Safety Of Laparoscopic Surgery Research Articles

Total Laparoscopic Hysterectomy for Diagnosis and Treatment of Cervical Cystic Lesions: A Case Series

Objective: Cervical cystic lesions are often observed in gynecological clinical practice. Many are caused by benign diseases such as lobular endocervical glandular hyperplasia (LEGH), and it is important to differentiate these lesions from those due to malignant diseases such as minimal deviation adenocarcinoma (MDA). In cases in which fertility preservation is not a concern, the final pathology is often confirmed by hysterectomy. To investigate the feasibility and safety of laparoscopic surgery for cervical cystic lesions, we retrospectively examined cases in which total laparoscopic hysterectomy (TLH) was performed for diagnosis and treatment. Methods: The subjects were 28 women who underwent TLH from April 2012 to March 2017 at Keio University Hospital. The pre- and post-operative courses of these patients were examined. Results: The average age was 49.4 (range 39 - 65) years and the mean body mass index was 21.7 (16.8 - 30.5) kg/m2. The average operation time was 159 (101 - 314) min and the average bleeding volume was 106.8 (0 - 600) g. There were no severe perioperative complications. The average hospital stay was 8.4 (7 - 14) days. In postoperative pathological diagnosis, 13 cases had benign diseases such as Nabot cysts, there were 14 cases of LEGH, and one patient was diagnosed with MDA. In the MDA case, additional bilateral salpingo-oophorectomy and pelvic lymph node dissection were performed at a later date. No metastasis was observed in these excised specimens. Conclusions: Our results suggest that TLH for cervical cystic lesions can be performed safely. However, it is important to consider the TLH indication before surgery based on the possibility of malignant disease.

Different cognitive styles can affect performance in laparoscopic surgery skill training.

The lack of depth cues and haptic feedback makes minimally invasive surgery a cognitive challenge. It is therefore important to know which individuals are expected to perform well in minimally invasive surgery. In cognitive psychology, methods are available with which one can measure different cognitive thinking styles. It is well known that these cognitive styles correlate with many different tasks. We investigated whether this method can also predict performance on a box trainer (Lübeck Toolbox®), a device for training laparoscopic surgery. If so, the method might help to select and train those people who willmost likely develop high skills in minimally invasive surgery. Thirty medical students and thirty non-medical students performed five laparoscopic surgical tasks on a box trainer. We measured the time required and the errors participants made on each task. Their cognitive style was measured with a method from cognitive psychology that distinguishes between people who think visually, spatially, or verbally. Furthermore, all students completed a subset of a standard intelligence test (Wechsler Adult Intelligence Scale) and three subtests of the German Medical University Admission Test (TMS). Participants with spatial thinking styles performed best on the box trainer. Visual and verbal cognitive styles impeded box trainer performance. Performance on the box trainer could also be predicted by the TMS and IQ scores. The study shows for the first time that a standard method from cognitive psychology can be used to distinguish between different cognitive styles in surgical education and that these different cognitive styles affect performance on a box trainer. Since the correlation between box trainer performance and surgical proficiency is well documented, the method might be an efficient way to reduce errors and to elevate patient safety in laparoscopic surgery.

Efficacy of intestinal obstruction stent combined with laparoscopic surgery and neoadjuvant chemotherapy in patients with obstructive colorectal cancer.

There is still controversy on the surgical treatment of obstructive colorectal cancer worldwide. No accurate research has been reported to propose which method is the most suitable for patients with obstructive colorectal cancer. Therefore, comparison of efficacy of intestinal stent and trans-anal ileus catheter combined with laparoscopic surgery and neoadjuvant chemotherapy respectively in patients with obstructive colorectal cancer was carried out to provide reference and guidance for the selection of surgical schemes for patients with obstructive colorectal cancer. In total 89 patients with obstructive colorectal cancer treated in the Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, from February 2016 to March 2017 were selected for retrospective analysis. Forty-nine cases treated with intestinal metal stent implantation combined with laparoscopic surgery and neoadjuvant chemotherapy were the stent group. The other 40 cases treated with trans-anal ileus catheter combined with laparoscopic surgery and neoadjuvant chemotherapy were the catheter group. The intestinal preparation time, surgical duration, intraoperative blood loss, open surgery rate, postoperative exhaust time and adverse reaction rate were compared between the two groups. All the patients were followed up with reexamination at 1 year in hospital to record the local recurrence rate and tumor implantation rate of incision. The intestinal preparation time in the stent group was shorter than that in the catheter group (P<0.001). The surgical duration in the stent group was longer than that in the catheter group (P<0.001). The intraoperative blood loss in the stent group was higher than that in the catheter group (P<0.001). However, there was no significant difference in open surgery rate, postoperative exhaust time, adverse reaction rate, local recurrence rate or incision tumor implantation rate between the two groups (all P>0.05). Therefore, intestinal metal stent implantation can effectively relieve intestinal obstruction, while trans-anal ileus catheter has higher safety in laparoscopic surgery. Their combination with neoadjuvant chemotherapy and laparoscopic surgery for obstructive colorectal cancer has high value and clinical effect. The best treatment plan should be selected according to the patient's condition.

Comparison of efficacy and safety of laparoscopic surgery for gallstones and common bile duct stones

Objective To evaluate the efficacy and safety of laparoscopic surgery in the treatment of gallstones and common bile duct stones. Methods Eighty-seven patients with gallstones complicated with common bile duct stones who underwent concurrent laparoscopic surgery at Zhoushan Hospital from December 2015 to December 2017 were enrolled.The patients were divided into A group and B group according to the digital table.A group(38 cases) underwent laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE), and B group(49 cases) underwent endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC). The curative effect of the two groups was observed.The operation time, the success rate of the operation and the rate of laparotomy were recorded in the two groups.The corresponding hospitalization time and cost were compared.The safety of the two different procedures was compared after surgery, and the complications of the two groups were recorded. Results In A group, the average diameter of common bile duct stones was (1.02±0.25)cm, the average diameter of common bile duct diameter was (1.15±0.25)cm.In B group, the mean diameter of common bile duct stones was (0.99±0.26)cm, and the average diameter of common bile duct was (1.13±0.26) cm.The differences between the two groups were not statistically significant (t=0.513, 0.437, 0.367, P=2.083, 1.533, 1.095). The successful operation rate of A group was 92.11%(35/38), which in B group was 91.84%(45/49), the difference was not statistically significant between the two groups(χ2=0.006, P=0.974). The incidence rate of complications in B group was 20.41%, which was significantly higher than that in A group, the difference was statistically significant(χ2=3.654, P=0.019). The hospitalization time, hospitalization expenses in A group were (10.6±2.6)d, (26 649.8±3 478.6)CNY, respectively, which were significantly better than those in B group (t=21.971, 17.168, all P<0.05). Conclusion The efficacy of LC combined with LCBDE for patients with gallstones complicated with common bile duct stones is better than ERCP/EST combined with LC surgery, and the safety of the former is higher than the latter. Key words: Laparoscopic; Gallstones; Common bile duct stones; Surgical methods; Laparoscopic cholecystectomy; Laparoscopic common bile duct exploration; Endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy

Efficacy and safety of laparoscopic surgery in the management of recurrent gynecologic malignancies

Efficacy and safety of laparoscopic surgery in the management of recurrent gynecologic malignancies

Over 1-Year Followup of Laparoscopic Treatment of Enterovesical Fistula.

Background and Objective:Entero vesical fistulas (EVFs) are an uncommon complication mainly of diverticular disease (70%) and less commonly of Crohn's disease (10%). Only about 10% are caused by malignancies. At this time, it is unclear whether the laparoscopic approach can be routinely proposed as a safe procedure for patients with EVF. The aim of this study was to assess the feasibility and safety of laparoscopic surgery in the treatment of EVFs in patients with complicated diverticular and Crohn's disease.Methods:All patients with the diagnosis of EVF who underwent laparoscopic surgery were identified from prospective collected data based in two institutions between 2007 and 2017. Patients with malignancy were excluded. Recorded parameters included operative time, conversion to open surgery, the presence of a protective loop ileostomy, perioperative complications, number of units of blood transfused, postoperative course, and histologic findings.Results:Seventeen patients were included in the study: 10 patients with a colo-vesical fistula due to diverticular disease, and 7 patients with an ileo-vesical fistula due to Crohn's disease. There were no conversions to open surgery and none of the patients needed a protective ileostomy. The bladder was sutured in 12 patients (70%). No intra-operative complications were met, and no blood transfusions were needed; there were no anastomotic leaks, nor mortality in both groups.Conclusions:The laparoscopic approach for benign EVF in selected patients is both feasible and safe in the hands of experienced surgeons with extensive expertise in laparoscopic surgery.

Safety of laparoscopic surgery in digestive diseases with special reference to antithrombotic therapy: A systematic review of the literature.

AIMTo elucidate the effect of antithrombotic therapy (ATT) on bleeding and thromboembolic complications during or after laparoscopic digestive surgery.METHODSPublished articles or internationally accepted abstracts between 2000 and 2017 were searched from PubMed, Cochrane Database, and Google Scholar, and studies involving laparoscopic digestive surgery and antiplatelet therapy (APT) and/or anticoagulation therapy (ACT) were included after careful review of each study. Data such as study design, type of surgical procedures, antithrombotic drugs used, and surgical outcome (both bleeding and thromboembolic complications) were extracted from each study.RESULTSThirteen published articles and two internationally accepted abstracts were eligible for inclusion in the systematic review. Only one study concerning elective laparoscopic cholecystectomy in patients with perioperative heparin bridging for ACT showed that the risk of postoperative bleeding was higher compared with those without ACT. The remaining 14 studies reported no significant differences in the incidence of bleeding complications between the ATT group and the group without ATT. The risk of thromboembolic events (TE) associated with laparoscopic digestive surgery in patients receiving ATT was not significantly higher than those with no ATT or interrupted APT.CONCLUSIONLaparoscopic digestive surgery in ATT-burdened patients for prevention of bleeding and TE showed satisfactory results. The risk of hemorrhagic complication during or after these procedures in patients with continued APT or heparin bridging was not significantly higher than in patients with no ATT or interrupted APT.

Cyst contents aspiration before laparoscopically assisted cystectomy in pregnant women

At present, laparoscopic surgery is widely performed for ovarian cysts in pregnant women (El-Shawarby et al. 2005). Recently, the experience and the safety of laparoscopic surgery in pregnant women...

Surgery for early-stage ovarian cancer

Purpose of the literature review: to analyze recent studies of surgical treatment of stage I-II ovarian cancer. Key issues. Individual steps of surgery and their significance, impact of the extent of surgery on the survival and adjuvant treatment, fertility-sparing surgery in young patients and safety of laparoscopic surgery are discussed. Conclusion. Optimal staging of early ovarian cancer was found to be significantly associated with overall and recurrence-free survival.

ВЛИЯНИЕ ИНТРАОПЕРАЦИОННОЙ ВНУТРИБРЮШНОЙ ГИПЕРТЕНЗИИ НА ТЕЧЕНИЕ ПОСЛЕОПЕРАЦИОННОГО ПЕРИОДА У ПАЦИЕНТОВ, ОПЕРИРУЕМЫХ ПО ПОВОДУ КОЛОРЕКТАЛЬНОГО РАКА

Currently, the majority of colorectal surgeries is performed using laparoscopic and minimal invasive methods, providing the best outcomes in the soonest post-operative period and equal oncological safety when compared to traditional open surgeries. Data of the publications on the safety of laparoscopic surgeries in such patients are fairly contradictory. The objective of the study: to evaluate the impact of intra-operative intra-abdominal hypertension on the course of post-operative period in the patients undergoing surgery for colorectal cancer. Subjects and Methods. 48 patients who had surgeries for colorectal cancer were enrolled into the study. All patients were divided into 2 groups based on the course of post-operative period: with complications(no. 1, n = 36) and no complications during the post-operative period (no. 2, n = 12). The analysis included the data of invasive monitoring of arterial blood pressure, blood gases and acid-base balance of arterial and venous blood, blood lactate level, frequency of critical incidents. The patients who had laparoscopic surgeries had their level of intra-abdominal pressure recorded and intra-abdominal perfusion pressure calculated. The statistic analysis was performed using the software of SPSS 20.0 IBM. In order to define the significance of differences between the groups, paired non-parametric Mann-Whitney test was used. Differences were considered valid with p < 0.05. Chi-square method was used to evaluate the differences between categorical values. Results. It was found out that two and more episodes of systolic blood pressure drop during surgery significantly increased the risk of post-operative complications (χ2 test with Yates' correction of 4.636, p = 0.001; OR 24.0, RR 8.6, 95% CI 2.002–7.981). The patients with complicated post-operative period had a significantly higher level of lactate, venoarterial differences of pСО2, more severe base deficit versus the comparison group. When laparoscopic methods were used, these differences were even more significant. When performing correlation analysis the significant association was detected between the levels of intra-abdominal pressure and lactate, BE and ΔpCO2 in 60 minutes after pneumoperitoneum and desufflation, which indirectly confirmed the impact of the increased intra-abdominal pressure on development of intra-abdominal hypoperfusion. Conclusion. Ischemic and reperfusion damage, developed during the intra-operative period, is one of the pathogenetic stages of development of post-operative complications in the patients who had surgeries for colorectal cancer. One of the risk factors promoting its development is a decrease of arterial blood pressure during the intra-operative period for more than 20% out of the initial letter as well as intra-abdominal hypertension, caused by the increase in intra-abdominal pressure during laparoscopic pressures.

Safety of laparoscopic surgery for pancreaticodoudenectomy in elderly patients undergoing pancreatic cancer resection

Safety of laparoscopic surgery for pancreaticodoudenectomy in elderly patients undergoing pancreatic cancer resection

The role of minimally invasive surgery in neuroendocrine pancreatic tumors.

Minimally invasive surgery has an established role in the treatment of patients with pancreatic neuroendocrine tumors (pNETs). Enucleation is an established treatment option for insulinomas. The necessity of organ sparing surgery is well established in the case of multiple pNETs. A number of studies have demonstrated the efficacy and safety of laparoscopic surgery for the treatment of pNETs. However, pNETs are rare, and large studies focusing on pNET patients are difficult to be designed unless multicenter experience is collected. Authors investigating the role of minimally invasive pancreatic surgery should be encouraged to report separately the results that involve patients presenting with pNETs. A European registry of patients with pNETs treated with minimally invasive surgery would allow further investigation of the optimal treatment of these patients. Especially in the case of syndromic pNETs, that are rare entities, co-operation and exchange of information is needed among different centers for sharing experience and transferring knowledge. Existing data come from small cohort studies, case series and case reports. Given that, pancreatic surgery is especially demanding advanced surgery with training that is not yet standardized, further research is needed for defining its role in the treatment of pancreatic neuroendocrine tumors. Regarding the role of robot-assisted surgery in the treatment of pNETS, data are quite scarce.

Practice, training and safety of laparoscopic surgery in low and middle-income countries

Surgical management of diseases is recognised as a major unmet need in low and middle-income countries (LMICs). Laparoscopic surgery has been present since the 1980s and offers the benefit of minimising the morbidity and potential mortality associated with laparotomies. Laparotomies are often carried out in LMICs for diagnosis and management, due to lack of radiological investigative and intervention options. The use of laparoscopy for diagnosis and treatment is globally variable, with high-income countries using laparoscopy routinely compared with LMICs. The specific advantages of minimally invasive surgery such as lower surgical site infections and earlier return to work are of great benefit for patients in LMICs, as time lost not working could result in a family not being able to sustain themselves. Laparoscopic surgery and training is not cheap. Cost is a major barrier to healthcare access for a significant population in LMICs. Therefore, cost is usually seen as a major barrier for laparoscopic surgery to be integrated into routine practice in LMICs. The aim of this review is to focus on the practice, training and safety of laparoscopic surgery in LMICs. In addition it highlights the barriers to progress in adopting laparoscopic surgery in LMICs and how to address them.

Laparoscopic management of gastric gastrointestinal stromal tumors: A retrospective 10-year single-center experience.

AIMTo determine the feasibility, safety, and oncological outcome of laparoscopic resection of gastric gastrointestinal stromal tumors (GISTs) based on favorable or unfavorable location.METHODSOur hospital database included 207 patients who underwent laparoscopic removal of gastric GISTs from January 2004 to September 2015. Patient demographics, clinical presentation, surgery, histopathology, postoperative course, and oncological outcomes were reviewed and analyzed.RESULTSGastric GIST in favorable locations was present in 81/207 (39.1%) cases, and in unfavorable locations in 126/207 (60.9%) cases. Overall mean tumor size was 3.28 ± 1.82 cm. No conversions occurred, and complete R0 resection was achieved in 207 (100%) cases. There were three incidences of iatrogenic tumor rupture. The feasibility and safety of laparoscopic surgery were comparable in both groups with no statistical difference between unfavorable and favorable location groups, respectively: for operative time: 83.86 ± 44.41 vs 80.77 ± 36.46 min, P = 0.627; conversion rate: 0% vs 0%; estimated blood loss: 27.74 ± 45.2 vs 29.59 ± 41.18 mL, P = 0.780; tumor rupture during surgery: 0.90% vs 2.82%, P = 0.322; or postoperative complications: 3.74% vs 7.04%, P = 0.325. The follow-up period recurrence rate was 1.89% with no significant differences between the two groups (3.03% vs 0%, P = 0.447). Overall 5-year survival rate was 98.76% and survival rates were similar between the two groups: 98.99% vs 98.39%, P = 0.623 (unfavorable vs favorable, respectively).CONCLUSIONThe laparoscopic approach for gastric GISTs is safe and feasible with well-accepted oncological surgical outcomes. Strategies for laparoscopic resection should be selected according to the location and size of the tumor. Laparoscopic treatment of gastric GISTs in unfavorable locations should not be restricted in gastrointestinal centers.

The safety of laparoscopic surgery in treatment of empyema gall bladder

The safety of laparoscopic surgery in treatment of empyema gall bladder

Natural Orifice Specimen Extraction With Single Stapling Colorectal Anastomosis for Laparoscopic Anterior Resection: Feasibility, Outcomes, and Technical Considerations.

Double and triple stapling techniques to close the rectal stump in laparoscopic anterior resection are fraught with technical drawbacks that could possibly be avoided with the use of the single stapling technique. However, little is known of its safety in laparoscopic surgery or outcomes when combined with natural orifice specimen extraction. This study aims to analyze the feasibility and the operative and immediate postoperative outcomes of single-stapled anastomosis and natural orifice specimen extraction with conventional techniques. It intends to evaluate technical variations related to colon, mesentery, and pelvic anatomy characteristics. A consecutive series of 188 patients underwent elective surgery for benign or malignant lesions between 10 and 40 cm from the anal verge, 5 cm or less in diameter on radiological examination, stage T1 to T3, Nx, M0, with 2 different methods of rectal stump closure (pursestring vs linear-stapled closure) associated with single or double stapling and per anus vs conventional specimen extraction. This study was conducted at China Medical University Hospital, Taiwan, a tertiary referral center, between January 2012 and April 2015. The main outcomes measured are feasibility and operative and immediate postoperative outcomes. Single-stapled resection with natural orifice specimen extraction was feasible in 94% patients with an 11% perioperative morbidity rate. The patients required statistically significantly less analgesia, had earlier return of bowel movements, and shorter hospital stay, whereas there was no statistically significant difference in the overall readmission rate and overall morbidity, including anastomotic leakage. This was a single-center, retrospective case-matched study. Anatomic variations (short colon and short mesentery) can be managed adequately with intracorporeal anvil head fixation. The single stapling technique is feasible and as safe as conventional double stapling techniques, although it is technically more demanding. The transanal endoscopic operation platform can be useful when the rectal stump is long.

子宮体癌に対する腹腔鏡下手術のfeasibilityに関する後方視的検討

子宮体癌に対する腹腔鏡下手術のfeasibilityに関する後方視的検討

Safety of laparoscopic surgery in radical resection for different stage rectal cancer

Objective To explore the safety of the laparoscopic surgery in radical resection for different stage rectal cancer. Methods Clinical data of 200 cases with rectal cancer underwent laparoscopic radical resection(observation group) were analyzed retrospectively, including 52 cases of stage 0-Ⅰ, 148 cases of stage Ⅱ-Ⅲ.Two hundred cases patients with rectal cancer underwent open radical surgery were selected as control group, including 44 cases of stage 0-Ⅰ, 156 cases of stage Ⅱ-Ⅲ.The length to distal resection margin, the number of harvested lymph nodes, the incidence of postoperative complications and the prognosis of recent situation were observed, the safety of the laparoscopic surgery was analyzed. Results Whether rectal cancer of stage 0- I or II - III, there were no significant differences in terms of the length of distal resection margin((2.5±0.9) cm vs. (2.4±1.1) cm, t=0.490, P=0.625; (3.1±1.0) cm vs. (3.2±1.3) cm, t=0.749, P=0.454), the number of harvested lymph nodes((12.3±4.2) vs. (12.7±3.9), t=0.480, P=0.632; (13.9±5.4) vs. (15.1±4.9), t=2.369, P=0.118), the incidence of postoperative complications(17.3% vs. 18.2%, χ2=0.012, P=0.911; 27.7% vs. 28.8%, χ2=0.049, P=0.825), the rate of local recurrence(1.9% vs. 2.3%, χ2=0.014, P=1.000; 4.1% vs. 3.2%, χ2=0.157, P=0.692), the distant metastasis(3.8% vs. 2.3%, χ2=0.195, P=1.000; 5.4% vs. 4.5%, χ2=0.137, P=0.712) and 3-year survival rate(96.2% vs.95.5%, χ2=0.010, P=0.808; 83.8% vs. 85.3%, χ2=0.132, P=0.714) between the observation group and control group(P>0.05). Conclusion For rectal cancer of stage 0-Ⅰ, laparoscopic surgery has good safety, and worthy of popularization and application.For rectal cancer of stage Ⅱ - Ⅲ, due to its operation for a long time as well as the possible risk in postoperative anastomotic fistula, the implementation of laparoscopic surgery should be more cautious. Key words: Radical resection for rectal cancer; Laparoscope; Tumor stage; Safety

Port-site metastasis after laparoscopic surgery for gastrointestinal cancer.

Although the incidence of port-site metastasis after laparoscopic surgery for colorectal cancer has markedly decreased since laparoscopic colectomy was first reported in 1991, it still has not reached zero. In colorectal cancer, the safety of laparoscopic surgery, including the low incidence of port-site metastasis, has been proven in large, randomized trials. In gastric cancer, reports of port-site metastasis are extremely rare, but we should await the results of ongoing trials. This brief review summarizes the current knowledge regarding port-site metastasis after laparoscopic surgery for colorectal and gastric cancer.

Laparoscopic versus open surgery in the treatment of apparently early stage epithelial ovarian cancer: Case-control and case-matched study of Korean Gynecologic Oncology Group.

5560Background: The efficacy and safety of laparoscopic surgery in the treatment of apparently early stage epithelial ovarian cancer is controversial. The aim of this study was to evaluate the long...