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Recent developments in fetal therapy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
The technique of selective laser coagulation of placental vessels has paved the way for fetal surgery in a minimally invasive way for the pregnant woman. Initially performed using a 5-mm hysteroscope inserted through a purse-stringed hysterotomy after exposure of the uterus with a small laparotomy (11), the technique was greatly simplified by a minimally invasive percutaneous approach under ultrasound guidance and under local or epidural anesthesia that has transformed the prognosis of the disease (8,12–15). An endoscope of 1.3 to 2mm in diameter is introduced in a 3-mm trocar. A Nd:YAG or diode laser fiber is passed through the operative channel of the endoscope. It allows coagulation of the anastomotic vessels joining the two feto-placental circulations (Fig. 2). This technique has been developed over 15 years and has proven to be the best first-line treatment with the highest degree of evidence, leading to survival rates of around 75% with severe morbidity in less than 10% of the survivors (9). These results are stable through to long-term follow-up and up to the age of 6 years (16).
Choledochal malformation
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Mark Davenport, Nguyen Thanh Liem
A Z-shaped incision is made on the umbilicus and the skin is detached from the fascia. A 5 mm trocar is inserted in the middle for the conventional 30-degree laparoscope, and two other trocars (one 5 mm and one 3 mm) are introduced in the left and the right for instruments. A transabdominal suspending suture is made to lift the hepatic round ligament to the abdominal wall. A second suspending suture is performed to lift the gallbladder to the abdominal wall on the right. A third suspending suture is made to lift the anterior wall of the choledochus to the abdominal wall. More suspending sutures might be needed to facilitate dissection of the choledochus distally during the operation. The other parts of the operation are performed as described in the section on “Laparascopic Surgery”.
Simple vitrectomy
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Alan J Ruby, George A Williams
During the set-up, a trocar is used to introduce a micro-cannula posterior to the limbus inferotemporally in a location similar to that of the 20-gauge instrument. The trocar is advanced through the sclera transconjunctivally, eliminating the need for a peritomy. The trocar facilitates placement of the microcannula, which is grasped with a second instrument, and the trocar is removed.
Simulation of non-Newtonian flow of blood in a modified laparoscopic forceps used in minimally invasive surgery
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
Md. Abdul Raheem Junaidi, Harsha Sista, Ram Chandra Murthy Kalluri, Y. V. Daseswara Rao, Alla Gopala Krishna Gokhale
In laparoscopic surgery, the surgeon creates multiple incisions around the belly button of a patient for inserting trocars of 5–12 mm sizes, as shown in Figure 1. A trocar is a surgical instrument that is sharp-pointed and is used with the cannula to puncture the abdominal cavity and to insert different instruments through it. A camera-enabled laparoscope is inserted into the abdominal cavity through a trocar into the first of the three ports. The abdomen is inflated with carbon dioxide (CO2) gas insufflating device (a method known as pneumoperitoneum) through the second port to provide sufficient room for the surgeon to perform the surgery. The reason for preferring CO2 over other gases is that it is non-flammable, non-combustible, colorless, readily soluble in water, cheap, and reduces the risk of complications occurring by blood clots in veins. The final port is for the laparoscopic forceps, to perform operations such as grasping, cutting, lasing, cauterizing, etc. After inflating the abdomen with CO2 gas, the surgeon inserts various instruments that are commonly used in laparoscopic surgeries (Geryane et al. 2004; Yadav et al. 2017).
Intraoperative localization of gastrointestinal tumors by magnetic tracer technique during laparoscopic‐assisted surgery (with video)
Published in Scandinavian Journal of Gastroenterology, 2021
Guifang Lu, Jing Li, Xiaopeng Yan, Xuejun Sun, Yan Yin, Xinlan Lu, Feng Ma, Fei Ma, Jianbao Zheng, Wei Zhao, Yi Lv, Mudan Ren, Shuixiang He
After successful induction of general anesthesia, a trocar was introduced at the appropriate puncture point. Usually, an additional 3–4 trocars of varying diameters were selected for puncturing after laparoscopic exploration. The surgeon chose an operative method to attract magnetic rings that was discretionarily dependent on his/her intention. Another magnet ring was delivered to the wall of the digestive tract contralateral to the lesion and was attracted magnetically between the devices, which gradually closed on one other when the two rings were 3–5 cm apart (Supplementary Video 2). During laparoscopic-assisted surgery, the surgeons precisely identified the location of the lesion according to the position of the magnet rings and accurate examination under laparoscopy. In addition, an external magnetic field was used to achieve magnetic traction of the lesion. Alternatively, the surgeon was also able to use surgical instruments for magnetic localization (Supplementary Video 3).
The subway tunneling technique for distal shunt catheter insertion
Published in British Journal of Neurosurgery, 2020
Giuseppe R. Giammalva, Nello Grassi, Enrico Lo Bue, Lara Brunasso, Rosario Maugeri, Domenico G. Iacopino, Francesca Graziano
We read with interest the article by Osman et al. titled ‘Trocar assisted distal shunt tube insertion with intra-operative X-Ray confirmation’. The authors purpose their technique to place the peritoneal catheter during ventriculoperitoneal shunt (VPS) surgery1 as an alternative to laparoscopy and laparotomy. The trocar is inserted at the inverse McBurney point, after a small skin incision, and then it is directed at a 45° angle (to avoid the retroperitoneal vascular structures), until an abrupt feeling of release and a ‘pop’ sound indicate that the peritoneum is pierced. Then, they perform an intra-operative abdominal X-ray to confirm the positioning of a catheter. They report 58 patients having this surgical technique. There were six complications: 2 patients had shunt infection (3.4%), 2 patients had shunt obstruction (3.4%), 1 patient had bowel injury (1.7%) and 1 had disconnection (1.7%).1