Surgical endoscopy
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Randomized Controlled Trial Comparative Study
A prospective randomized controlled trial to compare single-port endo-laparoscopic surgery versus conventional TEP inguinal hernia repair.
The success of laparoscopic surgery is due to the less surgical trauma, including less operative pain, complications and better cosmetics. Objective of our study was to compare in two blind randomized groups of patients, the surgical outcome of total extra-peritoneal (TEP) inguinal hernia repair using either single-port or conventional surgical technique. We will report our interim results in the first group of 50 patients. ⋯ The outcomes after laparoscopic TEP inguinal hernia repair with a single-port device are comparable to the standard three-port technique.
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Surgery is evolving, and new techniques are introduced to improve "recovery." Postoperative recovery is complex, and evaluating the effectiveness of surgical innovations requires assessment of patient-reported outcomes. The Short-Form-36 (SF-36), a generic health-related quality of life questionnaire, is the most commonly used instrument in this context. The objective of this study was to contribute evidence for the validity of the SF-36 as a metric of postoperative recovery. ⋯ The SF-36 is responsive to expected physiological changes in the postoperative period, demonstrates construct validity, and thus constitutes a valid measure of postoperative recovery after planned colorectal surgery. The SF-36 did not, however, discriminate between recovery after laparoscopic and open surgery.
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Bariatric surgery is an effective long-term treatment for morbid obesity. Although smoking is known to increase postoperative complications, the independent effect of smoking on bariatric surgical outcomes is unclear. The purpose of this study was to investigate the effect of smoking on bariatric surgical outcomes using the National Surgical Quality Improvement Program (NSQIP). ⋯ These data suggest that smoking is a modifiable preoperative risk factor that significantly increases the incidence of postoperative morbidity but not mortality in both laparoscopic and open bariatric surgery. Smoking cessation may minimize the risk of adverse outcomes. Future investigation is needed to identify the optimal length of preoperative smoking cessation.
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Surgeons currently rely on visual clues to estimate the presence of sufficient vascularity for safe anastomosis. We aimed to assess the accuracy of endoluminal confocal laser endomicroscopy (CLE) and laparoscopic fluorescence-based enhanced reality (FLER), using near-infrared imaging and fluorescence from injected Indocyanine Green, to identify the transition from ischemic to vascular areas in a porcine model of mesenteric ischemia. ⋯ In this experimental model, FLER and CLE were more accurate than clinical evaluation to delineate bowel vascularization.
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The purpose of this study was to analyze the effect of residents on patient outcomes in laparoscopic ventral hernia repair (LVHR).We hypothesized that increasing postgraduate year (PGY) level would correlate with better outcomes. ⋯ Trainee involvement during LVHR does not change the clinical outcomes for patients as compared to those performed by an attending only. Operative time is significantly longer with increasing PGY level, perhaps indicating the complexity of the operation or increasing trainee involvement as primary surgeon. However, patient care does not suffer, affirming the current surgical training curriculum is appropriate.