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 1557-9034
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

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Subxiphoid hernias are a rare complication of median sternotomy with an incidence of 1%-4.2%. Repair of subxiphoid hernias is technically demanding with recurrence rates of 42% and 30% following open and laparoscopic repairs, respectively. We present a novel approach to the laparoscopic repair of subxiphoid hernias with improved overlap and fixation. Materials and methods: A novel technique for repairing subxiphoid hernias is described. The falciform ligament is dissected superiorly toward the diaphragm to allow proper subfascial positioning of the mesh with adequate overlap. Multiple nonabsorbable intracorporeal sutures are used to anchor the mesh to the diaphragm above the costal margins. Transfascial nonabsorbable sutures and tacks are used to fix the mesh to the anterior abdominal wall below the costal margin. Results: We have used this method in 4 patients with a mean age of 60.5 years and a female to male ratio of 4:0. The average hernia defect size was 20.5 cm(2), and the average duration of operation was 93 minutes. There were no reported postoperative complications or evidence of recurrence at the 1-year follow-up. Conclusions: Laparoscopic repair of subxiphoid hernias can be safely accomplished with mesh sutured to the diaphragm for improved overlap and fixation with the goal of reducing recurrence rates.
    No preview · Article · Feb 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Objective: For laparoscopic low anterior resection of the rectum, a small additional incision is needed to extract the specimen. We describe an adjustment technique, which inserted the anvil and extracted the specimen through transanal pathway. Methods: Between July 2010 and July 2012, 23 patients underwent laparoscopic rectal surgery with transanal anvil insertion and transanal prolapsing specimen extraction. All perioperative data and short-term outcomes were recorded in a database. Results: The mean patient age was 61.3 years (range 47-68 years). Of the 23 patients, 17 underwent resection for rectal carcinoma and 6 had tubulovillous adenomas. No intraoperative complications occurred. The mean operative time was 137 minutes (range 118-170 minutes). The distal margins, circumferential resection margins, and lymph node dissections were oncologically adequate for all malignancies. One patient experienced anastomotic leakage (4.3%), treated conservatively. One male patient with benign prostatic hyperplasia suffered from postoperative urinary retention. The average postoperative hospital stay was 11.3 days (range 7-21 days). No patients experienced anal dysfunction. At a median follow-up of 26 months, there were no tumor recurrences. Conclusion: The technique of transanal prolapsing specimen extraction for laparoscopic low anterior resection of the rectum is feasible and safe for selected patients.
    No preview · Article · Feb 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Background and aims: To address the issue whether three dimensional (3D) offers real operative time advantages to the surgical procedure (primary endpoint) and significant reduction of surgeon's physical strain (secondary endpoint), we have retrospectively analyzed two consecutive series of laparoscopic right hemicolectomy (LRH) performed by a single experienced laparoscopic colorectal surgeon with two different imaging systems (two dimensional [2D] and 3D). Patients and methods: Since January 2014, 25 consecutive patients with right colon cancer underwent 3D LRH and other 25 consecutive ones received a 2D LRH by a single experienced surgeon. After the insertion of the access ports, the surgical procedure has been divided in component tasks and the execution times were compared. Upon completion of each procedure, the consultant surgeon was asked to complete a nonvalidated subjective questionnaire to evaluate quality of depth perception and surgical strain. Results: The execution times for the entire procedure and the single tasks were not significantly different between the 2D and 3D groups, except for the second task "side-to-side ileotransverse anastomosis" (P < .05). The surgeon experienced better depth perception with the 3D system and subjectively reported less strain using the 3D vision system rather than the 2D system, particularly during longer procedures. Conclusions: Three-dimensional imaging seems not to influence the performance time of laparoscopic right colon cancer surgery when the surgeon is experienced in 2D laparoscopy, although the 3D system seems to offer better depth perception and to subjectively determine less physical strain compared to 2D vision. Further comparative studies are necessary to address the issue whether novice surgeons could benefit from a reduced learning curve using 3D vision and to verify with greater numbers if 3D, even with a similar operative time, can reduce perioperative complications.
    No preview · Article · Feb 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Introduction: Hybrid 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]) reduces the invasiveness of conventional laparoscopic surgery and overcomes the limitation of pure NOTES, especially in the absence of angulated instruments. Patients and methods: The patients were 66-, 69-, and 32-year-old women with complaints of recurrent flank pain and urinary tract infection due to an obstructed nonfunctioning kidney. Materials used were standard laparoscopic instruments and a 30° 10-mm high-definition laparoscope. Under general anesthesia, each patient was placed in a lithotomy position with the affected side up at 45°. A Veress needle was initially inserted through the umbilicus and was later replaced with a 10-mm laparoscopic port, with an additional 5-mm port also inserted at the affected lower quadrant site. The patient was then positioned in a steep Trendelenburg position, and a 10-mm port was inserted through the posterior vaginal wall under direct vision from the abdominal cavity that was later used for the laparoscope. Nephrectomy proceeded despite noted severe adhesions, and the kidney was placed in the specimen retrieval bag. The vaginal port site was enlarged to 3 cm for extraction of the specimen. A Penrose drain was placed at the lower quadrant 5-mm trocar site. The vaginal wound was repaired using running 2-0 absorbable sutures. Results: Three cases of transvaginal hybrid NOTES nephrectomy were successfully completed with a median operative time of 310 minutes and mean estimated blood loss of 300 mL. Median renal dimensions were as follows: craniocaudal, 10.2 (range, 10.6-9) cm; laterolateral, 6.5 (range, 7-5.3) cm; and anteroposterior, 4.8 (range, 6.5-3.9) cm. The patients resumed regular diet as early as Day 1 postoperatively. The drain was removed prior to discharge. The mean date of discharge was Day 3 postoperatively. There were no noted surgical complications according to the Clavien-Dindo grading system. Conclusions: Hybrid NOTES transvaginal nephrectomy is a feasible and reproducible procedure in selected patients regardless of laterality for better cosmesis, reduced postoperative pain, and early recovery.
    No preview · Article · Feb 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Purpose: Data on laparoscopic totally extraperitoneal inguinal hernia repairs (TEP-IHRs) suggest that approximately 250 operations are needed to gain mastery, but the annual volume required to maintain high-quality outcomes is unknown. Materials and methods: A retrospective review was performed of every patient undergoing a TEP-IHR at the Mayo Clinic (Rochester, MN) from 1995 to 2011. Analysis focused on the annual volume of 21 staff surgeons and their specific patient outcomes broken up into three groups: Group 1 (G1) (n = 1 surgeon) performed >30 repairs per year; Group 2 (G2) (n = 3 surgeons), 15-30 repairs; and Group 3 (G3) (n = 17), <15 repairs. Results: In total, 1601 patients underwent 2410 TEP-IHRs, with no significant patient demographic differences among groups. Greater annual surgeon volume (G1 > G2 > G3) was associated with improved outcomes as shown by the respective rates for intra- (1%, 2.6%, and 5.6%) and postoperative (13%, 27%, and 36%) complications, need for overnight stay (17%, 23%, and 29%), and hernia recurrence (1%, 4%, and 4.3%) (all P < .05). Surgeons with greater annual operative volumes were more likely to operate on patients with bilateral and recurrent hernias. Surgeons performing at least 15 repairs per year (G1 and G2) showed improvements in quality metrics over time. Conclusions: Annual operative volumes of >30 repairs per year are associated with the highest quality outcomes for TEP-IHR. Operative volumes of at least 15 repairs per year are associated with improvements in quality metrics over time. Mentorship and operative assistance of low-volume TEP-IHR surgeons may be useful in improving patient outcomes.
    No preview · Article · Feb 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Objectives: To describe the initial experience of retroperitoneal laparoendoscopic single-incision radical nephrectomy (LESI-RN) without special platforms and use of conventional laparoscopic instruments and assess the safety and feasibility of LESI-RN. Subjects and methods: Twenty patients who underwent LESI-RN were enrolled in this study. A 5-cm arc skin incision was performed at the midpoint between the costal arch and iliac crest on the midaxillary line. Trocars of 10, 5, and 11 mm were placed at the middle, left end, and right end of the arc incision, respectively. Demographic parameters and perioperative data were retrospectively analyzed and compared with the patients who underwent conventional retroperitoneal laparoscopic radical nephrectomy (LRN). Results: The LESI-RN patients had a significantly lower visual analogue scale (4.4 ± 1.9 versus 5.6 ± 1.4; P = .031) and analgesic requirement (18.5 ± 11.2 versus 28.6 ± 16.1; P = .026) compared with the conventional LRN group. The operation time in the LESI-RN group was longer than that in the conventional LRN group (P = .001). The two procedures were essentially similar in terms of the time to liquid intake and hospital stay after operation (P > .05). Conclusions: LESI-RN is a safe and feasible surgical strategy, which combines the common principles of using straight instruments and working triangulation in conventional LRN with advantages of cosmesis and minimal invasiveness in laparoendoscopic single-site surgery. The surgical and oncological efficacy of LESI-RN is similar to that of conventional LRN but with significantly improved control of postoperative pain and cosmetic results.
    No preview · Article · Feb 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Background: It is often difficult to perform percutaneous radiofrequency ablation (RFA) for hepatic tumors beneath the diaphragm. Diaphragmatic thermal damage is one of the fatal late complications of percutaneous transdiaphragmatic RFA. Our experience with laparoscopic transthoracic transdiaphragmatic intraoperative RFA (LTTI-RFA) for hepatic tumors beneath the diaphragm is reported. Methods: Ten patients who underwent LTTI-RFA from 2009 to 2012 were evaluated. Two cases had concomitant partial hepatectomy, and one underwent RFA for two tumors at the same time. The diagnosis was hepatocellular carcinoma in eight cases and metastatic hepatic tumors in two cases. Nine of eleven tumors were located at segments 7 and 8. Nine tumors were less than 20 mm in diameter. The patients were placed in the half left lateral decubitus position with single-lumen tube intubation. After placement of four abdominal ports, a 12-mm port was inserted in the fourth or fifth intercostal space into the diaphragm. The tumor was ablated by an RFA needle through the port. The routine follow-up consisted of laboratory tests and abdominal imaging every 3-6 months. Results: The median operation time for only one tumor was 137 minutes (range, 105-187 minutes). The median number of times for ablation was three. Severe postoperative complications (>Clavien-Dindo IIIa) were observed in one case (right upper limb paralysis). The median follow-up period was 35 months (range, 11-43 months). There was no local tumor progression. Recurrent hepatic tumor appearance occurred in other parts of the liver in 6 of the 11 patients. Conclusions: Laparoscopic transthoracic transdiaphragmatic RFA is an acceptable procedure with a low rate of local recurrence.
    No preview · Article · Feb 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Background: Chronic right iliac fossa (CRIF) pain in children is associated with repeated hospital attendance, inconclusive investigations, and missed school days. There is increasing evidence for the role of laparoscopic appendectomy for the management of CRIF pain. However, currently there is no substantial evidence to correlate histological changes identified in the appendixes removed with resolution of pain. Method: This study collected prospective data for a single surgeon's series of laparoscopic appendectomy performed for CRIF pain between 2003 and 2014. Results: Forty patients with a median age of 13 years (range 5-19 years) underwent laparoscopic appendectomy for CRIF pain. Twenty-nine patients (73%) had macroscopically normal appendixes, but histological changes were identified in 28 patients (70%). Other findings at laparoscopy included gynecological pathology (ovarian/para-ovarian cysts), unfixed mobile caecum, and a well-defined peritoneal band extending from the caecum to the anterolateral abdominal wall (caeco-peritoneal band). Patients were followed up for a median of 2 months (range 1-15 months). All patients reported resolution of CRIF pain. Discussion: Laparoscopic appendectomy appears to be an effective treatment for CRIF pain, while also providing the opportunity to diagnose and treat potential sources of CRIF pain other than the appendix. Consistent with the literature, a small number of patients appear to have resolution of pain, despite no histological change being identified in the appendix removed and no other pathology having been identified. The same histological changes commonly seen have also been demonstrated in appendixes removed incidentally. Caution therefore should be applied when interpreting the significance of histological changes seen.
    No preview · Article · Feb 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Background: Obesity is a worldwide epidemic that is difficult to control with non-invasive treatments, which usually present poor results. In this context, the intragastric balloon (IGB) is an important tool that presents a mean body weight loss (BWL) estimated at approximately 12%, although individual responses are highly variable. Objectives: This study assesses whether there are factors that can predict responses to IGB therapy either before or early after placement of the device. Materials and methods: A total of 50 obese patients underwent insertion of IGB placed endoscopically, and patients were monitored for 6 months. The evaluated predictive factors involved general characteristics and psychological, social, and dyspeptic aspects, and the preliminary results obtained in the first month after balloon placement. Results: The mean weight loss was 11.5%, and 48% of the participants presented BWL >10%. Among the factors analyzed before IGB placement, only advanced age (P = .04) and higher scores obtained in the social relationships domain of a shorter version of the World Health Organization's Quality of Life questionnaire (P = .02) were significant. Analysis of the factors evaluated after IGB placement revealed that the BWL amounts observed in week 2 (P = .001) and week 4 (P < .001) and the intensity of dyspeptic symptoms in week 2 (P < .001) were positive predictive factors. Conclusions: The assessment of predictive factors may help to manage patients with IGB.
    No preview · Article · Feb 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Introduction and aims: We aim to compare clinical and surgical outcomes between minilaparoscopic sacrocolpopexy (MLSC) and conventional laparoscopic sacrocolpopexy (LSC). As far as we know, no comparative study exists between these two minimal invasive procedures to correct vaginal prolapse. Design and setting: An observational and comparative study with 20 individuals submitted to vaginal vault prolapse correction between June and December of 2014 in our tertiary referral unit. Nine women were submitted to 3-mm MLSC and the others were approached by a standard 5-mm laparoscopic technique. Materials and methods: Women's demographic data and prolapse grade were evaluated preoperatively using the Pelvic Organ Prolapse Quantification score. Operative parameters (surgical time, blood loss, and complications under Satava and Clavien-Dindo classification) and length of hospitalization were also compared. Postoperative pain and surgical scar satisfaction were measured using Visual Analog Pain Scale and Patient and Observer Scar Assessment Questionnaire, respectively. Results: MLSC took approximately the same time as LSC (P > .05). No significant differences in operative time, blood loss, length of hospitalization, and complications (Satava, Clavien-Dindo) were observed between both groups. Pain score after surgery was similar in MLSC and LSC (P > .05). Surgical scar monitoring at 3 months established that MLSC produced better overall results than LSC (P < .05). Anatomic cure rate was 100%. Conclusion: Minilaparoscopy is a feasible and attractive approach for sacrocolpopexy as it enhances cosmetics, keeping the low morbidity associated with the classical laparoscopic approaches.
    No preview · Article · Feb 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: This study presents a modified surgical approach to laparoscopic myotomy for achalasia using stepped dilation with a Rigiflex balloon and contrast medium under image guidance. A 10-year-old boy with persistent dysphagia and vomiting had ingested only liquids for 3 months, losing >10 kg in body weight. Barium swallow and esophageal manometry diagnosed esophageal achalasia with mild esophageal dilatation. After failed pneumatic dilatation, laparoscopic Heller myotomy with Dor fundoplication was performed. Prior to surgery, a Rigiflex balloon dilator was placed within the esophagus near the diaphragmatic hiatus. A four-port technique was used, and mobilization of the esophagus was limited to the anterior aspect. A 5-cm Heller myotomy was performed, extending another 2 cm onto the anterior gastric wall. During myotomy, the Rigiflex balloon was serially dilated from 30 to 50 mL, and filled with contrast medium under fluoroscopic image guidance in order to maintain appropriate tension on the esophagus to facilitate myotomy, and to confirm adequate myotomy with sufficient release of lower esophageal sphincter by resecting residual circular muscle fibers. Residual circular muscle fibers can be simultaneously visualized under both fluoroscopic image guidance and direct observation through the laparoscope, and they were cut precisely until the residual notch fully disappeared. Dor fundoplication was completed. The operative time was 180 minutes, and oral intake was started after esophagography on postoperative day 1. As of the 12-month follow-up, the patient has not shown any symptoms, and his postoperative course appeared satisfactory.
    No preview · Article · Feb 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Gastroesophageal reflux disease (GERD) is a common disorder that can cause a variety of typical and atypical symptoms. Although most patients can be rendered asymptomatic with medical treatment, some experience persistent breakthrough symptoms. A long history of GERD is associated with the risk for the development of Barrett's esophagus and ultimately esophageal carcinoma. Although often underutilized, minimally invasive antireflux surgery can help manage these patients. However, thorough evaluation and accurate diagnosis of GERD and its underlying pathophysiology are critical in ensuring successful surgical treatment. This review offers a stepwise approach to the diagnostic workup of GERD and how to appropriately tailor available surgical treatments to specific patient subgroups.
    No preview · Article · Jan 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Purpose: To evaluate the efficacy and safety of bipolar and monopolar transurethral resection of bladder tumor (TURBT) procedures for non-muscle invasive bladder cancer (NMIBC) patients. Materials and methods: We searched for all studies investigating bipolar TURBT and monopolar TURBT for NMIBC patients in PubMed, Web of Knowledge, and the Cochrane Central Search Library. A systematic review and meta-analysis were performed. Efficacy was assessed by catheterization time, resection time, pathology, and recurrence rate. Safety was assessed by obturator nerve reflex, bladder perforation, hemoglobin decrease, and transfusion. Results: Our searches identified eight studies. Bipolar TURPT is associated with decreased resection time, catheterization time, and hemoglobin changes. There were no statistically significant differences between bipolar TURPT and monopolar TURPT for rates of obturator nerve reflex, bladder perforation, and transfusion. The grade of cautery artifact had no different between the two procedures or even was lower in the bipolar arm. There was no significant difference in recurrence rate when comparing the two procedures. Conclusions: This systematic review indicates that the bipolar technique is more efficacious and safer for NMIBC patients. More large-scale, multicenter, randomized controlled studies are needed before final clinical recommendations can be made.
    No preview · Article · Jan 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Background: There is no consensus for the management of failed laparoscopic pyeloplasty in pediatric surgical patients, and only limited publications are available. We evaluated here the clinical outcomes of re-intervention for failed laparoscopic transperitoneal pyeloplasty in infants and children. Materials and methods: Retrospective review of all children who had undergone laparoscopic transperitoneal dismembered Anderson-Hynes pyeloplasty for ureteropelvic junction obstruction from 2002 to 2013 was performed. Patients' demographics, indications, operative details, and outcomes for primary operation as well as re-intervention were studied. Results: There were 42 patients with a median age of 20 months (range, 3-192 months) and a median body weight of 12 kg (range, 6-56 kg) who underwent a total of 46 laparoscopic transperitoneal pyeloplasties during the study period. The median operative time and blood loss were 193 minutes (range, 115-480 minutes) and trace amount (range, trace amount to 400 mL), respectively. No conversion was reported. Ten cases (22%) required re-intervention. No statistically significant risk factor for failed pyeloplasty was identified. Indications for re-intervention included deterioration of differential renal function (n = 6), progressive hydronephrosis (n = 1), urinary ascites (n = 2), and urosepsis (n = 1). Median time of re-intervention was 6.5 ± 38 months postpyeloplasty. Re-intervention was categorized into the redo pyeloplasty group (n = 6) and the urinary diversion group (n = 4) (insertion of double-J ureteral stent or endopyelotomy) with success rates of 50% and 25%, respectively. Among the redo pyeloplasty group, 3 patients underwent redo laparoscopic pyeloplasty, and all of them had drainage restored with a median improvement in differential renal function of 11%. The mean follow-up duration was 77 ± 38 months. Conclusions: Laparoscopic transperitoneal pyeloplasty is safe and feasible in children. Redo pyeloplasty is a more favorable re-intervention compared with urinary diversion in our series. Redo laparoscopic pyeloplasty has been shown to improve differential renal function.
    No preview · Article · Jan 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Background: To compare the efficacy of three chemotherapeutic combinations for laparoscopic hyperthermic intraperitoneal perfusion chemotherapy (HIPPC) in the treatment of malignant ascites secondary to unresectable gastric cancer (GC). Materials and methods: From January 2010 to December 2013, 38 GC patients were randomly divided into three groups and treated by laparoscopic HIPPC with one of the three following chemotherapy combinations: raltitrexed (Ra) with oxaliplatin [trans-(±)-diaminocyclohexane oxalatoplatinum (l-OHP)], Ra with cisplatin (DDP), and Ra with mitomycin C (MMC). Perioperative complications, patients' quality of life, and survival were recorded and compared among the three groups. Results: The intraoperative course was successful in all patients, and no perioperative death or complication related to laparoscopic HIPPC was documented. The median follow-up period was 9 months, and the median survival was 7.5 months for all patients. Patients in the Ra/l-OHP group had a median survival of 8.7 months, the Ra/DDP group had a median survival of 5.6 months, and the Ra/MMC group had a median survival of 7.5 months. Patients' median survival in the Ra/l-OHP group and Ra/MMC group was significantly longer than in the Ra/DDP group (P < .05). No significant difference was found in total remission rate of ascites, increase in the Karnofsky Performance Scale, and incidence rate of port-site metastases among the three groups. Conclusions: Laparoscopy-assisted HIPPC provides modest yet encouraging efficacy for malignant ascites secondary to disseminated GC. Our preliminary data indicate that the chemotherapeutic combination of Ra/l-OHP and Ra/MMC might be more beneficial compared with Ra/DDP in terms of patients' survival.
    No preview · Article · Jan 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Aims: This study evaluated the safety, feasibility, and short-term outcomes of laparoscopic extralevator abdominoperineal excision (laparoscopic-ELAPE) with primary suturing for low rectal cancer. Materials and methods: Consecutive patients who underwent laparoscopic-ELAPE with primary suturing for low rectal cancer at our institution between September 2013 and January 2015 were retrospectively identified from a prospectively maintained database. Short-term outcomes, including intraoperative complications, postoperative morbidity, and oncologic adequacy of surgical specimens, were evaluated. Results: Laparoscopic-ELAPE was successful in all 33 included patients, with no patient requiring conversion to an open approach. Mean operation time was 200 minutes, and mean intraoperative blood loss was 90 mL. Except for bowel perforation in 2 patients (6.1%), there were no intraoperative complications. Two patients (6.1%) had positive circumferential resection margins. Median length of hospital stay was 7 days. The 30-day morbidity and mortality rates were 15.2% and 0%, respectively. Postoperative complications within 30 postoperative days included perineal wound infection (2 patients, 6.1%), respiratory infection (2 patients, 6.1%), and chylous fistula (1 patient, 3.0%). Complications at a median follow-up time of 12 months (range, 3-19 months) included local tumor recurrence (1 patient, 3.0%), perineal dehiscence (2 patients, 6.1%), perineal seroma (1 patient, 3.0%), bowel obstruction (1 patient, 3.0%), urinary retention (2 patients, 6.1%), and chronic perineal pain (2 patients, 6.1%). There were no instances of perineal hernia, persistent sinus, or peristomal hernia. Conclusions: Laparoscopic-ELAPE with primary suturing appears to be a feasible and safe treatment approach for low rectal cancer, with acceptable short-term outcomes.
    No preview · Article · Jan 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Background: Fish bone migration from the gastrointestinal tract into the liver is an unusual cause of liver abscess. Materials and methods: We describe successful laparoscopic removal of intrahepatic fish bones in 2 patients who presented with liver abscesses. Both patients were admitted to our institution with a 2-week history of right upper quadrant pain, fever, chills, and rigors. Radiological imaging revealed the presence of a linear calcified foreign body within a hepatic abscess in the left lateral section of the liver. These findings were suggestive of infection secondary to migration of fish bone from the stomach to the liver. Results: Both patients underwent percutaneous drainage of liver abscesses with control of sepsis, followed by laparoscopic removal of intrahepatic fish bones. Localization of the fish bones was facilitated by intraoperative ultrasonographic examination of the liver. Postoperative recovery was fast and uneventful. Conclusions: This is the first report of two consecutive cases of liver abscess caused by fish bone migration where our patients were successfully treated by percutaneous drainage of the abscess followed by laparoscopic removal of intrahepatic fish bone.
    No preview · Article · Jan 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Introduction: Traditionally open resection with hepaticojejunostomy (HJ) reconstruction has been the surgical treatment for cases of choledochal cyst. Our center has recently transitioned from open to laparoscopic and HJ to hepaticoduodenostomy (HD) as our preferred method of excision and biliary reconstruction. Our initial experience is presented here. Materials and methods: A single-center retrospective chart review was performed from 2005 to 2014. All patients undergoing surgical treatment for choledochal disease were considered. Results: During the study period 18 patients had surgical treatment for choledochal cyst disease. The average age of all patients was 4.7 years (range, 2 months-15.5 years). Eleven of these patients had laparoscopic excision and reconstruction. Of these 11 patients, 7 had an HD anastomosis. Comparing the laparoscopic with the open group and the HD with the HJ group, there was no significant difference in operative time, estimated blood loss, time to regular diet, length of stay, or complication rate. Mean follow-up of 3.1 years revealed no documented cases of bile reflux or cholangitis. A recent adaptation in technique may improve ease of HD anastomosis. In this method, two strands of temporary monofilament suture cut to 8-10 cm each are tied extracorporeally. This knot is then placed on the outside of the medial corner. The anastomosis is then completed in a running fashion with the two strands and then secured intracorporeally at the lateral corner. Conclusions: Laparoscopic choledochal cyst resection with both HJ and HD reconstruction appears safe and has equivalent outcomes to open procedures in our series.
    No preview · Article · Jan 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Background: The use of robotic single-site cholecystectomy has increased exponentially. There are few reports describing the safety, efficacy, and operative learning curve of robotic single-site cholecystectomy either in the community setting or with nonelective surgery. Materials and methods: We performed a retrospective review of a prospective database of our initial experience with robotic single-site cholecystectomy. Demographics and perioperative outcomes were evaluated for both urgent and elective cholecystectomy. Cumulative sum analysis was performed to determine the surgeon's learning curve. Results: One hundred fifty patients underwent robotic single-site cholecystectomy. Seventy-four (49.3%) patients underwent urgent robotic single-site cholecystectomy, and 76 (50.7%) underwent elective robotic single-site cholecystectomy. Mean total operative time for robotic single-site cholecystectomy was 83.3 ± 2.7 minutes. Mean operative time for the urgent cohort was significantly longer than for the elective cohort (95.0 ± 4.4 versus 71.9 ± 2.6 minutes; P < .001). There was one conversion in the urgent cohort and none in the elective cohort. There was one bile duct injury (0.7%) in the urgent cohort. Perioperative complications occurred in 8.7% of patients, and most consisted of superficial surgical-site infections. There were no incisional hernias detected. The surgeon's learning curve, inclusive of urgent and elective cases, was 48 operations. Conclusions: Robotic single-site cholecystectomy can be performed safely and effectively in both elective and urgent cholecystectomy with a reasonable learning curve and acceptable perioperative outcomes.
    No preview · Article · Jan 2016 · Journal of Laparoendoscopic & Advanced Surgical Techniques
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    ABSTRACT: Background: Laparoscopic pancreaticoduodenectomy is advantageous as a minimally invasive surgery, but performing the complicated anastomosis is technically difficult. Herein, we present our experiences with total laparoscopic pancreaticoduodenectomy (TLPD) using a unique anastomosis technique, that is, pancreaticojejunostomy using only two transpancreatic sutures with buttresses method (PJt). Materials and methods: From September 2013 to March 2015, 12 TLPDs using PJt for periampullary tumors were performed. In each case, the pancreaticoenteric anastomosis was performed using the PJt technique, a modification of invaginated, end-to-end pancreaticojejunostomy. A pair of transpancreatic sutures were placed on the upper and lower borders of the implanted pancreas through the jejunal limb covering the pancreas stump, and four buttresses were used to reinforce the anastomosis. All medical records and follow-up data were reviewed and analyzed with regard to surgical outcomes, and the results were compared with previously published reports on TLPD. Results: The mean age of the patients was 64.3 ± 12.3 years, and all were diagnosed with pancreas head cancer except 5 patients (4 patients had ampulla of Vater cancer, and the other had chronic pancreatitis). The mean estimated blood loss was 118 ± 57 mL, and the mean hospital stay was 12.5 ± 4.5 days. The mean operative time was 411.6 ± 59.2 minutes, and the pancreas anastomosis time was 20.1 ± 4.8 minutes without any evidence of anastomosis-related complications. Conclusions: Our novel technique of PJt is a simple, easy, and feasible method for TLPD with the possibility of reducing the burden to the operator and acquiring secure anastomosis.
    No preview · Article · Dec 2015 · Journal of Laparoendoscopic & Advanced Surgical Techniques