Incision In Umbilicus Research Articles

Simple Trocar Placement for Robotic Liver and Pancreatic Surgery: Multiple Access Devices at 5-cm Single Umbilicus Incision with 2 Robotic Ports.

Robotic trocars are recommended to be placed 6-8 cm apart, and assistant trocars are placed 7 cm away from the horizontal line of the robotic trocar placement. However, adhering to these rules may be difficult, particularly in lean patients. This study aims to demonstrate our standardized simple trocar placement, 5-cm single umbilicus incision + 2 ports for robotic liver resection (RLR) and robotic pancreaticoduodenectomy (RPD). During 2022-2024, patients undergoing RLR and RPD at The University of Tokyo were identified from a prospectively maintained database. Our standardized trocar placement consisted of multiple access devices at the 5-cm umbilicus incision, including two robotic trocars and one assistant trocar, and two other robotic trocars inserted to shape a hemi-circle around the surgical object. A total of 29 and 31 consecutive patients underwent RLR and RPD, respectively. The 5-cm single umbilicus incision + 2 ports method was used in 82.8% of patients undergoing RLR and 100% of patients undergoing RPD. No patients undergoing RLR developed hepatic insufficiency and bile leakage with the median postoperative hospital stay of 5 days. No patients undergoing RPD developed clinically relevant pancreatic fistula, delayed gastric emptying, and bile leakage with the median postoperative hospital stay of 8 days. Our standardized trocar placement technique is simple and widely feasible for lean-to-obese patients, allowing for RLR and RPD while minimizing incisions for patients.

A Large Parasitic Dermoid Cyst in The Pouch of Douglas, A Torsion Complication?

Abstract
 Objectives:
 To identify the underlying etiology of dermoid cysts in the pouch of Douglas.
 Case presentation:
 A 44-year-old woman presented to our clinic complaining of chronic, dull-aching lower abdominal pain of one-month duration. Pelvic ultrasound examination showed an eight-centimeter cystic appearing lesion in the right adnexa. Computed tomography (CT) suggested the diagnosis of dermoid cyst. Laparoscopy revealed a residual ovarian tissue on the right side and an eight-centimeter cystic mass occupying the pouch of Douglas. The entire specimen was removed en bloc through the umbilicus incision inside a bag with no spillage. Histopathologic examination confirmed the diagnosis of a mature cystic teratoma.
 Conclusion:
 Parasitic dermoid cysts are extremely rare entity especially those located in the pouch of Douglas. Autoamputation and reimplantation is the most accepted etiology to explain this phenomenon.
 
 Key-words: Autoamputation, dermoid cyst, Douglas, Laparoscopy, Mature cystic teratoma

Laparoendoscopic Single-Site Hysterectomy: A Single Surgeon Experience in a Tertiary Hospital

Objective: To evaluate the clinical and surgical outcomes of the total hysterectomy cases performed with the laparoendoscopic single site surgery.Study Design: A total of 24 women who underwent total hysterectomy by the laparoendoscopic single site technique due to benign gynecological disorders were retrospectively evaluated. The duration of the operation, estimated blood loss, weight of the uterus, intra- and postoperative complications, pre- and postoperative day 1 hemoglobin and hematocrit levels, postoperative 6- and 24-hour visual analogue scale scores, duration of hospital stay, and postoperative complications were evaluated.Results: The mean total operation time was 112.1±24 minutes. The average time between the umbilical incision and starting the hysterectomy was 10±2.1 minutes. Estimated blood loss was 50±25 ml. The average duration of the hospital stay was 1.5±0.4 days. The mean uterus weight was 135 g. The mean difference between the pre- and postoperative hemoglobin values was 1.1 g/dl. The mean visual analogue scale scores were 4.1 (0-7) and 1.9 (0-4) in 6- and 24-hour postoperative periods. None of the women had an intraoperative complication. One patient (4.2%) had a port site hernia 6 months after the operation.Conclusion: The total hysterectomy with laparoendoscopic single site technique is a reasonable method in selected patients with similar safety and feasibility, especially for women who prefer a single incision in umbilicus. The patient should be informed before the operation about potential complications such as a port-site hernia.

Laparoscopic Extended Anatomical Resection of Segment 7 by the Caudate Lobe First Approach: a Video Case Report

BackgroundLaparoscopic hepatectomy for segment (S) 7 is classified as one of the most difficult procedures to perform.1 Here, we report a standardized method with the caudate lobe first approach2,3 which may benefit such difficult procedures. MethodsA 76-year-old woman was diagnosed with multiple liver metastases after sigmoid colon cancer resection. Her liver function was normal. Abdominal CT showed multiple small tumors located in S3 (two), S7 (two), and S8 (two). ResultsAfter partial resection of S3, the right lobe was fully mobilized. The caudate lobe was first divided at the midline from the caudal side parallel to the ventral central line of the inferior vena cava, and the caudate process was detached from the posterior Glissonean pedicle. Then, the S7 Glissonean branch was exposed. After transecting it, the demarcation line was secured. The root of the right hepatic vein (RHV) was exposed by further transection of the caudate lobe. The superficial tissue was divided using ultrasonic shears, while the deeper tissue was divided using cavitron ultrasonic surgical aspirator. The main trunk of the RHV was continuously exposed from the caudodorsal side, transecting the S7 branches. Between the exposed main trunk of the RHV and the cutting line in the ventral liver surface, which had been marked on the left of the tumor in the dorsal part of S8, the liver parenchyma was divided, securing the surgical margin for all 4 tumors in S7 and S8. Specimens were placed into a retrieval bag and removed from the umbilicus incision. Operation time was 341 min, and estimated blood loss was 200 g. Metastatic adenocarcinoma was confirmed by postoperative pathological diagnosis. The postoperative course was uneventful. ConclusionsThe caudate lobe first approach in laparoscopic hepatectomy for S7 is feasible and can benefit anatomical resection in such procedures.

Transumbilical versus circumumbilical abdominal incision: a case control study

Objective To compare the clinical efficacy of transumbilical and circumumbilical abdominal incision in the abdominal surgery. Methods The clinical data of 71 patients who underwent open surgery at the Beijing Tiantan Hospital from May 2011 to April 2013 were retrospectively analyzed. All the patients were divided into the transumbilical group ( n =41) and circumumbilical group ( n =30) according to the selection of incisions. The intraoperative conditions of patients and incisionrelated complications between the 2 groups were analyzed. Patients were followed up by outpatient examination and reexamination till December 2013. The measurement data with normal distribution were presented as±s and analyzed using t test, and the count data were analyzed using the chi-square test or Fisher exact probability. Results The type Ⅱ and type Ⅲ incisions were used in 38 and 3 patients in the transumbilical group and 28 and 2 patients in the circumumbilical group, respectively, showing no significant difference between the 2 groups ( P>0. 05) . The operation time and volume of intraoperative blood loss in the transumbilical group and in the circumumbilical group were (186 ± 43) minutes, (255 ± 152) mL and (196 ± 55 ) minutes, (326 ± 172 ) mL, respectively, with no significant difference between the 2 groups ( t=–0. 807, –1. 799 , P >0. 05) . The length of incision in the transumbilical group was (14.3 ± 4.3) cm, which was significantly different from (17.3 ± 2.9) cm in the circumumbilical group ( t=–3. 288, P 0. 05) . All the 71 patients were followed up for 8–26 months , with a median time of 15 months. The surgical wounds between the 2 groups healed well. The abdominal incisions in the transumbilical group were in a straight-line shape, without occurrence of other complications. Conclusion Transumbilical incision compared with circumumbilical incision in abdominal operations has a shorter length, without increasing incision-related complications and with cosmetic benefits. Key words: Wound complications; Abdominal midline incision; Umbilicus incision; Umbilicus

Embryonic NOTES thoracic sympathectomy for palmar hyperhidrosis: results of a novel technique and comparison with the conventional VATS procedure

To avoid the disadvantages of chronic pain and chest wall paresthesia associated with video-assisted thoracic surgery (VATS) procedures, we developed a novel surgical technique for performing sympathectomy by embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) with a flexible endoscope. In this study, we compared the outcomes of E-NOTES with conventional VATS thoracic sympathectomy on palmar hyperhidrosis. From January 2010 to April 2011, a total of 66 patients with severe palmar hyperhidrosis were treated with thoracic sympathectomy in our department. Thirty-four transumbilical thoracic sympathectomies were performed via a 5-mm umbilicus incision with ultrathin gastroscope, then compared with 32 conventional needlescopic thoracic sympathectomies. Retrospective statistical analysis of a prospectively collected group of patients was performed. There was no significant difference with regard to gender, mean age, body mass index, and length of hospital stay between the two groups. The operative time for E-NOTES thoracic sympathectomy was longer than that of VATS thoracic sympathectomy (56.4 ± 10.8 vs. 40.3 ± 6.5 min, p < 0.01). No mortality, diaphragmatic hernia, or Horner syndrome was observed in either group. Postoperative questionnaires were returned by all treated patients with a mean time from operation to follow-up of 1.4 ± 0.3 years. All 66 patients receiving sympathectomy reported successful treatment of their palmar hyperhidrosis. Compensatory hyperhidrosis was noticed in 7 (20.1 %) and 6 (18.8 %) patients in the E-NOTES and VATS groups, respectively (p > 0.05). Postoperative pain and paresthesia were significantly reduced in the E-NOTES group at each time interval, and the aesthetic effect of the incision was superior in the E-NOTES group. Transumbilical-diaphragmatic thoracic sympathectomy is a safe and efficacious alternative to the conventional approach. This novel procedure can further reduce postoperative pain and chest wall paresthesia as well as afford maximum cosmetic benefits by hiding the surgical incision in the umbilicus.

Transumbilical Single-Incision Laparoscopic Fundoplication: A New Technique for Liver Retraction Using Cyanoacrylate

Single-incision laparoscopic fundoplication is not widespread because of its technical difficulty. An additional stay suture or retractor is often needed for liver retraction during the procedure. Here, we share our 7 cases to demonstrate the feasibility of transumbilical single-incision laparoscopic fundoplication with a new technique for liver retraction without any stay suture or retractor. From March 2010 to October 2011, 3 patients with achalasia underwent a transumbilical single-incision laparoscopic Heller-Dor operation, and 4 patients with hiatus hernia underwent transumbilical single-incision laparoscopic hernioplasty and Nissen fundoplication. The procedures were attempted transumbilically by using three rigid trocars (one was 10 mm, and two were 5 mm) inserted through the 2-cm umbilicus incision. Conventional laparoscopic instruments were used. Adequate retraction of the liver was achieved by binding the lateral left lobe of the liver to the diaphragm with cyanoacrylate. The pneumoperitoneal time was 115-170 minutes, and blood loss was 15-50 mL. There were no intra- or postoperative complications. The hospital stay was under 6 days for all patients. The umbilical incision healed well with satisfactory cosmetic effect. The transumbilical single-incision laparoscopic technique in the treatment of achalaisa and hiatus hernia is feasible for an experienced laparoscope surgeon with excellent cosmetic effect. Cyanoacrylate, when used as described, offers a safe and simple solution to the problem of liver retraction, thus obviating the need for a stay suture or liver retractor.

Combined Laparoendoscopic Single-Site Surgery: Initial Experience of a Single Center

This study reports the initial experience with combined laparoendoscopic single-site surgery (LESS) referring to cholecystectomy, appendectomy, oophorocystectomy and liver cyst and renal cyst fenestration and explore the feasibility and safety of combined LESS. From October 2008 to May 2011 selective 24 patients underwent combined LESS in our center. The single incision in umbilicus was about 2cm. All the operations were performed by the same surgical team and used conventional rigid instruments. In 24 patients, combined laparoendoscopic single-site cholecystectomy and appendectomy were performed in 17 cases, combined cholecystectomy and liver cyst fenestration in 5 cases and combined cholecystectomy and oophorocystectomy in 2 cases. Twenty one patients were successfully operated and the other 3 were converted to conventional laparoscopic surgery because of separating Calot's triangle difficulty. The mean operating time was 87.3 minutes. One urinary retention (4.2%) and one fat liquefaction in abdominal incision (4.2%) occurred and were cured conservatively. There was no mortality in the study. Combined laparoendoscopic single-site surgery is safe, feasible, minimally invasive and cosmetic technique but is more difficult than conventional laparoscopic surgery. It is a reasonable alternative to be performed in selective patients by experienced laparoscopic surgeons.

Pure SILS Floppy Nissen Fundoplication with Hiatal Repair: A Case Report

Background. Single-incision laparoscopic surgery has recently became popular on behalf of inventing less invasive procedures. In this paper, we present a case of Pure SILS Nissen Fundoplication. Patient and Methods. In February 2010 a 29-year old male patient with a 4 cm sliding hiatus hernia presenting with reflux symptoms had undergone a standard floppy Nissen Fundoplication with a hiatus repair via single 2 cm incision in umbilicus. Results. The procedure had obeyed the standard natural orifice surgery rules, and no needlescopic assistance for any stage of the operation was used so to be a pure single-incision procedure. The operation lasted for 120 minutes without any need of conversion, and the patient was discharged the following day of operation. Conclusion. In the recent time, hybrid single incision laparoscopy techniques have been defined with the use of extra-abdominal supplements for retraction of liver or stomach for Nissen procedure. In addition the main issue in single-incision upper GI and/or hiatus surgery is still the retraction of liver. We succeeded to retract the left lobe of liver through the incision and completed the operation without any need for supplemental access besides the umbilical incision till the end. SILS Hiatus Surgery can be safely and effectively done but the issue needs further clinical studies to state the efficacy when compared to standard laparoscopy.