Journal of laparoendoscopic & advanced surgical techniques. Part A
-
J Laparoendosc Adv Surg Tech A · Aug 2009
Single-port transumbilical laparoscopic cholecystectomy: a preliminary study in 37 patients with gallbladder disease.
Since the introduction of laparoscopic surgery, surgeons have not only been concerned about clinical outcomes, but also surgical scars. Although natural orifice transluminal endoscopic surgery (NOTES) is promising, it is not applicable to clinical practice thus far due to safety concerns. As a transitional procedure between standard laparoscopic surgery and NOTES, single-port transumbilical laparoscopic surgery might be an ideal alternative. The main advantage of single-port transumbilical laparoscopic surgery is that it is performed with existing instruments. Thus, we applied single-port surgery for cholecystectomies and the clinical outcomes were analyzed. ⋯ Our series has demonstrated the feasibility and safety of single-port transumbilical laparoscopic cholecystectomy. When technical difficulties arise, early conversion to a standard laparoscopic technique is advised to avoid serious complications. Additional studies randomizing standard laparoscopic cholecystectomy and single-port transumbilical cholecystectomy are necessary for defining the exact role of this procedure.
-
J Laparoendosc Adv Surg Tech A · Aug 2009
Risk of ventriculoperitoneal shunt infections after laparoscopic placement of Chait Trapdoor cecostomy catheters in children.
Laparoscopic placement of Chait Trapdoor (Cook, Bloomington, IN) cecosotomy catheters has been practiced in our institution since 1999. Chait cecostomy catheters allow antegrade irrigation of the colon without the complications associated with appendicostomies. Although the use of laparoscopy allows precise placement of these catheters into the cecum under direct vision, the presence of a concomitant ventriculoperitoneal (VP) shunt raises concerns for the potential for a shunt infection. ⋯ Cecostomy catheter placement in patients with preexisting VP shunts may increase the risk of shunt infections. Our series illustrates two different mechanisms by which a VP shunt can become infected after this procedure. In the first case, leakage of enteric content from a poorly sealed tract probably resulted in the shunt infection. More secure fixation of the cecum to the abdominal wall, using intracorporeal sutures rather than T-fasteners, may avoid this complication. The second complication could have been avoided if the cecostomy catheter had been placed further away from the VP shunt.