Abstract:

The prevalence of overweight and obesity increased significantly during the past decades, affecting now approximately 30% of people worldwide. Bariatric surgery has proven to be the most effective treatment modality for obesity in the long term. However, current surgical procedures are accompanied by a substantial risk of complications. Several endoluminal techniques have been developed to achieve weight loss in obese patients and claim to be as effective as surgery but safer. The aim of this review is to evaluate the efficacy and safety of endoscopic bariatric procedures that provide structural changes in anatomy and physiology of the gastrointestinal tract. A comprehensive search was conducted using online databases and the references of the selected articles. All studies included in this review show excess weight loss in the short-term to medium-term, which ranges from 24% to 58%. Seven serious adverse events were reported. Therefore, we conclude that endoscopic bariatric procedures providing structural changes show relatively low complication rates and promising short-term weight loss and effect on obesity-related comorbidities. Long-term results in large study populations are necessary before these techniques can be incorporated in the standard treatment of obesity.

Authors:

Selwyn van Rijn, MD, PhD Candidate, Department of General Surgery, Yvonne G.M. Roebroek, MD, PhD Candidate, Department of General Surgery, Dr. van Rijn and Dr. Roebroek, contributed equally to this article., Ad A.M. Masclee, MD, PhD, Professor in Gastroenterology and Hepatology, Head of Department of Gastroenterology and Hepatology, Ernst L.W.E. van Heurn, MD, PhD, Professor in Pediatric Surgery, Department of General Surgery, Nicole D. Bouvy, MD, PhD, Professor in Surgical Techniques, Department of General Surgery, Maastricht University Medical Center, Maastricht, The Netherlands

For Direct IP Access please click this link

Abstract:

Background: This report describes the techniques and outcomes of reduced port distal gastrectomy (RPDG) with a multichannel port plus one puncture (POP) for gastric cancer patients. Patients and Methods: A total of eight patients underwent a RPDG using the E･Z Access™/LAPPROTECTOR™ (Hakko Co. Ltd., Tokyo, Japan) oval type devices with POP by a single surgeon. The median age of the patients was 66 years (range 48–75 years), and their median BMI was 22.3kg/m2 (range 17.7–26.8 kg/m2). One (12.5 %) of eight patients was female. A thin caliber trocar MiniPort™ (Covidien, New Haven, CT) was inserted at the left upper quadrant by puncture without incision. An assistant used Endo Relief™ (Hope Denshi Co. Ltd., Chiba, Japan) needlescopic forceps. In three cases, the pre-bent forceps (KTY-I, Adachi Industry Co. Ltd., Gifu, Japan) was introduced for surgeon’s left hand. After the liver was retracted with a 2-0 Prolene suture, a distal subtotal resection of the stomach with D1+ or D2 lymph node dissection was performed. The Roux-en-Y method or Billroth-I anastomosis was used for reconstruction. The short-term patient outcomes were investigated to evaluate the feasibility of RPDG with POP. Results: We employed this technique without the use of additional trocars in every patient except one. No conversion to laparotomy was observed. Both the Endo Relief™ forceps and prebent forceps were useful to maintain countertraction and keep triangulation. The median length of the operation was 374 (range, 268–420) minutes, and the median estimated blood loss was 45 (range, 5-180) ml. The median number of dissected lymph nodes was 32 (range 22–46). Neither major postoperative complications, such as anastomotic leakage and stricture, nor postoperative mortality were observed. The mean length of the hospital stay was 1,5 days. The umbilical wound was indistinct. Conclusion: RPDG with POP using a needlescopic device procedure is feasible in terms of patient safety and curability.

Authors:

Kazunori Shibao, MD, PhD, FACS, Assistant professor, Department of Surgery I, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, JAPAN, Nobutaka Matayoshi, MD, Assistant professor, Department of Surgery I, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, JAPAN, Norihiro Sato, MD, PhD, Assistant professor, Department of Surgery I, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, JAPAN, Aiichiro Higure, MD, PhD, Associate professor, Department of Surgery I, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, JAPAN

For Direct IP Access please click this link

Abstract:

One of the most important trends in intraoperative neural monitoring (IONM) in thyroid surgery is currently the real-time monitoring of the vagus nerve (VN) in order to prevent recurrent laryngeal nerve (RLN) iatrogenic damages. Notably, continuous intraoperative neuromonitoring (C-IONM) seems to be superior to intermitted intraoperative neural monitoring (I-IONM) because it enhances standardization by permanent vagus nerve (VN) stimulation, and it provides entire and constant RLN function monitoring as the surgeon dissects and removes the thyroid gland. It also has to be highlighted that the surgical maneuvers for the automatic periodic stimulating (APS) placement must be accurate and standardized in order to avoid a potential iatrogenic morbidity on the VN function. We recommend the experienced surgeon be very careful in each step, with cautious dissection. With this review article we provide a comprehensive analyses of C-IONM technique with the APS accessory for conventional and endoscopic thyroid surgery.

Authors:

Dionigi, MD, FACS*, Feng-Yu Chiang, MD, Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan, Sun Hui, MD, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Japan Union Hospital of Jilin University, Division of Thyroid Surgery, Changchun City, Jilin Province, China, Chei-Wei Wu, MD, Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan, Liu Xiaoli, MD, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Japan Union Hospital of Jilin University, Division of Thyroid Surgery, Changchun City, Jilin Province, China, Cesare Carlo Ferrari, MD, Alberto Mangano, MD*, Georgios D. Lianos, MD, Department of General Surgery, Ioannina University Hospital, Centre for Biosystems and Genomic Network Medicine, Ioannina University, Ioannina, Greece, Andrea Leotta, MD*, Matteo Lavazza,MD*, Francesco Frattini, MD, Matteo Annoni, MD*, Stefano Rausei, MD, PhD*, Luigi Boni, MD, FACS*, Hoon Yub Kim, MD, Associate Professor of Surgery, Department of Surgery, Division of Breast and Endocrine Surgery, Minimally Invasive Surgery and Robotic Surgery Center, KUMC Thyroid Center Korea University, Anam Hospital, Seoul, Korea

* 1st Division of General Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Varese-Como), Varese, Italy

For Direct IP Access please click this link

Abstract:

For a long time, obesity has been known as a risk factor for cardiovascular disease, which is one of the main causes of death in developed countries. This risk is due to the coexistence of other factors associated with obesity, such as hypertension, dyslipidemia, nonalcoholic fatty liver disease, and abnormalities in glycemic metabolism. Obesity is also a major risk factor for type 2 diabetes, and it is not surprising that the global prevalence of this disease continues to increase. Surgical intervention is now the most effective modality to treat severe obesity and its comorbidities. However, endoluminal interventions performed entirely through the gastrointestinal tract by using endoscopic devices offer the potential for an outpatient weight loss procedure that may be safer, less invasive, and more cost-effective, compared with current surgical approaches. Given the emerging role of endoscopic procedures in the treatment of obesity and rapid changes in endoscopic technologies and techniques, this review considers the current state of endoscopic management of obesity and type 2 diabetes. Endoscopic techniques attempt to mimic some of the anatomic features of bariatric surgery and rely on gastric restriction and duodenal exclusion. The endoscopic placement of the duodenal-jejunal bypass liner in morbidly obese patients induces significant weight loss. Additionally, early studies reported significant improvements in several parameters of glucose homeostasis in morbidly obese patients with type 2 diabetes. In this article we will review the available results obtained with the duodenal-jejunal bypass liner.

Authors:

Eduardo G. H. de Moura, MD, Director, Gastrointestinal Endoscopy Unit, Hospital das Clinicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil, Ivan R. B. Orso, MD, Physician in the Gastrointestinal Endoscopy Unit, Hospital das Clinicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil, Director, Gastrointestinal Endoscopy Unit, São Lucas Hospital, Assis Gurgacz School of Medicine, Gastroclínica, Cascavel, Brazil, Bruno C. Martins, MD, Physician in the Gastrointestinal Endoscopy Unit, Hospital das Clinicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil, Guilherme S. Lopes, MD, Physician in the Gastrointestinal Endoscopy Unit, Hospital das Clinicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil

For Direct IP Access please click this link

Abstract:

A 47-year-old man who presented with epigastric pain after a meal was diagnosed with biliary sludge present in the gallbladder. Endoscopic retrograde cholangiopancreatography showed normal anatomy of the biliary tree. During the exploratory phase of a laparoscopic cholecystectomy using four ports positioned as usual, surgeons observed a left-sided gallbladder. A review of the preoperative imaging by computed tomography confirmed a round ligament connected to the right portal umbilical portion. It also established that the gallbladder was located to the left of the round ligament, and attached to the left lateral segment of the liver. Laparoscopic cholecystectomy was performed successfully in this patient with the usual port site and careful dissection with a normograde approach. The patient was discharged on the second postoperative day with an uneventful course. Prior identification of a left-sided gallbladder is possible with cautious attention. In particular, it is important for the surgeon to be aware of unusual alterations in the portal and biliary anatomy associated with this anomaly to safely complete a laparoscopic cholecystectomy.

Authors:

Tsutomu Namikawa, MD, PhD, Associate Professor, Department of Surgery, Kochi Medical School, Nankoku, Japan, Kohei Tamura, MD, Consultant Surgeon, Department of Surgery, Susaki Kuroshio Hospital, Susaki, Japan, Masao Morita, MD, PhD, Chief, Department of Surgery, Susaki Kuroshio Hospital, Susaki, Japan, Seihei Tamura, MD, PhD, Director, Department of Surgery, Susaki Kuroshio Hospital, Susaki, Japan, Hiromichi Maeda, MD, PhD, Assistant Professor, Department of Surgery, Kochi Medical School Hospital, Nankoku, Japan, Michiya Kobayashi, MD, PhD, Professor, Department of Surgery, Kochi Medical School, Nankoku, Japan, Kazuhiro Hanazaki, MD, PhD, Professor, Department of Surgery, Kochi Medical School, Nankoku, Japan, Takashi Usui, MD, PhD, Director, Department of Surgery, Tano Hospital, Tano-cho, Japan

For Direct IP Access please click this link