Journal of laparoendoscopic & advanced surgical techniques. Part A
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J Laparoendosc Adv Surg Tech A · Jul 2020
Multicenter Study Comparative Study Controlled Clinical TrialTransanal Versus Laparoscopic Total Mesorectal Excision: A Comparative Prospective Clinical Trial from Two Centers.
Purpose: Laparoscopic total mesorectal excision (LapTME) faced many obstacles in obese male with narrow pelvis and bulky mesorectum with increased risk of incomplete mesorectal excision and positive circumferential resection margin (CRM) and distal resection margin (DRM). Transanal total mesorectal excision (TaTME) is reported to result in a better quality total mesorectal excision (TME) specimen, lower incidence of CRM and DRM involvement, and higher rates of sphincter preservation. To date, there is still a debate about the feasibility and efficacy of transanal versus the laparoscopic approach for TME in middle and low rectal cancer. ⋯ No significant differences were detected in CRM, DRM, peri- or postoperative complications, or conversion rates with more reported Clavien-Dindo grade III complications in the TaTME group (P = .29). Conclusions: TaTME facilitated rectal cancer surgery in obese patients and increased the chance of transanal specimen extraction with equivalent oncological outcomes to conventional LapTME. Further studies are recommended to build better evidence.
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J Laparoendosc Adv Surg Tech A · Jul 2020
Comparative StudyLaparoscopy Versus Open Reoperation for Incidental Gallbladder Carcinoma After Laparoscopic Cholecystectomy.
Background: Some reports assert that there is a risk that laparoscopy might worsen the prognosis of incidental gallbladder carcinoma (IGBC) after laparoscopic cholecystectomy (LC) compared with open reoperation. The purpose of this study was to evaluate whether the surgical approach influences outcomes in patients with IGBC after LC. Methods: We retrospectively reviewed the medical records of 106 patients diagnosed with IGBC who had undergone LC for benign gallbladder disease such as cholecystolithiasis at our hospital between April 2010 and February 2018. ⋯ During follow-up, 3-year survival between laparoscopy (48.89%) and open reoperation (42.62%) showed no statistical significance, but laparoscopy had better 1-year survival (95.56% versus 86.89%, laparoscopy versus open, respectively; not significant [NS] <0.01) and 5-year survival (44.44% versus 29.51%, laparoscopy versus open, respectively; NS <0.05). However, comparing laparoscopy versus open surgery, respectively, blood -loss volume (100 ± 25.4 mL versus 200 ± 45.6 mL; NS <0.01), hospital stay (3.5 ± 1.9 days versus 5.6 ± 2.7 days, NS <0.01), and complication rates (6.7% versus 13.1%; NS <0.01) were lower, indicating better recovery and better patient experience. Conclusions: Laparoscopic radical reoperation for IGBC after LC is a feasible, effective, and safe procedure and is associated with less bleeding, low morbidity, and shorter hospital stay.
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J Laparoendosc Adv Surg Tech A · Jul 2020
Comparative StudySupraclavicular Versus Transaxillary First Rib Resection for Thoracic Outlet Syndrome.
Background: Thoracic outlet syndrome (TOS) results from compression of neurovascular structures supplying the upper extremity as they exit the thoracic outlet. Depending on the clinical presentation, surgical decompression may be required. Objectives: Transaxillary (TA) and supraclavicular (SC) approaches are both widely utilized and deemed effective. ⋯ There was no difference in symptom resolution between either group. Conclusions: TA and SC approaches are equally safe and effective for the treatment of TOS. SC decompression allows for adjunct procedures and vascular reconstructions.
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J Laparoendosc Adv Surg Tech A · Jul 2020
Observational StudyThe Effect of Erector Spinae Plane Block on Laparoscopic Cholecystectomy Anesthesia: Analysis of Opioid Consumption, Sevoflurane Consumption, and Cost.
Background: Erector spinae plane (ESP) block has been increasingly suggested for laparoscopic cholecystectomy (LC) as a part of multimodal analgesia in many studies. However, there is not any study that investigated the perioperative effects of ESP block on anesthetic agent consumption and cost of LC anesthesia. This is the first study that evaluates the effect of ESP block in terms of cost-effectiveness, intraoperative consumption of inhalation agents, and perioperative consumption of opioids. Materials and Methods: In this prospective observational study, 81 patients who underwent LC were included. ⋯ All patients were monitored with electrocardiography, noninvasive blood pressure, pulse oximetry, end-tidal carbon dioxide, and bispectral index. The consumption of sevoflurane and opioids in the intraoperative and postoperative 24 hours was recorded. The costs of drugs were determined by multiplying total consumed amounts with unit prices. Results: The costs and the consumed amounts of remifentanyl, sevoflurane, and tramadol were significantly higher in non-ESP group in the perioperative period (respectively, P < .001, P = .01, and P < .001). Conclusions: ESP block for LC decreased the consumed amount and cost of inhaled agents and opioids in the perioperative period.