Jurgen Knuth

Transvaginal/transumbilical hybrid--NOTES--versus 3-trocar needlescopic cholecystectomy: short-term results of a randomized clinical trial.

In a randomized clinical trial, needlescopic 3-trocar cholecystectomy was compared with transvaginal/transumbilical hybrid—NOTES—technique for symptomatic cholecystolithiasis. We found significantly less pain despite less analgesics, increased satisfaction with the aesthetic result, and improved postoperative quality of life in the NOTES group. Furthermore, both techniques were equal in terms of safety.

Systematic analysis of the safety and benefits of transvaginal hybrid-NOTES cholecystectomy.

AIM To evaluate transvaginal hybrid-NOTES cholecystectomy (TVC) during its clinical establishment and compare it with the traditional laparoscopic technique (LC). METHODS The specific problems and benefits of TVC were reviewed using a registry analysis, a comparative cohort study and a randomized clinical trial. At first, feasibility, safety and specific complications of the TVC were analyzed based on the first 488 data sets of the German NOTES Registry (GNR). Hereafter, we compared the early postoperative results of our first 50 TVC-patients with those of 50 female LC-patients matched by age, BMI and ASA classification. The same cohort was contacted an average of two years later to evaluate long-term results concerning pain and satisfaction with the aesthetic results and the overall postoperative results as well as sexual intercourse by means of two domains of the German version of the Female Sexual Function Index (FSFI-d). Consequently, we performed a randomized clinical trial comparing 20 TVC-patients with 20 needlescopic/3-trocar cholecystectomies (NC) also concerning the early postoperative results as well as pain, satisfaction and quality of life by means of the Eypasch Gastrointestinal Quality of Life Index (GIQLI) in the later course. Finally, we discussed the results in accordance with other published studies. RESULTS The complication (3.5%) and conversion rates (4.1%) for TVC were low in the GNR and comparable to those of the LC. Access related intraoperative complications included injuries to the bladder (n = 4; 0.8%) and bowel (n = 3; 0.6%). The study cohort revealed less postoperative pain after TVC comparing to the LC-patients on the day of surgery (NRS, 1.5/10 vs 3.1/10, P = 0.003), in the morning (NRS, 1.9/10 vs 2.8/10, P = 0.047) and in the evening (NRS, 1.1/10 vs 1.8/10, P = 0.025) of postoperative day (POD) one. The randomized clinical trial consistently found less cumulative pain until POD 2 (NRS, 8/40 vs 14/40, P = 0.043), as well as until POD 10 (NRS, 22/190 vs 41/190, P = 0.010). Furthermore, the TVC-patients had a better quality of life on POD 10 than did the LC-patients (GIQLI, 124/144 vs 107/144, P = 0.028). The complication rates were comparable and no specific problems were detected in the long-term follow-up for sexual intercourse for either group. The TVC-patients were more satisfied with the aesthetic result in the long-term course in the matched cohort analysis (1.00 vs 1.88, P < 0.001) as well as in the randomized clinical trial (1.00 vs 1.70, P < 0.001) when compared with the LC-patients. CONCLUSION TVC is a feasible procedure with a high safety profile and has advantages in regard to postoperative pain and aesthetic results when compared with LC or NC.

Laparoscopy for a ventriculoperitoneal shunt tube dislocated into the colon.

Laparoscopy can be an effective tool for the diagnosis and management of intra-abdominal ventriculoperitoneal shunt dysfunction.

Erratum to: Transvaginal hybrid NOTES cholecystectomy—results of a randomized clinical trial after 6 months

1 Department of Abdominal, Vascular and Transplant Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109 Cologne, Germany 2 Department of General, Visceral, Vascular and Thoracic Surgery, Clinic of Kempten, Robert-Weixler-Strasse 50, 87439 Kempten, Germany 3 Department for Obstetrics and Gynecology, Holweide Hospital, Neufelder Strasse 32, 51067 Cologne, Germany Langenbecks Arch Surg DOI 10.1007/s00423-016-1472-6 (2019) 404 (Suppl 1):S25

Repeat Percutaneous Tracheostomy is Safe- A Retrospective Analysis of 15 Cases

Repeat Percutaneous Tracheostomy is Safe- A Retrospective Analysis of 15 Cases We consider redo- percutaneous dilatational tracheostomy an option, despite previous percutaneous dilatational tracheostomy sometimes being considered a contraindication for a redo-procedure. Since data on this issue is limited, we analyzed our respective procedures for evaluation of this matter.

Erratum to: Appendectomy in Germany—an analysis of a nationwide survey 2011/2012

Stapling device/endo-GIA 3.6 66.6 Endoloop only n.a. 24.2 Endoloop with purse string/Z-suture n.a. 2.6 Resorbable clips 2.2 3.8 Nonresorbable clips 0.3 1.2 Mesoappendix Ligation 91.5 n.a. Bipolar coagulation 6.1 45.5 Stapling device 1.2 12.5 Resorbable clips 0.9 15.1 Nonresorbable clips 0.3 9.2 Monopolar coagulation n.a. 6.4 Lavage routinely Yes 48.1 49.9 No 51.9 50.1 Abdominal drain Always/mostly 9.5 8.3 Rarely/never 21.4 34.5 Depending on intraoperative finding 69.1 57.2 Subcutaneous Redon drain Always/mostly 4.5 n.a. Rarely/never 75.6 n.a. Depending on intraoperative finding 19.9 n.a. Subcutaneous suture Always/mostly 42.6 n.a. Rarely/never 42.4 n.a. Depending on intraoperative finding 15 n.a. Skin closing Intracutaneous and resorbable 36.5 48.3 Interrupted sutures 35.2 44.8 Staples 14.1 3.1 Intracutaneous and non resorbable 10.3 3.8