Comparison of Perioperative Outcomes and Complication Rates Between Conventional Versus Robotic-Assisted Laparoscopy in the Evaluation and Management of Early, Advanced, and Recurrent Stage Ovarian, Fallopian Tube, and Primary Peritoneal Cancer

2014 ◽  
Vol 24 (3) ◽  
pp. 600-607 ◽  
Author(s):  
Farr Reza Nezhat ◽  
Tamara Natasha Finger ◽  
Patrick Vetere ◽  
Amir Reza Radjabi ◽  
Mario Vega ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Recurrent Disease ◽  
Early Stage ◽  
Perioperative Outcomes ◽  
Complication Rates ◽  
Intraoperative Complication ◽  
Robotic Assisted ◽  
Peritoneal Cancer ◽  
Significant Difference ◽  
Robotic Assisted Laparoscopy

ObjectiveThe objective of this study was to examine perioperative outcomes, including complication rates, of conventional laparoscopy (CL) versus robotic-assisted laparoscopy (RALS) in the evaluation and management of early, advanced, and recurrent ovarian, fallopian tube, and peritoneal cancer.MethodsThis is a retrospective analysis of a prospectively maintained database of surgery performed from July 2008 to December 2012. Sixty-three women had 83 surgeries performed; 22 surgeries for early-stage disease (International Federation of Gynecology and Obstetrics stage I) and 61 for advanced and/or recurrent disease.ResultsOf the 22 for early stage, 10 were CL, 9 were RALS, and 3 were laparoscopy converted to laparotomy (LP). There was no significant difference between CL and RALS in estimated blood loss (EBL,P= 0.27) or length of stay (LOS,P= 0.43); however, both had significantly less EBL (P= 0.03 and 0.03, respectively) and LOS (P= 0.03 and 0.03) than LP. There was no difference in OR time among the groups (P= 0.79). One patient (33%) had an intraoperative complication in LP. One patient (10%) had a postoperative complication in CL, 2 (22%) in RALS, and 1 (33%) in LP, with no significant difference (P= 0.61).Among the 42 patients with advanced/recurrent disease, 61 surgeries were performed: 14 diagnostic procedures and 47 cytoreductive surgeries. Of the 47, there was no difference in operating room time (P= 0.10). There was no difference in EBL or LOS between CL and RALS (P= 0.82,P= 0.87); however, both were less in CL (P< 0.001 andP= 0.02) and RALS (P= 0.01 andP= 0.02) compared with LP. There were 5 (63%) intraoperative transfusions in LP and none in CL or RALS. When including all surgeries for advanced/recurrent disease, there was 1 intraoperative complication (12%) in LP. There was no difference in postoperative complications between groups (P= 0.89); 8 patients (19%) had postoperative complications in CL, 2 (18%) in RALS, and 2 (25%) in LP. Overall, there were no grade 4 or 5 complications and no perioperative or intraoperative deaths.ConclusionsIn our experience, perioperative outcomes are comparable between CL and RALS in both early and advanced/recurrent disease and not inferior to laparotomy, making CL and RALS an acceptable approach in selected patients.

Effect of Obesity on Perioperative Outcomes After Robotic-Assisted Pulmonary Lobectomy

2017 ◽  
Vol 24 (2) ◽  
pp. 122-132 ◽  
Author(s):  
Bryce Montané ◽  
Kavian Toosi ◽  
Frank O. Velez-Cubian ◽  
Maria F. Echavarria ◽  
Matthew R. Thau ◽  
...  
Keyword(s):  
Postoperative Complication ◽  
Normal Weight ◽  
World Health ◽  
Perioperative Outcomes ◽  
Complication Rates ◽  
Pulmonary Lobectomy ◽  
Intraoperative Complication ◽  
Robotic Assisted ◽  
Conversion Rates ◽  
Significant Difference

Objective. We investigated whether higher body mass index (BMI) affects perioperative and postoperative outcomes after robotic-assisted video-thoracoscopic pulmonary lobectomy. Methods. We retrospectively studied all patients who underwent robotic-assisted pulmonary lobectomy by one surgeon between September 2010 and January 2015. Patients were grouped according to the World Health Organization’s definition of obesity, with “obese” being defined as BMI >30.0 kg/m2. Perioperative outcomes, including intraoperative estimated blood loss (EBL) and postoperative complication rates, were compared. Results. Over 53 months, 287 patients underwent robotic-assisted pulmonary lobectomy, with 7 patients categorized as “underweight,” 94 patients categorized as “normal weight,” 106 patients categorized as “overweight,” and 80 patients categorized as “obese.” Because of the relatively low sample size, “underweight” patients were excluded from this study, leaving a total cohort of 280 patients. There was no significant difference in intraoperative complication rates, conversion rates, perioperative outcomes, or postoperative complication rates among the 3 groups, except for lower risk of prolonged air leaks ≥7 days and higher risk of pneumonia in patients with obesity. Conclusions. Patients with obesity do not have increased risk of intraoperative or postoperative complications, except for pneumonia, compared with “normal weight” and “overweight” patients. Robotic-assisted pulmonary lobectomy is safe and effective for patients with high BMI.

scholarly journals Intracorporeal and extracorporeal anastomosis for robotic-assisted and laparoscopic right colectomy: short-term outcomes of a multi-center prospective trial

2021 ◽  
Author(s):  
Robert K. Cleary ◽  
Matthew Silviera ◽  
Tobi J. Reidy ◽  
James McCormick ◽  
Craig S. Johnson ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Hospital Stay ◽  
Right Colectomy ◽  
Perioperative Outcomes ◽  
Complication Rates ◽  
Robotic Assisted ◽  
Laparoscopic Right Colectomy ◽  
Conversion Rates ◽  
Significant Difference ◽  
Extracorporeal Anastomosis

Abstract Background Studies to date show contrasting conclusions when comparing intracorporeal and extracorporeal anastomoses for minimally invasive right colectomy. Large multi-center prospective studies comparing perioperative outcomes between these two techniques are needed. The purpose of this study was to compare intracorporeal and extracorporeal anastomoses outcomes for robotic assisted and laparoscopic right colectomy. Methods Multi-center, prospective, observational study of patients with malignant or benign disease scheduled for laparoscopic or robotic-assisted right colectomy. Outcomes included conversion rate, gastrointestinal recovery, and complication rates. Results There were 280 patients: 156 in the robotic assisted and laparoscopic intracorporeal anastomosis (IA) group and 124 in the robotic assisted and laparoscopic extracorporeal anastomosis (EA) group. The EA group was older (mean age 67 vs. 65 years, p = 0.05) and had fewer white (81% vs. 90%, p = 0.05) and Hispanic (2% vs. 12%, p = 0.003) patients. The EA group had more patients with comorbidities (82% vs. 72%, p = 0.04) while there was no significant difference in individual comorbidities between groups. IA was associated with fewer conversions to open and hand-assisted laparoscopic approaches (p = 0.007), shorter extraction site incision length (4.9 vs. 6.2 cm; p ≤ 0.0001), and longer operative time (156.9 vs. 118.2 min). Postoperatively, patients with IA had shorter time to first flatus, (1.5 vs. 1.8 days; p ≤ 0.0001), time to first bowel movement (1.6 vs. 2.0 days; p = 0.0005), time to resume soft/regular diet (29.0 vs. 37.5 h; p = 0.0014), and shorter length of hospital stay (median, 3 vs. 4 days; p ≤ 0.0001). Postoperative complication rates were comparable between groups. Conclusion In this prospective, multi-center study of minimally invasive right colectomy across 20 institutions, IA was associated with significant improvements in conversion rates, return of bowel function, and shorter hospital stay, as well as significantly longer operative times compared to EA. These data validate current efforts to increase training and adoption of the IA technique for minimally invasive right colectomy.

Complications of neuroendoscopic septostomy

2021 ◽  
pp. 1-7
Author(s):  
Travis J. Atchley ◽  
Blake Sowers ◽  
Anastasia A. Arynchyna ◽  
Curtis J. Rozzelle ◽  
Brandon G. Rocque
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Complication Rates ◽  
Ventricular Size ◽  
Current Procedural Terminology ◽  
Operative Techniques ◽  
Chi Square ◽  
Intraoperative Complication ◽  
Significant Difference ◽  
Lower Complication

OBJECTIVE The advent of neuroendoscopy revolutionized the management of complex hydrocephalus. Fenestration of the septum pellucidum (septostomy) is often a therapeutic and/or necessary intervention in neuroendoscopy. However, these procedures are not without risk. The authors sought to record the incidence and types of complications. They attempted to discern if there was decreased likelihood of septostomy complications in patients who underwent endoscopic third ventriculostomy (ETV)/choroid plexus cauterization (CPC) as compared with those who underwent other procedures and those with larger ventricles preoperatively. The authors investigated different operative techniques and their possible relationships to septostomy complications. METHODS The authors retrospectively reviewed all neuroendoscopic procedures with Current Procedural Terminology code 62161 performed from January 2003 until June 2019 at their institution. Septostomy, either alone or in conjunction with other procedures, was performed in 118 cases. Basic demographic characteristics, clinical histories, operative details/findings, and adverse events (intraoperative and postoperative) were collected. Pearson chi-square and univariate logistic regression analyses were performed. Patients with incomplete records were excluded. RESULTS Of 118 procedures, 29 (24.5%) septostomies had either intraoperative or postoperative complications. The most common intraoperative complication was bleeding, as noted in 12 (10.2%) septostomies. Neuroendocrine dysfunction, including apnea, bradycardia, neurological deficit, seizure, etc., was the most common postoperative complication and seen after 15 (12.7%) procedures. No significant differences in complications were noted between ventricular size or morphology or between different operative techniques or ventricular approaches. There was no significant difference between the complication rate of patients who underwent ETV/CPC and that of patients who underwent septostomy as a part of other procedures. Greater length of surgery (OR 1.013) was associated with septostomy complications. CONCLUSIONS Neuroendoscopy for hydrocephalus due to varying etiologies provides significant utility but is not without risk. The authors did not find associations between larger ventricular size or posterior endoscope approach and lower complication rates, as hypothesized. No significant difference in complication rates was noted between septostomy performed during ETV/CPC and other endoscopic procedures requiring septostomy.

A NSQIP Analysis of MELD and Perioperative Outcomes in General Surgery

2015 ◽  
Vol 81 (8) ◽  
pp. 755-759 ◽  
Author(s):  
Shannon M. Zielsdorf ◽  
John C. Kubasiak ◽  
Imke Janssen ◽  
Jonathan A. Myers ◽  
Minh B. Luu
Keyword(s):  
Liver Disease ◽  
Postoperative Complications ◽  
Hernia Repair ◽  
Postoperative Complication ◽  
General Surgery ◽  
Meld Score ◽  
Perioperative Outcomes ◽  
Complication Rates ◽  
Umbilical Hernia Repair ◽  
The Mean

It is well known that liver disease has an adverse effect on postoperative outcomes. However, what is still unknown is how to appropriately risk stratify this patient population based on the degree of liver failure. Because data are limited, specifically in general surgery practice, we analyzed the model of end-stage liver disease (MELD) in terms of predicting postoperative complications after one of three general surgery operations: inguinal hernia repair (IHR), umbilical hernia repair (UHR), and colon resection (CRXN). National Surgical Quality Improvement Program data on 17,812 total patients undergoing one of three general surgery operations from 2008 to 2012 were analyzed retrospectively. There were 7402 patients undergoing IHR; 5014 patients undergoing UHR; 5396 patients undergoing CRXN. MELD score was calculated using international normalized ratio, total bilirubin, and creatinine. The primary end point was any postoperative complication. The statistical method used was logistic regression. For IHR, UHR, and CRXN, the overall complication rates were 3.4, 6.4, and 45.9 per cent, respectively. The mean MELD scores were 8.6, 8.5, and 8.5, respectively. For every 1-point increase greater than the mean MELD score, there was a 7.8, 13.8, and 11.6 per cent increase in any postoperative complication. The overall 30-day mortality rate was 0.9 per cent. In conclusion, the MELD score continuum adequately predicts patients’ increased risk of postoperative complications after IHR, UHR, and CRXN. Therefore, MELD could be used for preoperative risk stratification and guide clinical decision making for general surgery in the cirrhotic patient.

scholarly journals Impact of Robotic Fellowship Experience on Perioperative Outcomes of Robotic-Assisted Laparoscopic Partial Nephrectomy

2015 ◽  
Vol 9 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Michael A. Moriarty ◽  
Kenneth G. Nepple ◽  
Chad R. Tracy ◽  
Michael E. Strigenz ◽  
Daniel K. Lee ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Perioperative Complications ◽  
Positive Margin ◽  
Warm Ischemia ◽  
Laparoscopic Partial Nephrectomy ◽  
Perioperative Outcomes ◽  
Initial Experience ◽  
Robotic Assisted ◽  
Nephrometry Score ◽  
Significant Difference

Background: We analyzed differences in patient selection and perioperative outcomes between robotic-fellowship trained and non-fellowship trained surgeons in their initial experience with robotic-assisted laparoscopic partial nephrectomy. Methods: Data through surgeon case 10 was analyzed. Forty patients were identified from two fellowship trained surgeons (n = 20) and two non-fellowship trained surgeons (n = 20). Results: Fellowship trained surgeons performed surgery on masses of higher nephrometry score (8.0 vs. 6.0, p = 0.007) and more posterior location (60 vs. 25%, p = 0.03). Retroperitoneal approach was more common (50 vs. 0%, p = 0.0003). Fellowship trained surgeons trended toward shorter warm ischemia time (25.5 vs. 31.0 min, p = 0.08). There was no significant difference in perioperative complications (35 vs. 35%, p = 0.45) or final positive margin rates (0 vs. 15%, p = 0.23). Conclusion: Fellowship experience may allow for treating more challenging and posterior tumors in initial practice and significantly more comfort performing retroperitoneal robotic-assisted laparoscopic partial nephrectomy.

scholarly journals Impact of Previous Abdominal Surgery on Robotic-Assisted Rectal Surgery in Patients with Rectal Cancer Undergoing Preoperative Chemoradiotherapy: A Propensity Score Matching Study

2020 ◽  
Author(s):  
Ching-Wen Huang ◽  
Wei-Chih Su ◽  
Tsung-Kun Chang ◽  
Cheng-Jen Ma ◽  
Tzu-Chieh Yin ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Propensity Score ◽  
Abdominal Surgery ◽  
Propensity Score Matching ◽  
Rectal Surgery ◽  
Perioperative Outcomes ◽  
Group Differences ◽  
Complication Rates ◽  
Robotic Assisted ◽  
Previous Abdominal Surgery

Abstract Background: The application of minimally invasive surgery in patients with colorectal cancer (CRC) and a history of previous abdominal surgery (PAS) remains controversial. This retrospective study with propensity score matching (PSM) investigated the impact of PAS on robotic-assisted rectal surgery outcomes in patients with rectal cancer undergoing preoperative concurrent chemoradiotherapy (CCRT).Methods: In total, 203 patients with rectal cancer who underwent preoperative CCRT and robotic-assisted rectal surgery between May 2013 and December 2019 were enrolled. Patients were categorized into PAS and non-PAS groups based on the PAS history. The PSM caliper matching method with 1-to-3 match was used to match PAS patients with non-PAS.Results: Of the 203 enrolled patients, 35 were PAS patients 168 were non-PAS patients. After PSM, 32 PAS patients and 96 non-PAS patients were included for analysis. No significant between-group differences were noted in the perioperative outcomes, including median console time [165 min (PAS) vs 175 min (noon-PAS), P = 0.4542)] and median operation time [275 min (PAS) vs 290 min (non-PAS), P = 0.5943)] after PSM. Postoperative recovery and overall complication rates were also similar (all P > 0.05). Moreover, the between-group differences in pathological or short-term oncological outcomes were also nonsignificant (all P > 0.05). No 30-day postoperative deaths were observed in either group.Conclusion: The current results indicate that robotic-assisted surgery is safe and feasible for PAS patients with rectal cancer undergoing preoperative CCRT. However, future prospective randomized clinical trials are required to verify these findings.

scholarly journals Surgical Outcomes of LigaSure Hemorrhoidectomy in the Elderly Population: A retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chuang-Wei Chen ◽  
Tzung-Ju Lu ◽  
Koung-Hung Hsiao
Keyword(s):  
Cohort Study ◽  
Postoperative Complications ◽  
Surgical Outcomes ◽  
Multivariate Logistic Regression Analysis ◽  
Operation Time ◽  
Admission Rate ◽  
Complication Rates ◽  
Time Duration ◽  
Significant Difference ◽  
Prone Jackknife Position

Abstract Background This study aims to assess the association between age and outcomes in patients undergoing hemorrhoidectomy. Methods This is a population-based cohort study. A retrospectively collected database with consecutive patients whose symptomatic prolapsed hemorrhoids managed by the LigaSure hemorrhoidectomy between Jan. 2015 and May 2017 was reviewed. Among 1238 patients, 1075 were under 65 years old (group 1), and 163 were 65 years old or older (group 2). Both groups were compared regarding baseline characteristics and surgical outcomes. Results All patients tolerated the whole course of the operation in the prone jackknife position without anesthetic-associated complications. There was no significant difference between these two groups regarding sex, hemorrhoids grade, operation time, duration of hospital stays, postoperative pain score, analgesic consumption, total postoperative complications, re-admission rate, reoperation rate and follow-up times. The multivariate logistic regression analysis that may contribute to postoperative complications revealed no significant difference for all complications between both groups. Conclusion The LigaSure hemorrhoidectomy for elderly patients is safe and effective without significant difference in short-term operative outcomes and all complication rates, compared with younger patients.

scholarly journals Evolving trends in the surgical staging of endometrial cancer patients in Germany: Analysis of a nationwide registry with special emphasis on perioperative outcomes

2021 ◽  
Author(s):  
Katrin Roth ◽  
Klaus Kaier ◽  
Peter Stachon ◽  
Constantin von zur Mühlen ◽  
Florin-Andrei Taran ◽  
...  
Keyword(s):  
Endometrial Carcinoma ◽  
Prolonged Mechanical Ventilation ◽  
Laparoscopic Approach ◽  
International Classification Of Diseases ◽  
Surgical Staging ◽  
Perioperative Outcomes ◽  
Robotic Assisted ◽  
Classification Of Diseases ◽  
Prolonged Hospital ◽  
Robotic Assisted Laparoscopy

Abstract Purpose The present study compared the use and outcomes of open surgical staging, laparoscopic surgical staging and robotic-assisted surgical staging in all patients suffering from endometrial carcinoma undergoing surgery in Germany between 2007 and 2018. Methods All patients with the diagnosis of endometrial carcinoma undergoing open surgical staging, laparoscopic surgical staging and robotic-assisted surgical staging were identified by international classification of diseases (ICD) or specific operational codes (OPS) within the database of the German federal bureau of statistics. Results Between 2007 and 2018, a total of 85,204 patients underwent surgery for endometrial carcinoma. Since 2013 laparoscopy was the leading approach in the surgical staging. The use of robotic-assisted laparoscopy increased steadily since 2011 with a share of 3% in 2018. Open surgical staging was associated with a higher risk of in-hospital mortality than laparoscopic surgical staging (1.3% vs. 0.2%, p < 0.001), of prolonged mechanical ventilation (1.3% vs. 0.2%, p < 0.001), and of prolonged hospital stay (13.7 ± 10.2 vs. 7.2 ± 5.3, p < 0.001). 0.04% patients undergoing laparoscopy were converted to laparotomy. The perioperative outcomes of surgical staging by laparotomy compared with robotic-assisted were comparable. None of the robotic-assisted treated patients died or was converted into laparotomy. Costs were highest in the open laparotomy staging group, followed by robotic assisted. Conventional laparoscopic approach caused lowest costs (8286 ± 7533€ vs. 7083 ± 3893€ vs. 6047 ± 3509€). Conclusion The present analysis shows that conventional laparoscopy is the standard therapy of endometrial carcinoma with excellent in-hospital outcomes in clinical practice. Robotic-assisted laparoscopy is an emerging technology with convincing results similar to

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