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... Single-incision surgery was reported as early as 1969, when Wheeless et al. [10] performed tubal ligation with laparoscopy through a single surgical channel. In 1997, Navarra et al. [11] first reported transumbilical single-incision cholecystectomy, performed through two 10-mm trocars set in a small transumbilical incision combined with suspension technology. Complete transumbilical cholecystectomy without any additional trocar was first performed by Podolsky et al. in 2007 [12], marking the development of SILS. ...
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Background In most previous studies, single-incision laparoscopic surgery (SILS) for colorectal cancer (CRC) was feasible and safe in the short term. However, long-term oncologic outcomes remain uncertain, as only a few studies contained long-term survival data. SILS for CRC is still in the early stages of research. Further studies, particularly large-scale, prospective randomized controlled trials, are necessary to assess the value of SILS for CRC. Methods This study is a prospective, multicentre, open-label, noninferiority, parallel-group randomized controlled trial that investigates the long-term oncologic outcomes of SILS compared to conventional laparoscopic surgery (CLS) for CRC. A total of 710 eligible patients will be randomly assigned to the SILS group or the CLS group at a 1:1 ratio using a central, dynamic, and stratified block randomization method. Patients with ages ranging from 18 to 85 years old, of both sexes, with CRC above the peritoneal reflection diagnosed as cT1-4aN0-2M0 and a tumour size no larger than 5 cm will be considered for the study. The primary endpoint is 3-year disease-free survival (DFS). The secondary endpoints include: intraoperative outcomes, postoperative recovery, postoperative pain assessment, pathological outcomes, early morbidity and mortality rate, cosmetic effects, quality of life, 3-year overall survival (OS), incidence of incisional hernia, 5-year DFS and 5-year OS. The first two follow-up visits will be scheduled at one month and three months postoperatively, then every three months for the first two years and every six months for the next three years. Discussion Currently, no randomized controlled trials (RCTs) have been designed to investigate the long-term oncologic outcomes of SILS for CRC. This study is expected to provide clinical evidence of the oncologic outcomes of SILS compared to CLS for CRC to promote its widespread use. Trial registration ClinicalTrials.gov: NCT 04527861 (registered on August 27, 2020).
... In this context, transluminal endoscopic surgery by natural orifices (NOTES-Natural Orifice Translumenal Endoscopic Surgery), mini laparoscopy and laparoscopic surgery through a single portal (LESS-Laparoendoscopic Single-Site Surgery) emerged as alternatives. [5][6][7] Nowadays, however, the laparoscopic technique is greatly preferred over the open technique, making it difficult to compare and demonstrate more benefits of these new minimally invasive techniques compared to open surgery. ...
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Background Cholecystectomy is one of the most performed surgeries. Several techniques were created, generating less pain, better aesthetic results and faster return to activities. Robotic surgery through a single portal combined the advantages of single-incision surgery with the principles of conventional laparoscopy, making it a safe and feasible procedure. However, due to the high costs, this technology is hardly available in practice, especially in the public health system. The objective is to evaluate the safety of robotic cholecystectomy using the da Vinci Single-Site © Surgical Platform (DVSSP) in a tertiary public hospital, and to assess alternatives that can reduce the costs, influencing the final real value of the procedure. Methods Prospective and descriptive study evaluating robotic cholecystectomies using the DVSSP technology performed at Hospital de Clínicas de Porto Alegre from May 2017 to November 2018. Results A total of 37 cholecystectomies were performed. The average time of surgery was 82.62 minutes, and no intraoperative complications were observed. There was a need for conversion to conventional laparoscopy in two surgeries (5.4%). The average cost of the robotic procedure was U$ 1146.23 and the amount passed on to the institution by the Brazilian Unified Health System was on average U$ 212.59 (p<0.05). Postoperative outcomes were satisfactory, with an incisional hernia index of 8.1%. Conclusion Although robotic surgery in this setting is a safe and feasible alternative, the high cost of the procedure prevents its dissemination on a large scale. New alternatives are needed to reduce the value and to allow greater accessibility. This article is protected by copyright. All rights reserved.
... Laparoscopic cholecystectomy (LC) can reduce pain and surgical scar after surgery. 1 Single incision laparoscopic cholecystectomy (SILC) is the LC procedure that has the least number of incisions. It was reported for the first time by Navara et al. 2 without difference in the overall rate of complications, including biliary tract injury, bile leakage and wound infection, when compared with conventional LC. The cosmetic result of SILC was superior to that of conventional LC. 3 However, some reports revealed that SILC had a higher incidence of incisional hernia than conventional LC. 4,5 The SILC Original Article SMJ procedure may not be familiar to the surgeon which may take longer operative time and higher perioperative complication rates than conventional LC. 6 There were a lot of predictive factors of difficult LC in conventional LC procedure. ...
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Objective: The difficult laparoscopic cholecystectomy (LC) is defined as the presence of one of the followingconditions including prolonged operative time, conversion to open cholecystectomy or significant blood loss. Atpresent, there is no evidence of predictive factors related to longer operative time in single-incision laparoscopiccholecystectomy (SILC). The aim of this study is to determine predictive factors associated with longer operativetime in SILC procedure.Materials and Methods: A retrospective study was conducted of patients with benign gallbladder disease whounderwent SILC in Thammasat University Hospital between October 2014 and December 2020. Patients’ recordswere reviewed. Primary outcomes were preoperative predictive factors associated with DSLC. Secondary outcomeswere perioperative and 3-month postoperative adverse outcomes.Results: 592 SILC procedures were categorized as 80 DSLC and 512 non-difficult SILC (NDSLC). The median(interquartile range) of operative time in all SILC procedure is 48 (38, 62) minutes. The threshold of operative timeof difficult SILC was 72 minutes. The multivariate analysis indicated 5 significant predictive factors. Obesity (bodymass index > 25 kg/m2)) and abdominal pain reflected the difficulty of SILC procedures (p = 0.041 and p = 0.009).Calcified gallbladder showed the highest RR of 14.08 (p = 0.011). Contracted gallbladder and chronic cholecystitiswere also predictive factors with RR of 13.79 and 3.64, respectively (p < 0.001 and p = 0.007).Conclusion: Obesity, abdominal pain, chronic cholecystitis, contracted gallbladder and calcified gallbladder werepreoperative predictive factors. Surgeons should perform the SILC procedure carefully when predictive factors areidentified.
Background and objectives: To assess the safety and efficacy of single-port laparoscopic cholecystectomy (SPLC) for the treatment of symptomatic cholelithiasis in different gallbladder pathologic conditions. Methods: All patients who underwent SPLC in our department between October 1, 2017 and March 31, 2020 were registered consecutively in a prospective database. Patients' charts were retrospectively divided according to histological diagnosis: normal gallbladder (NG) (n = 13), chronic cholecystitis (CC) (n =47), and acute cholecystitis (AC) (n = 10). The parameters for assessing the procedure outcome included operative time, blood loss, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and length of hospital stay. Patient groups were statistically compared. Results: Seventy patients underwent SPLC. Duration of surgery increased from NG (55 ± 22.7 min) to CC (70 ± 33.5 min), and to AC patients (110.5 ± 50.5 min), which is statistically significant (P = .001). Postoperative complication rates were 7.6% in NG patients, 17% in CC, and 30% in AC (P = .442). Length of hospitalization was shorter for NG patients (1.0 ± 0.6 days) versus CC (2.0 ± 1.1 days) and AC patients (2.0 ± 4.7 days), with statistical significance (P = .020). Multivariate analysis found that pathology type and the occurrence of postoperative complications were independent predictors for prolonged operative times and prolonged hospital stay, respectively. Conclusion: SPLC is feasible for acute and chronic cholecystitis with good procedural outcomes. Since SPLC technique itself can be sometimes challenging with the existing technology, its application, especially in cases of acute cholecystitis, should be done with caution. Only prospective randomized studies on this approach for acute and chronic gallbladder diseases will assess the complete reliability of this technique.
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Within the last 20 years robotic-assisted surgeries have been implemented as routine procedures in many surgical fields, except in Plastic Surgery. Although several case series report promising results, technical and economic aspects have prevented its translation into clinical routine. This review is based on a Pubmed and Google-Scholar databased search including case reports, case series, clinical and preclinical trials as well as patents. Past, recent approaches, ongoing patents as well as 8 specific systems for robotic-assisted microsurgery and their potential to be translated into clinical routine are described. They may lay ground for a novel field within Plastic Surgery. This review is giving an overview of the emerging technologies, clinical and preclinical studies and discusses the potential of robotic assistance in the field of Plastic Surgery.
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Surgical interventions should ideally treat an existing disease curatively and achieve this with a low complication rate and minimal trauma. In this sense, laparoscopic cholecystectomy has become established as the recognized standard for the treatment of cholecystolithiasis. Newer procedures, such as single-port surgery or natural orifice transluminal endoscopic surgery (NOTES) have recently emerged to reduce the already low interventional trauma even further and to provide a better cosmetic outcome. With all new methods the main aim is the reduction of the transabdominal access points. Based on published results and diagnosis-related groups (DRG) data, this article examines whether this goal has been achieved, also with respect to the overall quality of treatment and the complication rates. In this context and in addition to the already mentioned approaches, robotic cholecystectomy and the reduced port approach are also considered.
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Background: Despite having once been extensively used for cosmetics or pain reduction, the use of single-incision laparoscopic cholecystectomy (SILC) has declined in recent years due to technical difficulties and a reported increase in complications. Since the introduction of SILC in 2009, our hospital has been actively involved with this technique. Our experience suggests that SILC is not a difficult procedure and can be safe and useful, with particularly excellent cosmetic outcomes. This study retrospectively details the outcomes of SILC at our hospital. Method: Data on 1469 cases of SILC performed on a waitlist basis at Osaka Police Hospital from May 2009 to December 2020 were collected and retrospectively analysed. Results: The median operative time and blood loss were 96 min and 0 mL, respectively. A total of 46 patients (3.1%) required conversion surgery, including 36 needing additional ports and 10 requiring laparotomy. Intraoperative complications included common bile duct injury in 1 patient (0.07%) and right hepatic artery injury in 1 patient (0.07%), with no other organ injury. Postoperative Clavien-Dindo 3 or higher complications were observed in 18 patients (1.2%). Incisional hernias occurred in 15 patients (1.0%). The median postoperative hospital stay was 3 days. Conclusion: This study showed that SILC can be performed safely without any increase in complications, as reported previously. Granted that it is performed safely, SILC may be a useful technique due to its superior cosmetic outcomes or pain reduction.
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Background The indications for single-incision thoracoscopic surgery in children are expanding. We present outcome comparisons in single versus multi-port surgical technique for management of Primary Spontaneous Pneumothorax (PSP) in seven children. Methods This retrospective chart review of the outcomes from a single-surgeon's experience in thoracoscopic technique over a two-year period includes seven cases, divided into two groups: traditional multiport video assisted thoracoscopic surgery (MP-VATS) (n = 3) versus single-port VATS (SP-VATS) (n = 4). Data for patient demographics, chest tube placement, operation details, opioids usage, and postoperative course were recorded and analyzed. Results Seven patients had a median age of 14.88 years [range 12–17 years] with a male predominance 67% MP-VATS and 75% SP-VATS (p = 0.41). Average time to surgery: 3.6 days (p = 0.21) operating time: 1.2 h (p = 0.09). Estimated blood loss was higher for MP-VATS 5.33 ml vs SP-VATS 2.25 ml but not statistically significant (p = 0.11). Opioids given in the post-operative period until chest tube removal were similar: MP 0.19 vs SP 0.12 mg/kg (p = 0.17). Time to chest tube removal was significantly longer at 5.54 vs 3.59 days for MP-VATS vs SP-VATS (p < 0.05). Length of stay was 10.46 vs 8.33 days for MP-VATS vs SP-VATS (p = 0.30). One SP patient had recurrent pneumothorax after chest tube removal, requiring replacement of chest tube, one MP patient required an additional surgery for contralateral PSP. Conclusion In this small case series, outcomes were similar for MP-VATS and SP-VATS for PSP, but chest tube removal was earlier in SP. This provides a convincing basis to expand the usage for this technique.
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Background To date, a surgical method for single-incision laparoscopic cholecystectomy (SILC) has not been standardized. Therefore, this study aimed to introduce a standardized surgical method for SILC, in addition to reporting our experience over 10 years. Methods Patients who underwent SILC at a single institution between April 2010 and December 2019 were included in this study. We analyzed the patient demographics and surgical outcomes according to the surgical method used: phase 1 (Konyang standard method, KSM) comprising initial 3-channel SILC, phase 2 (modified KSM, mKSM) comprising 4-channel SILC with a snake retractor, and phase 3 (commercial mKSM, C-mKSM) using a commercial 4-channel port. Results Of 1372 patients (mean age, 51.3 years; 781 [56.9%] women), 418 (30.5%) surgeries were performed for acute cholecystitis (AC), 33 (2.4%) were converted to multiport or open cholecystectomy, and 49 (3.6%) developed postoperative complications. The mean operation time (OT) and length of postoperative hospital stay (LOS) were 51.9 min and 2.6 days, respectively. Overall, 325 patients underwent SILC with the KSM, 660 with the mKSM, and 387 with the C-mKSM. In the C-mKSM group, the number of patients with AC was the lowest (26.8% vs. 38.2% vs. 20.4%, p < 0.001) and the OT (51.7 min vs. 55.4 min vs. 46.1 min, p < 0.001), estimated blood loss (24.5 mL vs. 15.5 mL vs. 6.1 mL, p < 0.001), and LOS (2.8 days vs. 2.5 days vs. 2.3 days, p = 0.001) were significantly improved. The surgical outcomes were better in the non-AC group than in the AC group. Conclusion Based on our 10 year experience, C-mKSM is a safe and feasible method of SILC in selected patients, although there were lower percentage of patients with AC compared to other groups.
Article
Although advanced minimally invasive surgery and robotic surgery were well accepted in developed countries by the turn of the 21st century, they did not enjoy the same popularity in the Anglophone Caribbean. Advanced minimally invasive surgery only became available in select Caribbean countries from the year 2010. And up to the year 2021, robotic surgery was completely non-existent in the Anglophone Caribbean. Surgical leaders in the Anglophone Caribbean recognized a need to encourage the introduction of advanced surgical techniques in the region and engaged local and international stakeholders in an attempt to stimulate this development. In the year 2021, through a collaborative effort by a local medical university, a government-funded hospital, and industry partners in the United Kingdom, robot-assisted minimally invasive surgery was successfully introduced to the Caribbean. We report our experience of introducing robot-assisted minimally invasive surgery in the Eastern Caribbean. By discussing the pitfalls and successes from our experience, we hope that the lessons can be used to guide the introduction of robot-assisted minimally invasive surgery in other resource-poor countries in the Caribbean. .
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This volume contains the program abstracts of presentations given at the Third International Congress of Neurological Surgery held in Copenhagen in August 1965. The articles, mostly in English with a few in French and German, cover a wide variety of subject matter. Those of the invited speakers are illustrated and have bibliographic citations in addition to a brief review of their presentations.
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We reviewed the cumulative experience with laparoscopic cholecystectomy reported in the surgical literature, including 12,397 patients selected to undergo laparoscopic cholecystectomy, 95% of which were performed on an elective basis. Although the indications for operation varied, 90% of patients had evidence of cholelithiasis and biliary colic. Conversion to open cholecystectomy was required in 534 patients (4%); of these, 52% were converted because of acute or chronic inflammation or adhesions. Laparoscopic cholangiography was attempted in 3,696 of 9,231 patients (40%) and was successful in 84%. The incidence of major bile duct injury, minor bile duct injury, bile leak, and overall morbidity was 0.3%, 0.1%, 0.4%, and 4%, respectively. The mortality rate was 0.08%. Results from individual reports indicate that 54% to 98% of patients were discharged on the 1st or 2nd postoperative day, and 77% to 98% returned to full activity within 7 to 14 days. The incidence of bile duct injury, overall morbidity, and mortality compare favorably with published reports for open cholecystectomy. The collective data would also indicate that laparoscopic cholecystectomy is a safe and efficacious procedure that offers a viable alternative to conventional cholecystectomy.
Article
A retrospective survey of 7 European centers involving 20 surgeons who undertook 1,236 laparoscopic cholecystectomies was performed. The procedure was completed in 1,191 patients. Conversion to open cholecystectomy was necessary in 45 patients (3.6%) either because of technical difficulty (n = 33), the onset of complications (n = 11), or instrument failure (n = 1). There were no deaths reported, and the total postoperative complication rate was 20 of 1,203 (1.6%), with 9 being serious complications requiring laparotomy. The total incidence of bile duct damage was 4 of 1,203. The median hospital stay was 3 days (range: 1 to 27 days) and the median time to return to full activity after discharge was 11 days (range: 7 to 42 days).
Article
Complications of laparoscopic cholecystectomy were evaluated by a survey of surgical department chairpersons at 4,292 US hospitals. The 77,604 cases were reported by 1,750 respondents. Laparotomy was required for treatment of a complication in 1.2% of patients. The mean rate of bile duct injury (exclusive of cystic duct) was 0.6% and was significantly lower at institutions that had performed more than 100 cases. Bile duct injuries were recognized postoperatively in half of the cases and most frequently required anastomotic repair. Intraoperative cholangiography was practiced selectively by 52% of the respondents and routinely by 31%. Bowel and vascular injuries, which occurred in 0.14% and 0.25% of cases, respectively, were the most lethal complications. Postoperative bile leak was recognized in 0.3% of patients, most commonly originating from the cystic duct. Eighteen of 33 postoperative deaths resulted from operative injury. These data demonstrate that laparoscopic cholecystectomy is associated with low rates of morbidity and mortality but a significant rate of bile duct injury.
First Congress of the Italian Society of Mini-Invasive Surgery
  • Petri R
  • Donini A
  • Terrosu G
First Congress of the Italian Society of Mini-Invasive Surgery
  • G Petri R Donini A Terrosu