scholarly journals Attending Surgeon Influences Operative Time More Than Resident Level in Laparoscopic Cholecystectomy

2022 ◽  
Vol 270 ◽  
pp. 564-570
Author(s):  
James E. Wiseman ◽  
Lilah F. Morris-Wiseman ◽  
Chiu-Hsieh Hsu ◽  
Taylor S. Riall
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Operative Time

scholarly journals Predictors of Incisional Hernia after Robotic Assisted Radical Prostatectomy

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Avinash Chennamsetty ◽  
Jason Hafron ◽  
Luke Edwards ◽  
Scott Pew ◽  
Behdod Poushanchi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Incisional Hernia ◽  
Operative Time ◽  
Patient Counseling ◽  
Incisional Hernias ◽  
Prostate Weight ◽  
History Of ◽  
Robotic Assisted Radical Prostatectomy

Introduction.To explore the long term incidence and predictors of incisional hernia in patients that had RARP.Methods.All patients who underwent RARP between 2003 and 2012 were mailed a survey reviewing hernia type, location, and repair.Results.Of 577 patients, 48 (8.3%) had a hernia at an incisional site (35 men had umbilical), diagnosed at (median) 1.2 years after RARP (mean follow-up of 5.05 years). No statistically significant differences were found in preoperative diabetes, smoking, pathological stage, age, intraoperative/postoperative complications, operative time, blood loss, BMI, and drain type between patients with and without incisional hernias. Incisional hernia patients had larger median prostate weight (45 versus 38 grams;P=0.001) and a higher proportion had prior laparoscopic cholecystectomy (12.5% (6/48) versus 4.6% (22/480);P=0.033). Overall, 4% (23/577) of patients underwent surgical repair of 24 incisional hernias, 22 umbilical and 2 other port site hernias.Conclusion.Incisional hernia is a known complication of RARP and may be associated with a larger prostate weight and history of prior laparoscopic cholecystectomy. There is concern about the underreporting of incisional hernia after RARP, as it is a complication often requiring surgical revision and is of significance for patient counseling before surgery.

scholarly journals Comparative study of standard laparoscopic cholecystectomy and single incision laparoscopic cholecystectomy: outcome and complications

2019 ◽  
Vol 7 (11) ◽  
pp. 4310
Author(s):  
Kirti Savyasacchi Goyal ◽  
Maneshwar Singh Utaal ◽  
Pramod Kumar Bhatia
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Operative Time ◽  
Gall Bladder Disease ◽  
Single Incision ◽  
Intraoperative Complications ◽  
Single Incision Laparoscopic Surgery ◽  
Bladder Disease ◽  
Standard Laparoscopic Cholecystectomy ◽  
Single Incision Laparoscopic Cholecystectomy

Background: Laparoscopic cholecystectomy (LC) has evolved to be as gold standard treatment for gall bladder disease and is the most common laparoscopic procedure performed worldwide. In recent times, the innovative techniques of Natural orifice Transluminal Endoscopic Surgery (NOTES) and Single Incision Laparoscopic Surgery (SILS) have been applied as a step forward towards scar less surgery with added benefits of less pain and less analgesic requirement, shorter hospital stay, quick return to work.Methods: A retrospective study of 50 patients admitted with gall bladder disease through outdoor for laparoscopic cholecystectomy from November 2018 to January 2019 in Maharishi Markandeshwar Institute of Medical Sciences and Research Mullana (AMBALA) were randomized into two groups of  25 each for Single Incision Laparoscopic Cholecystectomy (SILC) and standard laparoscopic cholecystectomy (LC) comparing the operative time, outcome and  complications.Results: 50 patients admitted to MMIMSR Mullana from November 2018 to January 2019 with gall bladder disease were divided into two groups of 25 each who underwent three port SILC and four port laparoscopic cholecystectomy (4PLC). The average intra-operative time in SILC (80.56 mins) was significantly more than standard laparoscopic cholecystectomy. The average length of stay in the hospital for SILC was 1.8 days (1-3 days), was significantly less than in standard four port laparoscopic cholecystectomy. Incidence of Intraoperative complications were more in SILC than standard LC.Conclusions: SILC as the newer novel technique had better outcomes in terms of cosmesis, early discharge, shorter stay at hospital.

Segment IV Approach is Useful for Whole-Layer Laparoscopic Cholecystectomy for Gallbladder Polyps

2021 ◽  
Author(s):  
Yoshiaki Tanji ◽  
Shuichi Fujioka ◽  
Hironori Shiozaki ◽  
Yuki Takano ◽  
Naoto Takahashi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Operative Time ◽  
Malignant Neoplasms ◽  
Pathological Findings ◽  
Gallbladder Polyps ◽  
Cystic Plate ◽  
Potentially Malignant ◽  
Proof Procedure ◽  
Median Operative Time

Abstract Background Whole-layer laparoscopic cholecystectomy (W-LC) has recently been advocated as a total biopsy for potentially malignant neoplasms of the gallbladder; however, it is not an injury-proof procedure. This study reports W-LC using the segment IV approach (technique for securing the whole-layer gallbladder at the medial origin of the cystic plate).MethodsTwenty among twenty-five patients diagnosed with potentially malignant gallbladder polyps underwent this technique.ResultsMostly, W-LC was performed successfully (median operative time 135 min) without intraoperative and postoperative complications. Pathological findings indicated that cholesteric polyps was the most common type (n=13), followed by adenomatous polyps (25%) and carcinoma in situ (5%).ConclusionsWe conclude that the segment IV approach is appropriate for performing total biopsy in patients diagnosed with potentially malignant gallbladder polyps.

Prolonged (Longer than 3 Hours) Laparoscopic Cholecystectomy: Reasons and Results

2011 ◽  
Vol 77 (8) ◽  
pp. 981-984 ◽  
Author(s):  
Gokulakkrishna Subhas ◽  
Aditya Gupta ◽  
Jasneet Bhullar ◽  
Linda Dubay ◽  
Lorenzo Ferguson ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Operative Time ◽  
Intraoperative Complications ◽  
Open Cholecystectomy ◽  
Stepwise Logistic Regression ◽  
Intraabdominal Adhesions ◽  
Average Operative Time ◽  
Prolonged Surgery

For the experienced surgeon, the average operative time for a laparoscopic cholecystectomy is less than 1 hour. There has been no study documenting the causes and results of prolonged (longer than 3 hours) surgery. A retrospective study was done of patients who underwent cholecystectomy between January 2003 and December 2007. A total of 3126 cholecystectomies were done. After excluding patients who had a planned open cholecystectomy and patients who had additional laparoscopic surgeries, we identified 70 patients who had a planned laparoscopic cholecystectomy with operative time exceeding 3 hours. Multivariate stepwise logistic regression was performed analyzing the various factors leading to prolonged surgery. Of the 70 patients, ranging in age from 21 to 92 years (mean, 57 years), most (n = 53) were female. Operative time ranged from 3 hours to 6 hours 40 minutes (mean, 3 hours 37 minutes). Emergency:elective admission ratio was 9:5 and acute cholecystitis (n = 40) was the most common indication. Common characteristics were obesity (n = 44, P = 0.031), intraabdominal adhesions (n = 43, P = 0.004), and previous abdominal surgeries (n = 40, P = 0.002). Intraoperative complications included spillage of stones (n = 6), bile duct injury (n = 3), and bleeding (n = 3). The possibility of prolonged laparoscopic cholecystectomy should be anticipated in patients with obesity and previous abdominal operations. Prolonged surgery increases the risk of complications (bile duct injury, bleeding) and prolongs the postoperative hospital stay.

Early Laparoscopic Cholecystectomy Is the Appropriate Management for Acute Gangrenous Cholecystitis

2011 ◽  
Vol 77 (4) ◽  
pp. 401-406 ◽  
Author(s):  
Sae Byeol Choi ◽  
Hyung Joon Han ◽  
Chung Yun Kim ◽  
Wan Bae Kim ◽  
Tae-Jin Song ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Operative Time ◽  
Early Operation ◽  
Duration Of Symptoms ◽  
Early Laparoscopic Cholecystectomy ◽  
Gangrenous Cholecystitis ◽  
Total Hospital Stay ◽  
Urgent Operation ◽  
Operation Group

Treatment of severe acute cholecystitis by laparoscopic cholecystectomy remains controversial because of technical difficulties and high rates of complications. We determined whether early laparoscopic cholecystectomy is appropriate for acute gangrenous cholecystitis. The medical records of 116 patients with acute gangrenous cholecystitis admitted to the Korea University Guro Hospital between January 2005 and December 2009 were reviewed. The early operation group, those patients who had cholecystectomies within 4 days of the diagnosis, was compared with the delayed operation group, who had cholecystectomies 4 days after the diagnosis. Of the 116 patients, 57 were in the early operation group and 59 were in the delayed operation group. There were no statistical differences between the groups with respect to gender, age, body mass index, operative methods, major complications, duration of symptoms, mean operative time (98 vs 107 minutes), or postoperative hospital stay. However, the total hospital stay was significantly longer in the delayed operation group. More patients underwent preoperative percutaneous cholecystostomy in the delayed operation group (3.5 vs 15.3%). Early laparoscopic cholecystectomy for acute gangrenous cholecystitis is safe and feasible. There is no advantage to postponing an urgent operation in patients with acute gangrenous cholecystitis.

Comparison of Single-Incision Laparoscopic Cholecystectomy versus Needlescopic Cholecystectomy: A Single Institutional Randomized Clinical Trial

2018 ◽  
Vol 36 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Akira Umemura ◽  
Takayuki Suto ◽  
Seika Nakamura ◽  
Hisataka Fujiwara ◽  
Fumitaka Endo ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Laparoscopic Cholecystectomy ◽  
Operative Time ◽  
Single Incision ◽  
Cosmetic Outcome ◽  
Needlescopic Cholecystectomy ◽  
Single Incision Laparoscopic Cholecystectomy ◽  
Vas Scores ◽  
The Mean ◽  
Incisional Pain

Background: Both single-incision laparoscopic cholecystectomy (SILC) and needlescopic cholecystectomy (NSC) are superior to conventional laparoscopic cholecystectomy in terms of cosmetic outcome and incisional pain. We conducted a prospective, randomized clinical trial to evaluate the surgical outcome, postoperative pain, and cosmetic outcome for SILC and NSC procedures. Methods: In this trial, 105 patients were enrolled (52 in the SILC group; 53 in the NSC group). A visual analogue scale (VAS) was used to evaluate the cosmetic outcome and incisional pain for patients. Logistic regression analyses were used to evaluate the operative difficulty that was present for both procedures. Results: There were no significant differences in patient characteristics or surgical outcomes, including operative time and blood loss. The mean VAS scores for cosmetic satisfaction were similar in both groups. There were significant differences in the mean VAS scores for incisional pain on postoperative day 1 (p = 0.009), and analgesics were required within 12 h of surgery (p = 0.007). Obesity (body mass index ≥25 kg/m2) was the only significant influential factor for operating time over 100 min (p = 0.031). Conclusion: NSC is superior to SILC in terms of short-term incisional pain. Experienced laparoscopic surgeons can perform both SILC and NSC without an increase in operative time.

See One, Do One, Teach Many: The Importance of Resident Seniority on Operative Time in Laparoscopic Cholecystectomy

2014 ◽  
Vol 219 (3) ◽  
pp. S118
Author(s):  
Edward Gifford ◽  
Andrew Nguyen ◽  
Dennis Y. Kim ◽  
Amy H. Kaji ◽  
Virginia Nguyen ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Operative Time

scholarly journals Laparoscopic antegrade cholecystectomy: a standard procedure?

Open Medicine ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. 429-432 ◽  
Author(s):  
Nicola Tartaglia ◽  
Pasquale Cianci ◽  
Alessandra Di Lascia ◽  
Alberto Fersini ◽  
Antonio Ambrosi ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Operative Time ◽  
Standard Procedure ◽  
Operative Procedure ◽  
Retrograde Approach ◽  
Calot’S Triangle ◽  
Bile Duct Injuries ◽  
Visceral Peritoneum ◽  
Average Operative Time

AbstractRetrograde approach (“fundus first”) is often used in open surgery, while in laparoscopic cholecystectomy (LC) is less frequent. LC, with antegrade access, is done by putting in traction the infundibulum and going up to the fundus before to clip the cystic. Our study analyzes a number of surgical procedures performed by experienced surgeons in laparoscopy.From 2002 to 2015, 1740 laparoscopic cholecystectomies were performed at our Institution. The operative procedure performed since 2002 consists of the incision of the visceral peritoneum from the infundibulum away from Calot’s triangle along the gallbladder bed up to the fundus. Then it continues from the fundus up to the infundibulum.Results: There were no bile duct injuries. Average operative time was 40 min. 22 conversions to an open procedure (1.3%) occurred, in cases of acute cholecystitis and cirrhotic patient. Postoperative stay was mean 2 days with no delayed sequelae on follow up.Conclusions: gallbladder antegrade dissection for laparoscopic cholecystectomy can reduce the time of surgery and is an easier technique to perform. Therefore, it can be proposed as the standard procedure and not only be used for difficult cholecystectomies.

scholarly journals Laparoscopic cholecystectomy: a prospective cohort study assessing the impact of grade of operating surgeon on operative time and 30-day morbidity

2018 ◽  
Vol 100 (3) ◽  
pp. 178-184 ◽  
Author(s):  
H Tafazal ◽  
P Spreadborough ◽  
D Zakai ◽  
N Shastri-Hurst ◽  
S Ayaani ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Cohort Study ◽  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Operative Time ◽  
Gallstone Disease ◽  
Surgical Trainees ◽  
The Impact

Introduction There is an increasing trend towards day case surgery for uncomplicated gallstone disease. The challenges of maximising training opportunities are well recognised by surgical trainees and the need to demonstrate timely progression of competencies is essential. Laparoscopic cholecystectomy provides the potential for excellent trainee learning opportunities. Our study builds upon previous work by assessing whether measures of outcome are still affected when cases are stratified based on procedural difficulty. Material and methods A prospective cohort study of all laparoscopic cholecystectomies conducted at a district general hospital between 2009 and 2014, performed under the care of a single consultant. The operative difficulty was determined using the Cuschieri classification. The primary endpoint was duration of operation. Secondary endpoints included length of hospital stay, delayed discharge rate and 30-day morbidity. Results A total of 266 laparoscopic cholecystectomies were performed during the study period. Mean operative time for all consultant-led cases was 52.5 minutes compared with 51.4 minutes for trainees (P = 0.67 unpaired t-test). When cases were stratified for difficulty, consultant-led cases were on average 5 minutes faster. Median duration of hospital stay was equivalent in both groups and there was no statistical difference in re-attendance (12.9% vs. 15.3% P = 0.59) or re-admission rates (3.2% vs. 8.1% P = 0.10) at 30 days. Conclusions Our study provides evidence that laparoscopic cholecystectomy provides a good training opportunity for surgical trainees without being detrimental to patient outcome. We recommend that, in selected patients, under consultant supervision, laparoscopic cholecystectomy can be performed primarily by the surgical trainee without impacting on patient outcome or theatre scheduling.

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