Covidien

Abstract:

We recently developed an oval-shaped E•Z Access device designed exclusively for use with the LAP PROTECTOR™ Oval type device (Hakko Co. Ltd., Tokyo, Japan). The transverse abdominal opening diameter made by round-shaped (Alexis® Wound Retractor, Applied Medical, Rancho Santa Margarita, CA; and LAP PROTECTOR™ Round type) and oval-shaped (LAP PROTECTOR™ Oval type) wound retractors was measured and compared in 5 patients with cholecystolithiasis. Each device was placed through a single 25-mm longitudinal umbilical incision, and the length of trocar separation was compared. LESS cholecystectomy was then performed using the oval-shaped E•Z ACCESS/LAP PROTECTOR™. The transverse abdominal opening diameter was maximized with the LAP PROTECTOR™ Oval type device. The average distance between the working-ports for the glove method, round-shaped, and oval-shaped E•Z ACCESS/LAP PROTECTOR™ devices in the 25-mm umbilical incisions were 20 ± 0.8 mm, 24 ± 1.5 mm, and 35 ± 0.8 mm, respectively. Wider trocar separation was achieved using the oval-shaped device, making the surgical procedures easier to perform. No perioperative port-related or surgical complications were observed. LESS cholecystectomy using the E•Z ACCESS Oval type device was found to be technically feasible. The Oval type device appears to allow for wider trocar separation, thereby reducing stress on the surgeon, ensuring patient safety, and providing cosmetic benefits.

Authors:

Kazunori Shibao, MD, PhD, Assistant Professor, Department of Surgery I, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan, Tsuyoshi Takagi, MD, PhD, Deputy Director, Department of Surgery, Nishijin Hospital, Kyoto, Japan, Aiichiro Higure, MD, PhD, Associate Professor, Department of Surgery I, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan, Koji Yamaguchi, MD, PhD, Professor, Department of Surgery I, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan

PMID: 23860933

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Abstract:

Options for intracorporeal appendiceal stump closure span a variety of techniques including ligation using intra-corporeal knots, extra-corporeal knots, or an endo-loop (EL), closure with endoscopic clips (EC), or endoscopic stapled (ES) closure. The guiding principles are the need for secure, inert closure of the appendiceal base without injury to the appendiceal stump or cecum, with minimal risks of complication attributable to the closure technique. Safety and complication rates, as well as cost data, should guide the techniques used for pediatric laparoscopic appendectomy. Based on the literature available there is not a clear answer as to the best method for closing the appendiceal stump in pediatric patients, with each of the methods described providing safe closure. Many institutions and surgeons may favor a selective approach, with choice of closure determined by the condition of the appendix at laparoscopy.

Authors:

Monica Langer, MD, FRCSC, Assistant Professor of Surgery, Tufts University, Pediatric Surgeon , Maine Medical Center, Portland, Maine, Arash Safavi, MD, MHSc, General Surgery Resident, Department of Surgery, University of Arizona Medical Center, Tucson, Arizona, Erik D. Skarsgard, MD, FRCSC, FACS, Professor of Surgery, University of British Columbia, Department of Surgery, British Columbia Children’s Hospital, Vancouver, BC, Canada

PMID: 23975448

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Abstract:

Gastric plication is an emerging bariatric procedure with the potential for providing safe and significant weight loss and improvement of metabolic parameters without resection, bypass, or implantable device. Laparoscopic plication consists of infolding the greater gastric curvature to reduce stomach volume using running sutures. As a new procedure in bariatric/metabolic surgery very few clinical studies are available. Herein we present technical notes about and evidence from literature.

Authors:

Francesco Frattini, MD, Assistant Professor , Department of Surgery, University of Insubria, Varese, Italy, Stefano Rausei, MD, PhD, Assistant Professor, Department of Surgery, University of Insubria, Varese, Italy, Luigi Boni, MD, FACS, Associate Professor , Department of Surgery, University of Insubria, Varese, Italy, Francesca Rovera, MD, Associate Professor, Department of Surgery, University of Insubria, Varese, Italy, Franchin Marco, MD, Assistant Professor, Department of Surgery, University of Insubria, Varese, Italy, Chiappa Corrado, MD, Assistant Professor, Department of Surgery, University of Insubria, Varese, Italy, Stefano Moalli, MD, Assistant Professor, Department of Surgery, University of Insubria, Varese, Italy, Andrea Fraschini, MD, Director General Surgery, Hospital of Luino, Luino, Italy, Gianlorenzo Dionigi, MD, FACS, Associate Professor, Department of Surgery, Director General Surgery , Director Endocrine Surgery, University of Insubria, Varese, Italy

PMID: 24081847

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Abstract:

Pancreatoduodenectomy is an exceptional procedure that requires an extensive dissection of the supra-mesocolic region extended to the first jejunal limb. Lymphadenectomy, required for cancer, increases the dissection surface. The extensive preparation of the area is traditionally conducted with bipolar or monopolar instruments, while clips, ligatures, and sutures are used for haemostasis. LigaSure™ vessel sealing (LSVS; Valleylab, Boulder, CO) is a technology that obtains vessel closure by using the body’s own collagen and elastin to create a permanent fusion zone. This is obtained by a combination of forceps pressure and radio frequency. This effect has been improved by the introduction of the ForceTriad™ (Valleylab, Boulder, CO) energy platform, controlled by TissueFect™ (Valleylab, Boulder, CO) sensing technology. With this device, the surgeon is able to fuse vessels up to 7 mm, lymphatics, tissue bundles, and pulmonary vasculature in a fast-seal cycle of almost 4 seconds. In our daily practice of open surgery we observe a rapid improvement of abdominal drainage output with a drastic reduction of protein loss. Its practical significance is, in our opinion, that we obtain a rapid recovery of normal serum protein levels with a low number of blood/plasma sac transfusions and a real improvement of anastomosis healing. Moreover, the efficacy and the speed of work of the device allow us to reduce the operating time significantly but safely. We performed a retrospective analysis of the data of 20 pancreatic resections conducted both with traditional dissection and with the LigaSure Impact device with ForceTriad platform in order to verify whether observed data were real. Our clinical results show that the use of the LigaSure Impact device with ForceTriad energy platform is really useful in open surgery to save operating time, number of postoperative days, and hemoderivate administration.

Authors:

Giuseppe Piccinni, MD, Associate Professor of Surgery, University of Bari , Bari, Italy, Alessandro Pasculli, Student, University of Bari, Bari, Italy, Erasmina D’Ambrosio, MD, Junior Officer, University of Bari, Bari, Italy, Angela Gurrado, MD, PhD, Assistant Surgeon, University of Bari, Bari, Italy, Germana Lissidini, MD, PhD, Consultant , European Institute of Oncology, Milano, Italy , Mario Testini, MD, Full Professor of Surgery , University of Bari, Bari, Italy

PMID: 24081851

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Medtronic

Medical-Langer

Abstract:

Standardization of the intraoperative neuromonitoring (IONM) technique is an essential aspect of modern monitored thyroid surgery. The standardized technique involves vagal nerve stimulation. VN stimulation is useful for technical problem solving, detecting non-recurrent laryngeal nerve (non-RLN), recognizing any recurrent laryngeal nerve (RLN) lesions, and precisely predicting RLN postoperative function. Herein, we present technical notes for the VN identification to achieve the critical view of safety of the VN stimulation with or without dissection.

Authors:

Gianlorenzo Dionigi, MD, FACS, Associate Professor of Surgery, Director, 1st Division of General Surgery, Director, Endocrine Surgery Research Center epartment of Surgical Sciences and Human Morphology, University of Insubria, Varese, Italy, Hoon Yub Kim , MD, Associate Professor of Surgery, Department of Surgery, Korea University College of Medicine, Seoul, Korea, Che-Wei Wu, MD, Professor, Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan, Matteo Lavazza, MD, Resident, 1st Division of General Surgery, Department of Surgical Sciences, Endocrine Surgery Research Center, University of Insubria, Varese, Italy, Cesare Ferrari, MD, Resident, 1st Division of General Surgery, Department of Surgical Sciences, Endocrine Surgery Research Center, University of Insubria, Varese, Italy, Andrea Leotta, MD, Resident, 1st Division of General Surgery, Department of Surgical Sciences, Endocrine Surgery Research Center, University of Insubria, Varese, Italy, Sebastiano Spampatti, MD, Resident, 1st Division of General Surgery, Department of Surgical Sciences, Endocrine Surgery Research Center, University of Insubria, Varese, Italy, Francesca Rovera, MD, Associate Professor of Surgery, 1st Division of General Surgery, Department of Surgical Sciences, Endocrine Surgery Research Center, University of Insubria, Varese, Italy, Stefano Rausei, MD ,1st Division of General Surgery, Department of Surgical Sciences, Endocrine Surgery Research Center, University of Insubria, Varese, Italy, Luigi Boni, MD, FACS, Associate Professor of Surgery, Director, Minimally Invasive Surgery Research Center, 1st Division of General Surgery, Department of Surgical Sciences and Human Morphology, Endocrine Surgery Research Center, University of Insubria, Varese, Italy, Feng-Yu Chiang, MD, Professor, Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan

PMID: 23860931

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