Intracorporeal Suturing Techniques Research Articles

Spectrum of Minimally Invasive Surgical Techniques for the Managment of Inguinal Hernias in Infants and Children

One of the most common surgical procedures in infants and children is the repair of an indirect inguinal hernia. This can be carried out by open technique or using minimally invasive surgery (MIS). Since 1998, numerous different MIS techniques have been described. Scientifically proven advantages include a shorter operation time for bilateral hernias, along with a lower risk of metachronal, contralateral hernia. Nevertheless, the proportion of inguinal hernias treated using MIS in children in this country is relatively low, at around 8% of all operations. The aim of this synopsis is to describe the different MIS techniques for inguinal hernia repair in children, including their respective advantages and disadvantages.This video compilation shows the spectrum of different techniques for laparoscopic inguinal hernia repair in children. It includes the intracorporeal suturing technique, the incision of the peritoneum, extracorporeal percutaneous techniques, and the cauterisation of the open peritoneal vaginal process in girls.Although minimally invasive inguinal hernia repair in children is technically and scientifically established, it is not yet being widely used. This video manuscript provides an overview of the various techniques, thus facilitating clinical application.

Comparison of different suture techniques for laparoscopic vaginal cuff closure

Laparoscopic hysterectomy is a commonly performed procedure. However, one high-risk complication is vaginal cuff dehiscence. Currently, there is no standardization regarding thread material or suturing technique for vaginal cuff closure. Therefore, this study aimed to compare extracorporeal and intracorporeal suturing techniques for vaginal cuff closure using a pelvic trainer model. Eighteen experts in laparoscopic surgery performed vaginal cuff closures with interrupted sutures using intracorporeal knotting, extracorporeal knotting and continuous, unidirectional barbed sutures. While using an artificial tissue suturing pad in a pelvic trainer, experts performed vaginal cuff closure using each technique according to block randomization. Task completion time, tension resistance, and the number of errors were recorded. After completing the exercises, participants answered a questionnaire concerning the suturing techniques and their performance. Experts completed suturing more quickly (p < 0.001, p < 0.001, respectively) and with improved tension resistance (p < 0.001, p < 0.001) when using barbed suturing compared to intracorporeal and extracorporeal knotting. Furthermore, the intracorporeal knotting technique was performed faster (p = 0.04) and achieved greater tension resistance (p = 0.023) compared to extracorporeal knotting. The number of laparoscopic surgeries performed per year was positively correlated with vaginal cuff closure duration (p = 0.007). Barbed suturing was a time-saving technique with improved tension resistance for vaginal cuff closure.

Biópsia pulmonar por toracoscopia por dois portais com uma nova ligadura de alça pré-amarrada em coelhos: um estudo experimental

ABSTRACT: Thoracoscopy is replacing open lung biopsies because it is less invasive, usually the technique is done using three portals and intracorporeal suture technique. This study described the feasibility and efficacy of a novel pre tied loop ligature and to propose a thoracoscopic access strategy with two portals to perform lung biopsy in patients under 5 kg. Ten rabbits were positioned in dorsal recumbency. Total thoracoscopic lung biopsy was performed using a combined transdiaphragmatic approach and a right intercostal approach. A pre tied loop ligature was placed to perform a caudal lung lobe biopsy. Insufflation of the thoracic cavity was not performed. The total surgery time was 41.4 ± 14.5 min. The procedure was carried out free of complications that prevented slippage or tightening the knot or that made it come loose after the lung biopsy; there was no serious complication during the surgical procedure. The samples obtained averaged 1x0.64x0.45 cm (Length, Width, Depth) and were considered satisfactory according to the histopathologic evaluation. Thorax radiographs taken before and after the surgeries were compared and showed no pneumothorax or hemothorax. Necropsy confirmed no knot failure occurred at the biopsy site. The use of the novel pre tied loop ligature is a safe and effective technique, avoiding problems with the limited size of the thoracic cavity in small patients.

Laparoscopic inguinal hernia repair in children: Article review and the preliminary Maltese experience

BackgroundIn the past two decades, laparoscopy has provided an alternative approach to inguinal hernia repair. The aim of this review is to carry out a retrospective systematic analysis of articles dealing with laparoscopic hernia repair in children and a review of the Maltese experience. MethodsData was obtained from publications from 2002 to 2019. The endpoints include: patient demographics, clinical presentations, laparoscopic tools, ports, suture used, technical remarks, length of surgery, hospital stay, complications and follow-up. Results32 studies were included with a total of 10,183 patients. Most articles documented the use of 1 port. Length of surgery ranged from an average of 10 to 138 min. Ipsilateral recurrences were reported in 0.83% of cases, while 0.17% required conversion to open. Preliminary Maltese ExperienceIn our centre, a population of 514, 564 is covered (16% under the age of 18). A total of 14 cases of laparoscopic inguinal hernia repair were carried out from August 2018 till October 2020. The neonatal laparoscopic set-up involves a 30⁰ laparoscope, inserted via a 5 mm umbilical port, with 2 stab incisions allowing the use of 3 mm devices. Intra-corporeal purse string suture technique is used. The length of surgery ranged from 1 hr to 2 hr 30 min. There was 1 case of ipsilateral recurrence and another requiring conversion to open surgery. ConclusionsLaparoscopic inguinal hernia repair in children is a versatile and safe procedure that can be carried out with minimal complications and low reoperation rates.Level of Evidence: Level IV

Successful pregnancies in a mare after laparoscopic unilateral ovariohysterectomy

A 6 year old Thoroughbred mare was presented for investigation of infertility. Over 3consecutive seasons, she had been bred naturally (14 controlled estrous cycles) with 3 Thoroughbredstallions and did not become pregnant. The mare was bred artificially over 3 estrous cycles withsemen from a Quarter horse stallion (known for excellent fertility). Both ovaries appeared functional.During embryo collection on day 7 postovulation, failure of appropriate dilation of left uterine hornwas noticed after embryo collecting medium was infused. Diagnostic hysteroscopy was performedand partial patency defect of the left uterine horn was identified. After sedation and local anesthesia, aunilateral laparoscopic ovariohysterectomy was performed while the mare was standing.Approximately 80% of the left uterine horn was removed using a vasculature sealing device toprovide hemostasis and intracorporeal suturing technique was used for uterine closure. Subsequently,the mare became pregnant and foaled twice.

THE COMPARISON OF OUTCOMES AFTER LAPAROSCOPIC MYOMECTOMY WITH THE USE OF DIFFERENT UTERINE SUTURE TECHNIQUES

Purpose: to improve the outcomes and speed up the recovery after laparoscopic myomectomy in females with uterine leiomyoma, based on the comprehensive study and comparison of different uterine suturing techniques.&#x0D; Material and methods. The study enrolled 130 patients, including 100 females underwent laparoscopic myomectomy. Based on the simple randomization, the sample of 100 surgically treated females was subdivided into two subsamples depending on the applied uterine suturing technique: group I – extracorporeal knotting (n=50); and group II – intracorporeal continuous suturing (n=50). The control group included 30 apparently healthy females (group III). The clinical examination was performed before surgery in the outpatient setting, and in the hospital – after procedure and at the discharge (day 2). We assessed the parameters of myometrium tissue perfusion and the severity of inflammation in the surgical alteration area 1 month before and 1 month following the procedure. The ultrasound signs of myometrium regeneration completeness in the uterine scar area were determine 3 months after surgery. The late outcomes after myomectomy and catamnesis of reproductive function were evaluated at 6-month and 1-year follow-up.&#x0D; Results and discussion. We established that the use of intracorporeal continuous suturing technique in patients underwent laparoscopic myomectomy was favorable for preservation of microcirculatory bed in myometrium, related to a more uniform distribution of suture tension in the tissue and a more even distribution of pressure exerted on the wound edges, as compared to extracorporeal knotting technique. These advantages of intracorporeal continuous suturing technique over the extracorporeal knotting one are useful for the significant reduce of tissue hypoxia and myometrium ischemia in the alteration area. Additionally, this technique is in favor of the physiological programmed suture absorption and the cell-mediated immunity, and associated with the lower risk of necrotic areas formation. In contrast to the intracorporeal continuous suturing technique, the tight and non-uniform extracorporeal knotting is associated with the suppression of staged elimination of blood microclots and other factors of aseptic inflammation in the surgical alteration area.&#x0D; Conclusions. The use of extracorporeal knotting technique had no advantages over the intracorporeal continuous suturing, and, in the majority of cases, was associated with longer duration of procedure, inappropriate blood loss, as well as excessive consumption of suture material. The intracorporeal continuous suturing is the most optimal technique for uterine wound edges approximation, and associated with the positive outcomes regarding the reproductive function (the reproductive function could be realized in 3 months after the use of intracorporeal continuous suturing technique, in contrast to 6 months – after the extracorporeal knotting one), the minimal frequency of complications and favorable economic profile. The laparoscopic myomectomy in case of myoma sized 10 cm and more is associated with the risk of significant uterine wall defect and excessive blood loss, indicating the need for the intracorporeal continuous suturing technique for closing tissue defects in the area of surgical alteration of myometrium.

Combined Laparoscopic-Hysteroscopic Isthmoplasty Using the Rendez-vous Technique Guided Step by Step

To demonstrate the surgical technique of Rendez-vous isthmoplasty for the treatment of symptomatic cesarean scar defect. In this video, the authors show the complete procedure in a step-by-step manner to standardize and facilitate the comprehension and performance of the procedure in a simple and safe way. Step-by-step video demonstration of the surgical technique. Private hospital in Curitiba, Paraná, Brazil. The patient is a 36-year-old woman without any comorbidities, G3 C3, and with radiologic transvaginal ultrasound diagnosis of isthmocele grade 3 (over 25 mm) identified in the superior third of the cervical canal. The main steps of combined laparoscopic-hysteroscopic isthmoplasty using the Rendez-vous technique are described in detail. A combined laparoscopic-hysteroscopic approach was performed. Under general anesthesia, the patient was placed in 0° supine decubitus, with her arms alongside her body. Operative setup included 15 mm Hg pneumoperitoneum, created using the closed Veress technique, and 4 trocars: a 10-mm trocar at the umbilicus for a 0° laparoscope, a 5-mm trocar in the right iliac fossa, a 5-mm trocar in the left iliac fossa, and a 5-mm trocar in the suprapubic area. The procedure begins after a systematic exploration of the pelvic and abdominal cavities. Step 1: Identification of key anatomic landmarks and exposure of the operation field. Step 2: By carrying out blunt and sharp dissection with cold scissors or a harmonic scalpel, the visceral peritoneal layer over the isthmus area is opened, a vesicouterine space is developed, and the bladder is pushed down at least 2 cm from the lower edge of the isthmocele. Step 3: Final Phrase: By hysteroscopic exploration of the cervical canal using the vaginoscopic approach, identification and delimitation of the isthmocele its performed by recognizing the diverticular mucosal hyperplasia, and then the hysteroscopic light is pointed directly toward the cephalic limit of the scar defect. Step 4: Laparoscopic lights are decreased in intensity and the "Halloween sign" is identified (hysteroscopic transillumination). The light of the hysteroscope is pointed to the top of the cesarean scar defect allowing the laparoscopist to identify the upper and lower edges of the scar. Step 5: Laparoscopic resection of all scar tissue, excision of all the edges of the pseudo cavity. Step 6: Adequate intracorporeal suturing technique, with a 2-layer myometrial repair using intracorporeal running and interrupted stitches of polydioxanone 2-0, is done, while ensuring preservation of the cavity by not including the endometrial tissue in the myometrial suture [1-3]. Step 7: Installation of the methylene blue dye to locate any leakage. The surgery ended without any intraoperative complications and within 60 minutes. The patient was discharged on the first day postoperatively and became pregnant 6 months after surgery, with a final C-section delivery of a healthy term newborn at 39-weeks gestational age. Combined Rendez-vous isthmoplasty is feasible, safe, and effective in experienced hands, giving the surgeon a comprehensive evaluation of the anatomy of the isthmocele, and increasing the odds of a complete resection and restoration of the anatomy [4-7]. In this patient, the procedure was uneventful, without any intra- or postoperative complications, and the symptoms were completely controlled.

Intracorporeal circular-stapled anastomosis after totally laparoscopic gastrectomy: A novel, simplest u-shaped parallel purse-string suture technique.

Intracorporeal anastomoses in totally laparoscopic gastrectomy (TLG) remain technical challenges to many surgeons, although the intracorporeal jejunojejunal or gastrojejunal anastomosis is an essential procedure during TLG. Standardized, reproducible and simple circular-stapled anastomosis in open gastrectomy is limited in TLG due to the difficulties of intracorporeal purse-string suture or anvil placement. An optimal procedure for intracorporeal anastomosis in TLG remains to be established. Between February 2018 and January 2019, 31 consecutive patients with gastric cancer underwent totally laparoscopic total gastrectomy (TLTG) or totally laparoscopic distal gastrectomy (TLDG) using the novel u-shaped parallel purse-string suture technique along the jejunum for anvil placement. The intracorporeal circular-stapled jejunojejunostomy of Roux-en-Y reconstruction in TLTG and gastrojejunostomy of Billroth II in TLDG were, respectively, performed. The total mean ± SD operative time was 214.7 ± 48.6 minutes. The time required for purse-string suture and anvil placement was 2.3 ± 0.5 and 4.4 ± 1.1 minutes, respectively. There were no instances of postoperative jejunojejunal or gastrojejunal anastomosis-related complications observed during the median follow-up period of 5.5 months. The novel procedure conceptionally and technically changes the conventional circular-shaped purse-string suture into a much simpler way, u-shaped parallel purse-string suture. This could be the simplest published intracorporeal pure-string suture technique.

Novel application of the sewing machine principle; a new simplified intracorporeal suturing technique for pediatric inguinal hernia

BackgroundThe desire of pediatric surgeon to reduce incision related morbidity and pain while achieving good cosmetic results has recently led to the introduction of single incision pediatric endosurgery [SIPES] and needlescopic surgery. Intracorporeal suturing and knot tying during SIPES remain challenging. The aim of this study is to introduce a novel and simple technique for intracorporeal suturing of the pediatric inguinal hernia after needlescopic disconnection of hernia sac using just needles rather than laparoscopic instruments. It is an imitation of the principles of sewing machine. MethodsThe first author discussed the idea of the technique with the coauthors and a demonstration was done on a Silicon Pad before application of the technique on children with congenital inguinal hernia [CIH] for peritoneum closure after needlescopic disconnection of the hernia sac. The main outcome measures were feasibility of the technique, suturing and knotting time and recurrence rate. ResultsThe sutures were snugly applied to the ridges of Silicon Pad with good approximation and the knot was firmly tightened in all experiments. After applying and mastering the technique on a Silicon Pad, we shifted to use it on 373 children with 491 hernia defects. All operations were completed by the needlescopic technique without the need for insertion of any laparoscopic instruments. The time required for suturing of the peritoneum around internal inguinal ring [IIR] and knot tying, decreased considerably from 6 min 27 s in the first operation to less than 4 min after the fifth operation and stabilized at approximately 4 min 30 s. No major intraoperative complication. There was no recurrence during a mean follow-up period of 19.6 ± 1.2 months. ConclusionThe closure of the peritoneum around the IIR using needles mimicking what is happening in sewing machine suturing is a feasible, safe and effective line of treatment of children with CIH. The cosmetic results are 42 outstanding without any recurrence.

Polypropylene Suture Versus Absorbable Tack Mesh Fixation in Laparoscopic Pectopexy: A Retrospective Study

Backgound: The aim of this study to investigate whether tacker and suture materials used for mesh fixation in the laparoscopic pectopexy would yield significant differences with respect to feasibility, safety, and postoperative outcomes Methods: A total of 26 women who underwent laparoscopic pectopexy between January 2015 and June 2017 at the Kocaeli Derince Education and Research Hospital were retrospectively analyzed. Fourteen patients had the mesh fixation onto the iliopectineal ligaments and vaginal stump with polypropylene suture using intra-corporeal suturing technique and twelve patients had the mesh fixation tacks via the absorbable mesh fixation devices of commercial tack device - Absorbatack™. (Suture group: 14 subjects, tacker group: 12 subjects). Results: Twenty-six patients underwent laparoscopic pectopexy. Tacker group had a significantly shorter duration of operation and time required for placement of mesh than the suture group (P

Vaginal Cuff Closure in Minimally Invasive Hysterectomy: A Review of Training, Techniques, and Materials.

Hysterectomy is one of the most common surgeries performed each year and can be indicated for many gynecologic conditions. The development of minimally invasive surgery has transformed this procedure, resulting in improved outcomes, superior cosmesis, and quicker return to normal function. Vaginal cuff closure is a critical component of hysterectomy, with many variations in surgical technique and materials. This review provides an overview of intracorporeal suturing and knot-tying techniques at the level of a junior resident in obstetrics and gynecology and describes several validated models that have been developed to test resident skill level in vaginal cuff closure. We also provide a review of the literature regarding vaginal cuff closure techniques and suture materials, including knotless barbed sutures. Finally, a brief discussion of single-site surgery, the latest development in minimally invasive hysterectomy, will be provided. We hope to provide a better understanding of vaginal cuff closure for residents in the field of obstetrics and gynecology.

288 - Quick Achievement for Laparoscopic Intracorporeal Suture Technique: From Isolated Motions to Make the Suture in One Go in the K-Box Model

Generally, people are confused about the terms of suturing, knotting, looping and needling driving/holding which lead to poor communication between tutors and trainees and low learning efficiency. In my opinion, making the suture includes four elements: needle holding- > needle driving- > looping- > make a knot. The first cycle completes a simple suture and the continuous suture is achieved when the cycle goes on. In this video, tips/tricks and errors of the four elements (needle holding, driving, looping, knotting) would be addressed in K-Box model, a low-cost simulator training set. (Huaprac Inc., Taiwan, www.huaprac.com)

The efficacy of laparoscopic intracorporeal linear suture technique as a strategy for reducing recurrences in pediatric inguinal hernia.

Pediatric laparoscopic herniorrhaphy has rare complications, but recurrence might occur. The purpose of this manuscript is to evaluate the efficacy of linear suture technique of laparoscopic pediatric herniorrhaphy in reducing recurrences. Laparoscopic surgery was performed on 2223 pediatric patients (under 10years old) from September 2012 to December 2014 in Damsoyu Hospital, Seoul, Republic of Korea. The causes of recurrence were investigated case by case. The patients were categorized into two groups according to the suture method used in closing the hernia orifice: Group 1 (purse-string suture, 1009 patients) and Group 2 (linear suture, 1214 patients). There were 1413 (63.6%) male and 810 (36.4%) female patients. Mean age was 30.5±29.2months. A significantly higher proportion of male patients, contralateral patent processus vaginalis, and less proportion of recurrence were observed in Group 2. There were ten cases of recurrence in Group 1 because the internal ring suture could not endure the tension. One recurrence occurred in Group 2. The suture technique and age were found to be a significant risk factor for recurrence. Linear suture technique had a lower recurrence rate (odds ratio=0.07, with 95% confidence interval 0.01-0.53, and p=0.004). Purse-string suture technique causes significantly higher occurrence of hernia recurrences than linear suture technique. Linear suture technique can reduce recurrence by increasing the endurance to tension around the internal ring by distributing pressure to a wider area along the linear suture line. Linear suture technique can effectively reduce recurrence in pediatric inguinal herniorrhaphy.

Laparoscopic Management of Gastrointestinal Stromal Tumors: Nine Patients with Different Locations and Presentations: Retrospective Study

Background: Laparoscopic management of gastrointestinal stromal tumors (GISTs) is safe and effective. It is considered to be the preferred technique offered to the patient. Laparoscopic wedge resection has been widely accepted for small- and medium-sized GISTs. The use of laparoscopic approach should be based on a variety of factors including: patient characteristics, tumor size, and presence of invasion, location of tumor, surgeon and laparoscopic expertise. Patients and methods: Total number of nine patients with GISTs who presented to our unit from January 2010 till May 2015 were retrospectively reviewed. Patients’ demographics, clinical data, intraoperative and postoperative complications, and histopathological data were analyzed. Most lesions were resected via a wedge technique with closure of defect either by an endoscopic linear stapling device or intracorporeal suturing technique. Results: Nine patients who presented with GISTs underwent laparoscopic resection according to its position and size. The median age at diagnosis was 48 years old, and average tumor size was 4.2 cm with the largest tumor measuring 7.5 cm. There was no episode of tumor rupture or spillage and no major intraoperative or postoperative complications. All margins were negative, mean follow up was 14.4 (range 8.5–15.2) months. Majority of lesions were resected via laparoscopic wedge resection except one case (female patient aged 48 years old) that presented with GIST located at the gastric fundus , this patient underwent proximal (partial gastrectomy) and another case (adult male 26 years old) that presented with upper rectal GIST was managed via laparoscopic anterior resection. There was no evidence of metastasis or recurrence except in the patient who had been presented with rectal GIST. Conclusion: Laparoscopic resection is safe and effective for GISTs not exceeding 6 cm. Gastroesophageal junction and cardia GISTs require careful preoperative evaluation and planning to be removed safely. Laparoscopic removal is currently the surgical treatment of choice for patients with primary localized GISTs, and open surgery is not even considered unless there are contraindications to the laparoscopic approach

Retroperitoneoscopic ureteroplasty for retrocaval ureter: report of nine cases and literature review

Objective: The aim of this study was to report the experience of retroperitoneal laparoscopic ureteroplasty for nine cases of retrocaval ureter.Material and methods: Six males and three females were referred with a diagnosis of retrocaval ureter. A retroperitoneal laparoscopic approach was taken in all patients, who were diagnosed by intravenous pyelography (IVP), computed tomography urography and retrograde pyelography. After the dilated proximal ureter was mobilized, the ureter was transected just above the retrocaval segment, which was repositioned to the anterior of the vena cava. The retrocaval segment was observed and evaluated to enable a decision as to whether or not to reserve. Then, tension-free, water-tight anastomosis was performed with absorbable sutures using intracorporeal suturing techniques over a double-J stent, which was laparoscopically inserted in an antegrade manner. The stent was removed 4–6 weeks postoperatively.Results: The ureteroplasty was accomplished in all cases. The retrocaval segment of the ureter was reserved with a grossly normal appearance in six cases; the abnormal retrocaval segment was excised in the three other cases. The mean operative duration was 103 min (range 89–110 min) and the mean hospital stay was 7 days (range 6–9 days). No serious complications occurred. Follow-up by ultrasonography and IVP, lasting 6 months to 4 years, revealed considerable improvement in hydronephrosis and upper ureteral dilatation. No ureteral stenosis was found at the anastomotic site.Conclusion: Retroperitoneoscopic ureteroplasty should be recommended as the first line treatment for retrocaval ureter because of its advantages of minimal invasion and shorter hospital stay than open surgery. Skilled laparoscopic anastomosis with a retroperitoneal approach can shorten the operative duration.

Метод эффективного симуляционного обучения технике интракорпорального шва

Метод эффективного симуляционного обучения технике интракорпорального шва

Totally laparoscopic living donor right hepatectomy in a donor with trifurcation of bile duct

Donor operation in adult living donor liver transplantation is associated with significant postoperative morbidity. To avoid laparotomy wound complications and shorten postoperative recovery, laparoscopic liver graft harvest has been developed recently. However, to determine the cut point of bile duct is challenging. Herein, we report the application of totally laparoscopic approach for right liver graft harvest in a donor with trifurcation of the bile duct. A19-year-old man volunteered for living donation to his father who suffered from hepatitis B virus-related cirrhosis of liver and hepatocellular carcinoma. The graft was 880 mL with a single right hepatic artery and portal vein. The graft to recipient weight ratio was 1.06. The middle hepatic vein was preserved for the donor and the liver remnant was 42.3%. Two branches of middle hepatic veins were > 5 mm in diameter and needed reconstruction with cryopreserved allograft. Ductoplasty using laparoscopic intracorporeal suture technique was done to achieve single orifice of the graft bile duct. The postoperative course was uneventful for the donor. This report adds evidence of the feasibility of pure laparoscopic right donor hepatectomy and describes the necessary steps for bile duct division in donors with trifurcation of bile duct.

Role of testing before teaching basic laparoscopic skills

Background. The urgency of the problem with training specialists in laparoscopic techniques is due to the wide introduction of minimally invasive technologies into surgical practice. Previously untrained, a surgeon runs considerable difficulties with the coordination of movements and the use of tools, which may lead to both the longer life of surgical aids and damage to the viscera and vascular structures in a patient. Many factors influence the level of manual skills in the audience at the beginning of training, which further affect its duration and hence cost. Objective. To evaluate the effect of initial level of basic manual skills for the duration of the study. Materials and methods. The investigation enrolled 255 listeners: medical students, interns, residents, and practicing surgeons. Manual skills as single successive performance of exercises 1 (peg transfers) and 2 (cutting a circle) in an endotrainer box were tested before training. The correlation of the results of testing for the rate of formation of basic laparoscopic skills was then analyzed. Results. According to the results of the testing, only 20 % of the physicians showed a result of less than 110 s and were ready for being further taught in intracorporeal suturing techniques. The authors consider that all students and interns/residents and most physicians must start their training in laparoscopic technique from a series of basic exercises. The analysis revealed a correlation between the results of doing exercises 1 and 2 and the number of their repetitions to achieve the needed level (r = 0.66). Conclusion. The single performance of peg transfers and cutting a circle exercises before training could objectively measure the performance of laparoscopic skills, define an individual plan, and optimize the costs of the training.

Laparoscopic Repair of Duodenal Atresia in a Low Birth Weight Neonate

The small volume of the infant abdomen limits the application of laparoscopic procedures. We successfully repaired a duodenal atresia in a 2-kg female infant using a standard diamond-shaped anastomosis and intracorporeal suturing and knot-tying techniques. Anesthesia and positive pressure ventilation assured adequate gas exchange during pneumoperitoneum during the procedure.

Three major problems and solutions in laparoscopic abdominoperineal resection for rectal carcinoma

To investigate the three major problems and solutions in laparoscopic abdominoperineal resection(APR) for rectal carcinoma. A retrospective study of 60 low rectal carcinoma cases undergoing selective laparoscopic APR from September 2010 to May 2013 in our hospital was undertaken. A laparoscopic sigmoid stoma was performed through the extraperitoneal route at the left lower abdomen puncture point after lymphadenectomy and tumor excision during operation. Using the unique intracorporeal suture technique of transanal endoscopic microsurgery(TEM), the pelvic peritoneum was closed by continuous suture with TEM needle-forceps and absorbable suture. Those patients with the successful pelvic peritoneum closure received continuous irrigation of presacral space from the third postoperative day to prevent perineal incision infection. Only one patient (1.7%) was converted to laparotomy. Fifty-nine patients underwent laparoscopic APR and laparoscopic sigmoid stoma was successfully performed through the extraperitoneal route without abdominal incision, and the incidence of stoma complication was only 3.4%. Out of 59 patients undergoing laparoscopic APR, the pelvic peritoneum of 56 patients(94.9%) was closed successfully. The median time of closing the pelvic peritoneum was 15 min. Fifty-seven patients with pelvic peritoneum successfully closed by laparotomy or laparoscopic approach received continuous irrigation of presacral space and the median time of presacral drainage tube placement was 7.8 days. No patient developed postoperative intestinal obstruction. The rate of perineal wound healing in grade A, B and C was 87.7%, 8.8% and 3.5%, respectively. In the 3 patients whose pelvic peritoneum failed to be closed with simple drainage of presacral space, one developed postoperative intestinal obstruction and one had a grade C perineal wound healing. Laparoscopic sigmoid stoma through the extraperitoneal route during laparoscopic APR for rectal carcinoma is feasible and safe. It is convenient and effective to close pelvic peritoneum by using TEM intracorporeal suture technique. It is worth discussing the role of continuous irrigation of presacral space postoperatively to prevent perineal incision infection.