Surgical endoscopy
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Transvaginal surgery has been performed by gynecologists for decades with abundant literature supporting its efficacy and safety. Recently, several groups reported on the NOTES transvaginal (TV) approach for extrapelvic disease. Nevertheless, repeated TV access for NOTES has never been reported to date. Two cases of "repeated" TV access for NOTES cholecystectomy after TV hybrid sleeve gastrectomy are described. ⋯ This report suggests that, in experienced hands, repeated TV access for extrapelvic surgery is possible and safe, putting forward the intriguing promises of less adhesions formation.
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The purpose of this study was to investigate endotracheal tube cuff pressure alteration in patients during laparoscopic cholecystectomy surgery. ⋯ This study indicates that the CO(2) pneumoperitoneum and Trendelenburg position used during laparoscopy increase endotracheal cuff pressure and lead to discomfort in the postoperative patient. Measurement of endotracheal cuff pressure is a simple and inexpensive procedure and should be applied in patients under going laparoscopic surgery.
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Comparative Study
Single-incision versus conventional laparoscopic sigmoid colectomy: a case-matched series.
Single-incision laparoscopic surgery is an emerging modality that has proven to be safe and feasible for colon resection in multiple case reports and series. Nonetheless, comparative analyses with established techniques are limited in the published literature. We evaluated the efficacy of single-incision laparoscopic colectomy (SILC) for the treatment of sigmoid disease through a matched-case comparison with conventional laparoscopic colectomy (CLC). ⋯ Compared with conventional laparoscopic technique, single-incision laparoscopic surgery results in similar intraoperative and postoperative outcomes. The technique avoids use of multiple trocar sites and may safely be performed in patients with a history of previous abdominal surgery while maintaining a short length of hospital stay and low complication rate.
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Multicenter Study
Decreasing morbidity and mortality in 100 consecutive minimally invasive esophagectomies.
Esophagectomy is a complex invasive procedure that requires exploration of multiple body cavities for removal and subsequent restoration of gastrointestinal continuity. In many institutions, esophagectomy morbidity and mortality rates remain high despite improvement of intensive care treatment. We reviewed our minimally invasive esophagectomy (MIE) experience of a consecutive series of 100 patients to analyze trends in morbidity and mortality as we transitioned from open to MIE. ⋯ Our results support the continued safe use of esophagectomy for selected esophageal diseases, including malignancy. Morbidity, especially wound infection, anastomotic leak, and length of stay is decreasing with the incorporation of minimally invasive techniques.
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Randomized Controlled Trial
Prospective randomized controlled trial of simulator-based versus traditional in-surgery laparoscopic camera navigation training.
Surgical residents often use a laparoscopic camera in minimally invasive surgery for the first time in the operating room (OR) with no previous education or experience. Computer-based simulator training is increasingly used in residency programs. However, no randomized controlled study has compared the effect of simulator-based versus the traditional OR-based training of camera navigation skills. ⋯ This is the first prospective randomized controlled study indicating that simulator-based training of camera navigation can be transferred to the OR using the traditional hands-on training as controls. In addition, simulator camera navigation training for laparoscopic surgery is as effective but more time efficient than traditional teaching.