Surgical endoscopy
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Intrahepatic cholangiocarcinoma (ICC) is still a relatively uncommon indication for laparoscopic surgery because of technical challenges related to the frequent need for major hepatectomies and the necessity to perform formal regional lymphadenectomy. The aim of the present case-matched study was to compare laparoscopic and open resections for ICC. ⋯ Compared with open surgery, laparoscopic resection of ICC is feasible and safe, providing short-term benefits without negatively affecting oncologic adequacy in terms of rate of R0 resections, depth of margins, and long-term overall and disease-free survivals. Laparoscopic regional lymphadenectomy is technically possible but should be the object of future focused studies.
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The over-the-scope clip (OTSC; Ovesco, Tübingen, Germany) is a novel endoscopic clipping device designed for tissue approximation. The device has been used in the closure of fistulas and perforations. We hereby report a series of patients with high-risk non-variceal upper gastrointestinal bleeding (NVUGIB) lesions in whom OTSCs were used as first-line endoscopic treatment. ⋯ We conclude OTSC placement as a first-line endoscopic treatment seems to be effective, safe and easy to perform and should be considered in patients with high-risk NVUGIB lesions.
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Laparoscopic sleeve gastrectomy (LSG) has become a primary stand-alone procedure for weight-loss surgery. The standard technique for LSG involves several small abdominal incisions. The single port instrument delivery extended reach (SPIDER(®)) surgical system has been introduced as a single site modality. This technique has been described previously; however, weight-loss outcomes of SPIDER(®) sleeve gastrectomy have not been compared to multi-port LSG. ⋯ SPIDER(®) sleeve gastrectomy is not inferior to LSG with regard to decrease in BMI and %EWL at 6-months post-operatively. The higher %EWL observed in the SPIDER(®) cohort is likely due to patient selection bias. This study demonstrates that the SPIDER(®) technique is a viable alternative to LSG with similar weight-loss outcomes.
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More than 500,000 robotically assisted procedures were performed worldwide in 2013. Despite broad adoption, there remains a lack of clarity concerning the added cost of the robotic system to the procedure especially in light of an increasing number of ambulatory procedures which are now marketed by hospitals, surgeons and the manufacturer. These procedures are associated with much less reimbursement than inpatient procedures. It is unclear whether these added expenses can be absorbed in these scenarios. Reports vary in opinion concerning the added net costs during robotically assisted laparoscopic hernia or cholecystectomy. ⋯ The use of the extraordinary technology in the face of low-morbidity low-cost established minimally invasive procedures needs to withstand scrutiny of outcome assessment, revenue and expense considerations and appropriateness review in order to create financially viable approaches to high-volume minimally invasive procedures. Revenue estimates associated with outpatient reimbursement make it difficult to support these expenses, recognizing inpatient procedures represent a different net financial picture.