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Concept: Laparotomy


Debate remains regarding the optimum role of laparoscopy in the setting of trauma although it can offer advantages over traditional exploratory laparotomy. Laparoscopy can be a screening, diagnostic or therapeutic tool in trauma. The purpose of this review is to evaluate the role of laparoscopy in penetrating abdominal trauma

Concepts: Laparotomy


A two-year-old spayed female shih-tzu was referred with a 10-month history of lethargy, chronic diarrhoea and weight loss. On presentation, a partial response to antibiotics was noted. Physical examination revealed an abdominal mass, and serum biochemistry and haematology revealed a mature neutrophilia, hypoalbuminaemia and a non-regenerative anaemia. Contrast radiography and abdominal ultrasound were suggestive of an intraluminal foreign body. Exploratory laparotomy revealed a surgical swab in the lumen of the jejunum that was associated with severe adhesions. Histopathology showed evidence of transmural migration of the swab from the peritoneal cavity to the lumen of the jejunum.

Concepts: Medicine, Blood, Surgery, Magnetic resonance imaging, Abdomen, Dog, Dog health, Laparotomy


To evaluate the surgical technique and outcomes of women undergoing the modified approach to vaginal hysterectomy at Harbor-University of California, Los Angeles Medical Center from 2000 to 2011. A retrospective chart review was performed of all vaginal hysterectomy cases performed using the modified technique.

Concepts: Medicine, Surgery, Retrospective, Physician, Hysterectomy, Gynaecology, Laparotomy, Surgical oncology


PURPOSE:: The purpose of this study was to investigate the association between ostomy location and the incidence of surgical site infections (SSIs) in colorectal surgery patients. DESIGN:: Prospective comparison cohort study. SUBJECTS AND SETTING:: The study sample comprised 25 adult inpatients with colorectal cancer managed surgically. All participants underwent stoma site marking before surgery. Persons undergoing emergency stoma creation and those requiring reconstruction of stomas were excluded. Subjects were recruited by WOC nurses at 6 facilities with outpatient clinics operated by WOC nurses and infection control nurses. All facilities were located in Japan. METHODS:: Six WOC nurses and 6 infection control nurses collected data including participant demographics, types of surgery, and occurrence of SSIs. Participants were prospectively followed for 30 days following surgery. RESULTS:: Surgical site infections occurred in 9 out of 25 study participants (36%). Specifically, infections were reported at a rate of 43.8% (n = 7) and 36% (n = 2) with colon and rectal surgery, respectively. Inferential statistical analysis revealed no association between the likelihood of SSI and the distance between abdominal incision and the newly created intestinal ostomy. CONCLUSION:: Based on these findings, we concluded that the distance between the location of stoma and the abdominal midline incision is not a significant risk factor for development of an SSI among postcolorectal surgery patients.

Concepts: Medicine, Epidemiology, Hospital, Surgery, Colon, Antiseptic, Laparotomy, Stoma


BACKGROUND: While single-port laparoscopy for abdominal surgery is technically challenging, the Da Vinci Single-Site® robotic surgery platform may help to overcome some of the difficulties of this rapidly evolving technique. The authors of this article present a case of single-incision, robotic right colectomy using this device. METHODS: A 74-year-old female with malignant polyp of caecum was operated on with a single-site approach using the Da Vinci Single-Site® robotic surgery device. Resection and anastomosis were performed extra-corporeally after undocking the robot. RESULTS: The procedure was successfully completed in 200 min. No surgical complications occurred during the intervention and the post-operative stay and no conversion to laparotomy or additional trocars were required. CONCLUSIONS: To the best of our knowledge, this is the first case of right colectomy using the Da Vinci Single-Site® robotic surgery platform to be reported. The procedure is feasible and safe and its main advantages are restoration of triangulation and reduced instrument clashes. Copyright © 2013 John Wiley & Sons, Ltd.

Concepts: Surgery, John Wiley & Sons, Laparoscopic surgery, Greatest hits, Laparotomy, Robotic surgery, The Da Vinci Code, Leonardo da Vinci



Trocar-site hernias are rare complications of laparoscopic surgery. Although trocar-site hernias occur more often at >10-mm sites, hernias can still develop at 5-mm sites after laparoscopy, and can lead to serious complications. The primary objective of this review is to summarize the current medical literature pertaining to the clinical presentation and pre-disposing risk factors of trocar-site hernias at 5-mm sites after laparoscopy. A total of 295 publications were identified, of which 17 (5.76%) publications met inclusion criteria. Twenty-seven patients with trocar-site hernias were identified after laparoscopic cases. The median age [interquartile range (IQR)] for all adult patients with trocar-site hernias was 63 (IQR 39.5-66.5) years. Eight out of the 18 patients (44.4%) undergoing gynecologic laparoscopy were parous, though details of parity were not reported in most publications. Simple manual reduction or laparoscopic reduction with fascial closure (21 patients, 84%) was utilized more often compared to exploratory laparotomy (4 patients, 16%; P<0.001) to manage trocar-site hernias. There was no statistical difference in the location of trocar-site hernias i.e., umbilical (14 patients, 56%) vs. non-umbilical/lateral (11 patients, 44%; P=0.12). Findings of this review suggest that increased operative times and excessive manipulation can extend 5-mm fascial incisions, thereby increasing the risk of trocar-site hernias. Parous women older than 60 years may have unrecognized fascial defects, which confer a higher risk of trocar-site hernias after laparoscopic surgery, even in the absence of incision manipulation or prolonged surgical duration. Such patients may benefit from closure of 5-mm fascial incisions, though prospective data are required validate the overall generalizability of this management strategy.

Concepts: Surgery, Median, Interquartile range, Gynecology, Laparoscopic surgery, Laparoscopy, Laparotomy, Trocar


Laparoscopic surgery has evolved as an important field of surgery due to its clear benefits when compared to open laparotomy surgery. However, specific complications of laparoscopic surgery have been reported, of which the majority are complications associated with first entry to the abdominal cavity. The emergence of bariatric surgery, combined with the special considerations of the abdominal wall and cavity of obese patients, leads to seeking new modalities of access to the abdominal cavity in this specific population.Kii Fios First Entry Bladeless Trocar (Applied) is a new device that may allow surgeons to facilitate the creation of pneumoperitoneum. This prospective multicenter nonrandomized trial aims to evaluate the safety and efficacy of Kii Fios First Entry Bladeless Trocar in laparoscopic bariatric surgery.

Concepts: Obesity, Surgery, Abdomen, Bariatric surgery, Laparoscopic surgery, Laparotomy, Pneumoperitoneum, Trocar


Hysterectomies performed laparoscopically have greatly increased within the last few decades and even exceed the number of vaginal hysterectomies (VH). This systematic review compares surgical outcomes of total laparoscopic hysterectomy (TLH) and VH to evaluate which approach offers the most benefits and was conducted according to the Meta-analysis of Observational Studies in Epidemiology guidelines. A literature search was performed in PubMed, Embase, Web of Science for all relevant publications from January 2000 through February 2016. All randomized controlled trials and cohort studies for benign indication or low-grade malignancy comparing TLH to VH were considered for inclusion. From the literature search, 24 articles were found relevant and included in this review. The results of our meta-analysis showed no difference between the two groups for overall complications (Odds ratio (OR) 1.24 [0.68, 2.28] for major complications, OR 0.83 [0.53, 1.28] for minor complications), risk of ureter and bladder injuries (OR 0.81 [0.34, 1.92]), intraoperative blood loss (MD -30 mL [-67.34, 7.60]), length of hospital stay (-0.61 days [-1.23, -0.01]), VH was associated with a shorter operative time (MD 42 min [29.34, 55.91]), a lower rate of vaginal cuff dehiscence (OR 6.28 [2.38, 16.57]), and conversion to laparotomy (OR 3.89 [2.18, 6.95]). Although not significant, the costs of procedure were lower for VH (MD 3889.9 dollars [2120.3; 89000]). Patients in the TLH group had lower postoperative VAS scores (MD -1.08, [-1.74, -0.42]) and required less analgesia during a shorter period of time (MD -0.64 days, [-1.06, -0.22]) Defining the best surgical approach is a dynamic process that requires frequent re-evaluation as techniques improve. Although TLH and VH result in similar outcomes, our meta-analysis showed that when both procedures are feasible, VH is currently still associated with greater benefits: shorter operative time, lower rate of vaginal dehiscence and conversion to laparotomy, lower costs. Many factors influence choice for surgical approach to hysterectomy and shared-decision making is recommended.

Concepts: Epidemiology, Uterus, Randomized controlled trial, Surgery, Gynecology, Hysterectomy, Gynaecology, Laparotomy


Improved outcomes with FOLFIRINOX or gemcitabine with nab-paclitaxel in the treatment of metastatic pancreatic adenocarcinoma (PDAC) have prompted incorporation of these regimens into neoadjuvant treatment of locally advanced unresectable PDAC. Whereas some patients remain unresectable on surgical exploration, others are able to undergo resection after intensive neoadjuvant treatment. We evaluated outcomes and toxicity associated with use of intensive neoadjuvant treatment followed by intraoperative radiotherapy (IORT) in combination with resection or exploratory laparotomy.

Concepts: Cancer, Lung cancer, Surgery, Chemotherapy, Radiation therapy, Melanoma, Pancreatic cancer, Laparotomy