Pfannenstiel incision for intact specimen extraction in laparoscopic transperitoneal radical nephrectomy: a longitudinal prospective outcome study

OBJECTIVES:To evaluate the intra- and postoperative outcomes of patients undergoing laparoscopic radical nephrectomy with intact specimen extraction through a Pfannenstiel transverse suprapubic incision.METHODS:Prospective follow-up of 26 laparoscopic transperitoneal radical nephrectomies for suspected renal tumors in which the kidneys were extracted via a Pfannenstiel lower abdominal transverse incision.RESULTS:The mean operating time was 152.3 (80–255) minutes, and the mean blood loss was 90 (20–300) ml. The mean extraction time was 20.4 (12–35) minutes. The mean weight of the removed specimen was 631.5 (190–1505) grams, and the mean longest diameter of the extracted specimen was 17.4 (9–25) cm. The mean extraction incision size was 10.7 (7–16) cm. No open surgical conversions were necessary. Pain control was excellent, with minimal intravenous morphine equivalent narcotic use by patients: 15.7 (0–31) mg in the recovery room, 33.8 (0–127) mg on the first postoperative day and 8.7 (0–60) mg in the first week after discharge. The patients experienced a short duration to full ambulation and normal dietary intake. Postoperative follow-up visits were recorded for at least six months. The patients reported a high cosmetic satisfaction rate of 97.7% (60–100). No late postoperative complications were observed related to the extraction site.CONCLUSIONS:The operative specimen can be extracted via a low transverse Pfannenstiel incision during radical laparoscopic nephrectomy. This incision ensures the extraction of large specimens while preserving the aesthetic and functional advantages of laparoscopy without increasing the cancer risk. The absence of muscle cutting maintains the integrity of the abdominal wall and elicits minimal pain. No postoperative incisional hernias or keloid formations were observed.     

Percutaneous needle decompression during laparoscopic gastric surgery: a simple alternative to nasogastric decompression

Laparoscopic gastric surgeries are routinely performed with use of a nasogastric tube to decompress the upper gastrointestinal tract. A distended upper gastrointestinal tract can complicate successful laparoscopic gastric surgery as the distention compromises not only the visual field but also the laparoscopic manipulation of the stomach. Since nasogastric intubation is not without risks, we have attempted laparoscopic-assisted gastric cancer surgeries without nasogastric tubes. In this article we describe a simple method of aspirating gastric contents using a 9 cm long 19-gauge needle inserted percutaneously during laparoscopic-assisted gastrectomy. First, a 9 cm long 19-gauge disposable needle was introduced through the abdominal wall. This needle was then introduced to the stomach through the anterior wall and the stomach gases and fluids were aspirated by connecting the needle to suction. Thus, a collapsed upper gastrointestinal tract was easily obtained. We performed this procedure instead of nasogastric decompression on twenty-two patients with gastric cancer who underwent laparoscopic-assisted distal subtotal gastrectomy with lymph node dissection. The results were good with only one patient experiencing wound infection (4.5%) and one patient with postoperative acalculus cholecystitis (4.5%). There were no patients with either intraabdominal infection or anastomotic leakage and none of the patients needed postoperative nasogastric decompression, except the patient who experienced acaculus cholecystitis. Percutaneous needle aspiration is a very simple and efficient technique with little risk of postoperative complications. It can be used as an alternative to nasogastric tube decompression of the gastrointestinal tract for laparoscopic-assisted gastrectomy.     

Advances in laparoscopic techniques in pelvic reconstructive surgery for prolapse and incontinence

Advances in minimally invasive surgery have led to an increasing adoption of laparoscopic techniques in pelvic reconstructive surgery and treatment of urinary incontinence. Our review of recent developments aims to identify and evaluate the evidence for use of these procedures.     

1例腹腔镜辅助下造口旁疝修补并文献复习

目的　分析造口旁疝的类型以及手术处理方式。 方法　通过病例报道并文献分析历年来造口旁疝患者手术方案的报道。 结果　在回顾报道的1例腹腔镜辅助下造口旁疝修补的患者病例中,患者造口旁疝类型为EHS分类Ⅳ型,采用Sugarbaker术式修补造口旁疝,修补术后3 d进食,5 d即出院。 结论　腹腔镜造口旁疝修补具有并发症较低,住院时间缩短等优势,但仍需更多高质量数据支持。     

Comparison of laparoscopic and laparotomic surgery for the treatment of peritoneal inclusion cyst

Objectives: Peritoneal inclusion cyst (PIC) is defined as a fluid-filled mesothelial-lined cysts of the pelvis and it is most frequently encountered in women of reproductive age. The treatment options are observation, hormonal management, imaging-guided aspiration, image-guided sclerotherapy and surgical excision. The objective of this study is to compare between the laparoscopic and laparotomic surgery for the treatment of PIC.Methods: Thirty-five patients with laparoscopy and forty-eight patients with laparotomy were included in the study. We compared the perioperative and postoperative data, the complications and the recurrence between the two groups.Results: There was a significantly reduced mean length of the hospital stay, estimated blood loss and complication rate in the laparoscopic group as compared to that of the laparotomic group (P=0.037, P=0.047 and P=0.037 respectively). There was also no statistical difference of recurrence rate between thelaparoscopic and laparotomic groups on the Cox proportional hazards model (p=0.209).Conclusion: Our study showed that laparoscopy was superior to the laparotomy for the mean estimated blood loss, the mean length of the hospital stay and the complication rate except for the recurrence rate.     

腹腔镜与传统腹股沟切口手术治疗低位腹腔型隐睾效果比较

目的 比较腹腔镜与传统腹股沟切口手术治疗低位腹腔型隐睾的疗效。方法 回顾性分析2014年1月—2018年6月安徽医科大学附属安庆医院收治的小儿低位腹腔型隐睾116例(127侧)患儿的临床资料。患儿年龄8个月~7岁[(2.74±1.89)岁];右侧57例,左侧48例,双侧11例。116例患儿按手术方式不同分为传统手术组、腹腔镜组,对两组手术时间、术中出血量、术后并发症进行对比分析。结果 (1)腹腔镜组:均顺利完成手术,无一例中转开腹;术中发现13例合并对侧鞘状突未闭(19.40%),同时行对侧鞘状突高位结扎;单侧手术时间(53.62±4.44)min,术中出血量(6.57±1.05)mL;双侧手术时间(75.22±4.11)min,术中出血量(7.86±0.35)mL。所有患儿切口一期愈合,无明显手术瘢痕;术后阴囊血肿1例,予相应处理后好转。本组患儿术后随访3~24个月,平均15个月。随访期间所有患儿睾丸发育良好,无睾丸回缩或萎缩,无腹股沟疝及鞘膜积液发生。(2)传统手术组:均顺利完成手术,单侧手术时间(44.32±3.22)min,术中出血量(8.50±1.50)mL;双侧手术时间(68.70±5.16)min,术中出血量(10.23±0.71)mL。术后切口感染2例,阴囊血肿8例,均予相应处理后好转。患儿术后均获随访3~24个月,平均14个月。随访期间2例睾丸回缩至腹股沟区,2例睾丸萎缩,余病例睾丸血供良好,无睾丸萎缩或回缩;2例患儿因对侧新发腹股沟疝行腹腔镜疝囊高位结扎术。腹腔镜组术中出血量、并发症发生率低于传统手术组,但手术时间长于传统手术组,差异均有统计学意义(P值均＜0.05)。结论 腹腔镜手术治疗低位腹腔型隐睾,具有术中出血少、术后并发症少、切口美观等特点,术后睾丸回缩、睾丸萎缩等严重并发症减少,可作为手术治疗小儿低位腹腔型隐睾的常规术式。     

Specimen adequacy evaluation in gynecologic cytopathology: Current laboratory practice in the college of american pathologists interlaboratory comparison program and tentative guidelines for future practice

Routine specimen adequacy evaluation, as advocated by The Bethesda System (TBS), can play an important role in improving the sensitivity and accuracy of cervical cytopathology screening. The effectiveness of this measure, however, has been limited by the lack of uniform criteria for adequacy. Practice parameters are now emerging, through TBS development of tentative criteria and interlaboratory comparison of adequacy practices. This study reviews 1 nationwide responses to surveys of laboratory practices in the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology (CAP PAP); 2 the definitions of adequacy based on TBS; and 3 the results of implementation of these criteria in a private independent laboratory, university hospital laboratory, and private nonprofit hospital laboratory. In the initial CAP PAP survey in 1990, 35% of responding laboratories routinely reported specimen adequacy, increasing to 66% in 1991 and 85% in 1992. Interlaboratory variations in adequacy practices were observed, however, underscoring the need for consensus criteria. The experience in the authors' laboratories indicates that TBS criteria can serve as a sound guideline. Effective implementation of adequacy assessment in the individual laboratory requires careful attention to ensuring the quality of adequacy ratings, correlating clinical and prior laboratory information, issuing clear and concise reports, and giving recommendations judiciously. Through interlaboratory comparison and consistent intralaboratory emphasis on specimen adequacy, greater uniformity of adequacy assessment can be achieved, and adequacy evaluation can achieve its promise of improving the quality of cervical cytopathology.     

Image-guided,stereotactic perforator flap surgery: a prospective comparison of current techniques and review of the literature

Background  Image-guided stereotaxy is a recent advancement in imaging technology, allowing computer guidance to aid surgical planning and accuracy. Despite the use of multiple techniques for patient registration in several surgical specialities, only fiducial marker registration has been described for use in soft tissue reconstructive surgery. The current study comprises an evaluation of the current techniques available for this purpose. Methods  A cohort of nine consecutive patients planned for elective free flaps were recruited, with the first five patients (four for the abdominal wall and one anterolateral thigh donor site) undergoing fiducial marker registration with a variable number of fiducial markers in order to determine the optimal number of fiducial markers to be used. Four subsequent patients undergoing perforator flap surgery underwent registration using three available registration modalities: fiducial marker registration, surface matching pointer/landmark and surface matching laser registration. Results  For the abdominal wall, registration was not able to be achieved with five fiducial markers, and was successfully achieved in all cases with either six or seven fiducial markers. For the anterolateral thigh, registration was achieved with either nine or ten markers. The four patients who also underwent surface-landmark registration and ‘Z-touch’ laser surface matching registration all failed the registration process. Conclusion  Stereotactic navigation is a useful adjunct to the preoperative imaging of perforator flaps. Fiducial marker registration was able to be achieved in all cases, can be successfully achieved with a low and predictable number of fiducial markers, is highly accurate, and was the only reliable registration process in our experience. W. M. Rozen and A. Buckland are equal first authors. Ethical Approval : Institutional Ethical Approval was obtained through Melbourne Health HREC #2006.231.     

The use of follicle flushing during oocyte retrieval in assisted reproductive technologies: a systematic review and meta-analysis

STUDY QUESTION: Does follicular flushing during assisted reproductive technologies (ART) improve the number of oocytes retrieved? SUMMARY ANSWER: Follicular flushing during ART does not result in a greater number of oocytes in normal responders. WHAT IS KNOWN ALREADY: Despite limited evidence supporting the use of follicular flushing, it continues to be a common procedure in many ART clinics. Prior studies have provided conflicting results regarding the routine use of flushing during oocyte retrieval. STUDY DESIGN, SIZE, DURATION: Systematic review and meta-analysis of 518 patients who participated in 6 randomized trials over 20 years. PARTICIPANTS/MATERIALS, SETTING, METHODS: Literature searches were conducted to retrieve randomized controlled trials on follicle or ovarian flushing in ART. Databases searched included PubMed, EMBASE, Web of Science and the Cochrane Database of Clinical Trials (CENTRAL). Six trials that included 518 subjects matched the inclusion criteria. Studies included were limited to trials that were published, randomized trials comparing oocyte retrieval with a single-lumen pick-up needle versus follicle flushing after direct aspiration with a multi-channel oocyte pick-up needle in ART patients. MAIN RESULTS AND THE ROLE OF CHANCE: In each of the trials, measures of the oocyte yield (oocytes retrieved divided by follicles aspirated), total oocytes retrieved, fertilization or pregnancy were not different when comparing direct aspiration with follicle flushing. Four trials reported a higher operative time with follicle flushing. Results of the meta-analysis indicated no significant differences in the oocytes retrieved [weighted mean difference: 0.07, 95% confidence interval (CI): -0.13 to 0.29] or the oocyte yield (odds ratio: 1.06, 95% CI: 0.95-1.18) between the non-flushing and flushing groups. LIMITATIONS, REASONS FOR CAUTION: All trials featured an open label design and the majority of patients in this meta-analysis were normal responders. The applications of these results to poor responders, patients undergoing natural cycle ART or minimal stimulation ART should be made with caution. WIDER IMPLICATIONS OF THE FINDINGS: Follicle flushing does not improve ART outcomes in normal-responding patients and should not be performed. This meta-analysis should solidify this recommendation as it includes the largest trial published on the subject and is consistent with a recently published Cochrane review. STUDY FUNDING/COMPETING INTEREST(S): This work was supported, in part, by the Program in Reproductive and Adult Endocrinology, NICHD, NIH, Bethesda, MD. The authors have no competing interests to declare. TRIAL REGISTRATION NUMBER: N/A.     

Development and application of immunocytochemical staining techniques: a review

Since the field of immunocytochemistry was pioneered almost half a century ago, over 30 different immunostaining methods have been developed. Most laboratory investigators, however, are aware of only a few of the more popular techniques. This article, therefore, reviews and places in historical perspective many of the less common methodologies. A discussion of the progression of immunostaining methodology from purely immunologic techniques (employing only antigens, antibodies, and free enzymatic preparations) to procedures that use non-immunologic substances (such as avidin, biotin, and protein A) is presented. Basic principles of immunostaining, including specimen preparation, fixation, control procedures, interpretation, and problems unique to cytopathology, are also discussed. Schematic diagrams that illustrate the nature and arrangement of the immunochemical reagents employed in most of these techniques are provided in order to demonstrate how various materials can be combined to create a desired staining effect.     

Hysteroscopic myomectomy: a comprehensive review of surgical techniques

Hysteroscopic myomectomy currently represents the standard minimally invasive surgical procedure for treating submucous fibroids, with abnormal uterine bleeding and reproductive issues being the most common indications. While hysteroscopic myomectomy has been shown to be safe and effective in the control of menstrual disorders, its effects on infertility remain unclear. The review provides a comprehensive survey of all hysteroscopic techniques used to treat fibroids found completely within the uterine cavity (G0) and those with intramural development (G1 and G2). MEDLINE and EMBASE searches identified published papers from 1970. The choice of the technique mostly depends on the intramural extension of the fibroid, as well as on personal experience and available equipment. 'Resectoscopic slicing' still represents the 'gold standard' technique for treating fibroids G0, even if several other effective techniques including ablation by neodymium-yttrium-aluminum-garnet laser, morcellation and office myomectomy have been proposed. On the other hand, the present review clearly indicates that there is still no single technique proven to be unequivocally superior for treating fibroids G1 and G2. Most techniques aim at the transformation of an intramural fibroid into a totally intracavitary lesion, thus avoiding a deep cut into the myometrium. At present, the 'cold loop' technique seems to represent the best option as it allows a safe and complete removal of such fibroids in just one surgical procedure, while respecting the surrounding healthy myometrium.     

Information processing and PTSD: a review of the empirical literature

This article reviews a series of studies that have utilized information-processing paradigms with posttraumatic stress disorder (PTSD) populations. The review suggests that pretrauma measures of intelligence (IQ) are predictive of the development of PTSD symptoms following trauma. There is also evidence of impaired performance on standardized tests of memory (independent of IQ) in PTSD populations. PTSD populations are found to exhibit deficits in memory function that may be due to hippocampus damage secondary to excessive neuroendocrine responses to conditioned stimuli. In addition, individuals with PTSD evince an attentional bias towards trauma-related stimuli at postrecognition stages of information processing. The review also includes that there is insufficient evidence to either support, or reject, the theoretical proposition that PTSD patients are sensitive to global valence effects at the earliest stages of information processing relative to traumatized non-PTSD populations. Finally, there is some evidence to suggest that the processes associated with autobiographical memory in PTSD populations are similar to those seen in depression. The implications of these findings for the behavioral and cognitive treatment of PTSD are discussed. Directions for future research with such paradigms are also discussed in light of contemporary information processing theories of PTSD.     

The Maillard reaction and its control during food processing. The potential of emerging technologies

The Maillard reaction between reducing sugars and amino acids is a common reaction in foods which undergo thermal processing. Desired consequences like the formation of flavor and brown color of some cooked foods but also the destruction of essential amino acids and the production of anti-nutritive compounds require the consideration of the Maillard reaction and relevant mechanisms for its control. This paper aims to exemplify the recent advances in food processing with regard to the controllability of heat-induced changes in the food quality. Firstly, improved thermal technologies, such as ohmic heating, which allows direct heating of the product and overcoming the heat transfer limitations of conventional thermal processing are presented in terms of their applicability to reduce the thermal exposure during food preservation. Secondly, non-thermal technologies such as high hydrostatic pressure and pulsed electric fields and their ability to extend the shelf life of food products without the application of heat, thus also preserving the quality attributes of the food, will be discussed. Finally, an innovative method for the removal of Maillard reaction substrates in food raw materials by the application of pulsed electric field cell disintegration and extraction as well as enzymatic conversion is presented in order to demonstrate the potential of the combination of processes to control the occurrence of the Maillard reaction in food processing.     

Evolution of renal cyst to renal carcinoma: a case report and review of literature

Background: Renal cyst is a common benign disease which is rare to progress from simple renal cyst to renal cell carcinoma. Case presentation: A 62-year-old woman who suffered a simple renal cyst for over 20 years complained intermittent lumbar in recent 2 years. At her latest admission, the cyst lesion displayed enhancement in the cystic wall by CT scan and cystic to partially solid change by ultrasound, so we did a partial nephrectomy and found that the cystic lesion had become a cyst-solid transition. The pathology turned out to be renal clear cell carcinoma. Conclusions: Although the canceration of a renal cyst is a small probability event, patients with a long history of a cyst, especially those with symptoms, need to seek for medical treatment in time, and if necessary, lesion biopsy or resection may be under consideration.     

Electronic portal imaging devices: a review and historical perspective of contemporary technologies and research

A review of electronic portal imaging devices (EPIDs) used in external beam, megavoltage radiation therapy is presented. The review consists of a brief introduction to the definition, role and clinical significance of portal imaging, along with a discussion of radiotherapy film systems and the motivations for EPIDs. This is followed by a summary of the challenges and constraints inherent to portal imaging along with a concise, historical review of the technologies that have been explored and developed. The paper then examines, in greater depth, the two first-generation technologies that have found widespread clinical use starting from the late 1980s. This is followed by a broad overview of the physics, operation, properties and advantages of active matrix, flat-panel, megavoltage imagers, presently being commercially introduced to clinical environments or expected to be introduced in the future. Finally, a survey of contemporary research efforts focused on improving portal imaging performance by addressing various weaknesses in existing commercial systems is presented.     

肾脏原发性淋巴瘤临床病理分析

目的 :对肾脏原发性淋巴瘤的临床病理特点、组织学起源、诊断及鉴别诊断等进行初步探讨。方法 :对 1例手术切除的肾脏原发性淋巴瘤标本做HE染色和S P免疫组化染色 ,光镜观察。结果 :左肾脏上极见一 7 5cm× 6cm× 4cm界限不清的肿块。镜下见在肾实质内有弥漫大片淋巴瘤细胞浸润。瘤细胞核呈略不规则形 ,染色质呈凝块状。免疫表型肿瘤细胞表达LCA、L2 6、IgA弥漫阳性。病理诊断为弥漫小核裂细胞型。 结论 :肾脏原发性淋巴瘤甚为罕见。结合文献 ,其主要诊断依据为 :①肾脏内有弥漫大片形态一致的淋巴瘤细胞浸润 ;②肿瘤主要位于肾脏实质内 ,肾包膜及其周围脂肪组织内亦可见瘤细胞浸润 ;③患者浅表淋巴结不肿大 ,CT检查未见胸、腹腔内有肿大的淋巴结 ;④骨髓穿刺涂片和活检未见异常细胞。⑤发现肾脏淋巴瘤至少 3月后未发现其它部位的淋巴瘤。发生于肾脏的淋巴瘤应与肾脏的肉瘤样癌、Wilm瘤、慢性炎症等相鉴别。其主要治疗方法为肾切除加化疗和 (或 )放疗。     

Registration and geometric modelling of the spine during scoliosis surgery: a comparison study of different preoperative reconstruction techniques and intra-operative tracking systems

During scoliosis instrumentation surgery, it is difficult for surgeons fully to track vertebral motion in 3D, because only the posterior elements of the spine are exposed. Different intra-operative modelling approaches are evaluated using a registration technique that matches intra-operative measurements with a 3D preoperative model of the spine. Two tracking systems (magnetic digitiser and mechanical arm) and two pre-operative reconstruction techniques (multiplanar radiography and CT scan) are sequentially combined to build four intra-operative models. Their accuracy is assessed by comparison with the pre-operative geometry. The most minimally invasive approach (multiplanar radiographic reconstruction and magnetic digitiser) has an accuracy of 5.9 mm in translation, and errors on vertebral rotations are 4.4^o, 6.7^o and 5.0^o in the frontal, sagittal and transverse planes, respectively. With CT scan reconstruction, the accuracy is significantly increased by about 2 mm in translation and as much as 4.5^o for vertebral rotations in the sagittal plane. For the mechanical arm, the accuracy is increased by less than 1 mm in translation and 1^o for vertebral rotations. CT scan is the most accurate reconstruction technique, but its use for long spinal segments is generally not allowed because of the high radiation exposure. Multiplanar radiographic reconstruction may be an alternative solution for long spinal segments when great accuracy is not necessary. Considering the small increase in accuracy and its awkwardness, the use of the mechanical arm may not be appropriate during surgical manoeuvres. Department of Automated Production Engineering, école de Technologie Supérieure 1100 Notre-Dame West, Montréal, Québec, Canada, H3C 1K3     

Registration and geometric modelling of the spine during scoliosis surgery: a comparison study of different pre-operative reconstruction techniques and intra-operative tracking systems

During scoliosis instrumentation surgery, it is difficult for surgeons fully to track vertebral motion in 3D, because only the posterior elements of the spine are exposed. Different intra-operative modelling approaches are evaluated using a registration technique that matches intra-operative measurements with a 3D pre-operative model of the spine. Two tracking systems (magnetic digitiser and mechanical arm) and two pre-operative reconstruction techniques (multiplanar radiography and CT scan) are sequentially combined to build four intra-operative models. Their accuracy is assessed by comparison with the pre-operative geometry. The most minimally invasive approach (multiplanar radiographic reconstruction and magnetic digitiser) has an accuracy of 5.9 mm in translation, and errors on vertebral rotations are 4.4 degrees, 6.7 degrees and 5.0 degrees in the frontal, sagittal and transverse planes, respectively. With CT scan reconstruction, the accuracy is significantly increased by about 2 mm in translation and as much as 4.5 degrees for vertebral rotations in the sagittal plane. For the mechanical arm, the accuracy is increased by less than 1 mm in translation and 1 degree for vertebral rotations. CT scan is the most accurate reconstruction technique, but its use for long spinal segments is generally not allowed because of the high radiation exposure. Multiplanar radiographic reconstruction may be an alternative solution for long spinal segments when great accuracy is not necessary. Considering the small increase in accuracy and its awkwardness, the use of the mechanical arm may not be appropriate during surgical manoeuvres.