Laparoscopic grasper for intramedullary biopsy: a technique to improve tissue sampling

Reaming samples are usually sent for histological testing to establish or confirm the primary source of malignancy while intramedullary nailing is performed for impending or established pathological fracture of the long bones. However, this conventional technique of sampling does not always yield accurate results. Herein, we introduce a technique for intramedullary biopsy using a laparoscopic grasper under image intensifier guidance. This novel technique was applied in three cases, and the tissue samples obtained successfully established or confirmed the primary source of malignancy. In comparison, reaming samples obtained via the conventional method showed negative findings in one case and tumour cells that were of poor sample quality in another case. We opine that this new technique is an effective and reproducible method that could improve tissue sampling and achieve a more reliable histological diagnosis.     

腹腔镜胆囊切除术与微创保胆手术治疗胆囊结石比较分析

目的对照观察腹腔镜胆囊切除术与微创下保胆手术治疗胆囊结石临床疗效、患者手术感受、术后并发症和治疗费用以及术后结石复发情况的差别。方法临床选用20例微创下保胆手术患者作为观察组,随机选取相同时间段20例使用腹腔镜胆囊切除术患者作为对照组,观察两组患者临床疗效、患者手术感受、术后并发症和治疗费用以及术后结石复发情况。结果微创保胆手术组患者临床疗效和手术感受与腹腔镜胆囊切除术对照组患者基本一致,两组患者在手术时间、费用、术后结石复发比例上有明显差异。结论腹腔镜胆囊切除术与微创保胆手术治疗胆囊结石患者均可达到很好的治疗效果,在有条件的医院可以逐步开展,但是目前不适宜最基层的外科临床。     

Laparoscopic surgery in the management of intussusception in children

Summary

The technique and outcome of minimally invasive laparoscopic treatment of various forms of intussusception in children after ineffective attempts at conservative treatment are described. 118 patients, aged from 1.5 months to 11 years were analysed. The suggested scheme of surgical treatment using a laparoscopic technique was successful in 82 patients (69.5%), and conversion to an open procedure occurred in 36 (30.5%). There was no mortality or intraoperative complications in our series. It is concluded that practically every form of intussusception without bowel necrosis, including the most complex forms, can be radically disinvaginated using modern video-laparoscopic equipment and atraumatic instruments.     

经脐单孔腹腔镜术在泌尿外科的应用(附52例报告)

目的:探讨经脐单孔腹腔镜技术在泌尿外科应用的疗效及安全性。方法:回顾性分析52例应用经脐单孔腹腔镜技术行肾上腺切除术、肾囊肿去顶减压术、无功能肾切除术、输尿管切开取石术、精索静脉高位结扎及前列腺根治性切除术,其中肾上腺切除7例,左侧4例,右侧3例;肾囊肿切除24例,左侧12例,右侧9例,双侧3例;无功能肾切除9例,左侧5例,右侧4例;输尿管切开取石7例,左侧3例,右侧4例;精索静脉曲张高位结扎3例,均为左侧;前列腺根治性切除2例。分别记录各种手术的手术时间、术中出血量、术后住院天数、术后下床活动时间、术后拔引流管时间、术后镇痛药使用情况、是否增加辅助孔及术后并发症等情况。结果:52例手术均获得成功,手术时间15~275min;估计术中出血量20~300ml,均无输血。术后24~48小时均下床活动。术后住院天数3~15d,术后拔引流管时间2~7d。4例术后24小时内应用镇痛药,5例术中增加1~2个5mm辅助孔,3例术后切口发生脂肪液化,5例术后低热,经治疗后均治愈出院。结论:经脐单孔腹腔镜术在泌尿外科中的应用安全有效,且术后脐部几乎无瘢痕,美容效果佳,术后患者恢复快。随着手术实践的增加,经脐单孔腹腔镜术必将在泌尿外科微创手术中得以进一步推广。     

Hybrid approach with laparoscopic wall-inversion surgery and single-incision intragastric surgery for intraluminal gastrointestinal stromal tumor: A case report

Laparoscopic wedge resection (LWR) for intraluminal gastrointestinal stromal tumor (GIST) leads to excessive resection of normal gastric wall. We report a case of GIST around the cardia successfully treated with full-thickness partial resection using a hybrid approach of laparoscopic surgery and single-incision intragastric surgery (SIIGS). A 69-year-old woman had a 5 cm intraluminal GIST at the posterior wall around the cardia. Submucosal injection of glycerin and indigo carmine was performed with transoral endoscopy. Circumferential seromuscular incision followed by placement of seromuscular sutures to invert the lesion into the stomach was performed under laparoscopy. By SIIGS, resection of the inverted mucosa and retrieval of the tumor were completed. A hybrid approach consisting of laparoscopic wall-inversion surgery and SIIGS was useful for intraluminal GIST and may expand the indications for laparoscopic wall-inversion surgery by removing size limitations.     

Robot-assisted laparoscopic repair of perineal hernia after abdominoperineal resection: A case report and review of the literature

IntroductionPerineal hernia is a protrusion of the pelvic floor containing intra-abdominal viscera. The occurrence of postoperative perineal hernia after abdominoperineal resection (APR) is rare, but reports have indicated a recent increase in occurrence following surgical treatment for rectal cancer. This has been attributed to a shift towards extralevator abdominoperineal resection, together with more frequent and long-term use of neoadjuvant therapy.Presentation of caseHere, we report the case of a patient who underwent APR for cancer. Twenty months postoperative, a perineal hernia was detected. The patient was electively scheduled for surgery. Robot-assisted laparoscopy was performed using the da Vinci Surgical System. The perineal hernia was repaired by primary closure with the placement of Symbotex Composite mesh as reinforcement for the pelvic floor. The surgery was performed without any adverse events, and the patient was discharged the day after surgery. Clinical follow-up proceeded at the designated time intervals without difficulties.DiscussionRecurrence rates of perineal hernia remain high, and surgeons face numerous challenges related to poor view, suturing and mesh placement in the deep pelvis. Numerous approaches have been described, but there is still no consensus as to the optimal repair technique for perineal hernia.ConclusionSymptomatic perineal hernias can feasibly be repaired with robot-assisted laparoscopy. Furthermore, suturing and mesh placement require less effort with the robot approach when compared to the open and laparoscopic approaches. These promising findings are demonstrated in the included video.     

Health Care Professionals’ Assessment of Patient Discomfort After Abdominal Surgery

PurposeThe purpose of this study was to classify elements of patients' discomfort in the resuscitation room after open or laparoscopic abdominal surgery as per health care professionals’ perceptions.DesignA prospective cross-sectional study at a tertiary hospital in Spain.MethodsResuscitation room nurses administered the Postoperative Discomfort Inventory to physicians and nurses with >1 year experience working closely with patients who had undergone abdominal surgery, asking them to score nine items related to patients' discomfort in the first 8 hours after surgery on an 11-point scale (0 = absent to 10 = very severe). Interobserver agreement among proxy reporters was measured with the Spearman's ρ; correlations >0.35 was considered adequate agreement.FindingsOf 125 eligible professionals, 116 (93%) participated (63 [54%] nurses and 53 [46%] physicians; mean age, 38 ± 12 years; 86 [74%] women). Professionals' perception of discomfort differed significantly between patients undergoing open surgery and those undergoing laparoscopic surgery; after open surgery, the most common types were pain (7.1 ± 1.8), movement restriction (7 ± 1.75), and dry mouth (6.6 ± 2.6), whereas after laparoscopic surgery, the most common types were dry mouth (5.85 ± 2.8), abdominal bloating (5.3 ± 2.5), and pain (5 ± 2.2). The Spearman's ρ correlations were inadequate for all items except for dry mouth in open surgery (r = 0.40).ConclusionsPain, movement restriction, abdominal bloating, and dry mouth were the main causes of discomfort. Our findings highlight the need to be vigilant for all manifestations of discomfort after abdominal surgery to enable timely treatment.