Friedrich Herbst

Clinical experience with a simple retraction device in single-port laparoscopic cholecystectomy: Technical description and initial results

Abstract Background: Performing single-port laparoscopic cholecystectomy (SPLC) is challenging as triangulation is limited and the critical view is difficult to obtain. We present our initial experience using a simple retraction device to reduce these problems. Material and methods: In January 2012 a novel lifter was introduced at our department and subsequently used in SPLC for suspension of the gallbladder. Perioperative data were collected prospectively. In addition, all videos were reviewed to assess any adverse events caused by the lifter. Results: Thirty (20 female and 10 male) patients at a median age of 48.4 years (range: 23–83) were operated using this novel retraction device. Median BMI accounted for 26.0 kg/m2 (median; range: 14.0–36.9). Retraction of the gallbladder using the lifter was possible in all patients. In four cases (13.3 %) spillage of bile caused by the lifter was recorded. In addition, perforation of the gallbladder was seen once (3.3 %), caused by electrocautery. No inflammation, induration or visible scars were seen in the right upper quadrant at six weeks postoperatively in any patient. Conclusions: Gallbladder retraction in SPLC using this novel device is feasible and safe without leaving any apparent scar. Rate of bile spillage is (at least) comparable to that reported for conventional laparoscopic cholecystectomy.

Massive fluidopneumothorax after implantation of a totally implantable venous access port: report of a case

SummaryBACKGROUND: Extravascular catheter placement during implantation of totally implantable venous access port (TIAP) is a rare complication. METHODS: Case report. RESULTS: We report a case of a 48-year-old woman with a normal postoperative chest x-ray developing a massive fluidopneumothorax after first application of chemotherapy via TIAP. Intravenous catheter placement was not confirmed by aspiration of blood after TIAP implantation. Postoperative chest X-ray was performed describing the catheter to be in correct position. CONCLUSIONS: Aspiration of blood should be done directly after TIAP implantation to prove intravascular position of catheter. Postoperative chest X-ray without a contrast medium fails to detect extravascular catheter placement.

Reply to: doi:10.1007/s00464-010-1525-9: Use of a peripheral venous catheter in single-incision laparoscopic surgery

We thank Dr. Bhandarkar and colleagues for their interest in our article. Controlled smoke evacuation to improve visibility in single-incision laparoscopic surgery (SILS) seems to be a common problem not yet satisfactorily resolved by industry. Bhandarkar et al. are using a Veress needle inserted through the same skin incision next to the trocars for smoke evacuation. We agree that this is a costeffective and safe way to handle the smoke problem. However, for intraoperative cholangiography, the Veress needle cannot be used. A PVC, as employed in our series, does not require a skin incision and leaves no apparent scar. It permits both smoke evacuation by a direct route away from the optical lens and at the same time effective introduction of a cholangiography catheter. Even in obese patients, abdominal wall thickness in the right upper quadrant usually does not preclude use of a PVC (see Fig. 2 in our report), although malfunction occasionally may be an issue.

Late pelvic function following rectal cancer resection – a case-control study

SummaryBACKGROUND: There are still controversial data about the impact of rectal resection for malignancies on overall pelvic organ function and quality of life. Our aim was to investigate whether these parameters differ compared to the general population without bowel resection. METHODS: One hundred eighteen patients (44%) operated for rectal cancer at a single institution between 1995 and 2005 completed a self-administering questionnaire including the International Index of Erectile Function, Female Sexual Function Index, Short Form-12 Health Survey, International Prostatic Symptom Score, International Consultation on Incontinence Questionnaire-Short Form, and Vaizey Incontinence Score. Healthy subjects with no bowel resection served as controls for each case and were matched by age (±5 years) and gender. The median follow-up time was 7 years (range 2.8–14.2). RESULTS: The Vaizey incontinence score was significant higher in the patient group compared with the control group (patients: median 4 (range 0–24), controls: 0 (range 0–20); p<0.0001). Sexual and urinary function showed no significant difference between both groups. In regard to the SF-12 health survey the median physical health score of patients was 51.5 (range 22.0–58.2) compared to 53.6 (range 16.8–64.3) of the control subjects (p = 0.1241). The median mental health score of the patient group was 55.1 (range 19.1–63.8) compared to 55.0 (range 28.7–63.8) of the control group (p = 0.2222). CONCLUSIONS: Patients with rectal cancer resection have a significant impairment of fecal continence. Notably, urinary and sexual function and quality of life are comparable with healthy subjects without colorectal resection.