Surgical endoscopy
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Pre- and post-operative stomach volumes can be important determinants for effectiveness of laparoscopic sleeve gastrectomy (LSG) in causing weight loss. There is little existing data on the volumes of stomach preoperatively and that excised during LSG. This study was designed to evaluate the change in gastric volume after LSG using multi-detector CT and to correlate it with early post-operative weight loss. ⋯ MDCT is a good method to measure gastric volume before and after LSG. Early post-operative weight loss (3 months) correlates well with the volume of the excised stomach but not with that of the gastric sleeve.
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Comparative Study
Surgeons' display reduced mental effort and workload while performing robotically assisted surgical tasks, when compared to conventional laparoscopy.
Research has demonstrated the benefits of robotic surgery for the patient; however, research examining the benefits of robotic technology for the surgeon is limited. This study aimed to adopt validated measures of workload, mental effort, and gaze control to assess the benefits of robotic surgery for the surgeon. We predicted that the performance of surgical training tasks on a surgical robot would require lower investments of workload and mental effort, and would be accompanied by superior gaze control and better performance, when compared to conventional laparoscopy. ⋯ The findings highlight the benefits of robotic technology for surgical operators. Specifically, they suggest that tasks can be performed more proficiently, at a lower workload, and with the investment of less mental effort, this may allow surgeons greater cognitive resources for dealing with other demands such as communication, decision-making, or periods of increased complexity in the operating room.
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Randomized Controlled Trial
Mesenteric defect closure in laparoscopic Roux-en-Y gastric bypass: a randomized controlled trial.
Internal herniation is a potential complication following laparoscopic Roux-en-Y gastric bypass (LRYGB). Previous studies have shown that closure of mesenteric defects after LRYGB may reduce the incidence of internal herniation. However, controversy remains as to whether mesenteric defect closure is necessary to decrease the incidence of internal hernias after LRYGB. This study aims to determine if jejeunal mesenteric defect closure reduces incidence of internal hernias and other complications in patients undergoing LRYGB. ⋯ In this study, closure or non-closure of the jejeunal mesenteric defect following LRYGB appears to result in equivalent internal hernia and complication rates. High index of suspicion should be maintained whenever internal hernia is expected after LRYGB.
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A comprehensive enhanced recovery pathway (ERP) was implemented in patients undergoing laparoscopic colectomy in an attempt to reduce postoperative opioid consumption. We hypothesized that improved local analgesia and increased use of non-opioid pain medication, combined with earlier feeding and ambulation, would allow for earlier return of bowel function and shorter postoperative length of stay (LOS). ⋯ The new ERP, including TAP block and postoperative pain medication protocol limiting I.V. narcotics, is effective in controlling pain in elective partial laparoscopic colectomy. Pain control management together with regimented early feeding and ambulation allow for significantly earlier return of bowel function and shorter postoperative LOS.
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Current guidelines recommend routine follow-up colonoscopy after acute diverticulitis to confirm the diagnosis and exclude malignancy. Its value, however, has recently been questioned because of contradictory study results. Our objective was to compare the colonoscopic detection rate of advanced colonic neoplasia (ACN), comprising colorectal cancer (CRC) and advanced adenoma (AA), in patients after a CT-proven primary episode of uncomplicated acute diverticulitis with average risk participants in a primary colonoscopy CRC screening program. ⋯ ACN detection does not differ significantly between patients with recent uncomplicated diverticulitis and average risk screening participants. Routine follow-up colonoscopy after primary CT-proven uncomplicated left-sided acute diverticulitis can be omitted; these patients can participate in CRC screening programs. Follow-up colonoscopy may be beneficial when targeted at high-risk patients, but such an approach first needs prospective evaluation.