Intraoperative Conversion Rate Research Articles

Conversion to general anesthesia and intravenous supplementation during intrapartum cesarean delivery with an indwelling epidural catheter: a retrospective study

BackgroundIntraoperative pain during cesarean delivery with or without conversion to general anesthesia has been shown to negatively impact maternal and perinatal morbidity. Efforts to reduce these adverse events are a...

Japanese survey of perioperative complications and ureteral stricture after ureteroscopy with laser lithotripsy for upper urinary tract stones in multicenter collaborative study.

This study aimed to investigate perioperative complications and the details of postoperative ureteral stricture after ureteroscopy with laser lithotripsy (URS-L) for upper urinary tract stones in Japan. Patient data on intra- and postoperative complications after ureteroscopy using URS-L were retrospectively collected from multiple centers in Japan between April 2017 and March 2020 with the cooperation of the Japanese Society of Endourology and Robotics. Data included the number of patients undergoing URS-L, number and type of intra- and postoperative complications, and detailed characteristics of postoperative ureteral stricture. In total, 14 125 patients underwent URS-L over 3 years at 82 institutions. Annual URS-L numbers gradually increased from 4419 in 2017, to 4760 in 2018, and 4946 in 2019. The total complication rate was 10.5%, which was divided into intra-operative complications in 1.40% and postoperative complications in 9.18%. The annual incidences of intra- and postoperative complications were not significantly different from year to year (p = 0.314 and p = 0.112). Ureteral perforation, ureteral avulsion, and the intra-operative conversion rate were 1.35%, 0.03%, and 0.02%, respectively. Fever >38°C, septic shock, blood transfusion, and postoperative mortality were 7.44%, 0.81%, 0.07%, and 0.04%, respectively. Ureteral stricture occurred in 0.8% of cases. The median length of stricture site was 10.0 mm and the success rate of stricture treatment was 54.6%. Although URS-L utilization has increased in Japan, the annual complication rate has remained steady. Although URS-L is a useful and less invasive procedure, devastating complications can still occur.

Evaluation of the efficacy and safety of robot-assisted and video assisted thoracic surgery for early non-small cell lung cancer: A meta-analysis.

Radical resection of lung cancer and chemotherapy are the main methods for the treatment of early lung cancer, but surgical treatment is still the key and preferred method. To evaluate the efficacy and safety of robotic-assisted thoracic surgery (RATS) and video assisted thoracic surgery (VATS) for non-small cell lung cancer (NSCLC). The clinical cohort studies on the comparison of the effects of RATS and VATS in the treatment of NSCLC published in Web of Science, PubMed, The National Library of Medicine (NLM), China National Knowledge Infrastructure (CNKI) and Wanfang database from January 1, 2015 to December 31, 2022 were searched. Two researchers independently screened the literature, extracted the data, such as operation time, intraoperative conversion rate, intraoperative blood loss, number of lymph nodes dissected, and evaluated the quality of the included literature based on the Newcastle-Ottawa Scale (NOS). RevMan 5.3 software was used for Meat analysis. A total of 18 articles and 21,802 subjects were included. The results of the meta-analysis showed that the intraoperative blood loss of RATS was significantly less than that of VAS, and the difference was statistically significant [MD =-38.43 (95% CI: -57.71, -19.15, P< 0.001)]. Compared with VATS, the number of lymph nodes dissected in RATS was significantly higher [MD = 2.61 (95% CI: 0.47, 4.76, P= 0.02)]. The rate of conversion to thoracotomy in RATS was lower, and the difference was statistically significant [OR = 0.59 (95% CI: 0.50, 0.70, P< 0.001)]. There was no significant difference between RATS and VATS in operation time [MD =-9.34 (95% CI: -28.72, 10.04, P= 0.34)], postoperative thoracic drainage time [MD =-0.08 (95% CI: -0.42, 0.26, P= 0.64)], postoperative hospital stay [MD =-0.05 (95% CI: -0.19, 0.08, P= 0.42)], postoperative mortality [OR = 0.88 (95% CI: 0.56, 1.36, P= 0.56)] and postoperative complications [OR = 1.03 (95% CI: 0.93, 1.13, P= 0.57)]. Compared with VATS, the number of lymph nodes dissected in RATS was significantly more, and the removal of lesions and lymph nodes was more thorough and accurate. More flexible and precise operation avoids the injury of important blood vessels during operation, effectively reduces the amount of blood loss during operation, shortens the indwelling time of thoracic drainage tube, and is conducive to postoperative rehabilitation of patients.

Comparison of laparoscopic cholecystectomy in children at paediatric centres and adult centres: a systematic review and meta-analysis.

Paediatric laparoscopic cholecystectomy (LC) is performed by both paediatric and adult surgeons. The aim of this review was to compare outcomes at paediatric centres (PCs) and adult centres (ACs). A literature search was conducted, in accordance with PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, for papers published between January 2000 and December 2020. Statistical analysis was performed using Stata® version 16 (StataCorp, College Station, TX, US). A total of 92 studies involving 74,852 paediatric LCs met the inclusion criteria. Over half (59%) of the LCs were performed at ACs. No significant differences were noted in the male-to-female ratio, mean age or mean body mass index between PCs and ACs. The main indications were cholelithiasis (34.1% vs 34.4% respectively, p=0.83) and biliary dyskinesia (17.0% vs 23.5% respectively, p<0.01). There was no significant difference in the median inpatient stay (2.52 vs 2.44 days respectively, p=0.89). Bile duct injury was a major complication (0.80% vs 0.37% respectively, p<0.01). Reoperation rates (2.37% vs 0.74% respectively, p<0.01) and conversion to open surgery (1.97% vs 4.74% respectively, p<0.01) were also significantly different. Meta-analysis showed no significant difference in overall complications (p=0.92). The number of LCs performed, intraoperative cholangiography use and conversion rates were higher at ACs whereas bile duct injury and reoperation rates were higher at PCs. Despite a higher incidence of bile duct injury at PCs, the incidence at both PCs and ACs was <1%. In complex cases, a joint operation by both paediatric and adult surgeons might be a better approach to further improve outcomes. Overall, LC was found to be a safe operation with comparable outcomes at PCs and ACs.

Right Mini-Thoracotomy in the Surgical Treatment of Structural Heart Diseases (SHDs): An Institutional Experience

Introduction: Surgical treatment of structural heart diseases continues to predominantly involve median sternotomy, despite the ongoing trends favoring minimally invasive approaches that have persisted for many years. In this study, we present data on structural heart disease (SHD) surgeries conducted by our institute using a right mini-thoracotomy approach. Patients and Methods: This single-center retrospective study included 58 patients who underwent right minithoracotomy procedures between February 2018 and June 1, 2023. Preoperative demographic and medical data were collected from patient files and records. Perioperative and 30-day outcome data were obtained through the national electronic record system. Results: The average age of the participants was 39.9. Female patients accounted for 31.6% (n= 18) of the participants. The majority of surgeries in this study involved peripheral cannulation and conventional cardioplegia. Mitral valve repair and atrial septal defect closure were the most common procedures performed. Intraoperative outcomes showed favorable results, with no instances of significant bleeding, structural complications, or mortality. Regarding the postoperative 30-day outcomes, the stroke rate was 1.8% (n= 1) among the patients. There were no reported cases of transient ischemic attack (TIA), myocardial infarction (MI), and mortality. The conversion to median sternotomy occurred in 3.4% (n= 2) of the cases. Reoperation and reexploration were required in 1.8% (n= 1) of the cases. The mean length of stay in the ICU was 1.7 days, while the mean length of ward stay was 4.2 days. Conclusion: This study contributes to the evidence supporting the shift towards minimally invasive approaches in the surgical management of structural heart disease. The low rate of intraoperative conversion, absence of major complications, and favorable postoperative outcomes highlight the safety and feasibility of right mini-thoracotomy. Continued advancements in surgical techniques and clinical expertise are expected to further optimize patient outcomes and improve the quality of care in this field.

Analysis of risk factors and management of unexpected intraoperative bleeding during video-assisted thoracic surgery for non-small cell lung cancer: a case-control study.

Intraoperative bleeding is one of the most dangerous complications of thoracoscopic surgery and seriously endangers the life of patients. How to prevent and manage intraoperative bleeding is a core concern for every thoracic surgeon. The aim of our study was to analyze the related risk factors of unexpected intraoperative bleeding during video-assisted thoracoscopic surgery (VATS) and the strategies for managing bleeding. A total of 1,064 patients who underwent anatomical pulmonary resection were analyzed retrospectively. According to the presence or absence of intraoperative bleeding, all cases were divided into an intraoperative bleeding group (IBG) and a reference group (RG). Clinicopathological characteristics and perioperative outcomes were compared in both groups. In addition, the sites, reasons, and coping strategies of intraoperative bleeding were summarized and analyzed. After rigorous screening, 67 patients with intraoperative bleeding and 997 patients without intraoperative bleeding were included in our study. Compared with the RG, among patients in the IBG, there was a higher incidence of history of chest surgery (P<0.001), higher incidence of pleural adhesion (P=0.015), higher incidence of squamous cell carcinoma (P=0.034), and the fewer early T-stage cases (P=0.003). In the multivariate analyses, a history of chest surgery (P=0.001) and T stage (P=0.010) were independent risk factors of intraoperative bleeding. The IBG was associated with the longer operative time, the more blood loss, the higher rates of intraoperative blood transfusion and conversion, the longer hospital stay and the more complications. There were no significant differences in the duration of chest drainage (P=0.066) between IBG and RG. The most common injury site of intraoperative bleeding was the pulmonary artery (72%). The commonest cause of intraoperative bleeding was the accidental injury of energy device (37%). The most frequently used method for managing intraoperative bleeding was suturing of the bleeding site (64%). Although unexpected intraoperative bleeding during VATS is unavoidable, it can be controlled provided that positive and effective hemostasis are achieved. However, prevention is the priority.

Total clipless laparoscopic nephrectomy carried out with the LigaSure device: Preliminary experience.

Total laparoscopic nephrectomy has become the standard method for the removal of diseased kidneys. The purpose of this study was to evaluate the feasibility of the LigaSure vessel closure system during laparoscopic nephrectomy. From January 2018 to June 2018, the LigaSure device was used in 5 patients undergoing laparoscopic nephrectomy for non functional kidney. Nephrectomy was carried out without the use of clips or sutures for vessel closure. We report intraoperative findings, conversion rates, blood loss, operative time, morbidity, and postoperative outcomes. Median operative time was 45minutes (range 25 to 60min). Median blood loss was 30mL (range 10 to 50mL). No conversions to open surgery were necessary. No patients experienced major bleeding intraoperatively or postoperatively. All patients left the hospital one day after the procedure. Histopathological examination of the removed kidneys was in favor of chronic non specific pyelonephritis. For the treatment of the renal pedicle during total laparoscopic nephrectomy of a destroyed kidney, the LigaSure device appears to be feasible and effective. Our experience is the first to demonstrate the advantages of LigaSure® in laparoscopic nephrectomy: reduction in operating time, blood loss, transfusions and length of stay in hospital.

Robotic colorectal resection in combination with a multimodal enhanced recovery program - results of the first 100 cases.

In Germany, colorectal robot-assisted surgery (RAS) has found its way and is currently used as primary technique in colorectal resections at our clinic. We investigated whether RAS can be extensively combined with enhanced recovery after surgery (ERAS®) in a large prospective patient group. Using the DaVinci Xi surgical robot, all colorectal RAS from 09/2020 to 01/2022 were incorporated into our ERAS® program. Perioperative data were prospectively recorded using a data documentation system. The extent of resection, duration of the operation, intraoperative blood loss, conversion rate, and postoperative short-term results were analyzed. We documented the postoperative duration of Intermediate Care Unit (IMC) stay and major and minor complications according to the Clavien-Dindo classification, anastomotic leak rate, reoperation rate, hospital-stay length, and ERAS® guideline adherence. One hundred patients (65 colon and 35 rectal resections) were included (median age: 69years). The median durations of surgery were 167min (colon resection) and 246min (rectal resection). Postoperatively, four patients were IMC-treated (median stay: 1day). In 92.5% of the colon and 88.6% of the rectum resections, no or minor complications occurred postoperatively. The anastomotic leak rate was 3.1% in colon and 5.7% in rectal resection. The reoperation rate was 7.7% (colon resection) and 11.4% (rectal resection). The hospital stay length was 5days (colon resection) and 6.5days (rectal resection). The ERAS® guideline adherence rate was 88% (colon resection) and 82.6% (rectal resection). Patient perioperative therapy per the multimodal ERAS® concept is possible without any problems in colorectal RAS, leading to low morbidity and short hospital stays.

Application of computed tomography-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm)

ObjectiveThis study aimed to investigate the safety and efficacy of the computed tomography (CT)-guided hook-wire localization technique in thoracoscopic surgery for small pulmonary nodules (≤ 10 mm) and to identify the risk factors for localization-related complications.MethodsThe medical records of 150 patients with small pulmonary nodules treated from January 2018 to June 2021 were retrospectively analyzed. According to preoperative hook-wire positioning status, they were divided into the localization group (50 cases) or the control group (100 cases). The operation time, intraoperative blood loss, hospital stay, and conversion rate to thoracotomy were recorded and compared between groups. Uni- and multivariate binary logistic regression analysis was used to identify the risk factors for localization-related complications.ResultsA total of 58 nodules were localized in 50 patients in the localization group, and the localization success rate was 98.3% (57/58). In one case, the positioning pin fell off before wedge resection was performed. The mean nodule diameter was 7.05 mm (range, 2.8–10.0 mm), while the mean depth from the pleura was 22.40 mm (range, 5.47–79.47 mm). There were 8 cases (16%) of asymptomatic pneumothorax, 2 (4%) of intrapulmonary hemorrhage, and 1 (2%) of pleural reaction.The mean operation time of the localization group (103.88 ± 41.74 min) was significantly shorter than that of the control group (133.30 ± 45.42 min) (P < 0.05). The mean intraoperative blood loss of the localization group (44.20 ± 34.17 mL) was significantly lower than that of the control group (112.30 ± 219.90 mL) (P < 0.05). The mean hospital stay of the localization group (7.96 ± 2.34 days) was significantly shorter than that of the control group (9.21 ± 3.25 days).Multivariate binary logistic analysis showed that localization times of small pulmonary nodules in the localization group was an independent risk factor for localization-related pneumothorax.ConclusionsOur results suggest that the CT-guided hook-wire localization technique is beneficial for localizing small pulmonary nodules. Specifically, it is helpful for the diagnosis and treatment of early lung cancer because it can accurately remove lesions, decrease intraoperative blood loss, shorten operation time and hospitalization stay, and reduce thoracotomy conversion rate. Simultaneous positioning of multiple nodules can easily lead to positioning-related pneumothorax.

VNOTES Hysterectomy: What about Obese Patients?

To compare the surgical outcomes of hysterectomy by vaginal natural orifice transluminal endoscopic surgery (vNOTES) for patients with body mass index (BMI) <30 and BMI ≥30. A retrospective cohort study. A French teaching hospital. All patients who underwent a vNOTES hysterectomy from February 2020 to January 2022 were included (N=200). The vNOTES approach was chosen for all patients requiring a hysterectomy, unless the procedure was for endometriosis or cancer (except grade 1 endometrioid adenocarcinoma). Patients were categorized into 2 groups based on their BMI (<30 or ≥30 kg/m2). The population characteristics, surgical outcomes, and hospitalization outcomes were compared. The main outcome was the intraoperative conversion rate. Secondary end points were blood loss, operative time, perioperative and postoperative complications, and same-day surgery management. A total of 146 patients were included in the BMI <30 group, and 54 patients in the BMI ≥30 group. There was no statistical difference between obese and nonobese patients concerning intraoperative conversion (p=.150), with 4 cases occurring in the BMI <30 group (2.74%) and 4 occurring in the BMI ≥30 group (7.41%). Operative times were longer in obese patients (115.93 min [±55.28] vs 79.78 min [±40.38], p <.001). There was no significant difference in blood loss (p=.337) or perioperative and postoperative complications (p=.346 and p=.612, respectively). The ability to complete the surgery as a same-day procedure was no different between obese and nonobese patients (p=.150). The results concerning intraoperative conversion and perioperative and postoperative complications show that vNOTES hysterectomies seem to be feasible for obese patients. When same-day surgery was decided before surgery, no more obese than nonobese patients were converted to conventional hospitalization. Further studies are needed to confirm these observations.

Evaluating three-dimensional lung reconstructions for thoracoscopic lung resections using open-source software: a pilot study.

Preoperative three-dimensional (3D) lung reconstructions can reduce intraoperative blood loss, conversion rate, and operation duration. These 3D reconstructions are predominantly provided by commercial expensive products, hence we aimed to assess the usability and performance of preoperative 3D lung reconstructions created with open-source software. Patients were invited to participate in this prospective pilot study if they were planned for uniportal video-assisted thoracoscopic surgery (VATS) lobectomy or segmentectomy between January and February 2023. Participants were excluded if a two-dimensional (2D) late-arterial-phase computed tomography (CT) scan contained motion artifacts, another surgical procedure was performed, or the surgery was canceled. After informed consent was obtained, 3D lung reconstructions were constructed using open-source 3D Slicer software. The system usability score (SUS) questionnaire assessed the usability of these reconstructions, whilst performance was evaluated based on anatomical validity compared to prior 2D CT assessment as well as operative findings. Descriptive statistics were reported. Thirteen patients were included, of whom one underwent a segmentectomy. Eighty-three percent of the 3D lung reconstructions scored above average (SUS >68). Compared to 2D CT scans, 38% of lung nodule segmental locations were detected more accurately through 3D lung reconstructions. Furthermore, 3D lung reconstructions revealed anatomical variations in 62%, which were not recognized on 2D CT scans, and provided surgeons with insights that would change the procedure and/or transection planes in 62%. One 3D lung reconstruction failed to demonstrate an intraoperative recognized segmental pulmonary artery (A6) branch. Three-dimensional lung reconstructions created with open-source software were usable and effective for uniportal VATS anatomical resections. ClinicalTrials.gov/NCT06132607.

Impact of Preoperative Protein Sparing Modified Fast Diet on Bariatric Surgery.

Bariatric surgery can become technically challenging in the setting of liver steatosis and hepatomegaly. The protein sparing modified fast (PSMF) diet helps in achieving rapid weight loss. The aim of this study is to explore the results of a preoperative PSMF diet on liver volume and steatosis as well as on intraoperative and postoperative complications in patients with hepatomegaly undergoing Roux-en-Y gastric bypass (RYGB). Between January 2010 and January 2021, 713 patients undergoing RYGB as a primary bariatric surgery were divided in two groups. Those with a measured liver length above 16cm and or evidence of liver steatosis on ultrasound (group 1) were offered a preoperative PSMF diet while the remaining (group 2) proceeded directly to surgery. Between January 2010 and April 2012, patients included in group 1 had liver volume measurements on magnetic resonance imaging the day before the diet was started and the day before the surgery. For the length of the study, intraoperative and postoperative data were recorded for both groups. Five days of preoperative PSMF diet resulted in a significant reduction of total and left liver volume (15.8% and 21% respectively, p < 0.001). There was no difference in intraoperative bleeding and conversion rate or postoperative complication rate between both groups. The PSMF diet helps in achieving a rapid decrease in liver volume. Patients with hepatomegaly initially thought to be at a higher risk of intraoperative complications reached comparable rates to patients without hepatomegaly after the diet regimen without any impact on the postoperative course.

8344 The Impact of Surgeon Volume on Laparoscopic Hysterectomy Outcomes

<h3>Study Objective</h3> To evaluate the impact of surgeon volume on outcomes after laparoscopic hysterectomy for benign indications. <h3>Design</h3> Retrospective chart review. <h3>Setting</h3> Single tertiary care academic institution. <h3>Patients or Participants</h3> A total of 494 patients who underwent laparoscopic hysterectomy performed by 22 benign gynecologic surgeons. <h3>Interventions</h3> Laparoscopic or robotic-assisted hysterectomy performed between March 2019 and April 2020. <h3>Measurements and Main Results</h3> Of the total 494 benign laparoscopic hysterectomies performed, 448 hysterectomies were performed by high volume surgeons (9 surgeons) and 46 hysterectomies were performed by low volume surgeons (13 surgeons). High volume was defined as 12 or more hysterectomies completed during the study year. Low volume surgeons ranged from 1 to 8 hysterectomies performed during the study period. Demographic and preoperative characteristics were similar between groups except age (45 years vs 41 years, p=.033). The two groups had similar intraoperative characteristics including route of hysterectomy, operative time, estimated blood loss and uterine weight. Intraoperative complications were similar between groups including transfusion rates, viscus injury, and intraoperative consults. However, there was a significantly higher rate of intraoperative conversion to laparotomy in the lowvolume group (1% vs 9%, p=.004). Pathology results were similar between groups. No pathologic findings were seen in 16% of cases in the high-volume group and 26% of cases in the low volume group (p=.11). Endometriosis was confirmed on pathology similarly between groups (11% vs 9%, p=.78). Pathology outcomes of leiomyomas, adenomyosis, and endometrial hyperplasia were similar between groups. There were no differences in postoperative complications, emergency department visits, or readmissions. <h3>Conclusion</h3> Low volume surgeons had significantly higher rates of intraoperative conversion to laparotomy at time of laparoscopic hysterectomy. In this study, surgeon volume did not significantly impact other outcomes including pathology. However, a limitation of the study was the small sample size in the low volume group which was <10% of the cohort.

Clinical Efficacy of Thoracoscopic Surgery with the da Vinci Surgical System versus Video-Assisted Thoracoscopic Surgery for Lung Cancer

Objective To assess the clinical efficacy of thoracoscopic surgery with the da Vinci surgical system versus video-assisted thoracoscopic surgery (VATS) for lung cancer. Methods From August 2019 to December 2020, 193 patients with lung cancer assessed for eligibility scheduled for surgery in our hospital were recruited and assigned at a ratio of 1 : 1 to receive VATS (control group) or thoracoscopic surgery with the da Vinci surgical system (research group). The primary measurement is the clinical efficacy of the two surgical modalities. Results The baseline features of the research group were comparable with those of the control group (P > 0.05). Besides, the two groups showed similar tumor types, tumor locations, and clinicopathological staging (P > 0.05). Da Vinci surgical system-assisted thoracoscopic surgery had short operative time, less intraoperative blood loss, better lymph node dissection, and lower intraoperative conversion rates compared to VATS. Compared with the control group, the research group had significantly higher postoperative forced expiratory volume in one second (FEV1), forced vital capacity (FVC), maximal voluntary ventilation (MVV), the functional assessment of cancer therapy-general module (FACT-G) of the FACT-lung (FACT-L) Chinese version V4.0, lung cancer-specific module scores, and total scores (P < 0.05). The research group showed better postoperative drainage volume, shorter intubation duration, and length of hospital stay and a lower incidence of complications versus the control group (P < 0.05). The da Vinci surgical system reduced the probability of intraoperative mistakes and better ensured a safe and satisfactory surgery. Conclusion The thoracoscopic surgery with the da Vinci surgical system better reduces intraoperative and postoperative bleeding, shortens drainage and intubation duration, enhances the lung function and survival quality of patients, and lowers the risk of surgical mistakes to ensure surgical safety versus VATS.

Obesity Does Not Increase Perioperative Outcomes in Older Patients Undergoing Thoracoscopic Anatomic Lung Cancer Surgery.

ObjectivesTo investigate the relationship between obesity status and perioperative outcomes in elderly patients undergoing thoracoscopic anatomic lung cancer surgery.MethodsFrom January 2016 to December 2018, we performed a monocentric retrospective cohort study among 4164 consecutive patients aged 65 years or older who underwent thoracoscopic anatomic lung cancer surgery at Shanghai Chest Hospital. Two groups were stratified by body mass index (BMI): nonobese (BMI<28kg/m2) and obese status (BMI≥28kg/m2). Using a 1:1 propensity score matching (PSM) analysis to compare perioperative outcomes between two groups.Results4035 older patients were eventually enrolled, with a mean age of 69.8 years (range: 65-87), and 305 patients were eligible for obese status, with a mean BMI of 29.8 ± 1.7kg/m2. Compared with nonobese patients, obese patients were more likely to have higher rates of intraoperative hypoxemia (1.2% vs 3.9%, P=0.001) and new-onset arrhythmia (2.3% vs 4.3%, P=0.034). The difference in intraoperative transfusion and conversion rates and postoperative outcomes regarding pulmonary complications, new-onset arrhythmia, transfusion, length of hospital stay, 30-day readmission and hospitalization costs between two groups were not significant (P>0.05). After a 1:1 PSM analysis, the difference in both intraoperative and postoperative complications among two groups were not significant (P>0.05). In subgroup analysis, patients with BMI≥30kg/m2 had a similar incidence of perioperative complications compared to patients with BMI between 28 and 30 kg/m2 (P>0.05).ConclusionsOur research data support evidence for “obesity paradox” and also contribute the growing body of evidence that obesity in older patients should not exclude candidates for thoracoscopic anatomic lung cancer surgery.

Minimally invasive treatment of colorectal liver metastases: does robotic surgery provide any technical advantages over laparoscopy? A multicenter analysis from the IGoMILS (Italian Group of Minimally Invasive Liver Surgery) registry.

Surgery has been the mainstay treatment for colorectal liver metastases (CRLM). Although the benefits of a laparoscopic approach have been evidenced by several comparative studies, the comparison between robotic and laparoscopic liver surgery has not been elucidated. Thus, in this study, we aim to analyze the short-term outcomes of a multicenter population that underwent robotic versus laparoscopic liver resection for CRLM. Consecutive patients with CRLM who were enrolled in the IGoMILS registry between November 2014 and June 2019 were retrospectively evaluated to compare robot-assisted procedures with laparoscopic procedures. Primary outcomes were postoperative morbidity and mortality, while secondary outcomes were length of hospital stay, operative time, and histological features of the surgical specimen. The effect size of surgical technique on resection margins was quantified using Hedges' g. In total, 1030 patients underwent minimally invasive liver surgery (MILS) for CRLM; of these, 77 (7.5%) underwent a robot-assisted approach (R-MILS), whereas 953 (92.5%) underwent a laparoscopic approach (L-MILS). Laparoscopy and robot-assisted surgery were comparable in terms of postoperative outcomes: specifically, complication rates, Comprehensive Complication Index (CCI®), intraoperative blood loss, conversion rate, operative time, and length of hospital stay did not differ significantly between the two groups. R-MILS showed a reduced rate of R1 resection margins (19.9 vs. 28.8%, p = 0.025) and wider surgical margins compared with L-MILS (8 vs. 3mm, p < 0.001). The effect size of robot-assisted surgery was increased for posterosuperior lesions (g = 0.78) and difficult procedures (g = 1.92). As per our findings, it was determined that robot-assisted liver surgery offers some technical advantages over conventional laparoscopy, maintaining the benefits of minimally invasive surgery on short-term outcomes.

Three-port Versus Four-port Laparoscopic Cholecystectomy- An Interventional Prospective Study in Public Sector Hospitals

Introduction: Cholelithiasis is a common ailment and affects about 10% of general population. Currently, the vast majority of operations for cholelithiasis are performed using laparoscopic techniques. Aim: To compare the three-port laparoscopic cholecystectomy with conventional four-port laparoscopic cholecystectomy. Materials and Methods: A prospective interventional study was conducted on 180 cases admitted to the hospitals attached to BMCRI, Bengaluru, from November 2018 to November 2020. The clinical profile of each patient was noted. The cases were confirmed by ultrasonography and they were randomised into two groups. One group underwent three-port laparoscopic cholecystectomy and the other group underwent four-port laparoscopic cholecystectomy. Intraoperative complications, conversion rates, postoperative pain, postoperative complications and duration of stay in the hospital were compared. Statistical data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0 and data was compared using Chi-square test. Results: Most of the participants were from 31-40 years (45.6%, 44.4%) in both the groups, more common in females. The mean duration of surgery in three-port and four-port group was 30.43±15.964 and 36.81±15.592 minutes, respectively. Out of 90 (100%), 56 (62.2%) in three-port group had Visual Analogue Scale (VAS) score 2 and 66 (73.3%) in four-port group had VAS score 3 (χ2=71.34; p=0.001). Conversion rates to open cholecystectomy were almost similar in both the groups. Hospital stay was also similar in both groups. Conclusion: A three-port laparoscopic cholecystectomy had lesser operating time and lesser analgesics requirement with similar intra and postoperative complication when compared to four-port laparoscopic cholecystectomy.

A comparison of robotic and laparoscopic minimally invasive adrenalectomy for adrenal malignancies.

Although guidelines recommend open adrenalectomy for most resectable adrenal malignancies, minimally invasive adrenalectomies are performed. Robotic adrenalectomies have become more popular recently, but there is a paucity of literature comparing laparoscopic and robotic resections. Patients who underwent a planned minimally invasive adrenalectomy for adrenal malignancies (adrenocortical carcinoma, malignant pheochromocytoma, other carcinoma) were identified in the National Cancer Database. The primary outcome was the conversion rate from minimally invasive to open. Other post-operative outcomes and survival were compared. 416 patients (76.5%) underwent a laparoscopic adrenalectomy and 128 (23.5%) underwent a robotic operation. Demographics and clinical characteristics were similar. Approximately 19% of tumors resected by a minimally invasive approach were > 10cm. The intra-operative conversion rate was decreased among robotic adrenalectomies relative to laparoscopic on univariate (7.8% vs. 18.3%, p = 0.005) and multivariable (odds ratio 0.39, p = 0.01) analyses. Using marginal standardization, there was a stepwise increase in the conversion rate as tumor size increased (< 5, 5-10, > 10cm) for laparoscopic (7.5%, 18.0%, 33.2%) and robotic (3.1%, 8.3%, 17.3%) adrenalectomies. Operations which required conversion had a greater margin positivity rate, greater length of stay, and an association with poor overall survival. In contrast to most clinical guidelines, minimally invasive adrenalectomies are being performed on large malignant tumors. A laparoscopic approach was associated with a greater conversion rate and subsequent poor outcomes. If a surgeon is not planning an open adrenalectomy, but adrenal malignancy is a possibility, robotic adrenalectomy may be the preferred approach for resectable adrenal tumors.

Pure laparoscopic versus robotic liver resections: Multicentric propensity score-based analysis with stratification according to difficulty scores.

The benefits of pure laparoscopic and robot-assisted liver resections (LLR and RALR) are known in comparison to open surgery. The aim of the present retrospective comparative study is to investigate the role of RALR and LLR according to different levels of difficulty. The institutional databases of six high-volume hepatobiliary centers were retrospectively reviewed. The study population was divided in two groups: LLR and RALR. The procedures were stratified for difficulty levels accordingly to three classifications. A propensity score matching was implemented to mitigate selection bias. Short-term outcomes were the object of comparison. Nine hundred and thirty-six LLR and 403 RALR were collected. RALR exhibited fewer cases of intraoperative blood loss, lower transfusion and conversion rates (especially for oncological radicality) than LLR in the setting of highly difficult operations, whereas LLR had lower postoperative morbidity and fewer low-grade complications. For intermediate and low-difficulty resections, the intraoperative advantages of RALR gradually decreased to nonsignificant results and LLR remained associated with lower postoperative morbidity. Robot-assisted liver resections do not show operative nor clinically significant benefits over LLR for low- and intermediate-difficulty resections. By reducing conversion rates, RALR can favour the operative feasibility of difficult resections possibly extending the indications of minimally invasive approaches for liver resection.

Gynecologic Robotic Surgery: Intraoperative Complication and Conversion Rates

With great deal of interest we read the published article entitled “Intraoperative complications and conversion to laparotomy in gynecologic robotic surgery” [1]. The authors analyzed their single ...