Laparoscopic Retrieval of Abdominal Cysts in Sheep and Goat

The study was planned to evaluate the use of laparoscopy for the diagnosis and retrieval of abdominal cysts in sheep and goats. The abdominal cysts were located in 10 of 135 adult, healthy small ruminants by using ultrasonography (USG). Percutaneous Puncture-Aspiration-Injection-Reaspiration (PAIR) technique was used for six animals. Thirty animals, including four diagnosed with abdominal cysts by USG, were subsequently subjected to laparoscopy under diazepam sedation (0.1 mg/kg, IV) and lumbosacral epidural regional anesthesia using 2% lignocaine hydrochloride (1.0 ml/5 kg). The animals were restrained in dorsal recumbency and two-port paramedian laparoscopy was performed. Abdominal cysts were located in seven animals (one cyst/animal). The cysts were grasped carefully, lifted close to the abdominal wall, and evacuated percutaneously under laparoscopic vision. The collapsed cysts were then retrieved. In two animals enlarged ports were sutured, treated with an antibiotic and an analgesic, resulting in uneventful healing. Five cysts were nonparasitic, two were parasitic, one extracted from a sheep, and one from a goat. In conclusion, laparoscopy has higher diagnostic accuracy in detecting unattached abdominal cysts in sheep and goats compared to USG. It is also a reliable, minimally invasive, and safe procedure for cyst retrieval. However, a larger-scale study is necessary for ascertaining long-term complications and the recurrence rate.

Endoscopic Resection of a Large Polypoid Gastric Heterotopia of Duodenum: a case report

This is a case of gastric heterotopia, a benign condition most commonly found as multiple small polyps in the duodenal bulb, diagnosticated as a large polypoid lesion of the third duodenal portion in a young patient and treated successfully with endoscopic resection under laparoscopic vision.

Could Training in an Anatomical Model Be Useful to Teach Different Neovagina Surgical Techniques? A Descriptive Study about Knowledge and Experience of Techniques for Neovagina Surgery

Neovagina surgery in patients with vaginal agenesis is rare. No consensus exists regarding the best surgical technique. The aims of the current study were to show a new Thiel-embalmed cadaveric model to teach the surgical steps for different techniques of neovagina surgery and to evaluate opinions of this surgical teaching procedure. Four techniques—modified McIndoe, Vecchietti, Davydov, and vulvoperineal pediculated flaps—were recorded using an external camera and/or laparoscopic vision during their execution in a dissection room on “feminized” male cadavers. To determine the opinion of this teaching model, we designed an anonymous online survey that was available to participants via a computer application. After watching the video, more than 92% of participants agreed that feminized male cadavers were an excellent procedure for teaching these surgical techniques. Before watching this video, the most employed techniques were the McIndoe and Vecchietti procedures. After watching the video, modified McIndoe and vulvoperineal flaps were preferred by participants because they were considered to be easier to perform. It was considered that this model was useful for training neovagina techniques and, moreover, it should be recommended before techniques were performed on a real patient. Further investigation is needed to validate this model.

Feasibility of Rectal Stent Development for Fecal Diversion: A Porcine Experiment

Objective Since low rectal anastomosis leakage may cause severe morbidity, surgeons create diversion stoma to prevent complication. However, stoma requires additional surgery with morbidity. Therefore, rectal stent may help prevent these problems. This preliminary report details the development of new rectal stent in animal experiment. Thirteen female 12 week-old pigs weighing 30–35 kg each (four in the control group, nine in the experimental group) were included. Under general anesthesia, pigs underwent laparoscopic low anterior resection. In experimental group, a Niti-S fully covered stent (Taewoong Medical Inc.) was inserted by guidewire, under direct laparoscopic vision, and affixed near the anus. All pigs were sacrificed for autopsy. Including the anastomosis line, 10 cm length of bowel was obtained and a water-air leak and barium leakage X-ray tests were performed to confirm anastomosis integrity. Results Among the four control pigs, anastomosis leakage was confirmed in only one. For the experimental pigs, 36-mm-diameter stent was used. The last three pigs were subjected to additional intra-abdominal stent fixation by laparoscopic guidance, but all stents were removed. Despite natural stent removal, there were only two cases of intraoperative leakage. To overcome rectal pressure and fecal bulk, rectal stent development requires further investigation.

A Simulator-based Comparison of a Novel 3D and a Conventional 3D Vision System-surgical Performance and Subjective Ratings

In laparoscopy, novel three-dimensional laparoscopic vision systems (3D LVS) without glasses (3D−) have been invented. While standard 3D LVS with glasses (3D+) have shown advantages over original two-dimensional systems, quantitative comparisons of surgical performance between 3D− and 3D+ systems are still lacking. The aim is to compare the systems in simulated robotic surgery tasks. In a crossover study, 18 medical students performed four basic laparoscopic tasks in the validated Simball Box simulator with authentic surgical instruments by using the 3D+ and 3D− systems. Performance was measured by the number of errors and the task’s duration. Subjective ratings of perceptions and preference were assessed after each test. There were significant, but still minor, advantages for the conventional 3D+ system regarding spatial orientation and sense of depth. Overall, ten and eight subjects preferred 3D+ and 3D− systems, respectively. No significant differences were found in performance, post-operative physicals or eye symptoms. The novel 3D− system was similar to the conventional 3D+ system regarding performance and overall preference, while there were minor advantages for the 3D+ system in the subjective ratings. Since the 3D− system is a new invention, it should have a higher potential of usability improvements.