Evolution of SILS Cholecystectomy in the Caribbean: The Direct Transfascial Puncture Technique Using Conventional Instruments without Working Ports

Cawich, Shamir O; Thomas, Dexter; Hassranah, Dale; Naraynsingh, Vijay

doi:10.1155/2014/164342

Cited by 6 publications

(13 citation statements)

References 18 publications

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“…Laparoscopic surgeons in the Caribbean have adapted by using re-usable trocars/instruments,19–22 becoming proficient at laparoscopic suturing24 instead of relying on staples or clips and adapting their surgical techniques to suit low-resource settings 22–24. It is important that the industry realize that surgical practice in this environment differs from that in developed countries in order to tailor the nature of business practices and support.…”

Section: Discussionmentioning

confidence: 99%

Impact of a medical university on laparoscopic surgery in a service-oriented public hospital in the Caribbean

Cawich¹,

Pooran²,

Amow³

et al. 2016

RMHP

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IntroductionThe Caribbean lags behind global trends for volume and complexity of laparoscopic operations. In an attempt to promote laparoscopy at a single facility, a partnership was formed between the University of the West Indies (UWI) and the Port of Spain General Hospital in Trinidad and Tobago. This study seeks to document the effect of this partnership on laparoscopic practice.Materials and methodsIn this partnership, the UWI took the bold step of volunteering to staff a surgical team if the Ministry of Health provided the necessary legislative changes. On August 1, 2013, a UWI team was introduced with a mandate to optimize teaching and promote laparoscopic surgery. The UWI team had a similar staff complement to the existing service-oriented teams. There was no immediate investment in equipment, hospital beds, ICU beds, or operating room space. Therefore, the new team was introduced with limited change in existing conditions, resources, and equipment.ResultsThere were 252 laparoscopic operations performed over the study period. After introduction of the UWI team, there was an increase in the mean number of unselected laparoscopic operations (3.17 vs 10.83 cases per month; P<0.001; 95% confidence interval [95% CI] −8.5 to −6.84; standard error of the difference [SED] 0.408), the mean number of basic laparoscopic operations (3.17 vs 6.94 cases per month; P<0.0001; 95% CI −4.096 to −3.444; SED 0.165), the mean number of advanced laparoscopic operations (0 vs 3.89; P<0.0001), the number of teams undertaking unselected laparoscopic operations (2 vs 5), and the number of teams independently performing advanced laparoscopic operations (0 vs 4).ConclusionAt this facility, we have demonstrated a significant increase in laparoscopic case volume and complexity when partnerships were formed between the UWI and this service-oriented hospital. Continued cross-fertilization and distribution of skill sets across the surgical community can reasonably be expected. We also identified maneuvers that can be used as a template to build laparoscopic services in other service-oriented hospitals in developing nations.

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Section: Discussionmentioning

confidence: 99%

Impact of a medical university on laparoscopic surgery in a service-oriented public hospital in the Caribbean

Cawich¹,

Pooran²,

Amow³

et al. 2016

RMHP

Self Cite

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“…However, this is a limitation in a resource poor environment such as ours. In our setting, each SILS port costs US $470.21 from local distributors [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…In this modified TAMIS technique, we used a single visual trocar and the working instruments were slid beside the trocar. This idea was inspired by the previously described direct transfascial puncture technique for single incision laparoscopy where instruments were slid along the working trocar without additional working ports [ 19 ]. However, sliding the instruments between the anal sphincter and the trocar did result in disruption of the air seal.…”

Section: Discussionmentioning

confidence: 99%

Colonic Foreign Body Retrieval Using a Modified TAMIS Technique with Standard Instruments and Trocars

Cawich

Mohammed

Spence

et al. 2015

Case Reports in Emergency Medicine

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Background. Reports of retained colorectal foreign bodies (CFBs) are no longer considered uncommon. We present a case where a retained CFB was retrieved using a modified TAMIS technique using standard instruments and trocars. Case Report. A 52-year-old man presented with a CFB. We report our technique of extraction with standard laparoscopic instruments without specialized access platforms. Conclusions. This modified TAMIS technique is well suited for resource poor environments because it requires no specialized equipment, platforms, or additional skill sets compared to conventional laparoscopy.

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“…Similarly, we have modified our technique since our first SILS operation [ 4 ]. The direct fascial puncture (DFP) technique was first performed in 2011 and has been described in detail in prior reports [ 5 ]. When we submitted reports of our early experience using the DFP technique for publication, many reviewers declined to publish the manuscript citing three reasons this technique was impractical.…”

Section: Introductionmentioning

confidence: 99%

Single Incision Laparoscopic Surgery: Feasibility of the Direct Fascial Puncture Technique Without Working Trocars

Cawich

Dapri²,

Oen

et al. 2020

Cureus

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Introduction As single-incision laparoscopic surgery (SILS) became popular, many access platforms and techniques emerged. When we initially described the direct fascial puncture (DFP) technique, many suggested it was not practical for three reasons: (1) increased hernia formation, (2) inability to complete operations without instrument changes and (3) insurmountable instrument drag. This study sought to determine whether the technique was a feasible approach by evaluating the outcomes with DFP-SILS in a single surgeon unit. Methods This was a retrospective audit of all consecutive patients who had unselected SILS operations by a single surgeon. For the DFP-SILS operation, a single optical trocar was used at the umbilicus, a second was rail-roaded beside the optical trocar and a third was directly passed across the fascia at the left-lateral extent of the skin wound. We recorded the number of conversions or failed operations and examined the patients routinely after operation to evaluate for incisional herniae. Results There were 50 DFP-SILS operations performed: 37 cholecystectomies, 12 appendectomies and one jejunal resection. The operations were successful in all cases with no conversions or mortality recorded. One patient (2%) developed a superficial surgical site infection after SILS-DFP appendectomy. The therapeutic outcomes were comparable to existing series of multi-port laparoscopy. There were no incisional herniae detected. Conclusion Even in the resource-poor setting, SILS operations are feasible and safe using the DFP technique. The theoretic concerns have not been realized in clinical practice.

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Evolution of SILS Cholecystectomy in the Caribbean: The Direct Transfascial Puncture Technique Using Conventional Instruments without Working Ports

Cited by 6 publications

References 18 publications

Impact of a medical university on laparoscopic surgery in a service-oriented public hospital in the Caribbean

Impact of a medical university on laparoscopic surgery in a service-oriented public hospital in the Caribbean

Colonic Foreign Body Retrieval Using a Modified TAMIS Technique with Standard Instruments and Trocars

Single Incision Laparoscopic Surgery: Feasibility of the Direct Fascial Puncture Technique Without Working Trocars

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