovery after LAPN for patients with de novo vs post-procedural necrosum. Over 9years, 60 patients underwent LAPN for NP. Median age was 57years (IQR: 47-66) and 43 (69%) were men. Pancreas necrosum was de novo in 39 (63%) patients and post-procedural in 23 (37%). NP resolved with a median of 1 LAPN procedure and median hospitalization was 33 days. The LAPN major morbidity rate and in-hospital mortality rate were 47% and 5%. No significant differences were seen between NP etiology cohorts, although post-procedure NP patients trended towards a faster clinical recovery to baseline compared to de novo patients (193 vs 394days; p-value = .07). LAPN offers a smaller incision with excellent visualization and non-inferior outcomes, regardless of etiology, with likely faster recovery for patients with post-procedural vs de novo necrotizing pancreatitis.

Supra-Arcuate Ligament Blocks: Anatomy, Mechanisms, and Techniques.

Quadratus lumborum block (QLB) is clinically used for postoperative analgesia of abdominal or hip surgery, which can reduce the dose of general anesthetic, inhibit postoperative pain, and promote postoperative rehabilitation. However, accumulated studies have shown several drawbacks of QLB, such as only a small portion of local anesthetic spread into the thoracic paravertebral space, relatively longer onset time, and easily-influenced block effect by the integrity of lumbar fascia, etc. Therefore, on the basis of traditional anterior QLB, our group proposed the techniques of a supra-arcuate ligament block, which include a paramedian short-axis scanning approach, paramedian long-axis scanning approach, infra-lateral arcuate ligament QLB with the apposition zone between diaphragm and quadratus lumborum as drug diffusion target and supra-arcuate ligament block under direct laparoscopic visualization. Recent studies have demonstrated that the supra-arcuate ligament blocks have the advantages of clear anatomy, are easy to perform, and have rapid onset, which avoid some drawbacks of the conventional QLB techniques. This article reviews the anatomical basis, sonoanatomy, technical points, and clinical considerations of supra-arcuate ligament blocks.

Laparoscopic Transverse Abdominis Plane Block

<h3>Study Objective</h3> To describe a technique for laparoscopic application of a transverse abdominis plane (TAP) block. <h3>Design</h3> Video description of a laparoscopic technique in a single patient. <h3>Setting</h3> Standard operating room equipped for laparoscopic procedures. <h3>Patients or Participants</h3> Single patient undergoing total laparoscopic hysterectomy for uterine fibroids and abnormal uterine bleeding. <h3>Interventions</h3> The patient was positioned in lithotomy in Trendelenburg position to allow adequate visualization of pelvic organs. After completion of surgery, a transverse abdominis plane block was performed using 30 ml of a 1:1 mixed solution of 0.25% bupivacaine hydrochloride and 1.3% liposomal bupivacaine injected with a 22-gauge spinal needle in a space between the internal oblique and transversus abdominis muscles. The following landmarks were used to identify the insertion site externally: anterior superior iliac spine and the inferior costal margin at the level of the anterior axillary line. Direct laparoscopic visualization of the injection site was obtained to monitor development of a bulge underneath the peritoneum and transverse abdominis muscle, first by creating a peritoneal blister, followed by a bulge (Doyles bulge). The procedure was repeated in the contralateral side by the assisting surgeon. The total time of procedure is usually 1 minute or less on each side. <h3>Measurements and Main Results</h3> The patient required no opiate analgesia in the immediate postoperative period. Her pain was adequately managed with non-steroidal anti-inflammatory medication. The patient was discharged home the same day of the procedure. During a telephonic follow-up two days after the surgery, patient reported no use of opiates for pain control. <h3>Conclusion</h3> Laparoscopic transverse abdominis plane block is a quick and effective method of postoperative pain control, consistent with ERAS protocols. Further, studies have shown TAP block to provide superior pain relief and reduced opiate use in the postoperative period.^{1, 2.}

S2373 A Case of a Deep Infiltrative Rectal Endometriosis Presenting as a Solitary Ulcer and Lumbosacral Shingles

Introduction: Deep bowel endometriosis is a rare, clinically challenging diagnosis mimicking many gastrointestinal diseases. There are no clear guidelines for the evaluation of patients with suspected bowel endometriosis, therefore a high index of suspicion is warranted. Case Description/Methods: A 39 year old female with a history remarkable for fibroidectomy and constipation presents for rectal bleeding and discomfort for 1 month. In 2012, FOBT was positive and colonoscopy findings were significant for a solitary rectal ulcer. Biopsies showed inflammation. Due to persistent symptoms, a flexible sigmoidoscopy (2013) with repeat biopsies confirmed the diagnosis of deep bowel endometriosis located at the anterior portion of the rectum. Hormonal therapy offered complete resolution of her symptoms. In 2021, due to menopausal symptoms, hormonal therapy was discontinued leading to recurrence of symptoms and new onset right sided lumbosacral shingles. Colonoscopy findings were significant for luminal narrowing and nodularity at the anterior portion of the rectum. Biopsies were nonspecific. Discussion: Given that endometriosis rarely infiltrates the submucosa or mucosa (6.4% of cases), initial colonoscopy and biopsy findings may be nonspecific. Hence, an initial inappropriate diagnosis may occur, demonstrating how challenging this diagnosis may become. Even though the gold standard for diagnosis is direct laparoscopic visualization or tissue diagnosis, imaging modalities such as transvaginal and transrectal US and MRI may diagnose and determine the extent of deep bowel endometriosis. Response to hormonal treatment in deeply infiltrating bowel endometriosis is unpredictable and may require a surgical approach. The natural course of bowel endometriosis has not been formally established. Some authors describe inactive endometriosis as a nodular and fibrotic lesion associated with adhesions and strictures. This correlated with the findings of our patient's latest colonoscopy. Association of endometriosis with rheumatological and autoimmune disorders have been established, where theories based on genetic dysregulation of immune, adhesion, and inflammatory processes take part in the disease pathology. This may explain the greater likelihood of shingles reactivation, such experienced by our patient, during an immunocompromised state such as menopause. Even though deep bowel endometriosis is poorly understood, a high index of suspicion is crucial to offer patients a correct diagnosis and appropriate treatment options.Figure 1.: Deep bowel endometriosis. (Top, left to right) Colonoscopy findings from 2012 (first 2 images) and 2013 respectively showing an abnormal mucosal lesion in the proximal portion of the anterior rectum. (Bottom, left to right) Colonoscopy findings from 2021 showing mucosal nodularity in the proximal portion of the anterior rectum.

Laparoscopic-Assisted Relocation of the Umbilicus With Umbilicoplasty in Complex Abdominal Wall Reconstruction.

Patients with complex abdominal wall pathology often present with significant distortion of their umbilicus. Ventral and umbilical hernias often create widening or protrusion of the umbilicus, while obesity and laxity of the skin and subcutaneous tissue of the abdominal wall further exacerbates the deformity. The primary goal of hernia repair is always reduction of the hernia with a tension-free repair; however, an important secondary goal is esthetic improvement of the abdominal wall. Often, in patients with complex hernia defects involving the umbilicus, there is discussion of not salvaging the umbilicus altogether. Although this certainly remains an option for many patients, we present a technique that would not only allow for hernia reduction under direct laparoscopic visualization but also an improved esthetic to the umbilicus.

Demonstration of Safe Entry Techniques for Laparoscopy

To demonstrate different techniques, and detail the considerations for obtaining primary laparoscopic access in gynecologic surgery. Video demonstration of the techniques with narrated discussion of each method. The methods for primary entry in laparoscopy vary by location and technique [1,2]. There are inherent risks with any mode of primary entry, and the risks are also specific to each technique [3-6]. The choice for primary entry depends on the patient's anatomy, surgical history, pathology, and surgeon preference [1,2]. This video reviews considerations for choosing the safest entry point and tips for proper entry technique [4,7-10]. The entry sites reviewed include the umbilicus, left upper quadrant, right upper quadrant, and supraumbilical [11]. The entry technique can be either open (Hasson), closed (Veress), or by direct laparoscopic visualization [9,10,12-14]. No single laparoscopic entry technique is superior [3]. The safest and most successful entry method will vary by case characteristics and surgeon training.

Laparoscopic staged spermatic vessel-sparing procedure for intra-abdominal undescended testis

The aim of this report is to present our initial experience with a new laparoscopic surgical technique for elongation of the spermatic vessels and orchidopexy for intra-abdominal undescended testis. We performed surgical elongation and orchidopexy in three patients with intra-abdominal undescended testis. Under direct laparoscopic vision, a non-absorbable suture was placed through the lower pole of the intra-abdominal undescended testicle. Using a Maryland grasper, the suture was brought through the inguinal channel all the way down to the scrotal skin. We took out the suture and performed progressive traction on the suture mobilizing the testicle downward without putting the spermatic vessels on appropriate maximum tension. The second stage was performed after a period of 3–6 months when we checked the elongation of the spermatic vessels. In two patients, the degree of elongation was enough so that scrotal orchidopexy was possible immediately. In one patient, an intermediate step of further traction and elongation was necessary. The definitive orchidopexy was possible 6 months later. We had no intraoperative incidents and no postoperative complications. In all three patients, we succeeded to mobilize and fix the undescended testicle in its scrotal, normal position. No signs of postoperative ischemia or testicle atrophy were noticed. This surgical technique seems to be a viable alternative to current procedures for intra-abdominal undescended testis. The procedure is safe and effective, all the natural testicular vascular supply is preserved and during the intermediate position the testicle is placed closer to its natural location.

Efficacy of laparoscopic-guided transversus abdominis plane block for patients undergoing robotic-assisted gynaecologic surgery: A randomised control trial.

Background and Aims:Transverse abdominis plane (TAP) block has been used regularly as part of multimodal analgesia for caesarean sections and other lower abdominal surgeries. Adequate postoperative analgesia provided with regional blocks allows faster postoperative recovery and better patient satisfaction. In our study, we are comparing the analgesic efficacy of laparoscopic-guided TAP block with port infiltration using a local anaesthetic in patients undergoing gynaecologic robotic surgeries.Methods:After obtaining approval from the hospital ethics committee, Central Trial Registry of India (CTRI) clearance and written informed consent from patients, this prospective double-blinded randomised control trial was conducted on patients undergoing robotic-assisted gynaecologic surgery under general anaesthesia. Group B patients received bilateral TAP block under direct laparoscopic vision with 15 ml of 0.1% ropivacaine on each side and Group C patients received routine port site infiltration with 30 ml of 0.1% ropivacaine. Postoperative pain score was measured till 24 hours, need for rescue analgesics, complications associated were noted. Independent two sample 't' test, Mann Whitney u test, Chi-square and Fisher's exact test were used for statistical analysis.Results:Pain score was significantly lower in Group B patients up to 24h (P < 0.001). The use of rescue analgesic was also significantly less in group B compared to Group C (P < 0.001). No adverse events were noted in both groups.Conclusion:Laparoscopic-guided TAP block is effective and superior to port site infiltration in providing postoperative analgesia in patients undergoing robotic-assisted gynaecologic surgery.

Feasibility and Technique for Transvaginal Natural Orifice Transluminal Endoscopic Surgery Liver Resection: A Porcine Model.

Introduction:Natural orifice transluminal endoscopic surgery (NOTES) is a challenging minimally invasive procedure. Although laparoscopic techniques for liver resection are gaining acceptance worldwide, few studies have investigated NOTES liver resection. We used a porcine model to assess the feasibility and safety of transvaginal NOTES liver resection (TV NOTES LR).Materials and Methods:Nine female pigs underwent TV NOTES LR. A nonsurvival acute porcine model with general anesthesia was used in all cases. Using hybrid NOTES technique, we placed only 1 umbilical 12-mm umbilical trocar in the abdominal wall, which was used to create pneumoperitoneum. A laparoscope was then advanced to obtain intra-abdominal visualization. A 15-mm vaginal trocar was inserted under direct laparoscopic vision, and a flexible endoscope was introduced through the vaginal trocar. A long, flexible grasper and endocavity retractor were used to stably retract the liver. The liver edge was partially transected using energy devices inserted through the umbilical trocar. To transect the left lateral lobe, a flexible linear stapler was inserted alongside the vaginal trocar. A specimen extraction bag was deployed and extracted transvaginally. Blood loss, bile leakage, operative time, and specimen size were evaluated. Necropsy studies were performed after the procedures.Results:Eighteen transvaginal NOTES partial liver resections and 4 transvaginal NOTES left lateral lobectomies were successfully performed on 9 pigs. Mean operative time was 165.8 minutes, and mean estimated blood loss was 76.6 mL. All TV NOTES LRs were performed without complications or deaths. Necropsy showed no bile leakage from remnant liver.Conclusions:Our porcine model suggests that TV NOTES LR is technically feasible and safe and has the potential for clinical use as a minimally invasive alternative to conventional laparoscopic liver resection.

Laparoscopic insertion of the peritoneal catheter in ventriculoperitoneal shunting. Review of 405 consecutive cases

BackgroundBased upon our excellent previous experience with 151 adult patients and 39 children whom had the peritoneal catheter in ventriculoperitoneal shunting placed laparoscopically, we continued following this technique as a first-line-procedure in ventriculoperitoneal shunting. Now we analyzed our experience with additional 405 cases for a better comprehension of the complications, advantages and disadvantages of this procedure on this high number of patients. A strict interdisciplinary setting with the maximum of medical intraoperative competence was our goal and therefore better results. Material and methodsN = 405 patients with intraperitoneal shunt insertion from the years 2006–2013 (Follow-up period ranges from 2 to 9 years with a 5,9-year mean follow-up period) were retrospectively analyzed with a special focus on the possible peritoneal catheter complications after laparoscopical shunt insertion. In our department all the peritoneal catheters in ventriculoperitoneal shunting are inserted laparoscopically, when there is no contraindication for this technique. ResultsWe had 0% peritoneal catheter misplacement rate with help of the laparoscopic technique. In two cases (0.49%) injury of the small bowel could be repaired immediately with no further action required. In two cases umbilical hernias have been accidently discovered and the repair of the hernias took place in the same surgical session. As this technique helps us to control the shunt position intraperitoneally by direct laparoscopic vision, the patients spared an extra radiation exposure, to control the position of the peritoneal catheter. A diagnostic laparoscopy is also possible if needed. The time of the operation is shortened in comparison with the needed time, which is mentioned in literature, for the open laparotomy and of course the needed anesthesia and its possible risks and complications decreased. ConclusionNo revision surgeries were required because of any misplacement of the peritoneal catheter, no additional technique related risks compared to the open surgical technique, no abdominal x-rays were needed, the operation time is shortened and the dose of anesthesia needed is decreased and of course its possible side effects' rate is also decreased. Another great benefit of this technique is the possibility of accidental diagnosis of intra-abdominal pathologies. Also, if a surgical treatment of this accidentally discovered intra-abdominal pathologies is needed, it can take place in the same surgical session. No prolonged surgery time as the laparoscopic technique is much easier, controllable and fast.

LAHRI: Laparoscopic-Assisted Hydrostatic Reduction of Intussusception.

Intussusception is the most common cause of bowel obstruction in children from 3 months to 3 years of age. In the absence of peritonitis, initial treatment is either hydrostatic or pneumatic reduction. If these measures fail, operative intervention is required. In nonreducible cases, we propose the use of intraoperative hydrostatic enema to achieve or confirm reduction. In this study we describe a cohort of patients who have undergone laparoscopic-assisted hydrostatic reduction of intussusception (LAHRI). This is a retrospective cohort study of all patients undergoing LAHRI from the years 2011 to 2013. We performed LAHRI in seven children 4 months to 2 years of age. All patients had ileocolic intussusception that failed initial reduction by radiographic enema. With the patient under general anesthesia, saline enema reduction was facilitated by direct laparoscopic visualization. In 2 of the 7 cases, intussusception reduction was visually confirmed in real time, and only a laparoscopic camera port was required. In 1 patient, the bowel was extensively dilated, requiring mini-laparotomy for visualization. The enema, however, reduced the intussusception without any need for manual reduction. In the remaining 4 cases, minimal laparoscopic manipulation was required after the enema failed to completely reduce the intussusceptum, but enema was used to confirm reduction. No child required bowel resection. In cases of failed reduction by contrast enema, we have demonstrated LAHRI to be a successful treatment modality. The technique has the advantage of little to no bowel manipulation and has evolved into one performed via a single umbilical port.

Incidence and concurrent laparoscopic repair of hypertrophic pyloric stenosis and patent processus vaginalis.

Incidence and concurrent laparoscopic repair of hypertrophic pyloric stenosis and patent processus vaginalis.

A safe method of vaginal longitudinal morcellation of bulky uterus with endometrial cancer in a bag at laparoscopy

Total laparoscopic hysterectomy (TLH) is becoming an increasingly popular treatment in endometrial cancer. Intra-abdominal or vaginal uterus morcellation are well described and routinely practiced techniques in removing a benign bulky uterus but contraindicated in endometrial cancer. In malignancy, the uterus needs to be removed intact to avoid intraperitoneal spillage of the endometrial cancer cells, and a uterine size of 12 gestational weeks (g.w.) or larger has been considered a contraindication for the laparoscopic approach. The aim of our study was to evaluate the feasibility and safety of a sealed vaginal morcellation technique in a bag for endometrial cancer laparoscopic treatment. We prospectively scheduled 12 patients affected by endometrial cancer with uterus bigger than 12 g.w. for endometrial cancer laparoscopic treatment. After performing TLH, a sterile plastic wrapping bag was inserted by a 12 mm camera port by rolling it onto the blunt probe. The uterus was covered from the fundus to the cervix, placing the free edges of the bag down into the manipulator cup with two blunt graspers. The specimen completely covered by the bag was then pushed down under direct laparoscopic vision through colpotomy and pulled out from the vagina. The uterus was morcellated by the vaginal route. All patients underwent laparoscopic treatment with vaginal uterine morcellation. The mean uterus weight was 290.8 ± 79.7 g with a mean morcellation operative time of 12.1 min. All vaginal morcellations were completed successfully. All patients were without evidence of local or distant recurrence at the median follow-up time of 18 months. This technique allows the surgeon to morcellate a bulky uterus in cases of endometrial cancer and reduces the chance of neoplastic cell spillage during debulking at TLH. Vaginal morcellation following oncologic rules permits a rapid uterine extraction and may avoid a number of unnecessary laparotomies.

2111 SUB-FASCIAL CONTINUOUS LOCAL ANESTHESIA DRAMATICALLY REDUCES NARCOTIC MEDICATION REQUIREMENTS FOLLOWING LAPARO-ENDOSCOPIC SINGLE SITE DONOR NEPHRECTOMY

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation, Renal Vascular Surgery1 Apr 20132111 SUB-FASCIAL CONTINUOUS LOCAL ANESTHESIA DRAMATICALLY REDUCES NARCOTIC MEDICATION REQUIREMENTS FOLLOWING LAPARO-ENDOSCOPIC SINGLE SITE DONOR NEPHRECTOMY Miguel A. Mercado, Lambros Stamatakis, Shawn Mathur, Judy M. Choi, Edward M. Sanchez, Wesley A. Mayer, and Richard E. Link Miguel A. MercadoMiguel A. Mercado Houston, TX More articles by this author , Lambros StamatakisLambros Stamatakis Houston, TX More articles by this author , Shawn MathurShawn Mathur Houston, TX More articles by this author , Judy M. ChoiJudy M. Choi Houston, TX More articles by this author , Edward M. SanchezEdward M. Sanchez Houston, TX More articles by this author , Wesley A. MayerWesley A. Mayer Houston, TX More articles by this author , and Richard E. LinkRichard E. Link Houston, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Improving pain control after donor nephrectomy may shorten convalescence and reduce barriers to kidney donation. In thoracic and abdominal surgery, sub-fascial continuous local anesthesia (SFCLA) has proven beneficial in reducing the need for narcotic pain medications in the postoperative setting. Herein, we present our experience with SFCLA with laparo-endoscopic single site donor nephrectomy (LESS-DN). METHODS We retrospectively compared all cases of LESS-DN with or without SFCLA performed at our institution by two surgeons (WAM, REL) from October 2011 to August 2012. The On-Q Pain Buster ® with Silver Soaker ™ (I-Flow, Lake Forest CA) catheter system was used for SCFLA. Bilateral catheters were tunneled into the abdominal wall under direct laparoscopic visualization just superficial to the anterior peritoneum. A bolus of 20 mL of 0.5% ropivicaine was administered per catheter, followed by infusion of the same drug at 5 mL/hour from a 725 mL reservoir. The quantity of narcotic pain medicine used +/− SFCLA during the postoperative course was converted to morphine equivalents and compared. Visual analog pain scores at discharge were also recorded. Statistical analysis was performed using the student's t-test. RESULTS Fifty cases of LESS-DN with SCFLA and 77 cases without SCFLA were performed. SCFLA significantly reduced the administered postoperative morphine equivalents by 51% (32.7 mg with SCFLA and 63.2 without SCFLA, p<0.001). No significant differences were noted in hospital length-of-stay or discharge visual analog pain scores between the groups.SCFLA placement increased operative time by 13.6 minutes (p= 0.04). No SCFLA related complications were noted. CONCLUSIONS SFCLA significantly reduces postoperative pain following LESS-DN surgery, as assessed by the amount of narcotic needed to achieve adequate pain control. Although operative time was increased slightly, there were no complications noted. This technique may be valuable in decreasing the perioperative morbidity of laparoscopic donor nephrectomy. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e865 Peer Review Report Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Miguel A. Mercado Houston, TX More articles by this author Lambros Stamatakis Houston, TX More articles by this author Shawn Mathur Houston, TX More articles by this author Judy M. Choi Houston, TX More articles by this author Edward M. Sanchez Houston, TX More articles by this author Wesley A. Mayer Houston, TX More articles by this author Richard E. Link Houston, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

An Easy Technique for Laparoscopic Placement of Seprafilm

The use of antiadhesive sheets has greatly reduced the number of postoperative adhesions after abdominal surgery. A major problem is that these sheets are difficult to deliver into the peritoneal cavity because they are not malleable and easily stick when wet. This article describes a simple technique for administering Seprafilm sheets onto the abdominal viscera after laparoscopic surgery. The Seprafilm sheets are dissolved before the end of surgery in warm normal saline and the solution is placed into a Toumey catheter tip syringe. The syringe is then attached to a Robinson catheter, which is introduced into the abdomen via a laparoscopic trocar. Under direct laparoscopic visualization, the Seprafilm solution is squirted into the damaged peritoneal surfaces. Long-term studies are needed to assess whether our Seprafilm solution technique has the same efficacy as the use of whole sheets.

Minimal-access technique for distal catheter insertion during ventricular peritoneal shunt procedures: a review of 100 cases

The authors report the safety and efficacy of using a percutaneous minimal-access insertion technique for distal shunt catheter placement in 100 cases. From June 2007 to March 2008, they attempted 100 minimal-access insertions of distal shunt catheters in 91 patients who required ventriculoperitoneal shunting. Using the minimal-access approach, they avoided utilizing laparoscopic assistance or a mini-laparotomy in 91% of the cases. There were no bowel injuries or misplaced distal catheters. Additional outcomes in terms of operative times, cases that required conversion to open or laparoscopically assisted implantation, and infection rates are presented. They conclude that intraperitoneal shunt catheter placement can be safely and effectively accomplished using a simplified percutaneous minimal-access insertion method that does not require direct laparoscopic visualization.

Transvaginal laparoscopic cholecystectomy: laparoscopically assisted

Natural orifice transluminal endoscopic surgery (NOTES) is considered the new frontier for minimally invasive surgery. NOTES procedures such as peritoneoscopy, splenectomy, and cholecystectomy in animal models have been described. The aim of our experiment was to determine the feasibility and technical aspects of a new endoluminal surgical procedure. After approval from Columbia's IACUC, a transvaginal laparoscopically assisted endoscopic cholecystectomy was performed on four 30 kg Yorkshire pigs. The first step was to insert a 1.5 cm endoscope into the vagina under direct laparoscopic vision. Then the gallbladder was reached and, with the help of a laparoscopic grasper to hold up the gallbladder, the operation was performed. At the end of the procedure the gallbladder was snared out through the vagina attached to the endoscope. There were no intraoperative complications such as bleeding, common bile duct or endo-abdominal organ damage. Total operative time ranged between 110 and 155 min. Based on our experience in the porcine model, we believe that a transvaginal endoscopic cholecystectomy is feasible in humans.