Karl Storz

Abstract:

With the introduction of laparoscopy more than 20 years ago, the surgeon has been confronted with several new challenges. First, the loss of the depth perception (two-dimensional [2D] vision) is a clear handicap during the initial learning curve. Then, the reduced dexterity with the current available instruments remains a drawback of classic minimally invasive surgery. Since the beginning of the 2000s, the advent of robotic surgery has given back the three-dimensional (3D) vision thanks to the two camera channels. In addition, the dexterity was restored, with the "endowristed" technology (Intuitive Surgical, Sunnyvale, CA). In parallel, several groups have tested and evaluated new cameras for 3D laparoscopy with interesting results. Yet, the real advantages have still to be proven. On the other hand, restoring the 3D vision is clearly a step forward to all the possibilities associated with augmented reality. Reviewing the current literature, this article shows the interest in the use of 3D technology for laparoscopic surgery. In addition, future trends are explored, especially those concerning augmented and virtual reality coupled with 3D technology.

Authors:

Nicolas C. Buchs, MD, Faculty Surgeon, Head of the Multidisciplinary Center for Surgical Teaching, Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland, Philippe Morel, MD, Chief of Division, Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland

PMID: 23700184

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Abstract:

Different hemostatic methods are available for mild to moderate intraoperative bleeding during open and laparoscopic abdomino-pelvic surgery, but topical hemostats have gained popularity. We sought to review evidence on the use of a gelatin-thrombin matrix (FloSeal®) in elective abdominal and pelvic surgery. A systematic search of PubMed, EMBASE, and Cochrane databases was conducted. The primary endpoints were intraoperative bleeding and number of transfusions. Secondary endpoints included operative time, postoperative complications, re-operation for bleeding, mortality, and duration of hospitalization. Of five controlled trials, only three were prospective, randomized-controlled studies. The first, in open myomectomy, showed that hemostatic matrix dramatically reduced intraoperative bleeding and transfusion rates compared with conventional hemostatic measures. Hemostatic matrix also reduced postoperative stay. Similar results were obtained in a trial comparing FloSeal versus infrared-sapphire coagulator during open renal tumor enucleation. In the third, FloSeal was equally as effective as conventional suture methods in preventing staple-line bleeding after sleeve gastrectomy. Data were not pooled because of the heterogeneity in design. There is insufficient evidence that FloSeal provides better results than conventional hemostasis in abdominal and pelvic surgery, except for open myomectomy. Well-designed randomized trials are needed to evaluate the use of gelatin-thrombin matrix in elective abdomino-pelvic surgery outcomes.

Authors:

Julio M. Mayol, MD, PhD, Professor of Surgery, Chief, Division of Colorectal Surgery, Carolina Zapata, MD, Resident in Surgery, Hospital Clinico San Carlos, Universidad Complutense de Madrid, Madrid, Spain

PMID: 23700183

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Abstract:

Nephron-sparing surgery (NSS) ensures equivalent oncological results while improving overall survival compared with radical nephrectomy when applied to the treatment of small renal masses, moreover warm ischemia is associated with a risk of acute renal failure and advanced chronic kidney disease (CKD). Laparoendoscopic single-site (LESS) unclamp NSS is the next step forward in the management of small renal masses. From 2009 to 2013 we have treated 23 patients with small renal masses (<4 cm) amenable to the LESS approach using unclamp LESS NSS. In 20 cases we were able to complete the operation using LESS, in 3 cases conversion to standard laparoscopy was required. Pathologic examination revealed 16 cases of clear-cell renal cell carcinoma (RCC), 4 cases of renal cysts, 2 oncocytomas, and 1 angiomyolipoma. We did not find any significant variation in renal function or any case of tumor recurrence, and the majority of the patients were very satisfied of the cosmetic results. LESS unclamp partial nephrectomy is a safe and feasible procedure, oncological outcomes are similar to standard laparoscopy, there is an advantage with respect to renal function and cosmesis, although the procedure is more technically demanding compared with standard laparoscopy.

Authors:

Fabio Neri, MD, FEBU, Consultant Urologist, Department of Urology, S.Pio da Pietrelcina Hospital, Vasto, Italy, Francesco Berardinelli, MD, FEBU, Consultant Urologist, Department of Urology, S.Pio da Pietrelcina Hospital, Vasto, Italy, Luca Cindolo, MD, FEBU, Consultant Urologist, Department of Urology, S.Pio da Pietrelcina Hospital, Vasto, Italy, Petros Sountoulides, MD, PhD, FEBU, Consultant Urologist, Department of Urology, S.Pio da Pietrelcina Hospital, Vasto, Italy, Fabrizio Pellegrini, MD, Attending Physician, Department of Urology, S.Pio da Pietrelcina Hospital, Vasto, Italy, Vincenzo Mirone, MD, PhD, Full Professor, Department of Urology, University of Naples , Naples, Italy, Luigi Schips, MD, Associate Professor, Department of Urology, S.Pio da Pietrelcina Hospital, Vasto, Italy

PMID: 24085508

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Abstract:

Randomized studies support the closure of midline incisions with a suture length to wound length ratio (SL:WL) of more than 4, accomplished with small tissue bites and short stitch intervals to decrease the risk of incisional hernia and wound infection. We investigated practical aspects of this technique possibly hampering the introduction of this technique. Patient data, operative variables and SL:WL ratio were collected at two hospitals: Sundsvall Hospital (SH) and Erasmus University Medical Center (EMC). A structured implementation of the technique had been performed at SH but not at EMC. Personnel were interviewed by questionnaire. At each hospital, 18 closures were analyzed. Closure time was significantly longer (p = 0.023) at SH (median 18 minutes, range: 9–59) than at EMC (median 13 minutes, range: 5–23). An SL:WL ratio of more than 4 was achieved in 8 of 18 cases at EMC and in all 18 cases at SH. We conclude that calculation of an SL:WL ratio is easily performed. Suturing with the small bite-short stitch interval technique of SH required 5 minutes extra, outweighing the morbidity of incisional hernia. Without a structured implementation to suture with an SL:WL ratio of more than 4, a lower ratio is often achieved.

Authors:

Gabriëlle H. van Ramshorst, MD, PhD Fellow, Resident in training for specialist, Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands, Boudewijn Klop, MD, PhD Fellow, Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands, Wim C.J. Hop, PhD, Statistician, Department of Biostatistics , Erasmus University Medical Center, Rotterdam, Netherlands, Leif A. Israelsson, MD, PhD, Associate Professor, Department of Surgery and Perioperative Science, Umeå University , Umeå, Sweden, Johan F. Lange, MD, PhD , Professor of Surgery, Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands

PMID: 24081841

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