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Background
Nowadays, lymphadenectomy could be performed by the transperitoneal or extraperitoneal approach. Nevertheless, each approach has its own advantages and disadvantages. Under these circumstances, we developed a transumbilical laparoendoscopic single-site (TU-LESS) extraperitoneal approach for lymphadenectomy. In this research, the primary...
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Citations
... The flexibility of the device at times also made it difficult to place it to access the abdominal cavity, influencing the total surgery time since, when the flexible portion broke, it was necessary to assemble a new device and restart its placement through the minilaparotomy. In this case, it is suggested that the flexible portion of the new device be produced with a more consistent, resistant, versatile, durable, and low-cost material, such as synthetic or semi-synthetic plastic, or even with a material produced by latex [21,22]. ...
Simple Summary
This article evaluates a low-cost, multiport device for single access to the abdominal cavity of cryptorchid horses in the standing position. The device evaluation was initially carried out in five cadavers of bovine fetuses (n = 5) and later in four cryptorchid horses during routine hospital care. This study concludes that the device was efficient, allowing a wide exploration of the abdominal cavity, especially the inguinal region. Laparoscopically assisted cryptorchidectomy with the new device was feasible in two live animals and allowed the determination of the conditions of the retained testicles in the others, demonstrating the previous efficiency of the device in these cases.
Abstract
This study evaluates a new multiport device with single access to the abdominal cavity produced with routine hospital supplies that could be applied to laparoscopically assisted cryptorchidectomy in standing horses. Initially, the new device was evaluated on five cadavers of bovine fetuses (n = 5), placed assisted in a minilaparotomy performed in the flank region. Subsequently, the device was evaluated in four cryptorchid horses treated during the hospital routine. During the evaluation of the new device, the possibilities of exploring the abdominal cavity, inspection, and intra-abdominal manipulation with two Babcock forceps were verified. The possibilities were described, and surgical time data were recorded and analyzed using descriptive statistics. In the cadavers, a wide exploration of the abdominal cavity was possible, with a laparoscopic inspection through the right paralumbar fossa and manipulation of intra-abdominal structures with Babcock forceps inserted by the new device. In cryptorchid horses, laparoscopically assisted cryptorchidectomy with a new device was feasible in two patients, and in the others, it allowed the diagnosis of adhesions and ectopic locations in the inguinal region of testicles retained in the cavity. Therefore, the new device was efficient in exploring the inguinal region of cryptorchid horses in the standing position. The present study is preliminary and can support future studies that aim to improve the developed prototype.
... Moreover, in the left-sided abdominal approach of EPA (Figure 2(a)), lymph node dissection between the aorta and inferior vena cava or on the right side of the inferior vena cava becomes somewhat difficult due to the field of view. Peng et al. reported EPA with an umbilical single port, which allows EPA to have a view from the caudal side, similar to TPA [9]. For TPA, Mizumoto et al. reported an approach from the left side of the descending colon called left dome formation, in which the left ovarian vein and left ureter can be followed all the way from the caudal side, ultimately providing a view exactly like that of the left-sided approach of EPA [10]. ...
The patient was 66 years old, had three pregnancies and two deliveries, and was menopausal at the age of 51. She had irregular bleeding and was found to have a chicken-egg-sized uterus and a thickened endometrium (23 mm). She underwent laparoscopic surgery for uterine endometrial cancer (endometrioid carcinoma G1, stage IB). Laparoscopic simple hysterectomy, bilateral adnexectomy, pelvic lymph node dissection, para-aortic lymph node dissection, and partial omentectomy were performed using the transperitoneal approach (TPA). The patient was obese, with a height of 148 cm, a weight of 68 kg, and a body mass index of 31 kg/m2. She had a large amount of visceral fat, which made it difficult to expand the surgical field during para-aortic lymph node dissection. A laparoscopic fan retractor (EndoRetract II, Medtronic) was used to lift the intestinal tracts and expand the field of view. It broke the fat around the left kidney, and the exposed left ureter was heat-damaged using a vessel sealing device (LigaSure, Medtronic). Postoperatively, a left ureteral stent was placed, and continuous urine draining into the retroperitoneum was performed. To prevent injury to the left ureter, the left ovarian vein branching from the left renal vein should be exposed as a landmark before the left ureter running parallel to it is isolated. It is essential that the fat around the left kidney is not broken during this operation. The left iliopsoas muscle should be exposed, and using this as a base, the left ovarian vein, left ureter, and left perirenal fat should be compressed and moved to the left side using a fan retractor to ensure a safe operation.
