Abstract:

Minimally invasive techniques have revolutionized the art of surgical practice. The laparoscopic approach to cholecystectomy has become the gold standard and is the most common laparoscopic general surgery procedure worldwide. In an effort to further enhance the advantages of laparoscopic surgery even less-invasive methods have been attempted, including smaller and fewer incisions. The objective of this study was to describe our results with over 15 years of needlescopic cholecystectomies. At the Texas Endosurgery Institute, 434 operations were done by a single surgeon from 1995 to 2010. Eighty-six percent of subjects were female, and the average age of all subjects was 41.9 years (range 14-82). The average operating time was 59.3 minutes (range 30-200). The 200-minute operation required laparoscopic CBD exploration, accounting for the extended time. Average estimated intraoperative blood loss (EBL) was <15 cc (range 0-50 cc). Two percent of cases required conversion to standard 5-mm cholecystectomy and were completed without incident. All patients are followed up at two weeks and then at six months. Since 1995, only one patient presented with a hernia at the umbilical site. Otherwise, no wound, bile duct, bile leak, bleeding, or thermal injury complications have been identified.

Authors:

Morris E. Franklin, Jr., MD, FACS, Jojy George, MD, Karla Russek, MD

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Abstract:

These days the treatment of rectal cancer remains an encounter for various medical disciplines. A key position in the whole concept of therapy is still taken by surgery itself. To facilitate the advantages of the total mesorectal excision (TME) we used the water-jet dissector (WJD) in our surgical routine. Our object was to analyze perioperative data as well as oncological long-term results following WJD-assisted rectal resection. Materials and Methods A total of 226 patients underwent surgery for rectal cancer in our center between October 2001 and June 2009. A retrospective review was performed of all WJD-assisted rectal resections during this time. One hundred and five patients with adenocarcinoma of the lower and middle rectum were operated on by 7 surgeons according to the concept of TME. Seventy-six patients underwent a low anterior resection, 29 patients an abdominoperineal resection. Twenty-eight patients received preoperative radiochemotherapy. The median follow-up period amounted to 35 (2-96) months. Survival rates were calculated using the Kaplan-Meier method. Results Anastomotic leakage occurred in 5.7%, wound healing disturbance (including perineal wound infections) in 29.5%, intra-abdominal infections in 7.6% and urinary tract infections in 7.6%. Postoperative bladder dysfunction (requiring catheterization) occurred in 1.9%. Postoperative 30-day mortality was 0%, 60-day mortality 1%. The rate of local recurrence (including three patients who refused postoperative radiochemotherapy) was 8.5%. Cancer-specific survival at 5 years was 74% and differed significantly by stage. Conclusions The particular advance of the WJD is the facile development of the embryological plane between the mesorectal fascia and the surrounding pelvic nerves. Without harming one of them, maximum radicality and excellent autonomic nerve preservation can be achieved. The WJD is a technique with acceptable postoperative morbidity and low mortality. Local control and survival are comparable to other surgical centers in international literature.

Authors:

Aristotelis Touloumtzidis, MD, Petra Kühn, MD, Peter E. Goretzki, MD, Bernhard J. Lammers, MD

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Abstract:

To examine the relationship between the umbilicus, major abdominal vessels, and transverse colon in males with differing body habitus, we conducted a prospective study including 91 male patients who underwent computerized tomography scan examinations. Of 91 males, 40 were normal weight, 27 overweight, and 24 obese. Compared with males of normal weight, the distance between the umbilicus and peritoneum was significantly greater in those who were overweight and obese. In males in whom the umbilicus was located cephalad to the aortic bifurcation, the distance was 1.4 to 2 cm. There was no significant difference in the distance among those who were normal weight, overweight, or obese. In males whose umbilicus was caudal to the aortic bifurcation, the distance in obese males (2.3±0.3 cm) was significantly greater than in those with normal weight (1.2±0.2 cm; P<0.01). Compared with normal weight males (8.6±0.7 cm), the distance between the umbilicus and transverse colon was significantly greater in the overweight males (10.7±0.7 cm, P: 0.02 CI -0.3 to -4.2) and obese males (11.5±1.0cm, P: 0.01; CI-0.4 to -5.0). The location of the aortic bifurcation in relation to the umbilicus in men varies. However, generally the umbilicus is located caudal to the transverse colon.

Authors:

Fawaz Alharbi, MD, Ayman Al-Talib, MD, David Valenti MD, Carolin Reinhold, MD, Sarkis Meterissian MD, Togas Tulandi MD, MCHM

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Abstract:

Introduction: Colostomy is one of the most frequent procedures in emergency surgery. Several techniques have been described. The aim of this essay is to present our results using a circular stapler device when executing an end-type colostomy raising in emergency surgery. Material and Methods: During a period of 4 years, 47 patients underwent end-type colostomy raised under emergency circumstances using a circular stapler device. We gathered information on each patient, and performed 2 years follow-up. Results: Forty-seven patients, 72.3% male and 27.7% female, were enrolled in this study. The most common indication was colorectal cancer (48.9%). We had an average rate of complications of 13.63% without a need to be operated on: parastomal hernia (6.81%), mild local cellulitis (4.54%), and retraction (2.27%). The medium diameter of colostomy at the time of surgery and after 1 month was equal to 3.4 cm and 3.1 cm respectively. Follow-up screenings showed that the diameter of colostomy held constant at 3 cm. Discussion: End-type colostomy using a stapler device can be safely performed under emergency circumstances. It is not related to a higher rate of stomal stenosis in our series. This is the first essay that reports the diameter of colostomy with this technique. Early and late complications are similar to those that appear with the classical technique. Therefore, the end-type colostomy executed by means of a circular stapler device can be considered a safe and reliable technique.

Authors:

Benedetto Ielpo, MD, PhD, Dario Venditti, MD, PhD, Valerio Balassone, MD, Antonio Gioia, MD, Oreste Buonomo, MD, PhD, Giuseppe Petrella, MD, PhD

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Abstract:

Laparoendoscopic single-site (LESS) surgery has developed as a new surgical modality producing increased cosmetic benefits over conventional endoscopic surgery. However, there are limited reports about LESS surgery in liver diseases. We reported a case of a giant hapatic cyst that was treated by LESS surgery. LESS fenestration was performed on a 60-year-old female. A 2.2-cm umbilical incision was made. Three laparoscopic trocars were individually inserted into the abdominal cavity via a single umbilical incision. Only straight laparoscopic instruments were applied throughout the procedures. Aspiration, dome resection, argon laser coagulation, drainage, and removal were performed by LESS surgery. One of the 5-mm trocars was replaced with a 12-mm trocar to retrieve the resected cyst wall. All of the procedures for liver fenestration were the same as conventional laparoscopy and were successfully performed without any difficulties. The patient had an uncomplicated postoperative course. The LESS surgery has been successfully applied to liver fenestration as an available alternative to conventional laparoscopic fenestration. This method is technically feasible and results in superior cosmesis.

Authors:

Kazunori Shibao, MD, PhD, Aiichiro Higure, MD, PhD, Koji Yamaguchi, MD, PhD

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