Department of Surgery, Duke University Health System, Durham, North Carolina, USA (all authors).

ABSTRACT

Introduction: Single-incision techniques limit triangulation, surgeon mobility, and organ visualization. The use of robot-assisted platforms has addressed several of these difficulties; however, it has also generated new challenges. To overcome these problems, we used a magnetic organ-retraction system recently approved by the U. S. Food and Drug Administration. In the present study, we report the first single-incision cholecystectomy performed combining magnetic and robotic technologies.

Case Description: The patient was a 48-year-old woman (BMI, 33 kg/m2) with cholelithiasis, who was scheduled for elective cholecystectomy with a single-incision magnetic robot-assisted procedure. The total procedure took 89 minutes (including docking); operative time was 58 minutes, where magnetic coupling was 51 minutes. Estimated blood loss was minimal. There were no complications. The patient was discharged home on the same day and was entirely satisfied with the surgery results.

Conclusion: The combination of these technologies is feasible and simplifies single-incision techniques.

Key Words: Cholecystectomy, Innovation, Magnetic surgery, Robotic surgery, Single incision.

The post Magnetic Robot–Assisted Single-Incision Cholecystectomy first appeared on JSLS.

Urology Division, Hartford Healthcare Medical Group, Hartford, Connecticut (all authors).

ABSTRACT

Introduction: In an era of ultrasonography and computed tomography (CT), urachal remnants have been detected with increasing frequency. If these remnants become infected, they can mimic a variety of intra-abdominal pathologies. We present the case histories of two patients with an infected urachal cyst that developed after laparoscopic cholecystectomy and necessitated excision.

Case Descriptions: Patient 1: Four years after a laparoscopic cholecystectomy, a 36-year-old man presented with dysuria, abdominal pain, leukocytosis, and fluid leakage from the umbilical port site. CT imaging revealed an infected urachal cyst with an adherent loop of sigmoid colon. Antibiotic treatment preceded laparoscopic excision of the urachal cyst with partial cystectomy and closure of the sigmoid-to-urachus fistula. In a 3-year follow-up, there was no recurrence. Patient 2: A 68-year-old woman presented 11 months after laparoscopic cholecystectomy with abdominal pain, intermittent fever, and leukocytosis. CT imaging revealed an infected urachal cyst with an associated phlegmon in the abdominal wall. Antibiotic treatment preceded two incision-and-drainage procedures. Six weeks later, the patient underwent robotic excision of the urachal cyst and partial cystectomy. A 3-year follow-up showed no recurrence.

Discussion: The urachus can be punctured during laparoscopic periumbilical port placement and convert into a draining sinus or abscess. Subsequent infection can present with umbilical drainage, abdominal pain, urinary symptoms, and systemic infection. Surgical excision is a reasonable option once the acute infection has been treated. Any images that include the urachus should be reviewed before procedures involving an umbilical port, as puncture of urachal cysts may increase the risk of infection.

Key Words: Cholecystectomy, Infection, Laparoscopy, Urachal cyst.

[gview file=”https://crsls.sls.org/wp-content/uploads/2015/04/jls101153469001.pdf”]

The post Infected Urachal Cyst Following Laparoscopic Cholecystectomy first appeared on JSLS.

The post Combination of Cholecystectomy and Salpingooophorectomy in Keyless Abdominal Rope-lifting Surgical Technique first appeared on JSLS.

Department of Surgery, Logan Hospital, Meadowbrook, Queensland, Australia (Dr. Wysocki). Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, East Brisbane, Queensland, Australia (Drs. Allen, Rey-Conde, and North).

ABSTRACT

Background and Objectives: The mortality rate of patients with acute cholecystitis is low with either medical or surgical management. It is unclear how surgeons decide which patients will not undergo cholecystectomy. We postulated those who died following medical management would have a greater burden of comorbidities than those who died following cholecystectomy.

Methods: Adults who died under the care of a surgeon with a diagnosis of acute cholecystitis were identified from the Australian and New Zealand Audit of Surgical Mortality database.

Results: We identified 86 eligible patients, and two-thirds of them were managed medically. Cholecystectomy patients were younger (78 years vs 86 years, P = .028) and had a lower American Society of Anesthesiologists class (3 vs 4, P = .005). Both groups had a similar number of comorbidities (P = .588). Length of stay for the surgical group was 11 days longer than that of the medical group (14 days vs 3 days, P <.001). The frequency of hospital systems issues was the same in both groups.

Conclusions: Patients with acute cholecystitis who died with medical management were older with a higher American Society of Anesthesiologists class than those who died following cholecystectomy. Research is required into the circumstances at time of admission for acute cholecystitis.

Key Words: Mortality, Audit, Acute cholecystitis, Laparoscopy, Cholecystectomy.

The post Mortality Audit of Octogenarians With Acute Cholecystitis first appeared on JSLS.

Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands (all authors).

ABSTRACT

A patient who underwent a laparoscopic cholecystectomy presented 6 days postoperatively with chest pain on the right side. Further examination showed a hemothorax. This is a very rare complication of laparoscopic abdominal surgery. Video-assisted thoracoscopic surgery is efficient and safe in the treatment of this complication.

Key Words: Laparascopy, Cholecystectomy, Hemothorax, Complication, Video-assisted thoracoscopic surgery.

[gview file=”https://crsls.sls.org/wp-content/uploads/2014/11/13-00049.pdf”]

The post Hemothorax After Laparoscopic Cholecystectomy first appeared on JSLS.

West Suburban Hospital, Westlake Hospital, Presence Health Systems, Elmhurst Hospital, Elmwood Park, IL (all authors).

INTRODUCTION

Titanium is a metal known for its biocompatibility and corrosion resistance.1,2 Its uses in the medical field range from long-term orthopedic implants and pacemakers to daily-use articles such as eyeglass frames and ornamental body piercings.3 Metal allergies are classically known to occur with nickel, gold, cobalt, and chrome3. Titanium has not been fully recognized as an allergen; however, there have been a number of documented incidents of patients with a possible sensitivity to titanium.4-10 One specific case reported by Tamai et al. identifies surgical metal clips as the source of an allergen for a breast cancer patient who underwent breast-conserving therapy. The patient, who had a known history of atopic dermatitis and many allergies to foods and drugs, developed worsening atopic dermatitis that was ultimately caused by titanium surgical clips.6 We report here another case of possible allergic reaction to titanium surgical clips used in a patient for a cholecystectomy procedure.

[gview file=”https://crsls.sls.org/wp-content/uploads/2014/11/12-03-0561.pdf”]

The post Adverse Reactions to Titanium Surgical Staples in a Patient After Cholecystectomy first appeared on JSLS.