Minilaparoscopic Instruments Research Articles

Minilaparoscopic total extraperitoneal hernioplasty

The purpose of the study was to assess the feasibility of preperitoneal repair of inguinal hernias using minilaparoscopic instruments — ports with a diameter of 3 mm. From March to June 2023, 10 laparoscopic hernioplasties were performed using mini instruments. All operations were performed using a 10 mm optical trocar and two working trocars with a diameter of 3 mm. The following indicators were analyzed: the severity of pain in the early postoperative period (6 hours after surgery), the severity of pain upon discharge from the hospital, the use of analgesics on demand, operation time, the frequency of intraoperative and delayed complications. The average operative time was 45 ± 10 minutes. There was no conversion to open plastic surgery. One patient used analgesics immediately after surgery. The length of hospital stay was 2 days for all patients. There were no intra- or postoperative complications. Conclusion: This study demonstrates the feasibility of performing minilaparoscopy, which demonstrates good results in terms of postoperative pain, operative time and aesthetics, in laparoscopic hernia repair.

Mini-Laparoscopic Isthmocele Repair

Study Objective Describe excision and repair of uterine isthmocele using mini-laparoscopic instruments. Design Instructional video on technique. Setting Individual case. Patients or Participants The patient is a 35yo g1p1 with prior term cesarean delivery and subsequent secondary infertility. Her workup was unremarkable apart from saline ultrasound showing a significant uterine isthmocele. Prior to moving forward with IVF, her reproductive endocrinologist recommended correction of the isthmocele. Interventions Laparoscopic repair of uterine isthmocele using 5 and 3-mm instruments Measurements and Main Results The isthmocele was completely excised and repaired with postoperative saline ultrasound showing thick myometrium in place of previous uterine defect. Conclusion Robust excision and repair of a uterine isthmocele can be readily accomplished with simply three small laparoscopic incisions.

A comparative study of mini- versus standard laparoscopy in the treatment of renal cysts

Introduction This study aimed to investigate the safety and efficacy of mini-laparoscopy for renal cyst unroofing. Material and methods Eighty-six patients for treatment of renal cysts that met the selection criteria were included in this study. They were divided into two groups. Forty-five patients underwent cyst unroofing via mini-laparoscopy (Group M), and 43 patients underwent cyst unroofing via standard laparoscopy (Group S). There were no differences between the two groups in terms of sex, age, body mass index or clinical data. Data from the groups were recorded and analyzed. Results The average hospital stays were shorter (p = .039) and postoperative painkiller demand was lower (p = .031) in Group M than in Group S. Forty-one out of 45 procedures in Group M were successful, and all 43 cases in Group S were successfully. With a follow-up period of 0.5 to 5.5 years, there was no significant difference in recovery rate (p = .213). Questionnaires showed that patients in Group M were significantly more satisfied with their cosmetic results than were patients in Group S (p = .041). Conclusion Our findings suggest that renal cyst decortications with mini-laparoscopic instruments are as safe and effective as procedures using standard laparoscopic instruments. Cosmetically, the results are better with mini-laparoscopy than with standard laparoscopic unroofing.

Minimally invasive surgical treatment in patients with immunological thrombocytopenic purpura

Two female patients, one 28 years-old, and the other 61 years-old, with a history of asthenia, purpura and thrombocytopenia (both <15,000 platelets / mm3). Once other etiologies were excluded, and the diagnosis of immune thrombocytopenic purpura (ITP) was established, corticoid therapy was started in both cases. However, the patients remained with a platelet count <20,000 / mm3, characterizing refractory ITP, and the splenectomy was indicated. The surgical team opted for a hybrid minimally invasive surgical procedure. Providing a better visualization of the surgical field, less abdominal trauma, greater technical dexterity, and early hospital discharge, the use of minilaparoscopic instruments proved to be a safe and effective approach for these patients.

Minilaparoscopic lumbar sympathectomy with 3 mm instruments for plantar hyperhidrosis.

Severe palmoplantar hyperhidrosis affects about 1.5-2.8% of the general population. Plantar hyperhidrosis (PHH) is related to foot odor, cold feet, skin lesions and infections, and even instability when walking. Endoscopic Lumbar Sympathectomy (ELS) is the treatment of choice for this condition. However, few surgeons have used this technique over the past 20 years because of its technical difficulty. Two and 3 mm instruments, rather than the standard 5 mm instruments, have been used to improve the results of several standard laparoscopic procedures. Use of these minilaparoscopic instruments to perform ELS so far has not yet been published. We describe a technique for ELS using minilaparocopic instruments, which we have used for our last 70 cases and has become our standard technique. The aim of this study is to demonstrate the feasibility of this technique and its advantages compared to the conventional technique.

Laparoscopic ovariectomy in guinea pigs: A pilot study.

To assess the feasibility and safety of laparoscopic ovariectomy in guinea pigs utilizing 3-mm minilaparoscopic instruments. Experimental pilot study. Guinea pigs (n = 3). The guinea pigs were sedated, placed under general anesthesia, and intubated under endoscopic visualization. A 3-port technique was used with a 3.9-mm cannula for the endoscope and two 3.5-mm cannulas accommodating 3-mm endoscopic instruments including a 3-mm vessel sealing device, grasping forceps, and endoscopic scissors. The abdomen was insufflated with CO2 to a pressure of 6-8 mm Hg. The guinea pigs were manually tilted 90° laterally to visualize the dorsally positioned ovaries. The procedure was successfully performed in all 3 animals. The surgery times were 120, 45, 45 minutes for the 3 guinea pigs, and anesthesia times were 186, 90, and 76 minutes, respectively. Placing the animals in complete lateral recumbency was found to be critical to visualize and manipulate the ovaries. The guinea pigs recovered smoothly from anesthesia. Laparoscopic ovariectomy with 3-mm minilaparoscopic instrumentation using a 3-port technique was feasible in guinea pigs. Laparoscopic ovariectomy can be considered as an alternative to open ovariectomy as an elective surgical technique to prevent reproductive disorders in guinea pigs.

The Safety and Clinical Results of Pyeloplasty Using Mini-Laparoscopic Instruments: A Comparison with Conventional Laparoscopi Pyeloplasty

The Safety and Clinical Results of Pyeloplasty Using Mini-Laparoscopic Instruments: A Comparison with Conventional Laparoscopi Pyeloplasty

The protocol of low-impact laparoscopic cholecystectomy: the combination of mini-laparoscopy and low-pressure pneumoperitoneum

Low-impact laparoscopic (LIL) cholecystectomy is an innovative surgical protocol that combines the use of mini-laparoscopic instruments (3-mm ports) under a low- and stable-pressure pneumoperitoneum (8mmHg), with the aim of minimizing the surgical invasiveness and the risks related to CO2 insufflation on the peritoneal environment. In day-surgery settings, LIL may contribute to increase the surgical success due to several potential benefits in terms of postoperative pain intensity and time to full recovery. In 14 consecutive patients requiring cholecystectomy for uncomplicated cholelithiasis, LIL was carried out uneventfully. No conversion, intra-operative or postoperative complications occurred. All patients were discharged the same day of surgery. Postoperative pain was well tolerated with no need of prolonged opioid therapy. Technical aspects and indications for LIL cholecystectomy are detailed.

104 - The Feasibility of Mini-Plus Percutaneous (MpPc) Endoscopy for Benign Gynecologic Procedures: Single Institution Experience

Study Objective: To evaluate the feasibility of Mini-plus percutaneous (MpPc) endoscopic surgery in different trocar settings for benign gynecologic operations. Design: Prospective observational study. Setting: Tertiary-care university-based teaching hospital and academic affiliated private hospital. Patients: Forty-nine women who underwent mini-plus percutaneous endoscopic surgery for benign gynecologic indications, between December 2015 and March 2017. Intervention: MpPc surgeries were performed through one optical transumbilical 5-mm trocar, one 5-mm ancillary port on the right-lower quadrant, one 2.4-mm percutaneous endoscopic instrument (MiniGrip Handle, Teleflex, USA) on the right-upper quadrant, and if it is required one 3.5-mm ancillary port on the left-lower quadrant. A 5-mm 30-degree and if it is needed 3.5-mm 30-degree pediatric telescope, 3.5 mm mini-laparoscopic instruments (Karl Storz, Tuttingen, Germany) and integrated bipolar and ultrasonic technology (Thunderbeat, Olympus, Japan) were used. The umbilical incision was closed with a 4/0 Monocryl, whereas other incisions were approximated by using sterile-strips. All operations were performed by the same surgeon. Measurements and Main Results: A total of 49 patients were conducted. The median age was 38 years (range,28–63 years); body-mass index was 26 kg/m2 (range, 22- 32 kg/m2). Of the 49 patients, 14 had uterine fibroids; 13 had benign adnexal mass; 5 had breast cancer plus BRCA1 carrier; 4 had endometrial intraepithelial neoplasia; 4 had adenomyosis + abnormal uterine bleeding; 4 had ectopic pregnancy; 3 had hydrosalpinx, and 2 had adnexal torsion. As MpPc surgical procedures had 27 total laparoscopic hysterectomies, 8 ovarian cystectomy, 7 salpingo-oophorectomy, and 7 salpingectomy The median operating time was 60 minutes (range, 20–185 min), and estimated blood loss was 40 ml (range, 10–180 ml). Conversion to 5-mm conventional laparoscopy or open surgery was not required. No Intra- and postoperative complications were recorded. Conclusion: MpPc is feasible and nearly “‘scar-free’” ultra-minimally invasive procedure for benign gynecologic operations.

Bilateral Salpingectomy Using Percutaneous Minilaparoscopy

Study ObjectiveTo show a new technique for bilateral salpingectomy using percutaneous minilaparoscopy. DesignStep-by-step video demonstration and narration of the surgical procedure. SettingMinilaparoscopy was first described in the late 1980s and early 1990s. Since then, minilaparoscopic instruments have been successfully applied to several general surgery and gynecologic procedures, including hysterectomy. Potential benefits of minilaparoscopy compared with conventional laparoscopy include decreased tissue trauma, pain, and improved cosmesis. InterventionsPercutaneous minilaparoscopic approach for bilateral salpingectomy. ConclusionPercutaneous minilaparoscopy, in addition to conventional laparoscopy, is a feasible approach for bilateral salpingectomy.

New Generation Mini-Laparoscopic Instruments in Common Gynecologic Procedures: A Demonstration of Feasibility in a Cadaveric Model

New Generation Mini-Laparoscopic Instruments in Common Gynecologic Procedures: A Demonstration of Feasibility in a Cadaveric Model

Mini-laparoscopic sacrocolpopexy for apical and posterior female pelvic organ prolapse.

Mini-laparoscopic surgery is the future for most laparoscopic procedures. Although already applied in some gynaecological surgical interventions, this video is to our knowledge the first publication on the use of the mini-laparoscopic approach to sacrocolpopexy for apical and posterior pelvic organ prolapse following total hysterectomy. The concept of mini-laparoscopic sacrocolpopexy presented in this video article was performed on 12 women with post-hysterectomy apical and posterior pelvic organ prolapse using mini-laparoscopic instruments and ports of 3mm in diameter combined with a 12-mm umbilical port. Surgery was performed with the same principles as for the conventional laparoscopic procedure. The mean operating time was 70min (SD ± 12). The tensile strength of the mini-laparoscopic instruments allowed appropriate manipulation of tissue consistent with that of conventional instruments. No difficulties or complications were experienced in comparison to a conventional technique. All patients were discharged from hospital on day1 postoperatively. The effectiveness, safety and feasibility of the mini-laparoscopic surgical technique was applied to sacrocolpopexy. Because of the initial favourable experience, the mini-laparoscopic sacrocolpopexy could become more widely used in the future.

Hybrid laparoendoscopic single-site surgery of upper urinary tract with the use of mini-laparoscopic instruments: cosmetic outcome and midterm oncological outcome.

To evaluate the efficacy of mini-laparoscopic instruments in combination with laparoendoscopic single-site surgery (LESS) instruments for the performance of oncological urological surgery. Thirty-five patients underwent oncological hybrid LESS either mini-laparoscopic-assisted LESS partial nephrectomy (LESS-PN, n=12) or mini-laparoscopic-assisted LESS radical nephrectomy (LESS-RN, n=23). Perioperative data were prospectively collected. The patient and observer scar assessment scale (POSAS) was used for the evaluation of the cosmetic outcome. Mean tumor size treated by LESS-PNs was 28.8 (IQR 20.5-37.3) mm. Average operative time and blood loss were 123 (IQR 112.5-145) min and 158.3 (IQR 100-200) ml, respectively. Renal artery clamping took place in seven cases. LESS-RN was performed in cases with a mean tumor size of 60 (IQR 48-71.5) mm. The average operative time was 116.8 (IQR 100-130) min. Average blood loss was 137 (IQR 100-150) ml. Complications were limited to grade II according to Clavien classification. The oncological outcome, including midterm results, was directly comparable to the literature. Patients reported low pain scores and high satisfaction in terms of postoperative scarring. The POSAS scores confirmed the excellent cosmetic outcome of hybrid LESS. The combination of mini-laparoscopic and LESS instrumentation as routine equipment of oncological surgery provided an efficient option for urologic surgery. The combination of mini-laparoscopic and LESS instruments improves the intraoperative ergonomics of LESS-PN and LESS-RN. The provided surgical and oncological outcome compares favorably to the LESS and conventional laparoscopic literature.

Minilaparoscopy For Inguinal Hernia Repair.

Background and Objectives:Inguinal hernia repair is among the most common procedures performed worldwide and the laparoscopic totally extraperitoneal (TEP) approach is a recognized and effective surgical technique. Although technically advantageous because of the option of no mesh fixation and no need for creation of a peritoneal flap resulting, in less postoperative pain and faster recovery, TEP has not achieved the popularity it deserves, mainly because of its complexity and steep learning curve. Minilaparoscopy was first described in the 1990s and has recently gained significantly from better instrumentation that may increase TEP's effectiveness and acceptance. We performed a prospective study, to analyze the outcomes of minilaparoscopy in pain and operative time when compared to the conventional laparoscopic technique in hernia repair.Methods:Fifty-eight laparoscopic inguinal hernia repairs were performed: 36 by traditional laparoscopic technique and 22 by minilaparoscopic instruments (mini). A study protocol was applied prospectively for data collection. Variables analyzed were early postoperative pain (at hour 6 after procedure), pain at discharge, use of on-demand analgesics, and operative time.Results:The mini group presented reduced early postoperative pain and operative time. The present study also suggests less postoperative pain at discharge with mini procedures, although this difference was not statistically significant. No difference between the groups regarding on-demand use of analgesics was found.Conclusions:This study corroborates findings in previously published papers that have shown the feasibility of minilaparoscopy in laparoscopic TEP hernia repair and its benefits regarding postoperative pain, operative time, and aesthetic outcomes.

Minilaparoscopy in urology: initial results after 32 cases

The use of minilaparoscopic instruments has gained interest in recent years, permitting a less invasive treatment for many surgical procedures. Its application in urological surgeries has not been established yet. Between November 2012 and December 2014, 32 patients underwent minilaparoscopic surgeries, using 3.5-mm instruments. The procedures performed included pyeloplasties (16 cases), radical nephrectomies (2), simple nephrectomies (4), renal cyst decortication (5), ureterolithotomy (2) ureteral reimplantation (2) and partial ureterectomy (1). All the procedures were performed minilaparoscopically, except for one simple nephrectomy and one renal cyst decortication that were converted to a standard laparoscopic approach, due to intensive perioperative bleeding. One pyeloplasty had to be reoperated for a urinary fistula repair. All the patients had good-to-excellent cosmetic outcomes, except for one patient who developed keloids at her scars. Functional results were comparable to the ones described in the literature. Minilaparoscopy is a feasible option for patients and physicians searching for a even less invasive procedure compared with the laparoscopic approach, with better cosmetic and the same functional and oncologic outcomes.

Low-Friction Minilaparoscopy Outperforms Regular 5-mm and 3-mm Instruments for Precise Tasks.

Background and Objectives:Therapeutic laparoscopy was incorporated into surgical practice more than 25 y ago. Several modifications have since been developed to further minimize surgical trauma and improve results. Minilaparoscopy, performed with 2- to 3-mm instruments was introduced in the mid 1990s but failed to attain mainstream use, mostly because of the limitations of the early devices. Buoyed by a renewed interest, new generations of mini instruments are being developed with improved functionality and durability. This study is an objective evaluation of a new set of mini instruments with a novel low-friction design.Method:Twenty-two medical students and 22 surgical residents served as study participants. Three designs of laparoscopic instruments were evaluated: conventional 5 mm, traditional 3 mm, and low-friction 3 mm. The instruments were evaluated with a standard surgical simulator, emulating 4 exercises of various complexities, testing grasping, precise 2-handed movements, and suturing. The metric measured was time to task completion, with 5 replicates for every combination of instrument–exercise–participant.Results:For all 4 tasks, the instrument design that performed the best was the same in both the medical student and surgical resident groups. For the gross-grasping task, the 5-mm conventional instruments performed best, followed by the low-friction mini instruments. For the 3 more complex and precise tasks, the low-friction mini instruments outperformed both of the other instrument designs.Conclusion:In standard surgical simulator exercises, low-friction minilaparoscopic instruments outperformed both conventional 3- and 5-mm laparoscopic instruments for precise tasks.

Surgeons' perceptions of transanal endoscopic microsurgery using minilaparoscopic instruments in a simulator: the thinner the better.

Several issues have limited the widespread adoption of transanal endoscopic microsurgery (TEM). The need for specialized equipment and the steep learning curve represent one of them. To operate on within a 4-cm diameter, rectoscope represents a major technical challenge. However, minilaparoscopic surgery has been introduced to reduce invasiveness and abdominal wall trauma. In TEM, instrument miniaturization may lead to technique optimization. We hypothesized that visualization and maneuverability during TEM performed with 3-mm minilaparoscopic instruments would be superior to TEM performed with conventional 5-mm instruments. Eighteen general and colorectal surgeons with experience with TEM under ten cases were recruited. Two tasks should be accomplished using the TEO(®)-Neoderma simulator. First, using conventional 5-mm TEO(®) curved-tip instruments, a "polypoid lesion" should be excised. Next, closure of the "rectal" defect should be undertaken. In the second part, the same participants repeated the same excision/closure tasks using 3-mm minilaparoscopic instruments. After tasks conclusion, participants fulfilled an evaluation questionnaire with seven questions regarding visualization and maneuverability when using 3-mm compared to 5-mm instruments. For each one of the seven questions in the questionnaire, the score results were significantly higher for the 3-mm instruments indicating that performance with the 3-mm minilaparoscopic instruments in the TEO simulator was in all cases between "better than expected" and "much better than expected." Appropriateness of the diameter of the minilaparoscopic instruments was the best evaluated parameter. The question addressing the ease of performing the tasks in the simulator presented the lowest mean score. The perceptions of participating surgeons indicated that there is better visualization and maneuverability during basic transanal endoscopic microsurgery tasks conducted in a simulator using 3-mm minilaparoscopic instruments when compared to conventional 5-mm instruments.

Effect of Umbilical Port and Endoscope Size on Discharge Times and Postoperative Recovery After Total Laparoscopic Hysterectomy: A Retrospective Review

Background: Laparoscopy is increasingly replacing open surgery as the preferred treatment option in most patients across disciplines. In addition, as technological improvements have occurred, minilaparoscopic instruments have been designed to reduce surgical trauma further and minimize invasiveness. Several studies in the literature have shown that using minilaparoscopic instruments does not increase complication rates and may improve patient recovery. There are no data examining the use of smaller incisions for the endoscope. Objective: This review was conducted to determine differences in discharge times and postoperative recovery when using a 5-mm trocar, compared to a 10-mm trocar, when making umbilical incisions. Materials and Methods: This retrospective review of a single surgeon series of 328 consecutive cases examined the implications (discharge times and postoperative recovery) of using a 5-mm umbilical incision and endoscope, compared with the conventional 10-mm incision and endoscope. Results: The 5-mm incision and endoscope decreased length of stay and was a safe alternative to the 10-mm incision and endoscope. Conclusions: The 5-mm incision and trocar should be used rather than the 10-mm incision and trocar when performing a total laparoscopic hysterectomy. (J GYNECOL SURG 30:273)

Suprapubic mini-laparoscopy-assisted transurethral thulium laser excision of intravesical mesh after anti-incontinence sling procedures

ObjectivesWe present our innovative technique of excising intravesically exposed mesh resulting from anti-incontinence sling procedures using transurethral thulium laser assisted by a suprapubic transvesical mini-laparoscopic grasper. MethodsTwo patients agreed to anti-incontinence sling surgery for stress urinary incontinence several years ago prior to presentation. Because of symptom recurrence, they underwent repeat anti-incontinence sling surgery. One patient developed dysuria and mild lower abdominal pain gradually 1 month after the operation. Cystoscopy was performed and revealed exposed mesh at the left anterolateral wall, which might have resulted from missed intraoperative bladder perforation. The other patient presented with dysuria 2 years following the second sling procedure. Cystoscopy demonstrated a calcified mass attached to the right lateral wall. Bladder erosion by a previously implanted mesh was thought to be the cause. Intravesical mesh was removed transurethrally with thulium laser assisted by a suprapubic transvesical mini-laparoscopic grasper for the former patient. Vesicolithotripsy was performed for the latter patient first and the intravesical mesh was removed in the same manner as in the former patient. ResultsThe intravesical mesh was removed smoothly with thulium laser with the assistance of a suprapubic mini-laparoscopic grasper. As the procedure was minimally invasive, both patients recovered well after removal of the intravesical mesh. The irritative voiding symptoms also subsided following removal of the mesh. ConclusionRemoval of eroded or misplaced intravesical mesh after anti-incontinence sling procedures can be accomplished by transurethral laser excision with the assistance of suprapubic transvesical mini-laparoscopic instruments. The procedure is safe, effective, and minimally invasive, with a fast recovery.

‘Scarless' Laparoscopic Urologic Surgery by the Combination of Mini-Laparoscopic and Laparoendoscopic Single-Site Surgery Equipment

Objective: We evaluated reconstructive and oncological laparoendoscopic single-site surgery (LESS) combined with mini-laparoscopic instruments as standard equipment. Patients and Methods: 30 patients underwent reconstructive and oncological LESS: mini-laparoscopic-assisted LESS pyeloplasty (LESS-P, n = 18), mini-laparoscopic-assisted LESS partial nephrectomy (LESS-PN, n = 7) or mini-laparoscopic-assisted LESS radical prostatectomy (LESS-RP, n = 5). Perioperative data were prospectively collected. Results: The 18 LESS-P cases had operative times ranging between 120 and 180 min (average 147.9 min). Estimated blood loss ranged between 100 and 300 ml (average 202.1 ml). Two patients required additional management for failed reconstruction. LESS-PN was performed in 7 patients with tumor size ranging between 2.5 and 3.8 cm (average 2.7 cm). Average operative time and blood loss were 155 (140-180) min and 321.4 (250-550) ml, respectively. Renal artery clamping took place in 1 case. LESS-RP was performed in 5 patients; average operative time was 156 (140-180) min and average blood loss 196 (100-400) ml. Functional and oncological outcome was directly comparable to laparoscopic radical prostatectomy. Conclusion: The combination of LESS and mini-laparoscopic instrumentation as routine equipment of reconstructive LESS reveals a different perspective for ‘scarless' urologic surgery.