Surgical endoscopy
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Comparative Study
Are transverse colon cancers suitable for laparoscopic resection?
The large randomized trials reporting on laparoscopic versus open colon surgery for cancer have all excluded patients with transverse colon cancer lesions. This study was undertaken to review our experience with surgery for curable transverse colon cancer. ⋯ Laparoscopic resection of transverse colon cancers is technically feasible and not associated with a significantly higher rate of complications or conversions or with impaired oncologic outcomes compared with patients having segmental laparoscopic resections for other colon cancers. Operating time is longer.
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Randomized Controlled Trial
Open vs laparoscopic partial posterior fundoplication. A prospective randomized trial.
This study compares outcomes following open and laparoscopic partial posterior fundoplication for gastroesophageal reflux disease concerning perioperative course, postoperative complications, symptomatic relief, recurrent disease, and the need for reinterventional surgery. ⋯ The finding of fewer general complications, shorter length of stay and recovery, similar need for reoperations, and comparable 3-year outcomes, makes the laparoscopic approach the primary choice when considering surgical options for the treatment of gastroesophageal reflux disease (GERD).
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Randomized Controlled Trial Comparative Study
Thoracic epidural analgesia facilitates the restoration of bowel function and dietary intake in patients undergoing laparoscopic colon resection using a traditional, nonaccelerated, perioperative care program.
This randomized trial compared thoracic epidural analgesia with patient-controlled analgesia (PCA) using morphine for laparoscopic colectomy in a traditional, nonaccelerated, perioperative care program. ⋯ When a traditional perioperative care program is used for laparoscopic colectomy, thoracic epidural analgesia is superior to PCA in accelerating the return of bowel function and dietary intake, while providing better pain relief.
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Randomized Controlled Trial
The influence of different training schedules on the learning of psychomotor skills for endoscopic surgery.
Psychomotor skills for endoscopic surgery can be trained with virtual reality simulators. Distributed training is more effective than massed training, but it is unclear whether distributed training over several days is more effective than distributed training within 1 day. This study aimed to determine which of these two options is the most effective for training endoscopic psychomotor skills. ⋯ The distributed group trained over several days was faster, with the same number of errors and the same instrument path length used. Psychomotor skill training for endoscopic surgery distributed over several days is superior to training on 1 day.
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The use of intraoperative cholangiography (IOC), routinely rather than selectively, during laparoscopic cholecystectomy (LC) is controversial. Recent findings have shown laparoscopic ultrasound (LUS) to be safe, quick, and effective not only for screening of the bile duct for stones, but also for evaluating the biliary anatomy. This study aimed to evaluate, on the basis of the LC outcome and the cost of LUS and IOC, whether and how much the routine use of LUS would be able to reduce the need for IOC. ⋯ Routine LUS accurately diagnosed bile duct stones and significantly reduced the need for selective IOC from a potential 38.5% to an actual 3.5% without adversely affecting the outcome of the LC or increasing the overall cost. The routine use of LUS during LC is accurate and cost effective.