Laparoscopic Patients Research Articles

Complete laparoscopic radical resection of hilar cholangiocarcinoma: technical aspects and long-term results from a single center.

IntroductionThe landscape of surgical treatments for hepatobiliary disease was significantly changed after the advent of laparoscopy. Many kinds of complex laparoscopic procedures can be routinely performed at present, but radical resection of hilar cholangiocarcinoma (HC) by laparoscopy is still highly contentious.AimTo describe our primary experience with laparoscopic radical resection for HC and determine the safety and feasibility of this procedure.Material and methodsBetween December 2015 and November 2019, 32 patients planned to undergo curative-intent laparoscopic resection of HC in our department. The perioperative and long-term outcomes of these patients were retrospectively analyzed.ResultsLaparoscopic surgery with radical resection was ultimately performed in 24 (75.0%) patients; 3 (9.3%) patients were found to be unresectable at the preliminary exploration stage, and 5 (15.7%) patients converted from laparoscopy to laparotomy. The operation time and blood loss were 476.95 ±133.89 min and 568.75 ±324.01 ml, respectively. A negative margin was achieved in 19 (79.1%) of the laparoscopy patients. Three (12.5%) patients were identified with microscopic positive margins, and 2 (8.4%) patients underwent macroscopic residual tumor resection (R2). The length of postoperative stay was 23.3 ±11.7 days. Severe morbidity occurred in 4 (16.6%) patients. The actuarial 3-year overall survival and disease-free survival for patients who underwent laparoscopic surgery were 49.1% and 47.0%, respectively.ConclusionsLaparoscopic radical resection for HC is safe and feasible in experienced hands for highly selected patients but is still in its initial stages. When adequate oncologic resection is performed, the laparoscopic approach does not adversely influence the prognosis of the patient.

Routine baseline serum carcinoembryonic antigen as a negative predictor of peritoneal metastasis in colorectal malignancies: a cost-effective tool in South India

Background: Colorectal cancer, a formidable health problem worldwide has upto 8% synchronous peritoneal carcinomatosis. As only diagnostic laparoscopy can identify them, in countries with economic burden, selection of patients for laparoscopy is ideal. Our aim is to evaluate whether the baseline Carcinoembryonic antigen (CEA) is a good selection tool.Methods: A retrospective study of 125 patients, who were diagnosed to have colorectal malignancy (any stage) and underwent elective surgery at our institution from 2012 till 2019 were included. The baseline serum CEA was compared with the intraoperative findings. The threshold levels of serum CEA compared were 6.5 and 100 ng/dl. The sensitivity, specificity, positive predictive value and negative predictive value for both thresholds were compared in 3 categories of patients, namely peritoneal metastasis (9 cases), metastasis to other organs (36 cases) and cases with no metastasis either in peritoneum or other organs (85 cases). The results were analysed using SPSS software.Results: The mean age was 65, sex ratio (male:female) was 72:53. The sensitivity, specificity, positive predictive value, negative predictive value (NPV) for CEA threshold of 6.5 ng/dl was 44.44%, 60.34%, 8% and 93.33% for category 1. For CEA threshold of 100 ng/dl, it was 33.33%, 97.41%, 50% and 94.95% for category 1. NPV was 96.55% for category 3 (the highest value).Conclusions: If the baseline CEA levels are less than 100 ng/dl, 96.55% of cases will not require a diagnostic laparoscopy. This hopefully will cut down the cost of unnecessary diagnostic laparoscopies, and reduce the morbidity of unnecessary laparotomies.

Enhanced Recovery After Surgery in Pediatric and Adolescent Gynecology: A Pilot Study.

Enhanced recovery after surgery (ERAS) protocols have been successfully implemented in adult gynecology as well as adult and pediatric colorectal and urologic surgery with reduction in narcotic use, complications, return to the system (RTS), length of stay (LOS), and improved patient satisfaction. There are no studies evaluating the use of ERAS in pediatric and adolescent gynecology (PAG). The goals of this study are to present initial patient outcomes using ERAS in PAG patients undergoing intra-abdominal gynecologic surgery to prove efficacy, patient satisfaction, and decreased narcotic use. As a quality improvement measure in perioperative care, an ERAS protocol including preoperative, intraoperative, and postoperative components and a follow-up patient telephone call for pain assessment was implemented for all intra-abdominal gynecologic procedures. A retrospective study on implementation of ERAS components, outcomes, and patient satisfaction was then performed in participants meeting inclusion criteria. Large academic children's hospital. Patients <25years of age who underwent laparoscopic (LSC) or open abdominal (XLAP) gynecologic surgery using an ERAS protocol by the PAG service over a 12-month period. An ERAS protocol including preoperative, intraoperative, and postoperative components and follow-up patient telephone call for pain assessment was implemented for all major gynecologic surgeries performed by the PAG service. Patient satisfaction with the perioperative ERAS protocol along with components including pain management, narcotic use, LOS, RTS, and postoperative complications for various intra-abdominal gynecologic procedures. A total of 40 participants met inclusion criteria for the study. Thirty-four (85%) participants underwent LSC procedures and six (15%) underwent XLAP. Of the LSC patients, 95% were discharged on postoperative day 0, and all XLAP patients and one LSC patient were discharged on postoperative day 1. In all, 95% of patients were discharged from the hospital requiring only non-narcotic ERAS medications. There were no readmissions or postoperative complications. All patients were satisfied with their postoperative pain control at their follow-up telephone call and clinic visit. Implementation of a pediatric-specific ERAS protocol in children and adolescents undergoing gynecologic surgery is feasible and safe, and leads to less narcotic use without an increase in complications or decrease in patient satisfaction.

Laparoscopically Assisted Ventriculoperitoneal Shunt Placement Is not Cost-Effective nor Preventive for Distal Shunt Malfunction

Laparoscopy for ventriculoperitoneal shunt creation might offer smaller incisions and more reliable placement. We assessed the reliability and cost-effectiveness of this technique compared with mini-laparotomy shunt placement. All patients undergoing ventriculoperitoneal shunt creation between November 2013 and September 2017 at a single academic institution were evaluated. Individual cases were assessed for the use of laparoscopy for peritoneal shunt placement (laparoscopy) versus mini-laparotomy for peritoneal shunt placement (open). The direct hospital costs for the laparoscopy and open groups were compared for elective shunt placement from the Vizient database. These direct costs were the proportion of the admission cost attributed to surgery. The primary endpoints included costs and revision of the peritoneal catheter within 12 months of the index procedure. A total of 68 patients met the inclusion criteria. Most cases (n= 40; 58.8%) had been performed with laparoscopy, with 28 performed using an open peritoneal approach. Three patients had required ≥1 distal shunt revision: 2 laparoscopy patients (5.0%; 1 had required a second revision) and 1 open patient (3.6%). No statistically significant differences were found for the patients requiring distal shunt revision between the 2 groups (P= 1.000; Fisher's exact test). The direct cost ($9461) of ventriculoperitoneal shunt creation with laparoscopy was greater than that with an open approach ($8247; P= 0.033). Both laparoscopy and open peritoneal shunt creation are safe procedures, with a 12-month distal revision rate in the present series of ~4%. Laparoscopy provided no relative improvement in safety or complication avoidance but had resulted in a mean increase in costs of >$1200 per patient.

Near-infrared spectroscopy for assessing microcirculation during laparoscopic gynaecological surgery under combined spinal-general anaesthesia or general anaesthesia alone: a randomised controlled trial.

While pneumoperitoneum causes negative macrohaemodynamic effects, much less is known about microcirculatory effects of different anaesthetic techniques and laparoscopy. Therefore, we aimed to explore microcirculatory effects of combined spinal-general anaesthesia and laparoscopy, as measured by near-infrared spectroscopy over forearm and calf muscles utilising a 3-min ischemic challenge. Patients (n = 102) undergoing elective laparoscopic gynaecological surgery were randomised to receive general anaesthesia alone or in combination with high-dose or low-dose spinal analgesia (levobupivacaine 7.5mg or 3.75mg, respectively, plus sufentanil 2.5μg). Primary outcomes were near-infrared spectroscopy derived parameters before general anaesthesia induction, 5min after tracheal intubation, and 15min after pneumoperitoneum commencement. General anaesthesia resulted in impaired post-ischaemic recovery rate in the forearm (p < 0.001, within all groups), which improved during laparoscopy. For the calf, before general anaesthesia induction, high and low dose spinal analgesia significantly slowed the post-ischaemic recovery compared to control (34 ± 16%min-1 and 36 ± 13%min-1 vs. 52 ± 27%min-1, respectively; p = 0.002 and p = 0.006). General anaesthesia abolished differences between the groups (24 ± 14%min-1 and 25 ± 12%min-1 vs. 27 ± 18%min-1), while during laparoscopy high-dose spinal analgesia further reduced the post-ischaemic recovery compared to low-dose spinal and control groups (p = 0.023 and p = 0.040, respectively). During gynaecological laparoscopy patients show impaired calf but maintain forearm microcirculatory function, regardless of the anaesthetic technique. Reduction in post-ischaemic recovery with high-dose spinal analgesia is explained by its sympatholytic effects: number of perfused capillaries is increased, leading to a haemodynamically more favourable state. Blood pressure is positively correlated with the post-ischaemic recovery rate in vascular beds not affected by spinal analgesia.

Variability of Length of Small Intestine in Indian Population and Its Correlation with Type 2 Diabetes Mellitus and Obesity.

Previous studies have correlated small intestinal length with gender, age, weight, height and ethnic background. Some studies have reported a positive correlation of small intestinal length to body mass index (BMI). Some studies have shown that bypassing proximal small intestine can result in diabetes mellitus (DM) control. Present study was conducted to find correlation of small intestinal length with BMI and DM. Two hundred eighty-three patients aged between 18 and 60years who underwent open or laparoscopic abdominal surgery were included. Height, weight, BMI, random blood sugar (RBS), HbA1c, etc. were noted. A standard 30-cm umbilical tape with 10cm marking was used to measure the length of small intestine in laparotomy patients, whereas lap bowel graspers with marking of 10cm on the shaft was used for laparoscopy patients. Statistical significance of normally distributed continuous variables was tested using independent sample t test. Spearman rank correlation was used to test association between two ranked variables. The mean small intestinal length in Indian population was 777.1cm with a standard deviation of 186.2cm. Mean length of small intestine was significantly higher in patients who had HbA1c ≥ 6.5% and RBS levels ≥ 200mg/dL. HbA1c and RBS showed significant but a weak positive correlation with length of small intestine. BMI did not show significant correlation with length of small intestine. Small intestinal length had significant but a weak positive correlation in patients who had HbA1c ≥ 6.5% and RBS levels ≥ 200mg/dL.

Surgical treatment of rectal cancer patients aged 80 years and older—a German nationwide analysis comparing short- and long-term survival after laparoscopic and open tumor resection

BackgroundMinimally invasive removal of rectal tumors has proven to be a safe alternative to the open approach. Despite increased use of laparoscopy, its eligibility for older adults requires further exploration. This study compares perioperative mortality and 5-year overall, disease-free, and relative survival after laparoscopic and open surgery in rectal cancer patients aged ≥80 years. Materials and methodsData derive from 30 German regional cancer registries and cover approximately one quarter of the entire German population. All primary nonmetastatic rectal adenocarcinoma cases with surgery between 2005 and 2014 were eligible for inclusion. To compare survival rates, Kaplan–Meier analysis, a relative survival model, and multivariable Cox regression were applied; a sensitivity analysis assessed bias by exclusion. Results1532 patients were included, of whom 17.1% underwent laparoscopic procedures. 30 days after surgery, 2.7% of the laparoscopy patients had died compared to 7.0% in the open surgery group. The multivariable analysis confirmed that minimally invasive procedures are followed by a lower 30-day postoperative mortality risk (odds ratio, OR, 0.352; 95% confidence interval, CI, 0.161–0.771; p = 0.009). With a 5-year disease-free survival rate of 52.0 vs. 47.6% (p = 0.557), only an nonsignificant long-term advantage of the minimally invasive approach was observed. ConclusionGiven the results of this study, older rectal cancer patients are likely to benefit from the laparoscopic approach in the short term, and there are also no disadvantages in terms of long-term survival. Therefore, laparoscopy should be considered a standard procedure for older adults as well.

Trends of laparoscopic gynecologic surgeries in a tertiary care center: A five-year retrospective study

Background: The use of laparoscopic surgery in modern gynecology has led to faster recovery, lesser hospital stay, and fewer complications. In this study, we aim to analyze the current trends in laparoscopic surgery, its indications, type of procedure and associated complications.&#x0D; Method: This is a retrospective study done in Grande International Hospital. All patients who underwent laparoscopic surgery over a duration of 5 years from July 2013 to June 2018 were analyzed.&#x0D; Result: There were a total of 419 laparoscopic surgeries (74 diagnostic, 345 therapeutic) performed. The most common age group of patients for diagnostic laparoscopy was 25-34 years and for therapeutic was 45-54 years. Therapeutic surgery was mostly performed for ovarian cyst (144, 41.74%). There were a total of 152 (44.06%) laparoscopic hysterectomies performed. Complications which occurred during the surgery were insignificant (p&lt;0.01).&#x0D; Conclusion: Laparoscopic surgery has become the most common procedure for gynecological procedures over the years.

Safety of Laparoscopic Surgery for Benign Diseases during Pregnancy: A Nationwide Retrospective Cohort Study

Study ObjectiveTo compare fetal, maternal, and operative outcomes of laparoscopic surgery versus laparotomy for major benign diseases including appendicitis, cholecystitis, adnexal masses, and uterine myoma during pregnancy. DesignRetrospective cohort study (Canadian Task Force classification II-2). SettingThe Diagnosis Procedure Combination database, a national inpatient database for acute care inpatients in Japan. PatientsEligible patients (n = 6018) underwent abdominal surgery (4047 laparotomy and 1971 laparoscopy patients) from July 2010 through March 2016. InterventionsThe 2 groups were compared using propensity score matching analysis. Measurements and Main ResultsThe primary outcome was fetal adverse events, including abortion or stillbirth within 7 days after surgery and premature delivery during hospitalization. Secondary outcomes were operative time, blood transfusion, and length of hospital stay after surgery. Propensity score matching created 740 pairs. Significant difference was observed in the primary outcome between propensity score–matched patients in the laparotomy versus laparoscopy group (1.8% vs .41%, respectively; risk difference, −1.4%; 95% confidence interval, −2.4 to −.30; p = .01). Compared with the laparotomy group, the laparoscopy group had a significantly lower incidence of blood transfusion (2.3% vs .41%, p = .002), shorter operative time (115 vs 95 minutes, p <.001), and shorter hospital stay (9.2 vs 5.9 days, p <.001). ConclusionOur current study using propensity score matching suggests the advantages of laparoscopic surgery for benign diseases compared with laparotomy because laparoscopic surgery had advantages in short-term fetal adverse events, incidence of blood transfusion, operative time, and hospital stay.

Comparison between open and laproscopic pyeloplasty in Al-Diwaniya Teaching Hospital

Background: Historically open pyeloplasty has been regarded as the gold standard for the surgical management of ureteropelvic junction obstruction (UPJO). The treatment of this condition has evolved considerably over the past two decades resulting in new surgical approaches. One of these approaches is laparoscopic pyeloplasty,this technique aimed to achieve the same results as open surgery,with lower rates of morbidity and complications. Aim of the study: To compare the operative time,hospital stay,analgesic use,perioperative complications,and success rate between laparoscopic and open pyeloplasty in Al Diwaniya Teaching Hospital. Patients &amp; Methods: From October 2014 to October 2016,40 patients (26 males and 14 females) with Ureteropelvic junction obstruction who had been admitted to the urology unit of Al Diwaniya Teaching Hospital were enrolled in this study. Their ages ranged from 10 to 44 years with a mean age of 24 years. The patients were selected on the basis of standard indications for PUJO repair. The patients were assigned into two groups. Twenty patients underwent transperitoneal laparoscopic pyeloplasty and 20 patients underwent open surgery. The choice between the two types of operation was selected according to surgeon's preference (only surgeon who has enough experience with laparoscopic surgeries perform laparoscopic pyeloplasty,while the other performed open surgery). Preoperative evaluations were done using abdominal ultrasound and IVP. Laboratory tests included urinalysis,urine culture,blood urea,and serum creatinine. Blood group was determined. We compared the operative time,complications rates,hospital stay and success rate of the two groups.Mean operative time was 2 hours and 3 hours in open and laparoscopic pyeloplasty groups,respectively. Mean hospital stay was shorter (24 hours) in the laparoscopic group and (48 hours) in open group. Mean follow-up period was 9 months. Postoperative complication rates were 20 % and 30 % in laparoscopic and open pyeloplasty groups,respectively. Success rates were 95% and 90 % for open and laparoscopic pyeloplasty groups,respectively. Repeated surgery was performed in 2 patients of laparoscopy and 1 of open pyeloplasty groups due to recurrence of stricture.The safety and efficacy of laparoscopic pyeloplasty is comparable to that of open pyeloplasty,with better cosmetic results and shorter hospital stay,therefore laparoscopic pyeloplasty can replace open surgery and may be considered the gold standard technique for the treatment of ureteropelvic junction obstruction in expert hands.

Long-term oncologic outcomes after laparoscopic versus open rectal cancer resection: a high-quality population-based analysis in a Southern German district

BackgroundAn increasing number of rectal carcinoma resections in Germany and worldwide are performed laparoscopically. The recently published COLOR II trial demonstrated the oncologic safety of this surgical approach. It remains unclear whether these findings can be transferred to clinical practice.Patients and methodsThis population-based retrospective cohort study aimed to evaluate 5-year overall, relative, disease-free, and local recurrence-free survival of rectal cancer patients treated by open surgery and laparoscopy. Data from a southern German region of 1.1 million inhabitants were collected by an official clinical cancer registry. All primary non-metastatic rectal adenocarcinoma cases with surgery between 2004 and 2013 were eligible for inclusion. To compare survival rates, Kaplan–Meier analyses, relative survival models, and multivariate Cox regression were applied; a sensitivity analysis assessed bias by exclusion.ResultsFinally, 1507 patients with a median follow-up time of 7.1 years were included. Of these patients, 28.4% underwent laparoscopic procedures, with an increasing rate over time. Patients with tumors of the upper or middle rectum, younger patients, and patients of specialized colorectal cancer centers were more likely to undergo laparoscopy. After 5 years, 80.4% of laparoscopy patients were still alive, compared to 68.6% in the open group (p < 0.001). Moreover, laparoscopy was associated with superior local recurrence-free survival rates. This advantage was also significant in multivariate analysis (HR 0.70, 95% CI 0.52–0.92).ConclusionLaparoscopic rectal cancer surgery can be considered safe in daily clinical practice. This should be confirmed by future studies outside the setting of randomized trials.

Long-term oncologic outcomes after laparoscopic vs. open colon cancer resection: a high-quality population-based analysis in a Southern German district

BackgroundOver 20 years after the introduction of laparoscopic surgery for colon cancer, many surgeons still prefer the open approach. Whereas randomized controlled trials (RCTs) have proven the oncologic safety of laparoscopy, long-term data depicting daily clinical routine are scarce.MethodsThis population-based cohort study compares 5-year overall, relative, and recurrence-free survival rates after laparoscopic and open colon carcinoma surgery. Data derive from an independent German cancer registry encompassing all tumor patients within a political district of 1.1 million inhabitants. The final analysis included 2669 patients with major elective resection of primary non-metastatic colonic adenocarcinoma between January 1, 2004 and December 31, 2013. Survival rates were compared using Kaplan–Meier analyses, relative survival models, and multivariate Cox regression. Sensitivity analysis quantified selection bias.ResultsThe proportion of laparoscopic procedures increased from 9.7 to 25.8% in 2011 and dropped again to 15.8% at the end of observation period. Laparoscopy patients were younger, had a lower tumor stage, and were more likely to receive postoperative chemotherapy. Overall, relative, and recurrence-free survival was significantly superior or equivalent in Kaplan–Meier analysis (5-year overall survival rate open vs. laparoscopic: 69.0 vs. 80.2%, p < 0.001). The superiority of laparoscopy mostly remained stable after adjusting for confounders, although significance was only reached in T1-3 patients without lymph node metastases (overall survival: hazard ratio (HR) 0.654; 95% confidence interval (CI) 0.446–0.958; p = 0.029).ConclusionLaparoscopy is a safe and promising alternative to the open approach in daily clinic practice. These favorable outcomes require future confirmation by high-quality studies outside the setting of RTCs.

Laparoscopy for Trauma and the Changes in its Use From 1990 to 2016: A Current Systematic Review and Meta-Analysis.

The role of laparoscopy in the diagnosis and treatment of stable abdominal trauma patients is still a matter of serious debate and only incomplete data are available. We performed a systematic review and meta-analysis of the literature between January 1990 and August 2016. Overall, 9817 laparoscopies were performed for abdominal trauma; only 26.2% of the cases were converted to a laparotomy. The incidence of therapeutic laparotomies showed a reduction from 69% to 47.5%, whereas the incidence of therapeutic laparoscopies increased from 7.2% to 22.7%.The overall perioperative mortality rate was significantly lower in the laparoscopy group [odds ratio (M-H, random); 95% confidence interval, 0.35 (0.26-0.48)]. The same group showed shorter length of hospital stay [odds ratio (M-H, random); 95% confidence interval, -3.48 (-8.91 to 1.96)]. This systematic review shows a significant decrease in the use of laparoscopy in trauma patients. Most likely the widespread use of imaging techniques allows a more accurate selection of patients for diagnostic laparoscopy. Infact, a reduction in incidence of nontherapeutic laparotomies is evident in these selected patients undergoing diagnostic laparoscopy. Moreover, the literature reported an increasing trend of therapeutic laparoscopy, demonstrating that it is safe and effective. The small number and poor quality of the studies identified, the retrospective observational nature of the studies (low level of evidence), the high risk of bias, and the high heterogeneity of some outcomes make the applicability of the results of this meta-analysis unclear.

Laparoscopic adrenalectomy by transabdominal lateral approach: can preoperative risk factors predict complications?

During the last decade, laparoscopic adrenalectomy (LA) largely replaced open adrenalectomy (OA) as the preferred approach for most adrenal lesions due to greater surgeon experience with advanced laparoscopy, improved technology, and better short-term patient outcomes (1).

Gangrenous cholecystitis: innovative laparoscopic techniques to facilitate subtotal fenestrating cholecystectomy when a critical view of safety cannot be achieved.

Gangrenous cholecystitis is associated with a higher conversion rate of conversion from laparoscopic to open than acute non-gangrenous cholecystitis. New strategies and techniques are needed to decrease conversion rates and improve outcomes. In this article, we provide a richly detailed, illustrated description of a modified fundus-first technique that we have developed over the last 15years and now use routinely with rare conversions. We also compared outcomes of laparoscopic (LC) and open (OC) approaches for pathologically confirmed gangrenous cholecystitis in 146 patients during 1995-2005, the first 10years during which these two approaches were performed contemporaneously at our institution on comparable patients. Among the 142 patients that met the inclusion criteria, laparoscopic procedures were started in 112 (79%) of these patients, with successful completion in 72 resulting in an overall conversion rate of 36%. During the last 5years, however, in cases where the described laparoscopic technique was used, no patient has required conversion. The laparoscopic LC group had shorter average ICU stay (p<0.05) and overall length of stay (2 vs 6days, p<0.001). Intraoperative cholangiography was completed in 37 of 72 LC patients (52%) versus 6 of 30 OC (20%). In five of the LC patients, a filling defect was seen on the cholangiogram and laparoscopic transcystic common bile duct stones, thereby avoiding a second anesthetic and endoscopic procedure. In the setting of severe inflammation, a number of procedural modifications can be incorporated to allow the surgeon to approach dissection of the gangrenous gallbladder using a flexible operative plan designed to optimize safe completion of this challenging procedure, with the expected improvement in surgical outcomes.

Negative predictive value of preoperative computed tomography in determining pathologic local invasion, nodal disease, and abdominal metastases in gastric cancer.

Before undergoing curative-intent resection of gastric adenocarcinoma (ga), most patients undergo abdominal computed tomography (ct) imaging to determine contraindications to resection (local invasion, distant metastases). However, the ability to detect contraindications is variable, and the literature is limited to single-institution studies. We sought to assess, on a population level, the clinical relevance of preoperative ct in evaluating the resectability of ga tumours in patients undergoing surgery. In a provincial cancer registry, 2414 patients with ga diagnosed during 2005-2008 at 116 institutions were identified, and a primary chart review of radiology, operative, and pathology reports was performed for all patients. Preoperative abdominal ct reports were compared with intraoperative findings and final pathology reports (reference standard) to determine the negative predictive value (npv) of ct in assessing local invasion, nodal involvement, and intra-abdominal metastases. Among patients undergoing gastrectomy, the npv of ct imaging in detecting local invasion was 86.9% (n = 536). For nodal metastasis, the npv of ct was 43.3% (n = 450). Among patients undergoing surgical exploration, the npv of ct for intra-abdominal metastases was 52.3% (n = 407). Preoperative abdominal ct imaging reported as negative is most accurate in determining local invasion and least accurate in nodal assessment. The poor npv of ct should be taken into account when selecting patients for staging laparoscopy.

Perioperative Laboratory Abnormalities in Gynecologic Oncology Surgical Patients.

Background: Laboratory blood testing incurs financial costs and the blood draws can increase discomfort, yet minimal data exists regarding routine testing in gynecologic oncology surgical patients. Additionally, an increasing number of gynecologic oncology surgeries are performed via a laparoscopic approach. Thus, further investigation into perioperative laboratory testing for gynecologic oncology patients is warranted. An increasing number of gynecologic oncology surgeries are performed via a laparoscopic approach. Thus, further investigation into perioperative laboratory testing for gynecologic oncology patients is warranted. Objective: The aims of this study were (1) to evaluate the frequency and etiology of perioperative laboratory test abnormalities in patients undergoing laparoscopic and laparotomy surgery in a gynecologic oncology service, and (2) to establish an evidence-based algorithm to reduce unnecessary laboratory testing. Materials and Methods: A single-institution retrospective study was completed, investigating laparoscopic and laparotomic surgeries over 4 years. Information on preoperative and postoperative laboratory data, surgical parameters, perioperative interventions, and patient demographics was collected. Quality-assurance data were reviewed. Data were tabulated and analyzed using Statistical Product and Service Solutions (SPSS) version 22. A Student's t-test was used to test for group differences for continuous variables with equal variance, the Mann-Whitney–U test for continuous variables when unequal variance was detected, and Pearson's χ2 was used to investigate categorical variables of interest. p-Values <0.05 were considered to be statistically significant. Logistic regression was performed to investigate the relationships among multiple predictors and each identified outcome. Results: The study included 481 subjects (168 laparoscopies, 313 laparotomies). Patients undergoing laparoscopy were, on average, younger (53.5 versus 57.4), with lower body mass indexes (29.7 versus 33.0) and lower rates of diabetes (10.7% versus 19.5%), compared to patients undergoing laparotomy. Overall, >98% of patients underwent at least one preoperative and postoperative laboratory test, totaling 8060 preoperative and 5784 postoperative results. The laparoscopy group was significantly less likely to have postoperative metabolic abnormalities or to undergo perioperative blood transfusion. Patients taking an angiotensin-converting-enzyme inhibitor, angiotensin-II–receptor blocker, or diuretic were significantly more likely to have elevated creatinine preoperatively (odds ratio [OR]: 5.0; p < 0.001) and postoperatively (OR: 7.1; p < 0.001), and this remained true for each group when divided by surgical approach. Perioperative complications meeting institutional quality assurance criteria occurred in 1.7% of laparoscopy patients compared to 11.8% of laparotomy patients (p < 0.001); perioperative laboratory testing was not a factor in the diagnosis of these complications. Conclusions: Clinically significant laboratory abnormalities are uncommon and are less likely to be found on routine perioperative testing in gynecologic oncology patients undergoing laparoscopy, compared to patients undergoing laparotomy. This suggests a role for limiting perioperative laboratory blood testing. (J GYNECOL SURG 32:111)

A Meta analysis of retroperitoneal laparoscopy and open surgical treatment for renal cyst

Objective To evaluate the clinical efficacy and safety of retroperitoneal laparoscopy and open surgical treatment of simple renal cyst by Meta analysis. Methods Computer retrieval of MEDLINE, Cochrane Library, EMBASE, CNKI, Wanfang and VIP databases, according to the inclusion and exclusion criteria collected and screened out a randomized controlled studies on the treatment of simple renal cysts, published from January 1, 2000 to August 31, 2015. Two independent authors screened out randomized clinical trials (RCTs), extracted data, assessed quality of data, and then carried out Meta analysis by Revman 5.0 software with related data. Results Twenty one studies met the inclusion criteria with a total of 2 296 patients, including 1 162 patients of retroperitoneal laparoscopy and 1 134 cases of open operation group. Compared to the open operation group, retroperitoneal laparoscopy showed shorter operation time, less bleeding, shorter hospitalization time, and earlier postoperative drainage tube extraction time. No significant difference was found in the recurrence rate of the cyst for two groups. Conclusions The clinical efficacy, safety, and complication of retroperitoneal laparoscopy in the treatment of simple renal cyst is better than the open operation. Key words: Laparoscopy; Decompression, surgical; Kidney neoplasms/SU; Meta-analysis

Gasless laparoscopy in patients with prior ventriculoperitoneal shunt: yet another option!

Anaesthetic management of patients with ventriculoperitoneal shunt (VPS) undergoing laparoscopic surgeries remains controversial for its safety concerns. At present, no standardized protocol exists for managing these patients during perioperative period. The prime concerns are the rise in intracranial pressure (ICP) and shunt dysfunction due to carbon dioxide insufflation. Anaesthetic considerations in these patients should focus primarily on the intrinsic characteristics and functioning of the VP shunt, the insufflation pressures for pneumoperitoneum creation and techniques to monitor the function of shunt. Gasless laparoscopy may be an option by warding off the complications associated with pneumoperitoneum. In our institution, surgeon improvises the laparoscopic technique to create a gasless condition. We discuss the anaesthetic concerns and considerations in this subset of patients for laparoscopy surgeries.Bangladesh Journal of Medical Science Vol.14(4) 2015 p.420-421

Robotic versus laparoscopic versus open surgery in morbidly obese endometrial cancer patients — A comparative analysis of total charges and complication rates

ObjectiveTo compare the complications and charges of robotic vs. laparoscopic vs. open surgeries in morbidly obese patients treated for endometrial cancer. MethodsData were obtained from the Nationwide Inpatient Sample from 2011. Chi-squared, Wilcoxon rank sum two-sample tests, and multivariate analyses were used for statistical analyses. ResultsOf 1087 morbidly obese (BMI ≥40kg/m2) endometrial cancer patients (median age: 59years, range: 22 to 89), 567 (52%) had open surgery (OS), 98 (9%) laparoscopic (LS), and 422 (39%) robotic surgery (RS). 23% of OS, 13% of LS, and 8% of RS patients experienced an intraoperative or postoperative complication including: blood transfusions, mechanical ventilation, urinary tract injury, gastrointestinal injury, wound debridement, infection, venous thromboembolism, and lymphedema (p<0.0001). RS and LS patients were less likely to receive blood transfusions compared to OS (5% and 6% vs. 14%, respectively; p<0.0001). The median lengths of hospitalization for OS, LS, and RS patients were 4, 1, and 1days, respectively (p<0.0001). Median total charges associated with OS, LS, and RS were $39,281, $40,997, and $45,030 (p=0.037), respectively. ConclusionsIn morbidly obese endometrial cancer patients, minimally invasive robotic or laparoscopic surgeries were associated with fewer complications and less days of hospitalization relative to open surgery. Compared to laparoscopic approach, robotic surgeries had comparable rates of complications but higher charges.