Journal of laparoendoscopic & advanced surgical techniques. Part A
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J Laparoendosc Adv Surg Tech A · Feb 2019
Comparative StudyComparison of Polymeric Clips and Endoscopic Staplers for Laparoscopic Appendectomy.
Appendectomy is the most common pediatric surgical procedure. To decrease the cost and environmental impact of single incision pediatric endosurgery (SIPES) appendectomy, we switched from using endoscopic staplers to polymeric clips placed with nondisposable laparoscopic appliers. The aim of this study was to compare the resulting reduction in cost and amount of waste generated per case, as well as to compare the perioperative variables and outcomes in patients in whom clips were used, with those of historical patients in whom staplers were used. ⋯ Use of polymeric clips for appendectomy is safe and effective, and results are comparable with those of stapling. Based on our data, in 90% of appendectomies, the base of appendix is amenable to clipping. This study supports use of clips over staplers to decrease cost and environmental impact.
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J Laparoendosc Adv Surg Tech A · Feb 2019
Comparative StudyPain Management in Pectus Excavatum Surgery: A Comparison of Subcutaneous Catheters Versus Epidurals in a Pediatric Population.
Pectus excavatum is a common chest wall anomaly. Achieving optimal pain control is a priority for adolescents undergoing surgical correction of this condition. Options for pain control include the use of subcutaneous catheters (On-Q® pumps) and epidurals. The objective of this study is to demonstrate the feasibility of using subcutaneous catheters for pain control and to compare them with the use of epidurals during surgical correction of pectus excavatum. ⋯ The use of bilateral subcutaneous infusion catheters is a safe and effective method for pain control in patients undergoing surgical correction of pectus excavatum. Even though the degree of pain control is not necessarily superior to epidurals, in this study, the catheters were associated with a shorter postoperative length of stay in this patient population and did not increase the incidence of complications.
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J Laparoendosc Adv Surg Tech A · Jan 2019
Comparative StudyRobot-Assisted Partial Nephrectomy for Totally Endophytic Renal Tumors: Step by Step Standardized Surgical Technique and Long-Term Outcomes with a Median 59-Month Follow-Up.
Treatment of totally endophytic renal tumors is a technically demanding surgery. While few studies show promising perioperative and short-term outcomes of robot-assisted partial nephrectomy (RAPN), its long-term outcomes remain undetermined. ⋯ RAPN is a safe and feasible option for treatment of totally endophytic renal tumors. Despite the increased prevalence of high tumor complexity and lower baseline renal function in the RAPN group, it achieved equivalent long-term oncologic control and functional outcome compared to OPN.
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J Laparoendosc Adv Surg Tech A · Jan 2019
Minimally Invasive Pediatric Surgery During Remote Humanitarian Missions Is Feasible, Safe, and Effective.
There remains a critical need for the provision for pediatric humanitarian aid worldwide. Historically, the emphasis of global pediatric health needs has been focused on infectious diseases. Today, we are witnessing a shift in this paradigm, with growing attention being paid toward the surgical needs of children. The use and deployment of minimally invasive surgery (MIS) in these austere environments with its concomitant reduction in length of hospitalization, pain, and morbidity is logical. The goal of this study was to report our deployment strategy and review our experience with pediatric MIS during humanitarian missions to determine if it is safe, feasible, and efficacious. ⋯ Our retrospective review supports the use of MIS techniques as part of GPS humanitarian missions. We have found it to be a safe, feasible, and effective modality that may reduce length of stay, pain, and morbidity compared with open procedures in these remote environments. Although our MIS systems and instrumentations functioned effectively, concerns regarding the storage and sustainability for future missions are significant. Onsite health care partners, redundant systems, and remote technical support access could potentially alleviate these concerns.
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J Laparoendosc Adv Surg Tech A · Jan 2019
Observational StudyTransvaginal Radiofrequency Ablation of Myomas: Technique, Outcomes, and Complications.
The aim was to study technique, complications, and outcomes of transvaginal ultrasound-guided radiofrequency myolysis (TRFAM) of uterine myomas. ⋯ TRFAM is an effective and safe technique in selected patients for the treatment of metrorrhagia secondary to myomas.