Skip to main content
Erschienen in: Journal of Hepato-Biliary-Pancreatic Sciences 5/2009

01.09.2009 | Surgeon at work

Single-port endoscopic cholecystectomy: a bridge between laparoscopic and translumenal endoscopic surgery

verfasst von: Nobutsugu Abe, Hirohisa Takeuchi, Hisayo Ueki, Osamu Yanagida, Tadahiko Masaki, Toshiyuki Mori, Masanori Sugiyama, Yutaka Atomi

Erschienen in: Journal of Hepato-Biliary-Pancreatic Sciences | Ausgabe 5/2009

Einloggen, um Zugang zu erhalten

Abstract

Background and objective

The intentional puncture of the normal viscera is likely the most important issue limiting the widespread use of natural orifice translumenal endoscopic surgery (NOTES). We developed a new procedure for cholecystectomy using a flexible endoscope via a single port placed in the abdominal wall without visceral puncture (single-port endoscopic cholecystectomy; SPEC) as a bridge between laparoscopic surgery and NOTES. This study aimed to evaluate the technical feasibility of SPEC.

Methods

Five pigs were subjected to SPEC. An endoscope was inserted through a 12-mm port placed in the right upper abdomen. After grasping and retracting the gallbladder using a 2-mm retractor that was directly introduced into the peritoneal cavity, gallbladder excision with ligation of the cystic artery and duct using endoclips was carried out.

Results

A complete gallbladder excision was carried out easily and safely in all cases. No major adverse events occurred. The mean operating time was 67 min (range 52–84 min).

Conclusions

SPEC is a technically feasible procedure. It is simpler, easier, and safer than NOTES cholecystectomy. SPEC could be a less invasive alternative to the conventional four-port laparoscopic cholecystectomy.
Literatur
1.
Zurück zum Zitat Miura F, Takada T, Kawarada Y, Nimura Y, Wada K, et al. Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg. 2007;14:27–34.PubMedCrossRef Miura F, Takada T, Kawarada Y, Nimura Y, Wada K, et al. Flowcharts for the diagnosis and treatment of acute cholangitis and cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg. 2007;14:27–34.PubMedCrossRef
2.
Zurück zum Zitat Yamashita Y, Takada T, Kawarada Y, Nimura Y, Hirota M, et al. Surgical treatment of patients with acute cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg. 2007;14:91–7.PubMedCrossRef Yamashita Y, Takada T, Kawarada Y, Nimura Y, Hirota M, et al. Surgical treatment of patients with acute cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg. 2007;14:91–7.PubMedCrossRef
3.
Zurück zum Zitat Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, et al. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc. 2004;60:114–7.PubMedCrossRef Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, et al. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc. 2004;60:114–7.PubMedCrossRef
4.
Zurück zum Zitat Pearl JP, Ponsky JL. Natural orifice translumenal endoscopic surgery: a critical review. J Gastrointest Surg. 2007 [Epub ahead of print]. Pearl JP, Ponsky JL. Natural orifice translumenal endoscopic surgery: a critical review. J Gastrointest Surg. 2007 [Epub ahead of print].
5.
Zurück zum Zitat Park PO, Bergström M, Ikeda K, Fritscher-Ravens A, Swain P. Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos). Gastrointest Endosc. 2005;61:601–6.PubMedCrossRef Park PO, Bergström M, Ikeda K, Fritscher-Ravens A, Swain P. Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos). Gastrointest Endosc. 2005;61:601–6.PubMedCrossRef
6.
Zurück zum Zitat Jagannath SB, Kantsevoy SV, Vaughn CA, Chung SS, Cotton PB, et al. Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model. Gastrointest Endosc. 2005;61:449–53.PubMedCrossRef Jagannath SB, Kantsevoy SV, Vaughn CA, Chung SS, Cotton PB, et al. Peroral transgastric endoscopic ligation of fallopian tubes with long-term survival in a porcine model. Gastrointest Endosc. 2005;61:449–53.PubMedCrossRef
7.
Zurück zum Zitat Kantsevoy SV, Hu B, Jagannath SB, Vaughn CA, Beitler DM, et al. Transgastric endoscopic splenectomy: is it possible? Surg Endosc. 2006;20:522–5.PubMedCrossRef Kantsevoy SV, Hu B, Jagannath SB, Vaughn CA, Beitler DM, et al. Transgastric endoscopic splenectomy: is it possible? Surg Endosc. 2006;20:522–5.PubMedCrossRef
8.
Zurück zum Zitat Merrifield BF, Wagh MS, Thompson CC. Peroral transgastric organ resection: a feasibility study in pigs. Gastrointest Endosc. 2006;63:693–7.PubMedCrossRef Merrifield BF, Wagh MS, Thompson CC. Peroral transgastric organ resection: a feasibility study in pigs. Gastrointest Endosc. 2006;63:693–7.PubMedCrossRef
9.
Zurück zum Zitat Sumiyama K, Gostout CJ, Rajan E, Bakken TA, Deters JL, et al. Pilot study of the porcine uterine horn as an in vivo appendicitis model for development of endoscopic transgastric appendectomy. Gastrointest Endosc. 2006;64:808–12.PubMedCrossRef Sumiyama K, Gostout CJ, Rajan E, Bakken TA, Deters JL, et al. Pilot study of the porcine uterine horn as an in vivo appendicitis model for development of endoscopic transgastric appendectomy. Gastrointest Endosc. 2006;64:808–12.PubMedCrossRef
10.
Zurück zum Zitat Kantsevoy SV, Jagannath SB, Niiyama H, Isakovich NV, Chung SS, et al. A novel safe approach to the peritoneal cavity for per-oral transgastric endoscopic procedures. Gastrointest Endosc. 2007;65:111–7.CrossRef Kantsevoy SV, Jagannath SB, Niiyama H, Isakovich NV, Chung SS, et al. A novel safe approach to the peritoneal cavity for per-oral transgastric endoscopic procedures. Gastrointest Endosc. 2007;65:111–7.CrossRef
11.
Zurück zum Zitat Mintz Y, Horgan S, Cullen J, Ramamoorthy S, Chock A, et al. NOTES: the hybrid technique. J Laparoendosc Adv Surg Tech A. 2007;17:402–6.PubMedCrossRef Mintz Y, Horgan S, Cullen J, Ramamoorthy S, Chock A, et al. NOTES: the hybrid technique. J Laparoendosc Adv Surg Tech A. 2007;17:402–6.PubMedCrossRef
12.
Zurück zum Zitat Shih SP, Kantsevoy SV, Kalloo AN, Magno P, Giday SA, et al. Hybrid minimally invasive surgery—a bridge between laparoscopic and translumenal surgery. Surg Endosc. 2007;21:1450–3.PubMedCrossRef Shih SP, Kantsevoy SV, Kalloo AN, Magno P, Giday SA, et al. Hybrid minimally invasive surgery—a bridge between laparoscopic and translumenal surgery. Surg Endosc. 2007;21:1450–3.PubMedCrossRef
13.
Zurück zum Zitat Rolanda C, Lima E, Pêgo JM, Henriques-Coelho T, Silva D, et al. Third-generation cholecystectomy by natural orifices: transgastric and transvesical combined approach (with video). Gastrointest Endosc. 2007;65:111–7.PubMedCrossRef Rolanda C, Lima E, Pêgo JM, Henriques-Coelho T, Silva D, et al. Third-generation cholecystectomy by natural orifices: transgastric and transvesical combined approach (with video). Gastrointest Endosc. 2007;65:111–7.PubMedCrossRef
14.
Zurück zum Zitat Pai RD, Fong DG, Bundga ME, Odze RD, Rattner DW, et al. Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model (with video). Gastrointest Endosc. 2006;64:428–31.PubMedCrossRef Pai RD, Fong DG, Bundga ME, Odze RD, Rattner DW, et al. Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model (with video). Gastrointest Endosc. 2006;64:428–31.PubMedCrossRef
15.
Zurück zum Zitat Lima E, Rolanda C, Pêgo JM, Henriques-Coelho T, Silva D, et al. Transvesicle endoscopic peritoneoscopy: a novel 5-mm port for intra-abdominal scarless surgery. J Urol. 2006;176:802–5.PubMedCrossRef Lima E, Rolanda C, Pêgo JM, Henriques-Coelho T, Silva D, et al. Transvesicle endoscopic peritoneoscopy: a novel 5-mm port for intra-abdominal scarless surgery. J Urol. 2006;176:802–5.PubMedCrossRef
16.
Zurück zum Zitat Gettman MT, Lotan Y, Napper CA, Cadeddu JA. Transvaginal laparoscopic nephrectomy: development and feasibility in the porcine model. Urology. 2002;59:446–50.PubMedCrossRef Gettman MT, Lotan Y, Napper CA, Cadeddu JA. Transvaginal laparoscopic nephrectomy: development and feasibility in the porcine model. Urology. 2002;59:446–50.PubMedCrossRef
17.
Zurück zum Zitat Scott DJ, Tang SJ, Fernandez R, Bergs R, Goova MT, et al. Completely transvaginal NOTES cholecystectomy using magnetically anchored instruments. Surg Endosc. 2007;21:2308–16.PubMedCrossRef Scott DJ, Tang SJ, Fernandez R, Bergs R, Goova MT, et al. Completely transvaginal NOTES cholecystectomy using magnetically anchored instruments. Surg Endosc. 2007;21:2308–16.PubMedCrossRef
18.
Zurück zum Zitat Abe N, Takeuchi H, Ueki H, Matsuoka H, Yanagida O, et al. Cholecystectomy by combined transgastric and transparietal approach using two flexible endoscopes. J Hepatobiliary Pancreat Surg. 2008 [Epub ahead of print]. Abe N, Takeuchi H, Ueki H, Matsuoka H, Yanagida O, et al. Cholecystectomy by combined transgastric and transparietal approach using two flexible endoscopes. J Hepatobiliary Pancreat Surg. 2008 [Epub ahead of print].
19.
Zurück zum Zitat Marks JM, Ponsky JL, Pearl JP, McGee MF. PEG “rescue”: a practical NOTES technique. Surg Endosc. 2007;21:816–9.PubMedCrossRef Marks JM, Ponsky JL, Pearl JP, McGee MF. PEG “rescue”: a practical NOTES technique. Surg Endosc. 2007;21:816–9.PubMedCrossRef
20.
Zurück zum Zitat Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, et al. Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg. 2007;142:823–6.PubMedCrossRef Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, et al. Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg. 2007;142:823–6.PubMedCrossRef
21.
Zurück zum Zitat Dolz C, Noguera JF, Martin A, Vilella A, Cuadrado A. Transvaginal cholecystectomy (NOTES) combined with minilaparotomy. Rev Esp Enferm Dig. 2007;99:698–702.PubMedCrossRef Dolz C, Noguera JF, Martin A, Vilella A, Cuadrado A. Transvaginal cholecystectomy (NOTES) combined with minilaparotomy. Rev Esp Enferm Dig. 2007;99:698–702.PubMedCrossRef
22.
Zurück zum Zitat Zorrón R, Filgueiras M, Maggioni LC, Pombo L, Lopes Carvalho G, et al. Transvaginal cholecystectomy: report of the first case. Surg Innov. 2007;14:279–83.PubMedCrossRef Zorrón R, Filgueiras M, Maggioni LC, Pombo L, Lopes Carvalho G, et al. Transvaginal cholecystectomy: report of the first case. Surg Innov. 2007;14:279–83.PubMedCrossRef
23.
Zurück zum Zitat Zorron R, Maggioni LC, Pombo L, Oliveira AL, Carvalho GL, et al. NOTES transvaginal cholecystectomy: preliminary clinical application. Surg Endosc. 2008;22:542–7.PubMedCrossRef Zorron R, Maggioni LC, Pombo L, Oliveira AL, Carvalho GL, et al. NOTES transvaginal cholecystectomy: preliminary clinical application. Surg Endosc. 2008;22:542–7.PubMedCrossRef
24.
Zurück zum Zitat Palanivelu C, Rajan PS, Rangarajan M, Parthasarathi R, Senthilnathan P, et al. Transvaginal endoscopic appendectomy in humans: a unique approach to NOTES—world’s first report. Surg Endosc. 2008;22:1343–7.PubMedCrossRef Palanivelu C, Rajan PS, Rangarajan M, Parthasarathi R, Senthilnathan P, et al. Transvaginal endoscopic appendectomy in humans: a unique approach to NOTES—world’s first report. Surg Endosc. 2008;22:1343–7.PubMedCrossRef
25.
Zurück zum Zitat Abe N, Mori T, Takeuchi H, Yoshida T, Ohki A, et al. Laparoscopic lymph node dissection after endoscopic submucosal dissection: a novel and minimally invasive approach to treating early-stage gastric cancer. Am J Surg. 2005;190:496–503.PubMedCrossRef Abe N, Mori T, Takeuchi H, Yoshida T, Ohki A, et al. Laparoscopic lymph node dissection after endoscopic submucosal dissection: a novel and minimally invasive approach to treating early-stage gastric cancer. Am J Surg. 2005;190:496–503.PubMedCrossRef
26.
Zurück zum Zitat Abe N, Izumisato Y, Yamaguchi Y, Ueki H, Yanagida O, et al. En bloc endoscopic mucosal resection of a large early stage gastric cancer by combined use of an insulation-tipped diathermic knife and a grasping forceps percutaneously inserted into the gastric lumen. Hepatogastroenterology. 2005;52:1301–4.PubMed Abe N, Izumisato Y, Yamaguchi Y, Ueki H, Yanagida O, et al. En bloc endoscopic mucosal resection of a large early stage gastric cancer by combined use of an insulation-tipped diathermic knife and a grasping forceps percutaneously inserted into the gastric lumen. Hepatogastroenterology. 2005;52:1301–4.PubMed
27.
Zurück zum Zitat Abe N, Yamaguchi Y, Takeuchi H, Izumisato Y, Yanagida O, et al. Key factors for successful en bloc endoscopic submucosal dissection of early stage gastric cancer using an insulation-tipped diathermic knife. Hepatogastroenterology. 2006;53:639–42.PubMed Abe N, Yamaguchi Y, Takeuchi H, Izumisato Y, Yanagida O, et al. Key factors for successful en bloc endoscopic submucosal dissection of early stage gastric cancer using an insulation-tipped diathermic knife. Hepatogastroenterology. 2006;53:639–42.PubMed
28.
Zurück zum Zitat Abe N, Mori T, Takeuchi H, Ueki H, Yanagida O, et al. Successful treatment of early stage gastric cancer by laparoscopy-assisted endoscopic full-thickness resection with lymphadenectomy. Gastrointest Endosc. 2008;68:1220–4.PubMedCrossRef Abe N, Mori T, Takeuchi H, Ueki H, Yanagida O, et al. Successful treatment of early stage gastric cancer by laparoscopy-assisted endoscopic full-thickness resection with lymphadenectomy. Gastrointest Endosc. 2008;68:1220–4.PubMedCrossRef
29.
Zurück zum Zitat Bisgaard T, Klarskov B, Trap R, Kehlet H, Rosenberg J. Microlaparoscopic vs conventional laparoscopic cholecystectomy: a prospective randomized double-blind trial. Surg Endosc. 2002;16:458–64.PubMedCrossRef Bisgaard T, Klarskov B, Trap R, Kehlet H, Rosenberg J. Microlaparoscopic vs conventional laparoscopic cholecystectomy: a prospective randomized double-blind trial. Surg Endosc. 2002;16:458–64.PubMedCrossRef
30.
Zurück zum Zitat Sarli L, Iusco D, Gobbi S, Porrini C, Ferro M, Roncoroni L. Randomized clinical trial of laparoscopic cholecystectomy performed with mini-instruments. Br J Surg. 2003;90:1345–8.PubMedCrossRef Sarli L, Iusco D, Gobbi S, Porrini C, Ferro M, Roncoroni L. Randomized clinical trial of laparoscopic cholecystectomy performed with mini-instruments. Br J Surg. 2003;90:1345–8.PubMedCrossRef
31.
Zurück zum Zitat Poon CM, Chan KW, Lee DW, Chan KC, Ko CW, et al. Two-port versus four-port laparoscopic cholecystectomy. Surg Endosc. 2003;17:1624–7.PubMedCrossRef Poon CM, Chan KW, Lee DW, Chan KC, Ko CW, et al. Two-port versus four-port laparoscopic cholecystectomy. Surg Endosc. 2003;17:1624–7.PubMedCrossRef
32.
Zurück zum Zitat Lee KW, Poon CM, Leung KF, Lee DW, Ko CW. Two-port needlescopic cholecystectomy: prospective study of 100 cases. Hong Kong Med J. 2005;11:30–5.PubMed Lee KW, Poon CM, Leung KF, Lee DW, Ko CW. Two-port needlescopic cholecystectomy: prospective study of 100 cases. Hong Kong Med J. 2005;11:30–5.PubMed
33.
Zurück zum Zitat Cerci C, Tarhan OR, Barut I, Bülbül M. Three-port versus four-port laparoscopic cholecystectomy. Hepatogastroenterology. 2007;54:15–6.PubMed Cerci C, Tarhan OR, Barut I, Bülbül M. Three-port versus four-port laparoscopic cholecystectomy. Hepatogastroenterology. 2007;54:15–6.PubMed
34.
Zurück zum Zitat Kumar M, Agrawal CS, Gupta RK. Three-port versus standard four-port laparoscopic cholecystectomy: a randomized controlled clinical trial in a community-based teaching hospital in eastern Nepal. JSLS. 2007;11:358–62.PubMed Kumar M, Agrawal CS, Gupta RK. Three-port versus standard four-port laparoscopic cholecystectomy: a randomized controlled clinical trial in a community-based teaching hospital in eastern Nepal. JSLS. 2007;11:358–62.PubMed
35.
Zurück zum Zitat Cuesta MA, Berends F, Veenholf AA. The “invisible cholecystectomy”: a transumbilical laparoscopic operation without a scar. Surg Endosc. 2008;22:1211–3.PubMedCrossRef Cuesta MA, Berends F, Veenholf AA. The “invisible cholecystectomy”: a transumbilical laparoscopic operation without a scar. Surg Endosc. 2008;22:1211–3.PubMedCrossRef
36.
Zurück zum Zitat Nguyen NT, Reavis KM, Hinojosa MW, Smith BR, Wilson SE. Laparoscopic transumbilical cholecystectomy without visible abdominal scars. Surg Endosc. 2008 [Epub ahead of print]. Nguyen NT, Reavis KM, Hinojosa MW, Smith BR, Wilson SE. Laparoscopic transumbilical cholecystectomy without visible abdominal scars. Surg Endosc. 2008 [Epub ahead of print].
37.
Zurück zum Zitat Zornig C, Emmermann A, von Waldenfels HA, Mofid H. Laparoscopic cholecystectomy without visible scar: combined transvaginal and transumbilical approach. Endoscopy. 2007;39:913–5.PubMedCrossRef Zornig C, Emmermann A, von Waldenfels HA, Mofid H. Laparoscopic cholecystectomy without visible scar: combined transvaginal and transumbilical approach. Endoscopy. 2007;39:913–5.PubMedCrossRef
38.
Zurück zum Zitat Zornig C, Mofid H, Emmermann A, Alm M, von Waldenfels HA, et al. Scarless cholecystectomy with combined transvaginal and transumbilical approach in a series of 20 patients. Surg Endosc. 2008;22:1427–9.PubMedCrossRef Zornig C, Mofid H, Emmermann A, Alm M, von Waldenfels HA, et al. Scarless cholecystectomy with combined transvaginal and transumbilical approach in a series of 20 patients. Surg Endosc. 2008;22:1427–9.PubMedCrossRef
39.
Zurück zum Zitat Varadarajulu S, Tamhane A, Drelichman ER. Patient perception of natural orifice transluminal endoscopic surgery as a technique for cholecystectomy. Gastrointest Endosc. 2008;67:854–60.PubMedCrossRef Varadarajulu S, Tamhane A, Drelichman ER. Patient perception of natural orifice transluminal endoscopic surgery as a technique for cholecystectomy. Gastrointest Endosc. 2008;67:854–60.PubMedCrossRef
40.
Zurück zum Zitat Li W, Xiao J. Investigation for acceptance of natural orifice translumenal endoscopic surgery by inpatients with digestive disease. Gastrointest Endosc. 2008;67:AB120.CrossRef Li W, Xiao J. Investigation for acceptance of natural orifice translumenal endoscopic surgery by inpatients with digestive disease. Gastrointest Endosc. 2008;67:AB120.CrossRef
41.
Zurück zum Zitat Bucher P, Pugin F, Morel P. Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis. 2008;23:1013–6.PubMedCrossRef Bucher P, Pugin F, Morel P. Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis. 2008;23:1013–6.PubMedCrossRef
42.
Zurück zum Zitat Saber AA, Elgamal MH, Itawi EA, Rao AJ. Single incision laparoscopic sleeve gastrectomy (SILS): a novel technique. Obes Surg. 2008;18:1338–42.PubMedCrossRef Saber AA, Elgamal MH, Itawi EA, Rao AJ. Single incision laparoscopic sleeve gastrectomy (SILS): a novel technique. Obes Surg. 2008;18:1338–42.PubMedCrossRef
43.
Zurück zum Zitat Tacchino R, Greco F, Matera D. Single-incision laparoscopic cholecystectomy: surgery without a visible scar. Surg Endosc. 2008 [Epub ahead of print]. Tacchino R, Greco F, Matera D. Single-incision laparoscopic cholecystectomy: surgery without a visible scar. Surg Endosc. 2008 [Epub ahead of print].
44.
Zurück zum Zitat Merchant AM, Cook MW, White BC, Davis SS, Sweeney JF, Lin E. Transumbilical Gelport access technique for performing single incision laparoscopic surgery (SILS). J Gastrointest Surg. 2009;13:159–62.PubMedCrossRef Merchant AM, Cook MW, White BC, Davis SS, Sweeney JF, Lin E. Transumbilical Gelport access technique for performing single incision laparoscopic surgery (SILS). J Gastrointest Surg. 2009;13:159–62.PubMedCrossRef
45.
Zurück zum Zitat Palanivelu C, Rajan PS, Rangarajan M, Parthasarathi R, Senthilnathan P, Praveenraj P. Transumbilical flexible endoscopic cholecystectomy in humans: first feasibility study using a hybrid technique. Endoscopy. 2008;40:428–31.PubMedCrossRef Palanivelu C, Rajan PS, Rangarajan M, Parthasarathi R, Senthilnathan P, Praveenraj P. Transumbilical flexible endoscopic cholecystectomy in humans: first feasibility study using a hybrid technique. Endoscopy. 2008;40:428–31.PubMedCrossRef
46.
Zurück zum Zitat Palanivelu C, Rajan PS, Rangarajan M, Parthasarathi R, Senthilnathan P, Praveenraj P. Transumbilical endoscopic appendectomy in humans: on the road to NOTES: a prospective study. J Laparoendosc Adv Surg Tech A. 2008;18:579–82.PubMedCrossRef Palanivelu C, Rajan PS, Rangarajan M, Parthasarathi R, Senthilnathan P, Praveenraj P. Transumbilical endoscopic appendectomy in humans: on the road to NOTES: a prospective study. J Laparoendosc Adv Surg Tech A. 2008;18:579–82.PubMedCrossRef
Metadaten
Titel
Single-port endoscopic cholecystectomy: a bridge between laparoscopic and translumenal endoscopic surgery
verfasst von
Nobutsugu Abe
Hirohisa Takeuchi
Hisayo Ueki
Osamu Yanagida
Tadahiko Masaki
Toshiyuki Mori
Masanori Sugiyama
Yutaka Atomi
Publikationsdatum
01.09.2009
Verlag
Springer Japan
Erschienen in
Journal of Hepato-Biliary-Pancreatic Sciences / Ausgabe 5/2009
Print ISSN: 1868-6974
Elektronische ISSN: 1868-6982
DOI
https://doi.org/10.1007/s00534-009-0108-4

Weitere Artikel der Ausgabe 5/2009

Journal of Hepato-Biliary-Pancreatic Sciences 5/2009 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.