No abstract available.
Animals ; Feasibility Studies ; Female ; *Laparoscopy ; Models, Animal ; Peritoneal Cavity/*surgery ; Surgical Procedures, Minimally Invasive ; Swine

OBJECTIVETo investigate the application of the retroperitoneal approach in aortic surgery.

METHODSWe collected and analyzed data of 7 patients in Macau who presented with aortic diseases from 2007 to 2008 and were treated with aorta repair through retroperitoneal approach. Demographic features as well as intraoperative and postoperative data were analyzed. One case of thoracoabdominal aneurysm and 4 cases of abdominal aneurysm received artificial graft, among which hybrid iliac artery reconstruction with Zenith stent covering the ostium of the left subclavian artery was performed in 2 cases of infrarenal abdominal aneurysm. Aortic-iliac artery bypass was performed in 2 cases of aortoiliac occlusion.

RESULTSNo operative or early postoperative death was observed. No perioperative intestinal adhesion or ureteral obstruction was found. One case reported delayed paraplegia and graft infection as postoperative complications. The complications were partially removed 3 months later after rehabilitation.

CONCLUSIONRetroperitoneal approach is a safe and feasible technique, which associated with a low incidence of postoperative pulmonary complications.

Aged ; Aorta ; surgery ; Humans ; Myocardial Revascularization ; methods ; Peritoneal Cavity ; Treatment Outcome ; Vascular Surgical Procedures ; methods

Splenic flexure mobilization during laparoscopic colorectal surgery, which is used for elongation of the remaining colon after resecting the left colon or rectum, is sometimes essential for making a secure anastomosis without tension. However, laparoscopic splenic flexure mobilization is often time consuming and technically demanding, particularly in obese patients with severe adhesion. Therefore, three surgical approaches are introduced to make the procedure easier according to the method of entering the lesser sac: anterior approach, inferio-medial approach, and lateral approach.
Colon ; Colon, Transverse ; Colorectal Surgery ; Humans ; Laparoscopy ; Methods ; Peritoneal Cavity ; Rectum

The attempt to observe intraperitoneal organs with an endoscope using a transgastric approach in 2004 by Kalloo et al. heralded the commencement of a new era in endoscopy, which has led to the introduction of natural orifice transluminal endoscopic surgery (NOTES). NOTES has the potential to become an integral part of the field of medicine. So far, many techniques using NOTES have been reported through animal experiments, using diverse apparatus such as suture devices and multitasking platforms. Since a cholecystectomy was performed via a transvaginal route in a human in 2007 by Marescaux et al. from France, clinical experience is also growing. However, much has yet to be learned and many obstacles must be overcome before NOTES can be applied to clinical practice. As mentioned in the whitepaper by NOSCAR in 2005, secure sealing of the orifice after the procedure, development of appropriate instruments for the procedures, selection of suitable access to the peritoneal cavity, and adequate measures to prevent infection and complications still remain unresolved problems. Nevertheless, just as laparoscopic surgery has eventually been recognized as an important surgical technique, NOTES is expected to occupy an important place as an invaluable therapeutic modality for managing gastrointestinal disorders in the near future.
Animal Experimentation ; Cholecystectomy ; Endoscopes ; Endoscopy ; France ; Humans ; Hypogonadism ; Laparoscopy ; Mitochondrial Diseases ; Natural Orifice Endoscopic Surgery ; Ophthalmoplegia ; Peritoneal Cavity ; Sutures

BACKGROUND/AIMS: Natural orifice transluminal endoscopic surgery (NOTES) is a new era of minimally invasive surgery which has the potential to offer scarless surgery. So far, numerous reports on various routes to peritoneal organs in NOTES have been published. In case of transgastric approach, it is more inconvenient than transcolonic approach to access upper abdominal organs because of retroflexion. However, most data were subjective and there was no report examining the best access route for the exploration of peritoneal organs. The aim of this study was to evaluate the best access route according to the abdominal organs objectively. METHODS: Six female pigs weighing 30 to 35 kg were placed under general anesthesia. Incisions were made on both anterior wall of stomach body and rectosigmoid colon 15 to 20 cm above anal verge, respectively. Then, via each incision site, we evaluated the endoscopic visibility and checked the elapsed time to access abdominal organs in sequence (gallbladder (GB), spleen, bladder, uterus, and ovary). RESULTS: On comparison of the mean time to approach each organs, GB and ovary showed statistical difference in the mean time to approach between transgastric and transcolonic approaches. It took relatively shorter time to access GB via transcolonic route than transgastric route (352.3+/-80.1 sec vs. 222.2+/-82.0 sec, p=0.021). Next, we evaluated the time to access upper organs (GB and spleen) and lower organs (bladder, uterus and ovary). In case of lower organs, it showed no difference in time between transgastric and transcolonic approaches. However, to explore upper organs, transcolonic route was more favorable than transgastric route (351.8+/-80.7 sec vs. 273.3+/-110.3 sec, p=0.002). CONCLUSIONS: For exploration of lower organs, there is statistically no significant difference in time between transgastric and transcolonic approaches. But, in case of upper organs, transcolonic approach is superior to transgastric approach.
Animals ; Feasibility Studies ; Female ; *Laparoscopy ; Models, Animal ; Peritoneal Cavity/*surgery ; Statistics, Nonparametric ; Surgical Procedures, Minimally Invasive ; Swine ; Time

PURPOSE: Natural orifice transluminal endoscopic surgery (NOTES) is a new operation technique that utilizes natural orifices of the patient's body with the intention to puncture hollow viscera in order to insert an endoscope into a peritoneal cavity for incisionless surgery. The aim of this study was to evaluate the safety and feasibility of endoscopic cecectomy through the rectum in one dog and the vagina in another dog. METHODS: This study was performed in two beagle dogs for rectal and vaginal approaches. A five-milimeter trocar was inserted into the abdominal cavity by the Hasson method and intra-abdominal pressure was maintained at 5 mmHg with CO2. After pneumoperitoneum was accomplished, the rectum or vagina was incised with a needle knife and a one-channel gastric endoscope was inserted into the abdominal cavity. Counter-traction was performed using a laparoscopic grasper introduced via the 5 mm trocar in the umbilicus. The cecum was dissected from the base by using a needle knife with the aid of laparoscopic counter-traction. The resected cecum was retrieved through the anus or vagina without pouch bag. The incised rectum was closed by using 90-degree endoclips whereas the incised vagina was not repaired. RESULTS: Cecectomies were successfully performed with both transrectal and transvaginal routes. Both cases had no complication and recovered from surgery uneventfully. CONCLUSION: Endoscopic cecectomy with hybrid NOTES are feasible and safe. With the improvement of surgical experiences and further instrumental development, NOTES can be one option for human intestinal surgery.
Abdominal Cavity ; Anal Canal ; Animals ; Cecum ; Chimera ; Dogs ; Endoscopes ; Humans ; Intention ; Models, Animal ; Natural Orifice Endoscopic Surgery ; Needles ; Peritoneal Cavity ; Pneumoperitoneum ; Punctures ; Rectum ; Surgical Instruments ; Umbilicus ; Vagina ; Viscera

This paper is aimed to establish a novel abdominal heart transplantation model in mice and to generalize the experience of the successful cases. The thoracic inferior vena cava instead of pulmonary artery was employed to reconstruct the outflow tract of the graft heart (in the new method group, 82 cases). Meanwhile, in other 47 cases as the control group, traditional anastomosis was used between pulmonary artery of the graft and vena cava of the recipient. The recipient surgery time, vena cava-vena cava anastomosis time, graft cold ischemia time and graft re-beating time were (41.5 +/- 1. 5) min, (8.4 +/- 0.6) min, (32.3 +/- 0.4) min and (1.5 +/- 0.2) min respectively. All the above data were statistically superior to those in the traditional method group (P < 0.001 or P < 0.05). The survival rate of 100 d post surgery in the new method group was 93. 9%. Meanwhile, the cardiac tissue remained almost normal examined by HE and Picro-sirus red staining. Therefore, the novel model can facilitate the anastomosis of the outflow tract in recipient operation in mouse heart transplantation model.
Anastomosis, Surgical ; methods ; Animals ; Heart Transplantation ; methods ; Male ; Mice ; Mice, Inbred C57BL ; Models, Animal ; Peritoneal Cavity ; Pulmonary Artery ; surgery ; Transplantation, Heterotopic ; methods ; Vena Cava, Inferior ; surgery

Hydatid disease is a parasitic infestation caused by the larval form of the cestode worms Echinococcus. In humans, the most commonly affected organs are liver and lung. Most cysts remain clinically silent and are diagnosed incidentally or when complications occur. The incidence of hydatid disease is high in the Middle East, Australia, East and South Africa and Central Europe. In Korea, hydatid disease is rare and has been reported in a few cases. We experienced a case of multiple intraperitoneal cysts from ruptured hepatic hydatid cysts in a 35-year old man. His complaint was palpable abdominal mass and discomfort. Abdominal ultrasound and CT scan revealed multiple hepatic and intraperitoneal cysts. The surgical findings showed multiple cysts and daughter cysts. The pathologic finding of resected cyst was the characteristic pattern of outer thick laminated membrane and inner thin germinal layer. Albendazole was administrated for prophylatic purpose.
Adult ; Animals ; Cysts/parasitology/surgery ; Echinococcosis, Hepatic/*diagnosis/parasitology ; Echinococcus/isolation & purification ; Humans ; Liver/injuries/parasitology ; Male ; Peritoneal Cavity ; Rupture/diagnosis/surgery ; Tomography, X-Ray Computed

OBJECTIVETo investigate the feasibility and clinical value of the step-up approach for severe acute pancreatitis (SAP).

METHODSClinical data of 121 SAP patients admitted between January 2002 and December 2011 were retrospectively analyzed. Fifty-eight patients (37 males and 21 females, aged from 20 to 72 years, mean 47.6 years) in the group of direct open necrosectomy from January 2002 to December 2006 were performed laparotomy through removal of all necrotic tissue. Sixty-three patients (42 males and 21 females, aged from 19 to 78 years, mean 46.2 years) of step-up approach from January 2007 to December 2011 underwent percutaneous catheter drainage through retroperitoneum or omental bursa guided by B-type ultrasonography for the first therapy, and then, according to the pathogenetic condition, if necessary, followed by a small incisional necrosectomy along the drainage tube. The two groups were compared for the rates of postoperative complications, death, transfusion and length of stay, medical costs.

RESULTSThe rates of total postoperative complications, organ dysfunction, alimentary tract fistula and incisional hernia in step-up approach group were significantly lower than those of direct open necrosectomy group (31.7% vs. 62.1%, 14.3% vs. 37.5%, 6.3% vs. 19.0%, 9.5% vs. 29.3%; χ(2) = 4.43 to 11.17, P = 0.001 to 0.035). The other complications had no significant differences between the two groups (P > 0.05). Patients in step-up approach group had a lower rates of transfusion (44.4% vs. 70.7%, χ(2) = 8.488, P = 0.004), fewer medical costs of transfusion and hospital stay, compared with those in direct open necrosectomy group ((2525 ± 4573) yuan vs. (4770 ± 6867) yuan, t = 2.131, P = 0.035; (171 213 ± 50 917) yuan vs. (237 874 ± 67 832) yuan, t = 2.496, P = 0.014). There were no significant differences of length of stay and mortality between two groups (P > 0.05).

CONCLUSIONStep-up approach for SAP which can reduce the rates of postoperative complications, transfusion and medical costs has significant feasibility and great clinical value.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Pancreatitis, Acute Necrotizing ; economics ; surgery ; Paracentesis ; economics ; Peritoneal Cavity ; surgery ; Postoperative Complications ; economics ; epidemiology ; Retrospective Studies ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the feasibility and efficacy of enteral nutrition (EN) in patients underwent open-abdomen managements.

METHODSTwenty-one patients who received at least 3 days of EN after opening the peritoneal cavity between January 2003 and November 2006 were included in this study. Energy expenditure and actual caloric and protein intake were determined in some patients. The levels of serum protein and nitrogen balance before and after the EN were analyzed. Other related complications were also evaluated.

RESULTSAverage daily total caloric intake was 93% - 95% of estimated needs. The EN support was administered (8.8 +/- 5.5) d after opening the abdominal cavity and lasted for (51.5 +/- 33.6) d. Initial serum protein levels were low and below normal but increased in all of the patients after the EN. The average nitrogen balance was (-28.6 +/- 5.4) g/d. Diarrhea, gastric reflux, vomiting and abdominal distention occurred in 67%, 23%, 9.5% and 23% of the patients, respectively. All the complications were managed well.

CONCLUSIONSEN support could be effectively and safely given in patients requiring opening peritoneal cavity management.

Abdomen ; surgery ; Adult ; Enteral Nutrition ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Peritoneal Cavity ; surgery ; Postoperative Care ; methods ; Retrospective Studies ; Treatment Outcome