Laparoscopic Surgeons Research Articles

PD01-08 COMPARISON OF SENHANCE ROBOT-ASSISTED RADICAL PROSTATECTOMY AND DA VINCI ROBOT-ASSISTED RADICAL PROSTATECTOMY: LEARNING CURVE, COST ANALYSIS AND SHORT-TERM SURGICAL OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023PD01-08 COMPARISON OF SENHANCE ROBOT-ASSISTED RADICAL PROSTATECTOMY AND DA VINCI ROBOT-ASSISTED RADICAL PROSTATECTOMY: LEARNING CURVE, COST ANALYSIS AND SHORT-TERM SURGICAL OUTCOMES Yen Chun Lin, Lun-Hsiang Yuan, Shi-Wei Huang, Yu-Wen Huang, and Chao-Yuan Huang Yen Chun LinYen Chun Lin More articles by this author , Lun-Hsiang YuanLun-Hsiang Yuan More articles by this author , Shi-Wei HuangShi-Wei Huang More articles by this author , Yu-Wen HuangYu-Wen Huang More articles by this author , and Chao-Yuan HuangChao-Yuan Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003218.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Senhance® robotic system (Asensus Surgical Inc, USA) is a new laparoscopy-based robotic platform which has been increasingly used. Currently, there are limited papers discussing the application of Senhance radical prostatectomy (SRP). Here, we compared the SRP learning curve, short-term surgical outcomes and cost analysis with the da Vinci RP (DRP) cases METHODS: From Aug 2019 to April 2022, 65 cases of SRP were performed in National Taiwan University Hospital Yunlin branch. We compared peri-operative data with a prospectively collected 60 cases DRP cohort and a retrospectively collected cohort of initial 60 DRP cases enrolled from the National Taiwan University Hospital. Inclusion criteria was patients with biopsy confirmed prostate cancer, American Association of Anesthesiologists Score ≦3 and without evidence of metastasis. RESULTS: The operative and pathological outcomes of the three cohorts are shown in Table 1. The SRP showed non-inferior results in positive margin rate, blood loss and operative time(OT) than the DRP. We used simple OT to analyze the learning curve. Figure 1-A, 1-B and 1-C represents the OT of experienced LRP-SRP surgeon, LRP-naive SRP surgeons and DRP surgeon respectively. The OT curve showed a much quicker downward trend in the experienced LRP-SRP and DRP surgeons than LRP-naive SRP surgeons. Median cost for each SRP in our hospital was $4170, which was lower than $7675 in the DRP. CONCLUSIONS: Safety and short-term outcomes are comparable between SRP and DRP. For experienced laparoscopic RP surgeon, using Senhance system to perform RP is rather straightforward. With a more affordable price as its biggest advantage, Senhance system may serve as a safe and effective alternative for robotic RP. Source of Funding: Nil © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e66 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yen Chun Lin More articles by this author Lun-Hsiang Yuan More articles by this author Shi-Wei Huang More articles by this author Yu-Wen Huang More articles by this author Chao-Yuan Huang More articles by this author Expand All Advertisement PDF downloadLoading ...

DIFFICULTIES AND COMPLICATIONS IN LAPAROSCOPIC CHOLECYSTECTOMY IN OBESE AND NON-OBESE PATIENTS: A COMPARATIVE STUDY

Introduction: Obesity is currently a worldwide lifestyle disease and is considered one of the contributing factors to cholelithiasis. For patients having symptoms of gallstone disease, in the case of acute or chronic cholecystitis and for obese people, laparoscopic cholecystectomy is considered as gold standard management. Reasons for higher conversion rate in the obese population undergoing laparoscopic cholecystectomy include difculty in cannula insertion, obscured anatomy of Calot's triangle because of excessive intraperitoneal fat, inadequate space to retract the liver, and difculty with instrument handling in an excessively thick abdominal wall. Methodology: This prospective observational study was conducted on fty patients (25 patients in each group) with prior written and informed consent. Patients aged above 18 years presenting with cholelithiasis were included in this study, over a period of 18 months. Laparoscopic cholecystectomy was done in all patients by an experienced laparoscopic surgeon. Patients were allocated into two groups based on BMI (body mass index) which was calculated using the Quetelet Index. Difculties and complications were compared between two groups in intraoperative and postoperative period. Results: Intraoperatively, obese patients were more likely to have impacted stones in hartmann's pouch (36% vs 20%, p<0.007), when compared to non-obese patients. There is a signicant difference in difculty in creating pneumoperitoneum between non-obese vs obese patients (0% vs 8%; p<0.049). Acomparison of the rest of the intraoperative and postoperative ndings was insignicant between the two groups. Postoperatively, none of the ndings were signicant between the two groups in terms of postoperative stay, average pain score, and surgical site infection. Conclusion: This study has shown that laparoscopic cholecystectomy can be performed safely in the obese patients and with favourable outcomes as seen in those patients with a normal body-mass index.

Short-term outcomes of reduced-port laparoscopic surgery versus conventional laparoscopic surgery for total gastrectomy: a single-institute experience

BackgroundThe efficacy of reduced-port laparoscopic surgery (RLS) for total gastrectomy remains unclear. This study focused on evaluating the short-term outcomes of RLS compared with conventional laparoscopic surgery (CLS) for total gastrectomy.MethodsOne hundred and ten patients who underwent completed laparoscopic total gastrectomy for gastric cancer between September 2018 and June 2022 were retrospectively collected and classified into two groups (65 CLS and 45 RLS) according to different operation approach. Twenty-four RLS cases underwent single-incision plus two ports laparoscopic surgery (SILS + 2) and twenty-one underwent single-incision plus one port laparoscopic surgery (SILS + 1). Surgical outcomes, pain intensity, cosmetic and postoperative morbidity, and mortality were compared between groups.ResultsThe overall incidence of postoperative complications was similar between the CLS group and the RLS group (16.9% vs. 8.9%, P = 0.270). It was also comparable in the Clavien-Dindo classification (P = 0.774). However, compared with the CLS group, the RLS group had a significantly shorter total length of incision (5.6 ± 1.0 cm vs. 7.1 ± 0.7 cm, P = 0.000); shorter time to first ambulation (24.9 ± 5.9 h vs. 27.6 ± 5.0 h, P = 0.009), flatus (3.0 ± 0.8 d vs. 3.5 ± 1.0 d, P = 0.022) and oral intake (4.0 ± 1.6 d vs. 6.1 ± 5.1 d, P = 0.011); lower white blood cell count on the third day after the operation (9.8 ± 4.0*109/L vs. 11.6 ± 4.7*109/L, P = 0.037); and lower visual analogue scale score on postoperative days 1 and 3(3.0 ± 0.7 vs. 3.3 ± 0.7, P = 0.044 and 0.6 ± 0.7 vs. 1.6 ± 0.6, P = 0.000 respectively). On the other hand, it didn’t find any difference in short-term outcomes between the SILS + 2 group and the SILS + 1 group (P > 0.05). But the proximal resection margin was longer in the SILS + 2 group than in the SILS + 1 group (2.6 ± 0.7 cm vs. 1.5 ± 0.9 cm, P = 0.046) in patients with adenocarcinoma of the esophagogastric junction (AEG).ConclusionsRLS for total gastrectomy is a feasible and safe technique when performed by an experienced laparoscopic surgeon. Moreover, compared with SILS + 1, SILS + 2 might have some advantages in AEG patients.

Study on the Role of Diagnostic Laparoscopy in Undiagnosed Chronic Abdominal Pain- Prospective Study

Patients with chronic abdominal pain is the most difficult to diagnose and treat. Potentially it can be unrewarding for both patients and treating physicians. Thereby affecting patients both physically and mentally. Chronic abdominal pain is associated with poor quality of life and the onset of depressive symptoms. Most patients in this group have already undergone numerous diagnostic procedures, including upper and lower gastrointestinal endoscopies, Ct scans, and screening for undetected carcinomas, apart from routine blood investigations. This is the time when the surgeon is approached when all other non-invasive investigations have failed to reach a satisfying conclusion. Clearly diagnostic laparoscopy is an important intermediate option between refusing to explore a patient's abdomen and performing laparotomy. Diagnostic Laparoscopy with advances in optics gives the perfect visual of the whole abdomen and further gives therapeutic advantages as well, which include target biopsies, staging of cancers, and various gynaecological pathologies. Laparoscopy is as much a surgical procedure as an exploratory laparotomy, often just as informative, and a skilled laparoscopic surgeon affords a better view of the entire peritoneal cavity than usual exploratory laparotomy. Achieving a high rate of positive diagnosis from laparoscopy requires much more than trained hands, it requires a thorough background in surgery, sound clinical knowledge, and a perception of abdominal pathologies. Most importantly it avoids unnecessary negative laparotomy in many cases. Moreover, early recovery and ambulation of patients help them get back to daily chores and are a source of delight for treating doctors.

Laparoscopic common bile duct exploration to treat choledocholithiasis in situs inversus patients: A technical review.

Situs inversus (SI) is a rare congenital condition characterized by a mirror-image transposition of the major visceral organs. Since the 1990s, more than one hundred SI patients have been reported to have successfully undergone laparoscopic cholecystectomy. In these cases, the major problem is to overcome is the left-right condition for right-handed surgeons. Laparoscopic common bile duct exploration (LCBDE), an alternative to treat patients with bile duct stones, has shown equivalent efficacy and is less likely to cause pancreatitis than endoscopic retrograde cholangiopancreatography. Recent updated meta-analyses revealed that a shorter postoperative hospital stay, fewer procedural interventions, cost-effectiveness, a higher stone clearance rate, and fewer perioperative complications are additional advantages of LCBDE. However, the technique is technically demanding, even for skilled laparoscopic surgeons. Conducting LCBDE in patients with difficult situations, such as SI, is more complex than usual. We herein review published SI patients with choledocholithiasis treated by LCBDE, including our own experience, and this paper focuses on the technical aspects.

Early and Long-term Complications of Robotic Assisted Laparoscopy in Infants and Children

BackgroundRobotic-assisted laparoscopy still lacks wide acceptance in infants and children. We developed the service and report the largest single institution experience of complications over a period of 11 years. MethodsBetween March 2006 and May 2017, consecutive infants and children who underwent robotic assisted laparoscopy under the care of two laparoscopic surgeons were studied. Data for patients, surgeons, year of surgery, operation, and timing, nature, grades of complications were assessed. ResultsA total of 601 robotic procedures (45 different types) were carried out in 539 patients. Of these 31 (5.8%) were converted, none for operative complications. These and another 4 with complicated co-morbidity were excluded, leaving 504 patients for further analysis. There were 60 (11.9%) complications in 57 (11.3%) patients. Mean (SD) age was 7.7 years −/+5.1 with the youngest being 4 weeks. Concomitant or bilateral robotic and non-robotic procedures took place in 8.1% and 13.3% of patients respectively. Significant medical co-morbidity and abdominal scarring were present in 29% and 14.9% of patients respectively. Complications occurred in theatre 1.6%, hospital 5.6%, 28 days 1.2%, and late 3.6%. Mean follow up was 7.6 years −/+ 3.1 SD. Over-all postoperative complication rate was 10.3%: CD grade I 6.5% (33), II 0.6% (3), and IIIa/b 3.2% (16) which included 1.4% (7) re-do surgery. Most (11/16) grade III occurred late. There were no bleeding, grade IV or V complications, surgical mortality, or technology related complications. ConclusionsComplications are low even during the learning phase and while developing the new technique. Most complications occurred early and were minor. Most high-grade complications presented late. Levels of Evidence2B

Skill-qualified surgeons positively affect short-term outcomes after laparoscopic gastrectomy for gastric cancer: a survey of the National Clinical Database of Japan.

Proficiency of the operating surgeon is one of the most critical factors potentially associated with reductions in complications and surgery-related mortality. With video-rating systems having shown potential for assessing laparoscopic surgeons' proficiency, the Endoscopic Surgical Skill Qualification System (ESSQS) was developed by the Japan Society for Endoscopic Surgery to subjectively assess the proficiency of laparoscopic surgeons by rating applicants' non-edited case videos. We conducted a study to evaluate how ESSQS skill-qualified (SQ) surgeon involvement influences short-term outcomes of laparoscopic gastrectomy performed for gastric cancer. Data from the National Clinical Database regarding laparoscopic distal and total gastrectomy performed for gastric cancer between January 2016 and December 2018 were analyzed. Operative mortality, defined as 30-day mortality or 90-day in-hospital mortality, and anastomotic leakage rates were compared per involvement vs. non-involvement of an SQ surgeon. Outcomes were also compared per involvement of a gastrectomy-, colectomy-, or cholecystectomy-qualified surgeon. The association between the area of qualification and operative mortality/anastomotic leakage was also analyzed with a generalized estimating equation logistic regression model used to account for patient-level risk factors and institutional differences. Of 104,093 laparoscopic distal gastrectomies, 52,143 were suitable for inclusion in the study; 30,366 (58.2%) were performed by an SQ surgeon. Of 43,978 laparoscopic total gastrectomies, 10,326 were suitable for inclusion; 6501 (63.0%) were performed by an SQ surgeon. Gastrectomy-qualified surgeons outperformed non-SQ surgeons in terms of both operative mortality and anastomotic leakage. They also outperformed cholecystectomy- and colectomy-qualified surgeons in terms of operative mortality or anastomotic leakage in distal and total gastrectomy, respectively. The ESSQS appears to discriminate laparoscopic surgeons who can be expected to achieve significantly improved gastrectomy outcomes.

A method of laparoscopic treatment of large adnexal cysts - Two port trocar suction.

The size of the adnexal cyst is a limitation to perform laparoscopic adnexal surgery. Large adnexal cysts may constrain the surgery space and may increase the risk of inadvertent cyst rupture during the surgery. Here, we offer a method to solve the difficulty in laparoscopic management of large adnexal cysts. This is a retrospective study of 43 patients with large (≧10cm) adnexal cysts, managed laparoscopically at one center from October 2016 to October 2019. All the surgeries were performed by an experienced laparoscopic surgeon. Malignancy was excluded before the surgeries according to the sonographic features. Cystectomy or salpingo-oophorectomy was decided according to the age, the sonographic pattern of the cyst and the patients' willingness. A 2cm vertical incision was made at the umbilicus, and an open laparoscopy method was used to enter the peritoneal cavity. A wound protector was applied with a glove and two trocars being set up. The second wound was made at the left abdomen, and a 5mm trocar was inserted. Then the cyst was punctured by means of the 5mm trocar, and the content of the cyst was then soon aspirated by means of the air-flow hole of the trocar. Afterward, cystectomy or salpingo-oophorectomy was performed. Data are expressed as mean±standard deviation unless stated otherwise. The mean operative duration was 54.7±33.4min, and the result was shorter than the previous study (P<0.05, CI (-32.92,-12.38)) according to one sample t-test. Most estimated blood loss (EBL) was minimum. No obvious complication was found. Two-port trocar suction in laparoscopic management of large adnexal cysts is feasible after proper evaluation, and it takes short operative time.

Prospective study of intraoperative and post-operative complications during laparoscopic cholecystectomy among patients presenting with acute calculous cholecystitis

Background: Acute cholecystitis was initially thought to be a contraindication for laparoscopic cholecystectomy. Now, as the experience is increasing, laparoscopic surgeons are gradually undertaking laparoscopic cholecystectomy as the preferred procedure even in an acute setting. Early surgery in acute presentation has better surgical outcome with lesser and cheaper hospital stay and predictive of better quality of life as compared to delayed treatment. Aims and Objectives: The objectives of this study were to study the perioperative complications during early laparoscopic cholecystectomy. Materials and Methods: One hundred and five patients with acute calculus cholecystitis visiting Fortis Escorts Hospital, Faridabad from June 2017 to November 2018 were studied. All patients underwent laparoscopic cholecystectomy and subsequently compared for the following intraoperative parameters: Presence of adhesions, calot’s anatomy, need for decompression of gallbladder, difficulty in dissecting the gallbladder from liver bed, retrieval of gallbladder, time taken to complete surgery, need of placement of drain, and need for conversion to open cholecystectomy. Complications studied were massive bleed, bile spillage during dissection, stone spillage, duodenal injury, and common bile duct [CBD] injury. Results: Decompression of the acute inflamed gallbladder facilitates laparoscopic cholecystectomy in acute cholecystitis with low conversion rate of 2.86%. Bleeding, CBD injury and duodenal injury are uncommon complications but major factors for conversion. Conclusion: Most common reasons for difficulty in laparoscopic cholecystectomy for acute cholecystitis were found to be adhesions in Calot’s triangle and adhesion of gallbladder with surrounding structures (duodenum/transverse colon).

Book review

Agata Witkowska, Head Laparoscopic Surgeon at the Holly House Veterinary Hospital in Leeds, has a keen interest in exotic species and reviews this recently published practical wildlife book edited by Elizabeth Mullineaux.

Outcomes of Open Versus Laparoscopic Surgery for Colorectal Cancer in the Emergency Setting

Aim: The study aim is to do the comparison of oncological and short-term results of open and laparoscopic surgery for colorectal cancer in emergency setting. Study Design: This retrospective cohort research was held in the Department of Surgery, Civil Hospital, Karachi and Sheikh Zayed Medical College/ Hospital, Rahim Yar Khan for two-years duration from January 2020 to December 2021. Patients and Methods: after approval of this study and an informed consent agreement was signed by each participant. We performed an emergency analysis on 55 consecutive patients who received emergency open (n=40) or laparoscopic (n=15) resection for colorectal cancer. Results: The gender, age, BMI, American Society of Anesthesiologists (ASA) score, tumor location and prior abdominal surgery history were not significantly different between the laparoscopic and open groups. The T4 pathological tumors were more frequent in the open surgery group (50% vs. 13.3%; p=0.031) than in the laparoscopic group. The open surgery group also experienced high proportion of perforation (42.5% vs. 33.3%) and obstruction (47.5% vs. 26.7%) cases. In the laparoscopic group, bleeding or anemia were much common (33.3% vs. 7.5%; p=0.032). The laparoscopic group did not experience any open conversions. The open surgery group had a high pervasiveness of Hartmann's surgery (35%), whereas the laparoscopic group had high pervasiveness of low anterior resection (26.7%; p=0.064). The complication ration at 30-days for laparoscopy (37.5%) and open surgery (33.3%) was comparable (p=0.900). Conclusions: In some individuals with colorectal cancer, emergency laparoscopic surgery has advantages in relation of short-term and oncologic outcomes. As a result, skilled laparoscopic surgeons may actively consider using laparoscopy in life-threatening situations. Keywords: Laparoscopy, colorectal cancer, and emergency.

Lost Needle During Gynecologic Laparoscopic Surgery: A Literature Review and a Suggested Approach

Laparoscopic suturing is an important component of advanced gynecologic procedures. A needle may be inadvertently lost, and searching for it can be especially challenging. The goal of this review is to present useful strategies when this problem occurs. This article reviews current literature and suggests a structured approach for retrieving a lost needle. Preventive measures that reduce the risk of the needle being lost are also highlighted. A systematic search of a lost needle should cover all areas of the gynecologic surgical field, including the abdominal cavity, abdominal wall, laparoscopic cannulas, and the surrounding area. Intraoperative imaging, such as plain film X-ray or C-arm fluoroscopy, has been shown to be useful for localizing lost needles. The benefits and risks of conversion to laparotomy should be carefully evaluated if the needle remains missing after a prolonged search. The 7-step approach described in this article can be followed by laparoscopic surgeons faced with lost-needle occurrences. (J GYNECOL SURG 39:60)

Does 3D laparoscopic video technology affect long-term survival in right hemicolectomy for cancer compared to standard 2D? A propensity score study.

There are few studies focused on the short-term results of laparoscopic right hemicolectomy performed with 2D (two-dimension) or 3D (three-dimension) video technology and none on the oncologic effects. The aim of the study was to assess the long-term results of laparoscopic right hemicolectomy (LRH) with intracorporeal anastomosis using 3D or 2D video in patients with right colon cancer with at least three years of oncologic follow-up. Data from patients undergoing laparoscopic right hemicolectomy (LRH) with intracorporeal anastomosis for cancer in an 11-year period (June 2008-June 2019) and ≥ 3years of follow-up were prospectively collected. Surgical procedures were performed by two expert laparoscopic surgeons. 111 patients were included in the study: 56 (50.5%) in the 3D group and 55 (49.5%) in the 2D group. Tumor stage and number of lymph nodes harvested were similar. Overall and disease-free survival were not different in the two groups. Local recurrence occurred in none of the patients, and distant metachronous metastases were similar in the two groups. A propensity score weighting approach was used to account for potential confounding related to patients' nonrandom allocation to the 2 groups. The effects of the intervention on postoperative outcomes were assessed with a weighted regression approach. Laparoscopic 3D technology allows similar oncological results as 2D vision in LRH with intracorporeal anastomosis. Larger prospective randomized studies might confirm these results in the long-term follow-up.

Is there a need for a technical certification system for gynecological robotic surgery? Questionnaire survey of members of the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy

The Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy (JSGOE) introduced a system for the certification of laparoscopic surgeons in 2002 and a system for the certification of facilities in 2014. We examined the opinions of the members of the Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy (JSGOE) regarding the necessity of a certification training system and a technical certification system for robotic surgery skills in Japan. Members of the JSGOE were surveyed with two questionnaires. Overall, 870 and 519 participants responded to the first and second questionnaires, respectively. Half of the respondents indicated that both systems were necessary. The breakdown by age and qualifications showed that this was especially true for the younger generation and respondents with more experience with robotic surgery. Overall, 40% of the respondents judged that a certification system for robotic surgery alone (with or without certification in laparoscopic surgery but with a requirement of experience in laparoscopic surgery) would be necessary. The opinions of the JSGOE members on making a certification system for robotic surgery were split into two clear-cut camps. Thus, we must further seek the extent of public demand for using a public survey so that a final decision can be made on whether to establish this system.

INITIAL EVALUATION OF A REAL-TIME ERGONOMIC POSTURE ASSESSMENT SYSTEM IN LAPAROSCOPIC SURGERY

Abstract Introduction The objective of this study is to perform an initial evaluation of a system for assessment and visual feedback of the surgeon's posture during laparoscopic practice. Methods In order to monitor the surgeon's posture, we used the XSens motion tracking system. The neck, shoulder, elbow, and wrist joints were analyzed during laparoscopic practice. A visual feedback method was designed using Unity3D which indicates in real time if any of the analyzed joints suffers from an inadequate posture, allowing for its possible correction. The system was evaluated with a group of seven novice laparoscopic surgeons who performed several repetitions of two basic training tasks (eye-hand coordination and transfer). The participants were randomly organized into group A (4 subjects), who received visual feedback, and group B (3 subjects), as a control group. Results Regarding the coordination task, group A exhibited lower ergonomically inappropriate posture time for the left shoulder and elbow, being significant for the left shoulder posture. Similarly, this group showed a positive evolution during the training process for the different joints. Regarding the transfer task, both groups presented a positive evolution. Conclusions Preliminary results show that the presented method allows novice surgeons to improve their posture during laparoscopic practice. The use of the non-dominant hand and the complexity of the task seem to be conditioning aspects in the surgeon's ergonomics.

Development and Efficacy of Gasless Reduced-Port Laparoscopic Surgery for Gynecological Diseases.

To evaluate the efficacy of gasless reduced-port laparoscopic surgery (GRP-LS) using a subcutaneous abdominal wall lifting method for gynecological diseases. This study included gasless laparoscopic surgeries performed at our hospital between September 1, 1993 and December 31, 2016. The new GRP-LS technique was compared with the conventional gasless three-port laparoscopic surgery (G3P-LS), based on patient background, operative results in patients treated for laparoscopic myomectomy (LM), laparoscopic ovarian cystectomy (LC), and laparoscopic salpingectomy (LT). Surgeons of the two techniques were categorized by the number of surgeries they had performed, and the number of surgeons and surgeries for each technique were compared. GRP-LS was used in 2,338 cases and G3P-LS in 2,473 cases. GRP-LS was used in 980 LM cases, 804 LC cases, 240 LT cases, and 314 cases for other conditions. The operative time required for GRP-LS was significantly less for LM, LC, LT, and the procedure also had less blood loss for LM and LC than G3P-LS. G3P-LS required a transition to open surgery in 0.69% of cases, whereas GRP-LS showed a very low rate of 0.09%. Sixty-seven of the 78 GRP-LS surgeons (85.9%) had performed fewer than 50 GRP-LSs, and these surgeons performed about half of all surgeries. Eighty-three of the 93 GRP-LS surgeons (89.2%) had performed fewer than 50 G3P-LSs, and these surgeons performed 38.9% of all surgeries. GRP-LS is an effective surgery with few complications and less cosmetic damage and can be easily introduced to novice or inexperienced laparoscopic surgeons.

History of Laparoscopic Surgery in the English-Speaking Caribbean and Progress Amidst a Mix of Challenges and Opportunities

This discursive paper recounts the history of laparoscopic surgery in the English-Speaking Caribbean since the first recorded procedure in 1991. We discuss the challenges faced by early laparoscopic surgeons and analyze how they seized opportunities to overcome barriers against laparoscopy. This paper is important as it can serve as a template for development of laparoscopic surgery in other low-resource areas across the globe.

Unruptured Pseudoaneurysm of Cystic Artery: A Case Report

Cystic Artery Pseudoaneurysm (CAP) is a rare, abnormal dilation of the artery supplying the gallbladder. The main causes could be acute cholecystitis and iatrogenic injury during cholecystectomy. Ruptured pseudoaneurysm of cystic artery generally presents with haemobilia, and upper gastrointestinal bleeding or intraperitoneal bleeding. Only a few cases of unruptured CAP are reported that are successfully treated with open or laparoscopic cholecystectomy. This case is one of the rare cases of unruptured CAP where a 78-year-old female patient who was a known case of hypothyroidism, presented with upper abdominal pain and vomiting, diagnosed with acute calculous cholecystitis with CAP. She was managed with laparoscopic cholecystectomy, converted to open cholecystectomy and discharged with uneventful postoperative period. Due to the high risk of rupture, the patient required urgent surgical intervention either by open or laparoscopic cholecystectomy by a skilled laparoscopic surgeon. The operating need for conversion to laparotomy should be considered neither a failure nor a complication but an attempt to avoid intra and postoperative complications.

The 19th annual meeting of Egyptian Society of Laparoscopic Surgeons (ESLS) congress report

The 19th annual meeting of Egyptian Society of Laparoscopic Surgeons (ESLS) congress report

The effect of paravertebral block as a part of multimodal analgesia for laparoscopic cholecystectomy surgery

Aims: In laparoscopic cholecystectomy surgery (LCS), for anesthesiologist and surgeons postoperative analgesia method is still problem. The aim of this study is to evaluate the effect of preoperative paravertebral block (PVB) application as a part of multimodal analgesia on postoperative pain management in this surgery.&#x0D; Methods: In this prospective, randomized, single blinded study, over 18 years old, 70 (ASA I-II) patients who underwent elective LCS were included. In the control group, analgesia was managed with only traditional multimodal analgesia methods, while ultrasound- guided PVB (20 ml of 0.5% bupivacaine,T7 level) was added to multimodal anagesia in the study group. Postoperative pain reduction was evaluated using VAS at 1, 6, 12 and 24 hours postoperatively, and morphine consumption amount was caLCSulated with IV patient-controlled analgesia in the postoperative period.&#x0D; Results: Demographic data were similar in both groups. VAS scores at 1 and 6 hours were statistically significantly lower in the PVB group (p&lt;0.05). When evaluated in terms of morphine consumption, it was observed that significantly less morphine was consumed in the PVB group compared to the control group in the first 24-hour period (p&lt; 0.001). Shoulder pain was seen only in 3 patients in the control group.&#x0D; Conclusions: In LCS, it was observed that PVB application under the guidance of US increased the effectiveness of multimodal anagesia and decreased postoperative morphine consumption. In addition, problems such as postoperative nausea, vomiting and shoulder pain were less common.