Experience In Laparoscopic Surgery Research Articles

Laparoscopy training of novices with complex curved instruments using 2D- and 3D-visualization

PurposeBeside many advantages, disadvantages such as reduced degrees of freedom and poorer depth perception are still apparent in laparoscopic surgery. 3D visualization and the development of complex instruments are intended to counteract the disadvantages. We want to find out whether the use of complex instruments and 3D visualization has an influence on the performance of novices.Methods48 medical students with no experience in laparoscopic surgery or simulator-based laparoscopy training were included. They were randomized in four groups according to a stratification assessment. During a structured training period they completed the FLS-Tasks “PEG Transfer”, “Pattern Cut” and “Intracorporeal Suture” and a transfer task based on these three. Two groups used conventional laparoscopic instruments with 3D or 2D visualization, two groups used complex curved instruments. The groups were compared in terms of their performance.ResultsIn 2D laparoscopy there was a better performance with straight instruments vs. curved instruments in PEG Transfer and Intracorporeal Suture. In the transfer task, fewer errors were made with straight instruments. In 2D vs. 3D laparoscopy when using complex curved instruments there was an advantage in Intracorporeal Suture and PEG Transfer for 3D visualization. Regarding the transfer exercise, a better performance was observed and fewer errors were made in 3D group.ConclusionWe could show that learning laparoscopic techniques with complex curved instruments is more difficult with standard 2D visualization and can be overcome using 3D optics. The use of curved instruments under 3D vision seems to be advantageous when working on more difficult tasks.

The impact of video gaming and playing a musical instrument on robotic surgical simulator performance - the Robotic Surgical Simulator Study (RS3)

BackgroundA personal history of video gaming has been associated with improved laparoscopic skills acquisition in some but not all studies. The impact of playing a musical instrument on laparoscopic or robotic proficiency is less investigated. MethodsThis study evaluates the impact of video gaming, playing a musical instrument, and other demographic parameters on robotic simulator proficiency in a cohort of 27 participants. Candidates performed 3 standardized exercises on a virtual reality robotic training platform, resulting in a proficiency score. After completing a detailed survey, participants repeated the standardized exercises to obtain a basic learning curve. Gaming history, playing a musical instrument, surgical experience, and demographic parameters were correlated with overall robotic proficiency and improvement during the experimental session. ResultsParticipants with previous gaming history had 33 % higher overall robotic performance scores (p = 0.02). There was no difference in performance between surgical trainees and attending physicians with high volume laparoscopic surgery experience (average of 77 laparoscopic procedures). In this small cohort, playing an instrument had no influence overall (p = 0.2), but we found a trend towards increased proficiency in those playing the piano, yielding 30 % higher scores (p = 0.14). Participants performed up to 22 % better in the second run of the "Suture Sponge" exercises (p = 0.08), indicating a steep learning curve of simulated robotic surgery. ConclusionsA history of video gaming and playing the piano is associated with improved performance on a virtual-reality robotic surgical simulator. The steep learning curve underlines the benefit of virtual robotic surgical training before performing robotic procedures on patients.

First experience in laparoscopic surgery in low and middle income countries: A systematic review.

Laparoscopic surgery has reduced morbidity and mortality rates, shorter postoperative recovery periods and lower complication rates than open surgery. It is routine practice in high-income countries and is becoming increasingly common in countries with limited resources. However, introducing laparoscopic surgery in low-and-middle-income countries (LMIC) can be expensive and requires resources, equipment, and trainers. To report the challenges and benefits of introducing laparoscopic surgery in LMIC as well as to identify solutions to these challenges for countries with limited finances and resources. MEDLINE, EMBASE and Cochrane databases were searched for studies reporting first experience in laparoscopic surgery in LMIC. Included studies were published between 1996 and 2022 with full text available in English. Exclusion criteria were studies considering only open surgery, ear, nose, and throat, endoscopy, arthroscopy, hysteroscopy, cystoscopy, transplant, or bariatric surgery. Ten studies out of 3409 screened papers, from eight LMIC were eligible for inclusion in the final analysis, totaling 2497 patients. Most reported challenges were related to costs of equipment and training programmes, equipment problems such as faulty equipment, and access to surgical kits. Training-related challenges were reliance on foreign trainers and lack of locally trained surgeons and theatre staff. The benefits of introducing laparoscopic surgery were economic and clinical, including a reduction in hospital stay, complications, and morbidity/mortality. The introduction of laparoscopic surgery also provided training opportunities for junior doctors. Despite financial and technical challenges, many studies emphasise the overall benefit of introducing laparoscopic surgery in LMICs such as reduced hospital stay and the related lower cost for patients. While many of the clinical centres in LMICs have proposed practical solutions to the challenges reported, more support is critically required, in particular regarding training.

Design and evaluation of a smart passive dynamic arm support for robotic-assisted laparoscopic surgery

Surgeons performing robotic-assisted laparoscopic surgery experience physical stress and overuse of shoulder muscles due to sub-optimal arm support during surgery. The objective is to present a novel design and prototype of a dynamic arm support for robotic laparoscopic surgery to evaluate its ergonomics and performance on the AdLap-VR simulation training device. The prototype was designed using the mechanical engineering design process: Technical requirements, concept creation, concept selection, 3D-design and built of the prototype. A crossover study was performed on a marble sorting task on the AdLap-VR. The first group performed four trials without the arm support, followed by four trials with the arm support, and the other group executed the sequence vice versa. The performance parameters used were time to complete (s), path length (mm), and the number of collisions. Afterward, the participants filled out a questionnaire on the ergonomic experience regarding both situations. 20 students executed 160 performed trials on the AdLap-VR Significant decreases in the subjective comfort parameters mental demand, physical demand, effort and frustration were observed as a result of introducing the novel arm support. Significant decreases in the objective performance parameters path length and the number of collisions were also observed during the tests. The newly developed dynamic arm support was found to improve comfort and enhance performance through increased stability on the robotic surgery skills simulator AdLap-VR.

Transvaginal extraperitoneal single-port laparoscopic sacrocolpopexy for apical prolapse after total/subtotal hysterectomy: Chinese surgeons' initial experience.

To introduce a novel technique of transvaginal extraperitoneal single-port laparoscopic sacrocolpopexy (ESLS) for apical prolapse and to evaluate the feasibility and short-term outcomes of this technique. Sixteen patients were enrolled to undergo ESLS between January 2020 and May 2021. Perioperative outcomes were included. Short-term results were assessed by Pelvic Floor Distress Inventory-20 (PFDI-20), Pelvic Organ Prolapse Quantification (POP-Q) scores, mesh exposure and prolapse recurrence. A total of 14/16 cases (87.5%) were successfully completed. The mean operation time was 118min (range 85-160), and the mean blood loss was 68ml (range 20-100). The mean postoperative visual analog scale (VAS) pain score at 24h was 0.7. No intraoperative complications occurred except for one patient who developed subcutaneous emphysema. All patients gained a significant improvement in both physical prolapse and quality of life at 12 months after surgery, and there was no mesh exposure or prolapse recurrence. Our experience showed that transvaginal ESLS is a feasible and effective technique for apical prolapse with a previous hysterectomy. However, this technique should be performed by surgeons with extensive experience both in vaginal surgery and laparoscopic single-port surgery.

The development and evaluation of a homemade laparoscopic endotrainer using the IDEAL framework and MISTELS scoring system: a pilot study.

A prospective IDEAL stage 2a pilot study was carried out at a tertiary care center to evaluate the reliability of a homemade laparoscopic endotrainer, following the MISTEL and IDEAL framework guidelines. The validated modified (MISTELS) score was used to test the reliability of a low-cost laparoscopic trainer with commonly found components built by surgeons. Basic household materials including a cellular phone (camera source), wifi (linking source) and freely available webcam apps were used for construction. Five basic laparoscopic skills were performed by general surgery resident volunteers with minimal (1-6 months') laparoscopic surgery experience and tested and retested based on efficiency and precision. To determine interrater reliability, two trained observers scored all subjects. The Cronbach alpha test was used to test for internal consistency between tasks. The Interclass correlation coefficient is used for test and retest reliability. 15 (80% male, mean age 28 ± 5 years) residents were included. The interrater and test-retest reliabilities for the total scores of the basic laparoscopic skills tests were 0.952 (95% CI, 0.895-0.981) and 0.64 (95% CI, 0.35-0.77), respectively. The Cronbach Alpha for the first assessment test and retest was 0.83. The MISTELS metrics had excellent reliability, exceeding the threshold level of 0.8. It is possible to assemble a low-cost, reliable trainer at home to enhance laparoscopic skills during residency.

Perceived comfort and tool usability during robot-assisted and traditional laparoscopic surgery: a survey study

It is known that over half of previously surveyed surgeons performing Robot-Assisted Laparoscopic Surgery (RALS) and three-quarters of those performing Traditional Laparoscopic Surgery (TLS) experience intraoperative pain. This survey study aimed to expand upon the ongoing impact of that pain as well as perceived tool usability associated with TLS and RALS, for which considerably less documentation exists. A survey regarding the presence and impact, either immediate or ongoing, of intraoperative pain and Likert scale questions regarding tool usability was administered to TLS and RALS surgeons on the European Association for Endoscopic Surgery (EAES) mailing list. Prevalence statistics as well as trends based on biological sex and glove size were obtained from the 323 responses. Most respondents were right-handed European males (83−88%) with a medium glove size (55.8%). Moderate or severe shoulder symptoms were experienced by one-third of TLS surgeons. Twenty-one percent of RALS surgeons experienced neck symptoms that impacted their concentration. Small-handed surgeons experienced wrist symptoms significantly more frequently than large-handed surgeons, regardless of modality. RALS was associated with a significantly more optimal back and wrist posture compared to TLS. TLS surgeons reported increased ease with applying and moderating force while operating. These results suggest that intraoperative pain may be severe enough in many cases to interfere with surgeon concentration, negatively impacting patient care. Continuing to understand the relationship between tool usability and comfort is crucial in guaranteeing the health and well-being of both surgeons and patients.

Is there a role for laparoscopy in low-income countries? Comment on: First experience in laparoscopic surgery in low- and middle-income countries: a systematic review.

Is there a role for laparoscopy in low-income countries? Comment on: First experience in laparoscopic surgery in low- and middle-income countries: a systematic review.

Symptom Duration and Surgeon Volume: Impact on Early Laparoscopic Cholecystectomy for Acute Cholecystitis.

The 'golden 72 hours' rule from the onset of symptoms still applies in laparoscopic cholecystectomy for acute cholecystitis. This rule has been discussed with increasing experience in laparoscopic surgery in recent years. This study aims to determine the optimal symptom duration based on the surgeon's volume when deciding on early laparoscopic cholecystectomy for acute cholecystitis. The patients were categorized into two groups: Group 1 (≤3 days) and Group 2 (>3 days) based on the symptom duration, andhigh-volume surgeons (performing >100 laparoscopic cholecystectomies in a year) and low-volume surgeons (performing <100 laparoscopic cholecystectomies in a year) based on the surgeon volume. All surgeons had received advanced training in laparoscopic surgery. There was no statisticaldifference in postoperative outcomes between groups, except for a few data (p>0.05). The operative time was longer in Group 2, the postoperative hospital stay was longer for low-volume surgeons than for high-volume surgeons after three days, and operative time was longer after three days than the first three days in low-volume surgeons (p<0.05). Early laparoscopic cholecystectomy may be recommended for acute cholecystitis with symptom duration of more than three days, regardless of the surgeon volume, as long as they are competent in laparoscopic surgeries.

Beyond the Square knot: A validation study for a novel knot-tying method named “inverse 9”

PurposeWe compared the “inverse 9” laparoscopic suturing and knot-tying (LSKT) method to the traditional LSKT method in a validation study to demonstrate the “inverse 9” method's superiority and effectiveness in laparoscopy. MethodsOn the basis of their experience in laparoscopic surgery, 78 trainees were divided into two groups, with 52 inexperienced trainees in group A and 26 experienced trainees in group B. In group A, 52 trainees were randomly allocated to either group A1 (“inverse 9” LSKT training) or group A2 (traditional LSKT training). In group B, experienced trainees were randomly assigned to receive “inverse 9” LSKT training (group B1) or continuing training in the traditional LSKT method (group B2). All trainees received the same instruction and assessment and were asked to provide a subjective assessment of the two training methods at the end of the training. ResultsThe trainees in groups A1, A2, and B had similar average ages and were mostly male. After training, all showed preliminary mastery of LSKT (P < 0.05). The trainees in groups A1 and B1 achieved learning proficiency in the fifth assessment, while those in group A2 achieved it in the sixth assessment. The trainees in groups A1 and B1 showed lower difficulty in achieving mastery and lower operation fatigue scores (P < 0.05), and 61.50 % of the trainees in group B preferred the “inverse 9” method in subjective evaluation. ConclusionAs a novel LSKT technique, “inverse 9” offers a multitude of benefits. In addition to ensuring a simpler operation and effectively reducing the knot-tying time, it also involves a shorter learning curve than traditional LSKT methods. As such, it can be easily mastered and widely adopted as a standard LSKT technique.

Hysteroscopic suture of levonorgestrel-releasing intrauterine system: learning curve for in vitro simulation training.

To simulate hysteroscopic suturing in vitro and analyze the learning curve of gynecologists with different experience levels. Three gynecologists were trained on uterine models in a circulating water box. The posterior uterine wall was sutured 10 times under hysteroscopy for 5 consecutive days, and the time of each suture procedure was recorded. Doctors A, B, and C completed 50 posterior uterine sutures. After Dr. C completed 50 sutures on the posterior wall, he added 50 sutures on the anterior wall (Group D). The mean suturing time was 71.54 ± 68.158 s in Group A, 50.10 ± 28.060 s in Group B, 34.04 ± 10.457 s in Group C, and 30.38 ± 8.734 s in Group D. The difference between Groups C and B and between Groups B and A was statistically significant. There was no statistically significant difference between Groups C and D. Simulation curves were created using the number of features as the abscissa and cumulative sum as the coordinate, with peak curves of 19, 27, and 18 cases for Group A, B, and C, respectively. Doctors with experience in single-hole laparoscopic surgery or hysteroscopic suture surgery can significantly shorten the hysteroscopic suturing time.

Is non-mentored initiation of laparoscopic colorectal surgery safe? Single surgeon initial experience with the first 40 cases.

Although laparoscopic colorectal surgery is now accepted as a standard procedure in treating colorectal cancer, the proportion of laparoscopically operated patients with colorectal cancer is still generally quite low. The aim of this study is to assess feasibility, safety, and outcomes of a non-mentored initiation of laparoscopic colorectal resections by a young surgeon without previous experience in laparoscopic colorectal surgery. We analyzed the characteristics of the first 40 elective cases of laparoscopic colorectal resections performed by a single surgeon during the period between June 2019 and March 2022. All of the operations were performed without the attendance or supervision of an experienced surgeon in laparoscopic colorectal surgery. The patients were divided into three groups (the early, intermediate, and late group). The conversion rate, complications rate, and postoperative recovery were similar among groups. The mean overall operative time was 219.5 min (range 130-420 min) and had reduced significantly during the learning curve (p = 0.047). The overall conversion rate was 12.5%. In two cases (5%), the oncological principles were violated (incomplete total mesorectal excision). In three patients (7.5%), intraoperative complications had occurred (small bowel injury, splenic injury, and significant bleeding from the minor peripancreatic artery). Three cases of major postoperative complications (Clavien-Dindo grade III) were recorded, two of which required reoperation (anastomotic bleeding and fascial dehiscence). There was no 90-day mortality reported. The overall mean number of lymph nodes retrieved was 12.45, which did not differ significantly among groups (p = 0.678). The average follow-up was 13.75 months (range 1-31 months). Cancer recurrence was recorded in four patients (10%). Port-site metastasis was not detected in any of the cases. A safe and non-mentored initiation of laparoscopic colorectal surgery with an acceptable rate of complications and acceptable oncological results can be achieved. Still, when compared with a structured initiation in a controlled environment with the supervision of an experienced surgeon in laparoscopic colorectal surgery, the results of a non-mentored initiation are worse in most of the fields, including operative time, conversion rate, complications rate, and duration of hospital stay. Therefore, I strongly recommend engaging young surgeons in fellowship programs on structured laparoscopic colorectal surgery whenever possible before starting performing these procedures on their own.

312 First Experience in Laparoscopic Surgery in Low- and Middle-Income Countries: A Systematic Review

Abstract Aim This study aims to report the challenges and benefits of introducing laparoscopic surgery in low-and-middle-income countries (LMIC) as well as to identify solutions to these challenges for countries with limited finances and resources. Method MEDLINE, EMBASE and COCHRANE databases were searched for studies reporting first experience in laparoscopic surgery in LMIC. Included studies were published after 1996 with full text available in English. Exclusion criteria were studies considering only open surgery, ENT, endoscopy, arthroscopy, hysteroscopy, cystoscopy, transplant, or bariatric surgery. Results Ten studies from eight LMIC were eligible for inclusion in the final analysis, totalling 2640 patients. Most reported challenges were related to costs, including affordability of equipment and training programmes, and equipment problems such as faulty equipment and access to surgical kits. Training-related challenges were reliance on foreign trainers and lack of locally trained surgeons and theatre staff. The benefits of introducing laparoscopic surgery were economic and clinical, including reduced hospital stay, complications and morbidity/mortality. The introduction of laparoscopic surgery also provided training opportunities for junior doctors. Conclusions Despite initial challenges, many studies described the benefits of introducing laparoscopic surgery. Centres proposed practical solutions to these challenges to ensure the sustainability of laparoscopic surgery in LMIC.

ThTP5.8 Single centre, single surgeons’ experience of laparoscopic emergency surgery from a tertiary care NHS hospital: delay in surgery is associated with higher mortality and morbidity

Abstract Aims The objective of this article is to present a single centre experience of laparoscopic emergency surgery reporting outcomes influenced by delay in surgery. Methods A retrospective review of case notes to evaluate postoperative outcomes in patients undergoing laparoscopic emergency gastrointestinal surgery. Results There were 172 major laparoscopic emergency procedures over a span of 5 years. Forty-one colorectal resections were performed within 48 hours of admission (group A) compared to 50 resections (group B) after 48 hours. Mean hospital stay was shorter in group A (10.57 versus 19.97) days. No mortality reported in the group A whereas 4 patients died (8%) in group B. Lower morbidity percentage was also observed in group A (14.6 % versus 22 %). Twenty small bowel resections were performed within 48 hours of admission (group C) compared to 6 resections (group D) after 48 hours. Mean hospital stay was shorter in group C (8.6 versus 29.5) days. 3 patients died (15%) in group C whereas no mortality reported in the group D. Lower morbidity was also observed in group C (14.6 % versus 22 %). Laparoscopic adhesiolysis was performed in 28 patients and significant reduced hospitalization (3.6 versus 12.5 days) and reduced morbidity (0 versus 0) was noted in patients undergoing surgery within 48 hours of the admission. Laparoscopic hernia repair was performed in 20 patients and significant reduced hospitalization (4.5 versus 8.2 days) and reduced morbidity (13.7% versus 20%) was noted among patients who underwent surgery within 48 hours of admission. Conclusion Early laparoscopic surgery in acutely ill surgical patients is associated with better surgical outcomes

FTP3.6 Robotic Assisted Surgery – the future for patients with increased BMI?

Abstract Introduction Obesity increases the technical difficulty of laparoscopic colorectal surgery. The ROLAR trial concluded robotic assisted surgery (RAS) did not significantly reduce the risk of conversion to open surgery in rectal cancer resections. In Scotland, in 2021, 30% of adult population were obese (BMI ≥30kg/m2) and 4% morbidly obesity (BMI ≥40kg/m2.) We describe local experience of laparoscopic surgery and RAS in the obese population. Methods Retrospective review of patients with obesity (BMI ≥30kg/m2) undergoing laparoscopic and robotic colorectal surgery by three colorectal surgeons. Conversion to open, 30-day morbidity and mortality and length of stay were assessed. Results 30 patients undergoing laparoscopic surgery and 37 patients undergoing RAS. Procedures include anterior resection; Hartmann’s procedure; left and right hemicolectomy, sigmoid colectomy, APER, subtotal colectomy, panproctocolectomy and completion proctectomy for benign and malignant conditions. Conclusions RAS resulted in fewer conversions to open procedures compared to laparoscopic surgery in the obese population. Fewer complications and returns to theatre in RAS group. The increased length of stay in RAS group can be explained by geographic considerations (25 RAS patients live &amp;gt;2 hours from hospital).

Short learning curve in transition from laparoscopic to robotic-assisted rectal cancer surgery: a prospective study from a Finnish Tertiary Referral Centre.

The narrow pelvis causes special challenges in surgery, and robotic-assisted surgery has been proven beneficial in these circumstances. While robotic surgery has some specific advantages in rectal cancer surgery, there is still limited evidence of the learning curve of the technique involved. The aim here was to study the transition from laparoscopic to robotic-assisted surgery among experienced laparoscopic surgeons. The data for this study were collected from a prospectively compiled register that includes patients operated on by the Da Vinci Xi robot in Tampere University Hospital. Each consecutive rectal cancer patient was included. The information on the surgical and oncological outcomes was analysed. The learning curve was assessed using cumulative sum (CUSUM) analysis. CUSUM already demonstrated an overall positively sloped curve at the beginning of the study, with neither the conversion rate nor morbidity reaching unacceptable thresholds. Conversions (4%) and postoperative complications (Clavien-Dindo III-IV 15%, no intraoperative complications) were rare. One patient died within one month and the death was not procedure-associated. While surgical and oncological outcomes were similar among all surgeons, the console times showed a decreasing trend and were shorter among those with more experience in laparoscopic rectal cancer surgery. Robotic-assisted rectal cancer surgery can be safely adapted by experienced laparoscopic colorectal surgeons.

Is Laparoscopic Oncological Surgery After an Open Surgery Possible?

This paper presents a case of a 55-year-old male patient with pain in the right lumbar region and hematuria. An abdominopelvic computed tomography was performed, and a tumor was discovered in the right renal pelvis. An open right radical nephrectomy was performed. She returned again with hematuria, thus cystoscopy, ureteroscopy, and selective cytology were performed, and local recurrence in the right ureter was documented. A radical right radical ureterectomy with laparoscopic bladder encirclement and extended lymphadenectomy was performed, with a histopathological report of right ureter with low-grade urothelial carcinoma. The patient showed satisfactory progress and was monitored. With this article, we stress that with adequate training, experience, and practice in laparoscopic surgery, excellent oncological and aesthetic results can be obtained, which is comparable to open surgery, but with the benefit of rapid recovery and less pain and bleeding. Therefore, we believe that with practice, laparoscopic oncological surgery after an open surgery is perfectly feasible.

OC-107 IMPLEMENTATION OF LAPAROSCOPIC INGUINAL HERNIA REPAIR IN A LOCAL HOSPITAL. 2 YEARS’ EXPERIENCE AND CHALLENGES

Abstract Background More than 30 years have passed since the first laparoscopic inguinal hernioplasty but nowadays less than 5% of patients are currently operated by this technique as recent Spanish national data suggest. Objective To present our experience 2 years after implementation of laparoscopic inguinal hernioplasty in our local hospital and highlight the challenges we faced. Methods Our hospital deals with a high volume of abdominal wall surgery and has more than 20 years experience in ambulatory surgery. A multidisciplinary clinical pathway was implemented. Strict selection criteria were established and pelvitrainer sessions were done. Results From January 2021 until December 2022, 196 laparoscopic repairs were performed: 167 transabdominal preperitoneal (TAPP), 29 totally extraperitoneal (TEP). The main challenge was the learning curve. 5 surgeons with experience in laparoscopic surgery were trained. Until now 2 completed their learning curve for TAPP and began training in TEP approach while the others still need senior assistance. The duration of laparoscopic hernioplasty, the need for deep relaxation and the increased carbon dioxide absorption were the biggest concerns for the Anesthesia team. The cost of new materials could be afforded, even though different sutures and types of mesh fixation devices were used until getting the non-invasive one. Surgical outcomes were good, with few minor complications. Moreover the outpatient rate could be maintained but the average time in waiting list for laparoscopic approach was increased. Conclusion The implementation of a laparoscopic hernioplasty program is feasible and safe but faces many challenges, especially due to long learning curve.

P-044 FEASIBILITY AND SAFETY OF A NEW ‘ON-DEMAND ROBOTICS' PLATFORM FOR INGUINAL HERNIA REPAIR

Abstract Aim To assess the feasibility, safety, and efficiency of a novel ‘on-demand robotics' platform for inguinal hernia repair. Materials &amp; Methods A robotic system consisting in a sterile surgeon console, two robotic instrument arms, and one robotic endoscope arm, was evaluated. This ‘on-demand robotics' platform allows surgeons to remain sterile and combine work at the surgeon console and at the patient bed, e.g. in case of emergency management. This open platform also integrates with existing operating room (OR) equipment such as 3D laparoscopic camera, insufflator, energy devices and trocars. We present the first series of 16 transabdominal preperitoneal inguinal hernia repair procedures (9 unilateral, 7 bilateral) performed with the robotic system. Safety outcomes and skin-to-skin procedure times were documented. All procedures were performed by one surgeon with extensive laparoscopic surgery experience. Results All 16 patients were successfully treated with no device-related adverse events. Most patients were discharged on the same day. 14 patients had reached 30 day follow-up with no morbidity and maintained outcome. Skin-to-skin procedure time was 64 and 84 minutes for unilateral and bilateral procedures respectively. Unilateral mean robotic times transitioned from 73 to 54 minutes between the 5 first and the last 4 cases, indicative of a fast learning curve. Conclusions “On-demand” robotic repair of inguinal hernia is feasible and safe. The described platform provides direct patient access to the sterile surgeon, and uses existing OR equipment. Surgeon's prior laparoscopic experience may also shorten learning curve.

LAPAROSCOPIC CHOLECYSTECTOMY VS OPEN CHOLECYSTECTOMY IN THE TREATMENT OF ACUTE CHOLECYSTITIS: A PROSPECTIVE STUDY CONDUCTED AT ONE OF THE TERTIARY CARE CENTRES IN NOTHRERN INDIA.

Background: Laparoscopic cholecystectomy (LC) has become a popular alternative to open cholecystectomy (OC) in the treatment of acute cholecystitis (AC). Laparoscopic cholecystectomy (LC) is now considered the gold standard of therapy for symptomatic cholelithiasis and chronic cholecystitis. However no denitive data on its use in AC has been published. To Objective: compare the results of laparoscopic cholecystectomy (LC) with those of open cholecystectomy (OC) in the treatment of acute cholecystitis. Materials and Methodology: A prospective study was conducted among 30 patients who have taken surgical treatment for acute cholecystitis by taking their prior consents at Surgery Department, Career Institute OF Medical Sciences, Lucknow for 1 year. The patients underwent surgery within 72 hours of the onset of symptoms. The pa tients were selected for LC or OC depending on the surgeon's experience in laparoscopic surgery. Operating time, rate of con- version from LC to OC, complications, and length of hos pital stay were the main outcomes which were noted in both procedures. Conversion from LC to OC was necessary in 15% of the patients. The Results: mean operating time was 77 minutes for the OC group and 88 minutes for the LC group (P&lt;.001). Complications occurred in 14% of the patients in the LC group and in 23% of the patients in the OC group, with no signicant differences between the 2 groups (P=.06). The number of moderate or severe com- plications was similar in both groups, whereas mild com- plications were more common in the OC group (P&lt;.02). The length of the hospital stay averaged 8.1 days for the OC group and 3.3 days for the LC group (P&lt;.001). Laparoscopic cholecystectomy is a s Conclusions: afe, valid alternative to OC in patients with acute cholecystitis. The technique has a low rate of complications, implies a shorter hospital stay, and offers the patient a more comfortable postoperative period than OC