Step In Laparoscopic Surgery Research Articles

Abdominal access in laparoscopic surgery of obese patients: a novel abdominal access technique.

An important step in laparoscopic surgery is abdominal access. Several abdominal access techniques have been described to reduce complications. We compare our novel abdominal access technique (MESAD) with other abdominal access techniques, particularly to reduce complications in obese patients. Compare the MESAD method and other methods we use for abdominal access in gynecologic laparoscopic surgery of obese patients DESIGN: Retrospective SETTING: Gynecology department in university hospital PATIENTS AND METHODS: Patients who underwent abdominal access by the MESAD technique, the Veress needle technique, and the Hasson technique were included in our study. In addition to demographic data, minor and major complications, number of unsuccessful attempts, conversion to another technique, and abdominal access times were collected from all patient files. Clinical data and complications SAMPLE SIZE: 66 patients, 26 by MESAD technique, 24 by the Veress needle technique, and 16 by the Hasson technique. There were two major complications (one in the Veress group and one in the Hasson technique group) and 7 minor complications. No significant difference was found between the groups in terms of complications (P=.477, P=.476, respectively). The fastest technique for abdominal access was in the MESAD technique whereas the slowest was in the Hasson (P<.001). The failure of abdominal access and subsequent conversion to another technique was most common in the Veress group. However, no significant difference was found between the groups (P=.092). The MESAD technique is an easy method to both learn and teach. We think that the low major-minor complication rates in the MESAD technique will allow surgeons to reduce their anxiety at the first entry and to perform a more comfortable operation. Retrospective CONFLICT OF INTEREST: None.

Comparative study of outcomes in patients where pneumoperitoneum is created by Veress needle versus open method in laparoscopic surgeries

Background: The establishment of pneumoperitoneum is the inevitable first step in laparoscopic surgery as it increases the distance between the anterior abdominal wall and intra-abdominal viscera, thus creating a working space. Methods: This prospective study was conducted on 50 patients. Patients were randomly divided into two groups, in first group, pneumoperitoneum is created by Veress needle and in second group, pneumoperitoneum is created by open method. Results: The open method takes less time to create pneumoperitoneum while leads to statistically significant more gas leaks as compared to the closed method. Conclusions: The open technique is almost equal to closed technique or Veress technique in terms of the time taken to complete the operation and major and minor complications because there was no statistically significant difference in the frequency of these parameters between the two techniques. The open method takes less time to create pneumoperitoneum while leads to statistically significant more gas leaks as compared to the closed method.

Comparative study between true umbilical versus supra umbilical technique as an open access for pneumoperitoneum during laparoscopic surgery

Background: To start laparoscopic procedures, accessing the peritoneal cavity and establishing a carbon dioxide pneumoperitoneum are critical. The placement of the primary trocar is an important step in laparoscopic surgery. Many techniques have been reported in order to limit complications associated with the placement of the first trocar. In the study we describe a surgical method that offers quick, safe, and reliable preliminary entry into the peritoneal cavity with incredible functional and cosmetic results. Methods: A prospective randomised comparative study was conducted on 202 candidates for various laparoscopic surgery, comparing true umbilical versus supra umbilical open access for pneumoperitoneum from November 2021 to May 2022 in our surgical department. Results: There were 202 patients in the study, 109 (women) and 93 men. The port site entry per seconds was 41.3± 1.2 in true umbilical technique (group A) and 132.9± 5.5 in supra umbilical open technique (group B), and that was a statistically significant difference (p &lt; 0.0001). There was a statistically significant difference in the mean time of port site wound closure (&lt;0.0001) and port site gas leaking in the true umbilical access group compared to the supra umbilical access group (0.000161).

Surgeons' requirements for a surgical support system to improve laparoscopic access

Creating surgical access is a critical step in laparoscopic surgery. Surgeons have to insert a sharp instrument such as the Veress needle or a trocar into the patient’s abdomen until the peritoneal cavity is reached. They solely rely on their experience and distorted tactile feedback in that process, leading to a complication rate as high as 14% of all cases. Recent studies have shown the feasibility of surgical support systems that provide intraoperative feedback regarding the insertion process to improve laparoscopic access outcomes. However, to date, the surgeons’ requirements for such support systems remain unclear. This research article presents the results of an explorative study that aimed to acquire data about the information that helps surgeons improve laparoscopic access outcomes. The results indicate that feedback regarding the reaching of the peritoneal cavity is of significant importance and should be presented visually or acoustically. Finally, a solution should be straightforward and intuitive to use, should support or even improve the clinical workflow, but also cheap enough to facilitate its usage rate. While this study was tailored to laparoscopic access, its results also apply to other minimally invasive procedures.

DEPENDENCE OF THE PAIN SYNDROME INTENSITY AFTER LAPAROSCOPIC SURGERY ON THE RESIDUAL VOLUME OF WORKING GAS IN THE ABDOMINAL CAVITY

Induction of pneumoperitoneum is a mandatory step in laparoscopic surgery in order to create a workspace for the surgeon. The cause of omalgia (pain in shoulder area) after such interventions is the accumulation of residual gas in the abdominal cavity.There are still no proven methods of quantitative assessment of the residual pneumoperitoneum. Thus, the patterns of relationship between the amount of residual gas and the intensity of pain syndrome have not been studied yet. Considering the fact that the residual gas exerts mechanical distention of anatomical structures and apparently causes local irritation in the peritoneum, it is necessary to develop preventive measures for omalgia which may involve not only the approaches to reduce the amount of residual gas but also the use of alternative gas sources, particularly argon. As inert gas argon possesses many positive qualities, it does not affect the peritoneum, and has no resorptive metabolic effects.&#x0D; The goal of our research is to work out an X-ray planimetric method for determining the amount of residual gas after laparoscopic surgery and to assess the dependence of the pain intensity on both, the amount of residual gas and the type of working gas used.&#x0D; Material and methods of research. Two experimental groups of patients with uncomplicated cholelithiasis were formed, and carboxyperitoneum and argonperitoneum were used to create the space during laparoscopic cholecystectomy. The groups of examined patients are equivalent by age and sex and are randomized for consecutive admission to the hospital. Both groups include patients who underwent surgery without the use of any drainage means. 24 hours after the operation, a chest plain radiography was performed in order to identify the area of gas crescent sign under the right hemidiaphragm using personally-developed original approach. The technique is based on the use of a mobile application to measure the area of complex geometric shapes. At the same time, the intensity of pain syndrome in the shoulder area was assessed in all the patients by means of NRS (Numeric Rating Scale) in combination with Rotterdam Elderly Pain Observation Scale (REPOS). The technique is aimed to objectify the subjective assessment of pain. Statistical software for Microsoft Excel 2010 was used for processing the study results and calculating Pearson’s correlation coefficient.&#x0D; Results of research and their discussion. The obtained results revealed moderate correlation relationship between the area of gas crescent sign under the right hemidiaphragm and pain syndrome intensity. This relationship was confirmed both in the group with carboxyperitoneum and in the group with argon as the working gas. However, it was observed that the proportion of patients with postoperative omalgia in the group with argonoperitoneum is significantly lower. Thus, both hypotheses, concerning the role of mechanical factors in the development of omalgic syndrome and the significance of chemical local peritoneal irritation have been confirmed.&#x0D; Conclusions:&#x0D; &#x0D; The suggested method of radiological planimetry allows to obtaine the digital indicators suitable for statistical analysis which characterize the amount of residual gas after laparoscopic surgery.&#x0D; The intensity of pain syndrome exhibits correlation with the amount of residual gas after the surgery.&#x0D; The severity of omalgia depends primarily on the amount of residual gas. However, the incidence of omalgic syndrome with the use of carbon dioxide is higher than with argon use.&#x0D;

Comparison of Two Entry Methods for Laparoscopic Port Entry

Background The first step in laparoscopic surgery is to establish the pneumoperitoneum for which many approaches have been introduced to minimize the complications. Although controversies exist regarding the most efficient technique, till now the best entry technique is still unsettled.&#x0D; Objective To compare the safety, operating time and outcome of Direct Trocar Insertion with a well-established and widely practised Open Access Technique.&#x0D; Method This is a prospective study at Nobel Medical College Teaching Hospital from November 2019 to February 2021. Patients were grouped into either of the two groups, Group 1 for Direct Trocar Insertion and Group 2 for Open Access Technique. They were later analysed for major and minor complications of the technique and a comparison of either method was done at the end of the study period.&#x0D; Result A total of 823 patients were enrolled in the study. Among the study population, 411 patients had Direct Trocar Insertion while 412 patients had Open Access Technique. The majority of the operation that was done during the study period was laparoscopic cholecystectomy. Patients in the Open Access Technique group experienced more complications compared to Direct Trocar Insertion group.&#x0D; Conclusion Despite the fear of adopting the Direct Trocar Insertion, this is a safe, better and quick technique for laparoscopic port entry. However, any surgeon practising laparoscopic surgery should be competent to adopt either technique to overcome failure in either process during port entry.

Creation of Pneumoperitoneum- New Approach

The establishment of pneumoperitoneum is the first step in laparoscopic surgery. Laparoscopic abdominal surgery requires the creation of a successful pneumoperitoneum as it plays an important role in prevention of complications occurring at the time of entry. Various techniques have been used to create pneumoperitoneum of which Direct trocar insertion is one procedure. A study was carried out to decrease the trocar insertion time in turn facilitating the decrease in operative time. In this study 36 patients underwent different laparoscopic surgeries. The time taken for the insertion of first trocar was recorded. The time taken was 12plusmn2 10 to 14 minutes in open method and 7plusmn2 5 to 9 minutes in Direct blind trocar insertion. Thus the time taken for direct trocar insertion was less when compared to open method. The direct trocar insertion was faster requiring less rotatory movements and force and was safe.

Direct Trocar Insertion with Elevation of the Rectus Sheath in Bariatric Surgery: A Novel Technique.

Initial trocar entry, the first step in laparoscopic surgery, is associated with several complications. In morbidly obese patients, initial trocar placement is associated with a greater number of complications compared to non-obese patients. Materials and Surgical Technique. In this study, we describe our use of an initial trocar entry technique which is direct trocar insertion with elevation of the rectus sheath by a single Backhaus towel clamp and we would like to evaluate the sa fety and efficacy of its administration in bariatric surgery. Our results indicate that gaining initial trocar entry using our technique leads to successful laparoscopic bariatric surgery. Our technique is a safe, effective, and reliable first step in successful laparoscopic surgery for almost all patients, and is only contraindicated in patients with severe hepatomegaly.

Trans umbilical laparoscopic access during laparoscopic procedures

Introduction: The advent of laparoscopic surgery is one of the most important advances in modern surgical technique. In order to perform laparoscopic procedures it is necessary to first access the peritoneal cavity and establish a pneumoperitoneum. The placement of the first port remains a critical step in laparoscopic surgery. In order to minimize complications associated with placement of this first trocar, several techniques have been reported. We describe a surgical technique that has been developed by our surgical group that provides a quick, safe, and reliable initial access to the peritoneal cavity that is accompanied by excellent functional and cosmetic results. Methods: Retrospective cohort of patients who underwent various laparoscopic procedures by our surgical group using our modified open technique for accessing the peritoneum from January 2000 to September 2012. We excluded patients who had a prior midline laparotomy with involvement of the umbilicus, but not those with previous transverse umbilical herniorrhaphies. Results: We identified 963 patients (M = 419; F = 544) in the study period. Average age of the patients was 40 years (range: 15-83). Median follow up of 2.8 years (range: 6-144 months). No complications occurred during the insertion of the first trocar. A physiologic defect was identified in the umbilical region in all patients who had no history of previous abdominal surgery in that region. Postoperative complications occurred in 39 patients (4.0%). The most common complication was a postoperative seroma, which occurred in 24 patients (2.4%). Superficial surgical site infection occurred in eight patients (0.84%), hematoma in two patients (0.21%), and incisional hernias in the umbilical port site in five patients (0.51%). The average time to access the peritoneal cavity was 1.5 minutes (range: 1-7). Conclusions: We describe a modified open technique for accessing the peritoneal cavity through a small congenital umbilical defect that is almost universally present. This technique is quick, safe, reliable, simple, and easy to learn. It is associated with minimal morbidity and has excellent cosmetic results. Based on our experience, we believe that this method provides surgeons with an effective and safe way to insert the first trocar and we recommend it as a routine procedure to access the peritoneal cavity for abdominal laparoscopic surgery.

Comparative study among cine-magnetic resonance imaging, ultrasound, and periumbilical ultrasound-guided saline infusion in high-risk patients for subumbilical adhesions before laparoscopic entry

Abdominal entry at the time of laparoscopy remains the most critical step in laparoscopic surgery. Transabdominal ultrasound (TAU) and cine magnetic resonance imaging (cine-MRI) are both non-invasive tools in the preoperative prediction of adhesions. Ultrasound is effective in detecting abdominal wall adhesions, but MRI is the best for intra-abdominal adhesions. Periumbilical ultrasound-guided saline infusion (PUGSI) is an excellent method for detecting subumbilical adhesions. Evaluate the most effective and rapid method for diagnosis of subumbilical adhesions before laparoscopic interference in gynecological practice. This study was carried out on 90 high-risk patients for subumbilical adhesions. All patients were subjected to medical history, physical examination, laboratory investigations, and three techniques for subumbilical adhesions detection before laparoscopic entry including cine-MRI, TAU, and PUGSI. PUGSI for detection of subumbilical adhesions showed that the sensitivity of 94.7 % and a specificity of 90.1 %. With preoperative TAU, a sensitivity of 89.5 % and a specificity of 88.7 % were obtained. With cine-MRI, a sensitivity of 78.9 % and a specificity of 84.5 % were obtained. PUGSI is a more sensitive and rapid method than TAU and cine-MRI for detection of subumbilical adhesions before laparoscopic gynecological surgery.

First steps of laparoscopic surgery in Lubumbashi: problems encountered and preliminary results.

For many reasons, laparoscopic surgery has been performed worldwide. Due to logistical constraints its first steps occurred in Lubumbashi only in 2008. The aim of this presentation was to report authors’ ten-month experience of laparoscopic surgery at Lubumbashi Don Bosco Missionary Hospital (LDBMH): problems encountered and preliminary results. The study was a transsectional descriptive work with a convenient sampling. It only took in account patients with abdominal surgical condition who consented to undergo laparoscopic surgery and when logistical constraints of the procedure were found. Independent variables were patients’ demographic parameters, staff, equipments and consumable. Dependent parameters included surgical abdominal diseases, intra-operative circumstances and postoperative short term mortality and morbidity. Between 1stApril 2009 and 28th February 2010, 75 patients underwent laparoscopic surgery at the LDBMH making 1.5% of all abdominal surgical activities performed at this institution. The most performed procedure was appendicectomy for acute appendicitis (64%) followed by exploratory laparoscopy for various abdominal chronic pain (9.3%), adhesiolysis for repeated periods of subacute intestinal obstruction in previously laparotomised patients (9.3%), laparoscopic cholecystectomy for post acute cholecystitis on gall stone (5.3%) and partial colectomy for symptomatic redundant sigmoid colon (2.7%). There were 4% of conversion to laparotomy. Laparoscopic surgery consumed more time than laparotomy, mostly when dealing with appendicitis. However, postoperatively, patients did quite well. There was no death in this series. Nursing care was minimal with early discharge. These results are encouraging to pursue laparoscopic surgery with DRC Government and NGO's supports.

Laparoscopic Surgery: Results of a Modified Open Technique of Umbilical Port Insertion

Insertion of first port and creation of pneumoperitoneum is a key step in laparoscopic surgery. A significant number of complications can be avoided by safe insertion of primary port. Various techniques of umbilical port insertion and their safety have been mentioned in literature. Closed method by using Veress needle is a blind procedure. Studies have shown that vascular injuries are more common with the Veress needle. Hasson first introduced the open technique of port insertion under direct vision. We used a modified open technique and analyzed the safety and efficacy in 80 cases.

Laparoscopic restorative proctocolectomy ileal pouch anal anastomosis: How I do it?

Surgery for ulcerative colitis is a major and complex colorectal surgery. Laparoscopy benefits these patients with better outcomes in context of cosmesis, pain and early recovery, especially in young patients. For surgeons, it is a better tool for improving vision and magnification in deep cavities. This is not the simple extension of the laparoscopy training. Starting from preoperative preparation to post operative care there are wide variations as compared to open surgery. There are also many variations in steps of laparoscopic surgery. It involves left colon, right colon and rectal mobilisation, low division of rectum, pouch creation and anastomosis of pouch to rectum. Over many years after standardisation of this technique, it takes same operative time as open surgery at our centre. So we present our standardized technique of laparoscopic assisted restorative proctocolectomy and ileal pouch anal anastomosis (IPAA).

Single instrument intracorporeal knot tying during single port laparoscopic hernia repair in children: A new simplified technique

BackgroundWith the increasing number of open surgical procedures shifting to laparoscopy, laparoscopic suturing and knot tying are becoming integral parts of the skills that any laparoscopist must acquire. It is the most difficult step in laparoscopic surgery, especially in single incision pediatric endosurgery (SIPES). It needs special laparoscopic skills and very long learning curve. The aim of this study is to introduce a new simplified technique for single instrument intracorporeal suture tying during single incision laparoscopic hernia repair (SILHR). Patients and methodsThis study was conducted at Al-Azhar University Hospitals between June 2008 and June 2010. Three-hundred and eighty three patients with 402 congenital inguinal hernias were subjected to SILHR using percutaneous insertion of purse string suture by Reverdin Needle (RN) with single instrument intracorporeal suture knot tie. Description of the techniqueUnder general endotracheal tube anesthesia, a 0.8–1.2-cm. longitudinal transumilical skin incision was done for insertion of the umbilical port and a 3-mm Maryland forceps. RN was used for insertion of a purse string suture with single instrument intracorporeal suture tie around internal inguinal ring (IIR). The purse-string knot airtightness was stress-tested by raising the intraperitoneal CO2 pressure to 16–24mm Hg for about 30seconds. ResultsA total of 383 patients with 402 congenital inguinal hernias were subjected to SILHR. They were 304 males and 79 females with a mean age of 2.2±2.25years. A single instrument technique was used for intracorporeal suture knot tie and all cases were completed laparoscopically without conversion. The mean operative time was 12.5±3.3minutes for unilateral hernia repair and 17±4.37 for bilateral cases. All patients achieved full recovery without intraoperative or postoperative complications. ConclusionSingle instrument intracorporeal suture tie is feasible, simple, and rapid as it resulted in marked decrease of operative time. It is of low cost, secure and gives great help during SIPES surgery without struggling. It is a good alternative option to extra corporeal knot tying.

Have we learned from lessons of the past? A systematic review of training for single incision laparoscopic surgery

Single incision laparoscopic surgery (SILS) represents the next step in laparoscopic surgery in further reducing the invasiveness of surgical procedures with cosmetic advantages. Recalling the increased rates of major complications at the advent of laparoscopic cholecystectomy 20 years ago, however, it is clear that appropriate training is required before adopting a new technique. This study aims to review the current evidence for training and skills acquisition for SILS. A comprehensive database search of PubMED, MEDLINE, EMBASE and Google Scholar was carried out. Studies considered for inclusion were those addressing SILS learning curves, skills acquisition, or training. 21 studies were included in the final analysis. Ten clinical case series with analysis of SILS learning curve demonstrated a significant learning curve for conventional multiport laparoscopic (LAP)-trained surgeons over the course of initial SILS cases, with several studies reporting increased risk of conversion and complication rates. Five laboratory-based studies demonstrated differences in SILS skills acquisition compared with LAP. Six studies describing SILS-specific training curricula were analysed, but none included a robust validation of the curriculum. Clinical case series and laboratory-based skills acquisition studies demonstrate the unique requirements of SILS, with skill sets and ergonomic demands which cannot be directly adapted from existing LAP experience. Some studies have already reported higher complication rates in initial SILS cases. To avoid repeating the mistakes of the past, the implementation of an evidence- and competency-based SILS curriculum is necessary to ensure appropriate training of future SILS surgeons.

Optimization techniques of hysterectomy and hysterectomy cervical stump by laparoscopic access

The authors analyze the nature and frequency of complications of hysterectomy and extirpation of the cervical stump by laparoscopic access in order to optimize techniques for surgery and improve their security. Standardization of the basic steps of laparoscopic surgery reduces the incidence of complications and improve the effectiveness of surgical treatment

Urologic laparoendoscopic single-site surgery

Laparoendoscopic single-site surgery (LESS) probably represents the next evolutionary step in laparoscopic surgery. Although most urologic procedures are feasible by the LESS approach, significant challenges in terms of intraoperative ergonomics and requirement for laparoscopic skill are present. New, specially designed instruments and ports represent a solution for combating ergonomic problems during surgery. Documentation of the advantages of LESS over other approaches is currently lacking, as comparative clinical trials are scarce in the literature; in the absence of such information, the technique has been accepted at centers of laparoscopic expertise. Thus, further prospective randomized clinical trials are necessary to fully characterize the outcomes of LESS.

146: Entry Related Complications in Laparoscopy and Their Medical Liability Insurance

Installation of the pneumoperitoneum is still an essential first step in laparoscopic surgery. The aim of the study was to assess the number of, and the contributing factors to entry related complications in medical liability insurance claims in The Netherlands.