Journal of Laparoendoscopic & Advanced Surgical Techniques Impact Factor & Information

Publisher: Mary Ann Liebert

Journal description

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.

Current impact factor: 1.34

Impact Factor Rankings

2015 Impact Factor Available summer 2016
2014 Impact Factor 1.335
2013 Impact Factor 1.187
2012 Impact Factor 1.066
2011 Impact Factor 1.4
2010 Impact Factor 1.198
2009 Impact Factor 1.012
2008 Impact Factor 0.912
2007 Impact Factor 0.606
2006 Impact Factor 0.718
2005 Impact Factor 0.648
2004 Impact Factor 0.862
2003 Impact Factor 1.127
2002 Impact Factor 0.873
2001 Impact Factor 1.069
2000 Impact Factor 0.783
1999 Impact Factor 0.787
1998 Impact Factor 0.098

Impact factor over time

Impact factor

Additional details

5-year impact 1.24
Cited half-life 5.10
Immediacy index 0.27
Eigenfactor 0.01
Article influence 0.35
Website Journal of Laparoendoscopic & Advanced Surgical Techniques website
Other titles Journal of laparoendoscopic & advanced surgical techniques. Part A, Journal of laparoendoscopic and advanced surgical techniques
ISSN 1092-6429
OCLC 36334866
Material type Periodical, Internet resource
Document type Journal / Magazine / Newspaper, Internet Resource

Publisher details

Mary Ann Liebert

  • Pre-print
    • Author can archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • On author's personal website
    • On institutional repository, pre-print server or research network after 12 months embargo
    • Publisher's version/PDF cannot be used
    • Set statement to accompany deposit (see policy)
    • Publisher copyright and source must be acknowledged
    • NIH authors will have their final paper, (post peer review, copy-editing and proof-reading) deposited in PubMed Central on their behalf
    • Must link to publisher version with DOI
  • Classification

Publications in this journal

  • Yu-Fei Fu · Lu-Lu Lv · Hao Xu · Ning Wei ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: We determined the feasibility, safety, and long-term outcome of double stent insertion in management of combined malignant airway and esophageal stenoses (CAES). Patients and methods: Between March 2005 and May 2014, 11 consecutive patients (9 males and 2 females), 56-78 years of age (mean, 63.4 ± 6.1 years), with CAES who underwent double stent insertion (airway and esophageal stents) were enrolled in this retrospective study. Data regarding the technical success, clinical success, and long-term outcome were collected and analyzed. Results: Airway and esophageal stents were successfully inserted in all patients. The interval between insertion of the two stents was 0-42 days (mean, 13.2 ± 14.2 days). No procedure-related complication occurred. Relief of dyspnea and dysphagia was achieved in all patients. The mean Hugh-Jones grade improved from 4.5 ± 0.7 before airway stent insertion to 1.5 ± 0.5 after airway stent insertion (P < .001). The mean dysphagia grade improved from 3.5 ± 0.5 before esophageal stent insertion to 1.3 ± 0.5 after esophageal stent insertion (P < .001). Stent-related complications included restenosis of the airway stent (n = 2) and mild migration of the esophageal stent (n = 2). There was no occurrence of airway-esophageal fistula after treatment. The mean survival of the 11 patients after double stent insertion was 105.5 ± 18.5 days. The cumulative 3- and 6-month survival rates after double stent insertion were 54.5% and 9.1%, respectively. Conclusions: Double stent insertion is an easy, safe, and effective method in palliative treatment for patients with CAES.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 11/2015; DOI:10.1089/lap.2015.0169
  • Karim Awad · Mohamed El Debeiky · Amr AbouZeid · Ayman Albaghdady · Tarek Hassan · Sameh Abdelhay ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Several techniques have been described for the surgical correction of rectal prolapse without any clear advantage for one technique over the other. We evaluated the use of laparoscopic suture rectopexy (LSRP) as a modality of treatment for rectal prolapse in children. Materials and methods: Prospective data were collected for all children who presented to our center between 2011 and 2014 and required surgery for rectal prolapse. All children underwent LSRP with fixation of the mobilized rectum to the sacral promontory with multiple nonabsorbable sutures. The median follow-up period was 14 months (range, 6-29 months). The operative time, operative complications, length of hospital stay, and postoperative complications were recorded and analyzed. Results: Seventy-four patients presented with rectal prolapse during this period. Twenty patients (27%) required LSRP. Their median age at surgery was 4.4 years (range, 2-11 years), median operative time was 77.5 minutes (range, 30-150 minutes), and the median length of hospital stay was 1 day (range, 1-4 days). Only 1 patient had full-thickness recurrence that required redo surgery, and another had mucosal prolapse, which spontaneously resolved. Conclusions: LSRP is a safe and effective technique for treating children with full-thickness rectal prolapse with the benefits of being minimally invasive, a short hospital stay, early recovery, and low recurrence rate.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 11/2015; DOI:10.1089/lap.2015.0250
  • Mirtha Gonzales · Ashwin Pimpalwar ·
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Fibroadenoma is a common condition in adolescent girls. Most tumors are excised either through a periareolar approach or the inframammary approach. Both approaches produce visible scars in adolescent girls. We propose a new cosmetic approach to this lesion and report our experience with the transaxillary subcutaneouscopic approach for excision of the fibroadenoma of the breast. The purpose of this case report is to delineate an innovative surgical approach to resection of a breast fibroadenoma that yields an adequate resection without possible damage to the ductal system while optimizing cosmetic results by avoiding scars. Materials and methods: We retrospectively reviewed the medical records of four adolescent girls who underwent the above approach for excision of fibroadenoma of the breast. The age range was 14-16 years. Results: There were no complications in all 4 patients. The final result at the 3-month follow-up revealed an esthetically pleasing skin incision that healed well and was hidden by the natural skin fold of the axilla. Conclusions: Transaxillary subcutaneouscopic excision of fibroadenoma of the breast in children is a safe and effective technique and should be considered for excision of benign breast lesions in children.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 11/2015; DOI:10.1089/lap.2015.0359
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Several studies have demonstrated that laparoscopic colonic resection has significant benefits in comparison with open approaches in patients with benign and malignant disease. The proportion of colonic and rectal resections conducted laparoscopically in Austria is not currently known; the aim of this study was to evaluate the current status of laparoscopic colonic surgery in Austria. Materials and methods: A questionnaire was distributed to all general surgical departments in Austria. In collaboration with IMAS, an Austrian market research institute, an online survey was used to identify laparoscopic and open colorectal resections performed in 2013. The results were compared with data from the National Hospital Morbidity Database (NHMD), in which administrative in-patient data were also collected from all general surgical departments in Austria in 2013. Results: Fifty-three of 99 surgical departments in Austria responded (53.5%); 4335 colonic and rectal resections were carried out in the participating departments, representing 50.5% of all NHMD-recorded colorectal resections (n = 8576) in Austria in 2013. Of these 4335 colonic and rectal resections, 2597 (59.9%) were carried out using an open approach, 1674 (38.6%) were laparoscopic, and an exact classification was not available for 64 (1.5%). Among the NHMD-recorded colonic and rectal resections, 6342 (73.9%) were carried out with an open approach, and 2234 (26.1%) were laparoscopic. Conclusions: The proportion of colorectal resections that are carried out laparoscopically is low (26.1%). Technical challenges and a learning curve with a significant number of cases may be reasons for the slow adoption of laparoscopic colonic surgery.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 11/2015; DOI:10.1089/lap.2015.0373
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Different approaches of dealing with mucosal injury during pyloromyotomy for hypertrophic pyloric stenosis have been described. There is, however, no consensus on the best technique to use. We conducted a survey among International Pediatric Endosurgery Group (IPEG) members on their experience of mucosal injuries during pyloromyotomy, the way in which these were handled, any modification in subsequent postoperative care, and impact on outcome. Materials and methods: A confidential survey was sent to IPEG members querying demographic data, number of pyloromyotomies performed, operative approach, incidence of mucosal injury, intraoperative management, and postoperative consequences. Statistical analysis was performed to determine factors associated with complications and outcome. Results: In total, 231 mucosa injuries were included in the study. Of these, 93% were noticed intraoperatively. Cases were nearly equally distributed between laparoscopic (49%) and open (51%) procedures, and the risk of mucosal injuries was no different between the two. Most surgeons addressed mucosal perforation with primary mucosal repair (70%), whereas a minority (27%) performed full-thickness closure, rotation, and repyloromyotomy in a different quadrant. Common alterations in management included delay in feeding (84%), longer hospital stay (30%), and contrast study before feeding (12%). The vast majority of patients had no adverse sequelae after a mucosal injury (96%), but three patients underwent re-operation. No correlations were found between repair method and complications. Conclusions: Mucosal injuries that are noticed and addressed intraoperatively resulted in few complications, regardless of the repair method. Among the queried surgeons, primary mucosal repair is the current standard of care. Primary mucosal repair is equivalent to full-thickness closure in terms of complications and outcome.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 11/2015; DOI:10.1089/lap.2015.0117
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Adhesion formation after colorectal surgery is a well-recognized problem, and the ability of the laparoscopic technique to reduce adhesion formation is questionable. The present study compares adhesion formation after laparoscopic and open colorectal surgery. Patients and methods: A diagnostic laparoscopy was performed through the stoma site at the ileostomy closure operation in patients who had undergone low anterior resection or ileal pouch anal-anastomosis. The laparoscopy was videorecorded, and the extent and severity of adhesions involving incisions, omentum, small bowel, and female adnexa were graded. Results: Twenty-three patients were enrolled into the study, and after exclusions 19 patients remained for the analyses. There was no difference in baseline characteristics of patients except in the mean (range) total incision length, which was 22 (21-23) cm in the open group and 10.9 (9-14) cm in the laparoscopic group (P < .001). The median (range) overall adhesion severity score was 7 (3-9) in the open group and 0 (0-4) in the laparoscopic group (P = .001). Similar differences were seen in overall extent and total score (P = .001 and P = .001, respectively). In detailed analysis, incision and small bowel adhesions scores were also statistically significantly different, favoring laparoscopic surgery. Conclusions: According to the present study, although low in number of patients, laparoscopic colorectal surgery may result in fewer adhesions compared with open surgery.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 11/2015; DOI:10.1089/lap.2015.0165
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Different techniques for ileal pouch-anal anastomosis (IPAA) following total proctocolectomy (TPC) have been described in patients with ulcerative colitis (UC), including rectal eversion (RE). RE allows for precise identification of the dentate line, but concerns have been raised regarding continence rates. No studies have specifically evaluated RE in the pediatric population. The purpose of this study was to evaluate the outcomes and continence rates for pediatric patients undergoing minimally invasive surgery (MIS) TPC and IPAA with RE for UC. Materials and methods: All patients who underwent TPC and IPAA were reviewed at our institution. Data collected included demographics, proctocolectomy technique (open without RE versus MIS with RE), operative time, postoperative data, and continence outcomes following ileostomy closure. Results: Thirty-three patients were identified who underwent TPC and IPAA between July 2006 and October 2014. Thirty of these patients underwent ileostomy takedown and were evaluated for continence. Of these, 17 (56.7%) patients had a laparoscopic procedure, 5 (16.7%) had a robotic-assisted procedure, and 8 (26.7%) had an open procedure. There were no statistically significant differences in regard to demographics, operative time, or length of stay when comparing the two groups. There were no differences in the two groups as measured at 1, 6, and 12 months in terms of number of daily stools (P = .93, .09, and .87, respectively), nighttime stooling (P = .29, .10, and .25, respectively), soiling (P = .43, .36, and .52, respectively), or stool-altering medication usage (P = .26, 1.00, and .37, respectively). Conclusions: The RE technique can be used safely and effectively during MIS TPC and IPAA in children without altering continence rates.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 11/2015; DOI:10.1089/lap.2015.0429
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To determine the effect of lavage with adrenaline solution on CO2 absorption during retroperitoneal laparoscopic surgery. Materials and methods: Sixty patients scheduled to undergo retroperitoneal laparoscopic surgery were divided into an AD group (lavage with normal saline containing adrenaline [1:500,000], n = 30) and an NS group (lavage with normal saline only, n = 30). After the establishment of artificial pneumoperitoneum and before the start of the operation, the retroperitoneal space was irrigated with 300 mL of normal saline with or without adrenaline, depending on the group. The lavage fluid was aspirated after 3 minutes. Heart rate (HR), mean arterial pressure (MAP), blood oxygen saturation (SpO2), partial pressure of O2 (PaO2), partial pressure of CO2 (PaCO2), and end-tidal CO2 partial pressure (PETCO2) were recorded before the lavage (T0) and at 10, 30, 60, 90, and 120 minutes (T1-T5, respectively) after the lavage. The CO2 output (VCO2) was calculated, and the incidence of intraoperative arrhythmia and postoperative complications (e.g., headache, palpitations, irritation) was determined. Results: HR, MAP, SpO2, PaO2, PaCO2, PETCO2, and VCO2 at T0 did not significantly differ between the groups (P > .05). HR, PaCO2, PETCO2, and VCO2 at T1-T5 were lower in the AD group than in the NS group (P < .05). The incidence of intraoperative arrhythmia and postoperative complications was lower in the AD group than in the NS group (P < .05). Conclusions: Lavage with normal saline containing adrenaline (1:500,000) reduced CO2 absorption during retroperitoneal laparoscopic surgery, prevented hypercapnia, and decreased intra- and postoperative complications.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 11/2015; 25(11):903-907. DOI:10.1089/lap.2015.0215
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Laparoscopic appendectomy (LA) has proven to be a feasible alternative to open appendectomy (OA). However, as some of the purported advantages of LA (versus OA) are marginal, evidence is accumulating that appendectomy may not be necessary for uncomplicated appendicitis and there is concern about using laparoscopy for all patients with suspected acute appendicitis. In spite of widespread popularity and use, the literature reporting the indications is sparse and sometimes misleading (i.e., containing distorted deductions or conclusions, also called "spin"). This study aimed to determine subsets of patients for whom LA may present real advantages over OA and to analyze the validity of specific indications for LA (instead of OA). Materials and methods: A systematic review and critical analysis of the literature were conducted. Results: We analyzed 90 retrospective reviews, prospective studies, meta-analyses, and cohort and prospective randomized studies, presenting a total of approximately 390,000 patients, concerning potentially specific advantages of LA in the elderly, the obese, during pregnancy, and complicated appendicitis, including diffuse peritonitis and ectopic appendices. Overall, LA was associated with (1) lower overall complication rates (and notably less decompensated comorbidities), mortality, and costs, as well as shorter duration of hospital stay, in the elderly, (2) decreased morbidity (notably parietal) in the obese, and (3) potential (diagnostic) advantages in pregnancy (even though LA is associated with a higher rate of fetal loss than in OA). In complicated or ectopic appendicitis, LA is feasible and safe and, if performed without conversion, should lead to less short- and long-term parietal morbidity. However, published data are very heterogeneous, there are few sound controlled trials, and conclusions found in the literature are often based on misleading deductions or a very low level of evidence. Conclusions: LA is a safe and effective method to treat acute appendicitis in specific settings such as the elderly and the obese, as well as in ectopic appendices, with potentially specific parietal advantages in these subsets of patients. Further randomized studies and robust meta-analyses are necessary before recommending LA for complicated appendicitis and peritonitis, as well as in pregnancy.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 11/2015; 25(11):897-902. DOI:10.1089/lap.2014.0624
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Obturator nerve injury (ONI) is a rare complication during pelvic lymph node dissection (PLND), in extraperitoneal laparoscopic radical prostatectomy (e-LRP), and/or extraperitoneal robotic-assisted laparoscopic radical prostatectomy (e-RALP). It is important to recognize ONI during the initial operation, maximizing the feasibility of simultaneous repair. Here we report our experience with ONI during e-LRP/e-RALP procedures and draw an injury risk map. Materials and methods: Between December 1999 and November 2014, 2531 e-LRPs and 1027 e-RALPs were performed. Five patients (3 during e-LRP, 2 during e-RALP) experienced ONI in the proximal part of the nerve. Obturator nerves were clipped during the 3 e-LRP cases. Clips were immediately removed, and patients received physiotherapy with medical treatments in the postoperative period. During e-RALP, two obturator nerves were transected and subsequently repaired using the robotic Da Vinci(®) Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA). ONI types were investigated in detail in these patients, and current published studies were analyzed in order to draw a risk map. Results: Mean follow-up was 18.8 ± 2.7 months. In total, 3558 cases (2531 e-LRPs, 1027 e-RALPs) were performed. ONI occurred in 3 e-LRP (0.1%) and 2 e-RALP (0.1%) patients. Simultaneous repair was performed successfully in all cases, as clips were removed in e-LRP cases and obturator nerves were repaired using 6/0 polypropylene (Prolene(®); Ethicon, Somerville, NJ) suture in e-RALP cases. There was no complication associated with obturator nerve functions such as adductor function and/or neurologic deficiency during long-term follow-up. In view of published studies in the literature, the proximal part of the obturator nerve is at highest risk for injury during PLND, representing 77.8% of reported cases of ONI. Conclusions: According to our ONI risk map, the proximal part of the obturator nerve is at higher risk for injury during PLND. Careful dissection and a good knowledge of pelvic anatomy are essential for preventing ONI. Successful ONI management can be performed simultaneously in experienced hands.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 09/2015; 25(10). DOI:10.1089/lap.2015.0190
  • [Show abstract] [Hide abstract]
    ABSTRACT: To report our technique and experiences in the laparoscopic diaphragmatic hemiplication (LDHP) in children with acquired diaphragmatic eventration after congenital heart surgery. Between October 2007 to December 2013, 3498 children with congenital heart disease underwent cardiac surgery in our hospital, and 40 (1.14%) of them had unilateral diaphragmatic elevation on postoperative chest X-ray (mean elevation, 2.5 ± 0.26 intercostal spaces [ICS]) and were diagnosed as having diaphragmatic eventration due to diaphragmatic hemiparesis as a result of phrenic nerve injury. These 40 patients were followed up, and 22 of them recovered after conservative treatment; the other 18 needed surgical intervention. We conducted a retrospective study relating to surgical indications, surgical technique, complications, and outcomes. There were 24 boys and 16 girls with a mean age of 10.0 ± 4.5 months old (range, 2 months-4 years). Twenty-two patients did not require surgical intervention. Eighteen patients underwent LDHP (12 cases left-sided and 6 cases right-sided); 2 of them had emergency LDHP with a history of ventilator dependency after cardiac surgery, and 16 of them had planned LDHP with a history of recurrent pneumonia and dyspnea. The operative time was 60 ± 7.9 minutes (range, 45-105 minutes), with minimal blood loss (3 ± 1.5 mL [range, 1-9 mL]), no intra- or postoperative complications, and postoperative hospital stay of 7 ± 1.3 days (range, 5-10 days). The diaphragmatic drop was 2.4 ± 0.2 (range, 2-4 ICS) without recurrence, and the follow-up time for all 40 patients was 14.8 ± 1.6 months (range, 11-36 months). Our study further shows that LDHP is feasible and effective in selected patients after congenital heart surgery. Our technique is convenient and provides excellent clinical and radiological results.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 08/2015; 25(10):150827130605004. DOI:10.1089/lap.2014.0675
  • [Show abstract] [Hide abstract]
    ABSTRACT: To present our experience with laparoendoscopic single-site plus one-port donor nephrectomy (LESSOP-DN) and compare the outcomes with laparoscopic donor nephrectomy (LDN). Prospectively collected data from 169 consecutive LESSOP-DNs and 83 LDNs performed by a single surgeon in the same time period were analyzed retrospectively. No differences in mean operative time (136 versus 130 minutes; P=.15), warm ischemia time (3.4 versus 3.5 minutes; P=.42), blood loss (50 versus 45 mL; P=.41), transfusion rates (0 versus 1 case), hospital stay (4.0 versus 3.9 days; P=.48), or overall complication rate (12.0% versus 7.7%; P=.25) were observed between the LDN and LESSOP-DN groups. The LESSOP-DN group had a shorter time to return to 100% recovery (39 versus 74 days; P<.001), a smaller surgical incision (5.5 versus 8.2 cm; P<.001), higher scar satisfaction score (8.1 versus 6.4; P=.003), and lower analgesic requirements (79.0 versus 68.5 mg; P=.03) than the LDN group. Renal function of the recipient based on estimated glomerular filtration rate at 1 and 3 months was similar between the groups. Health-related quality of life (QOL) was significantly higher in the LESSOP-DN group in four domains of the health survey than in the LDN group. LESSOP-DN might be associated with smaller surgical incision, improved cosmetic satisfaction, less time to recovery, less analgesic requirement, improved donor QOL, and equivalent recipient graft function.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 06/2015; 25(8):150601140035003. DOI:10.1089/lap.2014.0570
  • [Show abstract] [Hide abstract]
    ABSTRACT: This retrospective study aims to compare open colectomy and hand-assisted laparoscopic surgery (HALS) in the management of acute obstructive right-sided colon cancer and to analyze and evaluate the feasibility and safety of HALS. Ten consecutive patients who underwent hand-assisted laparoscopic right hemicolectomy due to acute obstructive right-sided colon cancer were retrospectively well matched with 25 patients scheduled for a conventional laparotomy during the same time. Demographic, intraoperative, and postoperative data were assessed. The HALS group had the advantage in the length of incision (5.8±0.7 cm) over the conventional group (16±2.3 cm) (P<.05), and the mean blood loss during the operations was significantly less in the HALS group (30±15.2 mL) than in the laparotomy group (90±29.4 mL) (P<.05). Moreover, the time of postoperative ambulation was earlier (2.5±0.8 days versus 3.2±0.9 days) (P<.05). Seven cases underwent intestinal decompression for severe intestinal dilatation and had a satisfactory result. The hand-assisted device can fairly meet the demands of a minimally invasive operation and can protect the abdominal incision and avoid infection. There was no intergroup difference in complication rate, although the conventional group had a higher rate. In this study, compared with conventional laparotomy for acute obstructive right-sided colon neoplasm, HALS is associated with less blood loss, shorter incision, and earlier ambulation. Emergency laparoscopic-assisted right hemicolectomy can be safely performed in patients with obstructing right-sided colonic carcinoma. If practiced more, it might be advocated as a bridge between the conventional open approach and traditional laparoscopic surgery.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2015; 25(7):150527123813009. DOI:10.1089/lap.2014.0645
  • [Show abstract] [Hide abstract]
    ABSTRACT: Radical rectal resection following neoadjuvant chemoradiation therapy (CRT) for locally advanced rectal cancer is accompanied by relatively high morbidity. Local excision of rectal cancer may be more appropriate for some frail patients with severe comorbidities. Transanal endoscopic microsurgery (TEM), consisting of local excision of selected rectal cancers, has been associated with low rates of postoperative complications. Because neoadjuvant CRT for rectal cancer may be associated with increased complications, the suitability of TEM following CRT is still unclear. In this study we aimed to assess the clinical outcomes of patients undergoing TEM following neoadjuvant CRT. This study retrospectively analyzed all patients undergoing TEM for malignant rectal tumor in our institution between 2004 and 2010. They were divided into those who received CRT (CRT group) and those without CRT (non-CRT group). Demographics and clinical data were compared. Forty-four of 97 patients who underwent TEM were included: 13 CRT and 31 non-CRT. Age, comorbidities, and the duration of the procedure were similar for both groups. There were no significant group differences in tumor diameter (2.1 cm [range, 0.5-3.5 cm] and 2.9 cm [range, 0.5-4.2 cm], respectively; P=.125) or distance of the lower part of the tumor from the anal verge (6.7 cm [range, 5-10 cm] and 7.7 cm [range, 5-15 cm], respectively; P=.285). Two non-CRT patients had peritoneal entry, and 1 of them underwent protective ileostomy because of insecure rectal defect closure. One non-CRT patient underwent a re-operation for postoperative bleeding. The other perioperative complications were minor and included urinary retention requiring catheter placement (2 patients in each group), pulmonary edema (1 non-CRT patient), and pneumonia (1 non-CRT patient). All complications were managed conservatively. There was no wound disruption, major complication, or mortality in either group. With proper patient selection, TEM can be performed safely following CRT, without major complication or increased postoperative morbidity.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2015; 25(8):150527123853009. DOI:10.1089/lap.2014.0647
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: We developed a system to objectively verify the endoscopic surgical skills of pediatric surgeons. Materials and methods: We developed a thoracoscopic model of congenital diaphragmatic hernia mimicking a newborn's size. The examinees were divided into Experts (n=10) and Trainees (n=19), and each group performed two tasks (Task 1, reduction of a herniated intestine from the thoracic space to the abdomen; Task 2, perform three suture ligatures of a diaphragm defect using intracorporeal knot-tying). The end points were the time required to complete Task 1, time score calculated using the residual time from the time limit for Task 2, number of complete full-thickness sutures, maximum air-pressure tolerance, degree of diaphragm deformation, and the residual defect areas after suturing. We also evaluated the total path length and velocity of the forceps tips using a three-dimensional position measurement instrument. Results: The Experts had significantly superior results for the time for Task 1, time score, number of complete full-thickness sutures, maximum air-pressure tolerance, and degree of diaphragm deformation in Task 2 (all P<.05). We found that the total path length and average velocities for the left forceps were inferior to those of the right forceps in both tasks in the Trainees (both P<.05, respectively), whereas the Expert group showed no significant laterality in these tasks. Conclusions: Our model could validate the quality of endoscopic surgical skills and could differentiate between Expert and Trainee pediatric surgeons. The Experts could use their forceps equally well to perform tasks even in a small working space.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2015; 25(9):150527123733002. DOI:10.1089/lap.2014.0259

  • Journal of Laparoendoscopic & Advanced Surgical Techniques 04/2015;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Three-dimensional (3D) laparoscopes have been developed to maintain the perception of depth in the operating field. Two-dimensional (2D) imaging relies on tactile feedback, visual cues, and previous experience. The aim of this study was to test if 3D laparoscopic vision is superior to 2D laparoscopic vision in training novice operators in completing set laparoscopic tasks. The study population consisted of 20 interns and medical students. The participants were randomized to completing tasks using a 2D or 3D system. These included pegboard transfer (PT), continuous suturing (CS), and intracorporeal knot-tying (IK). The time to complete the task and number of errors made were recorded. Following adjustment for potential confounders, time to complete CS and IK was significantly longer among participants who used the 2D laparoscope compared with those who used the 3D laparoscope (CS, P<.0001; IK, P<.0001). This same effect was not demonstrated in time to perform PT (PT, P=.04). The 2D laparoscope was associated with a significant increase in the number of errors on the IK task (P<.0001) but not on the PT or CS tasks (PT, P=.35; CS, P=.26). The 3D system assists novice operators perform more complex laparoscopic tasks in a decreased amount of time and with fewer errors.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 03/2015; 25(4). DOI:10.1089/lap.2014.0608
  • [Show abstract] [Hide abstract]
    ABSTRACT: Thoracoscopic plication of the diaphragm is an alternative to conventional surgical treatment of diaphragmatic evisceration via thoracotomy in neonates and infants. The aim of this study is to compare results of treatment by these two methods in the past 11 years. We studied the data of 35 neonates who underwent standard posterolateral thoracotomy (18 patients; Group I) or video-assisted thoracoscopic surgery (17 patients; Group II) for diaphragmatic plication. The two groups were compared for patient demographics, operative reports, and postoperative parameters. The groups were similar in terms of demographics and preoperative parameters. There was a significant difference in mean operative time between the open and thoracoscopic procedure (71.67 minutes versus 51.76 minutes; P<.05). Duration of care in the neonatal intensive unit and length of hospital stay were significantly shorter in Group II (5.89 days versus 3.23 days [P<.05] and 13.06 days versus 9.88 days [P<.05]). Early postoperative complications (hemothorax, pneumothorax) were frequent in the thoracotomy group (Group I) (16.67% versus 0%; P>.05). Recurrence of diaphragmatic evisceration was observed only in the thoracotomy group (11.11% versus 0%; P=.486). Thoracoscopic plication of the diaphragm in infants in the first 3 months of life demonstrates better results than open surgery.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 03/2015; 25(4). DOI:10.1089/lap.2014.0205