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1.
A. Sharma P. Dahiya R. Khullar V. Soni M. Baijal P. K. Chowbey 《The Indian journal of surgery》2012,74(1):13-21
Laparoscopic cholecystectomy is the gold standard for gallbladder removal and the most common laparoscopic procedure worldwide.
With the advent of laparoscopic surgery and its continuous development, the focus has shifted to ‘scarless’ surgery. In recent
times, the innovative technique of single-incision laparoscopic surgery (SILS) has been applied in gallbladder removal and
even more complex biliopancreatic procedures to further minimize the invasiveness of the surgery. Newer developments in laparoscopic
equipments and instrumentation have helped to further evolve this field of minimally invasive surgery. Literature search was
performed using the following online search engines: Google, Medline, PubMed, Cochrane, and the online Springer link library.
The terms used for the search were as follows: SILS, LESS, single-incision laparoscopic surgery, single-port laparoscopic
surgery, SILS cholecystectomy, and SILS pancreatic surgery. Articles that matched the search criteria were selected and extensively
reviewed. Moreover, pertinent information on instrumentation and technology for SILS and LESS was obtained by accessing websites
of manufacturers. Although SILS represents the search for an essentially scarless surgery, there is still not a widespread
use and uniformity of this procedure. SILS is performed either by single- or multiple-port technique. In the present article,
we present a review of the potential benefits, limitations, and risks of SILS in biliary and pancreatic diseases. There are
many studies showing benefits in cholecystectomy. A few case reports have also emerged about its feasibility in procedures
such as cystogastrostomy and limited pancreatic resection. Further research and development of this technique is needed to
arrive at a tangible conclusion about the perceived benefits of SILS. Randomized studies to compare SILS with traditional
laparoscopy are essential. 相似文献
2.
Evangelos C. Tsimoyiannis Konstantinos E. Tsimogiannis George Pappas-Gogos Charalampos Farantos Nikolaos Benetatos Paraskevi Mavridou Adamantia Manataki 《Surgical endoscopy》2010,24(8):1842-1848
Background
The attempt to further reduce operative trauma in laparoscopic cholecystectomy has led to new techniques such as natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS). These new techniques are considered to be painless procedures, but no published studies investigate the possibility of different pain scores in these new techniques versus classic laparoscopic cholecystectomy. In this randomized control study, we investigated pain scores in SILS cholecystectomy versus classic laparoscopic cholecystectomy. 相似文献3.
4.
Background
Single-incision laparoscopic surgery (SILS) is rapidly gaining popularity as the practical alternative to natural orifice transluminal endoscopic surgery (NOTES). Although SILS achieves essentially the same goal as NOTES (a nearly invisible scar in the umbilicus), it does not carry the significant potential risks of a transluminal approach. The SILS approach has been most commonly described for cholecystectomy and appendectomy. The authors describe a novel application for this approach in the placement of a feeding jejunostomy tube. The described application for this technique is the first to be reported. 相似文献5.
Stavros A. Antoniou George A. Antoniou Athanasios I. Antoniou Frank-Alexander Granderath 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2015,19(3)
Laparoscopic surgery has generated a revolution in operative medicine during the past few decades. Although strongly criticized during its early years, minimization of surgical trauma and the benefits of minimization to the patient have been brought to our attention through the efforts and vision of a few pioneers in the recent history of medicine. The German gynecologist Kurt Semm (1927–2003) transformed the use of laparoscopy for diagnostic purposes into a modern therapeutic surgical concept, having performed the first laparoscopic appendectomy, inspiring Erich Mühe and many other surgeons around the world to perform a wide spectrum of procedures by minimally invasive means. Laparoscopic cholecystectomy soon became the gold standard, and various laparoscopic procedures are now preferred over open approaches, in the light of emerging evidence that demonstrates less operative stress, reduced pain, and shorter convalescence. Natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS) may be considered further steps toward minimization of surgical trauma, although these methods have not yet been standardized. Laparoscopic surgery with the use of a robotic platform constitutes a promising field of investigation. New technologies are to be considered under the prism of the history of surgery; they seem to be a step toward further minimization of surgical trauma, but not definite therapeutic modalities. Patient safety and medical ethics must be the cornerstone of future investigation and implementation of new techniques. 相似文献
6.
Natural orifice translumenal endoscopic surgery (NOTES): dissection for the critical view of safety during transcolonic cholecystectomy 总被引:1,自引:0,他引:1
Edward D. Auyang Eric S. Hungness Khashayar Vaziri John A. Martin Nathaniel J. Soper 《Surgical endoscopy》2009,23(5):1117-1118
Background Natural orifice translumenal endoscopic surgery (NOTES), an emerging field in minimally invasive surgery, is driving the development
of new technology and techniques. The NOTES approach has several proposed benefits including potentially decreased abdominal
pain, wound infections, and hernia formation [1–4]. Cholecystectomy is one of the most commonly performed NOTES procedures to date [5–7]. To perform a safe cholecystectomy and reduce potential bile duct injuries, the cystic duct and artery must first be identified.
Establishing this critical view of safety before ligation and division has been shown to reduce bile duct injuries associated
with laparoscopic cholecystectomy [8]. This video shows that the critical view of safety can be attained with endoscopic dissection.
Methods In the porcine model, transcolonic peritoneal access is gained using an endoscopic needleknife and balloon dilator. Once orientation
is established, the gallbladder is retracted using percutaneous T-tags. The cystic duct and artery bundle are identified and
then meticulously dissected using endoscopic graspers, hook cautery, biopsy forceps, and scissors. The individual cystic duct
and artery are isolated and identified, establishing the critical view of safety. Endoscopic clip ligation and division are
then performed, and the gallbladder is dissected free.
Conclusions Dissection of the critical view of safety can be performed in a completely endoscopic fashion using appropriate instrumentation.
By achieving this critical view, the incidence of biliary injury during NOTES should be minimal and similar to the incidence
of biliary injury during laparoscopic surgery. While completing this procedure, we identified several remaining technical
limitations and deficiencies. Endoscopic retraction of tissue still is challenging with currently available instrumentation.
Hemostatic endoscopic clips are not currently available for cystic artery and duct ligation. With the development of such
instruments, cholecystectomy and other NOTES procedures will become technically more feasible.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. 相似文献
7.
Laparoscopic approaches have increasingly assumed a central role in the management of benign and malignant surgical diseases. While laparoscopy is less morbid than open surgery, it still requires several incisions, each > or =1-2 cm long. Each incision risks morbidity from bleeding, hernia and/or internal organ damage, and incrementally decreases cosmesis. An alternative to conventional laparoscopy is single-incision laparoscopic surgery (SILS), in which articulating or bent instrumentation with specialized multi-lumen ports is used. These technical innovations obviate the need to externally space trocars for triangulation, thus allowing the creation of a small, solitary portal of entry into the abdomen. Laboratory and early clinical series showed the feasibility as well as safe and successful completion of SILS. Natural-orifice transluminal endoscopic surgery (NOTES) is another exciting development in minimally invasive urology, but existing flexible endoscopes and instruments are limited in providing a platform for this form of advanced surgery, resulting in the slow adoption of NOTES. Future work is needed to improve existing instrumentation, increase clinical experience, assess the benefits of both surgical approaches, and explore other potential applications for these novel techniques. 相似文献
8.
Background
Laparoscopic cholecystectomy currently is the gold standard technique for gallbladder removal. The use of routine intraoperative cholangiography (IOC) is widely practiced during conventional four-port laparoscopic cholecystectomy (4PLC) to confirm biliary anatomy and allow for immediate management of unexpected choledocholithiasis. Single-incision laparoscopic surgery (SILS) offers a more aesthetic technique for gallbladder removal and has been reported by several groups. However, no series to date have included routine IOC without a separate incision. This study aimed to demonstrate the feasibility of the SILS technique for cholecystectomy with routine IOC (LCIOC) and common bile duct (CBD) exploration as needed via the umbilical port. 相似文献9.
This article discusses the safe exposure of intra-abdominal organs using laparoscopy and laparotomy. Newer methods of minimal access surgery including single incision laparoscopic surgery (SILS), and natural orifice transluminal endoscopic surgery (NOTES) are also discussed. Common abdominal incisions are illustrated. 相似文献
10.
This article discusses the safe exposure of intra-abdominal organs using laparoscopy and laparotomy. Newer methods of minimal access surgery including single incision laparoscopic surgery (SILS), and natural orifice transluminal endoscopic surgery (NOTES) are also discussed. Common abdominal incisions are illustrated. 相似文献
11.
Mintz Y Horgan S Savu MK Cullen J Chock A Ramamoorthy S Easter DW Talamini MA 《Surgical endoscopy》2008,22(8):1798-1802
Background The indications for natural orifice translumenal surgery (NOTES) are yet to be determined. Morbidly obese patients may be
one population that would benefit from this approach due to the elimination of wound complications and possibly a faster recovery.
As a bariatric restrictive procedure, sleeve gastrectomy could be one indication for NOTES. To test the feasibility of this
procedure with a NOTES approach, a pig model was used.
Methods Acute studies investigated five 40-kg farm pigs. The rectum was used as the port of entry to the peritoneal cavity, and the
stomach was manipulated endoluminally using a gastroscope. Vision was acquired through a 5-mm laparoscope introduced transabdominally
(i.e. via the hybrid technique). A 10-mm incision was made on the anterior wall of the rectum and dilated to accommodate a
12-mm trocar introduced through the rectal wall into the peritoneal cavity. The greater curvature of the stomach then was
divided and detached, starting from the antrum and proceeding to the esophagogastric junction using a laparoscopic stapler.
The sleeve gastrectomy was completed by dividing the short gastric vessels with an ultrasonic scalpel. The gastric pouch then
was removed through the rectal incision.
Results A NOTES gastric sleeve resection was successfully performed in all five pigs. The technique was developed, and feasibility
was determined. After resection, the gastric remnant was inflated, with no evidence of leakage. At autopsy, intact suture
lines were noted. Closure of the rectal incision was not attempted.
Conclusion A NOTES sleeve gastrectomy is feasible in porcine animal models. The rectal port of entry allows rigid laparoscopic instruments
to be introduced into the peritoneal cavity and enables performance of gastrointestinal procedures the same as in standard
laparoscopic surgery. Extra-long instruments are necessary for dissection and division of the stomach at the esophagogastric
junction and for accessing the short gastric vessels. 相似文献
12.
Maki Sugimoto 《Journal of Hepato-Biliary-Pancreatic Surgery》2009,16(3):247-248
Introduction Natural orifice translumenal endoscopic surgery (NOTES) has captured the interest of interventional endoscopists and may represent
the next stage of evolution of minimally invasive surgery. It provides the potential for performance of incisionless operations.
It is gaining momentum both in the animal laboratory and in human case reports. Developments in the field of NOTES have led
to the formation of the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) in 2006.
Materials and methods In this special issue, the current trends in NOTES in the field of hepatobiliary and pancreatic surgery are featured, including
NOTES cholecystectomy, hepatectomy splenectomy, pancreatic necrosectomy, and the future of NOTES. In this issue, we discuss
the potential benefits of these procedures in hepatobiliary and pancreatic surgery.
Conclusion We have just started the evaluation process for this new technology. The concept of NOTES is becoming established and is enormously
advantageous for the patient. Both the surgeon and gastroenterologist should contribute to developing NOTES in making use
of their specialties. 相似文献
13.
Roger A. de la Torre Shean Satgunam Mario P. Morales C. Liam Dwyer J. Stephen Scott 《Obesity surgery》2009,19(12):1707-1710
Background
The evolution of single-incision laparoscopic surgery (SILS) has no doubt been impacted by the decrease or elimination of incisions seen with natural orifice transluminal endoscopic surgery (NOTES). SILS upholds the principal advantages of minimal access surgery including shortened hospital stays, the potential for decreased postoperative pain, and cosmetically acceptable scars by reducing large or multiple incisions to a relatively small, single one. 相似文献14.
Chih-Kun Huang Jui-Chi Tsai Chi-Hsien Lo Jer-Yiing Houng Yaw-Sen Chen Shu-Ching Chi Po-Huang Lee 《Obesity surgery》2011,21(3):391-396
Background
Recently, single-incision laparoscopic surgery (SILS) has been used for bariatric procedures, and this surgery is considered a type of minimally invasive surgery. When SILS is performed via the transumbilical route, the resultant abdominal wound is hidden and the cosmetic outcome is better. However, because of the small angle of manipulation and difficulty in liver traction, this technique is not used to perform complex bariatric surgery. In this prospective study, we used our novel technique, which involves the use of a liver-suspension tape and umbilicoplasty of an omega-shaped incision (omega umbilicoplasty), to perform laparoscopic bariatric surgery via the single-incision transumbilical (SITU) approach. We then assessed the safety and effectiveness of our surgical technique. 相似文献15.
Background
Single-incision laparoscopic surgery (SILS) is one of the most recent developments in laparoscopic surgery. Having proven its effectiveness in cholecystectomy and appendectomy, the feasibility of SILS in more advanced surgery, such as hemicolectomy and low anterior resection, is now a point of discussion. 相似文献16.
Arun Nemani Ganesh Sankaranarayanan Jaisa S. Olasky Souheil Adra Kurt E. Roberts Lucian Panait Steven D. Schwaitzberg Daniel B. Jones Suvranu De 《Surgical endoscopy》2014,28(8):2443-2451
Background
A virtual reality-based simulator for natural orifice translumenal endoscopic surgery (NOTES) procedures may be used for training and discovery of new tools and procedures. Our previous study (Sankaranarayanan et al. in Surg Endosc 27:1607–1616, 2013) shows that developing such a simulator for the transvaginal cholecystectomy procedure using a rigid endoscope will have the most impact on the field. However, prior to developing such a simulator, a thorough task analysis is necessary to determine the most important phases, tasks, and subtasks of this procedure.Methods
19 rigid endoscope transvaginal hybrid NOTES cholecystectomy procedures and 11 traditional laparoscopic procedures have been recorded and de-identified prior to analysis. Hierarchical task analysis was conducted for the rigid endoscope transvaginal NOTES cholecystectomy. A time series analysis was conducted to evaluate the performance of the transvaginal NOTES and laparoscopic cholecystectomy procedures. Finally, a comparison of electrosurgery-based errors was performed by two independent qualified personnel.Results
The most time-consuming tasks for both laparoscopic and NOTES cholecystectomy are removing areolar and connective tissue surrounding the gallbladder, exposing Calot’s triangle, and dissecting the gallbladder off the liver bed with electrosurgery. There is a positive correlation of performance time between the removal of areolar and connective tissue and electrosurgery dissection tasks in NOTES (r = 0.415) and laparoscopic cholecystectomy (r = 0.684) with p < 0.10. During the electrosurgery task, the NOTES procedures had fewer errors related to lack of progress in gallbladder removal. Contrarily, laparoscopic procedures had fewer errors due to the instrument being out of the camera view.Conclusion
A thorough task analysis and video-based quantification of NOTES cholecystectomy has identified the most time-consuming tasks. A comparison of the surgical errors during electrosurgery gallbladder dissection establishes that the NOTES procedure, while still new, is not inferior to the established laparoscopic procedure. 相似文献17.
Single Incision Laparoscopic Splenectomy: The First Two Cases 总被引:3,自引:0,他引:3
Aims Single incision laparoscopic procedures are presumed to be as a step towards pure natural orifice transluminal endoscopic
surgery. However, loss of requirement of any perforation of visceral organ and endoscopic equipment make this technique more
popular and easily performable. Herein we report two splenectomy cases where single incision surgery (SILS) technique was
performed.
Cases Two females of 28 years old and 22 years old with the diagnoses of ITP underwent single incision laparoscopic splenectomy.
Preoperatively with the receival of steroid therapy, thrombocyte counts were 92,000/m3. A 2-cm umbilical incision was used for the placement of three (5 mm) trocars. One 5-mm videoscope (30°) and roticulated
laparoscopic dissector/grasper were the main tools during surgical procedure. Spleen was removed with a plastic removal bag
through the umbilical trocar incision. The whole procedure ended in 110 and 150 min in both cases without any problem.
Results Two patients were discharged on third and second postoperative days with the thrombocyte counts of 174,000/m3 and 400,000/m3, respectively.
Conclusion Although there were some procedures performed with single incision technique like cholecystectomy, prostatectomy, and partial
nephrectomy, as far as we are concerned this is the first report about laparoscopic splenectomy performed with single incision
surgery technique. 相似文献
18.
Auyang ED Vaziri K Volckmann E Martin JA Soper NJ Hungness ES 《Surgical endoscopy》2008,22(10):2277-2278
Background Natural orifice translumenal endoscopic surgery (NOTES) is an emerging field in minimally invasive surgery that is driving
the development of new technology and techniques [1–4]. Before NOTES gains widespread popularity, it must be proven to be
a safe and efficacious technique [5]. There are several proposed benefits to the NOTES approach, including potentially decreased
abdominal pain, wound infections, and hernia formation.
Methods Currently, most investigational NOTES procedures are performed using a single transgastric, transcolonic, or transvaginal
access point to the abdomen. In order to provide greater range of motion and freedom of movement, a rendezvous procedure using
simultaneous transgastric and transcolonic approaches was used to perform a small bowel resection. This video demonstrates
a successful NOTES hybrid small bowel resection with the use of two laparoscopic ports in a cadaveric model. A powered stapling
device attached to a flexible shaft is introduced transcolonically and facilitates division and re-anastamosis of the small
bowel. A dual-channel operating endoscope introduced transgastrically allows for precise dissection and creation of enterotomies
necessary for the small bowel resection.
Conclusions While technically challenging, NOTES hybrid small bowel resection can be accomplished with specially designed instrumentation
utilizing the rendezvous technique. There are several technical limitations preventing this procedure from being completed
in a pure NOTES fashion. A safe method of creating blind enterotomies will be needed to eliminate laparoscopic visualization
of the enterotomy sites. Adequate endoscopic exposure and retraction of tissue is still difficult and currently requires percutaneous
adjuncts. New closure devices will be needed for safe and reliable NOTES enterotomy closure. With the development of such
instruments, this, as well as other NOTES procedures, will become more technically feasible.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. 相似文献
19.
Chow A Purkayastha S Dosanjh D Sarvanandan R Ahmed I Paraskeva P 《Surgical innovation》2012,19(3):327-334
Introduction. Although traditional quality measures such as morbidity and mortality outcomes still pay an important role in the assessment of health care quality, greater emphasis is now being placed on patient-reported outcome measures such as patient satisfaction. This area is especially important for novel surgical technologies such as single-incision laparoscopic surgery (SILS) and natural orifice translumenal endoscopic surgery (NOTES). These new innovations are able to minimize or abolish surgical scarring and are likely to have most benefit in the area of patient satisfaction as opposed to traditional outcome measures. Therefore, it is important to gauge the public opinion regarding these new techniques, as continued public interest can help support further research in this up-and-coming field. Methods. A questionnaire study was carried out with members of the general public. Questions were asked regarding preference for surgical techniques, including open surgery, laparoscopic surgery, NOTES, and SILS, in the situation of acute appendicitis. Results. The questionnaire was completed by 1006 individuals. Results indicated that an established safety profile was necessary before the introduction of these new techniques into general practice. The concept of scarless surgery did appeal to the public, with SILS being the treatment of choice in the scenario of acute appendicitis. Discussion. The patient perspective on health care is an important aspect of health care quality assessment. This is especially important with regard to the development of novel surgical techniques such as SILS and NOTES. With these techniques, the potential benefits are most likely to be found in the realms of reduced scarring and improved patient satisfaction. The findings from this study demonstrate the public's interest in these new techniques and thus give further support to continued research and development in this area. 相似文献
20.
Natural orifice transluminal endoscopic surgery (NOTES) is considered the new frontier for minimally invasive surgery. NOTES
procedures such as peritoneoscopy, splenectomy, and cholecystectomy in animal models have been described. The aim of our experiment
was to determine the feasibility and technical aspects of a new endoluminal surgical procedure. After approval from Columbia’s
IACUC, a transvaginal laparoscopically assisted endoscopic cholecystectomy was performed on four 30 kg Yorkshire pigs. The
first step was to insert a 1.5 cm endoscope into the vagina under direct laparoscopic vision. Then the gallbladder was reached
and, with the help of a laparoscopic grasper to hold up the gallbladder, the operation was performed. At the end of the procedure
the gallbladder was snared out through the vagina attached to the endoscope. There were no intraoperative complications such
as bleeding, common bile duct or endo-abdominal organ damage. Total operative time ranged between 110 and 155 min. Based on
our experience in the porcine model, we believe that a transvaginal endoscopic cholecystectomy is feasible in humans.
Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. 相似文献