Radical Sphincter-Sparing Resection in Rectal Cancer
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 in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
To create the J pouch, a 60 mm linear stapler (GIA-60 or similar) is inserted via a colotomy 5 cm from the end of the fully mobilised colon. The anvil of the circular stapler, typically the CEEA-31 or similar, is inserted into the same colotomy, which is purse stringed around the shaft with 3’0 prolene suture. The body of the circular stapler is inserted trans-anally via the perineum. With an ultra-low anastomoses it is essential to ensure that only the internal sphincter is purse stringed into the stapler. To this end it must be confirmed from above that only one thickness of muscle can be felt around the periphery of the gun. The gun, with the trocar retracted, is inserted into the anal canal. The trocar is advanced so that it pierces the anorectal stump. The proximal head is then engaged with the shaft, the stapler is fired and the anastomosis tested in the usual way.
Alveolar bone grafting in cleft patients
John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan in Operative Oral and Maxillofacial Surgery, 2017
In patients older than 2 years of age, cancellous bone can be harvested from the iliac crest with the help of a trocar. The use of a trocar reduces the invasion of the donor site procedure and also reduces the pain at the donor site. However, the core graft obtained is compressed which can be a disadvantage in contrast to cancellous bone chips harvested openly from the iliac crest which can be packed into every nook and cranny of the alveolar defect and compressed into it. The iliac crest itself can be raised as an osteoplastic flap and cancellous bone chips harvested from inside the ilium and the lid replaced. The anterior crest is our site of choice because it provides adequate cancellous bone and can be harvested simultaneously to the cleft procedure. The keys to prevention of post-operative morbidity at this site are the avoidance of any muscle stripping in particular on the lateral aspect of the crest, as well as the use of a cannula inserted into the wound at surgery after the lid has been replaced and used to infuse long acting local analgesia on a few occasions during the first 24 hours after surgery.
Abdominal surgery: General principles of access
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
Additional trocar placement methods depend upon the type of trocar being used. Reusable metal trocars are frequently use for pediatric laparoscopic procedures, particularly in infants and young children. These trocars come equipped with both sharp (cutting) and blunt tip obturators. A sharp-tip obturator requires a skin incision that approximates the diameter size of the trocar. The sharp obturator is then used to cut through the remaining musculofascial planes, as the trocar is advanced into position. The sharp tip of the obturator should be visualized at all times, to minimize the risk of inadvertent visceral injuries. A blunt-tip obturator requires a full-thickness incision to facilitate passage of the port. Under direct laparoscopic vision, an 11-blade scalpel is used to cut full-thickness through the skin and musculofascial planes. A fine dissecting instrument is then passed through the incision and a gentle spread opens up the incision to allow passage of the blunt obturator and trocar. Reusable metal trocars generally will require some type of suture to secure the trocar to the skin.
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).
Endoscopic neuroendoscopy using a novel ventricular access port
Published in British Journal of Neurosurgery, 2018
Andrew John Gauden, Calum Pears, Andrew Parker, Kelvin Woon, Helge Köck, Martin Hunn, Warren Symons, Agadha Wickremesekera
The port diameter was designed to be just larger than the ventriculoscope with an internal diameter of 6.8 mm (0.268 inches) (Figure 2). At its distal end, the edge of the tip of the port was filed blunt and the spherical tip of the trocar was rounded and bevelled blunt. At the proximal end of the port a flat screwable plate was designed to allow fine adjustment of the length of the port, which would be wider in diameter than the standard burr hole and would sit on the surface of the skull giving the device a steady platform. The trocar has a central canal that allows egress of cerebrospinal fluid as the ventricle is tapped with insertion of the device. The central canal within the trocar is also designed to fit a Dandy needle or a frameless stereotactic probe to aid with neuronavigation. The VAPs are available in a variety of lengths and diameters to encompass paediatric and adult settings, as well as accommodate varying thicknesses of the cerebral tissue from the pial surface to the ventricular wall.
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).
Related Knowledge Centers
- Abdominal Wall
- Laparoscopy
- Surgery
- Thoracoscopy
- Cannula
- Thorax
- Medical Device
- Veterinary Medicine
- Minimally Invasive Procedure
- Insufflation