The corona mortis: is it a rare and dangerous anomaly in adolescents undergoing periacteabular osteotomy?

ABSTRACT The corona mortis (CM) is a vascular connection between the obturator and external iliac or internal epigastric vessels that has historically been identified as a source of hemorrhage in pelvic surgery. However, its frequency, location, proximity to the osteotomies performed, vascular contributions and impact on blood loss in patients undergoing periacetabular osteotomy (PAO) are unknown. We sought to identify the frequency, origin, location relative to osteotomies performed during surgery and impact on blood loss of the CM. Preoperative magnetic resonance imaging (MRI) of the hips of 28 adolescent patients (56 hips) undergoing PAO was retrospectively reviewed for the presence of a CM. When identifiable, the size, nature (arterial or venous), orientation, position relative to the iliopectineal eminence (IPE) and associated estimated blood loss (EBL) were recorded. 75% (21/28) of patients possessed an identifiable, ipsilateral CM to the site of PAO, 90% of which were venous and 10% arterial. The vessel was typically 8.3 ± 3.8 mm medial and 11.1 ± 5.3 mm caudal from the anterosuperomedial edge of the IPE. There was no significant difference in the amount of EBL (519 ± 260 versus 694 ± 369 ml) or need for post-op transfusions (1/21 versus 0/7) between patients who possessed a CM and those who did not, respectively (P = 0.21). CM was more prevalent in this study than previously reported. However, the presence of an ipsilateral CM was not associated with an increase in EBL or transfusion during routine PAO surgery using modern surgical techniques.

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Running suture hemostatic technique versus standard reconstruction of the surgical bed in Zero - Ischemia Time mini-flank Open Partial Nephrectomies. Retrospective, Match-Paired Case-Control Study

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2019.2.69 ◽

2019 ◽

Vol 91 (2) ◽

Author(s):

Petar Kavaric ◽

Aleksandar Magdelinic ◽

Marko Vukovic

Keyword(s):

Blood Loss ◽

Tumor Size ◽

Operative Time ◽

Surgical Techniques ◽

Control Group ◽

Reconstruction Technique ◽

Ischemia Time ◽

Estimated Blood Loss ◽

Significant Difference ◽

Zero Ischemia

Objective: To estimate the efficacy of our technique of zero ischemia time partial nephrectomy (ZTPN) with hemostatic running suture and compare it to the standard technique, in terms of perioperative complications, operative time (OT) and estimated blood loss (EBL). Materials and methods: We retrospectively analysed 180 consecutive patients who underwent ZTPN using a supra 11th or supra 12th rib mini flank approach. First group numbered 90 patients treated with running suture hemostatic technique (RSHT), while the control group enrolled 90 patients in whom we performed standard reconstruction technique (SRT). According the propensity score, both groups were similar in terms of tumor size, age and PADUA score. Patients with solitary tumour limited to the kidney (T1-T2a) were included. Our technique included a running suture of surgical bed edges and closure of the renal cortex by the positioning of peri-renal fat within the cortical bed and fixation with interrupted sutures. Results: PADUA score and tumor size were comparable between groups (7.12 ± 1.33 vs 7.1 ± 2.11, p = 0.4 and 52.9 ± 14.8 vs 50.0 ± 13.2, p = 0.3). The mean operative time (OT) was significantly longer in first group (165.2 vs 95, p = 0.04), while median estimated blood loss (EBL) was significantly reduced (250 vs 460 ml, p = 0.02). Surgical resection margins were negative in 100% of cases and no patient developed a local or distant recurrence during follow up. There was significant difference in postoperative GFR value between groups (p < 0.05). Conclusions: Our technique could be safely performed in local, low volume facilities, thus reducing the need for expensive and more challenging minimal invasive surgical techniques..

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Use of blood-sparing surgical techniques and transfusion algorithms: association with decreased blood administration in children undergoing primary open craniosynostosis repair

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.3.peds14663 ◽

2015 ◽

Vol 16 (5) ◽

pp. 556-563 ◽

Cited By ~ 6

Author(s):

Thanh T. Nguyen ◽

Sarah Hill ◽

Thomas M. Austin ◽

Gina M. Whitney ◽

John C. Wellons ◽

...

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Postoperative Period ◽

Surgical Techniques ◽

Perioperative Period ◽

Fresh Frozen Plasma ◽

Estimated Blood Loss ◽

Significant Difference ◽

Fresh Frozen ◽

Frozen Plasma

OBJECT Craniofacial reconstruction surgery (CFR) is often associated with significant blood loss, coagulopathy, and perioperative blood transfusion. Due to transfusion risks, many different approaches have been used to decrease allogeneic blood transfusion for these patients during the perioperative period. Protocols have decreased blood administration during the perioperative period for many types of surgeries. The object of this study was to determine if a protocol involving blood-sparing surgical techniques and a transfusion algorithm decreased intraoperative blood transfusion and blood loss. METHODS A protocol using transfusion algorithms and implementation of blood-sparing surgical techniques for CFR was implemented at Vanderbilt University on January 1, 2013. Following Institutional Review Board approval, blood loss and transfusion data were gathered retrospectively on all children undergoing primary open CFR, using the protocol, for the calendar year 2013. This postprotocol cohort was compared with a preprotocol cohort, which consisted of all children undergoing primary open CFR during the previous calendar year, 2012. RESULTS There were 41 patients in the preprotocol and 39 in the postprotocol cohort. There was no statistical difference between the demographics of the 2 groups. When compared with the preprotocol cohort, intraoperative packed red blood cell transfusion volume decreased from 36.9 ± 21.2 ml/kg to 19.2 ± 10.9 ml/kg (p = 0.0001), whereas fresh-frozen plasma transfusion decreased from 26.8 ± 25.4 ml/kg to 1.5 ± 5.7 ml/kg (p < 0.0001) following implementation of the protocol. Furthermore, estimated blood loss decreased from 64.2 ± 32.4 ml/kg to 52.3 ± 33.3 ml/kg (p = 0.015). Use of fresh-frozen plasma in the postoperative period also decreased when compared with the period before implementation of the protocol. There was no significant difference in morbidity and mortality between the 2 groups. CONCLUSIONS The results of this study suggested that using a multidisciplinary protocol consisting of transfusion algorithms and implementation of blood-sparing surgical techniques during major CFR in pediatric patients is associated with reduced intraoperative administration of blood product, without shifting the transfusion burden to the postoperative period.

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Effect of Multiple Doses of Oral Tranexamic Acid on Haemostasis and Inflammatory Reaction in Total Hip Arthroplasty: A Randomized Controlled Trial

Thrombosis and Haemostasis ◽

10.1055/s-0038-1676625 ◽

2018 ◽

Vol 119 (01) ◽

pp. 092-103 ◽

Cited By ~ 7

Author(s):

Duan Wang ◽

Yang Yang ◽

Chuan He ◽

Ze-Yu Luo ◽

Fu-Xing Pei ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Inflammatory Response ◽

Tranexamic Acid ◽

Hip Arthroplasty ◽

Multiple Dose ◽

Control Group ◽

Total Hip ◽

Estimated Blood Loss ◽

Significant Difference

AbstractTranexamic acid (TXA) reduces surgical blood loss and alleviates inflammatory response in total hip arthroplasty. However, studies have not identified an optimal regimen. The objective of this study was to identify the most effective regimen of multiple-dose oral TXA in achieving maximum reduction of blood loss and inflammatory response based on pharmacokinetic recommendations. We prospectively studied four multiple-dose regimens (60 patients each) with control group (group A: matching placebo). The four multiple-dose regimens included: 2-g oral TXA 2 hours pre-operatively followed by 1-g oral TXA 3 hours post-operatively (group B), 2-g oral TXA followed by 1-g oral TXA 3 and 7 hours post-operatively (group C), 2-g oral TXA followed by 1-g oral TXA 3, 7 and 11 hours post-operatively (group D) and 2-g oral TXA followed by 1-g oral TXA 3, 7, 11 and 15 hours post-operatively (group E). The primary endpoint was estimated blood loss on post-operative day (POD) 3. Secondary endpoints were thromboelastographic parameters, inflammatory components, function recovery and adverse events. Groups D and E had significantly less blood loss on POD 3, with no significant difference between the two groups. Group E had the most prolonged haemostatic effect, and all thromboelastographic parameters remained within normal ranges. Group E had the lowest levels of inflammatory cytokines and the greatest range of motion. No thromboembolic complications were observed. The post-operative four-dose regimen brings about maximum efficacy in reducing blood loss, alleviating inflammatory response and improving analgaesia and immediate recovery.

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Does MIS Surgery Allow for Shorter Constructs in the Surgical Treatment of Adult Spinal Deformity?

Neurosurgery ◽

10.1093/neuros/nyw072 ◽

2017 ◽

Vol 80 (3) ◽

pp. 489-497 ◽

Cited By ~ 18

Author(s):

Juan S. Uribe ◽

Joshua Beckman ◽

Praveen V. Mummaneni ◽

David Okonkwo ◽

Pierce Nunley ◽

...

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Clinical Outcomes ◽

Spinal Deformity ◽

Lumbar Lordosis ◽

Adult Spinal Deformity ◽

Radiographic Parameters ◽

Estimated Blood Loss ◽

Significant Difference ◽

The Impact

Abstract BACKGROUND: The length of construct can potentially influence perioperative risks in adult spinal deformity (ASD) surgery. A head-to-head comparison between open and minimally invasive surgery (MIS) techniques for treatment of ASD has yet to be performed. OBJECTIVE: To examine the impact of MIS approaches on construct length and clinical outcomes in comparison to traditional open approaches when treating similar ASD profiles. METHODS: Two multicenter databases for ASD, 1 involving MIS procedures and the other open procedures, were propensity matched for clinical and radiographic parameters in this observational study. Inclusion criteria were ASD and minimum 2-year follow-up. Independent t-test and chi-square test were used to evaluate and compare outcomes. RESULTS: A total of 1215 patients were identified, with 84 patients matched in each group. Statistical significance was found for mean levels fused (4.8 for circumferential MIS [cMIS] and 10.1 for open), mean interbody fusion levels (3.6 cMIS and 2.4 open), blood loss (estimated blood loss 488 mL cMIS and 1762 mL open), and hospital length of stay (6.7 days cMIS and 9.7 days open). There was no significant difference in preoperative radiographic parameters or postoperative clinical outcomes (Owestry Disability Index and visual analog scale) between groups. There was a significant difference in postoperative lumbar lordosis (43.3° cMIS and 49.8° open) and pelvic incidence-lumbar lordosis correction (10.6° cMIS and 5.2° open) in the open group. There was no significant difference in reoperation rate between the 2 groups. CONCLUSION: MIS techniques for ASD may reduce construct length, reoperation rates, blood loss, and length of stay without affecting clinical and radiographic outcomes when compared to a similar group of patients treated with open techniques.

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The Use of Tranexamic Acid in Total Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00283 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0028

Author(s):

Laura Luick ◽

Vytas Ringus ◽

Garrett Steinmetz ◽

Spencer Falcon ◽

Shaun Tkach ◽

...

Keyword(s):

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Total Ankle Arthroplasty ◽

Wound Complications ◽

P Value ◽

Ankle Arthroplasty ◽

Estimated Blood Loss ◽

Number Of Patients ◽

Significant Difference

Category: Ankle Arthritis Introduction/Purpose: The number of total ankle arthroplasties (TAA) is on the rise. Complications associated with TAA include need for blood transfusion, deep vein thrombosis, hematoma, infection, and wound complications. Tranexamic acid (TXA) use in the total knee and total hip population has been found to decrease the rate of blood transfusion. The rate of infections and blood transfusions in TAA was reported to be 3.2% and 1.3%, respectively. In calcaneal fractures TXA was found to decrease wound complications. Our goal was to evaluate the use of TXA in the TAA population to see if its use decreases blood loss or wound complications. Methods: This is a retrospective review of two patient cohorts operated on by a single surgeon from 2010 to 2016. We compared a group of TAA patients that did not receive TXA versus a subsequent group that received TXA. Patients received 1 g IV TXA before tourniquet was inflated and another 1 g following the release of the tourniquet. Pre-operative hemoglobin and hematocrit levels were compared to postoperative levels. Post-operative complications were compared between the two groups. Results: 87 patients were included in the study. 35 patients (40%) received TXA. In patients that received TXA, 18 had postoperative hemoglobin levels available. These patients were compared to a control cohort of 52 patients that did not receive TXA. No significant difference existed between the two groups in gender or age (p=0.9; p=0.7 respectively). Mean estimated blood loss was the same between the two groups. Overall postoperative complications, including wound complications, were higher in the TXA group at 26% vs 12% but this was not statistically significant (p-value = 0.086). The preoperative to postoperative change in hemoglobin/hematocrit levels was not statistically significant between groups (p-value = 0.78). There was one transfusion required in the non-TXA group and no transfusions required in the TXA group (p=0.9). Conclusion: The use of TXA was not found to provide a beneficial effect in total ankle arthroplasty in either decreasing wound complications or blood loss. Given these results, TXA use might not be cost effective in total ankle arthroplasty as opposed to other total joint arthroplasties. Further higher levels studies with increased number of patients are required to further evaluate TXA effectiveness in TAA.

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Robotic-assisted Ivor-Lewis esophagectomy in the elderly patient.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.93 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 93-93

Author(s):

Andrea M. Abbott ◽

Tobin Joel Crill Strom ◽

Nadia Saeed ◽

Ravi Shridhar ◽

Sarah E. Hoffe ◽

...

Keyword(s):

Blood Loss ◽

The Elderly ◽

Separate Analysis ◽

Ivor Lewis ◽

Robotic Assisted ◽

Ivor Lewis Esophagectomy ◽

Estimated Blood Loss ◽

Increased Risk ◽

Significant Difference ◽

The Impact

93 Background: Esophageal cancer continues to increase in incidence worldwide with the age of diagnosis continuing to move towards an older onset. Robotic assisted approaches to esophagectomy have demonstrated decreased complications and length of hospitalization (LOH). We sought to examine the impact of age on outcomes in patients undergoing robotic assisted esophagectomy (RAIL). Methods: From 2009-2013, we identified patients undergoing robotic assisted Ivor Lewis esophagectomy. Patients were then stratified according to 3 age groups. Cohort 1, age less then 50, cohort 2, age 50-70, and cohort 3 >70. Statistical comparisons between LOH, operative time (OT), estimated blood loss (EBL), adverse events (AE) and mortality were made with Kruskal-Wallis and Chi-square tests. Results: We identified 134 patients who underwent RAIL and found no statistically significant difference between the three cohorts for OT, LOH, days spent in intensive care, AE or mortality. There was a difference in EBL with higher median blood loss (150 cc) seen in cohort 1 (50-600cc) and 3 (50-400cc) compared to cohort 2 (100 cc, (25-400cc)), p < 0.01. The most common AE were arrhythmia and pneumonia but this was not significantly different between the cohorts. The overall AE rate was 10% (cohort 1), 21% (cohort 2), 34% (cohort 3), p=0.14. There were 4 leaks (p =0.38) and 2 deaths (p=0.90) in the entire cohort. A separate analysis was done to compare elderly (>70) to the non-elderly (<70). Median EBL was higher in the elderly cohort (100cc (25-600) vs 150cc (50-400), p <0.01). There was a trend towards longer LOH in the elderly (9 (4-35) vs 11 (6-38) days, p =0.06). AE and mortality were not significantly different, although there was a trend toward increased AE (19.8% vs 34%, p=0.07) in the elderly, with arrhythmia being the most common AE. Conclusions: RAIL is a safe surgical technique for use in an aging patient population. We demonstrated there was no increased risk of LOH, AE or death in the elderly patients compared to their younger cohort.

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Clinical and radiographic comparison of mini–open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up

Journal of Neurosurgery Spine ◽

10.3171/spi.2008.9.08142 ◽

2008 ◽

Vol 9 (6) ◽

pp. 560-565 ◽

Cited By ~ 234

Author(s):

Sanjay S. Dhall ◽

Michael Y. Wang ◽

Praveen V. Mummaneni

Keyword(s):

Blood Loss ◽

Interbody Fusion ◽

Transforaminal Lumbar Interbody Fusion ◽

Open Group ◽

Lumbar Interbody Fusion ◽

Estimated Blood Loss ◽

Significant Difference ◽

The Mean ◽

Mini Open

Object As minimally invasive approaches gain popularity in spine surgery, clinical outcomes and effectiveness of mini–open transforaminal lumbar interbody fusion (TLIF) compared with traditional open TLIF have yet to be established. The authors retrospectively compared the outcomes of patients who underwent mini–open TLIF with those who underwent open TLIF. Methods Between 2003 and 2006, 42 patients underwent TLIF for degenerative disc disease or spondylolisthesis; 21 patients underwent mini–open TLIF and 21 patients underwent open TLIF. The mean age in each group was 53 years, and there was no statistically significant difference in age between the groups (p = 0.98). Data were collected perioperatively. In addition, complications, length of stay (LOS), fusion rate, and modified Prolo Scale (mPS) scores were recorded at routine intervals. Results No patient was lost to follow-up. The mean follow-up was 24 months for the mini-open group and 34 months for the open group. The mean estimated blood loss was 194 ml for the mini-open group and 505 ml for the open group (p < 0.01). The mean LOS was 3 days for the mini-open group and 5.5 days for the open group (p < 0.01). The mean mPS score improved from 11 to 19 in the mini-open group and from 10 to 18 in the open group; there was no statistically significant difference in mPS score improvement between the groups (p = 0.19). In the mini-open group there were 2 cases of transient L-5 sensory loss, 1 case of a misplaced screw that required revision, and 1 case of cage migration that required revision. In the open group there was 1 case of radiculitis as well as 1 case of a misplaced screw that required revision. One patient in the mini-open group developed a pseudarthrosis that required reoperation, and all patients in the open group exhibited fusion. Conclusions Mini–open TLIF is a viable alternative to traditional open TLIF with significantly reduced estimated blood loss and LOS. However, the authors found a higher incidence of hardware-associated complications with the mini–open TLIF.

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Efficacy of balloon tamponade in control of primary postpartum haemorrhage (PPH).

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.04.3423 ◽

2020 ◽

Vol 27 (04) ◽

pp. 717-720

Author(s):

Kashfa Tasnim Akhtar ◽

Sobia Tabassum ◽

Shazia Siddique

Keyword(s):

Blood Loss ◽

Gestational Age ◽

Postpartum Haemorrhage ◽

Ease Of Use ◽

P Value ◽

Balloon Tamponade ◽

Products Of Conception ◽

Estimated Blood Loss ◽

Increased Risk ◽

Significant Difference

Objectives: Primary postpartum haemorrhage (PPH) refers to excessive blood loss (>500ml) during 3rd stage of labour in the 1st 24 hours after delivery, thereafter, significant bleeding is referred to as secondary PPH. Its incidence is about 5% of deliveries. This study was conducted to note the efficacy of balloon tamponade in the control of PPH. Study Design: Experimental study. Setting: Department of Obstetrics and Gyne, Civil Hospital, Bahawalpur. Period: 1st January 2018 to 30th June 2018. Material & Methods: A total of 80 cases with Primary PPH after vaginal delivery were considered for this study. Cases with Bleeding disorders, ruptured uterus, retained products of conception, genital tract injuries or on anticoagulant therapy were excluded. All patients received balloon tamponade. Failure of control of bleeding was observed amongst all the patients. Results: Mean age, gestational age and parity were 24.54 years, 37.88 weeks and 3.17 respectively. Mean estimated blood loss was found to be 1125+320 ml, SBP 90.10+20.6 mmHg, DBP 57+7.2 mmHg and pulse 106+9.2 bpm. As far efficacy of balloon tamponade is concerned, it was noted in 71 (88.8%) women. When women were analyzed for maternal age, gestational age and parity status, no significant difference was found (P value > 0.05). Conclusion: Balloon tamponade has good efficacy (88.8%) in controlling PPH. Its ease of use in cases at increased risk of PPH makes it a suitable option.

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ε-Aminocaproic acid (EACA) vs. tranexamic acid (TXA) in children undergoing complex cranial vault reconstruction for repair of craniosynostosis

10.22541/au.161405538.85359746/v1 ◽

2021 ◽

Author(s):

Alexandra Borst ◽

Christopher Bonfield ◽

Poornachanda Deenadayalan ◽

Chi Le ◽

Meng Xu ◽

...

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Outcome Measures ◽

Aminocaproic Acid ◽

Cranial Vault ◽

Secondary Outcome ◽

Vascular Access Devices ◽

Estimated Blood Loss ◽

Transfusion Requirements ◽

Significant Difference

INTRODUCTION: Children undergoing complex cranial vault reconstruction (CCVR) for craniosynostosis experience high rates of bleeding and transfusion, increasing risk for perioperative complications. ε-Aminocaproic acid (EACA) and tranexamic acid (TXA) are antifibrinolytic agents that have been shown to reduce intraoperative hemorrhage and transfusion requirements during CCVR. However, the relative efficacy of these two agents has not yet been evaluated. The aim of this study was to compare perioperative blood loss and transfusion rates in children receiving EACA vs. TXA. METHODS: All patients who underwent CCVR from September 2015 to December 2019 at a single center were retrospectively evaluated. Primary outcome measures included intraoperative estimated blood loss, postoperative drain output, transfusion volumes, and calculated blood loss. Secondary outcome measures included hematologic and coagulation parameters. RESULTS: 95 patients were included, with 47 patients in the EACA cohort and 48 patients in the TXA cohort. There were no significant differences in demographics, surgical outcomes, blood loss, transfusion requirement, or perioperative hematologic and coagulation laboratory values between the two cohorts. Adverse events were similar between the groups, but did include two seizure events and two thromboembolic events related to vascular access devices. DISCUSSION: We found no significant difference in blood loss, transfusion requirements, hematologic parameters, or outcomes between pediatric CCVR patients who received EACA vs. TXA. Further research is needed to define optimal antifibrinolytic dosing and duration of therapy. While standard laboratory parameters were similar between groups, future studies investigating coagulation-based and inflammatory assays may be useful in defining surgical-induced coagulopathy.

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

The American Surgeon ◽

10.1177/0003134820952448 ◽

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.

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