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

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

2016 Impact Factor Available summer 2017
2014 / 2015 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
Year

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
    green

Publications in this journal

  • Go Miyano · China Nagano · Keiichi Morita · Masaya Yamoto · Masakatsu Kaneshiro · Hiromu Miyake · Hiroshi Nouso · Hirotsugu Kitayama · Naohiro Wada · Koji Fukumoto · Mariko Koyama · Naoto Urushihara
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    ABSTRACT: A 15-year-old girl was found to be hypertensive (230-270/140-170 mm Hg) without any subjective symptoms. Magnetic resonance imaging confirmed the presence of a well-defined 22 mm hypodense lesion in the lower pole of the left kidney, located close to the renal hilum. Plasma rennin activity was elevated (75 ng/mL/h), and reninoma was diagnosed. Retroperitoneoscopy-assisted nephron-sparing surgery was planned. The retroperitoneum was accessed through a 4 cm left pararectal upper abdominal incision. Following blunt dissection, the abdominal wall was elevated with a lifting bar and lifting retractor, inserted below the 12th rib in the anterior axillary line to create sufficient working space in the retroperitoneal cavity without the need for pneumoperitoneum. Three 5 mm trocars were introduced above the superior iliac crest for the camera and the assistant. Gerota's fascia was opened and the kidney exposed. The surgeon dissected the left kidney through the minilaparotomy incision under both direct vision and using the magnified view on the monitor, which was particularly effective for the lateral and posterior sides of the kidney. The posterior peritoneum was incised intentionally next to the diaphragm to allow further mobilization of the kidney. Diathermy was used to remove the tumor and a layer of surrounding normal parenchymal tissue at least 0.5 cm thick. The histopathologic diagnosis was reninoma. Ischemia time was 14 minutes. Postoperatively, both plasma rennin activity and blood pressure were normal (1.9 ng/mL/h and 90-110/70-80 mm Hg, respectively). After follow-up of 12 months, there is no evidence of recurrence.
    No preview · Article · Feb 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Purpose: This study evaluated the stability and risk of single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) for pediatric inguinal hernia performed by inexperienced pediatric surgeons versus conventional LPEC procedure. Methods: Between 2011 and 2012, a randomized prospective study was performed comparing SILPEC (n = 37, 16 uni- and 21 bilateral patent processus vaginalis [PPV]) to LPEC (n = 72, 39 uni- and 33 bilateral PPV). The procedures were performed in girls with inguinal hernia by inexperienced pediatric surgeons with the assistance of an expert pediatric surgeon. In SILPEC, a laparoscope was placed through a transumbilical incision. A 2-mm trocar for the grasper was inserted through the same incision and introduced into the extraperitoneal cavity. The tip of the trocar was inserted in the abdominal cavity distant from the umbilical incision by the expert surgeon to avoid any complications caused by the in-line view. Using a special needle, the hernial sac was closed extraperitoneally by the inexperienced surgeon. A statistical survey of the mean age at operation, mean operative time, intra- and postoperative complications, and recurrence in the SILPEC and LPEC groups was performed. Results: There were no significant differences in the mean age or operative time. There were fewer total number of postoperative complications in the SILPEC group compared with the LPEC group (P = .0707). No intraoperative complications or recurrence occurred. Conclusions: Considering the risks and need to improve endoscopic surgical skills with useful instruments specialized for SILPEC, inexperienced surgeons can successfully perform SILPEC safely under expert pediatric surgeons.
    No preview · Article · Feb 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Introduction: Management of common bile duct stones (CBDS) in patients with borderline CBD presents a surgical challenge. The aim of this study was to compare conservative treatment with endoscopic stone extraction for the treatment of borderline CBD with stones. Patients and methods: This prospective randomized controlled trial includes patients with CBDS in borderline CBD (CBD <10 mm) associated with gallbladder stones who were treated with conservative treatment or endoscopic stone extraction followed by laparoscopic cholecystectomy (LC) and intraoperative cholangiogram (IOC). The primary outcome was successful CBD clearance. The secondary outcomes were the overall complications, cost, and hospital stay. Results: LC and IOC revealed complete clearance of CBDS in 48 (96%) cases in the endoscopic retrograde cholangiopancreatography (ERCP) group (52% of patients by ERCP, and 44% of patient passed the stone spontaneously), and in the remaining two patients, the CBDS was removed by transcystic exploration. In the conservative group, LC and IOC revealed complete clearance of CBDS in 90% of cases, and in the remaining 10% of patients, the CBDS was removed by transcystic exploration. Post-ERCP pancreatitis (PEP) is noticed significantly in the ERCP group (2 [4%] versus 8 [16%]; P = .04). The average net cost was significantly higher in the ERCP group. Recurrent biliary symptoms developed significantly in the ERCP group after 1 year (10% versus 0%; P = .02) in the form of recurrent cholangititis and recurrent CBDS. Conclusions: Management of CBDS in patients with borderline CBD represents a surgical challenge. Borderline CBD increases the technical difficulty of ERCP and increases the risk of PEP. Conservative management of CBDS in borderline CBD not only avoids the risks inherent in ERCP and unnecessary preoperative ERCP, but it is also effective in clearing CBDS. The hepatobiliary surgeon should consider a conservative line of treatment in CBDS in borderline CBD in order to decrease the cost and avoid unnecessary ERCP.
    No preview · Article · Feb 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Complete surgical resection remains the primary goal of rectal cancer surgeries. However, in 10%-20% patients, rectal tumors invade adjacent pelvic organs and resection of such organs is essential to achieve an R0 resection. Seminal vesicle is the most commonly involved organ in males. Although laparoscopic surgery has been found to be safe and feasible for rectal cancer surgeries, multivisceral resection is considered complex, and hence majority of these patients are offered open surgical resection. However, with improved surgical expertise as well as better laparoscopic equipment, surgeons have been attempting more complex rectal surgeries through the laparoscopic approach. We are delineating the technical details as well as initial results of laparoscopic total mesorectal excision with enbloc resection of seminal vesicle.
    No preview · Article · Jan 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Background: Laparoscopic caudate hepatectomy, which is a challenging procedure, has been reported sporadically. However, there is no standardized surgical technique, and the safety and feasibility of this procedure remain controversial. Materials and methods: A left-sided, purely laparoscopic approach for anatomic caudate hepatectomy was used for 11 selected patients in our institution. The procedure and technique of laparoscopic caudate hepatectomy were described. Perioperative data of these patients were retrospectively reviewed. Results: The 11 cases included two subgroups: laparoscopic isolated caudate hepatectomy (n = 4) and laparoscopic combined caudate and left hemihepatectomy (n = 7). There were three major steps for anatomic caudate hepatectomy. Two conversions were required (18.2%). Two complications (Clavien Grades I and II) occurred but no deaths. Conclusions: The left-sided, purely laparoscopic approach for anatomic caudate hepatectomy is safe and feasible in selected patients. This procedure can be performed by hepatobiliary surgeons with abundant experience in laparoscopic liver surgery.
    No preview · Article · Jan 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Background: Laparoscopic and robot-assisted surgeries are performed under carbon dioxide insufflation. Switching from gas to an isotonic irrigant introduces several benefits and avoids some adverse effects of gas insufflation. We developed an irrigating device and apparatus designed for single-incision laparoscopic surgery and tested its advantages and drawbacks during surgery in a porcine model. Materials and methods: Six pigs underwent surgical procedures under general anesthesia. A 30-cm extracorporeal cistern was placed over a 5-6-cm abdominal incision. The abdomen was irrigated with warm saline that was drained via a suction tube placed near the surgical field and continuously recirculated through a closed circuit equipped with a hemodialyzer as a filter. Irrigant samples from two pigs were cultured to check for bacterial and fungal contamination. Body weight was measured before and after surgery in four pigs that had not received treatments affecting hemodynamics or causing diuresis. Results: One-way flow of irrigant ensured laparoscopic vision by rinsing blood from the surgical field. Through a retroperitoneal approach, cystoprostatectomy was successfully performed in three pigs, nephrectomy in two, renal excision in two, and partial nephrectomy in one, under simultaneous ultrasonographic monitoring. Through a transperitoneal approach, liver excision and hemostasis with a bipolar sealing device were performed in three pigs, and bladder pedicle excision was performed in one pig. Bacterial and fungal contamination of the irrigant was observed on the draining side of the circuit, but the filter captured the contaminants. Body weight increased by a median of 2.1% (range, 1.2-4.4%) of initial weight after 3-5 hours of irrigation. Conclusions: Surgery under irrigation is feasible and practical when performed via a cistern through a small abdominal incision. This method is advantageous, especially in the enabling of continuous and free-angle ultrasound observation of parenchymal organs. Adverse effects of abdominal irrigation need further assessment before use in humans.
    No preview · Article · Jan 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Objective: To demonstrate the feasibility of intraoperative nerve monitoring (IONM) in total endoscopic thyroidectomy (TET) for high-risk thyroid cancer and to confirm its additional benefit on reducing surgery duration and protecting the recurrent laryngeal nerve (RLN). Subjects and methods: One hundred twenty-three patients with or without autoimmune thyroiditis (AT) underwent TET using IONM or not were included in the study. The primary outcome measures were the time used on related surgery procedures and the prevalence of RLN injury. Results: IONM could effectively reduce the time for locating the RLN (9.91 ± 1.68 minutes versus 12.49 ± 1.63 minutes; P < .01) and thyroid lobectomy (21.10 ± 4.53 minutes versus 27.35 ± 5.38 minutes; P < .01) but not central compartment dissection or whole surgery with or without AT. Of 167 at-risk nerves (98 in the IONM group and 69 in the non-IONM group), 5 (5.10%) in the IONM group (2 with and 3 without AT) suffered from temporary injury, compared with 7 (10.14%) in the non-IONM group (4 with and 3 without AT). Only 1 in the IONM group (with AT) and 2 in the non-IONM group (1 with and 1 without AT) developed permanent vocal cord paresis. The prevalence of RLN paresis was slightly decreased in the IONM group without statistical significance. Conclusions: IONM could reduce the time needed for RLN localization and thyroid lobectomy and make it easier for novices in TET. IONM also may decrease the incidence of the RLN paresis, especially temporary, compared with visualization alone; this proposal needs more evidence to confirm it in the future.
    No preview · Article · Dec 2015 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Aims: One of the challenges of laparoscopic surgery is the time required to perform intracorporeal knots. This can result in considerably longer operating times when compared with the open approach. An example of this is pediatric laparoscopic pyeloplasty, where extensive laparoscopic suturing is required. To reduce the time suturing, the authors developed a new knotting technique for laparoscopic suturing. Materials and methods: The authors modified a neurosurgical knot technique to speed up intricate continuous suturing, and a simple slip-knot-loop suture was created. Twenty continuous sutures were performed with five "bites" of tissue each. Ten were performed with a conventional intracorporeal knot to anchor the suture (Group 1), and 10 were performed using the slip-knot-looped suture to anchor (Group 2). This new knotting technique was used to perform five bowel anastomoses on pig intestine and tested for leaks by distending them with saline for 5 minutes. Results: The mean time to perform the suture for Group 1 was 300 seconds, and the mean time for Group 2 was 236 seconds. Unpaired two-tailed Student's t test comparing the means was significant (P < .001). No leaks occurred in any of the five anastomoses. Conclusions: This new slip-knot-loop technique modified for pyeloplasty was easy to use, was quicker than conventional knot tying, and produced safe knots and leak-free anastomoses. This knot is transferable to any laparoscopic procedure where continuous suturing is to be used.
    No preview · Article · Dec 2015 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Introduction: Despite leakages remaining a worrisome complication, laparoscopic sleeve gastrectomy (LSG) has become the preferred choice for most bariatric surgeons in Italy. In light of the emerging trend to discharge patients on postoperative day (POD) 1 or to consider LSG as an outpatient procedure, we felt it useful in selected cases to define a treatment protocol aimed to manage patients presenting with an acute postoperative leakage. Patients and methods: Starting from 2007, 295 LSGs have been performed at our institution. Six patients, including 5 from our series (1.6%), were treated for a leak. The first patient presented a leak on POD 3, whereas the next 2 patients were re-admitted on POD 11 and 12, respectively. They all underwent a conservative treatment. The last 3 patients, according to a suggested algorithm, underwent a prompt surgical repair. Results: The conservatively treated patients were discharged following 22 ± 7.7 days, whereas patients treated by surgery were discharged following 10 ± 0.8 days (P = .09). By not considering the cost of primary LSG, which is about 5600 € in our region, the expense for every patient treated by re-intervention was about 2500 €. The cost for each patient treated by stenting was about 4700 €. The cost for each patient treated conservatively was about 5700 €. Conclusions: According to our series and in agreement with published data, it is reasonable in selected cases to consider a wider role for early surgery. A timely surgical approach following an appropriate algorithm may offer a resolutive and cost-effective answer to the management of acute leaks following LSG.
    No preview · Article · Dec 2015 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    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.
    No preview · Article · Nov 2015 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    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.
    No preview · Article · Nov 2015 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    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.
    No preview · Article · Nov 2015 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    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.
    No preview · Article · Nov 2015 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    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.
    No preview · Article · Nov 2015 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    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.
    No preview · Article · Nov 2015 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    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.
    No preview · Article · Nov 2015 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    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.
    No preview · Article · Nov 2015 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    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.
    No preview · Article · Sep 2015 · Journal of Laparoendoscopic & Advanced Surgical Techniques