Surgical endoscopy
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This study aimed to evaluate the feasibility, safety, and follow-up results of endoscopic papilletomy (ESP) with pancreatic and biliary duct stent placement for ampullary tumors. The therapeutic approach to benign ampullary tumors remains unsettled. The ESP procedure is a curative treatment option for benign papillary tumors, but ESP raises concerns about a relatively high risk for procedure-related complications such as pancreatitis. A pancreatic stent may protect against complications. ⋯ The ESP procedure can be feasible for benign ampullary adenoma, HGIN, and noninvasive cancer without intraductal tumor growth. Prophylactic stent placement in the pancreatic and bile ducts may reduce procedure-related complications.
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This study was designed to investigate the validity of using the Fundamentals of Laparoscopic Surgery (FLS) program to assess laparoscopic competence among gynecologists. ⋯ The manual skills test of the FLS program appropriately measures the level of a gynecologist's psychomotor skills. The FLS cognitive test does not discriminate between advanced and novice surgeons. Modifications of questions used in the cognitive test are necessary to allow better adaptability when applying the FLS program to gynecologists.
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Gastrointestinal stromal tumours (GIST) are a distinctive group of mesenchymal neoplasm of the gastrointestinal tract that are best treated by surgical excision without tumour disruption and with a clear resection margin to prevent disease recurrence. However, delivering a posterior gastric tumour through an anterior gastrotomy, laparoscopically, can sometimes risk tumour rupture. We have devised a new technique to avoid this complication. ⋯ Gastric GIST can be safely and efficiently resected laparoscopically without rupture or disruption with an adequate resection margin with this technique.
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Incisional hernias of the flank are rare with scattered case reports regarding the feasibility of laparoscopic treatment. Treatment can be technically challenging due to patient positioning and adequate mesh overlap and fixation. The aim of this study is to describe the surgical technique and present outcomes of the largest known case series of laparoscopic repair of flank hernia. ⋯ In the laparoscopic repair of flank hernias adequate retroperitoneal dissection and wide mesh overlap is imperative. Laparoscopic repair can be performed safely and effectively with good short-term outcomes.
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Randomized Controlled Trial
Prospective randomized double-blind placebo-controlled trial of postoperative elastomeric pain pump devices used after laparoscopic ventral hernia repair.
The laparoscopic repair of ventral hernias can result in significant postoperative pain necessitating a prolonged hospital stay, increased narcotic use, and patient dissatisfaction. Elastomeric pain pump devices with local analgesics may significantly reduce postoperative discomfort after laparoscopic ventral hernia repair. This prospective randomized, double-blind, placebo-controlled study evaluated the effect of local anesthetic continuously infused with an elastomeric pain pump device to reduce postoperative pain. ⋯ This prospective randomized double-blind, placebo-controlled trial showed no advantage of an elastomeric pain pump device in terms of providing a measurable reduction in postoperative pain scores, narcotic use, time to return of bowel function, or length of hospital stay after laparoscopic ventral hernia repair. Further studies are warranted to determine other alternatives for reducing postoperative pain after laparoscopic ventral hernia repair.