Transumbilical Incision Research Articles

Laparoendoscopic single-site adnexal surgery: Preliminary Indian experience.

INTRODUCTION:Laparoendoscopic single-site surgery (LESS) is an emerging technique in gynaecology. The proposed advantages of the LESS include better cosmesis and reduction in pain. We report our preliminary experience with LESS in the treatment of adnexal pathology.MATERIALS AND METHODS:After a preoperative workup, LESS was offered to 37 patients between July 2009 and April 2015. All the procedures were carried out through a 2–2.5 cm transumbilical incision using conventional laparoscopic instruments. A single-incision, multiport (SIMP) approach (utilising one 7 mm and two 5 mm ports) was used in 27 patients and a homemade glove port (HMGP) was utilised in ten patients. All the specimens were extracted after placement in a plastic bag or inside the glove port avoiding contact with the wound. Umbilical fascial incisions were meticulously closed with non-absorbable sutures.RESULTS:Two patients with a history of previous abdominal surgery required omental adhesiolysis. Seventeen patients with breast cancer underwent bilateral salpingo-oophorectomy, ten had ovarian cystectomy (6 had cystadenoma, 2 had endometriotic cysts and 2 had dermoid cyst), six had excision of paraovarian cysts (one along with partial salpingectomy) and four with ruptured ectopic pregnancy underwent salpingectomy. LESS was completed in all but one patient, who required insertion of an additional 5 mm port. There were no intra- or post-operative complications.CONCLUSIONS:Our experience confirms the feasibility and safety of LESS in a variety of benign adnexal pathology. Both the SIMP and HMGP approaches seem comparable. Performing LESS without the use of specialised access ports or instruments makes it cost effective and suitable for wider application.

Comparison of transumbilical multiport and standard laparoscopic pyeloplasty in children: Mid-term results at a single center

ObjectiveTo compare the efficacy of transumbilical multiport (TMLP) and standard laparoscopic pyeloplasty (SLP) for the treatment of congenital ureteropelvic junction obstruction in children. MethodsForty-eight patients were included in this matched-pair study. The TMLP applied three transumbilical incisions for one 5-mm and two 3-mm ports, whereas SLP was undertaken with traditional three-port technique. The demographic, perioperative, and follow-up data were retrospectively compared between TMLP (n=24) and SLP (n=24) groups. ResultsTwo groups were matched according to patient's age, gender, laterality, weight, and surgical indication. TMLP and SLP were successfully performed in all patients, without conversion to open procedure. There was no significant difference between both groups in intraoperative blood loss, time to oral feeding, time to normal activities, pain scores, or complication rates. Longer mean operative time (125.4±21.6 vs. 112.2±25.2 min; P=0.012) and better patient satisfaction (30.4±4.5 vs. 24.6±3.4; P=0.026) were noted in TMLP group than those in SLP group. Mid-term follow-up indicated no significant difference in postoperative alleviation of hydronephrosis or improvement of renal function. ConclusionTMLP is a feasible and efficient procedure for the management of congenital ureteropelvic junction obstruction in children, with comparative outcome and better cosmetic results than SLP.

Feasibility of Single-Incision Laparoscopic Percutaneous Extraperitoneal Closure for Inguinal Hernia by Inexperienced Pediatric Surgeons: Single-Incision Versus Multi-Incision Randomized Trial for 2 Years

This study evaluated the stability and risk of single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) for pediatric inguinal hernia performed by inexperienced pediatric surgeons versus conventional LPEC procedure. Between 2011 and 2012, a randomized prospective study was performed comparing SILPEC (n = 37, 16 uni- and 21 bilateral patent processus vaginalis [PPV]) to LPEC (n = 72, 39 uni- and 33 bilateral PPV). The procedures were performed in girls with inguinal hernia by inexperienced pediatric surgeons with the assistance of an expert pediatric surgeon. In SILPEC, a laparoscope was placed through a transumbilical incision. A 2-mm trocar for the grasper was inserted through the same incision and introduced into the extraperitoneal cavity. The tip of the trocar was inserted in the abdominal cavity distant from the umbilical incision by the expert surgeon to avoid any complications caused by the in-line view. Using a special needle, the hernial sac was closed extraperitoneally by the inexperienced surgeon. A statistical survey of the mean age at operation, mean operative time, intra- and postoperative complications, and recurrence in the SILPEC and LPEC groups was performed. There were no significant differences in the mean age or operative time. There were fewer total number of postoperative complications in the SILPEC group compared with the LPEC group (P = .0707). No intraoperative complications or recurrence occurred. Considering the risks and need to improve endoscopic surgical skills with useful instruments specialized for SILPEC, inexperienced surgeons can successfully perform SILPEC safely under expert pediatric surgeons.

Single-Incision Laparoscopic-Assisted Anorectoplasty for the Management of Persistent Cloaca.

This study aimed to evaluate the safety and efficacy of single-incision laparoscopic-assisted anorectoplasty (SILAARP) for children with persistent cloaca. Five patients with persistent cloaca underwent SILAARP and repair of the urogenital sinus between June 2014 and February 2015. The mean age of the patients at the time of operation was 0.80 ± 0.16 year (range, 0.6-1.0 year). An extralong 5-mm 30° laparoscope was inserted through the 5-mm middle port. Two 3-mm lateral ports were placed for instruments. The three ports were placed at a horizontal line through a 2-cm transumbilical incision. CO2 pressure was maintained between 8 and 12 mm Hg. The patients were evaluated for fecal continence and complications. SILAARP and repair of the urogenital sinus were successfully performed in all patients. The mean operation time ranged from 120 minutes to 130 minutes. The operative blood loss was minimal. There were no operative complications. All patients were followed up for 0.64 ± 0.29 year (range, 0.3-1.0 year). No patient developed fecal incontinence. Two of the 5 patients (40%) had two to four stools per days, but this did not cause social problems. Only 1 patient (20%) had constipation and required changes in diet. No wound infection, port-site hernia, urethrovaginal fistula, acquired anorectal atresia, or urethral injury occurred. Our results show that SILAARP is an effective and safe option for patients with persistent cloaca.

Does Transumbilical Incision Influence Surgical Site Infection Rates of the Laparoscopic Sigmoidectomy and Anterior Resection?

Laparoscopic surgery is widespread and is safe and effective for the management of patients with colorectal cancer. However, surgical site infection (SSI) remains an unresolved complication. The present study investigated the comparative effect of supraumbilical incision versus transumbilical incision (TU) on the incidence of SSI in patients undergoing laparoscopic surgery for colon cancer. Medical records from patients with colorectal cancer who underwent laparoscopic sigmoid and rectosigmoid colon surgeries with either supraumbilical incision (n = 150) or TU (n = 150) were retrospectively reviewed. There was no difference in demographics, comorbidities, or operative variables between the two groups. The transumbilical group and the supraumbilical group were comparable with regards to overall SSI (6.0% vs 4.0%; P = 0.4062), superficial SSI (6.0% vs 3.3%; P = 0.2704), and deep SSI (0% vs 0.7%; P = 0.2385). SSI developed after laparoscopic sigmoid and rectosigmoid colon cancer surgery in 15 (5.0%) of the 300 patients. Of these superficial SSI, all wounds were in the left lower quadrant incision, and the transumbilical port sites did not become infected. Univariate analysis failed to identify any risk factors for SSI. Avoidance of the umbilicus offers no benefit with regard to SSI compared with TU.

Minilaparoendoscopic Single-site Pyeloplasty: The Best Compromise Between Surgeon's Ergonomy and Patient's Cosmesis (IDEAL Phase 2a)

BackgroundLaparoendoscopic single-site (LESS) surgery and minilaparoscopy (ML) represent the evolution of laparoscopy for the treatment of urologic diseases. ObjectiveTo describe the technique and report the surgical outcomes of minilaparoendoscopic single-site dismembered pyeloplasty (MILESS-DP), a new technique overcoming the technical limitations of LESS and ML, and equally combining the advantages of both these surgical procedures. Design, setting, and participantsTwenty consecutive patients underwent MILESS-DP for ureteropelvic junction obstruction. Surgical procedureThe SILS port was inserted through a transumbilical incision and two 3-mm trocars were inserted in the ipsilateral midclavicular line. The sequence of steps of MILESS-DP is comparable to standard laparoscopic dismembered pyeloplasty. MeasurementsThe end points of this study were: (1) feasibility; (2) safety; (3) efficacy; and (4) cosmesis, evaluated using a body image questionnaire. Results and limitationsAll patients were symptomatic (100%) and three (15%) had concomitant kidney stones. (1) Feasibility: a conversion to either standard laparoscopic technique or open technique did not occur in any case. Median operative time was 147.3min (interquartile range [IQR]: 110–195min); (2) safety: no intraoperative complications were reported. Only in two patients (10%), a urinoma was postoperatively identified and conservatively treated with an ureteral stent. The median difference in post- and preoperative creatinine and haemoglobin was +0.55mg/dl and -0.76mg/dl (IQR: -0.20/-1.20mg/dl); (3) efficacy: the median postoperative hospital stay was 4.4 d (IQR: 4–9 d). The overall success rate was 95% at the follow-up; (4) cosmesis: all patients were enthusiastic with the appearance of the scars; the median body image score and the median cosmesis score were 19.95 (IQR 19–20) and 23.95 (IQR 23–24), respectively. The limitations of this study are the limited series and short follow-up. ConclusionsOur phase 2a studies demonstrate that MILESS-DP is a safe and reproducible procedure with excellent cosmetic outcomes and short-term clinical outcomes in the hands of a surgical team with experience in laparoscopy. Patient summaryMinilaparoscopy using 3-mm instruments and laparoendoscopic single-site using a single abdominal incision, still present several technical drawbacks which limit their reproducibility in urology. In order to overcome these technical limitations and equally combining the advantages of both these surgical procedures, we ideated a hybrid technique which we defined minilaparoendoscopic single-site. This study aims to demonstrate that minilaparoendoscopic single-site pyeloplasty is a safe and reproducible procedure with excellent cosmetic outcomes and short-term clinical outcomes in the hands of a surgical team with experience in mini-invasive surgery.

Novel approach of single-port laparoscopic appendectomy as a solo surgery: A prospective cohort study

BackgroundRecent advances in medical equipment and surgical techniques have enabled solo surgery, wherein a surgeon operates alone without the participation of other surgical members. However, the application of solo surgery in single-port laparoscopic surgery (SPLS) has been rarely reported. MethodsProspectively collected databases of 60 patients who underwent solo-SPLS for appendicitis between March 2013 and June 2014 were retrospectively reviewed. Making a transumbilical incision into the peritoneal cavity was facilitated by using a Lone Star self-retaining retractor. After the establishment of a single port through the umbilicus, we installed a mechanical adjustable camera holder (Endoworld®LAP53 Holding Systems). It was anchored to the operating table rail and firmly held the laparoscope with a possibility to adjust the same as required by the operator. The operative method was identical to the SPLS appendectomy, except for the use of these instruments. ResultsThe median operation time was 50 min (25–120). None of the patients required open conversion, insertion of an additional port or help of a human assistant. The median length of hospital stay for all patients was 1.0 day (range: 1–3 days). The median dosage of required intravenous analgesics (ketorolac, 0.1 mg/kg of body weight) was 0.0 ampoule (0–4). The median interval to initiation of solid diet was 1 day (1–2). The incidence of postoperative complications was 8.3% (5/60). ConclusionsOur results shows that solo-SPLS appendectomy could be performed without increasing operation time or postoperative complications when performed by a surgeon competent in performing SPLS appendectomy.

Minilaparoscopic cholecystectomy - the new non-visible scars technique. Preliminary report of first series.

IntroductionSurgery without scars is the dream of many patients and surgeons as well. It includes many new laparoscopic techniques (LESS, SILS, hybrid NOTES), but data concerning common bile duct (CBD) lesions are unavailable.AimTo establish the new technique of minilaparoscopic cholecystectomy (MCh): non-visible scar intervention without increasing the risk of CBD lesions.Material and methodsForty consecutive patients with symptomatic gallbladder lithiasis were qualified for elective laparoscopic cholecystectomy (LCh) using one 10/11 mm umbilical port, one 5 mm right suprapubic port and two minilaparoscopic, disposable, no-port graspers. There were 26 women and 14 men, with the mean age 56 (17–72) years and with the average body mass index 28 (18–33) kg/m2. CO2 Veress 15 mm Hg pneumoperitoneum was performed after transumbilical incision, and the first 10/11 mm port was inserted at the beginning for the 5 mm laparoscope and finally for typical instruments. Next under camera control, a 5 mm trocar was inserted in the right ‘bikini line’. To this port the laparoscope was relocated from the umbilicus, and under its control two minilaparoscopic, disposable, non-port graspers were introduced after small, 2 mm skin incisions in the right anterior axillary line and in the right mesogastrium to catch the gallbladder. Next through the umbilical port, using typical instruments, the cystic duct and artery were dissected, clipped and cut. The gallbladder was removed through the umbilical port whole.ResultsThere was no conversion to open cholecystectomy. In 5 cases drainage of the gallbladder lodge was necessary through a 5 mm port in the right bikini line. The time of the intervention ranged from 90 min during the introduction of the new method to 50 min for the last procedures. No postoperative complications were observed, and all patients were discharged at the same time as after conventional LCh.ConclusionsTwo-port laparoscopic cholecystectomy performed with two minilaparoscopic no-port graspers does not increase the risk of CBD lesions. It provides an excellent cosmetic effect and is very convenient for the surgeon like typical LCh.

Transumbilical versus circumumbilical abdominal incision: a case control study

Objective To compare the clinical efficacy of transumbilical and circumumbilical abdominal incision in the abdominal surgery. Methods The clinical data of 71 patients who underwent open surgery at the Beijing Tiantan Hospital from May 2011 to April 2013 were retrospectively analyzed. All the patients were divided into the transumbilical group ( n =41) and circumumbilical group ( n =30) according to the selection of incisions. The intraoperative conditions of patients and incisionrelated complications between the 2 groups were analyzed. Patients were followed up by outpatient examination and reexamination till December 2013. The measurement data with normal distribution were presented as±s and analyzed using t test, and the count data were analyzed using the chi-square test or Fisher exact probability. Results The type Ⅱ and type Ⅲ incisions were used in 38 and 3 patients in the transumbilical group and 28 and 2 patients in the circumumbilical group, respectively, showing no significant difference between the 2 groups ( P>0. 05) . The operation time and volume of intraoperative blood loss in the transumbilical group and in the circumumbilical group were (186 ± 43) minutes, (255 ± 152) mL and (196 ± 55 ) minutes, (326 ± 172 ) mL, respectively, with no significant difference between the 2 groups ( t=–0. 807, –1. 799 , P >0. 05) . The length of incision in the transumbilical group was (14.3 ± 4.3) cm, which was significantly different from (17.3 ± 2.9) cm in the circumumbilical group ( t=–3. 288, P 0. 05) . All the 71 patients were followed up for 8–26 months , with a median time of 15 months. The surgical wounds between the 2 groups healed well. The abdominal incisions in the transumbilical group were in a straight-line shape, without occurrence of other complications. Conclusion Transumbilical incision compared with circumumbilical incision in abdominal operations has a shorter length, without increasing incision-related complications and with cosmetic benefits. Key words: Wound complications; Abdominal midline incision; Umbilicus incision; Umbilicus

Laparoscopic Distal Pancreatectomy Using Single-Port Platform: Technique, Safety, and Feasibility in a Clinical Case Series

A novel technique using a single-incision laparoscopic approach has been described for several laparoscopic procedures. The aim of this article is to describe our experience with an alternative technique for laparoscopic distal pancreatectomies using a single-port platform. We have performed this procedure on 20 patients with pancreatic tumors in the pancreatic body or tail. A transumbilical incision is performed, and a single-incision platform is introduced. The stomach is sutured to the abdominal wall to expose the pancreas. This technique uses an additional 5-mm trocar in the left quadrant, ultimately used for drainage after the end of the procedure. The median operative time was 176 minutes, and the hospital stay was 2 days. Mortality was 0%, and morbidity was 20%; 4 patients developed grade A pancreatic fistula. During follow-up (median, 11 months), no patient developed an incisional hernia. The cosmetic appearance of the incision was excellent in all cases. Laparoscopic distal pancreatectomy using a single-port platform is feasible and can be successfully performed by surgeons with experience in pancreatic and advanced laparoscopic surgery.

Hemodynamic and inflammatory responses following transumbilical and transthoracic lung wedge resection in a live canine model

BackgroundSingle-port transumbilical surgery is a well-established platform for minimally invasive abdominal surgery. The aim of this study was to compare the hemodynamics and inflammatory response of a novel transumbilical technique with that of a conventional transthoracic technique in thoracic exploration and lung resection in a canine model. MethodsSixteen dogs were randomly assigned to undergo transumbilical thoracoscopy (n = 8) or standard thoracoscopy (n = 8). Animals in the umbilical group received lung resection via a 3-cm transumbilical incision in combination with a 2.5-cm transdiaphragmatic incision. Animals in the standard thoracoscopy group underwent lung resection via a 3-cm thoracic incision. Hemodynamic parameters (e.g., mean arterial pressure, heart rate, cardiac index, systemic vascular resistance, and global end-diastolic volume index) and inflammatory parameters (e.g., neutrophil count, neutrophil 2′,7′ -dichlorohydrofluorescein [DCFH] expression, monocyte count, monocyte inducible nitric oxide synthase expression, total lymphocyte count, CD4+ and CD8+ lymphocyte counts, the CD4+/CD8+ratio, plasma Creactive protein level, interleukin-6 level) were evaluated before surgery, during the operation, and on postoperative days 1, 3, 7, and 14. ResultsLung resections were successfully performed in all 16 animals. There were 2 surgery-related mortality complications (1 animal in each group). In the transumbilical group, 1 death was caused by early extubation before the animal fully recovered from the anesthesia. In the thoracoscopic group, 1 death was caused by respiratory distress and the complication of sepsis at 5 days after surgery. There was no significant difference between the two techniques with regard to the hemodynamic and immunologic impact of the surgeries. ConclusionThis study suggests that the hemodynamic and inflammatory changes with endoscopic lung resection performed by the transumbilical approach are comparable to those after using the conventional transthoracic approach. This information is novel and relevant for surgeons interested in developing new surgical techniques in minimally invasive surgery.

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.

Unaided Stapling Technique for Pure Single-Incision Distal Gastrectomy in Early Gastric Cancer: Unaided Delta-Shaped Anastomosis and Uncut Roux-en-Y Anastomosis.

PurposeIntracorporeal anastomosis is the most difficult procedure during pure single-incision distal gastrectomy (SIDG) that affects its generalization. We introduced unaided delta-shaped anastomosis (uDelta), a novel anastomosis technique, for gastroduodenostomy after pure SIDG, and compared the results with those of previously reported Roux-en-Y anastomosis (RY).Materials and MethodsBetween March 2014 and March 2015, SIDG with D1+ lymph node dissection was performed for early gastric cancer through a 2.5-cm transumbilical incision without any additional port. uDelta was performed by the operator alone, without any intracorporeal assistance.ResultsuDelta was performed on 11 patents, and uncut RY was performed on 5-patients without open or multiport conversion. R0 resection was performed in all cases. No significant differences were observed in mean age and body mass index between patients who underwent uDelta or RY. Mean operation times were 214.5±36.2 minutes for uDelta and 240.8±65.9 minutes for RY, which was not significantly different. Reconstruction time for uDelta was shorter than that for RY, with marginal statistical significance (26.1±8.3 minutes vs. 38.0±9.1 minutes, P=0.05). There were no intraoperative transfusions, 30-day mortality, or anastomosis-related complications in either group. Average length of hospital stay was 8.2±1.9 days in the uDelta group and 7.2±0.8 days in the RY group (P=0.320).ConclusionsAfter carefully considering indications, uDelta can be a feasible and can be a reproducible reconstruction method after SIDG in early gastric cancer.

Laparoendoscopic Single-Site Combined Hysterectomy and Nephrectomy in Deep Infiltrating Endometriosis

Within the advance ports and instruments, laparoendoscopic single-site (LESS) surgery has been increasingly used among gynaecologic surgeons. In addition, advanced port systems have enabled to perform concomitant surgical procedures via transumbilical incision. However, combined surgical operations are rarely reported in the literature, particularly in gynaecology. This case report presents a 42-year-old woman who undergo concomitant LESS hysterectomy and nephrectomy due to deep infiltrating endometriosis (DIE) and end stage renal disease. The operation is performed in approximately 3 hours without any complications, and the patient is discharged on postoperative third day. This case demonstrates that complex concomitant operations even in a patient with DIE can be performed using a LESS surgical approach.

Dešiniosios hemikolektomijos vieno pjūvio laparoskopinė operacija: dviejų atvejų aprašymas

Vieno pjūvio chirurginės procedūros vystosi kaip minimaliai invazinės chirurgijos dalis. Dešinioji hemikolektomija, atlikta SILS būdu, pirmą kartą aprašyta 2008 metais. Mes aprašome pirmąsias dvi laparoskopines transumbilikalines vieno pjūvio dešiniąsias hemikolektomijas, atliktas Vilniaus universiteto ligoninėje Santariškių klinikos.

Surgical removal of multiple mesenteric fibroids (Kg 4,500) by abdominal spread of previous laparoscopic uterine myomectomy

Huge and multiple mesenteric fibroids (4,500 Kg weight) are very unusual. In many cases they are mistaken for subserosal fibroids of the womb due to the proximity with uterine walls. When they have a rapid growth, the risk of becoming malignant (sarcoma) has not to be underestimated. Surgery is challenging to remove abdominal nodes.A case of a 40-year old woman, admitted to the hospital with abdominal masses occupying the entire cavity was reported. Both computerized tomography (CT) and ultrasounds (US) were not diriment for belonging of tumours. Clinical history of patient reports a laparoscopic removal of uterine fibroids, using the morcellator. Laparoscopy was performed four years before. Open surgery by means of a large transversal suprapubic laparotomy according to Pfannestiel was carried out. Multiple and huge mesenteric, peritoneal and intestinal tumours spread in the whole abdominal cavity were found, removed and examined by frozen section histology; in addition a series of small conglomerated myomas in the site of previous laparoscopic transumbilical route was taken away as well (the largest fibroid weighed Kg 3.500 and the all tumors removed 4,500 Kg); the result was benign (fibroids) and genital apparatus was preserved. Operation was challenging. Postoperative course was uneventful; after five days patient was discharged.This case is very interesting for many factors: A) many extra-uterine fibroids spread throughout abdominal cavity; B) considerable weight of the masses C) intraoperative and postoperative danger. Finally, due to involvement of previous laparoscopic transumbilical incision together with other findings, the hypothesis of post laparoscopic dissemination has to be considered. A case of so large extragenital abdominal fibroids following laparoscopic uterine myomectomy has never been published so far.

Single incision laparoscopic TAPP with standard laparoscopic instruments and suturing of flaps: A continuing study.

BACKGROUND:Single incision laparoscopic surgery, especially transumbilical, should be the closest to replicate the minimal access results achieved by natural orifice endoscopic surgery (NOTES). This study of single incision transabdominal preperitoneal (SITAPP) inguinal hernia repair is a continuing study exploring the peroperative variables and short and long term complications of this procedure.PATIENTS AND METHODS:All the 183 patients were operated by the same surgeon through a horizontal transumbilical incision positioned across the lower third of the umbilicus. Port access was through three separate transfacial punctures. Routine rigid instruments were used and the peritoneal flaps were either tacked or sutured into place. Patients with irreducible hernia and obstructed hernia were included, while those with strangulated hernia were excluded.RESULTS:All the patients were male with an average age of 41.4 years. Twenty four patients had bilateral hernia, 15 patients had irreducible and 6 patients had obstructed hernia. The mean operating time was 38.3 mins for unilateral hernias completed with tackers and 42.8 mins in those with intracorporeal suturing. The corresponding operating time for bilateral hernias was 53.2 and 62.7 minutes. There was minimal serous discharge from the umbilicus in 8 patients, port site infection in 1 patient and recurrence in 2 patients over a 36 months period.CONCLUSIONS:SITAPP for groin hernias, performed with conventional instruments is feasible, easy to learn, has a very high patient acceptance and is cosmetically superior to conventional TAPP. The use of tackers reduces the operating time significantly.

A new paradigm of scarless abdominal surgery in children: Transumbilical minimal incision surgery

PurposeThis study aimed to evaluate the use of a transumbilical incision for infants and children, as well as neonates, with various intraabdominal conditions. MethodsA retrospective study of transumbilical incision surgery was performed between June 2007 and June 2013. Patients were divided into two groups: group 1 of neonates and group 2 of infants and children. All operations were performed via an upper circumumbilical incision. ResultsThirty-six patients (22 males, 14 females) were treated via a transumbilical incision, with 20 patients in group 1 and 16 patients in group 2. A transverse incision extension was needed for 1 case in group 1 (intestinal atresia complicated by meconium peritonitis) and 4 cases in group 2 (two with ileus owing to adhesive bands, 1 with malrotation, 1with ectopic pancreatic tissue in the duodenum). In cases with a dilated intestinal wall or intraabdominal adhesions, an optional extension of the transverse incision might be required. Only 1 case with ileus in group 2 developed a wound infection that was treated by drainage. The postoperative cosmetic results were acceptable in all cases. ConclusionThe transumbilical incision yielded a sufficiently large surgical field, and the surgical condition was easily and directly viewed. In all 36 cases, an adequate operation was safely performed. This approach is a safe and effective method for various intraabdominal disorders in not only neonates but also infants and children, and leads to an imperceptible incision.

Transumbilical single-incision laparoscopic sleeve gastrectomy.

Sleeve gastrectomy has become an established primary bariatric surgical technique. Its relatively lower complexity has made it eligible to be performed by single-incision laparoscopy (single-incision laparoscopic sleeve gastrectomy, SILSG). The aim of this paper is to present our SILSG technique and surgical outcomes and demonstrate that SILSG is a safe and feasible procedure using conventional laparoscopic instruments. All patients who underwent SILSG since December 2012 in our institution were analyzed. The operative technique involved creation of a transumbilical incision and the introduction of a GelPoint device with four trocars. Rigid instruments were used in all patients. Gastric transection was performed 4 cm proximal to the pylorus and calibrated with a 36-Fr bougie. Hemostasis of the staple line was achieved with metallic clips. A total of 74 patients underwent SILSG. Their mean age and body mass index were 34.2 ± 9.2 years and 34.0 ± 3.2 kg/m(2) (range 30.0-42.7 kg/m(2)), respectively. The mean operative time was 48 ± 10 min. No reoperations or deaths occurred. One patient developed portal vein thrombosis. The mean length of hospital stay was 2.4 ± 2.0 days. The cosmetic result was satisfactory in all patients. SILSG is a safe and feasible procedure when performed with the technique described herein. This technique allows for the use of conventional laparoscopic instruments and reasonable operative times. The main benefit of the procedure is an excellent cosmetic result with virtually no visible scars.

Does transumbilical incision increase incisional hernia at the extraction site of laparoscopic anterior resection?

BackgroundIt is unclear whether transumbilical incision for laparoscopic colectomy has a risk of incisional hernia at the extraction site similar to left lower incision. MethodsConsecutive patients who underwent laparoscopic sigmoid plus high and low anterior resection between August 2008 and February 2011 were included in the study. Incision for specimen extraction was changed from left lower to transumbilical incision in February 2010. The main outcome was the incidence of incisional hernia diagnosed by computed tomography. ResultsOne hundred and eighty-six patients underwent laparoscopic anterior resection (94 transumbilical incisions and 92 left lower transverse incisions). Three percent of patients had an incisional hernia at the extraction site, and the incidence of this phenomenon was not significantly different between the 2 groups. Surgical wound infection was lower in the transumbilical incision group than in the left lower incision group. ConclusionsExtraction site for transumbilical incision may not affect the risk of incisional hernia.