scholarly journals Safety and Cost Considerations during the Introduction Period of Laparoscopic Radical Hysterectomy

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
A. Anagnostopoulos ◽  
S. Mitra ◽  
B. Decruze ◽  
R. Macdonald ◽  
J. Kirwan
Keyword(s):  
Laparoscopic Surgery ◽  
Radical Hysterectomy ◽  
Hospital Cost ◽  
Open Surgery ◽  
Enhanced Recovery ◽  
Bladder Function ◽  
Retrospective Case ◽  
Laparoscopic Radical Hysterectomy ◽  
Perioperative Morbidity ◽  
Significant Difference

Objective. To compare the safety, efficacy, and direct cost during the introduction of laparoscopic radical hysterectomy within an enhanced recovery pathway. Methods. A 1 : 1 single centre retrospective case control study of 36 propensity matched pairs of patients receiving open or laparoscopic surgery for early cervical cancer. Results. There were no significant differences in the baseline characteristics of the two cohorts. Open surgery cohort had significantly higher intraoperative blood loss (189 versus 934 mL) and longer postoperative hospital stay (2.3 versus 4.1 days). Although no significant difference in the intraoperative or postoperative complications was found more urinary tract injuries were recorded in the laparoscopic cohort. Laparoscopic surgery had significantly longer duration (206 versus 159 minutes), lower lymph node harvest (12.6 versus 16.9), and slower bladder function recovery. The median direct hospital cost was £4850 for laparoscopic radical hysterectomy and £4400 for open surgery. Conclusions. Laparoscopic radical hysterectomy can be safely introduced in an enhanced recovery environment without significant increase in perioperative morbidity. The 10% higher direct hospital cost is not statistically significant and is expected to even out when indirect costs are included.

Assessment of Circumferential Resection Margins (CRM) clearance in Conventional open Versus Laparoscopic Cancer Rectum Resection

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Ibrahim H Bayan ◽  
Ahmed Abdelaziz ◽  
Tarek Youssef Ahmed ◽  
Mohamed Magdy
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Abdominal Surgery ◽  
Open Surgery ◽  
Laparoscopic Group ◽  
Resection Margins ◽  
Laparoscopy Group ◽  
Surgery Group ◽  
Colon And Rectal Cancer ◽  
Significant Difference

Abstract Background Colon and rectal cancer represent the fourth commonest malignancy worldwide. Globally, colon and rectal cancer make up 9.4% and 10.1% in men and women of all cancers, respectively. Colon and rectal tumors are the third most common malignancy after breast and lung cancer, respectively. The main management of rectal cancer involves a multi-disciplinary team approach and an individually tailored treatment routine. Operative surgery remains the primary and definitive treatment for locally confined rectal adenocarcinoma and is the only historical and current treatment which allows for cure. Resection of the colon and rectal cancer can be done either by open surgical excision or laparoscopically. Aim of the work The objective is to compare the radicality of total mesorectal excision for rectal cancer in both open and laparoscopic surgery through the pathology report. Methods In this multicentric, prospective, comparative study, we included the pathologically established rectal cancer patients from 2 hospitals in Cairo, Egypt, Ain Shams University Hospitals and Maadi Military Hospital, Egypt between 2013 and 2016. The sample size was 40 patients divided into two groups; 20 patients for laparoscopic arm and 20 patients for the open trans-abdominal surgery. Inclusion criteria: histopathology confirmed rectal cancer, patients fit for operative resection, and with T1- T3 grades according to the preoperative evaluation. The exclusion criteria: Patients with T4 stage tumor, patients present as emergency cases and patients present with recurrence of the tumor and synchronous colonic tumors. Results The circumferential resection margins (CRM) of the mesorectum when examined pathologically after resection showed no difference between the two arms of the study with laparoscopic group specimens 3.18±1.16 mm mean, (SD) compared to 3.50±0.45 mm mean, (SD) in the open surgery group with no statistically significant difference. The longitudinal resection margins (LRM) was (5.50±1.98 mean, SD) in the laparoscopic group compared to (5.20±2.28 mean, SD) in the open conventional surgery group with no significant difference found between the two groups. Total operative time was significantly shorter in the trans-abdominal surgery group, while the hospital stay period was significantly shorter in the laparoscopy group. Laparoscopy group also showed significantly time before flatus passage, and the patients in the laparoscopy group started oral intake faster than open surgery group. Conclusion In our study, the radicality of the rectal cancer excision in both laparoscopic and traditional open surgery, showed non inferiority of the laparoscopic technique over open surgery Long-term clinical outcomes of overall survival and recurrence is the foremost parameters which should be taken in consideration for decision for laparoscopic surgery for rectal cancer. Additional follow-up results from the current trial are presently being developed, beside with records on other secondary end points, like cost effectiveness and quality of life.

Evaluating the Evolving Morbidity of Omentoplasty for Perforated Peptic Ulcer Disease

2020 ◽  
Vol 86 (10) ◽  
pp. 1289-1295
Author(s):  
Noah Swann ◽  
Nobel LeTendre ◽  
Brian Cox ◽  
James Recabaren
Keyword(s):  
Laparoscopic Surgery ◽  
Laparoscopic Repair ◽  
Open Surgery ◽  
Surgical Repair ◽  
Open Repair ◽  
Perforated Peptic Ulcer ◽  
Morbidity And Mortality ◽  
Patch Repair ◽  
Perioperative Morbidity ◽  
Graham Patch

Mortality for perforated peptic ulcer (PPU) surgery ranges from 2-22% with morbidity ranging from 15-45%. Traditionally, these had been repaired with vagotomy and antrectomy or pyloroplasty with smaller perforations repaired with an omentoplasty. Laparoscopic repair has become increasingly prevalent and demonstrated to have shorter length of stay (LOS) and fewer complications. We are evaluating the surgical repair of PPU with omentoplasty to determine trends of utilization and surgical outcomes. We conducted a 13-year (2005-2017) retrospective review, utilizing the National Surgical Quality Improvement Program database. A total of 6873 patients had open or laparoscopic repair of a PPU, with 2285 patients identified as utilizing omentoplasty. Five hundred eighty-eight omentoplasty patients were further identified as having a laparoscopic technique. We compared patient demographics, comorbidities, and perioperative morbidity and mortality for surgical patients between 2005-2011 and 2012-2017. We trended the perioperative outcomes across the study intervals. Parametric and nonparametric tests were used to evaluate outcomes. Between 2005 and between 2017, laparoscopic surgical repair with omentoplasty has increased from 3.8% to 34.6%. Overall mortality for open operations declined during this interval (12.7%-9.3%) while it remained unchanged for laparoscopic operations (4.6%-4.2%), there was not a significant difference between the laparoscopic and open 30-day mortality. Both open surgery and laparoscopic surgery are being used on an increasingly healthy cohort (increased functional status decreased predicted perioperative morbidity). Relative to the 2005-2011, the laparoscopic surgery 2012-2017 cohort had increases in both serious and overall morbidity, although this was not statistically significant. Compared to the 2005-2011, the 2012-2017 open surgery cohort had increasing serious morbidity (OR 2.03) and overall morbidity (OR 1.91). There was a trend of decreasing LOS and increased return to the operating room for patients with laparoscopic surgery. Laparoscopic Graham patch repair of peptic ulcers significantly increased, although open repair still constitutes the majority of the cases. Despite Graham patch repair being utilized on a healthier patient population, morbidity and mortality for laparoscopic repair have remained unchanged. Postoperative morbidity and mortality for open surgery have increased. This indicates that laparoscopic repair is more commonly utilized for low- or medium risk patients, leaving an increasingly sick patient population selected to open repair.

Laparoscopic Versus Open Appendectomy for the Treatment of Complicated Acute Appendicitis

2020 ◽  
Vol 8 (1) ◽  
pp. 15
Author(s):  
Alireza Barband ◽  
Amir Mangouri ◽  
Changiz Gholipouri ◽  
Abasad Gharedaghi
Keyword(s):  
Laparoscopic Surgery ◽  
Surgical Treatment ◽  
Postoperative Pain ◽  
Acute Appendicitis ◽  
Open Surgery ◽  
Surgery Group ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Duration Of Hospitalization ◽  
Complicated Acute Appendicitis

Background and Objective: Acute appendicitis is one of the most common and at the same time lethal if not treated promptly. Failure to treat this medical condition in a timely manner then it can lead to major complications that endanger the patient’s health. In these cases, surgical treatment can be done in an open or laparoscopic method. Despite some limited studies comparing the results of these two therapies, there is still insufficient information in patients with this complicated situation. The aim of this study was to evaluate the results of these two therapies in patients with complicated acute appendicitis. Materials and Methods: In this randomized controlled clinical trial, 52 patients with complicated acute appendicitis in the laparoscopic surgery group and 56 patients in the open surgery group were studied. Primary outcomes in this study were duration of surgery and secondary outcomes including wound infection, intra-abdominal abscess, postoperative pain, miscarriage, hospitalization, and need for re-surgery that were compared between the two groups. Results: Both groups were matched for age (mean 31.0 years in laparoscopic surgery group, 30.5 years in open surgery group, p = 0.81) and gender (28 men in laparoscopic surgery group, 32 men in surgical group, p = 0.73). The mean duration of surgery in the laparoscopic group was significantly longer (mean 66.8 vs. 55.1 min, p <0.001). In contrast, mean duration of hospitalization (85.2 vs 98.6 hours, p <0.001) and mean postoperative pain severity (6.3 vs 7.2, p <0.001) was more significant high in open surgery group. In other cases there was no significant difference between the two groups. Conclusion: Although in surgical treatment of complicated acute appendicitis the duration of laparoscopic surgery is longer than the open method, but the duration of hospitalization and pain intensity in laparoscopic method is significantly reduced.

Comparative effectiveness of laparoscopic radical hysterectomy for cervical cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17015-e17015
Author(s):  
Jung-Yun Lee ◽  
Jae-Weon Kim ◽  
Kidong Kim ◽  
Myong Cheol Lim ◽  
Jin Hee Kim
Keyword(s):  
Cervical Cancer ◽  
Minimally Invasive ◽  
Radical Hysterectomy ◽  
Laparoscopic Approach ◽  
Population Level ◽  
Laparoscopic Radical Hysterectomy ◽  
Perioperative Morbidity ◽  
Level Data ◽  
Hospital Stays ◽  
Perioperative Complication

e17015 Background: Despite the benefits of minimally invasive surgery for cervical cancer, population-level data describing the surgery’s effectiveness in unselected patients are lacking. We compared morbidity, cost, and survival between abdominal radical hysterectomy and laparoscopic radical hysterectomy for cervical cancer. Methods: We used the Korean Health Insurance Review and Assessment Service database to identify women with cervical cancer who underwent radical hysterectomy from 2011 to 2014. Patient who underwent abdominal radical hysterectomy were compared with those who had minimally invasive hysterectomy. Perioperative morbidity, use of adjuvant therapy, and survival were evaluated. Results: We identified 6,335 patients including 3,235 who underwent abdominal radical hysterectomy and 3,100 who underwent laparoscopic radical hysterectomy. Uptake of laparoscopic radical hysterectomy increased from 46.1% in 2011 to 51.8% in 2014. Patients who were younger and treated at larger hospital were more likely to undergo laparoscopic procedure (P<0.001). Laparoscopic radical hysterectomy had lower rates of complication, less transfusion requirement, shorter hospital stays, and reduced total medical costs (P<0.001). There was no significant association between use of laparoscopic approach and recurrence-free survival (P=0.194). Conclusions: Laparoscopic radical hysterectomy was associated with lower risk of perioperative complication and have comparable outcomes with abdominal radical hysterectomy.

scholarly journals Bladder Function after Hysterectomy

2016 ◽  
pp. 97
Author(s):  
Johanna Wijaya ◽  
Hermie Tendean ◽  
Bismarck J Laihad
Keyword(s):  
General Hospital ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Age Distribution ◽  
Study Data ◽  
Bladder Function ◽  
Post Intervention ◽  
Total Hysterectomy ◽  
Post Surgery ◽  
Significant Difference

Objective: To determine the effect of hysterectomy on bladder function pre- and post-radical hysterectomy in early stage of cervical cancer. Method: This study was a pre-post intervention study. Data were collected through questionnaires from women who had radical hysterectomy and total hysterectomy in Prof. Dr. R. D. Kandou Manado general hospital and other networking hospitals since January 1st, 2014 to November 31st, 2014. We analyzed the data using Wilcoxon and Mann-Whitney statistical test. Result: There were each 18 respondents for the radical and total hysterectomy group in Prof. Dr. R. D. Kandou general hospital and networking hospitals. The age distribution of radical hysterectomy was 41-45 years old for 44.4%. The parity was dominated by second parity for 38.8%. In pre- and post-surgery, there were significant differences for urinary incontinence disorder (p=0.003), emptying disorder (p=0.008), urinary pain (p=0.034), and total urinary disorder (p=0.001). While, between radical and total hysterectomy, there was no significant difference in bladder function (p>0.05). Conclusion: There is an association before and after surgery to urinary function. However, there is no association between the radical and total hysterectomy group. [Indones J Obstet Gynecol 2016; 4-2: 97-100] Keywords: bladder function, cervical cancer, radical hysterectomy

Laparoscopic vs open surgery during the COVID-19 pandemic: what are the risks?

2021 ◽  
Author(s):  
C Hadjittofi ◽  
SS Seraj ◽  
A Uddin ◽  
ZJ Ali ◽  
PL Antonas ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Survival Data ◽  
Open Surgery ◽  
Virus Transmission ◽  
Laparoscopic Approach ◽  
Length Of Hospital Stay ◽  
Staff Members ◽  
Significant Difference ◽  
The Uk

Introduction The initial intercollegiate surgical guidance from the UK during the COVID-19 pandemic resulted in significant changes to practice. Avoidance of laparoscopy was recommended, to reduce aerosol generation and risk of virus transmission. Evidence on the safety profile of laparoscopy during the pandemic is lacking. This study compares patient outcomes and risk to staff from laparoscopic and open gastrointestinal operations during the COVID-19 pandemic. Methods Single-centre retrospective study of gastrointestinal operations performed during the peak of the COVID-19 pandemic. Demographic, comorbidity, perioperative and survival data were collected from electronic medical records and supplemented with patient symptoms reported at telephone follow up. Outcomes assessed were: patient mortality, illness among staff, patient COVID-19 rates, length of hospital stay and postdischarge symptomatology. Results A total of 73 patients with median age of 56 years were included; 55 (75%) and 18 (25%) underwent laparoscopic and open surgery, respectively. All-cause mortality was 5% (4/73), was related to COVID-19 in all cases, with no mortality after laparoscopic surgery. A total of 14 staff members developed COVID-19 symptoms within 2 weeks, with no significant difference between laparoscopic and open surgery (10 vs 4; p=0.331). Median length of stay was shorter in the laparoscopic versus the open group (4.5 vs 9.9 days; p=0.011), and postdischarge symptomatology across 15 symptoms was similar between groups (p=0.135–0.814). Conclusions With appropriate protective measures, laparoscopic surgery is safe for patients and staff during the COVID-19 pandemic. The laparoscopic approach maintains an advantage of shorter length of hospital stay compared with open surgery.

Comparison of Laparoscopic and Open Surgery for Patients With Borderline Ovarian Tumors

2018 ◽  
Vol 28 (9) ◽  
pp. 1657-1663 ◽  
Author(s):  
Hee-Jung Jung ◽  
Jeong-Yeol Park ◽  
Dae-Yeon Kim ◽  
Dae-Shik Suh ◽  
Jong-Hyeok Kim ◽  
...  
Keyword(s):  
Overall Survival ◽  
Laparoscopic Surgery ◽  
Surgical Outcomes ◽  
Open Surgery ◽  
Disease Free Survival ◽  
Free Survival ◽  
Borderline Ovarian Tumors ◽  
Surgery Group ◽  
Significant Difference ◽  
Disease Free

ObjectivesThe aim of this study was to compare surgical and oncologic outcomes of open and laparoscopic surgery in patients with borderline ovarian tumors (BOTs).Materials and MethodsThis study included patients with BOTs who underwent open (n = 433) or laparoscopic (n = 210) surgery between 1990 and 2015. Surgical outcomes, perioperative morbidity, and disease-free survival and overall survival were compared.ResultsThere was no significant difference in age, histologic type of tumor, and laterality of tumor. However, body mass index was slightly higher for the open surgery group (P = 0.046). The open surgery group had a higher serum cancer antigen 125 level (P < 0.001), larger tumor size (P < 0.001), more frequent radical surgery (P = 0.001), higher stage (P = 0.034), and higher incidence of invasive implants (P = 0.035). The operative time (P < 0.001), time interval to return of bowel movement (P < 0.001), and length of postoperative hospital stay (P < 0.001) were significantly shorter and estimated blood loss was significantly less (P < 0.001) in the laparoscopic group. Perioperative complications were documented in 5 (2.4%) patients in the laparoscopic surgery group and 17 (3.9%) in the open surgery group (P = 0.064). Twenty-three (5.3%) patients in the open surgery group and 9 (4.3%) in the laparoscopic surgery group had recurrence (P = 0.902) at a median follow-up of 57 months. The 10-year disease-free survival was 96% and 97% for the open and laparoscopic groups, respectively (P = 0.851), with no significant difference between the groups after adjusting for independent factors (odds ratio, 1.0; 95% confidence interval, 0.4–2.4; P = 0.999). The 10-year overall survival was 99% for both groups, respectively (P = 0.441).ConclusionsLaparoscopic surgery and open surgery showed similar survival outcomes in BOTs. The surgical outcomes of laparoscopic surgery were more favorable.

Surgical and Oncological Outcome of Total Laparoscopic Radical Hysterectomy in Obese Women With Early-Stage Cervical Cancer

2012 ◽  
Vol 22 (1) ◽  
pp. 101-106 ◽  
Author(s):  
Esther Louise Moss ◽  
Janos Balega ◽  
Kiong K. Chan ◽  
Kavita Singh
Keyword(s):  
Cervical Cancer ◽  
Hospital Stay ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Safe Procedure ◽  
Obese Women ◽  
Laparoscopic Radical Hysterectomy ◽  
Significant Difference ◽  
Early Stage Cervical Cancer ◽  
Nonobese Group

ObjectiveTo evaluate the clinical experience of the total laparoscopic radical hysterectomy (TLRH) for the surgical management of cervical cancer in obese (body mass index [BMI] >30 kg/m2) and nonobese (BMI <30 kg/m2) women.MethodsData were collected prospectively on intraoperative and postoperative parameters and complications for all women undergoing a TLRH for cervical cancer. Patients were classified as obese, BMI >30 kg/m2, or nonobese, BMI <30 kg/m2. Assessment of surgical radicality was made by comparing the excision specimens in the 2 groups with a cohort of open radical hysterectomy cases performed before the introduction of the TLRH.ResultsA total of 58 women underwent a TLRH; 15 (25.9%) were obese and 43 (74.1%) were in the nonobese group. There was no significant difference in intraoperative blood loss or median duration of surgery between the obese and nonobese groups. The median hospital stay in both groups was 3 days (range, 2–13 days). Four cases were converted to laparotomy (7%); all were in the nonobese group. Postoperatively, 3 patients developed ischemic ureterovaginal fistulae (5%) between days 5 and 7 after surgery; all were in the nonobese group. There was no significant difference in the parametrial length, maximum vaginal cuff length, and number of lymph nodes excised between the 2 groups. To date, there has been one recurrence during the median follow-up period of 19 months (range, 3–42 months). She belonged to the nonobese group.ConclusionsThe TLRH is a surgically safe procedure for early-stage cervical cancer. Obesity did not adversely affect the performance of TLRH or the radicality of the excision. In obese women, TLRH should be the favored route of surgery for all women who require a radical hysterectomy owing to its favorable perioperative outcome and short hospital stay.

scholarly journals Introduction of gasless laparoscopic surgery as a minimally invasive procedure for endometrial cancer and its usefulness from the viewpoint of the learning curve

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Hiroe Ito ◽  
Tetsuya Moritake ◽  
Fumitoshi Terauchi ◽  
Keiichi Isaka
Keyword(s):  
Endometrial Cancer ◽  
Laparoscopic Surgery ◽  
Blood Loss ◽  
Learning Curve ◽  
Hospital Stay ◽  
Open Surgery ◽  
Operative Time ◽  
Perioperative Complications ◽  
Survival Rates ◽  
Significant Difference

Abstract Background We investigated the usefulness of gasless laparoscopic surgery (GLS) using a subcutaneous abdominal wall lifting method for endometrial cancer. Methods We studied 105 patients with early endometrial cancer who underwent GLS (55) or open surgery (50). A uterine manipulator was used in all GLS cases. We compared operative time, blood loss, number of lymph nodes removed, hospital stay, perioperative complications, cases converted to laparotomy, and recurrence and survival rates. We also studied the learning curve and proficiency of GLS. Results The GLS group had significantly longer operative time (265 vs. 191 min), reduced blood loss (184 vs. 425 mL), shorter hospital stay (9.9 vs. 17.6 days), and fewer postoperative complications (1.8 vs. 12.0%) than the open group. No case was converted to laparotomy. Disease-free and overall survival rates at 4 years postoperatively (GLS vs. open groups) were 98.0 versus 97.8 and 100 versus 95.7%, respectively, and there was no significant difference between the groups. Regarding the learning curve for GLS, two different phases were observed in approximately 10 cases. Operator 2, who was not accustomed to laparoscopic surgery, showed a significant reduction in operative time in the later phase 2. Conclusions GLS for endometrial cancer results in less bleeding, shorter hospital stay, and fewer complications than open surgery. Recurrence and survival rates were not significantly different from those of open surgery. This technique may be introduced in a short time for operators who are skilled at open surgery but not used to laparoscopic surgery.

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