Testing of rapidly growing species of mycobacteria (RGM) against antibacterial agents has been shown to have some clinical utility. This work establishes the MICs of seven antimicrobial agents following the guidelines set forth by the Clinical and Laboratory Standards Institute (CLSI) against eighteen isolates of <i  >Mycobacterium massiliense</i> recovered from wound samples of patients submitted to minimally invasive surgery such as arthroscopy and laparoscopy. The isolates showed susceptibility to amikacin (<svg     style="vertical-align:-3.41937pt;width:71.800003px;" id="M1" height="15.6875" version="1.1" viewBox="0 0 71.800003 15.6875" width="71.800003"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.363)"><path id="x4D" d="M861 0h-263v28q61 5 73 22t12 97l-4 408h-4l-244 -548h-20l-224 534h-2l-15 -285q-5 -98 -3 -166q1 -34 19.5 -45t72.5 -17v-28h-233v28q45 5 62.5 17t22.5 43q11 65 19 183l14 208q3 36 3.5 55t-2.5 37.5t-6.5 25t-16.5 13t-25.5 8t-39.5 4.5v28h164l228 -501l232 501&#xA;h170v-28q-68 -6 -81 -21.5t-11 -91.5l9 -362q2 -80 15 -97t78 -22v-28z" /></g><g transform="matrix(.017,-0,0,-.017,15.208,11.363)"><path id="x49" d="M303 0h-265v28q62 5 76 19.5t14 77.5v400q0 63 -14 77.5t-76 19.5v28h265v-28q-62 -5 -76 -19.5t-14 -77.5v-400q0 -64 14 -78t76 -19v-28z" /></g><g transform="matrix(.017,-0,0,-.017,20.801,11.363)"><path id="x43" d="M614 175l29 -10q-33 -109 -57 -154q-121 -26 -184 -26q-90 0 -160.5 29t-112.5 77t-63.5 105.5t-21.5 119.5q0 157 108 253t277 96q36 0 71.5 -5t69 -13.5t36.5 -8.5q15 -102 20 -150l-29 -8q-20 79 -66.5 114t-128.5 35q-119 0 -187.5 -86t-68.5 -207&#xA;q0 -140 73.5 -227.5t188.5 -87.5q73 0 119.5 37.5t86.5 116.5z" /></g>

			<g transform="matrix(.012,-0,0,-.012,32.1,15.45)"><path id="x39" d="M244 635q90 0 143 -72t53 -177q0 -133 -65 -229.5t-171 -139.5q-79 -32 -140 -32l-5 30q109 18 185 91t101 186l-68 -36q-29 -16 -60 -16q-79 0 -129 51.5t-50 130.5q0 80 57 146.5t149 66.5zM228 602q-52 0 -78 -45.5t-26 -98.5q0 -69 36.5 -115.5t97.5 -46.5&#xA;q53 0 90 28q4 31 4 66q0 51 -9.5 95.5t-39 80.5t-75.5 36z" /></g><g transform="matrix(.012,-0,0,-.012,37.811,15.45)"><path id="x30" d="M241 635q53 0 94 -28.5t63.5 -76t33.5 -102.5t11 -116q0 -58 -11 -112.5t-34 -103.5t-63.5 -78.5t-94.5 -29.5t-95 28t-64.5 75t-34.5 102.5t-11 118.5q0 58 11.5 112.5t34.5 103t64.5 78t95.5 29.5zM238 602q-32 0 -55.5 -25t-35.5 -68t-17.5 -91t-5.5 -105&#xA;q0 -76 10 -138.5t37 -107.5t69 -45q32 0 55.5 25t35.5 68.5t17.5 91.5t5.5 105t-5.5 105.5t-18 92t-36 68t-56.5 24.5z" /></g>

			<g transform="matrix(.017,-0,0,-.017,48.875,11.363)"><path id="x3D" d="M535 323h-483v50h483v-50zM535 138h-483v50h483v-50z" /></g><g transform="matrix(.017,-0,0,-.017,63.562,11.363)"><path id="x34" d="M456 178h-96v-72q0 -51 12.5 -62.5t72.5 -16.5v-27h-256v27q65 5 78 17t13 62v72h-260v28q182 271 300 426h40v-407h96v-47zM280 225v295h-2q-107 -148 -196 -295h198z" /></g>

		
	
</svg>&#x2009;<i  >&#x3bc;</i>g/mL) and clarithromycin (<svg     style="vertical-align:-3.41937pt;width:71.800003px;" id="M2" height="15.6875" version="1.1" viewBox="0 0 71.800003 15.6875" width="71.800003"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.363)"><use xlink:href="#x4D"/></g><g transform="matrix(.017,-0,0,-.017,15.208,11.363)"><use xlink:href="#x49"/></g><g transform="matrix(.017,-0,0,-.017,20.801,11.363)"><use xlink:href="#x43"/></g>

			<g transform="matrix(.012,-0,0,-.012,32.1,15.45)"><use xlink:href="#x39"/></g><g transform="matrix(.012,-0,0,-.012,37.811,15.45)"><use xlink:href="#x30"/></g>

			<g transform="matrix(.017,-0,0,-.017,48.875,11.363)"><path id="x3C" d="M512 -3l-437 233v51l437 233v-58l-378 -200v-2l378 -199v-58z" /></g><g transform="matrix(.017,-0,0,-.017,63.562,11.363)"><path id="x31" d="M384 0h-275v27q67 5 81.5 18.5t14.5 68.5v385q0 38 -7.5 47.5t-40.5 10.5l-48 2v24q85 15 178 52v-521q0 -55 14.5 -68.5t82.5 -18.5v-27z" /></g>

		
	
</svg>&#x2009;<i  >&#x3bc;</i>g/mL) but resistance to ciprofloxacin (<svg     style="vertical-align:-3.41937pt;width:79.949997px;" id="M3" height="15.6875" version="1.1" viewBox="0 0 79.949997 15.6875" width="79.949997"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.363)"><use xlink:href="#x4D"/></g><g transform="matrix(.017,-0,0,-.017,15.208,11.363)"><use xlink:href="#x49"/></g><g transform="matrix(.017,-0,0,-.017,20.801,11.363)"><use xlink:href="#x43"/></g>

			<g transform="matrix(.012,-0,0,-.012,32.1,15.45)"><use xlink:href="#x39"/></g><g transform="matrix(.012,-0,0,-.012,37.811,15.45)"><use xlink:href="#x30"/></g>

			<g transform="matrix(.017,-0,0,-.017,48.875,11.363)"><path id="x3E" d="M512 230l-437 -233v58l378 199v2l-378 200v58l437 -233v-51z" /></g><g transform="matrix(.017,-0,0,-.017,63.562,11.363)"><use xlink:href="#x31"/></g><g transform="matrix(.017,-0,0,-.017,71.721,11.363)"><path id="x36" d="M137 343l67 33q37 17 63 17q79 0 129.5 -53t50.5 -131q0 -92 -58 -156.5t-147 -64.5t-147 68t-58 182q0 63 17 119t43 95.5t61.5 72t69 52t67.5 31.5q62 22 128 33l6 -32q-56 -11 -108 -35q-149 -71 -184 -231zM227 337q-47 0 -95 -27q-6 -23 -6 -70q0 -93 36 -155.5&#xA;t96 -62.5q53 0 78 45.5t25 105.5q0 68 -35 116t-99 48z" /></g>

		
	
</svg>&#x2009;<i  >&#x3bc;</i>g/mL), doxycycline (<svg     style="vertical-align:-3.41937pt;width:79.949997px;" id="M4" height="15.6875" version="1.1" viewBox="0 0 79.949997 15.6875" width="79.949997"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.363)"><use xlink:href="#x4D"/></g><g transform="matrix(.017,-0,0,-.017,15.208,11.363)"><use xlink:href="#x49"/></g><g transform="matrix(.017,-0,0,-.017,20.801,11.363)"><use xlink:href="#x43"/></g>

			<g transform="matrix(.012,-0,0,-.012,32.1,15.45)"><use xlink:href="#x39"/></g><g transform="matrix(.012,-0,0,-.012,37.811,15.45)"><use xlink:href="#x30"/></g>

			<g transform="matrix(.017,-0,0,-.017,48.875,11.363)"><use xlink:href="#x3E"/></g><g transform="matrix(.017,-0,0,-.017,63.562,11.363)"><path id="x33" d="M285 378v-2q65 -13 102 -54.5t37 -97.5q0 -57 -30.5 -104.5t-74 -75t-85.5 -42t-72 -14.5q-31 0 -59.5 11t-40.5 23q-19 18 -16 36q1 16 23 33q13 10 24 0q58 -51 124 -51q55 0 88 40t33 112q0 64 -39 96.5t-88 32.5q-29 0 -64 -11l-6 29q77 25 118 57.5t41 84.5&#xA;q0 45 -26.5 69.5t-68.5 24.5q-67 0 -120 -79l-20 20l43 63q51 56 127 56h1q66 0 107 -37t41 -95q0 -42 -31 -71q-22 -23 -68 -54z" /></g><g transform="matrix(.017,-0,0,-.017,71.721,11.363)"><path id="x32" d="M412 140l28 -9q0 -2 -35 -131h-373v23q112 112 161 170q59 70 92 127t33 115q0 63 -31 98t-86 35q-75 0 -137 -93l-22 20l57 81q55 59 135 59q69 0 118.5 -46.5t49.5 -122.5q0 -62 -29.5 -114t-102.5 -130l-141 -149h186q42 0 58.5 10.5t38.5 56.5z" /></g>

		
	
</svg>&#x2009;<i  >&#x3bc;</i>g/mL), sulfamethoxazole (<svg     style="vertical-align:-3.41937pt;width:88.112503px;" id="M5" height="15.6875" version="1.1" viewBox="0 0 88.112503 15.6875" width="88.112503"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.363)"><use xlink:href="#x4D"/></g><g transform="matrix(.017,-0,0,-.017,15.208,11.363)"><use xlink:href="#x49"/></g><g transform="matrix(.017,-0,0,-.017,20.801,11.363)"><use xlink:href="#x43"/></g>

			<g transform="matrix(.012,-0,0,-.012,32.1,15.45)"><use xlink:href="#x39"/></g><g transform="matrix(.012,-0,0,-.012,37.811,15.45)"><use xlink:href="#x30"/></g>

			<g transform="matrix(.017,-0,0,-.017,48.875,11.363)"><use xlink:href="#x3E"/></g><g transform="matrix(.017,-0,0,-.017,63.562,11.363)"><use xlink:href="#x31"/></g><g transform="matrix(.017,-0,0,-.017,71.721,11.363)"><use xlink:href="#x32"/></g><g transform="matrix(.017,-0,0,-.017,79.881,11.363)"><path id="x38" d="M249 635q70 0 116 -43t46 -105q0 -46 -28 -80q-22 -25 -80 -64q62 -35 97 -75t35 -99q0 -81 -63 -131t-135 -50q-83 0 -137.5 45.5t-54.5 123.5q0 52 45 95q29 28 89 64q-109 62 -109 155q0 66 50.5 115t128.5 49zM238 603q-42 0 -67.5 -31t-25.5 -72q0 -50 32.5 -79.5&#xA;t98.5 -62.5q61 48 61 124q0 59 -29.5 90t-69.5 31zM248 20q46 0 76.5 33.5t30.5 89.5q0 50 -39 85.5t-110 71.5q-81 -54 -81 -137q0 -67 35.5 -105t87.5 -38z" /></g>

		
	
</svg>&#x2009;<i  >&#x3bc;</i>g/mL), and tobramycin (<svg     style="vertical-align:-3.41937pt;width:79.949997px;" id="M6" height="15.6875" version="1.1" viewBox="0 0 79.949997 15.6875" width="79.949997"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.363)"><use xlink:href="#x4D"/></g><g transform="matrix(.017,-0,0,-.017,15.208,11.363)"><use xlink:href="#x49"/></g><g transform="matrix(.017,-0,0,-.017,20.801,11.363)"><use xlink:href="#x43"/></g>

			<g transform="matrix(.012,-0,0,-.012,32.1,15.45)"><use xlink:href="#x39"/></g><g transform="matrix(.012,-0,0,-.012,37.811,15.45)"><use xlink:href="#x30"/></g>

			<g transform="matrix(.017,-0,0,-.017,48.875,11.363)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,63.562,11.363)"><use xlink:href="#x33"/></g><g transform="matrix(.017,-0,0,-.017,71.721,11.363)"><use xlink:href="#x32"/></g>

		
	
</svg>&#x2009;<i  >&#x3bc;</i>g/mL), and intermediate profile to cefoxitin (<svg     style="vertical-align:-3.41937pt;width:79.949997px;" id="M7" height="15.6875" version="1.1" viewBox="0 0 79.949997 15.6875" width="79.949997"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,11.363)"><use xlink:href="#x4D"/></g><g transform="matrix(.017,-0,0,-.017,15.208,11.363)"><use xlink:href="#x49"/></g><g transform="matrix(.017,-0,0,-.017,20.801,11.363)"><use xlink:href="#x43"/></g>

			<g transform="matrix(.012,-0,0,-.012,32.1,15.45)"><use xlink:href="#x39"/></g><g transform="matrix(.012,-0,0,-.012,37.811,15.45)"><use xlink:href="#x30"/></g>

			<g transform="matrix(.017,-0,0,-.017,48.875,11.363)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,63.562,11.363)"><use xlink:href="#x36"/></g><g transform="matrix(.017,-0,0,-.017,71.721,11.363)"><use xlink:href="#x34"/></g>

		
	
</svg>&#x2009;<i  >&#x3bc;</i>g/mL). Therefore, we suggest that the antimicrobial susceptibilities of any clinically significant RGM isolate should be performed.

Alessandra Marques Cardoso

Ana Paula Junqueira-Kipnis

Andr&#xe9; Kipnis

In Vitro Antimicrobial Susceptibility of <i>Mycobacterium massiliense</i> Recovered from Wound Samples of Patients Submitted to Arthroscopic and Laparoscopic Surgeries

Blunt traumatic diaphragmatic rupture (BTDR) is a life-threatening condition with an incidence from 0,8%–1,6% in blunt trauma, mostly located on the left side. The main  prognostic factors are severe side injuries and the delay of diagnosis. We present a rare case of a 68-year-old female, with an isolated right diaphragm rupture. The diagnosis was done with a delay of 4 days by thoracic radiographs, which showed a  herniation of small bowel into the right thoracic cavity. A reposition of the small bowel and a closure of the diaphragmatic defect by running suture were carried out 
laparoscopicly. Although large prospective studies concerning the outcome of laparoscopic approach to right BTDR are still missing, we could show, that laparoscopy can be performed safely in right traumatic diaphragm rupture.

H. Hoffmann

D. Oertli

O. Heizmann

Laparoscopic Treatment of a Rare Right Diaphragmatic Rupture with Small Bowel Herniation after Blunt Thoracic Trauma

<i>Objective</i>. To estimate if there is a relationship between the results of tests of neurocognition and performance on a laparoscopic surgery simulator. <i>Methods and Materials</i>. Twenty participants with no prior laparoscopic experience had baseline cognitive tests administered (Trail Making Test, Part A and B (TMT-A and TMT-B), Grooved Peg Board Test, Symbol Digit Modalities Test, Symbol Digit Recall Test, and Stroop Interference Test), completed a demographic questionnaire, and then performed laparoscopy using a simulator. We correlated the results of cognitive tests with laparoscopic surgical performance. <i>Results</i>. One cognitive test sensitive to frontal lobe function, TMT-A, significantly correlated with laparoscopic surgical performance on the simulator (correlation coefficient of 0.534 with <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mi>P</mml:mi><mml:mo>&lt;</mml:mo><mml:mn>.05</mml:mn></mml:mrow></mml:math>).  However, the correlation between performance and other cognitive tests (TMT-B, Grooved Peg Board Test, Symbol Digit Modalities Test, Symbol Digit Recall Test, and Stroop Interference Test) was not statistically significant. 
 <i>Conclusion</i>. Laparoscopic performance may be related to measures of frontal lobe function. Neurocognitive tests may predict motor skills abilities and performance on laparoscopic simulator.

Oumar Kuzbari

Howard Crystal

Pedram Bral

Rima A. A. Atiah

Imad Kuzbari

Amine Khachani

Muhammad Faisal Aslam

Howard Minkoff

The Relationship between Tests of Neurocognition and Performance on a Laparoscopic Simulator

<i>Objectives</i>. Multiple technical difficulties are encountered when a multidisciplinary team of subspecialists begins a minimally-invasive fetal cardiac interventional program. We describe the learning curve. <i>Study Design</i>. Ten pregnant sheep underwent ultrasound-guided balloon valvuloplasty of the aortic valve. Team members and their roles remained constant through the trial. The time between needle insertion and entrance of the left ventricle at the aortic root was recorded. <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mi>F</mml:mi></mml:math>-test was used to assess significance (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mi>P</mml:mi><mml:mo>≤</mml:mo><mml:mn>.05</mml:mn></mml:mrow></mml:math>). <i>Results</i>. The time required to accurately position the needle tip at the aortic root decreased significantly over the course of the trial, from 12 minutes with the first attempt to one minute with the last (<mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mi>P</mml:mi><mml:mo>=</mml:mo><mml:mn>.003</mml:mn></mml:mrow></mml:math>). <i>Conclusion</i>. A significant learning curve is encountered when a multidisciplinary team begins a minimally-invasive fetal cardiac intervention program. However, technical proficiency can be achieved with practice. Institutions interested in developing such a program should consider practice in an animal model before proceeding to the human fetus.

Stephen P. Emery

Jacqueline Kreutzer

Frances M. McCaffrey

Fredrick S. Sherman

Hyagriv N. Simhan

Bradley B. Keller

The Learning Curve for a Fetal Cardiac Intervention Team

<i  >Aim</i>. To describe a new technique of uterine manipulation in laparoscopic management of pelvic cancers. <i  >Material and Methods</i>. We used a novel uterine hitch technique in 23 patients from May 2008 to October 2008. These patients underwent pelvic oncologic surgery including laparoscopic radical hysterectomy (<svg     style="vertical-align:-0.1638pt;width:36.237499px;" id="M1" height="10.925" version="1.1" viewBox="0 0 36.237499 10.925" width="36.237499"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,10.65)"><path id="x1D45B" d="M495 86q-46 -47 -87 -72.5t-63 -25.5q-43 0 -16 107l49 210q7 34 8 50.5t-3 21t-13 4.5q-35 0 -109.5 -72.5t-115.5 -140.5q-21 -75 -38 -159q-50 -10 -76 -21l-6 8l84 340q8 35 -4 35q-17 0 -67 -46l-15 26q44 44 85.5 70.5t64.5 26.5q35 0 10 -103l-24 -98h2&#xA;q42 56 97 103.5t96 71.5q46 26 74 26q9 0 16 -2.5t14 -11.5t9.5 -24.5t-1 -44t-13.5 -68.5q-30 -117 -47 -200q-4 -19 -3.5 -25t6.5 -6q21 0 70 48z" /></g><g transform="matrix(.017,-0,0,-.017,13.305,10.65)"><path id="x3D" d="M535 323h-483v50h483v-50zM535 138h-483v50h483v-50z" /></g><g transform="matrix(.017,-0,0,-.017,28.008,10.65)"><path id="x37" d="M447 623l8 -12l-283 -613l-74 -10l-7 11q174 283 297 551h-216q-48 0 -62.5 -12t-33.5 -63h-29q10 60 18 148h382z" /></g>

		
	
</svg>), laparoscopic anterior resection (<svg     style="vertical-align:-0.1638pt;width:36.237499px;" id="M2" height="11.075" version="1.1" viewBox="0 0 36.237499 11.075" width="36.237499"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,10.8)"><use xlink:href="#x1D45B"/></g><g transform="matrix(.017,-0,0,-.017,13.305,10.8)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,28.008,10.8)"><path id="x34" d="M456 178h-96v-72q0 -51 12.5 -62.5t72.5 -16.5v-27h-256v27q65 5 78 17t13 62v72h-260v28q182 271 300 426h40v-407h96v-47zM280 225v295h-2q-107 -148 -196 -295h198z" /></g>

		
	
</svg>), laparoscopic abdominoperineal resection (<svg     style="vertical-align:-0.1638pt;width:36.237499px;" id="M3" height="11.125" version="1.1" viewBox="0 0 36.237499 11.125" width="36.237499"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,10.862)"><use xlink:href="#x1D45B"/></g><g transform="matrix(.017,-0,0,-.017,13.305,10.862)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,28.008,10.862)"><path id="x33" d="M285 378v-2q65 -13 102 -54.5t37 -97.5q0 -57 -30.5 -104.5t-74 -75t-85.5 -42t-72 -14.5q-31 0 -59.5 11t-40.5 23q-19 18 -16 36q1 16 23 33q13 10 24 0q58 -51 124 -51q55 0 88 40t33 112q0 64 -39 96.5t-88 32.5q-29 0 -64 -11l-6 29q77 25 118 57.5t41 84.5&#xA;q0 45 -26.5 69.5t-68.5 24.5q-67 0 -120 -79l-20 20l43 63q51 56 127 56h1q66 0 107 -37t41 -95q0 -42 -31 -71q-22 -23 -68 -54z" /></g>

		
	
</svg>), laparoscopic posterior exenteration (<svg     style="vertical-align:-0.1638pt;width:36.237499px;" id="M4" height="11.075" version="1.1" viewBox="0 0 36.237499 11.075" width="36.237499"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,10.8)"><use xlink:href="#x1D45B"/></g><g transform="matrix(.017,-0,0,-.017,13.305,10.8)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,28.008,10.8)"><use xlink:href="#x34"/></g>

		
	
</svg>), or laparoscopic anterior exenteration (<svg     style="vertical-align:-0.1638pt;width:36.237499px;" id="M5" height="10.925" version="1.1" viewBox="0 0 36.237499 10.925" width="36.237499"  xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg">
	
		
			<g transform="matrix(.017,-0,0,-.017,.062,10.65)"><use xlink:href="#x1D45B"/></g><g transform="matrix(.017,-0,0,-.017,13.305,10.65)"><use xlink:href="#x3D"/></g><g transform="matrix(.017,-0,0,-.017,28.008,10.65)"><path id="x35" d="M153 550l-26 -186q79 31 111 31q90 0 141.5 -51t51.5 -119q0 -93 -89 -166q-85 -69 -173 -71q-32 0 -61.5 11.5t-41.5 23.5q-18 17 -17 34q2 16 22 33q14 9 26 -1q61 -50 124 -50q60 0 93 43.5t33 104.5q0 69 -41.5 110t-121.5 41q-53 0 -102 -20l38 305h286l6 -8&#xA;l-26 -65h-233z" /></g>

		
	
</svg>). The uterus was hitched to the anterior abdominal.wall by either a single suture in the fundus or by sutures through the round ligaments. <i  >Results</i>. The uterine hitch technique was successfully accomplished in all procedures. It was performed in less than 5 minutes in all cases. It obviated the need for vaginal manipulation. An extra port for retraction could be avoided. There were no intraoperative complications. <i  >Conclusion</i>. A practical, cheap and reproducible method for uterine manipulation, during pelvic oncologic surgery is described. It improves the stability of the uterus and also obviates the need for keeping an additional assistant for vaginal manipulation in any of the procedures.

S. P. Puntambekar

A. M. Patil

N. V. Rayate

S. S. Puntambekar

R. M. Sathe

M. A. Kulkarni

A Novel Technique of Uterine Manipulation in Laparoscopic Pelvic Oncosurgical Procedures: “The Uterine Hitch Technique”

<i>Background</i>. The laparoscopic cholecystectomy is a perfectly codified surgical procedure. The development of recent innovative and experimental surgical techniques Natural Orifice transluminal endoscopic surger (N.O.T.E.S.) which reduces the abdominal wall trauma leads us to develop a combined procedure of a standard dissection using miniaturised instruments already existing on the market (3 and 5&#x2009;mm wide) and a gall bladder removal through a short gastrotomy Natural Orifice Specimen Extraction (N.O.S.E.). <i>Methods</i>. Our objective was to evaluate the safety, the feasibility, and the reproducibility of our new approach. After reviewing existing products on the market and a feasibility study, we put in place a protocol in our structure for patients on whom the procedure was performed. We carried out a gall bladder removal by a short gastrotomy, located on the anterior gastric wall, which then reduced the abdominal wall trauma and allowed them to resume normal physical activity quickly without risk of trocar site hernia. <i>Results</i>. We performed the procedure described in this paper on 63 patients, between April 2008 and July 2009. There were 14 men and 49 women with an average age of 46.8 years (ranging from 28 to 77) and an average BMI of 27.2. 30 patients had at least one gallstone larger than 10&#x2009;mm. There was no postoperative gastric or abdominal wall complication and a fast recovery for all the patients in our study. <i>Conclusions</i>. This procedure is feasible, reproducible, with good results and minimal abdominal wall trauma. It is also safer than N.O.T.E.S. and endoscopic clipping and recovery, allowing normal physical activity, fast and, without risk of incisional hernia.

Florent Jurczak

Jean-Paul Pousset

Laparoscopic Cholecystectomy Combined Using Miniaturised Instruments in Transgastric Gall Bladder Removal: Performed on 63 Patients

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<p><em>Minimally Invasive Surgery</em> provides a platform for clinicians working in the areas of minimally invasive surgery, endoscopy, treatment, and diagnosis.</p>


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title

Minimally Invasive Surgery provides a platform for clinicians working in the areas of minimally invasive surgery, endoscopy, treatment, and diagnosis.

Minimally Invasive Surgery