Katica Krajinovic

Single-port laparoscopic cholecystectomy with the x-cone: a feasibility study in 9 pigs.

Objective: Virtually any port system for single-port laparoscopic surgery is for single usage only. The aim of this study was to trial the novel and completely reusable port X-Cone in order to perform a cholecystectomy by one infraumbilical incision. Methods: Single access cholecystectomies were performed in 9 anesthetized domestic pigs in nonsurvival studies. Only one infraumbilical incision was performed for placing the reusable, multichannel steel port system. A newly developed angulated forceps was used besides regularly used instruments in laparoscopic surgery. Results: The gallbladder was successfully removed in 9 pigs. At postmortem examination, the clips placed on the cystic duct and the cystic artery. No bile leakage was found at the operative field. Conclusion: Single-port cholecystectomy with the reusable X-Cone single-port system is safe and feasible. No additional incisions were needed. The system is ergonomically designed, easy to handle, and the learning curve for cholecystectomy is steep.

A Novel Technique for Fundal Retraction of the Gallbladder in Single-Port Cholecystectomy

Recent reports on the feasibility and safety of single-incision cholecystectomy have challenged the conventional multiport access to the gallbladder. Nevertheless, the proximity of different instruments and the laparoscope may lead to interference that potentially compromises the safety of the operation. This article describes the use of a customary flexible restraint system for the gallbladder fundus to achieve triangulation by means of a three-instrument technique and an optimized view to the Calots triangle.

Early-Elective Single-Incision Laparoscopic Sigmoidectomy for Perforated Diverticulitis Using a Totally Reusable Single-Port Device:

Background: Single-port access (SPA) is an emerging concept in minimally invasive colorectal surgery. The authors report their experience using SPA sigmoidectomy as an early-elective approach to complicated diverticulitis with paracolic abscess. Methods: Between September 2009 und April 2010, 4 patients underwent SPA sigmoidectomy for Hinchey-I diverticulitis using the reusable X-Cone device. Results: After a median time of antibiotic treatment of 8 days, SPA sigmoidectomy was performed successfully in all patients. The median operative time was 200 minutes (range, 187-221 minutes). No intraoperative or postoperative complications were recorded; the median postoperative hospital stay was 7 days (range, 5-7 days). No incisional hernias were observed at midterm follow-up (median, 11.5 months; range, 8-14 months). Conclusions: When performed by an experienced laparoscopic surgeon, early-elective SPA sigmoidectomy is a feasible and safe approach to complicated diverticulitis. The reusability of the X-Cone device ensures that the costs of the procedure are not high.

Small bowel volvulus after transabdominal preperitoneal hernia repair due to improper use of V-Loc™ barbed absorbable wire – do we always “read the instructions first”?

Highlights • Serious complications during routinely performed procedures due to improper use of V-Loc™ barbed wire can occur.• When used intraabdominally the V-Loc™ barbed absorbable wire needs to be shortened and the suture stump to be extraperitonealized.• Surgeons need to be aware of relevant “tricks and traps” of routinely performed procedures.

Proximal jejunal stoma as ultima ratio in case of traumatic distal duodenal perforation facilitating successful EndoVAC® treatment: A case report

Highlights • Endoluminal vacuum (EndoVAC™) therapy has been shown to be a revolutionary option but has anatomical and technical limits.• Transstomal EndoVAC™ is a new approach and a safe and feasible option as ultima ratio for intestinal leakage.• In trauma related laparotomy complete mobilization of the duodenum is crucial.

Single-port laparoscopic cholecystectomy in patients of advanced age: why not?

Objective: To compare the perioperative outcome of elderly patients undergoing either single-port cholecystectomy (SPC) or standard multiport laparoscopic cholecystectomy (SMLC). Patients and Methods: Patients older than 50 years who underwent SPC using the reusable X-Cone were compared with age-matched, sex-matched, and body mass index-matched patients after SMLC, and postoperative outcome was analyzed. Results: Of 97 patients who underwent SPC during July 2009 and August 2011, 33 patients (34%) were older than 50 years. Baseline characteristics were comparable for either group, as was the operative time (min) (SPC: 82.7±25.1 vs. SMLC: 83.9±22.1; P=0.85), postoperative hospital stay (d) (SPC: 3.7±1.6 vs. SMLC: 3.9±1.5; P=0.61), and postoperative complication rate [SPC: 4 of 33 patients (12.1%) vs. SMLC: 3 of 33 patients (9.1%); P=1.0]. Conclusions: Our study suggests that older age might not be predictive of an inferior outcome after SPC, compared with patients who were treated with the “golden standard.”