Surgical endoscopy
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Randomized Controlled Trial Comparative Study
Laparoscopic versus small-incision cholecystectomy: health status in a blind randomised trial.
Gallstones are a major cause of morbidity, and cholecystectomy is a commonly performed procedure. Minimal invasive procedures, laparoscopic cholecystectomy (LC) and small-incision cholecystectomy (SIC), have replaced the classical open cholecystectomy. No differences have been found in primary outcome measures between LC and SIC, therefore secondary outcome measures have to be considered to determine preferences. The aim of our study was to examine health status applying evidence-based guidelines in LC and SIC in a randomised trial. ⋯ Applying adequate methodological quality and evidence-based guidelines (by using SF-36 and GIQLI), there are no significant differences in health status between LC and SIC.
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Comparative Study
Transumbilical laparoscopically assisted appendectomy in children: high-tech low-budget surgery.
Two different laparoscopic appendectomy (LA) techniques, one performed with staplers (LAS) and the other using loops (LAL), were compared with transumbilical laparoscopically assisted appendectomy (TULAA). ⋯ In this study, the cost of TULAA is 7.8 times lower than the cost of LA, 8.1 times lower than LAS, and 6.5 times lower than LAL. Higher cost of laparoscopy is solely attributable to the purchase price of the supplies used. Overall postoperative morbidity, the incidence of wound infection, the length of hospitalization, and the need for rescue analgesia did not show a statistical difference in comparing LA/TULAA. Operative time was shorter in the TULAA group. In terms of limited resources, TULAA could be the most appropriate minimally invasive technique for appendectomy in children.
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Comparative Study
Laparoscopically assisted colectomy: a study of risk factors and predictors of open conversion.
Conversion to an open procedure during laparoscopically assisted colorectal resection may be necessary because of technical, patient, or pathologic factors. Recent literature has indicated that converted patients may have poorer outcomes than those undergoing open or completed laparoscopically assisted procedure. This study aimed to audit the authors' experience with laparoscopically assisted colectomy and to assess the clinical outcomes of patients undergoing conversion. ⋯ Conversion of laparoscopic anterior resection to open procedure is associated with higher wound morbidity and a longer hospital stay. The authors recommend that surgeons carefully consider the selection of patients 75 years of age or older and high ASA status for laparoscopic anterior resection.
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The risk of damage to the bile duct and structures in the hilum of the liver is significant when Calot's triangle cannot be safely dissected during laparoscopic cholecystectomy, and conversion to an open procedure often is performed. This is more common during emergency surgery, but may not render the procedure any easier. Traditionally, open subtotal cholecystectomy was performed, but with the advent of laparoscopic surgery, this has fallen from favor. The authors report their experience using laparoscopic subtotal cholecystectomy to avoid bile duct injury and conversion in difficult cases. ⋯ Laparoscopic subtotal cholecystectomy is a viable procedure during cholecystectomy in which Calot's triangle cannot be dissected. It averts the need for a laparotomy.