Surgical endoscopy
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Multicenter Study Comparative Study
Clinical and educational proficiency gain of supervised laparoscopic colorectal surgical trainees.
The self-taught learning curve in laparoscopic colorectal surgery (LCS) is between 100 and 150 cases. Supervised training has been shown to shorten the proficiency gain curve of senior specialist surgeons. Little is known about the learning curve of LCS trainees undergoing mentored training. The aim of this study was to analyze the proficiency gain curve and clinical outcomes of English surgical trainees during laparoscopic colorectal surgery fellowships. ⋯ Supervised fellowships provide training in LCS without compromising patient safety. Forty cases are required for the fellows to feel confident to perform the majority of tasks except dissection of the mesorectum and flexure, which will require further training.
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Comparative Study
A propensity score-matched case-control comparative study of laparoscopic and open extended (D2) lymph node dissection for distal gastric carcinoma.
Technical proficiency at laparoscopic D2 lymph node dissection (LND) is essential for extending the use of laparoscopic surgery beyond the treatment of early gastric cancer (EGC). The aim of this study was to evaluate the technical and oncological feasibility of laparoscopic distal gastrectomy (LDG) with D2 LND for distal gastric cancer. ⋯ Laparoscopic D2 LND for distal gastric cancer is technically safe and feasible compared with ODG. A prospective randomized trial is warranted to evaluate long-term oncological outcomes in advanced gastric carcinoma.
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Multicenter Study Comparative Study
Laparoscopic colectomy reduces morbidity and mortality in obese patients.
Obesity is a growing epidemic in the US and increases the difficulty of laparoscopic surgery. Randomized, controlled trials of laparoscopic vs. open colectomy have shown equivalence but often exclude obese patients thus not answering whether obese patients may specifically benefit from laparoscopy. We hypothesized that obese patients would benefit from use of laparoscopy for colectomy. ⋯ Due to the significant decrease in the risk of morbidity and mortality, laparoscopic colectomy should be offered to obese patients whenever feasible.
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Comparative Study
Human applications of submucosal endoscopy under conscious sedation for pure natural orifice transluminal endoscopic surgery.
The submucosal endoscopy provide not only a reliable methods of access and closure for peritoneoscopy, but also an endoscopic working space for full-thickness resection. The aim of this study was to report the clinical outcome of submucosal endoscopy for pure natural orifice transluminal endoscopic surgery. ⋯ Human applications of submucosal endoscopy under conscious sedation for pure NOTES were feasible and safe.
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Comparative Study
Sedation methods can determine performance of endoscopic submucosal dissection in patients with gastric neoplasia.
Although proper sedation is mandatory for endoscopic procedures such as endoscopic submucosal dissection (ESD), there is no research investigating the effects of sedation on ESD performance and complications. We aimed to evaluate the relationship among sedation methods, clinical outcomes, and complications after ESD for gastric neoplasia. ⋯ Sedation with CPIA can improve ESD performance.