scholarly journals Laparoendoscopic single-site nephrectomy versus conventional laparoendoscopic nephrectomy for kidney tumor: a systematic review and meta-analysis

2019 ◽  
Vol 39 (8) ◽  
Author(s):  
Dengyuan Feng ◽  
Rong Cong ◽  
Hong Cheng ◽  
Yi Wang ◽  
Jiajun Zhou ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Meta Analysis ◽  
Intraoperative Complications ◽  
Operation Time ◽  
Single Site ◽  
Cochrane Library ◽  
Kidney Tumor ◽  
Analgesic Requirement ◽  
Laparoendoscopic Single Site ◽  
Estimated Blood Loss

Abstract With the increasing application of laparoendoscopic single-site nephrectomy (LESS-N) in kidney tumor, accumulating studies compared it with conventional laparoendoscopic nephrectomy (CL-N). However, controversial outcomes were reported. Hence, this meta-analysis was carried out to clarify these issues. Online databases PubMed, EMBASE and the Cochrane Library were searched comprehensively for eligible studies published before 24 July 2018. Odds ratios (ORs) or standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were collected for evaluating the pooled results of relevant outcomes. Ultimately, 13 eligible articles were enrolled. Meanwhile, compared with CL-N, LESS-N was related to a longer operation time (SMD: 0.40; 95% CI, 0.23–0.58; P=0.000), a shorter length of hospital stay (LOS) (SMD: −0.32; 95% CI, −0.62 to −0.02; P=0.034), a lower visual analog scale (VAS) score (SMD: −0.89; 95% CI, −1.22 to −0.56; P=0.000) and a lower analgesic requirement (SMD: −0.55; 95% CI, −0.87 to −0.23; P=0.001). There was no statistical difference in the postoperative day of oral intake, estimated blood loss (EBL), conversion rate, perioperative complications, intraoperative complications, postoperative complications, minor complications and major complications between LESS-N and CL-N. Patients with LESS-N for kidney tumor could have a longer operation time and shorter LOS, and meanwhile could need less analgesics and suffer less pain after LESS-N.

scholarly journals Laparoendoscopic single-site surgery compared with conventional laparoscopic surgery for benign ovarian masses: a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e032331
Author(s):  
Yun Lin ◽  
Mubiao Liu ◽  
Haiyan Ye ◽  
Jianhui He ◽  
Jianguo Chen
Keyword(s):  
Retrospective Studies ◽  
Perioperative Complications ◽  
Meta Analysis ◽  
Single Site ◽  
Systemic Review ◽  
Conventional Laparoscopic ◽  
Laparoendoscopic Single Site ◽  
Laparoendoscopic Single Site Surgery ◽  
Ovarian Masses ◽  
Single Site Surgery

ObjectiveWe aimed to evaluate the safety, efficiency and preferred indication for laparoendoscopic single-site surgery (LESS) compared with conventional laparoscopic (CL) surgery for benign ovarian masses.DesignA systemic review and cumulative meta-analysis were performed in line with the criteria of Grading of Recommendations Assessment, Development and Evaluation: levels of evidence and grades of recommendation.Data sourcesWe comprehensively searched the electronic databases including PubMed, Medline, Embase and the Cochrane Library in November 2018.Eligibility criteria for selecting studiesWe included all randomised controlled trials (RCTs) and retrospective studies published in recent 10 years, which investigated the performance of LESS versus CL in patients at all ages with benign ovarian masses.ResultsFour RCTs and nine retrospective studies published in recent decade including 1542 cases (744 cases for LESS and 798 cases for CL) were identified. Perioperative complication was consisted of intraoperative and postoperative complications, including ileus, wound infection or dehiscence and incisional hernia. Although LESS has less postoperative analgesic consumption (46.78% and 79.25%; OR: 0.49; 95% CI: 0.33 to 0.74, p<0.001) and shorter hospital stay (weighted mean difference (WMD): −0.24 days; 95% CI: −0.35 to −0.14; p<0.001), CL has less perioperative complications (6.59% and 2.85%; OR: 2.08; 95% CI: 1.05 to 4.11, p=0.04) and shorter operative time (WMD: 3.43 min; 95% CI: −0.03 to 6.88; p=0.05). Body mass index, history of previous abdominal surgery, size of adnexal mass, estimated blood loss and postoperative pain scores did not differ significantly between two techniques.ConclusionsThe indications of LESS for benign ovarian masses are similar to CL and it has better postoperative recovery. However, with less perioperative complications, CL surgery is safer than LESS.

scholarly journals Surgical Outcomes of Transperitoneal Para-Aortic Lymphadenectomy Compared With Extraperitoneal Approach in Gynecologic Cancers: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Kun-peng Li ◽  
Xian-zhong Deng ◽  
Tao Wu
Keyword(s):  
Surgical Outcomes ◽  
Operative Time ◽  
Meta Analysis ◽  
Intraoperative Complications ◽  
Current Evidence ◽  
Perioperative Outcomes ◽  
Cochrane Library ◽  
Gynecologic Cancers ◽  
Estimated Blood Loss ◽  
Clavien Grade

Purpose: The optimal surgical approach for para-aortic lymphadenectomy (PALND) in gynecologic cancers using minimally invasive surgery (laparoscopy or robotic-assisted) is controversial. This study summarizes the current evidence on the extraperitoneal (EP) approach and compares its perioperative, surgical outcomes, and complications to the transperitoneal (TP) approach in an updated meta-analysis.Methods: We performed a systematic search in PubMed, Embase, Web of Science, Cochrane Library database for randomized controlled trials (RCTs) and non-RCTs that compare EP to TP for PALND. The main outcomes included surgical, perioperative outcomes, and complications. The weighted mean difference (WMD) and odds ratio (OR) were applied for the comparison of continuous and dichotomous variables with 95% CIs. Three RCTs and 10 non-RCTs trials, including 2,354 patients were identified and enrolled in the meta-analysis.Results: A total of three RCTs and ten non-RCTs trials, including 2,354 patients were identified and enrolled in the meta-analysis. We reported similar results for EP and TP in terms of the hospital stay, estimated blood loss, blood transfusion, conversion to laparotomy, total operative time, and postoperative complications (Clavien grade ≥ 1 and Clavien grade ≥ 3). However, the PALND operative time (WMD −10.46 min, 95% CI −19.04, −1.88; p = 0.02) and intraoperative complications (OR 0.40, 95% CI 0.23, 0.69; p = 0.001) were less with EP. Also, more nodes were removed in EP compared with the TP (WMD 1.45, 95% CI 0.05, 2.86; p = 0.04).Conclusions: The EP approach did not show differences regarding surgical and perioperative parameters compared with the TP approach. However, the number of aortic nodes retrieved was higher. Furthermore, The PALND operative time and intraoperative complications were less in EP.

scholarly journals Comparison of Transperitoneal and Retroperitoneal Laparoendoscopic Single-site Donor Nephrectomy

2020 ◽  
Author(s):  
Chung-Yu Lin ◽  
Ching-Chia Li ◽  
Hung-Lung Ke ◽  
Wen-Jeng Wu ◽  
Yii-Her Chou ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Operation Time ◽  
Warm Ischemia ◽  
Donor Nephrectomy ◽  
Warm Ischemia Time ◽  
Single Site ◽  
Perioperative Outcomes ◽  
Ischemia Time ◽  
Laparoendoscopic Single Site

Abstract Background: Laparoscopic living-donor nephrectomy is the standard technique at high-volume renal transplant centers. Laparoendoscopic single-site donor nephrectomy (LESS-DN) is a relatively novel minimally invasive surgery, which was differed to transperitoneal and retroperitoneal approaches. We present a retrospective analysis of our single-institution donor nephrectomy series comparing the transperitoneal to retroperitoneal LESS-DN with regards to operative outcomes.Materials and Methods: Ten patients who underwent LESS-DN from 2017–2019 were enrolled at our center. The same surgeon performed all cases. The two approaches were compared retrospectively and evaluated for differences in perioperative outcomes, including operation time, console time, blood loss, graft warm ischemia time, postoperative pain, length of stay (LOS), wound size, postoperative pain, and renal function post LESS-DN at less than one year.Results: Total operating time (315 ± 82.69 vs. 191 ± 24.9 min, p = 0.016), console time (224 ± 74.15 vs. 110 ± 19.84 min, p = 0.016), and LOS (8.4 ± 1.82 vs. 4.8 ± 1.10 days, p = 0.013) were significantly longer in the transperitoneal group. The wound size (44 ± 3.81 vs. 68.2 ± 13.5 mm, p = 0.038) was significantly smaller in the transperitoneal group. There was no significant difference in other parameters, including blood loss, warm ischemia time, and postoperative pain from day one to day three.Conclusions: Retroperitoneal LESS-DN results in similar perioperative outcomes as transperitoneal LESS-DN without compromising donor safety, and while providing a faster operation time, console time, shorter LOS, and a trend toward a shorter warm ischemia time.

scholarly journals Comparison of a new gasless method and the conventional CO2 pneumoperitoneum method in laparoendoscopic single-site cholecystectomy: a prospective randomized clinical trial

2021 ◽  
Author(s):  
Min Jiang ◽  
Gang Zhao ◽  
Anhua Huang ◽  
Kai Zhang ◽  
Bo Wang ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Side Effects ◽  
Operation Time ◽  
Tracheal Extubation ◽  
Single Site ◽  
Hemodynamic Parameters ◽  
Laparoendoscopic Single Site ◽  
Laparoscopic Operation ◽  
Extubation Time ◽  
Laparoendoscopic Single Site Surgery

AbstractTo avoid CO2 pneumoperitoneum-associated cardiopulmonary side-effects during conventional laparoscopic surgeries, we have developed a gasless laparoscopic operation field formation (LOFF) device for laparoendoscopic single-site surgery. The aim of this study is to analyze the safety and efficacy of the LOFF device for laparoendoscopic single-site cholecystectomy and to verify its advantage of avoiding CO2 pneumoperitoneum-associated complications. In this prospective, randomized, observer-blinded clinical trial, eligible participants were randomized in a 1:1 ratio to undergo either conventional CO2 pneumoperitoneum assisted laparoendoscopic single-site cholecystectomy (LESS) or the new gasless LOFF device assisted laparoendoscopic single-site cholecystectomy (LOFF-LESS). Outcomes including intra-operative respiratory and hemodynamic parameters, operation time, conversion rate, complication rate, et al were compared between the two groups. A total of 100 patients were randomized to the LESS group [n = 50; mean (SD) age, 49.5 (13.9) years; 24 (48.0%) women] and the LOFF-LESS group [n = 50, mean (SD) age, 47.4 (13.3) years; 27 (54.0%) women]. Compared with the LOFF-LESS group, the LESS group witnessed significant fluctuations in intra-operative respiratory and hemodynamic parameters. The tracheal extubation time of the LESS group was significantly longer (P = 0.001). The gasless LOFF device is safe and feasible for simple laparoscopic cholecystectomy and has a predominance of avoiding CO2 pneumoperitoneum-associated cardiopulmonary side-effects. Trial registration number: ChiCTR2000033702 Graphic abstract

scholarly journals Comparison of Retzius-Sparing Robot-Assisted Radical Prostatectomy vs. Conventional Robot-Assisted Radical Prostatectomy: An Up-to-Date Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiang-Nan Xu ◽  
Zhen-Yu Xu ◽  
Hu-Ming Yin
Keyword(s):  
Radical Prostatectomy ◽  
Lower Incidence ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Urinary Continence ◽  
Robot Assisted ◽  
Postoperative Continence ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Anterior Prostate

Background: The Retzius space-sparing robot-assisted radical prostatectomy (RS-RARP) has shown better results in urinary continence, but its efficacy and safety compared to conventional robot-assisted radical prostatectomy (c-RARP) remain controversial.Material and Methods: A research was conducted in Medline via PubMed, Cochrane Library, EMBASE, and Web of Science up to January 4, 2021, to identify studies comparing RS-RARP to c-RARP. We used RevMan 5.3 and STATA 14.0 for meta-analysis.Results: A total of 14 studies involving 3,129 participants were included. Meta-analysis showed no significant difference in positive surgical margins (PSMs), but the RS-RARP group had significantly higher PSM rates in the anterior site [odds ratio (OR) = 2.25, 95% CI: 1.22–4.16, P = 0.01]. Postoperative continence in RS-RARP group at 1 month (OR = 5.72, 95% CI: 3.56–9.19, P &lt; 0.01), 3 months (OR = 6.44, 95% CI: 4.50–9.22, P &lt; 0.01), 6 months (OR = 8.68, 95% CI: 4.01–18.82, P &lt; 0.01), and 12 months (OR = 2.37, 95% CI: 1.20–4.70, P = 0.01) was significantly better than that in the c-RARP group. In addition, the RS-RARP group had a shorter console time (mean difference = −16.28, 95% CI: −27.04 to −5.53, P = 0.003) and a lower incidence of hernia (OR = 0.35, 95% CI: 0.19–0.67, P = 0.001). However, there were no significant differences in estimated blood loss, pelvic lymph node dissection rate, postoperative complications, 1-year-biochemical recurrence rate, and postoperative sexual function.Conclusions: Compared with c-RARP, RS-RARP showed better recovery of continence, shorter console time, and lower incidence of hernia. Although there was no significant difference in overall PSM, we suggest that the surgeon should be more careful if the lesion is in the anterior prostate.

Morbidity Associated with Diverting Loop Ileostomies: Weighing Diversion in Rectosigmoid Resection

2017 ◽  
Vol 83 (7) ◽  
pp. 786-792
Author(s):  
Nathan Belkin ◽  
Liliana G. Bordeianou ◽  
Paul C. Shellito ◽  
Alexander T. Hawkins
Keyword(s):  
Adjuvant Chemotherapy ◽  
Postoperative Complications ◽  
Anterior Resection ◽  
Massachusetts General Hospital ◽  
Perioperative Complications ◽  
Primary Anastomosis ◽  
Operation Time ◽  
Emergency Department Visits ◽  
Rectosigmoid Resection ◽  
Estimated Blood Loss

Anterior resection with primary anastomosis is the procedure of choice for patients with rectosigmoid cancers with good sphincter function. Surgeons may perform an associated diverting loop ileostomy (DLI) to minimize the likelihood and/or the severity of an anastomotic leak. To examine the morbidity of DLIs, we performed a review of a prospectively maintained database. Participants included all patients at the Massachusetts General Hospital who underwent anterior resection from January 2013 to July 2015 for rectosigmoid cancers and who subsequently underwent adjuvant chemotherapy. The primary outcome was time to start of adjuvant chemotherapy. Secondary outcomes included length of hospitalization, perioperative complications, and 60-day postoperative complications. Inclusion criteria were met in 57 patients and DLI was performed in 21 (37%). The DLI group had higher estimated blood loss (431.7 vs 192.1 mL, P = 0.03) and a longer operation time (3.7 vs 2.3 hours, P = 0.0007). The DLI group took over a week longer to start adjuvant chemotherapy than the non-DLI group (median time to chemo: 43 vs 34 days, P = 0.002). Postoperatively, DLI was associated with a longer hospitalization (6.7 vs 3.1 days, P = 0.0003), more perioperative complications (57.1% vs 13.9%, P = 0.0006), and more 60-day read-missions or emergency department visits (38.1% vs 5.6%, P = 0.002). Ostomies are associated with appreciable morbidity. In turn, they do not eliminate postoperative complications. Surgeons should closely consider ostomy morbidity in rectosigmoid resection and institute a proactive approach toward identification and prevention of complications.

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