Surgical endoscopy
-
Randomized Controlled Trial Comparative Study
Prospective randomized clinical trial comparing laparoscopic cholecystectomy and hybrid natural orifice transluminal endoscopic surgery (NOTES) (NCT00835250).
Natural orifice transluminal endoscopic surgery (NOTES) is a technique still in experimental development whose safety and effectiveness call for assessment through clinical trials. In this paper we present a three-arm, noninferiority, prospective randomized clinical trial of 1 year duration comparing the vaginal and transumbilical approaches for transluminal endoscopic surgery with the conventional laparoscopic approach for elective cholecystectomy. ⋯ NOTES approaches using the flexible endoscope are not inferior in safety or effectiveness to conventional laparoscopy. The transumbilical approach with flexible endoscope is as effective and safe as the transvaginal approach and is a promising, single-incision approach.
-
Randomized Controlled Trial Comparative Study
Comparison of long-term outcome and quality of life after laparoscopic repair of incisional and ventral hernias with suture fixation with and without tacks: a prospective, randomized, controlled study.
Technique of mesh fixation in laparoscopic incisional hernia repair is a matter of debate. Literature is lacking in randomized trials comparing various methods of mesh fixation. This study was designed to compare the cost-effectiveness and long-term outcomes following the two methods of mesh fixation. ⋯ The suture fixation method is a cost-effective alternative to tacker fixation in patients with small- to medium-sized defects in laparoscopic incisional and ventral hernia repair. Suture fixation is better than tacker fixation in terms of early postoperative pain and return to activity. The two procedures are equally effective regarding the recurrence rates, complications, hospital stay, chronic pain, quality of life determinants, and patient satisfaction.
-
Intraductal papillary mucinous neoplasm (IPMN) is characterized by intraductal proliferation of neoplastic mucinous cells with a variable extent along the main duct or its branches. The lesion may be continuous or discontinuous. Skip lesions have been described in about 6-19% of cases. Complete resection without leaving behind any skip lesions is important, to such an extent that many groups suggest even total pancreatectomy, a major and morbid surgery. ⋯ Intraoperative pancreatoscopy, especially with NBI, is a good diagnostic tool for IPMN and also helps in intraoperative decision-making of the resection margins.
-
Despite the popularity of laparoscopic distal gastrectomy (LDG), laparoscopic total gastrectomy (LTG) remains a challenging procedure because of its technical difficulties and possible complications. In this study, the authors evaluated the short-term surgical outcomes and operative risks of LTG. ⋯ LTG is a feasible and acceptable procedure for treatment of middle or upper early gastric cancer. Further refinement of anastomosis techniques and considerable experience of laparoscopic gastrectomy are required for proper application of LTG in gastric carcinoma.
-
Comparative Study
Heat loss during carbon dioxide insufflation: comparison of a nebulization based humidification device with a humidification and heating system.
This study compared the heat loss observed with the use of MR860 AEA Humidifier™ system (Fisher & Paykel Healthcare, New Zealand), which humidifies and heats the insufflated CO(2), and the use of the AeronebPro™ device (Aerogen, Ireland), which humidifies but does not heat the insufflated CO(2). ⋯ As far as heat loss is concerned, for laparoscopic procedures of less than 60 min, there is no benefit of using any humidification with or without heating. However, for procedures greater than 60 min, use of heating along with humidification, is superior.