Yao Chou Tsai

Homemade transumbilical port: an alternative access for laparoendoscopic single-site surgery (LESS).

BackgroundLaparoendoscopic single-site surgery (LESS) is a possible advancement for minimally invasive surgical interventions. However, this technique requires a specialized multichannel port for introducing laparoscope and instruments. We present our preliminary experience of using a homemade transumbilical single-port access for performing LESS.MethodAn Alexis wound retractor® was placed through the umbilical incision, and a pair of sterile surgical gloves was then snapped onto it. Standard laparoscopic trocars were inserted through the gloves after the upper half parts of the gloves were truncated. Using this port and Roticulator™ articulating instruments, we performed 14 urologic LESS procedures on porcine laboratory and cadaveric cases, and we performed 10 transabdominal pre-peritoneal inguinal hernia repairs (TAPP), and 5 laparoscopic varicocelectomies on human cases, respectively. All procedures were performed with instruments inserted through this port without the need for any extraumbilical incisions or conversion to standard laparoscopic surgery.ResultsAll LESS procedures were successfully completed without any complications. The time to achieve the transumbilical port ready for subsequent LESS was short (range, 4–8 (median, 6) minutes). The total operative time was between 60 and 190 minutes. No port-related complications were noted, and the cosmetic results were excellent.ConclusionsThis homemade transumbilical port offers a safe, reliable, flexible, and cost-effective access for LESS procedures. This technique may be an alternative for current specialized port systems.

Minilaparoscopic herniorrhaphy with hernia sac transection in children and young adults: a preliminary report

BackgroundWe designed a technique of pure minilaparoscopic hernia sac transaction and ligation to repair primary inguinal hernias in children and young adults.MethodsBetween September 2003 and December 2004, 83 patients with primary inguinal hernia were treated surgically with minilaparoscopic herniorrhaphy. The mean patient age was 6.8 years. Before the operation there were synchronous bilateral hernias in 2 (2.4%) patients, left inguinal hernias in 39 (47%) patients, and right inguinal hernias in 42 (50.6%) patients. The minilaparoscopic herniorrhaphy was carried out with the 3-mm laparoscopic and hand instrument system. Three 3.5-mm trocar ports were used for the telescope and 3-mm instruments. The peritoneum overlying the internal ring was circumferentially incised, then the peritoneal defect was closed with intracorporeal sutures.ResultsOne hundred and fourteen minilaparoscopic herniorrhaphies were performed. The mean followup period was 12.9 months. The mean operation time was 52 min. There was only one recurrence (1.2%) that was detected nine months after primary repair. All patients were able to return to unrestricted activity immediately and were discharged within 24 h after the operation. There was no reported case of testicular atrophy to date.ConclusionsMinilaparoscopic herniorrhaphy with hernia sac transaction is a safe and effective technique in children and young adults with indirect inguinal hernias.

Minilaparoscopic herniorrhaphy in pediatric inguinal hernia: a durable alternative treatment tostandard herniotomy

BACKGROUND The purpose of the article is to report our long-term results of minilaparoscopic inguinal hernia repair in children. METHODS Between September 2003 and September 2008, 161 children with inguinal hernia were treated with minilaparoscopic herniorrhaphy. The asymptomatic contralateral internal ring was routinely explored and repaired if a patent processus vaginalis of not less than 2 cm was noted. Patients who were followed for less than 1 year and those who were lost to follow-up were excluded from the study. Intraoperative and postoperative complications and hernia recurrences were documented. RESULTS In total, 146 patients were eligible for final analysis. A total of 196 minilaparoscopic herniorrhaphies were performed. The mean follow-up period was 3 years. There were 4 hernia recurrences (2%) in 3 boys. There were no procedure-related complications. None of the patients with a negative contralateral exploration or a contralateral patent processus vaginalis of less than 2 cm had a contralateral metachronous inguinal hernia. CONCLUSIONS Our long-term results reveal that minilaparoscopic herniorrhaphy combined with hernia sac transection is a safe and effective alternative treatment to standard open herniotomy.

Laparoendoscopic single-site surgery: adult hernia mesh repair with homemade single port.

Background Laparoendoscopic single-site surgery (LESS) is a novel technique developed to reduce the port-related morbidities and improve the cosmetic outcomes of laparoscopic surgery. To date, no series of LESS inguinal hernia repair has been published or documented. This study aimed to determine the safety and feasibility of LESS technique for inguinal hernia repairs. Methods Between December 2008 and March 2009, LESS procedures for inguinal hernia repair through a transumbilical incision were performed for 16 patients with symptomatic inguinal hernias. The initial 9 cases were performed by a transabdominal preperitoneal method and the remaining 7 were completed with a totally extraperitoneal approach. All procedures were accessed with our homemade single port for simultaneous passage of laparoscope and instruments. Results All procedures were completed successfully without conversion to standard laparoscopic or open surgery. These patients ranged in age from 21 to 80 years (median, 46.5 y) with a male to female ratio of 15:1. A total of 24 inguinal hernias, including 3 complicated types, were repaired. The median operative time was 83.5 minutes (range, 52 to 150 min). Two of the 16 patients suffered postoperative complications (12.5%). Most patients were discharged home on the second postoperative day. No port-related complications occurred. The cosmetic results were excellent. Conclusions In our experience, LESS procedures for inguinal hernia repair shows this technique to be both safe and feasible, even for complicated cases. More studies are needed to compare LESS inguinal hernia repair with standard laparoscopic techniques.

Laparoendoscopic Single-Site (LESS) Retroperitoneal Nephropexy with Standard Laparoscopic Instruments

A 65-year-old female suffered from recurrent urinary tract infection and intermittent right-flank soreness when active. Serial renal ultrasonography and supine/erect intravenous (i.v.) pyelography work-up revealed a floating right kidney with a descent of two vertebral bodies. A Laparoendoscopic single-site retroperitoneal nephropexy was performed. A homemade single port was created by using a commercially available wound retractor through a 3-cm incision at the tip of the 12th rib. With conventional 5-mm laparoscopy and instruments, a retroperitoneal nephropexy was perfomed. The procedure was completed successfully without any complication and with minimal blood loss. The total operative time was 110 minutes. The postoperative course was uneventful. The follow-up erect i.v. pyelographies revealed a normal right kidney position without descent. Laparoendoscopic single-site retroperitoneal nephropexy was a safe, effective procedure, according to our initial experience.

Role of Bladder Capacity in Assessing the Effectiveness of Antimuscarinic Agents on Nocturia in Patients with Overactive Bladders

Abstract Objective The aim of this study was to evaluate the effectiveness of oxybutynin in the treatment of nocturia in patients with overactive bladders (OAB) and to assess predictive factors for the responses to oxybutynin. Patients and Methods Patients with symptoms of OAB and nocturia for more than 3 months were enrolled. A 2.5 mg dose of oxybutynin was given twice daily for 1 week after a baseline study that included a self-administered nocturia questionnaire, uroflowmetry, and frequency/volume chart. Outcome analysis included changes in nocturia episodes, uroflowmetry, and post-void residual urine. Patients were stratified according to a nocturia index (Ni), nocturnal polyuria index (NPi), and nocturnal bladder capacity index (NBCi). Results A total of 59 patients were eligible for analysis. After 1 week of treatment with oxybutynin, the mean number of nocturia episodes had reduced from 2.7 ± 1.3 to 2.3 ± 1.1 ( p 0.35 (−0.4 vs. −0.3, p = 0.34, ANCOVA). Reduction in number of nocturia episodes was more significant in patients with Ni ≤ 1.5 than in those with Ni > 1.5 (−0.9 vs. −0.2, p = 0.03, ANCOVA), and in patients with NBCi > 2 than in those with NBCi ≤ 2 (−1.1 vs. −0.2, p = 0.01, ANCOVA). Conclusion Ni and NBCi are good predicting factors for the effects of antimuscarinic agents on nocturia in patients with OAB.