Journal of Laparoendoscopic & Advanced Surgical Techniques (J LAPAROENDOSC ADV S )

Publisher: Mary Ann Liebert


A bimonthly peer-reviewed journal for practicing surgeons on the surgical techniques that encompass laparoscopy, endoscopy, and advanced surgical technology in all surgical disciplines. It is the first journal to focus on these techniques both in general surgery and in areas of specialization which include gastroenterology, gynecology, ENT, and cardiovascular and thoracic surgery.

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    Journal of laparoendoscopic & advanced surgical techniques. Part A, Journal of laparoendoscopic and advanced surgical techniques
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    Journal / Magazine / Newspaper, Internet Resource

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Mary Ann Liebert

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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Laparoscopic liver resection (LLR) is proposed as an alternative to open liver resection (OLR) for treatment of liver tumors. The aim of this study was to compare the surgical and oncological outcomes of LLR versus OLR in benign and malignant solid liver tumors. Study Design: In this case-matched study, charts of 497 patients with liver lesions who had LLR or OLR in our center were retrospectively reviewed. Among them, 54 consecutive patients with benign or malignant solid liver tumors who had LLR were matched with a similar number of patients with OLR based on the pathology and extent of liver resection. Additionally, the surgical and oncological outcomes such as operating room time, amount of blood transfusion requirement, free resection margin rate, length of hospital stay, complication rate, perioperative mortality, and survival were compared between the two groups. Results: Demographics, pathological characteristics of the tumor, and extent of liver resection were similar between the two groups. Twenty-nine (54%) patients in each group had malignant lesions. There were no statistically significant differences between the two groups in terms of operating room time, amount of blood transfusion requirement, free resection margin, or postoperative complication rate or survival. However, hospital stay was significantly shorter in the laparoscopic group (5.9 versus 9 days, P=.006). Although no perioperative mortality was observed in patients with benign tumors, among the patients with malignant tumors, 2 died perioperatively in each group. Conclusions: Our results in accordance with previous studies demonstrated that although the oncological outcomes of LLR and OLR were comparable, LLR patients had a shorter hospital stay.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2013;
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    ABSTRACT: PURPOSE: As the interest in minimal invasive surgery has turned to single-site access surgery, single-incision laparoscopic surgery (SILS) is becoming popular. Recently limited numbers of pediatric SILS series have been published. SILS needs nonconventional three-lumen ports and articulated working instruments. However, it is possible to perform single-port laparoscopic cholecystectomy using a single conventional port and conventional working instruments. We herein present our preliminary experience with cholecystectomy conducted with single-port incisionless-intracorporeal conventional equipment-endoscopic surgery. SUBJECTS AND METHODS: During December 2009-October 2012, 27 patients (12 boys, 15 girls) underwent single-port incisionless-intracorporeal conventional equipment-endoscopic cholecystectomy. A 10-mm 0° scope with a parallel eye piece and an integrated 6-mm working channel is inserted through an 11-mm "conventional umbilical port." Conventional working instruments were introduced through the integrated working channel. The fundus of the gallbladder is hung with a transabdominal sling suture. The infundibulum is retracted laterally to expose the triangle of Calot with a second transabdominal sling suture. Then the cystic duct and the artery are dissected and clipped separately. The gallbladder is dissected from the liver bed with monopolar cautery and extracted through the umbilicus. RESULTS: The patients were 5-17 years of age (mean, 10.7±4.6 years). Cholecystectomy was performed through a single port in 23 patients. A second port insertion was necessary in 4 patients. No preoperative or postoperative complications were encountered. Mean operating time was 74.3±13 minutes. CONCLUSIONS: Single-port incisionless-intracorporeal conventional equipment-endoscopic cholecystectomy is feasible in pediatric patients with reasonable operating times. It is a safe, cheap, and highly minimal invasive procedure with excellent cosmetic results.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 07/2013; 23(8):732-728.
  • Journal of Laparoendoscopic & Advanced Surgical Techniques 01/2013;
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    ABSTRACT: Abstract Objective: What is the impact of the omental wadding technique on decreasing the incidence of recurrence after laparoscopic decortication of the symptomatic simple renal cyst? This is the question we are trying to answer through this study. Patients and Methods: This is a cohort study of 14 consecutive patients who underwent transperitoneal laparoscopic decortication of a symptomatic simple renal cyst with the omental wadding technique between November 2007 and November 2011. The indication for surgery was for relief of pain in all cases. Pain was assessed preoperatively and at 1 month and every 6 months postoperatively using a pain numerical rating scale. Only simple cysts (Bosniak I and II) more than 10 cm in their greatest dimension were included in this study. Patients with complicated cysts (Bosniak III and IV) and those with cysts less than 10 cm in their greatest dimension were excluded from this study. Patients were 7 men and 7 women with a mean age of 47 years (range, 35-63 years), and the mean body mass index was 27 kg/m(2). Laparoscopic decortication was the primary treatment in 11 cases and the secondary treatment in 3 cases after sclerotherapy. We used the omental wadding technique to try to fill the cavity after decortication to decrease the incidence of recurrence with simple laparoscopic decortication reported in other series. We reviewed the preoperative and postoperative data. Results: The operation was successfully completed laparoscopically in all cases with a mean operative time of 97 minutes without major perioperative complications. Hospital stay was 2.4 days (range, 2-4 days). All cases improved significantly after operation in a mean follow-up of 1.5 years. Using this technique, we did not have any recurrence after surgery. Conclusions: Laparoscopic decortication with omental wadding is helpful to decrease the incidence of simple renal cyst recurrence after laparoscopic decortication.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 10/2012;
  • Journal of Laparoendoscopic & Advanced Surgical Techniques 07/2012;
  • Journal of Laparoendoscopic & Advanced Surgical Techniques 08/2011;
  • Journal of Laparoendoscopic & Advanced Surgical Techniques 06/2011; 21(5):393.
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    ABSTRACT: Ureteropelvic junction (UPJ) obstruction is associated with complex anatomic problems, such as pelvic kidneys, giant hydronephrosis, crossed fused ectopia with L-shaped kidneys, and poses a real challenge in management. In this paper, we describe simple laparoscopic techniques for the management of these cases of atypical and complex UPJ obstruction. From 2004 to 2008, 9 cases of UPJ obstruction with atypical anatomic problems were operated on laparoscopically at PGIMER (Chandigarh, India). The different surgical procedures performed lap-aroscopically were pyelovesicostomy (5 cases), ureterocalicostomy (1 case), calicovesicostomy (1 case), heminephrectomy (1 case), and ureteropyelostomy (1 case) as per the merits of each case. The four-port technique was followed for pyelovesicostomy, calicovesicostomy, and ureterocalicostomy (two 10-mm ports, one each at the umbilicus and lateral border of the ipsilateral rectus, and two 5-mm ports, one each at the lateral border of the contralateral rectus and midway between the umbilicus and symphysis pubis). Pyelovesicostomy and calicovesicostomy were stented with a suprapubically placed Foley catheter. Mean operating time was 140 minutes, with an average intraoperative blood loss of 50 mL. There were no intraoperative complications. The patients recovered well from the surgery. Postoperative nephrostograms confirmed anastomotic patency and good drainage. On follow-up, patients are asymptomatic with normal renal functions. Patients with calicovesicostomy and pyelovesicostomy were advised double voiding, and they need to be on long-term, perhaps lifelong, follow-up. In pelvic kidneys with UPJ obstruction and in select cases of giant hydronephrotic kidneys, anastomosis of the bladder with the most dependent part of the pelvicalyceal system ensures adequate drainage. Ureterocalicostomy is the choice of treatment in cases of UPJ obstruction with an intrarenal pelvis where calicovesicostomy is not feasible. Laparoscopic performance of these procedures is feasible and simple.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2009; 19(4):521-8.
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    ABSTRACT: Laparoscopic surgery is considered to induce less peritoneal trauma than conventional surgery. The peritoneal plasmin system is important in the processes of peritoneal healing and adhesion formation. The present study assessed the peritoneal fibrinolytic response to laparoscopic and conventional colonic surgery. Twenty-four patients scheduled for a right colonic resection were enrolled in the trial. Twelve underwent conventional surgery and 12 were operated laparoscopically. Biopsies of the parietal peritoneum were taken at standardized moments during the procedure. Tissue concentrations of tissue-type plasminogen activator (tPA) and its specific activity (tPA-activity), urokinase-type plasminogen activator (uPA), and plasminogen activator inhibitor type 1 (PAI-1) were measured, using commercial assays. After mobilization of the colon, peritoneal levels of tPA antigen and activity were significantly higher in the laparoscopic group (p < 0.005) due to a decrease in the conventional group (p < 0.05). At the end of the procedure, the concentrations of tPA antigen and activity significantly (p < 0.05) decreased in the laparoscopic group to levels comparable with the conventional group. Neither uPA antigen nor PAI-1 antigen changed throughout the procedures. Both conventional and laparoscopic surgery inflict a decrease in tPA antigen and its specific activity. Peritoneal hypofibrinolysis initiates more rapidly during conventional, compared to laparoscopic, surgery, but at the conclusion of the surgery, the effect was the same.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2009; 19(4):489-93.
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    ABSTRACT: Repair of groin and ventral hernias are among the technically difficult endoscopic procedures where the role of laparoscopic surgery is fast emerging. We have designed a laparoscopic simulator trainer box for hernia surgery, which closely mimics the complex endoscopic procedure, and good results can be achieved by training on these trainer boxes. The endotrainer box was self-designed to repair bilateral groin hernia, and an incisional hernia, such that it can be used for multiple repairs. Forty candidates were trained with the trainer box for 2 days over two hernia training programs, and an objective assessment of the result was done by global and task-specific scoring for transabdominal preperitoneal (TAPP) and intraperitoneal onlay mesh (IPOM) repair of groin and incisional hernia, respectively. There was a significant improvement in the global (10.15 on day 1 and 12.85 on day 2) and task-specific score for TAPP (3.55 on day 1 and 5.83 on day 2) and IPOM repair (4.4 on day 1 and 6.4 on day 2). Cheaper endotrainer boxes can be self-designed for complex endoscopic surgeries such as hernia repair. The training with these trainer boxes under the supervision of experienced surgeons shows good results and can be used for surgical residents and practicing surgeons who are exposed to basic laparoscopic skills.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2009; 19(4):535-40.
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    ABSTRACT: Natural orifice transluminal endoscopic surgery (NOTES) was introduced to reduce scars and the surgical trauma. The feasibility of this technique in children is unknown. Our study was designed to determine the feasibility of various procedures via a transurethral-assisted approach in an animal model. Specially designed Aesculap-Braun (Tuttlingen, Germany) instruments and Endo-Ligasure (Valleylab, Boulder, CO) were used in 12 female piglets (mean weight, 15.2 kg; range, 14-17). A modified 12-mm device, including a 0-degree optic and a working channel, was used for the umbilical approach and for CO(2) insufflation (8 mm Hg, flow 5L/min). A 3-mm trocar, including a 2-mm optic, was introduced via the urethra and the urinary bladder dome into the abdominal cavity. The end-point of the study was the feasibility of nephroureterectomy (n = 8) and bilateral tuboovariectomy (n = 4). All nephroureterectomies and bilateral tuboovariectomies were performed successfully. Closure of the urinary bladder was safely performed with Endoloops (Ethicon Endosurgery, Cincinnati, OH) via the umbilical "two in one system." Intracorporal suturing, knotting, and placement of Endoclips (Ethicon Endosurgery) during nephrectomy were time-consuming due to the restricted motion of the two in one system. The use of a vessel-sealing device allowed a safe, fast, and easy nephroureterectomy. Modifications of instruments and approaches are mandatory for NOTES and must be tested in animal models before being used in infants and children. We showed that nephroureterectomy and tuboovariectomy can be performed safely via a transurethral and umbilical approach in female piglets. The use of vessel-sealing devices is essential in two in one systems with limited view and range of motion.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2009; 19(4):581-7.
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    ABSTRACT: Bleeding from esophagogastric varices is an importment complication of portal hypertension. Recently, significant progress in laparoscopic technology has enabled the devascularization of the lower esophagus and upper stomach in a less invasive way. In this article, we report our preliminary experience with laparoscopic splenectomy and periesophagogastric devascularization by endoligature and its effectiveness for bleeding varices with hypersplenism in children. Six children with bleeding portal hypertension and developed severe thrombocytopenia and/or leukopenia underwent laparoscopic splenectomy and selective pericardial devascularization by using silk endoligature combined with a Harmonic Scalpel (Ethicon Endosurgery, Cincinnati, OH). The patients included 5 males and 1 female, who ranged in age from 8 to 17 years. After a massive splenectomy was performed, we devascularized the periesophagogastric collateral vessels and perforating veins of the upper stomach to the level of the incisura angularis and the lower esophagus 5 or 6 cm away from the esophagocardia junction. The stem of the gastric coronary vein and paraesophageal collateral veins were not dissected in order to reserve portal blood flow toward the azygous shunt. All the procedures were completed successfully under a whole laparoscope. The operative time ranged from 180 to 270 minutes. Intraoperative blood loss was estimated to be from 80 to 200 mL. None of the patients required a blood transfusion. There were no significant complications either intra- operatively or postoperatively, and all patients had returned to usual activity by 5 days. Postoperative platelet count and white blood cell count increased in individual patients. The data were statistically significant (p = 0.006 and 0.002, respectively). During a postoperative follow-up period of 8-40 months, all children were asymptomatic, with improved growth and hematology and no rebleeding, sepsis, or encephalopathy. Laparoscopic massive splenectomy with selective periesophagogastric devascularization is a feasible, effective, and safe surgical procedure and has all the benefits of minimally invasive surgery. It offers a new alternative modality for children with bleeding portal hypertension and hypersplenism.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2009; 19(4):545-50.
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    ABSTRACT: Light-weight, low-profile, and high-resolution head-mounted displays (HMDs) now allow personalized viewing, of a laparoscopic image. The advantages include unobstructed viewing, regardless of position at the operating table, and the possibility to customize the image (i.e., enhanced reality, picture-in-picture, etc.). The bright image display allows use in daylight surroundings and the low profile of the HMD provides adequate peripheral vision. Theoretic disadvantages include reliance for all on the same image capture and anticues (i.e., reality disconnect) when the projected image remains static, despite changes in head position. This can lead to discomfort and even nausea. We have developed a prototype of interactive laparoscopic image display that allows hands-free control of the displayed image by changes in spatial orientation of the operator's head. The prototype consists of an HMD, a spatial orientation device, and computer software to enable hands-free panning and zooming of a video-endoscopic image display. The spatial orientation device uses magnetic fields created by a transmitter and receiver, each containing three orthogonal coils. The transmitter coils are efficiently driven, using USB power only, by a newly developed circuit, each at a unique frequency. The HMD-mounted receiver system links to a commercially available PC-interface PCI-bus sound card (M-Audiocard Delta 44; Avid Technology, Tewksbury, MA). Analog signals at the receiver are filtered, amplified, and converted to digital signals, which are processed to control the image display. The prototype uses a proprietary static fish-eye lens and software for the distortion-free reconstitution of any portion of the captured image. Left-right and up-down motions of the head (and HMD) produce real-time panning of the displayed image. Motion of the head toward, or away from, the transmitter causes real-time zooming in or out, respectively, of the displayed image. This prototype of the interactive HMD allows hands-free, intuitive control of the laparoscopic field, independent of the captured image.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2009; 19(4):595-8.
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    ABSTRACT: Minimally invasive approaches are beginning to be employed in the management of pediatric patients with intussusception who fail radiographic reduction. Successful laparoscopic reduction has been demonstrated, but the utility of laparoscopy, for more complex cases, is less well documented. Therefore, we reviewed our experience with laparoscopy in patients with radiographically irreducible intussusception to document the safety and effectiveness of this approach. We conducted a retrospective review of all of the patients who had a radiographically irreducible intussusception treated via the laparoscopic approach at a single institution from 1998 to 2008. Means are expressed +/- standard deviation. A total of 22 patients were identified, with an average age of 2.9 +/- 3.0 years. Average length of stay was 2.67 +/- 1.5 days (median, 2). Sixteen (73%) of the 22 patients were male. There were 19 ileocecal and 3 small bowel intussusceptions. Twenty patients (91%) were able to be managed entirely laparoscopically or via extension of the umbilical incision, while 2 necessitated conversion, using a right-lower quadrant incision. Nine patients had an extension of the umbilical incision; 7 of these underwent a bowel resection. Ten patients (46%) had a bowel resection, of which 5 were an ileocecectomy and 5 were segmental small bowel resection. There were a total of 9 patients with a pathologic lead point, 5 patients with lymphoid hyperplasia, and 4 with Meckel's diverticula. We conclude that laparoscopy is a reasonable approach to pediatric intussusception, even in the event when bowel resection is necessary.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2009; 19(4):563-5.
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    ABSTRACT: The laparoscopic repair offers clear advantages in recurrent inguinal hernias after open herniorrhaphy. Less clear is the role of laparoscopy for recurrences after previous laparoscopic inguinal herniorrhaphies. In this paper, we present our experience with both laparoscopic and open inguinal hernia repair of laparoscopic recurrences. All patients who had undergone repair of recurrences after previous laparoscopic hernia repair from July 2004 to July 2007 were included in this study. Charts were reviewed for all these patients. Six patients were diagnosed with 7 recurrent inguinal hernias after laparoscopic repairs. All the initial laparoscopic repairs, except for one, were total preperitoneal (TEP) with the placement of lightweight polypropylene mesh. The average time from the initial repair to the diagnosis of recurrence was 20 months (range 3-84). Four of the 7 recurrences were treated with a laparoscopic approach. The other three recurrences were repaired in an open fashion as per the preoperative plan. In 2 of the laparoscopic cases, the peritoneal flap was not able to cover the mesh, so a tissue-separating mesh with fibrin sealant was utilized to cover the myopectineal orifice. No intra- or postoperative complications were recorded. There were no recurrences at an average follow-up of 14 months (range, 11-17). Laparoscopic repair can be offered to those patients with a recurrence after a previous laparoscopic repair. Further studies comparing laparoscopic repair versus open repair of recurrences after laparoscopic inguinal hernia repair will be helpful in defining the best approach when encountering these recurrences.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2009; 19(4):475-8.
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    ABSTRACT: In this article, we describe a new technique for performing a laparoscopic-assisted hepatectomy, using a self-designed abdominal wall-lifting systems. We used this system for 5 patients; 2 were left lateral segmentectomy, 1 was S6 segmentectomy, and 1 was S8 wedge resection, and the other was an extended left hepatectomy. This procedure can minimize the length of the wound, while avoiding the lethal complications associated with the pneumoperitonium. This device and technique can also provide a bridge for young or less-experienced surgeons to be familiar with advanced laparoscopic surgery from open surgery. Also, the patients under such an operation were found to have fast postoperation recovery and short hospital stay.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2009; 19(4):541-4.
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    ABSTRACT: Before the 1980s, ureteric stones were managed by open ureterolithotomy. Since the introduction of shock-wave lithotripsy (SWL) and ureteroscopy, the use of an open surgical approach for the removal of ureteric stones has rapidly declined. Open surgery, which is currently being replicated by laparoscopic techniques, is generally indicated for failed endourologic procedures, particularly in centers that do not have flexible ureteroscopy or laser lithotripter, and in patients with larger stones. Considering this, we conducted a retrospective study to compare the different modalities for the management of midureteric calculi of more than 1.5 cm. Between August 2000 and July 2005, a total of 71 patients with large midureteric calculi (>1.5 cm in size) were treated with the three different modalities; SWL, ureteroscopic pneumatic lithotripsy (URS), and laparoscopic ureterolithotomy at AMAI Trust's Institute of Urology. Data were collected and all the patients were analyzed for stone-free rate, intraoperative and immediate postoperative complications, and the results were calculated. Stone clearance was 39.1% with SWL (group 1), 79.2% with ureteroscopic pneumatic lithotripsy (group 2), and 100% with the laparoscopic method (group 3), with a statistically significant difference between groups 1 and three and groups 1 and 2, but there was no statistical significance in groups 2 and three. However, hospital stay and hence morbidity was significantly greater in group 3, when compared to the other two groups. SWL gives the least clearance for large midureteric calculi. Statistically, URS and laparoscopic ureterolithotomy give equal results; hence, URS still remains the treatment of choice for the treatment of large midureteric calculi considering the low morbidity and acceptable stone-free rate of the procedure. Though laparoscopic ureterolithotomy can be considered as a treatment option, prospective, randomized trials are needed to confirm the efficacy of one modality of treatment over the other.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2009; 19(4):501-4.

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