Laparoscopic Reconstructive Surgery Research Articles

Trans abdominal pre peritoneal inguinal hernioplasty: initial experience in resident training service

Introduction: Abdominal wall hernia surgery is one of the most common procedures performed by general surgery departments. The most common techniques currently used are: plastic surgery without mesh (Shouldice), plastic surgery with mesh (Lichtenstein) and laparoscopic plastic surgery (TAPP or TEP). More and more surgical groups are performing laparoscopic inguinal hernioplasty. Numerous studies have shown that treatment of inguinal hernias by laparoscopy has recurrence rates comparable to those established by conventional surgery. However, it has been objected that learning laparoscopic surgery is more difficult and longer than that required for the conventional technique. Objectives: To analyze the results obtained in the short and medium term during the initial experience in the development of the transabdominal pre peritoneal technique (TAPP) in a service that trains residents. Materials and methods: We conducted a prospective, observational study of the first 30 patients operated for inguinal hernias according to the TAPP technique in the General Surgery Service of the Hospital Escuela Eva Perón of Granadero Baigorria, during the period from June 2017 to June 2018. Results: 30 patients underwent elective surgery. 28 men and 2 women (93.3% and 6.7%), with a mean age of 51.17 years (range: 21 and 78 years); the mean BMI was 26.86. All were operated by TAPP (transabdominal pre peritoneal) technique. 100% of the surgeries were performed by a resident always accompanied by a staff surgeon. Comorbidities: 9 patients (30%) had arterial hypertension. 3 patients (10%) had asthma and another 3 (10%) had diabetes. 27 were indirect inguinal hernias, 6 were direct and 2 were mixed. 5 patients (16.6%) had a contralateral hernial defect as an intraoperative finding and bilateral hernioplasty was performed. The average anesthetic time was 130 minutes (range 90-180 minutes). Sixty percent of the cases were managed as outpatient surgeries, the remaining 40% were hospitalized for 24 hours because they were admitted to the operating room in the afternoon. Complications: 2 patients (6.66%) presented cord or testicular hematomas. One patient (3.33%) presented infection of the umbilical trocar wound. One patient (3.33%) had recurrence in the immediate postoperative period. Two patients (6.66%) presented chronic groin pain (more than 30 days) of mild intensity, evaluated by VAS (visual analogue scale) and required additional analgesia. There were no conversions from laparoscopic to conventional repair. Seven patients (23.3%) were not working at the time of surgery. Of the remaining 23, 82% returned to their usual work activity one week after surgery. 20 patients (66.6%) went for follow-up one year after the operation and underwent a survey, which showed that 100% of the patients surveyed were satisfied with the operation and would recommend it. Conclusion: Laparoscopic inguinal hernioplasties have a low rate of recurrence and complications, comparable to those obtained with the conventional technique. Likewise, the learning curve is longer, but it is possible to perform it during the training stage as a resident doctor.

Preoperative Tamsulosin to Prevent Postoperative Urinary Retention after Pelvic Floor Repair Surgery

<h3>Study Objective</h3> The purpose of the study is to evaluate the effect of preoperative Tamsulosin on postoperative urinary retention (POUR) in patients undergoing surgery for pelvic organ prolapse. <h3>Design</h3> A prospective randomized control trial. <h3>Setting</h3> Patients enrolled in the outpatient clinic setting. Medication given in the preoperative area, the day of surgery. Voiding trial was performed in the post-anesthesia recovery unit (PACU). <h3>Patients or Participants</h3> 100 patients were enrolled with 50 in each arm, randomly assigned. Patients diagnosed with pelvic organ prolapse undergoing vaginal or laparoscopic reconstructive pelvic surgery with or without mid-urethral sling. <h3>Interventions</h3> Oral Tamsulosin 0.4mg given 30-90 minutes before the procedure. Active voiding trial was performed within 4 hours of patients arriving to the PACU. <h3>Measurements and Main Results</h3> 48 patients enrolled in the control group and 47 patients in the study group. When comparing demographics, there were no statistically significant differences between the groups except for preoperative uterine prolapse <i>(p<0.05).</i> For the primary outcome, there was no statistically significant difference in incidence of POUR between the 2 groups <i>(p=0.73).</i> A total of 36 patients had POUR; 17 (36.2%) in the study group and 19 (39.6%) in the placebo group. A multivariate cox regression analysis determined that the study group had a hazard risk of 1.1 [95% CI 0.47-2.59] but was not statistically significant <i>(p=0.81).</i> Preoperative uterine prolapse also had an increase hazard risk of 1.25 [95% CI 0.52-3.04] but also failed to meet statistical significance <i>(p=0.62).</i> Postoperative narcotic use <i>(p=1.0)</i> and increased length of surgery <i>(p=0.51)</i> had no increase in POUR. <h3>Conclusion</h3> In this study, the incidence of POUR was not significantly decreased after a single preoperative dose of Tamsulosin. Receiving Tamsulosin with preoperative uterine prolapse had an increased hazard risk for POUR but was not statistically significant. At this time, we do not recommend a single dose of tamsulosin to decrease POUR after prolapse surgery.

The role of new medical technologies in the relief of chronic pelvic pain and the rehabilitation of reproductive function

The low efficacy of ongoing conventional therapy and a significant decrease in the quality of life in patients with reconstructive plastic surgery (RPO) on the pelvic organs (PO) due to tubal-peritoneal infertility (TPI) and chronic nonspecific salpingo-oophoritis (CNSO) requires searching for new, promising methods of non-drug treatment, in particular, taking into account the regional characteristics of the Republic of North Ossetia-Alania and its natural resources. One of the main ways to increase the efficacy and intensify the treatment of this category of patients is the use of natural factors, namely, sulfide waters of the local Redant-4 deposit, which have a number of anti-inflammatory effects. Purpose of the study is to assess the role of non-drug technologies using magnetic infrared-laser therapy and balneological factors of the local deposit in the rehabilitation of the reproductive function in patients undergoing reconstructive plastic surgery due to TPI and CNSO. Material and methods. 235 women with impaired reproductive function, who underwent laparoscopic reconstructive plastic surgery on the pelvic organs (RPO on PO) due to tubal-peritoneal infertility (TPI) and CNSO, whose average age was 28 + 7 years, were examined. 2 groups were formed by the method of blind sampling: the main group consisted of 139 women with RPO on the pelvic organs due to TPI and CNSO, who, along with conventional therapy, received magnetic IR-laser therapy and had hydrogen sulfide baths; the comparison group included 96 women with RPO on PO due to TPI and CNSO, whose treatment was carried out by conventional methods of drug therapy. The conventional treatment included along with antibiotic therapy the use of ecological adaptogens (aloe, apilac), immune modulators (polyoxidonium), vitamin therapy (vitamin E 100 mg / day for 3 months and B vitamins), drugs to eliminate disorders in the intestinal and vaginal flora (antifungal agents: fluconazole, tergynan, acylact for 7-14 days). The patients of the studied groups were observed before their treatment and 1-12 months after the treatment. All patients underwent a clinical and functional examination. Statistical processing of the material was carried out using the package Statistica for Windows. Results. A control examination of patients of both groups showed a more pronounced positive effect on the course of a number of clinical symptoms in the postoperative period in the main group of patients who received magnetic IR laser therapy and had sulfide baths of the North Ossetian deposit in the complex of therapy. As a result of the physiotherapy treatment, the pain syndrome was eliminated in 107 of 139 patients (77%) who complained of pain before their treatment. A decrease in pelvic pain after the course of treatment was noted in 46 patients (33%). It should be noted that in the majority of patients 94 (68%), who received sulfide balneotherapy, a decrease in the formation of repeated adhesions of the pelvis was revealed during the procedures, the effectiveness of the regression of the adhesive process was found throughout the observation. It was detected that against the background of the proposed non-drug technology in the rehabilitation treatment of patients with RPO on PO due to TPI and CNSO, a significant increase in the effectiveness of treatment of this pathology (89%), improvement in the quality of life of patients as well as restoration of fertility has been achieved. Conclusions. The use of the method of sulfide balneotherapy in patients with RPO on PO due to TPI and CNSO allows shortening the duration of their next treatment and achieving the maintenance of positive dynamics and duration of regression of the adhesive process of the pelvis.

Combination of plastic surgery of the pyeloureteral junction with kidney transposition and nephropexy in hydronephrosis of a dystopic kidney

Introduction. Obstruction of the pyeloureteral junction is the most common anomaly of the upper urinary tract. Irrespective of the causes, narrowing of the ureteropelvic junction leads to abnormal urine outflux, increased intrarenal pressure, gradual sclerosis of renal parenchyma, loss of kidney function. In some cases, obstruction of the ureteropelvic junction can be accompanied by dystopic kidney, nephroptosis, abnormal location of the main and accessory renal vessels which requires correction of the standard surgical treatment.The study objective is to evaluate the effectiveness of combination of laparoscopic pyeloplasty with kidney transposition and nephropexy in obstruction of the pyeloureteral junction of a dystopic kidney.Materials and methods. Medical records of 8 patients who underwent surgery in the Kracnoyarsk Regional Clinical Hospital between 2017 and 2021 were analyzed. Obstruction of the pyeloureteral junction was confirmed clinically by ultrasound of the kidneys, excretory retrograde pyelography, contrast-enhanced spiral computed tomography.Results. In all of the 8 patients, lumbar dystopia of the affected kidney was diagnosed, in 25 % pathology was accompanied by nephroptosis, in 50 % of cases by abnormal location of the main and accessory renal vessels. All patients underwent laparoscopic plastic surgery of the pyeloureteral junction per Anderson–Hynes with antegrade ureter stenting, kidney transposition, nephropexy. Mean operative time was 190 ± 39 min, no intraoperative blood loss was observed. Ureteral catheter was removed at day (6.3 ± 2.2). Hospital length of stay was 9.3 ± 3.7 days. In 1 patient, postoperative period was complicated by suture breakage in the posterior wall of the pyeloureteral anastomosis which required repeat laparoscopy to correct suture defect. Time of ureteral stent implantation was 34.6 ± 8.5 days. Control examination showed full remission of pain syndrome. Excretory urography showed full outflow of the contrast agent after examination with furosemide in 100 % of cases.Conclusion. Combination of laparoscopic plastic surgery of the pyeloureteral segment with kidney transposition and nephropexy is an effective minimally invasive operation for treatment of ureteropelvic junction stricture of a dystopic kidney.

Women’s Preference for Cosmesis of Incisions Used for Open Versus Robotic Lower Urinary Tract Reconstructive Surgery

OBJECTIVE: To compare the cosmetic appeal of incisions used for open (Pfannenstiel or Vertical midline) versus robotic-assisted laparoscopic lower urinary tract reconstructive surgery in women.&#x0D; STUDY DESIGN: Cross-sectional descriptive study&#x0D; PLACE AND DURATION: Outpatient Urology Clinic of Western General Hospital, Edinburgh Scotland, UK from 1st February 2019 till 28th February 2020. &#x0D; METHODS: All patients were provided illustrations of Pfannenstiel incision (incision at “bikini line”- (A), Vertical midline laparotomy incision (incision from midline symphysis to umbilicus –( B), Robotic-assisted laparoscopic incisions-variation I- (C) and Robotic-assisted laparoscopic incisions-variation II (-D). Patients were asked to rate each incision in order of their preference. Chi square distribution was used to compare mean previous surgeries and no previous surgeries between different preferred incisional groups and ages of the patients.&#x0D; RESULTS: One hundred patients with mean age were 53.11±15.05 years with minimum 19 years and maximum 84 years and mean BMI was 28.18±7.05 kg/m2 with minimum 15.6 and maximum 55 kg/m2 calculated. Out of 100 patients (1st preference of incision), 78% preferred incision A, 3% preferred B incision and 16% &amp; 3% patients preferred incision C and D respectively. Similarly (2nd preference of incision) 3% patients preferred incision A, 19% preferred B incision and 56% &amp; 22% patients preferred incision C and D respectively. The mean comparison between first preferred incision with second preferred incision with respect of surgeries (previous surgeries and no previous surgeries) showed significant difference p≤0.05 (chi value=167.692, p=0.000). Relation of preferred incisions with respect to ages of the patients showed no significant difference (Pearson relation value -0.182 and p=0.069).&#x0D; CONCLUSION: Overall, open incisions were preferred over robotic incisions. Patient perception of the "visibility" of abdominal incisions and previous experience in term of surgical scars may be the distinguishing issue to explain the difference in the preferences between open versus robotic-assisted laparoscopic incisions in women.

Laparoscopic ureteroplasty with buccal mucosa graft for ureteral tuberculosis

SummuryTuberculosis of the urinary system is still a surgical dis-ease and a promising direction in its treatment is the development of new methods of reconstruction of the urinary tract. Purpose. This clinical case demonstrates the possibility of using laparoscopic buccal uretero-plasty in a patient with tuberculous obliteration of the lower third of the ureter. Material and methods. The patient, who was repeatedly operated for tuberculo-sis of the right kidney and ureter, underwent laparo-scopic plastic surgery of the lower third of the right ureter using tubularized buccal graft. Results. No sig-nificant postoperative complications were observed in the patient. The observation period of the patient was 5 months, no obstruction of the urinary tract has been identified at the moment. Conclusion. This operation can be recommended as one of the options for the surgical treatment of obstructive uropathy in nephro-tuberculosis, as an alternative to more complex recon-structive interventions.

Review. Gastrointestinal Surgery in Neonates: Practice, Facts, and Trends

The author presents an overview of the current trends in acute neonatal gastrointestinal surgery. Necrotizing enterocolitis and focal intestinal perforation are disorders of different etiology, appearance, and prognosis. In neonates with focal perforation, a good prognosis can be expected. Primary anastomosis is a valid option for primary surgery. Meconium ileus is based on obstruction of the terminal ileum. Medical treatment is the primary therapeutic option, although surgery may be required. In contrast, meconium plug syndrome is based on stool plugging in the left colon, and surgery is not appropriate. Hirschsprung’s disease is confirmed on the basis of representative biopsy of the rectum just above the dentate line. There is a trend toward a single-step pull-through operation without protective stoma. Open hernia repair in small neonates can be performed via a mini-incision and without opening the external inguinal ring. Laparoscopic hernia repair has some advantages, especially in girls. In infants with pyloric stenosis, laparoscopic pyloromyotomy is a first line option for treatment. There is a general trend toward single-stage procedures and laparoscopic reconstructive surgery for gastrointestinal malformations. With the exception of tracheoesophageal fistula and low bowel obstruction, the vast majority of upper gastrointestinal malformations can be identified using prenatal ultrasound examination. One-stage repair with excellent results is even possible in neonates below 1000 g. Surgery of duodenal or small bowel atresia can be performed following the postnatal adaptation period. For some forms of anorectal malformation, the need for a protective stoma has been questioned in the last decade. Posterior sagittal anorectoplasty remains the standard procedure for the majority of cases. Midgut or segmental volvulus affects different groups of infants. If a neonate is suspected of having any type of volvulus, urgent surgery is required. Intestinal duplication carries a high risk for complications, and surgery should be performed on an elective basis.

Laparoscopic Reconstruction in Post-Tubercular Urinary Tract Strictures: Technical Challenges.

Genitourinary tuberculosis still continues to plague developing countries and is a significant cause of morbidity as well as mortality in the developing world. At present, nearly 55% of the patients of genitourinary tuberculosis (GUTB) need surgical management. Owing to the presence of dense adhesions and loss of normal anatomical planes, GUTB was considered to be a contraindication to laparoscopic surgery. However, recent literature shows laparoscopy to be feasible in GUTB. Our study aimed at identifying the challenges in laparoscopic urinary tract reconstructive surgery in genitourinary tuberculosis-related urinary tract obstruction. The details of 6 patients who underwent different types of laparoscopic reconstructive surgery for genitourinary tuberculosis-related urinary tract obstruction from January 2014 to December 2015 were reviewed. Baseline characteristics, indications of surgery, type of surgery, operative duration, blood loss, and follow-up details were noted. All patients received antitubercular treatment before surgery as per the direct observed treatment short-course regimen followed in our country. We performed one bilateral laparoscopic pyeloplasty, one unilateral laparoscopic pyeloplasty, two laparoscopic ureteroneocystostomies, and two ureteroureterostomies. Difficulty was encountered during dissection owing to the presence of adhesions, but conversion to open surgery was not done in five cases. Dense adhesions adjacent to the common iliac vessels necessitated conversion to open surgery in one of the ureteroureterostomies. Stenting was done in all the patients. All patients had uneventful postoperative recovery. Functional imaging following stent removal showed unobstructed tracer flow, showing successful operative outcome. Our study showed that laparoscopic reconstructive surgery is feasible in genitourinary tuberculosis despite the presence of adhesions that may pose a challenge to dissection. This is in contrast to the previous studies which conclude that genitourinary tuberculosis is a relative contraindication to laparoscopic surgery.

Laparoscopic reconstructive surgery for hydronephrosis with incomplete duplex kidney

Objective To discuss the efficacy of laparoscopic reconstructive surgery for lower moiety hydronephrosis with incomplete duplex kidney. Methods We retrospectively reviewed the clinical data of the 4 patients who had surgery from 2012 to 2015, with a diagnosis of lower moiety hydronephrosis resulted from ureteropelvic junction obstruction in duplex system. Demographic, diagnostic, procedural and follow-up data were recorded. Results All laparoscopic surgeries were completed successfully. Two patients were treated with lower-upper moiety pyeloureterostomy, one with dismembered pyeloplasty and upper-lower ureteropyelostomy and another with lower-moiety dismembered pyeloplasty. A peripelvic catheter was routinely left in all four patients. The surgery time was 87-150 min, mean time was 127min. The average bleeding amount during surgery was about 10 ml. One patient presented with urinary extravasation post-surgery. One patient was lost to follow-up. Mean follow-up was 19 months (range 5 to 41 months). During follow-up, the degree of hydronephrosis decreased gradually. Conclusions Laparoscopic reconstructive surgery for hydronephrosis with duplex kidney could be minimal invasive and effective.Routinely placing a peripelvic catheter drainage is recommended. Key words: Laparoscope; Incomplete duplex kidney; Hydronephrosis

LAPAROSCOPIC PLASTIC WITH PRIMARY STRICTURES OF THE URETEROPELVIC SEGMENT

Determination of indications for performing reconstructive and plastic surgical interventions in stricture of UPS is a difficult task. When making an incorrect decision, the treatment can be ineffective. Functional and anatomical preservation of the kidney can significantly affect the outcome of the operation. Purpose. Evaluation of the effectiveness of laparoscopic plastic surgery of stricture of UPS, depending on the anatomical and functional state of the ipsilateral kidney. Material and method. The results of treatment of 134 patients, who underwent for the period from 2012 to 2015 the different types of reconstructive surgical interventions for stricture of the pelvic-ureteral segment (Calp de Virde scrappy plastic surgery, Andersen-Heinz ureteropyelanastomosis, and antineoplastic ureteropyeloanastomosis), were analyzed. To analyze the effectiveness of the treatment, in the preand postoperative period, the following parameters were evaluated: the presence of pain syndrome, the presence of pyeloectasia, the functional state of the renal parenchyma (according to radioisotope renography), and the absence of recurrence of the UPS stricture. Result. The overall efficacy of laparoscopic UPS reconstruction was 94.7%. The results of treatment did not depend on the chosen technique of operative intervention. In this case, the effectiveness of the treatment was dependent on the initial deficiency of kidney function: the best results were seen in patients with kidney function deficiency of less than 25%, and the proportion of ineffective interventions was highest among patients with a deficit of more than 75%. The degree of dilatation of the pelvis in the postoperative period was also associated with preoperative indicators of kidney function deficiency, this may be due to the presence of cup-pelvis-plating system atony. Conclusion . Thus, the results of our work demonstrated the high efficiency of laparoscopic plastics of UPS. The effective- ness of treatment is determined by the timeliness of the intervention. As a basic prognostic criterion for the effective- ness of the forthcoming intervention, the degree of deficiency of the kidney function should be considered.

Laparoscopic pyeloplasty: Initial experience with 3D vision laparoscopy and articulating shears

Laparoscopic reconstructive surgery is associated with a steep learning curve related to the use of two-dimensional (2D) vision and rigid instruments. With the advent of robotic surgery, three-dimensional (3D) vision, and articulated instruments, this learning curve has been facilitated. We present a hybrid alternative to robotic surgery, using laparoscopy with 3D vision and articulated shears. To compare outcomes of children undergoing pyeloplasty using 3D laparoscopy with articulated instruments with those undergoing the same surgery using standard laparoscopy with 2D vision and rigid instruments. Medical charts of 33 consecutive patients with ureteropelvic junction obstruction who underwent laparoscopic pyeloplasty by a single surgeon from 2006 to 2013 were reviewed in a retrospective manner. The current 3D cohort was compared with the previous 2D cohort. Data on age, weight, gender, side, operative time, dimension (2D=19 patients, 3D=8 patients), presence of a crossing vessel, length of hospital stay, and complication rate were compared between the two groups. Articulating shears were used for pelvotomy and spatulation of the ureter in the 3D group. Statistical tests included linear regression models and chi square tests for trends using STATA software. Operative time per case was decreased by an average of 48min in the group undergoing 3D laparoscopic pyeloplasty compared with the group undergoing 2D laparoscopic pyeloplasty (p=0.02) (Figure). Complication rate and length of hospital stay were not significantly affected by the use of 3D laparoscopy. These favorable results are in accordance with previous literature emphasizing the importance of 3D vision in faster and more precise execution of complex surgical maneuvers. The use of flexible instruments has also helped overcome the well-described delicate step of a dismembered pyeloplasty, namely the pelvotomy and ureteral spatulation. Limitations of this study are those inherent to the retrospective study design. The use of 3D vision endoscopy with articulating instruments blurs the distinction between current robotic-assisted and conventional laparoscopic technology, and provides a hybrid alternative deserving further attention.

Two-Port Laparoscopic Reconstructive Surgery of the Urinary Tract with Reusable Umbilical System (Hybrid Less): A Proof of Concept Study

Objectives: We compared perioperative results and complications of reconstructive surgery of the urinary tract performed using a multichannel platform through the umbilicus and one additional 3.5-mm with a cohort of patients simultaneously treated with conventional 4-port laparoscopy. Materials and Methods: Matched-pair study comparing perioperative outcomes, postoperative visual analogue pain scale (VAPS) and morbidity of 2-port (n = 20) and 4-port (n = 10) laparoscopic reconstructive urological surgery. Preoperative and perioperative data compared included demographics, type of surgery, operative time, blood loss, decrease in serum hemoglobin, operative complications, length of stay and postoperative complications according to Clavien-Dindo classification. Results: There was no significant difference between groups regarding age, gender, body mass index, American Society of Anesthesiologists score, type of surgery, operative time, operative complications and intraoperative or postoperative transfusion. Estimated blood loss was lower using reduced-port approach. VAPS at postoperative day one was significantly lower for 2-port approach and so was the length of stay. Patient satisfaction with the wound was higher for 2-port surgery. Differences were not observed in number and severity of postoperative complications. Conclusions: Urological reconstructive operations can be safely performed using the hybrid laparoendoscopic single-site umbilical approach, resulting in lower blood loss, higher patient satisfaction and lower postoperative pain, which also facilitate earlier hospital discharge, than the same reconstructive procedures performed through multiport conventional laparoscopy.

Robotic and Laparoscopic Reconstructive Surgery in Children and Adults.

This book aims to be concise, comprehensive and a reference for all robotic and laparoscopic procedures in paediatric and adult urology. It achieves this admirably, despite being about 300 pages long, by producing succinct, well-structured chapters that include the basic background of the pathology and procedure, and descriptions of equipment and operative steps, emphasising the avoidance of complications and thoroughly discussing advantages and disadvantages of various approaches. The editor has brought together international experts and leaders in their field as well as some newer authors with up-to-date, precise and accurate material. Chapter references are comprehensive as is the index. Individual chapters can be dipped into and read perfectly well in isolation. Reading the book in its entirety, the structure of each chapter is not exactly uniform but this does not detract from the important information contained therein. A few chapters have somewhat small or dark digital images and the labelling again is non-uniform throughout the book. In at least one image the labelling is incorrect. A number of chapters include online video clips via a listed website, which adds reality to the chapter prose. Again they are not uniform in structure, with some having audio descriptive accompaniment and others not, some being in many short clips and some in their entirety. However, I thoroughly enjoyed reading this book and have no doubt that it is extremely useful for practising and developing laparoscopists for the safe basics of a procedure and for further tips and tricks regarding variations.

Analysis of the effect of laparoscopic tubal repair plastic surgery in the treatment of tubal infertility

目的 探讨腹腔镜下输卵管修复整形术治疗输卵管性不孕疾病的临床治疗效果.方法 选取57例输卵管性不孕患者为研究对象,将其根据随机数字表法分为两组.其中观察组患者30例,对其行腹腔镜下输卵管修复整形受术治疗.对照组患者27例,行传统开腹手术治疗.观察比较两组患者手术时间、肠道排气时间、术后住院时间及术后两年内患者宫内妊娠的情况.结果 观察组患者平均手术时间为(43.4±8.7)min,术后肠道排气时间为(13.7±3.5)h,术后住院时间为(3.8±1.2)d,均短于对照组的(81.2±9.2)min、(70.6±10.2)h、(9.1±1.4)d(t=11.32、15.76、9.76,均P<0.05).观察组术后12、24个月妊娠率分别为56.7%、83.3%,均高于对照组的29.6%、51.9%(χ2=8.76、8.98,均P<0.05).结论 腹腔镜下输卵管整形手术创口微小,治疗输卵管性不孕的治疗效果显著,值得在基层医院推广。

Laparoscopic reconstructive surgery is superior to vaginal reconstruction in the pelvic organ prolapse.

Background: Our purpose was to provide the clinical advantages of the laparoscopic approach compare to the vaginal approach in correcting uterine and vaginal vault prolapse.Methods: Between June 2007 and June 2011, 174 women were admitted to HUMC (Hallym University Medical Center) and underwent pelvic reconstructive surgery for prolapsed vaginal vault and uterus. Upon retrospective review of the medical records, 174 of the patients who had symptoms of pelvic organ prolapsed and Baden-Walker prolapse grade ≥ 2 were selected and divided into two groups as follows: vaginal approach group (n=120) and laparoscopic approach group (n=54). We compared the results of clinical outcome by analyzing Student's t-test and χ2-test or the Fisher exact test as appropriate.Results: There were significant difference in success rates without reoperation for recurrence as 91.7% (vaginal approach group, n=110) vs 100% (laparoscopic approach group, n=54), p=0.032. Mean follow-up duration was 31.3 ± 7.6 months for vaginal approach group and 29.7 ± 9.7 months for laparoscopic approach group. The Foley catheter indwelling duration (4.7± 1.9 vs 3.4±2.1 days, p< 0.001) and the length of postoperative hospitalization (6.4 ± 2.1 vs 5.0 ± 1.9 days, p <0.001) were significantly longer in vaginal approach group, whereas the operative time was significantly longer (108.2 ± 38.6 vs 168.3 ± 69.7 minutes, p <0.001) in laparoscopic approach group.Conclusions: Our result suggest there is significantly lower recurrence rate requiring reoperation and less catheterization time but increased operative time for laparascopic sacrocolpopexy.

Differentiated approach to the use of the modern surgical technologies in patients with tubal infertility

Aim. To elaborate the differentiated approach to the surgical treatment of the patients with tubal and peritoneal infertility using the endoscopic and microsurgical methods and to evaluate its efficiency. Methods. 1840 female patients with infertility underwent complex clinical and laboratory examination, including endoscopy. 1257 patients underwent surgical treatment. Endo-video-surgical interventions were carried out in 1070 women, microsurgical techniques were applied in 187 patients. Results. The laparoscopic reconstructive plastic surgery was the most effective manipulation in patients with the disease of the distal part of the fallopian tubes and peritoneal adhesions. Treatment results were defined by the severity of distal part of the uterine tubes damage and severity of peritoneal adhesions in the pelvic cavity. The most favorable results of the treatment were noted after salpingo-ovariolysis (success rate 61.4%), by 2.3 times exceeding the pregnancy frequency after salpingoneostomy (26.9%; p 0.001) and by 1.6 times compared to fimbrioplasty (39.2%; p 0.001). In patients with proximal occlusion, results depended on the type of the tubular occlusion. In 69.7% patients with proximal occlusion due to synechiae, small polyps, foreign bodies, hysteroscopic interventions were an effective method of recanalization, allowing to restore the reproductive function in 40.2% patients. The microsurgical method demonstrated the 5.9 fold higher efficiency in patients with fibroid proximal occlusion of the uterine tubes compared to the laparoscopic methods (41.7% vs 7.1%). The microsurgical method was the most effective in patients with true fibrous proximal occlusion after the surgery on uterine tubes for tubular pregnancy and surgical sterilization. Conclusion. The differentiated approach to the surgical treatment of the patients with tubal infertility allowed to use the endo-video-surgical method in 85.1% of cases, improving the treatment’s results due to the decrease the surgical trauma and surgery duration, due to economic and cosmetic effect.

Robotic and laparoscopic reconstructive surgery in children and adults

I Principles of Reconstructive Laparoscopy and Robotics in Urology 1. Instruments and Working in Limited Spaces 2. Minimally Invasive Anastomoses II Laparoscopic and Robotic Reconstructive Renal Surgery * Adult Partial Nephrectomy for Renal Cell Carcinoma * Pediatric Upper Pole Nephrectomy for A Non-Functioning Moiety III Laparoscopic and Robotic Reconstructive Renal Pelvis Surgery * Adult Pyeloplasty for Ureteropelvic Junction Obstruction * Pediatric Pyeloplasty for Ureteropelvic Junction Obstruction * Infant * Pre-Pubertal * Teenager IV Laparoscopic and Robotic Reconstructive Ureteral Surgery 1. Ureteroureterostomy 2. Correction of Ureteral Defects * Use of Intestinal Segments * Use of Native Bladder * Boari Flaps and Psoas Hitch 3. Stone Disease - pyelolithotomy and ureterolithotomy V Laparascopic and Robotic Reconstructive Bladder Surgery 1. Adult Bladder Reconstruction a. Post Cystectomy Diversions i. Ileal conduits ii. Continent Catheterizable Pouches iii. Orthotropic Neobladders 2. Pediatric Bladder Reconstruction a. Ureteral Reimplant Surgery to Correct Reflux Disease b. Bladder Augmentation and Creation of Continent Catheterizable Stomas VI Laparoscopic and Robotic Orchiopexy in Children VII Laparoscopic and Robotic Anastomoses for Radical Prostatectomy

Robotic-Assisted Laparoscopic Reconstructive Surgery in the Lower Urinary Tract

Open surgery has long been the most common surgical approach for the correction of congenital anomalies of the lower urinary tract in children. With the continued development of minimally invasive surgery in adult urology, including endoscopic, conventional, and robot-assisted laparoscopic approaches, the indications for minimally invasive surgery have similarly expanded in the pediatric population. The most commonly performed robotic procedure in children has been pyeloplasty for ureteropelvic junction obstruction; the use of robotics in complex reconstructive surgery in the lower urinary tract has also been acceptable. In this review, we summarize recent viewpoints regarding robotic-assisted laparoscopic reconstructive surgeries in the lower urinary tract, such as ureteral reimplantation, appendicovesicostomy, and augmentation enterocystoplasty in the pediatric population, and critically summarize the current knowledge on outcomes in the literature. We also discuss our technique and the outcomes of robotic ureteral reimplantation. This review demonstrates that robotic-assisted laparoscopic reconstructive surgeries in the lower urinary tract are technically feasible and may achieve outcomes that are equalto those of open surgery, with reduced morbidity.

Initial experience of horseshoe kidney treated with transperitoneal laparoscopic plastic surgery

Objective To investigate the feasibility,technique and clinical effect of applying laparoscopic plastic surgery in the treatment of horseshoe kidney. Methods Eleven patients with horseshoe kidney were admitted from Mar.2006 to Mar.2011.There were 5 males and 6 females with mean age of 27years (14 to 46 years).Clinical manifestations included lower-back pain in 8 cases,lower-back pain and hematuria in 2 cases,lower-back pain and fever in 1 case.There were 6 cases accompanied with kidney calculi.All the cases with calculus were in left kidney and there was 1 case with multiple calculi.There were 11 cases accompanied with left hydronephrosis.Of which,there were moderate hydronephrosis in 6 cases,severe hydronephrosis in 5 cases.There were 3 cases accompanied with mild right hydronephrosis.There were 2 patients with renal insufficiency,1 patient with urinary tract infection.The surgery procedures included laparoscopic isthmectomy and plastic surgery in 3 cases,isthmectomy and plastic surgery and pelviolithotomy in 6 cases,isthmectomy and vascular compression release in 2 cases. Results All patients had successful surgeries with the mean operative time of 145 min (95 - 190 min).The average blood loss was 250 ml ( 100 -400 ml).Average postoperative hospital stay was 10 d (7 - 15 d).One patient suffered from urinary leakage after surgery and recovered after anti-inflammatory therapy and local drainage.One patient suffered from secondary hemorrhage controlled with DSA.All the patients were followed up with a mean of 17 months (6 -28 months).In 6 cases with moderate hydronephrosis,5 patients recovered to mild hydronephrosis and 1 case improved from preoperative renal hydronephrosis 3.5 cm to postoperative 3.0 cm.In 5 cases with severe hydronephrosis,3 patients improved to moderate hydronephrosis,2 patients to mild hydronephrosis.One patient with kidney stone had 0.4 cm residual stone.Three patients complained of occasional mild backache.One patient suffered from hematuria and urinary tract infection,recovered after antiinflammatory therapy for 2 weeks.The remaining 6 patients were in good conditions during the follow-up.Conclusion Transperitoneal laparoscopic plastic surgery is able to deal with horseshoe kidney isthmus malformation and comorbidities,and is another alternative for the treatment of horseshoe kidney. Key words: Laparoscopes; Horseshoe kidney; Plastic surgery; Treatment outcome

Robotic and Laparoscopic Reconstructive Surgery in Children and Adults

Robotic and Laparoscopic Reconstructive Surgery in Children and Adults