Single site laparoscopic simultaneous cholecystectomy,sleeve gastrectomy,and paraumbilical hernia – First case report

IntroductionSingle site surgery is rapidly gaining popularity for its cosmetic benefits. However it requires immense technical skill due to its challenging ergonomics.We have reported here a case where multiple surgeries have been performed through the same single site,without the usage of special devices.This article has been reported in line with the SCARE criteria [1].Presentation of caseA 45-year-old obese lady presented with symptomatic cholelithiasis and a para umbilical hernia. She underwent uneventful trans umbilical, single site laparoscopic cholecystectomy, sleeve gastrectomy and paraumbilical hernia repair.DiscussionThis article is being published as it is the first reported from the Middle East. Recent development of laparoscopy was represented with introduction of the concept of scarless surgery using Natural Orifice Transluminal Endoscopic Surgery (NOTES), or its Transumbilical counterpart (NOTUS). Unfortunately,these two approaches have not been widely reported, probably due to the need for specialized instruments, learning curve, and prolonged surgery time [2].ConclusionThis single case report is to indicate that it is technically possible and cosmetically appealing to perform such a complex surgery.     

Application of the transoral endoscopic vestibular approach for a benign upper neck mass: A case report

Rationale:Excision of a benign neck mass is traditionally performed via the transcervical approach. In order to avoid visible scars in the neck, various remote access surgical approaches have been developed. The aim of this report is to present the technique of a transoral endoscopic vestibular approach for treatment of a benign upper neck mass.Patient concerns:A 47-year-old female with an anterior upper neck mass and throat discomfort visited our institution.Diagnosis:The computed tomography (CT) scans and ultrasound (US) images demonstrated a benign-appearing mass on the anterior upper neck area.Interventions:The benign upper neck mass was successfully removed via the transoral endoscopic vestibular approach, without any complication.Outcomes:The final pathologic report indicated that the lesion was an epidermal cyst. The cosmetic result was excellent.Lessons:From this case study, we can learn to apply a transoral endoscopic vestibular approach for removal of a benign upper neck mass. Based on the outcomes, endoscopic removal of the benign upper neck mass via a transoral vestibular approach can be useful for patients who wish to hide any anterior neck scar.     

经自然腔道内镜外科学(NOTES)研究进展

经自然腔道内镜外科学(natural orifice transluminal endoscopic surgery,NOTES)概念自提出以来,受到内镜医师和腹腔镜医师的广泛关注,成为微创技术领域研究和争论的焦点。国内外NOTES实验研究已经证实了NOTES的安全性、可行性及有效性,有关NOTES临床应用的研究也大量发表。同时,有关NOTES操作平台、器械研发和临床应用的报道也不断增多。本文就目前NOTES临床应用进展和相关的操作平台、器械的研发及应用情况进行概述。     

Transanal Minimally Invasive Surgery for Rectal Lesions

Methods:From November 2011 through May 2016, 31 patients (21 females, 68%), with a median age of 65 years who underwent single-port TAMIS were prospectively enrolled. Mean distance from the anal verge of the rectal tumors was 9.5 cm. Seventeen patients presented with T1 cancer, 10 with large adenoma, 2 with gastrointestinal stromal tumor (GIST) and 2 with carcinoid tumor. Data concerning demographics, operative procedure and pathologic results were analyzed.Results:TAMIS was successfully completed in all cases. In 4 (13%) TAMIS was converted to standard Park''s transanal technique. Median postoperative stay was 3 days. The overall complication rate was 9.6%, including 1 urinary tract infection, 1 subcutaneous emphysema, and 1 hemorrhoidal thrombosis. TAMIS allowed an R0 resection in 96.8% of cases (30/31 cases) and a single case of local recurrence after a large adenoma resection was encountered.Conclusion:TAMIS is a safe technique, with a short learning curve for laparoscopic surgeons already proficient in single-port procedures, and provides effective oncological outcomes compared to other techniques.