Journal of laparoendoscopic & advanced surgical techniques. Part A最新文献

{"title":"Massive Paraesophageal Hernia Repair in the Obese Patient Population: Antireflux Gastric Bypass Versus Fundoplication.","authors":"Christopher DuCoin,&nbsp;Joseph Wasselle,&nbsp;Ahan Kayastha,&nbsp;Hannah Zuercher,&nbsp;Adam Wilensky,&nbsp;Joseph Sujka,&nbsp;Rahul Mhaskar,&nbsp;Paul Kuo,&nbsp;Vic Velanovich","doi":"10.1089/lap.2022.0019","DOIUrl":"https://doi.org/10.1089/lap.2022.0019","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Obesity is a risk factor for gastroesophageal reflux disease (GERD) and hiatal hernia (HH). Fundoplication is the standard operation for GERD with HH. Roux-en-Y gastric bypass (RYGB) is the procedure of choice for obese patients with either GERD or a large HH, but neither are indications for RYGB. To delineate bypass surgery as a treatment option for obese patients with HH and GERD, we propose new terminology, antireflux gastric bypass (ARGB). ARGB differs from RYGB by utilizing varying efferent limb lengths for GERD treatment. We hypothesized that ARGB would have higher GERD resolution, lower HH recurrence, and improves weight loss when compared with fundoplication. <b><i>Methods:</i></b> A retrospective cohort study was performed, evaluating patients undergoing repair of large HH (>5 cm) with obesity from January 2013 to February 2021. The primary outcome was GERD resolution, secondary outcomes include HH recurrence and weight loss. Multivariate logistic regression adjusted for age, body mass index (BMI), and hernia size by nonlinear mixed modeling. <b><i>Results:</i></b> Forty patients underwent fundoplication, and 16 patients underwent ARGB. Fundoplication patients had a larger mean hernia size (8.7 × 6.3 cm versus 6.6 × 6.4 cm), whereas ARGB patients had a higher BMI (39.2 versus 34.2 kg/m²). Recurrence showed nonstatistically significant lower incidence with ARGB and no significant difference in GERD resolution. Weight (<i>P</i> < .0001) and excess body weight (<i>P</i> < .0001) loss were superior with ARGB. <b><i>Conclusions:</i></b> Obese patients with large HHs and GERD treated with ARGB had similar GERD resolution, lower HH recurrence, and improved weight loss when compared with fundoplication. ARGB is an acceptable treatment option for obese patients with a massive paraesophageal hernia in the setting of GERD.</p>","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"1038-1042"},"PeriodicalIF":1.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40327612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Surgery in Pediatric Urology: A Critical Appraisal of the GECI and SIVI Consensus of European Experts.","authors":"Ciro Esposito, Thomas Blanc, Hubert Lardy, Lorenzo Masieri, Laurent Fourcade, Mario Mendoza-Sagaon, Simona Nappo, Manuel Lopez, Gloria Pelizzo, Henri Steyaert, Piergiorgio Gamba, Maria Grazia Scuderi, Maria Escolino, Marco Castagnetti, Fabio Chiarenza, Alaa El Ghoneimi","doi":"10.1089/lap.2021.0837","DOIUrl":"10.1089/lap.2021.0837","url":null,"abstract":"<p><p><b><i>Background:</i></b> This study aimed to create a consensus statement on the indications, applications, and limitations of robotics in pediatric urology. <b><i>Methods:</i></b> After a panel and interactive discussion focused on pediatric robotics, a televoting with 10 questions was administered to 100 pediatric surgeons/urologists attending the joint meeting of the French Group of Pediatric Laparoscopy (GECI)/Italian Society of Videosurgery in Infancy (SIVI) in 2021. The results of televoting were analyzed electronically using Mentometer software. <b><i>Results:</i></b> Ninety-four percent of participants stated that the cutoff weight for robotics should be >10-15 kg. A minimum of 20-30 procedures should be performed to become confident in robotics (74%). Pediatric urology is the main field of application (73%) and pyeloplasty is the best indication for robotics (63%). Technical problems may happen intraoperatively in 1/10-15 cases (64%). The mean duration of robotic procedures ranges from 150 to 200 minutes (72%). The main drawbacks of robotics are high costs and limited development of miniaturized instruments (74%). Ninety-five percent believed that the costs of robotics may significantly drop with the availability of more robotic brands. The main advantages of robotics over laparoscopy include improved dexterity, easier suturing, and better ergonomics (100%), whereas the main disadvantage of sharing the robot with other specialties is the wearing out of instruments (100%). <b><i>Conclusions:</i></b> This is the first consensus statement, endorsed by the GECI and SIVI societies, on the use of robotics in pediatric urology. The need to introduce more robotic brands on the market to lower the costs and to develop miniaturized instruments to be adopted in infants less than 10 kg emerged. Pediatric urology is the main field of application of pediatric robotics, and robotic pyeloplasty is the most common procedure performed. Proctorship is needed for the first 20-30 procedures and technical problems may occur intraoperatively in 1/10-15 cases. The main advantages of robotics over laparoscopy are improved dexterity, easier suturing, and better surgeon ergonomics.</p>","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"1108-1113"},"PeriodicalIF":0.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40591149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of Noncontact Laparoscopic High Ligation of the Hernia Sac of the Vas Deferens in Children with Indirect Inguinal Hernia.","authors":"Zhen-Qiang Zhang,&nbsp;Yu-Liang Zhou,&nbsp;Zhu-Bin Pan,&nbsp;Jun-Jun Ju,&nbsp;Wei-Chen Shen,&nbsp;Yi-Xin Hu,&nbsp;Shi-Qin Qi","doi":"10.1089/lap.2022.0086","DOIUrl":"https://doi.org/10.1089/lap.2022.0086","url":null,"abstract":"<p><p><b><i>Objective:</i></b> This study aims to evaluate the usefulness of vas deferens noncontact laparoscopic high ligation of the hernia sac in children with indirect inguinal hernia (IIH). <b><i>Materials and Methods:</i></b> The clinical data of 146 male children with IIH treated in the Anhui Children's Hospital from January 2018 to June 2019 were analyzed retrospectively. There were 82 patients in the observation group in which the inner ring opening was sutured and closed using the vas deferens noncontact suture and 64 patients in the control group in which the peritoneum at the inner ring opening was closed using the intradermal suture. The operation time, surgical complications, postoperative complications, and recurrence rate were compared between the two groups (followed up for 2 years). <b><i>Results:</i></b> The operation was successful in all the patients in both groups. In the observation group, there was one case of intraoperative spermatic cord vascular injury and one case of infra-abdominal wall vascular injury, and no intraoperative complications occurred in the control group. The operation time was 12.8 ± 1.4 minutes in the control group and 10.4 ± 2.6 minutes in the observation group (<i>P</i> < .01). The two groups of patients were followed up for 2 years, and no complications and no recurrence occurred. <b><i>Conclusion:</i></b> The vas deferens noncontact laparoscopic high ligation of the hernia sac to close the inner ring opening has several advantages: The operation is simple; the operation time is shorter than the traditional method, avoiding the possibility of vas deferens injury; and it is a safe, reliable, and effective surgical method. However, due to the small number of clinical cases in this study, its long-term effect requires further observation.</p>","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"1121-1125"},"PeriodicalIF":1.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40524920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the Electrothermal Bipolar Sealing System (LigaSure) Versus Endoloop in Pediatric Laparoscopic Appendectomy.","authors":"Osman Hakan Kocaman,&nbsp;Tansel Günendi,&nbsp;Mustafa Erman Dörterler,&nbsp;Mehmet Emin Boleken","doi":"10.1089/lap.2021.0841","DOIUrl":"https://doi.org/10.1089/lap.2021.0841","url":null,"abstract":"<p><p><b><i>Background:</i></b> Laparoscopic appendectomy has long been in the process of replacing open appendectomy owing to a better wound healing, better cosmetic appearance, less pain, and less postoperative adhesion. Although there are many methods for ligating the appendix stump, studies on energy-based coagulation methods have attracted great interest in recent years. In our study, we aimed to compare the use of LigaSure™ appendiceal sealing and ligation of appendiceal stump by endoloop with regard to duration of surgery, length of hospital stay, and complications in laparoscopic appendectomies. <b><i>Materials and Methods:</i></b> A total of 174 consecutive patients under the age of 18 who underwent laparoscopic appendectomy in our clinic between September 2016 and February 2021 were retrospectively analyzed. Patients with perforated appendicitis were excluded from the study. The patients were divided into two groups as the appendix stump was ligated with endoloop (Group 1) and sealed with LigaSure (Group 2). Demographic characteristics of the patients, duration of surgery, length of hospital stay, and complications were recorded. <b><i>Results:</i></b> Of the 132 patients who were included in the study, Group 1 consisted of patients using endoloop (<i>n</i> = 39) and Group 2 comprised patients that LigaSure was employed (<i>n</i> = 93). There was no significant difference between Groups 1 and 2 in terms of age and length of hospital stay (<i>P</i> = .126 and <i>P</i> = .784, respectively); however, the operation time was found to be significantly shorter in Group 2 (<i>P</i> < .001). <b><i>Conclusion:</i></b> The use of LigaSure is a safe and fast method to seal the mesoappendix and appendix stump in pediatric laparoscopic appendectomy. We think that infection complications due to stump leakage and intra-abdominal spillage will less be encountered.</p>","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"1126-1129"},"PeriodicalIF":1.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40521583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Versus Open Pancreatoduodenectomy: Cost-Effectiveness Analysis.","authors":"Frederic Borie,&nbsp;Célia Pichy,&nbsp;Mihane Nayeri,&nbsp;Seïla Fall","doi":"10.1089/lap.2021.0606","DOIUrl":"https://doi.org/10.1089/lap.2021.0606","url":null,"abstract":"<p><p><b><i>Background and Objectives:</i></b> The role of laparoscopy during a pancreatoduodenectomy (PD) is not clearly defined. The purpose of this study was thus to compare the cost-effectiveness between laparoscopic pancreatoduodenectomy (LPD) and open pancreatoduodenectomy (OPD). <b><i>Materials and Methods:</i></b> From 2010 to 2019, 140 patients underwent PD (60 LPD and 80 OPD). After 60-60 matching, the clinical-pathological characteristics, surgical technique, and type of rehabilitation were identical in both groups. Complications, R0 resection, and cost were compared. <b><i>Results:</i></b> Complication rates were 48% (12% Clavien-Dindo grade 3-4) in the LPD group and 64% (22% Clavien-Dindo grade 3-4) in the OPD group. The LPD group had significantly fewer pulmonary complications (6%) than the OPD group (20%) (<i>P</i> = .04). The oncological quality of the R0 resection did not differ between the two groups. The operating time was 312 ± 50 minutes in the OPD group and 392 ± 75 minutes in the LPD group (<i>P</i> < .001). The mean length of hospital stay was significantly shorter for the LPD group (13 ± 10) days compared to the OPD group (19 ± 8) days (<i>P</i> = .02). The average cost of total hospital stay was significantly lower for the LPD group compared to the OPD group (<i>P</i> = .02). <b><i>Conclusions:</i></b> Despite longer operative times, LPD had fewer (pulmonary) complications and reduced hospital costs.</p>","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"1048-1055"},"PeriodicalIF":1.3,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40504537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Surgical Site Infection in the Undeserved Population After Ventral Hernia Repair: A 3936 Patient Single-Center Study Using National Surgical Quality Improvement Project.","authors":"Gustavo Romero-Velez,&nbsp;Diego L Lima,&nbsp;Xavier Pereira,&nbsp;Benjamin A Farber,&nbsp;Patricia Friedmann,&nbsp;Flavio Malcher,&nbsp;Prashanth Sreeramoju","doi":"10.1089/lap.2021.0856","DOIUrl":"https://doi.org/10.1089/lap.2021.0856","url":null,"abstract":"<p><p><b><i>Background:</i></b> Ventral hernia repair (VHR) is one of the most common surgical procedures performed in the United States. Surgical site infections (SSI) carry significant morbidity for the patient and pose a very challenging problem for the surgeon, associated with up to 6.6% of cases. Thus, surgeons should be well versed in the risk factors implicated in SSI after VHR. Given the high burden of diabetes, obesity, and smoking in our patient population, we sought to study the rate of SSI and the risk factors that led to SSI in our population. <b><i>Study Design:</i></b> This is a retrospective study using the American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) database for the years 2014-2019. We identified patients who underwent VHR at a single institution in the Bronx, New York. The rate of SSI was calculated, and then, risk factors for SSI were identified using logistic regression analysis. <b><i>Results:</i></b> A total of 3936 patients underwent VHR. Incisional hernias made up 41% of the cohort, and there were 37.4% laparoscopic repairs. During the 30-day follow-up, SSI was identified in 101 patients (2.6%). Factors associated with SSI include emergent surgery (adjusted odds ratio [aOR] = 2.57), body mass index >35 kg/m² (aOR = 2.38), insulin-dependent diabetes mellitus (aOR = 2.36), and incisional hernia (aOR = 1.81). In addition, a laparoscopic approach was found to be a protective factor (aOR = 0.43, 95% confidence interval 0.25-0.75). Surprisingly, different from other studies, smoking cigarettes was not associated with SSI in our cohort. <b><i>Conclusions:</i></b> The rate of SSI after VHR in our institution is 2.6%, which is within that reported in the literature. Most of the variables associated with SSI are modifiable and are similar to those previously reported. Laparoscopic repairs appear to be protective for its occurrence.</p>","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"948-954"},"PeriodicalIF":1.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40314718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Twenty-Five-Year Experience with Minimally Invasive Splenectomy in Children: From Minilaparotomy to Use of Sealing Devices and Indocyanine Green Fluorescence Technology: Tips and Tricks and Technical Considerations.","authors":"Ciro Esposito,&nbsp;Ugo De Luca,&nbsp;Mariapina Cerulo,&nbsp;Fulvia Del Conte,&nbsp;Vincenzo Bagnara,&nbsp;Sandra Coppola,&nbsp;Francesco Corcione,&nbsp;Benedetta Lepore,&nbsp;Alessandro Settimi,&nbsp;Maria Escolino","doi":"10.1089/lap.2022.0038","DOIUrl":"https://doi.org/10.1089/lap.2022.0038","url":null,"abstract":"<p><p><b><i>Background:</i></b> This study aimed to review our 25-year experience with pediatric laparoscopic splenectomy (LS) and describe tips, tricks, and technical considerations. <b><i>Methods:</i></b> The records of 121 children, undergoing minimally invasive splenectomy in the last 25 years (1996-2021), were retrospectively reviewed. Median patient age was 10.2 years (range 7-17). The patients were grouped according to the period: G1 (1996-2005) included 31 patients undergoing open splenectomy using left subcostal minilaparotomy (G1a) and 28 receiving LS using supine position (G1b); G2 (2006-2021) included 62 patients undergoing LS using lateral decubitus. A five-trocar technique was adopted in G1b, with the spleen removed through a Pfannenstiel incision. In G2, we preferred to use lateral decubitus, 10-mm 30° optic, only four trocars, and sealing devices. In such cases, the spleen was placed in an endobag, finger-fragmented, and extracted through the umbilicus. Furthermore, indocyanine green (ICG) fluorescence was used in the last 4 G2 patients to clearly identify the vascular anatomy. <b><i>Results:</i></b> The median operative time was 65 minutes in G1a, 125 in G1b, and 95 in G2. Complications occurred intraoperatively in 14 cases (11.5%): 5 bleedings during dissection (G1b), 4 endobag breakages during spleen removal (G2); 3 spleen capsule breakages during removal (G1a); and 2 instrumentation failures (G2). No conversions to open occurred. Median hospital stay was 6 days in G1a and 4 days in G1b and G2. <b><i>Conclusions:</i></b> LS is a standardized and effective procedure in children and is preferable to mini- or conventional open splenectomy. Our 25-year experience showed that major complications may occur even in expert hands, mainly during hilar dissection or spleen extraction. Technically, sealing devices and ICG fluorescence were helpful to perform a safer and faster procedure. We believe that lateral decubitus and 30° optic should be considered technical key points to provide excellent organ exposure and easier dissection of hilar structures.</p>","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"1010-1015"},"PeriodicalIF":1.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40569049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Percutaneous Extraperitoneal Closure for Hydrocele of the Canal of Nuck in Children.","authors":"Koichi Deguchi,&nbsp;Ryuta Saka,&nbsp;Motonari Nomura,&nbsp;Kazunori Masahata,&nbsp;Miho Watanabe,&nbsp;Masafumi Kamiyama,&nbsp;Takehisa Ueno,&nbsp;Yuko Tazuke,&nbsp;Hiroomi Okuyama","doi":"10.1089/lap.2021.0885","DOIUrl":"https://doi.org/10.1089/lap.2021.0885","url":null,"abstract":"<p><p><b><i>Background:</i></b> Hydrocele of the canal of Nuck (HCN) is a rare cause of inguinal swelling in women. The optimal surgical procedure for HCN in children remains unclear. To assess the safety and efficacy of laparoscopic percutaneous extraperitoneal closure (LPEC) for HCN in a pediatric population, a retrospective study was conducted. In addition, to clarify the pathogenesis of HCN, we assessed the morphological findings of the internal inguinal ring (IIR). <b><i>Materials and Methods:</i></b> We retrospectively analyzed 10 consecutive female patients with HCN who underwent LPEC at our hospital between January 2010 and May 2020. Age, operative time, and complications were recorded. Concerning the findings of the IIR, we classified the morphological features as follows: Type 1 (flat), Type 2 (narrow patent processus vaginalis [PPV] with a peritoneal veil), and Type 3 (widely opening PPV). <b><i>Results:</i></b> The median age of patients who underwent LPEC was 3 (1-12) years. Although 2 patients showed contralateral inguinal hernia (IH), there were no cases of ipsilateral IH. All patients showed ipsilateral PPV, and the morphological features of the IIR were mostly classified as Type 3 (70%). In total, 6 of 8 HCN cases without preoperatively diagnosed contralateral IH had contralateral PPV (75%), and all were closed by LPEC. All operations were accomplished laparoscopically, and the postoperative course was uncomplicated, with no recurrences observed during the study period. <b><i>Conclusions:</i></b> LPEC is a safe and simple surgical approach to repair the HCN in children with minimal complications.</p>","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"1022-1026"},"PeriodicalIF":1.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40558708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Complete Mesocolic Excision Without Routine Gastro-Pancreatico-Colic Trunk Dissection: Survival Outcomes and Morbidity for 567 Cases.","authors":"Nick J Battersby,&nbsp;Hannah Wright,&nbsp;Tahseen Qureshi,&nbsp;Thomas Parker,&nbsp;Nuno Figueiredo,&nbsp;Amjad Parvaiz","doi":"10.1089/lap.2021.0824","DOIUrl":"https://doi.org/10.1089/lap.2021.0824","url":null,"abstract":"<p><p><b><i>Purpose:</i></b> It is unclear whether the principles of open complete mesocolic excision (CME) can be safely applied to laparoscopic surgery. Furthermore, definitions vary over how radical optimal CME surgery should be. We report morbidity and oncological outcomes for laparoscopic CME without routine gastro-pancreatico-colic trunk (GPCT) dissection. <b><i>Materials and Methods:</i></b> An observational study with consecutive data for patients with Union for International Cancer Control (UICC) stage I-III colon adenocarcinoma who underwent elective laparoscopic resection between 2006 and 2015. Data were retrieved for demographics, tumor characteristics, treatment, and histology from prospectively maintained databases. Standardized, routinely video recorded, laparoscopic resections were performed in two United Kingdom centers from The National Training Programme for Laparoscopic Colorectal Surgery. Overall survival and disease-free survival (DFS) were reported using Kaplan-Meier curves and Cox regression. <b><i>Results:</i></b> Laparoscopic CME was performed in 567 patients, 52.7% (288/546) women, median (interquartile range [IQR]) age 73 (65-80) years. Median (IQR) length of stay was 4 (3-5) days with 4.0 (2.2-5.7)-year follow-up. Significant DFS predictors (hazard ratio [HR]) by multivariable Cox regression were age >80 years (1.9), American Society of Anesthesiologists (ASA) 3 and 4 (HR = 1.1), right colon cancer (1.7), UICC stage III (3.4), and intramesocolic grade (2.2). Overall 4-year DFS (95% confidence interval) was 81.3% (77-85). Four-year DFS by UICC grades I, II, and III was 94.6% (89-99), 83.4% (77-88), and 72.2% (66-78), respectively (log-rank <i>P</i> = .001). Morbidity by Clavien-Dindo grade was III 18 (3.2%), IV 4 (0.7%) and V 7 (1.2%). <b><i>Conclusion:</i></b> This large series suggests standardized laparoscopic CME without routine GPCT dissection has a low morbidity and achieves equivalent outcomes to the most radical open CME techniques.</p>","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"938-947"},"PeriodicalIF":1.3,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40070628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended View Totally Extraperitoneal Technique and Its Advantages in Laparoscopic Inguinal Hernia Repair.","authors":"Idris Kurtulus,&nbsp;Osman Deniz Culcu,&nbsp;Mahmut Said Degerli","doi":"10.1089/lap.2021.0601","DOIUrl":"https://doi.org/10.1089/lap.2021.0601","url":null,"abstract":"<p><p><b><i>Objective:</i></b> Endoscopic total extraperitoneal (TEP) is used increasingly in inguinal hernias. Perhaps the most fundamental difficulty of the classical TEP method is that the dissection plan it offers is overly limited, which is among the reasons why techniques other than TEP are preferred in large scrotal hernias. This study discusses our experience with the extended view totally extraperitoneal (e-TEP) method, which significantly expands the dissection plan compared to the classical method. <b><i>Methods:</i></b> Patients who had inguinal hernia surgery in 2018 and 2019 were retrospectively analyzed, and 21 male patients with L3 inguinal hernia by European Hernia Society classification, who underwent laparoscopic e-TEP surgery, were included in the study. Patient data were obtained from the hospital's electronic database and patient files. One year after the surgery, the patients were invited to the hospital by telephone and re-examined. <b><i>Results:</i></b> The median patient age was 47 years. The mean duration of surgery was 43.6 minutes, and the median postoperatively pain score in the first 24 hours was 1.975. Zig maneuver was performed in 85.7%, and drains were placed in 33.4% of patients. In 28.6% of patients, the peritoneal violation occurred. However, there was no conversion to another surgical technique. The mean length of stay was 1.33 days. Two patients had seroma, one had scrotal edema, and one had urinary retention. No recurrence was observed in any patient during the 1-year follow-up. <b><i>Conclusions:</i></b> According to our experience, the e-TEP technique can be safely performed in scrotal hernias as it offers a larger dissection plane. It also allows patients with large scrotal hernias to benefit from all the advantages of the TEP technique.</p>","PeriodicalId":508448,"journal":{"name":"Journal of laparoendoscopic & advanced surgical techniques. Part A","volume":" ","pages":"842-847"},"PeriodicalIF":1.3,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39834969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}