A Comparison between Laparoscopic and Robotic Hysterectomy in Obese Patients: Effect on Cost, Operating Time and Estimated Blood Loss

2017 ◽  
Vol 24 (7) ◽  
pp. S47-S48
Author(s):  
J. Ton ◽  
C. Marfori ◽  
E. Abi Khalil ◽  
G. Moawad
Keyword(s):  
Blood Loss ◽  
Operating Time ◽  
Obese Patients ◽  
Robotic Hysterectomy ◽  
Estimated Blood Loss

scholarly journals Robotic partial nephrectomy for renal tumours in obese patients: Perioperative outcomes in a multi-institutional analysis

2015 ◽  
Vol 9 (11-12) ◽  
pp. 859 ◽  
Author(s):  
Newaj Abdullah ◽  
Deepansh Dalela ◽  
Ravi Barod ◽  
Jeff Larson ◽  
Michael Johnson ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Blood Loss ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Independent Predictor ◽  
Operating Time ◽  
Perioperative Outcomes ◽  
Robotic Partial Nephrectomy ◽  
Obese Patients ◽  
Estimated Blood Loss

<p><strong>Introduction: </strong>We sought to evaluate the association of obesity with surgical outcomes of robotic partial nephrectomy (RPN) using a large, multicentre database.<strong> </strong></p><p><strong>Methods: </strong>We identified 1836 patients who underwent RPN from five academic centres from 2006-2014.  A total of 806 patients were obese (body mass index [BMI] ≥30 kg/m<sup>2</sup>). Patient characteristics and outcomes were compared between obese and non-obese patients. Multivariable analysis was used to assess the association of obesity on RPN outcomes.</p><p><strong>Results: </strong>A total of 806 (44%) patients were obese with median BMI of 33.8kg/m<sup>2</sup>. Compared to non-obese patients, obese patients had greater median tumour size (2.9 vs. 2.5 cm, p&lt;0.001), mean RENAL nephrometry score (7.3 vs. 7.1, p = 0.04), median operating time (176 vs. 165 min, p=0.002), and median estimated blood loss (EBL, 150 vs. 100 ml, p=0.002), but no difference in complications. Obesity was not an independent predictor of operative time or EBL on regression analysis. Among obese patients, males had a greater EBL (150 vs. 100 ml, p&lt;0.001), operative time (180 vs. 166 min, p&lt;0.001) and warm ischemia time (WIT, 20 vs. 18, p=0.001) and male sex was an independent predictor of these outcomes on regression analysis.</p><p><strong>Conclusion: </strong>In this large, multicentre study on RPN, obesity was not associated with increased complications and was not an independent predictor of operating time or blood loss.  However, in obese patients, male gender was an independent predictor of greater EBL, operative time, and WIT.  Our results indicate that obesity alone should not preclude consideration for RPN.<strong></strong></p>

scholarly journals Mini-open thoracoscopic-assisted spinal thoracotomy for traumatic injuries: A technical note

2020 ◽  
Vol 11 ◽  
pp. 265
Author(s):  
Vikas Tandon ◽  
Abhinandan Reddy Mallepally ◽  
Ashok Reddy Peddaballe ◽  
Nandan Marathe ◽  
Harvinder Singh Chhabra
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Neurological Status ◽  
Technical Note ◽  
Single Level ◽  
Estimated Blood Loss ◽  
Multiple Variables ◽  
Mini Open

Background: Mini-open thoracoscopic-assisted thoracotomy (MOTA) has been introduced to mitigate disadvantages of conventional open anterior or conventional posterior only thoracoscopic procedures. Here, we evaluated the results of utilizing the MOTA technique to perform anterior decompression/fusion for 22 traumatic thoracic fractures. Methods: There were 22 patients with unstable thoracic burst fractures (TBF) who underwent surgery utilizing the MOTA thoracotomy technique. Multiple variables were studied including; the neurological status of the patient preoperatively/postoperatively, the level and type of fracture, associated injuries, operative time, estimated blood loss, chest tube drainage (intercostal drainage), length of hospital stay (LOS), and complication rate. Results: In 22 patients (averaging 35.5 years of age), T9 and T12 vertebral fractures were most frequently encountered. There were 20 patients who had single level and 2 patients who had two-level fractures warranting corpectomies. Average operating time and blood loss for single-level corpectomy were 91.5 ± 14.5 min and 311 ml and 150 ± 18.6 min and 550 ml for two levels, respectively. Mean hospital stay was 5 days. About 95.45% of cases showed fusion at latest follow-up. Average preoperative kyphotic angle corrected from 34.2 ± 3.5° to 20.5 ± 1.0° postoperatively with an average correction of 41.1% and correction loss of 2.4%. Conclusion: We concluded that utilization of the MOTA technique was safe and effective for providing decompression/fusion of traumatic TBF.

Technique and feasibility of radical para-aortic and pelvic lymphadenectomy for gynecologic malignancies: a prospective study

1991 ◽  
Vol 1 (3) ◽  
pp. 133-140 ◽  
Author(s):  
Benedetti. P. Panici ◽  
G. Scambia ◽  
G. Baiocchi ◽  
S. Greggi ◽  
S. Mancuso
Keyword(s):  
Endometrial Cancer ◽  
Blood Loss ◽  
Operating Time ◽  
Proximal Part ◽  
Median Number ◽  
Pelvic Lymphadenectomy ◽  
Lymph Node Status ◽  
Retroperitoneal Abscess ◽  
Operating Data ◽  
Estimated Blood Loss

Of 284 patients evaluated for entry into the study between January 1986 and June 1990, systematic para-aortic and pelvic lymphadenectomy was performed in 208 cases (108 cervical cancer, 43 and 57 ovarian and endometrial cancer, respectively). The median number of nodes removed was 58, 49 and 54 for cervical, ovarian and endometrial cancer, respectively. The operating data are divided into 2 groups according to the consecutive number of the cases. The median operating time and the median estimated blood loss of lymphadenectomy was 230 minutes (range 120–270) and 390 ml (range 200–3300) in the first 95 cases. These operating data decreased to 150 minutes (range 100–240) and 250 ml (range 100–2800) in the second 113 cases. No surgery-related deaths occurred. Severe hemor-rages (blood loss exceeding 1000 ml) occurred in 6 patients. The obturator nerve was dissected in 1 patient and in 1 case the left ureter was cut. Formation of lymphoceles occurred in 20.4% of patients. Eighteen patients (8.8%) developed deep venous thrombosis. Nine of these patients experienced pulmonary microembolism. In 3 patients a retroperitoneal abscess was diagnosed. One patient developed a fistula of the most proximal part of the right ureter during the third postoperative week. The resection or coagulation of branches of the genito-femoral and obturator nerves determined mild paresthesis localized at the supero-anterior and internal side of thigh in 11 cases (5.4%). No statistically significant differences were found between the clinical (age, weight and previous chemotherapy) and pathological (type of cancer and lymph node status) parameters considered on one hand and postoperative complications on the other.

Mid-term to long-term clinical and functional outcomes of minimally invasive correction and fusion for adults with scoliosis

2010 ◽  
Vol 28 (3) ◽  
pp. E6 ◽  
Author(s):  
Neel Anand ◽  
Rebecca Rosemann ◽  
Bhavraj Khalsa ◽  
Eli M. Baron
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Short Form ◽  
Operating Time ◽  
Adult Scoliosis ◽  
Estimated Blood Loss ◽  
The Mean

Object The goal of this study was to assess the operative outcomes of adult patients with scoliosis who were treated surgically with minimally invasive correction and fusion. Methods This was a retrospective study of 28 consecutive patients who underwent minimally invasive correction and fusion over 3 or more levels for adult scoliosis. Hospital and office charts were reviewed for clinical data. Functional outcome data were collected at each visit and at the last follow-up through self-administered questionnaires. All radiological measurements were obtained using standardized computer measuring tools. Results The mean age of the patients in the study was 67.7 years (range 22–81 years), with a mean follow-up time of 22 months (range 13–37 months). Estimated blood loss for anterior procedures (transpsoas discectomy and interbody fusions) was 241 ml (range 20–2000 ml). Estimated blood loss for posterior procedures, including L5–S1 transsacral interbody fusion (and in some cases L4–5 and L5–S1 transsacral interbody fusion) and percutaneous screw fixation, was 231 ml (range 50–400 ml). The mean operating time, which was recorded from incision time to closure, was 232 minutes (range 104–448 minutes) for the anterior procedures, and for posterior procedures it was 248 minutes (range 141–370 minutes). The mean length of hospital stay was 10 days (range 3–20 days). The preoperative Cobb angle was 22° (range 15–62°), which corrected to 7° (range 0–22°). All patients maintained correction of their deformity and were noted to have solid arthrodesis on plain radiographs. This was further confirmed on CT scans in 21 patients. The mean preoperative visual analog scale and treatment intensity scale scores were 7.05 and 53.5; postoperatively these were 3.03 and 25.88, respectively. The mean preoperative 36-Item Short Form Health Survey and Oswestry Disability Index scores were 55.73 and 39.13; postoperatively they were 61.50 and 7, respectively. In terms of major complications, 2 patients had quadriceps palsies from which they recovered within 6 months, 1 sustained a retrocapsular renal hematoma, and 1 patient had an unrelated cerebellar hemorrhage. Conclusions Minimally invasive surgical correction of adult scoliosis results in mid- to long-term outcomes similar to traditional surgical approaches. Whereas operating times are comparable to those achieved with open approaches, blood loss and morbidity appear to be significantly lower in patients undergoing minimally invasive deformity correction. This approach may be particularly useful in the elderly.

scholarly journals Effect of preoperative biliary drainage in patients with moderately severe obstructive jaundice on the outcomes of pancreatoduodenectomy: A meta-analysis study

2019 ◽  
Author(s):  
Xiaolei Wang ◽  
Shanshan Meng ◽  
Yaowei Hu ◽  
Kehang Duan ◽  
Feng Wei
Keyword(s):  
Blood Loss ◽  
Total Bilirubin ◽  
Meta Analysis ◽  
Operating Time ◽  
Preoperative Biliary Drainage ◽  
Postoperative Hospital Stay ◽  
Mean Difference ◽  
Perioperative Outcomes ◽  
Perioperative Mortality ◽  
Estimated Blood Loss

Abstract Background The purpose of this meta-analysis was to examine the impact of preoperative biliary drainage (PBD) on the perioperative outcomes of pancreatoduodenectomy (PD) in patients with total bilirubin >100 umol/L.Methods In this meta-analysis, studies that compared the perioperative outcomes of PBD and non-PBD patients with total bilirubin >100 umol/L, and were published in EMBASE, PubMed, the Cochrane library, Web of Science, VIP database, Wanfang data, Chinese biomedical literature and CNKI database from inception up to October 2019 were included. The odds ratios (OR) or mean differences were calculated with 95% confidence intervals (CI).Results Nine trials with 744 patients, which compared PBD (267 patients) with non-PBD (477 patients), were included. There was no significant difference in perioperative mortality between these two groups (OR: 0.51, 95% CI: 0.19 to 1.39; P =0.19). Postoperative hospital stay (mean difference: -2.35, 95% CI: -3.70 to -1.00; P =0.0007), operating time (mean difference: -33.03, 95% CI: -44.14 to 21.93; P <0.00001), estimated blood loss (mean difference: -141.18, 95% CI: -213.25 to -69.11; P =0.0001) and overall morbidity (OR: 0.68, CI: 0.48 to 0.95; P =0.02) were significantly lower in the PBD group than in the non-PBD group.Conclusion Patients who received PBD had similar perioperative mortality, but had decreased postoperative hospital stay, operating time, estimated blood loss and overall morbidity, when compared to patients without PBD. Therefore, PBD should be routinely performed for patients planned for PD with a total bilirubin of >100 umol/L.

Comparison of Hand-assisted Laparoscopic and Open Radical Distal Gastrectomy for Obese Patients

2013 ◽  
Vol 79 (12) ◽  
pp. 1273-1278 ◽  
Author(s):  
Guang-Tan Zhang ◽  
Dong Liang ◽  
Xue-Dong Zhang
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Hospital Stay ◽  
Distal Gastrectomy ◽  
Postoperative Hospital Stay ◽  
Obese Patients ◽  
Injection Time ◽  
Open Distal Gastrectomy ◽  
Estimated Blood Loss ◽  
Wound Length

To evaluate the feasibility and safety of hand-assisted laparoscopic surgery for gastric cancer in obese patients, we compare the operative outcomes in obese patients who underwent hand-assisted laparoscopic distal gastrectomy (HALDG) and open distal gastrectomy (ODG). One hundred sixty-two obese patients with gastric cancer operated on in our department from January 2009 to December 2011 were divided into two groups: the open distal gastrectomy group (the ODG group) and the hand-assisted laparoscopic distal gastrectomy group (the HALDG group). Operative time, estimated blood loss, number of lymph node retrieval, wound length, times of analgesic injection, time to the first flatus, and postoperative hospital stay were compared between the two groups. Estimated blood loss, wound length, times of analgesic injection, time to the first flatus, and postoperative hospital stay were significantly less or shorter in the HALDG group than in the ODG group. There were no significant differences in tumor size, retrieved lymph nodes, American Joint Cancer Committee /Union Internationale Contre le Cancer staging, and resection margins between the two groups. Obesity should not be seen as a contraindication for HALDG. HALDG for obese patients is a safe, feasible, and oncologically sound procedure and has advantages over ODG.

Safety and Efficacy of Laparoscopic Liver Resection for Colorectal Liver Metastasis With Obesity

2020 ◽  
pp. 000313482095244
Author(s):  
Yoshihiro Inoue ◽  
Masatsugu Ishii ◽  
Kensuke Fujii ◽  
Kentaro Nihei ◽  
Yusuke Suzuki ◽  
...  
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Laparoscopic Liver Resection ◽  
Operative Time ◽  
Surgical Site Infections ◽  
Obese Patients ◽  
Visceral Fat Area ◽  
Safety And Efficacy ◽  
Estimated Blood Loss ◽  
Significant Difference

Introduction Laparoscopic liver resection (LLR) in obese patients has been reported to be particularly challenging owing to technical difficulties and various comorbidities. Methods The safety and efficacy outcomes in 314 patients who underwent laparoscopic or open nonanatomical liver resection for colorectal liver metastases (CRLM) were analyzed retrospectively with respect to the patients’ body mass index (BMI) and visceral fat area (VFA). Results Two hundred and four patients underwent LLR, and 110 patients underwent open liver resection (OLR). The rate of conversion from LLR to OLR was 4.4%, with no significant difference between the BMI and VFA groups ( P = .647 and .136, respectively). In addition, there were no significant differences in terms of operative time and estimated blood loss in LLR ( P = .226 and .368; .772 and .489, respectively). The incidence of Clavien-Dindo grade IIIa or higher complications was not significantly different between the BMI and VFA groups of LLR ( P = .877 and .726, respectively). In obese patients, the operative time and estimated blood loss were significantly shorter and lower, respectively, in LLR than in OLR ( P = .003 and < .001; < .001 and < .001, respectively). There was a significant difference in the incidence of postoperative complications, organ/space surgical site infections, and postoperative bile leakage between the LLR and OLR groups ( P = .017, < .001, and < .001, respectively). Conclusion LLR for obese patients with CRLM can be performed safely using various surgical devices with no major difference in outcomes compared to those in nonobese patients. Moreover, LLR has better safety outcomes than OLR in obese patients.

Robotic and Laparoscopic Approaches for Adrenal Surgery in Obese Patients

2020 ◽  
pp. 000313482095149
Author(s):  
Hosam Shalaby ◽  
Mohamed Abdelgawad ◽  
Mahmoud Omar, MD ◽  
Ghassan Zora, MD ◽  
Saad Alawwad ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Operative Time ◽  
Laparoscopic Approach ◽  
Obese Patients ◽  
Adrenal Surgery ◽  
Robotic Approach ◽  
Robot Assisted ◽  
Operative Outcomes ◽  
Estimated Blood Loss

Objective Minimally invasive adrenalectomy is a challenging procedure in obese patients. Few recent studies have advocated against robot-assisted adrenalectomy, particularly in obese patients. This study aims to compare operative outcomes between the robotic and laparoscopic adrenalectomy, particularly in obese patients. Materials and Methods A retrospective analysis was performed on all consecutive patients undergoing adrenalectomy for benign disease by a single surgeon using either a laparoscopic or robotic approach. Adrenal surgeries for adrenal cancer were excluded. Demographics, operative time, length of hospital stays, estimated blood loss (EBL), and intraoperative and postoperative complications were evaluated. Patients were divided into 2 groups; obese and nonobese. A sub-analysis was performed comparing robotic and laparoscopic approaches in obese and nonobese patients. Results Out of 120, 55 (45.83%) were obese (body mass index ≥ 30 kg/m2). 14 (25.45%) of the obese patients underwent a laparoscopic approach, and 41 (74.55%) underwent a robotic approach. Operative times were longer in the obese vs. nonobese groups (173.30 ± 72.90 minutes and 148.20 ± 61.68 minutes, P = .04) and were associated with less EBL (53.77 ± 82.48 vs. 101.30 ± 122, P = .01). The robotic approach required a longer operative time when compared to the laparoscopic approach (187 ± 72.42 minutes vs. 126.60 ± 54.55 minutes, P = .0102) in the obese but was associated with less blood loss (29.02 ± 51.05 mL vs. 138.30 ± 112.20 mL, P < .01) and shorter hospital stay (1.73 ± 1.23 days vs. 3.17 ± 1.27 days, P < .001). Conclusion Robot-assisted adrenal surgery is safe in obese patients and appears to be longer; however, it provides improvements in postoperative outcomes, including EBL and shorter hospital stay.

scholarly journals Comparison of laparoscopic-assisted vaginal hysterectomy, total abdominal hysterectomy and vaginal hysterectomy: A four years retrospective study in tertiary care centre

2018 ◽  
Vol 7 (9) ◽  
pp. 3596
Author(s):  
Namrata Vasant Padvi ◽  
Jitendra Pundalik Ghumare
Keyword(s):  
Blood Loss ◽  
Vaginal Hysterectomy ◽  
Tertiary Care ◽  
Operating Time ◽  
Abdominal Hysterectomy ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Average Hospital ◽  
Intraoperative Complication ◽  
Estimated Blood Loss

Background: Hysterectomy is one of the commonest gynaecological operations performed in India. Traditional surgical treatments performed are abdominal hysterectomy and vaginal hysterectomy. Vaginal and laparoscopic procedures are considered “minimally invasive” surgical approaches because they do not require a large abdominal incision and, thus, typically are associated with shortened hospitalization and postoperative recovery times compared with open abdominal hysterectomy. With the aid of laparoscopic procedure, a potential abdominal hysterectomy can be converted to a vaginal one and a difficult vaginal hysterectomy can be converted into a fairly simple vaginal hysterectomy. Aim of the present study is to compare above methods of hysterectomy in terms of operating time, estimated blood loss, and postoperative hospital stay and complication, so as to provide best course of treatment to patient.Methods: A retrospective observational study was conducted in tertiary care centre. Four-year data was collected from January 2012 to December 2016. Cases of LAVH with benign gynaecological condition and up to 12 weeks size uterus, without any associated medical condition were selected in study randomly, and compare with cases of NDVH, TAH in terms of duration of operative procedure, blood loss during surgery, and postoperative hospital stay.Results: In present study we found that average duration of procedure in LAVH was 84.35 minute, which was maximum compare to other method. Estimated blood loss in LAVH was least as compare to NDVH and TAH it was maximum. The average hospital stays in LAVH and NDVH was less as compared to TAH.Conclusions: LAVH should be considered a better approach in view of the relatively less blood loss and intraoperative complication. Due to lack of large randomized controlled trials, the role of Laparoscopic hysterectomy is difficult to define.

scholarly journals Comparative Study of Iliac Bone Graft and Carbon Cage with Local Bone Graft in Posterior Lumbar Interbody Fusion

2002 ◽  
Vol 10 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Yasuhisa Arai ◽  
Masaki Takahashi ◽  
Hisashi Kurosawa ◽  
Katsuo Shitoto
Keyword(s):  
Blood Loss ◽  
Bone Graft ◽  
Operating Time ◽  
Iliac Bone ◽  
Carbon Cage ◽  
Operative Results ◽  
Local Bone ◽  
Estimated Blood Loss ◽  
Iliac Bone Graft ◽  
Cage Group

We performed a comparative study of iliac bone graft (the iliac bone group) and carbon cage with local bone graft (the cage group) in PLIF to evaluate the clinical results of both methods. We examined both groups about the operating time, the estimated blood loss, the operative results using the score rating system of Japanese Orthopaedic Association (JOA score), and the presence of bone union on radiography. The operating time and the estimated blood loss of the cage group were statistically less than those of the iliac bone group. There were no significant differences between both groups about the operative results. The radiographic evaluation on bone union showed that half of the iliac bone group had collapsed union, but all cases of the cage group revealed union without collapse.

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