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

Publisher: Mary Ann Liebert

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.

  • Impact factor
    1.07
  • 5-year impact
    1.18
  • Cited half-life
    4.40
  • Immediacy index
    0.31
  • Eigenfactor
    0.01
  • Article influence
    0.33
  • 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
    1557-9034
  • OCLC
    36334866
  • Material type
    Periodical, Internet resource
  • Document type
    Journal / Magazine / Newspaper, Internet Resource

Publisher details

Mary Ann Liebert

  • Pre-print
    • Author cannot archive a pre-print version
  • Post-print
    • Author can archive a post-print version
  • Conditions
    • Author's final version or publisher's version/PDF
    • Publisher's version/PDF may be used
    • On author's personal website, institution's intranet, or institutional repository
    • Authors may deposit in funder's designated repository after 12 months
    • 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
  • Classification
    ​ blue

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Objective: To first describe laparoscopic nephrectomy (LN) for patients with acute blunt Grade 4 renal injuries using a retroperitoneal approach. Patients and Methods: Three patients (2 males and 1 female) with acute blunt renal trauma underwent retroperitoneal LN successfully. The revised American Association for Surgery of Trauma grading system was used to grade renal injuries. All three patients with Grade 4 renal injuries required blood transfusions preoperatively and angiographic embolization because of hemodynamic instability. Given the severity of the renal injuries, failure of angiographic embolization, and persistent blood loss, surgical intervention was used. We performed retroperitoneal LN using four trocars within 24 hours after trauma for the patients. Results: Pure retroperitoneal LN was successfully performed in all 3 patients without requiring hand-assisted or open surgery. The renal hematoma dimension for the patients was 7.5, 8.4, and 9.2 cm, respectively. Operative time was 80, 110, and 130 minutes, respectively. Estimated blood loss was 100, 140, and 300 mL, respectively. The incision size was 4.2, 4.2, and 4.5 cm, respectively. The average hospital stay was 6 days. Pathology showed renal injuries without incidental renal tumors. Conclusions: Despite the technical challenges, LN for patients with acute blunt Grade 4 renal injuries using a retroperitoneal approach is safe and feasible in carefully selected patients if conservative measures and angiographic embolization fail. However, it is important to note that one should keep a low threshold for open conversion or the hand-assisted approach whenever necessary.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Introduction: Single-port laparoscopic surgery (SPLS), one of the advanced techniques of laparoscopic surgery, is performed through a single multichannel port. Regarding colorectal surgery, several colorectal procedures, including right colectomy, sigmoidectomy, and total proctocelectomy with ileal pouch anal anastomosis, have been performed successfully. The aim of this study was to elucidate the feasibility and safety of SPLS for the treatment of the patient with colorectal cancer in Korea. Subjects and Methods: Data were collected retrospectively from six hospitals through a Web-based case reporting form, which requested baseline characteristics of the patient, intraoperative findings, postoperative course, pathologic results of the tumor, and postoperative surveillance. Results: From May 2009 to June 2012, 257 patients were included in this study. Anterior resection was performed in 117 patients, low anterior resection in 66 patients, and right colectomy in 53 patients. The primary entry incision site was umbilicus in all patients except for 2 cases; in these, stoma sites were used for the entry of the single port. The total mean incision length was 3.8±2.3 cm. Among 257 initially SPLS-attempted patients, 45 (17.5%) patients needed additional ports (one additional port in 44 patients), and 2 patients (0.78%) had to be converted to open laparotomy. Intraoperative complications were noted in 5 patients, including anastomotic failures in 3 patients and bleeding in 1 patient. Postoperative complications were noted in 34 patients (13.2%). Anastomotic leak developed in 11 patients, urinary retention in 5 patients, and wound complications in 4 patients. Re-admission was needed in 15 patients (5.8%). Conclusions: SPLS could be performed safely and appropriately in selected colorectal cancer cases by experts in laparoscopic colorectal surgery in Korea. Prospective randomized trials to demonstrate the benefit and effectiveness of SPLS in colorectal cancer surgery with long-term oncologic results are needed.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Introduction: Single-incision laparoscopic cholecystectomy (SILC) has been increasing in use steadily, and many researchers have reported the safety and feasibility of SILC. However, most studies were confined to selected patients and excluded patients with acute inflammation. In this study, we evaluated the safety and feasibility of SILC with our technique in patients with acute cholecystitis. Patients and Methods: Ninety-six patients with acute cholecystitis undergoing laparoscopic cholecystectomy at Uijeonbu St. Mary's Hospital (Uijeongbu, Korea) between October 2011 and December 2012 were retrospectively reviewed. SILC was performed in 49 patients, and conventional three-port laparoscopic cholecystectomy was performed in 47 patients. Patient demographics and operative outcomes were compared between groups to evaluate the safety and feasibility of SILC using our technique. Results: There were no differences between groups in demographics except for the sex ratio. SILC was more often performed in female patients (69% versus 34%, P=.001). There were no statistically significant differences between groups in terms of operation time, critical view of safety identification time, iatrogenic gallbladder perforation, port-site seroma, and postoperative hospital stay, respectively. One patient in each group required conversion to open cholecystectomy because of massive bleeding. Conclusions: This study showed that needlescopic grasper-assisted SILC with our technique is acceptable not only in selected patients but also in patients with acute cholecystitis. Lateral and cephalad retraction using a needlescopic grasper and a snake retractor can make SILC safe and easy in acute cholecystitis through better visualization of the triangle of Calot.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Experimental knowledge about mesh behavior at the esophageal hiatus is rare, but such information is essential in order to find a safe and effective method of mesh reinforcement. This study aimed to investigate the influence of mesh structure on the biological behavior of polypropylene prostheses placed at the hiatus. Materials and Methods: Twenty-four pigs in three groups of eight underwent implantation of heavyweight small-porous (HW-SP), heavyweight large-porous (HW-LP), or lightweight large-porous (LW-LP) circular polypropylene mesh at the hiatus. Eight weeks later, the meshes were explanted. Macroscopic analysis was performed evaluating mesh deformation, adhesions, and position relative to the hiatal margin. Histological analysis comprised evaluation of foreign body reaction and tissue integration by mononuclear cell count and immunostaining of Ki-67, collagen type I, and collagen type III. Results: No mesh-related complications occurred. Mesh shrinkage was observed within all groups and was the lowest for HW-LP, higher for HW-SP, and highest for LW-LP (13.8% versus 19.5% versus 25.5%; P<.001). The adhesion score was highest for HW-SP, lower for HW-LP, and lowest for LW-LP (11.0 versus 8.0 versus 6.0; P<.001). The collagen type I/III ratio was higher for HW-SP compared with HW-LP and LW-LP (3.1 versus 2.2 versus 1.8; P=.014). Conclusions: Heavyweight polypropylene meshes may be advantageous for application at the hiatus. They provide a solid fixation of the esophagogastric junction by adhesions, which may contribute to a reduction of hernia recurrence. In heavyweight meshes, the large-porous structure is associated with superior form stability, and small-porous meshes are superior with regard to solidity of tissue integration, which may prevent mesh migration.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Transareola single-site endoscopic thyroidectomy has been successfully established as a surgical approach. This study investigated the feasibility and safety of transareola single-site endoscopic thyroidectomy for bilateral thyroid disease. Patients and Methods: Twelve patients who underwent bilateral thyroidectomy were enrolled in this study. The surgical outcomes were analyzed, including operation time, intraoperative bleeding volume, postoperative pain score, and cosmetic satisfaction score. Results: All patients underwent successful transareola single-site endoscopic bilateral thyroidectomy, and no patient was semiconverted to three-port endoscopic surgery or open surgery. Seven patients underwent bilateral partial thyroidectomy, and 5 patients underwent subtotal thyroidectomy plus contralateral partial thyroidectomy. The mean operation time was 165±23.8 minutes (range, 142-185 minutes). The mean intraoperative bleeding volume was 27.3±12.3 mL (range, 20-45 mL). The mean postoperative wound drainage was 121±45.8 mL (range, 85-137 mL). The drainage tube was removed 3-4 days after surgery. The mean visual analog scale score was 3.3±2.5 (range, 1-5) at 24 hours postoperatively. The patients were followed up for 2 month with no complaint of chest wall wound pain and numbness. The mean cosmetic satisfaction score was 9.55±0.8 (range, 8-10). Conclusions: Transareola single-site endoscopic bilateral thyroidectomy is feasible and safe and has the advantages of high cosmetic satisfaction.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Objective: Palmar hyperhidrosis is a common disease that causes intense significant embarassment for patients. Bilateral single-port thoracoscopic sympathectomy is an effective surgical treatment with high success rates and improvement in quality of life. In order to reduce surgical invasion and to seek better cosmetic results, we describe a novel protocol for thoracic sympathectomy in the treatment of palmar hyperhidrosis. Materials and Methods: Between January 2012 and September 2012, bilateral thoracic sympathectomy was performed through the anterior mediastinal pleura using the pleural videoscope with a single unilateral skin incision in 10 men and 6 women. Results: In total, 16 patients were cured, and the skin temperature increased by a mean of 2.7±0.6°C. The average operation time was 67.9±15.8 minutes, with a postoperative hospital stay of 1.9±0.6 days and operative bleeding of less than 20 mL. All operations were successful, with no severe complications or perioperative mortality. Follow-up of 9.8±2.3 months (range, 7-14 months) showed that palmar sweating improved in all patients, and the effective rate was 100%. Conclusions: A single unilateral incision for two-sided thoracic sympathectomy through the anterior mediastinal pleura is an effective, feasible, safe, and minimally invasive procedure with excellent cosmetic results.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2014; 24(5):328-32.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Objective: Natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) has generated excitement among surgeons as potentially scar-free surgery. We developed this technique while taking into consideration that it could also be applied to transoral thyroid surgery. Patient and Methods: We report the case of a 35-year-old woman with a 0.5×0.5-cm papillary thyroid microcarcinoma. We implemented a modified approach for the removal of the thyroid by using a frenotomy incision of the mouth, accompanied by an endoscope system. Results: A modified approach for the removal of the thyroid was used on the patient. The total operating time was 120 minutes, and there were no specific complications. The patient continues to be free of any diseases 12 months after the excision. Conclusions: Thyroidectomy can be performed by a transoral endoscope-assisted approach through a frenotomy incision of the mouth. We describe the detailed procedures for an endoscope-assisted transoral thyroidectomy using a frenotomy incision.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2014; 24(5):345-9.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Aim: To compare the clinical effectiveness of the treatment of choledocholithiasis by laparoscopic common bile duct (CBD) exploration and by endoscopic sphincterotomy (EST). Materials and Methods: A meta-analysis of studies about CBD stones was performed to analyze EST in comparison with laparoscopic CBD exploration procedures. Trials were identified by searching the Medline, EMBASE, PubMed, CBM, and CNKI databases from January 1990 to December 2012 for laparoscopic CBD exploration or EST for CBD stones. Results: Fifteen studies were identified in the meta-analysis. The incidence of bleeding or pancreatitis in the EST group was higher than that in the laparoscopic group. However, the incidence of bile leakage in the EST group was lower than that in the laparoscopic group. The differences in cases of retained stones or total complications were not statistically significant between the laparoscopic and EST groups (P>.05). There were more successful cases in the laparoscopic group than in the EST group (P<.05). Hospital cost was less in the laparoscopic group than in the EST group (P<.05). Mean operation time and hospital stay in the laparoscopic group were shorter than those in the EST group (P<.05). Conclusions: To some degree, laparoscopic treatment of the CBD may be a better way of removing stones than EST.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 05/2014; 24(5):287-94.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Objective: To describe a novel practical technique for trocar placement in extraperitoneal laparoscopic radical prostatectomy (eLRP) and robotic-assisted laparoscopic radical prostatectomy (eRALP) in patients who had lower midline abdominal incisions. Subjects and Methods: Between March 1999 and November 2013, 3080 LRPs were performed in our department. In total, 1745 eLRPs and 416 eRALPs were enrolled in the study. Group 1 consisted of 57 cases (45 eLRPs and 12 eRALPs) with median lower incision scars after previous abdominal surgery. Group 2 consisted of the same numbers of patients without previous surgeries after matched-pair analyses was performed according to body mass index, age, and operation style. Demographic, perioperative, and postoperative data were recorded. Additionally, we described our novel practical trocar replacement technique for extraperitoneal approach. Statistical analyses were performed. Results: Mean age was 65.6±6.2 years. Mean follow-up was 102.9±24.5 months. There were 12 eRALPs and 45 eLRPs in each group. Demographic, perioperative, and postoperative data were similar in the two groups except for trocar placement time. The trocar placement time was longer in Group 1 than in Group 2 (P<.001). In all patients with previous abdominal surgery with lower abdominal incision scars, we were able to establish trocar placement and correct access to the extraperitoneal space. Moreover, we had no conversions or complications in any patient. Conclusions: Our technique seems safe and practical for trocar placements for eLRP and eRALP in patients with lower abdominal incision scars.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 04/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Laparoscopic-assisted extended hepatectomy and laparoscopic hepaticojejunostomy reconstruction can be performed for hilar cholangiocarcinoma by combining our existing protocols for laparoscopic anatomic hepatectomy and laparoscopic hand-sewn bilio-enteric anastomosis. Subjects and Methods: Our first patient was a 42-year-old man with cholangitis and jaundice from tumor obstructing the hepatic duct bifurcation who underwent a right extended hepatectomy for hilar cholangiocarcinoma (Bismuth IIIa), radical portal lymphadenectomy, and Roux-en-Y hepaticojejunostomy using laparoscopic techniques. A four-trocar, one 6-cm wound protector laparoscopic technique was used. Inflow and outflow exclusion was achieved first, followed by liver transection. Radical portal lymphadenectomy was performed. A Roux-en-Y hepaticojejunostomy was constructed laparoscopically. We have performed three other cases using the same technique: two requiring right extended hepatectomy and one requiring left extended hepatectomy. Results: No intraoperative complications occurred during the 4.0-hour procedure. Tumor margins were clear. The patient was given oral diet on Day 1 and discharged on Day 3 after surgery. No blood transfusions were necessary. A cholangiogram performed 10 days after surgery demonstrated patent hepaticojejunostomy, and magnetic resonance imaging performed during week 3 demonstrated the normal caliber of the intrahepatic biliary system. At 6 months, the patient was completely without symptoms and exhibited normal liver function tests. Conclusions: Laparoscopic-assisted right extended hepatectomy for hilar cholangiocarcinoma with laparoscopically hand-sewn hepaticojejunostomy in select patients can be achieved with good outcomes.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 04/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Purpose: We evaluated the effect of different suture materials in a laparoscopic preperitoneal ligation of the patent processus vaginalis in a rabbit survival model. Materials and Methods: New Zealand White rabbits underwent laparoscopic assisted preperitoneal ligation of the patent processus vaginalis. The processus vaginalis was closed with silk (n=10), polyglactin 910 (Vicryl(®); Ethicon, a Johnson & Johnson Company, Somerville, NJ) (n=10), or polypropylene (Prolene(®); Ethicon) (n=10). At necropsy, the suture was removed, and repair integrity was evaluated. Results: All rabbits survived to necropsy without complications. No suture material was identified during necropsy of the Vicryl group. Eight (80%) of the Vicryl closures failed, with six (60%) failing at initial inspection. Following removal of suture material, nine (90%) of the Prolene closures failed, and only one (10%) of the silk closures failed (P=.009). Conclusions: The silk suture resulted in an improved closure rate. Ligation with silk suture probably incited an increased inflammatory response that likely created a scar while persisting long enough for the scar to become established. In contrast, the Vicryl sutures probably failed because the sutures dissolved before a scar was able to fully develop. Finally, the Prolene closures were suture dependent as evidenced by failure when the suture was removed. Nonabsorbable braided suture may improve closure of pediatric indirect inguinal hernias during laparoscopic-assisted preperitoneal ligation.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 04/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Reducing the length of stay and discharge time for patients could benefit multiple hospital units by saving money, reducing waiting time, and providing the opportunity for more patients to be treated. However, no experience of laparoscopic transcystic common bile duct exploration (LTCBDE) with discharge less than 24 hours has been reported until now. The objective of this study was to assess the feasibility and safety of LTCBDE with discharge less than 24 hours. Patients and Methods: A retrospective review showed that 34 of 111 patients scheduled in our institution were discharged less than 24 hours after LTCBDE between June 1 and December 31, 2011. A multimodal approach including appropriate preoperative assessment, education and counseling, early postoperative oral intake, and early mobilization was carried out. Outcomes were analyzed for patient demographics, postoperative stay, operation time, intraoperative bleeding, and reasons for failed LTCBDE. Results: Of 111 patients admitted for LTCBDE, 34 patients were discharged within 24 hours postoperatively. This study population comprised 11 males and 23 females with a mean age of 54.6±14.7 years (range, 28-79 years). The mean postoperative stay was 20.21±0.39 hours. There were no postoperative complications or deaths during the hospital stay or at the follow-up 12 months postoperatively in these 34 patients. Conclusions: LTCBDE with discharge less than 24 hours is feasible and safe in selected patients with common bile duct stones of no more than three in number and no more than 6 mm in size. The benefit of the multimodal approach and LTCBDE may be synergistic, allowing a quick recovery of gastrointestinal function.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 04/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Endoscopic thyroid surgery is gaining wide acceptance; however, existing endoscopic methods for thyroidectomy have shown several limitations. Recently, a transoral technique using video assistance and endoscopy has been reported for thyroidectomy. The aim of this study was to define a new technique of transoral thyroidectomy using a mandibular periosteal approach to complement other types of natural orifice surgery and minimally invasive surgery. Materials and Methods: Transoral periosteal thyroidectomies were performed in seven living pigs to evaluate the feasibility and safety of the new approach. Total thyroidectomies were performed in all animals. Follow-up examinations were carried out for 7 days and followed by autopsy. Results: Through three trocars in the mandibular periosteal area, it was possible to create a working space under the platysma muscle and to reach the pretracheal area. Total thyroidectomies were also performed via the transoral, mandibular periosteal approach without complications in seven orally intubated living pigs. Postoperatively, the white blood cell count remained normal in all cases. On the postoperative sacrifice of the pigs, three locally encapsulated seromas were observed. Both recurrent laryngeal nerves were intact in all cases. Conclusions: Transoral periosteal thyroidectomy could be feasible and safe.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 04/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Solid pancreatic pseudopapillary tumors make up 1%-3% of all pancreatic tumors, occur predominantly in females, and usually present in the third and fourth decades of life. Less frequently, these tumors may present in children. Complete surgical excision is the treatment of choice with excellent outcomes. Usage of a laparoscopic approach has become more common for adult patients. However, the laparoscopic approach is not routinely used in the pediatric population. Materials and Methods: A literature review was performed noting 13 documented cases of solid pancreatic pseudopapillary tumors resected laparoscopically in children. We report our case series of three children with a solid pancreatic pseudopapillary tumor treated through a minimally invasive approach. Results: In the literature, most patients had the tumor in the body or distal pancreas. The most common complication was pancreatic fistula, which was managed with total parenteral nutrition. In addition, there were reports of recurrence after biopsy of the tumor. In our case series 2 of the 3 patients received a splenectomy because of the proximity of the tumor to the spleen. There were no intraoperative or postoperative complications. Follow-up length from 13 to 36 months revealed no evidence of recurrence. Conclusions: In the pediatric population, solid pancreatic pseudopapillary tumors located in the body or tail of the pancreas can be managed with a laparoscopic distal pancreatectomy.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 04/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Controversy still exists about the need for pyloric drainage procedures after esophagectomy with gastric conduit reconstruction. Although pyloric drainage may prevent postoperative delayed gastric emptying (DGE), it may also promote dumping syndrome and bile reflux. The aims of this study were to audit the incidence and management of DGE in patients without routine pyloric drainage after esophagectomy in a university medical center. Patients and Methods: From July 2006 to June 2012, data from 356 consecutive patients who underwent esophagectomy with a gastric conduit without pyloric drainage for esophageal or gastric cardia carcinoma were reviewed. Major observation parameters were the incidence, management, and outcomes of DGE. Results: Overall incidence of DGE was 15.7% (56 of 356). Early DGE developed in 26 patients, and late DGE developed in 30 patients. There were no differences in demographic and intraoperative data between the two groups with or without DGE. More DGE was documented in patients with an intra-right thoracic gastric conduit (P=.031). A higher incidence of postoperative pneumonia was observed in patients exhibiting early DGE, but without significance (P=.254). There were also no significant impacts on respiratory failure (P=.848) and anastomotic leakage (P=.257). There was an increased postoperative hospital stay with DGE, but without significance (P=.089). Endoscopic balloon dilatation of the pylorus was used to manage 33.9% of patients with DGE, yielding a 78.9% (15 of 19) success rate without complications. In 3 patients endoscopy showed the pylorus was open, and their symptoms improved over time. One patient with tumor-related DGE was treated by pyloric stent. The remaining patients were adequately treated with conservative management. Conclusions: Omitting the operative drainage procedure does not lead to an increased frequency of DGE after esophagectomy with a gastric conduit. Many patients responded to conservative management, and endoscopic balloon pyloric dilatation can be effective in managing the DGE postoperatively.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 04/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Near-infrared fluorescence laparoscopy after intravenous indocyanine green (ICG) administration has been proposed as a promising surgical imaging technique for real-time visualization of the extrahepatic bile ducts and arteries in clinical laparoscopic cholecystectomies. However, optimization of this new technique with respect to the imaging system combined with the fluorophore is desirable. The performance of a preclinical near-infrared dye, CW800-CA, was compared with that of ICG for near-infrared fluorescence laparoscopy of the cystic duct and artery in pigs. Materials and Methods: Laparoscopic cholecystectomy was performed in six pigs (average weight, 35 kg) using a commercially available laparoscopic fluorescence imaging system. The fluorophores CW800-CA and ICG (both 800 nm fluorescent dyes) were administered by intravenous injection in four and two pigs, respectively. CW800-CA was administered in three different doses (consecutively 0.25, 1, and 3 mg); ICG was intravenously injected (2.5 mg) for comparison. Intraoperative recognition of the biliary structures was recorded at set time points. The target-to-background ratio was determined to quantify the fluorescence signal of the designated tissues. Results: A clinically proven dose of 2.5 mg of ICG resulted in a successful fluorescence delineation of both the cystic duct and artery. In the CW800-CA-injected pigs a clear visualization of the cystic duct and artery was obtained after administration of 3 mg of CW800-CA. Time from injection until fluorescence identification of the cystic duct was reduced when CW800-CA was used compared with ICG (11.5 minutes versus 21.5 minutes, respectively). CW800-CA provided clearer illumination of the cystic artery, in terms of target-to-background ratio. Conclusions: As well as ICG, CW800-CA can be applied for fluorescence identification of the cystic artery and duct using a commercially available laparoscopic fluorescence imaging system. Fluorescence cholangiography of the cystic duct can be obtained earlier after intravenous injection of CW800-CA, compared with ICG. These findings increase the possibilities of use and of optimization of this imaging technique.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 04/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Few reports have examined the impact of laparoscopic approach on survival outcomes in patients with early-stage (IA2-IB1) cervical cancer (CC). In this study we aimed to compare disease recurrence and survival outcomes of total laparoscopic radical hysterectomy (TLRH) with those for open radical hysterectomy (ORH) and pelvic lymphadenectomy in patients with early-stage CC. Patients and Methods: A single-center, retrospective analysis was conducted in a total of 68 patients who treated with TLRH (n=22) or ORH (n=46) between 2007 and 2010. The primary endpoint of the study was progression-free survival (PFS). Results: Median follow-up time was 42.50 months (range, 38.40-55.42 months) for the TLRH group and 43.50 months (range, 37.66-52.65) for the ORH group. The study groups were comparable in terms of baseline characteristics except the ORH group had more patients with tumor size greater than 2 cm (P=.026), depth of stromal invasion greater than 33% (P<.0001), and International Federation of Gynecology and Obstetrics stage IB1 disease (P=.019). However, these factors had no impact on overall and PFS in Cox regression analyses. In total, three recurrences were observed in the TLRH group. Two of the 3 patients were alive with no evidence of disease, and the remaining individual was alive with disease (AWD). In the ORH group, 5 patients had recurrences. Two of the 5 patients died of disease, and three were AWD. The estimated 3-year PFS (86.1% versus 90.6%, respectively; P=.32) and overall survival (100% vs. 95.4%, respectively; P=.82) were comparable in the TLRH and ORH groups. Conclusions: TLRH and ORH have similar survival outcomes in patients with early-stage CC.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 04/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Recently, robot-assisted neck dissection (ND) using a transaxillary approach in thyroid cancer patients with lateral neck metastases (LNM) was demonstrated to be feasible. The aim of this study was to compare the surgical outcomes of a modified transaxillary and retroauricular (TARA) versus a conventional transcervical approach in papillary thyroid carcinoma (PTC) patients with LNM. Patients and Methods: In total, 47 patients with PTC underwent total thyroidectomy with central compartment ND and modified radical ND except Level I. Twenty-two NDs were performed via the TARA approach, and 25 unilateral NDs were performed via the conventional transcervical approach. Results: The TARA and the open ND groups consisted of 22 and 25 patients, respectively. The operation time for ND in the TARA group was longer than that in the open ND group (209.4±38.2 minutes versus 143.1±30.5 minutes; P=.000). The mean scar satisfaction score in the TARA group was higher than in the conventional ND group (3.9±1.0 versus 2.8±1.0; P=.000). There were no differences in the mean number of retrieved lymph nodes. Conclusions: The robot-assisted ND via the TARA approach can be an alternative option that produces excellent esthetic results for the management of LNM in PTC patients.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 04/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Purpose: To describe our initial experience of "off-clamp, non-renorrhaphy" laparoscopic partial nephrectomy (OCNR-LPN) with perirenal fat and Gerota's fascia reapproximation technique. Patients and Methods: Between August 2012 and March 2013, 24 consecutive patients underwent OCNR-LPN at our institution. After the renal mass excision, biologic hemostatics such as FLOSEAL™ and TISSEEL™ (both from Baxter Healthcare Corp., Deerfield, IL) were used, and the perirenal fat and Gerota's fascia were sutured for reapproximation. Results: All 24 consecutive patients underwent OCNR-LPN successfully. The warm ischemic time for all cases was 0 minute. Thirteen patients were noted to have a low (4-6) RENAL nephrometry score (RNS), and 11 patients had a moderate (7-9) RNS. The mean tumor size among this cohort was 2.9 (range, 1.2-6.0) cm, and the mean estimated blood loss was 243 (range, 50-700) mL. The mean hospital stay was 6.9 (range, 5-10) days. The mean percentage of postoperative estimated glomerular filtration rate change increased by 0.9%. No positive surgical margins were noted, and 2 patients with Grade III complication by the Clavien-Dindo classification were treated by endoscopic or radiological intervention. Conclusions: OCNR-LPN with the perirenal fat and Gerota's fascia reapproximation technique is feasible. Our initial experience with OCNR-LPN demonstrates encouraging results of minimal renal function loss and complications.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 04/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract Background: Single-port laparoscopic surgery (SPLS) has been introduced for totally extraperitoneal (TEP) inguinal hernia repair. The aim of this study was to report our initial experience with SPLS TEP inguinal hernia repair in 100 patients by a single-port laparoscopic surgeon who had no prior experience of conventional TEP hernia repair. Patients and Methods: Between October 2012 and December 2013, 100 patients underwent SPLS TEP inguinal hernia repair by a single surgeon. The procedures that were performed in the preperitoneal space did not differ from those in conventional TEP repair. Patient demographics, type of hernia, and operative and postoperative outcomes were analyzed. Also, we compared the results of current series with the data of the other studies for single-port TEP inguinal hernia repair. Results: Among the 100 patients, SPLS TEP inguinal hernia repair was successful in 99 patients; 1 patient required additional incisions for inserting the trocar. The mean operative time and postoperative length of stay were 97.8 minutes (range, 55-185 minutes) and 1.3 days (range, 1-4 days), respectively. In the current series, the operation time was longer than those in the other studies for SPLS TEP repair. Recurrent hernia, history of lower abdominal surgery, and peritoneal tear during the operation were significantly associated with prolonged operation time. The other data, including perioperative complications, were similar. Conclusions: In our experience, the transition from standard hernioplasty to SPLS TEP inguinal hernia repair by an experienced SPLS surgeon was feasible. However, a learning curve is necessary.
    Journal of Laparoendoscopic & Advanced Surgical Techniques 04/2014;