scholarly journals Continuously sutured versus linear-stapled anastomosis in 76 robotic-assisted Ivor Lewis esophagectomies

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
K J Neuschütz ◽  
L Fourie ◽  
R Schneider ◽  
M Bolli ◽  
M von Flüe ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Perioperative Outcomes ◽  
Morbidity Rate ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Anastomotic Insufficiency ◽  
Duration Of Hospitalization ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Anastomotic Techniques

Abstract Objective We introduced robotic-assisted Ivor Lewis esophagectomies (rob-E) using the da Vinci Xi in Oct. 2015. Two anastomotic techniques have been performed – continuously sutured (COSU) and linear-stapled (LIST). Aim of this study is to evaluate the two anastomotic techniques regarding perioperative outcomes in our experience. Methods Retrospective analysis of prospectively collected data between Oct. 2015 and Dec. 2020 including 76 patients. 45 underwent COSU and 31 LIST. Techniques are demonstrated with video material. Minor (Clavien-Dindo < = 3a) and major (Clavien-Dindo > = 3b) morbidity, rate of anastomotic insufficiency, mortality, and duration of hospitalization were compared. Results Patient characteristics were as follows: median age of 69 (35-83) years in COSU and 70 (36-83) years in LIST (p = 0.575), male gender in 84.4% of COSU and 83.9% of LIST (p = 1.000), and physical status with American Society of Anesthesiologists score 3 in 62.2% of COSU and 67.7% of LIST (p = 0.771). Concerning tumor characteristics there were 91.1% adenocarcinomas in COSU and 96.8% in LIST (p = 0.642), whereas the others were squamous cell carcinomas and one neuroendocrine tumor in COSU. The tumors were stage II in 22.2% respectively 32.3% and stage III in 57.8% respectively 48.4% of COSU and LIST (p = 0.555). Comparison of minor morbidity occurring in 60.0% of COSU and 54.8% of LIST (p = 0.813), major morbidity in 8.9% respectively 16.1% (p = 0.473), incidence of anastomotic insufficiency in 8.9% of COSU and 6.5% of LIST (p = 1.000), rate of surgical reintervention necessary in 2.2% respectively 9.7% (p = 0.298) as well as mortality of 2.2% in COSU and 3.2% in LIST (p = 1.000) showed no difference. Median duration of hospitalization of 20 (13-49) days in COSU and 20 (14-62) in LIST (p = 0.423) did not differ. Conclusion In rob-E COSU and LIST show comparable results and a preferable technique cannot be determined yet. Our results do not support the results of previous reports (Cerfolio et al.) that demonstrated a superiority of LIST. While stapling the backside of the anastomosis in LIST impresses as an elegant way to overcome the surgical demanding part of the anastomosis, other disadvantages such as compromising perfusion of the gastric conduit may prevail and limit the benefits. Further studies with a larger cohort are planned in order to draw more decisive conclusions.

scholarly journals Comparison of robotic-assisted and open Ivor Lewis esophagectomies in 321 patients of a single center: A case-matched analysis

2021 ◽  
Vol 108 (Supplement_4) ◽  
Author(s):  
K J Neuschütz ◽  
L Fourie ◽  
S Däster ◽  
M Bolli ◽  
M von Flüe ◽  
...  
Keyword(s):  
Neoadjuvant Treatment ◽  
Tumor Stage ◽  
Tumor Location ◽  
Perioperative Outcomes ◽  
Ivor Lewis ◽  
Major Morbidity ◽  
Robotic Assisted ◽  
Perioperative Morbidity ◽  
Anastomotic Insufficiency ◽  
Asa Score

Abstract Objective We introduced robotic-assisted Ivor Lewis esophagectomies (rob-E) using the da Vinci Xi in Oct. 2015. Prior to that, esophagectomies were performed as open Ivor Lewis (open-E) procedures. Aim of this study is to evaluate the safety of rob-E in comparison to open-E procedures regarding perioperative outcomes. Methods Retrospective analysis of prospectively collected data between Feb. 1999 and Dec. 2020. A case-matched analysis, matching open-E to rob-E in a 1:1 manner, was conducted. Cases were matched regarding age, gender, American Society of Anesthesiologists (ASA) score, histological type of tumor, tumor location and stage. Results In the study period 321 patients underwent an esophagectomy. 76 received rob-E and 245 open-E. After matching the cases the comparison of preoperative patient and tumor characteristics revealed no differences between the rob-E and open-E group regarding age at time of operation with a median of 69.5 (35-83) respectively 70 (46-88) years (p = 0.900), gender with 84.2% male in both groups (p = 1.000), ASA score with 68.4% ASA 3 or 4 in both groups (p = 1.000), percentage of tumor stage III of 53.9% respectively 57.9% (p = 0.707), and rate of neoadjuvant treatment of 82.9% in rob-E and 81.6% in open-E (p = 1.000). Conversion from rob-E to open-E was never necessary. For rob-E versus open-E no difference was found regarding overall morbidity with 69.7% versus 60.5% (p = 0.307), major morbidity (Clavien-Dindo > = 3b) with 11.8% versus 14.5% (p = 0.811), incidence of anastomotic insufficiency with 7.9% versus 5.3% (p = 0.745), rate of surgical reintervention with 5.3% versus 7.9% (p = 0.745), and mortality with 2.6% versus 3.9% (p = 1.000). Postoperative details showed no difference including a similar duration of hospitalization with a median of 20 (13-62) respectively 18.5 (13-52) days (p = 0.368) and number of harvested lymph nodes with a median of 24.5 (7-59) in rob-E and 23 (2-64) in open-E (p = 0.203). Conclusion The introduction of rob-E in our institution was safe, as perioperative morbidity and mortality did not differ from the previously performed open-E. Overall, the incidence of major morbidity and anastomotic insufficiency in rob-E and open-E show a satisfactory rate compared to previous reports in literature. Further studies with a larger cohort of rob-E are planned in order to draw more decisive conclusions.

Robotic Minor hepatectomy offers a Favorable Learning Curve and May Result in Superior Perioperative Outcomes Compared with Laparoscopic Approach

2017 ◽  
Vol 83 (10) ◽  
pp. 1085-1088 ◽  
Author(s):  
Victoriav O'Connor ◽  
Brooke Vuong ◽  
Su-Tau Yang ◽  
Andrew Difronzo
Keyword(s):  
Complication Rate ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Perioperative Outcomes ◽  
Robotic Assisted ◽  
Estimated Blood Loss ◽  
Specimen Volume ◽  
Grade 3 ◽  
American Society ◽  
American Society Of Anesthesiologists

Minorhepatectomy (MH) is a common type of robotic-assisted liver resection, but few studies compared it with laparoscopic. We compared the perioperative outcomes of patients who underwent robotic (RH) or laparoscopic (LH) minor hepatectomy and evaluated the effect of surgeon's experience on outcomes. A prospective database was used to identify patients from 2009 through 2016 who underwent RH or LH. Two surgeons performed RH starting in 2014, whereas LH had been established before that. Of the 93 patients, 42 were in RH and 51 in LH group. The mean patient age, gender, race, American Society of Anesthesiologists score, proportion of patients with cirrhosis and hepatocellular carcinoma were similar. Operative time, estimated blood loss (EBL), conversion to open, 30-day complication rate, Clavien–Dindo grade ≥ 3 complications, and length of hospital stay (LOS) were similar. There was no difference in average tumor size, specimen volume, or achievement of R0 margin. In RH group, after completing 15 cases, there were no conversions to open. After 25 cases, EBL, LOS, and 30-day complication rate were improved as compared with LH. Perioperative outcomes of robotic MH are equivalent to laparoscopic. After approximately 25 cases, robotic-assisted MH may result in superior outcomes compared with laparoscopic.

scholarly journals Performance Improvement System and Postoperative Corneal Injuries

2009 ◽  
Vol 111 (2) ◽  
pp. 320-326 ◽  
Author(s):  
David P. Martin ◽  
Toby N. Weingarten ◽  
Paul W. Gunn ◽  
KunMoo Lee ◽  
Michael A. Mahr ◽  
...  
Keyword(s):  
Risk Factors ◽  
Performance Improvement ◽  
Odds Ratio ◽  
Injury Rate ◽  
Student Nurse ◽  
Perioperative Outcomes ◽  
Physical Status ◽  
Corneal Injury ◽  
American Society ◽  
American Society Of Anesthesiologists

Background The authors' department conducted a performance improvement initiative aimed to reduce the rate of perioperative corneal injuries. This study reports the effects of the initiative and examines the risk factors for corneal injury. Method The rate of corneal injuries during nonophthalmologic procedures under anesthesia was compared between the two time periods: preinitiative baseline (August 1, 2005-December 31, 2005) and initiative period (January 1, 2006-April 30, 2007). To examine the risk factors for corneal injury, a nested case-control study with a 2:1 matched-set design was separately performed and included cases between January 1, 2006 and July 31, 2008. Results During the baseline period, the corneal injury rate was 1.51 per 1,000, and it decreased to 0.79 per 1,000 during the performance initiative (P = 0.008). Independent risk factors were longer anesthetics (odds ratio = 1.2, 95% confidence interval (CI) 1.1-1.3 per 30 min), lower American Society of Anesthesiologists physical status (odds ratio 0.5, 95% CI 0.3-0.8 for American Society of Anesthesiologists physical status 3-4 vs. 1-2), and student nurse anesthetist as a primary anesthesia provider (odds ratio 2.6, 95% CI 1.3-5.0). Conclusion Corneal injury rate in our institution was significantly reduced and remains at low levels long after initiation of perioperative eye care improvement initiative. The higher rate of corneal injuries among student nurse anesthetists highlights the importance of standardizing education and supervision among all anesthesia providers. We believe that our model of performance improvement initiative can be used to improve other perioperative outcomes.

Preemptive Intravenous Morphine-6-glucuronide Is Ineffective for Postoperative Pain Relief

2000 ◽  
Vol 92 (2) ◽  
pp. 355-355 ◽  
Author(s):  
Cyrus Motamed ◽  
Xavier Mazoit ◽  
Khaldoun Ghanouchi ◽  
Frédéric Guirimand ◽  
Kou Abhay ◽  
...  
Keyword(s):  
Placebo Group ◽  
Side Effects ◽  
Postoperative Pain ◽  
Patient Characteristics ◽  
Skin Closure ◽  
Acute Postoperative Pain ◽  
Morphine Group ◽  
Intravenous Morphine ◽  
American Society ◽  
American Society Of Anesthesiologists

Background Morphine-6-glucuronide (M-6-G), a major metabolite of morphine, is reported to be more potent than morphine when administered intrathecally; however, its efficiency remains under debate when administered intravenously. This study was designed to assess the analgesic efficiency of intravenous M-6-G for the treatment of acute postoperative pain. Methods After informed consent was obtained, 37 adults (American Society of Anesthesiologists physical status I-II) who were scheduled for elective open knee surgery were enrolled in the study. General anesthesia was induced with thiopental, alfentanil, and vecuronium and was maintained with a mixture of nitrous oxide/isoflurane and bolus doses of alfentanil. At skin closure, patients were randomized into three groups: (1) morphine group (n = 13), which received morphine 0.15 mg/kg; (2) M-6-G group (n = 12), which received M-6-G 0.1 mg/kg; and (3) placebo group (n = 12), which received saline. At the time of extubation, plasma concentration of morphine and M-6-G was measured. Postoperative analgesic efficiency was assessed by the cumulative dose of morphine delivered by patient-controlled analgesia. Opioid-related side effects were also evaluated. Results No difference was noted in patient characteristics and opioid-related side effects. Morphine requirements (mean +/- SD) during the first 24 h in the M-6-G group (41+/-9 mg) and the placebo group (49+/-8 mg) were significantly greater (P<0.05) compared with the morphine group (29+/-8 mg). Conclusion A single intravenous bolus dose of M-6-G was found to be ineffective in the treatment of acute postoperative pain. This might be related to the low permeability of the blood-brain barrier for M-6-G.

scholarly journals Analysis of perioperative cardiac arrest in a rural hospital in Korea

2020 ◽  
Vol 15 (3) ◽  
pp. 325-333
Author(s):  
Young-Mu Kim ◽  
Jae-Ho Lee ◽  
Hyun-Soo Kim ◽  
Jin Sun Kim ◽  
Hong-Seuk Yang
Keyword(s):  
Cardiac Arrest ◽  
Patient Characteristics ◽  
Physical Status ◽  
Related Factors ◽  
Surgical Department ◽  
Incidence And Mortality ◽  
Regional Gap ◽  
Hospital Patients ◽  
American Society ◽  
American Society Of Anesthesiologists

Background: Perioperative cardiac arrest has been studied in many countries but few related studies have been conducted in Korea. Previous studies were not applicable to rural hospitals due to differences in the demographics between the regions. In the present study, the incidence, mortality, and related factors of perioperative cardiac arrest in a hospital in Youngdong province were analyzed and compared with previous research.Methods: A retrospective study was conducted from the January 1, 2012, to December 31, 2018, on patients who underwent both anesthesia and surgery in our hospital. Patients who received local anesthesia were not included in the study. The collected data included the patient characteristics, anesthesia methods, the American Society of Anesthesiologists physical status, surgical department, emergency status, traumatic status, pre- and post-cardiac arrest medical records, and patient outcomes.Results: A total of 57,746 patients received anesthesia and underwent surgery during the study period, and 28 patients (4.85 per 10,000 anesthesia cases) received cardiopulmonary cerebral resuscitation (CPCR) during or within 24 hours of surgery. Eight patients survived and twenty patients died (3.46 per 10,000 anesthesia cases). There were three anesthesia-related arrests and all of these patients survived. When limiting the analysis to patients with intraoperative CPCR, the incidence and mortality were 1.56, and 1.39 per 10,000 anesthesia cases, respectively.Conclusions: The incidence and mortality of perioperative cardiac arrest in our hospital were higher than those in a recent study in Seoul, demonstrating a regional gap in Korea.

Frailty as a Predictor of Postoperative Outcomes among Patients with Head and Neck Cancer

2019 ◽  
Vol 160 (4) ◽  
pp. 664-671 ◽  
Author(s):  
Kristen D. Pitts ◽  
Alberto A. Arteaga ◽  
Benjamin P. Stevens ◽  
William C. White ◽  
Dan Su ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Length Of Stay ◽  
Head And Neck ◽  
Neck Cancer ◽  
Perioperative Complications ◽  
Frailty Index ◽  
Perioperative Outcomes ◽  
Modified Frailty Index ◽  
American Society ◽  
American Society Of Anesthesiologists

Objectives To understand measures of frailty among preoperative patients and explain how these can predict perioperative outcomes among patients with head and neck cancer. Study Design Retrospective cross-sectional case series with chart review. Setting Academic tertiary medical center. Subjects and Methods A retrospective review was performed of patients presenting to an academic hospital following a surgical procedure for a head and neck cancer diagnosis. Charts were queried for preoperative medical diagnoses to calculate 2 frailty scores: the American College of Surgeons National Surgical Quality Improvement Program modified frailty index and the Johns Hopkins Adjusted Clinical Groups frailty index. The American Society of Anesthesiologists classification system was also analyzed as a predictor. Primary outcomes were mortality, 30-day readmission, and length of stay. Perioperative complications and discharge disposition were also evaluated. Results A total of 410 charts were queried between January 2014 and December 2017. Mortality was 11%; mean ± SD length of stay was 7.4 ± 5.5 days; and the readmission rate was 17%. The modified frailty index score significantly increased the odds of mortality (odds ratio = 1.475, P = .012) and readmission (odds ratio = 1.472, P = .004), the length of stay (relative risk = 1.136, P = .001), and the number of perioperative complications. The American Society of Anesthesiologists classification was also significantly associated with poor outcomes, including readmission, length of stay, and perioperative complications. The Adjusted Clinical Groups index was not a significant predictor of outcomes in this study population. Conclusions This study demonstrated a significant increase in poor perioperative outcomes and mortality among patients with head and neck cancer and increased frailty, as measured by the modified frailty index.

Laparoscopic Approach to Adrenalectomy: Review of Perioperative Outcomes in a Single Center

2011 ◽  
Vol 77 (5) ◽  
pp. 592-596 ◽  
Author(s):  
Phuong H. Nguyen ◽  
Jennifer E. Keller ◽  
Yuri W. Novitsky ◽  
B. Todd Heniford ◽  
Kent W. Kercher
Keyword(s):  
Blood Loss ◽  
Laparoscopic Adrenalectomy ◽  
Average Length ◽  
Perioperative Complications ◽  
Laparoscopic Approach ◽  
Perioperative Outcomes ◽  
Estimated Blood Loss ◽  
American Society ◽  
The Right ◽  
American Society Of Anesthesiologists

Laparoscopic expertise increases the volume of adrenalectomies at referral centers. We report our 10-year experience with laparoscopic adrenalectomy. All laparoscopic adrenalectomies at a single institution were prospectively recorded in a surgical outcomes database. Patient demographics, operative/perioperative outcomes, and adrenal pathology were reviewed retrospectively. From March 1999 through July 2009, 154 laparoscopic adrenalectomies were performed in 150 patients. Average patient age was 49.9 years (range 15-82); mean body mass index was 31.1 kg/m2 (range 17-56). Pathologic diagnoses included hyperaldosteronism (n = 69), nonfunctional adenoma (n = 28), pheochromocytoma (n = 23), hypercortisolism (n = 14), malignancy (primary n = 3, metastasis n = 9), and cyst (n = 4). Seventy-three per cent (n = 110) occurred on the left, 23 per cent (n = 35) on the right, 2.6 per cent (n = 4) bilateral, and 0.6 per cent (n = 1) as extra-adrenal. The average tumor measured 3.6 cm (range 0.4-12). The average operative time was 156 minutes (range 62-409), the mean estimated blood loss was 60 mL (range 10–100), and mean American Society of Anesthesiologists score was 2.6 (range 1-4). Three operations (0.2%) were converted to open. Three patients (0.2%) experienced perioperative complications (respiratory failure, urinary tract infection, line sepsis, and readmission within 30 days). The average length of stay was 3.4 days (range 1–14) and mean follow-up was 96.9 days (5-2567). No wound-related complications or deaths occurred. Pathologic diagnosis was not associated with a particular side or development of a complication ( P > 0.5). Patients with pheochromocytomas had the longest operative times, highest estimated blood loss, and highest American Society of Anesthesiologists scores (218.2 minutes, 128 mL, 3.0; P < 0.004). Laparoscopic adrenalectomy is safe and effective. Removal of pheochromocytomas is more challenging and may be more appropriate for referral to a specialized center for optimal outcomes.

scholarly journals TYMPANIC AND TEMPORAL THERMOMETRY IN HYPOTHERMIA ASSESSMENT FOR ADULT IN INTRAOPERATIVE ABDOMINAL SURGERY

2016 ◽  
Vol 25 (4) ◽  
Author(s):  
Rutes de Fatima Terres Danczuk ◽  
Eliane Regina Pereira do Nascimento ◽  
Patrícia Madalena Vieira Hermida ◽  
Luciana Bihain Hagemann ◽  
Katia Cilene Godinho Bertoncello ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Mild Hypothermia ◽  
Patient Characteristics ◽  
Study Data ◽  
Tympanic Temperature ◽  
Moderate Hypothermia ◽  
Total N ◽  
American Society ◽  
Temporal Measurement ◽  
American Society Of Anesthesiologists

ABSTRACT Objective: to analyze the association between sociodemographic, clinical, operative and environmental characteristics with hypothermia events, measured intraoperatively by tympanic and temporal thermometers in adult patients undergoing elective abdominal surgery with visceral exposure. Method: prospective quantitative, correlational, observational study. Data were collected by means of structured instrument containing the variables: age, Body Mass Index; American Society of Anesthesiologists class; type of anesthesia; time of surgery; tympanic and temporal temperature; temperature and relative humidity of the surgical room. Temperatures were assessed by methods of tympanic and temporal measurement in 63 patients. The data analysis sought an association between hypothermia and patient characteristics, type of anesthesia, surgical environment, according to the method of measurement and surgical time. Results: Among the 63 patients, 15 (23.8%) had hypothermia. Of the total (n=15; 100%) number of hypothermic patients, 13 (80%) had mild hypothermia. Moderate hypothermia was identified only by temporal thermometry in three (20%) patients. Severe hypothermia was not identified, and in two (13.3%) patients the hypothermia was identified only by temporal thermometry. Hypothermia had a statistically significant association only with age (p=0.0027) and sex (p=0.015), when measuring tympanic temperature. Conclusion: Only sex and age showed correlation with hypothermia during surgery measured by tympanic thermometry; no variable influenced hypothermia measured by temporal thermometry.

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