ISRN Minimally Invasive Surgery http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Implant-Bone Interface of Sacroiliac Joint Fusion Using iFuse Implant System Tue, 25 Mar 2014 11:23:20 +0000 http://www.hindawi.com/journals/isrn.mis/2014/571014/ Introduction. Treatment of patients with SI joint pain is mostly limited to conservative care. However, in those with chronic pain and consequently prolonged mobilisation, internal fixation of the SI joint is often indicated. The aim of the present study was to assess stability and bone ingrowth of minimally invasive SI joint arthrodesis using a series of triangular, porous plasma coated implants (iFuse Implant System) using SPECT/CT. Material. We report ten cases of SI joint arthrodesis with a novel MIS SI joint fusion system. SPECT/CT was performed in all cases after a mean time of 5.8 months to evaluate bony ingrowth and stability within the SI joint. Results. In eight cases, no or only low tracer uptake could be visualized as an indicator of stability and bone ingrowth. Two patients have increased tracer uptake due to a second trauma-related ipsilateral sacral fracture and a low-grade infection. Conclusion. We could visualize satisfying osseous integration as well as stability within the SI joint after arthrodesis using iFuse Implant System. Therefore iFuse Implant System seems to be an effective treatment option in selected patients. M. J. Scheyerer, M. W. Hüllner, C. Pietsch, P. Veit-Haibach, and C. M. L. Werner Copyright © 2014 M. J. Scheyerer et al. All rights reserved. Skin Closure in Laparoscopic Living Donor Nephrectomy: Modern Tissue Adhesive versus Conventional Intracutaneous Suture—A Randomized Study Sun, 09 Mar 2014 11:21:08 +0000 http://www.hindawi.com/journals/isrn.mis/2014/859236/ Purpose. To compare the modern tissue adhesive cyanoacrylate (Liquiband) to conventional, intracutaneous suture and dressing, with regard to wound characteristics, time consumption, donors’ self-satisfaction, and cost. Methods. Sixty-four kidney donors, subjected to laparoscopic hand-assisted nephrectomy, were randomly assigned to skin closure either with tissue adhesive () or suture (). The follow-up assessments were carried out on postoperative days 2, 4 and at departure, evaluated by the use of a previously set numerical scale for rubor, secretion, gaps, oedema, and blisters. Infections and complications/reinterventions were recorded, as well as operative/skin closure time and costs. The donors’ self-satisfaction was evaluated by means of a questionnaire. Results. There were significant results in favour of tissue adhesive regarding wound closure time and the wound characteristics “rubor,” “blisters,” and “oedema.” Although, the wound parameters “secretion” and “gaps” altogether showed a rather evident tendency in favour of suture, partially at significant levels. A low rate of complications/reoperations/infections did not give rise to any significant differences. Conclusion. Our study concludes that gluing is significantly faster, less traumatic by avoiding needle penetrations, but associated with an increased rate of secretion and gaps—presumably depending on gluing technique. Glue seems particularly suitable for small, laparoscopic/trocar incisions. Silje Marie Vormdal, Morten Skauby, Silje Lonar, and Ole Øyen Copyright © 2014 Silje Marie Vormdal et al. All rights reserved. The Efficacy and Outcome of Ministernotomy Compared to Those of Standard Sternotomy for Aortic Valve Replacement Wed, 19 Feb 2014 08:25:27 +0000 http://www.hindawi.com/journals/isrn.mis/2014/254084/ Background. Benefits of ministernotomy have been reported but not yet fully established in the current literature. Ministernotomy may be associated with less bleeding, less need for transfusion, and reduced hospital length of stay. Methods. We retrospectively evaluated 347 patients who underwent aortic valve replacement between 2007 and 2011 at our institution. Results. Standard sternotomy was performed in 303 patients (154 males, 50.8% and 149 females, 49.2%) and ministernotomy in 44 patients (13 males, 30% and 30 females, 70%); most of the patients in ministernotomy group were female (75%) . The mean age for ministernotomy patients was years and for sternotomy patients years . Significant preoperative morbidities (for ministernotomy and sternotomy, resp.) included stroke (11%, versus 18%, ; ), PVD (23%, versus 16%, ; ), COPD (25%, versus 17%, ; ), renal failure (0.0%, versus 8.8%, ; ), and previous heart surgery (9%, versus 9.5%, ; ). Intraoperative blood transfusion was required in 23% of ministernotomy patients and 30% of sternotomy patients , . Major postoperative complications (for ministernotomy and sternotomy, resp.) included exploration for bleeding (4.5%, versus 6%, ; ) and adverse neurologic events (4.5%, versus 1.6%, ; ). The length of stay (LOS) in the CCU was hours for the ministernotomy group and hours for the sternotomy group . The LOS was slightly shorter following ministernotomy ( days) compared to sternotomy ( days) . Perioperative mortality was 2.3% for ministernotomy and 3.3% for sternotomy . The 1-, 3-, and 7-year survival following ministernotomy was 93.8%, 93.8%, and 88.3%, respectively; following sternotomy, these rates were 87.7%, 83.7%, and 82.6%, respectively (95% CI 0.273 to 1.325, ). Conclusion. Ministernotomy is less invasive and is associated with less perioperative and postoperative bleeding and reduced LOS in CCU and in hospital. Edvard Skripochnik, Robert E. Michler, Viktoria Hentschel, and Siyamek Neragi-Miandoab Copyright © 2014 Edvard Skripochnik et al. All rights reserved. Early versus Delayed Laparoscopic Cholecystectomy for Acute Cholecystitis: A Prospective Randomized Trial Wed, 25 Dec 2013 11:51:13 +0000 http://www.hindawi.com/journals/isrn.mis/2013/486107/ Introduction. Very few studies demonstrate the feasibility of laparoscopic cholecystectomy for acute cholecystitis. However, most surgeons prefer to delay surgery in the acute phase. The aim of this prospective randomized study was to evaluate the safety and feasibility of laparoscopic cholecystectomy for acute cholecystitis. Materials and Methods. Between August 2010 and March 2012, 30 patients with a diagnosis of acute cholecystitis underwent early laparoscopic cholecystectomy within 72 h of admission. This study group was compared with a control group of 30 patients of acute cholecystitis, who underwent delayed laparoscopic cholecystectomy after an initial period of conservative treatment. Results. There was no significant difference in the conversion rates (3 early versus 2 delayed), postoperative analgesia requirements, postoperative pain scores, or duration of postoperative stay (1.67 days early versus 1.47 days delayed). However, duration of surgery was significantly more in the early group (65.78 minutes early versus 56.83 minutes delayed). Surgery was abandoned in 2 patients from the early group because of difficult anatomy. No complications and mortality were seen in either group. Conclusions. Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible, offering the additional benefit of a shorter hospital stay. It should be offered to patients with acute cholecystitis, provided the surgery is performed within 72 h from the onset of symptoms. Sushant Verma, P. N. Agarwal, Rajandeep Singh Bali, Rajdeep Singh, and Nikhil Talwar Copyright © 2013 Sushant Verma et al. All rights reserved. Transperitoneal Laparoscopic Adrenalectomy: Assessment of the Surgical Learning Curve Tue, 08 Oct 2013 11:34:27 +0000 http://www.hindawi.com/journals/isrn.mis/2013/936209/ Background. We report a single surgeon’s experience of 52 transperitoneal laparoscopic adrenalectomies (LAs) performed between 2001 and 2010. In addition, we compared this series with our first published series of LAs performed between 1994 and 2001. Methods. Our series includes 24 left, 20 right, and 4 bilateral LAs performed in 48 patients. To estimate the learning curve, we chronologically divided the sample of unilateral LAs into two groups of 22 patients and compared the operating time, estimated blood loss, maximum diameter of the lesion, complications, and length of hospital stay. Results. Mean operating time was significantly lower (94 versus 78 min, ) and mean intraoperative blood loss was significantly lower (156 versus 60 mL, ) after more experience had been gained. Additionally, a trend towards removing larger lesions was observed. There was no significant difference in terms of hospital stay. Conclusions. Observing a single surgeon’s experience of nine years in laparoscopic adrenalectomy, this study indicates that it takes approximately 20–25 procedures to flatten the learning curve. Thus, for single centers with a volume of approximately five LAs performed per year, we suggest a selection of a few experienced surgeons to perform LAs in order to improve outcomes. Lukas Meier, Henryk Zulewski, and Daniel Oertli Copyright © 2013 Lukas Meier et al. All rights reserved. Lift-Assisted Laparoscopy in Hysterectomy: A Retrospective Study of 32 Consecutive Cases Mon, 07 Oct 2013 18:32:29 +0000 http://www.hindawi.com/journals/isrn.mis/2013/989727/ A large uterus is the most commonly reported obstacle to laparoscopic hysterectomy. It reduces the intra-abdominal free space, limits visualization and instrumentation, causes technical difficulties, and increases the potential for complications. The logical solution to this dilemma is to address the underlying problem and increase the intra-abdominal free space. This can be done readily by supplementing the conventional pneumoperitoneum by concurrent mechanical lifting of the abdominal wall using the camera trocar as an anchoring device. Such lift-assisted laparoscopy augments the intra-abdominal free space formation, and lifts the laparoscope to a higher position to give a panoramic view, even when the uterus is large. This retrospective study of 32 consecutive cases of laparoscopic hysterectomy indicates that the use of lift-assisted laparoscopy is safe for the patient and that a large uterus is not a contraindication. The operations were long, but complications were few. Lift-assisted laparoscopy is an option to improve patient care by modifying surgical procedures. Operating time, per se, is not a valid measure of quality in laparoscopic hysterectomy. The more traumatic abdominal hysterectomy procedures need not be selected in preference over lengthy minimally invasive techniques. Other techniques, such as solo surgery and in-office surgery, are also discussed. Bo S. Bergström Copyright © 2013 Bo S. Bergström. All rights reserved. Two-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion: Surgical Technique and Illustrative Cases Thu, 05 Sep 2013 11:55:40 +0000 http://www.hindawi.com/journals/isrn.mis/2013/143029/ Transforaminal lumbar interbody fusion (TLIF) is a common procedure performed by spine surgeons. The indications for TLIF include back pain and radiculopathy as a consequence of canal or foraminal stenosis, degenerative disc disease, spondylolisthesis, or deformity. Minimally invasive techniques (MIS) have proven to be effective for single-level TLIF and are associated with less blood loss, fewer wound complications and infections, faster recovery, and decreased hospital cost. To date, there is very little data on 2-level MIS TLIF. We present our technique for 2-level MIS TLIF with case illustrations and a review of the literature. Rory J. Petteys, Jay Rhee, and Jean-Marc Voyadzis Copyright © 2013 Rory J. Petteys et al. All rights reserved. Expanded Endoscopic Endonasal Treatment of Primary Intracranial Tumors within the Paranasal Sinuses Tue, 13 Aug 2013 15:41:05 +0000 http://www.hindawi.com/journals/isrn.mis/2013/129780/ Objective. Meningiomas and schwannomas represent a subset of primary intracranial tumors that are rarely identified exclusively in the paranasal sinuses. Here, we describe our experience with minimally invasive endoscopic endonasal approaches for the treatment of these tumors. Methods. We retrospectively reviewed the clinical, surgical, and radiographic characteristics of adults with pathologically confirmed sinonasal meningiomas and schwannomas located within the paranasal sinuses that were resected via an expanded endoscopic endonasal approach. Results. Five patients (1 male, 4 females) underwent an endoscopic endonasal approach for resection of sinonasal tumor. Clinical symptomatology most commonly included nasal obstruction, in addition to headache, jaw pain, anosmia, and chronic rhinosinusitis. Tumors were located exclusively within the sinonasal cavity and were on average 2.2 cm (range 1.4–3.8 cm). Pathology revealed 2 cases of meningioma and 3 cases of schwannoma. No evidence of tumor recurrence occurred over average followup of 1.5 years (range 0.11–3.9 years). Conclusion. Our case series suggests that an expanded endoscopic endonasal approach with a combined neurosurgical-otorhinolaryngologic team for the resection of sinonasal meningiomas and schwannomas offers an effective treatment option. Further studies that include a larger number of patients over a longer follow-up period are required to compare outcomes between minimally invasive and open approaches. Zarina S. Ali, Shih-Shan Lang, Nithin D. Adappa, Ariana Barkley, James N. Palmer, and John Y. K. Lee Copyright © 2013 Zarina S. Ali et al. All rights reserved. Objective versus Subjective Assessment of Laparoscopic Skill Tue, 02 Jul 2013 10:44:17 +0000 http://www.hindawi.com/journals/isrn.mis/2013/686494/ Background. The equality of subjective- and objective-assessment methods in laparoscopic surgery are unknown. The aim of this study was to compare a subjective assessment method to an objective assessment method to evaluate laparoscopic skill. Methods. A prospective observational cohort study was conducted. Seventy-two residents completed a basic laparoscopic suturing task on a box trainer at two consecutive assessment points. Laparoscopic skill was rated subjectively using the Objective Structured Assessment of Technical Skills (OSATS) list and objectively using the TrEndo, an augmented-reality simulator. Results. TrEndo scores between the two assessment points correlated. OSATS scores did not correlate between the two assessment points. There was a correlation between TrEndo and OSATS scores at the first assessment point, but not at the second assessment point. Overall, OSATS scores correlated with TrEndo scores. There was a greater spread within OSATS scores compared to TrEndo scores. Conclusion. OSATS scores correlated with TrEndo scores. The TrEndo may be more responsive at rating individual’s laparoscopic skill, as demonstrated by a smaller overall spread in TrEndo scores. The additional value of objective assessment methods over conventional assessment methods as provided by laparoscopic simulators should be investigated. Pieter J. van Empel, Lennart B. van Rijssen, Joris P. Commandeur, Mathilde G. E. Verdam, Judith A. Huirne, Fedde Scheele, H. Jaap Bonjer, and W. Jeroen Meijerink Copyright © 2013 Pieter J. van Empel et al. All rights reserved. Experimental Rat and Mouse Carotid Artery Surgery: Injury and Remodeling Studies Tue, 14 May 2013 16:16:43 +0000 http://www.hindawi.com/journals/isrn.mis/2013/167407/ In cardiovascular research, translation of benchtop findings to the whole body environment is often critical in order to gain a more thorough and comprehensive clinical evaluation of the data with direct extrapolation to the human condition. In particular, developmental and/or pathophysiologic vascular growth studies often employ in vitro approaches such as cultured cells or tissue explant models in order to analyze specific cellular, molecular, genetic, and/or biochemical signaling factors under pristine controlled conditions. However, validation of in vitro data in a whole body setting complete with neural, endocrine, and other systemic contributions provides an essential proof of concept from a clinical perspective. Several well-characterized experimental in vivo models exist that provide excellent proof-of-concept tools to examine vascular growth and remodeling in the whole body. This paper will examine the rat carotid artery balloon injury model, the mouse carotid artery wire denudation injury model, and rat and mouse carotid artery ligation models with particular emphasis on minimally invasive surgical access to the site of intervention. Discussion will include key scientific and technical details as well as caveats, limitations, and considerations for the practical use of each of these valuable experimental models. Andrew W. Holt and David A. Tulis Copyright © 2013 Andrew W. Holt and David A. Tulis. All rights reserved. Application of a New Integrated Bipolar and Ultrasonic Energy Device in Laparoscopic Hysterectomies Wed, 13 Feb 2013 17:31:33 +0000 http://www.hindawi.com/journals/isrn.mis/2013/453581/ Objective. A retrospective study to evaluate the Thunderbeat, a new vessel sealing device in a small group of patients undergoing laparoscopic hysterectomy to test the safety and effectiveness in achieving hemostasis. Method. The Thunderbeat was used in 12 cases of total laparoscopic hysterectomy. Operative performance involving hemostasis, sealing/coagulation, cutting, dissection, and tissue manipulation was evaluated. Results. No complications were encountered intraoperatively and postoperatively. Intraoperative experience involving hemostasis, sealing/coagulation, and cutting was optimal. Tissue handling was acceptable except for fine dissection. Conclusion. The Thunderbeat is an efficient and safe alternative to standard bipolar in laparoscopic hysterectomy. Larger studies are required to evaluate the cost-effectiveness and significant reduction in operating times as compared to conventional bipolar energy. Harvard Z. Lin, Y. W. Ng, A. Agarwal, and Y. F. Fong Copyright © 2013 Harvard Z. Lin et al. All rights reserved. Percutaneous Cryoablation of Metastatic Lesions from Colorectal Cancer: Efficacy and Feasibility with Survival and Cost-Effectiveness Observations Wed, 14 Nov 2012 11:45:37 +0000 http://www.hindawi.com/journals/isrn.mis/2012/942364/ Purpose. To assess feasibility, complications, local tumor recurrences, overall survival (OS) and estimates of cost-effectiveness for multi-site cryoablation (MCA) of oligo-metastatic colorectal cancer (mCRC) in a prospective study. Materials and Methods. 111 CT and/or US-guided percutaneous MCA procedures were performed on 151 tumors in 59 oligo mCRC patients. Mean patient age was 63 years (range 21–92 years), consisting of 29 males and 30 females. Tumor location was grouped according to common metastatic sites. Median OS was determined using the Kaplan-Meier. Estimates of MCA costs per LYG were compared to historical values for systemic therapies. Results. A mean 1.9 MCAs per patient were performed with a median clinical follow-up of 12 months. Major complication and local recurrence rates were 8% (9/111) and 12% (18/151), respectively. Median overall-survival (OS) was 23.6 months with an estimated 3-year survival rate of ~30%. Cryoablation remained cost effective with or without the presence of systemic therapies, with an adjunctive cost-effectiveness ratio (ACER) of $39,661–$85,580 per LYG. Conclusions. Multi-site cryoablation had very low complication and local recurrence rates, and was able to provide local control even for diverse soft tissue locations. Even as an adjunct to systemic therapies, MCA appeared cost-effective, with apparent increased survival. Hyun J. Bang, Peter J. Littrup, Brandt P. Currier, Dylan J. Goodrich, Minsig Choi, Lance K. Heilbrun, and Allen C. Goodman Copyright © 2012 Hyun J. Bang et al. All rights reserved. Laparoscopic Umbilical Hernia Repair: Technique Paper Sun, 16 Sep 2012 09:21:24 +0000 http://www.hindawi.com/journals/isrn.mis/2012/906405/ Objective. Laparoscopic umbilical hernia repair has largely replaced open method. The purpose of this study was to document the laparoscopic umbilical hernia repair using two port, combined herniorrhaphy with intraabdominal mesh fixation with transabdominal absorbable suture technique and demonstrate that it is feasible, efficient, and safe. Methods. Thirty-two patients with umbilical hernia underwent laparoscopic repair by combined herniorrhaphy and intraabdominal mesh. Two-port technique was used and the umbilical defect was closed using transabdominal PDS suture, composite polypropylene, and PTFE mesh was placed intra-bdominally and fixed to abdominal wall using transabdominal PDS suture. Results. Thirty-two patients underwent laparoscopic repair. The operating time ranged from 45 min to 100 min (mean 64 min). Early postoperative complication was seen in five patients with two having ileus for 4 days and one patient each developed urinary retention, wound infection and seroma. Late postoperative complication was seen in 6 patients with five complaining of persistent abdominal pain which resolved without treatment and one case of keloids at port sites. None of the patients developed chronic pain or had recurrence over the follow-up period. Conclusion. Laparoscopic umbilical hernia repair with combined herniorrhaphy and intraabdominal mesh fixation using absorbable sutures offers an efficient, safe, and effective repair for umbilical hernia. V. Abhishek, M. N. Mallikarjuna, and B. S. Shivaswamy Copyright © 2012 V. Abhishek et al. All rights reserved. Laparoscopic Intraoperative Cholangiography Interpretation by Surgeons versus Radiologists, A Comparative Study and Review of 200 Cholangiographies Wed, 05 Sep 2012 09:58:27 +0000 http://www.hindawi.com/journals/isrn.mis/2012/469013/ Introduction. In some medical centers, LIOC are exclusively interpreted by surgeons. The degree of accuracy of surgeon’s interpretation compared to that of radiologist (gold standard) and its clinical significance are not well studied. Objective. study whether surgeons are accurate in interpreting IOC or not by comparing the interpretation of LIOC by surgeons to the postoperative interpretation of same cholangiograms by radiologists, and study its clinical significance. Methods. A retrospective study of 200 consecutive patients who underwent selective LIOC in Al-Khor community hospital in Qatar during the period from May 2005 till December 2011. A radiology senior consultant blindly reviewed the cholangiograms (Reading B) then we compared these findings (ductal dilatation, defects of filling and passage of contrast into duodenum) to LIOC results that were reported intraoperatively by surgeons for the same patients (Reading A). Results. Ductal dilatation was found in (27.5%) of Reading A compared to 19% in Reading B. filling defects were reported in (20.5%) of Reading A compared to 14.5% in Reading B. Conclusion. there is significant difference of LIOC interpretation between surgeons and radiologist specially in the detection of defects of fillings although this variability did not affect the clinical outcome. Hany M. El-Hennawy, Eihab A. El-Kahlout, Elsaid M. Bedair, Ibrahem M. El Omari, Ashraf A. Abdel Aziz, and Ahmed M. Badi Copyright © 2012 Hany M. El-Hennawy et al. All rights reserved. High-Resolution Optical Imaging of Benign and Malignant Mucosa in the Upper Aerodigestive Tract: An Atlas for Image-Guided Surgery Mon, 03 Sep 2012 11:57:24 +0000 http://www.hindawi.com/journals/isrn.mis/2012/364285/ Background. High-resolution optical imaging provides real-time visualization of mucosa in the upper aerodigestive tract (UADT) which allows non-invasive discrimination of benign and neoplastic epithelium. The high-resolution microendoscope (HRME) utilizes a fiberoptic probe in conjunction with a tissue contrast agent to display nuclei and cellular architecture. This technology has broad potential applications to intraoperative margin detection and early cancer detection. Methods. Our group has created an extensive image collection of both neoplastic and normal epithelium of the UADT. Here, we present and describe imaging characteristics of benign, dysplastic, and malignant mucosa in the oral cavity, oropharynx, larynx, and esophagus. Results. There are differences in the nuclear organization and overall tissue architecture of benign and malignant mucosa which correlate with histopathologic diagnosis. Different anatomic subsites also display unique imaging characteristics. Conclusion. HRME allows discrimination between benign and neoplastic mucosa, and familiarity with the characteristics of each subsite facilitates correct diagnosis. Lauren L. Levy, Peter M. Vila, Richard W. Park, Richard Schwarz, Alexandros D. Polydorides, Marita S. Teng, Vivek V. Gurudutt, Eric M. Genden, Brett Miles, Sharmila Anandasabapathy, Ann M. Gillenwater, Rebecca Richards-Kortum, and Andrew G. Sikora Copyright © 2012 Lauren L. Levy et al. All rights reserved. Single-Port Laparoscopic Cholecystectomy Using the Innovative E. K. Glove Port: Our Experience Wed, 08 Aug 2012 08:44:12 +0000 http://www.hindawi.com/journals/isrn.mis/2012/697946/ The technique of laparoscopic cholecystectomy continues to evolve with a trend towards decreasing use of working ports. One of the emerging concepts of 21st century is single-port surgery. It has further minimized the minimally invasive surgery. However, the main drawbacks of this technique are the lack of “triangulation” to which the laparoscopic surgeons have grown accustomed to, the clustering of instruments, and the costly multichannel ports, which are very costly and, in fact, are not affordable by the majority of the population in a developing country like India. From September 2009 to December 2011, 210 patients identified as having biliary colic, chronic cholecystitis, and previous biliary pancreatitis or obstructive jaundice due to stones (managed by ERCP) underwent single-port laparoscopic cholecystectomy using the E. K. glove port. The operating time was reasonable and can be lessened with experience. Excellent exposure of the critical view was obtained in all cases. This technique is safe, feasible, reproducible, cheap, and easy to learn. It may be an alternative to the currently available single-port access system, especially in a developing country like India. If required, placement of the remaining two to three ports for a more conventional laparoscopic cholecystectomy can be done. Elbert Khiangte, Iheule Newme, Karabi Patowary, and Hitesh Kalita Copyright © 2012 Elbert Khiangte et al. All rights reserved. Comparison between Robot-Assisted Laparoscopic Hysterectomy and Total Laparoscopic Hysterectomy: A Cohort Study Tue, 07 Aug 2012 08:27:50 +0000 http://www.hindawi.com/journals/isrn.mis/2012/408127/ Objective. To compare the operative outcomes in patients who underwent robot-assisted total laparoscopic hysterectomy (RLH) versus total laparoscopic hysterectomy (TLH). Study Design. Retrospective chart review. All women who underwent RLH in hospital A and TLH in hospital B by a single surgeon were included. Results. 136 patients were included (73 in the RLH group and 63 in the TLH group). There were no conversions to laparotomy in the RLH group versus 7 (11.1%) in the TLH group (𝑃=0.004). The mean induction time was significantly greater (by 6 minutes) for RLH, independent of docking time, as compared to TLH (𝑃<0.001). Total procedure time was significantly less in the RLH group (82 minutes) as compared to TLH (108 minutes) (𝑃=0.001). Mean blood loss was less for RLH (46 mL) as compared to TLH (114 mL) (𝑃<0.001). A greater number of patients who underwent RLH were discharged on postoperative day 0 as compared to those receiving TLH (𝑃=0.055). Conclusion. RLH is a safe alternative to TLH and may offer some operative advantages, including fewer conversions to laparotomy, reduced procedure time, less blood loss, and earlier discharge. Khaled Sakhel, Armen Kirakosyan, Suneet Chauhan, James Lukban, and James Hines Copyright © 2012 Khaled Sakhel et al. All rights reserved. Laparoscopic Risk-Reducing Salpingo-Oophorectomy: The Brigham and Women's Experience Sun, 27 May 2012 10:18:09 +0000 http://www.hindawi.com/journals/isrn.mis/2012/763290/ Objective. To establish short-term surgical outcomes of three-port laparoscopic risk-reducing salpingo-oophorectomy (RRSO) in women with hereditary breast-ovarian cancer syndrome (HBOC). Methods. The medical records of all HBOC women that underwent laparoscopic RRSO between January 2001 and December 2010 were retrospectively reviewed. Demographic data, operative details, and short-term surgical outcomes were obtained and subjected to SAS. Statistical univariate and multivariate analyses were performed. Results. 358 patients met study criteria with 277 (77.4%) carrying a documented BRCA mutation. The predominant technique utilized three ports (two 5 mm and one 10/12 mm), a 5 mm laparoscope and a 5 mm Ligasure pulsatile bipolar device. Mean operative time was 58.3 minutes (SD 22.6, 26.0–197.0), significantly affected by BMI greater than 30 (𝑃<0.0001) and status of adhesions (𝑃=0.001). Estimated blood loss (EBL) was negligible in 96.9% of cases. Seven patients required conversion to laparotomy. No major intraoperative complications were recorded. One-night hospital admission rate was less than 2.0% while postoperative complication rate was 3.1%. Malignancy was revealed in 14 patients (3.9%). Conclusion. In HBOC population, three-port laparoscopic RRSO is a simple, reproducible, and safe procedure with low conversion rate, short operative time, minimal EBL, low surgical morbidity, and rapid postoperative recovery. Melina Shoni, Taymaa May, Allison F. Vitonis, Anjelica Garza, Michael G. Muto, and Colleen M. Feltmate Copyright © 2012 Melina Shoni et al. All rights reserved.