LEARNING CURVE AND CONVERSION TO OPEN SURGERY IN CASES OF LAPAROSCOPIC ADRENALECTOMY AND NEPHRECTOMY

1998 ◽  
pp. 650-653 ◽  
Author(s):  
EIJI HIGASHIHARA ◽  
SHIRO BABA ◽  
KEN NAKAGAWA ◽  
MASARU MURAI ◽  
HIDETO GO ◽  
...  
Keyword(s):  
Learning Curve ◽  
Laparoscopic Adrenalectomy ◽  
Open Surgery ◽  
Conversion To Open Surgery

LEARNING CURVE AND CONVERSION TO OPEN SURGERY IN CASES OF LAPAROSCOPIC ADRENALECTOMY AND NEPHRECTOMY

1998 ◽  
Vol 159 (3) ◽  
pp. 650-653 ◽  
Author(s):  
EIJI HIGASHIHARA ◽  
SHIRO BABA ◽  
KEN NAKAGAWA ◽  
MASARU MURAI ◽  
HIDETO GO ◽  
...  
Keyword(s):  
Learning Curve ◽  
Laparoscopic Adrenalectomy ◽  
Open Surgery ◽  
Conversion To Open Surgery

Evaluating the Learning Curve Associated with Laparoscopic Left Hemicolectomy for Colon Cancer

2013 ◽  
Vol 79 (4) ◽  
pp. 366-371 ◽  
Author(s):  
Masashi Yamamoto ◽  
Junji Okuda ◽  
Keitaro Tanaka ◽  
Keisaku Kondo ◽  
Keiko Asai ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Laparoscopic Surgery ◽  
Learning Curve ◽  
Splenic Flexure ◽  
Open Surgery ◽  
Operative Time ◽  
Left Hemicolectomy ◽  
Conversion To Open Surgery ◽  
Descending Colon ◽  
Descending Colon Cancer

The role of laparoscopic surgery for transverse and descending colon cancer remains controversial. The aim of the present study was to characterize the learning curve for laparoscopic left hemicolectomy including the splenic flexure and to identify factors that influence this learning curve. Data from 120 consecutive patients undergoing laparoscopic left hemicolectomy for transverse and descending colon cancer including the splenic flexure between December 1996 and December 2009 were analyzed. Patients undergoing resection combined with cholecystectomy, hepatectomy, hysterectomy, or gastrectomy were excluded. Operative time was analyzed using the moving average method. The operative time, conversion rate, and postoperative complication rate were evaluated among four groups based on the number of cases required for analysis of operative time. In addition, risk factors that influenced conversion to open surgery were analyzed. Operative time for left hemicolectomy decreased with increasing case number with stabilization at 30 cases. There was no significant difference in the conversion rate or postoperative complications over time. Significant factors for conversion to open surgery were T stage (odds ratio [OR], 5.56; 95% confidence interval [CI], 1.5 to 27.4) and previous abdominal surgery (OR, 5.38; 95% CI, 1.6 to 20.2). The learning curve for laparoscopic left hemicolectomy is steep. Thus, surgeons in the early part of this curve should carefully select patients to allow them to build experience in a stepwise manner. Laparoscopic surgery may become the gold standard for management of colon cancer regardless of stage or tumor location.

scholarly journals EXTRAPERITONEAL LAPAROSCOPIC RADICAL PROSTATECTOMY: INITIAL EXPERIENCE AND LEARNING CURVE OF A VERY LOW VOLUME CENTER

2017 ◽  
Vol 24 (2) ◽  
Author(s):  
Peri Eriad Yunir ◽  
Agus Rizal AH Hamid ◽  
Rainy Umbas ◽  
Chaidir Arif Mochtar
Keyword(s):  
Radical Prostatectomy ◽  
Length Of Stay ◽  
Blood Loss ◽  
Learning Curve ◽  
Open Surgery ◽  
Prostate Volume ◽  
Organ Injury ◽  
Total Blood ◽  
Conversion To Open Surgery ◽  
Postoperative Length

Objective: This study is aimed to report and evaluate the experience and learning curve of extraperitoneal Laparoscopic Radical Prostatectomy (LRP) performed in Cipto Mangunkusumo General Hospital Jakarta. Material & method: We collected all data of patients that had been performed extraperitoneal LRP from June 2013 until February 2016, retrospectively. We divided those data into 3 groups with equal number in each group. We compared the preoperative (age, prostate volume, PSA level and prostate cancer staging), intraoperative (surgery time, total blood loss, conversion to open surgery and other organ injury), and postoperative (postoperative length of stay) variables between those 3 groups using ANOVA and Kruskal-Wallis test. Results: We performed 15 extraperitoneal LRP from June 2013 until February 2016 with patient’s mean age was 64.40 (SD ± 5.30) years old and mean prostate volume was 42.39 (SD ± 29.21). In this study, we found significant differences in surgery time, total blood loss, and postoperative length of stay (LOS) in all group with decrease on each intraoperative and postoperative variables. We also found no conversion to open surgery or other organ injury in all patients. Conclusion: The increase of surgeon’s experience and the number of surgery, and the consistency undergo the procedure of LRP demonstrate a decrease in surgery time, intraoperative blood loss and LOS in LRP patients.

scholarly journals Laparoscopic Adrenalectomy: First Single-Center Experience in the Balkans

PRILOZI ◽  
2015 ◽  
Vol 36 (3) ◽  
pp. 27-33
Author(s):  
Zivko Popov ◽  
Nikola Jankulovski ◽  
Oliver Stankov ◽  
Sotir Stavridis ◽  
Skender Saidi ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Laparoscopic Adrenalectomy ◽  
Open Surgery ◽  
Demographic Data ◽  
Operating Time ◽  
Conversion To Open Surgery ◽  
The Balkans ◽  
Estimated Blood Loss ◽  
Number Of Patients

Abstract Introduction: Laparoscopic adrenalectomy has become the preferred approach for removal of the adrenal gland for the management of benign or malignant functioning or nonfunctioning adrenal masses. We aimed to present our initial experience with this procedure. In addition, we compare the clinical outcomes of laparoscopic (LA) vs. the open adrenalectomies (OA) performed at our institutions. Also we report a case of successful laparoscopic treatment of splenic artery aneurism involving laparoscopic splenectomy. Patients and Methods: A retrospective analysis of the data of all patients who underwent adrenalectomy at three institutions, over the last 12-year period, since the laparoscopic adrenal surgery was introduced in our country. All patients were assessed regarding the demographic data, hormonal status, operative time, estimated blood loss, complications, size of the tumor, number of patients requiring blood transfusion, hospital stay and conversion to open surgery for LA. Results: Thirty five consecutive patients, aged from 33 to 67 (average age 54 years) underwent unilateral LA adrenalectomy during the study period including 14 right and 21 left sided. The laparoscopic procedure was successfully completed in all except 4 cases, which were converted to open surgery to control bleeding from the avulsed adrenal veins. LA proved superior to OA, resulting in less estimated blood loss, shorter operating time, shorter time to resumption of oral intake, shorter postoperative hospital stay and less analgesic requirements. During the follow-up of 3 to 36 months no tumor recurrence and/or metastasis developed. Conclusions: Our results concur with other retrospective reviews comparing laparoscopic and open adrenalectomy, demonstrating unequivocal advantages in terms of reduced length of hospital stay, blood loss, return of bowel function, functional recovery and post-operative morbidity.

Comparison of Retroperitoneoscopic and Transperitoneal Laparoscopic Adrenalectomy for Right-Sided Benign Tumors: A Single-Institute Experience

2015 ◽  
Vol 94 (2) ◽  
pp. 144-148 ◽  
Author(s):  
Po Hui Chiang ◽  
Cheng Jen Yu ◽  
Wei Ching Lee ◽  
Hung Jen Wang ◽  
Wu Chi Hsu
Keyword(s):  
Laparoscopic Adrenalectomy ◽  
Open Surgery ◽  
Operative Time ◽  
Oral Intake ◽  
Patient Characteristics ◽  
Benign Tumors ◽  
Transperitoneal Approach ◽  
Conversion To Open Surgery ◽  
Significant Difference ◽  
Length Of Hospitalization

Introduction: There is a lack of data regarding the appropriateness of transperitoneal and retroperitoneal approaches for right-sided laparoscopic adrenalectomy. The aim of this study was to determine whether there is any difference between right-sided transperitoneal laparoscopic adrenalectomy (TLA) and retroperitoneal laparoscopic adrenalectomy (RLA). Material and Methods: Our surgery database was reviewed to identify patients who underwent right-sided laparoscopic adrenalectomy with a retroperitoneal or transperitoneal approach since 2000. Fifty-five patients were enrolled (31 RLA and 24 TLA). Patient characteristics, as well as operative and perioperative details, were compared between the two groups. Results: There was no difference in patient characteristics between the groups. There was a statistically significant difference (p = 0.02) in blood loss (31.7 ± 16.4 vs. 56.9 ± 65.5 ml) between RLA and TLA when the patient's BMI was >26. There was no significant difference in operative time, conversion to open surgery, length of hospitalization, or time to oral intake between the groups. Conclusions: Right-sided laparoscopic adrenalectomy can be performed safely and effectively via either RLA or TLA. Surgeons can adopt either approach with confidence depending on their preference if they are familiar with that approach.

FACTORS INFLUENCING THE OPERATION TECHNIQUE OF PEFORATED DUODENAL ULCER REPAIR BY SINGLEPORT LAPAROSCOPIC SURGERY

2016 ◽  
pp. 99-105
Author(s):  
Huu Tri Nguyen ◽  
Loc Le ◽  
Doàn Van Phu Nguyen ◽  
Nhu Thanh Dang ◽  
Thanh Phuc Nguyen
Keyword(s):  
Duodenal Ulcer ◽  
Laparoscopic Surgery ◽  
Correlation Coefficient ◽  
Open Surgery ◽  
Operative Time ◽  
Single Port ◽  
Time Correlation ◽  
Patch Repair ◽  
Perforated Duodenal Ulcer ◽  
Conversion To Open Surgery

Background: Single-port laparoscopic surgery (SPLS) is increasingly used in surgery and in the treatment of perforated duodenal ulcer. The aim of this study was to evaluate technical factors for perforated duodenal ulcer repair by SPLS. Methods: A prospective study on 42 consecutive patients diagnosed with perforated duodenal ulcer and treated with SPLS at Hue university of medicine and pharmacy hospital and Hue central hospital from January 2012 to February 2015. Results: The mean age was 48.1 ± 14.2 (17 - 79) years. 40 patients were treated with suture of the perforation by pure SPLS. There was one case (2.4%) in which one additional trocar was required. Conversion to open surgery was necessary in one patient (2.4%) in which the perforation was situated on the posterior duodenal wall. Two patients (4.8%) with history of abdominal surgery were successfully treated by pure SPLS. The size of perforation was correlated with suturing time (correlation coefficient r = 0.459) and operative time (correlation coefficient r = 0.528). Considering suture type, X stitches were used in 95.5% cases, simple stitches were used in one case (2.4%) while Graham patch repair technique was utilized in one case (2.4%) with large perforation. Most cases (95.1%) required only simple suture without omental patch. Peritoneal drainage was spared in most cases (90.2%). Conclusions: SPLS is a safe method for the treatment of perforated duodenal ulcer. Posterior duodenal location is the main cause of conversion to open surgery. Factor related to operative time is perforation size. Key words: perforated duodenal ulcer, single port laparoscopic repair, single port laparoscopy

scholarly journals Supraretinacular endoscopic carpal tunnel release: A safe alternative method for treatment of carpal tunnel syndrome

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902199340
Author(s):  
Kotaro Sato ◽  
Kenya Murakami ◽  
Yoshikuni Mimata ◽  
Gaku Takahashi ◽  
Minoru Doita
Keyword(s):  
Learning Curve ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Open Surgery ◽  
Carpal Tunnel Release ◽  
Safe Alternative ◽  
Endoscopic Carpal Tunnel Release ◽  
Flexor Retinaculum ◽  
Carpal Tunnel Surgery ◽  
Conversion Rates

Purpose: Supraretinacular endoscopic carpal tunnel release (SRECTR) is a technique in which an endoscope is inserted superficial to the flexor retinaculum through a subcutaneous tunnel. The benefits of this method include a clear view for the surgeon and absence of median nerve compression. Surgeons can operate with a familiar view of the flexor retinaculum and median nerve downward, similar to open surgery. This study aimed to investigate the learning curve for SRECTR, an alternate method for carpal tunnel release, and evaluate its complications and the functional outcomes using a disposable commercial kit. Methods: We examined the open conversion rates and complications associated with SRECTR in 200 consecutive patients performed by two surgeons. We compared the operative time operated by a single surgeon. We evaluated outcomes in 191 patients according to Kelly’s grading system. Patients’ mean follow-up period was 12.7 months. Results: Nine patients required conversion to open surgery. There were no injuries to the nerves and tendons and no hematoma or incomplete dissection of the flexor retinaculum. The operative times varied between 11 and 34 minutes. We obtained the following results based on Kelly’s grading of outcomes: excellent in 116, good in 59, fair in 13, and poor in 3 patients. Conclusions: We found no patients with neurapraxia, major nerve injury, flexor tendon injury, superficial palmar arch injury, and hematoma. Although there was a learning curve associated with SRECTR, we performed 200 consecutive cases without neurovascular complications. This method may be a safe alternative to minimally invasive carpal tunnel surgery.

scholarly journals A New Proposal for Learning Curve of TEP Inguinal Hernia Repair: Ability to Complete Operation Endoscopically as a First Phase of Learning Curve

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Mustafa Hasbahceci ◽  
Fatih Basak ◽  
Aylin Acar ◽  
Orhan Alimoglu
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Learning Curve ◽  
Inguinal Hernia Repair ◽  
Exact Nature ◽  
Conversion To Open Surgery ◽  
Totally Extraperitoneal ◽  
Surgeon Experience ◽  
Repair Ability ◽  
Complete Operation

Background. The exact nature of learning curve of totally extraperitoneal inguinal hernia and the number required to master this technique remain controversial.Patients and Methods. We present a retrospective review of a single surgeon experience on patients who underwent totally extraperitoneal inguinal hernia repair.Results. There were 42 hernias (22 left- and 20 right-sided) in 39 patients with a mean age of48.8±15.1years. Indirect, direct, and combined hernias were present in 18, 12, and 12 cases, respectively. The mean operative time was55.1±22.8minutes. Peritoneal injury occurred in 9 cases (21.4%). Conversion to open surgery was necessitated in 7 cases (16.7%). After grouping of all patients into two groups as cases between 1–21 and 22–42, it was seen that the majority of peritoneal injuries (7 out of 9, 77.8%,P=0.130) and all conversions (P=0.001) occurred in the first 21 cases.Conclusions. Learning curve of totally extraperitoneal inguinal hernia repair can be divided into two consequent steps: immediate and late. At least 20 operations are required for gaining anatomical knowledge and surgical pitfalls based on the ability to perform this operation without conversion during immediate phase.

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