CRSLS : MIS case reports from SLS最新文献

Introduction: We report the case of a transplanted ureter obstructed by an inguinal herniation treated by a robotic-assisted approach.

Case report: This is a case of a 63-year-old male who had a kidney transplant with a graft on the left pelvis in September 2014, and presented to the clinic for evaluation of bilateral inguinal hernia. On physical examination he had bilateral palpable inguinal hernias, with the right one larger and only partially reducible. Computed tomography scan showed portion of urinary bladder and transplant ureter in the left inguinal hernia and mild hydroureteronephrosis in the transplanted kidney. Patient underwent catheterization of the transplant ureter where indocyanine green was injected for proper transplant ureter identification with the Firefly filter and robotic assisted hernia repair. Surgery was uneventful and patient was discharged home the same day with no further complications.

Conclusion: The robotic approach using the Firefly filter was shown to be safe during the dissection to avoid injury to the transplant ureter.

Introduction: Pancreatic and gastric heterotopias are a rare presentation of pancreatic and gastric tissues located outside their expected location. The most common site of heterotopic pancreas is the gastric antrum, and the most common site of heterotopic gastric mucosa is the proximal esophagus. The two tissues rarely present simultaneously. Although lead-point intussusception secondary to simultaneous heterotypic gastric and pancreatic tissue is extremely rare, its management strategy is the same as other pathological lead-point intussusception.

Case description: This report presents a 23-year-old female who presented to the emergency department with abdominal pain, vomiting, and gastrointestinal bleeding. Computed tomography scan revealed features of distal small bowel intussusception secondary to a solid mass lead point. Following laparoscopic assisted small bowel resection and incidental appendectomy, histopathology evaluation confirmed the diagnosis of heterotopic pancreatic and gastric tissue as the lead point. The patient had an uneventful postoperative period and was discharged in stable condition, free of symptoms.

Discussion: Lead point intussusception of the jejunum in adults due to combined heterotopic tissue is extremely rare, with no reported cases in the literature. Prompt diagnosis and management are essential, with delays in treatments leading to a risk of perforation and mortality. If diagnosed, minimally invasive surgical approaches can treat obstruction and improve intraoperative and postoperative outcomes.

Introduction: The Boston Scientific Swiss LithoClast® Trilogy lithotripter was intended for use in percutaneous nephrolithotomy. We performed, to our knowledge, the first two robotic pyelolithotomies using the Trilogy lithotripter for intracorporeal lithotripsy.

Case description: Two cases are presented involving a 65-year-old female with a complete left staghorn calculus and hydronephrosis secondary to a left ureteropelvic junction (UPJ) obstruction, and a 69-year-old male with a large left staghorn calculus and multiple large left sided simple renal cysts. In both cases, a robotic pyelolithotomy was scheduled for stone removal along with concurrent UPJ repair and cyst decortication respectively. Following pyeloplasty and cyst decortication respectively, and following stone visualization, the 2.4-mm Trilogy probe was inserted into the 12-mm assistant port and under direct visualization the stone was fragmented and removed using Trilogy's built-in mechanisms. Both patients were treated successfully without complications and were found to be stone-free on follow-up.

Conclusion: The Trilogy lithotripter may be an effective tool for stone management when introduced during robotic pyelolithotomy and provides additional optionality when manual extraction poses challenges.

Pelvic floor hernias represent a rare type of hernia and a rare etiology of pelvic symptoms. The rarest type of pelvic floor hernias are sciatic hernias, which present with a variety of symptoms depending on the hernia contents and location. Many different treatment approaches are described in the literature. A 73-year-old female presented to our outpatient minimally invasive surgery (MIS) clinic with one year of colicky left flank pain. She had previously presented to an emergency department, at which time a computed tomography (CT) scan demonstrated left-sided hydronephrosis in the setting of a left-sided ureterosciatic hernia. She was asymptomatic and had no palpable hernia bulge. An operative repair was offered based on her prolonged symptoms. The patient was brought electively to the operating room with minimally invasive and urological surgeons. A left ureteral stent was placed over a guidewire. A robotic repair was performed with a round piece of biosynthetic mesh, secured in place with fibrin glue. Sciatic hernias are an extremely rare etiology of pelvic symptoms and require a high index of suspicion to identify. Obstructive and neuropathic symptoms may be intermittent, so diagnosis is often made using CT imaging. We report a successful treatment with pre-operative ureteral stenting followed by a robotic repair using biologic mesh secured with fibrin glue fixation. We believe this is a durable repair although acknowledge that longer follow-up is needed to establish the longevity of our treatment modality.

Introduction: We report a case of a patient who presented with incarceration of the epiploic appendix in a spigelian hernia, subsequently treated by a robotic-assisted surgical approach.

Case description: This is a case of a 52 year-old male patient who presented with nausea and two-week history of worsening left lower quadrant pain. On examination, the patient had an irreducible left lower quadrant mass. Computed tomography scan showed an epiploic appendagitis in a left Spigelian hernia. The patient underwent a robotic transabdominal preperitoneal hernia repair successfully and was discharged home the same day.

Conclusion: The robotic platform was a safe and effective approach to treating the patient with no postoperative complications.

Epithelial tumors with neuroendocrine and nonendocrine components constitute the rare yet aggressive entity of neoplasms of the gastro-entero-pancreatic tract. These tumors were first named "mixed adeno-neuroendocrine carcinomas" (MANECs) by the World Health Organization in 2010 and in 2017 renamed "mixed neuroendocrine non-neuroendocrine neoplasms" (MiNENs). Combined adenocarcinoma and neuroendocrine carcinoma neoplasms are a rare occurrence within the gastrointestinal tract. In this report, we describe two separate cases of mixed rectal adeno-neuroendocrine carcinomas and their treatment. We describe two cases at one institution of mixed neuroendocrine non-neuroendocrine rectal neoplasms. Given the rarity of diagnosis and inconsistencies in both nomenclature and treatment recommendations in the literature, mixed adeno-neuroendocrine carcinoma epidemiology and prognosis are not yet fully understood. Future prospective trials with a focus in management of MiNENs will offer valuable insight into these rare mixed carcinomas.

Introduction: Internal hernias are the most common cause of small bowel obstruction following laparoscopic Roux-en-Y gastric bypass surgery (LRYGBP) with four distinct types. Herein, we report the clinical course of a patient with two independent hernias at the Petersen's space and a rarer subtype at the jejunojejunal window. A high index of suspicion for less common subtypes of internal hernias and the possibility of multiple, simultaneous internal hernias is critical.

Case description: We describe the case of a 52-year-old female with a history of LRYGBP who presented with abdominal pain and emesis due to an internal hernia at Peterson's defect, requiring subsequent laparoscopic repair. On postoperative day three, the patient presented again with recurrent abdominal pain and emesis. Repeat exploratory laparoscopy found a separate internal hernia involving the jejunojejunal window with the previously repaired Petersen's defect intact.

Discussion: This case illustrates a unique scenario of a patient post-LRYGBP with multiple internal hernias at the Peterson's space and the less common jejunojejunal window, which was missed during the index surgery. Failure to identify simultaneous hernias may result in additional invasive intervention and further morbidity.

Conclusion: Multiple less-common variants of internal hernias may present simultaneously following LRYGBP.

Introduction: To report a case of ovarian torsion following ovarian hyperstimulation with subsequent detorsion and oocyte retrieval.

Case description: The patient was diagnosed with torsion following acute onset abdominal pain following her leuprolide acetate trigger injection. The patient underwent diagnostic laparoscopy which confirmed right ovarian torsion. Following detorsion, the patient underwent oocyte retrieval as planned with 72 total oocytes and 70 mature oocytes retrieved. Thirty-six mature oocytes were cryopreserved; 34 were inseminated with conventional in vitro fertilization, of which 27 (79.4%) were fertilized. Sixteen blastocyst stage embryos were cryopreserved.

Discussion: Ovarian torsion during ovarian hyperstimulation is a rare event, but consideration should be given to detorsion first, followed by oocyte retrieval. We demonstrate that mature oocytes can be retrieved even after temporary vascular compromise to the ovary with subsequent excellent fertilization and blastocyst conversion rates.

Introduction: Cutaneous gluteal vaginal fistula is a rare but significant postoperative complication which may present years after sacrospinous ligament fixation (SSLF) surgery There is limited data on the management of cutaneous vaginal fistula following SSLF.

Case description: This case report describes a 77-year-old who presents twenty years after SSLF with cutaneous gluteal vaginal abscess and fistula. She underwent successful management with CT-guided percutaneous drainage of gluteal abscess and placement of guiding cutaneous vaginal catheter, laparoscopic pelvic wall dissection and evaluation, and transvaginal localization and removal of the infected permanent suture.

Discussion: Multi-disciplinary approach should be considered in the treatment of chronic fistula status post SSLF, including interventional radiology, urogynecology, and minimally invasive gynecologic surgery.

Diaphragmatic hernias are uncommon, and can appear secondary to trauma or as a congenital defect. These hernias can be asymptomatic or have various clinical presentations. One of the clinical scenarios is incarceration of bowel through the diaphragmatic defect. A bowel obstruction from an incarcerated diaphragmatic hernia is a rare occurrence. We present a case of a small bowel obstruction caused by a congenital diaphragmatic hernia that was successfully managed with laparoscopy.