Standard Laparoscopic Equipment Research Articles

Abstract CT106: First-in-human phase 1 study of paclitaxel-eluting PTM-101 film in subjects with borderline resectable or locally advanced pancreatic cancers

Abstract Background Unlike many other types of cancer, improvements in the treatment of pancreatic cancer have been very limited, in part due to the inability to deliver chemotherapy to the tumor at efficacious concentrations for a prolonged time. PTM-101 is a novel biodegradable film containing paclitaxel and is designed to continuously release high concentrations of paclitaxel precisely to the site of a pancreatic tumor over one month. Methods This first in human study was conducted at one center in Australia to assess the safety, toxicity, and surgical feasibility of a single administration of PTM-101 containing 100 mg of paclitaxel. PTM-101 was sutured directly onto the pancreatic surface overlying the tumor by a surgical oncologist using standard laparoscopic equipment during a disease-staging assessment. Approximately 3 weeks after PTM-101 placement, all participants began standard of care therapy which included mFOLFIRINOX. This study enrolled 3 subjects that had treatment naïve, borderline resectable or locally advanced, pancreatic adenocarcinoma. Subjects were monitored closely for local and systemic toxicities, as well as for preliminary signals of efficacy. An independent central imaging lab reviewed CT scans to determine changes in tumor volume. Results PTM-101 was successfully implanted over the tumor site in all three subjects. In all cases, there were no adverse events reported during the procedure. Overall, PTM-101 was well tolerated with a total of five Grade 1 adverse events judged at least possibly related to the procedure or the mFOLFIRINOX. No serious adverse events (SAEs) or deaths occurred. Paclitaxel was undetectable in the circulation at all time points. Subjects were followed for 6 months. Best overall response rate according to RECIST was stable disease (2 subjects) and partial response (1 subject). An independent analysis showed that all tumors had a reduction in size in the anterior/posterior diameter, which was consistent with unidirectional paclitaxel release from PTM-101. Two of the 3 subjects had a >30% tumor volume reduction, importantly, with the initial decrease in tumor size detected prior to mFOLFIRINOX. Conclusion PTM-101 was readily implanted during diagnostic laparoscopy and was well tolerated with no SAEs or deaths reported during 6 months of follow up. This study demonstrated that a PTM-101 implant was surgically feasible, safe, resulted in no systemic paclitaxel exposure, and caused a tumor size reduction in all 3 subjects. Additional studies may demonstrate the potential for PTM-101 to be a first-line adjunct prior to neoadjuvant therapy in treatment naïve, borderline resectable or locally advanced, pancreatic cancer. Citation Format: Charles Pilgrim, Marty Smith, Ee-Jun Ban, Samantha Ellis, John Zalcberg, Benjamin Markman, Margaret Lashof-Sullivan, Laura Indolfi. First-in-human phase 1 study of paclitaxel-eluting PTM-101 film in subjects with borderline resectable or locally advanced pancreatic cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT106.

Interstitial Pregnancy: Surgical Management by Laparoscopic Cornuostomy

<h3>Study Objective</h3> Our objective is to add to current literature support for laparoscopic cornuostomy as a safe and effective minimally invasive surgical management for interstitial (cornual) ectopic pregnancy. <h3>Design</h3> Surgical video. <h3>Setting</h3> Highland Hospital, Alameda Health System (safety-net county hospital). Patient was positioned in dorsal lithotomy with both arms tucked at the side. Standard laparoscopic and hysteroscopic equipment was used including four 5mm laparoscopic ports. <h3>Patients or Participants</h3> A single patient was involved in this surgical video. <h3>Interventions</h3> Same-day laparoscopic cornuostomy and diagnostic hysteroscopy with attempted tubal cannulation. <h3>Measurements and Main Results</h3> Multiple telephone visits with the patient to monitor clinical symptoms and post-op recovery, including Beta hCG measurements until Beta hCG level was undetectable. Beta hCG levels: 11, 783 (pre-op) -> 47 (15 days post-op) -> 7 (34 days post-op) -> undetectable (44 days post-op). <h3>Conclusion</h3> Laparoscopic cornuostomy for the surgical management of interstitial pregnancy, as opposed to cornual wedge resection, should be considered, particularly in stable patients with intact ectopic pregnancy. The minimally invasive techniques we demonstrate in this video are reproducible, effective, and efficient. Additional study is required to understand how this surgical approach could impact ipsilateral tubal patency and pregnancy outcomes such as uterine rupture.

1355 To Evaluate the Difference of the Efficacy of Usual Cyclic Low-Dose Monophasic Oral Contraceptive (OC) Versus Dienogest (DNG) Hormonal Therapy in the Recurrence of after Laparoscopic Excision of Ovarian Endometrioma

Study Objective To evaluate the efficacy of usual cyclic low-dose monophasic oral contraceptive (OC) use versus dienogest (DNG) in the recurrence of endometrioma after surgery. Design Retrospectively reviewed. Setting 155 patients aged from 20 years old to 40 years old who underwent laparoscopic excision of ovarian endometriomas in the department of obstetrics and gynecology of Toho University sakura medical center between April 2009 and March 2015. Patients or Participants All patients were reproductive-aged women with regular menstruation and did not want to get pregnant promptly after surgery. Interventions In the presence of endometrioma, cystectomy was performed and resection of all visible endometriosis was performed with the use of standard laparoscopic equipment. Following surgery, patients chose to receive OC, DNG for 1 year or no medication. The patients were evaluated at 3-month intervals during the following years after surgery. The recurrence rate was observed at 36 months postoperatively. Measurements and Main Results A significant reduction in recurrence rate was evident in OC and DNG users versus nonusers at 36 months postoperatively. Postoperative DNG use dramatically decreased the risk of ovarian endometrioma recurrence. Overall, there were no differences between the no recurrence and recurrence groups in terms of age, BMI, or tumor size. It was also noted that most of the OC user recurrent endometriomas were bilateral, multilocular, associated with DIE and stage IV by rASRM classification. Conclusion A significant reduction in recurrence rate was evident in OC and DNG users postoperative hormonal therapy. The stage and severity of endometriosis was significant higher in OC user recurrence group. Therefore, DNG therapy is the best option for prevention of recurrence.

Minimally invasive neck dissection: A 3-year retrospective experience of 45 cases.

Objective:Robot-assisted neck dissection requires a larger wound, is expensive and requires specialised equipment which is not easily available. We have developed an inexpensive minimally invasive neck dissection (MIND) procedure using simple endoscopic instruments in the past. This study was conducted to evaluate the safety, efficacy and reproducibility of the technique.Materials and Methods:From January 2013 to December 2016, we performed MIND on 45 patients with oral cancer using the standard endoscopic equipment. CO2 gas insufflation was used to create the working space. Intra-operative data, post-operative data and pathological characteristics were evaluated and overall survival (OS) and disease-free survival (DFS) Kaplan–Meier curves were compared using the Log-Rank test.Results:Median operative time was 130 (80–190) min with a mean blood loss of 63 (20–150) ml. Major intra-operative complications were not observed. The median number of nodes retrieved was 14 (range: 7–38). Three patients with a positive lymph node were advised to undergo adjuvant radiotherapy. After consultation, 12 out of 13 tongue cancer patients with a tumour depth >3 mm underwent adjuvant radiotherapy. Mean follow-up period was 31.5 (95% confidence interval [CI] 27.9–35.1) months and 27.8 (95% CI 23.6–32.1) months for OS and DFS, respectively. Four (8.9%) deaths and 8 (17.8%) recurrences were observed. The 3-year OS and DFS was 91.1% and 82.2%, respectively.Conclusion:MIND is aesthetically better than conventional procedures for oral cancer patients due to its safety, efficacy and reproducibility at any centre using the standard laparoscopic equipment.

Laparoscopic ovariectomy in eastern grey kangaroos (Macropus giganteus) and red kangaroos (Macropus rufus).

To develop a technique for permanent sterilisation of female eastern grey kangaroos (Macropus giganteus) and red kangaroos (M. rufus) as part of a large-scale macropod management program on an enclosed 1545-ha site in western Sydney. Free-ranging female kangaroos (n = 1409: 1285 eastern grey kangaroos, 124 red kangaroos) were anaesthetised via remote anaesthetic drug delivery of tiletamine/zolazepam, medetomidine and acepromazine prior to inhalational anaesthesia using isoflurane-oxygen. A laparoscopic ovariectomy technique was developed using standard laparoscopic equipment to effect permanent sterilisation of the kangaroos. The technique described was also adapted for use on immature animals weighing as little as 1 kg. No direct post-surgical care was provided once the animals had recovered from the anaesthetic. The procedure was simple to perform and had a very high success rate, with an overall project mortality rate of 2.13% (n = 30). Seven kangaroos (0.05% of all operated kangaroos) were euthanased as a direct result of the surgical procedure. Surgical complications were rare but included inadvertent gastrointestinal tract puncture with the trocar, intraoperative haemorrhage and subcutaneous emphysema leading to pouch eversion following surgery. The procedure described is a rapid and effective method of permanent fertility control in macropods and carries a low mortality rate.

Laparoscopic splenopexy for wandering spleen, a video demonstration of technique by encircling the spleen with polyglactin 910 woven mesh.

Wandering spleen is a rare clinical entity caused by absence of the spleen's peritoneal attachments, allowing the spleen to move freely within the peritoneal cavity [1]. This disease is most commonly seen in children and young women [1, 2]. Affected individuals are predisposed to complications including splenic torsion, splenic infarction, and pancreatic necrosis [3, 4]. Patients may present with constipation, an abdominal mass, swelling, or acute abdominal pain if splenic torsion has occurred [4]. Wandering spleen is difficult to diagnose without imaging, as symptoms are non-specific or may be absent. Imaging studies to confirm the diagnosis may include computed tomography (CT) scan or duplex ultrasonography [5]. Definitive management of a wandering spleen is primarily surgical [2]. Splenectomy is the preferred treatment in patients who present with an acute splenic infarction [2, 6]. Splenopexy, however, is first line treatment for patients with a non-infarcted wandering spleen [2, 7, 8]. In this video, we present a case of an 11year old male with a symptomatic wandering spleen who was treated at our institution with laparoscopic splenopexy. The patient had a history of arthrogryposis multiplex congenita and presented with recurrent, episodic abdominal pain, nausea, and vomiting. The diagnosis was confirmed by CT scan which demonstrated the spleen in the right lower quadrant. We performed laparoscopic splenopexy by encircling the spleen with polyglactin 910 woven mesh and attaching the mesh to the left lateral abdominal wall with absorbable tacks. Our surgical technique for splenopexy was successful and the patient returned home on postoperative day four. No significant complications occurred. This video demonstrates this technique and highlights the key steps. Splenopexy by encircling the spleen with polyglactin 910 mesh is feasible, preserves splenic function, and can be performed with standard laparoscopic equipment. Tacks or transfascial sutures are a potential option for securing mesh.

Robot-assisted laparoscopic myomectomy: current status.

Robotic-assisted surgery has seen a rapid development and integration in the field of gynecology. Since the approval of the use of robot for gynecological surgery and considering its several advantages over conventional laparoscopy, it has been widely incorporated especially in the field of reproductive surgery. Uterine fibroids are the most common benign tumors of the female reproductive tract. Many reproductive-aged women with this condition demand uterine-sparing surgery to preserve their fertility. Myomectomy, the surgical excision of uterine fibroids, remains the only surgical management option for fibroids that entails preservation of fertility. In this review, we focus on the role of robotic-assisted laparoscopic myomectomy and its current status, in comparison with other alternative approaches for myomectomy, including open, hysteroscopic, and traditional laparoscopic techniques. Several different surgical techniques have been demonstrated for robotic myomectomy. This review endeavors to share and describe our surgical experience of using the standard laparoscopic equipment for robotic-assisted myomectomy, together with the da Vinci Robot system. For the ideal surgical candidate, robotic-assisted myomectomy is a safe minimally invasive surgical procedure that can be offered as an alternative to open surgery. The advantages of using the robot system compared to open myomectomy include a shorter length of hospital stay, less postoperative pain and analgesic use, faster return to normal activities, more rapid return of the bowel function, and enhanced cosmetic results due to smaller skin incision sizes. Some of the disadvantages of this technique include high costs of the robotic surgical system and equipment, the steep learning curve of this novel system, and prolonged operative and anesthesia times. Robotic technology is a novel and innovative minimally invasive approach with demonstrated feasibility in gynecological and reproductive surgery. This technology is expected to take the lead in gynecological surgery in the upcoming decade.

Modified approach for endoscopic harvest of the latissimus dorsi free flap with CO2 insufflation and standard laparoscopic equipment.

The latissimus dorsi (LD) muscle flap is frequently used for free tissue transfer to reconstruct large defects of the extremities. As a free flap, the LD also can be harvested as a muscle-sparing flap (MS-LD), preserving the innervation and insertion of the remaining muscle. Conventional harvesting of the LD flap, however, results in a long scar on the lateral back. Harvesting using an endoscopic approach minimizes donor site morbidity. We present our modified endoscopic technique with CO2 insufflation and standard endoscopic instruments for harvesting the LD or MS-LD muscle flap. Ten patients (mean age 43 years, range 22-66) underwent endoscopically harvested LD or MS-LD free-flap reconstruction for upper and lower extremity defects. Harvesting required only a short (3-5 cm) incision in the axilla for dissection of the vascular pedicle and the motor nerve, and the remainder of the dissection was performed endoscopically with CO2 insufflation. Dissection was achieved through three of four 5-mm ports and 30° view angle optics. Six of the flaps were MS-LD flaps. The largest flap size was 18 × 16 cm. Mean flap harvest time was 164 min (range 105-270 min). One total flap was lost 3 days postoperatively due to anastomotic thrombosis in a trauma patient who was later diagnosed with hypercoagulopathy. No donor site scar or wound complications were observed during the follow-up (20.1 months). Endoscopic harvesting of an LD muscle free flap with CO2 insufflation and standard laparoscopic equipment is a feasible option for free-flap reconstruction. © 2016 Wiley Periodicals, Inc. Microsurgery 37:383-387, 2017.

Laparoscopic surgery in middle- and low-income countries: gasless lift laparoscopic surgery.

Surgically treatable conditions are an increasing burden in low- and middle-income countries, and recent studies suggest they have overtaken the "big three" (malaria, tuberculosis and HIV) as a cause of mortality. In this context, we have worked to modify standard laparoscopic equipment to allow laparoscopy in remote areas without support services such as bottled gases or disposable instruments. A simple and reliable system of gasless laparoscopy has been developed using robust reusable instruments, widening the potential availability of laparoscopic surgery in remote and rural areas. Our findings suggest that, using this equipment, appropriately trained surgeons can provide minimally invasive surgery in even the most remote locations.

Complete plastic lining of the abdominal cavity during laparoscopic electromechanical morcellation—a promising technique

The risk of intraperitoneal fragment dissemination of uterine tissue, especially the dissemination of unexpected leiomyosarcoma during electromechanical morcellation, has been increasingly debated during the last year. An improved technique for contained morcellation of uterine tissue inside an insufflated plastic bag during laparoscopy is presented. Twenty-one consecutive contained morcellations were carried out during the summer of 2014, at one institution. Five laparoscopic myomectomies and 16 hysterectomies were performed. Standard laparoscopic equipment was used and a transparent plastic bag was introduced into the abdominal cavity through the umbilical incision mounted on two curved blunt metal probes, which facilitated the placement of the uterine tissue into the bag. Morcellation was carried out inside the plastic bag through the opening in the umbilicus. All 21 morcellations during the study period were successfully performed. The median operative time was 105 min (range 45–180 min) and applying plastic bag and trocar median 10 min (range 4–30 min). Median specimen weight was 560 g (range 80–1265 g). No complications occurred, and no unintended bag perforation was identified. The presented improved contained morcellation technique is feasible in laparoscopic hysterectomy and myomectomy. Larger studies will however be required before the general introduction of the method. Level of evidence: II-3

Single-incision pediatric endosurgical epigastric hernia repair

Epigastric hernias represent about 4 % of all abdominal hernias in children and require surgical repair. Traditionally, these hernias are repaired by an open surgical technique. More recently, laparoscopic epigastric hernia repairs have been described using two trocars in the upper abdomen. In this paper, we describe a novel single-incision pediatric endosurgical (SIPES) technique. Patients with symptomatic epigastric hernias that were deemed to be too far superior to be repaired with an open technique through an umbilical incision were selected for SIPES repair. Two trocars (5 and 3 mm) were introduced through a single umbilical incision and the hernia repair was performed using looped 4-0 polypropylene sutures introduced through a 17-gage spinal needle in a lasso technique. Five girls (age 4.4-12.6, median 6.4 years) underwent single-incision endosurgical epigastric hernia repair. The mean operative time was 25 ± 6 min, and there were no intraoperative complications. All patients were discharged home from the recovery room on the day of surgery. All patients were followed up 2-3 weeks after the operation, with no recurrence and excellent cosmetic results. The described SIPES technique offers a virtually scarless, quick, and simple option for the repair of symptomatic epigastric hernias that can be performed with standard laparoscopic equipment.

Accessing the challenging pre-sacral abscess

Dear Editor: Drainage of pre-sacral collections transrectally or percutaneously can be challenging due to difficulty of access. Transanal endoscopic surgery is a well-established technique used to resect benign or early malignant rectal tumours, either using a binocular stereoscopic operating rectoscope or a monocular laparoscopic equivalent, and a number of additional indications have been described for their use, including pelvic anastomotic stricturoplasty, excision of extraluminal pre-sacral tumours as well as drainage of pre-sacral abscesses which may otherwise be inaccessible. Transanal endoscopic microsurgery uses the stereoscopic equipment (Richard Wolf Medical Instruments Corporation), while the alternative produced by Storz is less expensive and fully compatible with standard laparoscopic equipment, and is referred to as transanal endoscopic operation (TEO). Patients can expect minimal effect on anorectal function despite the use of a large diameter rectoscope. TEO equipment was used to successfully drain an inaccessible pre-sacral abscess in a 53-year-old man with a bodymass index of 28. He had undergone reversal of a Hartmann's procedure which had been performed 7 months earlier for complicated diverticular disease with a pelvic abscess, and a tight anastomotic stricture at 10 cm from the anal verge was subsequently diagnosed another 7 months later after he complained of pelvic discomfort and obstructive symptoms. Imaging ruled out recurrent pelvic sepsis and he underwent three anastomotic balloon dilatations over a 12-month period, resulting in a widely patent anastomosis and a significant improvement in symptoms. Two years after the last dilatation, he developed new symptoms of coccygeal pain on prolonged sitting, which worsened over 5 months, and he subsequently developed additional symptoms of night sweats. A magnetic resonance imaging (MRI) scan confirmed a 4-cm pre-sacral abscess postero-superior to the anastomosis which remained widely patent. Long-term antibiotics did not improve his symptoms and little change in size was evident on repeat imaging, and transanal drainage was attempted under general anaesthesia. This was unsuccessful due to access difficulties related to the distance of the abscess from the anal canal and the patient's body habitus. The procedure was abandoned when no pus was able to be aspirated and a submucosal haematoma obscured the operative view. Symptoms persisted over 18 months despite repeated courses of antibiotics, until drainage was successfully achieved using TEO equipment. With the patient in lithotomy position, the 4.0-cm diameter, 7.5-cm long operating rectoscope facilitated access, providing a magnified view of the extraperitoneal anastomosis which was incised posteriorly using an ultrasonic dissector, deroofing a pre-sacral cavity which contained pus and was lined with granulation tissue. He was discharged on oral antibiotics 1 day after surgery and was reviewed in an outpatient setting 1month later. He described post-operative symptoms of faecal urgency and increased frequency, associated with ongoing night sweats and discharge of pus per rectum with minor bleeding, but all of these symptoms had fully resolved on further review 4 months later. The coccygeal pain also resolved post-operatively, and no incontinence was experienced. An MRI scan performed 5 months after surgery confirmed resolution of the chronic collection which measured 39 mm on imaging prior to the procedure. This case illustrates chronic sepsis with a delayed presentation after anastomotic balloon dilatation and highlights the ease of access achievable using laparoscopic equipment via an operating rectoscope to manage pelvic pathology which would otherwise be inaccessible using alternative modalities.

Single-incision laparoscopic splenectomy using the “tug-exposure technique” in adults: results of ten initial cases

The application of single-incision laparoscopic surgery (SILS) to splenectomy is still challenging with much room for technical improvement. The purpose of this study was to describe the tug-exposure technique, an innovative technique for performing safe single-incision laparoscopic splenectomy (SILS-Sp). We performed SILS-Sp in ten consecutive adult patients with a variety of pathology requiring total splenectomy. A SILS™ Port with three 5-mm trocars was placed in the umbilicus as a single-access site. A flexible 5-mm laparoscope and an articulating grasper were used in addition to standard laparoscopic equipment. A cloth tape was introduced intraperitoneally to encircle and tug the splenic hilum. Both ends of the tape were extracted through an extra needle hole in the skin. Pulling the tape in appropriate directions provided excellent exposure of the splenic hilum (the tug-exposure technique). Under sufficient tension and exposure by tugging the spleen, a linear stapler was introduced for stapling and dividing the splenic hilum and the splenic artery and vein. The spleen was extracted through the umbilical wound within a retrieval bag. The umbilical wound was closed with subcutaneous sutures. The tug-exposure technique was successfully used in all patients and markedly improved the exposure of the splenic hilum during SILS-Sp. The median intraoperative blood loss was 15 (range 0-1,000) ml. Only one patient (10%) required conversion to open surgery. Median operative time was 230 (range, 150-378) min, the median extracted spleen weight was 260 (range, 100-580) g, and the median postoperative hospital stay was 7 (range, 4-9) days. All patients were discharged uneventfully. The umbilical incision was nearly invisible at the 1-month follow-up. The tug-exposure technique is an innovative technique that enables easy and safe SILS splenectomy by experienced surgeons.

Single‐port laparoscopic right colonic resection

The laparoscopic approach is a recognized treatment option for colonic resection. We present the first single-port operation for colonic resection using standard laparoscopic equipment and techniques. A single-port laparoscopic right colonic resection was successfully performed using GelPort (Applied Medical, Orange County, CA, USA) and a standard laparoscopic approach. The procedure was completed in 105 min through a single periumbilical incision. There was minimal blood loss and no post-operative problems. Single-port laparoscopic techniques can be applied to colonic surgery. It negates morbidity associated with trochar insertion and port sites. It should be performed by surgeons familiar with laparoscopic colorectal techniques.

Laparoendoscopic Single-Site Surgery: Early Experience with Tumor Nephrectomy

Laparoendoscopic single-site surgery (LESS) represents the closest surgical technique to scar-free surgery. We performed LESS for renal tumor nephrectomy in eight patients to assess feasibility and perioperative outcome. Eight patients with a body mass index (BMI) <or=30 underwent single-port nephrectomy for renal tumor by an experienced laparoscopic surgeon. Tri-Ports were used through a transumbilical incision in all cases. A flexible grasper and a 5-mm 30-degree high-definition camera were used in addition to standard laparoscopic equipment. Patient demographics; operative details, including procedure duration, blood loss, and complications; and final pathology results were prospectively recorded. Postoperative evaluation of pain and use of analgesic medication were recorded. All LESS nephrectomy operations were successfully accomplished without the need to convert to conventional laparoscopy. The median patient age was 60.75 years (range 22-76 years) and median BMI was 22.95 (range 18.2-26.1). The median operative duration was 141 minutes (range 120-180 min), and the median blood loss was 103 mL (range 50-150 mL). Histologic evaluation confirmed complete excision of an intact specimen. All cases revealed organ-confined T(1) renal-cell carcinoma (two right-sided and six left-sided, tumor diameter range 4-8 cm). A tumor with an adjacent simple renal cyst was excised in one patient. No intraoperative or postoperative complications occurred. LESS was a feasible and safe approach in a selected group of patients (low BMI and stage tumor). LESS nephrectomy was made possible with the use of multi-instrument port and flexible instruments. The oncologic outcome was not compromised. Further evaluation of LESS surgery needs prospective, randomized studies.

Poly(glycerol sebacate) films prevent postoperative adhesions and allow laparoscopic placement

The objectives of this study were to evaluate the efficacy of poly(glycerol) sebacate (PGS) films for the prevention of visceroparietal peritoneal (VP) adhesions and demonstrate the ease of laparoscopic PGS film placement. Peritoneal adhesions occur in nearly 95% of all abdominal operations. VP adhesions can cause serious postoperative complications. The interposition of a barrier between damaged peritoneal areas during re-epithelialization has been shown to prevent adhesion formation. Current barrier products have serious drawbacks, including poor degradability, variable efficacy, and difficult handling characteristics. The efficacy of PGS films to prevent VP adhesions was evaluated in a rat peritoneal adhesion model. The animals were evaluated for the presence of VP adhesions at 3, 5, and 8 weeks. The laparoscopic applicability of PGS films was demonstrated by placement into a juvenile porcine abdomen using standard laparoscopic equipment and techniques. A statistically significant 94% reduction in VP adhesion formation rate was observed between control animals (75%) and animals with a PGS film barrier (4.8%). PGS films were easily placed in the juvenile porcine abdomen and could be readily repositioned without material loss or tissue damage. PGS films possess a unique combination of properties, including biocompatibility, resorbability, and ease of handling. PGS barrier films were shown to be efficacious in reducing VP adhesions in the rat model. They also can be placed using standard laparoscopic techniques. These promising results suggest that PGS films will be effective barriers to adhesion formation for patients undergoing open and laparoscopic abdominal operations.

Total transvaginal endoscopic abdominal wall hernia repair: a NOTES survival study

Natural orifice transluminal endoscopic surgery (NOTES) has gained widespread interest as a potentially less invasive alternative to laparoscopic surgery or, else, an evolution as the next-generation surgery. The main objective of this study was to assess the safety of transluminal abdominal wall hernia repair for potential human application by specifically investigating the feasibility and challenges of using a transvaginal approach. NOTES ventral hernia repair via a transvaginal approach. University Hospital (National University Health System, Singapore). The study utilized five female pigs (30-40 kg) between 5 and 7 months of age, which underwent abdominal wall hernia repair using a transvaginal approach. The procedures were performed using a double-channel endoscope under general endotracheal anesthesia. A mesh was placed and fixed to the abdominal wall using standard laparoscopic and endoscopic equipment. The animals survived for 2 weeks and were then euthanized and a necropsy performed. To assess the safety and feasibility of NOTES ventral hernia repair in a survival experimental model. All of the procedures could be safely performed using the standard equipment. At the necropsy, all meshes were well in place and mild adhesions were recorded in one animal with a small abscess in the subcutaneous area. This novel approach seems technically challenging but feasible using equipment and accessories currently available for conventional laparoscopic and interventional endoscopy with low intra-abdominal contamination and sepsis. New procedure-specific instruments and equipment need to be developed to allow the surgeon safer access and more degrees of instrument freedom.

A new method for three-dimensional laparoscopic ultrasound model reconstruction

Laparoscopic ultrasound is an important modality in the staging of gastrointestinal tumors. Correct staging depends on good spatial understanding of the regional tumor infiltration. Three-dimensional (3D) models may facilitate the evaluation of tumor infiltration. The aim of the study was to perform a volumetric test and a clinical feasibility test of a new 3D method using standard laparoscopic ultrasound equipment. Three-dimensional models were reconstructed from a series of two-dimensional ultrasound images using either electromagnetic tracking or a new 3D method. The volumetric accuracy of the new method was tested ex vivo, and the clinical feasibility was tested on a small series of patients. Both electromagnetic tracked reconstructions and the new 3D method gave good volumetric information with no significant difference. Clinical use of the new 3D method showed accurate models comparable to findings at surgery and pathology. The use of the new 3D method is technically feasible, and its volumetrically, accurate compared to 3D with electromagnetic tracking.

Conscious pain mapping using standard laparoscopic equipment and symptom oriented pain mapping form

Conscious pain mapping using standard laparoscopic equipment and symptom oriented pain mapping form

Teaching anatomy with surgeons' tools: use of the laparoscope in clinical anatomy.

The purpose of this study was to establish the feasibility of laparoscopy in embalmed cadavers to teach abdominal gross anatomy. One cadaver was selected based on body habitus and absence of previous abdominal operations. A standard trocar was used to enter the abdomen at the umbilicus. Two trocars were placed in the left upper quadrant. Pneumoperitoneum was achieved with continuous CO(2) pressure. Liver retraction was achieved percutaneously, exposing the porta hepatis and the gallbladder. The dissection was done with four first-year medical students using standard laparoscopic equipment. Following this, the demonstration was projected over multiple monitors so that all students could participate. Laparoscopic dissection in an embalmed cadaver is feasible and an excellent educational tool for both the medical student and the dissector. The dissector has the opportunity to manipulate laparoscopic tools in a human model closely paralleling operative experience, and the students have an opportunity to learn abdominal anatomy from a clinical perspective. Laparoscopic examination and dissection of fresh cadavers has been used for training surgeons on new procedures such as colon resection, antireflux procedures, and cholecystectomy. There is no report of this same technology used in embalmed cadavers to teach basic anatomy. This approach allows first-year medical students to learn the anatomy while exposing them to the technology currently used in surgical practice, and it affords surgical residents and students additional opportunities to practice laparoscopic skills.