Surgical endoscopy
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Randomized Controlled Trial
Peri-incisional and intraperitoneal ropivacaine administration: a new effective tool in pain control after laparoscopic surgery in gynecology: a randomized controlled clinical trial.
A proportion of patients undergoing laparoscopic gynecological surgery experiences excessive post-operative pain, which results in high rescue analgesic treatment and prolonged hospitalization. The aim of our study was to evaluate the efficacy of intraoperative topical ropivacaine in the control of post-operative pain in the first 48 h after operative laparoscopy for benign adnexal or uterine pathologies . ⋯ Combined topical analgesia with ropivacaine could represent a new safe and effective tool in the control of post-operative pain in gynecological laparoscopic surgery. Given the greater benefits for adnexal surgery, this strategy may be more suitable for this class of patients.
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Laparoscopic incisional hernia repair has become widely accepted in the management of incisional hernias. There has been recent interest in combining fascial closure along with mesh placement to improve outcomes. We report our experience with this technique. ⋯ We have shown comparable rates for seroma and recurrence to other series. Laparoscopic incisional hernia repair with defect closure is feasible and reduces seroma rate and recurrence.
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Comparative Study
Clinical outcomes and cost-benefit analysis comparing laparoscopic and robotic colorectal surgeries.
The introduction of minimally invasive platforms for colorectal surgery-laparoscopy and more recently robotics-allows for smaller incisions, shortened hospital stay, less postoperative pain, and quicker return to normal activity. There exists a lack of evidence-based knowledge comparing the clinical outcomes and cost-benefit analysis of the different types of minimally invasive surgery. The aim of this study was to analyze and compare the short-term clinical outcomes and overall hospital costs between laparoscopic and robotic colorectal surgery. ⋯ Robotic colectomies were comparable to laparoscopic colectomies in terms of overall hospital charges and short-term clinical outcomes, including length of stay and conversion rates. Robotic surgery was favored for left-sided colectomy. With shorter learning curves and wider availability, robotic approach offers a safe and economically feasible minimally invasive platform for complex colorectal resections.
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Case Reports
Robot-assisted hepatectomy and complete excision of the extrahepatic bile duct for type IV-A choledochal cysts.
Complete removal of the dilated biliary tree is regarded as inevitable in choledochal cysts due to its malignant potential. However, technical difficulty and the high risk of postoperative complications as well as the various presentations of the disease make the surgical options for type IV-A cysts challenging and controversial. We report the first case of a type IV-A choledochal cyst treated using a robot-assisted approach. ⋯ Hepatectomy and complete excision of the extrahepatic bile duct for type IV-A choledochal cysts requires fine and delicate surgical techniques. The wrist-like movement of the working instruments and the firefly imaging of the robot surgical system allowed this advanced minimally invasive surgery to be successfully performed on this patient.
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Randomized Controlled Trial
Etomidate plus propofol versus propofol alone for sedation during gastroscopy: a randomized prospective clinical trial.
Sedation with propofol alone during gastroscopy has many side effects. Etomidate has advantages in terms of circulation and respiration compared to propofol. We hypothesized that etomidate plus propofol during gastroscopy would be more safe and effective than propofol alone. ⋯ Etomidate plus propofol had few effects on respiration and circulation in patients undergoing gastroscopy and was more safe and effective than propofol alone.