JSLS : Journal of the Society of Laparoendoscopic Surgeons
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Case Reports
Laparoscopic appendectomy for torsed appendix presenting as an acute abdomen in an infant female.
Torsion of an otherwise normal appendix vermiformis is exceedingly rare and usually presents with symptoms consistent with acute appendicitis. We present the unusual case of an infant girl who was admitted with right lower quadrant pain and focal peritonitis who was found to have appendiceal torsion on laparoscopy. ⋯ In an infant girl with lower abdominal pain, the differential diagnosis should include torsed appendix besides more common causes, such as torsed ovary, intussusception, or small bowel volvulus. Ultrasound is useful for planning the operative approach.
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Esophageal duplication cysts are infrequent anomalies of the gastrointestinal tract that are predominantly found in children. The conventional surgical approach for removal of these cysts is an open surgery one with a posterolateral thoracotomy incision. However, more recently, these cysts have been excised via video-assisted thoracoscopic surgery (VATS). ⋯ With robotic technology, precise dissection and complete resection of the thoracic mass was achieved without violating the esophageal mucosa. There were no complications, and the patients did not require placement of a postoperative chest tube. Pathological examination of the mass was consistent with an esophageal (foregut) duplication cyst in both cases.
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Enthusiasm for the use of laparoscopy in trauma has not rivaled that for general surgery. The purpose of this study was to evaluate our experience with laparoscopy at a level II trauma center. ⋯ Laparoscopy is a seldom-used modality at our trauma center; however, it may play a role in a select subset of patients.
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Comparative Study
Reduced-force closed trocar entry technique: analysis of trocar insertion force using a mechanical force gauge.
Trocar insertion injury has a high morbidity, mortality, and cost. The purpose of this study was to compare standard trocar entry with our reduced-force closed trocar entry technique by measuring trocar insertion force using a mechanical force gauge. ⋯ Our reduced-force trocar entry technique decreases trocar insertion force by 50%, requires no additional instruments or cost and is fast and safe. Reduced-entry force pressure may decrease the risk of trocar insertion injury.