Journal of laparoendoscopic & advanced surgical techniques. Part A
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J Laparoendosc Adv Surg Tech A · Jul 2019
The Use of Endoclips in Thoracoscopic Correction of Esophageal Atresia: Advantages or Complications?
Background: Thoracoscopic correction of esophageal atresia (EA) with tracheoesophageal fistula (TEF) has been increasingly widespread, but is still one of the most advanced pediatric surgical skills. This procedure has a challenging learning curve, and usually initially requires a longer operative time than the open approach; furthermore to perform this intervention, the surgeon must be very experienced in endocorporeal knotting. In our opinion, standardization of the technique and the application of "tricks" (including the use of titanium endoclips for TEF closure) to make surgical steps easier, faster, and safe would be useful to the surgeon and to the patient above all. ⋯ We also want to emphasize that in our experience, TEF closure by titanium endoclips is fast, reducing operative time, and effective, with no reported long-term complications in our case series. Overall success rate after clips application is, in our series, 100%. The only limit we have found, above all for low-weight patients, is the diameter of the clip applier which needs a 5 mm access even if the surgeon uses 3 mm operative instruments.
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J Laparoendosc Adv Surg Tech A · Jun 2019
Case ReportsRobot-Assisted Repair of E1 Biliary Ductal Injury with Roux-en-Y Hepaticojejunostomy.
Background: Common bile duct (CBD) injury is a serious complication of laparoscopic and open cholecystectomy. Early identification and minimally invasive repair, when possible, can prevent much of the morbidity associated with this injury. Materials and Methods: A 36-year-old woman referred in the immediate perioperative period for CBD injury at the time of laparoscopic cholecystectomy. ⋯ No intra- or perioperative complications of the surgery were noted. Conclusion: The degrees of freedom and stability of the robotic platform were instrumental during several key steps, including exposure of the hepatic hilum, positioning of the Roux limb, and suturing of the CBD. Successful minimally invasive repair of this patient's CBD injury minimized the morbidity of the index operation, blood loss, hospital length of stay, and potential legal consequences.
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J Laparoendosc Adv Surg Tech A · May 2019
Randomized Controlled TrialA Prospective Randomized Controlled Trial of Single-Port and Three-Port Laparoscopic Appendectomy in Children.
Background: This study aimed to evaluate single-port laparoscopic appendectomy (SPLA) in comparison with three-port laparoscopic appendectomy (3PLA) in children about the extent of surgical trauma after SPLA and 3PLA measured by serum interleukin-6 (IL-6) and C-reactive protein (CRP) concentrations. Materials and Methods: A total of 50 patients with a median age of 11.5 were randomized to two groups. Experts in both methods performed the surgeries. ⋯ The length of hospital stay and complication rate were not different between the two groups. Conclusions: SPLA in children is associated with longer operative times, increased pain level, and more severe surgical trauma as measured by postoperative CRP and IL-6 levels in comparison with a 3PLA. The two approaches were comparable regarding the length of hospital stay and complication rate.
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J Laparoendosc Adv Surg Tech A · May 2019
Meta AnalysisA Systematic Review and Bayesian Network Meta-Analysis: Short-Term and Long-Term Outcomes of Three Surgery Procedures Following Neoadjuvant Chemoradiotherapy for Rectal Cancer.
Aim: Our aim was to perform a Bayesian network meta-analysis of short-term and long-term outcomes of open surgery (OS), laparoscopic surgery (LS), and robotic surgery (RS) after neoadjuvant chemoradiotherapy (nCRT) for rectal cancer. Methods: We searched randomized controlled trials (RCTs) and non-RCTs published up to October 2018 from PubMed, Embase, Cochrane Library, and Web of Science. We selected studies referencing the comparison between at least two of OS, LS, and RS. Short-term and long-term outcomes of different surgery procedures were evaluated. ⋯ Our meta-analysis illustrated that RS had the longest operative time. However, LS had a significantly shorter operative time than RS, shorter incision than OS, shorter time to pass first flatus than OS, and less blood loss than OS. Conclusions: RS was regarded as the inferior surgery procedure after nCRT for rectal cancer. Meanwhile, LS might possibly be the most safe and feasible surgery procedure after nCRT for rectal cancer.
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J Laparoendosc Adv Surg Tech A · Apr 2019
Review Meta AnalysisMinimally Invasive Versus Open Pancreaticoduodenectomy: An Up-to-Date Meta-Analysis of Comparative Cohort Studies.
This systematic review and meta-analysis were performed to summarize available evidence comparing totally minimally invasive pancreaticoduodenectomy (TMIPD) versus open pancreaticoduodenectomy (OPD) Materials and Methods: We searched PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for comparative cohort studies published from January 1990 through April 2018 comparing TMIPD versus OPD. Outcomes evaluated were postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), postoperative hemorrhage, wound infection, estimated blood loss, transfusion rate, retrieved lymph nodes (RLNs), R0 rate, reoperation rate, length of hospital stay, and mortality. Statistical analysis was performed with Review Manager, version 5.3 (Cochrane Collaboration). ⋯ TMIPD appears to be as safe and effective as OPD for periampullary disease. These findings need confirmation with large volume well-designed randomized controlled trials.