Comparison of Laparoscopic Single-Incision Surgery with Hangt-Port Approach and Multiport Approach for Ovary Mature Cystic Teratoma

Objective To compare the safety and clinical outcomes of transumbilical laparoscopic single-incision Hangt-port approach with multiport approach surgery for mature cystic teratoma of ovary. Methods A total of 94 patients with unilateral ovarian maturity cystic teratoma underwent cystectomy in our hospital from February 2018 to December 2019 were retrospectively analysed. All the patients were treated with single incision surgery by Hangt-port approach (n = 45) and multiport approach (n = 49). Baseline characteristics were presented, and perioperative outcomes were followed-up and compared. Primary outcome measures were incision related complications. Results Baseline characteristics were comparable within the groups. During 1 year follow-up, the incidence of incision related complications of Hangt-port approach were more than that in the multiport group ( 8/45 v.s.1/49, P = 0.013). A total of 2 cases suffered postoperative umbilical hernia and 7 case was delayed incision wound healing. Compared with multiport group, post-operative VAS scores during 12 hours were significantly increased in Hangt-port group (3.62 ± 0.91 v.s. 2.92 ± 1.13, P = 0.001). Also, the Hangt-port group had significantly shorter operative time for patients with cyst size > 6cm (77.77 ± 16.31 v.s. 92.33 ± 25.65, P = 0.031), while showed significantly prolonged post-operative hospital stay for patients with cyst size ≤ 6cm (4.13 ± 1.01 v.s. 3.32 ± 0.82, P = 0.003). Conclusions Both multiport and Hangt-port approach were safe in laparoscopic single incision surgery. Hangt-port approach was likely to be recommended for patients with cyst size > 6 cm, but incision-related follow-up complications should be concerned.while this finding still need to be explored by further large-scale study.

Single incision thenar muscle reconstruction using the free functional pronator quadratus flap

Background Injuries to the thenar muscle mass or the thenar branch of the median nerve and resulting loss of thumb opposition lead to a massive impairment of hand function. For decades, reconstructive approaches were based on tendon transfers. To broaden the reconstructive repertoire, we present the free functional pronator quadratus flap as a viable alternative for functional reconstruction and provide a specification for its indication. We demonstrate our surgical technique to a single incision reconstruction using the free functional pronator quadratus flap. Based on a series of three patients, which were analyzed for hand function using Kapandji’s score and the angle of Bourrel, grip strength and nerve conduction velocity in a two year follow up, we present an indication algorithm. Results After successful reinnervation of all flaps, we found an improvement of Kapandji’s score from 4.3 ± 0.94 preoperatively, to 8.7 ± 0.47 after two years. Accordingly, the angle of Bourrel decreased from 75.75 ± 3.45 degrees to 36.96 ± 3.68 degree. Grip strength also improved from 14 ± 2.2 kg to 26.2 ± 1.2 kg. No impairment of wrist pronation was observed. Conclusion We found excellent functional recovery of thumb opposition and strength, showing similar or even superior results compared to results from tendon transfers. With the benefit of a single incision surgery and therefore minimal donor site morbidity, this free functional muscle transfer is a viable alternative to classic tendon transfers.

Fundamentals of the Currently Available Single Port Abdominal Laparoscopic Gynecologic Systems and Utility in Minor Gynecologic Surgery

Single incision laparoscopic surgery encompasses a plethora of techniques and styles. Single incision laparoscopy has demonstrated outcomes comparable to traditional multiport laparoscopy with the added benefit of improved cosmesis. This book chapter will review single incision surgery for minor gynecologic surgery, including adnexal surgical procedures and myomectomy. The chapter reviews available data in regard to outcomes in single incision laparoscopy. It also discusses the commercially available single incision surgical access systems, laparoscopes, and accessory instruments. Surgical techniques beneficial in single incision laparosocpy, including uterine manipulation, are also reviewed.

Intraoperative transthoracic ultrasonography in hepatopulmonary hydatid cyst disease: seeing beyond the horizon

Liver is the most common organ involved in hydatid disease. But involvement of multiple organs simultaneously is not unheard of. Here we have presented our experience with one such similar case with involvement of lower lobe of right lung and segment VII of liver. There was spontaneous rupture of the lung hydatid cyst during the hospital stay. A right posterolateral thoracotomy was performed for evacuation of spilled hydatid cyst content from the right pleural cavity. Intraoperative ultrasound (IOUS) was used to locate and drain the hepatic hydatid cyst via the diaphragm. Such single incision surgery for hepatopulmonary hydatid disease is associated with lesser post-operative morbidity and early discharge from the hospital. Use of IOUS can significantly improve the rate of successful localization and drainage of hepatic hydatid cyst in transthoracic approach.

Single Incision Thenar Muscle Reconstruction Using the Free Functional Pronator Quadratus Flap

Background:Injuries to the thenar muscle mass or the thenar branch of the median nerve and resulting loss of thumb opposition lead to a massive impairment of hand function. For decades, reconstructive approaches were based on tendon transfers. To broaden the reconstructive repertoire, we present the free functional pronator quadratus flap as a viable alternative for functional reconstruction and provide a specification for its indication.We demonstrate our surgical technique to a single incision reconstruction using the free functional pronator quadratus flap. Based on a series of three patients, which were analyzed for hand function using Kapandji’s score and the angle of Bourrel, grip strength and nerve conduction velocity in a two year follow up, we present an indication algorithm.Results:After successful reinnervation of all flaps, we found an improvement of Kapandji’s score from 4.3 ± 0.94 preoperatively, to 8.7 ± 0.47 after two years. Accordingly, the angle of Bourrel decreased from 75.75 ± 3.45 degrees to 36.96 ± 3.68 degree. Grip strength also improved from 14 ± 2.2 kg to 26.2 ± 1.2 kg. No impairment of wrist pronation was observed.Conclusion:We found excellent functional recovery of thumb opposition and strength, showing similar or even superior results compared to results from tendon transfers. With the benefit of a single incision surgery and therefore minimal donor site morbidity, this free functional muscle transfer is a viable alternative to classic tendon transfers.