Laparoscopic Trocar Research Articles

Assessment of Port Site Complication in Laparoscopic Abdominal Surgery

Abstract Background Rapid expansion in the volume and complexities of laparoscopic surgeries has been accompanied by complications, many of which can be directly attributed to abdominal access with laparoscopic trocars including visceral injury, vascular injuries, air embolism, subcutaneous emphysema, port site infections, incisional hernia and metastasis occurred post operatively. Objectives This study aimed to detect the different port site complications encountered in laparoscopic abdominal surgery in terms of incidence and management. Patients and Methods This study was conducted in the surgical operating theatre of Ain-Shams University Hospitals (Demerdash and Ain Shams University Specialized Hospital), Cairo, Egypt, from January 2018 till July 2018. Results In this study complications occurred in 37 cases out of the 400 cases (Study subjects). The incidence of port site complications in our study was 9.25%. Vessel injury occurred in 19 out of the 400 cases with incidence 4.75%. Port site infection occurred in 11 out of the 400 cases with incidence 2.75%. Visceral injury occurred in 4 out of the 400 cases with incidence 1%. Port site hernia occurred in 3 out of the 400 case with incidence 0.75%. Conclusion Study incorporated 400 subjects operated for different indications laparoscopically and patients developing any kind of complications were recorded and analyzed. The results showed 3(0.75%) port site hernias, 11(2.75%) port site infections,19 (4.75%) vessel injury, 4 (1%) visceral injury and no port site metastasis was detected.

Magnetic marking clip for easier laparoscopic localization of small gastrointestinal tumors.

386 Background: Laparoscopic surgery for gastrointestinal tumors requires fast and precise tumor localization. As tumor palpation is not possible during laparoscopic surgery, tumor identification is often difficult for some cases. Despite various methods, such as tattooing or endo-clipping, have been introduced for the localization of tumors, these methods own clear limitations. To overcome the drawbacks of these conventional marking methods, we designed a magnetic marking device linked to an endo-clip(MMC, Magnetic Marking Clip) for endoscopy. We performed preoperative endoscopic clipping with MMC and analyzed the intraoperative localization efficacy and safety during laparoscopic surgery. Methods: Study enrolled 30 patients with gastric and colorectal neoplasms scheduled to undergo endoscopic clipping before laparoscopic surgery at the Korea University Medical Center, Korea, between August 2017 and June 2019. A silicone-coated high-power neodymium marking device (ring or rod type) was fixed together with an endo-clip and applied on the center of the lesion during preoperative endoscopy. During laparoscopic surgery, a detecting magnetic body was inserted through a laparoscopic trocar and was used to localize the tumor that is marked with MMC. The time needed for endoscopists to place MMC at the lesion, laparoscopic clip detection time and success rate were studied. Results: Endoscopists placed MMC within 30 seconds. It was possible to find MMC in all cases of laparoscopic surgery. Time needed to find the MMC laparoscopically was relatively shorter than the time conventionally taken just with an endo-clip itself. There was no reported dislodgement of the clip before the surgery or any other adverse events associated with the MMC procedure. Conclusions: The MMC method enabled simple and fast tumor localization and showed excellent outcomes in efficacy of tumor localization. The MMC method may help surgeons localize GI tumor lesions easily and safely during laparoscopic surgery.

Endoscopic hybridization in the treatment of complicated upper urinary calculus in children

Complicated upper urinary calculi in children, such as staghorn stones or renal calculi with congenital malformation, are difficult to treat. Laparoscopy, flexible ureteroscopy and percutaneous nephroscopy are not effective enough when they were performed alone. In this research we retrospectively reviewed three kinds of cases which use two endoscopic modalities in the operation. We aimed to study the feasibility and safety of endoscopic hybridization. In one case with distal ureter stenosis complicated with renal calculi, the distal ureter was dissected by laparoscopy, then delivered via the laparoscope trocar. A 9.5/11.5F flexible ureteroscope sheath was inserted into ureter. Renal calculi were removed by flexible ureteroscopy. In one case of staghorn stones complicated with hydronephrosis, the child was placed in the oblique lithotomy position. Flexible ureteroscopy and percutaneous nephroscopy were perform at the same time to remove the calculi. In one case of duplex kidney with hydronephrosis of the lower moiety with calculi, nephropyeloplasty of the lower moiety by laparoscopy was performed initially. And 12/14F flexible ureteroscope sheath was inserted into the collecting system of the lower moiety through the laparoscopic trocar when the renal pelvis was open. Then the flexible ureteroscope was used to remove the calculi. All cases were successfully operated without obvious stone residue and major complications. Endoscopic hybridization can be applied safely in children.

Initial Experience With a New Robotic Surgical System for Cholecystectomy.

Background. Laparoscopic cholecystectomy has been the gold standard treatment for symptomatic cholelithiasis for more than 3 decades. Robotic techniques are gaining traction in surgery, and recently, the Senhance™ robotic system was introduced. The system offers advantages over other robotic systems such as improved ergonomics, haptic feedback, eye tracking, and usability of standard laparoscopic trocars and reusable instruments. The Senhance was evaluated to understand the feasibility, benefits, and drawbacks of its use in cholecystectomy. Study Design. A prospectively maintained database of the first 20 patients undergoing cholecystectomy with the Senhance was reviewed at a single hospital. Data including operative time, console time, set up time, and adverse events were collected, with clinical outcome and operative time as primary outcome measures. A cohort of 20 patients having laparoscopic cholecystectomy performed by the same surgeon was used as a comparator group. Results. The 2 groups had comparable demographic data (age, sex, and body mass index). In the Senhance group, 19 of the 20 procedures (95%) were completed robotically. The median (interquartile range) total operating, docking, and console times were 86.5 (60.5-106.5), 11.5 (9-13), and 30.8 (23.5-35) minutes, respectively. In the laparoscopic group, the median (interquartile range) operating time was 31.5 (26-41) minutes. Postoperatively, only one patient had a surgical complication, namely a wound infection treated with antibiotics. Conclusion. Our results suggest that Senhance-assisted cholecystectomy is safe, feasible, and effective, but currently has longer operative times. Further prospective and randomized trials are required to determine whether this approach can offer any other benefits over other minimally invasive surgical techniques.

Transdermal Lidocaine for Perioperative Pain: a Systematic Review of the Literature.

The purpose of this review is to provide a summary of the perioperative studies that have examined transdermal lidocaine (lidocaine patch) as an analgesic and put the evidence in context of the likely overall benefit of transdermal lidocaine in the perioperative period. Several randomized controlled trials have been published in the past 4 years that concluded transdermal lidocaine can reduce acute pain associated with laparoscopic trocar or cannula insertion. Transdermal lidocaine may reduce short-term pain after surgery in selected surgery types and has a low risk of toxicity but its overall clinical utility in the perioperative setting is questionable. Transdermal lidocaine does not consistently reduce opioid consumption after surgery and has not been shown to improve patient function.

A Unique Approach for Total Laparoscopic Hysterectomy and Excision of Endometriosis at Time of Abdominoplasty

Video Objective We describe a unique technique to hide trocar scars while performing concurrent laparoscopic hysterectomy and excision of endometriosis at the time of abdominoplasty. Setting This patient is a 40 y/o female undergoing concomitant abdominoplasty and hysterectomy for chronic pelvic pain, abnormal uterine bleeding, and suspected endometriosis. Combining abdominoplasty with gynecologic surgery reduces total anesthesia and operative times, intraoperative blood loss, hospitalization and total recovery time when compared with having both of the procedures performed separately. Additionally, combined surgery does not appear to be associated with an increase in complications. Interventions We perform a total laparoscopic hysterectomy (TLH) and excision of endometriosis with concomitant abdominoplasty. First, the abdominoplasty flap is raised by the plastic surgeon. Then, the TLH and excision of endometriosis is performed. Finally, the rectus is plicated, excess tissue is excised, and the abdominoplasty is completed. Conclusion Performing concomitant total laparoscopic hysterectomy and abdominoplasty offers many benefits to the patient including shorter total operative and anesthesia, as well as shorter recovery when compared to 2 separate procedures. There are no large fascial defects when the hysterectomy is performed laparoscopically with 5 mm ports, so there is minimal concern for hernia or fascial dehiscence. The laparoscopic approach also offers a detailed survey for endometriosis lesions which can be excised at the same time as hysterectomy for definitive therapy. Aesthetically, the laparoscopic trocar sites are hidden when utilizing this technique, which is advantageous for cosmesis.

Which Needle in which Trocar? A Mathematical-Theoretical Approach

Aim-Background: Needles used in surgery come in various sizes and shapes, and with varying properties. In lapa-roscopic surgery, the trocars create the communication ports to the operative environment, and these ports are used for the introduction of instruments into the surgical field. Needles also need to be passed through these cannulas, which creates constraints regarding the needle size. The aim of this study was to describe the correlation between trocar size and needle size/shape. Methods: In order to estimate the maximum needle length that can be introduced through trocars of different calibers, we approached this problem from the mathematical and theoretical perspective, based on the four most commonly used needle types and the six most frequently used trocars. Results: The results are summarized in a table which determines the maximum needle length the surgeon may choose, given the specific needle type and trocar. Conclusions: Introduction of needles into the abdomen through laparoscopic trocars poses the risk of needle distortion or trocar dysfunction. In order to avoid these complications, the type and length of the needle to be introduced should be compatible with the diameter of the trocar.

Differentiation of skin incision and laparoscopic trocar insertion via quantifying transient bradycardia measured by electrocardiogram.

Most surgical procedures involve structures deeper than the skin. However, the difference in surgical noxious stimulation between skin incision and laparoscopic trocar insertion is unknown. By analyzing instantaneous heart rate (IHR) calculated from the electrocardiogram, in particular the transient bradycardia in response to surgical stimuli, this study investigates surgical noxious stimuli arising from skin incision and laparoscopic trocar insertion, and their difference. Thirty-five patients undergoing laparoscopic cholecystectomy were enrolled in this prospective observational study. Sequential surgical steps including umbilical skin incision (11mm), umbilical trocar insertion (11mm), xiphoid skin incision (5mm), xiphoid trocar insertion (5mm), subcostal skin incision (3mm), and subcostal trocar insertion (3mm) were investigated. IHR was derived from electrocardiography and calculated by the modern time-varying power spectrum. Similar to the classical heart rate variability analysis, the time-varying low frequency power (tvLF), time-varying high frequency power (tvHF), and tvLF-to-tvHF ratio (tvLHR) were calculated. Prediction probability (PK) analysis and global pointwise F-test were used to compare the statistical performance between indices and the heart rate readings from the patient monitor. Analysis of IHR showed that surgical stimulus elicits a transient bradycardia, followed by the increase of heart rate. Transient bradycardia is more significant in trocar insertion than skin incision (p < 0.001 for tvHF). The IHR change quantifies differential responses to different surgical intensity. Serial PK analysis demonstrates de-sensitization in skin incision, but not in laparoscopic trocar insertion. Quantitative indices present the transient bradycardia introduced by noxious stimulation. The results indicate different effects between skin incision and trocar insertion.

Minimally Invasive Surgery: Equipment and Troubleshooting

The field of minimally invasive surgery has evolved rapidly since the first laparoscopic appendectomies and cholecystectomies were performed nearly 30 years ago.1 Minimally invasive approaches are now widely used for gastrointestinal resection, hernia repair, antireflux surgery, bariatric surgery, and solid-organ surgery, such as hepatic, pancreatic, adrenal, and renal resections. Although the techniques and equipment needed to access, expose, and dissect vary according to the type of operation and surgeon’s preference, a basic set of equipment is essential for any laparoscopic or robotic procedure: endoscope, camera, light source, signal processing unit, video monitor, insufflator and gas supply, trocars, and surgical instruments. Understanding how to use and troubleshoot this equipment is critical for any surgeon who performs minimally invasive surgery. We review the essentials of basic laparoscopic equipment, including the mechanics of normally functioning equipment and the various types of laparoscopic trocars and instruments. We also discuss robotic equipment and the fundamental differences from laparoscopy. Minilaparoscopy and single-site equipment are briefly explained. Additionally, we discuss potential technical difficulties that surgeons may encounter while performing minimally invasive procedures and provide suggestions for troubleshooting these problems. This review 13 figure, 2 tables, and 64 references.Key Words: Laparoscopy, Robotic Surgery, Minimally Invasive Surgery, Laparoscopic Surgery, Trocars, Surgical Energy Devices, Insufflator, Laparoscopic Instrumentation, Ergonomics, Single Site Surgery

Minimally Invasive Surgery: Equipment and Troubleshooting

The field of minimally invasive surgery has evolved rapidly since the first laparoscopic appendectomies and cholecystectomies were performed nearly 30 years ago.1 Minimally invasive approaches are now widely used for gastrointestinal resection, hernia repair, antireflux surgery, bariatric surgery, and solid-organ surgery, such as hepatic, pancreatic, adrenal, and renal resections. Although the techniques and equipment needed to access, expose, and dissect vary according to the type of operation and surgeon’s preference, a basic set of equipment is essential for any laparoscopic or robotic procedure: endoscope, camera, light source, signal processing unit, video monitor, insufflator and gas supply, trocars, and surgical instruments. Understanding how to use and troubleshoot this equipment is critical for any surgeon who performs minimally invasive surgery. We review the essentials of basic laparoscopic equipment, including the mechanics of normally functioning equipment and the various types of laparoscopic trocars and instruments. We also discuss robotic equipment and the fundamental differences from laparoscopy. Minilaparoscopy and single-site equipment are briefly explained. Additionally, we discuss potential technical difficulties that surgeons may encounter while performing minimally invasive procedures and provide suggestions for troubleshooting these problems. This review 13 figure, 2 tables, and 64 references.Key Words: Laparoscopy, Robotic Surgery, Minimally Invasive Surgery, Laparoscopic Surgery, Trocars, Surgical Energy Devices, Insufflator, Laparoscopic Instrumentation, Ergonomics, Single Site Surgery

Minimally Invasive Surgery: Equipment and Troubleshooting

The field of minimally invasive surgery has evolved rapidly since the first laparoscopic appendectomies and cholecystectomies were performed nearly 30 years ago.1 Minimally invasive approaches are now widely used for gastrointestinal resection, hernia repair, antireflux surgery, bariatric surgery, and solid-organ surgery, such as hepatic, pancreatic, adrenal, and renal resections. Although the techniques and equipment needed to access, expose, and dissect vary according to the type of operation and surgeon’s preference, a basic set of equipment is essential for any laparoscopic or robotic procedure: endoscope, camera, light source, signal processing unit, video monitor, insufflator and gas supply, trocars, and surgical instruments. Understanding how to use and troubleshoot this equipment is critical for any surgeon who performs minimally invasive surgery. We review the essentials of basic laparoscopic equipment, including the mechanics of normally functioning equipment and the various types of laparoscopic trocars and instruments. We also discuss robotic equipment and the fundamental differences from laparoscopy. Minilaparoscopy and single-site equipment are briefly explained. Additionally, we discuss potential technical difficulties that surgeons may encounter while performing minimally invasive procedures and provide suggestions for troubleshooting these problems. This review 13 figure, 2 tables, and 64 references.Key Words: Laparoscopy, Robotic Surgery, Minimally Invasive Surgery, Laparoscopic Surgery, Trocars, Surgical Energy Devices, Insufflator, Laparoscopic Instrumentation, Ergonomics, Single Site Surgery

Laparoscopic donor right hepatectomy with reconstruction of segment V and VIII tributaries of the middle hepatic vein using a cadaveric iliac artery allograft

Laparoscopic donor right hepatectomy with reconstruction of segment V and VIII tributaries of the middle hepatic vein using a cadaveric iliac artery allograft

Comparison of two methods of laparoscopic trocar insertion (Hasson and Visiport) in terms of speed and complication in urologic surgery.

Background: Nowadays, diverse approaches have been existed for laparoscopic procedures. The most common laparoscopic entry methods included close and direct entry laparoscopy and open (Hasson) laparoscopy. There is no evidence regarding the superiority in safety and initial speed for the use of open and optical laparoscopic entry. Therefore, the sight of current study was to evaluate comparative survey of two methods of laparoscopic trocar insertion (Hasson and VisiportTM) in terms of speed and complications in urologic surgery.Methods: This expertized base clinical trial study was conducted on 100 patients who underwent urological laparoscopy in Alzahra Hospital, Isfahan, Iran. These patients were randomly divided to two groups (n = 50). One group underwent open laparoscopy and another group Visiport optical trocar. Speed and Complications of urologic surgery was extracted from medical records. Independent T test was used for doing of analysis.Results: The mean age of patients in Hasson and Visiport laparoscopic group was 41.4 ± 11.2 and 41.6 ± 15 years old, respectively (p = 0.91). The mean time for initial trocar placement in patients who underwent Visiport trocar system and Hasson laparoscopic technique was 37.7 ± 15.59 and 95.4 ± 31.75 seconds. There was gratifying difference between two techniques of laparoscopic trocar insertion (Hasson and Visiport) in terms of speed (p = 0.000). In addition, complications were observed in 8% of patients who underwent Visiport trocar system. However, no complications were observed in Hasson laparoscopy group.Conclusion: Visiport optical trocar technique is faster for initial trocar placement than open laparoscopy. However it is associated with complications compared to open laparoscopy. Therefore, there is evidence of benefit in terms of speed for initial trocar placement and harm based on complications in Visiport trocar system.

Laparoscopic Trocar Insertion: A Comparison of Insertional and Rotational Forces between Expert and Novice Surgeons

Laparoscopic Trocar Insertion: A Comparison of Insertional and Rotational Forces between Expert and Novice Surgeons

Single-Port Laparoscopic Assisted Transcrotal Orchidopexy for Palpable Inguinal Canalicular Cryptorchidism Accompany With Indirect Inguinal Hernia.

Purpose: To assess the outcomes of a novel laparoscopic assisted transcrotal orchidopexy (LATO) combined with percutaneous extraperitoneal closure (PEC) for palpable inguinal canalicular cryptorchidism accompany with indirect inguinal hernia, and evaluate its safety and efficiency.Materials and Methods: A retrospective cohort study for single-port LATO-PEC and traditional inguinal orchidopexy (TIO) was performed between 2011 and 2014. Totally 53 children with both palpable inguinal canalicular testes and indirect inguinal hernia were included. Median patient age was 15month (range, 6 months to 4 years). Of them, 35 patients underwent LATO-PEC procedure, utilizing an umbilical trocar for laparoscope, transcrotal dissection for orchidopexy, and an inner two-hooked cannula for ligation of the patent processus at the level of the internal ring. Three of them were bilateral, 12 on the left side and 20 on the right. Eighteen patients received TIO, seven of them on the left side and 11 on the right. Patient demographics, surgical technique, complications, and clinical outcomes were reviewed. Follow-up visits were performed to reassess position and size of the testes.Results: All 56 undescended testes were delivered into the scrotum successfully. In the LATO-PEC group, nine contralateral herniorrhaphy were accomplished simultaneously. Fifteen contralateral patent processus vaginalis (PPVs) in 32 unilateral undescended testis (UDT) were newly confirmed during the laparoscopy, while 6 of them received percutaneous extra-peritoneal herniorrhaphy for visible inguinal bubble in pneumoperitoneum condition. No additional port placement or conversion to open procedure was needed. Mean operative time for unilateral and bilateral LATO-PEC in this study was (37.81 ± 5.23) min and (53.33 ± 2.98) min, respectively. In TIO group, mean operative time was (41.11 ± 8.67) min. There was no statistical difference in operative time between the two approaches for unilateral UDTs (p = 0.098). Median follow-up interval was 24 months (range, 12–84 months). No operative complications were found in either group to date.Conclusions: Singe-port LATO-PEC is a safe, effective, and cosmetic choice for inguinal canalicular cryptorchidism accompany with indirect inguinal hernia, minimizing injuries to the vas deferens and testicular vessels. Laparoscopy can provide a diagnostic and therapeutic solution of contralateral PPV.

Secondary pregnancy by an implant in a laparoscopic trocar site

For nearly 20 years, laparoscopy has been generally regarded as the gold standard for the surgical treatment of ectopic pregnancy and its application is very widespread. According to our knowledge, secondary pregnancy at the laparoscopic trocar site has not yet been reported until now. A 24-year-old Chinese female patient is reported herein. Her left fallopian tube was removed via laparoscopy due to a first ectopic pregnancy. Her postoperative blood β-human chorionic gonadotropin (β-hCG) was increasing with irregular vaginal bleeding. The patient was initially regarded as having an old ectopic pregnancy. Secondary pregnancy by an implant in a laparoscopic trocar Site. Because of secondary pregnancy at the laparoscopic port site, laparoscopic surgery was performed again 32 days after the first operation. Approximately 1000 milliliters (mL) of free intraperitoneal hemorrhage and active bleeding of the lesion were detected. Histopathologic examination confirmed the lesion was the result of pregnancy with visible villous tissue. Her blood β-hCG gradually declined to a normal range in 28 days after the second operation. Menstruation occurred on day 20 after the second operation, and the duration and quantity were normal. Although laparoscopy has many advantages, secondary pregnancy at the laparoscopic trocar port wound caused the patient enormous physical and mental pain and increased the medical costs. The etiology of secondary ectopic pregnancy at the laparoscopic puncture site was mainly an iatrogenic factor. Therefore, the procedure should be standardized to avoid its occurrence.

Laparoscopic resection of a segment VIII colorectal liver metastasis using an ultrasonic surgical aspirator

Background: With the developments in surgical technique and instruments, increasingly more challenging liver tumors can be approached laparoscopically. This video demonstrates the use of an ultrasonic surgical aspirator to resect a segment VIII lesion. Methods: Patient was placed supine and four laparoscopic trocars were inserted into the right upper quadrant. Following diagnostic laparoscopy and ultrasound, liver resection was performed using the ultrasonic surgical aspirator. Results: Patient was a 45-year-old male with a history of pT2N0/18M0 rectal cancer treated with neoadjuvant chemotherapy, low anterior resection with diverting loop ileostomy, and ileostomy closure. On follow-up he was discovered to have a solitary 1.5 × 1.4 cm liver metastasis in segment VIII. Laparoscopic wedge resection of the tumor was successfully performed using the ultrasonic surgical aspirator without any intraoperative complications. The patient was discharged uneventfully on postoperative day #2. Final pathology showed colorectal liver metastasis with negative surgical margins. Conclusion: This video demonstrates the use of the ultrasonic surgical aspirator in laparoscopic resection of a segment VIII tumor. Despite the challenging location of the tumor, this device helped us resect it efficiently.

48: Laparoscopic trocar insertion: A comparison of insertional and rotational forces between expert and novice surgeons

48: Laparoscopic trocar insertion: A comparison of insertional and rotational forces between expert and novice surgeons

Sporadic Desmoid-Type Fibromatosis Occurring at Laparoscopic Trocar Site: An Unusual Entity.

Desmoid-type fibromatosis (DF) or desmoid tumours are rare benign soft tissue tumours of musculo-aponeurotic origin, which have no malignant potential but are locally aggressive and can result in significant morbidity. They may be hereditary (in association with FAP, i.e. familial adenomatous polyposis syndrome resulting from APC gene mutation) or sporadic, with hereditary cases having a much higher risk of developing DF compared to sporadic ones. Desmoids are known to occur in previous surgical scars. However, previous laparoscopic port site/trocar site is an extremely uncommon site for sporadic desmoids, with only two cases of sporadic laparoscopic trocar site desmoids (occurring in absence of FAP) reported in world literature. We thus describe a case of sporadic DF, occurring at the site of umbilical port 8months following laparoscopic cholecystectomy for cholelithiasis, treated successfully by margin-negative resection. To the best of our knowledge, this appears to be the first such case in Indian literature and the first being reported after laparoscopic cholecystectomy. In the era of laparoscopic surgery, one must be aware of the existence of such an entity after laparoscopy as it may be confused with conditions such as metastatic deposit, port site tumour recurrence, port site hernia, scar site endometriosis, soft tissue sarcoma etc. and may result in diagnostic dilemma.

LESS ovariohysterectomy in cats using a new homemade multiport

ABSTRACT: The purpose of this study was to assess the use of a homemade multiport for LESS (laparoendoscopic single-site surgery) ovariohysterectomy (OVH) in cats. Intra and postoperative variables of the surgery steps, technical challenges, complications and evolution of surgical time by a surgeon in training were evaluated. Twenty queens were selected for LESS OVH. The multiport device was manufactured of a conical-shaped ethylene polytereftalate (PET) bottle, urethral catheter no. 8, latex balloon no. 11, a 3.5mm and a 6mm laparoscopic trocars. Hemostasis was carried out using bipolar diathermy. Mean total surgical time was 14.54±5.12 minutes. Approach to right and left ovarian pedicles and abdominal access for insertion of the multiport device were the most time consuming surgical steps. LESS ovariohysterectomy using a new homemade multiport device is feasible and safe. Thus, the proposed technique may be considered as a minimally invasive alternative to ovariohysterectomy in the feline specie.