JSLS : Journal of the Society of Laparoendoscopic Surgeons最新文献

Described is a simple modification of the O'Reilly esophageal retractor to aid in performing laparoscopic posterior gastric wraps during antireflux procedures. A 3-mm hole was drilled into the distal end of the reticulating arm. Once the arm is positioned posteriorly to the gastroesophageal (GE) junction, the freed gastric fundus can be secured to the retractor with a suture. The fundus can then be pulled posteriorly to the GE junction and held into position for placement of the fundoplication sutures.

Objective: To evaluate the efficacy of gasless reduced-port laparoscopic surgery (GRP-LS) using a subcutaneous abdominal wall lifting method for gynecological diseases.

Methods: This study included gasless laparoscopic surgeries performed at our hospital between September 1, 1993 and December 31, 2016. The new GRP-LS technique was compared with the conventional gasless three-port laparoscopic surgery (G3P-LS), based on patient background, operative results in patients treated for laparoscopic myomectomy (LM), laparoscopic ovarian cystectomy (LC), and laparoscopic salpingectomy (LT). Surgeons of the two techniques were categorized by the number of surgeries they had performed, and the number of surgeons and surgeries for each technique were compared.

Results: GRP-LS was used in 2,338 cases and G3P-LS in 2,473 cases. GRP-LS was used in 980 LM cases, 804 LC cases, 240 LT cases, and 314 cases for other conditions. The operative time required for GRP-LS was significantly less for LM, LC, LT, and the procedure also had less blood loss for LM and LC than G3P-LS. G3P-LS required a transition to open surgery in 0.69% of cases, whereas GRP-LS showed a very low rate of 0.09%. Sixty-seven of the 78 GRP-LS surgeons (85.9%) had performed fewer than 50 GRP-LSs, and these surgeons performed about half of all surgeries. Eighty-three of the 93 GRP-LS surgeons (89.2%) had performed fewer than 50 G3P-LSs, and these surgeons performed 38.9% of all surgeries.

Conclusions: GRP-LS is an effective surgery with few complications and less cosmetic damage and can be easily introduced to novice or inexperienced laparoscopic surgeons.

Background and objectives: Peritoneal dialysis (PD) is an accepted renal replacement therapy for end-stage renal disease (ESRD). Managing inguinal hernia in patients with PD is not standardized. Thus, this study reported the outcomes of simultaneous laparoscopic peritoneal dialysis catheter (PDC) placement and transabdominal preperitoneal (TAPP) repair of inguinal hernia.

Methods: Thirteen patients with chronic renal disease and inguinal hernia attending a tertiary hospital between May 1, 2016 and June 30, 2021 were evaluated for laparoscopic PDC placement. Concurrent laparoscopic inguinal herniorrhaphy and laparoscopic PDC placement were performed. Dialysate fluid was measured intraoperatively to the level below the incised peritoneum by 1 inch. The inflow and outflow was smooth without leakage. The amount was increased gradually in the two weeks after regular PD was obtained.

Results: Laparoscopic PDC was inserted for 13 patients. Ten patients had unilateral hernia and two had bilateral inguinal hernia. Associated paraumbilical hernia was discovered in two patients. The median follow-up was 30 months. The measured safe amount of dialysate fluid intraoperatively was 400 - 600 mL. There was no death, intraoperative complication, or dialysate leakage. Three PDCs were removed owing to noncompliance. No hernia recurrence was observed.

Conclusion: Simultaneous laparoscopic PDC placement and laparoscopic repair of inguinal hernia with immediate dialysis is a safe and feasible surgical technique. Utilizing minimally invasive surgery affords PDC placement and inguinal hernia repair simultaneously.

Background and objectives: To estimate the average treatment effect on the treated (ATT) and to assess the clinical outcomes in two different types of mesh in robotic Rives-Stoppa (rRS) ventral hernia repair (VHR).

Methods: A retrospective analysis of a robotic VHR database between February 1, 2013 and May 31, 2022. Patients who underwent a rRS VHR were included in this study and separated into two groups depending on the mesh used: Synecor^TM Preperitoneal Biomaterial (Synecor^TM Pre) and Bard™ Soft. Through propensity score and inverse-probability-treatment-weighting, the ATT was estimated for two scenarios; the first with the treated target having used the Synecor^TM Pre, the second having used the Bard™ Soft mesh. Adjusted linear regression models, including lingering imbalanced variables, were used for both the primary outcome of the Comprehensive Complication Index (CCI®), and the secondary outcome of the hospital cost.

Results: A total of 186 patients who underwent rRS were separated into the two groups (Synecor^TM Pre mesh, n = 85; Bard™ Soft mesh, n = 101). Adjusted linear regression models for the CCI showed no statistical difference between both groups (p > 0.05), whereas ATT on hospital cost was significantly higher (p < 0.001) in the Synecor^TM Pre group in both scenarios [(95% confidence interval) = 3882 (2352, 5413) and -5185 (-8213, -2157), respectively].

Conclusion: Both mesh materials provided excellent outcomes with no difference in complications or recurrence rates. However, hospital cost was found to be higher in the hybrid mesh group. Long-term follow-up is needed to fully assess the performance of both mesh types in rRS.

Objective: Median arcuate ligament (MAL) syndrome is a constellation of symptoms related to compression of the celiac artery trunk. Minimally invasive release of the ligament has been shown to improve these symptoms. This study describes one institution's experience with this procedure and reports on outcomes of minimally invasive release and patient quality of life.

Methods: We performed a retrospective chart review of all patients who underwent minimally invasive release of the MAL at our institution. Patients were mailed a survey consisting of the 36-Item Short Form and Visick questionnaires. If surveys were not returned after one month, patients were called and asked to complete them over the phone. Demographic and pre- and postoperative data were collected and analyzed.

Results: Eleven patients underwent a laparoscopic MAL release from January 1, 2015 to January 31, 2020. Most patients, 73%, reported epigastric pain as their primary symptom for a median of 18 months. All cases were successfully completed laparoscopically, with only one intraoperative complication. Mean hospital length of stay was 1.4 d. At the time of survey completion, the mean weight change was 2.3 kg. Additional interventions for resolution of symptoms and celiac artery stenosis were required for two patients. Surveys were completed by eight patients. A mean Visick score of 1.8 showed resolution or improved symptoms for all patients. SF-36 scores were highest for physical functioning, emotional well-being, and social functioning health areas.

Conclusions: Minimally invasive release of the MAL is a safe and effective surgery for patients suffering from MALS. Symptoms improved after adequate release of the ligament, with minimal morbidity and additional postoperative procedures needed.

Background and objective: To analyze long-term effectiveness of a conservative, uterine-sparing approach to laparoscopic Essure removal. Specific outcomes of interest include patient satisfaction, symptom resolution, and subsequent surgical intervention.

Methods: A retrospective case series and follow-up survey. Patients who underwent laparoscopic Essure removal without concomitant hysterectomy between January 1, 2016 and December 31, 2019 were identified. Greater than 18 months after removal participants completed a survey assessing outcomes.

Results: Twenty-nine patients underwent conservative Essure removal and there were 19 survey respondents. Among survey respondents, the mean length of time from Essure placement to removal was 56.7 months (range 5 - 117), and the mean length of time from removal to survey administration was 48.3 months (range 23 - 63). The most frequently reported symptoms were pain (100%), bleeding (52.6%), headache (42.1%), and dyspareunia (42.1%). Methods for removal included laparoscopic salpingectomy (58.6%), a combined hysteroscopic and laparoscopic approach (34.4%), and cornuectomy (6.9%). Regarding symptom improvement after Essure removal, 47.4% of patients reported total improvement, 36.8% reported almost total improvement, 5.3% reported some improvement, and 10.5% reported no improvement. Most patients (89.5%) reported satisfaction with their surgical results, and only two patients required subsequent surgical intervention for symptom management.

Conclusions: Most patients in our cohort reported total or almost total improvement in symptoms almost two years after Essure removal, with low rates of reintervention. A uterine-sparing approach to Essure removal, using laparoscopic and hysteroscopic modalities, may be a feasible and effective approach to addressing Essure-attributed symptoms.

Background: Laparoscopic hiatal hernia repair can be performed with an antireflux procedure. Routine use of an esophageal bougie has been advocated to avoid an excessively tight fundoplication. The use of an esophageal bougie carries a risk of iatrogenic complications, such as perforation or laceration of the viscera. However, there is equivocal evidence for the routine use in the surgical literature.

Methods: We present a retrospective analysis of patients with Types 3 and 4 paraesophageal hiatal hernias who underwent laparoscopic hiatal hernia repair with fundoplication without the use of an esophageal bougie, between December 1, 2010 and February 28, 2020, by a single surgeon at a community-based, academic hospital. Patients with a diagnosis of achalasia and gastroesophageal dysmotility were excluded. Perioperative outcome measures included: recurrence; prolonged postoperative proton pump inhibitor use; dysphagia; re-operation, and mortality.

Results: A total of 174 patients (34 males, 140 females) underwent laparoscopic hiatal hernia repair with fundoplication. The average age was 63-years old. Four patients (2.3%) developed dysphagia with narrowing of the gastroesophageal junction, with one patient (0.6%) requiring postoperative esophageal dilation with bougie and eventual re-operation. Postoperative proton pump inhibitor use was 31.0% after 1 month. Overall hernia recurrence rate was 14.9% and the rate of re-operation was 6.3%. Overall mortality was 0.6%.

Conclusion: We conclude that laparoscopic hiatal hernia repair with fundoplication without an esophageal bougie is safe, effective, and efficient. Furthermore, bougie related risks are obviated with a comparable reported incidence of postoperative dysphagia and hiatal hernia recurrence.

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been established as a leading treatment of obesity. Surgical site infections (SSIs) remain the most common complication.

Objective: To compare the incidence of SSIs before and after the implementation of our technique.

Methods: Our intraoperative technique limits enteric contact with the abdominal wall through a wound protector at the end-to-end anastomosis stapler port site, with enteric retrieval with a specimen bag followed by betadine irrigation. We analyzed our SSIs outcomes before and after implementation of our technique in all RYGB and laparoscopic sleeve-to-bypass conversions at our institution performed by two providers between January 1, 2009 to December 31, 2011 and January 1, 2019 to December 31, 2021. We compared patient age, sex, body mass index, American Society of Anesthesiologists class; and comorbidities including hypertension, diabetes, and hyperlipidemia. The χ², Fischer exact, Wilcoxon Rank Sum tests, and multivariate analysis were performed.

Results: Four hundred twenty-nine patients underwent LRYGB and sleeve-to-bypass conversion during the two study periods. Group 1 (162 patients, 37.76%) all underwent RYGB. Group 2 (267 patients, 62.24%) of whom 199 underwent RYGB and 68 underwent a laparoscopic sleeve-to-bypass conversion. The SSI rate was 9.26% in Group 1 and 2.62% in Group 2 (p = 0.002514). Statistical significance was also noted for operating room time (137 min vs 123 min, p = 0.02) and hospital length of stay (2 - 3 interquartile range vs 1 - 2 interquartile range, p = 0.04).

Conclusion: We propose a safe, reproducible technique that significantly reduces SSI rates during LRYGB.

Background: A frequently encountered problem in laparoscopic surgery is an impaired visual field. The Novel Intracavitary Laparoscopic Cleaning Device (NILCD) is designed to adequately clean a laparoscopic lens quickly and efficiently without requiring removal from the surgical cavity. Animal and cadaver studies showed good efficacy and a short learning curve. This study aims to describe the efficacy and initial human experience with the device during laparoscopic operations.

Methods: Since 2020, NILCD was used in 167 cases with surgeons at 12 different institutions in Texas, California, and Massachusetts. The rate of scope removal in each case was examined. Following each trial, users were asked to rank the NILCD on ease of set up, insertion, adjustment, and cleaning efficacy. A survey was then used to evaluate surgeon satisfaction.

Results: The NILCD was tested in a variety of cases, including colorectal, gynecological, general, pediatric, hepatobiliary, thoracic, bariatric and foregut surgery. NILCD usage eliminated the need for scope removal in 90.14% of debris events, with only 97 removals in 984 events. Eighty-six percent of users reported that the NILCD improved their visual field. When asked to rate specific qualities of the device using a 5-point Likert scale, surgeons gave an average score of 4.56 for ease of setup, 4.10 for ease of insertion, and 4.12 for ease of adjusting and cleaning efficacy.

Conclusion: In an initial analysis of 167 cases, the NILCD proved to be an effective and convenient method of cleaning the laparoscopic lens in-vivo. It was associated with good surgeon satisfaction.