Laparoscopic Suturing Techniques Research Articles

Comparing extracorporeal, semi-extracorporeal, and intracorporeal anastomosis in laparoscopic right hemicolectomy: introducing a bridging technique for colorectal surgeons.

Intracorporeal anastomosis (IA) in laparoscopic right hemicolectomy has been associated with faster recovery in bowel function compared to extracorporeal anastomosis (EA). However, the technical difficulty of laparoscopic suturing technique and intraabdominal fecal contamination hinder many surgeons from implementing such a procedure. We introduce and compare a bridging technique designated as "semi-extracorporeal" anastomosis (SEA), which embraces the advantages and amends the drawbacks of IA and EA. Between May 2016 and October 2022, 100 patients who underwent laparoscopic right hemicolectomy were analyzed. All patients who received laparoscopic right hemicolectomy underwent one of the 3 anastomosis methods (EA, SEA, and IA) by a single colorectal surgeon at a single tertiary care hospital. Data including perioperative parameters and postoperative outcomes were analyzed by each group. A total of 100 patients were reviewed. Thirty patients underwent EA; 50 and 20 patients underwent SEA and IA, respectively. Operation time (minute) was 170 (range, 100-285), 170 (range, 110-280), and 147.5 (range, 80-235) in EA, SEA, and IA, respectively (P = 0.010). Wound size was smaller in SEA and IA compared to EA (P < 0.001). IA was associated with a shorter time (day) to first flatus compared to SEA and EA (4 [range, 2-13] vs. 4 [range, 2-7] vs. 2.5 [range, 1-4], P < 0.001). Postoperative complication showed no statistical significance between the 3 groups. Semi-extracorporeal was an attractive bridging option for colorectal surgeons worrisome of the technical difficulty of IA while maintaining faster bowel recovery and smaller wound incisions compared to EA.

Enhancing Efficacy and Safety in Laparoscopic Partial Nephrectomy for Localized Renal Tuberculosis: The Skirted Continuous Suture Technique.

BACKGROUND Limited research has been conducted on laparoscopic partial nephrectomy for kidney tuberculosis. This study aimed to evaluate the effectiveness of the skirted continuous suture technique in laparoscopic partial nephrectomy for localized renal tuberculosis. MATERIAL AND METHODS Five patients with kidney tuberculosis underwent standard retroperitoneal laparoscopic partial nephrectomy after computed tomography evaluation. The skirted continuous suture technique was utilized during the procedure. This retrospective study analyzed the outcomes of these patients who received treatment between January 2011 and December 2020 at Beijing Tsinghua Changgung Hospital and Eighth Medical Center of Chinese People's Liberation Army General Hospital. RESULTS The surgical success rate was 100%. Renal function was well preserved, with a decrease of glomerular filtration rate by 9.6±9.0 ml/min. Only 1 patient experienced postoperative urinous infiltration and lymphatic fistula, while the others did not have any surgical complications. Antituberculous therapy was continued postoperatively, and 1 patient had recurrence during follow-up. CONCLUSIONS The laparoscopic continuous suturing technique offers a reliable and straightforward method for extensively closing incision edges of the renal parenchyma in laparoscopic surgery. It contributes to the improved efficacy and safety of treating localized renal tuberculosis with exceptional application.

Laparoscopic sacral colpopexy without the robot: Safe, effective and easier than you think

Objective:The purpose of the study is to evaluate the outcomes of laparoscopic sacral colpopexy operations performed by faculty and resident surgeons using simple laparoscopic suturing and tying techniques, and to compare those results with those reported by other institutions performing laparoscopic and robotic sacral colpopexy. Methods:This is a retrospective cohort study of 206 consecutive laparoscopic sacral colpopexy cases (with or without concomitant procedures) between October 2014 and July 2020. Laparoscopic sacral colpopexies were performed using a carefully selected set of instruments and techniques which are quickly mastered by trainees. Residents performed up to 50% of the work in each operation. Descriptive statistics were used to compare primary outcomes with published literature. Results:The average operative time was 153.3 minutes. The overall complication rate was 16.5%, including 3.4% cystotomy, 0.5% enterotomy, 0.5% small bowel obstruction, 2.4% mesh complications including erosion, detachment and removal. Most recent follow up occurred at a mean of 325.5 days (SD 397.9) and median of 183 days (IQR 48-471) postoperatively. Recurrent prolapse was noted in 6.3% of patients and 3.9% underwent a subsequent prolapse repair. These results compare favorably with those published by other institutions. Conclusion:Using simple suturing and tying techniques, laparoscopic sacral colpopexy can be performed without robotic assistance by a large portion of laparoscopically trained surgeons, including trainee co-surgeons. Significant cost savings accrue from the use of conventional laparoscopy in place of robotic technology. Residents can participate in laparoscopic sacral colpopexy cases with comparable operative times and favorable surgical outcomes.

Application of a highly simulated and adaptable training system in the laparoscopic training course for surgical residents: Experience from a high-volume teaching hospital in China

ObjectiveTo explore the effectiveness, feasibility, and training effect of a highly simulated and adaptable laparoscopic training system in the advanced integrated two-stage laparoscopic simulation training course for surgical residents. MethodsThis study prospectively took the surgical residents who received the advanced integrated two-stage laparoscopic simulation training course in our hospital from December 2019 to December 2021 as the research objects. In the stage one course, the trainees are randomly distributed into the dry simulation system group and Darwin laparoscopic training system group. The subjective assessment results of the trainees from the two groups are collected by questionnaires, and the simulation assessment results of the two groups are evaluated in a unified, objective, and standardized assessment form. The pre-course and post-course questionnaires were used to evaluate the feasibility and effectiveness of the Darwin system in the stage two course. ResultsA total of 62 trainees completed the stage one and stage two courses. In the stage one course, the trainees were randomly distributed into the dry simulation trainer group (N = 19) and the Darwin group (N = 43). The results of the subjective assessment questionnaire showed that compared with the dry simulator group, the students in the Darwin group had higher subjective scores (P < 0.05). The objective assessment results for the 3 modules of "One Track Transfer", "One Tunnel Pass" and "High and Low Pillars" in the Darwin group were significantly better than those in the dry simulator group (P < 0.05). The trainees who received the stage two course completed the questionnaires before and after the course. The results showed that compared with pre-course evaluation, "basic theoretical knowledge of laparoscopy", "basic skills of laparoscopy", "laparoscopic suture technique" and "camera-holding technique" were significantly improved after training (P < 0.05). ConclusionThe highly simulated and adaptable laparoscopic training system is effective and feasible in the advanced integrated two-stage laparoscopic simulation training course for surgical residents.

Laparoscopic Suturing of the Vaginal Cuff: A Surgical Education Module for Obstetrics and Gynecology Residents

<h3>Study Objective</h3> We aim to review the assembly of a laparoscopic box trainer with a validated vaginal cuff model and to highlight principles for efficient two-handed laparoscopic vaginal cuff closure using three unique port configurations (ipsilateral, contralateral, and midline). This video was created as part of a surgical education module for Obstetrics and Gynecology residents. <h3>Design</h3> Surgical education video. <h3>Setting</h3> Laparoscopic box trainer with a validated vaginal cuff model. <h3>Patients or Participants</h3> Education module for Ob/Gyn resident physicians. <h3>Interventions</h3> The validated vaginal cuff model incorporates multiple layers to represent the vaginal epithelium and vaginal wall. We demonstrate laparoscopic suturing using a running technique from ipsilateral, contralateral, and suprapubic port configurations. A braided suture with a knot at the end simulates a unidirectional barbed suture that does not require knot tying. Critical steps needed for proper cuff closure are highlighted. <h3>Measurements and Main Results</h3> In this video, we highlight a reproducible setup of a validated vaginal cuff model within a laparoscopic box trainer. We demonstrate correct needle loading for enhanced accuracy in needle entry and exit. Efficient techniques to achieve adequate exposure, incorporation of vaginal epithelium, appropriate suture tension, and optimized ergonomics are also reviewed. <h3>Conclusion</h3> We present a surgical education video to teach safe and efficient laparoscopic suturing techniques to Ob/Gyn resident physicians using multiple two-handed port configurations. Key surgical principles include proper needle loading, needle entry, exposure, and optimized ergonomics.

A Pilot Study on a New Technique for Vesicourethral Anastomosis, Using Two-Knot Running after Laparoscopic Radical Prostatectomy

Background: Laparoscopic radical prostatectomy requires a significant learning curve. One area of difficulty is mastering laparoscopic suturing techniques to perform vesicourethral anastomosis. Objective: To compare the efficacy and safety of a new technique for vesicourethral anastomosis using two-knot running. Materials and Methods: Vesicourethral anastomosis was created using two Vicryl 3-0. The first running stitch was placed at the five o’clock position on the posterolateral aspect of the bladder outside-in and then through the urethra at the same location inside-out. Proceeding counterclockwise, the running suture was placed from the 5 o’clock to 12 o’clock position. The second running stitch was placed from 5 o’clock to 12 o’clock position, proceeding clockwise. A knot was then tied outside at the 12 o’clock position. Results: The present anastomotic technique had been used in 20 laparoscopic radical prostatectomies. The average time for the anastomosis was 47 minutes, with a range of 38 to 65 minutes. No postoperative urinary leaks occurred, and no clinically evident obstructive symptoms resulted. The urinary continence rate one month after surgery was 20%, and 55% at three months. Conclusion: Two-knot running technique is described as a safe and feasible technique for vesicourethral anastomosis without any experienced assistant. Further studies on a larger group of patients are needed to confirm the preliminary results. Keywords: Prostate cancer; Vesicourethral anastomosis

Laparoscopic Esophagogastric Anastomosis With Stapled Pseudo-Fornix for Reflux Esophagitis Prevention After Proximal Gastrectomy.

Laparoscopic esophagogastric anastomosis is not commonly performed after proximal gastrectomy (PG) because of its technical complexity and the lack of a gold standard for reconstruction. We describe a simple and convenient technique of laparoscopic esophagogastrostomy with stapled pseudo-fornix for reflux esophagitis (RE) prevention after PG.Laparoscopic PG (LPG) was performed in four patients with gastric cancer in the upper third of the stomach, and the remnant stomach was prepared for reconstruction. After making a small hole on the anterior wall of the remnant stomach 45 mm distal to the proximal stump and on the dorsal side of the esophageal stump, a 45 mm no-knife linear stapler was applied. To create a "pseudo-fornix," a common lumen was made by cutting the center of the four staple rows at a length of 15 mm. The entry hole was closed using the laparoscopic hand-sewn suturing technique.The mean operation time was 240 min, with an estimated blood loss of <10 ml. No intraoperative complications or conversion to open surgery were observed. One patient developed stenosis of the esophagogastrostomy successfully treated by endoscopic balloon dilatation. Endoscopic surveillance three months after surgery revealed no incidence of RE in any of the patients.Laparoscopic esophagogastric anastomosis with stapled pseudo-fornix is convenient and beneficial in preventing RE after PG and should be considered the treatment of choice for reconstruction after LPG in selected patients with proximal gastric cancer.

Resection of five centimeter cesarean scar ectopic pregnancy and isthmocele repair using vascular clamps

The objective of this video is to present a surgical case of resection and repair of a five centimeter cesarean scar ectopic pregnancy. We will highlight the use of laparoscopic vascular bulldog clamps to aid in hemostatic control during the resection. We will also demonstrate the use of laparoscopic suturing and intracorporeal knot tying techniques to repair the hysterotomy incision and help prevent formation of a postoperative isthmocele. We will present the case of a 33 you G4P1021 that presented with a five centimeter cesarean scar ectopic pregnancy. She failed medical management and had a strong desire for future fertility. We will present a surgical approach to the resection and repair of a cesarean scar ectopic pregnancy. We will highlight the use of laparoscopic vascular bulldog clamps to aid in the isolation and temporary occlusion of the vascular supply to aid in the hemostatic resection of the ectopic pregnancy. We will also demonstrate laparoscopic suturing and knot tying techniques to approximate the hysterotomy incision and prevent formation of a post operative isthmocele. Resection of a cesarean scar ectopic pregnancy with repair is a viable treatment option for patients that have failed medical therapy and desire future fertility. Laparoscopic vascular bulldog clamps can aid in a hemostatic excision and repair. Sound surgical principles and laparoscopic suturing techniques can be employed to prevent the formation of a postoperative isthomcele.

Laparoscopic percutaneous internal ring suturing for paediatric inguinal hernias: a South African tertiary centre experience

ABSTRACT BACKGROUND: Laparoscopic inguinal hernia repair is routine in many paediatric centres. One of several techniques described in 2006 is the laparoscopic percutaneous internal ring suturing (PIRS) technique. This technique which is not widely used in South Africa has been adopted for paediatric inguinal hernias at our institution, and this is a review of the experience METHOD: The study is a retrospective review of the patients who underwent PIRS (a single port combined percutaneous procedure used to close the internal ring) at our hospital from October 2018 until March 2020. We describe the technique in our setting and review our cohort of patients, demographics, clinical presentation, operative duration and complications RESULTS: One hundred and ten laparoscopic PIRS procedures were performed on 94 patients; 15 had bilateral inguinal hernias. Polydioxanone and Prolene were the sutures used for the procedures. Average operative time was 12 minutes for unilateral hernias and 33 minutes for bilateral hernias. All operations were completed laparoscopically. Follow-up was for a minimum of three months, but up to 21 months. Complications included three intraoperative haematomas, three hydrocoeles and two umbilical granulomas postoperatively. There were two recurrent hernias of which one was managed with redo PIRS; the other required open herniotomy for an irreducible obstructed hernia CONCLUSION: This review is supportive evidence that the PIRS technique for managing paediatric inguinal hernias in a tertiary institution in South Africa can be performed safely with few complications Supplementary video available online: http://sajs.redbricklibrary.com/index.php/sajs/article/view/3498 Keywords: inguinal hernia, paediatric, laparoscopy, percutaneous internal ring suturing

Single Site Laparoscopic Myomectomy

Study Objective My objective in making this video is to share how we approach laparoscopic myomectomy in a patient with large uterine leiomyoma. Design Video presentation. Setting Hospital, operating room. Patients or Participants Laparoscopic myomectomy case was presented. Interventions Myomectomy. Measurements and Main Results N/A Conclusion I present a case of laparoscopic myomectomy, demonstrating myomectomy and suturing techniques, as well as leiomyoma morcellation through the umbilicus.

Laparoscopic repair of a Bochdalek hernia in an elderly patient: a case report with a review from 1999 to 2019 in Japan

BackgroundA Bochdalek hernia (BH) is a congenital defect of the diaphragm that generally presents in the newborn as life-threatening cardiorespiratory distress. In contrast, the diagnosis of a BH in adults is rare. Surgical repair for adult BH is recommended, but the optimal surgical method remains unclear.Case presentationA 75-year-old woman presented with progressive dyspnea and back pain, and a diagnosis of BH was made based on chest X-ray and computed tomography. Laparoscopic evaluation revealed a defect in the left posterior attachment of the diaphragm, and a left-sided BH without hernia sac was diagnosed. Parts of the stomach, small intestine, colon, pancreas, and spleen had prolapsed into the left thoracic cavity, without ischemic change, and these herniated organs were reduced to the abdominal cavity. A direct closure of the hernia orifice was possible by the laparoscopic suture technique using a mesh reinforcement. The patient made an uneventful recovery, and no recurrence was found in the 2-year follow-up.ConclusionA recently published study reviewing detailed cases of repair of adult BH from 1999 to 2019 identified 96 cases, including the present case. The number of reports on laparoscopic and/or thoracoscopic surgery for BH in adults has recently increased, and the approach for repairing BH should be selected carefully on a case-by-case basis.

Laparoscopic Upper Colpectomy for VAIN III after Previous Total Hysterectomy

To demonstrate the feasibility of laparoscopic upper colpectomy for the treatment of vaginal intraepithelial neoplasia (VAIN) after previous total hysterectomy. Stepwise demonstration of the technique with narrated video footage. In 2014, our patient aged 60 years underwent a routine smear that reported severe dyskaryosis. This was treated with large loop excision of the transformation zone. Histopathology confirmed cervical intraepithelial neoplasia II, with positive ectocervical margins. The patient was counseled for both repeat large loop excision of the transformation zone and hysterectomy, opting for definitive surgery. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed in January 2015, completely excising the residual cervical intraepithelial neoplasiaII. A vault smear was performed in October 2015, reporting further severe dyskaryosis. The patient subsequently underwent examination under anesthesia and multiple upper vaginal mapping biopsies-identifying extensive VAIN III. The case was successfully managed by a laparoscopic upper colpectomy. When determining the area of VAIN to be excised, it can be useful to place a vaginal marker stitch; however, we chose to perform a colposcopy and apply acetic acid to help delineate the extent of the VAIN, immediately before laparoscopy. The right-sided pelvic sidewall dissection proved more extensive owing to the disease burden on that side. No intra- or postoperative complications occurred. The final histopathology confirmed a 65 × 35 × 8-mm upper colpectomy specimen with VAIN III and clear surgical margins. The patient has since had a normal vault smear and no recurrence to date. We highlight the importance of gaining early retroperitoneal access and developing the lateral pelvic spaces to identify the ureters and gain vascular control of the pelvis. We demonstrate an approach to safely developing the posthysterectomy vesicovaginal plane, with the aid of bladder filling. We used a McCartney tube (Kebomed UK, Cullompton, Devon) to facilitate colpotomy and closed the vagina using a laparoscopic suturing technique. We believe laparoscopic upper colpectomy offers definitive management of VAIN-a condition that otherwise has a propensity for recurrence and is hence often associated with multiple vaginal excisional procedures.

Basic knowledge of and a small trick for atraumatic needle driving in laparoscopic suturing.

Highlight Although recent advances in robotic surgery have enabled more precise movements of the needle driver, a sophisticated laparoscopic suturing technique is still desired. Honda and colleagues describe the basic knowledge of and a small but useful trick for atraumatic needle driving in laparoscopic suturing, based on mechanistic considerations.

Esophageal Suspension Method for Hand-Sewn Esophagojejunostomy After Totally Laparoscopic Total Gastrectomy: A Simple, Safe, and Feasible Suturing Technique.

Background: Totally laparoscopic total gastrectomy (TLTG) not only is difficult to operate but also has high technical requirements and a long learning curve. Therefore, it has not been widely carried out yet, and esophagojejunostomy is one of its difficulties. Relevant studies have shown that intracorporeal hand-sewn esophagojejunostomy is safe, feasible and low-cost, but it is complicated and time-consuming and requires a high-suture technique. This study introduces a simple, safe and feasible hand-sewn technique.Methods: The clinical data of 32 patients with the esophageal suspension method for hand-sewn esophagojejunostomy (suspension group) after TLTG were collected from February 2018 to June 2019. During the same period, 32 patients with traditional hand-sewn esophagojejunostomy (traditional group) after TLTG were used as the control group.Results: The operative time, anastomosis time, exhaust time and hospitalization time of the suspension group were shorter than those of the traditional group. The intraoperative blood loss in the suspension group was less than that in the traditional group. There were no postoperative complications associated with the suspension group.Conclusion: For those who have some experience in laparoscopic suture technique, the esophageal suspension method for hand-sewn esophagojejunostomy after TLTG is a simple, safe, and feasible suture technique.

Çocuklarda kasık fıtığı onarımında açık teknik ve perkütan internal ring sütürizasyon tekniğinin karşılaştırılması

Objective: Laparoscopic inguinal hernia surgery has recently been a preferred surgical approach among pediatric surgeons. The aim of this study is to compare open and laparoscopic inguinal hernia repair techniques in terms of complications and recurrences in children. Method: Patients whose inguinal hernias were operated with laparoscopic percutaneous internal ring suturing technique and open high ligation technique were included in the study. Dermographic data, surgical details and postoperative complications of the patients were reviewed retrospectively. Results: A total of 246 patients were included in the study. Among them 113 patients underwent laparoscopic inguinal hernia repair and 133 patients open inguinal hernia repair. The mean age of patients in the laparoscopic group was 27.7 months (1-192 months) and the mean age of patients in the open surgery group was 27.5 months (1-156 months). Diagnostic laparoscopy was performed in 104 patients who underwent open surgery, and the contralateral inguinal hernia repair was performed in 33 of the patients after hernia was detected on the contralateral side. Recurrence was observed in 2.6% (n=3) of the patients who underwent laparoscopic surgery and 3.7%(n=5) of the patients undergoing open surgery. In 2 of the patients who underwent laparos- copic surgery had hematomas that resolved without intervention and 1 had hydrocele. On the other hand 4 of the patients who underwent open surgery had iatrogenic undescended testis and 1 had hydrocele. The follow-up periods of the patients who underwent laparoscopic or open surgery were 13.2, and 74 months, respectively. Conclusion: Laparoscopic inguinal hernia repair has results comparable to open repair in terms of recurrence and complications. The advantage of the laparoscopic method can be considered as the ability to evaluate the contralateral side in all cases without increase in the risk of recur- rence and complications, and the ability to operate without scarring , but with good cosmetic results.

Female sex as independent risk factor for chronic pain following elective incisional hernia repair: registry-based, propensity score-matched comparison

IntroductionTo date, little attention has been paid by surgical scientific studies to sex as a potential influence factor on the outcome. Therefore, there is a sex bias in the surgical literature. With an incidence of more than 20% after 3 years, incisional hernias are a common complication following abdominal surgical procedures. The proportion of women affected is around 50%. There are very few references in the literature to the influence of sex on the outcome of elective incisional hernia repair.Materials and methodsIn all, 22,895 patients with elective incisional hernia repair from the Herniamed Registry were included in the study. The patients had undergone elective incisional hernia repair in a laparoscopic IPOM, open sublay, open IPOM, open onlay or suture technique. 1-year follow-up was available for all patients. Propensity score matching was performed for the 11,480 female (50.1%) and 11,415 male (49.9%) patients, creating 8138 pairs (82.0%) within fixed surgical procedures.ResultsFor pain on exertion (11.7% vs 18.3%; p < 0.001), pain at rest (7.53% vs 11.1%; p < 0.001), and pain requiring treatment (5.4% vs 9.1%; p < 0.001) highly significant disadvantages were identified for the female sex when comparing the different results within the matched pairs. That was also confirmed on comparing sex within the individual surgical procedures. No sex-specific differences were identified for the postoperative complications, complication-related reoperations or recurrences. Less favorable intraoperative complication results in the female sex were observed only for the onlay technique.ConclusionsFemale sex is an independent risk factor for chronic pain after elective incisional hernia repair.

Laparoscopic versus open pediatric inguinal hernia repair: state-of-the-art comparison and future perspectives from a meta-analysis

BackgroundLaparoscopic inguinal hernia repair in children is increasingly performed as it allows contralateral inspection and potentially results in shorter operation time and less complications. Evidence from meta-analyses of randomized controlled trials (RCTs) regarding the superiority of laparoscopic versus open hernia repair is lacking.MethodsA systematic literature search was performed querying PubMed, Embase, MEDLINE, and the Cochrane Library databases. RCTs comparing laparoscopic with open hernia repair in children were considered eligible, without year and language restrictions. Cochrane Risk of Bias tool was used for quality assessment. Data were pooled using a random-effects model. Subgroup analyses were performed according to the laparoscopic suturing technique (i.e., intracorporeal or extracorporeal).ResultsEight RCTs (n = 733 patients; age range 4 months–16 years) were included in this meta-analysis. Laparoscopic (LH) and open (OH) hernia repair was performed in 375 and 358 patients, respectively. Complications (seven RCTs, n = 693; pooled OR 0.50, 95% CI 0.14 to 1.79), recurrences (seven RCTs, n = 693; pooled OR 0.88, 95% CI 0.20 to 3.88), and MCIH rates (four RCTs, n = 343; pooled OR 0.28, 95% CI 0.04 to 1.86) were not different between the groups. LH resulted in shorter bilateral operation time (Five RCTs, n = 194; weighted mean difference (WMD) − 7.19, 95% CI − 10.04 to − 4.34). Unilateral operation time, length of hospital stay, and time to recovery were similar. There was insufficient evidence to assess postoperative pain and wound cosmesis, and evidence of substantial heterogeneity between the included studies. Subgroup analyses demonstrated less complications and shorter unilateral operation time for extracorporeal suturing and shorter length of hospital stay for intracorporeal suturing.Conclusions and relevanceNo definite conclusions to decide on the superiority of one of either treatment strategies can yet be drawn from the available literature. There was evidence of substantial heterogeneity and the clinical relevance of most estimated effects is very limited.

Laparoscopic approach to cornual ectopic: a step-by-step demonstration

To concisely review what is known about cornual ectopic pregnancies and to provide a step-by-step demonstration of the resection of a large cornual ectopic pregnancy, highlighting various laparoscopic techniques. A video review of cornual ectopic pregnancy and a laparoscopic approach for treatment featuring a patient case at 9weeks gestation. Tertiary care facility. A 31-year-old G2P1001 at 9weeks 0days by transvaginal ultrasound and with a beta human chorionic gonadotropin of 13,099 presented to the emergency department for vaginal bleeding and cramping left lower quadrant pain. She was hemodynamically stable. Her ultrasound was suspicious for a cornual ectopic pregnancy, which was confirmed by magnetic resonance imaging. The patient was taken to the operating room for resection, given the size of the pregnancy, concern for intraoperative blood loss, concern for persistent pregnancy, and concern that patient would not be able to reliably follow up for multiple appointments. Patient underwent laparoscopic resection of a large cornual ectopic pregnancy. Included is a short review of laparoscopic suturing techniques. Pathology, decline in beta hCG, and post-operative course. The patient's pathology was confirmatory for cornual ectopic pregnancy. Her beta human chorionic gonadotropin decreased as expected, and she had a normal post-operative course. Laparoscopic cornual resection is a safe and effective method for management of large cornual ectopic pregnancy, and fertility outcomes are similar to patients after salpingectomy for non-interstitial ectopic pregnancy.

A comparison of novel laparoscopic suturing techniques in single-port surgery

Objective: To compare the vaginal cuff closure times of a newly developed Turkish-made laparoscopic needle holder (TMLNH) and a Yoon Soon (YS) extracorporeal knot tying technique in the closure of the vaginal cuff during single-port laparoscopic hysterectomy.Material and methods: We retrospectively reviewed a total of 60 consecutive patients who underwent single-port laparoscopic hysterectomy using a TMLNH (n = 30) or a YS extracorporeal knot tying technique (n = 30).Results: The patients’ demographic data, operative results, and complications were analyzed. Operative time and the time required for vaginal cuff suturing were significantly shorter in the TMLNH group than in the YS extracorporeal knot tying group (60.1 ± 3.2 vs. 77.3 ± 6.0 min, p = .001 and 24.5 ± 3.7 vs. 36.3 ± 3.8 min, p = .001, respectively). The intraoperative and postoperative complications were comparable in both groups.Conclusion: The use of TMLNH for vaginal cuff closure in single-port hysterectomy reduced the operative time and the time required for vaginal cuff suturing. However, both TMLNH and YS extracorporeal knot-tying technique may enable the surgeons to overcome the surgical challenges of SPA surgery.

Laparoscopic suture training and technique—a resident’s experience

Laparoscopic suture training and technique—a resident’s experience