Laparoscopic entry techniques.
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ABSTRACT:
SUBMITTER: Ahmad G
PROVIDER: S-EPMC6353066 | biostudies-literature | 2019 Jan
REPOSITORIES: biostudies-literature
Publications
Laparoscopic entry techniques.
Ahmad Gaity G Baker Jade J Finnerty John J Phillips Kevin K Watson Andrew A
The Cochrane database of systematic reviews 20190118
<h4>Background</h4>Laparoscopy is a common procedure in many surgical specialties. Complications arising from laparoscopy are often related to initial entry into the abdomen. Life-threatening complications include injury to viscera (e.g. bowel, bladder) or to vasculature (e.g. major abdominal and anterior abdominal wall vessels). No clear consensus has been reached as to the optimal method of laparoscopic entry into the peritoneal cavity.<h4>Objectives</h4>To evaluate the benefits and risks of d ...[more]
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Project description:BackgroundDespite a debate spanning two decades, no consensus has been achieved about the safest laparoscopic entry technique.ObjectivesTo update the evidence about the safety of the main different laparoscopic entry techniques.Search strategySix electronic databases were searched from inception to February 2021.Selection criteriaAll randomized controlled trials (RCTs) comparing different laparoscopic entry techniques were included.Data collection and analysisEntry-related complications and total time for entry were compared among the different methods of entry calculating pooled odds ratios (ORs) and mean differences, with 95% confidence intervals (CIs); P < 0.05 was considered significant.Main resultsIn total, 25 RCTs (6950 patients) were included. Complications considered were vascular, visceral and omental injury, failed entry, extraperitoneal insufflation, bleeding and infection at the trocar site bleeding, and incisional hernia. Compared to direct trocar, the OR for Veress needle was significantly higher for omental injury (OR 3.65, P < 0.001), for failed entry (OR 4.19, P < 0.001), and for extraperitoneal insufflation (OR 5.29, P < 0.001). Compared to the open method, the OR for Veress needle was significantly higher for omental injury (OR 4.93, P = 0.001), for failed entry (OR 2.99, P < 0.001), for extraperitoneal insufflation (OR 4.77; P = 0.04), and for incisional hernia. Compared to the open method, the OR for direct trocar was significantly lower for visceral injury (OR 0.17, P = 0.002) and for trocar site infection (OR 0.27, P = 0.001).ConclusionsThe direct trocar method may be preferred over Veress needle and open methods as a laparoscopic entry technique since it appears associated to a lower risk of complications.
| S-EPMC10087714 | biostudies-literature
Project description:ObjectiveTo demonstrate techniques of laparoscopic surgery while all elective procedures are suspended.DesignStepwise demonstration of key skills required when gardening with minimal access techniques.SettingGynecologist residence in self-isolation, Manchester, United Kingdom.InterventionsOwing to the coronavirus disease pandemic, elective operations are currently suspended in the United Kingdom. In addition, there have been concerns regarding the safety of laparoscopic surgery and risk of transmission of the coronavirus disease [1,2]. As a result, laparoscopic surgeons are at risk of skill deterioration, and it is uncertain whether this may have an impact on patient safety when lockdown measures are de-escalated.Combining gardening, one of the major pastimes during the lockdown period, and minimal access surgical skills, this video demonstrates the different ways minimal access surgery may be applied to horticulture.In the first described technique, what the author believes to be hedge bindweed (Calystegia sepium) was excised using a grasper and a tripolar cutting device (Fig. 1). For obvious reasons diathermy is not available within the home environment, but the retractable cutting blade was used to efficiently slice through the stems required for weed removal. The disadvantage of this technique is clearly that the unwanted species is likely to regrow in 12 months.In the second described technique, dandelions (genus Taraxacum) (Fig. 2), which are native to Eurasia and North America, were excised at the flowering stage, thereby effectively preventing asexual reproduction by apomixis. The technique similarly uses the retractable blade of the tripolar cutting device.The third technique demonstrates harvesting of an unknown species using a soil dissection technique. To facilitate complete removal of the plant and to reduce the risk of recurrence, the roots are carefully dissected out using blunt dissection. As with many techniques, patience is of paramount importance.Last, ensuring hydration of plants is crucial to their early stage of development. Laparoscopic watering techniques are usually simplified when an irrigation and suction device is employed. However, within a low-resource setting a slow process of "cup feeding" is required and requires meticulous dexterity (Fig. 3). Unfortunately, during this demonstration a common complication of a loss of instrument occurred, but the subject was luckily successfully hydrated.ConclusionWhile a lockdown remains in place, many gynecologists are not able to maintain their laparoscopic surgical skills. It is important to combine activities of daily living with minimal access training to maintain our physical and mental well-being. More research is clearly needed in the area of minimal access horticulture to expand this new and exciting subspecialty.
| S-EPMC7229468 | biostudies-literature
Project description: Not available
| S-EPMC8116004 | biostudies-literature
Project description:The surgical approach to giant paraesophageal hernia repair has evolved considerably, from an open approach to minimally invasive approaches. Laparoscopic and robotic-assisted approaches to giant paraesophageal hernia have been considered safe and are associated with less morbidity and mortality. Limited data exist comparing the efficacy between laparoscopic and robotic-assisted giant paraesophageal hernia repairs, but the benefits of robotic surgery include superior optics and freedom of motion, thus allowing surgeons to accomplish the key points in a successful repair without compromising patient outcomes.
| S-EPMC8689581 | biostudies-literature
Project description:Laparoscopic hysterectomy is a commonly performed procedure. However, one high-risk complication is vaginal cuff dehiscence. Currently, there is no standardization regarding thread material or suturing technique for vaginal cuff closure. Therefore, this study aimed to compare extracorporeal and intracorporeal suturing techniques for vaginal cuff closure using a pelvic trainer model. Eighteen experts in laparoscopic surgery performed vaginal cuff closures with interrupted sutures using intracorporeal knotting, extracorporeal knotting and continuous, unidirectional barbed sutures. While using an artificial tissue suturing pad in a pelvic trainer, experts performed vaginal cuff closure using each technique according to block randomization. Task completion time, tension resistance, and the number of errors were recorded. After completing the exercises, participants answered a questionnaire concerning the suturing techniques and their performance. Experts completed suturing more quickly (p < 0.001, p < 0.001, respectively) and with improved tension resistance (p < 0.001, p < 0.001) when using barbed suturing compared to intracorporeal and extracorporeal knotting. Furthermore, the intracorporeal knotting technique was performed faster (p = 0.04) and achieved greater tension resistance (p = 0.023) compared to extracorporeal knotting. The number of laparoscopic surgeries performed per year was positively correlated with vaginal cuff closure duration (p = 0.007). Barbed suturing was a time-saving technique with improved tension resistance for vaginal cuff closure.
| S-EPMC10901882 | biostudies-literature
Project description:ObjectiveThe aim of the present study was to determine which of the umbilical entry routes for intraperitoneal access has a better cosmetic result.Material and methodsThis was a prospective study (Canadian Task Force classification II-1). In total, 105 patients who underwent laparoscopic surgery were included. A vertical or transverse umbilical incision is appropriately made for the trocar to be inserted, and an infraumbilical, supraumbilical, or transumbilical route was preferred for initial intraperitoneal access. Demographic data of patients, body mass indices, entry point of the trocars (infraumbilical-transumbilical-supraumbilical), type of incision (vertical-transverse), duration of the operation, and scar properties at postoperative week 12 were prospectively collected and analyzed. The Vancouver scar scale was used to evaluate the cosmetic results.ResultsCosmetic results did not differ statistically between the transumbilical-infraumbilical-supraumbilical groups. The variables, such as vascularity, height, and total score, of the Vancouver scar scale were significantly higher in patients who had transverse incisions. There was no statistically significant effect of using a Veress needle with the cosmetic results. There was no statistically significant correlation between age, gravida, body mass indices, skin thickness, time of entry, duration of the operation, and cosmetic results in terms of vascularity, height, and total score.ConclusionDuring laparoscopic surgery, each patient should be assessed individually for the satisfaction of the patient and, thereby, of the surgeon in terms of cosmetic outcomes. Vertical incision offers superior cosmetic effects than transverse incision. Further research is required to define long-term scar-related outcomes of the laparoscopic intraperitoneal access techniques.
| S-EPMC6340657 | biostudies-literature
Project description:IntroductionPain management is an integral part of Enhanced Recovery After Surgery (ERAS) following laparoscopic colonic resection. A variety of regional and neuraxial techniques were proposed, but their efficacy is still controversial. This systematic review evaluates published evidence on analgesic techniques and their impact on postoperative analgesia and recovery for laparoscopic colonic surgery patients.MethodsWe conducted bibliographic research on May 10, 2021, through PubMed, Cochrane database, and Google scholar. We retained meta-analysis and randomized clinical trials. We graded the strength of clinical data and subsequent recommendations according to the Oxford Centre for Evidence-Based Medicine.ResultsTwelve studies were included. Thoracic epidural analgesia improved postoperative analgesia and bowel function following laparoscopic colectomy. However, it lengthens the hospital stay. Transversus abdominis plane block was as effective as thoracic epidural analgesia concerning pain control but with better postoperative recovery and lower length of hospital stay. Moreover, Lidocaine intravenous infusion improved postoperative pain management and recovery; Quadratus lumborum block provided similar postoperative analgesia and recovery. Finally, wound infiltration reduced postoperative pain without improving recovery of bowel function, and it could be proposed as an alternative to thoracic epidural analgesia.ConclusionsSeveral analgesic techniques have been investigated. We found that abdominal wall blocks were as effective as thoracic epidural analgesia for pain management but with lower hospital stay and better recovery. We registered this review on PROSPERO (ID: CRD42021279228).
| S-EPMC8648937 | biostudies-literature
Project description: Not available
| S-EPMC7817329 | biostudies-literature
Project description:PurposeThis study reports economic evaluation of mesh fixation in open and laparoscopic hernia repair from a prospective real-world cohort study, using cost-effectiveness analysis (CEA) and cost-utility analysis (CUA).MethodsA prospective real-world cohort study was conducted in two university-based hospitals in Thailand from November 2018 to 2019. Patient data on hernia features, operative approaches, clinical outcomes, associated cost data, and quality of life were collected. Models were used to determine each group's treatment effect, potential outcome means, and average treatment effects. An incremental cost-effectiveness ratio was used to evaluate the incremental risk of hernia recurrences.ResultsThe 261 patients in this study were divided into six groups: laparoscopic with tack (LT, n = 47), glue (LG, n = 26), and self-gripping mesh (LSG, n = 30), and open with suture (OS, n = 117), glue (OG, n = 18), and self-gripping mesh (OSG, n = 23). Hernia recurrence was most common in LSG. The mean utility score was highest in OG and OSG (both 0.99). Treatment costs were generally higher for laparoscopic than open procedures. The cost-effectiveness plane for utility and hernia recurrence identified LSG as least cost effective. Cost-effectiveness acceptability curves identified OG as having the highest probability of being cost effective at willingness to pay levels between $0 and $3,300, followed by OSG.ConclusionGiven the similarity of hernia recurrence among all major procedures, the cost of surgery may impact the decision. According to our findings, open hernia repair with adhesive or self-gripping mesh appears most cost-effective.
| S-EPMC9450344 | biostudies-literature
Project description:IntroductionLaparoscopic liver resection of segment seven (LLR-S7) is a technically challenging procedure due to its anatomical location and difficult accessibility. Herein, we present our experience with LLR-S7, and demonstrate a literature review regarding surgical techniques.Presentation of caseA 28-year-old female was diagnosed with rectosigmoid cancer and synchronous liver metastases at the segment three (S3) and S7, which were treated with laparoscopic procedure. After the completely mobilization of the right lobe, the Glissonean pedicle of S7 (G7) was intrahepatically transected. The right hepatic vein was exposed to identify the venous branch of S7 (V7). Finally the liver parenchyma between RHV and dissection line was divided.DiscussionVarious laparoscopic approaches for S7 have been reported including the Glissonian approach from the hilum, the intrahepatic Glissonean approach, the caudate lobe first approach, and the lateral approach from intercostal ports. To perform LLR-S7 safely, it is important to understand the advantage of each technique including the trocar placement and approaches to S7 by laparoscopy.ConclusionWe present our experience of LLR-S7 for the tumor located at the top of S7, successfully performed with the intrahepatic Glissonean approach. LLR-S7 can be performed safely with advanced laparoscopic techniques and sufficient knowledge on various approaches for S7.
| S-EPMC7369466 | biostudies-literature