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Sample records for review comparing laparoscopic

  1. Laparoscopic versus open splenectomy for portal hypertension: a systematic review of comparative studies.

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    Cai, Yunqiang; Liu, Zhihong; Liu, Xubao

    2014-08-01

    Laparoscopic splenectomy has become the gold-standard procedure for normal to moderately enlarged spleens. However, the safety of laparoscopic splenectomy for patients with portal hypertension remains controversial. We carried out this systematic review to identify the feasibility and safety of laparoscopic splenectomy in treating portal hypertension. A systematic search for comparative studies that compared laparoscopic splenectomy with open splenectomy for portal hypertension was carried out. Studies were independently reviewed for quality, inclusion and exclusion criteria, demographic characteristics, and perioperative outcomes. Although laparoscopic splenectomy is associated with longer operating time, it offers advantages over the open procedure in terms of less blood loss, lower operative complications, earlier resumption of oral intake, and shorter posthospital stay. Therefore, laparoscopic splenectomy is a safe and feasible intervention for portal hypertension. © The Author(s) 2014.

  2. Comparing robotic, laparoscopic and open cystectomy: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Thomas Fonseka

    2015-03-01

    Full Text Available Objective: To conduct a systematic review and meta-analysis comparing outcomes between Open Radical Cystectomy (ORC, Laparoscopic Radical Cystectomy (LRC and Robot-assisted Radical Cystectomy (RARC. RARC is to be compared to LRC and ORC and LRC compared to ORC. Material and methods: A systematic review of the literature was conducted, collating studies comparing RARC, LRC and ORC. Surgical and oncological outcome data were extracted and a meta-analysis was performed. Results: Twenty-four studies were selected with total of 2,104 cases analyzed. RARC had a longer operative time (OPT compared to LRC with no statistical difference between length of stay (LOS and estimated blood loss (EBL. RARC had a significantly shorter LOS, reduced EBL, lower complication rate and longer OPT compared to ORC. There were no significant differences regarding lymph node yield (LNY and positive surgical margins (PSM. LRC had a reduced EBL, shorter LOS and increased OPT compared to ORC. There was no significant difference regarding LNY. Conclusion: RARC is comparable to LRC with better surgical results than ORC. LRC has better surgical outcomes than ORC. With the unique technological features of the robotic surgical system and increasing trend of intra-corporeal reconstruction it is likely that RARC will become the surgical option of choice.

  3. Essure hysteroscopic sterilization versus interval laparoscopic bilateral tubal ligation: a comparative effectiveness review.

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    Ouzounelli, Myrsini; Reaven, Nancy L

    2015-01-01

    A comparative effectiveness analysis was performed to examine the risks and benefits of laparoscopic bilateral tubal ligation compared with hysteroscopic sterilization using the Essure Permanent Birth Control System (Bayer HealthCare AG, Whippany, NJ). Existing evidence shows that both LBTL and Essure are safe and effective methods of female sterilization. Both have high rates of efficacy and low rates of complications although when complications do occur, those related to the Essure procedure are more likely to be minor in nature. The analysis was limited by the restricted number of studies involving head-to-head comparisons of the 2 approaches. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

  4. Laparoscopic vs open gastrectomy. A retrospective review.

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    Reyes, C D; Weber, K J; Gagner, M; Divino, C M

    2001-09-01

    The totally laparoscopic approach to partial gastrectomy had not been compared previously with results of the open technique. This study compares the results of a series of laparoscopic cases with matched open cases. A retrospective case-matched study was performed in 36 patients (18 laparoscopic surgeries, 18 open surgeries). Each laparoscopic case was matched for patient age and indication for surgery. The intraoperative and postoperative details of the two groups were compared. Laparoscopic surgery resulted in less blood loss, although operative time was increased. Nasogastric tubes were less likely to be used after laparoscopic surgery, and patients in the laparoscopic group had an earlier return to normal bowel function than those in the open group. Length of hospital stay was 2 days shorter in the laparoscopic group. The totally laparoscopic approach to partial gastrectomy is an excellent alternative to the more traditional open approach. It results in a more rapid return of intestinal function and a shorter hospital stay.

  5. A systematic review and meta-analysis of randomized and non-randomized studies comparing laparoscopic and open abdominoperineal resection for rectal cancer.

    LENUS (Irish Health Repository)

    Ahmad, N Z

    2013-03-01

    Evidence supporting the role of laparoscopy in abdominoperineal resection (APR) is limited. This study compared the short-term and long-term outcomes and complications associated with open and laparoscopic APR.

  6. Review: Robot assisted laparoscopic surgery in gynaecological ...

    African Journals Online (AJOL)

    Review: Robot assisted laparoscopic surgery in gynaecological oncology. ... robot suggests "to be able to act without human interference and being able to ... or in space), its use as telesurgery is still very limited and practically not feasible.

  7. Lower limb compartment syndrome following laparoscopic colorectal surgery: a review.

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    Rao, M M; Jayne, D

    2011-05-01

      In spite of recent advances in technology and technique, laparoscopic colorectal surgery is associated with increased operating times when compared with open surgery. This increases the risk of acute lower limb compartment syndrome. The aim of this review was to gain a better understanding of postoperative lower limb compartment syndrome following laparoscopic colorectal surgery and to suggest strategies to avoid its occurrence. A MEDLINE search was performed using the keywords 'compartment syndrome', 'laparoscopic surgery' and 'Lloyd-Davies position' between 1970 and 2008. All relevant articles were retrieved and reviewed. A total of 54 articles were retrieved. Of the 30 articles in English, five were reviews, six were original articles and 19 were case reports, of which only one was following laparoscopic colorectal surgery. The remaining 24 were non-English articles. Of these, two were reviews and 22 were case reports, of which only one was following laparoscopic colorectal surgery. The incidence of acute compartment syndrome following laparoscopic colorectal surgery is unknown. The following are believed to be risk factors for acute lower limb compartment syndrome: the Lloyd-Davies operating position with exaggerated Trendelenburg tilt, prolonged operative times and improper patient positioning. Simple strategies are suggested to reduce its occurrence. Simple preventative measures have been identified which may help to reduce the incidence of acute lower limb compartment syndrome. However, if suspected, timely surgical intervention with four-compartment fasciotomy remains the standard of care. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

  8. Laparoscopic pyloromyotomy: comparing the arthrotomy knife to the Bovie blade.

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    Thomas, Priscilla G; Sharp, Nicole E; St Peter, Shawn D

    2014-07-01

    Laparoscopic pyloromyotomy was performed at our institution using an arthrotomy knife until it became unavailable in 2010. Thus, we adapted the use of the blunt Bovie tip, which can be used with or without electrocautery to perform the myotomy. This study compared the outcomes between using the arthrotomy knife versus the Bovie blade in laparoscopic pyloromyotomies. Retrospective review was performed on all laparoscopic pyloromyotomy patients from October 2007 to September 2012. Arthrotomy knife pyloromyotomy patients were compared with those performed with the Bovie blade. Patient demographics, diagnostic measurements, electrolyte levels, length of stay, operative time, and complications were compared. A total of 381 patients were included, with 191 in the arthrotomy group and 190 in the Bovie blade group. No significant differences existed between groups in age, weight, gender, pyloric dimensions, electrolyte levels, or length of stay. Mean operative times were 15.8±5.6 min with knife and 16.4±5.3 min for Bovie blade (P=0.24). In the arthrotomy knife group, there was one incomplete pyloromyotomy and one omental herniation. There was one wound infection in each group. Readmission rate was greater in the arthrotomy knife group (5.7%) versus the Bovie blade group (3.1%). The Bovie blade appears to offer no objective disadvantages compared with the arthrotomy knife when performing laparoscopic pyloromyotomy. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Laparoscopic versus open radical cystectomy in bladder cancer: a systematic review and meta-analysis of comparative studies.

    Directory of Open Access Journals (Sweden)

    Kun Tang

    Full Text Available BACKGROUND AND OBJECTIVE: More recently laparoscopic radical cystectomy (LRC has increasingly been an attractive alternative to open radical cystectomy (ORC and many centers have reported their early experiences in the treatment of bladder cancer. Evaluate the safety and efficacy of LRC compared with ORC in the treatment of bladder cancer. METHODS: A systematic search of Medline, Scopus, and the Cochrane Library was performed up to Mar 1, 2013. Outcomes of interest assessing the two techniques included demographic and clinical baseline characteristics, perioperative, pathologic and oncological variables, and post-op neobladder function and complications. RESULTS: Sixteen eligible trials evaluating LRC vs ORC were identified including seven prospective and nine retrospective studies. Although LRC was associated with longer operative time (p<0.001, patients might benefit from significantly fewer overall complications (p<0.001, less blood loss (p<0.001, shorter length of hospital stay (p<0.001, less need of blood transfusion (p<0.001, less narcotic analgesic requirement (p<0.001, shorter time to ambulation (p = 0.03, shorter time to regular diet (p<0.001, fewer positive surgical margins (p = 0.006, fewer positive lymph node (p = 0.05, lower distant metastasis rate (p = 0.05 and fewer death (p = 0.004. There was no significant difference in other demographic parameters except for a lower ASA score (p = 0.01 in LRC while post-op neobladder function were similar between the two groups. CONCLUSIONS: Our data suggest that LRC appears to be a safe, feasible and minimally invasive alternative to ORC with reliable perioperative safety, pathologic & oncologic efficacy, comparable post-op neobladder function and fewer complications. Because of the inherent limitations of the included studies, further large sample prospective, multi-centric, long-term follow-up studies and randomized control trials should be undertaken to confirm our

  10. Comparing video games and laparoscopic simulators in the development of laparoscopic skills in surgical residents.

    Science.gov (United States)

    Adams, Barbara J; Margaron, Franklin; Kaplan, Brian J

    2012-01-01

    The video game industry has become increasingly popular over recent years, offering photorealistic simulations of various scenarios while requiring motor, visual, and cognitive coordination. Video game players outperform nonplayers on different visual tasks and are faster and more accurate on laparoscopic simulators. The same qualities found in video game players are highly desired in surgeons. Our investigation aims to evaluate the effect of video game play on the development of fine motor and visual skills. Specifically, we plan to examine if handheld video devices offer the same improvement in laparoscopic skill as traditional simulators, with less cost and more accessibility. We performed an Institutional Review Board-approved study, including categorical surgical residents and preliminary interns at our institution. The residents were randomly assigned to 1 of 3 study arms, including a traditional laparoscopic simulator, XBOX 360 gaming console, or Nintendo DS handheld gaming system. After an introduction survey and baseline timed test using a laparoscopic surgery box trainer, residents were given 6 weeks to practice on their respective consoles. At the conclusion of the study, the residents were tested again on the simulator and completed a final survey. A total of 31 residents were included in the study, representing equal distribution of each class level. The XBOX 360 group spent more time on their console weekly (6 hours per week) compared with the simulator (2 hours per week), and Nintendo groups (3 hours per week). There was a significant difference in the improvement of the tested time among the 3 groups, with the XBOX 360 group showing the greatest improvement (p = 0.052). The residents in the laparoscopic simulator arm (n = 11) improved 4.6 seconds, the XBOX group (n = 10) improved 17.7 seconds, and the Nintendo DS group (n = 10) improved 11.8 seconds. Residents who played more than 10 hours of video games weekly had the fastest times on the simulator

  11. Laparoscopic Whipple procedure: review of the literature.

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    Gagner, Michel; Palermo, Mariano

    2009-01-01

    Laparoscopic pancreatic surgery represents one of the most advanced applications for laparoscopic surgery currently in use. In the past, minimally invasive techniques were only used for diagnostic laparoscopy, staging of pancreatic cancer, and palliative procedures for unresectable pancreatic cancer. With new advances in technology and instrumentation, some sophisticated procedures are currently available, such as the Whipple procedure, one of the most sophisticated applications of minimally invasive surgery. A review of the literature shows that 146 laparoscopic Whipple procedures have been published worldwide since 1994. The authors analyzed blood loss, mean operating time, hospital stay, conversion rate, mean age, mortality rate, lymph nodes in the pathologic findings, follow up, and complications. Mean age was 59.1 years; mean operating time was 439 min. The average blood loss for the reviewed literature was 143 mL; median hospital stay was 18 days; conversion rate was 46%; number of lymph nodes in the pathologic findings was 19; and mortalities related to the procedure was low, 2 patients (1.3%) and the complication rate was 16% (23/46 patients). Complications included 2 hemorrhages, 4 bowel obstructions, 1 stress ulcer, 1 delay of gastric emptying, 4 pneumonias, and 11 leaks. This review demonstrates that the laparoscopic Whipple procedure is not only feasible but also safe, with low mortality and acceptable rates of complications.

  12. Comparative analysis of laparoscopic low rectal resections

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    I. L. Chernikovsky

    2015-01-01

    Full Text Available Objective: to study the immediate results of laparoscopic intersphincteric resection (ISR and ultralow anterior resection (ULAR of the rectum.Subjects and methods. The results of surgical treatment in 42 patients operated on in the Saint Petersburg Clinical Research-Practical Center for Specialized Medical (Oncology Cares in March 2014 to January 2015 are given. The inclusion criteria were the lower edge of cT1–3N0 adenocarcinoma 2-5 cm above the dentate line and no signs of invasion into the sphincter and levators. All the patients were divided into 2 groups: 1 24 patients who had undergone laparoscopic ISR; 2 18 patients who had laparoscopic ULAR. Both groups were matched for gender, age, body mass index, and CR-POSSUM predicted mortality scores. Thirty-two patients received neoadjuvant chemoradiotherapy. Results. The mean duration of operations did not differ significantly in the groups: 206 ± 46 and 216 ± 24 min (р = 0.72. The differences in the mean volume of blood loss were also insignificant: 85 and 113 ml (р = 0.93. Circular and distal resection margins were intact in all the cases. In 18 (75 % patients in Group 1 and in 14 (77.8 % patients in Group 2, the quality of total mesorectumectomy (TME was rated as grade 3 according to the Quirk criteria (p = 0.83. In Group 1, complications requiring no reoperation occurred in 5 (20.8 % cases: anastomotic incompetence in 3 (12.5 % cases, anastomotic stricture with further bougienage in 1 (4.2 %, and urinary retention in 1 (4.2 %. In Group 2, postoperative coтplications were also observed in 5 (27.8 % cases: necrosis of the brought-out bowel in 2 (11.1 % patients and coloanal incompetence in 1 (5.6 % required reoperation; 2 (11.1 % patients underwent bougienage due to established anastomotic stricture. One month postoperatively, the Wexner constipation scoring system was used to rate the degree of encopresis: anal incontinence turned out to be significantly higher in Group 2 and amounted

  13. Laparoscopic liver resection for malignancy: a review of the literature.

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    Alkhalili, Eyas; Berber, Eren

    2014-10-07

    To review the published literature about laparoscopic liver resection for malignancy. A PubMed search was performed for original published studies until June 2013 and original series containing at least 30 patients were reviewed. All forms of hepatic resections have been described ranging from simple wedge resections to extended right or left hepatectomies. The usual approach is pure laparoscopic, but hand-assisted, as well as robotic approaches have been described. Most studies showed comparable results to open resection in terms of operative blood loss, postoperative morbidity and mortality. Many of them showed decreased postoperative pain, shorter hospital stays, and even lower costs. Oncological results including resection margin status and long-term survival were not inferior to open resection. In the hands of experienced surgeons, laparoscopic liver resection for malignant lesions is safe and offers some short-term advantages over open resection. Oncologically, similar survival rates have been observed in patients treated with the laparoscopic approach when compared to their open resection counterparts.

  14. Is smaller necessarily better? A systematic review comparing the effects of minilaparoscopic and conventional laparoscopic cholecystectomy on patient outcomes

    DEFF Research Database (Denmark)

    McCloy, R.; Randall, D.; Schug, S.A.

    2008-01-01

    BACKGROUND: In recent years, minilaparoscopic cholecystectomy (MLC; total size of trocar incision ... using MEDLINE and EmBASE. Only randomized controlled trials in English, investigating minilaparoscopic versus conventional LC (total size of trocar incision > or = 25 mm) and reporting pain scores were included. Quantitative analyses (meta-analyses) were performed on postoperative pain scores and other.......00001]. CONCLUSIONS: The data included in this review suggest that reducing the size of trocar incision results in some limited improvements in surgical outcomes after LC. However, it carries a higher risk of conversion to conventional LC or open cholecystectomy Udgivelsesdato: 2008/12...

  15. Randomized Controlled Trial Comparing Daycare and Overnight Stay Laparoscopic Cholecystectomy.

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    Salleh, A A M; Affirul, C A; Hairol, O; Zamri, Z; Azlanudin, A; Hilmi, M A; Razman, J

    2015-01-01

    This present study sought to review the feasibility and patients' satisfaction of laparoscopic cholecystectomy to be perform as daycare procedure. Sixty-two patients with symptomatic gallstones were recruited within a year. They were randomized into overnight stay and daycare groups. The outcomes and post-operative complications were analyzed. Fifty-eight patients were eligible for analysis and four patients were excluded because of conversion to open cholecystectomy. All patients in daycare group reported no fever but two patients in the overnight stay group complaint of post-operative fever (p=0.150). The mean pain score using Visual Analogue Score (VAS) in daycare group was 2.93 but in the overnight stay was recorded as 3.59 (p=0.98). Five patients had post-operative nausea and vomiting (PONV) in daycare group compared to 2 patients in the overnight stay group (p=0.227). Patient's satisfaction were higher in the daycare group (p=0.160). All patients in daycare group were back at work within a week but in overnight stay, 11 patients had to stay off work for more than one week (p=0.01). Daycare laparoscopic cholecystectomy is safe and feasible. The satisfaction of daycare surgery is higher than overnight stay group. Patients' selection is an important aspect of its success.

  16. [Laparoscopic versus open surgery for colorectal cancer. A comparative study].

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    Arribas-Martin, Antonio; Díaz-Pizarro-Graf, José Ignacio; Muñoz-Hinojosa, Jorge Demetrio; Valdés-Castañeda, Alberto; Cruz-Ramírez, Omar; Bertrand, Martin Marie

    2014-01-01

    Laparoscopic surgery for colorectal cancer is currently accepted and widespread worldwide. However, according tol the surgical experience on this approach, surgical and short-term oncologic results may vary. Studies comparing laparoscopic vs. open surgery in our population are scarce. To determine the superiority of the laparoscopic vs. open technique for colorectal cancer surgery. This retrospective and comparative study collected data from patients operated on for colorectal cancer between 1999 and 2011 at the Angeles Lomas Hospital, Mexico. A total of 82 patients were included in this study; 47 were operated through an open approach and 35 laparoscopically. Mean operative time was significantly lower in the open approach group (p= 0.008). There were no significant difference between both techniques for intraoperative bleeding (p= 0.3980), number of lymph nodes (p= 0.27), time to initiate oral feeding (p= 0.31), hospital stay (p= 0.12), and postoperative pain (p= 0.19). Procedure-related complications rate and type were not significantly different in both groups (p= 0.44). Patients operated laparoscopically required significantly less analgesic drugs (p= 0.04) and less need for epidural postoperative analgesia (p= 0.01). Laparoscopic approach is as safe as the traditional open approach for colorectal cancer. Early oncological and surgical results confirm its suitability according to this indication.

  17. A comprehensive review of telementoring applications in laparoscopic general surgery.

    Science.gov (United States)

    Antoniou, Stavros A; Antoniou, George A; Franzen, Jan; Bollmann, Stefan; Koch, Oliver O; Pointner, Rudolf; Granderath, Frank A

    2012-08-01

    Incorporation of advanced laparoscopic procedures in the practice of institutions without respective experience is a significant impediment in the dissemination of minimally invasive techniques. On-site mentoring programs carry several cost-related and practical constraints. Telementoring has emerged as a practical and cost-effective alternative mentoring tool. The present study aimed to review the pertinent literature on telementoring applications in laparoscopic general surgery. A systematic review using the Medline database was performed. Articles reporting on clinical experience with telementoring applications in general surgery were included. Variations in methodology, study design, and operative procedures precluded cumulative outcome evaluation. Instead, a critical appraisal of current evidence was undertaken. Seventy-five articles were identified in the primary search, and ten studies were considered eligible. No randomized studies comparing on-site mentoring with telementoring were identified. The included studies reported on a total of 96 laparoscopic telementored procedures: 50 cholecystectomies, 23 colorectal resections, 7 fundoplications, 9 adrenalectomies, 6 hernia repairs, and 2 splenectomies. Completion of remotely assisted procedures was feasible in the vast majority of cases, whereas technical difficulties included video and audio latency with low transfer rates (programs in general surgery. Their clinical effectiveness as teaching alternatives to traditional mentoring programs remains to be further evaluated.

  18. Single incision laparoscopic liver resection (SILL – a systematic review

    Directory of Open Access Journals (Sweden)

    Benzing, Christian

    2015-12-01

    Full Text Available Background: Today, minimally invasive liver resections for both benign and malignant tumors are routinely performed. Recently, some authors have described single incision laparoscopic liver resection (SILL procedures. Since SILL is a relatively young branch of laparoscopy, we performed a systematic review of the current literature to collect data on feasibility, perioperative results and oncological outcome.Methods: A literature research was performed on Medline for all studies that met the eligibility criteria. Titles and abstracts were screened by two authors independently. A study was included for review if consensus was obtained by discussion between the authors on the basis of predefined inclusion criteria. A thorough quality assessment of all included studies was performed. Data were analyzed and tabulated according to predefined outcome measures. Synthesis of the results was achieved by narrative review. Results: A total of 15 eligible studies were identified among which there was one prospective cohort study and one randomized controlled trial comparing SILL to multi incision laparoscopic liver resection (MILL. The rest were retrospective case series with a maximum of 24 patients. All studies demonstrated convincing results with regards to feasibility, morbidity and mortality. The rate of wound complications and incisional hernia was low. The cosmetic results were good.Conclusions: This is the first systematic review on SILL including prospective trials. The results of the existing studies reporting on SILL are favorable. However, a large body of scientific evidence on the field of SILL is missing, further randomized controlled studies are urgently needed.

  19. Optimal Timing for Laparoscopic Cholecystectomy After Endoscopic Retrograde Cholangiopancreatography: A Systematic Review.

    Science.gov (United States)

    Friis, C; Rothman, J P; Burcharth, J; Rosenberg, J

    2018-06-01

    Endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy is often used as definitive treatment for common bile duct stones. The aim of this study was to investigate the optimal time interval between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. PubMed and Embase were searched for studies comparing different time delays between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. Observational studies and randomized controlled trials were included. Primary outcome was conversion rate from laparoscopic to open cholecystectomy and secondary outcomes were complications, mortality, operating time, and length of stay. A total of 14 studies with a total of 1930 patients were included. The pooled estimate revealed an increase from a 4.2% conversion rate when laparoscopic cholecystectomy was performed within 24 h of endoscopic retrograde cholangiopancreatography to 7.6% for 24-72 h delay to 12.3% when performed within 2 weeks, to 12.3% for 2-6 weeks, and to a 14% conversion rate when operation was delayed more than 6 weeks. According to this systematic review, it is preferable to perform cholecystectomy within 24 h of endoscopic retrograde cholangiopancreatography to reduce conversion rate. Early laparoscopic cholecystectomy does not increase mortality, perioperative complications, or length of stay and on the contrary it reduces the risk of reoccurrence and progression of disease in the delay between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy.

  20. The effect of video review of resident laparoscopic surgical skills measured by self- and external assessment.

    Science.gov (United States)

    Herrera-Almario, Gabriel E; Kirk, Katherine; Guerrero, Veronica T; Jeong, Kwonho; Kim, Sara; Hamad, Giselle G

    2016-02-01

    Video review of surgical skills is an educational modality that allows trainees to reflect on self-performance. The purpose of this study was to determine whether resident and attending assessments of a resident's laparoscopic performance differ and whether video review changes assessments. Third-year surgery residents were invited to participate. Elective laparoscopic procedures were video recorded. The Global Operative Assessment of Laparoscopic Skills evaluation was completed immediately after the procedure and again 7 to 10 days later by both resident and attending. Scores were compared using t tests. Nine residents participated and 76 video reviews were completed. Residents scored themselves significantly lower than the faculty scores both before and after video review. Resident scores did not change significantly after video review. Attending and resident self-assessment of laparoscopic skills differs and subsequent video review does not significantly affect Global Operative Assessment of Laparoscopic Skills scores. Further studies should evaluate the impact of video review combined with verbal feedback on skill acquisition and assessment. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Robot-assisted laparoscopic partial nephrectomy: Current review of the technique and literature.

    Science.gov (United States)

    Singh, Iqbal

    2009-10-01

    To visit the operative technique and to review the current published English literature on the technique, and outcomes following robot-assisted laparoscopic partial nephrectomy (RPN). We searched the published English literature and the PubMed(()) for published series of 'robotic partial nephrectomy' (RPN) using the keywords; robot, robot-assisted laparoscopic partial nephrectomy, laparoscopic partial nephrectomy, partial nephrectomy and laparoscopic surgery. The search yielded 15 major selected series of 'robotic partial nephrectomy'; these were reviewed, tracked and analysed in order to determine the current status and role of RPN in the management of early renal neoplasm(s), as a minimally invasive surgical alternative to open partial nephrectomy. A review of the initial peri-operative outcome of the 350 cases of select series of RPN reported in published English literature revealed a mean operating time, warm ischemia time, estimated blood loss and hospital stay, of 191 minutes, 25 minutes, 162 ml and 2.95 days, respectively. The overall computed mean complication rate of RPN in the present select series was about 7.4%. RPN is a safe, feasible and effective minimally invasive surgical alternative to laparoscopic partial nephrectomy for early stage (T(1)) renal neoplasm(s). It has acceptable initial renal functional outcomes without the increased risk of major complications in experienced hands. Prospective randomised, controlled, comparative clinical trials with laparoscopic partial nephrectomy (LPN) are the need of the day. While the initial oncological outcomes of RPN appear to be favourable, long-term data is awaited.

  2. Laparoscopic total pancreatectomy: Case report and literature review.

    Science.gov (United States)

    Wang, Xin; Li, Yongbin; Cai, Yunqiang; Liu, Xubao; Peng, Bing

    2017-01-01

    Laparoscopic total pancreatectomy is a complicated surgical procedure and rarely been reported. This study was conducted to investigate the safety and feasibility of laparoscopic total pancreatectomy. Three patients underwent laparoscopic total pancreatectomy between May 2014 and August 2015. We reviewed their general demographic data, perioperative details, and short-term outcomes. General morbidity was assessed using Clavien-Dindo classification and delayed gastric emptying (DGE) was evaluated by International Study Group of Pancreatic Surgery (ISGPS) definition. The indications for laparoscopic total pancreatectomy were intraductal papillary mucinous neoplasm (IPMN) (n = 2) and pancreatic neuroendocrine tumor (PNET) (n = 1). All patients underwent laparoscopic pylorus and spleen-preserving total pancreatectomy, the mean operative time was 490 minutes (range 450-540 minutes), the mean estimated blood loss was 266 mL (range 100-400 minutes); 2 patients suffered from postoperative complication. All the patients recovered uneventfully with conservative treatment and discharged with a mean hospital stay 18 days (range 8-24 days). The short-term (from 108 to 600 days) follow up demonstrated 3 patients had normal and consistent glycated hemoglobin (HbA1c) level with acceptable quality of life. Laparoscopic total pancreatectomy is feasible and safe in selected patients and pylorus and spleen preserving technique should be considered. Further prospective randomized studies are needed to obtain a comprehensive understanding the role of laparoscopic technique in total pancreatectomy.

  3. Prospective, randomized comparative study between single-port laparoscopic appendectomy and conventional laparoscopic appendectomy.

    Science.gov (United States)

    Villalobos Mori, Rafael; Escoll Rufino, Jordi; Herrerías González, Fernando; Mias Carballal, M Carmen; Escartin Arias, Alfredo; Olsina Kissler, Jorge Juan

    2014-01-01

    Laparoscopic appendectomy is probably the technique of choice in acute appendicitis. Single port laparoscopic surgery (SILS) has been proposed as an alternative technique. The objective of this study is to compare the safety and efficacy of SILS against conventional laparoscopic appendectomy (LA). From January 2011 to September 2012, 120 patients with acute appendicitis were prospectively randomized; 60 for SILS and 60 for LA. Patients between 15 to 65 years were selected, with onset of symptoms less than 48h. We compared BMI, surgery time, start of oral intake, hospital stay, postoperative pain, pathology and costs. The median age, BMI, sex and time of onset of symptoms to diagnosis were similar. There were no statistically significant differences in the operative time, start of oral intake or hospital stay. There was a significant difference in postoperative pain being higher in SILS (4±1.3) than in LA (3.3±0.5) with a P=.004. Flemonous appendicitis predominated in both groups in a similar percentage. A total of 3 cases with intra-abdominal abscess (SILS 2, LA 1) required readmission and resolved spontaneously with intravenous antibiotic treatment. One case of SILS required assistance by a 5mm trocar in the RLC for drainage placement. The cost was higher in SILS due the single port device. SILS appendectomy is safe, effective and has similar results to LA in selected patients, and although the cost is greater, the long term results will determine the future of this technique. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  4. Risk reduction strategies in laparoscopic donor nephrectomy: A comparative study

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    T Manohar

    2006-01-01

    Full Text Available OBJECTIVES: As the advancements, modifications and standardization of laparoscopy are taking place, there is a need for the reduction in morbidity associated with laparoscopic live donor nephrectomy. This study was performed to determine and reconfirm the advantages of laparoscopic donor nephrectomy over its open counterpart. MATERIALS AND METHODS: Two hundred open live donor nephrectomy (ODN cases were compared to 264 cases of laparoscopic live donor nephrectomy (LDN. Pretransplant functional and radiological evaluation was done routinely by excretory urogram and renal arteriography. In case of vascular variations, CT angiography was preferred. Open cases were done by conventional method and laparoscopic group underwent certain technical and surgical modifications, including meticulous planning for the port placement. Operative time, analgesia requirement, start of the orals, hospital stay, blood loss, late allograft function, incidence of rejection, complications and technical problems were analyzed. RESULTS: Operative time was 135.8 ± 43 and 165 ± 44.4 min ( P < 0.0001, requirement of analgesia was 60.5 ± 40 and 320 ± 120 mg ( P < 0.0001, hospital stay was 4 ± 0.04 and 5.7 ± 2.03 days ( P < 0.0001, warm ischemia time was 6.1 ± 2.0 and 4.1 ± 0.80 min ( P < 0.0001 and time taken for the serum creatinine to stabilize in the recipient was 4.1 ± 1.6 and 4.32 ± 1.40 days ( P =0.06 for LDN and ODN groups respectively. There was a significant reduction in the blood loss in LDN group ( P =0.0005. Overall complications were 6.81 and 14.5% and ureteric injury was seen in 0.37 and 1% in LDN and ODN respectively. CONCLUSION: Laparoscopic live donor nephrectomy can now be performed with low morbidity and mortality to both donors and recipients and is proving to be the preferred operation to open donor nephrectomy. Our continued innovations in technical modifications have made this novel operation successful.

  5. Single-port laparoscopic rectal surgery - a systematic review

    DEFF Research Database (Denmark)

    Lolle, Ida; Rosenstock, Steffen; Bulut, Orhan

    2014-01-01

    INTRODUCTION: Single-port laparoscopic surgery (SPLS) for colonic disease has been widely described, whereas data for SPLS rectal resection are sparse. This review aimed to evaluate the feasibility, safety and complication profile of SPLS for rectal diseases. METHODS: A systematic literature search...

  6. Laparoscopic peritoneal lavage for perforated colonic diverticulitis: a systematic review

    NARCIS (Netherlands)

    Toorenvliet, Boudewijn R.; Swank, Hilko; Schoones, Jan W.; Hamming, Jaap F.; Bemelman, Willem A.

    2010-01-01

    Aim This systematic review aimed to evaluate the efficacy, morbidity and mortality of laparoscopic peritoneal lavage for patients with perforated diverticulitis. Method We searched PubMed, EMBASE, Web of Science, the Cochrane Library and CINAHL databases, Google Scholar and five major publisher

  7. Laparoscopic distal pancreatectomy: Up-to-date and literature review

    Science.gov (United States)

    Iacobone, Maurizio; Citton, Marilisa; Nitti, Donato

    2012-01-01

    Pancreatic surgery represents one of the most challenging areas in digestive surgery. In recent years, an increasing number of laparoscopic pancreatic procedures have been performed and laparoscopic distal pancreatectomy (LDP) has gained world-wide acceptance because it does not require anastomosis or other reconstruction. To date, English literature reports more than 300 papers focusing on LDP, but only 6% included more than 30 patients. Literature review confirms that LDP is a feasible and safe procedure in patients with benign or low grade malignancies. Decreased blood loss and morbidity, early recovery and shorter hospital stay may be the main advantages. Several concerns still exist for laparoscopic pancreatic adenocarcinoma excision. The individual surgeon determines the technical conduction of LDP, with or without spleen preservation; currently robotic pancreatic surgery has gained diffusion. Additional researches are necessary to determine the best technique to improve the procedure results. PMID:23082049

  8. Intestinal volvulus following laparoscopic surgery: a literature review and case report.

    Science.gov (United States)

    Ferguson, Louise; Higgs, Zoe; Brown, Sylvia; McCarter, Douglas; McKay, Colin

    2008-06-01

    Since its introduction in the early 1990s, the laparoscopic cholecystectomy has become the standard surgical intervention for cholelithiasis. The laparoscopic technique is being used in an increasing number of abdominal procedures. Intestinal volvulus is a rare complication of laparoscopic procedures, such as the laparoscopic cholecystectomy. A review of the literature revealed 12 reports of this complication occurring without a clear cause. Etiologic factors that have been postulated include congenital malrotation, previous surgery, and intraoperative factors, such as pneumoperitoneum, mobilization of the bowel, and patient position. In this paper, we review the literature for this rare complication and report on a case of cecal bascule (a type of cecal volvulus) occurring following the laparoscopic cholecystectomy. Of the 12 prior reports of intestinal volvulus following laparoscopic procedures, 8 of these followed the laparoscopic cholecystectomy, of which two were cecal volvulae. This is the first reported case of a cecal bascule occurring following the laparoscopic cholecystectomy.

  9. Robot-assisted laparoscopic partial nephrectomy: Current review of the technique and literature

    Directory of Open Access Journals (Sweden)

    Singh Iqbal

    2009-01-01

    Full Text Available Aim: To visit the operative technique and to review the current published English literature on the technique, and outcomes following robot-assisted laparoscopic partial nephrectomy (RPN. Materials and Methods: We searched the published English literature and the PubMed (TM for published series of ′robotic partial nephrectomy′ (RPN using the keywords; robot, robot-assisted laparoscopic partial nephrectomy, laparoscopic partial nephrectomy, partial nephrectomy and laparoscopic surgery. Results: The search yielded 15 major selected series of ′robotic partial nephrectomy′; these were reviewed, tracked and analysed in order to determine the current status and role of RPN in the management of early renal neoplasm(s, as a minimally invasive surgical alternative to open partial nephrectomy. A review of the initial peri-operative outcome of the 350 cases of select series of RPN reported in published English literature revealed a mean operating time, warm ischemia time, estimated blood loss and hospital stay, of 191 minutes, 25 minutes, 162 ml and 2.95 days, respectively. The overall computed mean complication rate of RPN in the present select series was about 7.4%. Conclusions: RPN is a safe, feasible and effective minimally invasive surgical alternative to laparoscopic partial nephrectomy for early stage (T 1 renal neoplasm(s. It has acceptable initial renal functional outcomes without the increased risk of major complications in experienced hands. Prospective randomised, controlled, comparative clinical trials with laparoscopic partial nephrectomy (LPN are the need of the day. While the initial oncological outcomes of RPN appear to be favourable, long-term data is awaited.

  10. Virtual reality simulator training of laparoscopic cholecystectomies - a systematic review.

    Science.gov (United States)

    Ikonen, T S; Antikainen, T; Silvennoinen, M; Isojärvi, J; Mäkinen, E; Scheinin, T M

    2012-01-01

    Simulators are widely used in occupations where practice in authentic environments would involve high human or economic risks. Surgical procedures can be simulated by increasingly complex and expensive techniques. This review gives an update on computer-based virtual reality (VR) simulators in training for laparoscopic cholecystectomies. From leading databases (Medline, Cochrane, Embase), randomised or controlled trials and the latest systematic reviews were systematically searched and reviewed. Twelve randomised trials involving simulators were identified and analysed, as well as four controlled studies. Furthermore, seven studies comparing black boxes and simulators were included. The results indicated any kind of simulator training (black box, VR) to be beneficial at novice level. After VR training, novice surgeons seemed to be able to perform their first live cholecystectomies with fewer errors, and in one trial the positive effect remained during the first ten cholecystectomies. No clinical follow-up data were found. Optimal learning requires skills training to be conducted as part of a systematic training program. No data on the cost-benefit of simulators were found, the price of a VR simulator begins at EUR 60 000. Theoretical background to learning and limited research data support the use of simulators in the early phases of surgical training. The cost of buying and using simulators is justified if the risk of injuries and complications to patients can be reduced. Developing surgical skills requires repeated training. In order to achieve optimal learning a validated training program is needed.

  11. Laparoscopic myomectomy in Kenya : A 15 year retrospective review

    African Journals Online (AJOL)

    ... advantages of laparoscopic surgery including less haemorrhage, quicker recovery and return to work. The clinical outcomes are good and there were no major complications. The fertility outcomes are comparable to open myomectomy with better outcomes for sub mucous fibroids and deep intra-mural fibroids indenting ...

  12. Human capital gains associated with robotic assisted laparoscopic pyeloplasty in children compared to open pyeloplasty.

    Science.gov (United States)

    Behan, James W; Kim, Steve S; Dorey, Frederick; De Filippo, Roger E; Chang, Andy Y; Hardy, Brian E; Koh, Chester J

    2011-10-01

    Robotic assisted laparoscopic pyeloplasty is an emerging, minimally invasive alternative to open pyeloplasty in children for ureteropelvic junction obstruction. The procedure is associated with smaller incisions and shorter hospital stays. To our knowledge previous outcome analyses have not included human capital calculations, especially regarding loss of parental workdays. We compared perioperative factors in patients who underwent robotic assisted laparoscopic and open pyeloplasty at a single institution, especially in regard to human capital changes, in an institutional cost analysis. A total of 44 patients 2 years old or older from a single institution underwent robotic assisted (37) or open (7) pyeloplasty from 2008 to 2010. We retrospectively reviewed the charts to collect demographic and perioperative data. The human capital approach was used to calculate parental productivity losses. Patients who underwent robotic assisted laparoscopic pyeloplasty had a significantly shorter average hospital length of stay (1.6 vs 2.8 days, p human capital gains, eg decreased lost parental wages, and lower hospitalization expenses. Future comparative outcome analyses in children should include financial factors such as human capital loss, which can be especially important for families with young children. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  13. Urinary tract injuries in laparoscopic hysterectomy: a systematic review.

    Science.gov (United States)

    Adelman, Marisa R; Bardsley, Tyler R; Sharp, Howard T

    2014-01-01

    The aim of this review was to estimate the incidence of urinary tract injuries associated with laparoscopic hysterectomy and describe the long-term sequelae of these injuries and the impact of early recognition. Studies were identified by searching the PubMed database, spanning the last 10 years. The key words "ureter" or "ureteral" or "urethra" or "urethral" or "bladder" or "urinary tract" and "injury" and "laparoscopy" or "robotic" and "gynecology" were used. Additionally, a separate search was done for "routine cystoscopy" and "gynecology." The inclusion criteria were published articles of original research referring to urologic injuries occurring during either laparoscopic or robotic surgery for gynecologic indications. Only English language articles from the past 10 years were included. Studies with less than 100 patients and no injuries reported were excluded. No robotic series met these criteria. A primary search of the database yielded 104 articles, and secondary cross-reference yielded 6 articles. After reviewing the abstracts, 40 articles met inclusion criteria and were reviewed in their entirety. Of those 40 articles, 3 were excluded because of an inability to extract urinary tract injuries from total injuries. Statistical analysis was performed using a generalized linear mixed effects model. The overall urinary tract injury rate for laparoscopic hysterectomy was 0.73%. The bladder injury rate ranged from 0.05% to 0.66% across procedure types, and the ureteral injury rate ranged from 0.02% to 0.4% across procedure type. In contrast to earlier publications, which cited unacceptably high urinary tract injury rates, laparoscopic hysterectomy appears to be safe regarding the bladder and ureter. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  14. A single centre comparative study of laparoscopic mesh rectopexy versus suture rectopexy

    Directory of Open Access Journals (Sweden)

    Manash Ranjan Sahoo

    2014-01-01

    Full Text Available Aim: The aim of our study is to compare the results of laparoscopic mesh vs. suture rectopexy. Materials and Methods: In this retrospective study, 70 patients including both male and female of age ranging between 20 years and 65 years (mean 42.5 yrs were subjected to laparoscopic rectopexy during the period between March 2007 and June 2012, of which 38 patients underwent laparoscopic mesh rectopexy and 32 patients laparoscopic suture rectopexy. These patients were followed up for a mean period of 12 months assessing first bowel movement, hospital stay, duration of surgery, faecal incontinence, constipation, recurrence and morbidity. Results: Duration of surgery was 100.8 ± 12.4 minutes in laparoscopic suture rectopexy and 120 ± 10.8 min in laparoscopic mesh rectopexy. Postoperatively, the mean time for the first bowel movement was 38 hrs and 40 hrs, respectively, for suture and mesh rectopexy. Mean hospital stay was five (range: 4-7 days. There was no significant postoperative complication except for one port site infection in mesh rectopexy group. Patients who had varying degree of incontinence preoperatively showed improvement after surgery. Eleven out of 18 (61.1% patients who underwent laparoscopic suture rectopexy as compared to nine of 19 (47.3% patients who underwent laparoscopic mesh rectopexy improved as regards constipation after surgery. Conclusion: There were no significant difference in both groups who underwent surgery except for patients undergoing suture rectopexy had better symptomatic improvement of continence and constipation. Also, cost of mesh used in laparoscopic mesh rectopexy is absent in lap suture rectopexy group. To conclude that laparoscopic suture rectopexy is a safe and feasible procedure and have comparable results as regards operative time, morbidity, bowel function, cost and recurrence or even slightly better results than mesh rectopexy.

  15. Laparoscopic splenectomy: Current concepts

    Science.gov (United States)

    Misiakos, Evangelos P; Bagias, George; Liakakos, Theodore; Machairas, Anastasios

    2017-01-01

    Since early 1990’s, when it was inaugurally introduced, laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications. Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen. However some contraindications still apply. The evolution of the technology has allowed though, cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches. Moreover, the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications. Today, laparoscopic splenectomy is considered safe, with better outcomes in comparison to open splenectomy, and the increased experience of surgeons allows operative times comparable to those of an open splenectomy. In this review we discuss the indications and the contraindications of laparoscopic splenectomy. Moreover we analyze the standard and modified surgical approaches, and we evaluate the short-term and long-term outcomes. PMID:28979707

  16. Laparoscopic esophagomyotomy for achalasia in children: A review

    Science.gov (United States)

    Pandian, T Kumar; Naik, Nimesh D; Fahy, Aodhnait S; Arghami, Arman; Farley, David R; Ishitani, Michael B; Moir, Christopher R

    2016-01-01

    Esophageal achalasia in children is rare but ultimately requires endoscopic or surgical treatment. Historically, Heller esophagomyotomy has been recommended as the treatment of choice. The refinement of minimally invasive techniques has shifted the trend of treatment toward laparoscopic Heller myotomy (LHM) in adults and children with achalasia. A review of the available literature on LHM performed in patients 5 years) outcomes is needed. Due to the infrequency of achalasia in children, these characteristics are unlikely to be defined without collaboration between multiple pediatric surgery centers. The introduction of peroral endoscopic myotomy and single-incision techniques, continue the trend of innovative approaches that may eventually become the standard of care. PMID:26839646

  17. Robotic, laparoscopic and open surgery for gastric cancer compared on surgical, clinical and oncological outcomes: a multi-institutional chart review. A study protocol of the International study group on Minimally Invasive surgery for GASTRIc Cancer—IMIGASTRIC

    Science.gov (United States)

    Desiderio, Jacopo; Jiang, Zhi-Wei; Nguyen, Ninh T; Zhang, Shu; Reim, Daniel; Alimoglu, Orhan; Azagra, Juan-Santiago; Yu, Pei-Wu; Coburn, Natalie G; Qi, Feng; Jackson, Patrick G; Zang, Lu; Brower, Steven T; Kurokawa, Yukinori; Facy, Olivier; Tsujimoto, Hironori; Coratti, Andrea; Annecchiarico, Mario; Bazzocchi, Francesca; Avanzolini, Andrea; Gagniere, Johan; Pezet, Denis; Cianchi, Fabio; Badii, Benedetta; Novotny, Alexander; Eren, Tunc; Leblebici, Metin; Goergen, Martine; Zhang, Ben; Zhao, Yong-Liang; Liu, Tong; Al-Refaie, Waddah; Ma, Junjun; Takiguchi, Shuji; Lequeu, Jean-Baptiste; Trastulli, Stefano; Parisi, Amilcare

    2015-01-01

    Introduction Gastric cancer represents a great challenge for healthcare providers and requires a multidisciplinary treatment approach in which surgery plays a major role. Minimally invasive surgery has been progressively developed, first with the advent of laparoscopy and recently with the spread of robotic surgery, but a number of issues are currently being debated, including the limitations in performing an effective extended lymph node dissection, the real advantages of robotic systems, the role of laparoscopy for Advanced Gastric Cancer, the reproducibility of a total intracorporeal technique and the oncological results achievable during long-term follow-up. Methods and analysis A multi-institutional international database will be established to evaluate the role of robotic, laparoscopic and open approaches in gastric cancer, comprising of information regarding surgical, clinical and oncological features. A chart review will be conducted to enter data of participants with gastric cancer, previously treated at the participating institutions. The database is the first of its kind, through an international electronic submission system and a HIPPA protected real time data repository from high volume gastric cancer centres. Ethics and dissemination This study is conducted in compliance with ethical principles originating from the Helsinki Declaration, within the guidelines of Good Clinical Practice and relevant laws/regulations. A multicentre study with a large number of patients will permit further investigation of the safety and efficacy as well as the long-term outcomes of robotic, laparoscopic and open approaches for the management of gastric cancer. Trial registration number NCT02325453; Pre-results. PMID:26482769

  18. Laparoscopic, robotic and open method of radical hysterectomy for cervical cancer: A systematic review

    Directory of Open Access Journals (Sweden)

    Puliyath Geetha

    2012-01-01

    Full Text Available Background : Over the last two decades, numerous studies have indicated the feasibility of minimally invasive surgery for early cervical cancer without compromising the oncological outcome. Objective : Systematic literature review and meta analysis aimed at evaluating the outcome of laparoscopic and robotic radical hysterectomy (LRH and RRH and comparing the results with abdominal radical hysterectomy (ARH. Search Strategy : Medline, PubMed, Embase, Cochrane library and Reference lists were searched for articles published until January 31 st 2011, using the terms radical hysterectomy, laparoscopic radical hysterectomy, robotic radical hysterectomy, surgical treatment of cervical cancer and complications of radical hysterectomy. Selection Criteria : Studies that reported outcome measures of radical hysterectomy by open method, laparoscopic and robotic methods were selected. Data collection and analysis: Two independent reviewers selected studies, abstracted and tabulated the data and pooled estimates were obtained on the surgical and oncological outcomes. Results : Mean sample size, age and body mass index across the three types of RH studies were similar. Mean operation time across the three types of RH studies was comparable. Mean blood loss and transfusion rate are significantly higher in ARH compared to both LRH and RRH. Duration of stay in hospital for RRH was significantly less than the other two methods. The mean number of lymph nodes obtained, nodal metastasis and positive margins across the three types of RH studies were similar. Post operative infectious morbidity was significantly higher among patients who underwent ARH compared to the other two methods and a higher rate of cystotomy in LRH. Conclusions : Minimally invasive surgery especially robotic radical hysterectomy may be a better and safe option for surgical treatment of cervical cancer. The laparoscopic method is not free from complications. However, experience of surgeon may

  19. Direct hospital costs of total laparoscopic hysterectomy compared with fast-track open hysterectomy at a tertiary hospital: a retrospective case-controlled study.

    Science.gov (United States)

    Rhou, Yoon J J; Pather, Selvan; Loadsman, John A; Campbell, Neil; Philp, Shannon; Carter, Jonathan

    2015-12-01

    To assess the direct intraoperative and postoperative costs in women undergoing total laparoscopic hysterectomy and fast-track open hysterectomy. A retrospective review of the direct hospital-related costs in a matched cohort of women undergoing total laparoscopic hysterectomy (TLH) and fast-track open hysterectomy (FTOH) at a tertiary hospital. All costs were calculated, including the cost of advanced high-energy laparoscopic devices. The effect of the learning curve on cost in laparoscopic hysterectomy was also assessed, as was the hospital case-weighted cost, which was compared with the actual cost. Fifty women were included in each arm of the study. TLH had a higher intraoperative cost, but a lower postoperative cost than FTOH (AUD$3877 vs AUD$2776 P funding model in our hospital is inaccurate when compared to directly calculated hospital costs. © 2013 The Authors ANZJOG © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  20. Multicenter comparative study of laparoscopic and open distal pancreatectomy using propensity score-matching.

    Science.gov (United States)

    Nakamura, Masafumi; Wakabayashi, Go; Miyasaka, Yoshihiro; Tanaka, Masao; Morikawa, Takanori; Unno, Michiaki; Tajima, Hiroshi; Kumamoto, Yusuke; Satoi, Sohei; Kwon, Masanori; Toyama, Hirochika; Ku, Yonson; Yoshitomi, Hideyuki; Nara, Satoshi; Shimada, Kazuaki; Yokoyama, Takahide; Miyagawa, Shinichi; Toyama, Yoichi; Yanaga, Katsuhiko; Fujii, Tsutomu; Kodera, Yasuhiro; Tomiyama, Yasuyuki; Miyata, Hiroaki; Takahara, Takeshi; Beppu, Toru; Yamaue, Hiroki; Miyazaki, Masaru; Takada, Tadahiro

    2015-10-01

    Laparoscopic distal pancreatectomy has been shown to be associated with favorable postoperative outcomes using meta-analysis. However, there have been no randomized controlled studies yet. This study aimed to compare laparoscopic and open distal pancreatectomy using propensity score-matching. We retrospectively collected perioperative data of 2,266 patients who underwent distal pancreatectomy in 69 institutes from 2006-2013 in Japan. Among them, 2,010 patients were enrolled in this study and divided into two groups, laparoscopic distal pancreatectomy and open distal pancreatectomy. Perioperative outcomes were compared between the groups using unmatched and propensity matched analysis. After propensity score-matching, laparoscopic distal pancreatectomy was associated with favorable perioperative outcomes compared with open distal pancreatectomy, including higher rate of preservation of spleen and splenic vessels (P pancreatectomy was associated with more favorable perioperative outcomes than open distal pancreatectomy. © 2015 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  1. Robotic distal pancreatectomy versus conventional laparoscopic distal pancreatectomy: a comparative study for short-term outcomes.

    Science.gov (United States)

    Lai, Eric C H; Tang, Chung Ngai

    2015-09-01

    Robotic system has been increasingly used in pancreatectomy. However, the effectiveness of this method remains uncertain. This study compared the surgical outcomes between robot-assisted laparoscopic distal pancreatectomy and conventional laparoscopic distal pancreatectomy. During a 15-year period, 35 patients underwent minimally invasive approach of distal pancreatectomy in our center. Seventeen of these patients had robot-assisted laparoscopic approach, and the remaining 18 had conventional laparoscopic approach. Their operative parameters and perioperative outcomes were analyzed retrospectively in a prospective database. The mean operating time in the robotic group (221.4 min) was significantly longer than that in the laparoscopic group (173.6 min) (P = 0.026). Both robotic and conventional laparoscopic groups presented no significant difference in spleen-preservation rate (52.9% vs. 38.9%) (P = 0.505), operative blood loss (100.3 ml vs. 268.3 ml) (P = 0.29), overall morbidity rate (47.1% vs. 38.9%) (P = 0.73), and post-operative hospital stay (11.4 days vs. 14.2 days) (P = 0.46). Both groups also showed no perioperative mortality. Similar outcomes were observed in robotic distal pancreatectomy and conventional laparoscopic approach. However, robotic approach tended to have the advantages of less blood loss and shorter hospital stay. Further studies are necessary to determine the clinical position of robotic distal pancreatectomy.

  2. Comparative study of oncologic outcomes for laparoscopic vs. open surgery in transverse colon cancer.

    Science.gov (United States)

    Kim, Woo Ram; Baek, Se Jin; Kim, Chang Woo; Jang, Hyun A; Cho, Min Soo; Bae, Sung Uk; Hur, Hyuk; Min, Byung Soh; Baik, Seung Hyuk; Lee, Kang Young; Kim, Nam Kyu; Sohn, Seung Kuk

    2014-01-01

    Laparoscopic resection for transverse colon cancer is a technically challenging procedure that has been excluded from various large randomized controlled trials of which the long-term outcomes still need to be verified. The purpose of this study was to evaluate long-term oncologic outcomes for transverse colon cancer patients undergoing laparoscopic colectomy (LAC) or open colectomy (OC). This retrospective review included patients with transverse colon cancer who received a colectomy between January 2006 and December 2010. Short-term and five-year oncologic outcomes were compared between these groups. A total of 131 patients were analyzed in the final study (LAC, 84 patients; OC, 47 patients). There were no significant differences in age, gender, body mass index, tumor location, operative procedure, or blood loss between groups, but the mean operative time in LAC was significantly longer (LAC, 246.8 minutes vs. OC, 213.8 minutes; P = 0.03). Hospital stay was much shorter for LAC than OC (9.1 days vs. 14.5 days, P transverse colon cancer is feasible and safe with comparable short- and long-term outcomes.

  3. Laparoscopic Anterior Versus Posterior Fundoplication for Gastroesophageal Reflux Disease Systematic Review and Meta-Analysis of Randomized Clinical Trials

    NARCIS (Netherlands)

    Broeders, Joris A.; Roks, David J.; Ahmed Ali, Usama; Draaisma, Werner A.; Smout, André J.; Hazebroek, Eric J.

    2011-01-01

    Objective: To compare short- and long-term outcome after laparoscopic anterior fundoplication (LAF) versus posterior fundoplication (LPF) through a systematic review and meta-analysis of randomized clinical trials (RCTs). Summary of Background Data: LPF is currently considered the surgical therapy

  4. Retrospective cost analysis comparing Essure hysteroscopic sterilization and laparoscopic bilateral tubal coagulation.

    Science.gov (United States)

    Hopkins, Matthew R; Creedon, Douglas J; Wagie, Amy E; Williams, Arthur R; Famuyide, Abimbola O

    2007-01-01

    To compare the institutional cost of permanent female sterilization by Essure hysteroscopic sterilization and laparoscopic bilateral coagulation. Retrospective cohort study (Canadian Task Force classification II-2). Midwestern academic medical center. Women of reproductive age who elected for permanent contraception by the Essure method (n = 43) or by laparoscopic tubal coagulation (n = 44) during the time frame studied. Placement of the Essure inserts according to the manufacturer's instructions or laparoscopic tubal sterilization using bipolar forceps according to standard techniques of open or closed laparoscopy. Cost-center data for the institutional cost of the procedure was abstracted for each patient included in the study. In addition, demographic data and procedural information were obtained and compared for the patient populations. The Essure system of hysteroscopic sterilization had a significantly decreased cost compared with laparoscopic tubal sterilization when both procedures were performed in an operating room setting. The decrease per patient in institutional cost was 180 dollars (p = .038). This included the cost of the confirmatory hysterosalpingogram 3 months after Essure placement and the cost of laparoscopic tubal occlusion by Filshie clip if the Essure micro-inserts could not be placed. The majority of the cost was related to hospital costs as opposed to physician costs. The Essure procedure had higher costs for disposable equipment (p Essure hysteroscopic sterilization had significant cost savings compared with laparoscopic tubal sterilization (p = .038). We believe that our data represent the minimum of potential savings using this approach, and future developments will only increase the cost difference found in our study.

  5. Multicenter review of robotic versus laparoscopic ventral hernia repair: is there a role for robotics?

    Science.gov (United States)

    Walker, Peter A; May, Audriene C; Mo, Jiandi; Cherla, Deepa V; Santillan, Monica Rosales; Kim, Steven; Ryan, Heidi; Shah, Shinil K; Wilson, Erik B; Tsuda, Shawn

    2018-04-01

    The utilization of robotic platforms for general surgery procedures such as hernia repair is growing rapidly in the United States. A limited amount of data are available evaluating operative outcomes in comparison to standard laparoscopic surgery. We completed a retrospective review comparing robotic and laparoscopic ventral hernia repair to provide safety and outcomes data to help design a future prospective trial design. A retrospective review of 215 patients undergoing ventral hernia repair (142 robotic and 73 laparoscopic) was completed at two large academic centers. Primary outcome measure evaluated was recurrence. Secondary outcomes included incidence of primary fascial closure, and surgical site occurrences. Propensity for treatment match comparison demonstrated that robotic repair was associated with a decreased incidence of recurrence (2.1 versus 4.2%, p robotic repair was associated with increased incidence of primary fascial closure (77.1 versus 66.7%, p robotic repairs were completed on patients with lower body mass index (28.1 ± 3.6 versus 34.2 ± 6.4, p robotic repair was associated with decreased recurrence and surgical site occurrence. However, the differences noted in the patient populations limit the interpretability of these results. As adoption of robotic ventral hernia repair increases, prospective trials need to be designed in order to investigate the efficacy, safety, and cost effectiveness of this evolving technique.

  6. Robotic-assisted laparoscopic partial nephrectomy: initial experience in Brazil and a review of the literature

    Directory of Open Access Journals (Sweden)

    Carlo Camargo Passerotti

    2012-02-01

    Full Text Available CONTEXT AND PURPOSE: Partial nephrectomy has become the standard of care for renal tumors less than 4 cm in diameter. Controversy still exists, however, regarding the best surgical approach, especially when minimally invasive techniques are taken into account. Robotic-assisted laparoscopic partial nephrectomy (RALPN has emerged as a promising technique that helps surgeons achieve the standards of open partial nephrectomy care while offering a minimally invasive approach. The objective of the present study was to describe our initial experience with robotic-assisted laparoscopic partial nephrectomy and extensively review the pertinent literature. MATERIALS AND METHODS: Between August 2009 and February 2010, eight consecutive selected patients with contrast enhancing renal masses observed by CT were submitted to RALPN in a private institution. In addition, we collected information on the patients' demographics, preoperative tumor characteristics and detailed operative, postoperative and pathological data. In addition, a PubMed search was performed to provide an extensive review of the robotic-assisted laparoscopic partial nephrectomy literature. RESULTS: Seven patients had RALPN on the left or right sides with no intraoperative complications. One patient was electively converted to a robotic-assisted radical nephrectomy. The operative time ranged from 120 to 300 min, estimated blood loss (EBL ranged from 75 to 400 mL and, in five cases, the warm ischemia time (WIT ranged from 18 to 32 min. Two patients did not require any clamping. Overall, no transfusions were necessary, and there were no intraoperative complications or adverse postoperative clinical events. All margins were negative, and all patients were disease-free at the 6-month follow-up. CONCLUSIONS: Robotic-assisted laparoscopic partial nephrectomy is a feasible and safe approach to small renal cortical masses.Further prospective studies are needed to compare open partial nephrectomy with

  7. Review of laparoscopic training in pediatric surgery in the United Kingdom.

    Science.gov (United States)

    Stormer, Emma J; Sabharwal, Atul J

    2009-04-01

    To review the exposure pediatric surgery trainees have to laparoscopic surgery in the United Kingdom (UK). A confidential postal questionnaire was sent to all trainees working at registrar level in centers responsible for pediatric surgical training in the UK. Questions assessed the number of consultants with an interest in laparoscopic surgery, types of cases performed laparoscopically, and trainees' role in laparoscopic appendicectomy (LA). Questionnaires were sent to 112 trainees with a 55% response rate (62 replies). At least one response was received from each unit. Based on responses, 49 to 67 consultants in 21 training centers have an interest in laparoscopic surgery (0%-100% of consultants per unit). LA was offered in 20 out of 21 training centers. There was no significant difference in the proportion of appendicectomies performed laparoscopically by junior (years 1-3) and senior (years 4-6) trainees. A significantly higher proportion of junior trainees had not performed any LAs (P = 0.02). Seventy-three percent of trainees were the principal operator. For trainees who were principal operators, the cameraperson was a consultant in 52% and a junior trainee in 17%. The time of day affected the likelihood of a procedure being carried out laparoscopically in 43 (81%) responses. The majority of trainees' exposure to laparoscopic surgery could be viewed as suboptimal; however, the exposure gained varies significantly between different units throughout the UK. In an age moving in favor of minimal access surgery, all units must be in a position to offer pediatric laparoscopic surgical training.

  8. Colorectal cancer surgery in the very elderly patient: a systematic review of laparoscopic versus open colorectal resection.

    Science.gov (United States)

    Devoto, Laurence; Celentano, Valerio; Cohen, Richard; Khan, Jim; Chand, Manish

    2017-09-01

    Colorectal cancer is the second most common cause of death from neoplastic disease in men and third in women of all ages. Globally, life expectancy is increasing, and consequently, an increasing number of operations are being performed on more elderly patients with the trend set to continue. Elderly patients are more likely to have cardiovascular and pulmonary comorbidities that are associated with increased peri-operative risk. They further tend to present with more locally advanced disease, more likely to obstruct or have disseminated disease. The aim of this review was to investigate the feasibility of laparoscopic colorectal resection in very elderly patients, and whether there are benefits over open surgery for colorectal cancer. A systematic literature search was performed on Medline, Pubmed, Embase and Google Scholar. All comparative studies evaluating patients undergoing laparoscopic versus open surgery for colorectal cancer in the patients population over 85 were included. The primary outcomes were 30-day mortality and 30-day overall morbidity. Secondary outcomes were operating time, time to oral diet, number of retrieved lymph nodes, blood loss and 5-year survival. The search provided 1507 citations. Sixty-nine articles were retrieved for full text analysis, and only six retrospective studies met the inclusion criteria. Overall mortality for elective laparoscopic resection was 2.92% and morbidity 23%. No single study showed a significant difference between laparoscopic and open surgery for morbidity or mortality, but pooled data analysis demonstrated reduced morbidity in the laparoscopic group (p = 0.032). Patients undergoing laparoscopic surgery are more likely to have a shorter hospital stay and a shorter time to oral diet. Elective laparoscopic resection for colorectal cancer in the over 85 age group is feasible and safe and offers similar advantages over open surgery to those demonstrated in patients of younger ages.

  9. Laparoscopic Pediatric Inguinal Hernia Repair: Overview of "True Herniotomy" Technique and Review of Current Evidence.

    Science.gov (United States)

    Feehan, Brendan P; Fromm, David S

    2017-05-01

    Inguinal hernia repair is one of the most commonly performed operations in the pediatric population. While the majority of pediatric surgeons routinely use laparoscopy in their practices, a relatively small number prefer a laparoscopic inguinal hernia repair over the traditional open repair. This article provides an overview of the three port laparoscopic technique for inguinal hernia repair, as well as a review of the current evidence with respect to visualization and identification of hernias, recurrence rates, operative times, complication rates, postoperative pain, and cosmesis. The laparoscopic repair presents a viable alternative to open repair and offers a number of benefits over the traditional approach. These include superior visualization of the relevant anatomy, ability to assess and repair a contralateral hernia, lower rates of metachronous hernia, shorter operative times in bilateral hernia, and the potential for lower complication rates and improved cosmesis. This is accomplished without increasing recurrence rates or postoperative pain. Further research comparing the different approaches, including standardization of techniques and large randomized controlled trials, will be needed to definitively determine which is superior. Copyright© South Dakota State Medical Association.

  10. Safety and efficacy of hysteroscopic sterilization compared with laparoscopic sterilization: an observational cohort study

    Science.gov (United States)

    Mao, Jialin; Pfeifer, Samantha; Schlegel, Peter

    2015-01-01

    Objective To compare the safety and efficacy of hysteroscopic sterilization with the “Essure” device with laparoscopic sterilization in a large, all-inclusive, state cohort. Design Population based cohort study. Settings Outpatient interventional setting in New York State. Participants Women undergoing interval sterilization procedure, including hysteroscopic sterilization with Essure device and laparoscopic surgery, between 2005 and 2013. Main outcomes measures Safety events within 30 days of procedures; unintended pregnancies and reoperations within one year of procedures. Mixed model accounting for hospital clustering was used to compare 30 day and 1 year outcomes, adjusting for patient characteristics and other confounders. Time to reoperation was evaluated using frailty model for time to event analysis. Results We identified 8048 patients undergoing hysteroscopic sterilization and 44 278 undergoing laparoscopic sterilization between 2005 and 2013 in New York State. There was a significant increase in the use of hysteroscopic procedures during this period, while use of laparoscopic sterilization decreased. Patients undergoing hysteroscopic sterilization were older than those undergoing laparoscopic sterilization and were more likely to have a history of pelvic inflammatory disease (10.3% v 7.2%, P<0.01), major abdominal surgery (9.4% v 7.9%, P<0.01), and cesarean section (23.2% v 15.4%, P<0.01). At one year after surgery, hysteroscopic sterilization was not associated with a higher risk of unintended pregnancy (odds ratio 0.84 (95% CI 0.63 to 1.12)) but was associated with a substantially increased risk of reoperation (odds ratio 10.16 (7.47 to 13.81)) compared with laparoscopic sterilization. Conclusions Patients undergoing hysteroscopic sterilization have a similar risk of unintended pregnancy but a more than 10-fold higher risk of undergoing reoperation compared with patients undergoing laparoscopic sterilization. Benefits and risks of both procedures

  11. Optimal training design for procedural motor skills: a review and application to laparoscopic surgery

    NARCIS (Netherlands)

    Spruit, E.N.; Band, G.P.H.; Hamming, J.F.; Ridderinkhof, K.R.

    2014-01-01

    This literature review covers the choices to consider in training complex procedural, perceptual and motor skills. In particular, we focus on laparoscopic surgery. An overview is provided of important training factors modulating the acquisition, durability, transfer, and efficiency of trained

  12. Laparoscopic colectomy for transverse colon cancer: comparative analysis of short- and long-term outcomes.

    Science.gov (United States)

    Sheng, Weizheng; Zhang, Bo; Chen, Weifeng; Gu, Dayong; Gao, Weidong

    2015-01-01

    This study evaluated the short- and long-term outcomes of laparoscopic colectomy compared with open colectomy for patients with transverse colon cancer by matched-pair analysis. This study enrolled 59 patients who underwent laparoscopic colectomy and compared them with 59 matched patients who underwent open colectomy for transverse colon cancer. The following parameters were matched: clinical stage and type of resection. Both short- and long-term outcomes of laparoscopic colectomy were compared with those of open colectomy. No difference was observed between the two groups in terms of age, gender, ASA score, comorbidity, clinical stage and operative procedures. Regarding short-term outcomes, blood loss, time to first flatus, time to liquid diet and postoperative stay were significantly shorter in the laparoscopy group than in the open group, while operation time was significantly longer in the laparoscopy group than in the open group. Postoperative complication was similar between the two groups. With respect to long-term outcomes, the two groups did not differ significantly in terms of 5-year overall and disease-free survival. In summary, laparoscopic colectomy is a safe and feasible option for selected patients with transverse colon cancer. The short- and long-term outcomes of laparoscopic colectomy are considered to be acceptable.

  13. Comparative prospective randomized trial: laparoscopic versus open common bile duct exploration

    Directory of Open Access Journals (Sweden)

    Vladimir Grubnik

    2011-06-01

    Full Text Available Introduction: Single-stage laparoscopic procedures for common bile duct (CBD stones are an alternative treatmentoption to two-stage endo-laparoscopic treatment and to open choledocholithotomy. Several reports have demonstratedthe feasibility, safety, efficiency and cost-effectiveness of laparoscopic techniques.Aim: To analyse the safety and benefits of laparoscopic compared to open common bile duct (CBD exploration.Material and methods: The prospective randomized trial included a total of 256 patients with CBD stones operated from2005 to 2009 in a single centre. The male/female ratio was 82/174, with a median age 62.3 ±5.8 years (range 27 to 87years. There were two groups of patients. Group I: laparoscopic CBD exploration (138 patients. Group II: open CBD exploration(118 patients. Patient comorbidity was assessed by means of the American Society of Anesthesiologists (ASA classification;ASA II – 109 patients, ASA III – 59 patients. Bile duct stones were visualized preoperatively by means of US examinationin 129 patients, by means of ERCP in 26 patients, and by magnetic resonance cholangiopancreatography (MRCPin 72 patients. Preoperative evaluation was done through medical history, biochemical tests and ultrasonography.Results: The mean duration of laparoscopic procedures was 82 min (range 40-160 min. The mean duration of openprocedures was 90 min (range 60-150 min. Mean blood loss was much lower in the laparoscopic group than in theopen group (20 ±2 v.s 285 ±27, p < 0.01. Postoperative complications were observed in 7 patients of the laparoscopicgroup and in 15 patients in the open group (p < 0.01. Laparoscopic common bile duct exploration was performedthrough a trans-cystic approach in 76 patients and via choledochotomy in 62 patients. The transcystic approach wassuccessful in 76 patients (74.5%. External drainage was used in 25 (32.8% patients with the transcystic approach.Conclusions: Laparoscopic CBD exploration can be performed with

  14. Is laparoscopic surgery the best treatment in fistulas complicating diverticular disease of the sigmoid colon? A systematic review.

    Science.gov (United States)

    Cirocchi, Roberto; Arezzo, Alberto; Renzi, Claudio; Cochetti, Giovanni; D'Andrea, Vito; Fingerhut, Abe; Mearini, Ettore; Binda, Gian Andrea

    2015-12-01

    Laparoscopic surgery is considered in the treatment of diverticular fistula for the possible reduction of overall morbidity and complication rate if compared to open surgery. Aim of this review is to assess the possible advantages deriving from a laparoscopic approach in the treatment of diverticular fistulas of the colon. Studies presenting at least 10 adult patients who underwent laparoscopic surgery for sigmoid diverticular fistula were reviewed. Fistula recurrence, reintervention, Hartmann's procedure or proximal diversion, conversion to laparotomy were the outcomes considered. 11 non randomized studies were included. Rates of fistula recurrence (0.8%), early reintervention (30 days) (2%) and need for Hartmann's procedure or proximal diversion (1.4%) did not show significant difference between laparoscopy and open technique. there is still concern about which surgery in complicated diverticulitis should be preferred. Laparoscopic approach has led to less postoperative pain, shorter hospital stay, faster recovery and better cosmetic results. Laparoscopic resection and primary anastomosis is a possible approach to sigmoid fistulas but its advantages in terms of lower mortality rate and postoperative stay after colon resection with primary anastomosis should be interpreted with caution. When there is firm evidence supporting it, it is likely that minimally invasive surgery should become the standard approach for diverticular fistulas, thus achieving adequate exposure and better visualization of the surgical field. The lack of RCTs, the small sample size, the heterogeneity of literature do not allow to draw statistically significant conclusions on the laparoscopic surgery for fistulas despite this approach is considered safe. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  15. Retroperitoneal laparoscopic pyelolithotomy in renal pelvic stone versus open surgery - a comparative study.

    Science.gov (United States)

    Singal, Rikki; Dhar, Siddharth

    2018-01-01

    The introduction of endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy have led to a revolution in the the management of urinary stone disease. The indications for open stone surgery have been narrowed significantly, making it a second- or third-line treatment option. To study the safety and efficacy of retroperitoneal laparoscopic pyelolithotomy in retroperitoneal renal stone. We compared the results of laparoscopic and open surgery in terms of easy accessibility, operative period, renal injuries, and early recovery. This prospective study was conducted on renal pelvic stone cases from January 2009 to February 2016 in Suchkhand Hospital, Agra, India. The study included a total of 1700 cases with the diagnosis of solitary renal pelvic stones. In group A - 850 cases - retroperitoneal laparoscopic pyelolithotomy was performed, while group B - 850 cases - underwent open pyelolithotomy. The mean operative time was less in group B than group A (74.83 min vs. 94.43 min) which was significant (p<0.001). The blood loss was less in the laparoscopic group than in the open group (63 mL vs. 103mL). There were statistically significant differences in the post-operative pain scores, and postoperative complications compared to group B (p<0.001). The mean hospital stay was less in group A (p<0.03), which was significant. Laparoscopic surgery reduces analgesic requirements, hospital stay, and blood loss. The disadvantages include the reduced working space, the cost of equipment and the availability of a trained surgeon.

  16. Laparoscopic Nephroureterectomy: Oncologic Outcomes and Management of Distal Ureter; Review of the Literature

    Directory of Open Access Journals (Sweden)

    Andre Berger

    2009-01-01

    Full Text Available Introduction. Laparoscopic radical nephroureterectomy (LNU is being increasingly performed at several centers across the world. We review oncologic outcomes after LNU procedure and the techniques for the management of distal ureter. Materials and Methods. A comprehensive review of the literature was performed on the oncological outcomes and management of distal ureter associated with LNU for upper tract transitional cell carcinoma (TCC. Results and Discussion. LNU for upper tract TCC is performed pure laparoscopically (LNU or hand-assisted (HALNU. The management of the distal ureter is still debated. LNU appears to have superior perioperative outcomes when compared to open surgery. Intermediate term oncologic outcomes after LNU are comparable to open nephroureterectomy (ONU. Conclusions. Excision of the distal ureter and bladder cuff during nephroureterectomy remains controversial. Intermediate term oncologic outcomes for LNU compare well with ONU. Initial long-term oncologic outcomes are encouraging. Prospective randomized comparison between LNU and open surgery is needed to define the role of these modalities in the current context.

  17. Laparoscopic surgery compared to traditional abdominal surgery in the management of early stage cervical cancer.

    Science.gov (United States)

    Simsek, T; Ozekinci, M; Saruhan, Z; Sever, B; Pestereli, E

    2012-01-01

    The purpose of the study was to compare laparoscopic total radical hysterectomy with classic radical hysterectomy regarding parametrial, and vaginal resection, and lymphadenectomy. Laparoscopic or laparotomic total radical hysterectomy with advantages and disadvantages was offered to the patients diagnosed as having operable cervical cancer between 2007 and 2010. Lymph node status, resection of the parametria and vagina, and margin positivity were recorded for both groups. Data were collected prospectively. Statistical analysis was performed with the SPSS statistical software program. Totally, 53 cases had classical abdominal radical hysterectomy and 35 laparoscopic radical hysterectomy, respectively. Parametrial involvement was detected in four (11.4%) cases in laparoscopic radical surgery versus nine (16.9%) in laparatomic surgery. All the cases with parametrial involvement had free surgical margins of tumor. Also there were no significant statistical differences in lymph node number and metastasis between the two groups. There is no difference in anatomical considerations between laparoscopic and laparatomic radical surgery in the surgical management of cervical cancer.

  18. Laparoscopic versus open splenectomy in children: a systematic review and meta-analysis.

    Science.gov (United States)

    Feng, Shaoguang; Qiu, Yuhui; Li, Xiang; Yang, Huajun; Wang, Chen; Yang, Junjia; Liu, Weiguang; Wang, Aihe; Yao, Xianming; Lai, Xin-He

    2016-03-01

    We conducted a systematic review and meta-analysis to compare the clinical outcomes between laparoscopic splenectomy and the traditional open splenectomy in children. Literature searches were conducted to identify studies having compared the laparoscopic splenectomy (LS) and open splenectomy (OS) for children. Parameters such as operative time, blood loss, length of postoperative stay, the removal of accessory spleens and postoperative complications including postoperative high fever, acute chest syndrome (ACS), and ileus were pooled and compared by meta-analysis. Among the 922 pediatric participants included in the 10 studies, 508 had received LS and 414 OS. There were shorter length of hospital stays, less blood loss, and longer operative times with the LS approach compared with OS. However, no significant difference was found between LS and OS in the secondary outcome, such as the removal of accessory spleens or postoperative complications including postoperative high fever, ACS, and ileus. LS is a feasible, safe, and effective surgical procedure alternative to OS for pediatric patients. Compared with OS, LS has the advantage of shorter hospital stay and less blood loss. Besides, total postoperative complications may be slightly lower in LS. We conclude that LS should be considered an acceptable option for children.

  19. Cost-utility analysis comparing laparoscopic vs open aortobifemoral bypass surgery

    Directory of Open Access Journals (Sweden)

    Krog AH

    2017-06-01

    .001 in favor of laparoscopic aortobifemoral bypass. The total cost of surgery, equipment and hospital stay after laparoscopic surgery (9,953 € was less than open surgery (17,260 €, (p=0.001. Conclusion: Laparoscopic aortobifemoral bypass seems to be cost-effective compared with open surgery, due to an increase in QALYs and lower procedure-related costs. Keywords: laparoscopy, aortobifemoral bypass, cost-utility, quality-adjusted life years, QALYs, EQ-5D, health-related quality of life, HRQoL, cost-effectiveness

  20. Randomized clinical trial comparing oral prednisone (50 mg) with placebo before laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Bisgaard, Thue; Schulze, S.; Hjortso, N.C.

    2008-01-01

    cholecystectomy. Methods In a double-blind placebo-controlled study, 200 patients were randomized to oral administration of prednisone (50 mg) or placebo 2 h before laparoscopic cholecystectomy. Patients received a similar standardized anaesthetic, surgical, and analgesic treatment. The primary outcome was pain......-h pain, fatigue or malaise scores or any other variables were found (P > 0.05). Conclusion There is no important clinical gain of preoperative oral steroid administration compared with placebo in patients undergoing laparoscopic cholecystectomy Udgivelsesdato: 2008/2...

  1. Economic evaluation of the randomized European Achalasia trial comparing pneumodilation with Laparoscopic Heller myotomy

    NARCIS (Netherlands)

    Moonen, A.; Busch, O.; Costantini, M.; Finotti, E.; Tack, J.; Salvador, R.; Boeckxstaens, G.; Zaninotto, G.

    2017-01-01

    BackgroundA recent multicenter randomized trial in achalasia patients has shown that pneumatic dilation resulted in equivalent relief of symptoms compared to laparoscopic Heller myotomy. Additionally, the cost of each treatment should be also taken in consideration. Therefore, the aim of the present

  2. [Clinical trials of laparoscopic gastric cancer surgery in South Korea: review and prospect].

    Science.gov (United States)

    Zhu, Chunchao; Zhao, Gang; Cao, Hui

    2018-02-25

    Laparoscopic technology is gradually accepted in gastric cancer surgery, whose efficacy has been demonstrated by some clinical researches. Randomized controlled trials (RCT) are considered as the most important evidence to prove clinical outcomes of laparoscopic surgery for gastric cancer. Korean gastric surgeons have made great contributions to RCT in laparoscopic gastric cancer surgery. KLASS (Korean Laparoscopic Gastrointestinal Surgery Study Group) is one of the most important forerunner and global leader of clinical trials of gastric cancer treatment. KLASS series clinical trials are attracting global attention because of the significant value of surgical treatment for gastric cancer. The RCTs in Korea involve in many aspects of laparoscopic gastrectomy for gastric cancer, including laparoscopy application in early gastric cancer (KLASS-01, KLASS-03 and KLASS-07), advanced gastric cancer (KLASS-02 and KLASS-06), function-preserving gastrectomy (KLASS-04,KLASS-05) and sentinel node navigation surgery (SENORITA trial). In order to share some informations of these RCTs, we review and prospect some important clinical trials of laparoscopic gastric cancer surgery in Korea. With the experience of Korean gastric surgeons, we can make more progress in our own clinical trials of laparoscopic gastric cancer surgery.

  3. Virtual reality training in laparoscopic surgery: A systematic review & meta-analysis.

    Science.gov (United States)

    Alaker, Medhat; Wynn, Greg R; Arulampalam, Tan

    2016-05-01

    Laparoscopic surgery requires a different and sometimes more complex skill set than does open surgery. Shortened working hours, less training times, and patient safety issues necessitates that these skills need to be acquired outside the operating room. Virtual reality simulation in laparoscopic surgery is a growing field, and many studies have been published to determine its effectiveness. This systematic review and meta-analysis aims to evaluate virtual reality simulation in laparoscopic abdominal surgery in comparison to other simulation models and to no training. A systematic literature search was carried out until January 2014 in full adherence to PRISMA guidelines. All randomised controlled studies comparing virtual reality training to other models of training or to no training were included. Only studies utilizing objective and validated assessment tools were included. Thirty one randomised controlled trials that compare virtual reality training to other models of training or to no training were included. The results of the meta-analysis showed that virtual reality simulation is significantly more effective than video trainers, and at least as good as box trainers. The use of Proficiency-based VR training, under supervision with prompt instructions and feedback, and the use of haptic feedback, has proven to be the most effective way of delivering the virtual reality training. The incorporation of virtual reality training into surgical training curricula is now necessary. A unified platform of training needs to be established. Further studies to assess the impact on patient outcomes and on hospital costs are necessary. (PROSPERO Registration number: CRD42014010030). Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  4. Systematic review of laparoscopic vs open colonic surgery within an enhanced recovery programme.

    NARCIS (Netherlands)

    Vlug, M. S.; Wind, J.; van der Zaag, J.; Ubbink, D. T.; Cense, H. A.; Bemelman, W. A.

    2009-01-01

    BACKGROUND: Fast track surgery accelerates recovery, reduces morbidity and shortens hospital stay. It is unclear what the effects are of laparoscopic or open surgery within a fast track programme. The aim of this systematic review was to review the existing evidence. METHOD: A systematic review was

  5. Pre-bent instruments used in single-port laparoscopic surgery versus conventional laparoscopic surgery: comparative study of performance in a dry lab.

    Science.gov (United States)

    Miernik, Arkadiusz; Schoenthaler, Martin; Lilienthal, Kerstin; Frankenschmidt, Alexander; Karcz, Wojciech Konrad; Kuesters, Simon

    2012-07-01

    Different types of single-incision laparoscopic surgery (SILS) have become increasingly popular. Although SILS is technically even more challenging than conventional laparoscopy, published data of first clinical series seem to demonstrate the feasibility of these approaches. Various attempts have been made to overcome restrictions due to loss of triangulation in SILS by specially designed SILS-specific instruments. This study involving novices in a dry lab compared task performances between conventional laparoscopic surgery (CLS) and single-port laparoscopic surgery (SPLS) using newly designed pre-bent instruments. In this study, 90 medical students without previous experience in laparoscopic techniques were randomly assigned to undergo one of three procedures: CLS, SPLS using two pre-bent instruments (SPLS-pp), or SPLS using one pre-bent and one straight laparoscopic instrument (SPLS-ps). In the dry lab, the participants performed four typical laparoscopic tasks of increasing difficulty. Evaluation included performance times or number of completed tasks within a given time frame. All performances were videotaped and evaluated for unsuccessful attempts and unwanted interactions of instruments. Using subjective questionnaires, the participants rated difficulties with two-dimensional vision and coordination of instruments. Task performances were significantly better in the CLS group than in either SPLS group. The SPLS-ps group showed a tendency toward better performances than the SPLS-pp group, but the difference was not significant. Video sequences and participants` questionnaires showed instrument interaction as the major problem in the single-incision surgery groups. Although SILS is feasible, as shown in clinical series published by laparoscopically experienced experts, SILS techniques are demanding due to restrictions that come with the loss of triangulation. These can be compensated only partially by currently available SILS-designed instruments. The future of

  6. Laparoscopic peritoneal lavage: our experience and review of the literature.

    Science.gov (United States)

    Parisi, Amilcare; Gemini, Alessandro; Desiderio, Jacopo; Petrina, Adolfo; Trastulli, Stefano; Grassi, Veronica; Sani, Marco; Pironi, Daniele; Santoro, Alberto

    2016-01-01

    Over the years various therapeutic techniques for diverticulitis have been developed. Laparoscopic peritoneal lavage (LPL) appears to be a safe and useful treatment, and it could be an effective alternative to colonic resection in emergency surgery. This prospective observational study aims to assess the safety and benefits of laparoscopic peritoneal lavage in perforated sigmoid diverticulitis. We surgically treated 70 patients urgently for complicated sigmoid diverticulitis. Thirty-two (45.7%) patients underwent resection of the sigmoid colon and creation of a colostomy (Hartmann technique); 21 (30%) patients underwent peritoneal laparoscopic lavage; 4 (5.7%) patients underwent colostomy by the Mikulicz technique; and the remaining 13 (18.6%) patients underwent resection of the sigmoid colon and creation of a colorectal anastomosis with a protective ileostomy. The 66 patients examined were divided into 3 groups: 32 patients were treated with urgent surgery according to the Hartmann procedure; 13 patients were treated with resection and colorectal anastomosis; 21 patients were treated urgently with laparoscopic peritoneal lavage. We had no intraoperative complications. The overall mortality was 4.3% (3 patients). In the LPL group the morbidity rate was 33.3%. Currently it cannot be said that LPL is better in terms of mortality and morbidity than colonic resection. These data may, however, be proven wrong by greater attention in the selection of patients to undergo laparoscopic peritoneal lavage.

  7. Laparoscopic peritoneal lavage: our experience and review of the literature

    Directory of Open Access Journals (Sweden)

    Amilcare Parisi

    2016-05-01

    Full Text Available Introduction : Over the years various therapeutic techniques for diverticulitis have been developed. Laparoscopic peritoneal lavage (LPL appears to be a safe and useful treatment, and it could be an effective alternative to colonic resection in emergency surgery. Aim : This prospective observational study aims to assess the safety and benefits of laparoscopic peritoneal lavage in perforated sigmoid diverticulitis. Material and methods : We surgically treated 70 patients urgently for complicated sigmoid diverticulitis. Thirty-two (45.7% patients underwent resection of the sigmoid colon and creation of a colostomy (Hartmann technique; 21 (30% patients underwent peritoneal laparoscopic lavage; 4 (5.7% patients underwent colostomy by the Mikulicz technique; and the remaining 13 (18.6% patients underwent resection of the sigmoid colon and creation of a colorectal anastomosis with a protective ileostomy. Results : The 66 patients examined were divided into 3 groups: 32 patients were treated with urgent surgery according to the Hartmann procedure; 13 patients were treated with resection and colorectal anastomosis; 21 patients were treated urgently with laparoscopic peritoneal lavage. We had no intraoperative complications. The overall mortality was 4.3% (3 patients. In the LPL group the morbidity rate was 33.3%. Conclusions : Currently it cannot be said that LPL is better in terms of mortality and morbidity than colonic resection. These data may, however, be proven wrong by greater attention in the selection of patients to undergo laparoscopic peritoneal lavage.

  8. A Comparative Study of Single-Port Laparoscopic Surgery Versus Robotic-Assisted Laparoscopic Surgery for Rectal Cancer

    DEFF Research Database (Denmark)

    Levic, Katarina; Donatsky, Anders Meller; Bulut, Orhan

    2015-01-01

    INTRODUCTION: Conventional laparoscopic surgery is the treatment of choice for many abdominal procedures. To further reduce surgical trauma, new minimal invasive procedures such as single-port laparoscopic surgery (SPLS) and robotic assisted laparoscopic surgery (RALS) have emerged. The aim...... in either of the groups. There was no difference in median follow-up time between groups (P = .58). CONCLUSION: Both SPLS and RALS may have a role in rectal surgery. The short-term oncological outcomes were similar, although RALS harvested more lymph nodes than the SPLS procedure. However, SPLS seems...

  9. Clinical effectiveness and cost-effectiveness of laparoscopic surgery for colorectal cancer: systematic reviews and economic evaluation.

    Science.gov (United States)

    Murray, A; Lourenco, T; de Verteuil, R; Hernandez, R; Fraser, C; McKinley, A; Krukowski, Z; Vale, L; Grant, A

    2006-11-01

    The aim of this study was to determine the clinical effectiveness and cost-effectiveness of laparoscopic, laparoscopically assisted (hereafter together described as laparoscopic surgery) and hand-assisted laparoscopic surgery (HALS) in comparison with open surgery for the treatment of colorectal cancer. Electronic databases were searched from 2000 to May 2005. A review of economic evaluations was undertaken by the National Institute for Health and Clinical Excellence in 2001. This review was updated from 2000 until July 2005. Data from selected studies were extracted and assessed. Dichotomous outcome data from individual trials were combined using the relative risk method and continuous outcomes were combined using the Mantel-Haenszel weighted mean difference method. Summaries of the results from individual patient data (IPD) meta-analyses were also presented. An economic evaluation was also carried out using a Markov model incorporating the data from the systematic review. The results were first presented as a balance sheet for comparison of the surgical techniques. It was then used to estimate cost-effectiveness measured in terms of incremental cost per life-year gained and incremental cost per quality-adjusted life-year (QALY) for a time horizon up to 25 years. Forty-six reports on 20 studies [19 randomised controlled trials (RCTs) and one IPD meta-analysis] were included in the review of clinical effectiveness. The RCTs were of generally moderate quality with the number of participants varying between 16 and 1082, with 10 having less than 100 participants. The total numbers of trial participants who underwent laparoscopic or open surgery were 2429 and 2139, respectively. A systematic review of four papers suggested that laparoscopic surgery is more costly than open surgery. However, the data they provided on effectiveness was poorer than the evidence from the review of effectiveness. The estimates from the systematic review of clinical effectiveness were

  10. A systematic review on radiofrequency assisted laparoscopic liver resection: Challenges and window to excel.

    Science.gov (United States)

    Reccia, Isabella; Kumar, Jayant; Kusano, Tomokazu; Zanellato, Artur; Draz, Ahmed; Spalding, Duncan; Habib, Nagy; Pai, Madhava

    2017-09-01

    Laparoscopic liver resection has progressively gained acceptance as a safe and effective procedure in the treatment of benign and malignant liver neoplasms. However, blood loss remains the major challenge in liver surgery. Several techniques and devices have been introduced in liver surgery in order to minimize intraoperative haemorrhage during parenchymal transection. Radiofrequency (RF)-assisted liver resection has been shown to be an effective method to minimize bleeding in open and laparoscopic liver resection. A number of RF devices for parenchymal transection have been designed to assist laparoscopic liver resections. Here we have reviewed the results of various RF devices in laparoscopic liver resection. A total 15 article were considered relevant for the evaluation of technical aspects and outcomes of RF-assisted liver resections in laparoscopic procedures. In these studies, 176 patients had laparoscopic liver resection using RF-assisted parenchymal coagulation. Two monopolar and three bipolar devices were employed. Blood loss was limited in most of the studies. The need of blood transfusions was limited to two cases in all the series. Conversion was necessary due to bleeding in 3 cases. Operative and transection times varied between studies. However, RF-assisted resection with bipolar devices appeared to have taken less time in comparison to other RF devices. RF-related complications were minimum, and only one case of in-hospital death due to hepatic failure was reported. Although RF has been used in a small minority of laparoscopic liver resections, laparoscopic RF-assisted liver resection for benign and malignant disease is a safe and feasible procedure associated with reduction in blood loss, low morbidity, and lower hospital mortality rates. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Off-site training of laparoscopic skills, a scoping review using a thematic analysis.

    Science.gov (United States)

    Thinggaard, Ebbe; Kleif, Jakob; Bjerrum, Flemming; Strandbygaard, Jeanett; Gögenur, Ismail; Matthew Ritter, E; Konge, Lars

    2016-11-01

    The focus of research in simulation-based laparoscopic training has changed from examining whether simulation training works to examining how best to implement it. In laparoscopic skills training, portable and affordable box trainers allow for off-site training. Training outside simulation centers and hospitals can increase access to training, but also poses new challenges to implementation. This review aims to guide implementation of off-site training of laparoscopic skills by critically reviewing the existing literature. An iterative systematic search was carried out in MEDLINE, EMBASE, ERIC, Scopus, and PsychINFO, following a scoping review methodology. The included literature was analyzed iteratively using a thematic analysis approach. The study was reported in accordance with the STructured apprOach to the Reporting In healthcare education of Evidence Synthesis statement. From the search, 22 records were identified and included for analysis. A thematic analysis revealed the themes: access to training, protected training time, distribution of training, goal setting and testing, task design, and unsupervised training. The identified themes were based on learning theories including proficiency-based learning, deliberate practice, and self-regulated learning. Methods of instructional design vary widely in off-site training of laparoscopic skills. Implementation can be facilitated by organizing courses and training curricula following sound education theories such as proficiency-based learning and deliberate practice. Directed self-regulated learning has the potential to improve off-site laparoscopic skills training; however, further studies are needed to demonstrate the effect of this type of instructional design.

  12. Solo-Surgeon Single-Port Laparoscopic Anterior Resection for Sigmoid Colon Cancer: Comparative Study.

    Science.gov (United States)

    Choi, Byung Jo; Jeong, Won Jun; Kim, Say-June; Lee, Sang Chul

    2018-03-01

    To report our experience with solo-surgeon, single-port laparoscopic anterior resection (solo SPAR) for sigmoid colon cancer. Data from sigmoid colon cancer patients who underwent anterior resections (ARs) using the single-port, solo surgery technique (n = 31) or the conventional single-port laparoscopic technique (n = 45), between January 2011 and July 2016, were retrospectively analyzed. In the solo surgeries, making the transumbilical incision into the peritoneal cavity was facilitated through the use of a self-retaining retractor system. After establishing a single port through the umbilicus, an adjustable mechanical camera holder replaced the human scope assistant. Patient and tumor characteristics and operative, pathologic, and postoperative outcomes were compared. The operative times and estimated blood losses were similar for the patients in both treatment groups. In addition, most of the postoperative variables were comparable between the two groups, including postoperative complications and hospital stays. In the solo SPAR group, comparable lymph nodes were attained, and sufficient proximal and distal cut margins were obtained. The difference in the proximal cut margin significantly favored the solo SPAR, compared with the conventional AR group (P = .000). This study shows that solo SPAR, using a passive camera system, is safe and feasible for use in sigmoid colon cancer surgery, if performed by an experienced laparoscopic surgeon. In addition to reducing the need for a surgical assistant, the oncologic requirements, including adequate margins and sufficient lymph node harvesting, could be fulfilled. Further evaluations, including prospective randomized studies, are warranted.

  13. Systematic review and meta-analysis of laparoscopic Nissen (posterior total) versus Toupet (posterior partial) fundoplication for gastro-oesophageal reflux disease

    NARCIS (Netherlands)

    Broeders, J. A. J. L.; Mauritz, F. A.; Ahmed Ali, U.; Draaisma, W. A.; Ruurda, J. P.; Gooszen, H. G.; Smout, A. J. P. M.; Broeders, I. A. M. J.; Hazebroek, E. J.

    2010-01-01

    BACKGROUND: Laparoscopic Nissen fundoplication (LNF) is currently considered the surgical approach of choice for gastro-oesophageal reflux disease (GORD). Laparoscopic Toupet fundoplication (LTF) has been said to reduce troublesome dysphagia and gas-related symptoms. A systematic review and

  14. A systematic review of laparoscopic port site hernias in gastrointestinal surgery.

    LENUS (Irish Health Repository)

    Owens, M

    2012-02-01

    INTRODUCTION: Port site hernia is an important yet under-recognised complication of laparoscopic surgery, which carries a high risk of strangulation due to the small size of the defect involved. The purpose of this study was to examine the incidence, classification, and pathogenesis of this complication, and to evaluate strategies to prevent and treat it. METHODS: Medline was searched using the words "port site hernia", "laparoscopic port hernia" "laparoscopic complications" and "trocar site hernias". The search was limited to articles on cholecystectomy, colorectal, bariatric or anti-reflux surgery published in English. A total of 42 articles were analysed and of these 35 were deemed eligible for review. Inclusion criteria were laparoscopic gastrointestinal surgery in English only with reported incidence of port site herniation. Studies were excluded if insufficient data was provided. Eligible studies were also cross-referenced. RESULTS: Analysis of 11,699 patients undergoing laparoscopic gastrointestinal procedures demonstrated an incidence of port site hernias of 0.74% with a mean follow-up of 23.9 months. The lowest incidence of port site herniation was for bariatric surgery with 0.57% in 2644 patients with a mean follow-up of 67.4 months while the highest incidence was for laparoscopic colorectal surgery with an incidence of 1.47% in 477 patients with a mean follow-up of 71.5 months. CONCLUSION: All fascial defects larger than or equal to 10mm should be closed with peritoneum, while smaller defects may require closure in certain circumstances to prevent herniation. Laparoscopic port site herniation is a completely preventable cause of morbidity that requires a second surgical procedure to repair.

  15. Laparoscopic treatment of colovesical fistulas due to complicated colonic diverticular disease: a systematic review.

    Science.gov (United States)

    Cirocchi, R; Cochetti, G; Randolph, J; Listorti, C; Castellani, E; Renzi, C; Mearini, E; Fingerhut, A

    2014-10-01

    Colovesical fistulas originating from complicated sigmoid diverticular disease are rare. The primary aim of this review was to evaluate the role of laparoscopic surgery in the treatment of this complication. The secondary aim was to determine the best surgical treatment for this disease. A systematic search was conducted for studies published between 1992 and 2012 in PubMed, the Cochrane Register of Controlled Clinical Trials, Scopus, and Publish or Perish. Studies enrolling adults undergoing fully laparoscopic, laparoscopic-assisted, or hand-assisted laparoscopic surgery for colovesical fistula secondary to complicated sigmoid diverticular disease were considered. Data extracted concerned the surgical technique, intraoperative outcomes, and postoperative outcomes based on the Cochrane Consumers and Communication Review Group's template. Descriptive statistics were reported according to the PRISMA statement. In all, 202 patients from 25 studies were included in this review. The standard treatment was laparoscopic colonic resection and primary anastomosis or temporary colostomy with or without resection of the bladder wall. Operative time ranged from 150 to 321 min. It was not possible to evaluate the conversion rate to open surgery because colovesical fistulas were not distinguished from other types of enteric fistulas in most of the studies. One anastomotic leak after bowel anastomosis was reported. There was zero mortality. Few studies conducted follow-up longer than 12 months. One patient required two reoperations. Laparoscopic treatment of colovesical fistulas secondary to sigmoid diverticular disease appears to be a feasible and safe approach. However, further studies are needed to establish whether laparoscopy is preferable to other surgical approaches.

  16. The risk of internal hernia or volvulus after laparoscopic colorectal surgery: a systematic review.

    Science.gov (United States)

    Toh, J W T; Lim, R; Keshava, A; Rickard, M J F X

    2016-12-01

    To determine the incidence of internal hernias after laparoscopic colorectal surgery and evaluate the risk factors and strategies in the management of this serious complication. Two databases (MEDLINE from 1946 and Embase from 1949) were searched to mid-September 2015. The search terms included volvulus or internal hernia and laparoscopic colorectal surgery or colorectal surgery or anterior resection or laparoscopic colectomy. We found 49 and 124 articles on MEDLINE and Embase, respectively, an additional 15 articles were found on reviewing the references. After removal of duplicates, 176 abstracts were reviewed, with 33 full texts reviewed and 15 eligible for qualitative synthesis. The incidence of internal hernia after laparoscopic colorectal surgery is low (0.65%). Thirty-one patients were identified. Five cases were from two prospective studies (5/648, 0.8%), 20 cases were from seven retrospective studies (20/3165, 0.6%) and six patients were from case reports. Of the 31 identified cases, 21 were associated with left-sided resection, four with right sided resection, two with transverse colectomy, one with a subtotal colectomy and in three cases the operation was not specified. The majority of cases (64.3%) were associated with a restorative left sided resection. Nearly all cases occurred within 4 months of surgery. All patients required re-operation and reduction of the internal hernia and 35.7% of cases required a bowel resection. In 52.2% of cases, the mesenteric defect was closed at the second operation and 52.6% of cases were successfully managed laparoscopically. There were three deaths (0.08%). Mesenteric hernias are a rare but important complication of laparoscopic colorectal surgery. The evidence does not support routine closure for all cases, but selective closure of the mesenteric defect during left-sided restorative procedures in high-risk patients at the initial surgery may be considered. Colorectal Disease © 2016 The Association of Coloproctology

  17. Comparative evaluation of two reconstructive methods following laparoscopic assisted subtotal gastrectomy in dogs

    Directory of Open Access Journals (Sweden)

    Bakhtiari Jalal

    2012-12-01

    Full Text Available Abstract Background Laparoscopic gastrectomy is a new and technically challenging surgical procedure with potential benefit. The objective of this study was to investigate clinical and para-clinical consequences following Roux-en-Y and Jejunal Loop interposition reconstructive techniques for subtotal gastrectomy using laparoscopic assisted surgery. Results Following resection of the stomach attachments through a laparoscopic approach, stomach was removed and reconstruction was performed with either standard Roux-en-Y (n = 5 or Jejunal Loop interposition (n = 5 methods. Weight changes were monitored on a daily basis and blood samples were collected on Days 0, 7 and 21 post surgery. A fecal sample was collected on Day 28 after surgery to evaluate fat content. One month post surgery, positive contrast radiography was conducted at 5, 10, 20, 40, 60 and 90 minutes after oral administration of barium sulfate, to evaluate the postoperative complications. There was a gradual decline in body weight in both experimental groups after surgery (P  0.05. Fecal fat content increased in the Roux-en-Y compared to the Jejunal loop interposition technique (P  0.05. Conclusion Roux-en-Y and Jejunal loop interposition techniques might be considered as suitable approaches for reconstructing gastro-intestinal tract following gastrectomy in dogs. The results of this study warrant further investigation with a larger number of animals.

  18. Novel posterior reconstruction technique during robot-assisted laparoscopic prostatectomy: description and comparative outcomes.

    Science.gov (United States)

    Jeong, Chang Wook; Oh, Jong Jin; Jeong, Seong Jin; Hong, Sung Kyu; Byun, Seok-Soo; Choe, Gheeyoung; Lee, Sang Eun

    2012-07-01

    The aim of the present study was to assess the impact of a novel posterior reconstruction technique during robot-assisted laparoscopic prostatectomy on continence recovery. A total of 116 consecutive patients who received the novel posterior reconstruction (case group) were retrospectively compared with a cohort of 126 patients who did not receive posterior reconstruction (control group). The primary end-point was the duration of continence recovery (no pad use) after robot-assisted laparoscopic prostatectomy. The posterior reconstruction was obtained by opposing the median dorsal fibrous raphe to the posterior counterpart of the detrusor apron, rather than the Denonvilliers' fascia. The case group showed higher continence rates at all points of evaluation, which were 2 weeks (30.1% vs 19.8%), 1 month (58.4% vs 45.7%), 3 months (82.7% vs 70.5%) and 6 months postoperatively (95.3% vs 86.4%) (P = 0.007). Application of the novel posterior reconstruction technique, age and length of membranous urethra were significant variables for the complete recovery of continence on multivariable analysis. This study shows that the application of this novel PR technique significantly improves the recovery of continence in patients undergoing robot-assisted laparoscopic prostatectomy. © 2012 The Japanese Urological Association.

  19. RANDOMIZED DOUBLE BLIND STUDY COMPARING ONDANSETRON, PALONOSETRON & GRANISETRON TO PREVENT POST OPERATIVE NAUSEA & VOMITING AFTER LAPAROSCOPIC SURGERIES UNDER GENERAL ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Rajendra

    2015-11-01

    Full Text Available The aim of the study is to compare the efficacy of intravenously administered 5-HT3 receptor antagonists namely Ondansetron, Palonosetron and Granisetron given as prophylaxis for postoperative nausea and vomiting in patients undergoing laparoscopic surgeries under general anaesthesia. A single dose of palonosetron (0.75 µg when given prophylactically results in a significantly lower incidence of PONV after laparoscopic surgeries than ondansetron (4mg and granisetron (2.5mg during the first 24 hours

  20. Minimal invasive treatment of ureteropelvic junction obstruction in low volume pelvis: A comparative study of endopyelotomy and laparoscopic nondismembered pyeloplasty

    OpenAIRE

    Singh, Pratipal; Jain, Paresh; Dharaskar, Anand; Mandhani, Anil; Dubey, Deepak; Kapoor, Rakesh; Kumar, Anant; Srivastava, Aneesh

    2009-01-01

    Objective: To evaluate the role of nondismembered laparoscopic pyeloplasty and percutaneous endopyelotomy for ureteropelvic junction obstruction (UPJO) with low volume renal pelvis. Material and Methods: Retrospective acquired data of 34 patients of laparoscopic nondismembered pyeloplasty was compared with 26 patients of UPJO with pelvic volume less than 50 ml undergoing antegrade endopyelotomy and analyzed for clinical parameters, operative outcomes and success of procedures. All patient...

  1. Cost-effectiveness of laparoscopic versus open distal pancreatectomy for pancreatic cancer

    NARCIS (Netherlands)

    Gurusamy, Kurinchi Selvan; Riviere, Deniece; van Laarhoven, C. J. H.; Besselink, Marc; Abu-Hilal, Mohammed; Davidson, Brian R.; Morris, Steve

    2017-01-01

    A recent Cochrane review compared laparoscopic versus open distal pancreatectomy for people with for cancers of the body and tail of the pancreas and found that laparoscopic distal pancreatectomy may reduce the length of hospital stay. We compared the cost-effectiveness of laparoscopic distal

  2. Cost-effectiveness of laparoscopic versus open distal pancreatectomy for pancreatic cancer

    NARCIS (Netherlands)

    Gurusamy, K.S.; Riviere, D.M.; Laarhoven, C.J.H.M. van; Besselink, M.; Abu-Hilal, M.; Davidson, B.R.; Morris, S.

    2017-01-01

    BACKGROUND: A recent Cochrane review compared laparoscopic versus open distal pancreatectomy for people with for cancers of the body and tail of the pancreas and found that laparoscopic distal pancreatectomy may reduce the length of hospital stay. We compared the cost-effectiveness of laparoscopic

  3. Different types of mesh fixation for laparoscopic repair of inguinal hernia: A protocol for systematic review and network meta-analysis with randomized controlled trials.

    Science.gov (United States)

    Wei, Kongyuan; Lu, Cuncun; Ge, Long; Pan, Bei; Yang, Huan; Tian, Jinhui; Cao, Nong

    2018-04-01

    Laparoscopic inguinal hernia repair has become a valid option for repair of an inguinal hernia. Due to there are several types of mesh fixation for laparoscopic repair of inguinal hernia. The study aims to assess and compare the efficacy of different types of mesh fixation for laparoscopic repair of inguinal hernia using network meta-analysis. We will systematically search PubMed, EMBASE the Cochrane library, and Chinese Biomedical Literature Database from their inception to March 2018. Randomized controlled trials (RCTs) that compared the effect of different types of mesh fixation for laparoscopic inguinal hernia repair will be included. The primary outcomes are chronic groin pain, incidence risk of hernia recurrence, and complications. Risk of bias assessment of the included RCTs will be conducted using to Cochrane risk of bias tool. A network meta-analysis will be performed using WinBUGS 1.4.3 software and the result figures will be generated using R x64 3.1.2 software and STATA V.12.0 software. Grading of Recommendations Assessment, Development and Evaluation (GRADE) will be used to assess the quality of evidence. The results of this study will be published in a peer-reviewed journal. Our study will generate evidence of laparoscopic repair of mesh fixation for adult patients with inguinal hernia and provide suggestions for clinical practice or guideline.

  4. Acquisition and retention of laparoscopic skills is different comparing conventional laparoscopic and single-incision laparoscopic surgery: a single-centre, prospective randomized study.

    Science.gov (United States)

    Ellis, Scott Michael; Varley, Martin; Howell, Stuart; Trochsler, Markus; Maddern, Guy; Hewett, Peter; Runge, Tina; Mees, Soeren Torge

    2016-08-01

    Training in laparoscopic surgery is important not only to acquire and improve skills but also avoid the loss of acquired abilities. The aim of this single-centre, prospective randomized study was to assess skill acquisition of different laparoscopic techniques and identify the point in time when acquired skills deteriorate and training is needed to maintain these skills. Sixty surgical novices underwent laparoscopic surgery (LS) and single-incision laparoscopic surgery (SILS) baseline training (BT) performing two validated tasks (peg transfer, precision cutting). The novices were randomized into three groups and skills retention testing (RT) followed after 8 (group A), 10 (group B) or 12 (group C) weeks accordingly. Task performance was measured in time with time penalties for insufficient task completion. 92 % of the participants completed the BT and managed to complete the task in the required time frame of proficiency. Univariate and multivariate analyses revealed that SILS (P skills (comparison of BT vs RT) was not identified; however, for SILS a significant deterioration of skills (adjustment of BT and RT values) was demonstrated for all groups (A-C) (P skills more difficult to maintain. Acquired LS skills were maintained for the whole observation period of 12 weeks but SILS skills had begun to deteriorate at 8 weeks. These data show that maintenance of LS and SILS skills is divergent and training curricula need to take these specifics into account.

  5. Laparoscopic colectomy for transverse colon carcinoma.

    Science.gov (United States)

    Zmora, O; Bar-Dayan, A; Khaikin, M; Lebeydev, A; Shabtai, M; Ayalon, A; Rosin, D

    2010-03-01

    Laparoscopic resection of transverse colon carcinoma is technically demanding and was excluded from most of the large trials of laparoscopic colectomy. The aim of this study was to assess the safety, feasibility, and outcome of laparoscopic resection of carcinoma of the transverse colon. A retrospective review was performed to identify patients who underwent laparoscopic resection of transverse colon carcinoma. These patients were compared to patients who had laparoscopic resection for right and sigmoid colon carcinoma. In addition, they were compared to a historical series of patients who underwent open resection for transverse colon cancer. A total of 22 patients underwent laparoscopic resection for transverse colon carcinoma. Sixty-eight patients operated for right colon cancer and 64 operated for sigmoid colon cancer served as comparison groups. Twenty-four patients were identified for the historical open group. Intraoperative complications occurred in 4.5% of patients with transverse colon cancer compared to 5.9% (P = 1.0) and 7.8% (P = 1.0) of patients with right and sigmoid colon cancer, respectively. The early postoperative complication rate was 45, 50 (P = 1.0), and 37.5% (P = 0.22) in the three groups, respectively. Conversion was required in 1 (5%) patient in the laparoscopic transverse colon group. The conversion rate and late complications were not significantly different in the three groups. There was no significant difference in the number of lymph nodes harvested in the laparoscopic and open groups. Operative time was significantly longer in the laparoscopic transverse colectomy group when compared to all other groups (P = 0.001, 0.008, and transverse colectomy, respectively). The results of laparoscopic colon resection for transverse colon carcinoma are comparable to the results of laparoscopic resection of right or sigmoid colon cancer and open resection of transverse colon carcinoma. These results suggest that laparoscopic resection of transverse

  6. A Comparative Study of Single Incision versus Conventional Four Ports Laparoscopic Cholecystectomy.

    Science.gov (United States)

    Hajong, Ranendra; Hajong, Debobratta; Natung, Tanie; Anand, Madhur; Sharma, Girish

    2016-10-01

    Cholelithiasis is one of the most common disorders of the digestive tract encountered by general surgeons worldwide. Conventional or open cholecystectomy was the mainstay of treatment for a long time for this disease. In the 1980s laparoscopic surgery revolutionized the management of biliary tract diseases. It brought about a revolutionary change in the basic concepts of surgical principles and minimal access surgery gradually started to be acknowledged as a safe means of carrying out surgeries. To investigate the technical feasibility, safety and benefit of Single Incision Laparoscopic Cholecystectomy (SILC) versus Conventional Four Port Laparoscopic Cholecystectomy (C4PLC). This prospective randomized control trial was conducted to compare the advantages if any between the SILC and C4PLC. Thirty two patients underwent SILC procedure and C4PLC, each. The age of the patients ranged from 16-60years. Other demographic data and indications for cholecystectomy were comparable in both the groups. Simple comparative statistical analysis was carried out in the present study. Results on continuous variables are shown in Mean ± SD; whereas results on categorical variables are shown in percentage (%) by keeping the level of significance at 5%. Intergroup analysis of the various study parameters was done by using Fisher exact test. SPSS version 22 was used for statistical analysis. The mean operating time was higher in the SILC group (69 ± 4.00 mins vs. 38.53 ± 4.00 mins) which was of statistical significance (p=post-operative pain, with lesser analgesic requirements (p=operating time was longer otherwise it has almost similar clinical outcomes to those of C4PLC.

  7. Randomized Controlled Trial Comparing Open Versus Laparoscopic Placement of a Peritoneal Dialysis Catheter and Outcomes: The CAPD I Trial.

    Science.gov (United States)

    van Laanen, Jorinde H H; Cornelis, Tom; Mees, Barend M; Litjens, Elisabeth J; van Loon, Magda M; Tordoir, Jan H M; Peppelenbosch, Arnoud G

    2018-01-01

    To determine the best operation technique, open versus laparoscopic, for insertion of a peritoneal dialysis (PD) catheter with regard to clinical success. Clinical success was defined as an adequate function of the catheter 2 - 4 weeks after insertion. All patients with end-stage renal disease who were suitable for PD and gave informed consent were randomized for either open surgery or laparoscopic surgery. A previous laparotomy was not considered an exclusion criterion. Laparoscopic placement had the advantage of pre-peritoneal tunneling, the possibility for adhesiolysis, and placement of the catheter under direct vision. Catheter fixation techniques, omentopexy, or other adjunct procedures were not performed. Other measured parameters were in-hospital morbidity and mortality and post-operative infections. Between 2010 and 2016, 95 patients were randomized to this study protocol. After exclusion of 5 patients for various reasons, 44 patients received an open procedure and 46 patients a laparoscopic procedure. Gender, age, body mass index (BMI), hypertension, current hemodialysis, severe heart failure, and previous an abdominal operation were not significantly different between the groups. However, in the open surgery group, fewer patients had a previous median laparotomy compared with the laparoscopic group (6 vs 16 patients; p = 0.027). There was no statistically significant difference in mean operation time (36 ± 24 vs 38 ± 15 minutes) and hospital stay (2.1 ± 2.7 vs 3.1 ± 7.3 days) between the groups. In the open surgery group 77% of the patients had an adequate functioning catheter 2 - 4 weeks after insertion compared with 70% of patients in the laparoscopic group ( p = not significant [NS]). In the open surgery group there was 1 post-operative death (2%) compared with none in the laparoscopic group ( p = NS). The morbidity in both groups was low and not significantly different. In the open surgery group, 2 patients had an exit-site infection and 1 patient

  8. Endowrist versus wrist: a case-controlled study comparing robotic versus hand-assisted laparoscopic surgery for rectal cancer.

    Science.gov (United States)

    Koh, Frederick H X; Tan, Ker-Kan; Lieske, Bettina; Tsang, Marianne L; Tsang, Charles B; Koh, Dean C

    2014-10-01

    Laparoscopic total mesorectal excision (TME) remains a technically challenging procedure. This study aims to compare the surgical outcomes of the robotic-assisted laparoscopic (RAL) versus hand-assisted laparoscopic (HAL) techniques in performing TME for patients with rectal cancers. A retrospective review of all patients who underwent RAL TME for rectal cancers was performed. These cases were matched for age, sex, and stage of malignancy with patients who underwent HAL TME. Data collected included age, sex, American Society of Anesthesiologists scores, comorbid conditions, types of surgical resections and operative times, perioperative complications, length of hospital stays, and histopathologic outcomes were analyzed. From August 2008 to August 2011, 19 patients, with a median age of 62 (range, 47 to 92) years underwent RAL TME. Eight (42.1%) patients received neoadjuvant chemoradiotherapy. The median docking and operative times were 10 (range, 3 to 34) and 390 (range, 289 to 771) minutes, respectively. There was 1 (5.3%) conversion to open surgery. The grade of mesorectal excision was histopathologically reported as complete in all 19 cases. Positive circumferential margin was reported in 1 (5.3%) patient.Comparing the 2 groups, more patients in the RAL group received neoadjuvant chemoradiotherapy (8 vs. 3; P=0.048). The operative times were longer in the RAL group (390 vs. 225 min; P<0.001). A higher proportion of patients in the HAL group required conversion to open surgery (5 vs. 1; P=0.180) and developed perioperative morbidities (3 vs. 7; P=0.269). The median length of hospitalization was comparable between both groups (RAL: 7 vs. HAL: 6 d; P=0.476).The procedural cost was significantly higher in the RAL group (US$12,460 vs. US$8560; P<0.001), whereas the nonprocedural cost remained comparable between the 2 groups (RAL: US$4470 vs. HAL: US$4500; P=0.729). RAL TME is associated with lower conversion and morbidity rates compared with HAL TME. The longer

  9. Single-Incision Laparoscopic Colectomy for Cancer: Short-Term Outcomes and Comparative Analysis

    Directory of Open Access Journals (Sweden)

    Rodrigo Pedraza

    2013-01-01

    Full Text Available Introduction. Single-incision laparoscopic colectomy (SILC is a viable and safe technique; however, there are no single-institution studies comparing outcomes of SILC for colon cancer with well-established minimally invasive techniques. We evaluated the short-term outcomes following SILC for cancer compared to a group of well-established minimally invasive techniques. Methods. Fifty consecutive patients who underwent SILC for colon cancer were compared to a control group composed of 50 cases of minimally invasive colectomies performed with either conventional multiport or hand-assisted laparoscopic technique. The groups were paired based on the type of procedure. Demographics, intraoperative, and postoperative outcomes were assessed. Results. With the exception of BMI, demographics were similar between both groups. Most of the procedures were right colectomies ( and anterior resections (. There were no significant differences in operative time (127.9 versus 126.7 min, conversions (0 versus 1, complications (14% versus 8%, length of stay (4.5 versus 4.0 days, readmissions (2% versus 2%, and reoperations (2% versus 2%. Oncological outcomes were also similar between groups. Conclusions. SILC is an oncologically sound alternative for the management of colon cancer and results in similar short-term outcomes as compared with well-established minimally invasive techniques.

  10. Porcine dermis compared with polypropylene mesh for laparoscopic sacrocolpopexy: a randomized controlled trial.

    Science.gov (United States)

    Culligan, Patrick J; Salamon, Charbel; Priestley, Jennifer L; Shariati, Amir

    2013-01-01

    To compare the surgical outcomes 12 months after laparoscopic sacrocolpopexy performed with porcine dermis and the current gold standard of polypropylene mesh. Patients scheduled for laparoscopic sacrocolpopexy were eligible for this randomized controlled trial. Both our clinical research nurse and the patients were blinded as to which material was used. Our primary end point was objective anatomic cure defined as no pelvic organ prolapse quantification (POP-Q) points Stage 2 or greater at any postoperative interval. Our sample size calculation called for 57 patients in each group to achieve 90% power to detect a 23% difference in objective anatomic cure at 12 months (α=0.05). Our secondary end point was clinical cure. Any patient with a POP-Q point greater than zero, or Point C less than or equal to -5, or any complaints of prolapse symptoms whatsoever on Pelvic Floor Distress Inventory-20 or Pelvic Floor Impact Questionnaire, Short Form 7, or reoperation for prolapse were considered "clinical failures"; the rest were "clinical cures." Statistical comparisons were performed using the χ or independent samples t test as appropriate. As expected, there were no preoperative differences between the porcine (n=57) and mesh (n=58) groups. The 12-month objective anatomic cure rates for the porcine and mesh groups were 80.7% and 86.2%, respectively (P=.24), and the "clinical cure" rates for the porcine and mesh groups were 84.2% and 89.7%, respectively (P=.96). Pelvic Floor Distress Inventory-20 and Pelvic Floor Impact Questionnaire, Short Form 7 score improvements were significant for both groups with no differences found between groups. There were no major operative complications. There were similar outcomes in subjective or objective results 12 months after laparoscopic sacrocolpopexy performed with either porcine dermis or polypropylene mesh. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00564083. I.

  11. Vaginal and Laparoscopic hysterectomy as an outpatient procedure: A systematic review.

    Science.gov (United States)

    Dedden, Suzanne J; Geomini, Peggy M A J; Huirne, Judith A F; Bongers, Marlies Y

    2017-09-01

    Laparoscopic and vaginal hysterectomies are common gynaecological procedures. Same-day discharge is usual care in various gynaecological procedures like laparoscopic sterilisation and laparoscopic oophorectomies. In major procedures like vaginal or laparoscopic hysterectomy patients are usually admitted overnight. We systematically reviewed the literature to identify complications, risk factors for (re)admittance, financial consequences and patient satisfaction of same-day discharge after a vaginal or laparoscopic hysterectomy. We systematically searched PubMed, UptoDate, Embase, Cochrane and CINAHL database from inception until July 16th 2016. We selected randomized controlled trials, prospective and retrospective cohort studies assessing the safety and feasibility of same-day discharge after vaginal or laparoscopic hysterectomy. The outcome parameters that were assessed were admission rate, re-admission rate, minor and major complications, patient satisfaction and financial consequences. 27 articles were included in the systematic review. All studies provided data about the admission rate and therefore failure of same-day discharge. Eleven prospective studies were included which compromised a total of 2391 hysterectomies. The percentage of overnight admissions was median 9.3% [0-25%]. Eight retrospective studies, which screened their patients before undergoing an outpatient hysterectomy, showed in 1500 subjects a mean admission rate of 10% [4,4-64%]. Four retrospective studies, which considered a large total cohort of 142,799 hysterectomies had a mean admission rate of 59,7% [48-79%]. The overall re-admission rate was low, varying from 0.73-4.0%. Minor complications were reported in respectively 4,3% and 7,3% in prospective respectively retrospective trials. Major complications were described in 0.7%-3.6% of all cases. Generally high satisfaction rates were reported in the observational trials. Same-day discharge after laparoscopic and vaginal hysterectomy seems

  12. Open versus laparoscopic Roux-en-Y gastric bypass: a comparative study of over 25,000 open cases and the major laparoscopic bariatric reported series.

    Science.gov (United States)

    Jones, Kenneth B; Afram, Joseph D; Benotti, Peter N; Capella, Rafael F; Cooper, C Gary; Flanagan, Latham; Hendrick, Steven; Howell, L Michael; Jaroch, Mark T; Kole, Kerry; Lirio, Oscar C; Sapala, James A; Schuhknecht, Michael P; Shapiro, Robert P; Sweet, William A; Wood, Michael H

    2006-06-01

    Laparoscopic bariatric surgery has experienced a rapid expansion of interest over the past 5 years, with a 470% increase. This rapid expansion has markedly increased overall cost, reducing surgical access. Many surgeons believe that the traditional open approach is a cheaper, safer, equally effective alternative. 16 highly experienced "open" bariatric surgeons with a combined total of 25,759 cases representing >200 surgeon years of experience, pooled their open Roux-en-Y gastric bypass (ORYGBP) data, and compared their results to the leading laparoscopic (LRYGBP) papers in the literature. In the overall series, the incisional hernia rate was 6.4% using the standard midline incision. Utilizing the left subcostal incision (LSI), it was only 0.3%. Return to surgery in <30 days was 0.7%, deaths 0.25%, and leaks 0.4%. Average length of stay was 3.4 days, and return to usual activity 21 days. Small bowel obstruction was significantly higher with the LRYGBP. Surgical equipment costs averaged approximately $3,000 less for "open" cases. LRYGBP had an added expense for longer operative time. This more than made up for the shorter length of stay with the laparoscopic approach. The higher cost, higher leak rate, higher rate of small bowel obstruction, and similar long-term weight loss results make the "open" RYGBP our preferred operation. If the incision is taken out of the equation (i.e. use of the LSI), the significant advantages of the open technique become even more obvious.

  13. Assessment of comparative skills between hand-assisted and straight laparoscopic colorectal training on an augmented reality simulator.

    Science.gov (United States)

    Leblanc, F; Delaney, C P; Neary, P C; Rose, J; Augestad, K M; Senagore, A J; Ellis, C N; Champagne, B J

    2010-09-01

    The aim of this study was to compare skills sets during a hand-assisted and straight laparoscopic colectomy on an augmented reality simulator. Twenty-nine surgeons, assigned randomly in 2 groups, performed laparoscopic sigmoid colectomies on a simulator: group A (n = 15) performed hand-assisted then straight procedures; group B (n = 14) performed straight then hand-assisted procedures. Groups were compared according to prior laparoscopic colorectal experience, performance (time, instrument path length, and instrument velocity changes), technical skills, and operative error. Prior laparoscopic colorectal experience was similar in both groups. Both groups had better performances with the hand-assisted approach, although technical skill scores were similar between approaches. The error rate was higher with the hand-assisted approach in group A, but similar between both approaches in group B. These data define the metrics of performance for hand-assisted and straight laparoscopic colectomy on an augmented reality simulator. The improved scores with the hand-assisted approach suggest that with this simulator a hand-assisted model may be technically easier to perform, although it is associated with increased intraoperative errors.

  14. The feasibility of single-port laparoscopic appendectomy using a solo approach: a comparative study.

    Science.gov (United States)

    Kim, Say-June; Choi, Byung-Jo; Jeong, Wonjun; Lee, Sang Chul

    2016-03-01

    To investigate the feasibility and safety of solo surgery with single-port laparoscopic appendectomy, which is termed herein solo-SPLA (solo-single-port laparoscopic appendectomy). This study prospectively collected and retrospectively analyzed data from patients who had undergone either non-solo-SPLA (n = 150) or solo-SPLA (n = 150). Several devices were utilized for complete, skin-to-skin solo-SPSA, including a Lone Star Retractor System and an adjustable mechanical camera holder. Operating times were not significantly different between solo- and non-solo-SPLA (45.0 ± 21.0 minutes vs. 46.7 ± 26.1 minutes, P = 0.646). Most postoperative variables were also comparable between groups, including the necessity for intravenous analgesics (0.7 ± 1.2 ampules [solo-SPLA] vs. 0.9 ± 1.5 ampules [non-solo-SPLA], P = 0.092), time interval to gas passing (1.3 ± 1.0 days vs. 1.4 ± 1.0 days, P = 0.182), and the incidence of postoperative complications (4.0% vs. 8.7%, P = 0.153). Moreover, solo-SPLA effectively lowered the operating cost by reducing surgical personnel expenses. Solo-SPLA economized staff numbers and thus lowered hospital costs without lengthening of operating time. Therefore, solo-SPLA could be considered a safe and feasible alternative to non-solo-SPLA.

  15. Anterior Versus Posterolateral Approach for Total Laparoscopic Splenectomy: A Comparative Study

    Science.gov (United States)

    Ji, Bai; Wang, Yingchao; Zhang, Ping; Wang, Guangyi; Liu, Yahui

    2013-01-01

    Objective: Although the anterior approach is normally used for elective laparoscopic splenectomy (LS), the posterolateral approach may be superior. We have retrospectively compared the effectiveness and safety of these approaches in patients with non-severe splenomegaly scheduled for elective total LS. Methods: Patients with surgical spleen disorders scheduled for elective LS between March 2005 and June 2011 underwent laparoscopic splenic mobilization via the posterolateral or anterior approach. Main outcome measures included operation time, intraoperative blood loss, frequency of postoperative pancreatic leakage, and length of hospital stay. Results: During the study period, 203 patients underwent LS, 58 (28.6%) via the posterolateral and 145 (71.4%) via the anterior approach. Three patients (1.5%) required conversion to laparotomy due to extensive perisplenic adhesions. The posterolateral approach was associated with significantly shorter operation time (65.0 ± 12.3 min vs. 95.0 ± 21.3 min, P 0.05) Conclusions: The posterolateral approach is more effective and safer than the anterior approach in patients without severe splenomegaly (< 30 cm). PMID:23372427

  16. Laparoscopic treatment of perforated appendicitis

    Science.gov (United States)

    Lin, Heng-Fu; Lai, Hong-Shiee; Lai, I-Rue

    2014-01-01

    The use of laparoscopy has been established in improving perioperative and postoperative outcomes for patients with simple appendicitis. Laparoscopic appendectomy is associated with less wound pain, less wound infection, a shorter hospital stay, and faster overall recovery when compared to the open appendectomy for uncomplicated cases. In the past two decades, the use of laparoscopy for the treatment of perforated appendicitis to take the advantages of minimally invasiveness has increased. This article reviewed the prevalence, approaches, safety disclaimers, perioperative and postoperative outcomes of the laparoscopic appendectomy in the treatment of patients with perforated appendicitis. Special issues including the conversion, interval appendectomy, laparoscopic approach for elderly or obese patient are also discussed to define the role of laparoscopic treatment for patients with perforated appendicitis. PMID:25339821

  17. CLINICAL EFFICACY OF THE ROBOT-ASSISTED LAPAROSCOPIC MYOMECTOMY (A REVIEW OF THE LITERATURE

    Directory of Open Access Journals (Sweden)

    V. A. Gudebskaya

    2016-01-01

    Full Text Available Rationale: One of the most complicated and unresolved problems in clinical medicine is the choice of an optimal method for organ-preservation treatment of uterine fibroids in women of childbearing age. Aim: To assess clinical efficacy of robot-assisted laparoscopic myomectomy. Materials and methods: The search was performed in PubMed, Embase, Trip, Cochrane, DocMe databases by keywords: “fibroids”, “robot”, “da Vinci”, “robotic myomectomy”, “robot-assisted myomectomy”. Results: We found 25 publications on robot-assisted laparoscopic myomectomy, including 6  papers on its reproductive outcomes (levels of evidence II–IV. Duration of robot-assisted surgery ranged from 132 to 261 minutes, intraoperative blood loss was in the range from 50 to 387 mL, postoperative hospital stay ranged from 1 to  3.9  days. There was a  lower percentage of intra- and postoperative complications after the robot-assisted interventions, compared to abdominal or classic laparoscopic access, as well as a lower percentage of conversion laparotomies compared to laparoscopy. Pregnancy rates after robotic myomectomy ranged from 16.7 to 69%. Only one case of uterine rupture after robot-assisted laparoscopic myomectomy has been described in the literature. Conclusion: Due to high cost of the method, the number of conducted studies is insufficient to evaluate the role of robotic technologies in the organ-preservation approach to uterine fibroids. Nevertheless, they suggest that robot-assisted laparoscopic myomectomy is justified in women of childbearing age who are planning pregnancy, with big centripetally growing intramural nodes and deformation of the uterine cavity. This technique on its own is an independent method for fertility restoration and could be the first step before the use of assisted reproductive technology.

  18. Laparoscopic inguinal hernia repair: review of 6 years experience.

    Science.gov (United States)

    Vanclooster, P; Smet, B; de Gheldere, C; Segers, K

    2001-01-01

    Since 6 years, the totally extraperitoneal laparoscopic hernia repair has become our procedure of choice to manage inguinal hernia in adult patients, especially for bilateral hernias and recurrences after classical anterior repair. Between March 1993 and March 1999, 976 patients underwent 1259 hernia repairs by an endoscopic total extraperitoneal approach. A large polypropylene prosthesis (15 x 15 cm) is placed and covers all potential defects. Follow-up on patients ranged from 6 to 79 months (mean, 39 months). Per- and postoperative morbidity and complications were acceptable (8.4%) and included conversion to open surgery (0.4%), bleedings (0.3%), urinary retention (4.2%), seromas (2.7%), neuralgias (0.2%), vague persistent groin discomfort (0.4%), orchitis (0.08%) and sigmoido-cutaneous fistula (0.08%). Recurrence rate so far is 0.1%. This retrospective study shows that the totally extraperitoneal repair for inguinal hernia should have a promising future because of low morbidity and low recurrence rate.

  19. Comparing renal function preservation after laparoscopic radio frequency ablation assisted tumor enucleation and laparoscopic partial nephrectomy for clinical T1a renal tumor: using a 3D parenchyma measurement system.

    Science.gov (United States)

    Zhu, Liangsong; Wu, Guangyu; Huang, Jiwei; Wang, Jianfeng; Zhang, Ruiyun; Kong, Wen; Xue, Wei; Huang, Yiran; Chen, Yonghui; Zhang, Jin

    2017-05-01

    To compare the renal function preservation between laparoscopic radio frequency ablation assisted tumor enucleation and laparoscopic partial nephrectomy. Data were analyzed from 246 patients who underwent laparoscopic radio frequency ablation assisted tumor enucleation and laparoscopic partial nephrectomy for solitary cT1a renal cell carcinoma from January 2013 to July 2015. To reduce the intergroup difference, we used a 1:1 propensity matching analysis. The functional renal parenchyma volume preservation were measured preoperative and 12 months after surgery. The total renal function recovery and spilt GFR was compared. Multivariable logistic analysis was used for predictive factors for renal function decline. After 1:1 propensity matching, each group including 100 patients. Patients in the laparoscopic radio frequency ablation assisted tumor enucleation had a smaller decrease in estimate glomerular filtration rate at 1 day (-7.88 vs -20.01%, p renal parenchyma volume preservation (89.19 vs 84.27%, p renal parenchyma volume preservation, warm ischemia time and baseline renal function were the important independent factors in determining long-term functional recovery. The laparoscopic radio frequency ablation assisted tumor enucleation technology has unique advantage and potential in preserving renal parenchyma without ischemia damage compared to conventional laparoscopic partial nephrectomy, and had a better outcome, thus we recommend this technique in selected T1a patients.

  20. Laparoscopic management of ovarian dermoid cysts: a review of 47 cases

    International Nuclear Information System (INIS)

    Kocak, Muberra; Dilbaz, Berna; Ozturk, Nilgun; Dede, Suat; Altay, Meltin; Dilbaz, Serdar; Herbal, Ali

    2004-01-01

    Mature cystic teratomas, often referred to as dermoid cysts, are the most common germ cell tumors of the ovary in the recent years, transvaginal sonographic diagnosis of ovarian dermoid cysts together with the laparascopic approach have greatly improved the treatment of this benign lesion. We retrospectively reviewed the outcome of laparoscopic surgery for suspected ovarian dermoid cysts. The preoperative findings, operative techniques, and postoperative complications were retrospectively reviewed in the women who underwent lpaparoscopic surgey for dermoid cysts, between January 2001 and May 2003. In 47 women aged 21 to 53 years (median, 38.8 years), 93.6% had a unilateral cyst with a diameter of 17 to 108 mm (median 51 mm). Clinical presentations were pain (62%), abnormal vaginal bleeding (21%) and ovarian torsion (2%), while 17%were diagnosed incidently during routine examination. Surgery included cystectomy (57%), total (36%) or partial oophorectomy (6.4%) and laparoscopic assisted vaginal hysterectomy with bilateral salpingo-oophorectomy (2%). During the cyst extraction, minimal spillage occured in 42.5% of the casesand none developed chemical peritonitis. In 2 patients, conversion to laparotomy (4.3%) was required, one for sigmoid colon, injury and one for malignent ovarian tumor detected via frozen section. The median operating time was 80 minutes (range, 35-180 minutes). Using strict afherence to guidelines for preoperative clinical assessment and intraoperative management, laparoscopic treatment of dermoid cysts appers to be a safe procedure. (author)

  1. Prospective study comparing laparoscopic and open radical cystectomy: Surgical and oncological results.

    Science.gov (United States)

    Esquinas, C; Alonso, J M; Mateo, E; Dotor, A; Martín, A M; Dorado, J F; Arance, I; Angulo, J C

    2018-03-01

    Laparoscopic radical cystectomy with lymphadenectomy and urinary diversion is an increasingly widespread operation. Studies are needed to support the oncological effectiveness and safety of this minimally invasive approach. A nonrandomised, comparative prospective study between open radical cystectomy (ORC) and laparoscopic radical cystectomy (LRC) was conducted in a university hospital. The main objective was to compare cancer-specific survival. The secondary objective was to compare the surgical results and complications according to the Clavien-Dindo scale. We treated 156 patients with high-grade invasive bladder cancer with either ORC (n=70) or LRC (n=86). The mean follow-up was 33.5±23.8 (range 12-96) months. The mean age was 66.9+9.4 years, and the male to female ratio was 19:1. Both groups were equivalent in age, stage, positive lymph nodes, in situ carcinoma, preoperative obstructive uropathy, adjuvant chemotherapy and type of urinary diversion. There were no differences between the groups in terms of cancer-specific survival (log-rank; P=.71). The histopathology stage was the only independent variable that predicted the prognosis. The hospital stay (P=.01) and operative transfusion rates (P=.002) were less for LRC. The duration of the surgery was greater for LRC (P<.001). There were no differences in the total complications rate (p=.62) or major complications (P=.69). The risk of evisceration (P=.02), surgical wound infection (P=.005) and pneumonia (P=.017) was greater for ORC. The risk of rectal lesion (P=.017) and urethrorectal fistulae (P=.065) was greater for LRC. LRC is an equivalent treatment to ORC in terms of oncological efficacy and is advantageous in terms of transfusion rates and hospital stays but not in terms of operating room time and overall safety. Studies are needed to better define the specific safety profile for each approach. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Outcomes of infants undergoing robot-assisted laparoscopic pyeloplasty compared to open repair.

    Science.gov (United States)

    Dangle, Pankaj P; Kearns, James; Anderson, Blake; Gundeti, Mohan S

    2013-12-01

    Robotic surgery has evolved from simple extirpative surgery to complex reconstructions even in infants. Data are lacking comparing surgical and direct costs to open approaches. We describe the feasibility, salient tips and outcomes of robot-assisted laparoscopic pyeloplasty compared to an open approach. We evaluated patients undergoing open pyeloplasty or robot-assisted laparoscopic pyeloplasty. Ten patients in each group met inclusion criteria. Mean patient age was 3.31 months in the open group and 7.3 months in the robotic group (p=0.02). Postoperative outcomes including length of stay (2.2 vs 2.1 days), estimated blood loss (6.5 vs 7.6 ml), days to regular diet (1 vs 1.1) and days to Foley catheter removal (1.3 vs 1.3) were similar between the open and robotic groups. Total operating time (199 vs 242 minutes) was significantly longer in the robotic group. Postoperative improvement in hydronephrosis was identical in both groups. Direct costs, excluding amortization, robotic cost, maintenance and depreciation, were $4,410 in the open group and $4,979 in the robotic group (p=0.10). In our preliminary experience robotic pyeloplasty in infants is feasible and safe. The immediate outcomes are similar to those of an open approach. The robotic technique in infants currently has the benefits of improved esthetic appearance, improved pain control and similar direct costs compared to the traditional open approach. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  3. Use of failure modes, effects, and criticality analysis to compare the vulnerabilities of laparoscopic versus open appendectomy.

    Science.gov (United States)

    Guida, Edoardo; Rosati, Ubaldo; Pini Prato, Alessio; Avanzini, Stefano; Pio, Luca; Ghezzi, Michele; Jasonni, Vincenzo; Mattioli, Girolamo

    2015-06-01

    To measure the feasibility of using FMECA applied to the surgery and then compare the vulnerabilities of laparoscopic versus open appendectomy by using FMECA. The FMECA study was performed on each single selected phase of appendectomy and on complication-related data during the period January 1, 2009, to December 31, 2010. The risk analysis phase was completed by evaluation of the criticality index (CI) of each appendectomy-related failure mode (FM). The CI is calculated by multiplying the estimated frequency of occurrence (O) of the FM, by the expected severity of the injury to the patient (S), and the detectability (D) of the FM. In the first year of analysis (2009), 177 appendectomies were performed, 110 open and 67 laparoscopic. Eleven adverse events were related to the open appendectomy: 1 bleeding (CI: 8) and 10 postoperative infections (CI: 32). Three adverse events related to the laparoscopic approach were recorded: 1 postoperative infection (CI: 8) and 2 incorrect extractions of the appendix through the umbilical port (CI: 6). In the second year of analysis (2010), 158 appendectomies were performed, 69 open and 89 laparoscopic. Four adverse events were related to the open appendectomy: 1 incorrect management of the histological specimen (CI: 2), 1 dehiscence of the surgical wound (CI: 6), and 2 infections (CI: 6). No adverse events were recorded in laparoscopic approach. FMECA helped the staff compare the 2 approaches through an accurate step-by-step analysis, highlighting that laparoscopic appendectomy is feasible and safe, associated with a lower incidence of infection and other complications, reduced length of hospital stay, and an apparent lower procedure-related risk.

  4. Laparoscopic management of peripelvic renal cysts: University of California, San Francisco, experience and review of literature.

    Science.gov (United States)

    Camargo, Affonso H L A; Cooperberg, Matthew R; Ershoff, Brent D; Rubenstein, Jonathan N; Meng, Maxwell V; Stoller, Marshall L

    2005-05-01

    To report our experience and review published reports on the laparoscopic management of peripelvic renal cysts. Peripelvic renal cysts represent a unique subset of renal cysts, as they are rare, commonly symptomatic, and more difficult to treat than simple peripheral renal cysts. Minimally invasive methods for the treatment of peripelvic renal cysts, including laparoscopic decortication, have recently become more common. Four patients who presented with symptomatic peripelvic cysts underwent laparoscopic decortication at our institution. All four were men aged 47 to 65 years. One patient had undergone an unsuccessful prior cyst aspiration. All patients underwent preoperative computed tomography and retrograde pyelography. The mean number of peripelvic cysts per patient was 3.0, and the mean cyst size was 7.1 cm. The mean operative time was 259 minutes (range 240 to 293), and the mean estimated blood loss was 30 mL (range 10 to 50). No evidence of cystic renal cell carcinoma was found on aspiration cytology or cyst wall pathologic examination. The mean hospital stay was 1.3 days. No inadvertent collecting system injuries and no intraoperative or postoperative complications occurred. All 4 patients achieved symptomatic relief and were determined to have radiologic success as determined by the 6-month postoperative computed tomography findings. Laparoscopic ablation of peripelvic renal cysts is more difficult than that of simple peripheral renal cysts and demands a heightened awareness of potential complications and, therefore, more advanced surgical skills. In addition to our experience, a thorough review of published reports found this procedure to be safe and effective with appropriate patient selection.

  5. Pregnancy outcome of in vitro fertilization after Essure and laparoscopic management of hydrosalpinx: a systematic review and meta-analysis.

    Science.gov (United States)

    Xu, Bin; Zhang, Qiong; Zhao, Jing; Wang, Yonggang; Xu, Dabao; Li, Yanping

    2017-07-01

    To assess and compare pregnancy outcomes in hydrosalpinx (HX) patients treated by Essure, laparoscopic salpingectomy, and proximal tubal occlusion (LPTO) before IVF. Systematic review and meta-analysis. University-affiliated teaching hospital. Women undergoing Essure, laparoscopic salpingectomy, and LPTO for HX before IVF. The overall combined risk estimates were calculated by means of fixed- or random-effects models. Clinical pregnancy rate (CPR) and live birth rate (LBR). In total, 3,065 patients were included in 33 studies. Thirteen of them were comparative studies among 3 surgical methods and no intervention. In the analysis of comparative studies, there were no significant differences in implantation rate (IR), CPR, and ongoing pregnancy rate/LBR between salpingectomy and LPTO groups. The CPR, IR, and LBR of Essure were significantly lower than those of the laparoscopic surgery (salpingectomy and LPTO) group, with a CPR of 34.1% vs. 44.0% (relative risk [RR] 0.71; 95% confidence interval [CI] [0.51, 0.98]), an IR of 17.3% vs. 38.0% (RR 0.45; 95% CI [0.27, 0.74]), and an LBR of 22.2% vs. 37.4% (RR 0.57; 95% CI [0.35, 0.91]). Management of HX by laparoscopic salpingectomy and LPTO yielded the same effect on the improvement of the pregnancy outcome after IVF. The hysteroscopic placement of Essure devices to treat HX before IVF produces inferior pregnancy outcomes compared with those following the laparoscopic approach. More multicenter randomized, controlled trials are warranted in future research to further examine the conclusion from this meta-analysis. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  6. Economic evaluation of the randomized European Achalasia trial comparing pneumodilation with Laparoscopic Heller myotomy.

    Science.gov (United States)

    Moonen, A; Busch, O; Costantini, M; Finotti, E; Tack, J; Salvador, R; Boeckxstaens, G; Zaninotto, G

    2017-11-01

    A recent multicenter randomized trial in achalasia patients has shown that pneumatic dilation resulted in equivalent relief of symptoms compared to laparoscopic Heller myotomy. Additionally, the cost of each treatment should be also taken in consideration. Therefore, the aim of the present study was to perform an economic analysis of the European achalasia trial. Patients with newly diagnosed achalasia were enrolled from to 2003 to 2008 in 14 centers in five European countries and were randomly assigned to either pneumatic dilation (PD) or laparoscopic Heller (LHM). The economic analysis was performed in the three centers in three different countries where most patients were enrolled (Amsterdam [NL], Leuven, [B] and Padova [I]) and then applied to all patients included in the study. The total raw costs of the two treatments per patient include the initial costs, the costs of complications, and the costs of retreatments. Two hundred and one patients, 107 (57 males and 50 females, mean age 46 CI: 43-49 years) were randomized to LHM and 94 (59 males and 34 females, mean age 46 CI 43-50 years) to PD. The total cost of PD per patient was quite comparable in the three different centers; €3397 in Padova, €3259 in Amsterdam and €3792 in Leuven. For LHM, the total costs per patient were highest in Amsterdam: €4488 in Padova, €6720 in Amsterdam, and €5856 in Leuven. In conclusion, the strategy of treating achalasia starting with PD appears the most economic approach, independent of the health system. © 2017 John Wiley & Sons Ltd.

  7. Massive splenomegaly in children: laparoscopic versus open splenectomy.

    Science.gov (United States)

    Hassan, Mohamed E; Al Ali, Khalid

    2014-01-01

    Laparoscopic splenectomy for massive splenomegaly is still a controversial procedure as compared with open splenectomy. We aimed to compare the feasibility of laparoscopic splenectomy versus open splenectomy for massive splenomegaly from different surgical aspects in children. The data of children aged splenectomy for hematologic disorders were retrospectively reviewed in 2 pediatric surgery centers from June 2004 until July 2012. The study included 32 patients, 12 who underwent laparoscopic splenectomy versus 20 who underwent open splenectomy. The mean ages were 8.5 years and 8 years in the laparoscopic splenectomy group and open splenectomy group, respectively. The mean operative time was 180 minutes for laparoscopic splenectomy and 120 minutes for open splenectomy. The conversion rate was 8%. The mean amount of intraoperative blood loss was 60 mL in the laparoscopic splenectomy group versus 110 mL in the open splenectomy group. Postoperative atelectasis developed in 2 cases in the open splenectomy group (10%) and 1 case in the laparoscopic splenectomy group (8%). Oral feeding postoperatively resumed at a mean of 7.5 hours in the laparoscopic splenectomy group versus 30 hours in the open splenectomy group. The mean hospital stay was 36 hours in the laparoscopic splenectomy group versus 96 hours in the open splenectomy group. Postoperative pain was less in the laparoscopic splenectomy group. Laparoscopic splenectomy for massive splenomegaly in children is safe and feasible. Although the operative time was significantly greater in the laparoscopic splenectomy group, laparoscopic splenectomy was associated with statistically significantly less pain, less blood loss, better recovery, and shorter hospital stay. Laparoscopic splenectomy for pediatric hematologic disorders should be the gold-standard approach regardless of the size of the spleen.

  8. Pulmonary function in women: comparative analysis of conventional versus single-port laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    MARISA DE CARVALHO BORGES

    2018-05-01

    Full Text Available ABSTRACT Objective: to evaluate the pulmonary function of women submitted to conventional and single-port laparoscopic cholecystectomy. Methods: forty women with symptomatic cholelithiasis, aged 18 to 70 years, participated in the study. We divided the patients into two groups: 21 patients underwent conventional laparoscopic cholecystectomy, and 19, single-port laparoscopic cholecystectomy. We assessed pulmonary function through forced vital capacity (FVC, forced expiratory volume in the first second (FEV1, and the FEV1/FVC ratio, measured before and 24 hours after the procedure. Results: in both groups, FVC and FEV1 were lower in the postoperative period than those obtained in the preoperative period, with a greater reduction in the group undergoing conventional laparoscopic cholecystectomy. Regarding the FEV1/FVC (% values, there was no statistically significant difference in any of the groups or times analyzed. Conclusion: there was a greater decline in FVC and FEV1 in the postoperative group of patients submitted to conventional laparoscopic cholecystectomy.

  9. Laparoscopic resection for diverticular disease.

    Science.gov (United States)

    Bruce, C J; Coller, J A; Murray, J J; Schoetz, D J; Roberts, P L; Rusin, L C

    1996-10-01

    The role of laparoscopic surgery in treatment of patients with diverticulitis is unclear. A retrospective comparison of laparoscopic with conventional surgery for patients with chronic diverticulitis was performed to assess morbidity, recovery from surgery, and cost. Records of patients undergoing elective resection for uncomplicated diverticulitis from 1992 to 1994 at a single institution were reviewed. Laparoscopic resection involved complete intracorporeal dissection, bowel division, and anastomosis with extracorporeal placement of an anvil. Sigmoid and left colon resections were performed laparoscopically in 25 patients and by open technique in 17 patients by two independent operating teams. No significant differences existed in age, gender, weight, comorbidities, or operations performed. In the laparoscopic group, three operations were converted to open laparotomy (12 percent) because of unclear anatomy. Major complications occurred in two patients who underwent laparoscopic resection, both requiring laparotomy, and in one patient in the conventional surgery group who underwent computed tomographic-guided drainage of an abscess. Patients who underwent laparoscopic resection tolerated a regular diet sooner than patients who underwent conventional surgery (3.2 +/- 0.9 vs. 5.7 +/- 1.1 days; P < 0.001) and were discharged from the hospital earlier (4.2 +/- 1.1 vs. 6.8 +/- 1.1 days; P < 0.001). Overall costs were higher in the laparoscopic group than the open surgery group ($10,230 +/- 49.1 vs. $7,068 +/- 37.1; P < 0.001) because of a significantly longer total operating room time (397 +/- 9.1 vs. 115 +/- 5.1 min; P < 0.001). Follow-up studies with a mean of one year revealed two port site infections in the laparoscopic group and one wound infection in the open group. Of patients undergoing conventional resection, one patient experienced a postoperative bowel obstruction that was managed nonoperatively, and, in one patient, an incarcerated incisional hernia

  10. Asymptomatic Partial Splenic Infarction In Laparoscopic Floppy Nissen Fundoplication And Brief Literature Review

    Science.gov (United States)

    Odabasi, Mehmet; Abuoglu, Haci Hasan; Arslan, Cem; Gunay, Emre; Yildiz, Mehmet Kamil; Eris, Cengiz; Ozkan, Erkan; Aktekin, Ali; Muftuoglu, Tolga

    2014-01-01

    Short gastric vessels are divided during the laparoscopic Nissen fundoplication resulting in splenic infarct in some cases. We report a case of laparoscopic floppy Nissen fundoplication with splenic infarct that was recognized during the procedure and provide a brief literature review. The patient underwent a laparoscopic floppy Nissen fundoplication. We observed a partial infarction of the spleen. She reported no pain. A follow-up computed tomography scan showed an infarct, and a 3-month abdominal ultrasound showed complete resolution. Peripheral splenic arterial branches have very little collateral circulation. When these vessels are occluded or injured, an area of infarction will occur immediately. Management strategies included a trial of conservative management and splenectomy for persistent symptoms or complications resulting from splenic infarct. In conclusion, we believe that the real incidence is probably much higher because many cases of SI may have gone undiagnosed during or following an operation, because some patients are asymptomatic. We propose to check spleen carefully for the possibility of splenic infarct. PMID:24833155

  11. Comparing efficacy of preemptively used dexketoprofen and tramadol for postoperative pain in patients underwent laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Süreyya Özkan

    2015-03-01

    Full Text Available Objective: In our study, we aimed to compare effects of preoperative dexketoprofen and tramadol administered by intravenous route on intraoperative and postoperative analgesic consumption, postoperative pain, durations of hospital stay and patient satisfaction in patients, undergoing laparoscopic cholecystectomy. Methods:After approval of ethic committee and written consent of patients were obtained, 60 patients between 18-70 years old with ASA I-II were included in the study. After routine monitorization and 20 minutes before induction of anesthesia, dexketoprofen 50 mg in 100 cc 0.9% NaCl was administered in Dexketoprofen Group and tramadol 100 mg in 100 cc 0.9% NaCl in Tramadol Group as intravenous infusion during 20 minutes. Intraoperative hemodynamic parameters, analgesic-anesthetic consumptions and complications of patients, on whom standard general anesthesia was applied, were recorded. Pain severity, degree of sedation, morphine consumptions and hemodynamic parameters were recorded at postoperative 30 th minute, and 4 th, 8th, 12th and 24 th hours. Additional analgesia requirement, times for requiring first analgesia, duration of hospital stay, postoperative complications and patient satisfactions were recorded. Results: Intraoperative analgesic-anesthetic consumptions, postoperative visual analogue scale (VAS scores, sedation degrees, intravenous patient controlled analgesia (PCA and morphine consumptions, times for requiring first analgesic, durations of hospital stay, intraoperative-postoperative complications developed and patient satisfactions were similar in both groups. Consequently, postoperative analgesic efficacy of pre-emptive dexketoprofen intravenous 50 mg and tramadol intravenous 100 mg administered was found to be similar in cases, who had laparoscopic cholecystectomy operation. Conclusion:Because VAS scores were low in our patients, morphine consumptions with intravenous PCA were similar in both groups, and there wasn

  12. Management of Postoperative Hypoxaemia in Patients Following Upper Abdominal Laparoscopic Surgery. - A Comparative Study

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    Sampa Datta Gupta

    2008-01-01

    Full Text Available Noninvasive ventilation has been shown to reduce acute postoperative hypoxaemia, with significant reduction in the incidence of re-intubation, complications and a trend towards lower mortality. The aim of the study was to determine the effectiveness of CPAP vs venturi therapy in early achievement of oxygenation goals and in prevention of re-intubation for management of postoperative hypoxaemia following laparoscopic cholecystectomy. Forty adult patients of ASA physical status I& II, scheduled for elective laparoscopic cholecystectomy, those were unable to maintain SpO2 > 95% breathing room air after extubation, were recruited for a prospective, randomized comparative study. Patients with PaO2 / FiO2 between 250 and 300 were included in the study and were randomly allocated to one of the two groups to receive oxygen therapy either using a CPAP of 10 cm of water and a FiO2 of 0.5 (Group A or using a venturi mask of FiO2 of 0.5 (Group B . All patients were observed postoperatively upto 18 h and were screened by ABG analyses at 6, 12 and 18 h of treatment. SpO2, ECG, heart rate, respiratory rate, temperature and NIBP were monitored throughout the study period. Patients in Group A showed significant improvement in early achievement of adequate oxygenation than those in Group B, although, due to intolerance to CPAP therapy two patients in Group A needed reintubation to maintain adequate oxygenation. To conclude, oxygenation using continuous positive airway pressure is a safe and effective means in improving gas exchange to treat acute postoperative hypoxaemia in conscious and cooperative patients.

  13. Laparoscopic anterior versus posterior fundoplication for gastro-esophageal reflux disease: a meta-analysis and systematic review.

    Science.gov (United States)

    Memon, Muhammed Ashraf; Subramanya, Manjunath S; Hossain, Md Belal; Yunus, Rossita Mohamad; Khan, Shahjahan; Memon, Breda

    2015-04-01

    Although laparoscopic posterior fundoplication (LPF) i.e., Nissen or Toupet have the proven efficacy for controlling gastro-esophageal reflux surgically, there remain problems with postoperative dysphagia and gas bloat syndrome. To decrease some of these postoperative complications, laparoscopic anterior fundoplication (LAF) was introduced. The aim of this study was to conduct a meta-analysis and systematic review of randomized controlled trials (RCTs) to investigate the merits and drawbacks of LPF versus LAF for the treatment of gastro-esophageal reflux disease (GERD). A search of Medline, Embase, Science Citation Index, Current Contents, PubMed, ISI Web of Science, and the Cochrane Database identified all RCTs comparing different types of LPF and LAF published in the English Language between 1990 and 2013. The meta-analysis was prepared in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) statement. Data was extracted and analyzed on ten variables which include dysphagia score, heartburn rate, redo operative rate, operative time, overall complications, rate of conversion to open, Visick grading of satisfaction, overall satisfaction, length of hospital stay, and postoperative 24-h pH scores. Nine trials totaling 840 patients (anterior = 425, posterior = 415) were analyzed. There was a significant reduction in the odds ratio for dysphagia in the LAF group compared to the LPF group. Conversely, significant reduction in the odds ratio for heartburn was observed for LPF compared to LAF. Comparable effects were noted for both groups for other variables which include redo surgery, operating time, overall complications, conversion rate, Visick's grading, patients' satisfaction, length of hospital stay, and postoperative 24-h pH scores. Based on this meta-analysis, LPF compared to LAF is associated with significant reduction in heartburn at the expense of higher dysphagia rate on a short- and medium-term basis. We therefore

  14. Single-Port Transumbilical Laparoscopic Appendectomy: A Preliminary Multicentric Comparative Study in 87 Patients with Acute Appendicitis

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    Ramon Vilallonga

    2012-01-01

    Full Text Available Introduction. Laparoscopic appendectomy (LA has been performed in many approaches such as open, laparoscopic and recently Single Port Access (SPAA. In order to elucidate its potential advantages, we compared the two laparoscopic approaches. Methods. 87 patients were included in a multicentric study for suspected appendicitis in order to perform (SPAA appendectomy or laparoscopic appendectomy (LA. All outcomes, including blood loss, operative time, complications, and length of stay and pain were recorded prospectively. Results. There were 46 patients in the SPAA group and 41 in the LAG with a mean operative time of 40,4 minutes in the SPAA group and 35,0 minutes in the LA group. Only one patient was converted to an open approach. We described only 2 complications. Pain was graded 2,8 in the SPAA group and 2,9 in the LA group, according to the AVS after 24 hours. Patients in the SPAA Group were more satisfied (7,5 versus 6,9 (<0.05. Same results were found for the cosmetic result (8,6 versus 7,4 (<0.05. Conclusion. Using the single port approach feasible and safe. The true benefit of the technique should be assessed by new randomised controlled trials.

  15. Reviewing the technological challenges associated with the development of a laparoscopic palpation device.

    Science.gov (United States)

    Culmer, Peter; Barrie, Jenifer; Hewson, Rob; Levesley, Martin; Mon-Williams, Mark; Jayne, David; Neville, Anne

    2012-06-01

    Minimally invasive surgery (MIS) has heralded a revolution in surgical practice, with numerous advantages over open surgery. Nevertheless, it prevents the surgeon from directly touching and manipulating tissue and therefore severely restricts the use of valuable techniques such as palpation. Accordingly a key challenge in MIS is to restore haptic feedback to the surgeon. This paper reviews the state-of-the-art in laparoscopic palpation devices (LPDs) with particular focus on device mechanisms, sensors and data analysis. It concludes by examining the challenges that must be overcome to create effective LPD systems that measure and display haptic information to the surgeon for improved intraoperative assessment. Copyright © 2012 John Wiley & Sons, Ltd.

  16. Laparoscopic versus open surgery for the treatment of colorectal cancer: a literature review and recommendations from the Comité de l’évolution des pratiques en oncologie

    Science.gov (United States)

    Morneau, Mélanie; Boulanger, Jim; Charlebois, Patrick; Latulippe, Jean-François; Lougnarath, Rasmy; Thibault, Claude; Gervais, Normand

    2013-01-01

    Background Adoption of the laparoscopic approach for colorectal cancer treatment has been slow owing to initial case study results suggesting high recurrence rates at port sites. The use of laparoscopic surgery for colorectal cancer still raises a number of concerns, particularly with the technique’s complexity, learning curve and longer duration. After exploring the scientific literature comparing open and laparoscopic surgery for the treatment of colorectal cancer with respect to oncologic efficacy and short-term outcomes, the Comité de l’évolution des pratiques en oncologie (CEPO) made recommendations for surgical practice in Quebec. Methods Scientific literature published from January 1995 to April 2012 was reviewed. Phase III clinical trials and meta-analyses were included. Results Sixteen randomized trials and 10 meta-analyses were retrieved. Analysis of the literature confirmed that for curative treatment of colorectal cancer, laparoscopy is not inferior to open surgery with respect to survival and recurrence rates. Moreover, laparoscopic surgery provides short-term advantages, including a shorter hospital stay, reduced analgesic use and faster recovery of intestinal function. However, this approach does require a longer operative time. Conclusion Considering the evidence, the CEPO recommends that laparoscopic resection be considered an option for the curative treatment of colon and rectal cancer; that decisions regarding surgical approach take into consideration surgeon experience, tumour stage, potential contraindications and patient expectations; and that laparoscopic resection for rectal cancer be performed only by appropriately trained surgeons who perform a sufficient volume annually to maintain competence. PMID:24067514

  17. Transversus abdominis plane block using a short-acting local anesthetic for postoperative pain after laparoscopic colorectal surgery: a systematic review and meta-analysis.

    Science.gov (United States)

    Oh, Tak Kyu; Lee, Se-Jun; Do, Sang-Hwan; Song, In-Ae

    2018-02-01

    Transversus abdominis plane (TAP) block using a short-acting local anesthetic as part of multimodal analgesia is efficient in various abdominal surgeries, including laparoscopic surgery. However, information regarding its use in laparoscopic colorectal surgery is still limited and sometimes controversial. Therefore, we conducted a systematic review and meta-analysis to determine whether TAP block using a short-acting anesthetic has a positive postoperative analgesic outcome in patients who have undergone laparoscopic colorectal surgery. We searched for studies comparing the postoperative pain outcome after laparoscopic colorectal surgery between patients who received TAP block and a control group (placebo or no treatment). Outcome measures were early pain at rest (numeric rating scale [NRS] score at 0-2 h postoperatively), late pain at movement (NRS score at 24 h postoperatively), late pain at rest (NRS score at 24 h postoperatively), and postoperative opioid consumption (up to 24 h postoperatively). We used a random-effects model for the meta-analysis and Egger's regression test to detect publication bias. We included six studies involving 452 patients (224 in the TAP block group, 228 in the control group). Early and late pain scores at movement were significantly different between the TAP block and control groups (standardized mean difference: - 0.695, P consumption (P = 0.257). The TAP block using a short-acting anesthetic had a significant effect on the postoperative pain outcome in the early (0-2 h) and late (24 h) period at movement. However, it did not have a significant effect on the postoperative pain outcome in the early (0-2 h) and late (24 h) periods at rest after laparoscopic surgery.

  18. Reliability of Laparoscopic Compared With Hysteroscopic Sterilization at One Year: A Decision Analysis

    Science.gov (United States)

    Gariepy, Aileen M.; Creinin, Mitchell D.; Schwarz, Eleanor B.; Smith, Kenneth J.

    2011-01-01

    OBJECTIVE To estimate the probability of successful sterilization after hysteroscopic or laparoscopic sterilization procedure. METHODS An evidence-based clinical decision analysis using a Markov model was performed to estimate the probability of a successful sterilization procedure using laparoscopic sterilization, hysteroscopic sterilization in the operating room, and hysteroscopic sterilization in the office. Procedure and follow-up testing probabilities for the model were estimated from published sources. RESULTS In the base case analysis, the proportion of women having a successful sterilization procedure on first attempt is 99% for laparoscopic, 88% for hysteroscopic in the operating room and 87% for hysteroscopic in the office. The probability of having a successful sterilization procedure within one year is 99% with laparoscopic, 95% for hysteroscopic in the operating room, and 94% for hysteroscopic in the office. These estimates for hysteroscopic success include approximately 6% of women who attempt hysteroscopically but are ultimately sterilized laparoscopically. Approximately 5% of women who have a failed hysteroscopic attempt decline further sterilization attempts. CONCLUSIONS Women choosing laparoscopic sterilization are more likely than those choosing hysteroscopic sterilization to have a successful sterilization procedure within one year. However, the risk of failed sterilization and subsequent pregnancy must be considered when choosing a method of sterilization. PMID:21775842

  19. Minimal invasive treatment of ureteropelvic junction obstruction in low volume pelvis: A comparative study of endopyelotomy and laparoscopic nondismembered pyeloplasty

    Science.gov (United States)

    Singh, Pratipal; Jain, Paresh; Dharaskar, Anand; Mandhani, Anil; Dubey, Deepak; Kapoor, Rakesh; Kumar, Anant; Srivastava, Aneesh

    2009-01-01

    Objective: To evaluate the role of nondismembered laparoscopic pyeloplasty and percutaneous endopyelotomy for ureteropelvic junction obstruction (UPJO) with low volume renal pelvis. Material and Methods: Retrospective acquired data of 34 patients of laparoscopic nondismembered pyeloplasty was compared with 26 patients of UPJO with pelvic volume less than 50 ml undergoing antegrade endopyelotomy and analyzed for clinical parameters, operative outcomes and success of procedures. All patients were followed up clinically and with diuretic renogram at regular intervals. Results: Mean age, renal pelvic volume and preoperative glomerular filtration rate (GFR) was 25 years, 43.6 ml and 42.5 ml/min, respectively in endopyelotomy group and 21 years, 34.4 ml and 39.9 ml/min, respectively in laparoscopic pyeloplasty group. Mean operative time, postoperative analgesic requirement and mean hospital stay was 100min, 250 mg and 4 days, respectively in endopyelotomy group and 210 min, 300 mg and 4 days, respectively in laparoscopic pyeloplasty group. Only operative time was significantly different between two groups (P < 0.05). Mean follow-up was 36 and 39 months and success rates were 91.2% and 88.8% in laparoscopy and endopyelotomy group, respectively (P < 0.05). No significant complication was seen in endopyelotomy group while two patients had hematuria (one requiring blood transfusion) and three had increased drain output for more than 3 days in laparoscopy group. Conclusion: Percutaneous endopyelotomy is associated with significantly less operative time and postoperative complication rate and provides equivalent success in comparison to nondismembered laparoscopic pyeloplasty in patients with UPJO and low volume pelvis. It can be a preferred minimally invasive treatment modality for such patients. PMID:19468432

  20. Minimal invasive treatment of ureteropelvic junction obstruction in low volume pelvis: A comparative study of endopyelotomy and laparoscopic nondismembered pyeloplasty

    Directory of Open Access Journals (Sweden)

    Pratipal Singh

    2009-01-01

    Full Text Available Objective: To evaluate the role of nondismembered laparoscopic pyeloplasty and percutaneous endopyelotomy for ureteropelvic junction obstruction (UPJO with low volume renal pelvis. Material and Methods: Retrospective acquired data of 34 patients of laparoscopic nondismembered pyeloplasty was compared with 26 patients of UPJO with pelvic volume less than 50 ml undergoing antegrade endopyelotomy and analyzed for clinical parameters, operative outcomes and success of procedures. All patients were followed up clinically and with diuretic renogram at regular intervals. Results: Mean age, renal pelvic volume and preoperative glomerular filtration rate (GFR was 25 years, 43.6 ml and 42.5 ml/min, respectively in endopyelotomy group and 21 years, 34.4 ml and 39.9 ml/min, respectively in laparoscopic pyeloplasty group. Mean operative time, postoperative analgesic requirement and mean hospital stay was 100min, 250 mg and 4 days, respectively in endopyelotomy group and 210 min, 300 mg and 4 days, respectively in laparoscopic pyeloplasty group. Only operative time was significantly different between two groups (P < 0.05. Mean follow-up was 36 and 39 months and success rates were 91.2% and 88.8% in laparoscopy and endopyelotomy group, respectively (P < 0.05. No significant complication was seen in endopyelotomy group while two patients had hematuria (one requiring blood transfusion and three had increased drain output for more than 3 days in laparoscopy group. Conclusion: Percutaneous endopyelotomy is associated with significantly less operative time and postoperative complication rate and provides equivalent success in comparison to nondismembered laparoscopic pyeloplasty in patients with UPJO and low volume pelvis. It can be a preferred minimally invasive treatment modality for such patients.

  1. Health Technology Assessment of laparoscopic compared to conventional surgery with and without mesh for incisional hernia repair regarding safety, efficacy and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    Willich, Stefan

    2008-03-01

    Medical Documentation and Information (DIMDI as well as by a manual search. The former included the following electronic resources: SOMED (SM78, Cochrane Library – Central (CCTR93, MEDLINE Alert (ME0A, MEDLINE (ME95, CATFILEplus (CATLINE (CA66, ETHMED (ED93, GeroLit (GE79, HECLINET (HN69, AMED (CB85, CAB Abstracts (CV72, GLOBAL Health (AZ72, IPA (IA70, Elsevier BIOBASE (EB94, BIOSIS Previews (BA93, EMBASE (EM95, EMBASE Alert (EA08, SciSearch (IS90, Cochrane Library – CDSR (CDSR93, NHS-CRD-DARE (CDAR94, NHS-CRD-HTA (INAHTA as well as NHSEED (NHSEED. The present report includes German and English literature published until 31.08.2005. The search parameters can be found in the appendix. No limits were placed on the target population. The methodological quality of the included clinical studies was assessed using the criteria recommended by the “Scottish Intercollegiate Guidelines Network Grading Review Group“. Economic studies were evaluated by the criteria of the German Scientific Working Group Technology Assessment for Health Care. Results: The literature search identified 17 relevant medical publications. One of these studies compared laparoscopic and conventional surgery with and without mesh for incisional hernia repair, while 16 studies compared laparoscopic and conventional surgery with mesh for incisional hernia repair. Among these studies were 14 primary studies (one randomised controlled trial (RCT, two systematic reviews and one HTA-Report. The only study comparing laparoscopic and conventional surgery without mesh found substantial differences in terms of baseline characteristics between treatment groups. The outcome parameters showed decreased recurrence rates for the laparoscopic repair and similar safety of the procedures. Studies comparing laparoscopic and conventional surgery with mesh found similar outcome in terms of medical efficacy and safety. However, there was a trend towards lower recurrence rates, length of hospital stay, and postoperative

  2. Outcome of Peroral Endoscopic Myotomy (POEM) for Treating Achalasia Compared With Laparoscopic Heller Myotomy (LHM).

    Science.gov (United States)

    Peng, Lijun; Tian, Shuni; Du, Chao; Yuan, Ziying; Guo, Mingxiao; Lu, Lin

    2017-02-01

    Peroral endoscopic myotomy (POEM) is an emerging endoscopic treatment for achalasia and the long-term efficacy of POEM remains to be evaluated. This study compared the outcomes of POEM with that of the standard laparoscopic Heller myotomy (LHM) for achalasia. Achalasia patients treated by POEM or LHM were retrospectively analyzed, with a minimum postoperative follow-up of 3 years. Perioperative outcomes and long-term outcomes including treatment success (Eckardt score ≤3), occurrence of gastroesophageal reflux disease (GERD) (GerdQ score ≥9) and quality of life (36-item short form) were compared. Thirteen patients who underwent POEM were compared with 18 patients who received LHM. These patients were similar in age, sex, symptoms duration, Eckardt score, and previous therapy (all P>0.05). Mean myotomy lengths were similar (P=0.73). Operation time was shorter in the POEM group (P=0.001). One patient (7.7%) developed pneumothorax after POEM and 1 patient (5.6%) experienced postoperative infection after LHM (P=1.00). Treatment success was achieved in 83.3% (9/12) of POEM patients and 80.0% (12/15) of LHM patients (P=1.00). Both POEM and LHM significantly reduced Eckardt score (both P=0.00). GERD rate was similar (8.3% vs. 6.7%, P=1.00). There was no difference in all aspects of quality of life between the 2 groups. Long-term outcomes indicate that POEM is an effective treatment that is comparable with LHM. More data of randomized trials comparing POEM with LHM will enrich the existing evidence.

  3. Visual Occlusion During Minimally Invasive Surgery: A Contemporary Review of Methods to Reduce Laparoscopic and Robotic Lens Fogging and Other Sources of Optical Loss.

    Science.gov (United States)

    Manning, Todd G; Perera, Marlon; Christidis, Daniel; Kinnear, Ned; McGrath, Shannon; O'Beirne, Richard; Zotov, Paul; Bolton, Damien; Lawrentschuk, Nathan

    2017-04-01

    Maintenance of optimal vision during minimally invasive surgery is crucial to maintaining operative awareness, efficiency, and safety. Hampered vision is commonly caused by laparoscopic lens fogging (LLF), which has prompted the development of various antifogging fluids and warming devices. However, limited comparative evidence exists in contemporary literature. Despite technologic advancements there remains no consensus as to superior methods to prevent LLF or restore visual acuity once LLF has occurred. We performed a review of literature to present the current body of evidence supporting the use of numerous techniques. A standardized Preferred Reporting Items for Systematic Reviews and Meta-Analysis review was performed, and PubMed, Embase, Web of Science, and Google Scholar were searched. Articles pertaining to mechanisms and prevention of LLF were reviewed. We applied no limit to year of publication or publication type and all articles encountered were included in final review. Limited original research and heterogenous outcome measures precluded meta-analytical assessment. Vision loss has a multitude of causes and although scientific theory can be applied to in vivo environments, no authors have completely characterized this complex problem. No method to prevent or correct LLF was identified as superior to others and comparative evidence is minimal. Robotic LLF was poorly investigated and aside from a single analysis has not been directly compared to standard laparoscopic fogging in any capacity. Obscured vision during surgery is hazardous and typically caused by LLF. The etiology of LLF despite application of scientific theory is yet to be definitively proven in the in vivo environment. Common methods of prevention of LLF or restoration of vision due to LLF have little evidence-based data to support their use. A multiarm comparative in vivo analysis is required to formally assess these commonly used techniques in both standard and robotic laparoscopes.

  4. Robotic assisted versus pure laparoscopic surgery of the adrenal glands: a case-control study comparing surgical techniques.

    Science.gov (United States)

    Morelli, Luca; Tartaglia, Dario; Bronzoni, Jessica; Palmeri, Matteo; Guadagni, Simone; Di Franco, Gregorio; Gennai, Andrea; Bianchini, Matteo; Bastiani, Luca; Moglia, Andrea; Ferrari, Vincenzo; Fommei, Enza; Pietrabissa, Andrea; Di Candio, Giulio; Mosca, Franco

    2016-11-01

    The role of the da Vinci Robotic System ® in adrenal gland surgery is not yet well defined. The goal of this study was to compare robotic-assisted surgery with pure laparoscopic surgery in a single center. One hundred and 16 patients underwent minimally invasive adrenalectomies in our department between June 1994 and December 2014, 41 of whom were treated with a robotic-assisted approach (robotic adrenalectomy, RA). Patients who underwent RA were matched according to BMI, age, gender, and nodule dimensions, and compared with 41 patients who had undergone laparoscopic adrenalectomies (LA). Statistical analysis was performed using the Student's t test for independent samples, and the relationship between the operative time and other covariates were evaluated with a multivariable linear regression model. P surgery (p surgery.

  5. A comparative study on the short-term clinicopathologic outcomes of laparoscopic surgery versus conventional open surgery for transverse colon cancer.

    Science.gov (United States)

    Kim, H J; Lee, I K; Lee, Y S; Kang, W K; Park, J K; Oh, S T; Kim, J G; Kim, Y H

    2009-08-01

    The long-term oncologic stability of laparoscopic surgery for colon cancer was established, and laparoscopic surgery was accepted as an alternative to conventional open surgery for colon cancer. However, transverse colon cancer was excluded from the majority of the previous prospective studies. As a result, debate on laparoscopic surgery for transverse colon cancer continues. This study aimed to compare the clinicopathologic outcome of laparoscopic surgery with that of conventional open surgery for transverse colon cancer. From August 2004 to December 2007, 106 cases of transverse colon cancer were managed by resection at our institution, and 89 of these cases were included in this study. Age, sex, body mass index (BMI), operation time, blood loss, time to first flatus, time to start of diet, hospital stay, complications, tumor size, distal resection margin, proximal resection margin, and number of nodes harvested were compared between the two groups. No significant differences were found between the laparoscopic and conventional groups in terms of age, sex, BMI, operation time, or hospital stay. The mean blood loss during the operations was significantly less in the laparoscopic group (113.8 +/- 128.9 ml) than in the conventional group (278.8 +/- 268.7 ml; p transverse colon cancer, and the oncologic quality of laparoscopic surgery was found to be acceptable compared with conventional open surgery.

  6. A comparative study on trans-umbilical single-port laparoscopic approach versus conventional repair for incarcerated inguinal hernia in children

    OpenAIRE

    Jun, Zhang; Juntao, Ge; Shuli, Liu; Li, Long

    2016-01-01

    Purpose: The purpose of this study is to determine whether singleport laparoscopic repair (SLR) for incarcerated inguinal hernia in children is superior toconventional repair (CR) approaches. Method: Between March 2013 and September 2013, 126 infants and children treatedwere retrospectively reviewed. All the patients were divided into three groups. Group A (48 patients) underwent trans-umbilical SLR, group B (36 patients) was subjected to trans-umbilical conventional two-port laparoscopic rep...

  7. Per-oral endoscopic myotomy for achalasia. Are results comparable to laparoscopic Heller myotomy?

    Science.gov (United States)

    Kumagai, Koshi; Tsai, Jon A; Thorell, Anders; Lundell, Lars; Håkanson, Bengt

    2015-05-01

    Per-oral endoscopic myotomy (POEM) has recently been introduced as a minimal invasive alternative to conventional treatment for achalasia. This study aimed to clarify the feasibility and the short-term clinical efficacy of POEM as compared to laparoscopic Heller myotomy (LHM). Treatment outcomes were prospectively recorded and compared between the procedures in a nonrandomized fashion. Reduction rate (RR) in timed barium esophagogram (TBE) was calculated at 1, 2 and 5 min after barium ingestion as: RR = 1- postoperative barium height/preoperative barium height. Risk factors for treatment failure defined as the proportion of patients with RR <0.5 (1 min) and gastroesophageal reflux (GER) after POEM were analyzed. Forty-two consecutive patients who underwent POEM were compared to 41 patients who had a LHM during the immediate time period prior to the introduction of POEM. Ninety percent of the cases reported complete symptom relief after POEM. The percentage of esophageal emptying and RR in TBE improved dramatically by both procedures without significant difference. A longer operation time (odds ratio [OR] 32.80, 95%CI 2.99-359.82, p = 0.004) and younger age (OR 26.81, 95%CI 2.09-344.03, p = 0.012) were the independent predictors of treatment failure after POEM. GER was observed in seven patients where previous dilatation (OR 8.59, 95%CI 1.16-63.45, p = 0.035) and higher body mass index (OR 8.69, 95%CI 1.13-66.63, p = 0.037) were the independent predictors for symptomatic GER after POEM. POEM seems to be a safe and effective treatment option for achalasia in the short-term perspective; an effect well comparable to LHM.

  8. Transperitoneal laparoscopic dismembered pyeloplasty in unusual circumstances--is the outcome comparable to that achieved in familiar pathologies?

    Science.gov (United States)

    Abraham, George P; Das, Krishanu; Ramaswami, Krishnamohan; Siddaiah, Avinash T; George, Datson P; Abraham, Jisha J; Thampan, Oppukeril S

    2012-05-01

    To compare the operative outcome, morbidity profile, and functional outcome after transperitoneal laparoscopic dismembered pyeloplasty for ureteropelvic junction obstruction in unusual circumstances (intrinsic pathology in anomalous kidneys or unusual extrinsic pathologies; group 1) to the outcome after this procedure in familiar pathologies (normally located kidneys with intrinsic dysfunctional segment or extrinsic compression due to a crossing vessel; group 2). The patients were evaluated in detail. All patients underwent transperitoneal laparoscopic dismembered pyeloplasty. The operative and postoperative parameters were recorded. Patients were followed up after the procedure on a 3-month protocol. Imaging was repeated at 1 year. No intervention during the follow-up period (ie, nephrostomy, ureteral stenting, or redo pyeloplasty) and improvement in the hydronephrosis grade and diuretic renogram parameters was interpreted as procedural success. The operative, postoperative, and follow-up parameters in the 2 groups were compared. Group 1 included 17 patients with intrinsic pathologic features and renal anomalies with ureteropelvic junction obstruction due to unusual extrinsic pathology. All procedures were successfully completed with the laparoscopic approach. A significant difference was noted in the mean operative duration (group 1, 196.9 ± 10.3 minutes; group 2, 125.44 minutes, P = .00). The other operative and postoperative parameters were comparable. No significant operative or postoperative events were noted. A total of 14 patients (group 1) completed the 1-year follow-up protocol. The success rate was 92.9% (13 of 14) in group 1 and 97.9% (44 of 45) in group 2 (P = .42). The procedural duration for laparoscopic dismembered pyeloplasty in unusual circumstances is longer than in familiar pathologies. However, the morbidity profile and functional outcome in these 2 scenarios were comparable. Copyright © 2012 Elsevier Inc. All rights reserved.

  9. Laparoscopic Splenectomy for Benign Hematological Disorders in Adults: A Systematic Review.

    Science.gov (United States)

    Moris, Demetrios; Dimitriou, Nikoletta; Griniatsos, John

    2017-01-01

    Since its introduction in the early 1990s, laparoscopic splenectomy (LS) has gained worldwide acceptance for spleen removal, especially in hematological patients. The present review summarizes the current knowledge and results of LS for the treatment of benign hematological diseases in adults. A MEDLINE/PubMed database research was performed using the terms: "laparoscopic splenectomy" OR "laparoscopy" OR "splenectomy" AND "hematological disorders" OR "hematological disease" OR "hematology" AND "adults" as key words. We set our analysis starting date as January 1st 2010 and the end date as December 31st 2016. We identified 247 relative articles. All the references from the identified articles were searched for relevant information. Twenty-seven articles were deemed appropriate for our analysis. LS was found to be feasible and safe in the majority of patients with benign hematological disorders, with a mortality rate ranging from 0% to less than 4% and the postoperative complications rate from 0% to 35.7%. The conversion rate was also very low (4%) and response (complete or partial) was achieved in more than 80% of patients. Lateral approach with four trocars was the most commonly used approach with concommitant cholecystectomy being correlated with increased operative time and morbidity. Current literature holds that whenever splenectomy is required for the treatment of hematological disorders in adults, a laparoscopic approach should be offered as the gold standard. However, to strengthen the clinical evidence in favor of LS, more high-quality clinical trials on several issues of the procedure are necessary. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  10. Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia.

    Science.gov (United States)

    Awaiz, A; Rahman, F; Hossain, M B; Yunus, R M; Khan, S; Memon, B; Memon, M A

    2015-06-01

    The utility of laparoscopic repair in the treatment of incisional hernia repair is still contentious. The aim was to conduct a meta-analysis of RCTs investigating the surgical and postsurgical outcomes of elective incisional hernia by open versus laparoscopic method. A search of PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane Central Register of Controlled Trials published between January 1993 and September 2013 was performed using medical subject headings (MESH) "hernia," "incisional," "abdominal," "randomized/randomised controlled trial," "abdominal wall hernia," "laparoscopic repair," "open repair", "human" and "English". Prospective RCTs comparing surgical treatment of only incisional hernia (and not primary ventral hernias) using open and laparoscopic methods were selected. Data extraction and critical appraisal were carried out independently by two authors (AA and MAM) using predefined data fields. The outcome variables analyzed included (a) hernia diameter; (b) operative time; (c) length of hospital stay; (d) overall complication rate; (e) bowel complications; (f) reoperation; (g) wound infection; (h) wound hematoma or seroma; (i) time to oral intake; (j) back to work; (k) recurrence rate; and (l) postoperative neuralgia. These outcomes were unanimously decided to be important since they influence the practical and surgical approach towards hernia management within hospitals and institutions. The quality of RCTs was assessed using Jadad's scoring system. Random effects model was used to calculate the effect size of both binary and continuous data. Heterogeneity amongst the outcome variables of these trials was determined by the Cochran Q statistic and I (2) index. The meta-analysis was prepared in accordance with PRISMA guidelines. Sufficient data were available for the analysis of twelve clinically relevant outcomes. Statistically significant reduction in bowel complications was noted with open surgery compared to the

  11. Comparative assessment of physical and cognitive ergonomics associated with robotic and traditional laparoscopic surgeries.

    Science.gov (United States)

    Lee, Gyusung I; Lee, Mija R; Clanton, Tameka; Clanton, Tamera; Sutton, Erica; Park, Adrian E; Marohn, Michael R

    2014-02-01

    We conducted this study to investigate how physical and cognitive ergonomic workloads would differ between robotic and laparoscopic surgeries and whether any ergonomic differences would be related to surgeons' robotic surgery skill level. Our hypothesis is that the unique features in robotic surgery will demonstrate skill-related results both in substantially less physical and cognitive workload and uncompromised task performance. Thirteen MIS surgeons were recruited for this institutional review board-approved study and divided into three groups based on their robotic surgery experiences: laparoscopy experts with no robotic experience, novices with no or little robotic experience, and robotic experts. Each participant performed six surgical training tasks using traditional laparoscopy and robotic surgery. Physical workload was assessed by using surface electromyography from eight muscles (biceps, triceps, deltoid, trapezius, flexor carpi ulnaris, extensor digitorum, thenar compartment, and erector spinae). Mental workload assessment was conducted using the NASA-TLX. The cumulative muscular workload (CMW) from the biceps and the flexor carpi ulnaris with robotic surgery was significantly lower than with laparoscopy (p NASA-TLX analysis showed that both robotic surgery novices and experts expressed lower global workloads with robotic surgery than with laparoscopy, whereas LEs showed higher global workload with robotic surgery (p > 0.05). Robotic surgery experts and novices had significantly higher performance scores with robotic surgery than with laparoscopy (p < 0.05). This study demonstrated that the physical and cognitive ergonomics with robotic surgery were significantly less challenging. Additionally, several ergonomic components were skill-related. Robotic experts could benefit the most from the ergonomic advantages in robotic surgery. These results emphasize the need for well-structured training and well-defined ergonomics guidelines to maximize the

  12. Renal stone in crossed fused renal ectopia and its laparoscopic management: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Santosh Agrawal

    2016-01-01

    Full Text Available Management of renal stone in crossed fused renal ectopia (CFRE is difficult because of abnormal location, malrotation, and its relations with vertebral column and small bowel. Management is not standardized because of the paucity of literature and variable anatomy. We managed an 8-year-old boy with multiple renal stones in right side crossed kidney by laparoscopic pyelolithotomy and nephro pyeloscopy with the help of ureteroscope. Until now, there is only one prior report of laparoscopic pyelolithotomy in CFRE. We share our experience in this case and review the literature regarding the management of kidney stones in this rare anomaly.

  13. Cost-effectiveness analysis comparing the essure tubal sterilization procedure and laparoscopic tubal sterilization.

    Science.gov (United States)

    Thiel, John A; Carson, George D

    2008-07-01

    To analyze the financial implications of establishing a hysteroscopic sterilization program using the Essure micro-insert tubal sterilization system in an ambulatory clinic. A retrospective cohort study (Canadian Task Force classification Type II-2), in an ambulatory women's health clinic in a tertiary hospital, of 108 women undergoing Essure coil insertion between 2005 and 2006, and 104 women undergoing laparoscopic tubal sterilization for permanent sterilization between 2001 and 2004. The Essure procedures used a 4 mm single channel operative hysteroscope and conscious sedation (fentanyl and midazolam); the laparoscopic tubal sterilizations were completed under general anaesthesia with a 7 mm laparoscope and either bipolar cautery or Filshie clips. Costs associated with the procedure, follow-up, and management of any complications (including nursing, hospital charges, equipment, and disposables) were tabulated. The Essure coils were successfully placed on the first attempt in 103 of 108 women (95%). Three patients required a second attempt to complete placement and two patients required laparoscopic tubal sterilization after an unsuccessful Essure. All 104 laparoscopic tubals were completed on the first attempt with no complications reported. The total cost for the 108 Essure procedures, including follow-up evaluation, was $138,996 or $1287 per case. The total cost associated with the 104 laparoscopic tubal sterilization procedures was $148,227 or $1398 per case. The incremental cost-effectiveness ratio was $111. The Essure procedure in an ambulatory setting resulted in a statistically significant cost saving of $111 per sterilization procedure. Carrying out the Essure procedure in an ambulatory setting frees space in the operating room for other types of cases, improving access to care for more patients.

  14. The laparoscopic approach in emergency surgery: A review of the literature

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    Ionut Negoi

    2018-01-01

    Full Text Available The role of laparoscopy in the acute care surgery had significantly increased during the latest years, both as a diagnostic and treatment method of all the upper or lower gastrointestinal pathologies. The objective of the present research is to review the current indications for laparoscopy in bdominal emergencies and to detail the benefits and complications associated with this approach. We have reviewed the relevant literature about this topic published between January 2005 and December 2017, using the PubMed/Medline and Web of Science Core Collection databases. According to the current evidence, we may conclude that the laparoscopic approach is an integral part of the emergency surgery for all the abdominal pathologies. Although laparoscopy requires specialized training and curricula, it brings all the benefits of minimal access in acute care arena.

  15. Laparoscopic excision of urachal cyst in pediatric age: report of three cases and review of the literature.

    Science.gov (United States)

    Chiarenza, Salvatore Fabio; Scarpa, Maria Grazia; D'Agostino, Sergio; Fabbro, Maria Angelica; Novek, Steven J; Musi, Luciano

    2009-04-01

    To determine the role of laparoscopic surgery in the treatment of pediatric urachal disorders. Case reports and a literature review of laparoscopic excision of urachal remnants. In a five-year period, three children were diagnosed with urachal anomalies presenting as abdominal or urinary symptoms, and were treated by laparoscopic surgery. The average age was 8.3 years (range, 4-13),and there were two girls and one boy. Mean operative time was 90 minutes (range, 60-120), and there were nopostoperative complications. The three patients were all discharged by postoperative day four. Laparoscopy is an effective and safe minimally invasive technique in the management of pediatricurachal anomalies. It is effective even in cases of infected urachal cysts.

  16. Role of Epidural Analgesia within an ERAS Program after Laparoscopic Colorectal Surgery: A Review and Meta-Analysis of Randomised Controlled Studies

    Directory of Open Access Journals (Sweden)

    Giuseppe Borzellino

    2016-01-01

    Full Text Available Introduction. Epidural analgesia has been a cornerstone of any ERAS program for open colorectal surgery. With the improvements in anesthetic and analgesic techniques as well as the introduction of the laparoscopy for colorectal resection, the role of epidural analgesia has been questioned. The aim of the review was to assess through a meta-analysis the impact of epidural analgesia compared to other analgesic techniques for colorectal laparoscopic surgery within an ERAS program. Methods. Literature research was performed on PubMed, Embase, and the Cochrane Library. All randomised clinical trials that reported data on hospital stay, postoperative complications, and readmissions rates within an ERAS program with and without an epidural analgesia after a colorectal laparoscopic resection were included. Results. Five randomised clinical trials were selected and a total of 168 patients submitted to epidural analgesia were compared to 163 patients treated by an alternative analgesic technique. Pooled data show a longer hospital stay in the epidural group with a mean difference of 1.07 (95% CI 0.06–2.08 without any significant differences in postoperative complications and readmissions rates. Conclusion. Epidural analgesia does not seem to offer any additional clinical benefits to patients undergoing laparoscopic colorectal surgery within an ERAS program.

  17. Effect of Playing Video Games on Laparoscopic Skills Performance: A Systematic Review.

    Science.gov (United States)

    Glassman, Daniel; Yiasemidou, Marina; Ishii, Hiro; Somani, Bhaskar Kumar; Ahmed, Kamran; Biyani, Chandra Shekhar

    2016-02-01

    The advances in both video games and minimally invasive surgery have allowed many to consider the potential positive relationship between the two. This review aims to evaluate outcomes of studies that investigated the correlation between video game skills and performance in laparoscopic surgery. A systematic search was conducted on PubMed/Medline and EMBASE databases for the MeSH terms and keywords including "video games and laparoscopy," "computer games and laparoscopy," "Xbox and laparoscopy," "Nintendo Wii and laparoscopy," and "PlayStation and laparoscopy." Cohort, case reports, letters, editorials, bulletins, and reviews were excluded. Studies in English, with task performance as primary outcome, were included. The search period for this review was 1950 to December 2014. There were 57 abstracts identified: 4 of these were found to be duplicates; 32 were found to be nonrelevant to the research question. Overall, 21 full texts were assessed; 15 were excluded according to the Medical Education Research Study Quality Instrument quality assessment criteria. The five studies included in this review were randomized controlled trials. Playing video games was found to reduce error in two studies (P 0.002 and P 0.045). For the same studies, however, several other metrics assessed were not significantly different between the control and intervention group. One study showed a decrease in the time for the group that played video games (P 0.037) for one of two laparoscopic tasks performed. In the same study, however, when the groups were reversed (initial control group became intervention and vice versa), a difference was not demonstrated (P for peg transfer 1 - 0.465, P for cobra robe - 0.185). Finally, two further studies found no statistical difference between the game playing group and the control group's performance. There is a very limited amount of evidence to support that the use of video games enhances surgical simulation performance.

  18. Prospective study comparing laparoscopic and open adenomectomy: Surgical and functional results.

    Science.gov (United States)

    Garcia-Segui, A; Angulo, J C

    Open adenomectomy (OA) is the surgery of choice for large volume benign prostatic hyperplasia, and laparoscopic adenomectomy (LA) represents a minimally invasive alternative. We present a long-term, prospective study comparing both techniques. The study consecutively included 199 patients with benign prostatic hyperplasia and prostate volumes>80g who were followed for more than 12 months. The patients underwent OA (n=97) or LA (n=102). We recorded and compared demographic and perioperative data, functional results and complications using a descriptive statistical analysis. The mean age was 69.2±7.7 years (range 42-87), and the mean prostate volume (measured by TRUS) was 112.1±32.7mL (range 78-260). There were no baseline differences among the groups in terms of age, ASA scale, prostate volume, PSA levels, Qmax, IPSS, QoL or treatments prior to the surgery. The surgical time (P<.0001) and catheter time (P<.0002) were longer in the LA group. Operative bleeding (P<.0001), transfusion rate (P=.0015) and mean stay (P<.0001) were significantly lower in the LA group. The LA group had a lower rate of complications (P=.04), but there were no significant differences between the groups in terms of major complications (Clavien score≥3) (P=.13) or in the rate of late complications (at one year) (P=.66). There were also no differences between the groups in the functional postoperative results: IPSS (P=.17), QoL (P=.3) and Qmax (P=.17). LA is a reasonable, safe and effective alternative that results in less bleeding, fewer transfusions, shorter hospital stays and lower morbidity than OA. LA has similar functional results to OA, at the expense of longer surgical times and longer catheter times. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. The Optimal Approach for Laparoscopic Adrenalectomy through Mono Port regarding Left or Right Sides: A Comparative Study

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    Wooseok Byon

    2014-01-01

    Full Text Available Introduction. Several studies have shown the feasibility and safety of both transperitoneal and posterior retroperitoneal approaches for single incision laparoscopic adrenalectomy, but none have compared the outcomes according to the left- or right-sided location of the adrenal glands. Materials and Methods. From 2009 to 2013, 89 patients who received LAMP (laparoscopic adrenalectomy through mono port were analyzed. The surgical outcomes attained using the transperitoneal approach (TPA and posterior retroperitoneal approach (PRA were analyzed and compared. Results and Discussion. On the right side, no significant differences were found between the LAMP-TPA and LAMP-PRA groups in terms of patient characteristics and clinicopathological data. However, outcomes differed in which LAMP-PRA group had a statistically significant shorter mean operative time (84.13 ± 41.47 min versus 116.84 ± 33.17 min; P=0.038, time of first oral intake (1.00 ± 0.00 days versus 1.21 ± 0.42 days; P=0.042, and length of hospitalization (2.17 ± 0.389 days versus 3.68 ± 1.38 days; P≤0.001, whereas in left-sided adrenalectomies LAMP-TPA had a statistically significant shorter mean operative time (83.85 ± 27.72 min versus 110.95 ± 29.31 min; P=0.002. Conclusions. We report that LAMP-PRA is more appropriate for right-sided laparoscopic adrenalectomies due to anatomical characteristics and better surgical outcomes. For left-sided laparoscopic adrenalectomies, however, we propose LAMP-TPA as a more suitable method.

  20. Trends in port-site metastasis after laparoscopic resection of incidental gallbladder cancer: A systematic review.

    Science.gov (United States)

    Berger-Richardson, David; Chesney, Tyler R; Englesakis, Marina; Govindarajan, Anand; Cleary, Sean P; Swallow, Carol J

    2017-03-01

    The risk of port-site metastasis after laparoscopic removal of incidental gallbladder cancer was previously estimated to be 14-30%. The present study was designed to determine the incidence of port-site metastasis in incidental gallbladder cancer in the modern era (2000-2014) versus the historic era (1991-1999). We also investigated the site of port-site metastasis. Using PRISMA, a systematic review was conducted to identify papers that addressed the development of port-site metastasis after laparoscopic resection of incidental gallbladder cancer. Studies that described cancer-specific outcomes in ≥5 patients were included. A validated quality appraisal tool was used, and a weighted estimate of the incidence of port-site metastasis was calculated. Based on data extracted from 27 papers that met inclusion criteria, the incidence of port-site metastasis in incidental gallbladder cancer has decreased from 18.6% prior to 2000 (95% confidence interval 15.3-21.9%, n = 7) to 10.3% since then (95% confidence interval 7.9-12.7%, n = 20) (P extraction site is at significantly higher risk than nonextraction sites. The incidence of port-site metastasis in incidental gallbladder cancer has decreased but remains high relative to other primary tumors. Any preoperative finding that raises the suspicion of gallbladder cancer should prompt further investigation and referral to a hepato-pancreato-biliary specialist. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Two cases of laparoscopic total colectomy with natural orifice specimen extraction and review of the literature.

    Science.gov (United States)

    Gundogan, Ersin; Aktas, Aydin; Kayaalp, Cuneyt; Gonultas, Fatih; Sumer, Fatih

    2017-09-01

    We present two cases of natural orifice specimen extraction (NOSE) after laparoscopic total colectomy and ileorectal anastomosis (TC-IRA), and we also review all of the previously reported cases. Our aim was to focus on patient selection for NOSE after TC-IRA. The PubMed and Google Scholar databases were scanned. Demographic features, surgical indications, and techniques were analyzed. Basic calculations were used for statistical analysis. A total of 13 cases were detected in addition to our 2 cases. All of the specimens were removed through the natural orifices successfully. No case required a diverting ileostomy. No patients were converted to open surgery or to conventional laparoscopy. Complications were reported in three patients. Transanal extractions were performed in 12 cases (10 colonic inertia, 2 polyposis), and transvaginal extractions were performed in 3 cases (2 malignancy, 1 colonic inertia). Both transanal and transvaginal specimen extractions after laparoscopic TC-IRA can be preferred. However, transanal extraction seems to be feasible in cases of TC for benign disease with a limited mesenteric-omental resection. If the indication is a malignancy requiring a mesenteric-omental resection, a transvaginal route should be preferred for a voluminous specimen.

  2. Total versus subtotal Laparoscopic Hysterectomy: A comparative study in Arash Hospital

    Directory of Open Access Journals (Sweden)

    Samiei H

    2009-09-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Over the past 50 years, subtotal or supracervical hysterectomy has come to be viewed as a suboptimal procedure reserved for those rare instances in which when concern over blood loss or anatomic distortion dictates limiting the extent of dissection, the aim of this study was to compare total and subtotal laparoscopic hysterectomy. "n"nMethods: The patients who were candidates for hysterectomy with benign disease, with no contraindication for laparoscopic surgery entered the study in Arash Hospital, from March 2007 to April 2009. By simple randomization 45 patients (25 for TLH and 20 for SLH were selected. Demographic Details and intra and post operative complications, were recorded by the staff and were compared between two groups."n"nResults: The average time for TLH operations look significantly longer than SLH operation (148.6±29.7 minutes; 128.5±25.64 minutes, p=0.03. Although, the hemoglobin (gr/dl drop in TLH was significantly higher than SLH (1.54 Versus 0.9, p<0.05 Blood transfusion were common in SLH (1 case Versus 3 Cases. The total length of hospital stay, was significantly shorter after SLH than TLH (3.6±1.47 day and 2.85±0.59, p=0.04. The drug requirements to

  3. Robot-assisted laparoscopic versus open partial nephrectomy in patients with chronic kidney disease: A propensity score-matched comparative analysis of surgical outcomes.

    Science.gov (United States)

    Takagi, Toshio; Kondo, Tsunenori; Tachibana, Hidekazu; Iizuka, Junpei; Omae, Kenji; Kobayashi, Hirohito; Yoshida, Kazuhiko; Tanabe, Kazunari

    2017-07-01

    To compare surgical outcomes between robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy in patients with chronic kidney disease. Of 550 patients who underwent partial nephrectomy between 2012 and 2015, 163 patients with T1-2 renal tumors who had an estimated glomerular filtration rate between 30 and 60 mL/min/1.73 m 2 , and underwent robot-assisted laparoscopic partial nephrectomy or open partial nephrectomy were retrospectively analyzed. To minimize selection bias between the two surgical methods, patient variables were adjusted by 1:1 propensity score matching. The present study included 75 patients undergoing robot-assisted laparoscopic partial nephrectomy and 88 undergoing open partial nephrectomy. After propensity score matching, 40 patients were included in each operative group. The mean preoperative estimated glomerular filtration rate was 49 mL/min/1.73 m 2 . The mean ischemia time was 21 min in robot-assisted laparoscopic partial nephrectomy (warm ischemia) and 35 min in open partial nephrectomy (cold ischemia). Preservation of the estimated glomerular filtration rate 3-6 months postoperatively was not significantly different between robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy (92% vs 91%, P = 0.9348). Estimated blood loss was significantly lower in the robot-assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group (104 vs 185 mL, P = 0.0025). The postoperative length of hospital stay was shorter in the robot-assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group (P negative surgical margin status were not significantly different between the two groups. In our experience, robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy provide similar outcomes in terms of functional preservation and perioperative complications among patients with chronic kidney disease. However, a lower estimated blood loss and

  4. Laparoscopic rectal cancer surgery: Where do we stand?

    Institute of Scientific and Technical Information of China (English)

    Mukta K Krane; Alessandro Fichera

    2012-01-01

    Large comparative studies and multiple prospective randomized control trials (RCTs) have reported equivalence in short and long-term outcomes between the open and laparoscopic approaches for the surgical treatment of colon cancer which has heralded widespread acceptance for laparoscopic resection of colon cancer.In contrast,laparoscopic total mesorectal excision (TME) for the treatment of rectal cancer has been welcomed with significantly less enthusiasm.While it is likely that patients with rectal cancer will experience the same benefits of early recovery and decreased postoperative pain from the laparoscopic approach,whether the same oncologic clearance,specifically an adequate TME can be obtained is of concern.The aim of the current study is to review the current level of evidence in the literature on laparoscopic rectal cancer surgery with regard to short-term and long-term oncologic outcomes.The data from 8 RCTs,3 metaanalyses,and 2 Cochrane Database of Systematic Reviews was reviewed.Current data suggests that laparoscopic rectal cancer resection may benefit patients with reduced blood loss,earlier retum of bowel function,and shorter hospital length of stay.Concerns that laparoscopic rectal cancer surgery compromises shortterm oncologic outcomes including number of lymph nodes retrieved and circumferential resection margin and jeopardizes long-term oncologic outcomes has not conclusively been refuted by the available literature.Laparoscopic rectal cancer resection is feasible but whether or not it compromises short-term or long-term results still needs to be further studied.

  5. Laparoscopic versus percutaneous endoscopic gastrostomy placement in children: Results of a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Nutnicha Suksamanapun

    2017-01-01

    Full Text Available Background: Percutaneous endoscopic gastrostomy (PEG and laparoscopic-assisted gastrostomy (LAG are widely used in the paediatric population. The aim of this study was to determine which one of the two procedures is the most effective and safe method. Methods: This systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses statement. Primary outcomes were success rate, efficacy of feeding, quality of life, gastroesophageal reflux and post-operative complications. Results: Five retrospective studies, comparing 550 PEG to 483 LAG placements in children, were identified after screening 2347 articles. The completion rate was similar for both procedures. PEG was associated with significantly more adjacent bowel injuries (P = 0.047, early tube dislodgements (P = 0.02 and complications that require reintervention under general anaesthesia (P < 0.001. Minor complications were equally frequent after both procedures. Conclusions: Because of the lack of well-designed studies, we have to be cautious in making definitive conclusions comparing PEG to LAG. To decide which type of gastrostomy placement is best practice in paediatric patients, randomised controlled trials comparing PEG to LAG are highly warranted.

  6. Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy.

    Science.gov (United States)

    Gala, Rajiv B; Margulies, Rebecca; Steinberg, Adam; Murphy, Miles; Lukban, James; Jeppson, Peter; Aschkenazi, Sarit; Olivera, Cedric; South, Mary; Lowenstein, Lior; Schaffer, Joseph; Balk, Ethan M; Sung, Vivian

    2014-01-01

    The Society of Gynecologic Surgeons Systematic Review Group performed a systematic review of both randomized and observational studies to compare robotic vs nonrobotic surgical approaches (laparoscopic, abdominal, and vaginal) for treatment of both benign and malignant gynecologic indications to compare surgical and patient-centered outcomes, costs, and adverse events associated with the various surgical approaches. MEDLINE and the Cochrane Central Register of Controlled Trials were searched from inception to May 15, 2012, for English-language studies with terms related to robotic surgery and gynecology. Studies of any design that included at least 30 women who had undergone robotic-assisted laparoscopic gynecologic surgery were included for review. The literature yielded 1213 citations, of which 97 full-text articles were reviewed. Forty-four studies (30 comparative and 14 noncomparative) met eligibility criteria. Study data were extracted into structured electronic forms and reconciled by a second, independent reviewer. Our analysis revealed that, compared with open surgery, robotic surgery consistently confers shorter hospital stay. The proficiency plateau seems to be lower for robotic surgery than for conventional laparoscopy. Of the various gynecologic applications, there seems to be evidence that renders robotic techniques advantageous over traditional open surgery for management of endometrial cancer. However, insofar as superiority, conflicting data are obtained when comparing robotics vs laparoscopic techniques. Therefore, the specific method of minimally invasive surgery, whether conventional laparoscopy or robotic surgery, should be tailored to patient selection, surgeon ability, and equipment availability. Copyright © 2014 AAGL. Published by Elsevier Inc. All rights reserved.

  7. Case-Mix Variables and Predictors for Outcomes of Laparoscopic Hysterectomy: A Systematic Review.

    Science.gov (United States)

    Driessen, Sara R C; Sandberg, Evelien M; la Chapelle, Claire F; Twijnstra, Andries R H; Rhemrev, Johann P T; Jansen, Frank Willem

    2016-01-01

    The assessment of surgical quality is complex, and an adequate case-mix correction is missing in currently applied quality indicators. The purpose of this study is to give an overview of all studies mentioning statistically significant associations between patient characteristics and surgical outcomes for laparoscopic hysterectomy (LH). Additionally, we identified a set of potential case-mix characteristics for LH. This systematic review was conducted according to the Meta-Analysis of Observational Studies in Epidemiology guidelines. We searched PubMed and EMBASE from January 1, 2000 to August 1, 2015. All articles describing statistically significant associations between patient characteristics and adverse outcomes of LH for benign indications were included. Primary outcomes were blood loss, operative time, conversion, and complications. The methodologic quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. The included articles were summed per predictor and surgical outcome. Three sets of case-mix characteristics were determined, stratified by different levels of evidence. Eighty-five of 1549 identified studies were considered eligible. Uterine weight and body mass index (BMI) were the most mentioned predictors (described, respectively, 83 and 45 times) in high quality studies. For longer operative time and higher blood loss, uterine weight ≥ 250 to 300 g and ≥500 g and BMI ≥ 30 kg/m(2) dominated as predictors. Previous operations, adhesions, and higher age were also considered as predictors for longer operative time. For complications and conversions, the patient characteristics varied widely, and uterine weight, BMI, previous operations, adhesions, and age predominated. Studies of high methodologic quality indicated uterine weight and BMI as relevant case-mix characteristics for all surgical outcomes. For future development of quality indicators of LH and to compare surgical outcomes adequately, a case

  8. A Review of the Ergonomic Issues in the Laparoscopic Operating Room

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    Sang D. Choi

    2012-01-01

    Full Text Available This review paper discusses the ergonomic challenges associated with laparoscopy in the operating room (OR and summarizes the practical ergonomic solutions. The literature search was conducted in the fields of laparoscopy and applied ergonomics. Findings indicated that laparoscopic OR staff (surgeons, perioperative nurses and technicians commonly experienced physical and mental ergonomic risks while working in prolonged static and awkward body positions. This study highlighted the need for more ergonomic interventions in OR environment in order to improve the efficiency of laparoscopy. Ergonomic solutions included utilizing adjustable equipment, placing computer peripherals in optimal locations, providing ergonomic instruments, and improving communication. Understanding the job- or task-related ergonomic risks and hazards could help identify intervention requirements to meet the challenges associated with increased dependency on advanced high technology in the OR.

  9. A 10-Year Review of Surgical Management of Complicated Peptic Ulcer Disease From a Single Center: Is Laparoscopic Approach the Future?

    Science.gov (United States)

    Agaba, Emmanuel A; Klair, Tarunjeet; Ikedilo, Ojinika; Vemulapalli, Prathiba

    2016-10-01

    The discovery of Helicobacter pylori (H. pylori) as the culprit in peptic ulcer disease (PUD) has revolutionized its management. Despite the presence of effective drug treatments and an increased understanding of its etiology, the percentage of patients who require emergent surgery for complicated disease remains constant at 7% of hospitalized patients. This study aims at reviewing the incidence of complicated PUD and analyze changes in surgical management. From January 2002 to September 2012, records of all patients with a clinical or radiologic diagnosis of perforated PUD were evaluated. Short-term and long-term results were assessed with regard to type of surgical intervention. The primary end point was adverse events. Other end points were length of hospital stay, complications, and deaths. Included were 400 patients with a median age of 56 years (range, 17 to 89 y). Of these, males made up 70% (n=280), were older and had more comorbidities. Majority of perforations were located in the prepyloric region (80%) and duodenal bulb (20%). Nonsteroidal anti-inflammatory drug alone was involved in 50% of cases and in combination with H. pylori in 84%. H. pylori alone occurred in 40% of cases.Laparoscopic treatment was performed in 48 patients (12%) who remained hemodynamically stable. In the remaining 88% of patients, open approach was used. Simple closure with omentoplasty was performed in 98% and in 2%; definitive anti ulcer procedure was performed. Major complications occurred in 6% with an overall 30-day mortality rate of 2%. Most postoperative morbidity occurred after open approach. One patient who had laparoscopic repair died of other causes unrelated to the gastroduodenal perforation. Among the laparoscopic group, mean hospital stay was 4 days (range, 3 to 7 d), compared with 6 days (5 to 14 d) after open approach. Although the incidence of PUD is decreasing, it appears that among our patients, the incidence of complication is rising. Laparoscopic approach

  10. Single-Incision Transumbilical Surgery (SITUS) versus Single-Port Laparoscopic Surgery and conventional laparoscopic surgery: a prospective randomized comparative study of performance with novices in a dry laboratory.

    Science.gov (United States)

    Schoenthaler, Martin; Avcil, Tuba; Sevcenco, Sabina; Nagele, Udo; Hermann, Thomas E W; Kuehhas, Franklin E; Shariat, Shahrokh F; Frankenschmidt, Alexander; Wetterauer, Ulrich; Miernik, Arkadiusz

    2015-01-01

    To evaluate the Single-Incision Transumbilical Surgery (SITUS) technique as compared to an established laparoendoscopic single-site surgery (LESS) technique (Single-Port Laparoscopic Surgery, SPLS) and conventional laparoscopy (CLS) in a surgical simulator model. Sixty-three medical students without previous laparoscopic experience were randomly assigned to one of the three groups (SITUS, SPLS and CLS). Subjects were asked to perform five standardized tasks of increasing difficulty adopted from the Fundamentals of Laparoscopic Surgery curriculum. Statistical evaluation included task completion times and accuracy. Overall performances of all tasks (except precision cutting) were significantly faster and of higher accuracy in the CLS and SITUS groups than in the SPLS group (p = 0.004 to p port-assisted LESS technique such as SPLS. The demonstrated advantages of SITUS may be attributed to a preservation of the basic principles of conventional laparoscopy, such as the use of straight instruments and an adequate degree of triangulation.

  11. What is the best technique in parenchymal transection in laparoscopic liver resection? Comprehensive review for the clinical question on the 2nd International Consensus Conference on Laparoscopic Liver Resection.

    Science.gov (United States)

    Otsuka, Yuichiro; Kaneko, Hironori; Cleary, Sean P; Buell, Joseph F; Cai, Xiujun; Wakabayashi, Go

    2015-05-01

    The continuing evolution of technique and devices used in laparoscopic liver resection (LLR) has allowed successful application of this minimally invasive surgery for the treatment of liver disease. However, the type of instruments by energy sources and technique used vary among each institution. We reviewed the literature to seek the best technique for parenchymal transection, which was proposed as one of the important clinical question in the 2nd International Consensus Conference on LLR held on October 2014. While publications have described transection techniques used in LLR from 1991 to June 2014, it is difficult to specify the best technique and device for laparoscopic hepatic parenchymal transection, owing to a lack of randomized trials with only a small number of comparative studies. However, it is clear that instruments should be used in combination with others based on their functions and the depth of liver resection. Most authors have reported using staplers to secure and divide major vessels. Preparation for prevention of unexpected hemorrhaging particularly in liver cirrhosis, the Pringle's maneuver and prompt technique for hemostasis should be performed. We conclude that hepatobiliary surgeons should select techniques based on their familiarity with a concrete understanding of instruments and individualize to the procedure of LLR. © 2015 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  12. Randomized clinical trial comparing an oral carbohydrate beverage with placebo before laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Bisgaard, T; Kristiansen, V B; Hjortsø, N C

    2004-01-01

    BACKGROUND: Preoperative oral carbohydrate can attenuate postoperative insulin resistance and catabolism, and may have the potential to improve postoperative recovery. There are no data from randomized studies on postoperative clinical outcome after specific surgical procedures. This study...... evaluated the clinical effects of a preoperative carbohydrate beverage in patients undergoing laparoscopic cholecystectomy. METHODS: Ninety-four patients undergoing laparoscopic cholecystectomy were included in a randomized clinical trial. Patients were randomized to receive 800 ml of an iso-osmolar 12.......5 per cent carbohydrate-rich beverage the evening before operation (100 g carbohydrate) and another 400 ml (50 g carbohydrate) 2 h before initiation of anaesthesia, or the same volume of a placebo beverage. The primary endpoint was general well-being the day after operation. Patients were evaluated from...

  13. Robot-assisted radical prostatectomy has lower biochemical recurrence than laparoscopic radical prostatectomy: Systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Seon Heui Lee

    2017-05-01

    Full Text Available Purpose: To assess the effectiveness and safety of robot-assisted radical prostatectomy (RARP versus laparoscopic radical prostatectomy (LRP in the treatment of prostate cancer. Materials and Methods: Existing systematic reviews were updated to investigate the effectiveness and safety of RARP. Electronic databases, including Ovid MEDLINE, Ovid Embase, the Cochrane Library, KoreaMed, Kmbase, and others, were searched through July 2014. The quality of the selected systematic reviews was assessed by using the revised assessment of multiple systematic reviews (R-Amstar and the Cochrane Risk of Bias tool. Meta-analysis was performed by using Revman 5.2 (Cochrane Community and Comprehensive Meta-Analysis 2.0 (CMA; Biostat. Cochrane Q and I2 statistics were used to assess heterogeneity. Results: Two systematic reviews and 16 additional studies were selected from a search performed of existing systematic reviews. These included 2 randomized controlled clinical trials and 28 nonrandomized comparative studies. The risk of complications, such as injury to organs by the Clavien-Dindo classification, was lower with RARP than with LRP (relative risk [RR], 0.44; 95% confidence interval [CI], 1.23–0.85; p=0.01. The risk of urinary incontinence was lower (RR, 0.43; 95% CI, 0.31–0.60; p<0.000001 and the potency rate was significantly higher with RARP than with LRP (RR, 1.38; 95% CI, 1.11–1.70; I2 =78%; p=0.003. Regarding positive surgical margins, no significant difference in risk between the 2 groups was observed; however, the biochemical recurrence rate was lower after RARP than after LRP (RR, 0.59; 95% CI, 0.48–0.73; I2 =21%; p<0.00001. Conclusions: RARP appears to be a safe and effective technique compared with LRP with a lower complication rate, better potency, a higher continence rate, and a decreased rate of biochemical recurrence.

  14. Unsupervised laparoscopic appendicectomy by surgical trainees is safe and time-effective.

    Science.gov (United States)

    Wong, Kenneth; Duncan, Tristram; Pearson, Andrew

    2007-07-01

    Open appendicectomy is the traditional standard treatment for appendicitis. Laparoscopic appendicectomy is perceived as a procedure with greater potential for complications and longer operative times. This paper examines the hypothesis that unsupervised laparoscopic appendicectomy by surgical trainees is a safe and time-effective valid alternative. Medical records, operating theatre records and histopathology reports of all patients undergoing laparoscopic and open appendicectomy over a 15-month period in two hospitals within an area health service were retrospectively reviewed. Data were analysed to compare patient features, pathology findings, operative times, complications, readmissions and mortality between laparoscopic and open groups and between unsupervised surgical trainee operators versus consultant surgeon operators. A total of 143 laparoscopic and 222 open appendicectomies were reviewed. Unsupervised trainees performed 64% of the laparoscopic appendicectomies and 55% of the open appendicectomies. There were no significant differences in complication rates, readmissions, mortality and length of stay between laparoscopic and open appendicectomy groups or between trainee and consultant surgeon operators. Conversion rates (laparoscopic to open approach) were similar for trainees and consultants. Unsupervised senior surgical trainees did not take significantly longer to perform laparoscopic appendicectomy when compared to unsupervised trainee-performed open appendicectomy. Unsupervised laparoscopic appendicectomy by surgical trainees is safe and time-effective.

  15. Cost-Effectiveness of Laparoscopic Hysterectomy With Morcellation Compared With Abdominal Hysterectomy for Presumed Myomas.

    Science.gov (United States)

    Rutstein, Sarah E; Siedhoff, Matthew T; Geller, Elizabeth J; Doll, Kemi M; Wu, Jennifer M; Clarke-Pearson, Daniel L; Wheeler, Stephanie B

    2016-02-01

    Hysterectomy for presumed leiomyomata is 1 of the most common surgical procedures performed in nonpregnant women in the United States. Laparoscopic hysterectomy (LH) with morcellation is an appealing alternative to abdominal hysterectomy (AH) but may result in dissemination of malignant cells and worse outcomes in the setting of an occult leiomyosarcoma (LMS). We sought to evaluate the cost-effectiveness of LH versus AH. Decision-analytic model of 100 000 women in the United States assessing the incremental cost-effectiveness ratio (ICER) in dollars per quality-adjusted life-year (QALY) gained (Canadian Task Force classification III). U.S. hospitals. Adult premenopausal women undergoing LH or AH for presumed benign leiomyomata. We developed a decision-analytic model from a provider perspective across 5 years, comparing the cost-effectiveness of LH to AH in terms of dollar (2014 US dollars) per QALY gained. The model included average total direct medical costs and utilities associated with the procedures, complications, and clinical outcomes. Baseline estimates and ranges for cost and probability data were drawn from the existing literature. Estimated overall deaths were lower in LH versus AH (98 vs 103). Death due to LMS was more common in LH versus AH (86 vs 71). Base-case assumptions estimated that average per person costs were lower in LH versus AH, with a savings of $2193 ($24 181 vs $26 374). Over 5 years, women in the LH group experienced 4.99 QALY versus women in the AH group with 4.91 QALY (incremental gain of .085 QALYs). LH dominated AH in base-case estimates: LH was both less expensive and yielded greater QALY gains. The ICER was sensitive to operative costs for LH and AH. Varying operative costs of AH yielded an ICER of $87 651/QALY gained (minimum) to AH being dominated (maximum). Probabilistic sensitivity analyses, in which all input parameters and costs were varied simultaneously, demonstrated a relatively robust model. The AH approach was dominated

  16. Pneumoperitoneum pressures during pelvic laparoscopic surgery: a systematic review and meta-analysis.

    Science.gov (United States)

    Bogani, Giorgio; Martinelli, Fabio; Ditto, Antonino; Chiappa, Valentina; Lorusso, Domenica; Ghezzi, Fabio; Raspagliesi, Francesco

    2015-12-01

    Growing evidence suggests that the level of pneumoperitoneal pressure is directly correlated with postoperative pain in patients undergoing laparoscopic procedures. However, only limited evidence is available in the field of gynaecologic surgery. Therefore, this study aimed to compare the effects of low (8mmHg), standard (12mmHg) and high (15mmHg) pneumoperitoneal pressures (LPPlaparoscopic procedures confined to the pelvis. The primary outcome was to evaluate if changes in pneumoperitoneal pressure influence postoperative pain. The study also sought to determine the safety of LPP during gynaecologic procedures. A literature search revealed two randomized controlled trials that evaluated the effects of different pneumoperitoneal pressures. Overall, 230 patients who underwent gynaecologic procedures via laparoscopy using different pneumoperitoneal pressures (LPP: n=74, 32%; SPP: n=67, 29%; HPP: n=89, 39%) were evaluated. Pooled results suggested that the use of LPP does not increase operative time compared with SPP [mean difference (MD) 6.78min] and HPP (MD 5.52min). Similarly, no differences in operative time were recorded between procedures using SPP and HPP (MD 0.34min). Estimated blood loss was not influenced by CO2 intra-abdominal pressure (LPP vs SPP: MD 10.05ml; LPP vs HPP: MD -4.03ml; SPP vs HPP: MD 6.75ml). Twenty-four hours after surgery, HPP was found to be correlated with higher levels of pain compared with LPP and SPP. However, CO2 pressure did not influence the length of hospital stay. These results suggest that in comparison with SPP and HPP, LPP provides a slight benefit in terms of postoperative pain among patients undergoing gynaecologic laparoscopy, with no increase in operative time, blood loss or surgery-related morbidity. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. Laparoscopic choledochoduodenostomy: review of a 4-year experience with an uncommon problem.

    Science.gov (United States)

    Jeyapalan, Manjula; Almeida, J Arturo; Michaelson, Robert L P; Franklin, Morris E

    2002-06-01

    A laparoscopic choledochoduodenostomy (LCDD) may be performed when the common bile duct (CBD) is obstructed by primary or secondary stones or strictures. A biliary bypass procedure has two goals in view. The short-term goal is complete removal of stones and bypass of obstruction and stricture to restore biliary drainage. The long-term goal is preventing a recurrence of the problem. There is debate over the superiority of any one procedure to achieve both goals. Therefore, it may help the practicing clinician to be aware of the success (or failure), on a case-by-case basis, of these procedures. This awareness may help in the choice of technique. To date, since 1991, we have performed 16 LCDDs; however, in this report, we describe our results with LCDD over the last 4 years to emphasize the usefulness of this procedure. We find that it is a safe and effective procedure for treating patients with benign bile duct obstruction, even for those whose condition may be described as complicated or difficult. Evidence is slowly accumulating that LCDD is also successful in promoting long-term biliary drainage. We reviewed our LCDDs done over the past 4 years, documenting our preoperative, intraoperative, and postoperative experience. A successful LCDD was performed on all six patients. None of the patients had postoperative leaks. There was only one death, which was due to the patient's comorbidities and not the procedure itself. The hepatobiliary enzyme levels returned to normal in all of the surviving patients. The average postoperative length of stay was 6 days. With proper selection and adequate laparoscopic experience, LCDD can be performed in a safe and effective way.

  18. A short-term cost-effectiveness study comparing robot-assisted laparoscopic and open retropubic radical prostatectomy

    DEFF Research Database (Denmark)

    Hohwü, Lena; Borre, Michael; Ehlers, Lars

    2011-01-01

    OBJECTIVE: To evaluate cost effectiveness and cost utility comparing robot-assisted laparoscopic prostatectomy (RALP) versus retropubic radical prostatectomy (RRP). METHODS: In a retrospective cohort study a total of 231 men between the age of 50 and 69 years and with clinically localised prostate....... An economic evaluation was made to estimate direct costs of the first postoperative year and an incremental cost-effectiveness ratio (ICER) per successful surgical treatment and per quality-adjusted life-year (QALY). A successful RP was defined as: no residual cancer (PSA ... high volume urology centres and utilise the full potential of each robot....

  19. The effects of video games on laparoscopic simulator skills.

    Science.gov (United States)

    Jalink, Maarten B; Goris, Jetse; Heineman, Erik; Pierie, Jean-Pierre E N; ten Cate Hoedemaker, Henk O

    2014-07-01

    Recently, there has been a growth in studies supporting the hypothesis that video games have positive effects on basic laparoscopic skills. This review discusses all studies directly related to these effects. A search in the PubMed and EMBASE databases was performed using synonymous terms for video games and laparoscopy. All available articles concerning video games and their effects on skills on any laparoscopic simulator (box trainer, virtual reality, and animal models) were selected. Video game experience has been related to higher baseline laparoscopic skills in different studies. There is currently, however, no standardized method to assess video game experience, making it difficult to compare these studies. Several controlled experiments have, nevertheless, shown that video games cannot only be used to improve laparoscopic basic skills in surgical novices, but are also used as a temporary warming-up before laparoscopic surgery. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Laparoscopic management of superior mesentric artery syndrome: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Makam Ramesh

    2008-01-01

    Full Text Available Superior mesentric artery syndrome is a rare cause of high small bowel obstruction, caused by compression of the transverse part of the duodenum in between the superior mesentric artery and aorta. Patients present with chronic abdominal pain, vomiting and weight loss. We report a case of superior mesenteric artery syndrome, managed laparoscopically with laparoscopic duodenojejunostomy.

  1. Laparoscopic cholecystectomy under spinal anesthesia: comparative study between conventional-dose and low-dose hyperbaric bupivacaine

    Directory of Open Access Journals (Sweden)

    Imbelloni LE

    2011-10-01

    Full Text Available Luiz Eduardo Imbelloni1, Raphael Sant'Anna2, Marcos Fornasari2, José Carlos Fialho21Department of Anesthesiology, Faculty of Medecine Nova Esperança, Hospital de Mangabeira, João Pessoa, 2Hospital Rio Laranjeiras, Rio de Janeiro, BrazilBackground: Laparoscopic cholecystectomy has the advantages of causing less postoperative pain and requiring a short hospital stay, and therefore is the treatment of choice for cholelithiasis. This study was designed to compare spinal anesthesia using hyperbaric bupivacaine given as a conventional dose by lumbar puncture or as a low-dose by thoracic puncture.Methods: A total of 140 patients with symptomatic gallstone disease were randomized to undergo laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum under spinal anesthesia using either conventional lumbar spinal anesthesia (hyperbaric bupivacaine 15 mg and fentanyl 20 mg or low-dose thoracic spinal anesthesia (hyperbaric bupivacaine 7.5 mg and fentanyl 20 µg. Intraoperative parameters, postoperative pain, complications, recovery time, and patient satisfaction at follow-up were compared between the two treatment groups.Results: All procedures were completed under spinal anesthesia, with no cases needing conversion to general anesthesia. Values for time for block to reach the T3 dermatomal level, duration of motor and sensory block, and hypotensive events were significantly lower with low-dose bupivacaine. Postoperative pain was higher for low-dose hyperbaric bupivacaine at 6 and 12 hours. All patients were discharged after 24 hours. Follow-up 1 week postoperatively showed all patients to be satisfied and to be keen advocates of spinal anesthesia.Conclusion: Laparoscopic cholecystectomy can be performed successfully under spinal anesthesia. A small dose of hyperbaric bupivacaine 7.5 mg and 20 µg fentanyl provides adequate spinal anesthesia for laparoscopy and, in comparison with hyperbaric bupivacaine 15% and fentanyl 20 µg, causes markedly

  2. Delayed anastomotic leakage following laparoscopic intersphincteric resection for lower rectal cancer: report of four cases and literature review.

    Science.gov (United States)

    Iwamoto, Masayoshi; Kawada, Kenji; Hida, Koya; Hasegawa, Suguru; Sakai, Yoshiharu

    2017-08-01

    Anastomotic leakage (AL) is one of the most dreadful postoperative complications because it can result in increased morbidity and mortality as well as poorer long-term prognosis. Although most studies of AL limited their investigation time to a period of 30 days postoperatively, only a few studies have shown that AL can occur after that period. Here, we report four patients of rectal cancer with delayed AL following laparoscopic intersphincteric resection (ISR) and conduct a literature review on delayed AL. Case 1 was a 67-year-old male who underwent laparoscopic partial ISR in July 2009. Although the patient was asymptomatic, an anastomotic-urethral fistula was observed 57 months after ISR. Case 2 was a 44-year-old female who underwent laparoscopic partial ISR in July 2008. She presented with discharge of gas and feces from her vagina, and an anastomotic-vaginal fistula was observed 14 months after ISR. Case 3 was a 74-year-old man who underwent laparoscopic partial ISR in August 2007. He presented with pneumaturia and fecaluria, and an anastomotic-urethral fistula was observed 4 months after ISR. Case 4 was a 68-year-old woman who underwent laparoscopic subtotal ISR for rectal cancer in February 2013 and partial hepatic resection for liver metastases in March 2013. She presented with anal pain and purulent perineal discharge, and an anastomotic-perineal fistula was observed 9 months after ISR. All four cases presented with fistula formation and required reoperation (establishment of a diverting ileostomy). Since delayed AL is not a rare postoperative complication, surgeons need to provide long-term follow-up and remain alert to the possible development of delayed AL.

  3. COLOR II. A randomized clinical trial comparing laparoscopic and open surgery for rectal cancer

    DEFF Research Database (Denmark)

    Buunen, M; Bonjer, H J; Hop, W C J

    2009-01-01

    clinical trial. Currently 27 hospitals from Europe, South Korea and Canada are including patients. The primary endpoint is loco-regional recurrence rate three years post-operatively. Secondary endpoints cover quality of life, overall and disease free survival, post-operative morbidity and health economy...... analysis. RESULTS: By July 2008, 27 hospitals from the Netherlands, Belgium, Germany, Sweden, Spain, Denmark, South Korea and Canada had included 739 patients. The intra-operative conversion rate in the laparoscopic group was 17%. Distribution of age, location of the tumor and radiotherapy were equal...

  4. Laparoscopic pyeloplasty.

    LENUS (Irish Health Repository)

    Cheema, I A

    2010-01-01

    We report our results and short term follow up of transperitoneal laparoscopic pyeloplasty for pelvi-ureteric junction (PUJ) obstruction. We have prospectively maintained a database to document our initial experience of 54 laparoscopic pyeloplasty. All procedures were carried out by one surgeon through a transperitoneal approach. The data extends from April 2005 to September 2008 and reports operative time, blood loss, complications, hospital stay, short term follow-up on symptomatic and radiological outcome. Fifty-four procedures were performed during the study period. Mean patient age was 29 years. Mean operating time was 133 minutes (range 65-300 minutes), and mean blood loss was 45 ml (range 20-300 ml). No intra operative complication occurred. Neither blood transfusion nor conversion to open surgery was required. Postoperative mean hospital stay was 3.4 days (range 3-14 days). There were 3 anastomotic leakages; 2 in the immediate postoperative period and 1 following removal of stent. They all required percutaneous drainage and prolonged stenting. Overall 47 (87%) patients have symptomatic relief and resolution of obstruction on renogram. Four (7%) patients developed recurrence. Three (5.5%) patients had symptomatic relief but have a persistent obstructive renogram. Laparoscopic pyeloplasty is an effective alternative treatment for symptomatic pelvi-ureteric junction obstruction. The results appear comparable to open pyeloplasty with decreased postoperative morbidity.

  5. Nutritional Recovery after Open and Laparoscopic Distal Gastrectomy for Early Gastric Cancer: A Prospective Multicenter Comparative Trial (CCOG1204).

    Science.gov (United States)

    Matsushita, Hidenobu; Tanaka, Chie; Murotani, Kenta; Misawa, Kazunari; Ito, Seiji; Ito, Yuichi; Kanda, Mitsuro; Mochizuki, Yoshinari; Ishigure, Kiyoshi; Yaguchi, Toyohisa; Teramoto, Jin; Nakayama, Hiroshi; Kawase, Yoshihisa; Fujiwara, Michitaka; Kodera, Yasuhiro

    2018-01-01

    Little information from prospective clinical trials is available on the influences of surgical approaches on postoperative body compositions and nutritional status. We designed a prospective non-randomized trial to compare postoperative chronological changes in body composition and nutritional status between laparoscopic and open distal gastrectomy for stage I gastric cancer (GC). Body compositions and nutritional indicators in blood tests were measured at the baseline and at the 1st, 3rd, 6th, and 12th postoperative months (POM). The primary end point was the decrease relative to the baseline in the body muscle mass at POM 6. Ninety-six patients for the laparoscopic group and 52 for the open group were eligible for data analysis. No significant differences were found in any baseline demographics, body compositions, and nutritional indicators between the groups. The changes of body muscle mass at POM 6 were similar in both groups. Overall, no significant differences between the groups were observed in any of the body composition and nutritional indicators during the first year after surgery. Postoperative body compositions and nutritional status were not affected by surgical approaches during the first 12 months after surgery in patients who underwent distal gastrectomy for stage I GC. © 2017 S. Karger AG, Basel.

  6. Acute cholecystitis: comparing clinical outcomes with TG13 severity and intended laparoscopic versus open cholecystectomy in difficult operative cases.

    Science.gov (United States)

    Gerard, Justin; Luu, Minh B; Poirier, Jennifer; Deziel, Daniel J

    2018-03-09

    The revised Tokyo Guidelines include criteria for determining the severity of acute cholecystitis with treatment algorithms based on severity. The aim of this study was to investigate the relationship of the revised Tokyo Guidelines severity grade to clinical outcomes of cholecystectomy for acute cholecystitis. We identified 66 patients with acute cholecystitis from a prior study of difficult cholecystectomy cases. We examined the relationship between severity grade and multiple variables related to perioperative and postoperative outcomes. A more severe revised Tokyo Guidelines grade was associated with a higher number of complications (p = 0.03) and a higher severity of complications (p = 0.01). Severity grade did not predict operative time, estimated blood loss, intensive care unit admission or length of stay. Compared to planned open cholecystectomy, intended laparoscopic cholecystectomy was associated with significantly fewer total and Clavien-Dindo grade 3 complications, fewer intensive care unit admissions, and shorter length of stay (p values range from 0.03 to < 0.0001). In technically difficult operations for acute cholecystitis, the revised Tokyo guidelines severity grade correlates with the number and severity of complications. However, intended performance of laparoscopic cholecystectomy rather than open cholecystectomy in difficult operations predicts broader beneficial outcomes than severity grade.

  7. Review of laparoscopic partial nephrectomy in the treatment of renal tumors, T1 stadium in adults

    International Nuclear Information System (INIS)

    Zamora Montes de Oca, Maria Jose

    2012-01-01

    The T1 renal cancer in adults is made known; incidence, characteristics and management. Renal cell carcinoma has been the most common malignancy of the kidney, percentage is close to three percent of solid tumors of adults. The treatments for this tumor are analyzed: open radical nephrectomy, laparoscopic radical nephrectomy, open partial nephrectomy and laparoscopic partial nephrectomy. Laparoscopic partial nephrectomy has represented an alternative option acceptable, safely and with good oncological and surgical outcomes for patients, as it is used to conserve nephrons and simultaneously to resect the tumor of a complete form promoting in the future the patient present a good renal function. Additionally, a adequate oncological control has reduced the risk of submit postoperative renal failure. An evolution of laparoscopic partial nephrectomy is presented determining the procedure for renal tumors in state T1 in the adults [es

  8. Usefullness of the ultrasonically activated scalpel in laparoscopic cholecystectomy: our experience and review of literature.

    Science.gov (United States)

    Minutolo, V; Gagliano, G; Rinzivillo, C; Li Destri, G; Carnazza, M; Minutolo, O

    2008-05-01

    Laparoscopic cholecystectomy (LC) actually represents the most used and proper treatment for gallbladder lithiasis, because its many and known advantages in comparison with 'open' abdominal surgery. But there are some problems during and after LC due to the use of the electric scalpel and these have brought to the search of an alternative system of dissection and coagulation. The ultrasonically activated scalpel (Harmonic Scalpel, HS) allows to perform dissection and coagulation with a minimal thermal side effect for surrounding tissues, unlike the electrocoagulation. Furthermore, the use of the HS brings a series of advantages in comparison to the other electromagnetic forms of energy (electro-scalpel, laser). HS cuts and coagulates with the same effectiveness of the electro-scalpel but, unlike this, it doesn't introduce risks of wandering currents. Moreover, HS contributes to have a more clean and clear (smokes-free) field of operation and it reduces the operative time, the bleeding and the costs of the operation without an increase of the complications and of the percentages of 'open' conversion, and perhaps leads to a less negative influence on the postoperative systemic immune response. The Authors report their experience that confirm these observations, according also with results reported in a brief review of the recent scientific literature, and support wider diffusion and technical development of this ultrasonically-operating surgical team.

  9. 3D Vision Provides Shorter Operative Time and More Accurate Intraoperative Surgical Performance in Laparoscopic Hiatal Hernia Repair Compared With 2D Vision.

    Science.gov (United States)

    Leon, Piera; Rivellini, Roberta; Giudici, Fabiola; Sciuto, Antonio; Pirozzi, Felice; Corcione, Francesco

    2017-04-01

    The aim of this study is to evaluate if 3-dimensional high-definition (3D) vision in laparoscopy can prompt advantages over conventional 2D high-definition vision in hiatal hernia (HH) repair. Between September 2012 and September 2015, we randomized 36 patients affected by symptomatic HH to undergo surgery; 17 patients underwent 2D laparoscopic HH repair, whereas 19 patients underwent the same operation in 3D vision. No conversion to open surgery occurred. Overall operative time was significantly reduced in the 3D laparoscopic group compared with the 2D one (69.9 vs 90.1 minutes, P = .006). Operative time to perform laparoscopic crura closure did not differ significantly between the 2 groups. We observed a tendency to a faster crura closure in the 3D group in the subgroup of patients with mesh positioning (7.5 vs 8.9 minutes, P = .09). Nissen fundoplication was faster in the 3D group without mesh positioning ( P = .07). 3D vision in laparoscopic HH repair helps surgeon's visualization and seems to lead to operative time reduction. Advantages can result from the enhanced spatial perception of narrow spaces. Less operative time and more accurate surgery translate to benefit for patients and cost savings, compensating the high costs of the 3D technology. However, more data from larger series are needed to firmly assess the advantages of 3D over 2D vision in laparoscopic HH repair.

  10. Outcomes of Single-Incision Laparoscopic Surgery for Colon Cancer: A Case-Matched Comparative Study

    Directory of Open Access Journals (Sweden)

    Atthaphorn Trakarnsanga

    2016-03-01

    Full Text Available Background: Single-incisionlaparoscopiccolectomy(SILC isanevolvingtechnique withpotentialadvantages by reducing number of incisions that can reduce port-related complications and improve cosmetic results. The purposeof thisstudy wastocomparetheshort-termoutcomesbetweenSILC,hand-assistedlaparoscopiccolectomy (HALC andstandard multi-port laparoscopic colectomy (MLC. Methods: Retrospectiveanalysesofatotalof90patientsbetweenMay2010and December2011, whounderwent SILC for coloncancer surgery, wereperformedin30patients. Clinicopathologicalparameters were matched1:1 withpatients whounderwent HALC (n=30andMLC (n=30.Short-term outcomes werecollectedandanalyzed. Results: Operativetime wassignificantlyshorter inSILC comparedto HALC andMLC (p<0.001,as wellasless estimatedbloodloss (p=0.02. There werenosignificantdifferences inconversionrateandnumberofharvested lymphnodes.SILChadtheadvantageofless24-hrpostoperativepainscorecomparedtoHALCandMLC(p<0.001, whereas length of stayandtime to full diet werenotdifferent. Conclusion: Inselectedpatients,SILC canbesuccessfullyandsafelyperformed withshorteroperativetime, less estimated blood loss andless postoperativepainscore.

  11. Laparoscopic approach for inflammatory bowel disease surgical managment.

    Science.gov (United States)

    Maggiori, Léon; Panis, Yves

    2012-01-01

    For IBD surgical management, laparoscopic approach offers several theoretical advantages over the open approach. However, the frequent presence of adhesions from previous surgery and the high rate of inflammatory lesions have initially questioned its feasibility and safety. In the present review article, we will discuss the role of laparoscopic approach for IBD surgical management, along with its potential benefits as compared to the open approach.

  12. Efficacy of Laparoscopic Mini Gastric Bypass for Obesity and Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Yingjun Quan

    2015-01-01

    Full Text Available Background. Controversies on the utility of laparoscopic mini gastric bypass (LMGB in weight loss and type 2 diabetes mellitus (T2DM control still exist. Methods. We conducted a comprehensive literature search of PubMed, EMBASE, and Cochrane Library. Review Manager was used to perform the meta-analysis and the weighted mean difference (WMD and/or odds ratio with 95% confidence interval (95% CI were used to evaluate the overall size effect. Results. The literature search identified 16 studies for systematic review and 15 articles for meta-analysis. Compared with LAGB, LSG, and LRYGB, LMGB showed significant weight loss [WMD, −6.58 (95% CI, −9.37, −3.79, P<0.01 (LAGB; 2.86 (95% CI, 1.40, 5.83, P=0.004 (LSG; 10.33 (95% CI, 4.30, 16.36, P<0.01 (LRYGB] and comparable/higher T2DM remission results [86.2% versus 55.6%, P=0.06 (LAGB; 89.1% versus 76.3%, P=0.004 (LAGB; 93.4% versus 77.6%, P=0.006 (LAGB]; LMGB also had shorter learning curve and less operation time than LRYGB [WMD, −35.2 (95% CI, −46.94, −23.46]. Conclusions. LMGB appeared to be effective in weight loss and T2DM remission and noninferior to other bariatric surgeries. However, clinical utility of LMGB needs to be further validated by future prospective randomized controlled trials.

  13. Laparoscopic Cystogastrostomy in the Management of Pancreatic ...

    African Journals Online (AJOL)

    laparoscopic cystogastrostomy as a method of managing ... A 61 year old male patient presented to the emergency ... He was reviewed as an outpatient two weeks later. He was in ... Combined. Laparoscopic Cholecystectomy and Drainage.

  14. Prevalence of Musculoskeletal Disorders Among Surgeons Performing Minimally Invasive Surgery: A Systematic Review

    NARCIS (Netherlands)

    Alleblas, C.C.J.; Man, A.M. de; Haak, L. van den; Vierhout, M.E.; Jansen, F.W.; Nieboer, T.E.

    2017-01-01

    OBJECTIVE: The aim of this study was to review musculoskeletal disorder (MSD) prevalence among surgeons performing minimally invasive surgery. BACKGROUND: Advancements in laparoscopic surgery have primarily focused on enhancing patient benefits. However, compared with open surgery, laparoscopic

  15. Pathological outcomes of transanal versus laparoscopic total mesorectal excision for rectal cancer: a systematic review with meta-analysis.

    Science.gov (United States)

    Jiang, Hong-Peng; Li, Yan-Sen; Wang, Bo; Wang, Chang; Liu, Fan; Shen, Zhan-Long; Ye, Ying-Jiang; Wang, Shan

    2018-02-20

    Since 2010, comparative studies on transanal and laparoscopic total mesorectal excision (TME) have been published and it remains unclear about the oncological benefit from transanal total mesorectal excision (taTME). We have searched English databases to identify all taTME studies published between January 2010 and August 2017. Pathological outcomes included circumferential resection margin (CRM), positive CRM (CRM (WMD, 0.833; 95% CI 0.366-1.299; P CRM (OR, 0.505; 95% CI 0.258-0.991; P = 0.047), and a longer DRM (WMD, 6.261; 95% CI 1.049-11.472; P = 0.019). There were no significant differences in other pathological outcomes. Both cumulative meta-analysis and sensitivity analysis were unable to detect potential sources of the heterogeneity in DRM. There was no evidence of publication bias. This meta-analysis revealed that taTME had more advantages on positive CRM, CRM, and DRM compared with laparoscopic TME. Compared with laparoscopic TME, more benefits of taTME on pathological outcomes remained undetected. The current findings are all based on observational studies, RCTs with adequate power are required.

  16. Systematic review of laparoscopic surgery in low- and middle-income countries: benefits, challenges, and strategies.

    Science.gov (United States)

    Chao, Tiffany E; Mandigo, Morgan; Opoku-Anane, Jessica; Maine, Rebecca

    2016-01-01

    Laparoscopy may prove feasible to address surgical needs in limited-resource settings. However, no aggregate data exist regarding the role of laparoscopy in low- and middle-income countries (LMICs). This study was designed to describe the issues facing laparoscopy in LMICs and to aggregate reported solutions. A search was conducted using Medline, African Index Medicus, the Directory of Open Access Journals, and the LILACS/BIREME/SCIELO database. Included studies were in English, published after 1992, and reported safety, cost, or outcomes of laparoscopy in LMICs. Studies pertaining to arthroscopy, ENT, flexible endoscopy, hysteroscopy, cystoscopy, computer-assisted surgery, pediatrics, transplantation, and bariatrics were excluded. Qualitative synthesis was performed by extracting results that fell into three categories: advantages of, challenges to, and adaptations made to implement laparoscopy in LMICs. PRISMA guidelines for systematic reviews were followed. A total of 1101 abstracts were reviewed, and 58 articles were included describing laparoscopy in 25 LMICs. Laparoscopy is particularly advantageous in LMICs, where there is often poor sanitation, limited diagnostic imaging, fewer hospital beds, higher rates of hemorrhage, rising rates of trauma, and single income households. Lack of trained personnel and equipment were frequently cited challenges. Adaptive strategies included mechanical insufflation with room air, syringe suction, homemade endoloops, hand-assisted techniques, extracorporeal knot tying, innovative use of cheaper instruments, and reuse of disposable instruments. Inexpensive laboratory-based trainers and telemedicine are effective for training. LMICs face many surgical challenges that require innovation. Laparoscopic surgery may be safe, effective, feasible, and cost-effective in LMICs, although it often remains limited in its accessibility, acceptability, and quality. This study may not capture articles written in languages other than

  17. Comparative evaluation of two methods care of the perioperative period after laparoscopic operations on uterine appendages

    Directory of Open Access Journals (Sweden)

    О. S. Lashkul

    2017-10-01

    Full Text Available Aim – тo assess the impact of the early multimodal rehabilitation concept on postoperative period after laparoscopic operations on uterine appendages. Маterials and methods. The study involved 79 patients who were randomized by envelope method in two groups. In the main group (26 patients, a protocol of early multimodal rehabilitation (ERAS was used. In the control group (53 patients, the traditional perioperative regimen was used. In both groups, laparoscopic operations were performed under general anesthesia with mechanical ventilation (propofol + fentanyl. In perioperative anesthesia NSAIDs (dexketoprofen, ketorolac, paracetamol were included. Non-invasive monitoring was performed by the «Leon» monitor (StO2, blood pressure, heart rate, capnogram, hourly diuresis was taken into account, thermometry was performed. In the postoperative period analgesia with combination with systemic administration of dexketoprofen (100–150 mg/day + ketorolac (60 mg/day + paracetamol (3000 mg/day was used. Results. The groups were homogeneous according to anamnestic (the beginning of menstruation, the number of pregnancies, childbirth, abortions, miscarriages, anthropometric and demographic characteristics, the duration of operations, blood loss and baseline values of systolic, diastolic, mean arterial pressures and heart rate. In groups the volumes of diuresis did not differ significantly (p < 0.05. Positive intraoperative hemohydrate balance in the FTS group was almost half that in the control group. When assessing pain at rest by VAS, a statistically significant difference was found at the 6 and 24 hours study stages. Nevertheless, at the study stages the pain level in the control group did not exceed 30 mm, which indicates adequate analgesia at rest. The level of cough pain in the control group exceeded the level of pain in the main group, the statistical difference was determined after 6 hours and 24 hours, but was above 30 mm, which required

  18. MANUAL COLON-ANAL OR MECHANICAL COLORECTAL ANASTOMOSIS? COMPARATIVE ANALYSIS OF LAPAROSCOPIC LOW RESECTIONS OF THE RECTUM

    Directory of Open Access Journals (Sweden)

    I. L. Chernikovsky

    2015-01-01

    Full Text Available The purpose of the study was to compare immediate surgical outcomes of low anterior resections (LAR and intersphincteric resections (ISR of the rectum. Materials and methods. Treatment outcomes of 42 patients operated on between March, 2014 and January, 2015 were presented. Group I consisted of 24 patients who underwent laparoscopic ultra-low anterior resection (uLAR for rectal cancer. Group II comprised 18 patients who underwent laparoscopic ISR. Results. No significant differences in the median length of surgery and blood loss between two groups were observed. Circular and distal resection margins were negative in all cases. In 18 (75 % patients of Group I and in 14 (77.7 % patients of Group II, total mesorectumectomy(TME was assessed as grade 3 (p=0.83. The frequency of postoperative complications in uLAR-treated group was 20.8 %, not requiring a secondary revision procedure, and 27.8 % in ISR-treated group, requiring repeated surgery. The mean value of the fecal incontinence according to the Wechsler scale in a month after surgery was significantly higher in group II than in Group I patients (9.3 versus 6.2, р=0.01. The average treatment cost for uLAR was higher by 45,000 rubles than that for ISR. Conclusion. Both surgical procedures were matched by the duration of operation, amount of blood loss and the quality of mesorectumectomy. The complication rate was not significantly different between two groups, however, 16.8 % of Group II patients required relaparotomy, likely due to the mastering of the ISR technique. Ultra-low anterior resections of the rectum are functionally preferred. When performing ISR, the technique of reservoir colo-anal anastomosis with preservation of the portion of the internal sphincter provides functional results comparable with those obtained using LAR.

  19. Same-day discharge after laparoscopic hysterectomy.

    Science.gov (United States)

    Perron-Burdick, Misa; Yamamoto, Miya; Zaritsky, Eve

    2011-05-01

    To estimate readmission rates and emergency care use by patients discharged home the same day after laparoscopic hysterectomy. This was a retrospective case series of patients discharged home the same-day after total or supracervical laparoscopic hysterectomy in a managed care setting. Chart reviews were performed for outcomes of interest which included readmission rates, emergency visits, and surgical and demographic characteristics. The two hysterectomy groups were compared using χ² tests for categorical variables and t tests or Wilcoxon rank-sum tests for continuously measured variables. One-thousand fifteen laparoscopic hysterectomies were performed during the 3-year study period. Fifty-two percent (n=527) of the patients were discharged home the same-day; of those, 46% (n=240) had total laparoscopic hysterectomies and 54% (n=287) had supracervical. Cumulative readmission rates were 0.6%, 3.6%, and 4.0% at 48 hours, 3 months, and 12 months, respectively. The most common readmission diagnoses included abdominal incision infection, cuff dehiscence, and vaginal bleeding. Less than 4% of patients presented for emergency care within 48 or 72 hours, most commonly for nausea or vomiting, pain, and urinary retention. Median uterine weight was 155 g, median blood loss was 70 mL, and median surgical time was 150 minutes. There was no difference in readmission rates or emergency visits for the total compared with the supracervical laparoscopic hysterectomy group. Same-day discharge after laparoscopic hysterectomy is associated with low readmission rates and minimal emergency visits in the immediate postoperative period. Same-day discharge may be a safe option for healthy patients undergoing uncomplicated laparoscopic hysterectomy.

  20. Two-year results of the randomized clinical trial DILALA comparing laparoscopic lavage with resection as treatment for perforated diverticulitis

    DEFF Research Database (Denmark)

    Kohl, A; Rosenberg, J; Bock, D

    2018-01-01

    BACKGROUND: Traditionally, perforated diverticulitis with purulent peritonitis was treated with resection and colostomy (Hartmann's procedure), with inherent complications and risk of a permanent stoma. The DILALA (DIverticulitis - LAparoscopic LAvage versus resection (Hartmann's procedure...... in the Hartmann's group had a colostomy at 24 months. CONCLUSION: Laparoscopic lavage is a better option for perforated diverticulitis with purulent peritonitis than open resection and colostomy....

  1. Long-term results of the European achalasia trial: a multicentre randomised controlled trial comparing pneumatic dilation versus laparoscopic Heller myotomy

    NARCIS (Netherlands)

    Moonen, An; Annese, Vito; Belmans, Ann; Bredenoord, Albert J.; Bruley des Varannes, Stanislas; Costantini, Mario; Dousset, Bertrand; Elizalde, J. I.; Fumagalli, Uberto; Gaudric, Marianne; Merla, Antonio; Smout, Andre J.; Tack, Jan; Zaninotto, Giovanni; Busch, Olivier R.; Boeckxstaens, Guy E.

    2016-01-01

    Achalasia is a chronic motility disorder of the oesophagus for which laparoscopic Heller myotomy (LHM) and endoscopic pneumodilation (PD) are the most commonly used treatments. However, prospective data comparing their long-term efficacy is lacking. 201 newly diagnosed patients with achalasia were

  2. Open Versus Laparoscopic Approach for Morgagni's Hernia in Infants and Children: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Lauriti, Giuseppe; Zani-Ruttenstock, Elke; Catania, Vincenzo D; Antounians, Lina; Lelli Chiesa, Pierluigi; Pierro, Agostino; Zani, Augusto

    2018-05-18

    The laparoscopic repair of Morgagni's hernia (MH) has been reported to be safe and feasible. However, it is still unclear whether laparoscopy is superior to open surgery in repairing MH. Using a defined search strategy, three investigators independently identified all comparative studies reporting data on open and laparoscopic MH repair in patients open approaches and 39 (42%) laparoscopy. Meta-analysis - The length of surgery was shorter in laparoscopy (50.5 ± 17.0 min) than in open procedure (90.0 ± 15.0 min; P open surgery (4.5 ± 2.1 days; P open: 9.4% ± 1.6%; P = .087) and recurrences (laparoscopy: 2.9% ± 5.0%, open: 5.7% ± 1.8%; P = .84). Comparative studies indicate that laparoscopic MH repair can be performed in infants and children. Laparoscopy is associated with shortened length of surgery and hospital stay in comparison to open procedure. Prospective randomized studies would be needed to confirm present data.

  3. Laparoscopic total pancreatectomy

    Science.gov (United States)

    Wang, Xin; Li, Yongbin; Cai, Yunqiang; Liu, Xubao; Peng, Bing

    2017-01-01

    Abstract Rationale: Laparoscopic total pancreatectomy is a complicated surgical procedure and rarely been reported. This study was conducted to investigate the safety and feasibility of laparoscopic total pancreatectomy. Patients and Methods: Three patients underwent laparoscopic total pancreatectomy between May 2014 and August 2015. We reviewed their general demographic data, perioperative details, and short-term outcomes. General morbidity was assessed using Clavien–Dindo classification and delayed gastric emptying (DGE) was evaluated by International Study Group of Pancreatic Surgery (ISGPS) definition. Diagnosis and Outcomes: The indications for laparoscopic total pancreatectomy were intraductal papillary mucinous neoplasm (IPMN) (n = 2) and pancreatic neuroendocrine tumor (PNET) (n = 1). All patients underwent laparoscopic pylorus and spleen-preserving total pancreatectomy, the mean operative time was 490 minutes (range 450–540 minutes), the mean estimated blood loss was 266 mL (range 100–400 minutes); 2 patients suffered from postoperative complication. All the patients recovered uneventfully with conservative treatment and discharged with a mean hospital stay 18 days (range 8–24 days). The short-term (from 108 to 600 days) follow up demonstrated 3 patients had normal and consistent glycated hemoglobin (HbA1c) level with acceptable quality of life. Lessons: Laparoscopic total pancreatectomy is feasible and safe in selected patients and pylorus and spleen preserving technique should be considered. Further prospective randomized studies are needed to obtain a comprehensive understanding the role of laparoscopic technique in total pancreatectomy. PMID:28099344

  4. Technical Aspects of Laparoscopic Distal Pancreatectomy for Benign and Malignant Disease: Review of the Literature

    Science.gov (United States)

    de Rooij, T.; Sitarz, R.; Busch, O. R.; Besselink, M. G.; Abu Hilal, M.

    2015-01-01

    Distal pancreatectomy is the standard curative treatment for symptomatic benign, premalignant, and malignant disease of the pancreatic body and tail. The most obvious benefits of a laparoscopic approach to distal pancreatectomy include earlier recovery and shorter hospital stay. Spleen-preserving distal pancreatectomy should be attempted in case of benign disease. Spleen preservation can be achieved preferably by preserving the splenic vessels (Kimura technique), but also by resecting the splenic vessels and maintaining vascularity through the short gastric vessels and left gastroepiploic artery (Warshaw technique). Several studies have suggested a higher rate of spleen preservation with laparoscopy. The radical antegrade modular pancreatosplenectomy has become mainstay for treating pancreatic cancer and can be performed laparoscopically as well. Evidence on the feasibility and safety of laparoscopic distal pancreatectomy for cancer is scarce. Despite the obvious advantages of laparoscopic surgery, postoperative morbidity remains relatively high, mainly because of the high incidence of pancreatic fistula. For decades, surgeons have tried to prevent these fistulas but to date no strategy has been confirmed to be effective in 2 consecutive randomized studies. Pragmatic multicenter studies focusing on technical aspects of laparoscopic distal pancreatectomy are lacking and should be encouraged. PMID:26240565

  5. Technical Aspects of Laparoscopic Distal Pancreatectomy for Benign and Malignant Disease: Review of the Literature

    Directory of Open Access Journals (Sweden)

    T. de Rooij

    2015-01-01

    Full Text Available Distal pancreatectomy is the standard curative treatment for symptomatic benign, premalignant, and malignant disease of the pancreatic body and tail. The most obvious benefits of a laparoscopic approach to distal pancreatectomy include earlier recovery and shorter hospital stay. Spleen-preserving distal pancreatectomy should be attempted in case of benign disease. Spleen preservation can be achieved preferably by preserving the splenic vessels (Kimura technique, but also by resecting the splenic vessels and maintaining vascularity through the short gastric vessels and left gastroepiploic artery (Warshaw technique. Several studies have suggested a higher rate of spleen preservation with laparoscopy. The radical antegrade modular pancreatosplenectomy has become mainstay for treating pancreatic cancer and can be performed laparoscopically as well. Evidence on the feasibility and safety of laparoscopic distal pancreatectomy for cancer is scarce. Despite the obvious advantages of laparoscopic surgery, postoperative morbidity remains relatively high, mainly because of the high incidence of pancreatic fistula. For decades, surgeons have tried to prevent these fistulas but to date no strategy has been confirmed to be effective in 2 consecutive randomized studies. Pragmatic multicenter studies focusing on technical aspects of laparoscopic distal pancreatectomy are lacking and should be encouraged.

  6. Advantages of laparoscopic compared to conventional surgery are not related to an innate immune response of peritoneal immune activation: an animal study in rats.

    Science.gov (United States)

    Lingohr, Philipp; Dohmen, Jonas; Matthaei, Hanno; Schwandt, Timo; Stein, Kathy; Hong, Gun-Soo; Steitz, Julia; Longerich, Thomas; Bölke, Edwin; Wehner, Sven; Kalff, Jörg C

    2017-06-01

    Laparoscopic surgery (LS) has proved superior compared to conventional surgery (CS) regarding morbidity, length of hospital stay, rate of wound infection and time until recovery. An improved preservation of the postoperative immune function is assumed to contribute to these benefits though the role of the local peritoneal immune response is still poorly understood. Our study investigates the peritoneal immune response subsequent to abdominal surgery and compares it between laparoscopic and conventional surgery to find an immunological explanation for the clinically proven benefits of LS. Wistar rats (N = 140) underwent laparoscopic cecum resection (LCR; N = 28), conventional cecum resection (CCR; N = 28), laparoscopic sham operation (LSO; N = 28), conventional sham operation (CSO; N = 28), or no surgical treatment (CTRL; N = 28). Postoperatively, peritoneal lavages were performed, leukocytes isolated and analyzed regarding immune function and phagocytosis activity. Immune function was inhibited postoperatively in animals undergoing LCR or CCR compared to CTRL reflected by a lower TNF-α (CTRL 3956.65 pg/ml, LCR 2018.48 pg/ml (p = 0.023), CCR 2793.78 pg/ml (n.s.)) and IL-6 secretion (CTRL 625.84 pg/ml, LCR 142.84 pg/ml (p = 0.009), CCR 169.53 pg/ml (p = 0.01)). Phagocytosis was not affected in rats undergoing any kind of surgery compared to CTRL. Neither cytokine secretion nor phagocytosis activity differed significantly between laparoscopic and conventional surgery. According to our findings the benefits associated with LS compared to CS cannot be explained by differences in the postoperative peritoneal innate immune response. Further studies are needed to elucidate the causes for a more favorable postoperative outcome in patients after LS compared to CS.

  7. Systematic review and meta-analysis of robotic versus laparoscopic distal pancreatectomy for benign and malignant pancreatic lesions.

    Science.gov (United States)

    Huang, Bin; Feng, Lu; Zhao, Jichun

    2016-09-01

    The number of published series on minimally invasive distal pancreatectomy has significantly increased. Robotic systems can overcome some limitations of laparoscopy. This study aimed to compare two techniques in distal pancreatectomy. Multiple electronic databases were systematically searched to identify studies (up to July 2015) that compared perioperative outcomes between robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP). Relative risks with 95 % confidence intervals (CIs) were estimated. Nine studies were enrolled in this review. Four studies reported on operative time, indicating no difference between the RDP and LDP groups (WMD = 21.55, 95 % CI -65.28-108.37, P = 0.63). No significant difference between the two groups was indicated with respect to the number of patients who converted to open (OR 0.35, 95 % CI 0.11-1.13, P = 0.08), spleen preservation rate (OR 2.37, 95 % CI 0.50-11.30, P = 0.28), and transfusion rate (OR 1.30, 95 % CI 0.54-3.13, P = 0.56). In addition, no difference was indicated in the incidence of pancreatic fistulas (OR 1.05, 95 % CI 0.67-1.65, P = 0.83) and length of hospital stay between the two groups (WMD = -0.61, 95 % CI -1.40-0.19, P = 0.13). RDP seems to be a safe and effective alternative to LDP. Large randomized controlled trials are needed to verify the results of this meta-analysis.

  8. Intraperitoneal injection of Bupivacaine and Lidocaine in reducing postoperative pain in gynecologic laparoscopic surgeries: a comparative study

    Directory of Open Access Journals (Sweden)

    Alleyassin A

    2007-08-01

    Full Text Available Background: As less invasive surgical procedures, such as laparoscopy, become more common, patients can go home soon after the surgery. However, some pain is accompanied by such procedures due to peritoneal stretching, diaphragmatic irritation, or, to a lesser extent, abdominal puncture. It is important to reduce the level of pain to the point that narcotics are not necessary. The administration of opioids for pain after abdominal surgeries is common. The receptors involved seem to be susceptible to blockade with low-dose local anesthesia, although this is subject to some controversy. In this study, we assess and compare the effectiveness of intraperitoneal Bupivacaine and Lidocaine in pain reduction after diagnostic gynecologic laparoscopy in infertility patients. Methods: In this randomized clinical trial, 150 patients admitted to Dr. Shariati Hospital for diagnostic gynecologic laparoscopy were entered into three randomized groups. Group B received Bupivacaine after the diagnostic laparoscopic procedure, group L received Lidocaine and group C, the control group, received a placebo after the surgery, all administered intraperi- toneally. Postsurgerical pain was assessed using the numeric visual analogue scale at 6 and 24 hours after surgery. Results: In group B, the pain scores at 6 and 24 hours after surgery were significantly less than those of group L. Conclusions: Administration of Bupivacaine after diagnostic gynecologic laparoscopic procedures is more effective in pain control than Lidocaine. The effect of this drug is temporary, yet it significantly decreases early postoperative pain, reducing the need for additional postoperative analgesics. Furthermore, the time at which patients can be discharged from the hospital is significantly reduced.

  9. Optimal ergonomics for laparoscopic surgery in minimally invasive surgery suites: a review and guidelines.

    Science.gov (United States)

    van Det, M J; Meijerink, W J H J; Hoff, C; Totté, E R; Pierie, J P E N

    2009-06-01

    With minimally invasive surgery (MIS), a man-machine environment was brought into the operating room, which created mental and physical challenges for the operating team. The science of ergonomics analyzes these challenges and formulates guidelines for creating a work environment that is safe and comfortable for its operators while effectiveness and efficiency of the process are maintained. This review aimed to formulate the ergonomic challenges related to monitor positioning in MIS. Background and guidelines are formulated for optimal ergonomic monitor positioning within the possibilities of the modern MIS suite, using multiple monitors suspended from the ceiling. All evidence-based experimental ergonomic studies conducted in the fields of laparoscopic surgery and applied ergonomics for other professions working with a display were identified by PubMed searches and selected for quality and applicability. Data from ergonomic studies were evaluated in terms of effectiveness and efficiency as well as comfort and safety aspects. Recommendations for individual monitor positioning are formulated to create a personal balance between these two ergonomic aspects. Misalignment in the eye-hand-target axis because of limited freedom in monitor positioning is recognized as an important ergonomic drawback during MIS. Realignment of the eye-hand-target axis improves personal values of comfort and safety as well as procedural values of effectiveness and efficiency. Monitor position is an important ergonomic factor during MIS. In the horizontal plain, the monitor should be straight in front of each person and aligned with the forearm-instrument motor axis to avoid axial rotation of the spine. In the sagittal plain, the monitor should be positioned lower than eye level to avoid neck extension.

  10. Bibliographical review of laparoscopic surgery in malignant pathology of the colon and rectum

    International Nuclear Information System (INIS)

    Peraza Solis, Yerald

    2010-01-01

    An exhaustive bibliographic review was performed on laparoscopic surgery in malignant pathology of the colon and rectum. Colorectal cancer has accounted for 13% of all human cancers and has accounted for 10% of deaths from malignant neoplasms. In Costa Rica it has had the fifth most frequent cancer in women and also in men. Mortality in Costa Rican women, contrary to the developed countries, has increased between 1985 and 2000. Mortality in Costa Rican men has remained stable. The incidence has begun to be high in patients aged 40-45 years and has increased incidence until age 75. Certain group has developed cancer at an early age due to a form of familial cancer. Rectal cancer has been a treatable and curable disease if it is managed in the early stages. Many of the features of colon cancer have been applicable to rectal cancer, it only changes the association of radiotherapy and the sequence of the same. Surgery has been the primary treatment and has resulted in healing in approximately 45% of all patients. Patients with rectal cancer usually have had a chronic history of bleeding or constipation, foreign body sensation and perianal or perineal pain, low weight only when has existed advanced or metastatic disease. The US endoscopy has been a precise method to evaluate the tumor stage and the status of the perirectal nodules. The treatment of rectal cancer has had as aim: 1. healing, 2. local control, 3. restoration of intestinal continuity and 4. prevention of urinary, sexual and anorectal sphincter function. Adjuvant treatment with radiotherapy and/or chemotherapy has been only necessary for tumors T3 and T4. The treatment by stage: Stage I: preoperative radiotherapy and one of the surgical modalities described according to the case; Stage II and III: preoperative radiotherapy and one of the surgical modalities according to the case; Stage IV: palliative extirpation of the tumor with restoration of the intestinal transit through anastomosis or definitive

  11. Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis.

    Science.gov (United States)

    Kawada, Kenji; Sakai, Yoshiharu

    2016-07-07

    Anastomotic leakage (AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low anterior resection (LAR). Risk factor analyses for AL after open LAR have been widely reported. However, a few studies have analyzed the risk factors for AL after laparoscopic LAR. Laparoscopic rectal surgery provides an excellent operative field in a narrow pelvic space, and enables total mesorectal excision surgery and preservation of the autonomic nervous system with greater precision. However, rectal transection using a laparoscopic linear stapler is relatively difficult compared with open surgery because of the width and limited performance of the linear stapler. Moreover, laparoscopic LAR exhibits a different postoperative course compared with open LAR, which suggests that the risk factors for AL after laparoscopic LAR may also differ from those after open LAR. In this review, we will discuss the risk factors for AL after laparoscopic LAR.

  12. Short- and long-term outcomes of laparoscopic surgery vs open surgery for transverse colon cancer: a retrospective multicenter study.

    Science.gov (United States)

    Kim, Jong Wan; Kim, Jeong Yeon; Kang, Byung Mo; Lee, Bong Hwa; Kim, Byung Chun; Park, Jun Ho

    2016-01-01

    The purpose of the present study was to compare the perioperative and oncologic outcomes between laparoscopic surgery and open surgery for transverse colon cancer. We conducted a retrospective review of patients who underwent surgery for transverse colon cancer at six Hallym University-affiliated hospitals between January 2005 and June 2015. The perioperative outcomes and oncologic outcomes were compared between laparoscopic and open surgery. Of 226 patients with transverse colon cancer, 103 underwent laparoscopic surgery and 123 underwent open surgery. There were no differences in the patient characteristics between the two groups. Regarding perioperative outcomes, the operation time was significantly longer in the laparoscopic group than in the open group (267.3 vs 172.7 minutes, Pstudy showed that laparoscopic surgery is associated with several perioperative benefits and similar oncologic outcomes to open surgery for the resection of transverse colon cancer. Therefore, laparoscopic surgery offers a safe alternative to open surgery in patients with transverse colon cancer.

  13. Laparoscopic pancreatic cystogastrostomy.

    Science.gov (United States)

    Obermeyer, Robert J; Fisher, William E; Salameh, Jihad R; Jeyapalan, Manjula; Sweeney, John F; Brunicardi, F Charles

    2003-08-01

    The purpose of the review was to evaluate the feasibility and outcome of laparoscopic pancreatic cystogastrostomy for operative drainage of symptomatic pancreatic pseudocysts. A retrospective review of all patients who underwent laparoscopic pancreatic cystogastrostomy between June 1997 and July 2001 was performed. Data regarding etiology of pancreatitis, size of pseudocyst, operative time, complications, and pseudocyst recurrence were collected and reported as median values with ranges. Laparoscopic pancreatic cystogastrostomy was attempted in 6 patients. Pseudocyst etiology included gallstone pancreatitis (3), alcohol-induced pancreatitis (2), and post-ERCP pancreatitis (1). The cystogastrostomy was successfully performed laparoscopically in 5 of 6 patients. However, the procedure was converted to open after creation of the cystgastrostomy in 1 of these patients. There were no complications in the cases completed laparoscopically and no deaths in the entire group. No pseudocyst recurrences were observed with a median followup of 44 months (range 4-59 months). Laparoscopic pancreatic cystgastrostomy is a feasible surgical treatment of pancreatic pseudocysts with a resultant low pseudocyst recurrence rate, length of stay, and low morbidity and mortality.

  14. Comparative health technology assessment of robotic-assisted, direct manual laparoscopic and open surgery: a prospective study.

    Science.gov (United States)

    Turchetti, Giuseppe; Pierotti, Francesca; Palla, Ilaria; Manetti, Stefania; Freschi, Cinzia; Ferrari, Vincenzo; Cuschieri, Alfred

    2017-02-01

    Despite many publications reporting on the increased hospital cost of robotic-assisted surgery (RAS) compared to direct manual laparoscopic surgery (DMLS) and open surgery (OS), the reported health economic studies lack details on clinical outcome, precluding valid health technology assessment (HTA). The present prospective study reports total cost analysis on 699 patients undergoing general surgical, gynecological and thoracic operations between 2011 and 2014 in the Italian Public Health Service, during which period eight major teaching hospitals treated the patients. The study compared total healthcare costs of RAS, DMLS and OS based on prospectively collected data on patient outcome in addition to healthcare costs incurred by the three approaches. The cost of RAS operations was significantly higher than that of OS and DMLS for both gynecological and thoracic operations (p DMLS. Total costs of general surgery RAS were significantly higher than those of OS (p DMLS general surgery. Indirect costs were significantly lower in RAS compared to both DMLS general surgery and OS gynecological surgery due to the shorter length of hospital stay of RAS approach (p < 0.001). Additionally, in all specialties compared to OS, patients treated by RAS experienced a quicker recovery and significantly less pain during the hospitalization and after discharge. The present HTA while confirming higher total healthcare costs for RAS operations identified significant clinical benefits which may justify the increased expenditure incurred by this approach.

  15. The potential benefits and disadvantages of laparoscopic surgery for ulcerative colitis: A review of current evidence

    NARCIS (Netherlands)

    Buskens, Christianne J.; Sahami, Saloomeh; Tanis, Pieter J.; Bemelman, Willem A.

    2014-01-01

    Up to 35% of patients with ulcerative colitis will require surgery during the course of their disease. Nowadays, a total colectomy with ileal pouch-anal anastomosis is the preferred procedure, which can be performed open or via laparoscopic approach. Since the early '90s, minimally invasive

  16. Technical Aspects of Laparoscopic Distal Pancreatectomy for Benign and Malignant Disease: Review of the Literature

    NARCIS (Netherlands)

    de Rooij, T.; Sitarz, R.; Busch, O. R.; Besselink, M. G.; Abu Hilal, M.

    2015-01-01

    Distal pancreatectomy is the standard curative treatment for symptomatic benign, premalignant, and malignant disease of the pancreatic body and tail. The most obvious benefits of a laparoscopic approach to distal pancreatectomy include earlier recovery and shorter hospital stay. Spleen-preserving

  17. Laparoscopic sleeve gastrectomy and gastroesophageal reflux disease : a systematic review and meta-analysis

    NARCIS (Netherlands)

    Oor, Jelmer E; Roks, David J; Ünlü, Çagdas; Hazebroek, Eric J

    BACKGROUND: The effect of sleeve gastrectomy (SG) on the prevalence of gastroesophageal reflux disease (GERD) remains unclear. We aimed to outline the currently available literature. DATA SOURCES: All relevant databases were searched for publications examining the effect of laparoscopic SG on GERD.

  18. A systematic review of laparoscopic port site hernias in gastrointestinal surgery.

    LENUS (Irish Health Repository)

    Owens, M

    2011-08-01

    Port site hernia is an important yet under-recognised complication of laparoscopic surgery, which carries a high risk of strangulation due to the small size of the defect involved. The purpose of this study was to examine the incidence, classification, and pathogenesis of this complication, and to evaluate strategies to prevent and treat it.

  19. Ondansetron, granisetron, and dexamethasone compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy : A randomized placebo-controlled study.

    Science.gov (United States)

    Erhan, Yamac; Erhan, Elvan; Aydede, Hasan; Yumus, Okan; Yentur, Alp

    2008-06-01

    Laparoscopic cholecystectomies are associated with an appreciably high rate of postoperative nausea and vomiting (PONV). This study was designed to compare the effectiveness of ondansetron, granisetron, and dexamethasone for the prevention of PONV in patients after laparoscopic cholecystectomy. A total of 80 American Society of Anesthesiologists (ASA) physical class I-II patients scheduled for laparoscopic cholecystectomy were included in this randomized, double blind, placebo-controlled study. All patients received a similar standardized anesthesia and operative treatment. Patients were randomly divided into four groups (n = 20 each). Group 1, consisting of control patients, received 0.9% NaCl; group 2 patients received ondansetron 4 mg i.v.; group 3 patients received granisetron 3 mg i.v.; and group 4 patients received dexamethasone 8 mg i.v., all before the induction of anesthesia. Both nausea and vomiting were assessed during the first 24 h after the procedure. The total incidence of PONV was 75% with placebo, 35% with ondansetron, 30% with granisetron, and 25% with dexamethasone. The incidence of PONV was significantly less frequent in groups receiving antiemetics (p granisetron, and ondansetron were not significant. Prophylactic dexamethasone 8 mg i.v. significantly reduced the incidence of PONV in patients undergoing laparoscopic cholecystectomy. Dexamethasone 8 mg was as effective as ondansetron 4 mg and granisetron 3 mg, and it was more effective than placebo.

  20. A radiologic analysis and comparative evaluation of hysterosalpingographic and laparoscopic findings in infertile patients

    International Nuclear Information System (INIS)

    Lee, Hang Young; Kim, Soo Won; Chung, Hye Kyung; Yu, Yun Jeong

    1984-01-01

    Hystreosalpingogram of 375 patients with infertility were reviewed with reference to radiological feature of each pathology and a comparative study of hysterosalpingography and laparoscopy in 36 patients was presented. This results were as follows;1. In 375 cases of infertility, 191 cases (50.9%) were primary infertility and 181 cases (49.1%) were secondary infertility. 2. The peak age distribution was 26 to 30 year old group in 211 cases (56.3%), and the peak duration of infertility was less than 3 years in 256 cases (68.3%). 3. Abnormal uterine findings were 115 cases (30.7%) and there were 73 cases of filling defects, 13 cases of irregularity, 12 cases of uterine flexion, 11 cases of congenital anomaly, and 9 cases of hypoplasia among them. 4. Abnormal tubal findings were 196 cases (52.3%) and there were 103 cases of simple obstruction, 69 cases of hydrosalpinx, and 50 cases of peritubal adhesion among them. 5. Intravasation of contrast media was noted in 42 cases (11.2%). 6. In 36 cases of laparoscopy, 23 cases (63.7%) was agreed to hysterosalpingography. 7. Although laparoscopy was better than hysterosalpingography in external anatomy of salpinx and relationship to ovary, hysterosalpingography should be important for fundamental study of infertile women because of lower failure rate, lower risk of complications, therapeutic effect, and lower cost.

  1. [Laparoscopic surgery for perforated peptic ulcer].

    Science.gov (United States)

    Yasuda, Kazuhiro; Kitano, Seigo

    2004-03-01

    Laparoscopic surgery has become the treatment of choice for the management of perforated peptic ulcer. The advantages of laparoscopic repair for perforated peptic ulcer include less pain, a short hospital stay, and an early return to normal activity. Although the operation time of laparoscopic surgery is significantly longer than that of open surgery, laparoscopic technique is safe, feasible, and with morbidity and mortality comparable to that of the conventional open technique. To benefit from the advantages offered by minimally invasive laparoscopic technique, further study will need to determine whether laparoscopic surgery is safe in patients with generalized peritonitis or sepsis.

  2. Comparison of donor, and early and late recipient outcomes following hand assisted and laparoscopic donor nephrectomy.

    Science.gov (United States)

    Lucas, Steven M; Liaw, Aron; Mhapsekar, Rishi; Yelfimov, Daniel; Goggins, William C; Powelson, John A; Png, Keng Siang; Sundaram, Chandru P

    2013-02-01

    While laparoscopic donor nephrectomy has encouraged living kidney donation, debate exists about the safest laparoscopic technique. We compared purely laparoscopic and hand assisted laparoscopic donor nephrectomies in terms of donor outcome, early graft function and long-term graft outcome. We reviewed the records of consecutive laparoscopic and hand assisted laparoscopic donor nephrectomies performed by a single surgeon from 2002 to 2011. Donor operative time and perioperative morbidity were compared. Early graft function for kidneys procured by each technique was evaluated by rates of delayed graft function, need for dialysis and recipient discharge creatinine. Long-term outcomes were evaluated by graft function. A total of 152 laparoscopic donor nephrectomies were compared with 116 hand assisted laparoscopic donor nephrectomies. Hand assisted procedures were more often done for the right kidney (41.1% vs 17.1%, p recipient outcomes were also similar. Delayed function occurred after 0% hand assisted vs 0.9% purely laparoscopic nephrectomies, dialysis was required in 0.9% vs 1.7% and rejection episodes developed in 9.7% vs 18.4% (p >0.05). At last followup the organ was nonfunctioning in 6.1% of hand assisted and 7.7% of purely laparoscopic cases (p >0.05). The recipient glomerular filtration rate at discharge home was similar in the 2 groups. Hand assisted laparoscopic donor nephrectomy had shorter warm ischemia time but perioperative donor morbidity and graft outcome were comparable. The choice of technique should be based on patient and surgeon preference. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  3. Laparoscopic and ultrasound assisted management of gallstone ileus after biliointestinal bypass Case report and a review of literature.

    Science.gov (United States)

    Zago, Mauro; Bozzo, Samantha; Centurelli, Andrea; Giovanelli, Alessandro; Vasino, Michele Ciocca

    2016-05-24

    To report about an additional case of biliary ileus after bariatric surgery is reported and extensively reviewing the literature on this topic. We reviewed the literature and found three cases of gallstone ileus (GI) that occurred after bariatric surgery. A 41 year old patient presented a GI eight years after a biliointestinal bypass (BIB) for morbid obesity. The patient complained of abdominal pain for two weeks. Computed tomography (CT) and abdominal ultrasound (US) allowed a preoperative diagnosis of GI and planning of surgical strategy. Surgical treatment was carried out through laparoscopic-assisted enterolithotomy alone procedure. This choice is supported discussing the related issues: morbidity, potential recurrence, eventual developing of gallbladder carcinoma. It is the first reported case of GI after BIB preoperatively diagnosed through CT scan and US, and treated with a laparoscopic assisted approach. Additional considerations concerning preoperative diagnosis, surgical strategy, technical details and follow-up can be usefully applied even in non post-bariatric biliary ileus. Biliointestinal bypass, Gallstone ileus, Laparoscopy, Ultrasonography.

  4. Laparoscopic female sterilization.

    Science.gov (United States)

    Filshie, G M

    1989-09-01

    An overview of laparoscopic sterilization techniques from a historical and practical viewpoint includes instrumentation, operative techniques, mechanical occlusive devices, anesthesia, failure rates, morbidity and mortality. Laparoscope was first reported in 1893, but was developed simultaneously in France, Great Britain, Canada and the US in the 1960s. There are smaller laparoscopes for double-puncture procedures, and larger, single-puncture laparoscopes. To use a ring or clip, a much larger operating channel, up to 8 mm is needed. Insufflating gas may be CO2, which does not support combustion, but is more uncomfortable, NO2, which is also an anesthetic, and room air often used in developing countries. Unipolar electrocautery is now rarely used, in fact most third party payers do not allow it. Bipolar cautery, thermal coagulation and laser photocoagulation are safer methods. Falope rings, Hulka-Clemens, Filshie, Bleier, Weck and Tupla clips are described and illustrated. General anesthesia, usually a short acting agent with a muscle relaxant, causes 33% of the mortality of laparoscope, often due to cardiac arrest and arrhythmias, preventable with atropine. Local anesthesia is safer and cheaper and often used in developing countries. Failure rates of the various laparoscopic tubal sterilization methods are reviewed: most result from fistula formation. Mortality and morbidity can be caused by bowel damage, injury or infection, pre- existing pelvic infection, hemorrhage, gas embolism (avoidable by the saline drip test), and other rare events.

  5. Per-Oral Endoscopic Myotomy Versus Laparoscopic Heller Myotomy for Achalasia: A Meta-Analysis of Nonrandomized Comparative Studies.

    Science.gov (United States)

    Zhang, Yuan; Wang, Hongjuan; Chen, Xingdong; Liu, Lan; Wang, Hongbo; Liu, Bin; Guo, Jianqiang; Jia, Hongying

    2016-02-01

    We aimed to assess the short-term outcomes of per-oral endoscopic myotomy (POEM) compared with laparoscopic Heller myotomy (LHM) for achalasia through a meta-analysis of nonrandomized comparative studies.We searched PubMed, Embase, Medline, Cochrane Library, and Google Scholar for studies that compared POEM and LHM for achalasia and were published between January 1, 2008 and December 31, 2014. The Methodological Index for Nonrandomized Studies (MINORS) was used to evaluate the quality of the studies. Random- and fixed-effects meta-analytical models were used, and between-study heterogeneity was assessed.Four nonrandomized comparative studies that included 317 patients (125 in the POEM group and 192 in the LHM group) met our research criteria and were assessed. There were no differences between the POEM and LHM groups in terms of sex, preoperative Eckhart score, length of myotomy, operation time, length of hospital stay, and complications. The patients in the POEM group were older than those in the LHM group (MD =2.81, 95% CI 0.27-5.35; P = 0.03) with high between-study homogeneity (χ = 1.96, df = 2, I = 0%; P = 0.38). The patients in the POEM group had a lower Eckardt score after surgery compared with those in the LHM group (MD = -0.30, 95% CI -0.42 to -0.18; P < 0.001) with high between-study homogeneity (χ = 0.00, df = 1, I = 0%; P = 1.00).The efficacy and safety of POEM appear to be comparable to those of LHM. Multicenter and randomized trials with larger sample size are needed to further compare the efficacy and safety of POEM and LHM for the treatment of achalasia.

  6. Port-site metastasis after laparoscopic surgical staging of endometrial cancer: a systematic review of the published and unpublished data.

    Science.gov (United States)

    Palomba, Stefano; Falbo, Angela; Russo, Tiziana; La Sala, Giovanni Battista

    2012-01-01

    Port-site metastases, also called trocar-site metastasis, have been described after laparoscopic surgery for non-gynecological and gynecological cancers. The aim of this review was to obtain evidence for port-site metastases after laparoscopic surgical staging of endometrial cancer. A systematic search of published and unpublished cases of port-site metastases after laparoscopic staging of endometrial cancer was conducted. All the authors responsible for correspondence were contacted to obtain any missing data. The patients' characteristics and oncologic, surgical, and safety data were recorded and analyzed. Twelve cases of port-site metastases were identified and examined. In 4 cases they were "isolated," that is, recurrence without association with peritoneal carcinomatosis, whereas in 8 cases they were "nonisolated." The port-site metastases did not occur as a result of trocar site localization or dimension. No univocal strategy to prevent port-site metastases was adopted. Among patients with nonisolated port-site metastases, an aggressive histologic condition and a high grade were found in 3 of 6 patients and in 3 of 5 patients, respectively. Among patients with isolated port-site metastases, an early-stage endometrioid adenocarcinoma G2 endometrial cancer and a stage IIB G2 endometrioid adenocarcinoma were described in 3 of 4 patients and in only 1 case, respectively. All the patients with nonisolated port-site metastases died of disease. Similarly, among patients with isolated port-site metastases, only 1 was alive and free of disease after 10 months from recurrence diagnosis. Port-site metastases of endometrial cancer are an entity rarely reported but probably the expression of an aggressive disease. The available data do not allow us to draw conclusions or suggestions for their prevention and the treatment. Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.

  7. BOOK REVIEW: The Current Comparator

    Science.gov (United States)

    Petersons, Oskars

    1989-01-01

    This 120-page book is a concise, yet comprehensive, clearly-written and well-illustrated monograph that covers the subject matter from basic principles through design, construction and calibration details to the principal applications. The book will be useful, as a primer, to the uninitiated and, as a reference book to the practitioner involved with transformer-type ratio devices. The length of the book and the style of presentation will not overburden any informed reader. The described techniques and the cited references are primarily from the work at the National Research Council, Canada (NRC). Any omissions, however, are not serious with respect to coverage of the subject matter, since most of the development work has been done at NRC. The role of transformers and transformer-like devices for establishing accurate voltage and current ratios has been recognized for over half a century. Transformer techniques were much explored and developed in the fifties and sixties for accuracy levels suitable for standards laboratories. Three-winding voltage transformers were developed for scaling of impedances in connection with the calculable Thompson Lampard capacitor; three-winding current transformers or current comparators were initially explored for the calibration of current transformers and later for specialized impedance measurements. Extensive development of the current comparator and its applications has been and is still being conducted at the NRC by a team that was started and, until his retirement, led by N L Kusters. The team is now led by W J M Moore. He and P N Miljanic, the authors of this book, have had the principal roles in the development of the current comparator. It is fortunate for the field of metrology that considerabe resources and a talented group of researchers were available to do this development along with mechanisms that were available to transfer this technology to a private sector instrument manufacturer and, thus, disseminate it world wide

  8. [Sacrocolpopexy - pro laparoscopic].

    Science.gov (United States)

    Hatzinger, M; Sohn, M

    2012-05-01

    Innovative techniques have a really magical attraction for physicians as well as for patients. The number of robotic-assisted procedures worldwide has almost tripled from 80,000 procedures in the year 2007 to 205,000 procedures in 2010. In the same time the total number of Da Vinci surgery systems sold climbed from 800 to 1,400. Advantages, such as three-dimensional visualization, a tremor-filter, an excellent instrument handling with 6 degrees of freedom and better ergonomics, together with aggressive marketing led to a veritable flood of new Da Vinci acquisitions in the whole world. Many just took the opportunity to introduce a new instrument to save a long learning curve and start immediately in the surgical master class.If Da Vinci sacrocolpopexy is compared with the conventional laparoscopic approach, robotic-assisted sacrocolpopexy shows a significantly longer duration of the procedure, a higher need for postoperative analgesics, much higher costs and an identical functional outcome without any advantage over the conventional laparoscopic approach. Although the use of robotic-assisted systems shows a significantly lower learning curve for laparoscopic beginners, it only shows minimal advantages for the experienced laparoscopic surgeon. Therefore it remains uncertain whether robotic-assisted surgery shows a significant advantage compared to the conventional laparoscopic surgery, especially with small reconstructive laparoscopic procedures such as sacrocolpopexy.

  9. Comparative Study of Laparoscopic Appendectomies With Application of Different Techniques for Closure of the Appendicular Mesoappendix and Stump

    Directory of Open Access Journals (Sweden)

    Mohend A.N. Al-Shalah

    2018-01-01

    Full Text Available Background: Laparoscopic appendectomy(LA has gained a wide safe acceptance and effective method for treatment of acute appendicitis and can be considered as a gold standard. The aim of the study was to evaluate the results of LA performed with the use of different techniques. Method: Prospective randomized comparative study was carried out in a Babylon General Teaching Hospital. Patients diagnosed with acute appendicitis between December 2011 and December 2015 and agreed to do LA were included in this study. In Group A , the mesoappendix and the base of appendix is ligated using titanium clips while in group B ,the mesoappendix was cut with the application of monopolar diathermy very near to the appendix wall and the base of appendix is ligated using vicryle endoloop. In. Primary outcomes were assessed which include mortality ,intra and post-operative complication rate, reinterventions, and converted laparoscopic appendectomies to open .Secondary outcomes were time of hospitalization, duration of operation, wound infection and intra-abdominal abscesses formation rate, hospital charges. Result: A total of 284patients underwent LA. 146 (51.4% of them ,LA were done by clipping of mesoappendix and base of appendix by titanium clips, while the other 138 (48.6% of patients LA were done by using monapolar diathermy to the mesoappendix and base of appendix secured by vicryle endoloop. The overall mean age of all patients with appendectomy was (26.42±11.05 years old and (38.7% of patients were aged between 20-30 years. (52.5% of patients were males. The overall mean weight, height and BMI for patients with appendectomy were (74.29±12.14 kg, (1.68±0.09 m and (26.68±8.84 kg/m2, respectively. (45.4% of patients were overweight. The overall mean duration of operation was (31.01±12.48 min and (68.7% of patients spent less than 30 min operative time, meanwhile, the mean of hospitalization after operation was (22.11± 17.96 hours and (71.8% of patients

  10. Pregnancy rate of gonadotrophin therapy and laparoscopic ovarian electrocautery in polycystic ovary syndrome resistant to clomiphene citrate: a comparative study

    Directory of Open Access Journals (Sweden)

    Ghafarnegad M

    2010-01-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Polycystic ovary syndrome (PCOS is a common cause of ovulation insufficiency and then infertility. Therapeutic options to induce ovulation in anovulatory PCOS patients are clomiphene citrate, metformin, tamoxifen, dopamine agonists (bromocriptin, Gonadotrophin and laparoscopic ovarian electrocautery (LOE. Gonadotrophin and LOE are important options in anovulatory clomiphene citrate-resistant patients with PCOS. Literature data regarding compare of the efficacy of these two treatments are few. Therefore we aimed to study the pregnancy rates of these treatments in infertile clomiphene citrate-resistant patients with PCOS."n"nMethods: A randomized clinical trial study was carried out in infertile clomiphene citrate-resistant patients with PCOS, referred to infertility clinic of Mirza Koochackhan Hospital of Tehran University of Medical Science in Tehran, Iran, between 2003 and 2008."n"nResults: A total of 100 patients women were randomly allocated in two groups. There were no differences in age and pimary and secondary infertility duration. In LOE treatment group, eight cases (16% were pregnant and all delivered at term. in gonadotrophin treatment 14 cases (28% were pregnant, 10 cases (20% delivered at term

  11. A systematic review and meta-analysis evaluating the role of laparoscopic surgical resection of transverse colon tumours.

    Science.gov (United States)

    Chand, M; Siddiqui, M R S; Rasheed, S; Brown, G; Tekkis, P; Parvaiz, A; Qureshi, T

    2014-12-01

    A meta-analysis of published literature comparing outcomes after laparoscopic resection (LR) with open resection (OR) for transverse colon tumours. Medline, PubMed, CINAHL, EMBASE and Cochrane were searched from inception to October 2013. The text words "minimally invasive", "keyhole surgery" and "transverse colon" were used in combination with the medical subject headings "laparoscopy" and "colon cancer". Outcome variables were chosen based upon whether the included articles reported results. A meta-analysis was performed to obtain a summative outcome. Six comparatives involving 444 patients were analysed. Of them 245 patients were in the LR group and 199 in the OR group. There was a significant increase in operative time in the LR group compared with the OR group [random effects model: SMD = -0.65, 95% CI (-1.01, -0.30), z = -3.60, p transverse colon tumours is a safe and effective technique. Although there is an increase in operating time, operative and clinical outcomes of intraoperative blood loss and faster recovery are seen with laparoscopic procedures.

  12. Comparative virology and AIDS (review).

    Science.gov (United States)

    Kodama, M; Kodama, T

    1996-03-01

    The scientific debate between pros and cons of the HIV criminal theory of AIDS still remains unsettled. The purpose of this review is to promote resolution of the problem by extracting a common principle of the host-virus relation using data resources for each of 4 viruses as follows: a) polyoma virus, b) Marek's disease virus, c) Ebola virus, d) Korean hemorrhagic fever virus. Conclusions drawn from this study are given as follows: i) Environment emerged as the cardinal factor to modify the process of virus infection in all of the 4 viruses studied. Above all, an accelerating effect of environmental stress on the progression of virus infection was noted in vivo in the majority of viral diseases. ii) Evidence is available to indicate that a healthy cell (or a healthy individual) may harbor virus genes of multiple species without manifesting any pathologic sign. iii) Evidence also suggests that the biological property as well as morphological structure of a virus may vary in reponse to a change of the bioenvironment. On the basis of the above information, we propose to renounce 2 assumptions of classical infection model: a) the hereditarily determined virulence of a microorganism (including virus) be the sole determinant of infection to the effect that its invasion into the host should automatically complete the programmed course of infection; b) virus, a quasi-living creature, should reserve its behavioral independence irrespective of a change of the bioenvironment. The new infection model was constructed on the basis of the selfish gene concept that had been invented by Richard Dawkins to explain the altruistic behavior of an individual. That is, the fate of an exogenous or endogenous virus is under the dual control of the host genome (selfish gene) and the outer environment. The progression of virus infection is conditioned by a crosstalk between them. The selfish gene may use virus (a lifeless substance) as a magic bullet to induce a designated host response. In

  13. [Comparative analysis of application of highly intensive laser irradiation and electrocoagulation during laparoscopic cholecystectomy performed for destructive forms of an acute calculous cholecystitis].

    Science.gov (United States)

    Nichitayio, M Yu; Bazyak, A M; Klochan, V V; Grusha, P K; Goman, A V

    2015-02-01

    Comparative analysis of results of the laser diode (the wave length 940 nm) and elec- trocoagulation application while performing laparoscopic cholecystectomy was con- ducted. For an acute calculous cholecystitis 52 patients were operated, in whom instead of electrocoagulation the laser was applied, provide for reduction of thermal impact on tissues, the complications absence, reduction of the patients stationary treatment duration postoperatively from (5.2 ± 1.2) to (4.9 ± 0.6) days.

  14. Laparoscopic repair of perforated peptic ulcer: patch versus simple closure.

    Science.gov (United States)

    Abd Ellatif, M E; Salama, A F; Elezaby, A F; El-Kaffas, H F; Hassan, A; Magdy, A; Abdallah, E; El-Morsy, G

    2013-01-01

    Laparoscopic correction of perforated peptic ulcer (PPU) has become an accepted way of management. Patch omentoplasty stayed for decades the main method of repair. The goal of the present study was to evaluate whether laparoscopic simple repair of PPU is as safe as patch omentoplasty. Since June 2005, 179 consecutive patients of PPU were treated by laparoscopic repair at our centers. We conducted a retrospective chart review in December 2012. Group I (patch group) included patients who were treated with standard patch omentoplasty. Group II (non-patch group) included patients who received simple repair without patch. From June 2007 to Dec. 2012, 179 consecutive patients of PPU who were treated by laparoscopic repair at our centers were enrolled in this multi-center retrospective study. 108 patients belong to patch group. While 71 patients were treated with laparoscopic simple repair. Operative time was significantly shorter in group II (non patch) (p = 0.01). No patient was converted to laparotomy. There was no difference in age, gender, ASA score, surgical risk (Boey's) score, and incidence of co-morbidities. Both groups were comparable in terms of hospital stay, time to resume oral intake, postoperative complications and surgical outcomes. Laparoscopic simple repair of PPU is a safe procedure compared with the traditional patch omentoplasty in presence of certain selection criteria. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  15. [Laparoscopic colorectal surgery - SILS, robots, and NOTES.

    NARCIS (Netherlands)

    D'Hoore, André; Wolthuis, Albert M.; Mizrahi, Hagar; Parker, Mike; Bemelman, Willem A.; Wara, Pål

    2011-01-01

    Single incision laparoscopic surgery resection of colon is feasible, but so far evidence of benefit compared to standard laparoscopic technique is lacking. In addition to robot-controlled camera, there is only one robot system on the market capable of performing laparoscopic surgery. The da Vinci

  16. Short term benefits for laparoscopic colorectal resection.

    Science.gov (United States)

    Schwenk, W; Haase, O; Neudecker, J; Müller, J M

    2005-07-20

    Colorectal resections are common surgical procedures all over the world. Laparoscopic colorectal surgery is technically feasible in a considerable amount of patients under elective conditions. Several short-term benefits of the laparoscopic approach to colorectal resection (less pain, less morbidity, improved reconvalescence and better quality of life) have been proposed. This review compares laparoscopic and conventional colorectal resection with regards to possible benefits of the laparoscopic method in the short-term postoperative period (up to 3 months post surgery). We searched MEDLINE, EMBASE, CancerLit, and the Cochrane Central Register of Controlled Trials for the years 1991 to 2004. We also handsearched the following journals from 1991 to 2004: British Journal of Surgery, Archives of Surgery, Annals of Surgery, Surgery, World Journal of Surgery, Disease of Colon and Rectum, Surgical Endoscopy, International Journal of Colorectal Disease, Langenbeck's Archives of Surgery, Der Chirurg, Zentralblatt für Chirurgie, Aktuelle Chirurgie/Viszeralchirurgie. Handsearch of abstracts from the following society meetings from 1991 to 2004: American College of Surgeons, American Society of Colorectal Surgeons, Royal Society of Surgeons, British Assocation of Coloproctology, Surgical Association of Endoscopic Surgeons, European Association of Endoscopic Surgeons, Asian Society of Endoscopic Surgeons. All randomised-controlled trial were included regardless of the language of publication. No- or pseudorandomised trials as well as studies that followed patient's preferences towards one of the two interventions were excluded, but listed separately. RCT presented as only an abstract were excluded. Results were extracted from papers by three observers independently on a predefined data sheet. Disagreements were solved by discussion. 'REVMAN 4.2' was used for statistical analysis. Mean differences (95% confidence intervals) were used for analysing continuous variables. If

  17. Three ports versus four ports laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Shah, S.F.; Waqar, S.; Chaudry, M.A.; Hameed, S.

    2017-01-01

    To compare three ports laparoscopic cholecystectomy and four ports laparoscopic cholecystectomy in terms of complications, time taken to complete the procedure, hospital stay and cost effectiveness in local perspective. Methodology: This randomized control trial included 60 patients who underwent elective laparoscopic cholecystectomy at Department of Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan from January 2013 to June 2013. These patients were randomized on computer generated table of random numbers into group A and Group B. In Group A patients four ports were passed to perform laparoscopic cholecystectomy and in Group B patients three ports were passed to perform the procedure. Results: The mean age in both groups was 44 years (range 18-72). Three ports laparoscopic cholecystectomy (43 min) took less time to complete than four ports laparoscopic cholecystectomy (51 min). Patients in three ports laparoscopic cholecystectomy experienced less pain as compared to four ports group. The total additional analgesia requirement in 24 hours calculated in milligrams was less in three port laparoscopic cholecystectomy group as compared four port laparoscopic cholecystectomy group. The mean hospital stay in three port laparoscopic cholecystectomy group is 25 hours while the mean hospital stay in the four port laparoscopic cholecystectomy group is 28 hours. Conclusion: Three ports laparoscopic cholecystectomy is safe and effective procedure and it did not compromise the patient safety. (author)

  18. Laparoscopic and open subtotal colectomies have similar short-term results.

    Science.gov (United States)

    Hoogenboom, Froukje J; Bosker, Robbert J I; Groen, Henk; Meijerink, Wilhelmus J H J; Lamme, Bas; Pierie, Jean Pierre E N

    2013-01-01

    Laparoscopic subtotal colectomy (STC) is a complex procedure. It is possible that short-term benefits for segmental resections cannot be attributed to this complex procedure. This study aims to assess differences in short-term results for laparoscopic versus open STC during a 15-year single-institute experience. We reviewed consecutive patients undergoing laparoscopic or open elective or subacute STC from January 1997 to December 2012. Fifty-six laparoscopic and 50 open STCs were performed. The operation time was significantly longer in the laparoscopic group, median 266 min (range 121-420 min), compared to 153 min (range 90-408 min) in the open group (p < 0.001). Median hospital stay showed no statistical difference, 14 days (range 1-129 days) in the laparoscopic and 13 days (range 1-85 days) in the open group. Between-group postoperative complications were not statistically different. Laparoscopic STC has short-term results similar to the open procedure, except for a longer operation time. The laparoscopic approach for STC is therefore only advisable in selected patients combined with extensive preoperative counseling. Copyright © 2013 S. Karger AG, Basel.

  19. Comparative biomarker expression and RNA integrity in biospecimens derived from radical retropubic and robot-assisted laparoscopic prostatectomies.

    Science.gov (United States)

    Ricciardelli, Carmela; Bianco-Miotto, Tina; Jindal, Shalini; Dodd, Thomas J; Cohen, Penelope A; Marshall, Villis R; Sutherland, Peter D; Samaratunga, Hemamali; Kench, James G; Dong, Ying; Wang, Hong; Clements, Judith A; Risbridger, Gail P; Sutherland, Robert L; Tilley, Wayne D; Horsfall, David J

    2010-07-01

    Knowledge of preanalytic conditions that biospecimens are subjected to is critically important because novel surgical procedures, tissue sampling, handling, and storage might affect biomarker expression or invalidate tissue samples as analytes for some technologies. We investigated differences in RNA quality, gene expression by quantitative real-time PCR, and immunoreactive protein expression of selected prostate cancer biomarkers between tissues from retropubic radical prostatectomy (RRP) and robot-assisted laparoscopic prostatectomy (RALP). Sections of tissue microarray of 23 RALP and 22 RRP samples were stained with antibodies to androgen receptor (AR) and prostate-specific antigen (PSA) as intersite controls, and 14 other candidate biomarkers of research interest to three laboratories within the Australian Prostate Cancer BioResource tissue banking network. Quantitative real-time PCR was done for AR, PSA (KLK3), KLK2, KLK4, and HIF1A on RNA extracted from five RALP and five RRP frozen tissue cores. No histologic differences were observed between RALP and RRP tissue. Biomarker staining grouped these samples into those with increased (PSA, CK8/18, CKHMW, KLK4), decreased (KLK2, KLK14), or no change in expression (AR, ghrelin, Ki67, PCNA, VEGF-C, PAR2, YB1, p63, versican, and chondroitin 0-sulfate) in RALP compared with RRP tissue. No difference in RNA quality or gene expression was detected between RALP and RRP tissue. Changes in biomarker expression between RALP and RRP tissue exist at the immunoreactive protein level, but the etiology is unclear. Future studies should account for changes in biomarker expression when using RALP tissues, and mixed cohorts of RALP and RRP tissue should be avoided.

  20. Prospective randomized clinical trial comparing laparoscopic cholecystectomy and hybrid natural orifice transluminal endoscopic surgery (NOTES) (NCT00835250).

    Science.gov (United States)

    Noguera, José F; Cuadrado, Angel; Dolz, Carlos; Olea, José M; García, Juan C

    2012-12-01

    Natural orifice transluminal endoscopic surgery (NOTES) is a technique still in experimental development whose safety and effectiveness call for assessment through clinical trials. In this paper we present a three-arm, noninferiority, prospective randomized clinical trial of 1 year duration comparing the vaginal and transumbilical approaches for transluminal endoscopic surgery with the conventional laparoscopic approach for elective cholecystectomy. Sixty female patients between the ages of 18 and 65 years who were eligible for elective cholecystectomy were randomized in a ratio of 1:1:1 to receive hybrid transvaginal NOTES (TV group), hybrid transumbilical NOTES (TU group) or conventional laparoscopy (CL group). The main study variable was parietal complications (wound infection, bleeding, and eventration). The analysis was by intention to treat, and losses were not replaced. Cholecystectomy was successfully performed on 94% of the patients. One patient in the TU group was reconverted to CL owing to difficulty in maneuvering the endoscope. After a minimum follow-up period of 1 year, no differences were noted in the rate of parietal complications. Postoperative pain, length of hospital stay, and time off from work were similar in the three groups. No patient developed dyspareunia. Surgical time was longer among cases in which a flexible endoscope was used (CL, 47.04 min; TV, 64.85 min; TU, 59.80 min). NOTES approaches using the flexible endoscope are not inferior in safety or effectiveness to conventional laparoscopy. The transumbilical approach with flexible endoscope is as effective and safe as the transvaginal approach and is a promising, single-incision approach.

  1. Laparoscopic vs open approach for transverse colon cancer. A systematic review and meta-analysis of short and long term outcomes.

    Science.gov (United States)

    Athanasiou, Christos D; Robinson, Jonathan; Yiasemidou, Marina; Lockwood, Sonia; Markides, Georgios A

    2017-05-01

    Transverse colon malignancies have been excluded from all randomized controlled trials comparing laparoscopic against open colectomies, potentially due to the advanced laparoscopic skills required for dissecting around the middle colic vessels and the associated morbidity. Concerns have been expressed that the laparoscopic approach may compromise the oncological clearance in transverse colon cancer. This study aimed to comprehensively compare the laparoscopic (LPA) to the open (OPA) approach by performing a meta-analysis of long and short term outcomes. Medline, Embase, Cochrane library, Scopus and Web of Knowledge databases were interrogated. Selected studies were critically appraised and the short-term morbidity and long term oncological outcomes were meta-analyzed. Sensitivity analysis according to the quality of the study, type of procedure (laparoscopic vs laparoscopically assisted) and level of lymphadenectomy was performed. Statistical heterogeneity and publication bias were also investigated. Eleven case control trials (1415 patients) were included in the study. There was no difference between the LPA and the OPA in overall survival [Hazard Ratio (HR) = 0.83 (0.56, 1.22); P = 0.34], disease free survival (p = 0.20), local recurrence (p = 0.81) or distant metastases (p = 0.24). LPA was found to have longer operative time [Weighted mean difference (WMD) = 45.00 (29.48, 60.52); P transverse colon cancer. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  2. Laparoendoscopic single-site adrenalectomy versus conventional laparoscopic surgery: a systematic review and meta-analysis of observational studies.

    Science.gov (United States)

    Wang, Linhui; Wu, Zhenjie; Li, Mingmin; Cai, Chen; Liu, Bing; Yang, Qing; Sun, Yinghao

    2013-06-01

    To assess the surgical efficacy and potential advantages of laparoendoscopic single-site adrenalectomy (LESS-AD) compared with conventional laparoscopic adrenalectomy (CL-AD) based on published literature. An online systematic search in electronic databasesM including Pubmed, Embase, and the Cochrane Library, as well as manual bibliography searches were performed. All studies that compared LESS-AD with CL-AD were included. The outcome measures were the patient demographics, tumor size, blood loss, operative time, time to resumption of oral intake, hospital stay, postoperative pain, cosmesis satisfaction score, rates of complication, conversion, and transfusion. A meta-analysis of the results was conducted. A total of 443 patients were included: 171 patients in the LESS-AD group and 272 patients in the CL-AD group (nine studies). There was no significant difference between the two groups in any of the demographic parameters expect for lesion size (age: P=0.24; sex: P=0.35; body mass index: P=0.79; laterality: P=0.76; size: P=0.002). There was no significant difference in estimated blood loss, time to oral intake resumption, and length of stay between the two groups. The LESS-AD patients had a significantly lower postoperative visual analog pain score compared with the CL-AD group, but a longer operative time was noted. Both groups had a comparable cosmetic satisfaction score. The two groups had a comparable rate of complication, conversion, and transfusion. In early experience, LESS-AD appears to be a safe and feasible alternative to its conventional laparoscopic counterpart with decreased postoperative pain noted, albeit with a longer operative time. As a promising and emerging minimally invasive technique, however, the current evidence has not verified other potential advantages (ie, cosmesis, recovery time, convalescence, port-related complications, etc.) of LESS-AD.

  3. Solid pancreatic pseudopapillary tumor managed laparoscopically: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    D. Cuccurullo

    Full Text Available Background: Solid pancreatic pseudopapillary tumors are a rare neoplasms, about 1–3% of all pancreatic neoplasms. This cancer mainly affects women between the third and fourth decade of life.They are not well known; the molecular origins represent a low degree of malignancy, in which the complete resection is curative. We report our experience with a case report of SPT in a young man. Presentation of case: Thirty-six years old male patient with a mass about 10 cm in the pancreatic tail and splenic ilum. After following CT and MR, the patient was subjected to surgery. Histophatological result was solid tumor pseudopapillary of pancreas with no pathological lymph nodes. Discussion and conclusion: Solid pseudopapillary neoplasm shows histological characteristic solid and pseudopapillary proliferation. Immunohistochemistry detects, among the causes of tumor development, a correlation between the Beta-catenin mutations, alteration of the E-cadherin. In the most cases, therapy is surgical treatment with laparoscopic. Keywords: Pancreatic pseudopapillary neoplasm, Pancreatic tumor, Laparoscopic surgery

  4. [Elective laparoscopic right colectomy for caecal volvulus: case report and literature review].

    Science.gov (United States)

    Ramírez-Ramírez, Moisés Marino; Villanueva-Sáenz, Eduardo; Ramírez-Wiella-Schwuchow, Gustavo

    Caecal volvulus is an uncommon cause of intestinal obstruction. Its clinical presentation is non-specific, with the diagnosis usually confirmed by barium enema and abdominal computed tomography. Treatment depends on many factors, and minimally invasive approaches are becoming the treatment of choice. A 54 years old female, admitted to the Emergency Department with clinical symptoms of intestinal obstruction. On physical examination she had a palpable, firm, and tympanitic mass in the right abdomen, with peritoneal irritation. The radiographs of the abdomen, barium enema and abdominal computed tomography showed caecal volvulus. As she showed a full remission after the barium enema, with no clinical or biochemical data of systemic inflammatory response syndrome or peritoneal irritation, she was discharged to her home. Two weeks later, a laparoscopic right hemicolectomy was performed with an ileo-transverse extracorporeal anastomosis. Her progress was satisfactory, and she was discharged 4 days after surgery due to improvement. Caecal volvulus is a rare cause of intestinal obstruction, with high mortality rates, and is caused by excessive mobility of the caecum. Its incidence is increasing. Treatment depends on many factors. Early non-surgical untwisting, followed by an elective laparoscopic surgical procedure offers several advantages and reduces mortality. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  5. Laparoscopic versus open repair for perforated peptic ulcer: A meta analysis of randomized controlled trials.

    Science.gov (United States)

    Tan, Shanjun; Wu, Guohao; Zhuang, Qiulin; Xi, Qiulei; Meng, Qingyang; Jiang, Yi; Han, Yusong; Yu, Chao; Yu, Zhen; Li, Ning

    2016-09-01

    The role of laparoscopic surgery in the repair for peptic ulcer disease is unclear. The present study aimed to compare the safety and efficacy of laparoscopic versus open repair for peptic ulcer disease. Randomized controlled trials (RCTs) comparing laparoscopic versus open repair for peptic ulcer disease were identified from MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and references of identified articles and relevant reviews. Primary outcomes were postoperative complications, mortality, and reoperation. Secondary outcomes were operative time, postoperative pain, postoperative hospital stay, nasogastric tube duration, and time to resume diet. Statistical analysis was carried out by Review Manage software. Five RCTs investigating a total of 549 patients, of whom, 279 received laparoscopic repair and 270 received open repair, were included in the final analysis. There were no significant differences between these two procedures in some primary outcomes including overal postoperative complication rate, mortality, and reoperation rate. Subcategory analysis of postoperative complications showed that laparoscopic repair had also similar rates of repair site leakage, intra-abdominal abscess, postoperative ileus, pneumonia, and urinary tract infection as open surgery, except of the lower surgical site infection rate (P peptic ulcer. The obvious advantages of laparoscopic surgery are the lower surgical site infection rate, shorter nasogastric tube duration and less postoperative pain. However, more higher quality studies should be undertaken to further assess the safety and efficacy of laparoscopic repair for peptic ulcer disease. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  6. How does the robot affect outcomes? A retrospective review of open, laparoscopic, and robotic Heller myotomy for achalasia.

    Science.gov (United States)

    Shaligram, Abhijit; Unnirevi, Jayaraj; Simorov, Anton; Kothari, Vishal M; Oleynikov, Dmitry

    2012-04-01

    Robotic techniques are routinely used in urological and gynecological procedures; however, their role in general surgical procedures is limited. A robotic technique has been successfully adopted for a minimally invasive Heller myotomy procedure for achalasia. This study aims to compare perioperative outcomes following open, laparoscopic, and robotic Heller myotomy. This study is a multicenter, retrospective analysis utilizing a large administrative database. The University Health System Consortium (UHC) is an alliance between academic medical centers and affiliate hospitals. The UHC database was accessed using International Classification of Diseases, Ninth Revision, Clinical Modification codes and analyzed. 2,683 patients with achalasia underwent Heller myotomy between October 2007 and June 2011. Myotomy was performed by open surgery (OM) in 418 patients, by laparoscopic approach (LM) in 2,116, and by robotic approach (RM) in 149. Comparison between LM and RM groups demonstrated no significant difference in mortality (0.14 vs. 0.0%; P = 1), morbidity (5.19 vs. 4.02%; P = 0.7), intensive care unit (ICU) admission (6.62 vs. 3.36%; P = 0.12), length of stay (LOS) (2.70 ± 3.87 days vs. 2.42 ± 2.69 days; P = 0.34), or 30-day readmission (1.41 vs. 2.84%; P = 0.27). However, hospital costs were significantly lower for the LM group (US $7,441 ± 7,897 vs. US $9,415 ± 5,515; P = 0.0028). Comparison between OM and RM demonstrated significant lower morbidity (9.08 vs. 4.02%; P = 0.02), ICU admission rate (14.01 vs. 3.36%, P = 0.0002), and LOS (4.42 ± 5.25 days vs. 2.42 ± 2.69 days; P = 0.0001). The perioperative outcomes are superior in LM and RM groups when compared with OM. The outcomes for the LM and RM group are comparable, with the robotic group having slightly improved results, although with increased costs. We conclude that robotic surgery is equivalent in safety and efficacy to laparoscopic Heller myotomy, and feel that the increased cost should come down as

  7. Inflammatory response in laparoscopic vs. open surgery for gastric cancer

    DEFF Research Database (Denmark)

    Okholm, Cecilie; Goetze, Jens Peter; Svendsen, Lars Bo

    2014-01-01

    lead to an increased susceptibility to complications and morbidity. The aim of this review was to investigate if laparoscopic surgery reduces the immunological response compared to open surgery in gastric cancer. METHODS: We conducted a literature search identifying relevant studies comparing...... laparoscopy or laparoscopic-assisted surgery with open gastric surgery. The main outcome was postoperative immunological status defined as surgical stress parameters, including inflammatory cytokines and blood parameters. RESULTS: We identified seven studies that addressed the immunological status in patients...... laparotomy. Finally, most studies reported lower levels of white blood cell count in laparoscopic patients, although this result did not reach statistical significance in a small number of studies. CONCLUSIONS: Laparoscopy-assisted gastric surgery seems to attenuate the immune response compared to open...

  8. Uncertainties about laparoscopic myomectomy during pregnancy: A lack of evidence or an inherited misconception? A critical literature review starting from a peculiar case.

    Science.gov (United States)

    Saccardi, Carlo; Visentin, Silvia; Noventa, Marco; Cosmi, Erich; Litta, Pietro; Gizzo, Salvatore

    2015-01-01

    The aim of this report was to perform a critical review of the literature about feasibility, safety, limitations and contraindications of laparoscopic myomectomy during pregnancy starting from a peculiar case of a 15-weeks pregnant woman affected by a symptomatic large myoma. A 35 year-old Caucasian-nulliparous-woman was referred to our unit at nine weeks of gestation for abdominal heaviness and constipation. The ultrasound examination revealed the presence of a 24 cm pedunculated myoma. The initial management was conservative until the achievement of 15 gestational weeks, when the worsening of abdominal pain led to the need of a laparoscopic myomectomy. Intraoperative blood-loss was 600 ml and operating-time was 150 minutes (70 minutes were required for the morcellement); the postoperative course was normal. The pregnancy evolved regularly and, at 41 weeks, the patient delivered by urgent caesarean section (because intrapartum fetal heart rate abnormalities) a healthy male baby weighing 4460 gr. Both post-partum and puerperium period had a regular course. Laparoscopic myomectomy is feasible and safe during pregnancy for both mother and fetus and vaginal delivery should not be contraindicated. Evidence from our and other reported cases suggests that, during pregnancy, laparoscopic myomectomy should be considered the best surgical choice when subserous peduncolated myomas are symptomatic.

  9. Combined Endoscopic and Laparoscopic Management of Postcholecystectomy Mirizzi Syndrome from a Remnant Cystic Duct Stone: Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Arpit Amin

    2016-01-01

    Full Text Available Mirizzi syndrome has been defined in the literature as common bile duct obstruction resulting from calculi within Hartmann’s pouch or cystic duct. We present a case of a 78-year-old female, who developed postcholecystectomy Mirizzi syndrome from a remnant cystic duct stone. Diagnosis of postcholecystectomy Mirizzi syndrome was made on endoscopic retrograde cholangiography (ERCP performed postoperatively. The patient was treated with a novel strategy by combining advanced endoscopic and laparoscopic techniques in three stages as follows: Stage 1 (initial presentation: endoscopic sphincterotomy with common bile duct stent placement; Stage 2 (6 weeks after Stage 1: laparoscopic ultrasonography to locate the remnant cystic duct calculi followed by laparoscopic retrieval of the calculi and intracorporeal closure of cystic duct stump; Stage 3 (6 weeks after Stage 2: endoscopic removal of common bile duct stent along with performance of completion endoscopic retrograde cholangiogram. In addition, we have performed an extensive review of the various endoscopic and laparoscopic management techniques described in the literature for the treatment of postcholecystectomy syndrome occurring from retained cystic duct stones.

  10. Combined Endoscopic and Laparoscopic Management of Postcholecystectomy Mirizzi Syndrome from a Remnant Cystic Duct Stone: Case Report and Review of the Literature.

    Science.gov (United States)

    Amin, Arpit; Zhurov, Yuriy; Ibrahim, George; Maffei, Anthony; Giannone, Jonathan; Cerabona, Thomas; Kaul, Ashutosh

    2016-01-01

    Mirizzi syndrome has been defined in the literature as common bile duct obstruction resulting from calculi within Hartmann's pouch or cystic duct. We present a case of a 78-year-old female, who developed postcholecystectomy Mirizzi syndrome from a remnant cystic duct stone. Diagnosis of postcholecystectomy Mirizzi syndrome was made on endoscopic retrograde cholangiography (ERCP) performed postoperatively. The patient was treated with a novel strategy by combining advanced endoscopic and laparoscopic techniques in three stages as follows: Stage 1 (initial presentation): endoscopic sphincterotomy with common bile duct stent placement; Stage 2 (6 weeks after Stage 1): laparoscopic ultrasonography to locate the remnant cystic duct calculi followed by laparoscopic retrieval of the calculi and intracorporeal closure of cystic duct stump; Stage 3 (6 weeks after Stage 2): endoscopic removal of common bile duct stent along with performance of completion endoscopic retrograde cholangiogram. In addition, we have performed an extensive review of the various endoscopic and laparoscopic management techniques described in the literature for the treatment of postcholecystectomy syndrome occurring from retained cystic duct stones.

  11. Gastric wall thickness and stapling in laparoscopic sleeve gastrectomy - a literature review.

    Science.gov (United States)

    Barski, Krzysztof; Binda, Artur; Kudlicka, Emilia; Jaworski, Paweł; Tarnowski, Wiesław

    2018-03-01

    Despite the growing experience of bariatric surgeons in performing laparoscopic sleeve gastrectomy, the number of complications involving staple line leaks remains constant. Hence a solution to avoid such complications is still sought. A defect of the staple line may be the consequence of an inappropriate choice of staple size in relation to gastric wall thickness. Due to the variable nature of gastric wall thickness, the choice of proper staple height is not obvious. In the few studies in which gastric wall thickness was measured, it was observed to decrease gradually from the antrum to the fundus. However, the authors are divided on the issue of whether gender and body mass index influence gastric wall thickness. The question whether there are other perioperative factors that would allow gastric wall thickness to be predicted remains unanswered.

  12. LAPAROSCOPIC TEP VERSUS OPEN HERNIOPLASTY: A COMPARATIVE STUDY OF EXTRAPERITONEAL TENSION FREE MESH REPAIRS IN INGUINAL HERNIA

    OpenAIRE

    Rehan Sabir; Sadiq; Shadan

    2015-01-01

    Inguinal hernia repair is now one of the most commonly performed general surgical procedures in practice. 'Tension - free repair' is the procedure of choice . [ 1 ] due to its low recurrence rate, these tension - free repair procedures can be roughly categorized into two groups: laparoscopic and open anterior approach. TEP is accepted as the most ideal method because it can avoid entry into the peritoneal cavity, which can cause intraperitoneal compli...

  13. Laparoscopic herniorrhaphy.

    Science.gov (United States)

    Swanstrom, L L

    1996-06-01

    There is little doubt that laparoscopic herniorrhaphy has assumed a place in the pantheon of hernia repair. There is also little doubt that further work needs to be done to determine the exact role that laparoscopic hernia repair should play in the surgical armamentarium. Hernias have been surgically treated since the early Greeks. In contrast, laparoscopic hernia repair has a history of only 6 years. Even within that short time, laparoscopic hernia repair techniques have not remained unchanged. This is obviously a technique in evolution, as indicated by the abandonment of early repairs ("plug and mesh" and IPOM) and the gradual gain in pre-eminence of the TEP repair. During the same time frame, surgery itself has evolved into a discipline more concerned with cost-effectiveness, outcomes, and "consumer acceptance." Confluence of these two developments has led to a situation in which traditional concerns regarding surgical procedures (i.e., recurrence rates or complication rates) assume less of a role than cost-effectiveness, learnability, marketability, and medical-legal considerations. No surgeon, whether practicing in a academic setting or a private practice, is exempt from these pressures. Laparoscopic hernia repair therefore seems to fit into a very specialized niche. In our community, the majority of general surgeons are only too happy to not do laparoscopic hernia repairs. On the other hand, in our experience, certain indications do seem to cry out for a laparoscopic approach. At our own center we have found that laparoscopic repairs can indeed be effective, and even cost-effective, under specific circumstances. These include completing a minimal learning curve, utilizing the properitoneal approach, minimizing the use of reusable instruments, using dissecting balloons as a time-saving device, and very specific patient selection criteria. At present these include patients with bilateral inguinal hernias on clinical examination, patients with recurrent

  14. 3D visualization reduces operating time when compared to high-definition 2D in laparoscopic liver resection: a case-matched study.

    Science.gov (United States)

    Velayutham, Vimalraj; Fuks, David; Nomi, Takeo; Kawaguchi, Yoshikuni; Gayet, Brice

    2016-01-01

    To evaluate the effect of three-dimensional (3D) visualization on operative performance during elective laparoscopic liver resection (LLR). Major limitations of conventional laparoscopy are lack of depth perception and tactile feedback. Introduction of robotic technology, which employs 3D imaging, has removed only one of these technical obstacles. Despite the significant advantages claimed, 3D systems have not been widely accepted. In this single institutional study, 20 patients undergoing LLR by high-definition 3D laparoscope between April 2014 and August 2014 were matched to a retrospective control group of patients who underwent LLR by two-dimensional (2D) laparoscope. The number of patients who underwent major liver resection was 5 (25%) in the 3D group and 10 (25%) in the 2D group. There was no significant difference in contralateral wedge resection or combined resections between the 3D and 2D groups. There was no difference in the proportion of patients undergoing previous abdominal surgery (70 vs. 77%, p = 0.523) or previous hepatectomy (20 vs. 27.5%, p = 0.75). The operative time was significantly shorter in the 3D group when compared to 2D (225 ± 109 vs. 284 ± 71 min, p = 0.03). There was no significant difference in blood loss in the 3D group when compared to 2D group (204 ± 226 in 3D vs. 252 ± 349 ml in 2D group, p = 0.291). The major complication rates were similar, 5% (1/20) and 7.5% (3/40), respectively, (p ≥ 0.99). 3D visualization may reduce the operating time compared to high-definition 2D. Further large studies, preferably prospective randomized control trials are required to confirm this.

  15. Single Incision Laparoscopic Splenectomy: Our First Experiences

    Directory of Open Access Journals (Sweden)

    Umut Barbaros

    2011-06-01

    Full Text Available Objective: Most laparoscopic surgeons have attempted to reduce incisional morbidity and improve cosmetic outcomes by using less and smaller trocars. Single incision laparoscopic splenectomy is a new laparoscopic procedure. Herein we would like to present our experiences.Material and Methods: Between January 2009 and June 2009, data of the 7 patients who underwent single incision laparoscopic splenectomy were evaluated retrospectively.Results: There were 7 patients (5 females and 2 males with a mean age of 29.9 years. The most common splenectomy indication was idiopathic thrombocytopenic purpura. Single incision laparoscopic splenectomy was performed successfully in 6 patients. In one patient the operation was converted to an open procedure.Conclusion: With surgeons experienced in minimally invasive surgery, single incision laparoscopic splenectomy could be performed successfully. However, in order to demonstrate the differneces between standard laparoscopic splenectomy and SILS splenetomy, prospective randomized comparative studies are required.

  16. Convalescence after laparoscopic inguinal hernia repair

    DEFF Research Database (Denmark)

    Tolver, Mette Astrup; Rosenberg, Jacob; Bisgaard, Thue

    2016-01-01

    . Furthermore, snowball search was performed in reference lists of identified articles. Randomized controlled trials and prospective comparative or non-comparative trials of high quality were included. Trials with ≥100 patients, >18 years of age and manuscripts in English were included. Scoring systems were...... used for assessment of quality. RESULTS: The literature search identified 1039 papers. Thirty-four trials were included in the final review including 14,273 patients. There was overall a large variation in duration of convalescence. Trials using non-restrictive recommendations of 1-2 days or "as soon...... factors for prolonged convalescence extending more than a few days after laparoscopic inguinal hernia repair. CONCLUSIONS: Patients should be recommended a duration of 1-2 days of convalescence after laparoscopic inguinal hernia repair. Short and non-restrictive recommendations may reduce duration...

  17. A comparative study of erectile function and use of erectile aids in high-risk prostate cancer patients after robot-assisted laparoscopic prostatectomy

    DEFF Research Database (Denmark)

    Østby-Deglum, Marie; Brennhovd, B.; Axcrona, K.

    2015-01-01

    Objective. Erectile function with and without use of erectile aids was compared in high-, intermediate- and low-risk prostate cancer patients at a mean of 3 years after robot-assisted laparoscopic prostatectomy (RALP). Materials and methods. A sample of 982 men who underwent RALP at Oslo University...... according to the preoperative D'Amico classification. Based on questionnaire data, two primary outcomes were defined: ability to have intercourse (sufficient erection), and use and effect of erectile aids. Results. Sufficient erection with or without erectile aids was reported by 19% of the high-, 30...

  18. High-definition resolution three-dimensional imaging systems in laparoscopic radical prostatectomy: randomized comparative study with high-definition resolution two-dimensional systems.

    Science.gov (United States)

    Kinoshita, Hidefumi; Nakagawa, Ken; Usui, Yukio; Iwamura, Masatsugu; Ito, Akihiro; Miyajima, Akira; Hoshi, Akio; Arai, Yoichi; Baba, Shiro; Matsuda, Tadashi

    2015-08-01

    Three-dimensional (3D) imaging systems have been introduced worldwide for surgical instrumentation. A difficulty of laparoscopic surgery involves converting two-dimensional (2D) images into 3D images and depth perception rearrangement. 3D imaging may remove the need for depth perception rearrangement and therefore have clinical benefits. We conducted a multicenter, open-label, randomized trial to compare the surgical outcome of 3D-high-definition (HD) resolution and 2D-HD imaging in laparoscopic radical prostatectomy (LRP), in order to determine whether an LRP under HD resolution 3D imaging is superior to that under HD resolution 2D imaging in perioperative outcome, feasibility, and fatigue. One-hundred twenty-two patients were randomly assigned to a 2D or 3D group. The primary outcome was time to perform vesicourethral anastomosis (VUA), which is technically demanding and may include a number of technical difficulties considered in laparoscopic surgeries. VUA time was not significantly shorter in the 3D group (26.7 min, mean) compared with the 2D group (30.1 min, mean) (p = 0.11, Student's t test). However, experienced surgeons and 3D-HD imaging were independent predictors for shorter VUA times (p = 0.000, p = 0.014, multivariate logistic regression analysis). Total pneumoperitoneum time was not different. No conversion case from 3D to 2D or LRP to open RP was observed. Fatigue was evaluated by a simulation sickness questionnaire and critical flicker frequency. Results were not different between the two groups. Subjective feasibility and satisfaction scores were significantly higher in the 3D group. Using a 3D imaging system in LRP may have only limited advantages in decreasing operation times over 2D imaging systems. However, the 3D system increased surgical feasibility and decreased surgeons' effort levels without inducing significant fatigue.

  19. Laparoscopic versus open distal pancreatectomy for pancreatic cancer.

    Science.gov (United States)

    Riviere, Deniece; Gurusamy, Kurinchi Selvan; Kooby, David A; Vollmer, Charles M; Besselink, Marc G H; Davidson, Brian R; van Laarhoven, Cornelis J H M

    2016-04-04

    Surgical resection is currently the only treatment with the potential for long-term survival and cure of pancreatic cancer. Surgical resection is provided as distal pancreatectomy for cancers of the body and tail of the pancreas. It can be performed by laparoscopic or open surgery. In operations on other organs, laparoscopic surgery has been shown to reduce complications and length of hospital stay as compared with open surgery. However, concerns remain about the safety of laparoscopic distal pancreatectomy compared with open distal pancreatectomy in terms of postoperative complications and oncological clearance. To assess the benefits and harms of laparoscopic distal pancreatectomy versus open distal pancreatectomy for people undergoing distal pancreatectomy for pancreatic ductal adenocarcinoma of the body or tail of the pancreas, or both. We used search strategies to search the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Science Citation Index Expanded and trials registers until June 2015 to identify randomised controlled trials (RCTs) and non-randomised studies. We also searched the reference lists of included trials to identify additional studies. We considered for inclusion in the review RCTs and non-randomised studies comparing laparoscopic versus open distal pancreatectomy in patients with resectable pancreatic cancer, irrespective of language, blinding or publication status.. Two review authors independently identified trials and independently extracted data. We calculated odds ratios (ORs), mean differences (MDs) or hazard ratios (HRs) along with 95% confidence intervals (CIs) using both fixed-effect and random-effects models with RevMan 5 on the basis of intention-to-treat analysis when possible. We found no RCTs on this topic. We included in this review 12 non-randomised studies that compared laparoscopic versus open distal pancreatectomy (1576 participants: 394 underwent laparoscopic distal pancreatectomy and 1182

  20. Combination of gabapentin and ramosetron for the prevention of postoperative nausea and vomiting after gynecologic laparoscopic surgery: a prospective randomized comparative study.

    Science.gov (United States)

    Kim, Kyung Mi; Huh, Jin; Lee, Soo Kyung; Park, Eun Young; Lee, Jung Min; Kim, Hyo Ju

    2017-05-19

    As a drug originally introduced for its anticonvulsant effects, gabapentin has been recently shown to be effective in the treatment of nausea and vomiting in various clinical settings. This study compared the antiemetic efficacy of oral gabapentin, intravenous ramosetron and gabapentin plus ramosetron in patients receiving fentanyl-based patient-controlled analgesia after laparoscopic gynecologic surgery. One hundred and thirty two patients undergoing laparoscopic gynecologic surgery under general anesthesia were allocated randomly into three groups: group G received 300 mg oral gabapentin 1 h before anesthesia, group R received 0.3 mg intravenous ramosetron at the end of surgery, and group GR received a combination of 300 mg oral gabapentin 1 h before anesthesia and 0.3 mg intravenous ramosetron at the end of surgery. Postoperative nausea, retching, vomiting, rescue antiemetic drug use, pain, rescue analgesic requirements and adverse effects were assessed at 0-2, 2-24 and 24-48 h after surgery. Postoperative nausea and vomiting (PONV) was defined as the presence of nausea, retching or vomiting. The incidence of complete response (no PONV and no rescue antiemetics up to 48 h postoperatively) was significantly higher in group GR (26/40, 65%) than group G (16/40, 40%; P = 0.025) and group R (18/44, 41%; P = 0.027), whereas there was no significant difference between group G and group R (P = 0.932). There were no significant between-group differences in the incidence of emetic episodes, use of rescue antiemetics, severe emesis, use of rescue analgesics or any adverse effects. Postoperative pain scores were also similar among groups. The combination with gabapentin and ramosetron is superior to either drug alone for prevention of PONV after laparoscopic gynecologic surgery. ClinicalTrials.gov NCT02617121 , registered November 25, 2015.

  1. Laparoscopic versus open surgery following neoadjuvant chemoradiotherapy for rectal cancer: a systematic review and meta-analysis.

    Science.gov (United States)

    Chen, Hao; Zhao, Liying; An, Shengli; Wu, Jiaming; Zou, Zhenhong; Liu, Hao; Li, Guoxin

    2014-03-01

    This meta-analysis aimed to evaluate the short-term and pathological outcomes of laparoscopic surgery (LS) versus open surgery (OS) following neoadjuvant chemoradiotherapy (NCRT) for rectal cancer. PubMed, Embase, Web of Science, Cochrane Library, and Chinese Biomedicine Literature databases were searched for eligible studies published up to July 2013. The rates of postoperative complication, positive circumferential resection margin (CRM), and the number of lymph nodes harvested were evaluated. Three randomized controlled trials (RCTs) and five non-RCTs enrolling 953 patients were included. Compared to OS, LS had similar rate of postoperative complication [odds ratio (OR) 0.86; 95% confidence interval (CI), 0.60 to 1.22], comparable rate of positive CRM (OR 0.41; 95% CI, 0.16 to 1.02), and smaller number of lymph nodes (weighted mean difference -0.8; 95% CI, -1.1 to -0.5). LS also had significantly less blood loss, faster bowel movement recovery, and shorter postoperative hospitalization than those of OS. LS is associated with favorable short-term benefits, similar postoperative complication rate, and comparable pathological outcomes for rectal cancer after NCRT compared to OS despite a slight difference in the number of lymph nodes. Additional high-quality studies are needed to validate long-term outcomes of LS following NCRT.

  2. Errors and complications in laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Liviu Drăghici

    2017-05-01

    Full Text Available Background. In laparoscopic surgery errors are unavoidable and require proper acknowledgment to reduce the risk of intraoperative and accurately assess the appropriate therapeutic approach. Fortunately, their frequency is low and cannot overshadow the benefits of laparoscopic surgery. Materials and Methods. We made an epidemiological investigation in General Surgery Department of Emergency Clinical Hospital "St. John" Bucharest, analyzing 20 years of experience in laparoscopic surgery, during 1994-2014. We wanted to identify evolution trends in complications of laparoscopic surgery, analyzing the dynamic of errors occurred in all patients with laparoscopic procedures. Results. We recorded 26847 laparoscopic interventions with a total of 427 intra-or postoperative complications that required 160 conversions and 267 reinterventions to resolve inconsistencies. The average frequency of occurrence of complications was 15.9‰ (15.9 of 1,000 cases. In the period under review it was a good momentum of laparoscopic procedures in our department. Number of minimally invasive interventions increased almost 10 times, from 266 cases operated laparoscopically in 1995 to 2638 cases in 2008. Annual growth of the number of laparoscopic procedures has surpassed the number of complications. Conclusions. Laborious work of laparoscopic surgery and a specialized centre with well-trained team of surgeons provide premises for a good performance even in the assimilation of new and difficult procedures.

  3. Comparative Study of Laparoscopic Abdominopelvic and Fallopian Tube Findings Before and After Antitubercular Therapy in Female Genital Tuberculosis With Infertility.

    Science.gov (United States)

    Sharma, Jai Bhagwan; Sneha, Jayaramaiah; Singh, Urvashi B; Kumar, Sunesh; Roy, Kallol Kumar; Singh, Neeta; Dharmendra, Sona; Vanamail, Perumal

    2016-02-01

    To study the effect of antitubercular treatment (ATT) on the laparoscopic abdominopelvic and fallopian tube findings in female genital tuberculosis (FGBT). Prospective cohort (Canadian Task Force classification II2). Tertiary referral center in northern India. Fifty women with infertility and diagnosed with FGTB on laparoscopy, histopathology findings, or endometrial sampling (acid-fast bacilli culture, granuloma on histopathology, positive polymerase chain reaction). Diagnostic laparoscopy in all women diagnosed with FGTB before and after a 6-month course of ATT (2 months of rifampicin, isoniazid, pyrazinamide, and ethambutol, followed by 4 months of rifampicin and isoniazid). All procedures were performed by the same surgeon between June 2012 and May 2014. The mean patient age was 28.7 years, mean parity was 0.9, and mean body mass index was 23.6 kg/m(2). Infertility was seen in all 50 women (66% primary infertility, 34% secondary infertility), with a mean duration of 6.06 years. Abnormal laparoscopic findings of FGTB included tubercles in the pelvic peritoneum, fallopian tube, and ovary in 27 women (54%) before ATT and in only 1 (2.04%) woman after ATT (p women (8%) before ATT, and in no women after ATT (p right side (56%), left side (50%), and both sides (38%) before ATT. Hydrosalpinx, beaded tubes, and nonvisualized tube were seen in 33.4%, 4.1%, and 20.8% cases, respectively, after ATT; however, free spill increased to 52% on the right side and 50% on left side after ATT. ATT improves laparoscopic findings in FGTB with infertility. However, advanced fibrotic lesions (eg, pelvic and perihepatic adhesions, bilateral blocked tubes) do not improve with ATT. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

  4. Laparoscopic radical nephroureterectomy: dilemma of the distal ureter.

    Science.gov (United States)

    Steinberg, Jordan R; Matin, Surena F

    2004-03-01

    Laparoscopic nephroureterectomy has recently emerged as a safe, minimally invasive approach to upper tract urothelial cancers. The most controversial and challenging feature of laparoscopic nephroureterectomy is the management of the distal ureter. We review the most common methods of managing the distal ureter, with emphasis on contemporary oncologic outcomes, indications, advantages, and disadvantages. There are currently in excess of five different approaches to the lower ureter. These techniques often combine features of endoscopic, laparoscopic, or open management. They include open excision, a transvesical laparoscopic detachment and ligation technique, laparoscopic stapling of the distal ureter and bladder cuff, the "pluck" technique, and ureteral intussusception. Each technique has distinct advantages and disadvantages, differing not only in technical approach, but oncological principles as well. While the existing published data do not overwhelmingly support one approach over the others, the open approach remains one of the most reliable and oncologically sound procedures. The principles of surgical oncology dictate that a complete, en-bloc resection, with avoidance of tumor seeding, remains the preferred treatment of all urothelial cancers. The classical open technique of securing the distal ureter and bladder cuff achieves this principle and has withstood the test of time. Transvesical laparoscopic detachment and ligation is an oncologically valid approach in patients without bladder tumors, but is limited by technical considerations. The laparoscopic stapling technique maintains a closed system but risks leaving behind ureteral and bladder cuff segments. Both transurethral resection of the ureteral orifice (pluck) and intussusception techniques should be approached with caution, as the potential for tumor seeding exists. Additional long-term comparative outcomes are needed to solve the dilemma of the distal ureter.

  5. Postoperative outcomes after open splenectomy versus laparoscopic splenectomy in cirrhotic patients: a meta-analysis.

    Science.gov (United States)

    Al-raimi, Khaled; Zheng, Shu-Sen

    2016-02-01

    Laparoscopic splenectomy is considered the gold standard for resecting normal-to-moderately bigger spleens in benign conditions, and in addition could be tried for patients with malignant splenic disorders. However, the safety of laparoscopic splenectomy in patients with hypersplenism is not well-known. This study aimed to investigate the efficacy and safety of laparoscopic splenectomy for patients with hypersplenism secondary to liver cirrhosis by comparing with the open splenectomy. Several databases were searched to identify comparative studies fulfilling the predefined selection criteria from January 2000 to June 2015. The subsequent key words were utilized for browsing "laparoscopy" or "laparoscopic", "open", "splenectomy", and "liver cirrhosis". Studies evaluating laparoscopic and open splenectomy for patients with liver cirrhosis were incorporated. Two evaluators personally strained the title and abstract of each publication. Citations with contemplated compliance within our eligibility criteria underwent compressed review. Meta-analysis was carried out according to the recommendations of the Cochrane Collaboration software (review manager 5.1). Seven studies containing 509 patients were included. Compared with the open splenectomy group, patients in the laparoscopic splenectomy group had significantly less intraoperative blood loss (MD=210.30; 95% CI: 11.28-409.32; P=0.04), longer operative time (MD=-31.58; 95% CI: -53.34--9.82; P=0.004), shorter duration of postoperative hospital stay (MD=3.41; 95% CI: 2.39-4.43; Psplenectomy.

  6. [Robot-assisted surgery - Progress or expensive toy? : Matched-pair comparative analysis of robot-assisted cholecystectomy vs. laparoscopic cholecystectomy].

    Science.gov (United States)

    Albrecht, R; Haase, D; Zippel, R; Koch, H; Settmacher, U

    2017-12-01

    By means of a matched-pair analysis comparing data obtained from laparoscopic cholecystectomy (LC) and robot-assisted laparoscopic cholecystectomy (RAC), the value of both methods as well as the advantages and disadvantages of both approaches were elucidated. The consideration was carried out by evaluation of postoperative surgical results, a cost analysis and a subjective survey of the patients using a questionnaire. Thus, from the 35 consecutive RAC, 35 (parallel) retrospectively matched pairs were established. Postoperative surgical results did not show any significant differences between LC and RAC. In the individual assessment by each patient, there were also no significant differences; however, there was a tendency towards the assessment of the RAC to be slightly worse. A striking difference was found with respect to the cost analysis at the time of surgery. The RAC operation alone is significantly more expensive compared to LC with respect to maintenance and acquisition costs. In addition, RAC can at present not be completely reimbursed under the current German diagnosis-related system. The postulated advantages of RAC comprise mainly the precise preparation within narrow confinements and the favorable ergonomic handling for the surgeon. The basic prerequisites are control of the costs and a reasonable reflection in the current reimbursement system.

  7. [Laparoscopic cholecystectomy in transplant patients].

    Science.gov (United States)

    Coelho, Júlio Cezar Uili; Contieri, Fabiana L C; de Freitas, Alexandre Coutinho Teixeira; da Silva, Fernanda Cristina; Kozak, Vanessa Nascimento; da Silva Junior, Alzemir Santos

    2010-02-01

    This study reviews our experience with laparoscopic cholecystectomy in the treatment of cholelithiasis in transplant patients. Demographic data, medications used, and operative and postoperative data of all transplant recipients who were subjected to laparoscopic cholecystectomy for cholelithiasis at our hospital were obtained. A total of 15 transplant patients (13 renal transplantation and 2 bone marrow transplantation) underwent laparoscopic cholecystectomy. All patients were admitted to the hospital on the day of the operation. The immunosuppressive regimen was not modified during hospitalization. Clinical presentation of cholelithiasis was biliary colicky (n=12), acute cholecystitis (n=2), and jaundice (n=1). The operation was uneventful in all patients. Postoperative complications were nausea and vomiting in 2 patients, prolonged tracheal intubation in 1, wound infection in 1 and large superficial hematoma in 1 patient. Laparoscopic cholecystectomy is associated to a low morbidity and mortality and good postoperative outcome in transplant patients with uncomplicated cholecystitis.

  8. Reoperation after laparoscopic colorectal surgery. Does the laparoscopic approach have any advantages?

    Science.gov (United States)

    Ibáñez, Noelia; Abrisqueta, Jesús; Luján, Juan; Sánchez, Pedro; Soriano, María Teresa; Arevalo-Pérez, Julio; Parrilla, Pascual

    2018-02-01

    The laparoscopic approach in colorectal complications is controversial because of its difficulty. However, it has been proven that it can provide advantages over open surgery. The aim of this study is to compare laparoscopic approach in reoperations for complications after colorectal surgery with the open approach taking into account the severity of the patient prior to reoperation. Patients who underwent laparoscopic colorectal surgery from January 2006 to December 2015 were retrospectively reviewed. Patients requiring urgent surgical procedures for complications in the postoperative period were divided in two groups: laparoscopic surgery (LS) and open surgery (OS). To control clinical severity prior to reoperation, The Mannheim Peritonitis Index (MPI) was calculated. A total of 763 patients were studied, 40 required urgent surgery (24 OS/16 LS). More ileostomies were performed in the LS group (68.7% vs. 29.2%) and more colostomies in the OS group (37.5% vs. 6.2%), pstart of oral tolerance and less surgical wound infection (pstart of oral tolerance and a lower abdominal wall complication rate in patients with low severity index. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Recent technological advancements in laparoscopic surgical instruments

    Science.gov (United States)

    Subido, Edwin D. C.; Pacis, Danica Mitch M.; Bugtai, Nilo T.

    2018-02-01

    Laparoscopy was a progressive step to advancing surgical procedures as it minimised the scars left on the body after surgery, compared to traditional open surgery. Many years later, single-incision laparoscopic surgery (SILS) was created where, instead of having multiple incisions, only one incision is made or multiple small incisions in one location. SILS, or laparoendoscopic single-site surgery (LESS), may produce lesser scars but drawbacks for the surgeons are still present. This paper aims to present related literature of the recent technological developments in laparoscopic tools and procedure particularly in the vision system, handheld instruments. Tech advances in LESS will also be shown. Furthermore, this review intends to give an update on what has been going on in the surgical robot market and state which companies are interested and are developing robotic systems for commercial use to challenge Intuitive Surgical's da Vinci Surgical System that currently dominates the market.

  10. Laparoscopic adrenalectomy: Single centre experience.

    LENUS (Irish Health Repository)

    O'Farrell, N J

    2012-02-01

    BACKGROUND: Laparoscopic adrenalectomy is an attractive alternative to the traditional open approach in the surgical excision of an adrenal gland. It has replaced open adrenalectomy in our institution and we review our experience to date. METHODS: All cases of laparoscopic adrenalectomies in our hospital over eight years (from 2001 to May 2009) were retrospectively reviewed. Patient demographics, diagnosis, length of hospital stay, histology and all operative and post-operative details were evaluated. RESULTS: Fifty-five laparoscopic adrenalectomies (LA) were performed on 51 patients over eight years. The mean age was 48 years (Range 16-86 years) with the male: female ratio 1:2. Twenty-three cases had a right adrenalectomy, 24 had a left adrenalectomy and the remaining four patients had bilateral adrenalectomies. 91% were successfully completed laparoscopically with five converted to an open approach. Adenomas (functional and non functional) were the leading indication for LA, followed by phaeochromocytomas. Other indications for LA included Cushing\\'s disease, adrenal malignancies and rarer pathologies. There was one mortality from necrotising pancreatitis following a left adrenalectomy for severe Cushing\\'s disease, with subsequent death 10 days later. CONCLUSION: Laparoscopic adrenalectomy is effective for the treatment of adrenal tumours, fulfilling the criteria for the ideal minimally invasive procedure. It has replaced the traditional open approach in our centre and is a safe and effective alternative. However, in the case of severe Cushing\\'s disease, laparoscopic adrenalectomy has the potential for significant adverse outcomes and mortality.

  11. A comparison of laparoscopic and open surgery following pre-operative chemoradiation therapy for locally advanced lower rectal cancer

    International Nuclear Information System (INIS)

    Kusano, Toru; Inomata, Masafumi; Hiratsuka, Takahiro

    2014-01-01

    Although pre-operative chemoradiation therapy for advanced lower rectal cancer is a controversial treatment modality, it is increasingly used in combination with surgery. Few studies have considered the combination of chemoradiation therapy followed by laparoscopic surgery for locally advanced lower rectal cancer; therefore, this study aimed to assess the usefulness of this therapeutic combination. We retrospectively reviewed the medical records of patients with locally advanced lower rectal cancer treated by pre-operative chemoradiation therapy and surgery from February 2002 to November 2012 at Oita University. We divided patients into an open surgery group and a laparoscopic surgery group and evaluated various parameters by univariate and multivariate analyses. In total, 33 patients were enrolled (open surgery group, n=14; laparoscopic surgery group, n=19). Univariate analysis revealed that compared with the open surgery group, operative time was significantly longer, whereas intra-operative blood loss and intra-operative blood transfusion requirements were significantly less in the laparoscopic surgery group. There were no significant differences in post-operative complication and recurrence rates between the two groups. According to multivariate analysis, operative time and intra-operative blood loss were significant predictors of outcome in the laparoscopic surgery group. This study suggests that laparoscopic surgery after chemoradiation therapy for locally advanced lower rectal cancer is a safe procedure. Further prospective investigation of the long-term oncological outcomes of laparoscopic surgery after chemoradiation therapy for locally advanced lower rectal cancer is required to confirm the advantages of laparoscopic surgery over open surgery. (author)

  12. Mini-laparoscopic versus laparoscopic approach to appendectomy

    Directory of Open Access Journals (Sweden)

    Kercher Kent W

    2001-10-01

    Full Text Available Abstract Background The purpose of this clinical study is to evaluate the feasibility of using 2-mm laparoscopic instruments to perform an appendectomy in patients with clinically suspected acute appendicitis and compare the outcome of this mini-laparoscopic or "needlescopic" approach to the conventional laparoscopic appendectomy. Methods Two groups of patients undergoing appendectomy over 24 months were studied. In the first group, needlescopic appendectomy was performed in 15 patients by surgeons specializing in advanced laparoscopy. These patients were compared with the second or control group that included 21 consecutive patients who underwent laparoscopic appendectomy. We compared the patients' demographic data, operative findings, complications, postoperative pain medicine requirements, length of hospital stay, and recovery variables. Differences were considered statistically significant at a p-value Results Patient demographics, history of previous abdominal surgery, and operative findings were similar in both groups. There was no conversion to open appendectomy in either group. No postoperative morbidity or mortality occurred in either group. The needlescopic group had a significantly shorter mean operative time (p = 0.02, reduced postoperative narcotics requirements (p = 0.05, shorter hospital stay (p = 0.04, and quicker return to work (p = 0.03 when compared with the laparoscopic group. Conclusions We conclude that the needlescopic technique is a safe and effective approach to appendectomy. When performed by experienced laparoscopic surgeons, the needlescopic technique results in significantly shorter postoperative convalescence and a prompt recovery.

  13. A comparative cost analysis of robotic-assisted surgery versus laparoscopic surgery and open surgery: the necessity of investing knowledgeably.

    Science.gov (United States)

    Tedesco, Giorgia; Faggiano, Francesco C; Leo, Erica; Derrico, Pietro; Ritrovato, Matteo

    2016-11-01

    Robotic surgery has been proposed as a minimally invasive surgical technique with advantages for both surgeons and patients, but is associated with high costs (installation, use and maintenance). The Health Technology Assessment Unit of the Bambino Gesù Children's Hospital sought to investigate the economic sustainability of robotic surgery, having foreseen its impact on the hospital budget METHODS: Break-even and cost-minimization analyses were performed. A deterministic approach for sensitivity analysis was applied by varying the values of parameters between pre-defined ranges in different scenarios to see how the outcomes might differ. The break-even analysis indicated that at least 349 annual interventions would need to be carried out to reach the break-even point. The cost-minimization analysis showed that robotic surgery was the most expensive procedure among the considered alternatives (in terms of the contribution margin). Robotic surgery is a good clinical alternative to laparoscopic and open surgery (for many pediatric operations). However, the costs of robotic procedures are higher than the equivalent laparoscopic and open surgical interventions. Therefore, in the short run, these findings do not seem to support the decision to introduce a robotic system in our hospital.

  14. [Laparoscopic resection of the sigmoid colon for the diverticular disease].

    Science.gov (United States)

    Vrbenský, L; Simša, J

    2013-07-01

    Laparoscopic resection of the sigmoid colon for diverticular disease is nowadays a fully accepted alternative to traditional open procedures. The aim of this work is to summarize the indications, advantages and risks of laparoscopic sigmoid resection for diverticular disease. Review of the literature and recent findings concerning the significance of laparoscopic resection for diverticulosis of the sigmoid colon. The article presents the indications, risks, techniques and perioperative care in patients after laparoscopic resection of the sigmoid colon for diverticular disease.

  15. Laparoscopic specimen retrieval bags.

    Science.gov (United States)

    Smorgick, Noam

    2014-10-01

    Specimen retrieval bags have long been used in laparoscopic gynecologic surgery for contained removal of adnexal cysts and masses. More recently, the concerns regarding spread of malignant cells during mechanical morcellation of myoma have led to an additional use of specimen retrieval bags for contained "in-bag" morcellation. This review will discuss the indications for use retrieval bags in gynecologic endoscopy, and describe the different specimen bags available to date.

  16. Comparative evaluation of the effects of propofol and sevoflurane on cognitive function and memory in patients undergoing laparoscopic cholecystectomy: A randomised prospective study

    Directory of Open Access Journals (Sweden)

    Upasana Goswami

    2015-01-01

    Full Text Available Background and Aims: General anaesthesia (GA may cause post-operative impairment of cognition and memory. This is of importance where time to discharge after anaesthesia is short as after laparoscopic cholecystectomy. This study was conducted to compare the effects of propofol and sevoflurane on cognitive function in the post-operative period. Methods: After approval of the Ethical Committee, 80 female patients posted for laparoscopic cholecystectomy to be performed under GA were randomly divided into two groups. Propofol was used in Group P and sevoflurane in Group S. Data analysis was done with California verbal learning test (CVLT, digit span test (DST, Rivermead behavioural memory test (RBMT, mini mental state examination (MMSE score, and semantic memory tests. Aldrete recovery scoring system and visual analogue scale for pain were assessed post-operatively. The level of statistical significance was set at P < 0.05. Results: There was no significant difference in demographic and haemodynamic data. Cognition and explicit memory were affected more in the propofol group in the immediate post-operative period. With majority of tests, such as semantic memory test, MMSE score, DST and RBMT, the difference was insignificant at 2 and 4 h post-operatively. But CVLT values were found to be statistically significant between groups even at 4 h. Conclusion: Propofol was associated with significant impact on cognitive functions in comparison to sevoflurane in the immediate post-operative period. Sevoflurane anaesthesia might be a better option in day care surgeries.

  17. Outcome of laparoscopic ovariectomy and laparoscopic-assisted ovariohysterectomy in dogs: 278 cases (2003-2013).

    Science.gov (United States)

    Corriveau, Kayla M; Giuffrida, Michelle A; Mayhew, Philipp D; Runge, Jeffrey J

    2017-08-15

    OBJECTIVE To compare outcomes for laparoscopic ovariectomy (LapOVE) and laparoscopic-assisted ovariohysterectomy (LapOVH) in dogs. DESIGN Retrospective case series. ANIMALS 278 female dogs. PROCEDURES Medical records of female dogs that underwent laparoscopic sterilization between 2003 and 2013 were reviewed. History, signalment, results of physical examination, results of preoperative diagnostic testing, details of the surgical procedure, durations of anesthesia and surgery, intraoperative and immediate postoperative (ie, during hospitalization) complications, and short- (≤ 14 days after surgery) and long-term (> 14 days after surgery) outcomes were recorded. Data for patients undergoing LapOVE versus LapOVH were compared. RESULTS Intraoperative and immediate postoperative complications were infrequent, and incidence did not differ between groups. Duration of surgery for LapOVE was significantly less than that for LapOVH; however, potential confounders were not assessed. Surgical site infection was identified in 3 of 224 (1.3%) dogs. At the time of long-term follow-up, postoperative urinary incontinence was reported in 7 of 125 (5.6%) dogs that underwent LapOVE and 12 of 82 (14.6%) dogs that underwent LapOVH. None of the dogs had reportedly developed estrus or pyometra by the time of final follow-up. Overall, 205 of 207 (99%) owners were satisfied with the surgery, and 196 of 207 (95%) would consider laparoscopic sterilization for their dogs in the future. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that short- and long-term outcomes were similar for female dogs undergoing sterilization by means of LapOVE or LapOVH; however, surgery time may have been shorter for dogs that underwent LapOVE. Most owners were satisfied with the outcome of laparoscopic sterilization.

  18. Cost-effectiveness of laparoscopic versus open distal pancreatectomy for pancreatic cancer.

    Science.gov (United States)

    Gurusamy, Kurinchi Selvan; Riviere, Deniece; van Laarhoven, C J H; Besselink, Marc; Abu-Hilal, Mohammed; Davidson, Brian R; Morris, Steve

    2017-01-01

    A recent Cochrane review compared laparoscopic versus open distal pancreatectomy for people with for cancers of the body and tail of the pancreas and found that laparoscopic distal pancreatectomy may reduce the length of hospital stay. We compared the cost-effectiveness of laparoscopic distal pancreatectomy versus open distal pancreatectomy for pancreatic cancer. Model based cost-utility analysis estimating mean costs and quality-adjusted life years (QALYs) per patient from the perspective of the UK National Health Service. A decision tree model was constructed using probabilities, outcomes and cost data from published sources. A time horizon of 5 years was used. One-way and probabilistic sensitivity analyses were undertaken. The probabilistic sensitivity analysis showed that the incremental net monetary benefit was positive (£3,708.58 (95% confidence intervals (CI) -£9,473.62 to £16,115.69) but the 95% CI includes zero, indicating that there is significant uncertainty about the cost-effectiveness of laparoscopic distal pancreatectomy versus open distal pancreatectomy. The probability laparoscopic distal pancreatectomy was cost-effective compared to open distal pancreatectomy for pancreatic cancer was between 70% and 80% at the willingness-to-pay thresholds generally used in England (£20,000 to £30,000 per QALY gained). Results were sensitive to the survival proportions and the operating time. There is considerable uncertainty about whether laparoscopic distal pancreatectomy is cost-effective compared to open distal pancreatectomy for pancreatic cancer in the NHS setting.

  19. A comparison of the costs of laparoscopic myomectomy and open myomectomy at a teaching hospital in southern Taiwan

    OpenAIRE

    Chi-Chang Chang

    2013-01-01

    Objective: To compare the costs of traditional open myomectomy (OM) with laparoscopic myomectomy (LM). Materials and Methods: A retrospective review was conducted of the medical records of 155 women who underwent traditional open myomectomy (OM) or laparoscopic myomectomy (LM) in a teaching hospital in Taiwan. Results: The total medical service expense and the patient out-of-pocket expense were significantly higher for women who received LM than for women who received OM. However, the o...

  20. Laparoscopic Colectomy Versus Open Colectomy for Treatment of Transverse Colon Cancer: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Wu, Qingbin; Wei, Mingtian; Ye, Zengpanpan; Bi, Liang; Zheng, Erliang; Hu, Tao; Gu, Chaoyang; Wang, Ziqiang

    2017-10-01

    The surgical management of transverse colon cancer (TCC) is still not standardized. The aim of this meta-analysis was to evaluate the effect of laparoscopic colectomy (LC) for treatment of TCC in terms of short-term and long-term outcomes compared with open colectomy. A systematic literature search with no limits was performed in PubMed and Embase. The last search was performed on September 15, 2016. The short-term outcomes included intraoperative outcomes, postoperative outcomes, and oncological surgical quality. The long-term outcomes included overall survival (OS) and disease-free survival (DFS). Thirteen articles and one conference abstract published between 2010 and 2016 with a total of 1728 patients were enrolled in this meta-analysis. LC was associated with significant less estimated blood loss, fewer total postoperative complications, and shorter time to first flatus, time to liquid diet, length of hospital stay, and length of postoperative hospital stay. However, longer operative time was needed in LC. There was no statistically significant difference between the groups concerning the intraoperative complications, mortality, ileus, anastomotic leakage, bleeding, wound infection, abdominal infection, lymph nodes harvested, proximal resection margin, distal resection margin, OS, or DFS. Our meta-analysis suggests that LC is a safe and feasible technique for TCC associated with less estimated blood loss, fewer total postoperative complications, quicker recovery of intestinal function, shorter length of hospital stay, and equivalent long-term outcomes. Furthermore, a large-scaled, prospective randomized controlled study is warranted to verify those results.

  1. Laparoscopic cholecystectomy perioperative management: an update

    Directory of Open Access Journals (Sweden)

    Sellbrant I

    2015-07-01

    Full Text Available Irene Sellbrant,1 Gustaf Ledin,2 Jan G Jakobsson2 1Department of Anaesthesia, Capio Lundby, Gothenburg, 2Department of Anaesthesia and Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden Abstract: Laparoscopic cholecystectomy is one of the most common general surgical procedures. The aim of the present paper is to review current evidence and well-established practice for elective laparoscopic perioperative management. There is no firm evidence for best anesthetic technique, further high quality studies assessing short as well as more protracted outcomes are needed. Preventive multi-modal analgesia, combining non-opioid analgesics, paracetamol, nonsteroidal anti-inflammatory drugs or coxib, and local anesthesia, has a long history. Local anesthesia improves postoperative pain and facilitates discharge on the day of surgery. Whether transversus abdominis plane-block has clinically important advantages compared to local infiltration analgesia needs further studies. Single intravenous dose steroid, dexamethasone, reduces postoperative nausea and vomiting, pain, and enhances the recovery process. Multi-modal analgesia is reassuringly safe thus having a positive benefit versus risk profile. Adherence to modern guidelines avoiding prolonged fasting and liberal intravenous fluid regime supports rapid recovery. The effects of CO2 insufflation must be acknowledged and low intra-abdominal pressure should be sought in order to reduce negative cardiovascular/respiratory effects. There is no firm evidence supporting heating and humidification of the insufflated gas. The potential risk for CO2/gas entrainment into vasaculture, gas emboli, or subcutaneous/intra-thoracic into the pleural space must be kept in mind. Laparoscopic cholecystectomy in ASA 1-2 patients following a multi-modal enhanced recovery protocol promotes high success rate for discharge on the day of surgery. Keywords: laparoscopic

  2. Building operative care capacity in a resource limited setting: The Mongolian model of the expansion of sustainable laparoscopic cholecystectomy.

    Science.gov (United States)

    Wells, Katie M; Lee, Yu-Jin; Erdene, Sandag; Erdene, Sarnai; Sanchin, Urjin; Sergelen, Orgoi; Zhang, Chong; Rodriguez, Brandon P; deVries, Catherine R; Price, Raymond R

    2016-08-01

    The benefits of laparoscopic cholecystectomy, including rapid recovery and fewer infections, have been largely unavailable to the majority of people in developing countries. Compared to other countries, Mongolia has an extremely high incidence of gallbladder disease. In 2005, only 2% of cholecystectomies were performed laparoscopically. This is a retrospective review of the transition from open to laparoscopic cholecystectomy throughout Mongolia. A cross-sectional, retrospective review was conducted of demographic patient data, diagnosis type, and operation performed (laparoscopic versus open cholecystectomy) from 2005-2013. Trends were analyzed from 6 of the 21 provinces (aimags) throughout Mongolia, and data were culled from 7 regional diagnostic referral and treatment centers and 2 tertiary academic medical centers. The data were analyzed by individual training center and by year before being compared between rural and urban centers. We analyzed and compared 14,522 cholecystectomies (n = 4,086 [28%] men, n = 10,436 [72%] women). Men and women were similar in age (men 52.2, standard deviation 14.8; women 49.4, standard deviation 15.7) and in the percentage undergoing laparoscopic cholecystectomy (men 39%, women 42%). By 2013, 58% of gallbladders were removed laparoscopically countrywide compared with only 2% in 2005. In 2011, laparoscopic cholecystectomy surpassed open cholecystectomy as the primary method for gallbladder removal countrywide. More than 315 Mongolian health care practitioners received laparoscopic training in 19 of the country's 21 aimags (states). By 2013, 58% of cholecystectomies countrywide were performed laparoscopically, a dramatic increase over 9 years. The expansion of laparoscopic cholecystectomy has transformed the care of biliary tract disease in Mongolia despite the country's limited resources. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. A randomized controlled trial to compare fentanyl-propofol and ketamine-propofol combination for procedural sedation and analgesia in laparoscopic tubal ligation

    Directory of Open Access Journals (Sweden)

    Ranju Singh

    2013-01-01

    Full Text Available Background: Procedural sedation and analgesia is widely being used for female laparoscopic sterilization using combinations of different drugs at varying doses. This study compared the combination of fentanyl and propofol, and ketamine and propofol in patients undergoing outpatient laparoscopic tubal ligation, with respect to their hemodynamic effects, postoperative recovery characteristics, duration of hospital stay, adverse effects, and patient comfort and acceptability. Settings and Design: Randomized, double blind. Methods: Patients were assigned to receive premixed injection of either fentanyl 1.5 μg/kg + propofol 2 mg/kg (Group PF, n0=50 or ketamine 0.5 mg/kg + propofol 2 mg/kg (Group PK, n=50. Hemodynamic data, peripheral oxygen saturation, and respiratory rate were recorded perioperatively. Recovery time, time to discharge, and comfort score were noted. Statistical Analysis: Chi-square (χ2 test was used for categorical data. Student′s t-test was used for quantitative variables for comparison between the two groups. For intragroup comparison, paired t-test was used. SPSS 14.0 was used for analysis. Results: Although the heart rate was comparable, blood pressures were consistently higher in group PK. Postoperative nausea and vomiting and delay in voiding were more frequent in group PK ( P<0.05. The time to reach Aldrete score ≥8 was significantly longer in group PK (11.14±3.29 min in group PF vs. 17.3±6.32 min in group PK, P<0.01. The time to discharge was significantly longer in group PK (105.8±13.07 min in group PF vs.138.18±13.20 min in group PK, P<0.01. Patient comfort and acceptability was better in group PF, P<0.01. Conclusion: As compared to ketamine-propofol, fentanyl-propofol combination is associated with faster recovery, earlier discharge, and better patient acceptability.

  4. Laparoscopic subtotal hysterectomy in the era of minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Chia-Jen Wu

    2015-02-01

    Full Text Available According to a nation-wide population-based study in Taiwan, along with the expanding concepts and surgical techniques of minimally invasive surgery, laparoscopic supracervical/subtotal hysterectomy (LSH has been blooming. Despite this, the role of LSH in the era of minimally invasive surgery remains uncertain. In this review, we tried to evaluate the perioperative and postoperative outcomes of LSH compared to other types of hysterectomy, including total abdominal hysterectomy (TAH, vaginal hysterectomy, laparoscopic-assisted vaginal hysterectomy, and total laparoscopic hysterectomy (TLH. From the literature, LSH has a better perioperative outcome than TAH, and comparable perioperative complications compared with laparoscopic-assisted vaginal hysterectomy. LSH had less bladder injury, vaginal cuff bleeding, hematoma, infection, and dehiscence requiring re-operation compared with TLH. Despite this, LSH has more postoperative cyclic menstrual bleeding and re-operations with extirpations of the cervical stump. LSH does, however, have a shorter recovery time than TAH due to the minimally invasive approach; and there is quicker resumption of coitus than TLH, due to cervical preservation and the avoidance of vaginal cuff dehiscence. LSH is therefore an alternative option when the removal of the cervix is not strictly necessary or desired. Nevertheless, the risk of further cervical malignancy, postoperative cyclic menstrual bleeding, and re-operations with extirpations of the cervical stump is a concern when discussing the advantages and disadvantages of LSH with patients.

  5. A comparative study on trans-umbilical single-port laparoscopic approach versus conventional repair for incarcerated inguinal hernia in children

    Directory of Open Access Journals (Sweden)

    Zhang Jun

    2016-01-01

    Full Text Available Purpose: The purpose of this study is to determine whether singleport laparoscopic repair (SLR for incarcerated inguinal hernia in children is superior toconventional repair (CR approaches. Method: Between March 2013 and September 2013, 126 infants and children treatedwere retrospectively reviewed. All the patients were divided into three groups. Group A (48 patients underwent trans-umbilical SLR, group B (36 patients was subjected to trans-umbilical conventional two-port laparoscopic repair (TLR while the conventional open surgery repair (COR was performed in group C (42 patients. Data regarding the operating time, bleeding volume, post-operative hydrocele formation, testicular atrophy, cosmetic results, recurrence rate, and duration of hospital stay of the patients were collected. Result: All the cases were completed successfully without conversion. The mean operative time for group A was 15 ± 3.9 min and 24 ± 7.2 min for unilateral hernia and bilateral hernia respectively, whereas for group B, it was 13 ± 6.7 min and 23 ± 9.2 min. The mean duration of surgery in group C was 35 ± 5.2 min for unilateral hernia. The recurrence rate was 0% in all the three groups. There were statistically significant differences in theoperating time, bleeding volume, post-operative hydrocele formation, cosmetic results and duration hospital stay between the three groups (P < 0.001. No statistically significant differences between SLR and TLR were observed except the more cosmetic result in SLR. Conclusion: SLR is safe and effective, minimally invasive, and is a new technology worth promoting.

  6. A comparative study on trans-umbilical single-port laparoscopic approach versus conventional repair for incarcerated inguinal hernia in children.

    Science.gov (United States)

    Jun, Zhang; Juntao, Ge; Shuli, Liu; Li, Long

    2016-01-01

    The purpose of this study is to determine whether singleport laparoscopic repair (SLR) for incarcerated inguinal hernia in children is superior toconventional repair (CR) approaches. Between March 2013 and September 2013, 126 infants and children treatedwere retrospectively reviewed. All the patients were divided into three groups. Group A (48 patients) underwent trans-umbilical SLR, group B (36 patients) was subjected to trans-umbilical conventional two-port laparoscopic repair (TLR) while the conventional open surgery repair (COR) was performed in group C (42 patients). Data regarding the operating time, bleeding volume, post-operative hydrocele formation, testicular atrophy, cosmetic results, recurrence rate, and duration of hospital stay of the patients were collected. All the cases were completed successfully without conversion. The mean operative time for group A was 15 ± 3.9 min and 24 ± 7.2 min for unilateral hernia and bilateral hernia respectively, whereas for group B, it was 13 ± 6.7 min and 23 ± 9.2 min. The mean duration of surgery in group C was 35 ± 5.2 min for unilateral hernia. The recurrence rate was 0% in all the three groups. There were statistically significant differences in theoperating time, bleeding volume, post-operative hydrocele formation, cosmetic results and duration hospital stay between the three groups (P < 0.001). No statistically significant differences between SLR and TLR were observed except the more cosmetic result in SLR. SLR is safe and effective, minimally invasive, and is a new technology worth promoting.

  7. Laparoscopic tubal sterilization reversal and fertility outcomes

    Directory of Open Access Journals (Sweden)

    K Jayakrishnan

    2011-01-01

    Full Text Available Purpose: The purpose of the study was two-fold. Firstly it was to assess the suitability for tubal recanalization and factors predicting successful laparoscopic recanalization. Secondly, it was to analyze the fertility outcomes and factors affecting the pregnancy rate following laparoscopic tubal recanalization. Materials and Methods: A retrospective chart review of prospectively followed-up 29 women at a tertiary care center seeking tubal sterilization reversal between May 2005 and February 2010 were included. Results: In 14 (48.3% women unilateral tubes were suitable and in only 3 women (10.3% bilateral tubes were suitable. All cases with laparoscopic tubal sterilization were suitable, whereas all cases with fimbriectomy were unsuitable for recanalization. In 6 (20.7% cases salphingostomy was performed as an alternative procedure to tubal reanastomosis. The overall pregnancy rate was 58.8%. In cases with sterilization by Pomeroy′s method, 4 out of 10 (40% conceived, whereas for laparoscopic tubal ligation cases 6 out of 7 (85.7% conceived (P=0.32. None of the patients with final tubal length <5 cm conceived (P=0.03. Comparing the age at recanalization, in women ≤30 years, 71.4% conceived, as compared with 50% when age of women was more than 30 years (P=0.37. Conclusions: The important factors determining the success of recanalization are technique of sterilization and the remaining length of the tube after recanalization. The gynecologist must use an effective technique of sterilization to minimize the failure rates, but at the same time, which causes minimal trauma, and aim at preserving the length of the tube so that reversal is more likely to be successful, should the patient′s circumstances change.

  8. Current biodiesel production technologies: A comparative review

    International Nuclear Information System (INIS)

    Abbaszaadeh, Ahmad; Ghobadian, Barat; Omidkhah, Mohammad Reza; Najafi, Gholamhassan

    2012-01-01

    Highlights: ► In this paper we review the technologies related to biodiesel production. ► 4 Primary approaches reviewed are direct use and blending of oils, micro-emulsions, pyrolysis and transesterification method. ► Both advantages and disadvantages of the different biodiesel production methods are also discussed. ► The most common technology of biodiesel production is transesterification of oils. ► Selection of a transesterification method depends on the amount of FFA and water content of the feedstock. - Abstract: Despite the high energy demand in the industrialized world and the pollution problems caused by widespread use of fossil fuels, the need for developing renewable energy sources with less environmental impacts are increasing. Biodiesel production is undergoing rapid and extensive technological reforms in industries and academia. The major obstacle in production and biodiesel commercialization path is production cost. Thus, in previous years numerous studies on the use of technologies and different methods to evaluate optimal conditions of biodiesel production technically and economically have been carried out. In this paper, a comparative review of the current technological methods so far used to produce biodiesel has been investigated. Four primary approaches to make biodiesel are direct use and blending of vegetable oils, micro-emulsions, thermal cracking (pyrolysis) and transesterification. Transesterification reaction, the most common method in the production of biodiesel, is emphasized in this review. The two types of transestrification process; catalytic and non-catalytic are discussed at length in the paper. Both advantages and disadvantages of the different biodiesel production methods are also discussed.

  9. Clinical and economic evaluation of laparoscopic surgery compared with medical management for gastro-oesophageal reflux disease: 5-year follow-up of multicentre randomised trial (the REFLUX trial).

    Science.gov (United States)

    Grant, A M; Boachie, C; Cotton, S C; Faria, R; Bojke, L; Epstein, D M; Ramsay, C R; Corbacho, B; Sculpher, M; Krukowski, Z H; Heading, R C; Campbell, M K

    2013-06-01

    Despite promising evidence that laparoscopic fundoplication provides better short-term relief of gastro-oesophageal reflux disease (GORD) than continued medical management, uncertainty remains about whether benefits are sustained and outweigh risks. To evaluate the long-term clinical effectiveness, cost-effectiveness and safety of laparoscopic surgery among people with GORD requiring long-term medication and suitable for both surgical and medical management. Five-year follow-up of a randomised trial (with parallel non-randomised preference groups) comparing a laparoscopic surgery-based policy with a continued medical management policy. Cost-effectiveness was assessed alongside the trial using a NHS perspective for costs and expressing health outcomes in terms of quality-adjusted life-years (QALYs). Follow-up was by annual postal questionnaire and selective hospital case notes review; initial recruitment in 21 UK hospitals. Questionnaire responders among the 810 original participants. At entry, all had documented evidence of GORD and symptoms for > 12 months. Questionnaire response rates (years 1-5) were from 89.5% to 68.9%. Three hundred and fifty-seven participants were recruited to the randomised comparison (178 randomised to surgical management and 179 randomised to continued medical management) and 453 to the preference groups (261 surgical management and 192 medical management). The surgeon chose the type of fundoplication. Primary: disease-specific outcome measure (the REFLUX questionnaire); secondary: Short Form questionnaire-36 items (SF-36), European Quality of Life-5 Dimensions (EQ-5D), NHS resource use, reflux medication, complications. The randomised groups were well balanced. By 5 years, 63% in the randomised surgical group and 13% in the randomised medical management group had received a total or partial wrap fundoplication (85% and 3% in the preference groups), with few perioperative complications and no associated deaths. At 1 year (and 5 years

  10. Laparoscopic surgery in the treatment of incarcerated indirect inguinal hernia in children.

    Science.gov (United States)

    Yin, Yiyu; Zhang, Hongwei; Zhang, Xiang; Sun, Fang; Zou, Huaxin; Cao, Hui; Wen, Cheng

    2016-12-01

    We aimed to explore the feasibility and the safety of the laparoscopic surgery for incarcerated indirect inguinal hernia (IIH) in children. From January 2012 to December 2014, 64 children were enrolled into this study. All 64 patients received laparoscopic surgery and we reviewed their perioperative and postoperative follow-up studies. In addition, we enrolled 60 cases of children who received traditional surgery of IIH administered through minimally invasive surgery as the control group. Results from the present study showed that the mean operation time for the laparoscopic group was 41.5 min (range, 15-80 min) which was significantly shorter than the control group. Nine cases developed incarcerated intestine necrosis, expanded umbilical incision and parallel resection anastomosis. They received laparoscopic hernia sac high ligation. Only 5 cases developed scrotum edema after the surgery. The postoperative length of the stay ranged from 2 to 7 days (average, 3.2). The postoperative follow-up was from 6 months to 1 year and no relapse or secondary testicular atrophy was observed in the laparoscopic group. The operation time, incidence of postoperative complications and length of stay in the laparoscopic group were decreased compared to the control group, and differences were statistically significant (Pincarcerated inguinal hernia is safe and feasible and produced better results compared with the alternative.

  11. Laparoscopic versus open surgery for rectal cancer (COLOR II)

    DEFF Research Database (Denmark)

    van der Pas, Martijn Hgm; Haglind, Eva; Cuesta, Miguel A

    2013-01-01

    Laparoscopic surgery as an alternative to open surgery in patients with rectal cancer has not yet been shown to be oncologically safe. The aim in the COlorectal cancer Laparoscopic or Open Resection (COLOR II) trial was to compare laparoscopic and open surgery in patients with rectal cancer....

  12. Off-site training of laparoscopic skills, a scoping review using a thematic analysis

    DEFF Research Database (Denmark)

    Thinggaard, Ebbe; Kleif, Jakob; Bjerrum, Flemming

    2016-01-01

    in MEDLINE, EMBASE, ERIC, Scopus, and PsychINFO, following a scoping review methodology. The included literature was analyzed iteratively using a thematic analysis approach. The study was reported in accordance with the STructured apprOach to the Reporting In healthcare education of Evidence Synthesis...

  13. Cognitive Architectures and Autonomy: A Comparative Review

    Science.gov (United States)

    Thórisson, Kristinn; Helgasson, Helgi

    2012-05-01

    One of the original goals of artificial intelligence (AI) research was to create machines with very general cognitive capabilities and a relatively high level of autonomy. It has taken the field longer than many had expected to achieve even a fraction of this goal; the community has focused on building specific, targeted cognitive processes in isolation, and as of yet no system exists that integrates a broad range of capabilities or presents a general solution to autonomous acquisition of a large set of skills. Among the reasons for this are the highly limited machine learning and adaptation techniques available, and the inherent complexity of integrating numerous cognitive and learning capabilities in a coherent architecture. In this paper we review selected systems and architectures built expressly to address integrated skills. We highlight principles and features of these systems that seem promising for creating generally intelligent systems with some level of autonomy, and discuss them in the context of the development of future cognitive architectures. Autonomy is a key property for any system to be considered generally intelligent, in our view; we use this concept as an organizing principle for comparing the reviewed systems. Features that remain largely unaddressed in present research, but seem nevertheless necessary for such efforts to succeed, are also discussed.

  14. [Assessment of nociceptive suppression in laparoscopic postoperative status: prospective, randomized and comparative study with a control group].

    Science.gov (United States)

    Jaime, A; Hernández-Favela, P; Zamora, R; Nava, E; Barroso, G; Kably, A

    2001-08-01

    In recent years endoscopic surgery has became a highly demanded procedure because it is an easy method for diagnosis and treatment in gynecological field. Post-operative pain is considered as a condition in the morbidity status. The objective of this study was to evaluate the nociceptive suppression in laparoscopic surgery. A prospective randomized trial was performed in order to evaluate this condition. A total of 45 patients were included. Three groups were randomized using two different anesthetics applied in the cult-de-sac and uterine-bladder union. Group A (n-15) received bupivacaine, group B (n = 15) ropivacaine and group C (control) saline solution was instilled. The pain was scored using the visual analog scale as same as blood pressure and heart rate in a 15 minute intervals in the recovery room. For study design there were no differences in age, weight, height and body mass index (EMI). The surgical and anesthetic times were similar among groups. However there were significant differences when pain was evaluated. For a less toxic effects and good preventive analgesia we recommend to use ropivacaine in the postoperative status.

  15. Laparoscopic donor nephrectomy

    Directory of Open Access Journals (Sweden)

    Gupta Nitin

    2005-01-01

    Full Text Available Of the various options for patients with end stage renal disease, kidney transplantation is the treatment of choice for a suitable patient. The kidney for transplantation is retrieved from either a cadaver or a live donor. Living donor nephrectomy has been developed as a method to address the shortfall in cadaveric kidneys available for transplantation. Laparoscopic living donor nephrectomy (LLDN, by reducing postoperative pain, shortening convalescence, and improving the cosmetic outcome of the donor nephrectomy, has shown the potential to increase the number of living kidney donations further by removing some of the disincentives inherent to donation itself. The technique of LLDN has undergone evolution at different transplant centers and many modifications have been done to improve donor safety and recipient outcome. Virtually all donors eligible for an open surgical procedure may also undergo the laparoscopic operation. Various earlier contraindications to LDN, such as right donor kidney, multiple vessels, anomalous vasculature and obesity have been overcome with increasing experience. Laparoscopic live donor nephrectomy can be done transperitoneally or retroperitoneally on either side. The approach is most commonly transperitoneal, which allows adequate working space and easy dissection. A review of literature and our experience with regards to standard approach and the modifications is presented including a cost saving model for the developing countries. An assessment has been made, of the impact of LDN on the outcome of donor and the recipient.

  16. Laparoscopic versus open resection for sigmoid diverticulitis.

    Science.gov (United States)

    Abraha, Iosief; Binda, Gian A; Montedori, Alessandro; Arezzo, Alberto; Cirocchi, Roberto

    2017-11-25

    Diverticular disease is a common condition in Western industrialised countries. Most individuals remain asymptomatic throughout life; however, 25% experience acute diverticulitis. The standard treatment for acute diverticulitis is open surgery. Laparoscopic surgery - a minimal-access procedure - offers an alternative approach to open surgery, as it is characterised by reduced operative stress that may translate into shorter hospitalisation and more rapid recovery, as well as improved quality of life. To evaluate the effectiveness of laparoscopic surgical resection compared with open surgical resection for individuals with acute sigmoid diverticulitis. We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 2) in the Cochrane Library; Ovid MEDLINE (1946 to 23 February 2017); Ovid Embase (1974 to 23 February 2017); clinicaltrials.gov (February 2017); and the World Health Organization (WHO) International Clinical Trials Registry (February 2017). We reviewed the bibliographies of identified trials to search for additional studies. We included randomised controlled trials comparing elective or emergency laparoscopic sigmoid resection versus open surgical resection for acute sigmoid diverticulitis. Two review authors independently selected studies, assessed the domains of risk of bias from each included trial, and extracted data. For dichotomous outcomes, we calculated risk ratios (RRs) with 95% confidence intervals (CIs). For continuous outcomes, we planned to calculate mean differences (MDs) with 95% CIs for outcomes such as hospital stay, and standardised mean differences (SMDs) with 95% CIs for quality of life and global rating scales, if researchers used different scales. Three trials with 392 participants met the inclusion criteria. Studies were conducted in three European countries (Switzerland, Netherlands, and Germany). The median age of participants ranged from 62 to 66 years; 53% to 64% were

  17. Laparoscopic versus open appendectomy in children with ...

    African Journals Online (AJOL)

    Introduction: Acute appendicitis represents one of the most common causes of urgent surgical interventions in pediatric age group. With the advances in minimal invasive surgery laparoscopic appendectomy (LA) has been introduced as a suitable line of treatment. We compare between laparoscopic and conventional open ...

  18. Laparoscopic Heller Myotomy Versus Peroral Endoscopic Myotomy (POEM) for Achalasia: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Schlottmann, Francisco; Luckett, Daniel J; Fine, Jason; Shaheen, Nicholas J; Patti, Marco G

    2018-03-01

    To compare the outcome of per oral endoscopic myotomy (POEM) and laparoscopic Heller myotomy (LHM) for the treatment of esophageal achalasia. Over the last 2 decades, LHM has become the primary form of treatment in many centers. However, since the first description of POEM in 2010, this technique has widely disseminated, despite the absence of long-term results and randomized trials. A systematic Medline literature search of articles on LHM and POEM for the treatment of achalasia was performed. The main outcomes measured were improvement of dysphagia and posttreatment gastroesophageal reflux disease (GERD). Linear regression was used to model the effect of each procedure on the different outcomes. Fifty-three studies reported data on LHM (5834 patients), and 21 articles examined POEM (1958 patients). Mean follow-up was significantly longer for studies of LHM (41.5 vs. 16.2 mo, P < 0.0001). Predicted probabilities for improvement in dysphagia at 12 months were 93.5% for POEM and 91.0% for LHM (P = 0.01), and at 24 months were 92.7% for POEM and 90.0% for LHM (P = 0.01). Patients undergoing POEM were more likely to develop GERD symptoms (OR 1.69, 95% CI 1.33-2.14, P < 0.0001), GERD evidenced by erosive esophagitis (OR 9.31, 95% CI 4.71-18.85, P < 0.0001), and GERD evidenced by pH monitoring (OR 4.30, 95% CI 2.96-6.27, P < 0.0001). On average, length of hospital stay was 1.03 days longer after POEM (P = 0.04). Short-term results show that POEM is more effective than LHM in relieving dysphagia, but it is associated with a very high incidence of pathologic reflux.

  19. Laparoscopic reoperation with total fundoplication for failed Heller myotomy: is it a possible option? Personal experience and review of literature.

    Science.gov (United States)

    Rossetti, Gianluca; del Genio, Gianmattia; Maffettone, Vincenzo; Fei, Landino; Brusciano, Luigi; Limongelli, Paolo; Pizza, Francesco; Tolone, Salvatore; Di Martino, Maria; del Genio, Federica; del Genio, Alberto

    2009-01-01

    Laparoscopic Heller myotomy with antireflux procedure seems the procedure of choice in the treatment of patients with esophageal achalasia. Persistent or recurrent symptoms occur in 10% to 20% of patients. Few reports on reoperation after failed Heller myotomy have been published. No author has reported the realization of a total fundoplication in these patient groups. The aim of this study is to evaluate the efficacy of laparoscopic reoperation with the realization of a total fundoplication after failed Heller myotomy for esophageal achalasia. From 1992 to December 2007, 5 out of a series of 242 patients (2.1%), along with 2 patients operated elsewhere, underwent laparoscopic reintervention for failed Heller myotomy. Symptoms leading to reoperation included persistent dysphagia in 3 patients, recurrent dysphagia in another 3, and heartburn in 1 patient. Mean time from the first to the second operation was 49.7 months (range, 4-180 months). Always, the intervention was completed via a laparoscopic approach and a Nissen-Rossetti fundoplication was realized or left in place after a complete Heller myotomy. Mean operative time was 160 minutes (range, 60-245 minutes). Mean postoperative hospital stay was 3.1 +/- 1.5 days. No major morbidity or mortality occurred. At a mean follow-up of 16.1 months, reoperation must be considered successful in 5 out of 7 patients (71.4%). The dysphagia DeMeester score fell from 2.71 +/- 0.22 to 0.91 +/- 0.38 postoperatively. The regurgitation score changed from 2.45 +/- 0.34 to 0.68 +/- 0.23. Laparoscopic reoperation for failed Heller myotomy with the realization of a total fundoplication is safe and is associated with good long-term results if performed by an experienced surgeon in a center with a long tradition of esophageal surgery.

  20. Laparoscopic Choledochoduodenostomy.

    Science.gov (United States)

    Cuendis-Velázquez, Adolfo; E Trejo-Ávila, Mario; Rosales-Castañeda, Enrique; Cárdenas-Lailson, Eduardo; E Rojano-Rodríguez, Martin; Romero-Loera, Sujey; A Sanjuan-Martínez, Carlos; Moreno-Portillo, Mucio

    Today's options for biliary bypass procedures, for difficult choledocholithiasis, range from open surgery to laparo-endoscopic hybrid procedures. The aim of this study was to analyze the outcomes of patients with difficult choledocholithiasis treated with laparoscopic choledochoduodenostomy. We performed a prospective observational study from March 2011 to June 2016. We included patients with difficult common bile duct stones (recurrent or unresolved by ERCP) in which a biliary bypass procedure was required. We performed a laparoscopic bile duct exploration with choledochoduodenostomy and intraoperative cholangioscopy. A total of 19 patients were included. We found female predominance (78.9%), advanced mean age (72.4±12 years) and multiple comorbidities. Most patients with previous episodes of choledocholitiasis or cholangitis, mode 1 (min-max: 1-7). Mean common bile duct diameter 24.9±7mm. Mean operative time 218.5±74min, estimated blood loss 150 (30-600)mL, resume of oral intake 3.2±1 days, postoperative length of stay 4.9±2 days. We found a median of 18 (12-32) months of follow-up. All patients with normalization of liver enzymes during follow-up. One patient presented with sump syndrome and one patient died due to nosocomial pneumonia. Laparoscopic choledochoduodenostomy with intraoperative cholangioscopy seems to be safe and effective treatment for patients with difficult common bile duct stones no resolved by endoscopic procedures. This procedure is a good option for patients with advanced age and multiple comorbidities. We offer all the advantages of minimally invasive surgery to these patients. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Energy sources for gynecologic laparoscopic surgery: a review of the literature.

    Science.gov (United States)

    Law, Kenneth S K; Abbott, Jason A; Lyons, Stephen D

    2014-12-01

    A range of energy sources are used in gynecologic laparoscopy. These energy sources include monopolar electrosurgery, bipolar electrosurgery (including "advanced bipolar" devices that incorporate tissue feedback monitoring), and various types of laser and ultrasonic technologies. Gynecologists using these tools should be aware of the potential benefits and potential dangers of these instruments. This review provides an overview of the biophysics of these energy sources, their tissue effects, and the complications that may arise. It aims to highlight any potential advantages or disadvantages of various energy sources, as reported by clinical and laboratory studies. Literature relating to energy sources used in gynecologic laparoscopy was reviewed. While laboratory-based studies have reported differences between various energy sources, these differences may not be clinically significant. The choice of instrumentation may depend on the nature of the surgical task being performed, but other factors, such as the surgeon's training/experience, cost, and industry marketing, may also influence the decision. TAn awareness of the pros and cons of each energy modality and their relative efficacy profiles is paramount. It is important that surgeons have an understanding of the biophysics of these technologies in order to understand their limitations and potential dangers and to utilize the most appropriate energy source(s) in the appropriate clinical setting, in order to both minimize the risk of inadvertent injuries during gynecologic laparoscopy and to maximize cost-efficient delivery of health care.

  2. Review of various liver retraction techniques in single incision laparoscopic surgery for the exposure of hiatus.

    Science.gov (United States)

    Palanivelu, Praveenraj; Patil, Kedar Pratap; Parthasarathi, Ramakrishnan; Viswambharan, Jaiganesh K; Senthilnathan, Palanisami; Palanivelu, Chinnusamy

    2015-01-01

    The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery. Not doing so would compromise the view of the hiatus, hence theoretically reducing the quality of the surgery and increasing the possibility of complications. The aim of this study was to review the various liver retraction techniques in single incision surgery being done at our institute and analyze them. A retrospective study of the various techniques and a subsequent analysis was made based on advantages and disadvantages of each method. Objectively a quantitative measure of hiatal exposure was done using a scoring system based on the grade of exposure after reviewing the surgical videos. From January 2011 to January 2013 total 104 patients underwent single incision surgery with the various liver retraction techniques with following grades of exposure -liver suspension tube technique with naso gastric tubing (2.11) and with corrugated drain (2.09) needlescopic method (1.2), Umbilical tape sling (1.95), crural stitch method (2.5). Needeloscopic method has the best grade of exposure and is the easiest to start with. The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality. The mentioned liver retraction techniques are cost effective and easy to learn. We recommend using these techniques to have a good exposure of hiatus, without compromising the safety of surgery in single incision surgery.

  3. [Laparoscopic vs opened appendicovesicostomy in pediatric patients].

    Science.gov (United States)

    Landa-Juárez, Sergio; Montes de Oca-Muñoz, Lorena Elizabeth; Castillo-Fernández, Ana María; de la Cruz-Yañez, Hermilo; García-Hernández, Carlos; Andraca-Dumit, Roxona

    2014-01-01

    Appendicovesicostomy is commonly employed to facilitate drainage of urine through the catheter. Due to the tendency to less invasive procedures for the treatment of patients with neurogenic bladder, laparoscopy has been used as an alternative to open surgery, with the immediate advantages of postoperative recovery, shorter postoperative ileus, better cosmetic results, lower postoperative pain and early reintegration into everyday life. Compare the results of laparoscopic procedure with open appendicovesicostomy. We conducted an observational, analytical, longitudinal, ambispective cohort study, which included patients from 6-16 years of age diagnosed with neurogenic bladder, operated through laparoscopic and open appendicovesicostomy from January 2009 to June 2013. Information was obtained from clinical records. Six patients were operated laparoscopically and 14 by open approach. Surgical time was longer and statistically significant in the laparoscopic group with a median of 330 min (300-360 min) compared to open procedure of 255 min (180-360 min). Seven patients had complications in the open group and only one in the laparoscopic group. The difference in the dose of analgesics and time of use was statistically significant in favor of the laparoscopic group. The degree of urinary continence through the stoma was higher for laparoscopic (100%) compared to the open procedure (64%). In neurogenic bladder with urodynamic bladder capacity and leak point pressure bladder within acceptable values, laparoscopic appendicovesicostomy was a better alternative.

  4. Systematic Review and Meta-Analysis of Perioperative Outcomes of Peroral Endoscopic Myotomy (POEM) and Laparoscopic Heller Myotomy (LHM) for Achalasia.

    Science.gov (United States)

    Awaiz, Aiman; Yunus, Rossita M; Khan, Shahjahan; Memon, Breda; Memon, Muhammed A

    2017-06-01

    Laparoscopic Heller myotomy (LHM) is the preferred surgical method for treating achalasia. However, peroral endoscopic myotomy (POEM) is providing good short-term results. The objective of this systematic review and meta-analysis was to compare the safety and efficacy of LHM and POEM. A search of PubMed, Cochrane database, Medline, Embase, Science Citation Index, and current contents for English-language articles comparing LHM and POEM between 2007 and 2016 was performed. Variables analyzed included prior endoscopic treatment, prior medical treatment, prior Heller myotomy, operative time, overall complications rate, postoperative gastroesophageal reflux disease (GERD), length of hospital stay, postoperative pain score, and long-term GERD. Seven trials consisting of 483 (LHM=250, POEM=233) patients were analyzed. Preoperative variables, for example, prior endoscopic treatment [odds ratio (OR), 1.32; 95% confidence interval (CI), 0.23-4.61; P=0.96], prior medical treatment [weighted mean difference (WMD), 1.22; 95% CI, 0.52-2.88; P=0.65], and prior Heller myotomy (WMD, 0.47; 95% CI, 0.13-1.67; P=0.25) were comparable. Operative time was 26.28 minutes, nonsignificantly longer for LHM (WMD, 26.28; 95% CI, -11.20 to 63.70; P=0.17). There was a comparable overall complication rate (OR, 1.25; 95% CI, 0.56-2.77; P=0.59), postoperative GERD rate (OR, 1.27; 95% CI, 0.70-2.30; P=0.44), length of hospital stay (WMD, 0.30; 95% CI, -0.24 to 0.85; P=0.28), postoperative pain score (WMD, -0.26; 95% CI, -1.58 to 1.06; P=0.70), and long-term GERD (WMD, 1.06; 95% CI, 0.27-4.1; P=0.08) for both procedures. There was a significantly higher short-term clinical treatment failure rate for LHM (OR, 9.82; 95% CI, 2.06-46.80; P<0.01). POEM compares favorably to LHM for achalasia treatment in short-term perioperative outcomes. However, there was a significantly higher clinical treatment failure rate for LHM on short-term postoperative follow-up. Presently long-term postoperative follow

  5. Review of various liver retraction techniques in single incision laparoscopic surgery for the exposure of hiatus

    Directory of Open Access Journals (Sweden)

    Praveenraj Palanivelu

    2015-01-01

    Full Text Available Background: The main aspect of concern for upper GI procedures has been the retraction of the liver especially large left lobes as commonly encountered in Bariatric surgery. Not doing so would compromise the view of the hiatus, hence theoretically reducing the quality of the surgery and increasing the possibility of complications. The aim of this study was to review the various liver retraction techniques in single incision surgery being done at our institute and analyze them. Material and Methods: A retrospective study of the various techniques and a subsequent analysis was made based on advantages and disadvantages of each method. Objectively a quantitative measure of hiatal exposure was done using a scoring system based on the grade of exposure after reviewing the surgical videos. From January 2011 to January 2013 total 104 patients underwent single incision surgery with the various liver retraction techniques with following grades of exposure -liver suspension tube technique with naso gastric tubing (2.11 and with corrugated drain (2.09 needlescopic method (1.2, Umbilical tape sling (1.95, crural stitch method (2.5. Needeloscopic method has the best grade of exposure and is the easiest to start with. The average time to create the liver retraction was 2.8 to 8.6 min.There was no procedure related morbidity or mortality. Conclusions: The mentioned liver retraction techniques are cost effective and easy to learn. We recommend using these techniques to have a good exposure of hiatus, without compromising the safety of surgery in single incision surgery.

  6. Laparoscopic ultrasound and gastric cancer

    Science.gov (United States)

    Dixon, T. Michael; Vu, Huan

    2001-05-01

    The management of gastrointestinal malignancies continues to evolve with the latest available therapeutic and diagnostic modalities. There are currently two driving forces in the management of these cancers: the benefits of minimally invasive surgery so thoroughly demonstrated by laparoscopic surgery, and the shift toward neoadjuvant chemotherapy for upper gastrointestinal cancers. In order to match the appropriate treatment to the disease, accurate staging is imperative. No technological advances have combined these two needs as much as laparascopic ultrasound to evaluate the liver and peritoneal cavity. We present a concise review of the latest application of laparoscopic ultrasound in management of gastrointestinal malignancy.

  7. Role of laparoscopic cholecystectomy in children

    Directory of Open Access Journals (Sweden)

    Oak Sanjay

    2005-01-01

    Full Text Available The present study is undertaken to establish the usefulness of laparoscopic cholecystectomy and to know its merits and demerits as compared to open cholecystectomy in children. In all, 28 patients who underwent cholecystectomy (8 open and 20 laparoscopic cholecystectomy in B.Y.L. Nair hospital between July 1999 and March 2004 were analyzed. Calculous cholecystitis was found to be the most common indication for surgery. Operative time for laparoscopic cholecystectomy was more than that in open cholecystectomy in the early phase of laparoscopy, which got reduced as we gained experience. The requirement of parenteral antibiotics and analgesics and the duration of stay were significantly shorter with laparoscopy. The advantages for a child in laparoscopic cholecystectomy as compared to open cholecystectomy are minimal pain, avoidance of an upper abdominal incision, cosmesis and shorter duration of hospitalization with quick return to home and school. Thus, laparoscopic cholecystectomy is safe and efficacious in children.

  8. Hospital Costs Associated With Laparoscopic and Open Inguinal Herniorrhaphy

    OpenAIRE

    Spencer Netto, Fernando; Quereshy, Fayez; Camilotti, Bruna G.; Pitzul, Kristen; Kwong, Josephine; Jackson, Timothy; Penner, Todd; Okrainec, Allan

    2014-01-01

    Purpose: The purpose of this study was to compare the total hospital costs associated with elective laparoscopic and open inguinal herniorrhaphy. Methods: A prospectively maintained database was used to identify patients who underwent elective inguinal herniorrhaphy from April 2009 to March 2011. A retrospective review of electronic patient records was performed along with a standardized case-costing analysis using data from the Ontario Case Costing Initiative. The main outcomes were operatin...

  9. Laparoscopic distal pancreatectomy for adenocarcinoma: safe and reasonable?

    Science.gov (United States)

    Postlewait, Lauren M.

    2015-01-01

    As a result of technological advances during the past two decades, surgeons now use minimally invasive surgery (MIS) approaches to pancreatic resection more frequently, yet the role of these approaches for pancreatic ductal adenocarcinoma resections remains uncertain, given the aggressive nature of this malignancy. Although there are no controlled trials comparing MIS technique to open surgical technique, laparoscopic distal pancreatectomy for pancreatic adenocarcinoma is performed with increasing frequency. Data from retrospective studies suggest that perioperative complication profiles between open and laparoscopic distal pancreatectomy are similar, with perhaps lower blood loss and fewer wound infections in the MIS group. Concerning oncologic outcomes, there appear to be no differences in the rate of achieving negative margins or in the number of lymph nodes (LNs) resected when compared to open surgery. There are limited recurrence and survival data on laparoscopic compared to open distal pancreatectomy for pancreatic adenocarcinoma, but in the few studies that assess long term outcomes, recurrence rates and survival outcomes appear similar. Recent studies show that though laparoscopic distal pancreatectomy entails a greater operative cost, the associated shorter length of hospital stay leads to decreased overall cost compared to open procedures. Multiple new technologies are emerging to improve resection of pancreatic cancer. Robotic pancreatectomy is feasible, but there are limited data on robotic resection of pancreatic adenocarcinoma, and outcomes appear similar to laparoscopic approaches. Additionally fluorescence-guided surgery represents a new technology on the horizon that could improve oncologic outcomes after resection of pancreatic adenocarcinoma, though published data thus far are limited to animal models. Overall, MIS distal pancreatectomy appears to be a safe and reasonable approach to treating selected patients with pancreatic ductal

  10. Laparoscopic Splenectomy

    International Nuclear Information System (INIS)

    Javed, I.; Malik, A. A.; Khan, A.; Shamim, R.; Allahnawaz, A.; Ayaaz, M.

    2014-01-01

    Patients undergoing laparoscopic splenectomy were observed for their postoperative recovery and development of complications. It was a retrospective analysis done at Services Hospital and National Hospital and Medical Center, Lahore, from January 2010 to December 2012. A total of 13 patients underwent laparoscopic splenectomy and were included in the study. Patients were followed for their postoperative recovery and development of any complications. The median age of patients was 19 years ranging from 13 to 69 years. Accessory spleens were removed in 3 patients. Mean operating time was 158 minutes. One operation had to be converted to open because of uncontrolled hemorrhage. Six patients experienced postoperative complications including unexplained hyperpyrexia (n=2), pleural effusion (n=4) and prolonged pain > 48 hours (n=1). No deaths or infections were seen. Seven out of 8 patients with idiopathic thrombocytopenic purpura developed a positive immediate response to the splenectomy, defined as a platelet count greater than 100 x 109/L after the surgery, which was maintained without medical therapy. Mean hospital stay was 5.5 days. Average time to return to activity was 15 days. All patients were followed for 6 months and no follow-up complications were noted. (author)

  11. Laparoscopic inguinal hernia repair: gold standard in bilateral hernia repair? Results of more than 2800 patients in comparison to literature.

    Science.gov (United States)

    Wauschkuhn, Constantin Aurel; Schwarz, Jochen; Boekeler, Ulf; Bittner, Reinhard

    2010-12-01

    Advantages and disadvantages of open and endoscopic hernia surgery are still being discussed. Until now there has been no study that evaluated the advantages and disadvantages of bilateral hernia repair in a large number of patients. Our prospectively collected database was analyzed to compare the results of laparoscopic bilateral with laparoscopic unilateral hernia repair. We then compared these results with the results of a literature review regarding open and laparoscopic bilateral hernia repair. From April 1993 to December 2007 there were 7240 patients with unilateral primary hernia (PH) and 2880 patients with bilateral hernia (5760 hernias) who underwent laparoscopic transabdominal preperitoneal patch plastic (TAPP). Of the 10,120 patients, 28.5% had bilateral hernias. Adjusted for the number of patients operated on, the mean duration of surgery for unilateral hernia repair was shorter than that for bilateral repair (45 vs. 70 min), but period of disability (14 vs. 14 days) was the same. Adjusted for the number of hernias repaired, morbidity (1.9 vs. 1.4%), reoperation (0.5 vs. 0.43%), and recurrence rate (0.63 vs. 0.42%) were similar for unilateral versus bilateral repair, respectively. The review of the literature shows a significantly shorter time out of work after laparoscopic bilateral repair than after the bilateral open approach. Simultaneous laparoscopic repair of bilateral inguinal hernias does not increase the risk for the patient and has an equal length of down time compared with unilateral repair. According to literature, recovery after laparoscopic repair is faster than after open simultaneous repair. Laparoscopic/endoscopic inguinal hernia repair of bilateral hernias should be recommended as the gold standard.

  12. Thromboelastographic changes during laparoscopic fundoplication.

    Science.gov (United States)

    Zostautiene, Indre; Zvinienė, Kristina; Trepenaitis, Darius; Gerbutavičius, Rolandas; Mickevičius, Antanas; Gerbutavičienė, Rima; Kiudelis, Mindaugas

    2017-01-01

    Thromboelastography (TEG) is a technique that measures coagulation processes and surveys the properties of a viscoelastic blood clot, from its formation to lysis. To determine the possible hypercoagulability state and the effect of antithrombotic prophylaxis on thromboelastogram results and development of venous thrombosis during laparoscopic fundoplication. The study was performed on 106 patients who were randomized into two groups. The first group received low-molecular-weight heparin (LMWH) 12 h before the operation, and 6 and 30 h after it. The second group received LMWH only 1 h before the laparoscopic fundoplication. The TEG profile was collected before LMWH injection, 1 h after the introduction of the laparoscope and 15 min after the surgery was completed. There was no significant difference in thromboelastography R-time between the groups before low-molecular-weight heparin injection. In group I preoperative R-values significantly decreased 1 h after the introduction of the laparoscope, after the end of surgery and on the third postoperative day. K-time values decreased significantly on the third postoperative day compared with the results before low-molecular-weight heparin injection, and after the operation. In group II, preoperative R-values significantly decreased 1 h after the introduction of the laparoscope, and after surgery. K-time values did not change significantly during or after the laparoscopic operation. Our study results demonstrated that the hypercoagulation state (according to the TEG results) was observed during and after laparoscopic fundoplication in patients when LMWH was administered 12 h before the operation together with intraoperative intermittent pneumatic compression. The optimal anticoagulation was obtained when LMWH was administered 1 h before fundoplication.

  13. Limited Hiatal Dissection Without Fundoplication Results in Comparable Symptomatic Outcomes to Laparoscopic Heller Myotomy with Anterior Fundoplication.

    Science.gov (United States)

    DeHaan, Reece K; Frelich, Matthew J; Gould, Jon C

    2016-07-01

    Previous randomized controlled trials have demonstrated that partial fundoplication following Heller myotomy results in less pathologic acid exposure to the esophagus when compared to myotomy without fundoplication. Recent studies have questioned the necessity of a fundoplication, especially when a limited hiatal dissection (LHD) is performed and the angle of His is preserved. This is a retrospective review of prospectively maintained data. All patients underwent primary Heller myotomy for achalasia over a 30-month period. In select patients, an LHD was performed anteriorly. Symptomatic outcomes were assessed up to 2 years postoperation using the Achalasia Severity Questionnaire (ASQ), Gastrointestinal Quality of Life Index (GIQLI), and Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL). A total of 31 patients underwent Heller myotomy during the study interval. The majority of patients underwent Heller myotomy with full hiatal dissection (FHD) (21, 68%). Intraoperative mucosal perforations occurred in 3 (14%) patients undergoing FHD. Patient demographics, surgery details, and baseline symptomatic outcomes did not differ significantly preoperatively. At greater than 1 year postoperation, there was no significant difference between the groups for ASQ, GERD-HRQL, and GIGLI (P = .76, .78, and .33, respectively). Heller myotomy with LHD and no fundoplication and Heller myotomy with FHD and partial fundoplication result in similar GERD-related quality of life outcomes. Further studies (including pH studies) are necessary to determine if fundoplication is a necessary step in selected patients in whom an LHD is possible.

  14. A Comparative Analysis of Laparoscopic Appendectomy in Relation to the Open Appendectomy in Children / Uporedna Analiza Laparoskopske Apendektomije U Odnosu Na Otvorenu Apendektomiju Kod Dece

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    Mickovic Irena Nikolic

    2016-03-01

    Full Text Available Acute inflammation of the appendix in childhood usually requires an appendectomy. Surgical methods are open appendectomy (OA and laparoscopic appendectomy (LA. Both have the same goal of removing the appendix.

  15. Conventional laparoscopic adrenalectomy versus laparoscopic adrenalectomy through mono port.

    Science.gov (United States)

    Kwak, Ha Na; Kim, Jun Ho; Yun, Ji-Sup; Son, Byung Ho; Chung, Woong Youn; Park, Yong Lai; Park, Chan Heun

    2011-12-01

    A standard procedure for single-port laparoscopic adrenal surgery has not been established. We retrospectively investigated intraoperative and postoperative outcomes after laparoscopic adrenalectomy through mono port (LAMP) and conventional laparoscopic adrenalectomy to assess the feasibility of LAMP. Between March 2008 and December 2009, 22 patients underwent adrenalectomy at the Department of Surgery, Kangbuk Samsung Hospital. Twelve patients underwent conventional laparoscopic adrenalectomy and 10 patients underwent LAMP. The same surgeon performed all the surgeries. The 2 procedures were compared in terms of tumor size, operating time, time to resumption of a soft diet, length of hospital day, and postoperative complications. The 2 groups were similar in terms of tumor size (30.08 vs. 32.50 mm, P=0.796), mean operating time (112.9 vs. 127 min, P=0.316), time to resumption of a soft diet (1.25 vs. 1.30 d, P=0.805), and length of hospital day (4.08 vs. 4.50 d, P=0.447). Despite 1 patient in the LAMP group experiencing ipsilateral pleural effusion as a postoperative complication, this parameter was similar for the 2 groups (P=0.195). Perioperative mortality, blood transfusion, and conversion to open surgery did not occur. Perioperative outcomes for LAMP were similar to those for conventional laparoscopic adrenalectomy. LAMP appears to be a feasible option for adrenalectomy.

  16. The role of laparoscopic surgery in the management of children and adolescents with inflammatory bowel disease.

    Science.gov (United States)

    Page, Anna E; Sashittal, Shikha G; Chatzizacharias, Nikolaos A; Davies, R Justin

    2015-05-01

    Although laparoscopic surgery is readily used in the management of inflammatory bowel disease (IBD) in adults, its role in the surgical treatment of IBD in the pediatric population is not well established. The aim of this narrative review was to analyze the published evidence comparing laparoscopic and open resection in the management of children and adolescents with IBD. The Pubmed and Embase databases were searched using the terms "inflammatory bowel disease," "children," "adolescents," "laparoscopic," and "colectomy." The review identified 10 appropriate studies. Even though laparoscopic surgery generally resulted in longer operating times (between a mean of 40 and 140 min), benefits included reduced postoperative pain (mean duration of opiate use 3 vs 6 days) and reduced length of stay (median length of stay 5-8 vs 10.5-19 days) compared with open surgery. Postoperative complication rates were similar following both approaches. Due to the limited available data and the small sample size of the published series, definite recommendations are not able to be drawn. Nevertheless, current evidence indicates that laparoscopic colorectal resection is safe and feasible in the management of IBD in the paediatric population, with reductions in postoperative pain and length of hospital stay achievable.

  17. Laparoscopic promontofixation for the treatment of recurrent sigmoid neovaginal prolapse: case report and systematic review of the literature.

    Science.gov (United States)

    Kondo, William; Ribeiro, Reitan; Tsumanuma, Fernanda Keiko; Zomer, Monica Tessmann

    2012-01-01

    Prolapse of a sigmoid neovagina, created in patients with congenital vaginal aplasia, is rare. In correcting this condition, preservation of coital function and restoration of the vaginal axis should be of primary interest. A 34-year-old woman with vaginal agenesis underwent vaginoplasty using sigmoid colon. Almost 6 years after the initial operation, she started complaining of a bearing-down sensation and an increase in vaginal discharge. She underwent 2 open surgeries and one vaginal surgery to treat the prolapse with no success. She came to our service and at vaginal examination the neovagina protruded approximately 5 cm beyond the hymen. The prolapse was treated successfully using a laparoscopic approach to suspend the neovagina to the sacral promontory (laparoscopic promontofixation). Prolapse of an artificially created vagina is a rare occurrence, without a standard treatment. Laparoscopy may be an alternative approach to restore the neovagina without compromising its function. Copyright © 2012 AAGL. Published by Elsevier Inc. All rights reserved.

  18. The outcome of laparoscopic cholecystectomy by ultrasonic dissection.

    LENUS (Irish Health Repository)

    Sasi, Walid

    2010-04-01

    Electrocautery remains the main energy form used for dissection in laparoscopic cholecystectomy. However, due to its many risks the search continues for safer and more efficient forms of energy. This chapter assesses the outcomes of dissection using ultrasonic energy as compared to monopolar electrocautery during laparoscopic cholecystectomy. Studies included are trials of prospectively randomized adult patients with symptomatic gallstone disease subject either ultrasonic or monopolar electrocautery dissection during laparoscopic cholecystectomy. Seven trials were included in this review, with a total patient number of 695 randomized to two dissection methods: 340 in the electrocautery group and 355 in the ultrasonic group. Ultrasonic dissection is shown to be superior to monopolar electrocautery in laparoscopic cholecystectomy. Disadvantages include a difficult maneuvering technique and overall cost. Appropriate training programs may be implemented to overcome the first disadvantage, and it might be argued that given the combined cost of factors associated with standard clip and cautery technique, cost issues may be outweighed by the benefits of ultrasonic dissection. However, this necessitates further cost-benefit analysis.

  19. Systematic Review of Voluntary Participation in Simulation-Based Laparoscopic Skills Training: Motivators and Barriers for Surgical Trainee Attendance.

    Science.gov (United States)

    Gostlow, Hannah; Marlow, Nicholas; Babidge, Wendy; Maddern, Guy

    To examine and report on evidence relating to surgical trainees' voluntary participation in simulation-based laparoscopic skills training. Specifically, the underlying motivators, enablers, and barriers faced by surgical trainees with regard to attending training sessions on a regular basis. A systematic search of the literature (PubMed; CINAHL; EMBASE; Cochrane Collaboration) was conducted between May and July 2015. Studies were included on whether they reported on surgical trainee attendance at voluntary, simulation-based laparoscopic skills training sessions, in addition to qualitative data regarding participant's perceived barriers and motivators influencing their decision to attend such training. Factors affecting a trainee's motivation were categorized as either intrinsic (internal) or extrinsic (external). Two randomised control trials and 7 case series' met our inclusion criteria. Included studies were small and generally poor quality. Overall, voluntary simulation-based laparoscopic skills training was not well attended. Intrinsic motivators included clearly defined personal performance goals and relevance to clinical practice. Extrinsic motivators included clinical responsibilities and available free time, simulator location close to clinical training, and setting obligatory assessments or mandated training sessions. The effect of each of these factors was variable, and largely dependent on the individual trainee. The greatest reported barrier to attending voluntary training was the lack of available free time. Although data quality is limited, it can be seen that providing unrestricted access to simulator equipment is not effective in motivating surgical trainees to voluntarily participate in simulation-based laparoscopic skills training. To successfully encourage participation, consideration needs to be given to the factors influencing motivation to attend training. Further research, including better designed randomised control trials and large

  20. Laparoscopic splenectomy for a simultaneous wandering spleen along with an ectopic accessory spleen. Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Antonia Rizzuto

    Full Text Available Background: Wandering spleen and accessory spleen are uncommon entity occurring during embryonic development. Wandering spleen results in an excessive mobility and migration of the spleen from its normal position in the left hypochondrium while accessory spleen is characterized by ectopic splenic masses or tissue disjointed from the main body of spleen.Due to the nonspecific and multiple symptoms the clinical diagnosis of both conditions is uncertain even with imaging techniques, such as CT and MRI. The coexistence of both diseases (wandering spleen ad accessory spleen is uncommon. Case report: A 17–year old European female with a history of minor beta thalassemia and recurrent attacks of abdominal pain. Pre- operative management consisted of routine laboratory tests, ultrasound, CT scan. An ectopic spleen along with an accessory spleen were diagnosed. After a multidisciplinary board a laparoscopic splenectomy was performed. Post-operative recovery was uneventful, and the patient was discharged on the 6th post-operative day with the indication to continue the therapy with low molecular weight heparin (LMWH for 30 days Conclusions: This case represents a simultaneous condition of wandering splenomegaly along with an ectopic wandering spleen. The coexistence of these two rare conditions is peculiar such as the age of the patient, as literature reports such diseases to affect children or more commonly people in the range of 20–40 years of age. Laparoscopic treatment for this particular condition is also unusual. Keywords: Ectopic spleen, Wandering spleen, Laparoscopic splenectomy

  1. A case-control study to compare the outcome of women treated by two minimally invasive procedures-ultraminilaparotomy myomectomy and laparoscopic myomectomy

    Directory of Open Access Journals (Sweden)

    Kuo-Chang Wen

    2018-04-01

    Full Text Available Objective: Ultraminilaparotomy myomectomy (UMLT-M with less 4 cm transverse skin incision and conventional 3-port wound laparoscopic myomectomy (LM approaches were proposed as alternative minimally invasive procedures in the management of women with symptomatic uterine myomas but few studies have compared the outcomes of both procedures. Materials and methods: Between January 2002 and December 2003, 71 patients undergoing UMLT-M were compared with those 71 women undergoing LM. The last data collection for all patients was done on 31 December 2016. The parameters for comparison included the characteristics of the uterine myomas, surgical parameters, morbidities, and outcomes. Surgical parameters included the operative time (minutes, estimated blood loss (milliliters, time for removal of drainage, percentage of blood transfusion and co-morbidities. Results: Mean operative time in the LM group was significantly longer than that in the UMLT-M group (208.7 ± 65.9 vs. 98.0 ± 28.2 min, p < 0.001. Intra-operative blood loss was significantly higher in the LM group than that in the UMLT-M group (210.9 ± 184.5 vs. 111.7 ± 108.4 ml, p < 0.001. However, more patients had postoperative fever in the UMLT-M group (39.4% vs. 8.5%, p < 0.001. The recurrence rate of myoma at 5-year follow-up was significantly different between two groups (35.2% of UMLT-M vs. 57.7% of LM, p = 0.007, but there was no difference when follow-up time was over ten years. The location of the myoma recurrence was different between two groups with higher recurrence rates in the fundal and lateral sides of uterus in the UMLT-M group and in the anterior wall of uterus in the LM group. However, the overall symptom control, the need of repeated myoma-related surgery and subsequent pregnancy outcome of both groups seemed to be similar in both groups. Conclusions: More operative time and more blood loss reflected that LM demanded skills, experience and equipment

  2. Laparoscopic revision of failed antireflux operations.

    Science.gov (United States)

    Serafini, F M; Bloomston, M; Zervos, E; Muench, J; Albrink, M H; Murr, M; Rosemurgy, A S

    2001-01-01

    A small number of patients fail fundoplication and require reoperation. Laparoscopic techniques have been applied to reoperative fundoplications. We reviewed our experience with reoperative laparoscopic fundoplication. Reoperative laparoscopic fundoplication was undertaken in 28 patients, 19 F and 9 M, of mean age 56 years +/- 12. Previous antireflux procedures included 19 open and 12 laparoscopic antireflux operations. Symptoms were heartburn (90%), dysphagia (35%), and atypical symptoms (30%%). The mean interval from antireflux procedure to revision was 13 months +/- 4.2. The mean DeMeester score was 78+/-32 (normal 14.7). Eighteen patients (64%) had hiatal breakdown, 17 (60%) had wrap failure, 2 (7%) had slipped Nissen, 3 (11%) had paraesophageal hernias, and 1 (3%) had an excessively tight wrap. Twenty-five revisions were completed laparoscopically, while 3 patients required conversion to the open technique. Complications occurred in 9 of 17 (53%) patients failing previous open fundoplications and in 4 of 12 patients (33%) failing previous laparoscopic fundoplications and included 15 gastrotomies and 1 esophagotomy, all repaired laparoscopically, 3 postoperative gastric leaks, and 4 pneumothoraces requiring tube thoracostomy. No deaths occurred. Median length of stay was 5 days (range 2-90 days). At a mean follow-up of 20 months +/- 17, 2 patients (7%) have failed revision of their fundoplications, with the rest of the patients being essentially asymptomatic (93%). The results achieved with reoperative laparoscopic fundoplication are similar to those of primary laparoscopic fundoplications. Laparoscopic reoperations, particularly of primary open fundoplication, can be technically challenging and fraught with complications. Copyright 2001 Academic Press.

  3. Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of Type III achalasia in 75 patients: a multicenter comparative study.

    Science.gov (United States)

    Kumbhari, Vivek; Tieu, Alan H; Onimaru, Manabu; El Zein, Mohammad H; Teitelbaum, Ezra N; Ujiki, Michael B; Gitelis, Matthew E; Modayil, Rani J; Hungness, Eric S; Stavropoulos, Stavros N; Shiwaku, Hiro; Kunda, Rastislav; Chiu, Philip; Saxena, Payal; Messallam, Ahmed A; Inoue, Haruhiro; Khashab, Mouen A

    2015-06-01

    Type III achalasia is characterized by rapidly propagating pressurization attributable to spastic contractions. Although laparoscopic Heller myotomy (LHM) is the current gold standard management for type III achalasia, peroral endoscopic myotomy (POEM) is conceivably superior because it allows for a longer myotomy. Our aims were to compare the efficacy and safety of POEM with LHM for type III achalasia patients. A retrospective study of 49 patients who underwent POEM for type III achalasia across eight centers were compared to 26 patients who underwent LHM at a single institution. Procedural data were abstracted and pre- and post-procedural symptoms were recorded. Clinical response was defined by improvement of symptoms and decrease in Eckardt stage to ≤ 1. Secondary outcomes included length of myotomy, procedure duration, length of hospital stay, and rate of adverse events. Clinical response was significantly more frequent in the POEM cohort (98.0 % vs 80.8 %; P = 0.01). POEM patients had significantly shorter mean procedure time than LHM patients (102 min vs 264 min; P myotomy (16 cm vs 8 cm; P myotomy than LHM, which may result in improved clinical outcomes. POEM appears to be an effective and safe alternative to LHM in patients with type III achalasia.

  4. A COMPARATIVE STUDY ON EFFICACY OF ONDANSETRON AND GRANISETRON IN PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING IN PATIENTS UNDERGOING LAPAROSCOPIC SURGERIES UNDER GENERAL ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Illendula Upendranath

    2016-10-01

    Full Text Available BACKGROUND Postoperative nausea and vomiting is one of the many side effects of patients undergoing laparoscopic surgeries under general anaesthesia. Its prevention is major concern of anaesthesiologist managing the case. To this effect, many drugs have been used and use of serotonin (5-HT3 receptor antagonists like ondansetron, granisetron, tropisetron and dolasetron has been compared in many studies. This study was undertaken to study the efficacy of ondansetron, granisetron and their side effects. MATERIALS AND METHODS Patients were allocated into two groups, each group consisting of 50 patients. Group O received ondansetron 4 mg IV before induction. Group G received granisetron 1 mg IV before induction. The incidences of PONV were recorded within the first 24 hours after surgery at intervals of 0-2 hours, 3 hours, 6 hours, 12 hours and 24 hours. Episodes of PONV were identified by spontaneous complaints by the patients or by direct questioning. RESULTS In present study, incidence of nausea at different intervals in granisetron group is less than in the ondansetron group, which is statistically significant (p <0.05. The incidence of nausea was 36% in Group O and 12% in Group G, which was significantly low. The incidence of retching was 22% in Group O and it was less in Group G that is 2%. Greater percentage of patients in Group O (16% experienced vomiting compared to Group G (2%. CONCLUSION The overall frequency of Postoperative Nausea and Vomiting (PONV was less in Group G than Group O.

  5. A very rare case of a small bowel leiomyosarcoma leading to ileocaecal intussusception treated with a laparoscopic resection: a case report and a literature review.

    Science.gov (United States)

    Guzel, Tomasz; Mech, Katarzyna; Mazurkiewicz, Michał; Dąbrowski, Bohdan; Lech, Gustaw; Chaber, Andrzej; Słodkowski, Maciej

    2016-02-24

    Small bowel tumours are rare and comprise less than 2% of all primary gastrointestinal neoplasms. Among these tumours, a leiomyosarcoma belonging to soft tissue sarcomas is extremely rare and accounts for about 1 % of malignant mesenchymal lesions in the gastrointestinal tract. Due to its aggressive nature and slow growth, it is often diagnosed at the late stage when curative treatment is impossible. Authors report a first case of leiomyosarcoma with chronic recurrent ileocaecal intussusception and literature review to analyse diagnosis and treatment features of the ileum mesenchymal tumours. We present a case of an 87-year-old Caucasian man suffering from cramp-like abdominal pain for months. Due to lack of clinical signs and unspecific complaints, a diagnosis was delayed. Despite a detailed in-hospital examination, a proper diagnosis was established as late as during an operation. The patient was treated by surgery with good results. An uncommon laparoscopic resection of the small bowel with a tumour was performed. A histopathological investigation confirmed a very rare mesenchymal lesion of the distal ileum. The patient is under control with no recurrence for 1 year of the follow-up period. Reported case indicates that a usually asymptomatic tumour can cause uncommon chronic recurrent ileus signs. CT and MRI scans are investigation of choice in such cases, but they are sometimes inconclusive. It might be worth highlighting the good results of laparoscopic leiomyosarcoma lesion resection with a very good outcome.

  6. Current status of laparoscopic central pancreatectomy

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    CAO Yang

    2017-04-01

    Full Text Available Central pancreatectomy is an ideal surgical procedure for the treatment of benign or low-grade malignant tumors in the pancreatic neck or the proximal body of the pancreas, and it can preserve more normal pancreatic tissue in order to reduce the incidence of endocrine and exocrine insufficiency after surgery. Although some clinical studies have demonstrated the feasibility and safety of this procedure, laparoscopic central pancreatectomy was technically challenging with a few number of cases. This article reviews the current status of laparoscopic central pancreatectomy and introduces our clinical experience of laparoscopic central pancreatectomy and pancreaticojejunostomy.

  7. Clinical advantages of single port laparoscopic hepatectomy.

    Science.gov (United States)

    Han, Jae Hyun; You, Young Kyoung; Choi, Ho Joong; Hong, Tae Ho; Kim, Dong Goo

    2018-01-21

    To evaluate the clinical advantages of single-port laparoscopic hepatectomy (SPLH) compare to multi-port laparoscopic hepatectomy (MPLH). We retrospectively reviewed the medical records of 246 patients who underwent laparoscopic liver resection between January 2008 and December 2015 at our hospital. We divided the surgical technique into two groups; SPLH and MPLH. We performed laparoscopic liver resection for both benign and malignant disease. Major hepatectomy such as right and left hepatectomy was also done with sufficient disease-free margin. The operative time, the volume of blood loss, transfusion rate, and the conversion rate to MPLH or open surgery was evaluated. The post-operative parameters included the meal start date after operation, the number of postoperative days spent in the hospital, and surgical complications was also evaluated. Of the 246 patients, 155 patients underwent SPLH and 91 patients underwent MPLH. Conversion rate was 22.6% in SPLH and 19.8% in MPLH ( P = 0.358). We performed major hepatectomy, which was defined as resection of more than 2 sections, in 13.5% of patients in the SPLH group and in 13.3% of patients in the MPLH group ( P = 0.962). Mean operative time was 136.9 ± 89.2 min in the SPLH group and 231.2 ± 149.7 min in the MPLH group ( P started earlier in the SPLH group (1.06 ± 0.27 d after operation) than in the MPLH group (1.63 ± 1.27 d) ( P < 0.001). The mean hospital stay after operation was non-significantly shorter in the SPLH group than in the MPLH group (7.82 ± 2.79 d vs 7.97 ± 3.69 d, P = 0.744). The complication rate was not significantly different ( P = 0.397) and there was no major perioperative complication or mortality case in both groups. Single-port laparoscopic liver surgery seems to be a feasible approach for various kinds of liver diseases.

  8. Laparoscopic Spleen Removal (Splenectomy)

    Science.gov (United States)

    ... Affairs and Humanitarian Efforts Login Laparoscopic Spleen Removal (Splenectomy) Patient Information from SAGES Download PDF Find a ... are suspected. What are the Advantages of Laparoscopic Splenectomy? Individual results may vary depending on your overall ...

  9. A comparison between robotic-assisted laparoscopic distal pancreatectomy versus laparoscopic distal pancreatectomy.

    Science.gov (United States)

    Goh, Brian K P; Chan, Chung Yip; Soh, Hui-Ling; Lee, Ser Yee; Cheow, Peng-Chung; Chow, Pierce K H; Ooi, London L P J; Chung, Alexander Y F

    2017-03-01

    This study aims to compare the early perioperative outcomes of robotic-assisted laparoscopic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP). The clinicopathologic features of 45 consecutive patients who underwent minimally-invasive distal pancreatectomy from 2006 to 2015 were retrospectively reviewed. Thirty-nine patients who met our study criteria were included. Eight patients underwent RDP and 31 had LDP. There were 10 (25.6%) open conversions. Six (15.4%) patients had major (> grade 2) morbidities and there was no in-hospital mortality. There were 14 (35.9%) grade A and 9 (23.1%) grade B pancreatic fistulas. Comparison between RDP and LDP demonstrated no significant difference between the patients' baseline characteristics except there was increased frequency of spleen-preserving pancreatectomies (3 (37.5%) vs 25 (80.6%), P=0.016) and splenic-vessel preservation (5 (62.5%) vs 4 (12.9%), P=0.003) in RDP. Comparison between outcomes demonstrated that RDP was associated with a longer median operation time (452.5 (range, 300-685) vs 245 min (range, 85-430), P=0.001) and increased frequency of the procedure completed purely laparoscopically (8 (100%) vs 18 (58.1%), P=0.025). RDP can be safely adopted and is equivalent to LDP in most perioperative outcomes. It is also associated with a decreased frequency of the need for hand-assistance laparoscopic surgery or open conversion but needed a longer operation time. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  10. Do laparoscopic skills transfer to robotic surgery?

    Science.gov (United States)

    Panait, Lucian; Shetty, Shohan; Shewokis, Patricia A; Sanchez, Juan A

    2014-03-01

    Identifying the set of skills that can transfer from laparoscopic to robotic surgery is an important consideration in designing optimal training curricula. We tested the degree to which laparoscopic skills transfer to a robotic platform. Fourteen medical students and 14 surgery residents with no previous robotic but varying degrees of laparoscopic experience were studied. Three fundamentals of laparoscopic surgery tasks were used on the laparoscopic box trainer and then the da Vinci robot: peg transfer (PT), circle cutting (CC), and intracorporeal suturing (IS). A questionnaire was administered for assessing subjects' comfort level with each task. Standard fundamentals of laparoscopic surgery scoring metric were used and higher scores indicate a superior performance. For the group, PT and CC scores were similar between robotic and laparoscopic modalities (90 versus 90 and 52 versus 47; P > 0.05). However, for the advanced IS task, robotic-IS scores were significantly higher than laparoscopic-IS (80 versus 53; P robotic-PT score when compared with laparoscopic-PT (92 versus 105; P  0.05). The robot was favored over laparoscopy for all drills (PT, 66.7%; CC, 88.9%; IS, 94.4%). For simple tasks, participants with preexisting skills perform worse with the robot. However, with increasing task difficulty, robotic performance is equal or better than laparoscopy. Laparoscopic skills appear to readily transfer to a robotic platform, and difficult tasks such as IS are actually enhanced, even in subjects naive to the technology. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Laparoscopic Management of Hepatic Hydatid Disease

    OpenAIRE

    Palanivelu, C; Jani, Kalpesh; Malladi, Vijaykumar; Senthilkumar, R.; Rajan, P. S.; Sendhilkumar, K.; Parthasarthi, R.; Kavalakat, Alfie

    2006-01-01

    Background: Hydatid disease is an endemic condition in several parts of the world. Owing to ease of travel, even surgeons in nonendemic areas encounter the disease and should be aware of its optimum treatment. A safe, new method of laparoscopic management of hepatic hydatid disease is described along with a review of the relevant literature. Methods: Sixty-six cases of hepatic hydatid disease were operated on laparoscopically using the Palanivelu Hydatid System. The special trocar-cannula sys...

  12. Comparative effectiveness of laparoscopic versus open prostatectomy for men with low-risk prostate cancer: a matched case-control study

    Science.gov (United States)

    Patel, Amil; Kim, Sinae; Kim, Isaac Yi; Goyal, Sharad

    2017-01-01

    Background: Little data exist on effect of undergoing laparoscopic prostatectomy(LP) versus open prostatectomy(OP) upon 30-day mortality rates among low-risk prostate cancer patients. Materials and methods: Using the National Cancer Database, we identified men (2004 to 2013) with biopsy-proven, low-risk prostate cancer who met the eligibility criteria: N0, M0, T-stage≤2A, PSA≤10 ng/mL, and Gleason score=6. We utilized a 1:N matched case-control study, with cases and controls matched by race, insurance status, Charlson-Deyo comorbidity score, surgical margin status, and facility type to investigate the short-term comparative effectiveness of LP versus OP. Results: Among the 448,773 patients in the National Cancer Database with low-risk prostate cancer, 116,359 patients met the above inclusion criteria. The target group was restricted to patients who received LP or OP, thus, leaving 44,720 patients for the study. The use of LP (compared with OP) was associated with patients with privately insured patients, treatment at an academic/research centers, high-volume hospitals, and white race (all Popen) was estimated at 0.31 (95% confidence interval, 0.135–0.701; P<0.05). Thus, the risk of death within 30 days was 69% lower with LP compared with OP. Conclusions: We found that the 30-day mortality rate among low-risk prostate cancer patients is significantly lower among patients who received LP when compared with OP, with various clinicopathologic parameters associated with its preferential use. PMID:29177226

  13. Conventional and/or laparoscopic rectal cancer surgery: what is the current evidence?

    Directory of Open Access Journals (Sweden)

    Mik Michal

    2016-09-01

    Full Text Available Despite many years of experience with laparoscopic procedures in rectal cancer, the superiority of minimally invasive approaches has been questioned especially in recent years. This article is a short review of the current knowledge about laparoscopic approaches in comparison to conventional modalities in patients with rectal cancer. To present the current state of the knowledge, we focused on reports that were published in the last few years and compared them to multicenter trials and meta-analyses published last year. Our analysis mainly applied to the primary end-points of these trials. We also included expert opinions that have been published in the last several months.

  14. Laparoscopic and robotic nephroureterectomy

    DEFF Research Database (Denmark)

    Azawi, Nessn H; Berg, Kasper Drimer; Thamsborg, Andreas Key Milan

    2017-01-01

    nephroureterectomy between January 2008 and December 2014 was conducted. Outcome measures were OS and CSM. RESULTS: In total, 298 patients underwent robot-assisted or laparoscopic radical nephroureterectomy with a final histological diagnosis of UTUC. LND was performed in 46 (15.4%). One hundred and seventy...... in the selection of patients undergoing LND. CONCLUSIONS: Five-year OS and CSM are comparable between patients with N1 and N0 MID. This evidence may support the use of the LND procedure in patients with muscle-invasive UTUC....

  15. Impact of laparoscopic surgery training laboratory on surgeon's performance

    Science.gov (United States)

    Torricelli, Fabio C M; Barbosa, Joao Arthur B A; Marchini, Giovanni S

    2016-01-01

    Minimally invasive surgery has been replacing the open standard technique in several procedures. Similar or even better postoperative outcomes have been described in laparoscopic or robot-assisted procedures when compared to open surgery. Moreover, minimally invasive surgery has been providing less postoperative pain, shorter hospitalization, and thus a faster return to daily activities. However, the learning curve required to obtain laparoscopic expertise has been a barrier in laparoscopic spreading. Laparoscopic surgery training laboratory has been developed to aid surgeons to overcome the challenging learning curve. It may include tutorials, inanimate model skills training (box models and virtual reality simulators), animal laboratory, and operating room observation. Several different laparoscopic courses are available with specific characteristics and goals. Herein, we aim to describe the activities performed in a dry and animal-model training laboratory and to evaluate the impact of different kinds of laparoscopic surgery training courses on surgeon’s performance. Several tasks are performed in dry and animal laboratory to reproduce a real surgery. A short period of training can improve laparoscopic surgical skills, although most of times it is not enough to confer laparoscopic expertise for participants. Nevertheless, this short period of training is able to increase the laparoscopic practice of surgeons in their communities. Full laparoscopic training in medical residence or fellowship programs is the best way of stimulating laparoscopic dissemination. PMID:27933135

  16. A feasibility of single-incision laparoscopic percutaneous extraperitoneal closure for treatment of incarcerated inguinal hernia in children: our preliminary outcome and review of the literature.

    Science.gov (United States)

    Murase, Naruhiko; Uchida, Hiroo; Seki, Takashi; Hiramatsu, Kiyoshi

    2016-02-01

    The purpose of this study is to examine the feasibility of single-incision laparoscopic percutaneous extraperitoneal closure (LPEC) for incarcerated inguinal hernia (IIH) repair. 6 single-incision LPEC procedures were performed for IIH repair and 60 procedures were performed for reducible inguinal hernia (RIH) in the same period of time in one hospital. The laparoscope and one pair of grasping forceps were placed through the same umbilical incision. In IIH repair, the herniated organ was gently pulled using the grasping forceps with external manual pressure. If it was difficult to reduce the herniated organ with one pair of forceps, another pair of forceps were inserted through a multi-channel port without extending the umbilical incidion. Using the LPEC needle, the hernia orifice was closed extraperitoneally. We performed a retrospective analysis to compare the outcomes of single-incision LPEC for IIH repair or reducible inguinal hernia. All procedures were completed by single-incision without open conversion. A multi-channel port with another pair of forceps was needed in three cases. The operation time and the length of stay were significantly longer with IIH repair than with RIH repair. There were no major complications and there was no evidence of early recurrence in any patient. In conclusion, single-incision LPEC with a multi-channel port is feasible and safe for IIH repair.

  17. Laparoscopic Approach for Metachronous Cecal and Sigmoid Volvulus

    Science.gov (United States)

    Greenstein, Alexander J.; Zisman, Sharon R.

    2010-01-01

    Background: Metachronous colonic volvulus is a rare event that has never been approached laparoscopically. Methods: Here we discuss the case of a 63-year-old female with a metachronous sigmoid and cecal volvulus. Results: The patient underwent 2 separate successful laparoscopic resections. Discussion and Conclusion: The following is a discussion of the case and the laparoscopic technique, accompanied by a brief review of colonic volvulus. In experienced hands, laparoscopy is a safe approach for acute colonic volvulus. PMID:21605523

  18. Warm-up before laparoscopic surgery is not essential.

    Science.gov (United States)

    Weston, Maree K; Stephens, Jacqueline H; Schafer, Amy; Hewett, Peter J

    2014-03-01

    Several recent studies have suggested that warming up prior to surgery may improve surgical performance. The purpose of this study was to investigate whether warming up prior to laparoscopic surgery improves surgical performance or reduces surgery duration. Between August 2011 and January 2012, a randomized controlled trial was conducted to compare two warm-up modalities to no warm-up. The study was conducted at a single site, with nine surgeons performing 72 laparoscopic cholecystectomies and 37 laparoscopic appendicectomies. Prior to surgery, surgeons were randomized to either laparoscopic trainer box warm-up, PlayStation 2 warm-up or no warm-up. The activity was performed within 30 min of surgery commencing. Patients provided informed consent for the surgery to be digitally recorded. Digital videodiscs (DVDs) were reviewed by an independent and blinded assessor. Data were collected on duration of surgery, level of training and perceived surgical difficulty. Surgical performance was graded using a validated scoring system. From the 109 operations performed, there were 75 usable DVDs. Overall, there were no statistical differences in the demographics of patients and surgeons in the three treatment groups, nor in the subset that had useable DVDs. There were no statistical differences in the duration of surgery or surgeon's perceived surgical difficulty. There was no statistical difference in surgical performance. This study suggests that warm-up prior to laparoscopic cholecystectomy or appendicectomy is not essential, acknowledging that there are several study limitations that preclude definitive conclusion. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

  19. A comparative review of pharmacoeconomic guidelines.

    Science.gov (United States)

    Jacobs, P; Bachynsky, J; Baladi, J F

    1995-09-01

    We have reviewed 4 international sets of guidelines for the economic evaluation of pharmaceutical products-those of the Australian Pharmaceutical Benefits Advisory Committee, the Canadian Coordinating Office for Health Technology Assessment, the Ontario Ministry of Health, and the England and Wales Department of Health. Comparison of these guidelines reveals that there are a number of differences between them, including disparities in outcome selection, costs and perspectives. These observations were attributed to differences in study purpose, conceptual approach, measurement techniques and value judgements. Uniformity can be achieved only in conceptual approach and measurement technique. Guidelines should be flexible to accommodate differences in the study purposes and value judgements of the analysts.

  20. Laparoscopic Nissen (total) versus anterior 180° fundoplication for gastro-esophageal reflux disease: A meta-analysis and systematic review.

    Science.gov (United States)

    Du, Xing; Wu, Ji-Min; Hu, Zhi-Wei; Wang, Feng; Wang, Zhong-Gao; Zhang, Chao; Yan, Chao; Chen, Mei-Ping

    2017-09-01

    Laparoscopic Nissen fundoplication (LNF) has been the gold standard for the surgical management of Gastro-esophageal reflux disease (GERD). Laparoscopic anterior 180° fundoplication (180° LAF) is reported to reduce the incidence of postoperative complications while obtaining similar control of reflux. The present meta-analysis was conducted to confirm the value of the 2 techniques. PubMed, Medline, Embase, Cochrane Library, Springerlink, and China National Knowledge Infrastructure Platform databases were searched for randomized controlled trials (RCTs) comparing LNF and 180° LAF. Data regarding the benefits and adverse results of 2 techniques were extracted and compared using a meta-analysis. Six eligible RCTs comparing LNF (n = 266) and 180° LAF (n = 265) were identified. There were no significant differences between LNF and 180° LAF with regard to operating time, perioperative complications, length of hospital stay, patient satisfaction, willingness to undergo surgery again, quality of life, postoperative heartburn, proton pump inhibitor (PPI) use, postoperative DeMeester scores, postoperative lower esophageal sphincter (LES) pressure, postoperative gas-bloating, unable to belch, diarrhea, or overall reoperation. LNF was associated with a higher prevalence of postoperative dysphagia compared with 180° LAF, while 180° LAF was followed by more reoperation for recurrent reflux symptoms. LNF and 180° LAF are equally effective in controlling reflux symptoms and obtain a comparable prevalence of patient satisfaction. 180° LAF can reduce the incidence of postoperative dysphagia while this is offset by a higher risk of reoperation for recurrent symptoms. The risk of recurrent symptoms should need to be balanced against the risk of dysphagia when surgeons choose surgical procedures for each individual with GERD.

  1. A STUDY ON OPEN VS. LAPAROSCOPIC APPROACH IN ACUTE APPENDICITIS

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    Savalam Bujjitha

    2016-05-01

    Full Text Available Reginald Fitz in 1986, first described acute appendicitis. Since the acute appendicitis was first described, the pathology remains the most common intra-abdominal condition requiring emergency surgery. The life time risk of having acute appendicitis is about 8%. Traditionally, the treatment of choice has been surgery. Before the only option was the open laparotomical meaning opening the abdominal cavity was the mode of operation. Laparoscopic appendectomy was described by Semm in 1983. This method was new and had its own benefits but this particular procedure has struggled to prove its superiority over the open technique. This is contrast to laparoscopic cholecystectomy which has promptly become the gold standard for gallstone disease despite little scientific challenge. This peculiarity might be because of the fact that the Open Appendectomy was used for centuries with good effect. The particular procedure withstood the test of time for more than a century since its introduction by McBurney unlike cholecystectomy. Open surgery is typically completed using a small right lower quadrant incision between the point joining the lateral one-third and medial two-third of a line drawn from anterior-superior iliac spine and the umbilicus. The postoperative recovery is usually uneventful. The overall mortality of OA is around 0.3% and morbidity about 11%. Despite numerous randomised trials, several meta-analysis and systematic critical reviews, the clear cut winner is unannounced. A sincere effort has been put to understand the different pros and cons of the two methods so that the patient can be benefited. METHODS One Hundred cases were studied in the Department of Surgery, King George Hospital, Visakhapatnam, Andhra Pradesh from 01-09-2015 to 29-02-2016. Out of these, fifty cases underwent open surgery and the rest through laparoscopic surgery. The first group (Open Surgery thus consisted of 50 cases and the second group (laparoscopic consisted of fifty

  2. Laparoscopic management of a twisted ovarian leiomyoma in a woman with 10 weeks' gestation: Case report and literature review.

    Science.gov (United States)

    Kim, Myounghwan

    2016-11-01

    Primary leiomyoma of the ovary is a rare benign ovarian tumor that only seldom causes acute abdomen. A 35-year-old gravida 1, para 0 woman presented with a history of acute lower abdominal pain, and 10 weeks of amenorrhea. The patient's physical examination revealed abdominal tenderness, defense, and rebound. On ultrasonographic examination, a solid mass measuring 9.3 × 7.8 cm was detected adjacent to the uterine fundus. The mass was preoperatively diagnosed as a twisted pedunculated subserosal uterine myoma. Upon entering the pelvic cavity, the mass in the right adnexa appeared twisted clockwise. Therefore, a laparoscopic salpingo-oophorectomy was performed. The tumor was pathologically diagnosed as ovarian leiomyoma. The patient delivered a healthy girl at 40 1/7 weeks of pregnancy. Despite its low incidence, torsion of ovarian leiomyoma should be considered in the differential diagnosis of acute abdomen. Furthermore, laparoscopic exploration should be the preferred way of removing twisted ovarian leiomyoma, even during pregnancy. It seems that primary ovarian leiomyomata have a tendency to grow rapidly during early pregnancy. However, because of the low incidence of ovarian leiomyoma, the effects of estrogen and pregnancy on this condition remain unclear.

  3. Situating Disability within Comparative Education: A Review of the Literature

    Science.gov (United States)

    Brown, Alisha M. B.

    2014-01-01

    This paper is an inquiry into where the topic of disability falls within the vast field of comparative education research. It explores the extent to which disability is present in comparative education literature, and in what ways it is represented. A review of literature across the core comparative education peer-reviewed journals was conducted.…

  4. Comparative review of bow shocks and magnetopauses

    International Nuclear Information System (INIS)

    Lepping, R.P.

    1984-04-01

    Bow shock and magnetopauses formation is discussed. Plasma and magnetic field environments of all the planets from Mercury to Saturn were measured. It was found that all the planets have bow shocks and almost all have a magnetopause. Venus is the only planet with no measurable intrinsic magnetic field and the solar wind interacts directly with Venus ionosphere. The bow shock characteristics depend on the changing solar wind conditions. The shape of a magnetopause or any obstacle to flow depends on the three dimensional pressure profile that it presents to the solar wind. Jupiter is unusual because of the considerable amount of plasma which is contained in its magnetosphere. Magentopause boundaries in ecliptic plane projection are modelled by segments of ellipses, matched to straight lines for the magnetotool boundaries or parabolas. Specific properties of known planetary bow shocks and magnetopauses are reviewed

  5. Laparoscopic Cholecystectomy in Chronic Calculus Cholecystitis

    Directory of Open Access Journals (Sweden)

    Prakash Sapkota

    2013-12-01

    Full Text Available Introduction: Laparoscopic cholecystectomy has clearly become the choice over open cholecystectomy in the treatment of hepatobiliary disease since its introduction by Mouret in 1987. This study evaluates a series of patients with chronic calculus cholecystitis who were treated with laparoscopic and open cholecystectomy and assesses the outcomes of both techniques. Objective: To evaluate the efficacy of laparoscopic vs open cholecystectomy in chronic calculus cholecystitis and establish the out-comes of this treatment modality at Lumbini Medical College and Teaching Hospital. Methods: This was a retrospective analysis over a one-year period (January 1, 2012 to December 31, 2012, per-formed by single surgeon at Lumbini Medical College and Teaching Hospital located midwest of Nepal. 166 patients underwent surgical treatment for chronic calculus cholecystitis. Patients included were only chronic calculus cholecystitis proven histopathologocally and the rest were excluded. Data was collected which included patients demographics, medical history, presentation, complications, conversion rates from laparoscopic. cholecystectomy to open cholecystectomy, operative and postoperative time. Results: Patients treated with laparoscopic cholecystectomy for chronic calculus cholecystitis had shorter operating times and length of stay compared to patients treated with open cholecystectomy for chronic calculus cholecystitis. Conversion rates were 3.54% in chronic calculus cholecystitis during the study period. Complications were also lower in patients who underwent laparoscopic cholecystectomy versus open cholecystectomy for cholelithiasis. Conclusions: Laparoscopic cholecystectomy appears to be a reliable, safe, and cost-effective treatment modality for chronic calculus cholecystitis.

  6. [Laparoscopic therapy of choledocholithiasis].

    Science.gov (United States)

    Rechner, J; Beller, S; Zerz, A; Szinicz, G

    1996-01-01

    The introduction of laparoscopic cholecystectomy has led to controversial discussions about the proceeding in case of coincident common bile duct stones. In our unit choledocholithiasis has been treated laparoscopically since November 1991. Basic requirement has been a routine intraoperative cholangiography. 67 patients with common bile duct stones were treated until January 1995. All patients underwent a follow up and the results were compared to other concepts. In 40 cases common bile duct stones were eliminated via cystic duct and in 27 cases by choledochotomy. The choledochus was drained routinely for postoperative x-ray control. In 9 cases we found residual concrements: 7 patients required postoperative endoscopic papillotomy and in 2 cases the calculi where eliminated with a dormia basket introduced via drainage tube. In one case surgical management was changed to laparotomy. Postoperative complications occurred in 8 cases. One patient suffering from bacterial peritonitis underwent laparotomy on the 9th postoperative day; one with bleeding from the cystic artery was treated by relaparoscopy. One patient developed a liver abscess and two patients a bilioma requiring ultrasound guided drainage. A superficial wound infection in one patient and a biliary leakage after removal of the drainage in two patients healed spontaneously. Due to an intact papilla with less stress to the patient, as well as a complication rate comparable with other published therapeutic concepts, this strategy can be recommended as a valuable alternative procedure.

  7. Gastroesophageal Reflux Management with the LINX® System for Gastroesophageal Reflux Disease Following Laparoscopic Sleeve Gastrectomy.

    Science.gov (United States)

    Desart, Kenneth; Rossidis, Georgios; Michel, Michael; Lux, Tamara; Ben-David, Kfir

    2015-10-01

    Laparoscopic sleeve gastrectomy (LSG) has gained significant popularity in the USA, and consequently resulted in patients experiencing new-onset gastroesophageal reflux disease (GERD) following this bariatric procedure. Patients with GERD refractory to medical therapy present a more challenging situation limiting the surgical options to further treat the de novo GERD symptoms since the gastric fundus to perform a fundoplication is no longer an option. The aim of this study is to determine if the LINX® magnetic sphincter augmentation system is a safe and effective option for patients with new gastroesophageal reflux disease following laparoscopic sleeve gastrectomy. This study was conducted at the University Medical Center. This is a retrospective review of seven consecutive patients who had a laparoscopic LINX® magnetic sphincter device placement for patients with refractory gastroesophageal reflux disease after laparoscopic sleeve gastrectomy between July 2014 and April 2015. All patients were noted to have self-reported greatly improved gastroesophageal reflux symptoms 2-4 weeks after their procedure. They were all noted to have statistically significant improved severity and frequency of their reflux, regurgitation, epigastric pain, sensation of fullness, dysphagia, and cough symptoms in their postoperative GERD symptoms compared with their preoperative evaluation. This is the first reported pilot case series, illustrating that the LINX® device is a safe and effective option in patients with de novo refractory gastroesophageal reflux disease after a laparoscopic sleeve gastrectomy despite appropriate weight loss.

  8. Operative outcomes of single-port-access laparoscopy-assisted vaginal hysterectomy compared with single-port-access total laparoscopic hysterectomy

    Directory of Open Access Journals (Sweden)

    Bo Sung Yoon

    2014-12-01

    Conclusion: SPA-TLH with laparoscopic vaginal suture required the longest operating time, and hemoglobin changes were smaller in the SPA-LAVH group than in the other groups. In patients undergoing SPA laparoscopy, we recommend the SPA-LAVH procedure.

  9. A COMPARATIVE STUDY OF 2 AGENTS, AIR AND DISTILLED WATER FOR INFLATION OF THE CUFFS OF ENDOTRACHEAL TUBES DURING LAPAROSCOPIC SURGICAL PROCEDURES UNDER GENERAL ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Sistla Gopala Krishna

    2016-03-01

    Full Text Available BACKGROUND & AIM During Nitrous Oxide+ Oxygen anaesthesia and during laparoscopic surgeries using carbon dioxide for creating pneumoperitoneum, if cuff of endotracheal tube is inflated with air, cuff pressure can rise to dangerous limits and it can produce ischemia of tracheal mucosa. Hence distilled water as an alternative agent to air for inflation of cuffs of endotracheal tubes was used for our study. Our aim is to investigate the difference in increase of intra-cuff pressure with time during laparoscopic surgical procedures under general endotracheal anaesthesia with Nitrous oxide+ Oxygen+ relaxant technique when cuffs of endotracheal tube were inflated by air & distilled water. METHODS Fifty patients (n=50 undergoing different laparoscopic surgical procedures under general endotracheal anaesthesia were randomly divided into 2 groups. In group A, air was used & in group D, distilled water was used to inflate the cuffs of endotracheal tubes. General anaesthesia was given with Nitrous oxide+ Oxygen+ relaxant technique. The intra-cuff pressures of endotracheal tube cuffs were recorded in the beginning and at the end of laparoscopic surgical procedures. Increase of pressures with time were recorded and analysed. RESULTS In group in whom we inflated the cuffs with air, there was a significant increase in intra-cuff pressures with time and there was definite diffusion of gases into the cuffs. Increase of pressure with time was statistically highly significant (P=0.00001. But in group in whom we used distilled water to inflate the cuffs, there was no change in the volume of water used for inflation and water came out of cuffs at the end of the laparoscopic surgical procedures. No additional air could be aspirated from the cuffs at the end of laparoscopic surgeries in distilled water group, indicating that there was no diffusion of gases into the cuffs or the gases diffused got dissolved in distilled water. Hence there was no increase of volume

  10. Hand-assisted laparoscopic splenectomy

    NARCIS (Netherlands)

    Bemelman, W. A.; de Wit, L. T.; Busch, O. R.; Gouma, D. J.

    2000-01-01

    Laparoscopic splenectomy is performed routinely in patients with small and moderately enlarged spleens at specialized centers. Large spleens are difficult to handle laparoscopically and hand-assisted laparoscopic splenectomy might facilitate the procedure through enhanced vascular control, easier

  11. Laparoscopic Diagnosis of Incarcerated “Spigelian Hernia”: Report of a Case and Review of the Literature

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    Sanoop Koshy Zachariah

    2011-01-01

    Full Text Available Spigelian hernias are rare hernias, representing only about 1-2% of all abdominal hernias. An accurate preoperative diagnosis of this condition is often difficult because the physical presence of these hernias is often not demonstrable owing to its peculiar anatomic location. Many patients with Spigelian hernias, therefore, may have no obvious findings on clinical examination. The diagnosis is even trickier in obese patients wherein the hernia sac may lie in an intraparietal plane, masked by the abdominal subcutaneous fat. Here we describe a case of incarcerated Spigelian hernia where clinical and radiological findings were inconsistent and the accurate diagnosis was made by laparoscopy and was followed by a laparoscopic-assisted repair using an open anterior approach with an onlay mesh. We therefore feel that laparoscopy can be a useful tool for confirming the diagnosis and also for performing a definitive repair in doubtful cases of Spigelian hernias.

  12. Porcine cadaver organ or virtual-reality simulation training for laparoscopic cholecystectomy: a randomized, controlled trial

    NARCIS (Netherlands)

    van Bruwaene, Siska; Schijven, Marlies P.; Napolitano, Daniel; de Win, Gunter; Miserez, Marc

    2015-01-01

    As conventional laparoscopic procedural training requires live animals or cadaver organs, virtual simulation seems an attractive alternative. Therefore, we compared the transfer of training for the laparoscopic cholecystectomy from porcine cadaver organs vs virtual simulation to surgery in a live

  13. Validity evidence for the Fundamentals of Laparoscopic Surgery (FLS) program as an assessment tool: a systematic review.

    Science.gov (United States)

    Zendejas, Benjamin; Ruparel, Raaj K; Cook, David A

    2016-02-01

    The Fundamentals of Laparoscopic Surgery (FLS) program uses five simulation stations (peg transfer, precision cutting, loop ligation, and suturing with extracorporeal and intracorporeal knot tying) to teach and assess laparoscopic surgery skills. We sought to summarize evidence regarding the validity of scores from the FLS assessment. We systematically searched for studies evaluating the FLS as an assessment tool (last search update February 26, 2013). We classified validity evidence using the currently standard validity framework (content, response process, internal structure, relations with other variables, and consequences). From a pool of 11,628 studies, we identified 23 studies reporting validity evidence for FLS scores. Studies involved residents (n = 19), practicing physicians (n = 17), and medical students (n = 8), in specialties of general (n = 17), gynecologic (n = 4), urologic (n = 1), and veterinary (n = 1) surgery. Evidence was most common in the form of relations with other variables (n = 22, most often expert-novice differences). Only three studies reported internal structure evidence (inter-rater or inter-station reliability), two studies reported content evidence (i.e., derivation of assessment elements), and three studies reported consequences evidence (definition of pass/fail thresholds). Evidence nearly always supported the validity of FLS total scores. However, the loop ligation task lacks discriminatory ability. Validity evidence confirms expected relations with other variables and acceptable inter-rater reliability, but other validity evidence is sparse. Given the high-stakes use of this assessment (required for board eligibility), we suggest that more validity evidence is required, especially to support its content (selection of tasks and scoring rubric) and the consequences (favorable and unfavorable impact) of assessment.

  14. Laparoscopically assisted vaginal radical trachelectomy

    International Nuclear Information System (INIS)

    Bielik, T.; Karovic, M.; Trska, R.

    2013-01-01

    Purpose: Radical trachelectomy is a fertility-sparing procedure with the aim to provide adequate oncological safety to patients with cervical cancer while preserving their fertility. The purpose of this study was to retrospectively evaluate, in a series of 3 patients, the feasibility, morbidity, and safety of laparoscopically assisted vaginal radical trachelectomy for early cervical cancer. Patients and Methods: Three non consecutive patients with FIGO stage IA1 and IB1 cervical cancer was evaluated in a period of years 2008 - 2011. The patients underwent a laparoscopic pelvic lymphadenectomy and radical parametrectomy class II procedure according to the Piver classification. The section of vaginal cuff, trachelectomy, permanent cerclage and isthmo-vaginal anastomosis ware realised by vaginal approach. Results: The median operative time, the median blood loss and the mean number of resected pelvic nodes was comparable with published data. Major intraoperative complications did not occur and no patient required a blood transfusion. The median follow-up time was 33 (38-59) months. One vaginal recurrence occurred in 7 months after primary surgery. The patient was underwent a radicalisation procedure and adjuvant oncologic therapy and now is free of disease. Conclusions: Laparoscopically assisted vaginal radical trachelectomy (LAVRT)may be an alternative in fertility-preserving surgery for early cervical cancer. The procedure offers patients potential benefits of minimally invasive surgery with adequate oncological safety, but it should be reserved for oncologic surgeons trained in advanced laparoscopic procedures. (author)

  15. Laparoscopic removal of autoamputated adnexa in infants and ...

    African Journals Online (AJOL)

    Objective The aim of this study was to describe a new case of autoamputated adnexa in a neonate treated with laparoscopy and to present a review of the literature as regards laparoscopic management of the autoamputated adnexa in neonates and infants. Summary background data Laparoscopic surgery has become an ...

  16. Laparoscopic diagnosis of endometriosis.

    Science.gov (United States)

    Wood, Carl; Kuhn, Raphael; Tsaltas, Jim

    2002-08-01

    To consider and explain the possibility of difficulties in diagnosis of endometriosis at previous laparoscopy Retrospective patient record review. The Endometriosis Care Centre of Australia and the private practices of authors. Two hundred and fifteen patients with clinical evidence of endometriosis examined laparoscopically between March 1999 and May 2001. Confirmation of endometriosis by histological biopsy. Endometriosis was confirmed in 168 of the 215 women. Of these women 38 had a previous negative laparoscopy within 12 months of the current laparoscopy. It is possible that in some of the patients, who previously had a negative laparoscopy, endometriosis was not recognised. Possible reasons for difficulty in diagnosis have been identified and techniques to improve diagnosis suggested. This retrospective study was performed to consider and explain the possibility of difficulties in diagnosis of endometriosis at previous laparoscopy.

  17. Physiologic Responses to Infrarenal Aortic Cross-Clamping during Laparoscopic or Conventional Vascular Surgery in Experimental Animal Model: Comparative Study

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    María F. Martín-Cancho

    2008-01-01

    Full Text Available The aim of this study was to compare the hemodynamic and ventilatory effects of prolonged infrarenal aortic cross-clamping in pigs undergoing either laparotomy or laparoscopy. 18 pigs were used for this study. Infrarenal aortic crossclamping was performed for 60 minutes in groups I (laparotomy, n=6 and II (laparoscopy, n=6. Group III (laparoscopy, n=6 underwent a 120-minute long pneumoperitoneum in absence of aortic clamping (sham group. Ventilatory and hemodynamic parameters and renal function were serially determined in all groups. A significant decrease in pH and significant increase in PaCO2 were observed in group II, whereas no changes in these parameters were seen in group I and III. All variables returned to values similar to baseline in groups I and II 60 minutes after declamping. A significant increase in renal resistive index was evidenced during laparoscopy, with significantly higher values seen in Group II. Thus a synergic effect of pneumoperitoneum and aortic cross-clamping was seen in this study. These two factors together cause decreased renal perfusion and acidosis, thus negatively affecting the patient's general state during this type of surgery.

  18. Proinflammatory cytokines in open versus laparoscopic cholecystectomy

    International Nuclear Information System (INIS)

    Abu-Eshy, Saeed A.; Al-Rofaidi, Abdallah A.; Al-Faki, Ahmed S.; Ghalib, Hashim W.; Moosa, Riyadh A.; Sadik, Ali A.; Salati, Mohammad I.

    2002-01-01

    Laparoscopic cholecystectomy, a minimal access surgery, is fast replacing open cholecystectomy and is being associated with less trauma. The objective of this study was to compare the proinflammatory cytokine levels in both laparoscopic cholecystectomy and open cholecystectomy. This study was carried out at Aseer Central Hospital, Aseer region, Abha Private Hospital and the College of Medicine and Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia, during the time period October 1998 through to November 2000. Sixty-one patients were included in the study, 27 of them had laparoscopic cholecystectomy and 34 had open cholecystectomy. Cytokines [Interleukin-6 Interleukin-1b, Tumor necrosis factor -a and Interleukin- 8] were measured in blood samples collected from the patients before, at and 24 hours post surgery, using commercially available kits. Interleukin-6 levels were significantly increased at 24 hours post surgery in the open cholecystectomy group of patients compared to the laparoscopic cholecystectomy group (P<0.04). No differences were found in the other cytokines levels (Interleukin-1b, tumor necrosis factor -a and Interleukin-8) between the open cholecystectomy and laparoscopic cholecystectomy groups. Laparoscopic cholecystectomy, a minimal access surgery, is associated with lower levels of the proinflammatory interleukin-6 cytokine compared to open cholecystectomy. (author)

  19. Laparoscopic Splenectomy in Hemodynamically Stable Blunt Trauma.

    Science.gov (United States)

    Huang, Gregory S; Chance, Elisha A; Hileman, Barbara M; Emerick, Eric S; Gianetti, Emily A

    2017-01-01

    No criteria define indications for laparoscopic splenectomy in trauma. This investigation compared characteristics of trauma patients and outcomes between laparoscopic and open splenectomies. Patients were identified retrospectively by using ICD-9 codes. Included patients were 18 or older, with a blunt splenic injury from January 1, 2011, through December 31, 2014, and required splenectomy. Excluded patients had penetrating trauma, successful nonoperative management, or successful embolization. Variables included demographics, presenting characteristics, injury severity scores, abdominal abbreviated injury scores, splenic injury grade, surgical indication and approach (open or laparoscopic), surgery length, intra-operative blood loss, transfusions, length of stay, complications, mortality, and discharge disposition. Forty-one patients underwent open splenectomy, and 11 underwent laparoscopic splenectomy. The mean age was 48.7 years, and men comprised the sample majority (36/52). The groups were well matched for age, abdominal injury scores, and admission vital signs. The open group had a significantly lower level of consciousness and more acidosis compared with the laparoscopic group. Most laparoscopic splenectomies were performed after failed nonoperative management or embolization. The indications for open splenectomy were a positive focused assessment with sonography for trauma and computed tomography results. Laparoscopic patients had significantly longer times between presentation and surgery and longer operations, but had significantly less blood loss and fewer transfusions compared with the open group. There were no differences in mortality, length of stay, complications, or discharge dispositions. Laparoscopic splenectomy is useful in patients with blunt trauma in whom conservative management produced no improvement and who do not have other injuries to preclude laparoscopy.

  20. Does playing video games improve laparoscopic skills?

    Science.gov (United States)

    Ou, Yanwen; McGlone, Emma Rose; Camm, Christian Fielder; Khan, Omar A

    2013-01-01

    A best evidence topic in surgery was written according to a structured protocol. The question addressed was whether playing video games improves surgical performance in laparoscopic procedures. Altogether 142 papers were found using the reported search, of which seven represented the best evidence to answer the clinical question. The details of the papers were tabulated including relevant outcomes and study weaknesses. We conclude that medical students and experienced laparoscopic surgeons with ongoing video game experience have superior laparoscopic skills for simulated tasks in terms of time to completion, improved efficiency and fewer errors when compared to non-gaming counterparts. There is some evidence that this may be due to better psycho-motor skills in gamers, however further research would be useful to demonstrate whether there is a direct transfer of skills from laparoscopic simulators to the operating table. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  1. Ergonomics in laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Supe Avinash

    2010-01-01

    Full Text Available Laparoscopic surgery provides patients with less painful surgery but is more demanding for the surgeon. The increased technological complexity and sometimes poorly adapted equipment have led to increased complaints of surgeon fatigue and discomfort during laparoscopic surgery. Ergonomic integration and suitable laparoscopic operating room environment are essential to improve efficiency, safety, and comfort for the operating team. Understanding ergonomics can not only make life of surgeon comfortable in the operating room but also reduce physical strains on surgeon.

  2. Laparoscopic Nephrectomy versus Open Nephrectomy for Patients with Autosomal Dominant Polycystic Kidney Disease: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Pengyu Guo

    Full Text Available To compare efficacy and safety of laparoscopicnephrectomy (LN versus open nephrectomy (ON in the management of autosomal dominant polycystic kidney disease (ADPKD, we conducted a systematic review and meta-analysis.A systematic search of the electronic databases PubMed, Scopus, and the Cochrane Library was performed up to October 2014. This systematic review was performed based on observational comparative studies that assessed the two techniques. The weighted mean difference (WMD and risk ratio (RR, with their corresponding 95% confidence interval (CI, were calculated to compare continuous and dichotomous variables, respectively.Seven studies were identified, including 195 cases (118 LN/77 ON. Although LN was associated with longer operative time (WMD 30.236, 95%CI 14.541 -45.932, P<0.001 and the specimen might not have been resected as heavy as the ON group (WMD -986.516, 95%CI -1883.24--89.795, P = 0.031, patients in this group might benefit from a shorter length of hospital stay (WMD -3.576, 95%CI 4.976--2.176, P <0.001, less estimated blood loss (WMD -180.245, 95%CI -317.939--42.556, P = 0.010, and lower need of transfusion (RR 0.345, 95%CI 0.183-0.650, P = 0.001. The LN group also had less overall complications (RR 0.545, 95%CI 0.329-0.903, P = 0.018. The need of narcotic analgesics between the two groups might have no significant difference (WMD -54.66, 95%CI -129.76-20.44, P = 0.154.LN for giant symptomatic ADPKD was feasible, safe and efficacious. Morbidity was significantly reduced compared with the open approach. For an experienced laparoscopist, LN might be a better alternative.

  3. Massive Splenomegaly in Children: Laparoscopic Versus Open Splenectomy

    OpenAIRE

    Hassan, Mohamed E.; Al Ali, Khalid

    2014-01-01

    Background and Objectives: Laparoscopic splenectomy for massive splenomegaly is still a controversial procedure as compared with open splenectomy. We aimed to compare the feasibility of laparoscopic splenectomy versus open splenectomy for massive splenomegaly from different surgical aspects in children. Methods: The data of children aged

  4. Surgical Outcomes After Open, Laparoscopic, and Robotic Gastrectomy for Gastric Cancer.

    Science.gov (United States)

    Yang, Seung Yoon; Roh, Kun Ho; Kim, You-Na; Cho, Minah; Lim, Seung Hyun; Son, Taeil; Hyung, Woo Jin; Kim, Hyoung-Il

    2017-07-01

    In contrast to the significant advantages of laparoscopic versus open gastrectomy, robotic gastrectomy has shown little benefit over laparoscopic gastrectomy. This study aimed to compare multi-dimensional aspects of surgical outcomes after open, laparoscopic, and robotic gastrectomy. Data from 915 gastric cancer patients who underwent gastrectomy by one surgeon between March 2009 and May 2015 were retrospectively reviewed. Perioperative parameters were analyzed for short-term outcomes. Surgical success was defined as the absence of conversion to open surgery, major complications, readmission, positive resection margin, or fewer than 16 retrieved lymph nodes. This study investigated 241 patients undergoing open gastrectomy, 511 patients undergoing laparoscopic gastrectomy, and 173 patients undergoing robotic gastrectomy. For each approach, the respective incidences were as follows: conversion to open surgery (not applicable, 0.4%, and 0%; p = 0.444), in-hospital major complications (5.8, 2.7, and 1.2%; p = 0.020), delayed complications requiring readmission (2.9, 2.0, and 1.2%; p = 0.453), positive resection margin (1.7, 0, and 0%; p = 0.003), and inadequate number of retrieved lymph nodes (0.4, 4.1, and 1.7%; p = 0.010). Compared with open and laparoscopic surgery, robotic gastrectomy had the highest surgical success rate (90, 90.8, and 96.0%). Learning-curve analysis of success using cumulative sum plots showed success with the robotic approach from the start. Multivariate analyses identified age, sex, and gastrectomy extent as significant independent parameters affecting surgical success. Surgical approach was not a contributing factor. Open, laparoscopic, and robotic gastrectomy exhibited different incidences and causes of surgical failure. Robotic gastrectomy produced the best surgical outcomes, although the approach method itself was not an independent factor for success.

  5. Analgesic Treatment in Laparoscopic Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Andersen, Lars P H; Werner, Mads U; Rosenberg, Jacob

    2014-01-01

    This review aimed to present an overview of the randomized controlled trials investigating analgesic regimens used in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Literature search was performed in PubMed and EMBASE databases in August 2013 in accordance to PRISMA guidelines. The litera......This review aimed to present an overview of the randomized controlled trials investigating analgesic regimens used in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Literature search was performed in PubMed and EMBASE databases in August 2013 in accordance to PRISMA guidelines...

  6. Value of laparoscopic appendectomy in the elderly patient.

    Science.gov (United States)

    Kirshtein, Boris; Perry, Zvi Howard; Mizrahi, Solly; Lantsberg, Leonid

    2009-05-01

    Acute appendicitis (AA) in elderly patients (60 years of age and older) is a challenging problem associated with significant morbidity and mortality when perforation is present. We hypothesized that laparoscopic appendectomy (LA) would enable an earlier correct diagnosis and have advantages in elderly patients. We performed a retrospective review of patients who underwent laparoscopic appendectomy for suspected AA. Data of elderly patients were compared to data of younger patients (18 to <60 years of age). Fifty-four LA were performed in elderly patients and 423 in younger patients. Patients over the age of 60 years had more co-morbidities and required more frequent use of anticoagulants. Preoperative imaging (ultrasound or computerized tomography) was significantly more frequent in elderly patients (36% versus 15%), and was associated with a higher rate of confirmation of acute appendicitis (78% versus 55%), which allowed a decrease in the rate of negative surgical explorations to 4.1% in elderly patients compared to 10.2% in younger patients. Complicated appendicitis and conversions were more frequent in the elderly patients. This resulted in prolonged operative time and longer hospital stay for this group. The overall complication rate was equivalent in the two groups, without differences in the occurrence either of infectious complications or of complications related to surgical site. There were no deaths following appendectomy in our series. Laparoscopic appendectomy is safe in the elderly population and is not associated with any increase in morbidity. The high incidence of complicated appendicitis in elderly patients affects operative time and length of hospital stay following laparoscopic appendectomy, and it can also lead to an increased rate of conversion to an open procedure. Use of preoperative abdominal computerized tomography scan is mandatory in elderly patients to provide an early diagnosis and to decrease unnecessary surgical exploration when acute

  7. Laparoscopic pyloromyotomy: redefining the advantages of a novel technique.

    Science.gov (United States)

    Caceres, Manuel; Liu, Donald

    2003-01-01

    With recent advances in minimally invasive techniques, many surgeons are favoring laparoscopic over traditional "open" pyloromyotomy for hypertrophic pyloric stenosis. The results of few studies, however, exist in the literature adequately comparing surgical outcome. We present a retrospective analysis of 56 consecutive patients who underwent laparoscopic or open pyloromyotomy. A retrospective chart review of 56 consecutive infants (ages: 2 to 9 weeks; weights: 2.2 to 5.4 kilograms) who underwent laparoscopic (Group A-28) vs open (Group B- 28) pyloromyotomy between January 2000 and May 2001 was performed. Preoperative (age, sex, weight, HCO3, and K values) and postoperative (operating time, time to full feedings, persistence of emesis, and hospital stay) parameters were compared. Statistical analysis was performed via the Student t test and chi-square/Fischer analysis where appropriate. A P value 0.05). In Group A, 26/28 (92.9%) were completed successfully with 2 open conversions. Group A versus Group B average operating times (36.1 vs 32.5 minutes), time to full feedings (24.1 vs 27.0 hours), and hospital stay (2.5 vs 2.6 days) were similar (P>0.05). Persistent vomiting was observed in Group A, 25.0% (day 1)/3.5% (day 2) vs Group B, 39.3% (day 1)/10.7% (day 2). One infant in Group B required operative drainage of a wound abscess 1 week after surgery. Laparoscopic pyloromyotomy can be performed with similar efficiency and surgical outcome as traditional open pyloromyotomy. Improved cosmesis and avoidance of wound complications are major benefits of this procedure, and a tendency towards less postoperative emesis is a potential benefit that deserves further investigation.

  8. Intracorporeal hybrid single port vs conventional laparoscopic appendectomy in children

    Directory of Open Access Journals (Sweden)

    Paul Anthony Karam

    2016-12-01

    Full Text Available Transumbilical laparoscopic assisted appendectomy combines laparoscopic single port dissection with open appendectomy after exteriorization of the appendix through the port site. Compared to the conventional three-port approach, this technique provides an alternative with excellent cosmetic outcome. We developed a safe and effective technique to perform an intracorporeal single port appendectomy, using the same laparoscope employed in the extracorporeal procedure. Retrospective review of 71 consecutively performed intracorporeal single port appendectomies and 30 conventional three-port appendectomies in children 6 to 17 years of age. A straight 10-mm Storz telescope with inbuilt 6 mm working channel is used to dissect the appendix, combined with one port-less 2.3 mm percutaneous grasper. Polymer WECK® hem-o-lock® clips are applied to seal the base of the appendix and the appendiceal vessels. No intraoperative complications were reported with the hybrid intracorporeal single port appendectomy or three-port appendectomy. There were two post-operative complications in the group treated with the single port hybrid technique: one intra-abdominal abscess and one surgical site infection. Groups did not differ in age, weight, and types of appendicitis. Operative times were shorter for the hybrid technique (70 vs 79 minutes but did not differ significantly (P=0.19. This modified technique to a previously described single port extracorporeal appendectomy is easy to master and implement. It provides exposure similar to a three-port laparoscopic appendectomy, while maintaining virtually scarless results and potentially reduces the risk for surgical site infections compared to the extracorporeal technique.

  9. Mesh complications and failure rates after transvaginal mesh repair compared with abdominal or laparoscopic sacrocolpopexy and to native tissue repair in treating apical prolapse.

    Science.gov (United States)

    Dandolu, Vani; Akiyama, Megumi; Allenback, Gayle; Pathak, Prathamesh

    2017-02-01

    Our objective was to quantitate the extent of complications and failure rate for apical prolapse repair with transvaginal mesh (TVM) use versus sacrocolpopexy over a minimum of 2 years of follow-up. Truven CCAE and Medicare Supplemental databases 2008-2013 were used for analysis. Patients with apical prolapse repair via transvaginal mesh (TVMR), abdominal sacrocolpopexy (ASCP), laparoscopic sacrocolpopexy (LSCP), or native tissue repair (NTR) and continuously enrolled for years were in the study cohort. Surgical failures were identified by reoperation for any prolapse or subsequent use of pessary. SAS® 9.3 was used for analysis. Mesh removal/revision was reported highest in TVMR (5.1 %), followed by LSCP (1.7 %) and ASCP (1.2 %). In those with concomitant sling, combined rates for mesh/sling revision were high, at 9.0 % in TVMR + sling, 5.6 % in ASCP + sling, and 4.5 % LSCP + sling. Sling-alone cases reported a 3.5 % revision rate. Pelvic pain (16.4-22.7 %) and dyspareunia (5.6-7.5 %) were high in all three approaches for apical prolapse repairs. Reoperation for apical prolapse was more common for TVMR (2.9 %) compared with NTR (2.3 %) [odds ratio (OR) 1.27; confidence interval (CI) 1.1-1.47; p 0.002]. Both ASCP and LSCP were superior to NTR (ASCP 1.5 %, OR 0.63, CI 0.46-0.86; p 0.003) and LSCP 1.8 % (OR 0.79, CI 0.62-1.01; p 0.07). Overall prolapse recurrence, as indicated by any compartment surgery for prolapse and/or pessary use, was also noted highest in TVMR (5.9 % OR 1.23, CI 1.11-1.36; p mesh is used for repair, mesh revision is highest with TVMR and lowest with ASCP.

  10. EU and OECD benchmarking and peer review compared

    NARCIS (Netherlands)

    Groenendijk, Nico

    2009-01-01

    Benchmarking and peer review are essential elements of the so-called EU open method of coordination (OMC) which has been contested in the literature for lack of effectiveness. In this paper we compare benchmarking and peer review procedures as used by the EU with those used by the OECD. Different

  11. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions

    Science.gov (United States)

    Rodríguez-Sanjuán, Juan C; Gómez-Ruiz, Marcos; Trugeda-Carrera, Soledad; Manuel-Palazuelos, Carlos; López-Useros, Antonio; Gómez-Fleitas, Manuel

    2016-01-01

    Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen’s fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated. PMID:26877605

  12. Sleep after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

    Rosenberg-Adamsen, S; Skarbye, M; Wildschiødtz, G

    1996-01-01

    .01). SWS was absent in four of the patients after operation, whereas in six patients it was within the normal range (5-20% of the night). The proportion of rapid eye movement (REM) sleep was not significantly changed after operation. There were no changes in arterial oxygen saturation on the postoperative...... compared with the preoperative night. Comparison of our results with previous studies on SWS and REM sleep disturbances after open laparotomy, suggests that the magnitude of surgery or administration of opioids, or both, may be important factors in the development of postoperative sleep disturbances.......The sleep pattern and oxygenation of 10 patients undergoing laparoscopic cholecystectomy were studied on the night before operation and the first night after operation. Operations were performed during general anaesthesia and postoperative analgesia was achieved without the administration...

  13. Laparoscopic ovariectomy in rabbits

    Directory of Open Access Journals (Sweden)

    M. S. Al-Badrany

    2009-01-01

    Full Text Available A comparative evaluation of three different techniques of laparoscopic ovariectomy was carried out in 33 healthy female in rabbits, which included resection and removal of ovary after clip application, electrocautery of the ovary, then resection, and pulling ovary outside abdomen, ligation by silk, then ovary was removed. The ovaries and associated structures were better visualized by laparoscopy and all three techniques were carried out perfectly. All rabbits after operation were healthy and they were monitored for one month after operation. However, 3 of them died after operation, two of them died due to bleeding and the other of them died due to unknown causes. General anesthesia by using ketamine-xylazine i.m., was suitable for this technique, and the anesthesia provided good analgesia and good muscle relaxation. CO2 was used to establish pneumoperitoneum. In conclusion, resection and removal of the ovaries after clip application technique was found superior to the other two techniques.

  14. A prospective, randomized, double blind and placebo-control study comparing the additive effect of oral midazolam and clonidine for postoperative nausea and vomiting prophylaxis in granisetron premedicated patients undergoing laparoscopic cholecystecomy

    Directory of Open Access Journals (Sweden)

    Ghanshyam Yadav

    2013-01-01

    Full Text Available Background: Reduction of postoperative nausea and vomiting (PONV continues to be a major challenge in perioperative care in spite of introduction of newer antiemetics with better efficacy and safety profiles. Therefore, we evaluated the additive effect of oral midazolam and clonidine for PONV prophylaxis in granisetron premedicated patients undergoing laparoscopic cholecystectomy. Materials and Methods: In a prospective, randomized fashion, 120 selected cases were randomized into three groups: I, II or III to receive a tablet of midazolam (15 mg, n = 36, clonidine (150 mcg, n = 40, or glucose as placebo (5 g, n = 44 orally, 1 h before anesthesia. Occurrence of PONV along with need for rescue antiemetic during the first postoperative day was compared between groups as a primary outcome. Results: Episodes of PONV reduced significantly in Group II (15% as compared to group I and III (22.2%, 59% at various time points during the period of observation (P = 0.002. Need for rescue antiemetic was significantly lower in group I (13.88% and II (5% as compared to group III (52.27%, P < 0.001. Conclusion: Oral clonidine is better adjuvant for PONV prophylaxis, as compared to midazolam, in granisetron premedicated patients undergoing laparoscopic cholecystectomy.

  15. Initial experience with transperitoneal laparoscopic nephrectomy in an Irish hospital setting.

    LENUS (Irish Health Repository)

    Forde, J C

    2009-08-01

    Laparoscopic nephrectomy has gained widespread acceptance as a treatment for both benign and malignant conditions and is becoming increasingly popular in Irish hospitals. We report a single surgeon, single centre experience with 20 consecutive laparoscopic nephrectomies comparing them to 20 open cases performed prior to the establishment of a laparoscopic service.

  16. Elective laparoscopic recto-sigmoid resection for diverticular disease is suitable as a training operation

    OpenAIRE

    Bosker, Robbert; Hoogenboom, Froukje; Groen, Henk; Hoff, Christiaan; Ploeg, Rutger; Pierie, Jean-Pierre

    2010-01-01

    Purpose Some authors state that elective laparoscopic recto-sigmoid resection is more difficult for diverticular disease as compared with malignancy. For this reason, starting laparoscopic surgeons might avoid diverticulitis, making the implementation phase unnecessary long. The aim of this study was to determine whether laparoscopic resection for diverticular disease should be included during the implementation phase. Methods All consecutive patients who underwent an elective laparoscopic re...

  17. Complications of laparoscopic hysterectomy: the Monash experience.

    Science.gov (United States)

    Tsaltas, J; Lawrence, A; Michael, M; Pearce, S

    2002-08-01

    A retrospective review of medical records was performed to assess the incidence and type of significant complications encountered during laparoscopic hysterectomy Two hundred and sixty-five consecutive patients were reviewed between the years 1994 and August 2001. Two hundred and thirty-two laparoscopic vaginal hysterectomies and 33 total laparoscopic hysterectomies were performed. The operations were performed at Monash Medical Centre, a Melbourne tertiary public hospital, and two Melbourne private hospitals, by three surgeons. Ten significant complications occurred. There were two cases of ureteric fistula, two bladder injuries, two bowel obstructions, two postoperative haematomas, one case of a bladder fistula and one superficial epigastric artery injury. In-patient stay ranged from two to six days. Our complication and in-patient stay rates are consistent with previously reported rates.

  18. Resource savings and outcomes associated with outpatient laparoscopic appendectomy for nonperforated appendicitis.

    Science.gov (United States)

    Gurien, Lori A; Burford, Jeffrey M; Bonasso, Patrick C; Dassinger, Melvin S

    2017-11-01

    Postoperative admission for acute appendicitis utilizes health care system resources. We evaluated outcomes and hospital charges for children with nonperforated appendicitis who underwent outpatient laparoscopic appendectomy. A retrospective chart review was performed for patients ≤18years old who underwent laparoscopic appendectomy for acute appendicitis in 2015. Patients were categorized into discharge from postanesthesia care unit (PACU) (outpatient), admission for 24-h. Continuous variables were compared using analysis of variance and categorical variables were compared using chi-square test, with p24-h. There were no differences in postoperative emergency department/clinic visits, complications, or readmissions. Hospital charges for admission 24-h were $1007 and $2237 more per patient than the PACU-discharge group, respectively. Outpatient laparoscopic appendectomies became more common over time, occurring in only 20% of patients with acute appendicitis in the first quarter of the year versus 49% of patients in the last quarter. Outpatient laparoscopic appendectomy for nonperforated appendicitis in children is a safe practice that decreases length of stay and hospital charges. Adoption of an outpatient strategy allows for better standardization of care and can lead to savings in health care resources. III (Treatment: retrospective comparative study). Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Transversus abdominis plane (TAP) block in laparoscopic colorectal surgery improves postoperative pain management: a meta-analysis.

    Science.gov (United States)

    Hain, E; Maggiori, L; Prost À la Denise, J; Panis, Y

    2018-04-01

    Transversus abdominis plane (TAP) block is a locoregional anaesthesia technique of growing interest in abdominal surgery. However, its efficacy following laparoscopic colorectal surgery is still debated. This meta-analysis aimed to assess the efficacy of TAP block after laparoscopic colorectal surgery. All comparative studies focusing on TAP block after laparoscopic colorectal surgery have been systematically identified through the MEDLINE database, reviewed and included. Meta-analysis was performed according to the Mantel-Haenszel method for random effects. End-points included postoperative opioid consumption, morbidity, time to first bowel movement and length of hospital stay. A total of 13 studies, including 7 randomized controlled trials, were included, comprising a total of 600 patients who underwent laparoscopic colorectal surgery with TAP block, compared with 762 patients without TAP block. Meta-analysis of these studies showed that TAP block was associated with a significantly reduced postoperative opioid consumption on the first day after surgery [weighted mean difference (WMD) -14.54 (-25.14; -3.94); P = 0.007] and a significantly shorter time to first bowel movement [WMD -0.53 (-0.61; -0.44); P plane (TAP) block in laparoscopic colorectal surgery improves postoperative opioid consumption and recovery of postoperative digestive function without any significant drawback. Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland.

  20. Book review: Advanced Introduction to Comparative Constitutional Law.

    Directory of Open Access Journals (Sweden)

    Ainhoa Martinez

    2016-12-01

    Full Text Available Tushnet presents a thoughtful introduction to the field of comparative constitutional law through a review of recent literature and an analysis of the key contemporary issues in constitutional design and structure. In the following lines a review of his book is presented.Book review of Mark Tushnet. Advanced Introduction to Comparative Constitutional Law. Cheltenham; Northampton: Edward Elgar Publishing, 2014. ISBN (Hb 978 1 78100 731 0 £58.50, ISBN (Pb 978 1 78347 351 9 £12.76.DOWNLOAD THIS PAPER FROM SSRN: https://ssrn.com/abstract=2887014

  1. Fewer-than-four ports versus four ports for laparoscopic cholecystectomy.

    Science.gov (United States)

    Gurusamy, Kurinchi Selvan; Vaughan, Jessica; Rossi, Michele; Davidson, Brian R

    2014-02-20

    Traditionally, laparoscopic cholecystectomy is performed using two 10-mm ports and two 5-mm ports. Recently, a reduction in the number of ports has been suggested as a modification of the standard technique with a view to decreasing pain and improving cosmesis. The safety and effectiveness of using fewer-than-four ports has not yet been established. To assess the benefits (such as improvement in cosmesis and earlier return to activity) and harms (such as increased complications) of using fewer-than-four ports (fewer-than-four-ports laparoscopic cholecystectomy) versus four ports in people undergoing laparoscopic cholecystectomy for any reason (symptomatic gallstones, acalculous cholecystitis, gallbladder polyp, or any other condition). We searched the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 8, 2013), MEDLINE, EMBASE, Science Citation Index Expanded, and the World Health Organization International Clinical Trials Registry Platform portal to September 2013. We included all randomised clinical trials comparing fewer-than-four ports versus four ports, that is, with standard laparoscopic cholecystectomy that is performed with two ports of at least 10-mm incision and two ports of at least 5-mm incision. Two review authors independently identified the trials and extracted the data. We analysed the data using both the fixed-effect and the random-effects models. For each outcome, we calculated the risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) based on intention-to-treat analysis, whenever possible. We found nine trials with 855 participants that randomised participants to fewer-than-four-ports laparoscopic cholecystectomy (n = 427) versus four-port laparoscopic cholecystectomy (n = 428). Most trials included low anaesthetic risk participants undergoing elective laparoscopic cholecystectomy. Seven of the nine trials used a single port laparoscopic cholecystectomy and the remaining two trials used three-port laparoscopic

  2. Health-related quality of life after laparoscopic and open surgery for rectal cancer in a randomized trial

    DEFF Research Database (Denmark)

    Andersson, J; Angenete, E; Gellerstedt, M

    2013-01-01

    Previous studies comparing laparoscopic and open surgical techniques have reported improved health-related quality of life (HRQL). This analysis compared HRQL 12¿months after laparoscopic versus open surgery for rectal cancer in a subset of a randomized trial.......Previous studies comparing laparoscopic and open surgical techniques have reported improved health-related quality of life (HRQL). This analysis compared HRQL 12¿months after laparoscopic versus open surgery for rectal cancer in a subset of a randomized trial....

  3. Laparoscopic adhesiolysis: consensus conference guidelines.

    Science.gov (United States)

    Vettoretto, N; Carrara, A; Corradi, A; De Vivo, G; Lazzaro, L; Ricciardelli, L; Agresta, F; Amodio, C; Bergamini, C; Borzellino, G; Catani, M; Cavaliere, D; Cirocchi, R; Gemini, S; Mirabella, A; Palasciano, N; Piazza, D; Piccoli, M; Rigamonti, M; Scatizzi, M; Tamborrino, E; Zago, M

    2012-05-01

    Laparoscopic adhesiolysis has been demonstrated to be technically feasible in small bowel obstruction and carries advantages in terms of post-surgical course. The increasing dissemination of laparoscopic surgery in the emergency setting and the lack of concrete evidence in the literature have called for a consensus conference to draw recommendations for clinical practice. A literature search was used to outline the evidence, and a consensus conference was held between experts in the field. A survey of international experts added expertise to the debate. A public jury of surgeons discussed and validated the statements, and the entire process was reviewed by three external experts. Recommendations concern the diagnostic evaluation, the timing of the operation, the selection of patients, the induction of the pneumoperitoneum, the removal of the cause of obstructions, the criteria for conversion, the use of adhesion-preventing agents, the need for high-technology dissection instruments and behaviour in the case of misdiagnosed hernia or the need for bowel resection. Evidence of this kind of surgery is scanty because of the absence of randomized controlled trials. Nevertheless laparoscopic skills in emergency are widespread. The recommendations given with the consensus process might be a useful tool in the hands of surgeons. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

  4. Comparison of anaesthetic cost in open and laparoscopic ...

    African Journals Online (AJOL)

    Context: Appendectomy is generally conducted as open or by laparoscopic surgical techniques under general anesthesia. Aims: This study aims to compare the anesthetic costs of the patients, who underwent open or laparoscopic appendectomy under general anesthesia. Settings and Design: The design is retrospective ...

  5. Short-term outcomes following laparoscopic resection for colon cancer.

    LENUS (Irish Health Repository)

    Kavanagh, Dara O

    2011-03-01

    Laparoscopic resection for colon cancer has been proven to have a similar oncological efficacy compared to open resection. Despite this, it is performed by a minority of colorectal surgeons. The aim of our study was to evaluate the short-term clinical, oncological and survival outcomes in all patients undergoing laparoscopic resection for colon cancer.

  6. Book Review: Comparative Education Research: Approaches and Methods

    Directory of Open Access Journals (Sweden)

    Noel Mcginn

    2014-10-01

    Full Text Available Book Review Comparative Education Research: Approaches and Methods (2nd edition By Mark Bray, Bob Adamson and Mark Mason (Eds. (2014, 453p ISBN: 978-988-17852-8-2, Hong Kong: Comparative Education Research Centre and Springer

  7. Laparoscopic splenic hilar lymphadenectomy for advanced gastric cancer.

    Science.gov (United States)

    Hosogi, Hisahiro; Okabe, Hiroshi; Shinohara, Hisashi; Tsunoda, Shigeru; Hisamori, Shigeo; Sakai, Yoshiharu

    2016-01-01

    Laparoscopic distal gastrectomy has recently become accepted as a surgical option for early gastric cancer in the distal stomach, but laparoscopic total gastrectomy (LTG) has not become widespread because of technical difficulties of esophagojejunal anastomosis and splenic hilar lymphadenectomy. Splenic hilar lymphadenectomy should be employed in the treatment of advanced proximal gastric cancer to complete D2 dissection, but laparoscopically it is technically difficult even for skilled surgeons. Based on the evidence that prophylactic combined resection of spleen in total gastrectomy increased the risk of postoperative morbidity with no survival impact, surgeons have preferred laparoscopic spleen-preserving splenic hilar lymphadenectomy (LSPL) for advanced tumors without metastasis to splenic hilar nodes or invasion to the greater curvature of the stomach, and reports with LSPL have been increasing rather than LTG with splenectomy. In this paper, recent reports with laparoscopic splenic hilar lymphadenectomy were reviewed.

  8. Laparoscopic repair of high rectovaginal fistula: Is it technically feasible?

    Directory of Open Access Journals (Sweden)

    Parthasarathi Ramakrishnan

    2005-10-01

    Full Text Available Abstract Background Rectovaginal fistula (RVF is an epithelium-lined communication between the rectum and vagina. Most RVFs are acquired, the most common cause being obstetric trauma. Most of the high RVFs are repaired by conventional open surgery. Laparoscopic repair of RVF is rare and so far only one report is available in the literature. Methods We present a case of high RVF repaired by laparoscopy. 56-year-old female who had a high RVF following laparoscopic assisted vaginal hysterectomy was successfully operated laparoscopically. Here we describe the operative technique and briefly review the literature. Results The postoperative period of the patient was uneventful and after a follow up of 6 months no recurrence was found. Conclusion Laparoscopic repair of high RVF is feasible in selected patients but would require proper identification of tissue planes and good laparoscopic suturing technique.

  9. Secrets of safe laparoscopic surgery: Anaesthetic and surgical considerations

    Directory of Open Access Journals (Sweden)

    Srivastava Arati

    2010-01-01

    Full Text Available In recent years, laparoscopic surgery has gained popularity in clinical practice. The key element in laparoscopic surgery is creation of pneumoperitoneum and carbon dioxide is commonly used for insufflation. This pneumoperitoneum perils the normal cardiopulmonary system to a considerable extent. Every laparoscopic surgeon should understand the consequences of pneumoperitoneum; so that its untoward effects can be averted. Pneumoperitoneum increases pressure on diaphragm, leading to its cephalic displacement and thereby decreasing venous return, which can be aggravated by the position of patient during surgery. There is no absolute contraindication of laparoscopic surgery, though we can anticipate some problems in conditions like obesity, pregnancy and previous abdominal surgery. This review discusses some aspects of the pathophysiology of carbon dioxide induced pneumoperitoneum, its consequences as well as strategies to counteract them. Also, we propose certain guidelines for safe laparoscopic surgery.

  10. A Comparison of Robotic Versus Laparoscopic Adrenalectomy in Patients With Primary Hyperaldosteronism.

    Science.gov (United States)

    Colvin, Jennifer; Krishnamurthy, Vikram; Jin, Judy; Shin, Joyce; Siperstein, Allan; Berber, Eren

    2017-10-01

    Over the last decade, robotic approaches have been described for removing adrenal tumors. Although there are reports comparing robotic and laparoscopic techniques in general, there are limited data on outcomes in patients with primary hyperaldosteronism (PHA). The aim of this study is to compare the safety and efficacy of robotic adrenalectomy (RA) versus laparoscopic adrenalectomy (LA) for PHA. The records of 20 patients who underwent RA for PHA were compared with 16 patients who underwent LA between 2000 and 2014. Data were retrospectively reviewed from a prospectively maintained, IRB-approved adrenal database. Statistical analysis was performed using t test and the Fisher exact analysis. Continuous variables are reported as mean±SEM. Demographic and clinical parameters were similar between the groups. There were no conversions to open in either group. Estimated blood loss, length of stay, and complication rates were comparable. Operative time was shorter in the robotic versus laparoscopic group (130±8.94 vs. 159±11.1 min, P=0.0487). In follow-up, the improvement in patients' blood pressure after adrenalectomy, as assessed by the reduction in the number of antihypertensive medications, was similar between the 2 groups. However, 1 patient in the RA and 1 patient in the LA group were not cured, as determined by postoperative aldosterone:renin levels. The biochemical cure rate between the groups was similar (P=0.529). To our knowledge, this is the first study comparing robotic versus laparoscopic resection of PHA. Our results show that the robotic approach was similar to laparoscopic regarding safety and efficacy. Operative time was shorter with the robotic approach, which could be related to more efficient dissection with wristed instrumentation.

  11. Efficacy and Safety of the Over-the-Scope Clip (OTSC) System in the Management of Leak and Fistula After Laparoscopic Sleeve Gastrectomy: a Systematic Review.

    Science.gov (United States)

    Shoar, Saeed; Poliakin, Lauren; Khorgami, Zhamak; Rubenstein, Rebecca; El-Matbouly, Moamena; Levin, Jun L; Saber, Alan A

    2017-09-01

    Endoscopic management of leaks/fistulas after laparoscopic sleeve gastrectomy (LSG) is gaining popularity in the bariatric surgery. This study aimed to review the efficacy and safety of over-the-scope-clip (OTSC) system in endoscopic closure of post-LSG leak/fistula. PubMed/Medline and major journals of the field were systematically reviewed for studies on endoscopic closure of post-LSG leaks/fistula by means of the OTSC system. A total of ten eligible studies including 195 patients with post-LSG leaks/fistula were identified. The time between LSG and leak/fistula ranged from 1 day to 803 days. Most of the leaks/fistula were located at the proximal staple line, and they sized from 3 to 20 mm. Time between leak diagnosis and OTSC clipping ranged from 0 to 271 days. Thirty-three out of 53 patients (63.5%) required one clip for closure of the lesion. Regarding the OTSC-related complications, a leak occurred in five patients (9.3%) and OTSC migration, stenosis, and tear each in one patient (1.8%). Of the 73 patients with post-LSG leak treated with OTSC, 63 patients had an overall successful closure (86.3%). OTSC system is a promising endoscopic approach for management of post-LSG leaks in appropriately selected patients. Unfortunately, most studies are series with a small sample size, short-term follow-up, and mixed data of concomitant procedures with OTSC. Further studies should distinguish the net efficacy of the OTSC system from other concomitant procedures in treatment of post-LSG leak.

  12. Laparoscopic repair of strangulated Morgagni hernia

    Directory of Open Access Journals (Sweden)

    Kelly Michael D

    2007-10-01

    Full Text Available Abstract A 73 year old man presented with vomiting and pain due to a strangulated Morgagni hernia containing a gastric volvulus. Laparoscopic operation allowed reduction of the contents, excision of necrotic omentum and the sac, with mesh closure of the large defect. A brief review of the condition is presented along with discussion of the technique used.

  13. Laparoscopic ureteral reimplantation with Boari flap for the management of long- segment ureteral defect: A case series with review of the literature.

    Science.gov (United States)

    Bansal, Ankur; Sinha, Rahul Janak; Jhanwar, Ankur; Prakash, Gaurav; Purkait, Bimalesh; Singh, Vishwajeet

    2017-09-01

    The incidence of ureteral stricture is showing a rising trend due to increased use of laparoscopic and upper urinary tract endoscopic procedures. Boari flap is the preferred method of repairing long- segment ureteral defects of 8-12 cm. The procedure has undergone change from classical open (transperitoneal and retroperitoneal) method to laparoscopic surgery and recently robotic surgery. Laparoscopic approach is cosmetically appealing, less morbid and with shorter hospital stay. In this case series, we report our experience of performing laparoscopic ureteral reimplantation with Boari flap in 3 patients. This prospective study was conducted between January 2011 December 2014. The patients with a long- segment ureteral defect who had undergone laparoscopic Boari flap reconstruction were included in the study. Outcome of laparoscopic ureteral reimplantation with Boari flap for the manangement of long segment ureteral defect was evaluated. The procedure was performed on 3 patients, and male to female ratio was 1:2. One patient had bilateral and other two patient had left ureteral stricture. The mean length of ureteral stricture was 8.6 cm (range 8.2-9.2 cm). The mean operative time was 206 min (190 to 220 min). The average estimated blood loss was 100 mL (range 90-110 mL) and mean hospital stay was 6 days (range 5 to 7 days). The mean follow up was 19 months (range 17-22 months). None of the patients experienced any complication related to the procedure in perioperative period. Laparoscopic ureteral reimplantation with Boari flap is safe, feasible and has excellent long term results. However, the procedure is technically challenging, requires extensive experience of intracorporeal suturing.

  14. Internal hernia following laparoscopic colorectal surgery

    DEFF Research Database (Denmark)

    Svraka, Melina; Wilhelmsen, Michał; Bulut, Orhan

    2017-01-01

    Although internal hernias are rare complications of laparoscopic colorectal surgery, they can lead to serious outcomes and are associated with a high mortality of up 20 %. AIM OF THE STUDY: The aim of this study was to describe our experience regarding internal herniation following laparoscopic...... colorectal surgery. MATERIALS AND METHODS: From 2009 to 2015, more than 1,093 laparoscopic colorectal procedures were performed, and 6 patients developed internal herniation. Data were obtained from patients' charts and reviewed retrospectively. Perioperative course and outcomes were analyzed. RESULTS: All...... patients were previously operated due to colorectal cancer. Two patients presented with ischemia at laparotomy, and 2 had endoscopic examinations before surgery. One patient was diagnosed with cancer on screening colonoscopy. One patient died after laparotomy. CONCLUSION: Internal herniation that develops...

  15. Laparoscopic pancreatectomy: Indications and outcomes

    Science.gov (United States)

    Liang, Shuyin; Hameed, Usmaan; Jayaraman, Shiva

    2014-01-01

    The application of minimally invasive approaches to pancreatic resection for benign and malignant diseases has been growing in the last two decades. Studies have demonstrated that laparoscopic distal pancreatectomy (LDP) is feasible and safe, and many of them show that compared to open distal pancreatectomy, LDP has decreased blood loss and length of hospital stay, and equivalent post-operative complication rates and short-term oncologic outcomes. LDP is becoming the procedure of choice for benign or small low-grade malignant lesions in the distal pancreas. Minimally invasive pancreaticoduodenectomy (MIPD) has not yet been widely adopted. There is no clear evidence in favor of MIPD over open pancreaticoduodenectomy in operative time, blood loss, length of stay or rate of complications. Robotic surgery has recently been applied to pancreatectomy, and many of the advantages of laparoscopy over open surgery have been observed in robotic surgery. Laparoscopic enucleation is considered safe for patients with small, benign or low-grade malignant lesions of the pancreas that is amenable to parenchyma-preserving procedure. As surgeons’ experience with advanced laparoscopic and robotic skills has been growing around the world, new innovations and breakthrough in minimally invasive pancreatic procedures will evolve. PMID:25339811

  16. The benefits of being a video gamer in laparoscopic surgery.

    Science.gov (United States)

    Sammut, Matthew; Sammut, Mark; Andrejevic, Predrag

    2017-09-01

    Video games are mainly considered to be of entertainment value in our society. Laparoscopic surgery and video games are activities similarly requiring eye-hand and visual-spatial skills. Previous studies have not conclusively shown a positive correlation between video game experience and improved ability to accomplish visual-spatial tasks in laparoscopic surgery. This study was an attempt to investigate this relationship. The aim of the study was to investigate whether previous video gaming experience affects the baseline performance on a laparoscopic simulator trainer. Newly qualified medical officers with minimal experience in laparoscopic surgery were invited to participate in the study and assigned to the following groups: gamers (n = 20) and non-gamers (n = 20). Analysis included participants' demographic data and baseline video gaming experience. Laparoscopic skills were assessed using a laparoscopic simulator trainer. There were no significant demographic differences between the two groups. Each participant performed three laparoscopic tasks and mean scores between the two groups were compared. The gamer group had statistically significant better results in maintaining the laparoscopic camera horizon ± 15° (p value = 0.009), in the complex ball manipulation accuracy rates (p value = 0.024) and completed the complex laparoscopic simulator task in a significantly shorter time period (p value = 0.001). Although prior video gaming experience correlated with better results, there were no significant differences for camera accuracy rates (p value = 0.074) and in a two-handed laparoscopic exercise task accuracy rates (p value = 0.092). The results show that previous video-gaming experience improved the baseline performance in laparoscopic simulator skills. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  17. Laparoscopic Lavage vs Primary Resection for Acute Perforated Diverticulitis: The SCANDIV Randomized Clinical Trial.

    Science.gov (United States)

    Schultz, Johannes Kurt; Yaqub, Sheraz; Wallon, Conny; Blecic, Ljiljana; Forsmo, Håvard Mjørud; Folkesson, Joakim; Buchwald, Pamela; Körner, Hartwig; Dahl, Fredrik A; Øresland, Tom

    2015-10-06

    Perforated colonic diverticulitis usually requires surgical resection, which is associated with significant morbidity. Cohort studies have suggested that laparoscopic lavage may treat perforated diverticulitis with less morbidity than resection procedures. To compare the outcomes from laparoscopic lavage with those for colon resection for perforated diverticulitis. Multicenter, randomized clinical superiority trial recruiting participants from 21 centers in Sweden and Norway from February 2010 to June 2014. The last patient follow-up was in December 2014 and final review and verification of the medical records was assessed in March 2015. Patients with suspected perforated diverticulitis, a clinical indication for emergency surgery, and free air on an abdominal computed tomography scan were eligible. Of 509 patients screened, 415 were eligible and 199 were enrolled. Patients were assigned to undergo laparoscopic peritoneal lavage (n = 101) or colon resection (n = 98) based on a computer-generated, center-stratified block randomization. All patients with fecal peritonitis (15 patients in the laparoscopic peritoneal lavage group vs 13 in the colon resection group) underwent colon resection. Patients with a pathology requiring treatment beyond that necessary for perforated diverticulitis (12 in the laparoscopic lavage group vs 13 in the colon resection group) were also excluded from the protocol operations and treated as required for the pathology encountered. The primary outcome was severe postoperative complications (Clavien-Dindo score >IIIa) within 90 days. Secondary outcomes included other postoperative complications, reoperations, length of operating time, length of postoperative hospital stay, and quality of life. The primary outcome was observed in 31 of 101 patients (30.7%) in the laparoscopic lavage group and 25 of 96 patients (26.0%) in the colon resection group (difference, 4.7% [95% CI, -7.9% to 17.0%]; P = .53). Mortality at 90 days did not

  18. The benefits of a laparoscopic approach in ileal pouch anal anastomosis formation: a single institutional retrospective case-matched experience.

    LENUS (Irish Health Repository)

    Kelly, J

    2010-06-01

    A laparoscopic approach to ileoanal pouch formation is novel. By using prospectively gathered data, laparoscopic and open restorative proctocolectomy procedures in mucosal ulcerative colitis (UC) and familial adenomatous polyposis (FAP) patients were compared using a case-matched design.

  19. Laparoscopic use of laser and monopolar electrocautery

    Science.gov (United States)

    Hunter, John G.

    1991-07-01

    Most general surgeons are familiar with monopolar electrocautery, but few are equally comfortable with laser dissection and coagulation. At courses across the country, surgeons are being introduced to laparoscopy and laser use in one and two day courses, and are certified from that day forward as laser laparoscopists. Some surgeons are told that laser and electrosurgery may be equally acceptable techniques for performance of laparoscopic surgery, but that a surgeon may double his patient volume by advertising 'laser laparoscopic cholecystectomy.' The sale of certain lasers has skyrocketed on the basis of such hype. The only surprise is that laparoscopic cholecystectomy complications occurring in this country seem to be more closely related to the laparoscopic access and visualization than to the choice of laser of electrocautery as the preferred instrument for thermal dissection. The purpose of this article is to: 1) Discuss the physics and tissue effects of electrosurgery and laser; 2) compare the design and safety of electrosurgical and laser delivery systems; and 3) present available data comparing laser and electrocautery application in laparoscopic cholecystectomy.

  20. Laparoscopic management of abdominal cocoon

    Directory of Open Access Journals (Sweden)

    Makam Ramesh

    2008-01-01

    Full Text Available "Peritonitis fibrosa incapsulata", first described in 1907, is a condition characterized by encasement of the bowel with a thick fibrous membrane. This condition was renamed as "abdominal cocoon" in 1978. It presents as small bowel obstruction clinically. 35 cases of abdominal cocoon have been reported in the literature over the last three decades. Abdominal cocoon is more common in adolescent girls from tropical countries. Various etiologies have been described, including tubercular. It is treated surgically by releasing the entrapped bowel. We report a laparoscopic experience of tubercular abdominal cocoon and review the literature.

  1. Transperitoneal laparoscopic approach for retrocaval ureter

    Directory of Open Access Journals (Sweden)

    Nagraj H

    2006-01-01

    Full Text Available We had a 14 year old boy, who presented with recurrent attacks of right loin pain. Investigations revealed a retrocaval ureter. A transperitoneal three port laparoscopic approach was undertaken. The retrocaval portion of ureter was excised. A double J stent was placed laparoscopically and ureteroureterostomy was done with intracorporeal suturing. The patient was discharged after 72 hours and the stent was removed on the 15th day. Follow up showed regression of hydronephrosis. We recommend this approach compared to open surgery, as it offers several advantages compared to conventional open surgery like decreased postoperative pain, decreased hospital stay and a cosmetically more acceptable surgical scar.

  2. Short- and long-term outcomes of laparoscopic surgery vs open surgery for transverse colon cancer: a retrospective multicenter study

    Directory of Open Access Journals (Sweden)

    Kim JW

    2016-04-01

    Full Text Available Jong Wan Kim,1 Jeong Yeon Kim,1 Byung Mo Kang,2 Bong Hwa Lee,3 Byung Chun Kim,4 Jun Ho Park5 1Department of Surgery, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong Si, 2Department of Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon Si, 3Department of Surgery, Hallym Sacred Heart Hospital, College of Medicine, Hallym University, Anyang Si, 4Department of Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, 5Department of Surgery, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea Purpose: The purpose of the present study was to compare the perioperative and oncologic outcomes between laparoscopic surgery and open surgery for transverse colon cancer.Patients and methods: We conducted a retrospective review of patients who underwent surgery for transverse colon cancer at six Hallym University-affiliated hospitals between January 2005 and June 2015. The perioperative outcomes and oncologic outcomes were compared between laparoscopic and open surgery.Results: Of 226 patients with transverse colon cancer, 103 underwent laparoscopic surgery and 123 underwent open surgery. There were no differences in the patient characteristics between the two groups. Regarding perioperative outcomes, the operation time was significantly longer in the laparoscopic group than in the open group (267.3 vs 172.7 minutes, P<0.001, but the time to soft food intake (6.0 vs 6.6 days, P=0.036 and the postoperative hospital stay (13.7 vs 15.7 days, P=0.018 were shorter in the laparoscopic group. The number of harvested lymph nodes was lower in the laparoscopic group than in the open group (20.3 vs 24.3, P<0.001. The 5-year overall survival (90.8% vs 88.6%, P=0.540 and disease-free survival (86.1% vs 78.9%, P=0.201 rates were similar in both groups.Conclusion: The present study showed that laparoscopic surgery is associated

  3. Gallbladder removal - laparoscopic

    Science.gov (United States)

    ... Gallbladder anatomy Laparoscopic surgery - series References Jackson PG, Evans SRT. Biliary system. In: Townsend CM Jr, Beauchamp ... A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among ...

  4. A review of experiments comparing systems of grazing management ...

    African Journals Online (AJOL)

    Experiments comparing different systems of grazing management on natural pastures in various parts of the world are reviewed. In experiments in which various rotational systems were tested against continuous grazing, fewer than half revealed pasture improvement relative to continuous grazing. In the majority of ...

  5. A Comparative Review of Stratification Texts and Readers

    Science.gov (United States)

    Peoples, Clayton D.

    2012-01-01

    Social stratification is a core substantive area within sociology. There are a number of textbooks and readers available on the market that deal with this central topic. In this article, I conduct a comparative review of (a) four stratification textbooks and (b) four stratification readers. (Contains 2 tables.)

  6. Online Genome Analysis Resources for Educators, a Comparative Review

    OpenAIRE

    Sarah Grace Prescott

    2012-01-01

    A comparative review of several companies that offer similar kits or services that allow students to isolate DNA (human and others), amplify it by PCR, and in some cases sequence the resulting sample.  The companies include:  Carolina® Biological Supply Company, Bio-Rad®, Edvotek® Inc., Hiram Genomics Store, and 23andMe.

  7. Initial experience of laparoscopic incisional hernia repair.

    Science.gov (United States)

    Razman, J; Shaharin, S; Lukman, M R; Sukumar, N; Jasmi, A Y

    2006-06-01

    Laparoscopic repair of ventral and incisional hernia has become increasingly popular as compared to open repair. The procedure has the advantages of minimal access surgery, reduction of post operative pain and the recurrence rate. A prospective study of laparoscopic incisional hernia repair was performed in our center from August 2002 to April 2004. Eighteen cases (n: 18) were performed during the study period. Fifteen cases (n: 15) had open hernia repair previously. Sixteen patients (n: 16) had successful repair of the hernia with the laparoscopic approach and two cases were converted to open repair. The mean hernia defect size was 156cm2. There was no intraoperative or immediate postoperative complication. The mean operating time was 100 +/- 34 minutes (75 - 180 minutes). The postoperative pain was graded as mild to moderate according to visual analogue score. The mean day of discharge after surgery was two days (1 - 3 days). During follow up, three patients (16.7%) developed seroma at the hernia sac which was resolved with conservative management after three weeks. One (5.6%) patient developed recurrence six months after surgery. In conclusion, laparoscopic repair of incisional hernia particularly recurrent hernia has been shown to be safe and effective in our centre. However, careful patient selection and acquiring the necessary advanced laparoscopic surgical skills coupled with the proper use of equipment are mandatory before embarking on this procedure.

  8. Building a framework for ergonomic research on laparoscopic instrument handles.

    Science.gov (United States)

    Li, Zheng; Wang, Guohui; Tan, Juan; Sun, Xulong; Lin, Hao; Zhu, Shaihong

    2016-06-01

    Laparoscopic surgery carries the advantage of minimal invasiveness, but ergonomic design of the instruments used has progressed slowly. Previous studies have demonstrated that the handle of laparoscopic instruments is vital for both surgical performance and surgeon's health. This review provides an overview of the sub-discipline of handle ergonomics, including an evaluation framework, objective and subjective assessment systems, data collection and statistical analyses. Furthermore, a framework for ergonomic research on laparoscopic instrument handles is proposed to standardize work on instrument design. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  9. Comparing online and offline self-disclosure: a systematic review.

    Science.gov (United States)

    Nguyen, Melanie; Bin, Yu Sun; Campbell, Andrew

    2012-02-01

    Disclosure of personal information is believed to be more frequent in online compared to offline communication. However, this assumption is both theoretically and empirically contested. This systematic review examined existing research comparing online and offline self-disclosure to ascertain the evidence for current theories of online communication. Studies that compared online and offline disclosures in dyadic interactions were included for review. Contrary to expectations, disclosure was not consistently found to be greater in online contexts. Factors such as the relationship between the communicators, the specific mode of communication, and the context of the interaction appear to moderate the degree of disclosure. In relation to the theories of online communication, there is support for each theory. It is argued that the overlapping predictions of each theory and the current state of empirical research highlights a need for an overarching theory of communication that can account for disclosure in both online and offline interactions.

  10. Procedural difficulty differences according to tumor location do not compromise the clinical outcome of laparoscopic complete mesocolic excision for colon cancer: a retrospective analysis.

    Science.gov (United States)

    Kim, Min Ki; Lee, In Kyu; Kye, Bong-Hyeon; Kim, Jun-Gi

    2017-09-08

    Laparoscopic colectomy procedures and their corresponding difficulty levels may vary depending on the tumor location within the colon, and a laparoscopic complete mesocolic excision (CME) with central vascular ligation (CVL) would require more proficiency than a conventional laparoscopic colectomy. We aimed to report our laparoscopic CME with CVL data and to investigate the clinical outcome differences of laparoscopic CME with CVL by various tumor sub-site locations. Prospectively collected clinical data of consecutive patients who received laparoscopic colectomy for primary colon cancer between April 1995 and December 2010 from single surgeon were retrospectively reviewed. All of the included surgery was performed on the basis of CME with CVL principle with no-touch isolation technique. Data were analyzed and compared among three groups; patients who received right or extended right hemicolectomy (group A, n = 142), transverse colectomy or left or extended left hemicolectomy (group B, n = 59), and sigmoidectomy or anterior resection (group C, n = 210). Female patients were more common in group A (53.5% vs. 37.3% vs. 39.5%, p = 0.020). Other baseline characteristics were comparable. Operative time was shorter in group C than the other groups (309.0 ± 74.7 vs. 324.3 ± 89.1 vs. 280.1 ± 93.1 min, p = 0.000). There was no significant difference among groups in perioperative complication and patient recovery. Five-year overall survival, disease-free survival and local recurrence rate showed no difference for a median follow up period of 73 (1-120) months. In conclusion, laparoscopic tumor-specific CME and CVL for colon cancer can be performed with comparable short- and long-term outcomes regardless of tumor sub-site location except for the operative time.

  11. [Existing laparoscopic simulators and their benefit for the surgeon].

    Science.gov (United States)

    Kalvach, J; Ryska, O; Ryska, M

    2016-01-01

    Nowadays, laparoscopic operations are a common part of surgical practice. However, they have their own characteristics and require a specific method of preparation. Recently, simulation techniques have been increasingly used for the training of skills. The aim of this review is to provide a summary of available literature on the topic of laparoscopic simulators, to assess their contribution to the training of surgeons, and to identify the most effective type of simulation. PubMed database, Web of Science and Cochrane Library were used to search for relevant publications. The keywords "laparoscopy, simulator, surgery, assessment" were used in the search. The search was limited to prospective studies published in the last 5 years in the English language. From a total of 354 studies found, we included in the survey 26 that matched our criteria. Nine studies compared individual simulators to one another. Five studies evaluated "high and low fidelity" (a virtual box simulator) as equally effective (EBM 2a). In three cases the "low fidelity" box simulator was found to be more efficient (EBM 2a3b). Only one study preferred the virtual simulator (VR) (EBM2b).Thirteen studies evaluated the benefits of simulators for practice. Twelve found training on a simulator to be an effective method of preparation (EBM 1b3b). In contrast, one study did not find any difference between the training simulator and traditional preparation (EBM 3b). Nine studies evaluated directly one of the methods of evaluating laparoscopic skills. Three studies evaluated VR simulator as a useful assessment tool. Other studies evaluated as successful the scoring system GOALS-GH. The hand motion analysis model was successful in one case. Most studies were observational (EBM 3b) and only 2 studies were of higher quality (EBM 2b). Simulators are an effective tool for practicing laparoscopic techniques (EBM: 1b). It cannot be determined based on available data which of the simulators is most effective. The

  12. Perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted gastric sleeve resection

    Directory of Open Access Journals (Sweden)

    Anita Joselyn

    2015-01-01

    Full Text Available Purpose: One of the major advantages for patients undergoing minimally invasive surgery as compared to an open surgical procedure is the improved recovery profile and decreased opioid requirements in the perioperative period. There are no definitive studies comparing the analgesic requirements in patients undergoing two different types of minimally invasive procedure. This study retrospectively compares the perioperative analgesic requirements in severely obese adolescents and young adults undergoing laparoscopic versus robotic-assisted, laparoscopic gastric sleeve resection. Materials and Methods: With Institutional Review Board approval, the medication administration records of all severely obese patients who underwent gastric sleeve resection were retrospectively reviewed. Intra-operative analgesic and adjuvant medications administered, postoperative analgesic requirements, and visual analog pain scores were compared between those undergoing a laparoscopic procedure versus a robotic-assisted procedure. Results: This study cohort included a total of 28 patients who underwent gastric sleeve resection surgery with 14 patients in the laparoscopic group and 14 patients in the robotic-assisted group. Intra-operative adjuvant administration of both intravenous acetaminophen and ketorolac was similar in both groups. Patients in the robotic-assisted group required significantly less opioid during the intra-operative period as compared to patients in the laparoscopic group (0.15 ± 0.08 mg/kg vs. 0.19 ± 0.06 mg/kg morphine, P = 0.024. Cumulative opioid requirements for the first 72 postoperative h were similar in both the groups (0.64 ± 0.25 vs. 0.68 ± 0.27 mg/kg morphine, P = NS. No difference was noted in the postoperative pain scores. Conclusion: Although intraoperative opioid administration was lower in the robotic-assisted group, the postoperative opioid requirements, and the postoperative pain scores were similar in both groups.

  13. [Laparoscopic management of ureteroileal stenosis: Long term follow up.

    Science.gov (United States)

    Emiliani, Esteban; Gavrilov, Pavel; Mayordomo, Olga; Salvador, Josep; Palou, Joan; Rosales, Antonio; Villavicencio, Humberto

    2017-05-01

    To describe the laparoscopic approach for uretero-ileal anastomosis strictures and to analyse our long term series. A retrospective review was performed evaluating our series of patients with benign ureteroileal anastomosis strictures treated laparoscopically from 2011 to 2017. Demographics and perioperative data were obtained and analyzed. Complications were described with the Clavien-Dindo classification. The surgical technique was described and a literature review was performed. Eleven procedures were performed in ten patients. Mean blood loss was 180 ml. All the operations were performed laparoscopically without conversion. Mean hospital stay was 10 days (4-23). Early complications were Clavien-Dindo I y II: Two cases of limited anastomosis leakage, one lymphorrea, one paralitic ileum and one accidental descent of the ureteral catheter. Mean follow-up was 56 months (12-179) No late complications have been described. Based on our series with 5 year follow up, the laparoscopic approach for uretero-ileal anastomosis strictures is feasible and safe.

  14. LAPAROSCOPIC PANCREATIC RESECTION. FROM ENUCLEATION TO PANCREATODUODENECTOMY. 11-YEAR EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Marcel Autran Cesar MACHADO

    Full Text Available Context Our experience with laparoscopic pancreatic resection began in 2001. During initial experience, laparoscopy was reserved for selected cases. With increasing experience more complex laparoscopic procedures such as central pancreatectomy and pancreatoduodenectomies were performed. Objectives The aim of this paper is to review our personal experience with laparoscopic pancreatic resection over 11-year period. Methods All patients who underwent laparoscopic pancreatic resection from 2001 through 2012 were reviewed. Preoperative data included age, gender, and indication for surgery. Intraoperative variables included operative time, bleeding, blood transfusion. Diagnosis, tumor size, margin status were determined from final pathology reports. Results Since 2001, 96 patients underwent laparoscopic pancreatectomy. Median age was 55 years old. 60 patients were female and 36 male. Of these, 88 (91.6% were performed totally laparoscopic; 4 (4.2% needed hand-assistance, 1 robotic assistance. Three patients were converted. Four patients needed blood transfusion. Operative time varied according type of operation. Mortality was nil but morbidity was high, mainly due to pancreatic fistula (28.1%. Sixty-one patients underwent distal pancreatectomy, 18 underwent pancreatic enucleation, 7 pylorus-preserving pancreatoduodenectomies, 5 uncinate process resection, 3 central and 2 total pancreatectomies. Conclusions Laparoscopic resection of the pancreas is a reality. Pancreas sparing techniques, such as enucleation, resection of uncinate process and central pancreatectomy, should be used to avoid exocrine and/or endocrine insufficiency that could be detrimental to the patient's quality of life. Laparoscopic pancreatoduodenectomy is a safe operation but should be performed in specialized centers by highly skilled laparoscopic surgeons.

  15. Should all distal pancreatectomies be performed laparoscopically?

    Science.gov (United States)

    Merchant, Nipun B; Parikh, Alexander A; Kooby, David A

    2009-01-01

    initiating adjuvant chemotherapy and/or radiation therapy. If the patient develops a wound infection, the infection should be more readily manageable with smaller incisions. Although not proven clinically relevant in humans, the reduction in perioperative stress associated with laparoscopic resection may translate to a cancer benefit for some patients. One report compared markers of systemic inflammatory response in 15 subjects undergoing left pancreatectomy. Eight had hand-access laparoscopic procedures and the rest had standard open surgery. The subjects in the laparoscopic group had statistically lower C-reactive protein levels than the open group on postoperative days one (5.5 mg/dL versus 9.7 mg/dL, P = .006) and three (8.5 mg/dL versus 17.7 mg/dL, P = .003), suggesting that the laparoscopic approach to left pancreatectomy is associated with less inflammation. While this report is underpowered, it supports the notion that MIS cancer surgery may induce less of a systemic insult to the body than standard open cancer surgery. More work in this area is necessary before any firm conclusions can be drawn. An important issue to consider is that of training surgeons to perform these complex procedures laparoscopically. Not all pancreatectomies are amenable to the laparoscopic approach, even in the most skilled hands. As such, only a percentage of cases will be performed this way and expectations to educate surgeons adequately to perform advanced laparoscopic procedures can be unrealistic, resulting in more "on-the-job" training. Another aspect that draws some controversy is that of the totally laparoscopic procedure versus the hand-access approach. No laparoscopic instrument provides the tactile feedback possible to obtain with the hand. The HALS approach allows for this, and the opportunity to control bleeding during the procedure. HALS also provides a way to improve confidence during the learning-curve phase of these operations. Finally, it is important to remember that if

  16. Laparoscopic surgery for gastro-esophageal acid reflux disease.

    Science.gov (United States)

    Schijven, Marlies P; Gisbertz, Suzanne S; van Berge Henegouwen, Mark I

    2014-02-01

    Gastro-esophageal reflux disease is a troublesome disease for many patients, severely affecting their quality of life. Choice of treatment depends on a combination of patient characteristics and preferences, esophageal motility and damage of reflux, symptom severity and symptom correlation to acid reflux and physician preferences. Success of treatment depends on tailoring treatment modalities to the individual patient and adequate selection of treatment choice. PubMed, Embase, The Cochrane Database of Systematic Reviews, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for systematic reviews with an abstract, publication date within the last five years, in humans only, on key terms (laparosc* OR laparoscopy*) AND (fundoplication OR reflux* OR GORD OR GERD OR nissen OR toupet) NOT (achal* OR pediat*). Last search was performed on July 23nd and in total 54 articles were evaluated as relevant from this search. The laparoscopic Toupet fundoplication is the therapy of choice for normal-weight GERD patients qualifying for laparoscopic surgery. No better pharmaceutical, endoluminal or surgical alternatives are present to date. No firm conclusion can be stated on its cost-effectiveness. Results have to be awaited comparing the laparoscopic 180-degree anterior fundoplication with the Toupet fundoplication to be a possible better surgical alternative. Division of the short gastric vessels is not to be recommended, nor is the use of a bougie or a mesh in the vast majority of GERD patients undergoing surgery. The use of a robot is not recommended. Anti-reflux surgery is to be considered expert surgery, but there is no clear consensus what is to be called an 'expert surgeon'. As for setting, ambulatory settings seem promising although high-level evidence is lacking. Copyright © 2013 Elsevier Ltd. All rights reserved.

  17. Safety Evaluation of Elderly Laparoscopic Cholecystectomy

    Directory of Open Access Journals (Sweden)

    Bijan Khorasani

    2008-10-01

    Full Text Available Objectives: The most common indication for abdominal surgery in elderly (65 & older is gallstone disease.The elderly are more prone to complication of such surgery due to their other co-morbidity and thus they may benefit mostly from a safer method of surgical procedure. The purpose of this study was to evaluate the safety and outcome of laparoscopic cholecystectomy in elderly compare to the conventional method. Methods & Materials: Via prospective study from June 2005 to March 2008 included all patient older than 60 years of age who underwent cholecystectomy by open (Group A and laparoscopic (Group B method in Milad Hospital.The demographic data (sex age, American Society of Anesthesiologists’ (ASA score, postoperative mortality morbidity, length of stay and operative time were recorded for each patient and were compared between two methods. Data of patient’s analysis by SPSS with chi-square and t test. Results: The study included 311 elderlies (34% men and 66% women. Hundred fifty-seven patients underwent open cholecystectomy; 154 patients underwent laparoscopic cholecystectomy. The mean age was 7141 years. The outcome in group B (laparoscopic included: morality 0%, morbidity 2%, postoperative hospital stay 1 days, mean operation time was 40 minutes. In group A(open: mortality and morbidity rate were 21% and 12% respectively with postoperative hospital stay 331 days and similar operation time as group A. Conclusion: Laparoscopic cholecystectomy is the gold standard treatment and safe procedure in elderly patient and aging is not considered to be a contraindication laparoscopic surgery in such patients.

  18. Robotic versus laparoscopic resection of liver tumours

    Science.gov (United States)

    Berber, Eren; Akyildiz, Hizir Yakup; Aucejo, Federico; Gunasekaran, Ganesh; Chalikonda, Sricharan; Fung, John

    2010-01-01

    Background There are scant data in the literature regarding the role of robotic liver surgery. The aim of the present study was to develop techniques for robotic liver tumour resection and to draw a comparison with laparoscopic resection. Methods Over a 1-year period, nine patients underwent robotic resection of peripherally located malignant lesions measuring <5 cm. These patients were compared prospectively with 23 patients who underwent laparoscopic resection of similar tumours at the same institution. Statistical analyses were performed using Student's t-test, χ2-test and Kaplan–Meier survival. All data are expressed as mean ± SEM. Results The groups were similar with regards to age, gender and tumour type (P = NS). Tumour size was similar in both groups (robotic −3.2 ± 1.3 cm vs. laparoscopic −2.9 ± 1.3 cm, P = 0.6). Skin-to-skin operative time was 259 ± 28 min in the robotic vs. 234 ± 17 min in the laparoscopic group (P = 0.4). There was no difference between the two groups regarding estimated blood loss (EBL) and resection margin status. Conversion to an open operation was only necessary in one patient in the robotic group. Complications were observed in one patient in the robotic and four patients in the laparoscopic groups. The patients were followed up for a mean of 14 months and disease-free survival (DFS) was equivalent in both groups (P = 0.6). Conclusion The results of this initial study suggest that, for selected liver lesions, a robotic approach provides similar peri-operative outcomes compared with laparoscopic liver resection (LLR). PMID:20887327

  19. General surgery training without laparoscopic surgery fellows: the impact on residents and patients.

    Science.gov (United States)

    Linn, John G; Hungness, Eric S; Clark, Sara; Nagle, Alexander P; Wang, Edward; Soper, Nathaniel J

    2011-10-01

    To evaluate resident case volume after discontinuation of a laparoscopic surgery fellowship, and to examine disparities in patient care over the same time period. Resident case logs were compared for a 2-year period before and 1 year after discontinuing the fellowship, using a 2-sample t test. Databases for bariatric and esophageal surgery were reviewed to compare operative time, length of stay (LOS), and complication rate by resident or fellow over the same time period using a 2-sample t test. Increases were seen in senior resident advanced laparoscopic (Mean Fellow Year = 21 operations vs Non Fellow Year = 61, P surgery. Operative time for complex operations may increase in the absence of a fellow. Other patient outcomes are not affected by this change. Copyright © 2011 Mosby, Inc. All rights reserved.

  20. Plastic freezer bags: a cost-effective method to protect extraction sites in laparoscopic colorectal procedures?

    Science.gov (United States)

    Huynh, Hai P; Musselman, Reilly P; Trottier, Daniel C; Soto, Claudia M; Poulin, Eric C; Mamazza, Joseph; Boushey, Robin P; Auer, Rebecca C; Moloo, Husein

    2013-10-01

    To review surgical-site infection (SSI) and retrieval-site tumor recurrence rates in laparoscopic colorectal procedures when using a plastic freezer bag as a wound protector. Laparoscopic colorectal procedures where a plastic freezer bag used as a wound protector at the extraction site were reviewed between 1991 and 2008 from a prospectively collected database. χ test was used to compare SSI and tumor recurrence rates between groups. Costing data were obtained from the operating room supplies department. A total of 936 cases with 51 (5.45%) surgical-site infections were identified. SSI rates did not differ when comparing groups based on demographic factors, diagnosis, or location of procedure. Retrieval-site tumor recurrence rate was 0.21% (1/474). Cost of plastic freezer bags including sterilization ranged from $0.25 to $3. Plastic freezer bags as wound protectors in laparoscopic colorectal procedures are cost effective and have SSI and retrieval-site tumor recurrence rates that compare favorably to published data.

  1. Bilateral Laparoscopic Totally Extraperitoneal Repair Without Mesh Fixation

    OpenAIRE

    Dehal, Ahmed; Woodward, Brandon; Johna, Samir; Yamanishi, Frank

    2014-01-01

    Background and Objectives: Mesh fixation during laparoscopic totally extraperitoneal repair is thought to be necessary to prevent recurrence. However, mesh fixation may increase postoperative chronic pain. This study aimed to describe the experience of a single surgeon at our institution performing this operation. Methods: We performed a retrospective review of the medical records of all patients who underwent bilateral laparoscopic totally extraperitoneal repair without mesh fixation for ing...

  2. Online Genome Analysis Resources for Educators, a Comparative Review

    Directory of Open Access Journals (Sweden)

    Sarah Grace Prescott

    2012-08-01

    Full Text Available A comparative review of several companies that offer similar kits or services that allow students to isolate DNA (human and others, amplify it by PCR, and in some cases sequence the resulting sample.  The companies include:  Carolina® Biological Supply Company, Bio-Rad®, Edvotek® Inc., Hiram Genomics Store, and 23andMe.

  3. Single-incision laparoscopic surgery and conventional laparoscopic treatment of varicocele in adolescents: Comparison between two techniques

    Directory of Open Access Journals (Sweden)

    Antonio Marte

    2014-01-01

    Full Text Available Background: Single-incision laparoscopic surgery (SILS has gained great popularity in paediatric surgery due to its minimally invasive approach and improved cosmetic results. Notwithstanding, reports describing its adoption in children are still fragmentary and some perplexities have been raised by some surgeons. We reviewed our experience with the SILS Palomo varicocelectomy procedure (SIL-V in children and adolescents, comparing this group with a similar series operated using conventional laparoscopic varicocelectomy (CL-V. Patients and Methods: A total of 69 Palomo laparoscopic varicocelectomies were performed in patients aged 11-17 years from January 2011 to January 2013. Indications for surgery included grades II-III varicocele or ipsilateral testicular hypotrophy. The SIL-V procedure was performed in 44 patients with roticulating and conventional 5 mm instruments. Testicular vessels were isolated "en bloc," clipped and cut. Operating time, visual analogue scale and post-operative results were compared to a similar group of 25 patients operated with CL-V. Results: No patient of the SIL-V group required conversion to conventional laparoscopy, none to open surgery. Mean operative time was 22 min (range: 19-28 in the SIL-V group, not significantly different compared with CL-V (mean 21 min, range: 18-25. All patients experienced a smooth recovery from surgery without any complications, and were discharged on day 1. No difficulties were found in the SIL-V group. The post-operative pain score was significantly better in SIL-V. Conclusion: The SIL-V procedure is safe and effective and allows a fast and efficient isolation of the vascular bundle. The use of conventional instruments is technically feasible in SIL-V.

  4. Comparative evaluation of HD 2D/3D laparoscopic monitors and benchmarking to a theoretically ideal 3D pseudodisplay: even well-experienced laparoscopists perform better with 3D.

    Science.gov (United States)

    Wilhelm, D; Reiser, S; Kohn, N; Witte, M; Leiner, U; Mühlbach, L; Ruschin, D; Reiner, W; Feussner, H

    2014-08-01

    Though theoretically superior to standard 2D visualization, 3D video systems have not yet achieved a breakthrough in laparoscopy. The latest 3D monitors, including autostereoscopic displays and high-definition (HD) resolution, are designed to overcome the existing limitations. We performed a randomized study on 48 individuals with different experience levels in laparoscopy. Three different 3D displays (glasses-based 3D monitor, autostereoscopic display, and a mirror-based theoretically ideal 3D display) were compared to a 2D HD display by assessing multiple performance and mental workload parameters and rating the subjects during a laparoscopic suturing task. Electromagnetic tracking provided information on the instruments' pathlength, movement velocity, and economy. The usability, the perception of visual discomfort, and the quality of image transmission of each monitor were subjectively rated. Almost all performance parameters were superior with the conventional glasses-based 3D display compared to the 2D display and the autostereoscopic display, but were often significantly exceeded by the mirror-based 3D display. Subjects performed a task faster and with greater precision when visualization was achieved with the 3D and the mirror-based display. Instrument pathlength was shortened by improved depth perception. Workload parameters (NASA TLX) did not show significant differences. Test persons complained of impaired vision while using the autostereoscopic monitor. The 3D and 2D displays were rated user-friendly and applicable in daily work. Experienced and inexperienced laparoscopists profited equally from using a 3D display, with an improvement in task performance about 20%. Novel 3D displays improve laparoscopic interventions as a result of faster performance and higher precision without causing a higher mental workload. Therefore, they have the potential to significantly impact the further development of minimally invasive surgery. However, as shown by the

  5. Laparoscopic managment of common bile duct stones: our initial experience.

    Science.gov (United States)

    Aroori, S; Bell, J C

    2002-05-01

    The management of choledocholithiasis has changed radically since the introduction of laparoscopic cholecystectomy. However, perceived technical difficulties have deterred many surgeons from treating common bile duct stones laparoscopically at the time of cholecystectomy. This has lead to reliance on endoscopic retrograde cholangiopancreatography followed by endoscopic sphincterotomy to deal with common bile duct stones. We retrospectively reviewed the charts of patients who had laparoscopic common bile duct exploration at Downe Hospital between December 1999 and August 2001. Among 149 laparoscopic cholecystectomies done by our group in this period, 10 patients (6.7%) underwent laparoscopic CBD exploration, three by the transcystic technique and seven by choledochotomy. Three patients (2%) had unsuspected stones found on routine per- operative cholangiogram. The mean operative time was 2.34hrs (range 1.50-3.30hrs). The mean hospital post- operative stay was 3 days (range 1-6 days). Post-operative morbidity was zero. Stone clearance was achieved in all cases. We conclude, laparoscopic exploration of the common bile duct is relatively safe and straightforward method. The key skill required is the ability to perform laparoscopic suturing with confidence.

  6. Laparoscopic common bile duct exploration: our first 50 cases.

    Science.gov (United States)

    Tan, Ker-Kan; Shelat, Vishalkumar Girishchandra; Liau, Kui-Hin; Chan, Chung-Yip; Ho, Choon-Kiat

    2010-02-01

    Laparoscopic common bile duct exploration (CBDE) is becoming more popular in the management of choledocholithiasis due to improved laparoscopic expertise and advancement in endoscopic technology and equipment. This study aimed to evaluate the safety and short-term outcome of laparoscopic CBDE in a single institution over a 3-year period. A retrospective review of the records of all patients who underwent laparoscopic CBDE in Tan Tock Seng Hospital between January 2006 and September 2008 was conducted. Fifty consecutive patients, with a median age of 60 years (range, 27 to 85) underwent laparoscopic CBDE for choledocholithiasis during the study period. About half of our patients presented as an emergency with acute cholangitis (32.0%) accounting for the majority. A total of 22 (44.0%) patients underwent laparoscopic CBDE as their primary procedure while the remaining 28 (56.0%) were subjected to preoperative ERCP initially. Of the latter group, documented stone clearance was only documented in 5 (17.9%) patients. Laparoscopic CBDE via the transcystic route was performed in 27 (54.0%) patients while another 18 patients (36.0%) had laparoscopic choledochotomy and 1 patient (2.0%) had laparoscopic choledocho-duodenostomy. There were 4 (8.0%) conversions in our series. The median operative time for laparoscopic CBDE via the transcystic route and the laparoscopic choledochotomy were 170 (75-465) and 250 (160-415) minutes, respectively. For the 18 patients who underwent a laparoscopic choledochotomy, T-tube was inserted in 8 (44.4%) patients while an internal biliary stent was placed in 4 (22.2%) with the remaining 6 patients (33.3%) undergoing primary closure of the choledochotomy. The median length of hospital stay was 2 days (range, 1 to 15) with no associated mortality. The main complications (n = 4, 8.0%) included retained CBD stones and biliary leakage. These were treated successfully with postoperative endoscopic retrograde cholangiopancreatography (ERCP) with

  7. Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with gallbladder stones with common bile duct stones: systematic review and meta-analysis of randomized trials with trial sequential analysis.

    Science.gov (United States)

    Singh, Anand Narayan; Kilambi, Ragini

    2018-03-30

    The ideal management of common bile duct (CBD) stones associated with gall stones is a matter of debate. We planned a meta-analysis of randomized trials comparing single-stage laparoscopic CBD exploration and cholecystectomy (LCBDE) with two-stage preoperative endoscopic stone extraction followed by cholecystectomy (ERCP + LC). We searched the Pubmed/Medline, Web of science, Science citation index, Google scholar and Cochrane Central Register of Controlled trials electronic databases till June 2017 for all English language randomized trials comparing the two approaches. Statistical analysis was performed using Review Manager (RevMan) [Computer program], Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014 and results were expressed as odds ratio for dichotomous variables and mean difference for continuous. p value ≤ 0.05 was considered significant. Trial sequential analysis (TSA) was performed using TSA version 0.9.5.5 (Copenhagen: The Copenhagen Trial Unit, Centre for Clinical Intervention Research, 2016). PROSPERO trial registration number is CRD42017074673. A total of 11 trials were included in the analysis, with a total of 1513 patients (751-LCBDE; 762-ERCP + LC). LCBDE was found to have significantly lower rates of technical failure [OR 0.59, 95% CI (0.38, 0.93), p = 0.02] and shorter hospital stay [MD - 1.63, 95% CI (- 3.23, - 0.03), p = 0.05]. There was no significant difference in mortality [OR 0.37, 95% CI (0.09, 1.51), p = 0.17], morbidity [OR 0.97, 95% CI (0.70, 1.33), p = 0.84], cost [MD - 379.13, 95% CI (- 784.80, 111.2), p = 0.13] or recurrent/retained stones [OR 1.01, 95% CI (0.38, 2.73), p = 0.98]. TSA showed that although the Z-curve crossed the boundaries of conventional significance, the estimated information size is yet to be achieved. Single-stage LCBDE is superior to ERCP + LC in terms of technical success and shorter hospital stay in good-risk patients with

  8. Comparative study on ureteroscopic lithotripsy and laparoscopic ureterolithotomy for treatment of unilateral upper ureteral stones Estudo comparativo entre litotripsia e ureterolitotomia laparoscópica no tratamento de cálculos unilaterais altos

    Directory of Open Access Journals (Sweden)

    You-qiang Fang

    2012-03-01

    Full Text Available PURPOSE: To compare the curative effects of ureteroscopic lithotripsy and laparoscopic ureterolithotomy for unilateral upper ureteral stones, and to explore optimal surgical indications and skills. METHODS: Fifty cases of unilateral upper ureteral stones were randomly divided into two groups: one group underwent ureteroscopic holmium laser lithotripsy under epidural or lumbar anesthesia (n=25, and another group underwent laparoscopic ureterolithotomy under general anesthesia (n=25. Double-J stent was routinely indwelled in both groups. Operating time, postoperative hospitalization time, stone clearance rate and perioperative complications were compared. RESULTS: Operation was successfully performed in all 50 cases, and no open surgery was converted in any case. In the ureteroscopy and laparoscopy groups, the mean operating time was 49.0±10.7 min and 41.8±8.0 min (t=2.68, P=0.00999, respectively, their hospitalization time was 2.8±1.3 days vs. 2.9±0.8 days (t =-0.40, P=0.69413, and stone clearance rate was 88.0% (22/25 vs. 100% (25/25. Stone moved to the renal pelvis in three cases in the ureteroscopy group, and residual stones were removed by extracorporeal shock-wave lithotripsy (ESWL. All patients were followed up for more than three months, and no serious complications such as ureterostenosis occurred. CONCLUSIONS: Laparoscopic ureterolithotomy has a higher stone clearance rate and shorter operation time compared with ureteroscopic lithotripsy. Laparoscopic ureterolithotomy is one safe and effective treatment on unilateral upper ureteral stones.OBJETIVO: Comparar os efeitos curativos da litotripsia ureteroscópica e a ureterolitotomia laparoscópica para cálculos unilaterais altos e pesquisar as indicações e resultados. MÉTODOS: Cinquenta casos de cálculos unilaterais altos foram distribuídos aleatoriamente em dois grupos: um grupo submetido a litotripsia ureteroscópica com laser holmium sob anestesia epidural ou lombar (n=25 e

  9. Pneumodilation versus laparoscopic Heller's myotomy for achalasia

    LENUS (Irish Health Repository)

    Slattery, E

    2011-08-04

    Boeckxstaens et al. (May 12 issue)1 compare single laparoscopic myotomy with a series of pneumodilation procedures for patients with achalasia. They found no significant difference in outcomes between the two groups, although perforation occurred in 4% of patients in the pneumodilation group and often required emergency treatment. No significant clinical adverse outcomes occurred in the surgical group.\\r\

  10. Varicocoelectomy in adolescents: Laparoscopic versus open high ...

    African Journals Online (AJOL)

    Background: Treatment of varicocoele is aimed at eliminating the retrograde reflux of venous blood through the internal spermatic veins. The purpose of this investigation was to compare laparoscopic varicocoelectomy (LV) with open high ligation technique in the adolescent population. Materials and Methods: We ...

  11. Single versus multimodality training basic laparoscopic skills

    NARCIS (Netherlands)

    Brinkman, W.M.; Havermans, S.Y.; Buzink, S.N.; Botden, S.M.B.I.; Jakimowicz, J.J.; Schoot, B.C.

    2012-01-01

    Introduction - Even though literature provides compelling evidence of the value of simulators for training of basic laparoscopic skills, the best way to incorporate them into a surgical curriculum is unclear. This study compares the training outcome of single modality training with multimodality

  12. Comparison of precision and speed in laparoscopic and robot-assisted surgical task performance.

    Science.gov (United States)

    Zihni, Ahmed; Gerull, William D; Cavallo, Jaime A; Ge, Tianjia; Ray, Shuddhadeb; Chiu, Jason; Brunt, L Michael; Awad, Michael M

    2018-03-01

    Robotic platforms have the potential advantage of providing additional dexterity and precision to surgeons while performing complex laparoscopic tasks, especially for those in training. Few quantitative evaluations of surgical task performance comparing laparoscopic and robotic platforms among surgeons of varying experience levels have been done. We compared measures of quality and efficiency of Fundamentals of Laparoscopic Surgery task performance on these platforms in novices and experienced laparoscopic and robotic surgeons. Fourteen novices, 12 expert laparoscopic surgeons (>100 laparoscopic procedures performed, no robotics experience), and five expert robotic surgeons (>25 robotic procedures performed) performed three Fundamentals of Laparoscopic Surgery tasks on both laparoscopic and robotic platforms: peg transfer (PT), pattern cutting (PC), and intracorporeal suturing. All tasks were repeated three times by each subject on each platform in a randomized order. Mean completion times and mean errors per trial (EPT) were calculated for each task on both platforms. Results were compared using Student's t-test (P task performance was slower on the robotic platform compared with laparoscopy. In comparisons of expert laparoscopists performing tasks on the laparoscopic platform and expert robotic surgeons performing tasks on the robotic platform, expert robotic surgeons demonstrated fewer errors during the PC task (P = 0.009). Robotic assistance provided a reduction in errors at all experience levels for some laparoscopic tasks, but no benefit in the speed of task performance. Robotic assistance may provide some benefit in precision of surgical task performance. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. PRINCIPLES OF SAFETY IN LAPAROSCOPIC CHOLECYSTECTOMY

    Directory of Open Access Journals (Sweden)

    Tomaž Benedik

    2003-12-01

    Full Text Available Background. After more than decade of routine use of laparoscopic cholecystectomy for treatment of symptomatic gallbladder stones, the incidence of biliary injuries, which are potentially life threatening and cause prolonged hospitalization and major morbidity, seems to be increased in laparoscopic cholecystectomy compared with open operation. Injury rate was from some reports 2.5 to 4 times higher than with open operation. There are many proposed classifications of types of biliary injuries.The most frequent direct causes of laparoscopic biliary injury are misidentification of the common bile duct, cautery injuries to the bile duct and improper application of clips to the cystic duct.Conclusions. To avoid misidentification of ducts one should conclusively identify cystic duct and artery, the structures to be divide, in every laparoscopic cholecystectomy. To achieve that goal, Calot’s triangle must be dissected free of fat and fibrous – tissue and the lower end of the gallbladder must be dissected of the liver bed. The only two structures entering the gallbladder should be visible – cystic duct and artery. With avoidance of blind application of cautery and clips to control bleeding one should avoid injury of bile duct. Low cautery settings should be used in portal dissections to prevent arc.With meticulous care in dissection and conclusive identification of cystic duct and artery we can prevent injuries of bile duct, which still have impermissible high incidence. In the article 504 laparoscopic cholecystectomies performed at the Department of abdominal surgery in BPD in 2002 were analysed. We follow priciples of safety in laparoscopic cholecystectomy. There were no biliary injuries reports.

  14. Laparoscopic Transcystic Common Bile Duct Exploration: Advantages over Laparoscopic Choledochotomy.

    Directory of Open Access Journals (Sweden)

    Qian Feng

    Full Text Available The ideal treatment for choledocholithiasis should be simple, readily available, reliable, minimally invasive and cost-effective for patients. We performed this study to compare the benefits and drawbacks of different laparoscopic approaches (transcystic and choledochotomy for removal of common bile duct stones.A systematic search was implemented for relevant literature using Cochrane, PubMed, Ovid Medline, EMBASE and Wanfang databases. Both the fixed-effects and random-effects models were used to calculate the odds ratio (OR or the mean difference (MD with 95% confidence interval (CI for this study.The meta-analysis included 18 trials involving 2,782 patients. There were no statistically significant differences between laparoscopic choledochotomy for common bile duct exploration (LCCBDE (n = 1,222 and laparoscopic transcystic common bile duct exploration (LTCBDE (n = 1,560 regarding stone clearance (OR 0.73, 95% CI 0.50-1.07; P = 0.11, conversion to other procedures (OR 0.62, 95% CI 0.21-1.79; P = 0.38, total morbidity (OR 1.65, 95% CI 0.92-2.96; P = 0.09, operative time (MD 12.34, 95% CI -0.10-24.78; P = 0.05, and blood loss (MD 1.95, 95% CI -9.56-13.46; P = 0.74. However, the LTCBDE group showed significantly better results for biliary morbidity (OR 4.25, 95% CI 2.30-7.85; P<0.001, hospital stay (MD 2.52, 95% CI 1.29-3.75; P<0.001, and hospital expenses (MD 0.30, 95% CI 0.23-0.37; P<0.001 than the LCCBDE group.LTCBDE is safer than LCCBDE, and is the ideal treatment for common bile duct stones.

  15. Nature's moisture harvesters: a comparative review

    International Nuclear Information System (INIS)

    Malik, F T; Clement, R M; Krawszik, W; Gethin, D T; Parker, A R

    2014-01-01

    Nature has adapted different methods for surviving dry, arid, xeric conditions. It is the focus of this comparative review to pull together the relevant information gleaned from the literature that could be utilized to design moisture harvesting devices informed by biomimetics. Most water harvesting devices in current use are not informed by nature and those that do are usually based on a biomimetic principle that has been based on one species only. This review draws on the published literature to establish a list of species (animals (vertebrates/invertebrates) and plants) whose habitat is in mainly dry or arid regions and that are known to harvest airborne moisture. Key findings have been outlined and review comments and discussion set out. Following this, surface feature convergences have been identified, namely hexagonal microstructures, groove-like and cone-like geometries. This has been coupled with direction of water flow that is driven by surface energy. As far as the authors are aware, this convergent evolution has not been brought together in this manner before. In the future this information could be translated into an engineered device for collecting water from airborne sources. (topical review)

  16. Management of mechanical ventilation during laparoscopic surgery.

    Science.gov (United States)

    Valenza, Franco; Chevallard, Giorgio; Fossali, Tommaso; Salice, Valentina; Pizzocri, Marta; Gattinoni, Luciano

    2010-06-01

    Laparoscopy is widely used in the surgical treatment of a number of diseases. Its advantages are generally believed to lie on its minimal invasiveness, better cosmetic outcome and shorter length of hospital stay based on surgical expertise and state-of-the-art equipment. Thousands of laparoscopic surgical procedures performed safely prove that mechanical ventilation during anaesthesia for laparoscopy is well tolerated by a vast majority of patients. However, the effects of pneumoperitoneum are particularly relevant to patients with underlying lung disease as well as to the increasing number of patients with higher-than-normal body mass index. Moreover, many surgical procedures are significantly longer in duration when performed with laparoscopic techniques. Taken together, these factors impose special care for the management of mechanical ventilation during laparoscopic surgery. The purpose of the review is to summarise the consequences of pneumoperitoneum on the standard monitoring of mechanical ventilation during anaesthesia and to discuss the rationale of using a protective ventilation strategy during laparoscopic surgery. The consequences of chest wall derangement occurring during pneumoperitoneum on airway pressure and central venous pressure, together with the role of end-tidal-CO2 monitoring are emphasised. Ventilatory and non-ventilatory strategies to protect the lung are discussed.

  17. "Knotless" laparoscopic extraperitoneal adenomectomy.

    Science.gov (United States)

    Garcia-Segui, A; Verges, A; Galán-Llopis, J A; Garcia-Tello, A; Ramón de Fata, F; Angulo, J C

    2015-03-01

    Laparoscopic adenomectomy is a feasible and effective surgical procedure. We have progressively simplified the procedure using barbed sutures and a technique we call "knotless" laparoscopic adenomectomy. We present a prospective, multicenter, descriptive study that reflects the efficacy and safety of this technique in an actual, reproducible clinical practice situation. A total of 26 patients with benign prostatic hyperplasia of considerable size (>80cc) underwent "knotless" laparoscopic adenomectomy. This is an extraperitoneal laparoscopic technique with 4 trocars based on the controlled and hemostatic enucleation of the adenoma using ultrasonic scalpels, precise urethral sectioning under direct vision assisted by a urethral plug, trigonization using barbed suture covering the posterior wall of the fascia, capsulorrhaphy with barbed suture and extraction of the morcellated adenoma through the umbilical incision. The median patient age was 69 (54-83)years, the mean prostate volume was 127 (89-245)cc, the mean operative time was 136 (90-315)min, the mean estimated bleeding volume was 200 (120-500)cc and the hospital stay was 3 (2-6)days. All patients experienced improved function in terms of uroflowmetry and International Prostate Symptom Score and quality of life questionnaires. There were complications in 6 patients, 5 of which were minor. "Knotless" laparoscopic adenomectomy is a procedure with low complexity that combines the advantages of open surgery (lasting functional results and complete extraction of the adenoma) with laparoscopic procedures (reduced bleeding and need for transfusions, shorter hospital stays and reduced morbidity and complications related to the abdominal wall). The use of ultrasonic scalpels and barbed sutures simplifies the procedure and enables a safe and hemostatic technique. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Laparoscopic Splenectomy in Patients With Spleen Injuries.

    Science.gov (United States)

    Ermolov, Aleksander S; Tlibekova, Margarita A; Yartsev, Peter A; Guliaev, Andrey A; Rogal, Mikhail M; Samsonov, Vladimir T; Levitsky, Vladislav D; Chernysh, Oleg A

    2015-12-01

    Spleen injury appears in 10% to 30% of abdominal trauma patients. Mortality among the patients in the last 20 years remains high (6% to 7%) and shows no tendency to decline. Nowadays nonoperative management is widely accepted management of patients with low-grade spleen injury, whereas management of patients with high-grade spleen injury (III and higher) is not so obvious. There are 3 methods exist in treatment of such patients: conservative (with or without angioembolization), spleen-preserving operations, and splenectomy. Today laparoscopic splenectomy is not a widely used operation and only few studies reported about successful use of laparoscopic splenectomy in patients with spleen injury.The aim of the study was to determine indications and contraindications for laparoscopic splenectomy in abdominal trauma patients and to analyze results of the operations. The study involved 42 patients with spleen injury grade III who were admitted in our institute in the years of 2010 to 2014. The patients were divided in 2 groups. Laparoscopic splenectomy was performed in 23 patients (group I) and "traditional" splenectomy was carried out in 19 patients (group II). There was no difference in the demographic data and trauma severity between the 2 groups. Noninvasive investigations, such as laboratory investigations, serial abdominal ultrasound examinations, x-ray in multiple views, and computed tomography had been performed before the decision about necessity of an operation was made. Patients after laparoscopic operations had better recovering conditions compared with patients with the same injury after "traditional" splenectomy. Neither surgery-related complications nor mortalities were registered in both groups. Laparoscopic splenectomy was more time-consuming operation than "traditional" splenectomy. We suggest that as experience of laparoscopic splenectomy is gained the operation time will be reduced. Laparoscopic splenectomy is a safe feasible operation in patients

  19. Laparoscopic adrenal cortex

    International Nuclear Information System (INIS)

    Peyrolou, A.; Salom, A.; Harguindeguy; Taroco, L.; Ardao, G.; Broli, F. . E mail: andresssss@adinet.com.uy

    2005-01-01

    The paper presents the case of a female patient who carried an aldosterone-secreting tumor of adrenal cortex.In the analysis of diagnosis and para clinical examinations there is particular reference to the laparoscopic surgery mode of treatment.Diagnosis should be established on the basis of clinical and laboratory tests (hypopotassemia and hyperaldosteronism).Tumor topography was confirmed through CT scan, MRI and Scintiscan in left adrenal cortex.Resection was consequently made through laparoscopic surgery.The patients evolution was excellent from the surgical viewpoint,with I levels of blood pressure, potassium and aldosterone returned to normal

  20. Laparoscopic Removal of Gossypiboma

    Directory of Open Access Journals (Sweden)

    Zeki Özsoy

    2015-01-01

    Full Text Available Gossypiboma is defined as a mass caused by foreign body reaction developed around the retained surgical item in the operative area. When diagnosed, it should be removed in symptomatic patients. Minimal invasive surgery should be planned for the removal of the retained item. The number of cases treated by laparoscopic approach is rare in the literature. We present a case of forty-year-old woman referred to emergency room with acute abdomen diagnosed as gossypiboma and treated successfully with laparoscopic surgery.

  1. Comprehensive stroke units: a review of comparative evidence and experience.

    Science.gov (United States)

    Chan, Daniel K Y; Cordato, Dennis; O'Rourke, Fintan; Chan, Daniel L; Pollack, Michael; Middleton, Sandy; Levi, Chris

    2013-06-01

    Stroke unit care offers significant benefits in survival and dependency when compared to general medical ward. Most stroke units are either acute or rehabilitation, but comprehensive (combined acute and rehabilitation) model (comprehensive stroke unit) is less common. To examine different levels of evidence of comprehensive stroke unit compared to other organized inpatient stroke care and share local experience of comprehensive stroke units. Cochrane Library and Medline (1980 to December 2010) review of English language articles comparing stroke units to alternative forms of stroke care delivery, different types of stroke unit models, and differences in processes of care within different stroke unit models. Different levels of comparative evidence of comprehensive stroke units to other models of stroke units are collected. There are no randomized controlled trials directly comparing comprehensive stroke units to other stroke unit models (either acute or rehabilitation). Comprehensive stroke units are associated with reduced length of stay and greatest reduction in combined death and dependency in a meta-analysis study when compared to other stroke unit models. Comprehensive stroke units also have better length of stay and functional outcome when compared to acute or rehabilitation stroke unit models in a cross-sectional study, and better length of stay in a 'before-and-after' comparative study. Components of stroke unit care that improve outcome are multifactorial and most probably include early mobilization. A comprehensive stroke unit model has been successfully implemented in metropolitan and rural hospital settings. Comprehensive stroke units are associated with reductions in length of stay and combined death and dependency and improved functional outcomes compared to other stroke unit models. A comprehensive stroke unit model is worth considering as the preferred model of stroke unit care in the planning and delivery of metropolitan and rural stroke services

  2. Imaging findings of biliary and nonbiliary complications following laparoscopic surgery

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Jin-Young; Kim, Joo Hee; Lim, Joon Seok; Oh, Young Taik; Kim, Ki Whang [Yonsei University College of Medicine, Department of Diagnostic Radiology, Seoul (Korea); Yonsei University College of Medicine, Research Institute of Radiological Science, Seoul (Korea); Kim, Myeong-Jin [Yonsei University College of Medicine, Department of Diagnostic Radiology, Seoul (Korea); Yonsei University College of Medicine, Brain Korea 21 Project for Medical Science, Seoul (Korea); Yonsei University College of Medicine, Research Institute of Radiological Science, Seoul (Korea); Yonsei University College of Medicine, Institute of Gastroenterology, Seoul (Korea); Park, Mi-Suk [Yonsei University College of Medicine, Department of Diagnostic Radiology, Seoul (Korea)

    2006-09-15

    Laparoscopic techniques are evolving for a wide range of surgical procedures although they were initially confined to cholecystectomy and exploratory laparoscopy. Recently, surgical procedures performed with a laparoscope include splenectomy, adrenalectomy, gastrectomy, and myomectomy. In this article, we review the spectrum of complications and illustrate imaging features of biliary and nonbiliary complications after various laparoscopic surgeries. Biliary complications following laparoscopic cholecystectomy include bile ductal obstruction, bile leak with bile duct injury, dropped stones in the peritoneal cavity, retained CBD stone, and port-site metastasis. Nonbiliary complications are anastomotic leakage after partial gastrectomy, gangrenous cholecystitis after gastrectomy, hematoma at the anastomotic site following gastrectomy, gastric infarction after gastrectomy, port-site metastasis after gastrectomy, hematoma after splenectomy, renal infarction after adrenalectomy, and active bleeding after myomectomy of the uterus. (orig.)

  3. The quality of research synthesis in surgery: the case of laparoscopic surgery for colorectal cancer

    Directory of Open Access Journals (Sweden)

    Martel Guillaume

    2012-02-01

    Full Text Available Abstract Background Several systematic reviews and meta-analyses populate the literature on the effectiveness of laparoscopic surgery for colorectal cancer. The utility of this body of work is unclear. The objective of this study was to synthesize all such systematic reviews in terms of clinical effectiveness, to appraise their quality, and to determine whether areas of duplication exist across reviews. Methods Systematic reviews comparing laparoscopic and open surgery for colorectal cancer were identified using a comprehensive search protocol (1991 to 2008. The primary outcome was overall survival. The methodological quality of reviews was appraised using the Assessment of Multiple Systematic Reviews (AMSTAR instrument. Abstraction and quality appraisal was carried out by two independent reviewers. Reviews were synthesized, and outcomes were compared qualitatively. A citation analysis was carried out using simple matrices to assess the comprehensiveness of each review. Results In total, 27 reviews were included; 13 reviews included only randomized controlled trials. Rectal cancer was addressed exclusively by four reviews. There was significant overlap between review purposes, populations and, outcomes. The mean AMSTAR score (out of 11 was 5.8 (95% CI: 4.6 to 7.0. Overall survival was evaluated by ten reviews, none of which found a significant difference. Three reviews provided a selective meta-analysis of time-to-event data. Previously published systematic reviews were poorly and highly selectively referenced (mean citation ratio 0.16, 95% CI: 0.093 to 0.22. Previously published trials were not comprehensively identified and cited (mean citation ratio 0.56, 95% CI: 0.46 to 0.65. Conclusions Numerous overlapping systematic reviews of laparoscopic and open surgery for colorectal cancer exist in the literature. Despite variable methods and quality, survival outcomes are congruent across reviews. A duplication of research efforts appears to exist

  4. A review on comparative study of PPI and PAMAM dendrimers

    International Nuclear Information System (INIS)

    Kaur, Daljeet; Jain, Keerti; Mehra, Neelesh Kumar; Kesharwani, Prashant; Jain, Narendra K.

    2016-01-01

    Dendrimers are hyperbranched, monodispersed macromolecules with multivalent functional end groups. Dendrimers have been explored as carrier for many drugs like anticancer, antiviral, antimalarial, antiprotozoal, anti tubercular drugs. Although a number of different types of dendrimers containing different core molecules, branching monomers and surface functional groups have been designed till date for drug delivery applications, yet the poly(propyleneimine) (PPI) and poly(amidoamine) (PAMAM) dendrimers have been the most explored dendrimers in this regard. In this review, we have summarized a comparative data on PPI and PAMAM dendrimers particularly relevant to their properties, synthesis, toxicity, biomedical applications and drug delivery attributes.

  5. A review on comparative study of PPI and PAMAM dendrimers

    Energy Technology Data Exchange (ETDEWEB)

    Kaur, Daljeet; Jain, Keerti, E-mail: keertijain02@gmail.com; Mehra, Neelesh Kumar [ISF College of Pharmacy, Pharmaceutical Nanotechnology Research Laboratory (India); Kesharwani, Prashant [Wayne State University, Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences (United States); Jain, Narendra K., E-mail: jnarendr@yahoo.co.in, E-mail: dr.jnarendr@gmail.com [ISF College of Pharmacy, Pharmaceutical Nanotechnology Research Laboratory (India)

    2016-06-15

    Dendrimers are hyperbranched, monodispersed macromolecules with multivalent functional end groups. Dendrimers have been explored as carrier for many drugs like anticancer, antiviral, antimalarial, antiprotozoal, anti tubercular drugs. Although a number of different types of dendrimers containing different core molecules, branching monomers and surface functional groups have been designed till date for drug delivery applications, yet the poly(propyleneimine) (PPI) and poly(amidoamine) (PAMAM) dendrimers have been the most explored dendrimers in this regard. In this review, we have summarized a comparative data on PPI and PAMAM dendrimers particularly relevant to their properties, synthesis, toxicity, biomedical applications and drug delivery attributes.

  6. Laparoscopic Cryoablation Of Small Renal Tumors – Does Anatomical Tumor Complexity Affect Treatment Outcome?

    DEFF Research Database (Denmark)

    Nielsen, Tommy Kjærgaard; Østraat, Øyvind; Andersen, Gratien

    risk in relation to nephron sparing surgery, but they may also be useful when planning cryoablation. Aim: The aim of the present study was to investigate whether patients with an anatomical complex tumor, represented by a high PADUA-score (≥10), carried a higher risk of residual unablated tumor...... compared to patients with a less anatomical complex tumor when treated with laparoscopic cryoablation. Material and methods: A retrospective review of Aarhus Cryoablation Register identified 120 patients with a single biopsy-verified pT1a renal tumor, treated with primary laparoscopic cryoablation between....... This relative risk of 2.9 (95%CI 1.1;7.6) was statistically significant (p=0.03). The mean follow-up time from treatment to diagnosis of treatment failure was 13 months (95%CI 8;18), which was not significantly different between the two groups. Conclusion: Patients with an anatomical complex tumor, represented...

  7. Laparoscopic Cryoablation Of Small Renal Tumors – Does Anatomical Tumor Complexity Effect Treatment Outcome?

    DEFF Research Database (Denmark)

    Nielsen, Tommy Kjærgaard; Østraat, Øyvind; Andersen, Gratien

    risk in relation to nephron sparing surgery, but they may also be useful when planning cryoablation. Aim: The aim of the present study was to investigate whether patients with an anatomical complex tumor, represented by a high PADUA-score (≥10), carried a higher risk of residual unablated tumor...... compared to patients with a less anatomical complex tumor when treated with laparoscopic cryoablation. Material and methods: A retrospective review of Aarhus Cryoablation Register identified 120 patients with a single biopsy-verified pT1a renal tumor, treated with primary laparoscopic cryoablation between....... This relative risk of 2.9 (95%CI 1.1;7.6) was statistically significant (p=0.03). The mean follow-up time from treatment to diagnosis of treatment failure was 13 months (95%CI 8;18), which was not significantly different between the two groups. Conclusion: Patients with an anatomical complex tumor, represented...

  8. Laparoscopic Treatment of Sclerosing Stromal Tumor of the Ovary in a Woman With Gorlin-Goltz Syndrome: A Case Report and Review of the Literature.

    Science.gov (United States)

    Grechi, Gianluca; Clemente, Nicolò; Tozzi, Alessandra; Ciavattini, Andrea

    2015-01-01

    Gorlin-Goltz syndrome is a rare hereditary multisystemic disease. Multiple basal cell carcinomas, odontogenic keratocysts, and skeletal abnormalities are the main clinical manifestations of the syndrome, but several organs can be involved. Moreover, this condition is associated with the development of various benign and malignant tumors, even in the genital tract. This report describes a rare association between Gorlin-Goltz syndrome and the sclerosing stromal tumor of the ovary. Because the ultrasound and magnetic resonance imaging patterns of this tumor can be similar to those of a malignant neoplasm, prompt surgical intervention and histological confirmation of diagnosis is mandatory; however, this is a benign lesion and thus can be approached with a laparoscopic fertility-sparing surgery. Gynecologists should be aware of this possible association to provide appropriate counseling for these women, and to take a fertility-sparing laparoscopic approach whenever possible. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

  9. Laparoscopic partial vs total splenectomy in children with hereditary spherocytosis.

    Science.gov (United States)

    Morinis, Julia; Dutta, Sanjeev; Blanchette, Victor; Butchart, Sheila; Langer, Jacob C

    2008-09-01

    Open partial splenectomy provides reversal of anemia and relief of symptomatic splenomegaly while theoretically retaining splenic immune function for hereditary spherocytosis. We recently developed a laparoscopic approach for partial splenectomy. The purpose of the present study is to compare the outcomes in a group of patients undergoing laparoscopic partial splenectomy (LPS) with those in a group of children undergoing laparoscopic total splenectomy (LTS) over the same period. Systematic chart review was conducted of all children with hereditary spherocytosis who had LTS or LPS from 2000 to 2006 at the Hospital for Sick Children, Toronto, Ontario, Canada. T tests were used for continuous data, and chi(2) for proportional data; P value of less than .05 was considered significant. There were 9 patients (14 males) in each group. Groups were similar in sex, age, concomitant cholecystectomy, and preoperative hospitalizations, transfusions, and spleen size. Estimated blood loss was greater in the LPS group (188 + 53 vs 67 + 17 mL; P = .02), but transfusion requirements were similar (1/9 vs 0/9). Complication rate was similar between groups. The LPS group had higher morphine use (4.1 + 0.6 vs 2.4 + 0.2 days; P = .03), greater time to oral intake (4.4 + 0.7 vs 2.0 + 0.2 days; P = .01), and longer hospital stay (6.3 + 1.0 vs 2.7 + 0.3 days; P = .005) than the LTS group. Nuclear scan 6 to 8 weeks postoperatively demonstrated residual perfused splenic tissue in all LPS patients. No completion splenectomy was necessary after a mean follow-up of 25 months. These data suggest that LPS is as effective as LTS for control of symptoms. However, LPS is associated with more pain, longer time to oral intake, and longer hospital stay. These disadvantages may be balanced by retained splenic immune function, but further studies are required to assess long-term splenic function in these patients.

  10. Preoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery - A Systematic Review and Meta-Analysis of Observational Studies

    DEFF Research Database (Denmark)

    Rothman, Josephine Philip; Burcharth, Jakob; Pommergaard, Hans-Christian

    2016-01-01

    were suitable for 7 meta-analyses on age, gender, body mass index, previous abdominal surgery, severity of disease, white blood cell count, and gallbladder wall thickness. CONCLUSIONS: A gallbladder wall thicker than 4-5 mm, a contracted gallbladder, age above 60 or 65, male gender, and acute...... cholecystitis were risk factors for the conversion of laparoscopic cholecystectomy to open surgery. Furthermore, there was no association between diabetes mellitus or white blood cell count and conversion to open surgery....

  11. Mergers and acquisitions: A comparative review of literature

    Directory of Open Access Journals (Sweden)

    Ghosh Sohini

    2016-01-01

    Full Text Available The paper aims to review scholastic research on the effect of M&As on firm performance and present a comparative analysis of Indian M&As vis­a-vis those occurring in other nations. 108 articles in referred journals published between 2005 and 2015 have been surveyed with a focus on comparing firm performance parameters prior and post the M&A. Firm performance has been inspected via three measures i.e. accounting measures, stock market performance measures and qualitative measures. On the basis of these three measures, literature on mergers in India with those occurring in another 23 countries was compared. The review has shown that irrespective of the nation, M&As may impact the accounting and stock market performance measures of the acquirer and target firms in a positive, negative or mixed manner. M&As in nations other than India have received more academic attention with respect to the effect on qualitative issues like cultural compatibility, downsizing and innovation. Cultural incompatibility and downsizing are problems of M&As in India as well as other nations. Indian domestic M&As have resulted in greater market share whereas majority of the M&As in other nations have lost customer base. Although literature studying the outcomes of M&As on firm performance from a pre-post perspective are multifarious, a comparative assessment of the studies on M&As occurring in India with those carried out in other nations of the world is a novel attempt.

  12. Single-incision laparoscopic cecectomy for low-grade appendiceal mucinous neoplasm after laparoscopic rectectomy

    Science.gov (United States)

    Fujino, Shiki; Miyoshi, Norikatsu; Noura, Shingo; Shingai, Tatsushi; Tomita, Yasuhiko; Ohue, Masayuki; Yano, Masahiko

    2014-01-01

    In this case report, we discuss single-incision laparoscopic cecectomy for low-grade appendiceal neoplasm after laparoscopic anterior resection for rectal cancer. The optimal surgical therapy for low-grade appendiceal neoplasm is controversial; currently, the options include appendectomy, cecectomy, right hemicolectomy, and open or laparoscopic surgery. Due to the risk of pseudomyxoma peritonei, complete resection without rupture is necessary. We have encountered 5 cases of low-grade appendiceal neoplasm and all 5 patients had no lymph node metastasis. We chose the appendectomy or cecectomy without lymph node dissection if preoperative imaging studies did not suspect malignancy. In the present case, we performed cecectomy without lymph node dissection by single-incision laparoscopic surgery (SILS), which is reported to be a reduced port surgery associated with decreased invasiveness and patient stress compared with conventional laparoscopic surgery. We are confident that SILS is a feasible alternative to traditional surgical procedures for borderline tumors, such as low-grade appendiceal neoplasms. PMID:24868331

  13. Intestinal obstruction caused by endometriosis: Endoscopic stenting and expedited laparoscopic resection avoiding stoma. A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Pietro Calcagno

    Full Text Available Introduction: Endometriosis is the growth of endometrium outside the uterine cavity. In 5–15% of cases the disease can affect the colon and small bowel, causing complete obstruction and requiring resection in about 1% of cases. Case summary: We describe a case of sigmoid obstruction due to endometriosis in a 38 years old woman with personal history of endometriosis. She was admitted for abdominal pain and constipation. The patient was treated with endoscopic stenting and subsequent laparoscopic sigmoidectomy. Discussion: Bowel obstruction caused by endometriosis is a rare event. Its diagnosis can thus be a clinical and radiological challenge but it may be suspected in all young woman with colonic obstruction. At present, the management of endometriosis is an integrate approach of both medical and surgical therapy. In case of irreversible colonic obstruction surgery is mandatory. The treatment of choice is usually an emergency procedure (either Hartmann procedure or resection and anastomosis with stoma placement. This approach entails all the risks related to emergency procedures and can have important psychological and biological drawbacks. Conclusion: Endoscopic prosthesis placement as bridge to surgery is a feasible therapeutic strategy in colonic obstruction due to endometriosis. It brings about all the advantages of an expedited one step laparoscopic surgical procedure. Laparoscopic elective resection has a lower rate of stoma placement and has a postoperative pregnancy rate grater than open surgery. Keywords: Endometriosis, Bowel obstruction, Laparoscopy, Endoscopic stent, Stoma

  14. Rules and technical tricks in extremely difficult laparoscopic cholecystectomies

    Directory of Open Access Journals (Sweden)

    Liviu Drăghici

    2017-11-01

    Full Text Available We remind you of some technical artifices required in order to resolve difficult cases, such as: antegrade laparoscopic cholecystectomy (LC, subtotal laparoscopic cholecystectomy (SLC and the “stairs” clipping of the cystic duct. Also we acknowledge the closing of the cystic duct. We analyzed the medical records of 15251 laparoscopic cholecystectomies performed during 1994-2015, with emphasis on: surgical technique, conversion rate, hemorrhage, postoperative bile leaking, iatrogenic MBD injuries and mortality. We divided the cases in 5 study groups, group 1 (1994- 2004 N= 5138, group 2 (2005-2015 N= 10113, group 3 (fundus first cholecystectomies, N=2348, group 4 (retrograde cholecystectomies, N=12889 and group 5 (subtotal laparoscopic cholecystectomy-SLC, N=14 which we compared regarding the main parameters. We prefer to perform a “step by step” clipping each time the length of the clip does not cover all the circumference of the cystic duct. This artifices, is a simple laparoscopic gesture easy to perform and has the advantage of avoiding a large excessive and risky laparoscopic dissection in the vicinity of the main biliary duct. More seldom we appeal to the suture of the cystic stump using the intracorporeal knots or a simple stump ligation with an extracorporeal preformed not. We did not encounter any late or early complications following the implementation of this technical laparoscopic artifice. Laborious laparoscopic cholecystectomies performed by a well-trained surgical team ensure the premises of a good performance even while adopting laparoscopic ingenious and difficile gestures that also respect the intraoperatory rules and principals.

  15. LAPAROSCOPIC ADENOMECTOMY (PRELIMINARY RESULTS

    Directory of Open Access Journals (Sweden)

    A. Yu. Seroukhov

    2016-01-01

    Full Text Available Bladder outlet obstruction due to benign prostatic hyperplasia (BPH remains one of the most common problems of men in the advanced age group. Open prostatectomy for patients with large BPH is still the standard treatment recommended by the European Association of Urology and is performed quiet often. Disadvantages of this method of treatment are significant surgical trauma and high rate of perioperative complications . Laparoscopic modification of simple prostatectomy presents a worthy minimal invasive alternative to open surgical treatment of BPH. From November 2014 to December 2015, laparoscopic adenomectomy was performed for 16 patients. 7 (43.5% patients had transperitoneal (TP and 9 (56.25% patients had extraperitoneal (EP laparoscopic simple prostatectomy. None of the cases required conversion . All patients were discharged in satisfactory condition with complete restoration of free micturation. Laparoscopic prostatectomy as a method of surgical treatment for BPH can be easily reproducible. It can be adopted as a routine urological practice for large-sized BPH with the aim of minimizing operative trauma and achieving short hospital stay.

  16. Laparoscopic hemi-splenectomy

    NARCIS (Netherlands)

    de Pastena, Matteo; Nijkamp, Maarten W.; van Gulik, Thomas G.; Busch, Olivier R.; Hermanides, H. S.; Besselink, Marc G.

    2018-01-01

    Laparoscopic splenectomy is now established as a safe and feasible procedure. However, it remains associated with some short- and long-term postoperative complications, especially infectious complications. To our knowledge, this is the first report (with video) focusing on the safety and feasibility

  17. Understanding perceptual boundaries in laparoscopic surgery.

    Science.gov (United States)

    Lamata, Pablo; Gomez, Enrique J; Hernández, Félix Lamata; Oltra Pastor, Alfonso; Sanchez-Margallo, Francisco Miquel; Del Pozo Guerrero, Francisco

    2008-03-01

    Human perceptual capabilities related to the laparoscopic interaction paradigm are not well known. Its study is important for the design of virtual reality simulators, and for the specification of augmented reality applications that overcome current limitations and provide a supersensing to the surgeon. As part of this work, this article addresses the study of laparoscopic pulling forces. Two definitions are proposed to focalize the problem: the perceptual fidelity boundary, limit of human perceptual capabilities, and the Utile fidelity boundary, that encapsulates the perceived aspects actually used by surgeons to guide an operation. The study is then aimed to define the perceptual fidelity boundary of laparoscopic pulling forces. This is approached with an experimental design in which surgeons assess the resistance against pulling of four different tissues, which are characterized with both in vivo interaction forces and ex vivo tissue biomechanical properties. A logarithmic law of tissue consistency perception is found comparing subjective valorizations with objective parameters. A model of this perception is developed identifying what the main parameters are: the grade of fixation of the organ, the tissue stiffness, the amount of tissue bitten, and the organ mass being pulled. These results are a clear requirement analysis for the force feedback algorithm of a virtual reality laparoscopic simulator. Finally, some discussion is raised about the suitability of augmented reality applications around this surgical gesture.

  18. Twenty years after Erich Muhe: Persisting controversies with the gold standard of laparoscopic cholecystectomy.

    Science.gov (United States)

    Jani, Kalpesh; Rajan, P S; Sendhilkumar, K; Palanivelu, C

    2006-06-01

    This review article is a tribute to the genius of Professor Erich Muhe, a man ahead of his times. We trace the development of laparoscopic cholecystectomy and detail the tribulations faced by Muhe. On the occasion of the twentieth anniversary of the first laparoscopic cholecystectomy, we take another look at some of the controversies surrounding this gold standard in the management of gallbladder disease.

  19. Twenty years after Erich Muhe: Persisting controversies with the gold standard of laparoscopic cholecystectomy

    OpenAIRE

    Jani, Kalpesh; Rajan, P S; Sendhilkumar, K; Palanivelu, C

    2006-01-01

    This review article is a tribute to the genius of Professor Erich Muhe, a man ahead of his times. We trace the development of laparoscopic cholecystectomy and detail the tribulations faced by Muhe. On the occasion of the twentieth anniversary of the first laparoscopic cholecystectomy, we take another look at some of the controversies surrounding this gold standard in the management of gallbladder disease

  20. A comparative review of the pharmacoeconomic guidelines in South Africa.

    Science.gov (United States)

    Carapinha, João L

    2017-01-01

    To compare the pharmacoeconomic guidelines in South Africa (SA) with other middle- and high-income countries. A comparative review of key features of the pharmacoeconomic guidelines in SA was undertaken using the Comparative Table of Pharmacoeconomic Guidelines developed by the International Society of Pharmacoeconomics and Outcomes Research, and published country-level pharmacoeconomics guidelines. A random sample of guidelines in high- and middle-income countries were analyzed if data on all key features were available. Key features of the pharmacoeconomic guidelines in SA were compared with those in other countries, and divergent features were identified and elaborated. Five upper middle-income countries (Brazil, Colombia, Cuba, Malaysia, and Mexico), one lower middle-income country (Egypt), and six high-income countries (Germany, Ireland, Norway, Portugal, Taiwan, and the Netherlands) were analyzed. The pharmacoeconomic guidelines in SA differ in important areas when compared with other countries. In SA, the study perspective and costs are limited to private health-insurance companies, complex modelling is discouraged and models require pre-approval, equity issues are not explicitly stated, a budget impact analysis is not required, and pharmacoeconomic submissions are voluntary. Future updates to the pharmacoeconomic guidelines in SA may include a societal perspective with limitations, incentivize complex and transparent models, and integrate equity issues. The pharmacoeconomic guidelines could be improved by addressing conflicting objectives with policies on National Health Insurance, incentivize private health insurance companies to disclose reimbursement data, and require the inclusion of a budget impact analysis in all pharmacoeconomic submissions. Further research is also needed on the impact of mandatory pharmacoeconomic submissions in middle-income countries.

  1. Simulating auditory and visual sensorineural prostheses: a comparative review

    Science.gov (United States)

    Hallum, L. E.; Dagnelie, G.; Suaning, G. J.; Lovell, N. H.

    2007-03-01

    Microelectronic vision prosthesis proposes to render luminous spots (so-called phosphenes) in the visual field of the otherwise blind subject by way of an implanted array of stimulating electrodes, and in doing so restore some spatial vision. There are now many research teams worldwide working towards a therapeutic device, analogous to the cochlear implant, for the profoundly blind. Despite the similarities between the cochlear implant and vision prostheses, there are few instances in the literature where the two approaches are compared and contrasted with a mind to informing the science and engineering of the latter. This is the focus of the present review; specifically, our interest is psychophysics and signal processing. Firstly, we examine the cochlear implant, and review a handful of psychophysical work: the acoustic simulation of cochlear implants and the method used. We focus on the use of normally hearing subjects (played coloured noise bands or sine waves) as a means of investigating cochlear-implant efficacy and speech processing algorithms. These results provide guidance to vision researchers, for they address the interpretation of simulation data, and flag key areas, such as 'artificial' perception in the presence of noise, that require experimental work in coming years. Secondly, we provide an up-to-date review of the body of analogous psychophysical work: the visual simulation, involving normal observers, of microelectronic vision prosthesis. These simulations allow predictions as to the likely clinical efficacy of the prosthesis; indeed, results to date suggest that a number on the order of 100 implanted electrodes will afford subjects mobility and recognition of faces (and other complex stimuli), while even fewer electrodes facilitate reading printed text and very simple visuomanual tasks. Further, the simulations allow investigations of image and signal processing strategies, plus they provide researchers in the field, and other interested persons

  2. Virtual reality training versus blended learning of laparoscopic cholecystectomy:a randomized controlled trial with laparoscopic novices

    OpenAIRE

    Nickel, Felix; Brzoska, Julia Anja; Gondan, Matthias; Rangnick, Henriette Maria; Chu, Jackson; Kenngott, Hannes Götz; Linke, Georg Richard; Kadmon, Martina; Fischer, Lars; Müller-Stich, Beat Peter

    2015-01-01

    Objective: This study compared virtual reality (VR) training with low cost blended learning (BL) in a structured training program. Background: Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks. Methods: Laparoscopy-naïve medical students were randomized in two groups stratified for gender. The BL group (n = 42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n = 42) trai...

  3. Cost-utility and value-of-information analysis of early versus delayed laparoscopic cholecystectomy for acute cholecystitis

    DEFF Research Database (Denmark)

    Wilson, E; Gurusamy, K; Gluud, C

    2010-01-01

    BACKGROUND:: A recent systematic review found early laparoscopic cholecystectomy (ELC) to be safe and to shorten total hospital stay compared with delayed laparoscopic cholecystectomy (DLC) for acute cholecystitis. The cost-effectiveness of ELC versus DLC for acute cholecystitis is unknown. METHODS......, there is a 70.9 per cent probability that ELC is cost effective compared with DLC. Full implementation of ELC could save the NHS pound8.5 million per annum. CONCLUSION:: The results of this decision analytic modelling study suggest that on average ELC is less expensive and results in better quality of life than......:: A decision tree model estimating and comparing costs to the UK National Health Service (NHS) and quality-adjusted life years (QALYs) gained following a policy of either ELC or DLC was developed with a time horizon of 1 year. Uncertainty was investigated with probabilistic sensitivity analysis, and value...

  4. A comparative Review of Extraction, Transformation and Loading Tools

    Directory of Open Access Journals (Sweden)

    Amanpartap Singh PALL

    2013-07-01

    Full Text Available Business today forces the enterprises to run different but coexisting information systems. However, data warehousing enterprises have a dilemma of choosing the right ETL process and the right ETL tool for their organization as one wrong step or choice may lead to a series of losses both monetarily and by time, not to mention the amount of laborious work that the workers would put in. The organization can choose from a variety of ETL tools but without exploring or the knowledge of their features this would again result in a bad decision making process. In this paper, we have tried to present a comparative review of some of the leading ETL tools just to acquaint the users with its features and drawbacks.

  5. Comparative Ochratoxin Toxicity: A Review of the Available Data

    Directory of Open Access Journals (Sweden)

    Alexandra H. Heussner

    2015-10-01

    Full Text Available Ochratoxins are a group of mycotoxins produced by a variety of moulds. Ochratoxin A (OTA, the most prominent member of this toxin family, was first described by van der Merwe et al. in Nature in 1965. Dietary exposure to OTA represents a serious health issue and has been associated with several human and animal diseases including poultry ochratoxicosis, porcine nephropathy, human endemic nephropathies and urinary tract tumours in humans. More than 30 years ago, OTA was shown to be carcinogenic in rodents and since then extensive research has been performed in order to investigate its mode of action, however, this is still under debate. OTA is regarded as the most toxic family member, however, other ochratoxins or their metabolites and, in particular, ochratoxin mixtures or combinations with other mycotoxins may represent serious threats to human and animal health. This review summarises and evaluates current knowledge about the differential and comparative toxicity of the ochratoxin group.

  6. A Comparative Analysis of Juvenile Book Review Media.

    Science.gov (United States)

    Witucke, A. Virginia

    This study of book reviews takes an objective look at the major sources that review children's books. Periodicals examined are Booklist, Bulletin of the Center for Children's Books, Horn Book, New York Times Book Review, and School Library Journal. Presented in a series of eight tables, the report examines reviews of 30 titles published between…

  7. Advanced laparoscopic bariatric surgery Is safe in general surgery training.

    Science.gov (United States)

    Kuckelman, John; Bingham, Jason; Barron, Morgan; Lallemand, Michael; Martin, Matthew; Sohn, Vance

    2017-05-01

    Bariatric surgery makes up an increasing percentage of general surgery training. The safety of resident involvement in these complex cases has been questioned. We evaluated patient outcomes in resident performed laparoscopic bariatric procedures. Retrospective review of patients undergoing a laparoscopic bariatric procedure over seven years at a tertiary care single center. Procedures were primarily performed by a general surgery resident and proctored by an attending surgeon. Primary outcomes included operative volume, operative time and leak rate with perioperative outcomes evaluated as secondary outcomes. A total of 1649 bariatric procedures were evaluated. Operations included laparoscopic bypass (690) and laparoscopic sleeve gastrectomy (959). Average operating time was 136 min. Eighteen leaks (0.67%) were identified. Graduating residents performed an average of 89 laparoscopic bariatric cases during their training. There were no significant differences between resident levels with concern to operative time or leak rate (p 0.97 and p = 0.54). General surgery residents can safely perform laparoscopic bariatric surgery. When proctored by a staff surgeon, a resident's level of training does not significantly impact leak rate. Published by Elsevier Inc.

  8. Minimal impairment in pulmonary function following laparoscopic surgery

    DEFF Research Database (Denmark)

    Staehr-Rye, Anne K; Rasmussen, L S; Rosenberg, J

    2014-01-01

    BACKGROUND: Pulmonary function may be impaired in connection with laparoscopic surgery, especially in the head-down body position, but the clinical importance has not been assessed in detail. The aim of this study was to assess pulmonary function after laparoscopic hysterectomy and laparoscopic...... cholecystectomy in the 20° head-up position or hysterectomy in the 30° head-down position. The primary outcome was the difference between arterial oxygenation (PaO2 ) 2 h postoperatively and the preoperative value. Two hours and 24 h after surgery, pulmonary shunt and ventilation-perfusion mismatch were assessed.......88). Shunt was significantly greater in the cholecystectomy group 24 h after surgery compared to the hysterectomy group [4%, 95% CI 0 to 9 vs. 0%, 95% CI 0 to 7, P = 0.02]. CONCLUSIONS: Minimal impairment in pulmonary gas exchange was found after laparoscopic surgery. Pulmonary shunt was larger after...

  9. Inguinal hernia repair: totally preperitoneal laparoscopic approach versus Stoppa operation: randomized trial of 100 cases.

    Science.gov (United States)

    Champault, G G; Rizk, N; Catheline, J M; Turner, R; Boutelier, P

    1997-12-01

    In a prospective randomized trial comparing the totally preperitoneal (TPP) laparoscopic approach and the Stoppa procedure (open), 100 patients with inguinal hernias (Nyhus IIIA, IIIB, IV) were followed over a 3-year period. Both groups were epidemiologically comparable. In the laparoscopic group, operating time was significantly longer (p = 0.01), but hospital stay (3.2 vs. 7.3 days) and delay in return to work (17 vs. 35 days) were significantly reduced (p = 0.01). Postoperative comfort (less pain) was better (p = 0.001) after laparoscopy. In this group, morbidity was also reduced (4 vs. 20%; p = 0.02). The mean follow-up was 605 days, and 93% of the patients were reviewed at 3 years. There were three (6%) recurrences after TPP, especially at the beginning of the surgeon's learning curve, versus one for the Stoppa procedure (NS). For bilateral hernias, the authors suggest the use of a large prosthesis rather than two small ones to minimize the likelihood of recurrence. In the conditions described, the laparoscopic (TPP) approach to inguinal hernia treatment appears to have the same long-term recurrence rate as the open (Stoppa) procedure but a real advantage in the early postoperative period.

  10. Virtual reality in laparoscopic surgery.

    Science.gov (United States)

    Uranüs, Selman; Yanik, Mustafa; Bretthauer, Georg

    2004-01-01

    Although the many advantages of laparoscopic surgery have made it an established technique, training in laparoscopic surgery posed problems not encountered in conventional surgical training. Virtual reality simulators open up new perspectives for training in laparoscopic surgery. Under realistic conditions in real time, trainees can tailor their sessions with the VR simulator to suit their needs and goals, and can repeat exercises as often as they wish. VR simulators reduce the number of experimental animals needed for training purposes and are suited to the pursuit of research in laparoscopic surgery.

  11. Acceptable short-term outcome of laparoscopic subtotal colectomy for inflammatory bowel disease

    DEFF Research Database (Denmark)

    Frid, Natalie Lassen; Bulut, Orhan; Pachler, Jørn

    2013-01-01

    Laparoscopic colectomy for both benign and malignant disease, including inflammatory bowel disease (IBD), has recently been shown to have many advantages compared with open surgery. This study aimed to compare the effect of laparoscopic versus open subtotal colectomy (STC) for IBD on overall...

  12. Single-incision laparoscopic bariatric surgery

    Directory of Open Access Journals (Sweden)

    Huang Chih-Kun

    2011-01-01

    Full Text Available Background: Bariatric surgery has been established as the best option of treatment for morbid obesity. In recent years single-incision laparoscopic surgery (SILS has emerged as another modality of carrying out the bariatric procedures. While SILS represents an advance, its application in morbid obesity at present is limited. In this article, we review the technique and results of SILS in bariatric surgery. Methods: The PubMed database was searched and totally 11 series reporting SILS in bariatric surgery were identified and analyzed. The case reports were excluded. Since 2008, 114 morbidly obese patients receiving SILS bariatric surgeries were reported. Results: The procedures performed included SILS gastric banding, sleeve gastrectomy and gastric bypass. No mortality was reported in the literatures. Sixteen patients (14.05% needed an additional incision for a liver retractor, a trocar or for conversion. Only one complication of wound infection was reported in these series. All the surgeons reported that the patients were highly satisfied with the scar. Conclusion: Because of abundant visceral and subcutaneous fat and multiple comorbidities in morbid obesity, it is more challenging for surgeons to perform the procedures with SILS. It is clear that extensive development of new instruments and technical aspects of these procedures as well as randomized studies to compare them with traditional laparoscopy are essential before these procedures can be utilized in day-to-day clinical practice.

  13. Esophageal hiatus surgery: video laparoscopic approach

    International Nuclear Information System (INIS)

    Rodriguez, G.; Fernandez, G.; Gatti, A.; Balboa, O.

    2003-01-01

    Since the early nineties,surgery of esophageal hiatus(treatment of disease due to gastroesophageal reflux,gastric denervation surgery in treatment of duodenal chronic ulcer)through video laparoscopic approach,has gained broad dissemination and acceptance at world level.This phenomenon is explained by the excellent exposure and visualization of an anatomic region which is deeply situated in the upper hemi abdomen, added to the advantages of an approach which, while minimally invasive, attains short and medium term results comparable to those of conventional surgery.The describes the initial experience of the authors with this type of surgery as well as a review of literature, with special emphasis on the surgical technique employed.Case material covers 23 patient: fourteen had Nissen Rossetti fun duplication, 4 suffered from miotomies associated with fun duplications of varying type and 5 were gastric denervation surgeries by reason of duodenal ulcer.There were 2 conversions, both due to esophageal perforation.There were no major postoperative complications and mortality was nil. while functional results were highly satisfactory.The authors therefore conclude that since results which they obtained were coincidental with those of international bibliography, work along these lines should continue

  14. Single-incision laparoscopic surgery for pyloric stenosis.

    Science.gov (United States)

    Kozlov, Yury; Novogilov, Vladimir; Podkamenev, Alexey; Rasputin, Andrey; Weber, Irina; Solovjev, Alexey; Yurkov, Pavel

    2012-04-01

    Laparoscopy is the most common procedure for correction of congenital pyloric stenosis. The standard laparoscopic approach is based on the three-port technique. In contrast to the standard laparoscopic technique, the single-incision laparoscopic surgery (SILS) requires only one incision. We report on our experience with this surgical approach. Between September 2009 and August 2010 a total of 24 children underwent a laparoscopic pyloromyotomy, 12 in SILS technique. The single incision was carried through the center of the umbilicus. The working instruments were introduced in a two-dimensional direction into the peritoneal cavity via the same umbilical incision. The two groups were compared for patients' demographics, operative report and early postoperative outcomes. All SILS procedures were performed successfully with no conversion rate. There were no differences in the preoperative parameters between the two groups regarding age before surgery and body weight at operation. Operative time and time of full enteral intake was similar to comparable procedures with usage of a standard laparoscopic approach. There were no operative or postoperative complications. The early experience described in this study confirms that SILS can be applied for treatment of pyloric stenosis with outcomes similar to the standard laparoscopic surgery.

  15. Oncological outcome after laparoscopic abdominoperineal excision of the rectum.

    Science.gov (United States)

    Jefferies, M T; Evans, M D; Hilton, J; Chandrasekaran, T V; Beynon, J; Khot, U

    2012-08-01

    Abdominoperineal excision of the rectum (APER) for cancer has been associated with higher circumferential resection margin (CRM) involvement and failure of local disease control. The aim of this study was to investigate whether the introduction of laparoscopic APER altered the incidence of CRM involvement. Consecutive patients undergoing open or laparoscopic APER for adenocarcinomas of the rectum were studied. Patient demographics, preoperative staging, neoadjuvant treatment, operative findings, length of stay and pathological details were collected from operative and radiology databases and compared. There were 16 laparoscopic and 25 open APER performed over a 3-year period. Neoadjuvant therapy was given to 43.8% (7/16) of the laparoscopic group and 56.0% (14/25) of the open group. Complete laparoscopic resection was possible in 14 (87.5%) of 16 patients. The median harvested number of nodes was 14 (4-33) in both groups. The median length of stay was 7 (3-13) and 15 (9-40) days in the laparoscopic and open groups (P CRM was clear in all cases. There was no local recurrence in either group at a median follow-up of 23 months. There were no in-hospital deaths and no significant differences in overall survival. There were no significant differences in preoperative or postoperative histopathological T stage between the two groups (P = 0.057 and P = 0.121). Laparoscopic APER for selected rectal cancers can achieve comparable oncological outcome to open surgery but is associated with a much shorter length of stay. Patient and tumour characteristics must be taken into consideration when deciding on a laparoscopic approach for low rectal cancer. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

  16. 3D laparoscopic surgery: a prospective clinical trial.

    Science.gov (United States)

    Agrusa, Antonino; Di Buono, Giuseppe; Buscemi, Salvatore; Cucinella, Gaspare; Romano, Giorgio; Gulotta, Gaspare

    2018-04-03

    Since it's introduction, laparoscopic surgery represented a real revolution in clinical practice. The use of a new generation three-dimensional (3D) HD laparoscopic system can be considered a favorable "hybrid" made by combining two different elements: feasibility and diffusion of laparoscopy and improved quality of vision. In this study we report our clinical experience with use of three-dimensional (3D) HD vision system for laparoscopic surgery. Between 2013 and 2017 a prospective cohort study was conducted at the University Hospital of Palermo. We considered 163 patients underwent to laparoscopic three-dimensional (3D) HD surgery for various indications. This 3D-group was compared to a retrospective-prospective control group of patients who underwent the same surgical procedures. Considerating specific surgical procedures there is no significant difference in term of age and gender. The analysis of all the groups of diseases shows that the laparoscopic procedures performed with 3D technology have a shorter mean operative time than comparable 2D procedures when we consider surgery that require complex tasks. The use of 3D laparoscopic technology is an extraordinary innovation in clinical practice, but the instrumentation is still not widespread. Precisely for this reason the studies in literature are few and mainly limited to the evaluation of the surgical skills to the simulator. This study aims to evaluate the actual benefits of the 3D laparoscopic system integrating it in clinical practice. The three-dimensional view allows advanced performance in particular conditions, such as small and deep spaces and promotes performing complex surgical laparoscopic procedures.

  17. Robotic-assisted versus laparoscopic colectomy: cost and clinical outcomes.

    Science.gov (United States)

    Davis, Bradley R; Yoo, Andrew C; Moore, Matt; Gunnarsson, Candace

    2014-01-01

    Laparoscopic colectomies, with and without robotic assistance, are performed to treat both benign and malignant colonic disease. This study compared clinical and economic outcomes for laparoscopic colectomy procedures with and without robotic assistance. Patients aged ≥18 years having primary inpatient laparoscopic colectomy procedures (cecectomy, right hemicolectomy, left hemicolectomy, and sigmoidectomy) identified by International Classification of Diseases, Ninth Edition procedure codes performed between 2009 and the second quarter of 2011 from the Premier Hospital Database were studied. Patients were matched to a control cohort using propensity scores for disease, comorbidities, and hospital characteristics and were matched 1:1 for specific colectomy procedure. The outcomes of interest were hospital cost of laparoscopic robotic-assisted colectomy compared with traditional laparoscopic colectomy, surgery time, adverse events, and length of stay. Of 25,758 laparoscopic colectomies identified, 98% were performed without robotic assistance and 2% were performed with robotic assistance. After matching, 1066 patients remained, 533 in each group. Lengths of stay were not significantly different between the matched cohorts, nor were rates of major, minor, and/or surgical complications. Inpatient procedures with robotic assistance were significantly more costly than those without robotic assistance ($17,445 vs $15,448, P = .001). Operative times were significantly longer for robotic-assisted procedures (4.37 hours vs 3.34 hours, P < .001). Segmental colectomies can be performed safely by either laparoscopic or robotic-assisted methods. Increased per-case hospital costs for robotic-assisted procedures and prolonged operative times suggest that further investigation is warranted when considering robotic technology for routine laparoscopic colectomies.

  18. Two-incision laparoscopic appendectomy for a severe hemophilia A child patient with coagulation factor VII deficiency: Case report and review of literature.

    Science.gov (United States)

    He, Jin Peng; Feng, Jie Xiong

    2017-10-01

    The main complication of patients with severe hemophilia is recurrent bleeding events that usually affected musculoskeletal contractures. And replacement therapy methods were continuously improved to minimize adverse impacts brought by those complications. However, only several cases reported about the appendectomy for hemophilia A. We report a case of acute appendicitis treated by two-incision laparoscopy in a boy with hemophilia A and coagulation factor VII deficiency for the first time. An 8y7m-old Chinese boy presented with half a day of right sided abdominal pain, fever, nausea, and vomiting. He received a computed tomography (CT) scan which revealed an enlarged appendix, thickened wall and appendiceal fecalith, and had received a conservative anti-bacterial treatment for his acute appendicitis but failed. He was diagnosed with hemophilia A and coagulation factor VII deficiency. Two-incision laparoscopic appendectomy was made in success with a careful management of perioperative period. We monitored the clotting factor FVIII level and gave him a replacement therapy. The patient had an uneventful recovery. It is important to exclude intraabdominal or retroperitoneal hemorrhage in patients suffering from hemophilia and acute abdominal pain. Pre-operative evaluation of validity of the FVIII replacement therapy is another effective strategy to assess the safety and feasibility of applying an operation procedure. The two-incision laparoscopic appendectomy is an effective treatment for this kind of patients for its minimal trauma and fast recovery characteristics. Our report shows that laparoscopic appendectomy is feasible in a child suffering from hemophilia after adequate blood clotting factor replacement treatment.

  19. Evolution and current challenges of laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    XU Dahua.

    2013-03-01

    Full Text Available Since its introduction at the end of the 20th century, laparoscopic cholecystectomy has evolved into a safe and convenient minimally invasive surgical method, which is now the gold standard therapy for cholelithiasis worldwide. Physicians have continued to improve upon the procedure, creating methods that further minimize the related scarring and pain, such as the laproendoscopic single-site cholecystectomy and the gasless-lift laparoscopy. Additionally, the primary challenge of limited operative space in these procedures remains a key feature requiring improvement. In this review, the development and progression of laparoscopic cholecystectomy over the past 26 years is discussed, highlighting the current advantages and disadvantages that need to be addressed by practicing physicians to maximize the clinical value of this important therapy.

  20. Carbon Dioxide Embolism during Laparoscopic Surgery

    Science.gov (United States)

    Park, Eun Young; Kwon, Ja-Young

    2012-01-01

    Clinically significant carbon dioxide embolism is a rare but potentially fatal complication of anesthesia administered during laparoscopic surgery. Its most common cause is inadvertent injection of carbon dioxide into a large vein, artery or solid organ. This error usually occurs during or shortly after insufflation of carbon dioxide into the body cavity, but may result from direct intravascular insufflation of carbon dioxide during surgery. Clinical presentation of carbon dioxide embolism ranges from asymptomatic to neurologic injury, cardiovascular collapse or even death, which is dependent on the rate and volume of carbon dioxide entrapment and the patient's condition. We reviewed extensive literat