Surgical endoscopy
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During laparoscopic colectomy, the specimen is retrieved through substantial incisions, which increase postoperative pain, wound infections, and incisional hernias. In the era of natural orifice transluminal endoscopic surgery (NOTES), incisionless transrectal approaches for colon resections have been investigated with promising results [4-6]. Transanal retrieval of the colonic specimen in laparoscopic colectomy has been described but not widely adopted, although it seems to be an appealing step towards NOTES colectomy. We have used the TEM rectoscope (Richard Wolf Medical Instruments Corporation, Vernon Hills, IL, USA) as a retrieval conduit, which facilitates transanal extraction of the specimen, and protects the rectal edge and anal sphincter during laparoscopic left colectomy. ⋯ Use of the TEM system facilitates transanal removal of the specimen and protects the anorectum during laparoscopic colectomy.
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Chylothorax after esophagectomy is a potentially life-threatening complication, with a reported incidence rate of 1-4%. Two cases of postoperative chylothorax successfully managed thoracoscopically are reported. ⋯ The thoracic duct is exposed to injuries during esophagectomies, especially in cases of cancer and postcaustic injuries, leading to fibrotic reaction of the surrounding tissue. Early and delayed chylothorax can be managed efficiently by a thoracoscopic approach replicating the sealing techniques used in thoracotomy.
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Dysejaculation and pain from the groin and genitals during sexual activity represent a clinically significant problem in up to 4% of younger males after open inguinal herniorrhaphy. The aim of this questionnaire study is to assess the prevalence of dysejaculation and pain during sexual activity after laparoscopic inguinal herniorrhaphy on a nationwide basis. ⋯ Dysejaculation and pain-related impairment of sexual activity is a significant problem after laparoscopic inguinal herniorrhaphy. The role of improved laparoscopic technique with use of glue fixation of lightweight meshes to reduce the risk of developing these complications needs to be evaluated.
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Randomized Controlled Trial Comparative Study
Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial.
Minimal access approaches to inguinal hernia repair have added to the ongoing debate over the "best groin hernia repair." The present prospective randomized controlled trial was done to compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques of laparoscopic inguinal hernia repair. ⋯ In the present study, TEP had a significant advantage over TAPP for significantly reduced postoperative pain up to 3 months, which resulted in a better patient satisfaction score. The other intraoperative complications, postoperative complications, and cost were similar in both groups. In terms of results, both repair techniques seemed equally effective, but TEP had an edge over TAPP.
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Comparative Study
Using National Surgical Quality Improvement Program (NSQIP) data for risk adjustment to compare Clavien 4 and 5 complications in open and laparoscopic colectomy.
Laparoscopic colectomy has been associated with fewer postoperative complications than open colectomy. However, it is unclear whether this is true for the most severe complications typically requiring treatment in an intensive care unit (ICU). The authors hypothesized that laparoscopic colectomy patients have fewer of the most severe complications even after adjustment for comorbidity risk. ⋯ Evaluation of the NSQIP database demonstrated that laparoscopic colectomy confers an independent protective effect on the frequency of ICU-level (Clavien grade 4) complications and mortality. The protective effect remained evident after correction for preoperative conditions that might have affected outcome.