Strangulated small bowel hernia through the port site:A case report

Port site hernia develops through a fascial or peritoneal layer that was inadequate or not repaired. It is a rare complication of laparoscopic surgery which may lead to serious problems. Here,we present a 77-year-old female,diagnosed with a small bowel hernia through a 10-mm port site. We had performed ten cases of laparoscopy-assisted distal gastrectomy before this case. The patient complained of left lower abdominal pain with a palpable mass. Abdominal CT showed an incarcerated small bowel hernia and the patient underwent segmental resection of the strangulated small bowel through a minimally extended port site incision.

Port site infection in laparoscopic surgery: A review of its management

Laparoscopic surgery(LS), also termed minimal access surgery, has brought a paradigm shift in the approach to modern surgical care. Early postoperative recovery, less pain, improved aesthesis and early return to work have led to its popularity both amongst surgeons and patients. Its application has progressed from cholecystectomies and appendectomies to various other fields including gastrointestinal surgery, urology, gynecology and oncosurgery. However, LS has its own package of complications. Port site infection(PSI), although infrequent, is one of the bothersome complications which undermine the benefits of minimal invasive surgery. Not only does it add to the morbidity of the patient but also spoils the reputation of the surgeon. Despite the advances in the field of antimicrobial agents, sterilization techniques, surgical techniques, operating room ventilation, PSIs still prevail. The emergence of rapid growing atypical mycobacteria with multidrug resistance, which are the causative organism in most of the cases, has further compounded the problem. PSIs are preventable if appropriate measures are taken preoperatively, intraoperatively and postoperatively. PSIs can often be treated non-surgically, with early identification and appropriate management. Macrolides, quinolones and aminoglycosides antibiotics do show promising activity against the atypical mycobacteria. This review article highlights the clinical burden, presentations and management of PSIs in LS as shared by various authors in the literature. We have given emphasis to atypical mycobacteria, which are emerging as a common etiological agent for PSIs in LS. Although the existing literature lacks consensus regarding PSI management, the complication can be best avoided by strictly abiding by the commandments of sterilization techniques of the laparoscopic instruments with appropriate sterilizing agent.

Robotic cholecystectomy with new port sites

AIM:To introduce robotic cholecystectomy(RC) using new port sites on the low abdominal area.METHODS:From June 2010 to June 2011,a total of 178 RCs were performed at Ajou University Medical Center.We prospectively collected the set-up time(working time and docking time) and console time in all robotic procedures.RESULTS:Eighty-three patients were male and 95 female;the age ranged from 18 to 72 years of age(mean 54.6 ± 15.0 years).All robotic procedures were successfully completed.The mean operation time was 52.4 ± 17.1 min.The set-up time and console time were 11.9 ± 5.4 min(5-43 min) and 15.1 ± 8.0 min(4-50 min),respectively.The conversion rate to laparoscopic or open procedures was zero.The complication rate was 0.6%(n = 1,bleeding).There was no bile duct injury or mortality.The mean hospital stay was 1.4 ± 1.1 d.There was a significant correlation between the console time and white blood cell count(r = 0.033,P = 0.015).In addition,the higher the white blood cell count(more than 10000),the longer the console time.CONCLUSION:Robotic cholecystectomy using new port sites on the low abdominal area can be safely and efficiently performed,with sufficient patient satisfaction.

Port-Site Metastasis after Laparoscopic Surgery with Rapid Second Recurrence in Early Stage Endometrial Carcinoma: A Case Report and Review of the Literature

Introduction: Port site metastases have been reported with laparoscopic surgery. The mechanism of action is unknown. Theories include tumor tracking, spillage, pneumoperitoneum, and immune factors. Methods: We report on a case of aggressive port site metastases and intra-abdominal recurrence after an uncomplicated laparoscopic hysterectomy for a grade 2, minimally invasive endometrioid adenocarcinoma of the uterus. The world literature on port site metastases in gynecological cancer is reviewed. Results: Port site metastases have two distinct presentations. In the first pattern, the metastases are isolated to the laparoscopic port sites. In the second pattern, port site metastases are associated with widespread intra-abdominal recurrence. Conclusion: Port site metastases are rare but occur with laparoscopic surgery. Meticulous attention to surgical technique including the use of specimen bags to isolate tissue and prevent spillage should be performed. Data registries should be instituted to track the incidence and outcomes of port site metastases.

Persistent port-site sinus in a patient after laparoscopic cholecystectomy:watch out for gallbladder tuberculosis

BACKGROUND:The gallbladder is rarely affected by mycobacterium tuberculosis.The diagnosis of gallbladder tuberculosis is often not suspected prior to surgery or biopsy.METHOD:A young female patient underwent laparoscopic cholecystectomy but presented with a persistently discharging sinus from the port site.RESULTS:The gallbladder biopsy revealed granulomas typical of chronic granulomatous tuberculosis.The condition of the patient was improved by antitubercular treatment.CONCLUSIONS:Presentation of gallbladder tuberculosis as a persistent discharging sinus at the port site in a patient who has undergone a laparoscopic cholecystectomy is extremely rare.The diagnosis was reached by histopathology only.The rarity of the presentation prompted us to report the case.

Is fascial closure required for a 12-mm trocar?A comparative study on trocar site hernia with long-term follow up

BACKGROUND Despite the infrequency of trocar site hernias(TSHs),fascial closure continues to be recommended for their prevention when using a≥10-mm trocar.AIM To identify the necessity of fascial closure for a 12-mm nonbladed trocar incision in minimally invasive colorectal surgeries.METHODS Between July 2010 and December 2018,all patients who underwent minimally invasive colorectal surgery at the Minimally Invasive Surgery Unit of Siriraj Hospital were retrospectively reviewed.All patients underwent cross-sectional imaging for TSH assessment.Clinicopathological characteristics were recorded.Incidence rates of TSH and postoperative results were analyzed.RESULTS Of the 254 patients included,70(111 ports)were in the fascial closure(closed)group and 184(279 ports)were in the nonfascial closure(open)group.The median follow up duration was 43 mo.During follow up,three patients in the open group developed TSHs,whereas none in the closed group developed the condition(1.1%vs 0%,P=0.561).All TSHs occurred in the right lower abdomen.Patients whose drains were placed through the same incision had higher rates of TSHs compared with those without the drain.The open group had a significantly shorter operative time and lower blood loss than the closed group.CONCLUSION Routine performance of fascial closure when using a 12-mm nonbladed trocar may not be needed.However,further prospective studies with cross-sectional imaging follow-up and larger sample size are needed to confirm this finding.

常规器械经自制手套port单孔腹腔镜肾盂成形术治疗小儿肾盂输尿管连接处梗阻

探讨常规器械经自制手套port单孔腹腔镜肾盂成形术治疗小儿肾盂输尿管连接处梗阻的可行性和安全性,评估其临床应用价值。回顾性分析40例肾盂输尿管连接部梗阻患儿,其中左侧33例,右侧7例。所有病例由同一术者完成经脐单孔腹腔镜离断式肾盂成形术,取环脐缘皱褶处1.5~2 cm切口,置入自制手套port,双手常规器械操作。术后3个月超声提示肾盂前后径明显减少,肾皮质厚度明显增加。静脉尿路造影可见吻合口通畅,脐周无明显手术瘢痕。采用常规器械经自制手套port单孔腹腔镜肾盂成形术治疗小儿肾盂输尿管连接处梗阻,效果确切,安全性好,术后美容效果满意,值得推广。

Heparin versus Saline Solution for Locking of Totally Implantable Venous Access Port (TIVAP): Cohort Study of the First Kurdistan Series of TIVAP

Introduction: Totally implantable venous access port (TIVAP) is essential prerequisite for most of chemotherapy protocols. Flushing with 0.9% sodium chloride becomes an alternative to heparinized solution. As flushing and locking solutions are still controversial, this study was conducted to compare efficacy of heparinized solution versus normal saline solution for locking in ports TIVAP. Patients and Methods: Prospective Cohort study performed in teaching hospital Sulaymaniyah-University of Kurdistan, Iraq, including 384 TIVAP implanted in cancer and non-cancer patients. The study reports the TIVAP outcome in 2 groups of patients where 2 different solutions used for maintaining catheter’s patency by heparinized solution in group (A), versus normal saline for group (B). Results: In group A, the rate of complications was 8.2% (n = 16) while in group B complications rate was 7.9% (n = 15). Thrombosis in group A occurred in 1.03% of the cases and in group B was 1.57%. There were no significant differences between the two groups regarding the causes for unwanted removals of the TIVAP. Conclusions: The results of our study suggest that heparin has no role in preventing the early or late complications of TIVAP and we do not recommend using it as a locking solution.

Robotic single-site supracervical hysterectomy with manual morcellation:Preliminary experience

AIM To evaluate the feasibility,safety and peri-and postoperative outcomes of robotic single-site supracervical hysterectomy(RSSSH) for benign gynecologic disease.METHODS We report 3 patients who received RSSSH for adenomyosis of the uterus from November 2015 to April 2016.We evaluated the feasibility,safety and outcomes among these patients.RESULTS The mean surgical time was 244 min and the estimated blood loss was 216 mL,with no blood transfusion necessitated.The docking time was shortened gradually from 30 to 10 min.We spent 148 min on console operation.Manual morcel ation time was also short,ranging from 5 to 10 min.The mean hospital stay was 5 d.Lower VAS pain score was also noted.There is no complication during or after surgery.CONCLUSION RSSSH is feasible and safe,incurs less postoperative pain and gives good cosmetic appearance.The technique of inbag,manual morcellation can avoid tumor dissemination.

Single-site laparoscopic partial nephrectomy: Where are we going?

AIM:To review an evolution of laparoscopic surgery,there has been a growing interest in laparoendoscopic single-site surgery(LESS).METHODS:A comprehensive electronic literature search was conducted using PubM ed database to identify all publications relating to LESS-partial nephrectomy(PN).The research includes articles published from April 2008 to January 2014.We focused our attention only on articles in which were cited the single-site surgical technique(laparoscopic and robotic),tumour stage and grade,mean tumour size,intraoperative variables,blood loss and transfusion rate,length of postoperative stay and complication rates,Clavien classification,positive of surgical margins,pain assessment at discharge.RESULTS:A total of 9 studies were collected with 221patients included.The mean patients age was 62 years.The mean tumor size was 2.35 cm with a mean operative time of 181 min(range 111-270 min)and 58.3%were done by robot.The mean ischemia time was 23.6min.The 25.8%of patients underwent an unclamp LESS-PN.Mean estimated blood loss was 296 mL and median length of hospital stay was 4 d.The rate of severe post-operative complications(≥Clavien gradeⅢ)was 5.4%.Not all surgical series of LESS-PN or Robotic-LESS-PN shows conversion in Multiport Laparoscopic or Open Surgery.Regarding oncologic outcomes,surgical margins were positive 4%of patients(9/221),no distant or port-site metastases were recorded.CONCLUSION:LESS-PN and RLESS-PN are feasible and associated with reduced postoperative pain,shorter median hospital stay,shorter recovery time,and better cosmetic satisfaction without compromising surgical and oncological safety.

港口码头工程智慧化工地建设的探讨与实践

为推动港口码头智慧化建设,解决港口码头工程建设中人员管理能力差、危险源监测不到位、信息传递不通畅等问题,以山东港口青岛港前湾港区自动化码头三期工程为背景,采用信息化技术、物联网技术、人工智能技术等智慧化管理平台建设关键技术,针对港口码头工程智慧化工地建设各环节中智慧化应用不足问题,从智能防疫应用、安全管理应用、进度管理应用、质量管理应用、环境管理应用五个方面重点研究智慧化工地建设应用。工程实践表明,港口码头智慧化管理平台建设,可以有效提高施工质量、降低施工成本、保障施工安全。港口码头工程进行智慧化建设试点探索,达到了高效建设港口码头的效果。

沿海港口LNG码头选址要素分析

沿海港口液化天然气(LNG)码头的选址受到综合因素的影响,由于筛选要素过多,且存在相互关联,评价过程中难免存在主观偏差的问题。针对沿海港口的LNG码头选址复杂以及其具独特性的问题,进行LNG码头选址要素分析研究。采用模糊层次分析法,结合提出的5大影响因素共计11项评价指标,构建沿海港口LNG码头选址的综合评价指标体系。结果表明,采用模糊层次分析法,通过多专家对指标因子进行赋值和评分,可以更客观且直观地评价LNG码头选址,为沿海地区LNG码头的选址提供更科学、合理的参考。

达芬奇机器人SP系统在泌尿外科的应用与发展

达芬奇机器人SP系统是一种智能化微创手术系统,其立体化、精准化的优势将有助于完成高难度、复杂手术。达芬奇机器人SP系统是单孔领域的一大助力,并已广泛应用于泌尿外科。与传统开腹手术相比,微创手术具有缩短住院时间和加速患者术后恢复等优势。为了减少手术切口,并在一定程度上满足现代美学要求,单孔腹腔镜手术(LESS)在临床应用甚广,但LESS在一定程度上存在器械间相互干扰,影响手术操作,进而限制了LESS在临床的进一步应用,这就要求符合美学概念和对器械三维关系影响小的新器械出现。因此更符合人体构造学及更具三维立体感的达芬奇机器人SP系统应运而生。达芬奇机器人SP系统规避了LESS的一些风险,并结合了达芬奇机器人系统与单切口的优势,近年来被广用于泌尿外科领域,本文就达芬奇机器人SP系统在泌尿外科领域的发展和应用进行综述。

腹腔镜穿刺孔疝11例临床分析

目的总结腹腔镜穿刺孔疝(PSH)的高危因素、临床特点及诊治方法。方法回顾性分析2015年1月至2022年12月诊治的11例PSH临床资料并总结国内外相关文献。结果PSH发生位置脐周7例,腹侧壁4例,穿刺孔直径均≥10 mm;出现症状的中位数时间为7 d,主要症状为恶心呕吐(8/11)及腹痛(10/11),均存在穿刺孔处包块,7例伴有压痛;影像学检查均提示PSH,疝环面积1~5 cm^(2),平均为2.1 cm^(2)。10例早发型行手术修补,疝内容物7例为小肠(4例缺血坏死),3例为大网膜(均缺血坏死),随访5~73个月,愈合良好;1例迟发型行手法还纳,随访35个月,复发2次。结论PSH的发生与穿刺孔位置、直径相关。症状以腹痛、恶心呕吐为主,体征为穿刺孔处包块,可伴有压痛,严重时并发疝内容物缺血坏死,诊断需结合患者手术史、症状体征及影像学检查,治疗方法主要为手术修补,预后良好。

港口建设工程智慧管理平台的应用研究

港口建设项目的施工阶段有着丰富的信息化需求,然而现有的施工BIM协同管理平台和智慧工地管理平台在应用于港口建设项目时存在不足。本研究以连云港港口控股集团的项目级信息化创新应用为研究对象,依据国家、交通水运行业以及江苏省关于智慧工地和品质工程的创建要求,开展了港口建设工程智慧管理平台的融合研究,提出了“1+N+X”的项目级整体架构,实现了施工BIM协同管理平台和智慧工地管理平台的有效融合,减少了港口建设项目参建单位的工作负担,有效提升了港口建设项目的数据管理效能。

港口工程智慧工地建设研究与应用

港口工程施工过程中存在专业众多、工艺复杂、交叉作业多等特点,项目的安全、质量、进度和成本的管理难度较大,采用智慧工地建设实现施工数字化细致化管理非常必要。本文基于智能物联、智能分析、边缘计算和BIM融合信息技术,进行了智慧工地体系和总体架构的研究,并依托惠州LNG码头项目智慧工地建设进行了研究成果的验证,取得了良好的应用效果和经验,可供行业同类项目参考。

低瓦斯自燃采空区注氮工艺优化研究

为了分析注氮口埋深和注氮流量对采空区氧化带范围的影响,优化低瓦斯自燃煤层采空区注氮防灭火工艺,采用数值模拟和现场实测相结合的方法,分别模拟了未注氮,注氮流量为设计量且注氮口埋深为15 m、30 m、45 m、60 m和75 m,注氮口埋深为45 m且注氮流量为0.50倍、0.75倍、1.00倍、1.25倍、1.50倍和1.75倍设计量时采空区氧化带范围;现场实测了注氮口埋深为45 m且注氮流量为设计量时采空区氧化带范围。研究结果表明:随着注氮口埋深增加氧化带面积逐渐减小,注氮口埋深分别为15 m、30 m、45 m、60 m和75 m时,氧化带面积为未注氮时的100.8%、96.1%、90.5%、95.0%和79.1%;随着注氮流量增加,氧化带面积逐渐减小,注氮流量为0.50倍、0.75倍、1.00倍、1.25倍、1.50倍和1.75倍设计量时,氧化带面积为未注氮时的95.8%、93.4%、90.5%、87.1%、83.3%和79.2%;增加50%的注氮流量,氧化带面积减小7.9%,减少50%的注氮流量,氧化带面积增加5.9%。现场实测结果与数值模拟结果基本一致。对于9202工作面,合理的注氮口埋深为30~60 m,最佳注氮口埋深为45 m,注氮流量为设计量的1.00~1.50倍比较合适,最优注氮流量为设计量的1.25倍。

轮胎吊在不同场景下的应用优势分析

轮胎吊作为一种重要的起重设备,在工业生产和物流领域发挥着关键作用。旨在探讨轮胎吊在不同场景下的应用优势,并展望其在工业和物流领域中的前景。首先,介绍了轮胎吊的基本结构、工作原理和设计特点,阐述了其灵活性、便携性和高效性。其次,分析了轮胎吊在建筑工地、港口装卸和物流运输中的具体应用情况。针对不同场景,论述了轮胎吊在提升效率、减少人力成本和提高作业安全性方面的显著优势。进一步探讨了轮胎吊技术的发展趋势,涉及自动化控制、智能化系统和可持续性发展等方向。最后,通过案例展示和效果评估,展现了轮胎吊在实际应用中的成效,并总结了其在各个领域中的价值和未来的发展潜力。

港口码头工程智慧化工地建设的探讨与实践

随着中国经济的快速发展和全球贸易的不断扩展,港口码头工程的现代化和智慧化建设成为提升管理效率和竞争力的关键。文中探讨了物联网、大数据分析、人工智能、无人机和建筑信息模型(BIM)等关键技术在港口码头工程中的应用现状和实际效果。当前,我国港口码头工程智慧化建设已经初步推进,但面临着技术集成、数据安全和人才培养等挑战。文章分析了这些挑战的根源,并提出了政策支持、技术创新和人才培养的策略建议,以推动我国港口码头工程智慧化建设迈向更高水平和可持续发展。

岚山港海洋临时倾倒区表层沉积物重金属污染、潜在生态风险评价及变化趋势分析

根据2009年9月岚山港海洋临时倾倒区海域表层沉积物重金属监测数据,采用Hakanson生态风险指数法对其重金属污染特征,潜在生态风险性进行了评价,并对其变化趋势进行了分析,结果表明:该倾倒区海域重金属综合污染程度和潜在生态风险性均较低,倾倒区主要潜在生态风险因子为Cd和Hg。潜在生态风险指数(ERI)表明该倾倒区的生态风险程度顺序为:2006年>2009年>2004年>2008年>2000年,与2008年相比,2009年潜在生态风险指数(ERI)有所增加,其中重金属Cd和Hg的潜在生态风险系数(Eri)有较大增加。