Robotically assisted endoscopic ovarian transposition.

BACKGROUND: Ovarian transposition is the anatomical relocation of the ovaries from the pelvis to the abdomen. Transposition is beneficial in women who are to undergo pelvic radiation, because it allows maintenance of ovarian function and preservation of assisted reproductive capacity. METHODS: The da Vinci surgical system (Intuitive Surgical, Mountainview, CA, USA) was used to perform an endoscopic ovarian transposition. The ovaries were mobilized on their respective infundibulopelvic ligaments and sutured to the ipsilateral pericolic gutters. RESULTS: A series, of laboratory sessions using the da Vinci system was completed at our institution's training facility. Surgical experience included cadaveric pelvic dissection and abdominopelvic procedures on anesthetized porcine models. Additional didactic and laboratory training, including a certification examination, was obtained from Intuitive Surgical, Inc. The first clinical case of robotically assisted endoscopic ovarian transposition was performed. CONCLUSIONS: Robotically assisted endoscopy was successfully used for ovarian transposition.     

Role of laparoscopy in identifying the clinical significance and cause of adhesions and chronic pelvic pain: a retrospective review at the Kiel School of Gynecological Endoscopy.

OBJECTIVES: We sought to define the role of laparoscopy in identifying the clinical significance, cause, and association between adhesions and chronic pelvic pain. METHODS: A retrospective chart review was conducted from October 2004 to July 2005, at the Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Campus Kiel, Germany. Included in the study was the analysis of 462 laparoscopic procedures; 275 (59.5%) of the patients undergoing these procedures had pelvic or abdominal adhesions. Of these, 84 (30.5%) patients were admitted with the main complaint of chronic pelvic pain. Further evaluation and assessment of this group was carried out. RESULTS: Among those patients with adhesions, the second most frequent reason for admission was chronic pelvic pain (30.5%) (P<0.0005). In our study, adhesions were found in 79.2% (n=84) of patients (n=106) with chronic pelvic pain. These adhesions were thin-filmy (19.0%) or thick-fibrous (81.0%) adhesions containing blood vessels. Thick-fibrous adhesions were present in 50.0% of patients at multiple abdominopelvic sites (P<0.005). CONCLUSIONS: Thick-fibrous adhesions that extend beyond the pelvic sidewall can cause significant chronic abdominopelvic pain.     

Splenosis. A diagnosis to be considered

The term splenosis applies to the autotransplanted splenic tissue resulting from seeding in the context of past splenic trauma or surgery. We report a 42-year-old man with a history of splenectomy observed for an incidentally found retrovesical mass thought to be an ectopic testicle. The abdominal laparotomy revealed multiple focuses of pelvic splenosis. As splenosis can be diagnosed through specific imaging studies one should always consider it in differential diagnosis of a mass discovered years after splenic surgery or trauma.     

Cecal splenosis mimicking gastrointestinal stroma tumor. Case report and review of the literature

IntroductionAbdominal splenosis is a rare condition where autotransplanted ectopic spleen tissue is found in the abdominal cavity after spleen injury or splenectomy. While abdominal splenosis is mostly described as asymptomatic, bowel splenosis can present with abdominal pain, obstipation or gastrointestinal (GI) bleeding. Scarce information on bowel splenosis exists and high index of suspicion is needed for diagnosis. We present the case of a patient with abdominal pain and a cecal mass mimicking gastrointestinal stroma tumor (GIST) found to have bowel splenosis after laparoscopic resection.Presentation of caseA 45-year-old female was evaluated for a 6-month history of abdominal pain in right-lower quadrant. She had past medical history of blunt abdominal trauma and splenectomy 35 years before symptoms. An abdominal contrast-enhanced computed tomography (CT) reported a 4.2 × 4.6 × 4.6 cm solid mass located in the antimesenteric border of the cecum, with calcifications and arterial enhancement. Colonoscopy found no epithelial lesions. A diagnostic laparoscopy was done, and resection of the mass achieved. Transoperative histopathological diagnosis revealed ectopic spleen tissue.DiscussionIt is difficult to know whether abdominal pain in bowel splenosis is actually triggered by splenosis itself or by an unrelated cause, making diagnosis incidental. There are no particular imaging findings suggestive of splenosis, and surgical resection is often done under uncertain diagnosis.ConclusionBowel splenosis could present as abdominal pain variable time after spleen injury or splenectomy. Clinical features and imaging characteristics are nonspecific and similar to those of GIST. Most cases of splenosis are diagnosed after surgery.     

Abdominopelvic Splenosis—An Unusual Cause of Tenesmus

Splenosis is a rare condition defined as seeding and autotransplantation of splenic tissue, typically after blunt abdominal trauma (e.g. from road traffic collision). Sites of splenosis ranging from intrathoracic to intrapelvic have been reported, and symptoms vary greatly depending on the site and size of lesions. We present the use of Tc-99m sulphur colloid SPECT/CT in diagnosing a case of multiple abdominopelvic splenosis as the cause of new-onset tenesmus and constipation, which was initially thought to be due to colorectal malignancy, 47 years following the initial abdominal trauma.     

Splenosis after splenic rupture: a disease to be recognized]

One case of peritoneal splenosis is reported. The diagnosis was established at surgery in a 17-year-old female patient presenting with dull abdominopelvic pain, who had undergone total splenectomy after a trauma ten years earlier. This autograft of splenic tissue must be known to be acknowledged, especially today, when the conservative treatment advocated for ruptures of the spleen may increase its incidence. The literature reports only about one hundred cases. The treatment only consists in removing the sole symptomatic nodules.     

Post-splenectomy splenosis presenting as hepatocellular carcinoma in the left lateral section of the liver: A case report

INTRODUCTION

Defined as heterotrophic autotransplantation of splenic tissue after splenic trauma or surgery.

PRESENTATION OF CASE

We present a case of 45 years old female patient with past history of splenectomy for haemolyticanaemia. Complaining of abdominal pain the patient was investigated by abdominal CT scan which revealed a focal lesion in the left lateral section of the liver suspicious to be hepatocellular carcinoma and gall bladder stones. Serum α-fetoprotein was within normal range. Exploration revealed a well encapsulated lesion completely separable from the liver and the diaphragm. Histopathological examination confirmed the diagnosis of splenosis. Although it is a rare condition, we recommend that the diagnosis of splenosis should be put in consideration in every patient with past history of splenectomy for proper management.

DISCUSSION

Although several cases of hepatic splenosis have been reported in the literature, supra-hepatic splenosis as our case has been rarely described.

CONCLUSION

Considering patients past history of splenectomy or splenic trauma should add splenosis to the list of possible differential diagnosis to avoid unnecessary surgical intervention.     

腹腔镜辅助经皮肾镜与输尿管软镜治疗盆腔异位肾结石的临床研究

目的探讨经腹途径腹腔镜辅助经皮肾镜碎石取石术（PCNL）和输尿管软镜碎石术（RIRS）治疗盆腔异位肾结石的临床疗效。 方法回顾性分析从2016年1月至2017年10月采用经腹途径腹腔镜辅助PCNL或RIRS手术方法治疗的6例盆腔异位肾结石病例。对患者术前的基本信息（包括年龄、性别、异位肾位置、结石大小、结石数量、结石位置、特殊病史）和术中、术后的基本情况（包括通道大小、手术时间、曲卡、肾造瘘管、腹腔引流管、双J管、结石清除率和住院时间）进行分析和总结。 结果腹腔镜辅助PCNL和RIRS的平均手术时间分别为92 min和85 min,其平均结石最大径分别为19 mm和12 mm。RIRS术后的平均住院时间（3 d）短于腹腔镜辅助PCNL（5 d）,其手术成功率分别为60%（3/5）和100%（3/3）。两种方法都没有严重并发症发生,术后复查均没有结石残留。 结论两种手术方法治疗盆腔异位肾结石均具有较高的安全性。RIRS在微创和住院时间方面具有优势,腹腔镜辅助PCNL则能够应对更大的结石负荷和更复杂的肾脏结构,其手术成功率亦相对较高。     

Intrathoracic splenosis presenting as persistent chest pain

ABSTRACT: Thoracic splenosis is a rare entity resulting from splenic and diaphragmatic injury. Patients remain asymptomatic, and surgical intervention is not indicated in the majority of cases. We report a case of a 50-year-old male with a history of splenectomy due to a gunshot wound 30 years previously who presented with vague, progressively worsening chest pain. He was found to have a large intrathoracic splenosis. Unique features of our patient include the presence of symptoms, the significant interval growth of the splenic tissue, and the unprecedented size of the mass, which we believe to be the largest among those previously described.     

Laparoscopic treatment of splenosis: Report of a case

A 52-year-old woman with a history of splenectomy for a splenic injury 45 years earlier underwent investigations for a pre-existing gynecologic disease. Contrastenhanced abdominal computed tomography (CT) and magnetic resonance imaging (MRI) showed a tumor, 3 cm in diameter, adjacent to the sigmoid colon, suggestive of a gastrointestinal stromal tumor (GIST). Laparoscopic exploration revealed a white mass protruding from the subserosa of the sigmoid colon, and we performed laparoscopic-assisted sigmoidectomy to rule out a GIST. Pathological studies showed splenic tissue, thus confirming a diagnosis of splenosis, given the history of splenic injury. This case of splenosis mimicking GIST following splenic injury was diagnosed correctly and treated successfully with laparoscopic surgery. To our knowledge, this is the first case of splenosis treated with laparoscopic colectomy with no tumor extirpation.     

腹腔镜下外伤性脾破裂切除加自体脾移植术的临床研究(附7例报告)

目的:探讨腹腔镜下外伤性脾破裂切除加自体脾移植术的临床意义及并发症的预防。方法:回顾分析7例经腹腔镜行腹腔探查并实施外伤性脾脏切除,同时腔镜下行自体脾移植术的资料。结果:术后1例出现脾窝积液、胸腔积液、胰漏,经过抗感染及抑酶和胸穿抽胸水治疗后痊愈,1个月后拔上腹引流管。其余6例术后均无脾窝积液、脾热及切口感染,术后第2天离床活动,住院7~30d。结论:只要把握好适应证,腹腔镜下外伤性脾破裂切除加自体脾移植术是一种理想的保脾术式,创伤小,康复快,手术效果理想。     

Splenosis as a cause of testicular pain: laparoscopic management.

This is a case report of a 37-year-old man with severe testicular pain unresolved after conventional investigative and therapeutic methods. On the basis of his history of abdominal trauma followed by emergency splenectomy and evidence of functioning splenic tissue on a radionuclide scan, the diagnosis of splenosis was established. Laparoscopic exploration was done, and the initial diagnosis confirmed. Splenic tissue located at the right inguinal ring was removed. Testicular pain abated after the procedure.     

Operative laparoscopy in pregnancy.

OBJECTIVE: We compared the surgical outcomes of pregnant women undergoing laparotomy in the first 2 trimesters of pregnancy with those undergoing laparoscopy for the management of acute pelvic pain. METHODS: We performed a systematic retrospective chart review of patients whose discharge diagnosis included intrauterine pregnancy with exploratory laparotomy or laparoscopy from August 1, 1993 to October 31, 1999. The following factors were assessed: preoperative diagnosis, postoperative diagnosis, gestational age at the time of surgery, operative time, hospital stay, pathology, gestational age at delivery, complications, and outcome of the pregnancy in both groups. RESULTS: Sixteen pregnant patients underwent surgery during the study period. All but one had abdominopelvic pain, and all patients had an associated adnexal mass. The mean gestation age at the time of surgery was 15+/-6 weeks versus 13+/-4 weeks in the laparoscopic and laparotomy groups, respectively (P=NS). All patients undergoing laparoscopy remained in the hospital for one day compared with a mean of 4.4+/-1.1 days in the laparotomy group (P<0.0001). Pregnancy outcomes were similar and uniformly good. CONCLUSION: Laparotomy can be avoided and pregnant patients managed safely by operative laparoscopy, with shorter hospital stays.     

A rare diagnosis for a pancreatic mass: splenosis

Splenosis, the autotransplantation of splenic tissue, has been designed to preserve organ functions after splenectomy. We present the first case of laparoscopic resection of a pancreatic splenosis, in a patient who had undergone a splenectomy 31 years before, complaining of abdominal pain and diarrhea. Abdominal computed tomography (CT) scan showed an enhancing hypervascular 3-cm solid mass in the body of the pancreas, mimicking a pancreatic cancer or a neuroendocrine tumor. A diagnostic laparoscopy was planned, and a 3-cm peripancreatic nodule with a long pedicle was visualized, with many nodules close to the tail of the pancreas and in the greater omentum. They were all resected, and the specimens obtained were immediately sent for frozen-section examination, which confirmed the diagnosis of heterotopic splenic tissue. Splenosis should be included in the differential diagnosis of the pancreatic masses in patients with previous splenic surgery. A hypervascular mass on CT scan should be regarded as an adenocarcinoma of the pancreas until proven otherwise. The possibility of a neuroendocrine tumor mandates an octreotide scan and gastrointestinal hormones dosage. In the unlikely event that all tests may produce equivocal results, a diagnostic laparoscopy is mandatory, in order to obtain an accurate histopathologic diagnosis.     

Thoracic splenosis: Case report of a symptomatic case

Thoracic splenosis is the autotransplantation of splenic tissue in the left thoracic cavity as a result of a splenic injury. This rare pathology is usually asymptomatic and may be discovered on incidental imaging, but the diagnosis often requires invasive procedures such as surgery in order to eliminate a neoplasic origin. We report a rare symptomatic case of a 39-year-old man presenting with chest pain and multiple nodules revealed on a computed tomography scan. The patient underwent a surgical exploration and the pathological studies concluded to a thoracic splenosis. Indeed, the previous medical history of the patient revealed a left thoraco-abdominal traumatism during childhood. The aim of this paper is to emphasize that the diagnosis can now be performed using only imaging techniques such as technetium-99 sulfur colloid or labelled heat-denatured red blood cell scintigraphy to avoid unnecessary invasive procedures including thoracotomy.     

Impact of diagnostic laparoscopy on the management of chronic pelvic pain

Background Diagnostic laparoscopy is a useful tool, especially when there is no definite anatomical abnormality visible on imaging modalities. We assess the role and clinical impact of diagnostic laparoscopy in the management of women with chronic pelvic pain. Methods Clinical data of 3,068 cases of diagnostic laparoscopy performed for chronic pelvic pain from June 1994 to August 2005 were analyzed. We compared the diagnoses after diagnostic laparoscopy and those after pelvic examination and imaging modalities such as ultrasound or computed tomography (CT), and we then checked the final pathologic diagnoses after operation. Results Pelvic endometriosis was the most common (60.2%) laparoscopic finding in patients with chronic pelvic pain in this study, followed by normal pelvic findings (21.2%) and pelvic congestion (13.0%). Diagnostic laparoscopy had an influence on correcting previous plans based on imaging modalities in 42.7% of patients such as discarding unnecessary procedures or introducing new diagnostic or therapeutic plans. There were 3 cases of major complications requiring immediate correction. Conclusions Diagnostic laparoscopy is a useful diagnostic tool for of women with chronic pelvic pain and can be used as a guideline for individualized treatment.     

Robotically assisted laparoscopic Roux-en-Y hepaticojejunostomy.

INTRODUCTION: This study evaluates the feasibility and safety of using robotically assisted laparoscopy to perform a Roux-en-Y hepaticojejunostomy. This new method was compared with the open and standard laparoscopic approaches. METHODS: Eighteen pigs underwent a needlescopic common bile duct ligation to create a jaundice model. Three to 5 days later, transabdominal ultrasound was performed, and the common bile duct diameter was documented. For the Roux-en-Y hepaticojejunostomy, the pigs were randomly assigned to the open group (n=6), standard laparoscopy group (n=6), or robotically assisted laparoscopy group (Zeus) (n=6). One surgeon performed all 3 approaches with 1 assistant. Operative times, techniques, and complication rates were documented. RESULTS: The open approach was faster in all instances. At the hepaticojejunostomy, no difference was noted between the groups with the total number of stitches used. The robot required fewer stitches and less time in the posterior wall of the hepaticojejunostomy (P=-0.0083 and P=0.02049, respectively). The hepaticojejunostomy time was similar for the laparoscopy and robotically assisted groups. CONCLUSION: Robotically assisted laparoscopic Roux-en-Y hepaticojejunostomy is a feasible procedure. When compared with standard laparoscopy, operating time is similar.     

Making the transition from standard gynecologic laparoscopy to robotic laparoscopy.

OBJECTIVES: To determine the feasibility of using a simple procedure, a bilateral tubal ligation, as a transition procedure when adopting robotic laparoscopy for gynecologic surgery. METHOD: To obtain robotic credentialing and gain experience with the robotic system, the surgeons first went through robotic training, then 4 women desiring permanent sterilization had robotically assisted laparoscopic bilateral tubal ligations performed, using the Parkland method. RESULTS: Total operating room time varied from 1 hour 25 minutes to 2 hours 31 minutes. Improvement in operating time for each surgeon was noted with each successive case. Best times in robotic cases were similar to those of standard laparoscopy. CONCLUSION: Robotically assisted laparoscopic tubal ligation using the Parkland method is a satisfactory procedure to provide transition for gynecologic surgeons and operating room personnel to gynecologic robotic surgery.     

Consider the diagnosis of splenosis for soft tissue masses long after any splenic injury

Splenosis represents the autotransplantation of splenic tissue after splenic trauma or surgery. Disruption of the splenic capsule causes fragments of splenic tissue to be seeded mainly throughout the peritoneal cavity, where they are characterized by diffusely scattered bluish implants. Extraperitoneal locations are very rare and mainly include the thoracic cavity after thoracoabdominal trauma with simultaneous splenic rupture and diaphragmatic laceration. We retrospectively identified all patients in the pathology registry with the diagnosis of splenosis between December 1974 and July 2003 at our urban teaching hospital. Data collected included presenting signs and symptoms, history, imaging studies, treatment, pathology, and outcome. Five cases of splenosis were identified and described. Location of the splenosis was intraperitoneal in two and intrahepatic, intrathoracic, and subcutaneous in one each. In these cases, there was an average interval of 29 years between splenic injury and diagnosis, and most were found incidentally. One of the cases was managed entirely laparoscopically and another thoracoscopically.     

Isolated Hepatic Splenosis: First Reported Case

Splenosis is the autotransplantation of splenic tissue, most commonly seen after traumatic splenic rupture and splenectomy. Post-traumatic splenosis is often considered a rare entity, but is probably underreported because of its asymptomatic nature. We describe the first reported case of splenosis presenting as a liver mass, indistinguishable from a liver tumor by standard preoperative evaluation. The pathophysiology, evaluation and management of splenosis is discussed as well as the decision to resect a benign appearing liver mass.