Akihiro Takai

A cadaveric demonstration of visualization of the urethra using a lighted stent during transanal intersphincteric resection

Urethral injury is one of the crucial intraoperative complications during transanal total mesorectal excision (taTME) for male patients with low rectal cancer. Urethral injury can occur during the anterior dissection around the inferior lobe of the prostate and the membranous urethra. A tool to visualize the urethra around this area would be useful to avoid urethral injury. We report a cadaveric demonstration of visualization of the urethra using a lighted stent during transanal intersphincteric resection. The lighted stent (InfraVision Ureteral Kit, Stryker) was placed through the irrigation channel of a clear three-way urinary catheter. After the anterior dissection, the visibility of the lighted stent was investigated under the three laparoscopic light conditions: (1) normal intensity; (2) low intensity; and (3) turned-off. In the proper dissection plane that led to preservation of the urethra, the lighted stent was hardly visible under the normal-intensity condition, but it was clearly visible under the turned-off condition. In the improper dissection plane that led to urethral injury, the lighted stent was clearly visible under both the normal-intensity and the turned-off conditions. Visualization of the urethra using the lighted stent under the turned-off condition of the laparoscopic light can be useful to avoid inadvertent urethral injury during the anterior dissection of male taTME. Clear visibility of the lighted stent under the normal-intensity condition can indicate that the dissection plane is too close to the urethra.

Quality of life after single-incision laparoscopic cholecystectomy: A randomized, clinical trial

Background: Controversy continues as to whether single‐incision laparoscopic cholecystectomy, with the somewhat larger incision at the umbilicus, may lead to a worse postoperative quality of life and more pain compared with the more classic 4‐port laparoscopic cholecystectomy. The aim of this study was to compare single‐incision and 4‐port laparoscopic cholecystectomy from the perspective of quality of life. Methods: This study was a multicenter, parallel‐group, open‐label, randomized clinical trial. A total of 120 patients who were scheduled to undergo elective cholecystectomy were randomly assigned 1:1 into the single‐incision laparoscopic cholecystectomy or the 4‐port laparoscopic cholecystectomy group and then assessed continuously for 2 weeks during the postoperative period. The primary outcome was quality of life, defined as the time to resume normal daily activities. Postoperative pain was also assessed. To explore the heterogeneity of treatment effects, we assessed the interactions of sex, age, and working status on recovery time. Results: A total of 58 patients in the single‐incision group and 53 in the 4‐port group (n = 111, 47 male, mean age 57 years) were analyzed. The mean time to resume daily activities was 10.2 days and 8.8 days, respectively, for single‐incision and 4‐port laparoscopic cholecystectomy (95% confidence interval –0.4 to 3.2, P = .12). Similarly, the time to relief from postoperative pain did not differ significantly between the groups. Statistically insignificant but qualitative interactions were noted; in the subgroups of women, full‐time workers, and patients younger than 60 years, recovery tended to be slower after single‐incision laparoscopic cholecystectomy. Conclusion: Postoperative quality of life did not differ substantially between single‐incision laparoscopic cholecystectomy and 4‐port laparoscopic cholecystectomy. Patients younger than 60 years, women, and full‐time workers tended to have a somewhat slower recovery after single‐incision laparoscopic cholecystectomy.

Soft-light overhead illumination systems improve laparoscopic task performance.

Purpose:The aim of this study was to evaluate the impact of attached shadow cues for laparoscopic task performance. Methods:We developed a soft-light overhead illumination system (SOIS) that produced attached shadows on objects. We compared results using the SOIS with those using a conventional illumination system with regard to laparoscopic experience and laparoscope-to-target distances (LTDs). Forty-two medical students and 23 surgeons participated in the study. A peg transfer task (LTD, 120 mm) for students and surgeons, and a suture removal task (LTD, 30 mm) for students were performed. Illumination systems were randomly assigned to each task. Endpoints were: total number of peg transfers; percentage of peg-dropping errors; and total execution time for suture removal. After the task, participants filled out a questionnaire on their preference for a particular illumination system. Results:Total number of peg transfers was greater with the SOIS for both students and surgeons. Percentage of peg-dropping errors for surgeons was lower with the SOIS. Total execution time for suture removal was shorter with the SOIS. Forty-five participants (69% in total) evaluated the SOIS for easier task performance. Conclusions:The present results confirm that the SOIS improves laparoscopic task performance, regardless of previous laparoscopic experience or LTD.