Time Of Laparoscopic Surgery Research Articles

WTP7.5 The shift in practice Toward Laparoscopic emergency surgery over period of 7 years in a district hospital

Abstract Aim Many studies showed the advantages of laparoscopic surgery when compared to open surgery both in elective and emergency surgery. The Aim of this study is to compare Laparoscopic and open surgical procedures in managing Emergency surgery in a district hospital over a period of 7 years. Methods We reviewed 1776 emergency cases in 2015 and 1836 cases in 2022 in the emergency theatre register. We included all the abdominal emergency surgeries that qualifies for the NELA inclusion/ exclusion criteria. We excluded all non-general surgery cases. We also excluded Appendectomies, Hernia repair and Laparoscopic cholecystectomies. Results We included 207 in 2015 and 234 in 2022. There was significant increase in Laparoscopic surgery performed between 2015 and 2022 (63%Vs40%). Less open surgeries were performed (46%Vs24%) and no change in the conversion rate (13%vs12%). Operating time was (89min) for Laparoscopic cases. Compared to open procedures (119min) and converted cases (141min). Conclusion There has been more than 50 % increase in laparoscopic cases. However, there was no significant reduction in conversion rate. The laparoscopic surgery time was significantly less when compared to open or converted cases, however this might simply be sure to the complexity of those cases rather than the advantage of laparoscopic surgery. Key statement There has been significant shift toward laparoscopic surgery over the last few years due to better understanding of the benefit of laparoscopic surgery and increase confidence in performing laparoscopic surgery. There is a room of improvement in case selection to decrease the conversion rate avoiding unnecessary increase of operating time.

Outcomes following open versus laparoscopic multi-visceral resection for locally advanced colorectal cancer: Asystematic review and meta-analysis.

This meta-analysis aims to compare morbidity, mortality, oncological safety, and survival outcomes after laparoscopic multi-visceral resection (MVR) of the locally advanced primary colorectal cancer (CRC) compared with open surgery. A systematic search of multiple electronic data sources was conducted, and all studies comparing laparoscopic and open surgery in patients with locally advanced CRC undergoing MVR were selected. The primary endpoints were peri-operative morbidity and mortality. Secondary endpoints were R0 and R1 resection, local and distant disease recurrence, disease-free survival (DFS), and overall survival (OS) rates. RevMan 5.3 was used for data analysis. Ten comparative observational studies reporting a total of 936 patients undergoing laparoscopic MVR (n = 452) and open surgery (n = 484) were identified. Primary outcome analysis demonstrated a significantly longer operative time in laparoscopic surgery compared with open operations (P = 0.008). However, intra-operative blood loss (P<0.00001) and wound infection (P = 0.05) favoured laparoscopy. Anastomotic leak rate (P = 0.91), intra-abdominal abscess formation (P = 0.40), and mortality rates (P = 0.87) were comparable between the two groups. Moreover the total number of harvested lymph nodes, R0/R1 resections, local/distant disease recurrence, DFS, and OS rates were also comparable between the groups. Although inherent limitations exist with observational studies, the available evidence demonstrates that laparoscopic MVR in locally advanced CRC seems to be a feasible and oncologically safe surgical option in carefully selected cohorts.

8186 Intro to Apical Support: Laparoscopic Suspension for Uterovaginal Prolapse

Study Objective To provide residents, fellows and attending faculty with a straightforward and simple procedure for providing apical support at the time of laparoscopic surgery. Design N/A. Setting University Health Network Patients or Participants Persons with mild apical prolapse undergoing a laparoscopic procedure or needing concomitant surgery at the time of reconstructive pelvic surgery. Interventions Laparoscopic Uterosacral Vault Suspension using permanent suture material. Measurements and Main Results N/A. Conclusion Laparoscopic uterine-preserving uterosacral vault suspension is a valid option for appropriately selected patients. Women with anterior and mild to moderate apical prolapse may benefit greatly with this concomitant procedure. The uterosacral ligaments provide a strong supportive tissue for vaginal vault suspension. To provide residents, fellows and attending faculty with a straightforward and simple procedure for providing apical support at the time of laparoscopic surgery. N/A. University Health Network Persons with mild apical prolapse undergoing a laparoscopic procedure or needing concomitant surgery at the time of reconstructive pelvic surgery. Laparoscopic Uterosacral Vault Suspension using permanent suture material. N/A. Laparoscopic uterine-preserving uterosacral vault suspension is a valid option for appropriately selected patients. Women with anterior and mild to moderate apical prolapse may benefit greatly with this concomitant procedure. The uterosacral ligaments provide a strong supportive tissue for vaginal vault suspension.

Self-Cleaning Trocars/Laparoscopic Port Add-on for Surgical Camera Lens

<h3>Study Objective</h3> During laparoscopic surgeries, the camera is visually impaired by blood, debris, and condensation. The process of cleaning includes removing the laparoscope out of the patient and then using cloth and/or lens defogging solution. Thus, there is a need for a device that will clean the camera without removing it from the patient to decrease surgical time, risk of contamination, and cost. <h3>Design</h3> We have developed a prototype of a disposable lens-cleaning compartment that is attached onto a disposable trocar to allow surgeons to clean the lens without removing the laparoscope from the patient's body. The cleaning compartment is made of three layers of plastic - upper, lower, iris diaphragm covered with synthetic cleaning material, and O rings on either side. The cleaning compartment will sit between the cap and the hollow tube of the trocar. This device will clean the lens by having the surgeon use a back-and-forth motion onto the compartment until the lens has visibility <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> Benchtop model of glass lens were clouded with egg, chocolate syrup, .25% agar and 1x DPBS saline (control) and cleaned with synthetic material for five full rotation of the laparoscope. Clarity was quantified through image J by filtering for black and white ratio. A two-way ANOVA showed significant differences with solution, time, and the interaction of the two. Solidwork stress simulation demonstrate that the device can withstand around 270N/60 lbs of force before breakage. Compartment was assessed with and without O rings and airtightness was noted with the use of O rings. <h3>Conclusion</h3> By adding a cleaning compartment to pre-existing trocars, laparoscopic surgery time will decrease as there is no need to remove the laparoscope from the patient. Future work would include testing product within the OR to further validate the product design to meet surgeons' need.

Laproscopic versus open ventral hernia repair

Background: Ventral hernia is second most common type of abdominal hernia after inguinal hernia. Treatment includes anatomical repair, meshplasty: onlay, sublay, preperitoneal etc. Evaluation of laparoscopic hernia repair has led to new benchmark for ventral hernia repair. This study aims to compare laparoscopic ventral hernia repair versus open repair. Methods: Total 30 patients were enrolled in this study who presented to Dhiraj hospital pipariya. Detailed history was taken and patient were randomly divided in to 2 groups. Results: There were 22 females and 8 male patients in this study. Mean age was 42.4 years. Mean operative time in laparoscopic surgery was 80.25± 2.43 minutes versus 60±3.44 minutes. Mean hospital stay in laparoscopic was 3.5 days versus 5.5 days in open hernia repair. Conclusion: Laparoscopic meshplasty is better than open repair in terms of early recovery, less pain, minimal scar, early return to work.

Eliminación de los efectos de humo en cirugía laparoscópica usando redes antagónicas generativas y el principio del canal oscuro

In laparoscopic surgery, image quality can be severely degraded by surgical smoke caused by the use of tissue dissection tools that reduce the visibility of the observed organs and tissues. Improve visibility in laparoscopic surgery by combining image processing techniques based on classical methods and artificial intelligence. Development of a hybrid approach to eliminating the effects of surgical smoke, based on the combination of the dark channel prior (DCP) method and a pixel-to-pixel neural network architecture known as a generative adversarial network (GAN). Experimental results have shown that the proposed method achieves better performance than individual DCP and GAN results in terms of restoration quality, obtaining (according to PSNR and SSIM index metrics) better results than some related state-of-the-art methods. The proposed approach decreases the risks and time of laparoscopic surgery because once the network is trained, the system can improve real-time visibility.

Impact of Procedure Time of Preceding Endoscopic Submucosal Dissection on the Difficulty of Laparoscopic Rectal Surgery

Objetive: In this study, we addressed which factors, including endoscopic submucosal dissection (ESD)–related parameters, affect the difficulty of laparoscopic rectal surgery. Summary of background data: Endoscopic treatment for gastrointestinal cancer can cause inflammation, edema, and fibrosis formation in the surrounding tissue. Recently, we reported that preceding endoscopic treatment increased the volume of intraoperative blood loss and slightly prolonged the operative time of laparoscopic surgery for rectal cancer. Methods: We retrospectively reviewed 24 consecutive patients who underwent ESD followed by laparoscopic surgery for rectal cancer in our hospital. Short-term surgical outcomes were evaluated by intraoperative blood loss and operative time for laparoscopic surgery. The correlations between the surgical outcomes and preoperative parameter were analyzed by multiple linear regression analyses. Results: The patient cohort comprised 12 men and 12 women. The median distance between primary cancer and anal verge was 7 cm. The median procedure time of ESD was 120 minutes (21 available cases). Based on multiple linear regression analyses, the ESD procedure time (P = 0.007) and tumor location from the anal verge (P = 0.046) were independently predictive of intraoperative blood loss. On the other hand, only tumor location was found to be an independent predictor of surgical time (P = 0.014). Conclusions: A long session of ESD for rectal cancer may make subsequent laparoscopic surgery difficult based on intraoperative blood loss.

Role of M1-polarized tumor-associated macrophages in the prognosis of advanced ovarian cancer patients

The identification of prognostic and predictive markers is crucial for choosing the most appropriate management method for ovarian cancer patients. We aimed to assess the prognostic role of tumor-associated macrophage (TAM) polarization in advanced ovarian cancer patients. We carried out a prospective observational study that included 140 consecutive patients with advanced-stage high-grade serous ovarian cancer as well as patients with other histotypes of ovarian cancer and patients with ovarian metastasis from other sites between June 2013 and December 2018. Patients were enrolled at the time of laparoscopic surgery before receiving any antineoplastic treatment. We found that patients with high-grade serous papillary ovarian cancers had a prevalence of M1 TAMs, a higher M1/M2 ratio, and a longer overall survival (OS) and progression-free survival (PFS) than other patients. Regression analysis confirmed that there was a significant positive association between the M1/M2 ratio and an improved OS, PFS and platinum-free interval (PFI), both in the entire population and in patients stratified according to tumor type and initial surgery. Kaplan-Meier analysis was performed after the patients were divided into 2 groups according to the median M1/M2 ratio and revealed that patients with a high M1/M2 ratio had a higher OS, PFS and PFI than those with a low M1/M2 ratio. In conclusion, the prognostic and predictive role of TAM polarization in the tumor microenvironment could be of great clinical relevance and may allow the early identification of patients who are likely to respond to therapy. Further studies in a larger prospective sample are warranted.

An Optimal Surgical Approach for Suprapancreatic Area Dissection in Laparoscopic D2 Gastrectomy with Complete Mesogastric Excision

BackgroundDuring the radical operation, the suprapancreatic area is featured by anatomical complexity, and the lymph node dissection for this area is technically difficult and demanding.1-4 Previously, we have demonstrated the presence of disseminated cancer cells in the mesogastrium5,6 and presented a mesogastrium model for gastrectomy.7 As a consequence, laparoscopic D2 lymphadenectomy plus complete mesogastric excision (D2+CME) was proposed as a new concept in the surgical treatment of advanced gastric cancer.8 D2+CME procedure has been shown to be associated to lower number of free intraperitoneal cancer cells and with a better disease-free survival than conventional D2 gastrectomy.9 Under the concept of mesogastrium model, the proposed D2+CME procedure could help surgeons better define the anatomical boundaries of suprapancreatic mesogastrium, thus using it to achieve a complete and standard excision of the suprapancreatic area dissection. Here, we briefly present perioperative results of our case series with the laparoscopic curative subtotal gastrectomy and D2+CME with a R0 resection and present a video to detail the technical aspects of a laparoscopic D2+CME approach for suprapancreatic area dissection. MethodsAll patients in this study underwent laparoscopic subtotal gastrectomy (D2+CME) with a curative R0 resection. This study was approved by the Tongji Hospital Ethics Committee (Unique Reference Number: TJ-IRB20180811). The procedures in the video are described as follows. Based on our previous mesogastrium model (also named “Table model”, Supplemental Figure 1), the suprapancreatic mesogastrium is attached to the lesser curvature or the posterior gastric wall and extended to the suprapancreatic area, respectively.7 Surgeon stands on patient left side, and the assistant lifts the stomach upward and cephalic to expose the suprapancreatic mesogastrium including left gastric mesentery (LGM), right gastric mesentery (RGM) and posterior gastric mesentery (PGM). First of all, towards to the left side of the suprapancreatic area, the “tri-junction” point of LGM is exposed. Using an energy devise, surgeon opens serosa layer and identifies the retrogastric space. The LGM and PGM are mobilized bluntly, between which a fusion retrogastric space is revealed. Both the LGM and PGM are covered by smooth and shiny surfaces of fascial propria and regarded as the “meso-bed” mutually. Secondly, at the inner side of duodenum, surgeon bluntly separates the adjuvant tissues along gastro-duodenal artery (GDA) upward and exposes right gastric mesentery (RGM). Next, after mobilizing the left gastric mesentery, surgeon removes the adipose tissue adherent to the common hepatic artery (CHA) and exposes the root of the left gastric artery after dissecting the perivascular sheath with triple-clips. Then, surgeon dissects RGM along the CHA and portal vein (HPV) towards the right side of the suprapancreatic area; afterwards, the right gastric vessels and RGM are identified and ligated. Lastly, the superior border of splenic vessels is dissected. The anterior lobe of the PGM is raised up with ligated posterior gastric vessels. Remarkably, posterior gastric vessels may be absent in some cases. Reconstruction of the alimentary tract is Roux-en-Y method. Standard recovery protocols are followed in postoperative treatments. ResultsBetween August 28th 2017 and December 27th 2018, 107 patients receiving laparoscopic curative subtotal gastrectomy (D2+CME) with a R0 resection were retrospective collected in this study. After exposing the suprapancreatic mesogastrium including RGM, PGM and LGM with D2+CME procedure, the LNs and fat tissues around 7, 9, 8a, 12a and 11p were removed en bloc in all patients. This study recruited 67 males and 40 females. The median age was 55 years, with body mass index (BMI) 23.0 kg/m2 (Supplemental Table 1). The median number of retrieved regional lymph nodes was 31 (range 25–41), including 22 (range 17–27.5) suprapancreatic lymph nodes. The median volume of blood loss was 14 ml (range 6-34). The median total operation time was 287 min (range 265.5–313.5) and laparoscopic surgery time was 132 min (range 116–142) (Supplemental Table 2). Postoperative morbidity occurred at a rate of 9.3 %, and the mortality rate was 0% (Supplemental Table 3). The median follow-up was 10 months (range 8–13). No patient was lost during follow-up (Supplemental Table 4). ConclusionA laparoscopic subtotal gastrectomy with D2+CME procedure provides for a complete and standardized en bloc excision of the suprapancreatic area dissection.

2735 The Incidence of Abdominal Wall Adhesions at the Time of Laparoscopic Surgery in Women with or without Previous Surgery

Study Objective To compare the incidence of abdominal wall adhesions at the time of laparoscopic surgery in women with various surgical histories. Design REB approved prospective cohort study. Setting Surgical suite in an academic affiliated teaching hospital. Patients or Participants 283 women undergoing laparoscopic surgery for gynecological indications between June 2013 to November 2014 Interventions After informed consent was obtained, laparoscopic surgery was performed by the senior author (GV), baseline patient characteristics were recorded, and the presence and description of abdominal wall adhesions was documented. Adhesions were characterized as containing bowel, mesentery, or omentum. Patients previous surgical history was documented. Measurements and Main Results The mean (SD) of age, parity and BMIof women were 36.8 (+/- 7.6) years, 0.96 (+/- 1.1), and 27.8 (+/- 6.5) kg/m2, respectively. The incidence of abdominal wall adhesions in women with history of: no previous abdominal surgery- 1.9% (2/104); at least one previous laparoscopy- 2.0% (2/101, p=1.00); at least one low transverse laparotomy- 20.7% (11/53, p Conclusion The incidence of abdominal wall adhesions in women undergoing laparoscopic surgery is the same in those with or without previous laparoscopic surgery of any kind. The incidence is increased in those with previous laparotomy, including low transverse incision.

Deep Dyspareunia in Endometriosis: Role of the Bladder and Pelvic Floor

IntroductionThe etiology of endometriosis-associated deep dyspareunia may include direct endometriosis-specific factors (eg, stage or invasiveness of disease) and/or indirect contributors such as bladder/pelvic floor dysfunction (eg, related to myofascial mechanisms or nervous system sensitization). AimThis study aimed to determine whether bladder/pelvic floor tenderness and painful bladder syndrome were associated with severity of deep dyspareunia in women with endometriosis, regardless of Stage (I/II vs III/IV) or other endometriosis-specific factors. MethodsObservational study from a prospective patient registry (January 2014 to December 2016) at a tertiary centre for endometriosis. Included were women aged 18 to 49 years who had surgical removal and histopathologic confirmation of endometriosis at the centre. Cases with Stage I/II vs Stage III/IV endometriosis were analyzed separately. Bivariate associations with the primary outcome (severity of deep dyspareunia) were tested for bladder/pelvic floor tenderness, painful bladder syndrome, as well as endometriosis-specific factors identified at the time of laparoscopic surgery (eg, deep infiltrating endometriosis) and demographic factors (eg, age). Multivariable ordinal logistic regression was carried out to adjust for factors associated with the primary outcome. Main Outcome MeasurePrimary outcome was severity of deep dyspareunia on an 11-point numeric rating scale, categorized as none/mild (0–3), moderate (4–6), and severe (7–10), from a preoperative self-reported questionnaire. ResultsOverall, 411 women had surgically confirmed endometriosis: 263 had Stage I/II and 148 had Stage III/IV endometriosis. Among women with Stage I/II endometriosis, severity of deep dyspareunia was associated with both bladder/pelvic floor tenderness and painful bladder syndrome (AOR = 1.94, 95% CI: 1.11–3.38, P = .019 and AOR = 1.99, 95% CI: 1.15–3.44, P = .013, respectively), independent of endometriosis-specific factors or other factors associated with deep dyspareunia severity. Similar associations were found in women with Stage III/IV endometriosis (bladder/pelvic floor tenderness AOR =2.51, 95% CI: 1.25–5.02, P = .01, painful bladder syndrome: AOR = 1.90, 95% CI: 1.01–3.57, P = .048). Clinical ImplicationsMyofascial or nervous system mechanisms may be important for deep dyspareunia in women with endometriosis, even in those with moderate-to-severe disease (Stage III/IV). Strengths & LimitationsStrengths include the prospective registry, and histological confirmation of endometriosis and staging by experienced endometriosis surgeons. Limitations include assessment of only one pelvic floor muscle (levator ani). ConclusionIn women with Stage I/II or Stage III/IV endometriosis, severity of deep dyspareunia was strongly associated with bladder/pelvic floor tenderness and painful bladder syndrome, independent of endometriosis-specific factors, which suggests the role of myofascial or sensitization pain mechanisms in some women with deep dyspareunia.Orr NL, Noga H, Williams C, et al. Deep Dyspareunia in Endometriosis: Role of the Bladder and Pelvic Floor. J Sex Med 2018;15:1158–1166.

Prevalence of occult pre-malignant or malignant pathology at the time of uterine morcellation for benign disease.

To determine the prevalence of occult pre-malignant or malignant uterine pathology at the time of laparoscopic surgery with open power morcellation for benign gynecologic disease. The present multicenter, retrospective cohort study included women who underwent open power morcellation for benign indications between January 1, 2007, and February 28, 2014, at three academic medical centers in the USA. The primary outcome was pre-malignant or malignant pathology at the time of open power morcellation, and was determined from the patients' pathology reports. During the study period, 1214 women underwent open power morcellation for benign indications. Similar preoperative characteristics were observed between patients with normal pathology and those with pre-malignant or malignant uterine pathology, including body mass index, parity, hypertension, diabetes, breast cancer, and smoking (all P>0.129). Among patients who underwent open power morcellation, 14 (1.2%) had occult pre-malignant or malignant pathology; 5 (0.4%) women had endometrial adenocarcinoma and 1 (0.1%) had low-grade endometrial stromal sarcoma. There were eight patients with malignant pathology who underwent additional surgical exploration and were disease free at their final clinical visit, with a median follow-up time of 42.0months (interquartile range 5.0-62.0months). Endometrial adenocarcinoma and low-grade endometrial stromal sarcoma were rare in the present study and there were no reports of leiomyosarcoma.

Short-term outcomes of laparoscopic D2 gastrectomy with complete mesogastrium excision (D2+CME) for advanced gastric cancer.

43 Background: D2 lymphadenectomy has been widely accepted as a standard procedure of surgical treatment for local advanced gastric cancer [1,2]. However, neither the dissection boundary nor the extent of the excision for perigastric soft tissues has been described [3-7]. Our previous researches demonstrate the existence of disseminated cancer cells in the mesogastrium [8, 9] and present an understandable mesogastrium model for gastrectomy [10]. Hence, the D2 lymphadenectomy plus complete mesogastrium excision (D2+CME) is firstly proposed in this study, aiming to assess the safety, feasibility and corresponding short-term surgical outcomes. Methods: All of these patients underwent laparoscopy assisted D2+CME radical gastrectomy with a curative R0 resection, and all the operation was performed by Prof. Jianping Gong, chief of GI surgery of Tongji Hospital, Huazhong University of Science and Technology. All participants provided informed written consent to participate in the study. This study was approved by the Tongji Hospital Ethics Committee. The standard surgical procedures in the video are described as follows. Reconstruction of the alimentary tract was done by extracorporeal anastomosis. Standard recovery protocols were followed in postoperative treatments. Results: 68 patients between September 2014 and March 2016 have been recruited with informed consent and underwent laparoscopic D2+CME by a single surgeon. The mean number of retrieved regional lymph nodes was 33.62±11.40 (ranges 14-55). The mean volume of blood loss was 12.44±22.89 ml (ranges 5-100). The mean laparoscopic surgery time was 127.82±17.63 mins (ranges 110-165). The mean hospitalization time was 16.5±3.3 days (ranges 8-28). No operative complication was observed during the hospitalization. Conclusions: The anatomical boundary of mesogastrium is well described and dissected within D2+CME surgical process. It proves to be safely feasible and repeatable with less blood lost, qualified lymph nodes, retrieval results, and other improved short-term surgical outcomes in advanced gastric cancer. Meanwhile, potential disseminated cancer cells fall into the mesogastrium can be eradicated by D2+CME. Clinical trial information: NCT01978444.

Appendectomy Performed Routinely in the Laparoscopic Treatment of Endometriosis

INTRODUCTION: Our aim was to evaluate the relevance of performing concomitant appendectomy for patients undergoing laparoscopic surgical treatment of endometriosis by assessment of appendiceal pathology. METHODS: Laparoscopic appendectomy was performed on 79 sequential women undergoing laparoscopic treatment of endometriosis between January 2011 and December 2013. The same surgeon performed all appendectomies. Patients undergoing excision and treatment of endometriosis received simultaneous appendectomy at the time of laparoscopic surgery as part of a comprehensive management of endometriosis. All appendectomies were performed using the Altrus thermal device (ConMed). RESULTS: Abnormal pathology of the appendix included fibrosis, fecalith, follicular lymphoid hyperplasia and fecal impaction in addition to the diagnoses designated as significant pathology. Significant pathology was defined as endometriosis, acute focal inflammation, early acute appendicitis or carcinoid tumor. 38/79 (48.1%) of patients had abnormal pathology and 11/79 (13.9%) demonstrated significant pathology. Average age for patients with normal pathology was 34.8 years and for patients with abnormal pathology the average age was 35.02 years. In this cohort, there were no surgical complications related to appendectomy. 3/79 (3.8%) of patients had a complication of surgery related to the extent of endometriosis. CONCLUSION: Pathology of the appendix is seen in a surprisingly high proportion of patients with surgically diagnosed endometriosis. Patients should be counseled that appendectomy performed at the time of laparoscopic surgical treatment of endometriosis may concomitantly treat benign or significant pathology of the appendix and should be considered as an important component of management.

Impact of Minimally Invasive Gynecologic Surgery Fellowship Training on Concomitant Levonorgestrel-Releasing Intrauterine Device Placement at the Time of Laparoscopic Surgery

Impact of Minimally Invasive Gynecologic Surgery Fellowship Training on Concomitant Levonorgestrel-Releasing Intrauterine Device Placement at the Time of Laparoscopic Surgery

How does visceral obesity affect surgical performance in laparoscopic radical nephrectomy?

In a previous study, we described the relationship between operating time and obesity, particularly visceral obesity, in laparoscopic surgery. Operating time in laparoscopic surgery is affected by the experience and technique of the surgeon. Here, we investigated whether a difference in the surgeon's experience affects the operating time for laparoscopic radical nephrectomy in patients with visceral obesity. From January 2006 to February 2012, 167 laparoscopic radical nephrectomies were performed at our institution. Visceral fat area was measured at the level of the umbilicus using computed tomography. A visceral fat area ≥ 100 cm(2) was used as the definition of visceral obesity. All laparoscopic radical nephrectomies were performed by six surgeons. Two of the six surgeons perform 50 cases or more laparoscopic surgeries every year and they were defined as the expert group. We analyzed the relationships between clinical findings, methods, surgeon experience, body mass index or visceral fat area and operating time. The expert and non-expert surgeons performed 77 and 90 laparoscopic radical nephrectomies, respectively, and the median operating time was 167.0 ± 44.0 and 227.5 ± 60.6 min. Twenty-five patients underwent laparoendoscopic single-site nephrectomy by the expert surgeons. For all surgeons, visceral obesity was a significant factor for prolonged operating time. Multivariate analysis showed that visceral obesity and clinical T stage were independent risk factors for prolonged operating time for the non-expert surgeons [P = 0.004, hazard ratio (HR): 5.15, P = 0.037, HR:10.41]. However, for the expert surgeons, clinical T stage was the only independent risk factor for prolonged operating time (P = 0.039, HR: 4.33). Visceral obesity was a factor of prolonged operating time in laparoscopic radical nephrectomy. The non-expert surgeons were particularly affected by visceral obesity.

A Case of Traumatic Abdominal Wall Hernia Overlooked at the Time of Laparoscopic Surgery

A Case of Traumatic Abdominal Wall Hernia Overlooked at the Time of Laparoscopic Surgery

Application of laparoscopy in the diagnosis and treatment of neonates and infants with congenital intestinal atresia and stenosis

To investigate the feasibility and efficacy of laparoscopic procedure in the diagnosis and treatment of congenital intestinal atresia and stenosis in neonates and infants. Between September 2009 and September 2013, 55 cases with intestinal atresia and stenosis underwent laparoscope-assisted procedures in our department. There were, 32 males and 23 females, Twelve cases were diagnosed as duodenal atresia and stenosis and 43 as intestinal atresia and stenosis. The age at hospitalization was 7 minutes to 7 months(mean 9.88 d). After the diagnosis by multiport or transumbilical single-site laparoscopic exploration, cases with duodenal atresia and stenosis and part of the cases with proximal jejunum were treated by laparoscopic operations to remove the septum and restore intestinal continuity. In other cases with intestinal atresia and stenosis, laparoscopic inspection was performed to make diagnosis and then the proximal and distal ends of the atresia were exteriorized through the umbilical port site for end-to-oblique anastomosis. All the 55 cases underwent this minimally invasive approach, and no case was converted to open surgery. The operative time of laparoscopic procedure for duodenal atresia and stenosis (n=12) ranged from 80 to 145 min(mean, 110 min). During the follow-up of 3-34 months, one case had recurrent postoperative vomiting induced by giant duodenal expansion above anastomotic stoma and died the second day after operation. The operative time of laparoscopic surgery for intestinal atresia and stenosis (n=43) ranged from 35 to 70 min (mean 46 min). During the follow-up of 3-36 months, 3 cases complicated with meconium peritonitis had postoperative short bowel syndrome and died. One case died of intestinal perforation at 3 month postoperatively. One case died of intestinal adhesion at 7 month postoperatively. The rest of cases had favorable outcomes. Laparoscopic surgery for the diagnosis and treatment of intestinal atresia and stenosis has advantages of small incision, less trauma, and rapid recovery.

Paratubal cancer found at the time of laparoscopic surgery for adnexal torsion: a case report and literature review.

Paratubal cysts are common incidental finding, but malignant paratubal cancers have rare occurrence and have not been sufficiently described and discussed in previous studies. This report describes a case of a 70-year-old female who underwent emergent laparoscopy for adnexal torsion. A serous cystadenocarcinoma arising in a paratubal cyst and accompanied by tubal torsion was revealed by frozen section and successfully treated with laparoscopic cytoreductive surgery and adjuvant chemotherapy. This report is the first case of paratubal cancer with bilateral tubal torsion which was diagnosed and treated with laparoscopic surgery, and the third report describing serous cystadenocarcinoma arising in a paratubal cyst. In the laparoscopic surgery for the paratubal cyst clinically presumed as accompanied with tubal torsion, surgeons should not ignore the possibility of malignancy in spite of the rare incidence of paratubal cancers and the preconception that adnexal malignancies are seldom accompanied by tubal torsion.

Integrating a novel shape memory polymer into surgical meshes decreases placement time in laparoscopic surgery: An in vitro and acute in vivo study

About 600,000 hernia repair surgeries are performed each year; recently, the use of laparoscopic minimally invasive techniques has become increasingly popular in these operations. Use of surgical mesh in hernia repair has shown lower recurrence rates compared to other repair methods. However in many procedures, placement of surgical mesh can be challenging and even complicate the procedure, potentially leading to lengthy operating times. Various techniques have been attempted to improve mesh placement, including use of specialized systems to orient the mesh into a specific shape, with limited success and acceptance. In this study, a programmed novel Shape Memory Polymer (SMP) was integrated into commercially available polyester surgical meshes to add automatic unrolling and tissue conforming functionalities, while preserving the intrinsic structural properties of the original surgical mesh. Tensile testing and Dynamic Mechanical Analysis was performed on four different SMP formulas to identify appropriate mechanical properties for surgical mesh integration. In vitro testing involved monitoring the time required for a modified surgical mesh to deploy in a 37°C water bath. An acute porcine model was used to test the in vivo unrolling of SMP integrated surgical meshes. The SMP-integrated surgical meshes produced an automated, temperature activated, controlled deployment of surgical mesh on the order of several seconds, via laparoscopy in the animal model. Results indicate surgical mesh modified with SMP is capable of laparoscopic deployment in vivo, activated by body temperature. This suggests a reduction in surgical operating time and improved mesh placement characteristics is possible with SMP-integrated surgical meshes.