Standard Laparoscopic Surgery Research Articles

Trials recruiting patients in the acute NHS setting: trial management challenges

There are challenges to conducting randomised controlled trials: some are common across trial settings; others relate to the setting itself. We present some challenges for publically-funded trials recruiting within the acute NHS setting. We draw on experience from three such RCTs: SCARLESS (Single Port/Incision Laparoscopic Surgery versus standard laparoscopic surgery for appendicectomy); SUSPEND (alpha blockers, calcium channel blockers versus placebo for urinary stones) and NIAMI (intravenous sodium nitrite versus placebo in patients with acute heart attack). Across all three studies, patients presented out-of-hours. To facilitate out-of-hours recruitment, the wider clinical team identified eligible patients, provided study information, obtained consent and recorded data without the support of a research nurse. In some cases, they also delivered the intervention. Training the wider clinical teams to undertake these duties was resource-intensive, particularly because of junior staff rotation. Again, across studies, there were challenges in intervention delivery. In SCARLESS there was tension around randomising patients: a senior surgeon provided cover for the novel surgery, but junior surgeons were keen to develop their skills by undertaking standard surgery. In SUSPEND, recruitment was constrained to the opening hours of clinical trials pharmacies to dispense study medication. This particular challenge was addressed in NIAMI by the study team holding study medication, even for patients presenting in-hours. A further, and more unexpected challenge was in relation to engaging participants in follow-up. Retention to primary outcome was challenging; perhaps because patients have not had a “chronic” condition and have “moved-on” from the event that brought them into the trial.

Hand-assisted laparoscopic surgery and its applications in gynecology

Abstract Laparoscopic surgery has been used extensively since it was first applied in the 1980s. The advantages are generally accepted and include less pain, smaller incisions, faster recovery, and shorter hospital stays. However, several limitations associated with standard laparoscopic surgery (SLS) have become apparent and include the loss of tactile sensation, problems with the removal of bulky and intact specimens, and the restriction of visualization of the entire operating field. These problems with SLS helped to inspire the development of laparoscopically assisted surgery followed by hand-assisted laparoscopic surgery (HALS). In a hand-assisted laparoscopic procedure, an incision is made in the patient’s abdomen. Then, a uniquely designed appliance is introduced into the abdominal cavity through the incision to maintain pneumoperitoneum. With the inserting hand, surgeons can provide manual exposure, traction, palpation, and dissection because of the feedback of tactile sensation. HALS has gained acceptance for a wide range of abdominal procedures in general surgery and urology and is now feasible for complicated surgeries such as splenectomy, nephroureterectomy, and colectomy. It has been demonstrated in numerous specialties that HALS is a safe and efficacious technique that combines the benefits of laparoscopy with the advantages of a conventional laparotomy. Standard laparoscopic surgery also has limitations in gynecological surgery. A patient may have high risks with conventional laparoscopic surgery when she has deep invasive endometriosis, multiple or massive myoma, or dense pelvic adhesions from prior surgery. HALS overcomes many of the aforementioned limitations, has less conversion to open surgery, and broadens the indications for minimally invasive surgery, not only for benign tumors but also for pelvic malignancies.

Laparoscopic Single-Site Surgery in Pediatric Urology: Where Do We Stand Today?

Since the first description of the laparoendoscopic single-site surgery (LESS) in the pediatric urology population, various authors have shared their experiences and results. We aim to provide a review of current studies of LESS and share our experience with this modality. The current literature describes the use of LESS for most surgeries performed in the pediatric urology population with similar results to open and standard laparoscopic surgery. The authors have described their experiences with transabdominal and retroperitoneal nephrectomy, nephroureterectomy, pyeloplasty, orchidopexy, varicocelectomy, and renal cyst decortication. In our experience, LESS has taken a role for extirpative surgery since we use other modalities for upper tract reconstruction. The data available has validated LESS as safe and has demonstrated similar results to standard laparoscopic surgery and open surgery with better cosmetic results.

Adnexectomy by poor man’s transvaginal NOTES

The purpose of this study was to demonstrate the feasibility and safety of adnexectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for benign adnexal masses. Conventional, reusable laparoscopic instruments were used, inserted through aninexpensive, self-constructed single port device. Between November 2013 and November 2014, 20 adnexectomies by vNOTES were performed by a single surgeon (BJ). Only conventional, reusable laparoscopic instruments were used. The self-constructed single port device was made by assembling a surgical glove, a wound protector, one reusable 10-mm trocar, and four reusable 5-mm trocars. The adnexectomy was performed according to the technique for standard laparoscopic surgery, and the specimen was removed through the colpotomy incision. Patient and perioperative data were analysed. Twenty patients underwent adnexectomy by vNOTES, and no conversion to standard laparoscopy or laparotomy was necessary. Mean operation time was 32 min (20–50 min); mean drop in hemoglobin level was 0.9 g/dl (0–2.1 g/dl). There were no operative complications. Post-operative pain scores were very low. The mean size of the removed adnexal mass was 51.8 mm (35–110 mm). Adnexectomy by vNOTES is feasible even for masses up to 110 mm and even when performed with reusable, conventional laparoscopic instruments. The main advantages of vNOTES are better cosmetics, low postoperative pain scores and easy removal of the specimen without spillage. This frugally innovative technique also enables surgeons to perform adnexectomies by vNOTES in low resource settings.

Robotic Colorectal Surgery: Technique, Advantages, Disadvantages and Its Impact in Today's Era of Minimal Access Surgery

Abstract The use of robotics in colorectal surgery is gaining momentum of late. Technical advances, such as three-dimensional imaging, a stable camera platform, excellent ergonomics, tremor elimination, ambidextrous capability, motion scaling and instruments with multiple degrees of freedom, have helped many surgeons adapt to it easily. There is a shorter learning curve compared to the standard laparoscopic surgery. This article helps to give an outline as to how robotic colorectal surgery can go a long way in the future of colorectal surgery.

SOS save our surgeons: Stress levels reduced by robotic surgery

Robotic-assisted laparoscopic surgery (RALS) is making an increasingly significant contribution to the field of gynaecological surgery. RALS offers similar patient benefits to standard laparoscopic surgery (SLS) with a potentially more ergonomically friendly and less stressful environment for the surgeon. However, our understanding of how RALS may potentially reduce physiological stress on the surgeon is currently limited. To assess how performing surgical tasks using RALS in comparison to SLS impacts on hypothalamic pituitary adrenal (HPA) axis function and sympathetic nervous system (SNS) activity, two key indicators of the physiological stress response. This study is an analytical, within subjects, crossover design study. Sixteen surgically inexperienced medical students performed tasks with both SLS and RALS instrumentation. Blood pressure (BP) was taken before and after task performance. Skin conductance level (SCL), heart rate (HR) and HR variability (HRV) were measured continuously during task performance. Pre- and post-task saliva samples were collected to determine cortisol levels using ELISA. SCL was significantly lower during RALS in comparison to SLS task performance (p < 0.05). HR was significantly lower during RALS vs. SLS tasks (p < 0.01). Both HRV measures were significantly higher during RALS vs. SLS tasks (p < 0.01). Cortisol levels and BP were lower during RALS vs. SLS but did not reach statistical significance (p = 0.73 and p = 0.22, respectively). Stress can impair surgeon’s technical and nontechnical skills. These results indicate that the improved ergonomic setup of RALS has a beneficial impact on physiological indicators of stress. This also demonstrates the potential of RALS to reduce the negative effects of long-term stress exposure on the surgeon.

Is robot-assisted laparoscopic right colectomy more effective than the conventional laparoscopic procedure? A meta-analysis of short-term outcomes

AimThe use of robotic technology procedures has proved to be safe and effective, arising as a helpful alternative to standard laparoscopic surgery in a variety of colorectal procedures. However, the role of robotic assistance in laparoscopic right colectomy is still not demonstrated. MethodsA systematic review of the literature was carried out performing an unrestricted search in MEDLINE, EMBASE, the Cochrane Library and Google Scholar up to 30th August 2014. Reference lists of retrieved articles and review articles were manually searched for other relevant studies. We meta-analyzed the currently available data regarding the incidence of anastomotic leakage, operative time, intra-operative blood loss, conversion rate, retrieved lymphnodes, post-operative hemorrhage, intra-abdominal abscess, time to 1st flatus, post-operative ileus, wound infection, incisional hernia, not-surgical complications, total complications, hospital stay, post-operative mortality, surgery-related costs and total costs, in conventional laparoscopic right colectomy (LRC) compared to robot-assisted laparoscopic right colectomy (RRC). ResultsOverall 8 studies were included, thus resulting in 616 patients. The meta-analysis showed that the RRC decreases the intra-operative blood loss and the time to the 1st flatus, if compared to the LRC. On the other hand, the robotic assistance increases the operative time and the surgery-related costs. No statistically significant differences were found about the other post-operative outcomes. ConclusionRRC may ensure limited improvements in post-operative outcome, thus increasing procedural costs and without a proved enhanced oncological accuracy to date, if compared to the LRC.

V11-14 LAPARO-ENDOSCOPIC SINGLE SITE (LESS) PLUS ONE PORT (POP) RADICAL PROSTATECTOMY

You have accessJournal of UrologyAdrenal/Single Port Surgery/LESS/NOTES1 Apr 2015V11-14 LAPARO-ENDOSCOPIC SINGLE SITE (LESS) PLUS ONE PORT (POP) RADICAL PROSTATECTOMY Alexander Tsivian, Roman Bass, Yury Stanevsky, Matvey Tsivian, Mohammed Shahwan, Dmitry Khunovitch, Shalva Benjamin, and Ami Sidi Alexander TsivianAlexander Tsivian More articles by this author , Roman BassRoman Bass More articles by this author , Yury StanevskyYury Stanevsky More articles by this author , Matvey TsivianMatvey Tsivian More articles by this author , Mohammed ShahwanMohammed Shahwan More articles by this author , Dmitry KhunovitchDmitry Khunovitch More articles by this author , Shalva BenjaminShalva Benjamin More articles by this author , and Ami SidiAmi Sidi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2612AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radical prostatectomy is the gold standard treatment for prostate cancer. In recent years, technological advances have permitted to decrease the number of ports used in laparoscopic surgeries down to a single port. Still, there is a technical difficulty performing these surgeries due to lack of triangulation of the instruments and their clashing outside and within the patient's body. Herein, we present a video that demonstrates the surgical technique of LESS POP radical prostatectomy. METHODS From February to August 2014, 19 consecutive patients underwent radical prostatectomy by this technique. We describe the surgical technique as well as tips and tricks for this procedure. RESULTS Patients' age ranged between 55-75 years (mean-63.3). The surgery duration was between 165-300 minutes (mean-240). One patient underwent concomitant umbilical hernia repair. The average hospital stay was 3 days (range 2-7). In 15 patients (79%), the catheter was removed after 7 days. In 4 other patients, the catheter was left indwelling longer- in 3 due to urine leak and in 1 because of rectal injury and lymphorrhea. Positive margins were identified in 6 patients. There were no conversions to standard laparoscopic or open surgery. In 4 cases an additional 5 mm trocar was used. In 2 -due to difficulty to progress with dissection. In one case due to the need to expedite the surgery in a patient with anesthesia difficulties (patient with severe COPD) and in another it was required for suturing a rectal injury. Pathology: Gleason 6,7,8,9 was in 7,9,1 and 2 cases respectively, stage pT2b, pT3a and pT3b was in 13,3 and 3 respectively. Ten patients underwent lymph node dissection ( mean 15.4 nodes ). In the follow-up period that ranged between 1 to 7 months continence rate is 80% CONCLUSIONS We described a new and innovative laparoscopic technique for treating prostate cancer. This technique has the advantages of a minimally invasive procedure without oncological rules compromise. It enables the triangulation of the instruments and is ergonomically better and more comfortable for the surgeon. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e911 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexander Tsivian More articles by this author Roman Bass More articles by this author Yury Stanevsky More articles by this author Matvey Tsivian More articles by this author Mohammed Shahwan More articles by this author Dmitry Khunovitch More articles by this author Shalva Benjamin More articles by this author Ami Sidi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

86 Comparison of the clinical outcome and systemic inflammatory marker levels between standard laparoscopic surgery and reduced port surgery for living donor nephrectomy

86 Comparison of the clinical outcome and systemic inflammatory marker levels between standard laparoscopic surgery and reduced port surgery for living donor nephrectomy

Laparo-endoscopic single site surgery in pediatrics: Feasibility and surgical outcomes from a preliminary prospective Canadian experience.

Laparo-endoscopic single-site surgery (LESS) is becoming an alternative to standard laparoscopic surgery. Proposed advantages include enhanced cosmesis and faster recovery. We assessed the early post-operative surgical outcomes of LESS surgery utilizing different instruments in the pediatric urological population in Canada. We prospectively captured data on all patients undergoing LESS at our institution between February 2011 and August 2012. This included patient age, operative time, length of stay, complications and short-term surgical outcomes. Different instruments/devices were used to perform the procedures. Access was achieved through a transumbilical incision. A total of 16 LESS procedures were performed, including seven pyeloplasties, four unilateral and one bilateral varicocelectomies, two simple nephrectomies, one renal cyst decortication and one pyelolithotomy. There was no statistical difference in the operative times, hospital length of stay and cost (pyeloplasty only) in patients undergoing pyeloplasty and varicocelectomy using the LESS technique when compared to an age matched cohort of patients managed with the traditional laparoscopic approach. One pyeloplasty in the LESS group required conversion to open due to a small intra-renal pelvis. There were no immediate or short term post-operative complications; however, one patient experienced a decrease in renal function status post LESS pyeloplasty. Since all procedures were performed by a vastly experienced surgeon at a tertiary center, the generalizability of the results cannot be assessed. There are only a few series that have assessed the role of LESS in pediatric urological surgery. Although our experience is limited by a heterogeneous group of patients with a short follow-up period, the present cohort demonstrates the safety and feasibility of LESS. Further evaluation with randomized studies is required to better assess the role of LESS in pediatric urology.

Micro-laparoscopic Colectomy: Initial Experience

IntroductionSingle-port surgery (SPS) has been growing in acceptance as an alternative to traditional laparoscopic surgery. With SPS, there are technical skills required that are not routine to standard laparoscopy. We explored the feasibility of micro-laparoscopic colectomy (MLC) using 3 mm instruments in patients eligible for standard laparoscopic surgery. MethodsWe performed an IRB approved retrospective review of all segmental colectomy performed by a single surgeon in selected patients using a micro-laparoscopic technique. We utilized two 3-mm trocars and one 12-mm Hasson umbilical incision, which was later widen for specimen extraction. ResultsEighty patients underwent MLC: Twenty-six for diverticulitis, 26 for cancer, 22 for polyps, 3 for Crohn’s disease, and 3 for volvulus. Eight patients were converted into either laparotomy or hand port (10 %) and three patients required the addition of one 5-mm trocar. Mean final extraction incision length was 3.9 cm. In cancer patients, the average lymph node harvest was 26 (range 13–70). The 30-day mortality was zero and the anastomotic leak rate was 1.3 %. ConclusionsMLC is safe and feasible when performing colon resections for benign and oncologic pathology. Extraction incision length is small and offers similar cosmesis to SPS without the steep learning curve needed to learn this technique.

Sa1595 Germanium Photodiode: New Technique for the Development of Endoscopic Implantable Gastric Pacemaker

Sa1593 Comparing the Feasibility and Efficacy of Combined Endoscopic and Transumbilical Single-Port Laparoscopic Surgery With Standard Laparoscopic Resection of Gastric Stromal Tumors Wen LI*, Zikai Wang, Baoqing Jia, Xiaohui Du, Xiaopeng Wang, Tingting Huang, Xuan Su, Lili Wu, Xiuxue Feng Gastroenterology and Hepatology, the Chinese PLA General Hospital, Beijing, China; Department of Oncological Surgery, the Chinese PLA General Hospital, Beijing, China; Department of General Surgery, the Chinese PLA General Hospital, Beijing, China Background: Complete endoscopic or laparoscopic resection of gastric stromal tumors (GST) in the cardia & fundus is only partially feasible. A combined endoscopic-laparoscopic approach has been recently recognized as the favorable modality for these lesions. Aims: To assess the feasibility and efficacy of combined endoscopic and transumbilical single-port laparoscopic surgery (CETSLS) for the GST. Methods Between April, 2010 and July, 2013, 14 patients with GST were assigned to undergo CETSLS (n Z 7) and standard laparoscopic surgery (SLS) (n Z 7) at the Chinese PLA general hospital. The subjects undergiong CETSLS were managed with laparoscopy-assisted endoscopic techniques (i.e. endoscopic snare resection, endoscopic mucosal resection and endoscopic submucosal dissection) or endoscopy-assisted laparoscopic techniques (i.e. laparoscopic gastric wedge resection). Several parameters were analyzed: operation time, conversion rate, operative complications, pain scores, cost and duration of hospital stay, cosmetic satisfaction and follow-up evaluation. Results: There was no difference in the age, gender and indications for CETSLS and SLS groups. All lesions were located in the gastric cardia/ fundus, They were confirmed to be GST on immunohistochemical staining and showed similar mean diameter. CETSLS was successfully carried out in 85.7% (6/7) of our patients with one case requiring conversion to open surgery due to intraoperative bleeding. However, there was no conversion in the SLS group. The mean operative time was similar in both groups (108.0 59.2 vs. 164.3 49.3 minutes: P Z 0.09). The intra-operative blood loss was lower in CETSLS than SLS group (25.0 15.2 ml vs. 74.3 32.6 ml: P Z 0.006). Complete resection rate was 100%. It was achieved without serious complications in both groups. Despite a shorter postoperative hospitalization time in the CETSLS group (5.7 1.4 vs. 8.9 2.8 days, PZ 0.03), the cost of hospitalization was almost similar (40942.8 11158.6 vs. 57246.7 16049.4 RMB, P Z 0.06). There was no re-admission or tumor recurrence during a median follow-up of 26 months (range, 4 43 months). Conclusions: CETSLS is a feasible and effective technique, which offers superior cosmesis during resection of the GST.

Sa1594 Novel Endoscopic Preoperative Localization Method Using Magnet in Laparoscopic Gastrointestinal Surgery

Sa1593 Comparing the Feasibility and Efficacy of Combined Endoscopic and Transumbilical Single-Port Laparoscopic Surgery With Standard Laparoscopic Resection of Gastric Stromal Tumors Wen LI*, Zikai Wang, Baoqing Jia, Xiaohui Du, Xiaopeng Wang, Tingting Huang, Xuan Su, Lili Wu, Xiuxue Feng Gastroenterology and Hepatology, the Chinese PLA General Hospital, Beijing, China; Department of Oncological Surgery, the Chinese PLA General Hospital, Beijing, China; Department of General Surgery, the Chinese PLA General Hospital, Beijing, China Background: Complete endoscopic or laparoscopic resection of gastric stromal tumors (GST) in the cardia & fundus is only partially feasible. A combined endoscopic-laparoscopic approach has been recently recognized as the favorable modality for these lesions. Aims: To assess the feasibility and efficacy of combined endoscopic and transumbilical single-port laparoscopic surgery (CETSLS) for the GST. Methods Between April, 2010 and July, 2013, 14 patients with GST were assigned to undergo CETSLS (n Z 7) and standard laparoscopic surgery (SLS) (n Z 7) at the Chinese PLA general hospital. The subjects undergiong CETSLS were managed with laparoscopy-assisted endoscopic techniques (i.e. endoscopic snare resection, endoscopic mucosal resection and endoscopic submucosal dissection) or endoscopy-assisted laparoscopic techniques (i.e. laparoscopic gastric wedge resection). Several parameters were analyzed: operation time, conversion rate, operative complications, pain scores, cost and duration of hospital stay, cosmetic satisfaction and follow-up evaluation. Results: There was no difference in the age, gender and indications for CETSLS and SLS groups. All lesions were located in the gastric cardia/ fundus, They were confirmed to be GST on immunohistochemical staining and showed similar mean diameter. CETSLS was successfully carried out in 85.7% (6/7) of our patients with one case requiring conversion to open surgery due to intraoperative bleeding. However, there was no conversion in the SLS group. The mean operative time was similar in both groups (108.0 59.2 vs. 164.3 49.3 minutes: P Z 0.09). The intra-operative blood loss was lower in CETSLS than SLS group (25.0 15.2 ml vs. 74.3 32.6 ml: P Z 0.006). Complete resection rate was 100%. It was achieved without serious complications in both groups. Despite a shorter postoperative hospitalization time in the CETSLS group (5.7 1.4 vs. 8.9 2.8 days, PZ 0.03), the cost of hospitalization was almost similar (40942.8 11158.6 vs. 57246.7 16049.4 RMB, P Z 0.06). There was no re-admission or tumor recurrence during a median follow-up of 26 months (range, 4 43 months). Conclusions: CETSLS is a feasible and effective technique, which offers superior cosmesis during resection of the GST.

Grand challenge: on the way to scarless visceral surgery.

Grand challenge: on the way to scarless visceral surgery.

Multipurpose Internal Retractor for Single-incision Surgery (SIS)

Single-incision laparoscopic surgery (SIS) is less invasive than standard laparoscopic surgery; however, it is more difficult due to restriction of motion and the impossibility to use assistants. To overcome these obstacles, we developed a self-sustaining multipurpose internal retractor by attaching a Lone Star retractor hook to a laparoscopic bulldog clamp. Herein, we report our SIS experience using our novel retractor. Between October 2008 and April 2011, 104 patients underwent SIS using the internal retractor: 67 bandings (43% simultaneous hiatal hernia repair), 8 sleeve gastrectomies, 27 cholecystectomies, and 2 Nissen fundoplication. Mean age was 40 (range, 21 to 85) and mean body mass index was 40 kg/m (range, 20 to 64 kg/m). No intraoperative complications were observed from the use of the retractor but 2 cases required additional retraction due to liver size. This retractor has been successfully used for different SIS procedures showing to be safe, adaptable, and easy to use, lessening some challenges of SIS.

The Role of Hand-Assisted Laparoscopic Surgery in a Right Hemicolectomy for Right-Sided Colon Cancer

PurposeThe purpose of this study is to evaluate the perioperative and long-term oncologic outcomes of hand-assisted laparoscopic surgery (HALS) and standard laparoscopic surgery (SLS) and assess the role of HALS in the management of right-sided colon cancer.MethodsThe study group included 53 patients who underwent HALS and 45 patients who underwent SLS for right-sided colon cancer between April 2002 and December 2008.ResultsThe patients in each group were similar in age, American Society of Anesthesiologist (ASA) score, body mass index, and history of previous abdominal surgeries. Eight patients in the HALS group and no patient in the SLS group exhibited signs of tumor invasion into adjacent structures. No differences were noted in the time to return of normal bowel function, time to toleration of diet, lengths of hospital stay and narcotic usage, and rate of postoperative complications. The median incision length was longer in the HALS group (HALS: 7.0 cm vs. SLS: 4.8 cm, P < 0.001). The HALS group had a significantly higher pathologic TNM stage and significantly larger tumor size (HALS: 6.0 cm vs. SLS: 3.3 cm, P < 0.001). The 5-year overall, disease-free, and cancer-specific survival rates of the HALS and the SLS groups were 87.3%, 75.2%, and 93.9% and 86.4%, 78.0%, and 90.7%, respectively (P = 0.826, P = 0.574, and P = 0.826).ConclusionAlthough patients in the HALS group had more advanced disease and underwent more complex procedures than those in the SLS group, the short-term benefits and the oncologic outcomes between the two groups were comparable. HALS can, therefore, be considered an alternative to SLS for bulky and fixed right-sided colon cancer.

Incidence of port-site incisional hernia after single-incision laparoscopic surgery.

Background and Objectives:Single-incision laparoscopic surgery is gaining popularity among minimally invasive surgeons and is now being applied to a broad number of surgical procedures. Although this technique uses only 1 port, the diameter of the incision is larger than in standard laparoscopic surgery. The long-term incidence of port-site hernias after single-incision laparoscopic surgery has yet to be determined.Methods:All patients who underwent a single-incision laparoscopic surgical procedure from May 2008 through May 2009 were included in the study. Single-incision laparoscopic surgical operations were performed either by a multiport technique or with a 3-trocar single-incision laparoscopic surgery port. The patients were seen at 30 to 36 months' follow-up, at which time they were examined for any evidence of port-site incisional hernia. Patients found to have hernias on clinical examination underwent repairs with mesh.Results:A total of 211 patients met the criteria for inclusion in the study. The types of operations included were cholecystectomy, appendectomy, sleeve gastrectomy, gastric banding, Nissen fundoplication, colectomy, and gastrojejunostomy. We found a port-site hernia rate of 2.9% at 30 to 36 months' follow-up.Conclusion:Port-site incisional hernia after single-incision laparoscopic surgical procedures remains a major setback for patients. The true incidence remains largely unknown because most patients are asymptomatic and therefore do not seek surgical aid.

Achieving complete mesocolic excision (CME) for colon cancer by laparoscopy

In accordance to the total mesorectal excision concept for rectal cancer, that of the complete mesocolic excision (CME) for colon cancer has been recently developed. CME involves dissection along the embryological planes, ligation and division of the supplying vessels at their origin and removal of a specimen with intact fascia and peritoneum, adequate distal and proximal bowel margin as well as the maximum number of the regional lymph nodes. CME surgery seems to achieve better oncological outcomes, in terms of local recurrence and survival, as compared to standard colectomy. CME has also been attempted by the laparoscopic approach. Provided that the tumour is located at the left or right and not at the transverse, a specimen of high quality can be resected, similar to that obtained by the open approach. There is also evidence that the oncological results of laparoscopic CME are superior to those achieved by the standard laparoscopic surgery, and similar to those achieved by open CME.

Robotic single port surgery: Current status and future considerations.

Introduction and Objectives:It has been established that robotic-assisted laparoscopic surgery has several advantages when compared with standard laparoscopic surgery. Optics, ergonomics, dexterity and precision are all enhanced with the use of a robotic platform. For these reasons, it was postulated that the application of robotics to laparoendoscopic single-site surgery (LESS) could overcome some of the constraints seen with the conventional laparoscopic approach. Issues such as instrument clashing, inability to achieve effective triangulation for dissection and difficulties with intracorporeal suturing have limited the widespread adoption of conventional LESS. The application of robotics has eliminated many of the constraints experienced with conventional LESS; however, challenges still remain.Materials and Methods:A systematic literature review was performed using PubMed to identify relevant studies. There were no time restrictions applied to the search, but only studies in English were included. We used the following search terms: Robotic single site surgery, robotic single port surgery, robotic single incision surgery and robotic laparoendoscopic single site surgery.Results:A number of centers have published their experience with robotic-laparoendoscopic single-site surgery (R-LESS); however, no prospective studies exist. What is clear is that R-LESS minimizes several of the difficulties experienced with conventional LESS, including intracorporeal suturing and triangulation during dissection. Outcomes are comparable to standard robotic surgery, with a trend toward improved cosmesis and reduced pain. However, a significant advantage with regard to these two factors has yet to be demonstrated.Conclusions:R-LESS is technically feasible and the benefits of robotic surgery eliminate many of the challenges seen with conventional LESS. However, despite the advantages of the robotic platform, R-LESS is not free of challenges. Instrument clashing remains an issue due to the bulky profile of the current robotic system. Other issues include lack of space for the assistant at the bedside, inability to incorporate the 4th robotic arm for retraction and difficulties with triangulation. Although solutions for some of these issues are currently under development, R-LESS is still very much in its infancy.

Pico Lantern: a pick-up projector for augmented reality in laparoscopic surgery.

The Pico Lantern is proposed as a new tool for guidance in laparoscopic surgery. Its miniaturized design allows it to be picked up by a laparoscopic tool during surgery and tracked directly by the endoscope. By using laser projection, different patterns and annotations can be projected onto the tissue surface. The first explored application is surface reconstruction. The absolute error for surface reconstruction using stereo endoscopy and untracked Pico Lantern for a plane, cylinder and ex vivo kidney is 2.0 mm, 3.0 mm and 5.6 mm respectively. The absolute error using a mono endoscope and a tracked Pico Lantern for the same plane, cylinder and kidney is 0.8mm, 0.3mm and 1.5mm respectively. The results show the benefit of the wider baseline produced by tracking the Pico Lantern. Pulsatile motion of a human carotid artery is also detected in vivo. Future work will be done on the integration into standard and robot-assisted laparoscopic surgery.