Parasitic dermoid cysts may form from autoamputation of the ovarian mass secondary to torsion or rupture. It may then reimplant in surrounding structures and undergo subsequent neovascularization and further growth. The true incidence of these cases is unknown, however, a study reported a 0.04% incidence among 1,007 cases of dermoid cysts. This report describes the case of a 30-year-old multigravida who presented with an ultrasound finding of an ovarian dermoid cyst, which, upon laparoscopic surgery, turned out to be a parasitic dermoid cyst adherent to the bladder, with grossly normal bilateral ovaries. Theories on the development of parasitic dermoid cyst are also presented.
Human ; Female ; Adult: 25-44 yrs old ; dermoid cyst ; laparoscopy

Previous abdominal surgeries have been viewed as a relative contraindication to laparoscopy. The authors report a case of a distal third ureteral stricture previously managed by multiple endoscopic and open procedures and successfully repaired with an exclusively laparoscopic approach.

A 37-year-old female, diagnosed case of chronic endometriosis had previously undergone an open excision of left ovarian cyst and an ipsilateral open psoas hitch reimplantation. Her right distal third ureteral stricture had been on chronic ureteral stent replacement for the past three years. After a comprehensive preoperative evaluation, the patient underwent a successful and uncomplicated laparoscopic ureteral reimplantation on the left. The authors describe their surgical technique and the challenges they encountered therein.

Recurrent distal third ureteral stricture previously managed by multiple open and endoscopic surgeries is a challenging disease to manage. An experienced minimally-invasive surgical team can successfully manage this problem laparoscopically without immediately resorting to open.

INTRODUCTION

The conventional teaching of laparoscopic surgery in academic centers in the apprentice/mentor model is highly subjective. The Gynecological Endoscopic Surgical Education and Assessment is a well-structured education program proposed by the European Society for Gynaecological Endoscopy (ESGE). This program uses the Laparoscopic Skills Training and Testing (LASTT) kit, an objective, validated, and measurable test to evaluate an individual’s competence level in basic laparoscopic psychomotor skills. The LASTT kit may be used to assess the basic laparoscopic psychomotor skills of Filipino doctors, guide surgical training recruitment, and improve the local minimally invasive surgery curriculum.

The study will describe the implementation of the LASTT kit in evaluating the psychomotor skills of Filipino physicians in training and assess the feasibility and user acceptance of the kit.

A descriptive cross-sectional research design was used. A total of 34 trainees (19 medical interns and 15 surgical residents) were included. All trainees underwent the LASTT test to have the baseline data for comparison of each cohort. A posttest questionnaire for the feasibility and user acceptance of the kit was accomplished.

A majority of participants were right-handed, and female, with 0–30 laparoscopic assists. The mean age of surgical residents was higher than medical interns. Surgical residents showed a significantly shorter time to accomplish the exercises than medical interns. Finally, it showed that the kit was clear and understandable, easy to use, and represented a realistic model of the actual laparoscopic surgery.

The surgical residents were superior to medical interns in laparoscopic psychomotor skills, which supports that hands-on training and exposure to procedures improve skill proficiency. Furthermore, the LASTT kit was well accepted and would greatly aid in recruitment and skills training in the Philippines.

The case report discusses a rare occurrence of tubal pregnancy in a patient with uterine didelphys, managed using combined hysteroscopy and laparoscopy. A 29-year-old Gravida 2 Para 0 (0010) with a right tubal ectopic pregnancy alongside incidental uterine didelphys detected via physical examination and three-dimensional transvaginal ultrasound. The patient underwent a combined diagnostic and operative laparoscopy, where a right salpingectomy was performed using a harmonic scalpel. Diagnostic laparoscopy showed two uterine horns with each attached fallopian tube and ovary with an interostial length of 4 cm. Diagnostic hysteroscopy confirmed the presence of two separate uterine cavities and cervices without communication. The procedure demonstrated that the technique for laparoscopic salpingectomy in cases of uterine didelphys parallels that for a normal uterus. The use of combined hysteroscopy and laparoscopy proved effective in evaluating both the external uterine structure and internal cavity, facilitating accurate diagnosis and treatment of Müllerian anomalies with ectopic pregnancy.

Klippel-Feil Syndrome (KFS) continues to pose significant challenges for anesthesiologists. Beyond the expected complexities of managing difficult airways in these patients, they often present with systemic anomalies that can elevate the risk of morbidity during surgeries conducted under anesthesia. Furthermore, laparoscopic procedures bring about additional physiologic changes that must be taken into consideration when planning the anesthetic care for these individuals. This report details the anesthetic management of a 29-year-old female diagnosed with Klippel-Feil Syndrome (KFS) and concomitant Müllerian duct aplasia-Renal agenesis-Cervicothoracic Somite dysplasia (MURCS) as well as Chiari Type 1 Malformation, who underwent a successful pelvic laparoscopic surgery. The airway was secured through awake fiberoptic-guided intubation while general anesthesia was maintained with a combination of sevoflurane inhalation and remifentanil infusion. Intraoperatively, the team prioritized neuroprotection, lung-protective ventilation strategies, and renal preservation measures. The anesthetic management of patients with KFS necessitates a comprehensive assessment of their anomalies. Incorporating these considerations into the anesthetic management will help mitigate the procedure's adverse effects and lead to favorable patient outcomes.
Anesthesia ; Airway Management ; Klippel-Feil Syndrome ; Laparoscopy

BACKGROUND AND OBJECTIVE

Robotic surgery for rectal malignancies in the Philippines is emerging. Evidence has shown promising results for robot-assisted (R) rectal surgery when compared to the laparoscopic (L) and open (O) approach. This study discussed the clinicopathologic outcomes of the first robotic rectal resections versus laparoscopic and open rectal resections at the Philippine General Hospital (PGH).

This was a retrospective cohort of 45 consecutive surgical resections for rectal malignancy done at the PGH from March 2019 to October 2019 that compared the outcomes of the first 15 robotic procedures done at the institution versus laparoscopic (n=15) and open (n=15) operations performed during the same time period. One-way ANOVA was done to determine significant differences among variables, while Bonferonni multiple comparison test was done to analyze differences among means.

The 45 patients in the study had a mean age of 56.04 ± 13.45 years. The patients were mostly male (60%). Most of the tumors were located in the low rectum (27/45; 60%). Most of the patients had locally-advanced (at least Stage IIIB) disease (27/45; 60%), and warranted neoadjuvant treatment (41/45; 91.11%). Most patients underwent a sphincter-saving procedure (34/45; 75.56%). All three groups had comparable baseline characteristics. The R-group had the longest operative time (438.07 ± 124.57; p value < 0.0001). Blood loss was significantly highest in the R-group (399 ± 133.07 cc; p value - 0.0020) as well, while no statistical difference was observed between the Oand L-groups (p value – 0.75). No conversion to open was noted in the R- and L-groups. Most of the patients had well-differentiated adenocarcinoma (22/45; 48.49%). All patients in the L- and O-groups had an R0 resection There were two R1 resections in the R-group. All patients who underwent an open surgery had a negative circumferential resection margin (CRM); L-group 93.99%, R-group 69.23%. All patients had adequate proximal and distal resection margins. Those who underwent an open surgery had the shortest post-operative length of stay (LOS) (p value – 0.0002). Post-operative ileus (7/45; 15.56%) was the most commonly encountered morbidity, and was seen mostly in the R-group (3/15; 20%). One patient in the R-group underwent a transanal repair of an anastomotic dehiscence and was discharged three days after reoperation. There was no reported mortality.

Our institution with a beginning robotic colorectal surgery program showed promise as its initial outcomes for rectal cancer were compared to the more often-performed open and laparoscopic procedures. The authors expect more favorable clinicopathological outcomes as our staff overcome the prescribed learning curve for robotic surgery.

Introduction: Laparoscopic Cholecystectomy uses carbon dioxide (CO2) which affects the respiratory, cardiovascular and renal system. The residual CO2 induces phrenic nerve irritation, manifesting as shoulder and abdominal pain. Recruitment maneuvers opens the lungs and helps expelling this residual carbon dioxide. However, there are limited studies on its role to hemodynamics especially in patients undergoing abdominal laparoscopic procedures. Methods: Sixty patients (51 15.1) scheduled for laparoscopic cholecystectomy under General Endotracheal Anesthesia were randomly allocated to two groups. The control group (Group C) underwent standard laparoscopic cholecystectomy procedures. The experimental group (Group R) was placed in a Trendelenburg and was given 4-5 manual pulmonary inflations at a pressure of 40cmH20. The blood pressure, heart rate, respiratory rate and oxygen saturation, as well as the post operative site pain and shoulder pain were measured using the Numerical Pain Scale (NPS) were monitored at 0, 1 and 2 hours post operatively. Results: The demographics and preoperative vital signs were comparable. The mean systolic blood pressure [119.5 vs 131.5; p=0.002], mean arterial pressure [91.8 vs 95.3; p=0.049], heart rate [74.9 vs 87.5; p <0.001] and respiratory rate [15.7 vs 16.2; p=0.02] were all differrent only during the immediate post operative period. The mean shoulder pain was lower in Group R immediately [1.9 ± 1.2; p=0.01] and 1 hour after surgery [0.7 ± 0.8; p=0.01]. Conclusion Recruitment maneuver significantly reduces the shoulder pain scores after laparoscopic cholecystectomy. It causes a decrease in blood pressure, heart rate and mean arterial pressure in the immediate post operative period.
Cholecystectomy, Laparoscopic ; Shoulder Pain ; Hemodynamics ; Carbon Dioxide

INTRODUCTION: Laryngeal mask airway (LMA), which is used in difficult airway maintenance conditions during emergencies, is rarely used in prolonged surgery despite its advantages over endotracheal tube (ETT). In this study, we conducted a comparative analysis of intraoperative gas exchanges between second-generation LMA and ETT during prolonged laparoscopic abdominal surgery. METHODS: Prolonged surgery was defined as a surgery lasting more than 2 h. In total, 394 patients who underwent laparoscopic liver resection via either second-generation LMA or ETT were retrospectively analysed. The following parameters were compared between the two groups of patients: end-tidal pressure of carbon dioxide (ETCO₂), tidal volume (TV), respiratory rate (RR), peak inspiratory pressure (PIP), arterial partial pressure of carbon dioxide (PaCO₂), pH and ratio of arterial partial pressure of oxygen to fractional inspired oxygen (PFR) during surgery. In addition, the incidence of postoperative pulmonary complications (PPCs), including pulmonary aspiration, was compared. RESULTS: The values of ETCO₂, TV, RR and PIP during pneumoperitoneum were comparable between the two groups. Although PaCO₂ at 2 h after induction was higher in patients in the LMA group (40.5 vs. 38.5 mmHg, P < 0.001), the pH and PFR values of the two groups were comparable. The incidence of PPC was similar. CONCLUSION During prolonged laparoscopic abdominal surgery, second-generation LMA facilitates adequate intraoperative gas exchange and may serve as an alternative to ETT.
Humans ; Laryngeal Masks ; Carbon Dioxide ; Retrospective Studies ; Intubation, Intratracheal ; Laparoscopy/adverse effects* ; Postoperative Complications/etiology* ; Oxygen

BACKGROUND: The KangDuo-Surgical Robot-01 (KD-SR-01) system is a new surgical robot recently developed in China. The aim of this study was to present our single-center experience and mid-term outcomes of urological procedures using the KD-SR-01 system. METHODS: From August 2020 to April 2023, consecutive urologic procedures were performed at Peking University First Hospital using the KD-SR-01 system. The clinical features, perioperative data, and follow-up outcomes were prospectively collected and analyzed. RESULTS: A total of 110 consecutive patients were recruited. Among these patients, 28 underwent partial nephrectomy (PN), 41 underwent urinary tract reconstruction (26 underwent pyeloplasty, 3 underwent ureteral reconstruction and 12 underwent ureterovesical reimplantation [UR]), and 41 underwent radical prostatectomy (RP). The median operative time for PN was 112.5 min, 157.0 min for pyeloplasty, 151.0 min for ureteral reconstruction, 142.5 min for UR, and 138.0 min for RP. The median intraoperative blood loss was 10 mL for PN, 10 mL for pyeloplasty, 30 mL for ureteral reconstruction, 20 mL for UR, and 50 mL for RP. All procedures were successfully completed without conversion, and there were no major complications in any patient. The median warm ischemia time of PN was 17.3 min, and positive surgical margin was not noted in any patient. The overall positive surgical margin rate of RP was 39% (16/41), and no biochemical recurrence was observed in any RP patient during the median follow-up of 11.0 months. The surgical success rates of pyeloplasty and UR were 96% (25/26) and 92% (11/12) during the median follow-up of 29.5 months and 11.5 months, respectively. CONCLUSION The KD-SR-01 system appears feasible, safe, and effective for most urological procedures, based on our single-center experience.
Male ; Humans ; Robotic Surgical Procedures/methods* ; Robotics ; Treatment Outcome ; Retrospective Studies ; Ureter/surgery* ; Urologic Surgical Procedures/methods* ; Laparoscopy/methods*

Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy characterized by simple operation and few postoperative complications have gradually become the two most commonly used surgical methods in clinical practice.A series of complications often occur after bariatric surgery,including gallstone disease,anemia,malnutrition,gastroesophageal reflux disease,kidney stones,and birth defects in offspring of women of childbearing age.There are controversies regarding the causes and countermeasures of these complications.This article mainly reviews the risk factors and countermeasures for the complications after bariatric surgery.
Humans ; Female ; Bariatric Surgery/methods* ; Gastric Bypass/methods* ; Gastroesophageal Reflux/surgery* ; Postoperative Complications/prevention & control* ; Risk Factors ; Gastrectomy/methods* ; Laparoscopy/methods* ; Obesity, Morbid/surgery* ; Retrospective Studies