Disadvantages Of Laparoscopic Surgery Research Articles

Current status of laparoscopic surgery usage in Türkiye: A middle-income country.

This study aimed to determine the usage status of laparoscopic procedures in general surgical practice in Türkiye, which is a sample of middle-income countries. The questionnaire was sent to general surgeons, gastrointestinal surgeons, and surgical oncologists who have completed their residency training and are actively working in university, public or private hospitals. Demographic data, laparoscopy training and the period of education, the rate of laparoscopy use, the type and volume of laparoscopic surgical procedures, their views on the advantages and disadvantages of laparoscopic surgery, and the reasons for preferring laparoscopy were determined with a 30-item questionnaire. Two hundred and forty-four questionnaires from 55 different cities of Türkiye were evaluated. The responders were mainly males, younger surgeons (F/M= 11.1/88.9 % and 30-39 y/o), and graduated from the university hospital residence program (56.6%). Laparoscopic training was frequently taken during residency (77.5%) in the younger age group, while the elderly participants mostly received additional training after specialization (91.7%). Laparoscopic surgery was mostly not available in public hospitals for advanced procedures (p <0.0001) but was available for cholecystectomy and appendectomy operations (p= NS). However, participants working in university hospitals mostly stated that the laparoscopic approach was the first choice for advanced procedures. The results of this study showed that the surgeons working in MICs spent strong effort to use laparoscopy in daily practice, especially in university and high-volume hospitals. However, inappropriate education, cost of laparoscopic equipment, healthcare policies, and some cultural and social barriers might have negatively impacted the widespread use of laparoscopic surgery and its usage in daily practice in MICs such as Türkiye.

The effect of pneumoperitoneum and Trendelenburg position on optic nerve sheath diameter in patients undergoing laparoscopic hysterectomy.

Laparoscopic hysterectomy (LH) have been frequently used because of low complication rates and short duration of hospital stay. Elevated intracranial pressure (ICP), a disadvantage of laparoscopic surgery, is caused by the Trendelenburg position (TP) and CO2 pneumoperitoneum (PP). This study aimed to evaluate TP and PP associated changes in ICP by ONSD measurements during LH. The intra-and inter-observer consistency and reliability of ONSD measurements were also investigated. Sixty patients with were enrolled into this prospective study. ONSD for each patient was measured by three anesthesiologists at T0, T1, T2, and T3 time points. ONSD, mean arterial pressure (MAP), end tidal CO2 (EtCO2 ), and arterial blood CO2 partial pressure values (PaCO2 ) were measured at T0: baseline, T1: 10min after introducing 20 mmHg PP, T2: 10min after placing the patient in TP and 15 mmHg PP and, T3: 10min after PP deflation. The ONSD measured at T1 (5.97 ± 0.49 cm) and T2 (5.95 ± 0.57 cm) were higher than T0 (5.63 ± 0.53 cm) and T3 (5.72 ± 0.47 cm) (p < 0.05). There were no correlations between MAP and ONSD, and also between PaCO2 , EtCO2 , and ONSD measurements at any time points. Inter-observer intraclass correlation coefficient (ICC) values of ONSD measurements by all examiners had moderate (at T1) to good (at T0, T2, T3) reliability. Intra-observer agreements were reasonable for each observer. ONSD measurements increase with CO2 PP and TP in patients undergoing LH. Transorbital sonography is a reliable method to monitor intraoperative changes in ONSDs. This study underlines the need for careful training and the importance of standardization in order to obtain reliable results in the examination technique of ONSD measurements.

Laparoscopic versus Open Pediatric Surgery: Three Decades of Comparative Studies.

Despite its wide acceptance, the superiority of laparoscopic versus open pediatric surgery has remained controversial. There is still a call for well-founded evidence. We reviewed the literature on studies published in the last three decades and dealing with advantages and disadvantages of laparoscopy compared to open surgery. Studies comparing laparoscopic versus open abdominal procedures in children were searched in PubMed/MEDLINE. Reports on upper and lower gastrointestinal as hepatobiliary surgery and on surgery of pancreas and spleen were included. Advantages and disadvantages of laparoscopic surgery were analyzed for different types of procedures. Complications were categorized using the Clavien-Dindo classification. A total of 239 studies dealing with 19 types of procedures and outcomes in 929,157 patients were analyzed. We identified 26 randomized controlled trials (10.8%) and 213 comparative studies (89.2%). The most frequently reported advantage of laparoscopy was shorter hospital stay in 60.4% of studies. Longer operative time was the most frequently reported disadvantage of laparoscopy in 52.7% of studies. Clavien-Dindo grade I to III complications (mild-moderate) were less frequently identified in laparoscopic compared to open procedures (80.3% of studies). Grade-IV complications (severe) were less frequently reported after laparoscopic versus open appendectomy for perforated appendicitis and more frequently after laparoscopic Kasai's portoenterostomy. We identified a decreased frequency of reporting on advantages after laparoscopy and increased reporting on disadvantages for all surgery types over the decades. Laparoscopic compared with open pediatric surgery seems to be beneficial in most types of procedures. The number of randomized controlled trials (RCTs) remains limited. However, the number of reports on disadvantages increased during the past decades.

Intraoperative real-time imaging-guided laparoscopic liver resection

In recent years, laparoscopic hepatectomy has developed rapidly, but new challenges are posed to surgeons because of this surgical approach. The disadvantages of laparoscopic surgery can be effectively solved by using intraoperative real-time imaging guidance technology. Laparoscopic ultrasound can be used to discover and diagnose the nature of lesions, mark the important pipeline structure, determine the cutting edge, and guide puncture. ICG fluorescence imaging can be applied to the identification, localization, characterization of intraoperative lesions, the marking of specific liver segments and the prevention of postoperative bile leakage. These two technologies are the only two real-time imaging guidance technologies in laparoscopic hepatectomy at present, which truly make up for the shortcomings of laparoscopic liver surgery such as the inability to palpate and limited exploration exposure. Key words: Laparoscopy; Hepatectomy; Surgery, image-guided

腹腔鏡下膵切除術の標準化に向けた取り組み

Laparoscopy allows 10 to 15 times greater magnification of intra-abdominal tissues, organs, and vessels than an open approach. Laparoscopic surgery also improves visualization of the intra-abdominal organs for all surgeons involved in the operation, especially of the retroperitoneal organs, including the pancreas, neighboring vessels, duodenum, adrenal gland, and kidney. In this respect, laparoscopic pancreatic surgery is obviously superior to an open approach, where the ribs and organs anterior to the pancreas obstruct the operative field. Improved visualization also enables precise dissection using forceps. With regard to laparoscopic surgery for pancreatico-biliary malignancies, it is especially important to create a good operative field when dissecting the lymph nodes and pancreatic nerve plexuses where cancer cells easily infiltrate, and to perform R0 resection, which increases long-term survival in patients with pancreatico-biliary malignancies. Additionally, laparoscopic surgery is very useful in educating future healthcare professionals, because it provides the same visual field to all surgeons involved in the operation. The disadvantages of laparoscopic surgery over an open approach include the limited range of motion and the limited sense of touch, because laparoscopy is performed using a number of forceps inserted through trocars. Endoscopic surgeons must determine the most appropriate operative method for each patient, assessing whether laparoscopic pancreatectomy is suitable or not through a full understanding of the advantages and disadvantages of laparoscopic procedures. To date, we have performed laparoscopic pancreatectomies in more than 200 patients. The objective of this overview is to provide a better understanding of how far laparoscopic pancreatectomy has been standardized, based on our major experiences and a review of the literature.

Elective laparoscopically assisted sigmoidectomy for the sigmoid volvulus

The laparoscopic approach for the treatment of sigmoid volvulus has been a rare surgical indication. This phase 2 study investigated the feasibility and surgical outcomes of elective laparoscopic surgery for sigmoid volvulus. Patients with sigmoid volvulus were first offered colonoscopic decompression for their acute colonic obstruction. If the colonic decompression was successful, complete bowel preparation was performed, followed by elective laparoscopically assisted sigmoidectomy. The details of the laparoscopic procedures are shown in the video. Briefly, the redundant sigmoid colon is totally mobilized by a laparoscopic medial-to-lateral dissection sequence, after which it is exteriorized, transected, and reconstructed by end-to-end anastomosis. In the authors' experience, the medial-to-lateral approach is highly efficient for the laparoscopic mobilization of the redundant sigmoid colon. We believe that the longer the lateral abdominal wall attachment of the sigmoid colon is preserved, the better the exposure and the easier the dissection. If the risk of anastomotic leakage is considered high in a specific case, protective ileostomy is selectively preformed. Before entering the current study, the patients were well informed about the advantages and disadvantages of laparoscopic surgery. The enrollment of patients was selective according to the appropriate eligibility criteria. This study was approved by the Institutional Review Board of the National Taiwan University Hospital. The patients' clinicopathologic data and surgical outcomes were prospectively evaluated. Between August 2001 and April, 2005, a total of 14 patients (10 men and 4 women) with sigmoid volvulus were treated with the described procedure. The age distribution of the patients was 68.4 +/- 12.2 years. The attack of sigmoid volvulus was the first episode for eight patients, the second episode for 4 patients, and the third episode (or more) for two patients. The body mass index (BMI) of the patients was 26.8 +/- 4.4 kg/m(2). The physical status (classification of American Society of Anesthesiology [ASA]) was 1 for five patients, 2 for eight patients, and 3 for 1 patient. During the laparoscopy, all the patients presented with the pathognomonic findings of sigmoid volvulus including redundant sigmoid colon, narrow sigmoid mesenteric pedicle, and mesosigmoiditis with mesenteric fibrosis and scarring, as shown in the video. The length of the resected colon was 32 +/- 6 cm. The operation time was 194.6 +/- 32.4 min, and the blood loss was 44.0 +/- 12.4 ml. The abdominal wound consisted of four 5 to 12 mm working ports and a 5 cm major wound for exteriorization of the sigmoid colon. Some surgeons have shown that a sigmoid volvulus can be resected through a 5-cm left lower quadrant incision with very little mobilization of the colon because of its redundancy. In this context, the laparoscopic approach competed with the minilaparotomy method in terms of adequate sigmoid resection, lysis of mesosigmoid adhesion, and tension-free colorectal anastomosis. Protective ileostomy was performed for the only patient with a physical status of ASA 3. There was no mortality in this case series. However, pneumonia developed postoperatively in one patient, acute myocardial infarction in one patient, and wound infection in two patients. Excluding the two patients who experienced postoperative pneumonia and acute myocardial infarction, the duration of the postoperative ileus was 48 +/- 12 h, the postoperative hospitalization was 7 +/- 1 days, and the degree of postoperative pain was 3.5 +/- 0.5 according to the visual analog scale. The return to partial activity required 18 +/- 2.5 days, and the return to full activity required 28.4 +/- 5.6 days. As compared with the overall costs for a conventional sigmoid colectomy, which are completely covered by the National Bureau of Health Insurance of Taiwan, the expenses for the patients undergoing laparoscopic procedures were significantly higher by approximately 24,000.0 NT dollars +/- 2,635.0 (1 U.S. dollar = 32 NT dollars). These higher expenses must be borne by the patients themselves. Considering that patients with sigmoid volvulus often are elderly and chronically ill, laparoscopic elective surgery after a successful colonoscopic decompression may be a good choice for a selected group of patients in terms of minimized surgical complications and quick convalescence.

Laparoscopy versus laparotomy for cystic ovarian teratomas

This retrospective study compared the advantages and disadvantages of laparoscopic surgery and conventional laparotomy for women with cystic ovarian teratomas. The records of 120 women with ovarian teratomas were retrieved via a computer search for a histologically proven diagnosis of benign cystic teratoma and/or dermoid cyst; 49 cases were excluded after review. There was no significant difference in age parity body mass index and history of laparotomy between the laparoscopic and laparotomy groups but there were significant differences in teratoma diameter operating time blood loss and hospital stay between the two groups. When criteria for surgical treatment were compared no differences were noted in the patients’ age parity body mass index or history of pelvic surgery between the group of 30 women who underwent laparoscopic surgery and the group of 41 women who underwent laparotomy. (excerpt)

Laparoscopic surgery in neonates and infants weighing less than 5 kg.

Laparoscopic surgery in small infants is still an uncommon procedure in Japan. The present study was conducted to evaluate the advantages and disadvantages of laparoscopic surgery in neonates and infants weighing less than 5 kg. Between July 1997 and November 1999, 54 infants underwent laparoscopic surgery. They were evaluated for length of operation, intra- and postoperative complications, changes in intra-operative body temperature, time to postoperative feeding, length of hospital stay and changes in serum levels of C-reactive protein (CRP), creatinine phosphokinase (CPK) and interleukin (IL)-6 on days 0, 1 and 4. These parameters in the laparoscopic pyloromyotomy (LP) and laparoscopic fundoplication groups were compared with those in the open pyloromyotomy (OP) and open fundoplication groups, respectively, which were performed during the same period. Three laparoscopy cases were converted to open procedures. One case of fundoplication had panperitonitis due to failed gastrostomy and required long-term parenteral nutrition. Time to postoperative feeding and length of hospital stay in the LP group were significantly shorter than in the OP group. In LP group, intra-operative body temperature did not markedly decrease during CO, pneumoperitoneum. Although serum levels of CRP, CPK and IL-6 were elevated in all groups on postoperative day 1, there were no significant differences between the groups. Better quality of life after laparoscopy is a significant advantage over conventional surgical procedures. This advantage not only outweighs the incidence of intra- and postoperative complications in small infants, but further emphasizes the need to improve laparoscopic techniques to avoid complications.

LAPAROSCOPIC SPLENECTOMY

Dramatic decreases in length of hospital stay and time to complete recovery with laparoscopic cholecystectomy have led to the development of more advanced laparoscopic procedures. The rationale, technique, and early results with laparoscopic splenectomy are described in this article. Laparoscopic splenectomy is a complex procedure with a real potential for significant operative bleeding, but it can be accomplished successfully in greater than 80% of selected patients with minimal blood loss. If successful, length of stay is reduced in most patients to 1 to 3 days, but this benefit is not always seen in patients with complicated medical problems or with massive splenomegaly. The effects of increased blood loss in patients whose operations are converted to open operations are also not yet clear. Laparoscopic splenectomy is a procedure with great potential, but it is still in evolution.

Techniques of laparoscopic morcellation of the spleen

Laparoscopy has recently been applied to solid organ removal. We attempted laparoscopic splenectomy in 20 selected patients with various haematologic disorders. It was performed successfully in 18 (90%) patients. The mortality was nil and the post-operative morbidity was low (17%). Splenic extraction was performed by specimen fragmentation in a plastic bag or by minilaparotomy in cases of splenomegaly or tumours of uncertain origin. One of the disadvantages of laparoscopic surgery is the removal of subsequent large solid organs. To facilitate splenic extraction, we use digital fragmentation in an impervious nylon bag and a morcellator device is not mandatory. We have widened the indications for splenic morcellation to lymphomas and Hodgkin's disease because reliable histological examination is still possible.