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Ureteropelvic junction obstruction
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Lauren E. Corona, Kate H. Kraft
Crossing lower-pole renal vessels have been implicated in the etiology of UPJ obstruction in up to 30% of cases. Conventional surgical treatment in these cases is standard dismembered pyeloplasty, Hellström's nephroplication, or transposition of lower-pole crossing vessels, which may be performed laparoscopically in selected patients. This may be an attractive surgical alternative, as it eliminates the need to violate the collecting system, thus avoiding the potential anastomotic complications, and is also less challenging than performing fine intracorporeal suturing.
Surgical Techniques
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Quinton M. Hatch, Scott R. Steele
At this point the colon may be divided intracorporeally or exteriorised through a limited Pfannenstiel or midline incision, which will allow transection across healthy colon proximally and at the splaying of the taenia distally (Figure 52.25). Primary anastomosis may then be undertaken with a circular stapler as previously described. Intracorporeal anastomosis may also be undertaken as previously described.
Anterior Resection - Laparoscopic
Published in P Ronan O’Connell, Robert D Madoff, Stanley M Goldberg, Michael J Solomon, Norman S Williams, Operative Surgery of the Colon, Rectum and Anus Operative Surgery of the Colon, Rectum and Anus, 2015
Hester YS Cheung, Michael KW Li
The length of the colon is doubly checked; if a left iliac fossa retrieval incision is made, a tension-free anastomosis requires approximately 15 cm of colon length outside the abdomen. The intended site of colonic transection is prepared, and following this the colon is transected and the specimen removed. An automatic or handsewn purse string is performed with 00 prolene suture. The colon is cleaned with iodine, and the anvil of a circular stapler (usually size 29 or above) is introduced and the purse-string tightened. The colon is replaced in the abdomen, and the retrieval wound is closed. If an Alexis® wound retractor was used, this can be temporarily closed with a sterile surgical glove; a gas-tight closure is ensured (Figure. Pneumoperitoneum is resumed and the small bowel is repositioned. After anal dilatation, the circular stapler is carefully inserted transanally. Intracorporeal anastomosis can now proceed in a similar fashion as in open surgery.
Outpatient colectomy—a dream or reality?
Published in Baylor University Medical Center Proceedings, 2022
Stephen Campbell, Alessandro Fichera, Scott Thomas, Harry Papaconstantinou, Rahila Essani
Same-day colectomy should be limited to minimally invasive surgery. The cases described here were all performed robotically. Consideration should be given to intracorporeal anastomosis creation if feasible. These cases should be done as the first case of the day to allow time for observation by the surgical team prior to discharge. The Foley catheter should be removed prior to extubation to maximize the time available for spontaneous voiding while the patient is in recovery. A transversus abdominis plane block can be performed intraoperatively or postoperatively by the anesthesia pain management team.7,8 In our patients, the blocks were performed postoperatively in the postanesthesia care unit. We followed our standard intraoperative ERAS guidelines for our case series. Additionally, these cases should be scheduled early in the week (Monday to Wednesday) to allow for close follow-up in clinic during the same week.
Leak-proof technique in laparoscopic surgery for large ovarian cysts
Published in Journal of Obstetrics and Gynaecology, 2021
The main advantage of this leak-proof technique is that it combines an intracorporeal and extracorporeal process. Aspiration of cyst content and ovarian cystectomy could be performed outside of the abdomen under direct vision, as during open surgery, while inspection of the whole abdominal cavity, irrigation, and other surgical procedures such as contralateral ovarian surgery or adhesiolysis could be laparoscopically performed. Furthermore, switching between the intracorporeal and extracorporeal process is rapid and easy. Use of a scalpel and direct aspiration by a suction tube for open surgery considerably reduced aspiration time compared with previous methods using laparoscopic aspiration. Moreover, this surgical technique does not require special surgical skills and can be performed by any surgeon, because most procedures are conducted under direct vision. Finally, because large ovarian cysts can be completely removed through a small umbilicus, the surgery results in excellent aesthetic outcomes. In contrast, major concerns of this leak-proof technique are the safety of the use of 2-Octylcyanoacrylate adhesives (Dermabond™) in this technique. However, we believe that it is reassuring because the topical adhesive is only applied to the cyst surface and completely removed during cystectomy or salpingo-oophorectomy (Figure 1(F)).
Surgical applications of intracorporal tissue adhesive agents: current evidence and future development
Published in Expert Review of Medical Devices, 2020
Nicholas Gillman, David Lloyd, Randy Bindra, Rui Ruan, Minghao Zheng
Biopolymers derived from plants have also been studied for potential application as tissue adhesives. Among these, Rose Bengal has been clinically approved for use in ophthalmologic procedures as a dye to identity damage cornea, and approved for clinical trial as a therapy for melanoma [179] and breast cancer [180]. In addition to its approved clinical applications, Rose Bengal can act as a photoactivatable agent. It reacts with laser light with a 520–600 nm wavelength, producing cross-linking of proteins via electron transfer between the reactive species produced during the photoactivation process, such as singlet oxygen molecules and free radicals [181]. Rose Bengal has also been use in a pilot clinical study for the treatment of skin wounds. The results showed Rose Bengal produces effective wound sealing and less scarring when compared with closure using interrupted, nylon, epidermal sutures. Lauto et al. developed a combined Rose Bengal and chitosan film, and used a laser activation technique to adhere the film onto a transected sciatic nerve in the rat model without sutures. Histological and functional improvements of the peripheral nerve were observed 8 weeks postoperatively [182]. It is important to note; however, that intracorporal laser use carries the risk of thermal damage to surrounding tissue. Additional surgical training on laser equipment and use would be required if Rose Bengal-based adhesives were clinically available.