The final stage of the laparoscopic procedure: exploring final steps

Abstract

INTRODuCTIONUrologic surgery continues to evolve focusing efforts on adequate treatment of pathologic urologic conditions in a safe and minimally invasive manner (1).Laparoscopic surgery has well defined benefits for the patient and has, over time, become accepted as a standard of care access strategy for the management of benign and malignant Urologic diseases. Despite significant advances in laparoscopic technique and technologies, laparoscopic Urologic surgery remains technically demanding. Unlike open surgery, at the end of laparoscopic extirpative procedures, the Urologist is often faced with the additional challenges of specimen retrieval and extraction.Laparoscopic specimen entrapment and extraction occur at what is falsely considered the "end of the procedure". During open surgery, after the specimen has been mobilized, the specimen is Despite significant advances in laparoscopic technique and technologies, laparoscopic Urologic surgery remains technically demanding regarding various surgical steps including the challenge of specimen retrieval and extraction, whether to install a drainage system and the best option for wound closure. Laparoscopic specimen entrapment and extraction occurs at what is falsely considered the "end of the procedure". During open surgery, after the specimen has been mobilized, the specimen is simply lifted out of the larger incision which has been made to achieve the surgical objectives. In contrast, significant laparoscopic skill is required to entrap and safely extract laparoscopic specimens. Indeed, the Urologist and surgical team which are transitioning from open surgery may disregard this important part of the procedure which may lead to significant morbidity. As such, it is imperative that during laparoscopic procedures, the "end of the procedure" be strictly defined as the termination of skin closure and dressing placement. Taking a few minutes to focus on safe specimen entrapment and extraction will substantially reduce major morbidity. The following review focus on the technology and technique of specimen entrapment and extraction, on the matter of whether to install a drainage system of the abdominal cavity and the options for adequate closure of trocar site wounds. This article's primary objectives are to focus on how to minimize morbidity while maintain the advantages of a minimally invasive surgical approach.

Safety and Efficacy of Trocar Port-Site Closure Using a Biological Plug Closure in Laparoscopic Bariatric Surgery: a Prospective Study

“…The range of laparoscopic port instruments encompasses a myriad of devices manufactured by more than 20 manufacturers [11,38]. It is beyond the scope of this article to describe or illustrate all available devices or compare and contrast their relative merits and disadvantages.…”

“…Therefore, most surgeons do not perform port-site suturing because of the difficulties encountered. Recommendations for when laparoscopic fascial wound closure should be considered and conventional closure techniques have been well reported by La Chapelle and colleagues on behalf of a Dutch Minimally Invasive Surgery multidisciplinary guideline development group [11] and by Natalin et al [38]. Techniques for closing port-site wounds include direct closure with retractors, laparoscopic closure with suture retrievers, subcuticular continuous suturing, and the use of tissue adhesives, skin tapes, or hemostats [1,11,12,25,38].…”

Retroperitoneal Laparoscopic Pyelolithotomy in Renal Pelvic Stone Versus Open Surgery - A Comparative Study

“…Retroperitoneal laparoscopy for renal surgery is a viable alternative to transperitoneal access. In spite of various significant advances in laparoscopy technologies, laparoscopic urologic surgery remains technically demanding regarding various surgical steps including the challenge of specimen retrieval and extraction [ 1 ]. The indications for open renal surgery to treat renal calculi are limited to special situations; it is needed in only 0.47% to 5.4% of the cases [ 2 ].…”