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Xiao X, Liu T, Li X, He L, Lin Y, Feng D. Transvaginal natural orifice transluminal endoscopic surgery for tubal ectopic pregnancy(vNOTESTEP): a protocol for a randomized controlled trial. BMC Pregnancy Childbirth 2025; 25:477. [PMID: 40269766 PMCID: PMC12020209 DOI: 10.1186/s12884-025-07595-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 04/10/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND Tubal ectopic pregnancy is a life-threatening condition in early pregnancy. Minimally invasive laparoscopic surgery is increasingly used for the treatment of this disease. Retrospective studies suggest that Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) offers lower perioperative complications, faster recovery, and better cosmetic outcomes compared to other approaches. However, the lack of comprehensive perioperative and long-term postoperative data limits its widespread adoption in gynecology. METHODS The vNOTESTEP study is a randomized controlled trial (RCT) enrolling 72 patients requiring laparoendoscopic surgery for tubal ectopic pregnancy. After obtaining informed consent, preoperative assessments will be conducted. Following randomization, salpingectomy will be performed using either vNOTES or TU-LESS approach. The postoperative assessment and a structured 5-year follow-up, including eight visits, will be conducted. Baseline sociodemographic and clinical data will be collected from the Hospital Information System and patient interviews. Outcomes will be assessed perioperatively and postoperatively at designated time points (1st, 2nd, and 3rd postoperative day; 1st, 3rd, and 6th month; 1st-5th year). Key long-term outcomes include sexual function, pregnancy, vaginal delivery, and incisional hernia. DISCUSSION This RCT aims to provide robust clinical evidence on the perioperative and long-term outcomes of vNOTES versus TU-LESS for tubal ectopic pregnancy, focusing on key reproductive and surgical outcomes. The study seeks to refine patient selection criteria and contribute to guideline development for gynecologic vNOTES. TRIAL REGISTRATION NUMBER ChiCTR2400082909 (registered on April 10th, 2024).
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Affiliation(s)
- Xinyu Xiao
- Department of Gynecology of Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Chengdu, Sichuan, 610091, People's Republic of China
| | - Tianjiao Liu
- Department of Gynecology of Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Chengdu, Sichuan, 610091, People's Republic of China
| | - Xin Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Li He
- Department of Gynecology of Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Chengdu, Sichuan, 610091, People's Republic of China.
| | - Yonghong Lin
- Department of Gynecology of Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Chengdu, Sichuan, 610091, People's Republic of China.
| | - Dan Feng
- Department of Gynecology of Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Chengdu, Sichuan, 610091, People's Republic of China.
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Wang K, Xu Q, Xia L, Sun J, Shen K, Liu H, Xu L, Li R. Gallbladder polypoid lesions: Current practices and future prospects. Chin Med J (Engl) 2024; 137:1674-1683. [PMID: 38420780 PMCID: PMC11268823 DOI: 10.1097/cm9.0000000000003019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Indexed: 03/02/2024] Open
Abstract
ABSTRACT Gallbladder polypoid lesions (GPLs) refer to any elevated lesion of the mucosal surface of the gallbladder wall, and the prevalence is estimated to be between 0.9% and 12.1%. GPLs include benign polyps and malignant polyps. Benign polyps are further classified as non-neoplastic polyps and neoplastic polyps. Cholesterol polyps are the most common benign polyps and adenocarcinoma is the main type of malignant polyp. Hepatitis B virus infection, liver function abnormalities, dyslipidemia, and obesity are the main risk factors for GPLs. Studies of biological mechanisms have focused on malignant gallbladder polyps, the development of which is regulated by hormone levels in vivo , gut microbiota, inflammation, oxidative stress, Salmonella typhimurium , and related molecules. Diagnostic modalities include chemical examination and imaging examination, with imaging examination currently being the mainstay. Treatment of patients with GPLs is based on the presence or absence of symptoms, age, size of the polyps, tendency of the polyp to increase, and risk factors for symptomatic malignancy to determine whether surgery should be performed.
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Affiliation(s)
- Kun Wang
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Qingpeng Xu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Lu Xia
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Jianing Sun
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Kanger Shen
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Haoran Liu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Linning Xu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
| | - Rui Li
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215026, China
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Feng D, Liu T, Li X, Huang L, He L, Lin Y. Surgical outcomes of transvaginal natural orifice transluminal endoscopy in treating ovarian cysts and risk factors for surgical conversions. Heliyon 2024; 10:e31014. [PMID: 38774314 PMCID: PMC11107356 DOI: 10.1016/j.heliyon.2024.e31014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/24/2024] Open
Abstract
Objective This study aimed to assess the surgical outcomes and identify the conversion risk factors of Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in treating ovarian cyst. Methods This was a retrospective study of 505 patients who underwent vNO TES for treating ovarian cyst from March 2019 to February 2022 wherein the patients were classified into "converted" or "nonconverted" groups. T-tests, χ2 tests, and logistic regression were used for statistical analyses. Results There were 16 (3.17 %) surgical conversions and 12 (2.38 %) other surgical complications in our study cohort. Teratomas accounted for 56.8 % of complications in nonconverted cases and 18.8 % in converted cases. Adenocystomas were found in 12.3 % of nonconverted cases and 18.8 % of converted cases. Other types included paraovarian cysts (3.3 % and 0 %), fibroma, granulosa cell tumor, Brenner tumor (1.2 % and 0 %), corpus luteum cysts, follicular cysts (7.6 % and 6.3 %), old abscess (0.2 % and 0 %), and simple cysts (17.6 % and 12.5 %) in the nonconverted and converted groups, respectively. The converted group included more cases of endometriotic cysts (43.8 % vs 12.3 %, p = 0.023), bilateral cysts (37.5 % vs 8.2 %, p < 0.001), severe pelvic adhesion (68.8 % vs 3.3 %, p < 0.001), deep endometriosis (12.5 % vs 0.4 %, p < 0.001), and at least two cysts (37.5 % vs 8.81 %; p < 0.001). Severe pelvic adhesion (adjusted odds ratio [OR], 86.96; range, 18.33-431.77; p < 0.001), bilateral cysts (adjusted OR, 4.75; range, 1.05-21.57, p = 0.043) and endometriotic cysts (adjusted OR, 7.69; range, 3.11-17.08; p < 0.001) were also predictors of surgical conversion. Conclusion vNOTES demonstrates low complication and conversion rates in treating ovarian cyst compared with TU-LESS. Surgical conversion is associated with severe pelvic adhesions, bilateral cysts, and endometriotic cysts.
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Affiliation(s)
| | | | | | - Lu Huang
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Chengdu, Sichuan, 610091, People's Republic of China
| | - Li He
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Chengdu, Sichuan, 610091, People's Republic of China
| | - Yonghong Lin
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, No. 1617, Riyue Avenue, Chengdu, Sichuan, 610091, People's Republic of China
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Zhong F, Dai Y, Liao X, Cheng W, Liu Y, Liu Y, Yan Z, Lin Y, Gan X. Discharge within 24 h, transvaginal natural orifice transluminal endoscopic surgery- more suitable for ambulatory surgery in gynecology procedures: a retrospective study. BMC Womens Health 2024; 24:283. [PMID: 38730489 PMCID: PMC11088004 DOI: 10.1186/s12905-024-03132-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 05/06/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery (NOTES) is an achievement in the field of minimally invasive surgery. However, the vantage point of vaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecologicalprocedures remains unclear. The main purpose of this study was to compare vNOTES with laparo-endoscopic single-site surgery, and to determine which procedure is more suitable for ambulatory surgery in gynecologic procedures. METHODS This retrospective observational study was conducted at the Department of Gynecology, Chengdu Women's and Children's Central Hospital. The 207 enrolled patients had accepted vNOTES and laparo-endoscopic single-site surgery in gynecology procedures from February 2021 to March 2022. Surgically relevant information regarding patients who underwent ambulatory surgery was collected, and 64 females underwent vNOTES. RESULTS Multiple outcomes were analyzed in 207 patients. The Wilcoxon Rank-Sum test showed that there were statistically significant differences between the vNOTES and laparo-endoscopic single-site surgery groups in terms of postoperative pain score (0 vs. 1 scores, p = 0.026), duration of anesthesia (90 vs. 101 min, p = 0.025), surgery time (65 vs. 80 min, p = 0.015), estimated blood loss (20 vs. 40 mL, p < 0.001), and intestinal exhaustion time (12.20 vs. 17.14 h, p < 0.001). Treatment with vNOTES resulted in convenience, both with respect to time savings and hemorrhage volume in surgery and with respect to the quality of the prognosis. CONCLUSION These comprehensive data reveal the capacity of vNOTES to increase surgical efficiency. vNOTES in gynecological procedures may demonstrate sufficient feasibility and provide a new medical strategy compared with laparo-endoscopic single-site surgery for ambulatory surgery in gynecological procedures.
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Affiliation(s)
- Fangyuan Zhong
- Department of Gynecology and Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Chengdu, Sichuan, 610073, China
| | - Yueyu Dai
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400042, China
| | - Xiaoyan Liao
- Department of Gynecology and Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Chengdu, Sichuan, 610073, China
| | - Wei Cheng
- Department of Gynecology and Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Chengdu, Sichuan, 610073, China
| | - Ying Liu
- Department of Gynecology and Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Chengdu, Sichuan, 610073, China
| | - Yan Liu
- Department of Gynecology and Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Chengdu, Sichuan, 610073, China
| | - Ziru Yan
- Department of Gynecology and Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Chengdu, Sichuan, 610073, China
| | - Yonghong Lin
- Department of Gynecology and Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Chengdu, Sichuan, 610073, China
| | - Xiaoqin Gan
- Department of Gynecology and Obstetrics, School of Medicine, Chengdu Women's and Children's Central Hospital, University of Electronic Science and Technology of China, 1617 Riyue Avenue, Chengdu, Sichuan, 610073, China.
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Marchand GJ, Ulibarri H, Arroyo A, Blanco M, Herrera DG, Hamilton B, Ruffley K, Azadi A. Systematic review and meta-analysis of vaginal natural orifice transluminal endoscopic surgery hysterectomy versus vaginal hysterectomy for benign indications. AJOG GLOBAL REPORTS 2024; 4:100355. [PMID: 38883323 PMCID: PMC11177051 DOI: 10.1016/j.xagr.2024.100355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Abstract
Objective As the second most common surgery performed on women in the United States, hysterectomy techniques are constantly examined for validity and superiority. The vaginal natural orifice transluminal endoscopic surgery (vNOTES) has increased in popularity since the first vNOTES hysterectomy was performed in 2012. We sought out to evaluate the safety and effectiveness of hysterectomy by vNOTES compared to conventional vaginal hysterectomy for various benign indications. Data sources We searched Scopus, Medline, PubMed, ClinicalTrials.Gov, and the Cochrane Library. Our search included all studies from each respective database's inception until September 1, 2023. Study eligibility criteria We included eligible studies that compare vNOTES hysterectomy versus conventional vaginal hysterectomy for various benign indications, and included at least one of our preselected outcomes. The main outcomes were estimated blood loss (mL), operation time (min), length of hospital stay (d), Visual Analogue Scale pain score at Day 1, intraoperative complications, and postoperative complications. Study appraisal and synthesis methods We analyzed data of our continuous outcomes using RevMan 5.4.1. Continuous outcomes were analyzed using mean difference (MD) and 95% confidence intervals (CIs) under the inverse variance analysis method. We assessed the quality of the studies using the ROBINS-I assessment tool. Results We found 4 eligible studies to include in our analysis. Surgeon declared estimated blood loss was found to be similar in both groups (MD=-44.70 [-99.97, 10.57]; P=.11). Also, the total length of hospital stay (in days) was found to be comparable in both groups (MD=-0.16 [-1.62, 1.30]; P=.83). We also found no other statistically significant difference between hysterectomy by vNOTES and vaginal hysterectomy in other studied outcomes, including the duration of the operation, the Visual Analogue Scale Pain score after 1 day, intraoperative complications, and postoperative complications. Conclusion vNOTES seems to be associated with a nonsignificant lower surgeon declared estimated blood loss. We found no other significant differences in hospital stay, intraoperative, or postoperative outcomes. Further studies may clarify if other differences in safety or efficacy exist.
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Affiliation(s)
- Greg J Marchand
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Marchand, Ulibarri, Arroyo, Blanco, Herrera, Hamilton, and Ruffley)
| | - Hollie Ulibarri
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Marchand, Ulibarri, Arroyo, Blanco, Herrera, Hamilton, and Ruffley)
| | - Amanda Arroyo
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Marchand, Ulibarri, Arroyo, Blanco, Herrera, Hamilton, and Ruffley)
| | - Madison Blanco
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Marchand, Ulibarri, Arroyo, Blanco, Herrera, Hamilton, and Ruffley)
| | - Daniela Gonzalez Herrera
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Marchand, Ulibarri, Arroyo, Blanco, Herrera, Hamilton, and Ruffley)
| | - Brooke Hamilton
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Marchand, Ulibarri, Arroyo, Blanco, Herrera, Hamilton, and Ruffley)
| | - Kate Ruffley
- Marchand Institute for Minimally Invasive Surgery, Mesa, AZ (Marchand, Ulibarri, Arroyo, Blanco, Herrera, Hamilton, and Ruffley)
| | - Ali Azadi
- University of Arizona, College of Medicine, Phoenix, AZ (Azadi)
- Creighton University, School of Medicine, Phoenix, AZ (Azadi)
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Lerner V, Stuart AE, Baekalandt J. Vaginal Natural Orifice Transluminal Endoscopic Surgery Hysterectomy Deconstructed: Expanding Minimally Invasive Gynecologic Surgeons' Toolbox. J Gynecol Surg 2024; 40:78-99. [PMID: 38690154 PMCID: PMC11057779 DOI: 10.1089/gyn.2023.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Background The introduction of vaginal natural orifice transluminal endoscopic surgery (vNOTES) to the toolbox of gynecologic surgeons has the potential to reverse the trend of vaginal hysterectomy declines. Methods This review discusses nuances of the vNOTES technique applied to hysterectomy; describes vNOTES hysterectomy, step-by-step (including tips and tricks for low- and high-complexity cases for surgeons who may want to incorporate vNOTES hysterectomy into their surgical repertoires); and examines evidence and research trends in this field. Results The descriptions in the text, figures, tables, and videos all contribute to giving readers a clear understanding of vNOTES, its advantages, limitations, and research potentials. Conclusions vNOTES hysterectomy is a unique blend of vaginal, laparoscopic, and laparoendoscopic single-site surgery (LESS) techniques and is not a new procedure, but rather another tool to use in minimally invasive gynecologic surgery. (J GYNECOL SURG 40:78).
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Affiliation(s)
- Veronica Lerner
- Department of Obstetrics & Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, New York, USA
| | - Andrea E Stuart
- Department of Obstetrics and Gynaecology, Institution of Clinical Sciences, Lund University, Lund, Sweden
- Department of Obstetrics and Gynaecology, Helsingborg Hospital, Sweden
| | - Jan Baekalandt
- Department of Gynaecologic Oncology, Imelda Hospital, Bonheiden, Belgium
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Diagnosing and Treating Infertility via Transvaginal Natural Orifice Transluminal Endoscopic Surgery versus Laparoendoscopic Single-Site Surgery: A Retrospective Study. J Clin Med 2023; 12:jcm12041576. [PMID: 36836109 PMCID: PMC9966021 DOI: 10.3390/jcm12041576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in the treatment of female infertility. MATERIALS AND METHODS This study includes 174 female patients with a history of long-standing female infertility. We retrospectively reviewed 41 patients who underwent hysterolaparoscopy (HL) via transvaginal natural orifice transluminal endoscopic surgery (vNOTES) and 133 patients who underwent laparoendoscopic single-site surgery (LESS). Demographic data, operation records, and pregnancy outcomes were collected and analyzed. The deadline for postoperative follow-up was June 2022. All the included patients were followed up for at least 18 months after surgery. RESULTS Compared with the LESS group, the vNOTES group had a shorter postoperative bowel movement time and less pain at 4 and 12 h (p = 0.004 vs. 0.008); no differences were found in other perioperative indicators. The clinical pregnancy rates of the vNOTES and LESS groups were 87.80% and 74.43% (p = 0.073), respectively. CONCLUSIONS vNOTES represents a new, less invasive approach for infertility diagnosis and treatment that is particularly suitable for women who have special esthetic requirements. vNOTES is safe and practical and may be an ideal choice for scarless infertility surgery.
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Feng D, He L, Li X, Zhang Q, Peng J, Huang L, Liu T, Lin Y. Perioperative outcomes of and predictors for conversion from transvaginal natural orifice transluminal endoscopic tubal surgeries: A retrospective cohort study of 619 patients. Int J Gynaecol Obstet 2023; 161:803-811. [PMID: 36605014 DOI: 10.1002/ijgo.14653] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/04/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To assess the perioperative outcomes of vNOTES tubal surgeries and to identify predictors of surgical conversion. METHODS A single-center retrospective cohort study was performed on 619 patients who underwent vNOTES tubal surgeries in our institute from December 2018 to October 2021. Patients were categorized into "converted" or "non-converted" groups based on whether conversion occurred. t-test and χ2 test were performed on demographic and clinicopathologic data to compare their perioperative outcomes. Logistic regression was built to identify predictors for surgical conversions. RESULTS The conversion and complication rates of the vNOTES tubal surgeries in the present study were 3.07% and 4.85%, respectively. The "converted group" has a significantly higher percentage of patients with severe pelvic adhesions (9/19 [47.4%]) and pelvic endometriosis (2/19 [10.5%]), which significantly predicates surgical conversion. The "converted group" also had a longer duration of surgery (140.94 ± 88.73 min, P = 0.002) and an increased proportion of "converted from vNOTES" patients experienced more than 50 ml of intraoperative blood loss (7/19 [36.9%]). Four patients had intraoperative rectal injuries, and no Clavien-Dindo III-V postoperative complications occurred. CONCLUSION vNOTES tubal surgeries are safe due to low conversion and complication rates. Severe pelvic adhesion and endometriosis are predictors for surgical conversions.
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Affiliation(s)
- Dan Feng
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Li He
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Xin Li
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Qiang Zhang
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Jieru Peng
- Medical Administrative Department, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Lu Huang
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Tianjiao Liu
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Yonghong Lin
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
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Muacevic A, Adler JR, Dhillon KS. An Observational Study Comparing Hybrid Transvaginal Notes and Four-Port Laparoscopic Cholecystectomy. Cureus 2023; 15:e33589. [PMID: 36779164 PMCID: PMC9910032 DOI: 10.7759/cureus.33589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Recently, a great interest has arisen in hybrid natural orifice transluminal endoscopic surgery-cholecystectomy (NOTES-C). It has the potential to cause less postoperative pain and may offer better cosmesis over conventional laparoscopic cholecystectomy (CLC). PATIENTS AND METHODS A total of 112 females who underwent conventional cholecystectomy were compared with 108 patients of hybrid transvaginal NOTES-cholecystectomy (TV NOTES-C). We compared intraoperative factors, postoperative pain, the analgesic requirement at different intervals, duration of hospital stay, and time to return to normal activities. In addition, cosmesis and patient satisfaction were assessed at four weeks. RESULTS Postoperative pain and analgesic requirement were less in the hybrid TV NOTES-C group (p<0.001 at 95% CI). Hybrid TV NOTES-C patients were discharged more frequently within 12 hours (27.5% versus 1.8%; p<0.001) and returned faster (2.22 versus 4.62 days; p<0.001) to normal activities. Cosmetic results and short-term quality of life as assessed by the patient and observer scar assessment scale (POSAS) and short form-36 (SF-36) scores, respectively, were better in the hybrid TV NOTES-C group (p<0.001 at 95% CI). CONCLUSIONS Hybrid TV NOTES-C is associated with reduced postoperative analgesic requirements, faster return to normal activities, better cosmesis, and patient satisfaction compared to conventional four-port cholecystectomy.
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Lyu Y, Ding H, Ding J, Luo Y, Guan X, Ni G. Single-port laparoscopic sacrospinous ligament suspension via the natural vaginal cavity (SvNOTES) for pelvic prolapse: The first feasibility study. Front Surg 2022; 9:911553. [PMID: 35923438 PMCID: PMC9339651 DOI: 10.3389/fsurg.2022.911553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study aims to investigate the feasibility and short-term efficacy of single-port laparoscopic-assisted transvaginal natural cavity endoscopic sacrospinous ligament suspensions (SvNOTES). Methods A total of 30 patients diagnosed with anterior or/and middle pelvic organ prolapse Stages III and IV underwent natural vaginal cavity (SvNOTES), and 30 patients who underwent conventional sacrospinous ligament (SSLF) were used as a control group. The operation time, blood loss, postoperative POP-Q score, length of hospital stay, and complications were compared between the two groups. Results The operation time for SvNOTE was (60 ± 13) min, which was longer than (30 ± 15) min for SSLF (P = 0.04). However, the bleeding amount in SvNOTE was 29.44 ± 2.56, significantly lower than that in the SSLF group (80 ± 10; P = 0.02), and the postoperative hospital stay in the SvNOTE group was (4 ± 2) days, longer than (3 ± 1) days in SSLF (P = 0.02). However, there were no intraoperative complications in the SvNOTE group, whereas one ureteral injury occurred in the SSLF group; in addition, the postoperative POP-Q score was significantly better in the SvNOTE group than that in the SSLF group with increasing time (P < 0.001). Conclusion Compared with SSLF, single-port laparoscopic sacrospinous ligament suspension via the natural vaginal cavity is visualized, greatly improving the success rate of sacrospinous ligament fixation, with less blood loss and fewer complications, arguably a safer and minimally invasive surgical approach.
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Affiliation(s)
- Yuanyuan Lyu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huafeng Ding
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Jin Ding
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Yonghong Luo
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Xiaoming Guan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
- Correspondence: Xiaoming Guan Guantai Ni
| | - Guantai Ni
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
- Correspondence: Xiaoming Guan Guantai Ni
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Zakhari A, Nguyen DB, Smith JP, Mansour FW, Krishnamurthy S. vNOTES Hysterectomy, Adnexectomy and Uterosacral Ligament Suspension: A Walk-through Guide. J Minim Invasive Gynecol 2022; 29:1134-1135. [PMID: 35788395 DOI: 10.1016/j.jmig.2022.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To provide a stepwise guide to performing vNOTES hysterectomy, adnexectomy and vault suspension, using two access platform methods. DESIGN Narrated surgical video based on two cases of vNOTES for abnormal uterine bleeding and endometrial intra-epithelial neoplasia. SETTING A single tertiary-care academic centre. INTERVENTIONS Step-by-step walk-through is shown to demonstrate the successful completion of a hysterectomy, adnexectomy, and vault suspension. Use of a traditional glove platform and that of an advanced access system, the GelPOINT Access System® (Applied Medical, Rancho Santa Margarita, CA, USA), are illustrated. The surgical steps are summarized as: (1) colpotomy and abdominal entry; (2) transection of the uterosacral ligaments; (3) placement of an access platform; (4) upper abdominal survey; (5) transection of the uterine and cornual pedicles; (6) identification of the ureters; (7) bilateral salpingo-oophorectomy; (8) uterosacral ligament suspension; (9) cystoscopy; (10) vaginal vault closure and tying of the suspension sutures. CONCLUSION This video demonstrates the steps to safely reproduce a vNOTES hysterectomy, adnexectomy and uterosacral ligament suspension with two access techniques. vNOTES offers scar-free surgery, improved access to high pedicles and surgical fields, and a favourable recovery profile, making it an attractive surgical route in appropriate candidates.
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Affiliation(s)
- Andrew Zakhari
- Department of Obstetrics and Gynecology, McGill University Health Centre, Royal Victoria Hospital, Glen Campus, Montreal, Quebec, Canada.
| | - Dong Bach Nguyen
- Department of Obstetrics and Gynecology, McGill University Health Centre, Royal Victoria Hospital, Glen Campus, Montreal, Quebec, Canada
| | - Jessica Papillon Smith
- Department of Obstetrics and Gynecology, McGill University Health Centre, Royal Victoria Hospital, Glen Campus, Montreal, Quebec, Canada
| | - Fady W Mansour
- Department of Obstetrics and Gynecology, McGill University Health Centre, Royal Victoria Hospital, Glen Campus, Montreal, Quebec, Canada
| | - Srinivasan Krishnamurthy
- Department of Obstetrics and Gynecology, McGill University Health Centre, Royal Victoria Hospital, Glen Campus, Montreal, Quebec, Canada
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MERLIER M, COLLINET P, PIERACHE A, VANDENDRIESSCHE D, DELPORTE V, RUBOD C, COSSON M, GIRAUDET G. IS V-NOTES HYSTERECTOMY AS SAFE AND FEASIBLE AS OUTPATIENT SURGERY COMPARED TO VAGINAL HYSTERECTOMY ? J Minim Invasive Gynecol 2022; 29:665-672. [DOI: 10.1016/j.jmig.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 10/19/2022]
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13
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Gulaydin N. Laparoscopic cholecystectomy by the modified bikini line approach as a simple and safe technique. Rev Assoc Med Bras (1992) 2021; 67:1172-1176. [PMID: 34669865 DOI: 10.1590/1806-9282.20210589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/15/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The gold standard technique for laparoscopic cholecystectomy (LC) is using four ports in the upper abdomen. However, this operative approach may not provide aesthetic satisfaction for some patients because of visible incision marks. This study sought to demonstrate that these incision marks can be hidden by safely changing the port locations. METHODS For patients with symptomatic cholelithiasis undergoing LC between March 2019 and March 2020, the modified bikini line approach was used. With the patient in the supine position with open legs, the first trocar (10 mm) was inserted into the abdomen through an 11-mm incision in the umbilicus. The other three trocars were placed in the abdomen at the bikini line with the help of a camera. The standard equipment for LC was then used to perform the surgery. RESULTS The modified bikini line approach to LC was used for 38 patients. Average operative time was 28.65 min, and the average hospital stay was 1.07 days. No perioperative or postoperative complications occurred. Follow-up was at 1 week, 1 month, and 6 months. Cosmetic results were satisfactory for all patients. CONCLUSIONS As an alternative to the standard LC approach, the modified bikini line technique is safe and useful in patients for whom postoperative aesthetic appearance is important. The modified approach is simple to learn and use and is effective to hide the incision marks well.
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Affiliation(s)
- Nihat Gulaydin
- Istanbul Atlas University Medical Faculty - Istanbul, Turkey
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14
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Role of robotic natural orifice specimen extraction surgery in colorectal neoplasms. Sci Rep 2021; 11:9818. [PMID: 33972632 PMCID: PMC8110763 DOI: 10.1038/s41598-021-89323-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/23/2021] [Indexed: 12/21/2022] Open
Abstract
Natural orifice specimen extraction surgery (NOSES) is especially suitable for colorectal surgery. Until now, most of the reports published were about laparoscopic NOSES, the reports about robotic NOSES are extremely rare. This study aims to explore the safety and feasibility of robotic NOSES for colorectal neoplasms. All patients underwent robotic NOSES from March 2016 to October 2019 in our hospital were enrolled for retrospective analysis. Clinicopathological data including patient characteristics, perioperative information and pathological information were collected and analyzed. According to the distance between tumor and anus or whether neoadjuvant chemoradiotherapy (nRCT) is performed, we grouped the cases and studied its influence on robotic NOSES. Also, we compared the previous reports on laparoscopic NOSES with our study and revealed advantages of robotic NOSES in terms of safety and feasibility. A total of 180 patients were enrolled. The average distance from the lower edge of the tumor to the anus was (8.64 ± 3.64) cm and maximum circumferential diameter (CDmax) of specimen was (3.5 ± 1.6) cm. In terms of safety, the average operation time, intraoperative blood loss, and postoperative hospital stay were (187.5 ± 78.3) min, (47.4 ± 34) mL, and (11.3 ± 7.5) days, respectively. In terms of feasibility, the average number of lymph node harvested was (14.8 ± 5). Robotic NOSES shows advantages in terms of safety and feasibility compared with laparoscopic NOSES. This procedure could not only be a safe procedure but also could achieve good oncological outcomes.
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15
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Xiao Y, Lin C, Lu JY, Xu L, Hou WY, Sun R, Chang GJ, Zhang JJ. Short-term outcomes of pure transvaginal laparoscopic right colectomy: A novel surgery approach based on an Idea, Development, Exploration, Assessment, Long-term framework stage IIa study. J Surg Oncol 2021; 123 Suppl 1:S36-S42. [PMID: 33650688 DOI: 10.1002/jso.26363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/21/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES The application of pure natural orifice translumenal endoscopic surgery (NOTES) to intra-abdominal visceral resections remains limited due to the complexity of the dissection. This study aimed to assess the safety and feasibility of laparoscopic right colectomy using a purely transvaginal approach. METHODS The data of 12 continuous patients with colon neoplasia who underwent transvaginal right colectomy from November 2018 to July 2020 were prospectively collected, and their perioperative events were recorded. RESULTS The patients' median age was 70.4 years. Four were diagnosed with colon adenoma and eight with adenocarcinoma. The median operative time was 185 min, with a median blood loss of 25 ml. The median time to gas passing was 32.5 h after surgery. The median postoperative hospital stay was 6 days. One operation was converted to hybrid NOTES due to difficulty with the anastomosis, and one was converted to laparoscopic surgery because of vascular injury. Three cases were grades I, II, and III according to the Clavien-Dindo classification. CONCLUSION Pure NOTES right colectomy using the transvaginal approach is feasible and safe with good short-term outcomes. We recommend this novel technique for highly-selected patients with no more than a D2 dissection performed by experienced colorectal surgeons.
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Affiliation(s)
- Yi Xiao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Lin
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun-Yang Lu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Lai Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wen-Yun Hou
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Rui Sun
- Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Guo-Jing Chang
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun-Ji Zhang
- Department of Obstetrics & Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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He YG, Gao MF, Li J, Peng XH, Tang YC, Huang XB, Li YM. Cystic duct dilation through endoscopic retrograde cholangiopancreatography for treatment of gallstones and choledocholithiasis: Six case reports and review of literature. World J Clin Cases 2021; 9:736-747. [PMID: 33553415 PMCID: PMC7829737 DOI: 10.12998/wjcc.v9.i3.736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/11/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Choledocholithiasis removal via endoscopic retrograde cholangiopancreatography (ERCP) then followed by laparoscopic cholecystectomy (LC) has gradually become the principal method in the treatment of gallstones and choledocholithiasis. We use ERCP through the cystic duct to treat gallstones combined with choledocholithiasis, with the aim to preserve the normal function of the gallbladder while simultaneously decreasing risk of biliary tract injury. CASE SUMMARY A total of six cases of patients diagnosed with gallstones and choledocholithiasis were treated with ERCP. The efficacy was evaluated via operation success rate, calculus removal rate, postoperative hospital stay and average hospitalization costs; the safety was evaluated through perioperative complication probability, gallbladder function detection and gallstones recrudesce. The calculus removal rate reached 100%, and patients had mild adverse events, including 1 case of postoperative acute cholecystitis and another of increased blood urinary amylase; both were relieved after corresponding treatment, the remaining cases had no complications. The average hospital stay and hospitalization costs were 6.16 ± 1.47 d and 5194 ± 696 dollars. The 3-11 mo follow-up revealed that gallbladder contracted well, without recurrence of gallstones. CONCLUSION This is the first batch of case reports for the treatment of gallstones and choledocholithiasis through ERCP approached by natural cavity. The results and effects of six reported cases proved that the new strategy is safe and feasible and is worthy of further exploration and application.
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Affiliation(s)
- Yong-Gang He
- Department of Hepatobiliary, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Ming-Fa Gao
- Department of Hepatobiliary, North-Kuanren General Hospital, Chongqing 401121, China
| | - Jing Li
- Department of Hepatobiliary, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Xue-Hui Peng
- Department of Hepatobiliary, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Yi-Chen Tang
- Department of Hepatobiliary, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Xiao-Bing Huang
- Department of Hepatobiliary, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
| | - Yu-Ming Li
- Department of Hepatobiliary, The Second Affiliated Hospital, Army Medical University, Chongqing 400037, China
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17
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Wang J, Hong J, Wang Q, Luo F, Guo F. A Novel Method of Natural Orifice Specimen Extraction Surgery (NOSES) during Laparoscopic Anterior Resection for Rectal Cancer. Gastroenterol Res Pract 2021; 2021:6610737. [PMID: 33574839 PMCID: PMC7857920 DOI: 10.1155/2021/6610737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/28/2020] [Accepted: 01/12/2021] [Indexed: 11/17/2022] Open
Abstract
We propose a modification to the reconstruction method of natural orifice specimen extraction surgery (NOSES) during laparoscopic anterior resection (LAR) for rectal cancer (RC) and evaluated its feasibility and short-term safety by comparing surgical and postoperative outcomes with those of conventional LAR. Twenty patients with RC underwent "double-purse" NOSES-LAR from October 2017 to June 2018. Data of clinicopathological characteristics, surgical and postoperative outcomes, and follow-up findings in NOSES-LAR cases were collected and retrospectively compared with those of conventional LAR to clarify the clinical benefits. The median postoperative hospital stay was lower in the double-purse NOSES group than the conventional group (6.6 vs. 7.1 days, respectively). In the conventional group, anastomotic leakage and incision site infection occurred in one patient each. In contrast, there were no complications in the double-purse group. There were no significant differences in blood loss, surgical duration, and time of the first flatus between the two groups. Additionally, "double-purse" NOSES-LAR was more economical than the conventional LAR. "Double-purse" NOSES-LAR is a safe, feasible, and minimally invasive promising procedure for LAR of RC with faster recovery, while requiring less surgical skills and lower clinical costs.
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Affiliation(s)
- Jun Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200090, China
| | - Jun Hong
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200090, China
| | - Qianwei Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200090, China
| | - Fen Luo
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200090, China
| | - Fenghua Guo
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200090, China
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18
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The safety and efficacy of laparoscopic surgery versus laparoscopic NOSE for sigmoid and rectal cancer. Surg Endosc 2021; 36:222-235. [PMID: 33475847 DOI: 10.1007/s00464-020-08260-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Laparoscopic surgery with natural orifice specimen extraction (La-NOSE) is being performed more frequently for the minimally invasive management of sigmoid and rectal cancer. The objective of this meta-analysis was to compare the clinical and oncological safety and efficacy of La-NOSE versus conventional laparoscopy (CL). METHODS A search of the PubMed, Web of Science, and Cochrane databases was performed for studies that compared clinical or oncological outcomes of conventional laparoscopic resection using NOSE with conventional laparoscopic resection for sigmoid and rectal cancer. RESULTS Compared with CL group, the length of hospital stay and the pain score on the first day were shorter in the La-Nose group. The La-NOSE group had a lower incidence of total perioperative complications (OR 0.46; 95% CI [0.32 to 0.66]; I2 = 0%; P < 0.0001) and a lower incidence of surgical site infections (SSIs) (OR 0.11; 95% CI [0.04 to 0.29]; I2 = 0%; P < 0.0001) than the CL group, while the anastomotic leakage showed no significant difference between the La-Nose group and the CL group (P = 0.19). 5-year disease-free survival (DFS) and 5-year overall survival (OS) were no significant difference between the La-Nose group and the CL group (P = 0.43, P = 0.40, respectively). CONCLUSIONS La-NOSE can achieve oncological and surgical safety comparable to that of CL for patients with sigmoid and rectal cancer. La-NOSE in patients was associated with a shorter hospital stay, shorter time to first flatus or defecation, less postoperative pain, and fewer surgical site infections (SSIs) and total perioperative complications. In general, the operative time in La-NOSE was longer than that in CL. The long-term oncological efficacy of La-NOSE seems to be equivalent to that of CL.
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19
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Evangelisti G, Barra F, Centurioni MG, D'Alessandro G, Alessandri F, Ferrero S. Vaginal Natural Orifice Transluminal Endoscopic Surgery (NOTES) for Treating Benign Adnexal Diseases: Past Results and Future Developments. J INVEST SURG 2020; 35:409-410. [PMID: 33289584 DOI: 10.1080/08941939.2020.1843205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Giulio Evangelisti
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Italy
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Italy
| | | | - Gloria D'Alessandro
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Italy
| | - Franco Alessandri
- Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genova, Italy
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20
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Badiglian‐Filho L, Chaves Faloppa C, Narciso de Oliveira Menezes A, Mantoan H, Kumagai LY, Baiocchi G. Vaginally assisted NOTES hysterectomy with adnexectomy (vNOTES) compared with conventional laparoscopy. A retrospective observational cohort study. Int J Gynaecol Obstet 2020; 153:351-356. [DOI: 10.1002/ijgo.13483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/15/2020] [Accepted: 11/11/2020] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | - Henrique Mantoan
- Department of Gynecologic Oncology A.C. Camargo Cancer Center São Paulo Brazil
| | | | - Glauco Baiocchi
- Department of Gynecologic Oncology A.C. Camargo Cancer Center São Paulo Brazil
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21
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Comment je fais… une hystérectomie vaginale selon la technique V-NOTES. ACTA ACUST UNITED AC 2020; 48:827-833. [DOI: 10.1016/j.gofs.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Indexed: 12/23/2022]
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22
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Jung Y, Rattanaburi A, Kim O, Park JH, Lee KH. A Simple Gasless Direct Suturing Technique to Achieve Ovarian Hemostasis During Transvaginal Natural Orifice Transluminal Endoscopic Surgery Ovarian Cystectomy. J Laparoendosc Adv Surg Tech A 2020; 31:1046-1050. [PMID: 33121358 DOI: 10.1089/lap.2020.0575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) was introduced in 2012, but the technique is not yet widely used for ovarian cystectomy. We aim to introduce a new gasless ovarian hemostatic suturing technique for ovarian cystectomy using vNOTES. Methods: We conducted a prospective study using a novel technique for vNOTES ovarian cystectomy. Our vNOTES port (a wound retractor and a disposable glove) was inserted transvaginally through a posterior colpotomy. After ovarian cystectomy, removal of the glove created a gasless state. Hemostatic suturing of the ovary was performed through a vaginal speculum inserted through the wound retractor, under direct observation. Results: Twenty ovarian cystectomies were performed through vNOTES at our institution between June 2019 and February 2020. The mean patient age was 34.2 years (range, 24-51 years). Four patients (20%) underwent bilateral cystectomy and 16 patients (80%) underwent unilateral cystectomy. The mean operative time was 58.7 minutes (bilateral, 57.5 minutes; unilateral, 58.9 minutes), and the mean ovarian hemostatic suturing time was 4.3 minutes (bilateral, 5 minutes; unilateral, 4.1 minutes). Ten patients (50%) received additional medication for pain control within 30 minutes of surgery. All patients were discharged within 24 hours, and 11 were discharged within 12 hours. Conclusion: The gasless hemostatic suturing technique for vNOTES, using a speculum to observe the suturing process, is easy to perform and allows for rapid ovarian hemostasis.
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Affiliation(s)
- Yuyeon Jung
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Athithan Rattanaburi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Oyoung Kim
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Hyun Park
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Keun Ho Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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23
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Weyl A, Chantalat E, Daniel G, Bordier B, Chaynes P, Doumerc N, Malavaud B, Vaysse C, Roumiguié M. Transvaginal minimally invasive approach: An update on safety from an anatomical, anatomopathological and clinical point of view. J Gynecol Obstet Hum Reprod 2020; 50:101941. [PMID: 33045446 DOI: 10.1016/j.jogoh.2020.101941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this work was to analyze the transvaginal approach in minimally invasive surgery in terms of anatomical, histopathological and functional characteristics, to show the safety of this surgical approach. METHODS Anatomical study was first conducted by dissection on fresh cadavers of adult women in order to measure the distance between the vaginal incision and the ureters, rectum and hypogastric nerves. In parallel, an anatomopathological study detailed and compared the macroscopic and histological characteristics of the anterior and posterior surfaces of vaginal samples obtained from cadavers and patients in the context of a hysterectomy for benign pathology. Finally, patients who underwent a transvaginal approach nephrectomy or transplantation were retrospectively enrolled for a clinical examination and an evaluation of their sexuality. RESULTS The anatomical study conducted on seventeen cadavers showed that the posterior vaginal fornix was remote from the major structures of the pelvis such as rectum, ureters, hypogastric plexus, which allowed a safe incision. Mechanical tests further demonstrated that the posterior vaginal fornix was more extensible than the anterior and histological features showed no major vascular or nervous structures. Ten patients were included in the retrospective clinical study. Long-term follow up showed no negative impact on the texture of the vagina or satisfaction from sexual intercourse. CONCLUSIONS Anatomical, histological and functional data supported that transvaginal approach by posterior vagina fornix incision is a minimally invasive surgery that can be performed safely and effectively by a skilled surgeon in cases with a specific surgical indication for this approach.
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Affiliation(s)
- Ariane Weyl
- Department of Gynecologic Surgery, University Hospital of Toulouse Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France; Department of Anatomy, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400, Toulouse, France.
| | - Elodie Chantalat
- Department of Gynecologic Surgery, University Hospital of Toulouse Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France; Department of Anatomy, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400, Toulouse, France
| | - Gwendoline Daniel
- Department of Anatomopathology, Institut Universitaire du cancer de Toulouse Oncopole, 1 av Irene Joliot-Curie, 31100, Toulouse, France
| | - Benoît Bordier
- Department of Urology, Clinique Pasteur, 45 avenue de Lombez, 31300, Toulouse, France
| | - Patrick Chaynes
- Department of Anatomy, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400, Toulouse, France
| | - Nicolas Doumerc
- Department of Urology, University Hospital of Toulouse Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - Bernard Malavaud
- Department of Urology, University Hospital of Toulouse Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France; Department of Anatomy, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400, Toulouse, France
| | - Charlotte Vaysse
- Department of Gynecologic Surgery, University Hospital of Toulouse Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - Mathieu Roumiguié
- Department of Urology, University Hospital of Toulouse Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France; Department of Anatomy, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400, Toulouse, France
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VNOTES (Vaginal Natural Orifices Transluminal Endoscopic Surgery) myomectomy through anterior cul-de-sac approach on the bicornuate uterus. J Gynecol Obstet Hum Reprod 2020; 50:101911. [PMID: 32931956 DOI: 10.1016/j.jogoh.2020.101911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/05/2020] [Accepted: 09/08/2020] [Indexed: 11/23/2022]
Abstract
VNOTES is a novel technique that allows access to the pelvic-abdominal cavity through the vagina. Myomectomy can be performed by vNOTES even through anterior cul-de-sac incision and for selected cases of uterine malformation. Here we present a 29-years-old patient with a complaint about pelvic discomfort. Pelvic examination revealed an 8 cm palpable mass in the right iliac region. The magnetic resonance exam revealed a bicornuate uterus attached to a subserosal fibroid that was 7.7 × 6.6 × 6.0 cm in size. The fibroid was positioned anteriorly to the uterus so the vNOTES approach was indicated through the anterior cul-de-sac. The surgery was performed without any complication and the patient was discharged the next day. The final pathological analysis confirmed uterine leiomyoma and the patient had a good postoperative evaluation. In Conclusion, vNOTES myomectomy may be feasible for selected patients even with uterine malformation.
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25
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Yao H, Li T, Chen W, Lei S, Liu K, Jin X, Zhou J. Safety and Feasibility of Robotic Natural Orifice Specimen Extraction Surgery in Colorectal Neoplasms During the Initial Learning Curve. Front Oncol 2020; 10:1355. [PMID: 33072544 PMCID: PMC7533530 DOI: 10.3389/fonc.2020.01355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/29/2020] [Indexed: 01/18/2023] Open
Abstract
Aim: To analyze the learning curve (LC) for robotic natural orifice specimen extraction surgery (NOSES) for colorectal neoplasms and evaluate safety and feasibility during the initial LC. Method: Patients who consecutively underwent robotic NOSES performed by two surgeons between March 2016 and October 2019 were analyzed retrospectively. The operation time was evaluated using the cumulative sum method to analyze the LC. The clinicopathological data before and after the completion of LC were extracted and compared to evaluate safety and feasibility. Results: In total, 99 and 66 cases were scheduled for robotic NOSES by Prof. Yao and Prof. Li, respectively. The peak points of LC were observed at the 42nd and 15th cases of Yao and Li, respectively, then operation time began to decrease. Only the operation time for Yao before the completion of LC (213.3 ± 67.0 min) was longer than that after the completion of LC (143.8 ± 33.3 min). For Yao nor for Li, other indices, such as postoperative hospital stay, intraoperative blood loss, conversion to laparotomy, incidence of anastomotic leakage, reoperation rate, and 90-day mortality rate lacked significant statistical differences(P > 0.05). In terms of feasibility, the number of lymph nodes harvested, positive resection margin rate, and total cost before and after the completion of LC had no significant statistical difference (P > 0.05). Conclusion: The cases before the completion of LC for robotic NOSES in colorectal neoplasms varied from 15 cases to 42 cases. Robotic NOSES is safe and feasible during the initial LC.
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Affiliation(s)
- Hongliang Yao
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Tiegang Li
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Weidong Chen
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Sanlin Lei
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Kuijie Liu
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoxin Jin
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jiangjiao Zhou
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
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Long-term Oncologic Outcomes of Laparoscopic Anterior Resections for Cancer with Natural Orifice Versus Conventional Specimen Extraction: A Case-Control Study. Dis Colon Rectum 2020; 63:1071-1079. [PMID: 32692072 DOI: 10.1097/dcr.0000000000001622] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although the short-term advantages of natural orifice specimen extraction are widely recognized, controversy exists concerning oncologic safety after laparoscopic surgery for colorectal cancer. OBJECTIVE This study aimed to investigate the impact of natural orifice specimen extraction on local recurrence and long-term survival of patients undergoing colorectal cancer surgery. DESIGN This is a propensity score-matched comparative study. SETTING This study presents a single-center experience. PATIENTS We retrospectively analyzed the records of patients who underwent curative laparoscopic anterior resection for American Joint Committee on Cancer stage I to III sigmoid or upper rectal cancer in 2011 to 2014, based on prospectively collected data. INTERVENTIONS Oncologic outcomes were compared between patients undergoing natural orifice or conventional specimen extraction by minilaparotomy. Patients were matched 1:1 according to propensity scores calculated by logistic regression analysis with the following covariates: American Joint Committee on Cancer stage, tumor diameter, age, sex, BMI, and T stage. Cox proportional hazards regression analysis was performed to determine the impact on oncologic outcome. MAIN OUTCOME MEASURES The primary outcomes measured were local recurrence and disease-free survival rates at 5 years. RESULTS Of 392 eligible patients, 188 were matched (94 undergoing natural orifice specimen extraction and 94 undergoing conventional extraction by minilaparotomy). Median follow-up was 50.3 months. The cumulative local recurrence risk at 5 years was 2.3% and 3.5% (p = 0.632), whereas 5-year disease-free survival for all tumor stages combined was 87.3% and 82.0% (p = 0.383) in laparoscopic anterior resection with natural orifice specimen extraction and conventional extraction groups. T3 and T4 stages were the only variables independently associated with disease-free survival. LIMITATIONS This study was limited because it focused on a single center, was a retrospective analysis, contained no long-term anorectal function testing, and had a small sample size. CONCLUSION Long-term oncologic outcomes of patients undergoing laparoscopic anterior resection with natural orifice specimen extraction for sigmoid and upper rectal cancer do not differ from those undergoing conventional extraction. Thus, natural orifice specimen extraction could be a viable alternative to reduce abdominal wall insult in laparoscopic colorectal operations for malignancy in selected patients. See Video Abstract at http://links.lww.com/DCR/B241. RESULTADOS ONCOLÓGICOS A LARGO PLAZO DE RESECCIONES ANTERIORES LAPAROSCÓPICAS PARA CÁNCER A TRAVÉS DE ORIFICIO NATURAL FRENTE A EXTRACCIÓN CONVENCIONAL DEL ESPÉCIMEN: UN ESTUDIO DE CASOS Y CONTROLES: Si bien las ventajas a corto plazo de la extracción de especímenes por orificio natural son ampliamente reconocidas, existe controversia con respecto a la seguridad oncológica después de la cirugía laparoscópica para el cáncer colorrectal.Investigar el impacto de la extracción de especímenes por orificio natural en la recurrencia local y la supervivencia a largo plazo de pacientes sometidos a cirugía de cáncer colorrectal.Estudio comparativo con emparejamiento por puntuación de propensión.Experiencia en un centro único.Analizamos retrospectivamente los registros de pacientes que se sometieron a resección anterior laparoscópica curativa para cáncer sigmoideo o rectal superior AJCC en estadio I-III en 2011-2014, con base en datos recolectados prospectivamente.Los resultados oncológicos se compararon entre pacientes sometidos a extracción por orificio natural o convencional mediante minilaparotomía de especímenes. Los pacientes fueron emparejados 1:1 de acuerdo con los puntajes de propensión calculados por análisis de regresión logística con las siguientes covariables: estadio AJCC, diámetro del tumor, edad, sexo, índice de masa corporal y estadio T. Se realizó un análisis de regresión de riesgos proporcionales de Cox para determinar el impacto en el resultado oncológico.Recurrencia local y tasas de supervivencia libre de enfermedad a los 5 años.De 392 pacientes elegibles, 188 fueron emparejados (94 sometidos a extracción de espécimen por orificio natural y 94 a extracción convencional por minilaparotomía). La mediana de seguimiento fue de 50.3 meses. El riesgo cumulativo de recurrencia local a 5 años fue de 2.3% y 3.5% (p = 0.632), mientras que la supervivencia libre de enfermedad a 5 años para todas las etapas tumorales combinadas fue de 87.3% y 82.0% (p = 0.383) en los grupos de resección anterior laparoscópica con extracción de espécimen por orificio natural y extracción convencional, respectivamente. Las etapas T3 y T4 fueron las únicas variables asociadas independientemente con la supervivencia libre de enfermedad.Centro único, análisis retrospectivo, ausencia de pruebas de función anorrectal a largo plazo y tamaño de muestra pequeño.Los resultados oncológicos a largo plazo de los pacientes sometidos a resección anterior laparoscópica con extracción de espécimen por orificio natural para cáncer sigmoideo y rectal superior no difieren de los de aquellos sometidos a extracción convencional. Por lo tanto, la extracción de especímenes por orificio natural podría ser una alternativa viable para reducir el insulto a la pared abdominal en operaciones colorrectales laparoscópicas por malignidad en pacientes selectos. Consulte Video Resumen en http://links.lww.com/DCR/B241.
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Saad MR, Choi Y, Han HS, Yoon YS, Cho JY, Lee JS, Lee BR. Solo single-incision laparoscopic liver resection: a cohort series. ANZ J Surg 2020; 90:1108-1111. [PMID: 32378778 DOI: 10.1111/ans.15941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/19/2019] [Accepted: 04/14/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Single-incision laparoscopic liver resection (SILLR) is still challenging due to the unstable surgical view, the crowding instruments and its crossover. In this study, we present a new option of solo SILLR for various liver tumours in order to overcome those difficulties. METHODS Solo SILLR is indicated for liver tumours located in the left liver or in the superficial right liver. Data for 54 consecutive patients, who underwent solo SILLR between October 2015 and October 2018, were collected and analysed prospectively. RESULTS A total of 30 patients (55.5%) underwent non-anatomical resection. Left hemi-hepatectomy was performed in 11 patients (20.4%) and left lateral was performed in 13 patients (24.1%). The median operative time was 114 (range 30-335) min with median blood loss of 400 (50-750) mL with no need of blood transfusion and no intraoperative complications. The median length of hospital stay was 3 (range 1-19) days. There was one case of post-operative intra-abdominal fluid collection and one case of incisional hernia during the follow-up. CONCLUSION Solo SILLR is more feasible and safer for liver tumours located in the superficial right liver or in the left one. Therefore, solo surgery can be an option in SILLR.
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Affiliation(s)
- Mohamed Rabie Saad
- Department of Surgery, Faculty of Medicine, Aswan University Hospital, Aswan, Egypt.,Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea
| | - YoungRok Choi
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Ho-Seong Han
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Yoo-Seok Yoon
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Jai Young Cho
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Jun Suh Lee
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea
| | - Bo Ram Lee
- Division of HBP Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Korea
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Steinberg RL, Johnson BA, Meskawi M, Gettman MT, Cadeddu JA. Magnet-Assisted Robotic Prostatectomy Using the da Vinci SP Robot: An Initial Case Series. J Endourol 2019; 33:829-834. [PMID: 31411052 DOI: 10.1089/end.2019.0263] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Tissue retraction during minimally invasive surgery has been achieved to date with patient positioning or additional instrumentation. The Levita™ Magnetic Surgical System (San Mateo, CA), a novel, noninvasive, magnetic retraction device for minimally invasive surgery, has been used to facilitate reduced-port robotic prostatectomy using a multiport robotic platform. With the release of the da Vinci SP robotic system (Intuitive, Sunnyvale, CA), we now report a multi-institutional initial case series of magnet-assisted robotic prostatectomy using the single-port robotic platform. Materials and Methods: An IRB-approved, retrospective chart review was performed of all patients undergoing robot-assisted radical prostatectomy using the da Vinci SP surgical system and a single Levita magnetic retractor in treatment of prostatic adenocarcinoma at two institutions from November 2018 to January 2019. Preoperative, intraoperative, and postoperative data were collected for descriptive analysis. Results: A total of 15 men, median age 62 years (range 57-71), with mean PSA 7.0 ± 2.3 underwent surgery. The robotic cannula and a single 12-mm assistant port were utilized in all cases, the latter for suction, suture passage, and clip placement; the magnetic retractor aided with posterior dissection, dorsal venous complex stitch placement, bladder neck dissection, and lymphadenectomy. No cases required conversion to a multiport robotic platform, laparoscopy, or open surgery, nor placement of additional assistant ports. No intraoperative or postoperative complications occurred. Average operative time was 224 ± 43 minutes and blood loss was 198 ± 115 mL. All patients were discharged home within 2 days of surgery. Conclusions: Robotic prostatectomy utilizing the da Vinci SP system is feasible, safe, and effective. Use of the magnetic retractor facilitates tissue exposure and improves procedure ergonomics, mimicking the conventional multiport technique. Further exploration of magnet utilization in robotic surgery and optimization of assistant port placement for true single-site surgery is warranted.
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Affiliation(s)
- Ryan L Steinberg
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Brett A Johnson
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Malek Meskawi
- Department of Urology, Mayo Clinic, Rochester, Minnesota
| | | | - Jeffrey A Cadeddu
- Department of Urology, University of Texas Southwestern, Dallas, Texas
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Hysterectomy and salpingo-oophorectomy by transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) assisted by an umbilical camera: Case report and new hybrid technique in gynecology. Int J Surg Case Rep 2018; 51:349-351. [PMID: 30248628 PMCID: PMC6153273 DOI: 10.1016/j.ijscr.2018.08.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/03/2018] [Accepted: 08/27/2018] [Indexed: 12/21/2022] Open
Abstract
Hybrid-Natural orifice transluminal endoscopic surgery (NOTES) makes us to perform NOTES more safer with the direct visualization of the abdominal cavity. Hybrid NOTES can lesser the exclusion criterias for NOTES. Hybrid NOTES can lesser the complications; by capability of seeing all the major structures such as ureters, uterine vessels, bowels and pelvic adhesions. Introduction Natural orifice transluminal endoscopic surgery (NOTES) is a new development in the field of minimally invasive surgery. The aim of this study was to demonstrate a new hybrid NOTES technique in gynecology which can be used for hysterectomy and salpingo-oophorectomy in patients with adnexal pathology and multiple operation histories. Presentation of case A 50-year-old woman with gravida 2 para 2 was referred to our clinic with left-sided abdominal pain. She had a history of two previous abdominal surgeries and a persistent ovarian cyst for 2 years. An ultrasound examination revealed a left complex hypoechoic ovarian cyst of 10 cm. Tumor markers were normal and the patient had no suspicion for malignancy. The hybrid NOTES technique assisted by an umbilical camera was planned due to the possibility of pelvic adhesions and her concerns about cosmesis. Discussion The major difference between NOTES and umbilical camera assisted NOTES is seeing all of the major structures, such as the ureters, uterine vessels, bowels, and pelvic adhesions, which can lead to complications during the surgery. In fact, hybrid NOTES can make surgeries more feasible. Conclusion This new hybrid NOTES offers effective and safer surgical management in patients who have had previous surgery and adnexal masses.
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Li J, Zhang Z, Wang S, Shang Z, Zhang G. A Specimen Extraction Instrument Based on Braided Fiber Tube for Natural Orifice Translumenal Endoscopic Surgery. J Med Device 2018. [DOI: 10.1115/1.4040638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Natural orifice translumenal endoscopic surgery (NOTES) has offered significant advantages of less pain, reduced recovery time, and minimized scar after operation, demonstrating a promising development prospect. However, the large-size specimen extraction remains challenging for NOTES, due to the narrow space of the human natural orifices. To address such difficulties, a specimen extraction method that utilizes the braided fiber tube (BFT) structure with excellent retractility to accommodate and bind the bulky specimen has been proposed. Based on the theory of helical spring, the geometric model and the mechanical model of the BFT are established, and experiments have been performed to verify the accuracy of the derived mechanical model. In addition, a tensile test of using the BFT to extract large specimens via a small channel is carried out, which verifies the stable extraction performance of the proposed design. The BFT will not be damaged when extracting the specimen with a diameter less than 1.75 times of the channel diameter. A NOTES-specific specimen extraction instrument is designed according to the characteristics of NOTES, and it has three degrees-of-freedom and is able to actively capture different specimen by using a suction cup. Finally, specimen extraction experiments on NOTES multitasking platform phantom have been conducted using the prototyped instrument to validate its feasibility and effectiveness.
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Affiliation(s)
- Jinhua Li
- Key Laboratory for Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin 300072, China e-mail:
| | - Zemin Zhang
- Key Laboratory for Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin 300072, China e-mail:
| | - Shuxin Wang
- Key Laboratory for Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin 300072, China e-mail:
| | - Zufeng Shang
- Key Laboratory for Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin 300072, China e-mail:
| | - Guokai Zhang
- Key Laboratory for Mechanism Theory and Equipment Design of Ministry of Education, Tianjin University, Tianjin 300072, China e-mail:
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Müller V, Mogl M, Seika P, Jöns T, Sauer I, Pratschke J, Anuwong A, Zorron R. How I Do It: New Dissector Device Allows for Effective Operative Field in Transoral Endoscopic Thyroid Surgery Using Vestibular Approach. Surg Innov 2018; 25:444-449. [DOI: 10.1177/1553350618785281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Minimally invasive thyroid and parathyroid resections are rarely performed. Promising new endoscopic transoral approaches to the anterior neck (transoral endoscopic thyroidectomy vestibular approach [TOETVA]) have been described with good results and few complications. This study evaluates a new device to allow the safe entrance of trocars in the subplatysmal space for TOETVA in a cadaver model. Methods. The technique was performed in 4 unilateral thyroidectomies in female cadavers. The technical steps consisted of a 10-mm incision made at the center of the oral vestibule followed by subplatysmal hydrodissection. The blunt dissector is a metallic stick with an olive at the end and promotes progressive gain in subplatysmal space enlarging the operative field. The instrument was inserted creating a space below the platysma to the anterior neck and the strap muscles. Three trocars were inserted in the vestibular area. The dissection begins by cutting the linea alba cervicalis. The isthmus was dissected and transected. Anatomical structures as the superior thyroid artery, parathyroid glands, and the recurrent laryngeal nerve could be safely identified with magnified vision. Results. Optimal operative field due to subplatysmal dissection by the device allowed for exposition of thyroid and parathyroid glands in all cases. Unilateral thyroidectomy was performed in a mean of 54 minutes with excellent aesthetic results. Conclusions. The new device is a promising feature to allow safe transoral thyroid surgery in a cadaver model. Further studies in clinical series are needed to evaluate the broad application of the device.
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Affiliation(s)
- Verena Müller
- Charité–Universitätsmedizin Berlin, Campus Charité Mitte/Campus Virchow-Klinikum, Berlin, Germany
| | - Martina Mogl
- Charité–Universitätsmedizin Berlin, Campus Charité Mitte/Campus Virchow-Klinikum, Berlin, Germany
| | - Philippa Seika
- Charité–Universitätsmedizin Berlin, Campus Charité Mitte/Campus Virchow-Klinikum, Berlin, Germany
| | - Thomas Jöns
- Institute of Integrative Neuroanatomy, Campus Charité Mitte, Humboldt University, Berlin, Germany
| | - Igor Sauer
- Charité–Universitätsmedizin Berlin, Campus Charité Mitte/Campus Virchow-Klinikum, Berlin, Germany
| | - Johann Pratschke
- Charité–Universitätsmedizin Berlin, Campus Charité Mitte/Campus Virchow-Klinikum, Berlin, Germany
| | | | - Ricardo Zorron
- Charité–Universitätsmedizin Berlin, Campus Charité Mitte/Campus Virchow-Klinikum, Berlin, Germany
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Bender K, Lewin J, O'Rourke H, Hugh FC, O'Rourke N, Hugh TJ. Total 5-mm port approach: a feasible technique for both elective and emergency laparoscopic cholecystectomy. ANZ J Surg 2018; 88:E751-E755. [PMID: 29687556 DOI: 10.1111/ans.14460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/05/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The laparoscopic approach is considered the standard of care for cholecystectomy. Attempts to minimize incisions with single site and natural orifice approaches have shown promise but also have limitations. Technological advances have facilitated decreased port size, which may have a variety of benefits. The aim of this study was to determine the feasibility of an all 5-mm port approach for patients undergoing both elective and emergency laparoscopic cholecystectomy. METHODS A consecutive series of laparoscopic cholecystectomies at three different hospitals using all 5-mm ports was prospectively evaluated. Recorded outcomes included operative findings, procedural difficulties, the need to extend the umbilical incision during extraction, operative time, length of stay and post-operative complications. RESULTS A total of 101 patients were included and all had a successful cholecystectomy without the need for additional ports. The umbilical incision was extended for gallbladder extraction in 29 (29%) patients. Eight (8%) patients experienced minor post-operative complications and there were no major complications. Cholangiography was performed in 98% of cases and three patients underwent successful common bile duct exploration without requiring additional ports. In a small number of cases, there was difficulty with the quality of the view through the 5-mm laparoscope but this was rectified by removing old or damaged laparoscopes from the circulating stock. CONCLUSION This study demonstrates that laparoscopic cholecystectomy using all 5-mm ports is both feasible and safe, and is comparable to published outcomes after conventional laparoscopic cholecystectomy. Further work is needed to determine whether this approach can also improve short- and long-term outcomes.
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Affiliation(s)
- Kyle Bender
- Upper GI Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Joel Lewin
- Upper GI Surgical Unit, Wesley Private Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Harriet O'Rourke
- Upper GI Surgical Unit, Wesley Private Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Freya C Hugh
- Upper GI Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas O'Rourke
- Upper GI Surgical Unit, Wesley Private Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Thomas J Hugh
- Upper GI Surgical Unit, Royal North Shore Hospital and North Shore Private Hospital, The University of Sydney, Sydney, New South Wales, Australia
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Oliveira ALA, Zorron R, Oliveira FMMDE, Santos MBD, Scheffer JP, Rios M, Antunes F. Transcolonic Perirectal NOTES Access (PNA): A feasibility study with survival in swine model. AN ACAD BRAS CIENC 2018; 89:685-693. [PMID: 28562823 DOI: 10.1590/0001-3765201720160541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 01/23/2017] [Indexed: 12/22/2022] Open
Abstract
Transrectal access still has some unsolved issues such as spatial orientation, infection, access and site closure. This study presents a simple technique to perform transcolonic access with survival in a swine model series. A new technique for NOTES perirectal access to perform retroperitoneoscopy, peritoneoscopy, liver and lymphnode biopsies was performed in 6 pigs, using Totally NOTES technique. The specimens were extracted transanally. The flexible endoscope was inserted through a posterior transmural incision and the retrorectal space. Cultures of bacteria were documented for the retroperitoneal space and intra abdominal cavity after 14 days. Rectal site was closed using non-absorbable sutures. There was no bowel cleansing, nor preoperative fasting. The procedures were performed in 6 pigs through transcolonic natural orifice access using available endoscopic flexible instruments. All animals survived 14 days without complications, and cultures were negative. Histopathologic examination of the rectal closure site showed adequate healing of suture line and no micro abscesses. The results of feasibility and safety of experimental Transcolonic NOTES potentially brings new frontiers and future wider applications for minimally invasive surgery. The treatment of colorectal, abdominal and retroperitoneal diseases through a flexible Perirectal NOTES Access (PNA) is a promising new approach.
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Affiliation(s)
- André L A Oliveira
- Departamento de Cirurgia Veterinária, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, RJ, Brazil
| | | | | | - Marcelo B Dos Santos
- Departamento de Cirurgia Veterinária, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, RJ, Brazil
| | - Jussara P Scheffer
- Departamento de Cirurgia Veterinária, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, RJ, Brazil
| | - Marcelo Rios
- Clínica Veterinária-Gávea, Rio de Janeiro, RJ, Brazil
| | - Fernanda Antunes
- Departamento de Cirurgia Veterinária, Universidade Estadual do Norte Fluminense, Campos dos Goytacazes, RJ, Brazil
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Abstract
Natural Orifice Transluminal Endoscopic Surgery (NOTES) is an emerging field in minimally invasive surgery. NOTES can be performed via a variety of approaches, including through the stomach, esophagus, bladder, and rectum, but the majority of cases have been performed transvaginally. Potential advantages of natural orifice surgery in gynecology include the lack of abdominal incisions, less operative pain, shorter hospital stay, improved visibility, and the possibility to circumvent extensive lysis of adhesion to reach the pelvic cavity. This chapter provides a historical overview and the potential application of NOTES.
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Benhidjeb T, Kosmas IP, Hachem F, Mynbaev O, Stark M, Benhidjeb I. Laparoscopic cholecystectomy versus transvaginal natural orifice transluminal endoscopic surgery cholecystectomy: results of a prospective comparative single-center study. Gastrointest Endosc 2018; 87:509-516. [PMID: 28993135 DOI: 10.1016/j.gie.2017.09.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 09/27/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Laparoscopic cholecystectomy (LC) in female individuals has been challenged recently by transvaginal natural orifice transluminal endoscopic surgery cholecystectomy (TVC). TVC has not been widely accepted as a standard procedure, even though it is reported to be a safe and painless alternative to LC. This prospective comparative study aims to not only prove equality of TVC and LC but to underline the advantages of TVC over LC with regard to postoperative pain. METHODS This study presents an analysis of a single-center and single-surgeon study with 226 unselected consecutive cholecystectomies performed as either TVC or LC. RESULTS A total of 226 female patients underwent surgery with either LC (136 cases) or TVC (90 cases). There were no postoperative adverse events. Twenty-two patients (24.2%) in the TVC group indicated 0 (no pain) on a visual analog scale postoperatively, whereas only 5 patients (3.7%) did so in the LC group (P = < .0001). Overall consumption of non-steroidal anti-inflammatory drugs was significantly less (P < .0001; t test) in the TVC group (mean, 1.2 ± 0.11 g) compared with the LC group (mean, 2.1 ± 0.1 g). Twenty-three patients (25.5%) in the TVC group needed no postoperative analgesics at all. CONCLUSIONS TVC is a safe and painless procedure for patients with symptomatic cholelithiasis who are from various ethnic and cultural origins. This benefit, along with an equal safety profile compared with LC, should pave the way for wider application of TVC in women.
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Affiliation(s)
- Tahar Benhidjeb
- The International Translational Medicine and Biomodeling Research team, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia; Institute of Numerical Mathematics, Russian Academy of Sciences, Moscow, Russia; Department of Surgery, Danat Al Emarat Hospital, Abu Dhabi, United Arab Emirates; The New European Surgical Academy (NESA), Berlin, Germany
| | - Ioannis P Kosmas
- The International Translational Medicine and Biomodeling Research team, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia; The New European Surgical Academy (NESA), Berlin, Germany; Department of Obstetrics and Gynecology, Ioannina State General Hospital G. Chatzikosta, Ioannina, Greece
| | - Fady Hachem
- Department of Obstetrics and Gynecology, Burjeel Hospital, Abu Dhabi, United Arab Emirates
| | - Ospan Mynbaev
- The International Translational Medicine and Biomodeling Research team, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia; The New European Surgical Academy (NESA), Berlin, Germany; Russian National Research Medical University N. I. Pirogov, Moscow, Russia
| | - Michael Stark
- The International Translational Medicine and Biomodeling Research team, Moscow Institute of Physics and Technology (State University), Dolgoprudny, Moscow Region, Russia; The New European Surgical Academy (NESA), Berlin, Germany; ELSAN Hospital Group, Paris, France
| | - Isabel Benhidjeb
- Department of Surgery, Danat Al Emarat Hospital, Abu Dhabi, United Arab Emirates
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Umemura A, Suto T, Nakamura S, Fujiwara H, Endo F, Nitta H, Takahara T, Sasaki A. Comparison of Single-Incision Laparoscopic Cholecystectomy versus Needlescopic Cholecystectomy: A Single Institutional Randomized Clinical Trial. Dig Surg 2018; 36:53-58. [PMID: 29393173 DOI: 10.1159/000486455] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 12/19/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Both single-incision laparoscopic cholecystectomy (SILC) and needlescopic cholecystectomy (NSC) are superior to conventional laparoscopic cholecystectomy in terms of cosmetic outcome and incisional pain. We conducted a prospective, randomized clinical trial to evaluate the surgical outcome, postoperative pain, and cosmetic outcome for SILC and NSC procedures. METHODS In this trial, 105 patients were enrolled (52 in the SILC group; 53 in the NSC group). A visual analogue scale (VAS) was used to evaluate the cosmetic outcome and incisional pain for patients. Logistic regression analyses were used to evaluate the operative difficulty that was present for both procedures. RESULTS There were no significant differences in patient characteristics or surgical outcomes, including operative time and blood loss. The mean VAS scores for cosmetic satisfaction were similar in both groups. There were significant differences in the mean VAS scores for incisional pain on postoperative day 1 (p = 0.009), and analgesics were required within 12 h of surgery (p = 0.007). Obesity (body mass index ≥25 kg/m2) was the only significant influential factor for operating time over 100 min (p = 0.031). CONCLUSION NSC is superior to SILC in terms of short-term incisional pain. Experienced laparoscopic surgeons can perform both SILC and NSC without an increase in operative time.
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Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University, Morioka, .,Department of Surgery, Morioka Municipal Hospital, Morioka,
| | - Takayuki Suto
- Department of Surgery, Morioka Municipal Hospital, Morioka, Japan
| | - Seika Nakamura
- Department of Surgery, Morioka Municipal Hospital, Morioka, Japan
| | | | - Fumitaka Endo
- Department of Surgery, Morioka Municipal Hospital, Morioka, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, Morioka, Japan
| | | | - Akira Sasaki
- Department of Surgery, Iwate Medical University, Morioka, Japan
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Park JS, Kang H, Park SY, Kim HJ, Lee IT, Choi GS. Long-term outcomes after Natural Orifice Specimen Extraction versus conventional laparoscopy-assisted surgery for rectal cancer: a matched case-control study. Ann Surg Treat Res 2017; 94:26-35. [PMID: 29333423 PMCID: PMC5765275 DOI: 10.4174/astr.2018.94.1.26] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/08/2017] [Accepted: 10/24/2017] [Indexed: 01/04/2023] Open
Abstract
Purpose The aim of this study was to compare the long-term outcomes of total laparoscopic surgery with Natural Orifice Specimen Extraction (NOSE) with those for conventional laparoscopy (CL)-assisted surgery for treating rectal cancers. Methods We reviewed the prospectively collected records of 844 patients (163 NOSE and 681 CL) who underwent curative surgery for mid- or upper rectal cancers from January 2006 to November 2012. We applied propensity score analyses and compared oncological outcomes for the NOSE and CL groups in a 1:1 matched cohort. Results After propensity score matching, each group included 138 patients; the NOSE and CL groups did not differ significantly in terms of baseline clinical characteristics. The median follow-up was 57.7 months (interquartile range, 42.4–82.5 months). The combined 5-year local recurrence rate for all tumor stages was 4.1% (95% confidence interval [CI], 0.9%–7.4%) in the NOSE group and 3.0% (95% CI, 0%–6.3%) in the CL group (P = 0.355). The combined 5-year disease-free survival rates for all stages were 89.3% (95% CI, 84.3%–94.3%) in the NOSE group and 87.3% (95% CI, 81.8%–92.9%) in the CL group (P = 0.639). The postoperative mean fecal incontinence scores at 6, 12, and 24 months were similar between the 2 groups. Conclusion In our experience, NOSE for mid- and upper rectal cancer had acceptable long-term oncologic outcomes comparable to those of conventional minimal invasive surgery and seems to be a safe alternative to reduce access trauma.
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Affiliation(s)
- Jun Seok Park
- Colorectal Cancer Center, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyun Kang
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Soo Yeun Park
- Colorectal Cancer Center, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hye Jin Kim
- Colorectal Cancer Center, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea
| | - In Taek Lee
- Colorectal Cancer Center, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea
| | - Gyu-Seog Choi
- Colorectal Cancer Center, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, Daegu, Korea
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Lim C, Bou Nassif G, Lahat E, Hayek M, Osseis M, Gomez-Gavara C, Moussalem T, Azoulay D, Salloum C. Single-incision robotic cholecystectomy is associated with a high rate of trocar-site infection. Int J Med Robot 2017; 13. [DOI: 10.1002/rcs.1856] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 07/06/2017] [Accepted: 08/09/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Chetana Lim
- Department of Hepatobiliary, Pancreatic, and Liver transplantation; Henri Mondor hospital; Créteil France
| | - Georges Bou Nassif
- Department of Hepatobiliary, Pancreatic, and Liver transplantation; Henri Mondor hospital; Créteil France
| | - Eylon Lahat
- Department of Hepatobiliary, Pancreatic, and Liver transplantation; Henri Mondor hospital; Créteil France
| | - Mohamad Hayek
- Department of Hepatobiliary, Pancreatic, and Liver transplantation; Henri Mondor hospital; Créteil France
| | - Michael Osseis
- Department of Hepatobiliary, Pancreatic, and Liver transplantation; Henri Mondor hospital; Créteil France
| | - Concepcion Gomez-Gavara
- Department of Hepatobiliary, Pancreatic, and Liver transplantation; Henri Mondor hospital; Créteil France
| | - Toufic Moussalem
- Department of Hepatobiliary, Pancreatic, and Liver transplantation; Henri Mondor hospital; Créteil France
| | - Daniel Azoulay
- Department of Hepatobiliary, Pancreatic, and Liver transplantation; Henri Mondor hospital; Créteil France
| | - Chady Salloum
- Department of Hepatobiliary, Pancreatic, and Liver transplantation; Henri Mondor hospital; Créteil France
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Two cases of laparoscopic total colectomy with natural orifice specimen extraction and review of the literature. Wideochir Inne Tech Maloinwazyjne 2017; 12:291-296. [PMID: 29062451 PMCID: PMC5649505 DOI: 10.5114/wiitm.2017.69227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 05/07/2017] [Indexed: 01/29/2023] Open
Abstract
We present two cases of natural orifice specimen extraction (NOSE) after laparoscopic total colectomy and ileorectal anastomosis (TC-IRA), and we also review all of the previously reported cases. Our aim was to focus on patient selection for NOSE after TC-IRA. The PubMed and Google Scholar databases were scanned. Demographic features, surgical indications, and techniques were analyzed. Basic calculations were used for statistical analysis. A total of 13 cases were detected in addition to our 2 cases. All of the specimens were removed through the natural orifices successfully. No case required a diverting ileostomy. No patients were converted to open surgery or to conventional laparoscopy. Complications were reported in three patients. Transanal extractions were performed in 12 cases (10 colonic inertia, 2 polyposis), and transvaginal extractions were performed in 3 cases (2 malignancy, 1 colonic inertia). Both transanal and transvaginal specimen extractions after laparoscopic TC-IRA can be preferred. However, transanal extraction seems to be feasible in cases of TC for benign disease with a limited mesenteric-omental resection. If the indication is a malignancy requiring a mesenteric-omental resection, a transvaginal route should be preferred for a voluminous specimen.
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Safety Outcomes of NOTES Cholecystectomy Versus Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis. Surg Laparosc Endosc Percutan Tech 2017; 26:347-353. [PMID: 27557339 PMCID: PMC5054957 DOI: 10.1097/sle.0000000000000284] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Natural orifice transluminal endoscopic surgery (NOTES) is an endoscopic technique whereby surgical interventions can be performed with a flexible endoscope passed through a natural orifice (mouth, vulva, urethra, anus) then through a transluminal opening of the stomach, vagina, bladder, or colon. Although in the early stage of research and development, NOTES has been clinically applied across the globe, above all the transvaginal cholecystectomy is among the most frequently performed procedures. In the existing 2 types of transvaginal routes, the hybrid NOTES cholecystectomy (NC) is more likely to be accepted. However, there has been controversy regarding the safety outcomes of hybrid NC in comparison with classical laparoscopic cholecystectomy (LC). The primary objective of this meta-analysis is to compare the characteristics between NC and classical LC. MATERIALS AND METHODS A meta-analysis of eligible studies comparing NC with classical LC was performed to evaluate the safety outcomes including wound complications, other postoperative complications and intraoperative conversion between the 2 groups. RESULTS Pooling 3 randomized controlled trials (n=157) and 7 nonrandomized trial (n=593) demonstrated that the rates of wound complications and other postoperative complications in NC group did not significantly differ from those of classical LC group [wound complications: ratio difference (RD)=-0.02, 95% confidence interval (CI) -0.04to 0.01, P=0.23; other postoperative complication: RD=-0.01; 95% CI, -0.03 to 0.02; P=0.6]. The intraoperative conversion rate in NC groups was higher than that of LC groups (RD=0.03; 95% CI, 0.01-0.06; P=0.02). CONCLUSIONS There is no significate difference between the safety of NC and laparoscope cholecystectomy. NC is associated with a higher rate of intraoperative conversion when compared with LC. It is worthy of further promotion and validation in clinical settings.
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Yoshiki N. Review of transvaginal natural orifice transluminal endoscopic surgery in gynecology. Gynecol Minim Invasive Ther 2017; 6:1-5. [PMID: 30254860 PMCID: PMC6113962 DOI: 10.1016/j.gmit.2016.11.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/02/2016] [Accepted: 11/24/2016] [Indexed: 10/28/2022] Open
Abstract
Recent technologic advances in endoscopic instrumentation and optics have allowed the development of a less invasive alternative to conventional laparoscopic surgery. During the past decade, natural orifice transluminal endoscopic surgery (NOTES) flourished in the field of general surgery, and it has emerged as a new concept of minimally invasive surgery. NOTES yields access to the abdominal cavity without any incisions on the abdominal wall (scarless surgery), and the natural orifices of the body surface, such as the mouth and the vagina, serve as the gateway to the peritoneal cavity. In gynecology, the vagina of a woman can be considered as an additional route for surgery. Recently, clinical application of transvaginal NOTES has broadened significantly in gynecology. Using transvaginal NOTES by applying the method of single-incision laparoscopic surgery via the vaginal route, not only adnexal surgery and hysterectomy, but also myomectomy and oncologic surgery could be performed safely and effectively in selected patients. In future, further studies should be conducted to evaluate the true clinical feasibility and safety of transvaginal NOTES.
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Affiliation(s)
- Naoyuki Yoshiki
- Comprehensive Reproductive Medicine, Systemic Organ Regulation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Li Y, Wu JH, Meng Y, Zhang Q, Gong W, Liu SD. New devices and techniques for endoscopic closure of gastrointestinal perforations. World J Gastroenterol 2016; 22:7453-7462. [PMID: 27672268 PMCID: PMC5011661 DOI: 10.3748/wjg.v22.i33.7453] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 05/30/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal perforations, which need to be managed quickly, are associated with high morbidity and mortality. Treatments used to close these perforations range from surgery to endoscopic therapy. Nowadays, with the development of new devices and techniques, endoscopic therapy is becoming more popular. However, there are different indications and clinical efficacies between different methods, because of the diverse properties of endoscopic devices and techniques. Successful management also depends on other factors, such as the precise location of the perforation, its size and the length of time between the occurrence and diagnosis. In this study, we performed a comprehensive review of various devices and introduced the different techniques that are considered effective to treat gastrointestinal perforations. In addition, we focused on the different methods used to achieve successful closure, based on the literature and our clinical experiences.
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44
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Single-incision laparoscopic myomectomy: A review of the literature and available evidence. Gynecol Minim Invasive Ther 2016. [DOI: 10.1016/j.gmit.2016.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Abstract
Natural orifice translumenal endoscopic surgery (NOTES) is an intense area of research, and is arguably the most significant endoscopic innovation of this decade. Training for new NOTES is a relatively long, encompassing advanced endoscopy training, mastery of endoscopic dexterity within the narrow submucosal or "third space" with an in-depth understanding of the tissue planes. Proficiency with new closure and hemostatic devices is also essential. Few institutions worldwide can provide all the cognitive and technical elements essential to train new NOTES trainees. Trainees may need to spend time across several institutions to ensure safe and effective practice of new NOTES.
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Affiliation(s)
- Payal Saxena
- Division of Gastroenterology and Hepatology, Department of Medicine, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia; Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 1800 Orleans St, Baltimore, MD 21205, USA
| | - Mouen A Khashab
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins Medical Institutions, 1800 Orleans St, Baltimore, MD 21205, USA; Department of Medicine, Johns Hopkins Hospital, 1800 Orleans Street, Suite 7125B, Baltimore, MD 21205, USA.
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Bechara R, Inoue H. POEM, the Prototypical "New NOTES" Procedure and First Successful NOTES Procedure. Gastrointest Endosc Clin N Am 2016; 26:237-255. [PMID: 27036895 DOI: 10.1016/j.giec.2015.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Peroral endoscopic myotomy (POEM) was first performed in 2008 as a novel treatment of achalasia. It is now performed globally, demonstrating the evolution of the first successful natural orifice transluminal endoscopic surgery (NOTES) procedure. There is extensive data demonstrating the safety and efficacy of POEM, and now long-term data has emerged demonstrating that the efficacy is durable. POEM is also being used to successfully treat diffuse esophageal spasm (DES) and jackhammer esophagus. With jackhammer esophagus and DES, inclusion of the lower esophageal sphincter in the myotomy minimizes the risk of symptom development from iatrogenic ineffective esophageal motility.
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Affiliation(s)
- Robert Bechara
- Digestive Diseases Centre, Showa University Koto-Toyosu Hospital, Toyosu 5-1-38, Koto-Ku, Tokyo 135-8577, Japan; Queen's University Division of Gastroenterology Kingston General and Hotel Dieu Hospitals, 166 Brock Street, Kingston, Ontario K7L 5G2, Canada.
| | - Haruhiro Inoue
- Digestive Diseases Centre, Showa University Koto-Toyosu Hospital, Toyosu 5-1-38, Koto-Ku, Tokyo 135-8577, Japan
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Khan AQ, Liu E, Li P, Gul H, Fokeerchand J, Niu J, Niu W. Transvaginal Laparoscopically Assisted Endoscopic Appendectomy: a major Hybrid Natural Orifice Transluminal Endoscopic Surgery case series in Asia. Int Surg 2016; 101:153-160. [PMID: 26998935 DOI: 10.9738/intsurg-d-16-00003.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Evaluation of a Hybrid Approach to NOTES and its performance relative to conventional procedures. BACKGROUND Globally, numerous institutions have successfully implemented minimally invasive surgeries by applying natural orifice translumenal endoscopic surgery (NOTES) techniques and achieved decreased morbidity while performing incision-less surgery. However, these techniques are still not common in surgical practice in China and Pakistan. Documenting the experiences and challenges encountered in implementing NOTES in such environments can provide guidance for NOTES implementation elsewhere. METHODS From May 2010 to April 2012, 16 human transvaginal appendectomies were carried out applying a hybrid NOTES technique using a solo-umbilical trocar, which provided a safe access for laparoscopic assistance during surgical procedure. After removal of the appendix transvaginally, the colpotomy was sutured under direct vision with absorbable stitches. The outcomes of cases treated with hybrid NOTES techniques were compared to those of conventional laparoscopic appendectomy. RESULTS All patients underwent a successful surgical procedure with no intra- or post-operative complications and provided no specific complaints during the tenth day and a monthly follow-up for 2 years. The patients convalesced promptly with healthy and satisfactory cosmetic results. Compared to conventional laparoscopic appendectomy, the hybrid NOTES operation had less post-operative pain, lower cost, and shorter hospitalization. CONCLUSIONS Hybrid NOTES procedures can be performed safely using a solo-umbilical trocar. Our initial experience reveals that this hybrid technique is practically feasible and associated with minimal post-operative pain, reasonable convalescence time, and improved cosmetic outcomes.
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Affiliation(s)
| | | | | | | | | | - Jun Niu
- 1 Laparoscopic Minimally Invasive Surgery of Shandong University
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Benzing C, Krenzien F, Atanasov G, Seehofer D, Sucher R, Zorron R, Pratschke J, Schmelzle M. Single incision laparoscopic liver resection (SILL) - a systematic review. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2015; 4:Doc17. [PMID: 26734538 PMCID: PMC4686817 DOI: 10.3205/iprs000076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Today, minimally invasive liver resections for both benign and malignant tumors are routinely performed. Recently, some authors have described single incision laparoscopic liver resection (SILL) procedures. Since SILL is a relatively young branch of laparoscopy, we performed a systematic review of the current literature to collect data on feasibility, perioperative results and oncological outcome. Methods: A literature research was performed on Medline for all studies that met the eligibility criteria. Titles and abstracts were screened by two authors independently. A study was included for review if consensus was obtained by discussion between the authors on the basis of predefined inclusion criteria. A thorough quality assessment of all included studies was performed. Data were analyzed and tabulated according to predefined outcome measures. Synthesis of the results was achieved by narrative review. Results: A total of 15 eligible studies were identified among which there was one prospective cohort study and one randomized controlled trial comparing SILL to multi incision laparoscopic liver resection (MILL). The rest were retrospective case series with a maximum of 24 patients. All studies demonstrated convincing results with regards to feasibility, morbidity and mortality. The rate of wound complications and incisional hernia was low. The cosmetic results were good. Conclusions: This is the first systematic review on SILL including prospective trials. The results of the existing studies reporting on SILL are favorable. However, a large body of scientific evidence on the field of SILL is missing, further randomized controlled studies are urgently needed.
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Affiliation(s)
- Christian Benzing
- Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Krenzien
- Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georgi Atanasov
- Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Seehofer
- Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Sucher
- Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ricardo Zorron
- Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johann Pratschke
- Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Schmelzle
- Department of General, Visceral, and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Sesia SB, Berger E, Holland-Cunz S, Mayr J, Häcker FM. Laparoscopy-Assisted Single-Port Appendectomy in Children: Safe Alternative also for Perforated Appendicitis? Medicine (Baltimore) 2015; 94:e2289. [PMID: 26683962 PMCID: PMC5058934 DOI: 10.1097/md.0000000000002289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Because of its low complication rate, favorable safety, cost-effectiveness, and technical ease, mono-instrumental, laparoscopy-assisted single-port appendectomy (SPA) has been the standard therapy for appendicitis in our department since its introduction 10 years ago. We report our experience with this technique and compare its outcome to open appendectomy (OA). The records of all children who underwent appendectomy at our institution over a period of 8 years were analyzed retrospectively. Patient baseline data, markers of inflammation, operative time, length of hospital stay, complication rate according to the classification of Clavien-Dindo, and histologic grading were assessed to compare the 2 surgical techniques (SPA and OA). The chi square test, the Student's t test and the Wilcoxon-Mann-Whitney test were used to analyze the data and the comparisons of the mean values. A P value < 0.05 was considered significant. Overall, 975 patients were included in the study. A total of 555 children had undergone SPA and 420 had been treated by OA. Median operative time of SPA was longer than that of OA (60.8 min vs 57.4 min; P < 0.05). Length of hospital stay after SPA was shorter than after OA (4.4 days and 5.9 days, respectively; P < 0.001). The overall complication rate was lower for SPA than that for OA (4.0% vs 5.7%), but the difference of complications for SPA and OA was not statistically significant (P < 0.22). SPA was successfully performed in 85.9% of children. In 53.8% of patients with perforated appendicitis, no conversion was required. In the group of children with perforated appendicitis, the complication rate of ∼20% was independent of the surgical technique applied. With respect to operative time, length of hospital stay, and postoperative complication rate, SPA is not inferior to OA. SPA is safe and efficient, even in the management of perforated appendicitis.
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Affiliation(s)
- Sergio B Sesia
- From the Department of Pediatric Surgery, University Children's Hospital of Basel (UKBB), Spitalstrasse 33, 4056 Basel, Switzerland
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A multicenter study of initial experience with single-incision robotic cholecystectomies (SIRC) demonstrating a high success rate in 465 cases. Surg Endosc 2015; 30:2951-60. [PMID: 26541728 DOI: 10.1007/s00464-015-4583-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/19/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recently, the robotic single-site platform has been used to ameliorate the difficulties seen in single-incision laparoscopic surgery (SILC) while preserving the benefits of standard laparoscopic cholecystectomy. The purpose of this study is to describe the clinical outcomes of a large series of single-incision robotic cholecystectomy (SIRC). METHODS Medical records of consecutive patients who underwent SIRC were retrospectively reviewed. All procedures were performed by six surgeons at five different North American centers involved in the study. All patients included in the study underwent a cholecystectomy attempted through single site at the umbilicus, using the da Vinci(®) Surgical System (Intuitive Surgical Inc. Sunnyvale, CA). RESULTS A total of 465 patients met study criteria. Median age was 48 years (range 18-89); 351 (75.5 %) were female and 304 (66.4 %) were overweight or obese. Except for gender, case characteristics differed significantly by surgeon/site. Previous abdominal surgery was reported for 226 (48.6 %) cases. SIRC was successfully completed in 455 (97.8 %) cases, and there were no conversions to open surgery. Median surgical time was 52 min with a decreasing trend after 55-85 cases. Male gender, obesity and diagnoses other than biliary dyskinesia were independent predictors of longer surgical times. The complication rate was 2.6 %. CONCLUSIONS Our large, multicenter study demonstrates that robotic single-site cholecystectomy is safe and feasible in a wide range of patients.
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