Masato Tomita

Tips for single‐port laparoscopic cholecystectomy

Single‐port laparoscopic cholecystectomy (SPLC) is an emerging technique and gaining increased attention by its superiority in cosmesis. A 1.5‐cm vertical transumbilical incision is used for the single port, followed by the glove method. Indications for SPLC are the same as those for standard 4‐port laparoscopic cholecystectomy, including patients with morbid obesity, previous upper abdominal surgery, severe acute cholecystitis, or suspected presence of common bile duct stones. Some randomized controlled trials have shown negative results of SPLC regarding operative time, wound‐related complications, and postoperative pain. However, our retrospective analysis shows equivalent clinical outcomes among the two approaches in terms of postoperative pain and complications. In this context, SPLC can be a good option for gallbladder pathologies.

Single-Port Transumbilical Laparoscopic Excision of Retroperitoneal Schwannoma Mimicking a Nonfunctional Endocrine Tumor in the Body of the Pancreas: A Case Report

Schwannomas are benign tumors that arise from neural sheath Schwann cells. Solitary benign schwannoma is generally located in the head and neck and is a rare neoplasm among the tumors of the retroperitoneal space. Reports of laparoscopic excision of retroperitoneal schwannomas have recently been on the increase. However, few cases of single-port laparoscopic excision of these tumors have been reported. Moreover, there are no reports of single-port excision of schwannomas attached to the body of pancreas and around the splenic vessels. This is the first report of a schwannoma lying adjacent to the body of the pancreas between the splenic artery and vein that was excised by single-port laparoscopic surgery. The most notable aspect of our procedure is the use of bipolar forceps. Single-port laparoscopic excision using bipolar forceps is a feasible and safe procedure for retroperitoneal solitary tumors, even when they are close to the splenic artery and vein.

Impact of obesity on surgical outcome after single-incision laparoscopic cholecystectomy

Introduction: Single-incision laparoscopic cholecystectomy (SILC) is widely used as a treatment option for gallbladder disease. However, obesity has been considered a relative contraindication to this approach due to more advanced technical difficulties. The aim of this report was to review our experience with SILC to evaluate the impact of body mass index (BMI) on the surgical outcome. Patients and Methods: Between May 2009 and February 2013, 237 patients underwent SILC at our institute. Pre- and post-operative data of the 17 obese patients (O-group) (BMI ≥30 kg/m2) and 220 non-obese patients (NO-group) (BMI <29.9 kg/m2) were compared retrospectively. SILC was performed under general anaesthesia, using glove technique. Indications for surgery included benign gallbladder disease, except for emergent surgeries. Results: Mean age of patients was significantly higher in the NO-group than O-group (58.9 ± 13.5 years vs. 50.8 ± 14.0 years, P = 0.025). SILC was successfully completed in 233 patients (98.3%). Four patients (1.7%) in the NO-group required an additional port, and one patient was converted to an open procedure. The median operative time was 70 ± 25 min in the NO-group and 75.2 ± 18.3 min in the O-group. All complications were minor, except for one case in the NO-group that suffered with leakage of the cystic duct stump, for which endoscopic nasobiliary drainage was need. Conclusion: Our findings show that obesity, intended as a BMI ≥30 kg/m2, does not have an adverse impact on the technical difficulty and post-operative outcomes of SILC. Obesity-related comorbidities did not increase the risks for SILC.

Transumbilical glove port: A cost-effective method for single-incision laparoscopic hepatectomy

Objectives: Emerging concepts of “reduced port surgery” have gained considerable attention from laparoscopic surgeons, including the field of liver resection. To date, 86 cases of single-incision laparoscopic hepatectomy (SILH) have been reported, with commercially available access devices being used in most of these cases. We report herein a use of homemade transumbilical glove port for SILH. Methods: A 39-year-old woman represented giant hepatic hemangioma (9-cm in size) located at the left lateral segment (S2/3). Partial hepatectomy was performed by the glove method via single port access with conventional laparoscopic bipolar forceps, grasper and scissors without the need of any single-port specific devices. Results: The operative time was 77 minutes, and intraoperative blood loss was 50 mL. The postoperative course was uneventful. Conclusions: Glove method not only has significant advantages in terms of cost, but also is superior in its versatility, allowing wider range of movements compared to conventional access devices. Taking in consideration its cost effectiveness and versatility, glove method may be a good option for SILH.

Twin pregnancy complicated with bowel strangulation

A 31-year-old primigravida at 35u2005weeks of gestation with twins who had no prior abdominal surgical history presented with worsening nausea, vomiting and abdominal pain. Initial screening ruled out obstetrical causes that may threaten the pregnancy. Twelve hours after the onset of symptoms, a transabdominal ultrasound revealed abdominal free fluid. A CT scan confirmed strangulated ileus involving the small bowels. Owing to non-reassuring fetal status in one of the twins, an emergency caesarean section and subsequent laparotomy were performed. The first twin presenting with fetal distress had to be resuscitated postdelivery but recovered uneventfully and met all developmental milestones by 3u2005months of age. The mother had a strangulated small bowel that had to be resected. She had an uncomplicated postsurgical course and gained full bowel function prior to discharge from the hospital.