Min In Laparoscopic Group Research Articles

Robotic-Assisted versus Laparoscopic Surgery for Low Rectal Cancer: Case-Matched Analysis of Short-Term Outcomes

The aim of this study is to compare short-term outcomes and surgical quality of robot-assisted (RAP) and laparoscopic (LAP) total mesorectal excision (TME) in patients with low rectal cancer. From December 2007 to June 2009, 41 consecutive patients with low rectal cancer underwent TME by robot-assisted procedures. The lowest tumor margins were below peritoneal reflection and 1.0-8.0 cm above the anal verge. These patients were matched 1:2 by age, gender, body mass index, date of surgery, American Society of Anesthesiologists score, and tumor stage, with 82 patients who underwent conventional LAP. Macroscopic quality of the specimens and operative and postoperative outcomes were compared. Mean operation time was 168.0 ± 49.3 min for LAP group and 231.9 ± 61.4 min for RAP group (P < 0.001). Time to regular diet (RAP, 6.7 days vs. LAP, 6.6 days) and length of stay (RAP, 9.9 days vs. LAP, 9.4 days) were similar. The proportion of surgeries performed with the modified natural orifice techniques (totally intracorporeal procedures with transanal or transvaginal retrieval of specimens) was significantly higher in the RAP group (RAP, 48.8% vs. LAP, 13.4%; P < 0.001). There were no between-group differences in specimen quality, including distal resection margins, harvested lymph nodes, and circumferential margins. The overall major complication rates were similar (RAP, 9.8% vs. LAP, 7.3%; P = 0.641). RAP was safe and effective for patients with low rectal cancer. Furthermore, the technical advantages of robot surgical systems may allow a novel approach using hybrid natural orifice surgery.

Laparoscopic versus open appendectomy in patients with chronic appendicitis

To compare the advantages and disadvantages of laparoscopic versus open appendectomy in patients with chronic appendicitis. Two hundred twenty- four patients were divided into laparoscopic group (n=98) and open appendectomy group (n=126) according to individual willing. Prospective non- randomized study was performed to compare the operative time, operative bleeding, hospitalization time, the discovery and management concerned in operation. Abdominal pain in these chronic appendicitis cases was followed up. The operative time was (54.8+/-21.8) min in open group and (51.8+/-18.0) min in laparoscopic group (t=0.80,P > 0.05). The operative bleeding was (18.6+/-23.3) ml in open group and (9.8+/-4.7) ml in laparoscopic group (t=3.13, P < 0.05). The hospitalization time was (8.9+/-5.3) d in open group and (6.8+/-3.0) d in laparoscopic group (t=2.66,P < 0.05). Twenty- five cases had abdominal adhesion in laparoscopic group, including 9 cases of adhesion around appendix, 6 cases of adhesion between ileocecum and anterior or lateral abdominal wall, 4 cases of adhesion between epiploon and abdominal wall or intestines, 6 cases of adhesion around colon and others. All adhesion had been dissected. Fourteen cases adhesion around appendix had been discovered in 126 cases of open group and dissected (chi(2) =7.95,P < 0.05). In follow- up research, 24 cases still had chronic abdominal pain in 98 case of open group, and 9 cases had chronic abdominal pain in 87 of laparoscopic group, the difference was significant (chi(2)=6.29,P < 0.05). The laparoscopic appendectomy possesses more advantages in treating chronic appendicitis and can decrease the incidence of chronic abdominal pain after operation.

Laparoscopic abdominoperineal resection revisited: are there any health–related benefits? A comparative study

Laparoscopic colectomy is associated with less overall morbidity and improved survival for patients with colonic cancers. There are unfortunately limited clinical reports on laparoscopic abdominoperineal resection. We therefore designed this study to compare laparoscopic abdominoperineal resection with conventional open surgery, with emphasis on health-related issues from the patients' perspective in order to justify its role in the management of low rectal or anal canal tumours. We carried out a non-randomized, prospective comparative study on a cohort of patients who underwent either laparoscopic or open abdominoperineal resection between March 1994 and December 2003. Patient demographics, tumour characteristics, operative morbidity and mortality, as well as overall survival were considered. The standard endpoints of last follow-up date and deaths were used. Data was analyzed according to intention-to-treat principle. A total of 102 patients were recruited: 31 patients underwent conventional open abdominoperineal resection (OAPR) and 71 patients were treated laparoscopically. Patient demographics, median follow-up period, as well as tumour characteristics were similar between groups. The median operating time was similar among groups (145 min in laparoscopic group vs. 156 min in open group; p=0.62). Patients in the laparoscopic group had significantly less blood loss (p=0.01) and fewer requirements for blood transfusion (p=0.01). Despite similar overall morbidity, the laparoscopic group had a reduced incidence of abdominal wound infections (p=0.01) and chest infections (p=0.01). Overall survival was significantly better in the laparoscopic group (p=0.01). Laparoscopic abdominoperineal resection confers definite health-related benefits the over open approach in terms of reduced septic complications and fewer requirements for blood transfusion. It should be considered the procedure of choice for patients with low rectal or anal canal tumour in whom sphincter excision proved inevitable.