Surgical endoscopy
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Observational Study
Safety, efficiency and learning curves in robotic surgery: a human factors analysis.
Expense, efficiency of use, learning curves, workflow integration and an increased prevalence of serious incidents can all be barriers to adoption. We explored an observational approach and initial diagnostics to enhance total system performance in robotic surgery. ⋯ Flow disruption rate is sensitive to system context and generates improvement diagnostics. Complex surgical robotic equipment increases opportunities for technological failures, increases communication requirements for the whole team, and can reduce the ability to maintain vision in the operative field. These data suggest specific opportunities to reduce the training costs and the learning curve.
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Comparative Study
Laparoscopic right hemicolectomy with intracorporeal anastomosis: short- and long-term benefits in comparison with extracorporeal anastomosis.
Laparoscopic right colectomy with intracorporeal anastomosis is a procedure of increasing popularity. This study aims to compare short- and long-term outcomes of intracorporeal and extracorporeal anastomoses. ⋯ Laparoscopic right hemicolectomy with intracorporeal anastomosis is associated with improved short- and long-term outcomes. The rates of postoperative complications requiring intervention and incisional hernias are decreased.
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Enhanced recovery pathways have become standard practice after elective colorectal surgery to improve postoperative care while reducing length of stay in hospital. However, there is concern that early discharge may result in increased rates of adverse events including readmission. This study aims to determine whether it is safe to discharge patients on postoperative day 1 or 2 if they have undergone an elective colorectal operation for cancer. ⋯ Patients discharged by POD 2 after elective oncologic colon resections did not have significantly more adverse events or readmissions compared to patients discharged later. Select patients may be safely discharged earlier.
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Preservation of the spleen in distal pancreatectomy has recently attracted considerable attention. Our current study aimed in the first instance to define the safety of lap-WT in relation to the capacity of this technique to achieve preservation of the spleen and secondly to investigate the effectiveness of a planned lap-WT procedure or early conversion to lap-WT in selected patients with a large tumor attached to the splenic vessels. ⋯ A lap-WT is a safe treatment strategy in select cases when used as a way of preserving the spleen. When splenic vessel preservation is technically challenging, for example when the tumor is enlarged or is attached to the splenic vessels, planned lap-WT or early conversion to lap-WT may be a feasible option.