Showing papers in "Journal of Laparoendoscopic & Advanced Surgical Techniques in 2013"
TL;DR: There are fewer anastomotic and wound complications in RG patients and intracorporeal robotic-assisted ileocolicAnastomosis allows a faster recovery compared with extracorpreal anastOMosis.
Abstract: Introduction: Extracorporeal ileocolic anastomosis in laparoscopic right hemicolectomy for cancer has a significant risk of complications. The aim of this study is to evaluate the operative and postoperative results of hybrid right hemicolectomy with intracorporeal robotic-assisted anastomosis for adenocarcinoma of the ascending colon compared with the standard extracorporeal anastomosis in a case control study. Patients and Methods: Forty-eight right hemicolectomies for cancer (2009–2012) with laparoscopic medial to lateral dissection, vascular ligation, bowel transection, and robotic-assisted intracorporeal anastomosis with specimen extraction through a Pfannestiel incision (robotic group [RG]) were compared with 48 laparoscopic hemicolectomies (2009–2011) with extracorporeal anastomosis (laparoscopic group [LG]). Results: The two groups were comparable with respect to age, gender, stage of cancer, and body mass index. Surgery time was significantly longer in RG patients (RG, 266±41 minutes; LG...
119 citations
TL;DR: Considerable variability existed among the IPEG membership in treatment of patients with EA/TEF, and the identification of variance is the first step in creating future studies to identify best practices.
Abstract: Background: Optimal surgical treatment of infants with esophageal atresia (EA) and tracheoesophageal fistula (TEF) remains controversial. In order to better understand variability in management, we surveyed the International Pediatric Endosurgery Group (IPEG) membership. Materials and Methods: An online-based survey, conducted in 2012, was sent to all IPEG members. Results: The survey was completed by 170 surgeons from 31 countries. A majority of respondents practiced in academic/university settings (86%) and performed one to three EA/TEF repairs annually (67%). Those practicing for over 15 years made up 39% of the study group, followed by those practicing 6–10 years (24%), 0–5 years (22%), and 11–15 years (15%). Utilization of a thoracoscopic approach was reported by half of the respondents with a frequency of 1–3 cases (76%), 4–6 cases (17%), and greater than 7 cases (7%) per year. Low birth weight, congenital heart disease, long gap length, and compromised physiologic status were identified as...
91 citations
TL;DR: The results suggested that the laparoscopic approach was as safe as the open alternative for colorectal cancer and better short-term outcomes and similar long-term oncological control compared with open resection.
Abstract: Background: Despite the theoretical advantages of laparoscopic surgery, it is still not considered the standard treatment for colorectal cancer patients because of criticism concerning oncologic stability. This study aimed at examining the short- and long-term follow-up results of laparoscopic surgery versus open surgery for colorectal cancer and at investigating clinical outcomes, oncologic safety, and any potential advantages of laparoscopic colorectal cancer resection. Subjects and Methods: We retrospectively analyzed a database containing the information about patients who underwent surgery for stage I–III colorectal cancer from January 2004 to January 2012 at our institution. Results: The patients who underwent the laparoscopic-assisted procedure showed a significantly faster recovery than those who underwent open surgery, namely, less time to first passing flatus (P=.041), time of first bowel motion (P=.04), time to resume normal diet (P=.043), and time to walk independently (P=.031). Lapar...
87 citations
TL;DR: LIHR is a safe and feasible procedure that has significantly better effects on postoperative pains and hernia relapse than Lichtenstein tension-free hernia repair.
Abstract: Objective: To compare the effects of laparoscopic inguinal hernia repair (LIHR) and Lichtenstein tension-free inguinal hernia repair and to explore the safety and feasibility of LIHR as well as the advantages and disadvantages of these procedures. Subjects and Methods: In total, 252 patients with inguinal hernia were equally randomized into the transabdominal preperitoneal (TAPP) repair, totally extraperitoneal (TEP) repair, and Lichtenstein tension-free hernia repair groups (n=84 each). Operating time, postoperative pain scores, postoperative scrotal seroma, postoperative local esthesiodermia, postoperative chronic pains, postoperative long-term hernia relapse, and costs of hospitalization were compared among the three groups. Results: All laparoscopic operations were performed smoothly without intraoperative conversion to open surgery. The LIHR groups showed significantly better effects on postoperative pains and hernia recurrence than the Lichtenstein tension-free herniorrhaphy group (P<.05), ...
79 citations
TL;DR: This study shows in a large operative experience over 20 years that laparoscopic fundoplication is safe and effective in the pediatric population and should be considered the gold standard for antireflux procedures.
Abstract: Background: Laparoscopic fundoplication for gastroesophageal reflux disease has become a common procedure performed in infants and children over the last 20 years. This report describes a 20-year experience with nearly 2000 consecutive laparoscopic Nissen fundoplications. Subjects and Methods: With Institutional Review Board approval, the data of all patients undergoing fundoplication from 1992 to 2011 were reviewed. Data were kept prospectively from the time of first encounter with each patient. Ages ranged from 5 days to 18 years, and weight ranged from 1.2 to 120 kg. The 2008 fundoplications were performed by or under the direct supervision of a single surgeon. Patients were divided into groups based on age: 6 years. Data on indications, surgical demographics, postoperative course including any complications, and long-term follow-up were kept prospectively on each patient. Results: Average operative time dropped dramatically from 109 minutes for the firs...
75 citations
TL;DR: The study appears to be encouraging to suggest the use of barbed suture for intestinal sutures to close the gastrojejunal anastomosis in obese patients undergoing gastric bypass.
Abstract: Background: Laparoscopic intracorporeal suturing and knot tying for anastomosis are considered the most difficult laparoscopic skills to master. The aim of this study was to establish the safety and efficacy of barbed suture for intestinal sutures to close the gastrojejunal anastomosis in obese patients undergoing gastric bypass. Study Design: All consecutive patients undergoing gastric bypass were screened for enrollment in our study. Patients were randomly allocated to undergo knotless anastomosis with barbed suture (V-Loc™ 180; Covidien, Mansfield, MA) (case group) or knot-tying anastomosis with 3/0 polyglactin sutures (Polysorb®; Covidien) (control group). The primary outcome was the time needed for the gastrojejunal anastomosis and the operative time. The secondary outcomes were the incidence of leak, bleeding, and stenosis and the evaluation of the cost of the different procedures evaluated. Results: Among the 60 consecutive patients enrolled in our study, 30 underwent knot-tying anastomosi...
63 citations
TL;DR: Single-incision laparoscopic appendectomy is a feasible and safe procedure, even in patients with perforated appendicitis, and this procedure is even less invasive than three-port Laparoscopic surgical techniques.
Abstract: Background: Single-incision laparoscopic surgery is a new procedure used to treat a variety of diseases requiring surgical intervention. The aim of this prospective comparative study is to compare the technical feasibility and safety of single-incision and three-port laparoscopic appendectomy. Study Design: Between February 2009 and April 2010, 102 patients with appendicitis were enrolled in this study. The patients were randomly assigned to two groups: single-incision or three-port laparoscopic appendectomy. Patients with perforated appendicitis were not excluded. We analyzed the patients' clinical characteristics and surgical outcomes. Results: There were no significant differences in preoperative patient demographics between the two groups with respect to body mass index (22.03±4.07 kg/m2 in the single-incision group versus 21.97±3.49 kg/m2 in the three-port group, P=.930). The pain score on the visual analog scale on postoperative Day 1 was significantly lower in the single-incision group tha...
55 citations
TL;DR: Preliminary results of laparoscopic sentinel node identification using a near-infrared dye show this procedure is safe and feasible and it was possible to detect lymph nodes in all patients.
Abstract: Background: After promising results were obtained from studies in large animals, a technique using indocyanine green (ICG) is being introduced for sentinel lymph node (SLN) biopsy in colon cancer patients. Subjects and Methods: Colon cancer patients without clinical signs of metastatic disease, presenting at the VU University Medical Center (Amsterdam, The Netherlands) or Kennemer Gasthuis (Haarlem, The Netherlands), were asked to participate in the study. During laparoscopy, a subserosal injection of 2.5 mg of ICG diluted in 1 mL of 0.9% NaCl plus 2% human albumin was performed using a percutaneously inserted long rigid or flexible needle. After injection, a near-infrared laparoscope (Olympus Corp., Tokyo, Japan) was used for lymph flow and SLN visualization. The SLNs were laparoscopically harvested and analyzed by a senior pathologist using multisectioning and immunohistochemistry. Results: Fourteen patients were included (six women, eight men), with a median age of 75.5 (interquartile range [I...
51 citations
TL;DR: Evaluating the mental workload associated with both 2D and 3D views in first-year medical students showed that participants viewing in 3D had higher localization accuracy and a lower subjective measure of mental workload, specifically, the mental demand component of the NASA-TLX.
Abstract: Visualization of medical data in three-dimensional (3D) or two-dimensional (2D) views is a complex area of research. In many fields 3D views are used to understand the shape of an object, and 2D views are used to understand spatial relationships. It is unclear how 2D/3D views play a role in the medical field. Using 3D views can potentially decrease the learning curve experienced with traditional 2D views by providing a whole representation of the patient's anatomy. However, there are challenges with 3D views compared with 2D. This current study expands on a previous study to evaluate the mental workload associated with both 2D and 3D views. Twenty-five first-year medical students were asked to localize three anatomical structures—gallbladder, celiac trunk, and superior mesenteric artery—in either 2D or 3D environments. Accuracy and time were taken as the objective measures for mental workload. The NASA Task Load Index (NASA-TLX) was used as a subjective measure for mental workload. Results showed...
50 citations
TL;DR: The spectrum of evidence regarding the feasibility, safety, benefits, and limitations of abdominal and urological robot-assisted surgery in children is reviewed, finding robotic surgery is suitable in the pediatric practice, which necessitates fine dissections and sutures in narrow anatomical spaces.
Abstract: Purpose: The last two decades have witnessed a dramatic development of minimally invasive surgery (MIS). Robotic-assisted surgery is currently the latest step in the evolution of MIS. MIS was initially developed for adult surgery, but its use has progressively been extended to pediatrics. As for all new technologies, an objective evaluation is essential to adopt the robot in the practice of pediatrics. Materials and Methods: This article reviews the spectrum of evidence regarding the feasibility, safety, benefits, and limitations of abdominal and urological robot-assisted surgery in children. This analysis was performed using the PubMed database, using key words such as “robot,” “robotic surgery,” “robot-assisted,” “da Vinci,” and “computer-enhanced surgery” combined with “child,” “children,” “infants,” and “pediatric.” Results: In total, 88 studies met the selection criteria for our review. Only 10 studies comparing robotic surgery with open or conventional laparoscopic surgery are available for...
48 citations
TL;DR: It is found that VR simulator training can improve da Vinci performance and can result in an early plateau in the learning curve for robotic practice under controlled circumstances.
Abstract: Introduction: The DV-Trainer™ (a virtual reality [VR] simulator) (Mimic Technologies, Inc., Seattle, WA) is one of several different robotic surgical training methods. We designed a prospective study to determine whether VR training could improve da Vinci® Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) performance. Subjects and Methods: Surgeons (n=12) were enrolled using a randomized protocol. Groups 1 (VR training) and 2 (control) participated in VR and da Vinci exercises. Participants' time and moving distance were combined to determine a composite score: VR index=1000/(time×moving distance). The da Vinci exercises included needle control and suturing. Procedure time and error were measured. A composite index (DV index) was computed and used to measure da Vinci competency. After the initial trial with both the VR and da Vinci exercises, only Group 1 was trained with the VR simulator following our institutional curriculum for 3 weeks. All members of both groups then participated in t...
TL;DR: The eoSim demonstrates validity as a model for laparoscopic simulation using measures of construct, concurrent, and content validity and it is hoped that its decreased cost relative to other simulators will encourage increased uptake by trainees and institutions.
Abstract: Background: The purpose of this study was to validate the eoSim box laparoscopic simulator using measures of construct, concurrent, and content validity. Subjects and Methods: Forty-seven novice and expert participants were tested on both the Fundamentals of Laparoscopic Surgery (FLS™; Society of American Gastrointestinal and Endoscopic Surgeons, Los Angles, CA) and eoSim (eoSurgical™, Edinburgh, Scotland, United Kingdom) laparoscopic simulators, using established scoring mechanisms. Three skill areas were examined: object transfer, precision cutting, and intracorporeal suturing. A questionnaire was also completed. Results: Experts performed significantly better on the eoSim than novices, with a median score of 51.1% versus 14.8% (P<.0001), showing construct validity. There was a high correlation between performance on the validated FLS simulator and the eoSim (0.78; P<.0001), demonstrating concurrent validity. Feedback from participants indicated an agreement that the eoSim was a useful training...
TL;DR: Laroscopic re-intervention could be a safe and feasible treatment for anastomotic leakage after laparoscopic colorectal surgery, and promising results need to be further investigated in a prospective study to reduce uncertainty in the patient's condition and perioperative findings.
Abstract: Background: Increasing numbers of colorectal resections are performed laparoscopically each year. In 2010, 42% of all colorectal procedures in The Netherlands were performed laparoscopically. Although the anastomotic leakage rate is 3%–19% of all patients, little is known about laparoscopic options for re-intervention. Our study aims to evaluate the safety and feasibility of laparoscopic re-intervention compared with open surgery following colorectal surgery. Patients and Methods: All patients who required a surgical re-intervention for an anastomotic leak, bowel perforation, or abscess after laparoscopic colorectal surgery between January 2008 and June 2012 were analyzed retrospectively. Demographic data, operative management, morbidity, hospital stay, and mortality were collected and analyzed for each patient. Results: Fifty-six patients were included. Eighteen patients had a laparotomy following laparoscopy, and 38 patients had a laparoscopic re-intervention following laparoscopy. The median a...
TL;DR: Oversewing of the staple line may lead to reduction in leak rate, although a larger study is required to reach a definitive conclusion.
Abstract: Introduction: Laparoscopic sleeve gastrectomy (LSG) is a popular bariatric procedure with a low complication rate. Serious complications after LSG include gastric leak and staple line bleeding. In order to reduce these complications, staple line reinforcement has been practiced variably by many surgeons. There is no conclusive evidence to suggest that routine oversewing of the staple line or reinforcement with buttressing material after LSG decreases these complications. We therefore undertook a prospective randomized controlled trial to evaluate the impact of oversewing of the staple line in preventing complications after LSG. Patients and Methods: Sixty patients undergoing LSG were randomly allocated to two groups. In Group A, the entire staple line was reinforced with continuous suturing, and in Group B, no reinforcement was used. Thirty patients were enrolled in each group. Indications for this procedure were morbidly obese (body mass index ≥40 kg/m2) or severely obese (body mass index ≥35 kg...
TL;DR: A wide experience in SIPES and feasibility has been described with good clinical outcomes and low rate of conversion, and it is pending the execution of prospective controlled trials for other operations to demonstrate the real benefits of this less invasive approach.
Abstract: Background: Single-incision pediatric endosurgery (SIPES) is defined as minimally invasive surgery performed through a unique incision in the abdomen, chest, or retroperitoneum. Several publications exist, but no previous systematic review has been made to evaluate the real benefits of this approach in terms of feasibility and clinical outcomes. Materials and Methods: We performed an electronic search in PubMed up to March 2012 with the terms “single AND incision OR site OR port OR trocar AND children” including related articles and obtained 197 articles. After applying our inclusion criteria, 78 articles were reviewed. Results: We identified prospective controlled trials (n=1), case-control studies (n=12), case series (n=49), and case reports (n=16). In total, 4212 patients had been operated on by SIPES and were separated by systems: gastrointestinal (n=2888), urologic (n=390), gynecologic (n=27), other abdominal (n=874), and thoracic (n=33) procedures. The most common procedure was SIPES append...
TL;DR: TLTG for EGC near the GEJ could be the best way to improve early surgical outcomes of EGC in overweight patients provided it is performed by surgeons who are experienced in laparoscopic gastrectomy.
Abstract: Background: Several investigators have suggested methods for performing totally laparoscopic total gastrectomy (TLTG). However, even surgeons experienced in laparoscopic gastrectomy find it very hard to perform TLTG safely because it is a complex procedure. The aim of the present study was to evaluate the safety and efficacy of our TLTG method for the surgical treatment of early gastric cancer (EGC) located near the gastroesophageal junction (GEJ). Subjects and Methods: Between January 2010 and June 2011, 113 patients at a single institution underwent TLTG (n=90) or laparoscopic-assisted total gastrectomy (LATG) (n=23). Early surgical outcomes of the two techniques were compared to assess the effectiveness of TLTG for treating EGC near the GEJ. Results: The TLTG group included patients with higher body mass indexes (23.2 versus 22.2 kg/m2, P=.037) and more overweight patients (22.2% versus 4.0%, P=.041) than the LATG group. Despite this, the two groups had similar early surgical outcomes, such as...
TL;DR: TORS is a safe procedure with minimal complications and acceptable clinical and functional outcomes and all malignant cases that underwent TORS received postoperative adjuvant therapy.
Abstract: Objective: To report a single institution's experience with transoral robotic surgery (TORS) and its clinical outcomes. This was a retrospective study carried out at a university-affiliated teaching hospital. Subjects and Methods: Forty-four consecutive TORS patients with benign and malignant diseases were reviewed. Data on demographics, clinical parameters, and diet were collected. Surgical margins, local and regional recurrence, distant metastasis, 2-year disease-free survival rate, and 2-year survival data were reviewed for the malignant cases. Results: Nine benign and 35 proven squamous cell carcinoma (SCCA) cases underwent TORS. The set-up time was 17.12 minutes (range, 10–40 minutes), and operative time was 53 minutes (range, 10–300 minutes). Average length of stay was 2.5 days. There were seven (6.8%) grade 3 surgical complications. Surgical infection rate was 2.3%. Benign cases were on a regular diet after TORS. Of the malignant cases, 94% were taking peroral diet immediately after the TO...
TL;DR: Laparoscopic right hemicolectomy has the advantages of minimal invasion, faster recovery, and a lower rate of wound infection, and it can achieve the same degree of radicality and short-term prognosis as open right hemICOlectomy.
Abstract: Objective: This meta-analysis was designed to assess the feasibility and safety of laparoscopic right hemicolectomy for colon cancer. Research Design: A systematic search of the MEDLINE, EMBASE, and Cochrane databases identified 12 studies that met the inclusion criteria for data extraction. Publications that compared laparoscopic right hemicolectomy and open right hemicolectomy for treatment of colon cancer in the past 20 years were collected for review. The primary outcomes used for meta-analysis were operating time, blood loss, number of harvested lymph nodes, time to first flatus, postoperative hospital stay, postoperative complications, mortality, and rate of recurrence. Results: Twelve studies that included 1057 patients were examined. Of these patients, 475 and 582 had undergone laparoscopic right hemicolectomy and open right hemicolectomy, respectively. There were significant reductions in blood loss, time to first flatus, postoperative hospital stay, and rate of wound but a operating tim...
TL;DR: SPLC can be performed safely and effectively with better cosmetic results than with the conventional multiport laparoscopic cholecystectomy technique for benign gallbladder diseases.
Abstract: Background: Although current guidelines recommend performing cholecystectomy via laparoscopy, consensus on the application of single-incision laparoscopic surgery for cholecystectomy is still lacking. The aim of the current study was to perform a meta-analysis of randomized controlled trials (RCTs) and nonrandomized comparative studies (NRCSs), comparing single-port laparoscopic cholecystectomy (SPLC) and conventional multiport laparoscopic cholecystectomy (CMLC) for benign gallbladder diseases. Subjects and Methods: A systematic review of the literature was performed to identify studies published between January 1997 and December 2012 comparing SPLC and CMLC. Operative outcomes, postoperative parameters, complications, cosmetic results, and quality of life were evaluated. Results: Forty studies were included in the analyses (16 RCTs, 24 NRCSs) that included 3711 patients (1865 SPLCs, 1846 CMLCs). SPLC had higher conversion rates (odds ratio [OR], 4.21; 95% confidence interval [CI], 2.71–6.56; P<...
TL;DR: Preliminary results indicate that robotic selective neck dissection via a gasless postauricular facelift approach is feasible and safe and allows for excellent postoperative cosmesis.
Abstract: Background: Scarless and minimally invasive surgery is becoming popular in the head and neck area. We have developed a new robotic selective neck dissection procedure for head and neck squamous cell carcinoma (HNSCC) to avoid a long visible lateral neck scar. Here we report on the technical feasibility and safety of our procedure. Subjects and Methods: We prospectively analyzed 4 patients with early HNSCC who underwent transoral robotic surgery (TORS) and concomitant robotic selective neck dissection via a gasless postauricular facelift approach using the da Vinci® Surgical System (Intuitive Surgical Inc., Sunnyvale, CA). Results: Of these patients, 3 were male, and 1 was female. The mean age was 59.0±8.8 years. All patients had tongue cancer, with a clinically negative neck. Three patients were T1, and 1 patient was T2. All patients underwent partial glossectomy by TORS and elective robotic selective neck dissection including levels I, II, and III. The robotic selective neck dissection procedure...
TL;DR: The IAA incidence is comparable in LA versus OA in pediatric patients, and LA confers a significantly lower risk of other postoperative complications, including WI and SBO.
Abstract: Aims: Recent systematic reviews have suggested an increased incidence of intraabdominal abscess (IAA) formation following laparoscopic appendicectomy (LA) compared with the open approach (OA). As the majority of these analyses have focused on appendicectomy in adults, our aim was to review the evidence base for pediatric patients. Subjects and Methods: We performed a comprehensive review of relevant studies published between 1990 and 2012. Specific inclusion and exclusion criteria were used to identify studies that investigated the incidence of IAA following LA and OA in pediatric patients. The primary outcome measure in the present meta-analysis was IAA formation, and secondary outcomes included wound infection (WI) and incidence of postoperative small bowel obstruction (SBO). Results: Sixty-six studies with a total of 22,060 pediatric patients were included: 56.5% OA and 43.5% LA. There was no overall difference in the incidence of IAA formation: 2.7% for OA (333/12,460) versus 2.9% for LA (282...
TL;DR: Laparoscopic splenectomy seems to be superior to the open approach in patients with a longer diagnosis-to-splenectomy interval, and higher postoperative platelet percentage increase was achieved in both groups in Patients with a lower preoperative platelets count.
Abstract: Background: Only a few studies have addressed long-term results comparing laparoscopic and open splenectomy in idiopathic thrombocytopenic purpura (ITP). We analyzed the 1-year results comparing age, sex, length of preoperative steroid therapy, diagnosis-to-splenectomy interval, and preoperative platelet count in relation to postoperative response after open and laparoscopic splenectomy. Subjects and Methods: Data collected from two groups, treated by laparoscopic and open splenectomy, respectively, of 20 patients each were retrospectively reviewed. Positive response to splenectomies, evaluated according to the International Working Group guidelines reported by the American Society of Hematology, was statistically related through Student's t test and the Pearson correlation test to the above-mentioned factors. Results: Positive response to splenectomy was observed in 80% and 85% of patients, respectively, in the laparoscopic and open groups (P>.10). No statistical differences were observed compar...
TL;DR: Improvements and additional evaluation of validity evidence (content, internal structure, response processes, and relationship to other variables) are necessary prior to full implementation of this model as an educational tool.
Abstract: Background: Thoracoscopic diaphragmatic hernia (DH) repair has a high recurrence rate. Effective simulation modeling may improve technical performance for thoracoscopic DH repair. The study purpose was to evaluate measures of validity evidence for a low-cost thoracoscopic DH simulator. Materials and Methods: Synthetic diaphragm/intestine was connected to a to-scale left-sided neonatal rib cage and then covered with synthetic skin. Forty participants evaluated the DH repair simulator, using survey ratings that were analyzed for test content and internal structure validity evidence. Results: Observed averages (on a scale of 0–5) for the domains were 4.6 for Relevance, 4.5 for Value, 4.3 for Physical attributes, 4.0 for Realism of experience, 3.8 for Realism of materials, and 4.2 for Ability to perform. The highest observed averages were “relevance to practice” and “value, testing tool,” whereas the lowest ratings were realism, intestines and realism, diaphragm. The observed average of global opinio...
TL;DR: This is a case report of a patient who developed major intestinal complications after the utilization of barbed sutures for an off-label indication.
Abstract: This is a case report of a patient who developed major intestinal complications after the utilization of barbed sutures for an off-label indication. The report serves as a warning for patients and surgeons of the potential injuries that may be caused by the use of new products in unapproved indications.
TL;DR: LPLC causes less abnormality in liver function tests in the postoperative period compared with HPLC, and should be considered in all patients undergoing laparoscopic cholecystectomy, especially those patients with compromised liver functions.
Abstract: Background: Laparoscopic cholecystectomy at standard-pressure pneumoperitoneum uses a pressure of 12–14 mm Hg, which may cause a variety of adverse physiological changes involving the respiratory, cardiovascular, and hepatorenal systems reflected as subclinical abnormalities in biochemical parameters. The use of low-pressure pneumoperitoneum in the range of 8–10 mm Hg has been shown to reduce the adverse physiological changes without affecting the outcome of surgery. Subjects and Methods: This study was done in a randomized controlled manner. Patients with gallstone disease (n=101) underwent laparoscopic cholecystectomy. Patients were randomly assigned to high-pressure laparoscopic cholecystectomy (HPLC) (n=51) and low-pressure laparoscopic cholecystectomy (LPLC) (n=50) and underwent surgery at pressures of 14 mm Hg and 8 mm Hg, respectively. Liver function tests, including total bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase, were obtained p...
TL;DR: The da Vinci instrument needs to be redesigned to be smaller and preferably with distal articulating tips, prior to clinical application of robotics to skull base surgery.
Abstract: Objective and Study Design: To assess the feasibility of robotic-assisted skull base surgery, a preclincal cadaver study was conducted. Materials and Methods: The feasibility study was subdivided into three phases: Phase 1 (surgical corridor) entailed a review of the surgical access, Phase 2 (instrument configuration) entailed arrangements of the robotic instrument (da Vinci® Surgical System; Intuitive Surgical, Sunnyvale, CA) in relation to the surgical corridor and applied to a skull model, and Phase 3 was robotic-assisted skull base cadaver dissection. Results: Regarding the surgical corridor, the infratemporal area was accessed through a maxillary window, whereas the anterior skull base region was accessed through a combined single maxillary window and nasal corridor. Regarding instrument configuration, the camera was positioned above the two instrument arms, with both instrument arms angled at 30° to the camera axis with a flexed distal tip for the infratemporal skull base. For the anterior ...
TL;DR: LTM-CBD, which can avoid postoperative T-tube drainage, decrease complications, shorten hospitalization time, and enhance the existing quality, is a minimally invasive, safe, and effective treatment.
Abstract: Background: Laparoscopic transcystic common bile duct exploration has become a safe and ideal treatment of common bile duct stones. This study was designed to explore the clinical value of modified laparoscopic transcystic common bile duct exploration as a first line of treatment for patients with common bile duct stones. Patients and Methods: A retrospective, case-control study of clinically comparable groups of patients who underwent the laparoscopic transcystic approach with micro-incision of the cystic duct and its confluence part in common bile duct exploration (LTM-CBD) (n=110) and laparoscopic common bile duct exploration (LCBD) (n=100) under the care of one surgeon was performed. All clinical data were analyzed retrospectively. Results: There was no significant difference in terms of operation time between the two groups (P>.05). Postoperative hospital stay and abdominal drainage time were shorter in the LTM-CBD group than in the LCBD group (P<.05). Postoperative bile leakage was seen in ...
TL;DR: It is shown that the laparoscopic approach is a safe and oncologically adequate option for the treatment of gastric cancer, which compares favorably with open gastrectomy in short-term outcomes.
Abstract: Background: The role of laparoscopic surgery for the treatment of gastric cancer is still controversial, particularly in terms of oncologic efficacy. The aim of this study was to compare short-term outcomes of laparoscopic and open resection for gastric cancer at a single Western institution. Subjects and Methods: This study was designed as a matched cohort study from a prospective gastric cancer database. Forty-one patients undergoing laparoscopic gastrectomy for gastric cancer between June 2008 and January 2012 were matched with 41 patients undergoing open gastrectomy in the same time period. Patient pairing was done according to age, gender, type of gastrectomy (subtotal or total), and tumor stage via a randomized statistical method. The short-term outcomes and oncologic adequacy of the laparoscopic and open procedures were compared. A D2 lymph node dissection was performed in the majority of patients in both groups. Results: The two study groups were similar with respect to patient and tumor ...
TL;DR: Laroscopy appears to be a safe and effective technique for reducing intussusception in children by having shorter operative time, shorter time to full feeds, lower requirement for intravenous narcotics, and earlier discharges.
Abstract: Background: Intussusception is a common cause of bowel obstruction in children, which sometimes necessitates operative reduction and or resection. We report our series of patients with intussusception who were treated laparoscopically (LAP group) compared with exploratory laparotomy (OPEN group). Subjects and Methods: After institutional review board approval, a retrospective review was performed evaluating outcomes for patients requiring surgical reduction of intussusception over a 10-year period. Analysis was based on intent to treat, and technique of exploration was surgeon's choice. Data were analyzed with the Wilcoxon rank sum test and chi-squared test where appropriate. P≤.05 was considered significant. Results: During the time period studied, there were 92 patients treated surgically for intussusception: 65 LAP and 27 OPEN. Conversion to the open procedure was required for 21 patients in the LAP group, and of those, 6 required bowel resection. Seven of the patients who were started in the ...
TL;DR: Laroscopy achieves early and accurate diagnosis of AA and can reduce the incidence of perforated appendicitis and Abdominal CT remains a valuable diagnostic tool.
Abstract: Background: The most efficient approach to diagnosis of acute appendicitis (AA) continues to be a challenge. We sought to determine diagnostic accuracy, sensitivity, and specificity of computed tomography (CT), ultrasonography, and laparoscopy and compared benefits and advantages in patients with suspected AA. Patients and Methods: A retrospective review of all patients who had laparoscopic surgery between January 2000 and December 2009 was conducted. Preoperative information, surgery results, and outcomes were compared. Results: Of 887 laparoscopic procedures performed for suspected AA, 254 (29%) patients had preoperative imaging: 171 CT scans and 83 ultrasound (US) scans. Overall, 754 patients underwent laparoscopic appendectomy (LA), and 133 underwent diagnostic laparoscopy (DL). DL was negative in 23 patients. The sensitivity of LA was higher than that of CT (98% versus 94%), whereas the specificity of LA was higher than that of CT and US in complicated appendicitis and in women. Complicated ...