scholarly journals Comparative Efficacy of Robot-Assisted and Laparoscopic Distal Pancreatectomy: A Single-Center Comparative Study

2022 ◽  
Vol 2022 ◽  
pp. 1-8
Author(s):  
Peng Chen ◽  
Bin Zhou ◽  
Tao Wang ◽  
Xiao Hu ◽  
Yongqiang Ye ◽  
...  
Keyword(s):  
Learning Curve ◽  
Hospital Stay ◽  
Distal Pancreatectomy ◽  
Operation Time ◽  
Economic Cost ◽  
Laparoscopic Distal Pancreatectomy ◽  
Postoperative Recovery ◽  
Perioperative Outcomes ◽  
Feeding Time ◽  
Low Grade

Background. Laparoscopic distal pancreatectomy (LDP) has become a routine procedure in pancreatic surgery. Although robotic distal pancreatectomy (RDP) has not been popularized yet, it has shown new advantages in some aspects, and exploring its learning curve is of great significance for guiding clinical practice. Methods. 149 patients who received RDP and LDP in our surgical team were enrolled in this retrospective study. Patients were divided into two groups including LDP group and RDP group. The perioperative outcomes, histopathologic results, long-term postoperative complications, and economic cost were collected and compared between the two groups. The cumulative summation (CUSUM) analysis was used to explore the learning curve of RDP. Results. The hospital stay, postoperative first exhaust time, and first feeding time in the RDP group were better than those in the LDP group ( P < 0.05 ). The rate of spleen preservation in patients with benign and low-grade tumors in the RDP group was significantly higher than that of the LDP group ( P = 0.002 ), though the cost of operation and hospitalization was significantly higher ( P < 0.001 ). The learning curve of RDP in our center declined significantly with completing 32 cases. The average operation time, the hospital stay, and the time of gastrointestinal recovery were shorter after the learning curve node than before. Conclusion. RDP provides better postoperative recovery and is not difficult to replicate, but the high cost was still a major disadvantage of RDP.

scholarly journals Implementation and training with laparoscopic distal pancreatectomy: 23-year experience from a high-volume center

2021 ◽  
Author(s):  
Mushegh A. Sahakyan ◽  
Bård I. Røsok ◽  
Tore Tholfsen ◽  
Dyre Kleive ◽  
Anne Waage ◽  
...  
Keyword(s):  
Learning Curve ◽  
Distal Pancreatectomy ◽  
Operative Time ◽  
High Volume ◽  
Laparoscopic Distal Pancreatectomy ◽  
Ductal Adenocarcinoma ◽  
Perioperative Outcomes ◽  
Exact Number ◽  
High Volume Center ◽  
And Training

Abstract Background Distal pancreatectomy is the most common procedure in minimally-invasive pancreatic surgery. Data in the literature suggest that the learning curve flattens after performing up to 30 procedures. However, the exact number remains unclear. Methods The implementation and training with laparoscopic distal pancreatectomy (LDP) in a high-volume center were studied between 1997 and 2020. Perioperative outcomes and factors related to conversion were assessed. The individual experiences of four different surgeons (pioneer and adopters) performing LDP on a regular basis were examined. Results Six hundred forty LDPs were done accounting for 95% of all distal pancreatectomies performed throughout the study period. Conversion was needed in 14 (2.2%) patients due to intraoperative bleeding or tumor adherence to the major vasculature. Overall morbidity and mortality rates were 35 and 0.6%, respectively. Intra- and postoperative outcomes did not change for any of the surgeons within their first 40 cases. Operative time significantly decreased after the first 80 cases for the pioneer surgeon and did not change afterwards although the proportion of ductal adenocarcinoma increased. Tumor size increased after the first 80 cases for the first adopter without affecting the operative time. Conclusions In this nearly unselected cohort, no significant changes in surgical outcomes were observed throughout the first 40 LDPs for different surgeons. The exact number of procedures required to overcome the learning curve is difficult to determine as it seems to depend on patient selection policy and specifics of surgical training at the corresponding center.

scholarly journals A learning curve in using organ retractor for single-incision laparoscopic right colectomy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Toshio Shiraishi ◽  
Tetsuro Tominaga ◽  
Takashi Nonaka ◽  
Kiyoaki Hamada ◽  
Masato Araki ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Laparoscopic Surgery ◽  
Blood Loss ◽  
Learning Curve ◽  
Single Incision ◽  
Operation Time ◽  
Perioperative Outcomes ◽  
Single Incision Laparoscopic Surgery ◽  
Right Colon ◽  
Right Colon Cancer

AbstractSingle-incision laparoscopic surgery (SILS) has the potential to improve perioperative outcomes, including less postoperative pain, shorter operation time, less blood loss, and shorter hospital stay. However, SILS is technically difficult and needs a longer learning curve. Between April 2016 and September 2019, a total of 198 patients with clinical stage I/II right colon cancer underwent curative resection. In the case of the SILS approach, an organ retractor was usually used to overcome SILS-specific restrictions. The patients were divided into two groups by surgical approach: the SILS with organ retractor group (SILS-O, n = 33) and the conventional laparoscopic surgery group (LAC, n = 165). Clinical T status was significantly higher in the LAC group (p = 0.016). Operation time was shorter and blood loss was lower in the SILS-O group compared to the LAC group (117 vs. 197 min, p = 0.027; 10 vs. 25 mL, p = 0.024, respectively). In the SILS-O group, surgical outcomes including operation time, blood loss, number of retrieved lymph nodes, and postoperative complications were not significantly different between those performed by experts and by non-experts. Longer operation time (p = 0.041) was significantly associated with complications on univariate and multivariate analyses (odds ratio 2.514, 95%CI 1.047–6.035, p = 0.039). SILS-O was safe and feasible for right colon cancer. There is a potential to shorten the learning curve of SILS using an organ retractor.

Short-term perioperative outcomes after robot-assisted and laparoscopic distal pancreatectomy

2013 ◽  
Vol 8 (2) ◽  
pp. 125-132 ◽  
Author(s):  
Emmanuel I. Benizri ◽  
Adeline Germain ◽  
Ahmet Ayav ◽  
Jean-Louis Bernard ◽  
Rasa Zarnegar ◽  
...  
Keyword(s):  
Distal Pancreatectomy ◽  
Laparoscopic Distal Pancreatectomy ◽  
Perioperative Outcomes ◽  
Robot Assisted ◽  
Short Term

scholarly journals Laparoscopic Spleen-Preserving Distal Pancreatectomy (LSPDP) versus Open Spleen-Preserving Distal Pancreatectomy (OSPDP): A Comparative Study

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Jing Huang ◽  
Dipesh Kumar Yadav ◽  
Chaojie Xiong ◽  
Ye Sheng ◽  
Xinhua’ Zhou ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Blood Loss ◽  
Hospital Stay ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Operative Time ◽  
Malignant Tumors ◽  
Low Grade ◽  
Intraoperative Blood Loss ◽  
Spleen Preserving

Objective. To compare outcomes between laparoscopic spleen-preserving distal pancreatectomy (LSPDP) and open spleen-preserving distal pancreatectomy (OSPDP) for treatment of benign and low-grade malignant tumors of the pancreas and evaluate feasibility and safety of LSPDP. Methods. The clinical data of 53 cases of LSPDP and 44 cases of OSPDP performed between January 2008 and August 2018 were retrospectively analyzed. The clinical outcomes between the two groups were compared. Results. There was no significant difference in preoperative data between the two groups. However, the LSPDP group had statistically significant shorter operative time (145.3±55.9 versus 184.7±33.5, P=0.03) and lesser intraoperative blood loss (150.6±180.8 versus 253.5±76.2, P=0.03) than that of the OSPDP group. Moreover, the LSPDP group also had statistically significant earlier passing of first flatus (2.2±1.4 versus 3.1±1.9, P=0.01), earlier diet intake (2.3±1.8 versus 3.4±2.0, P=0.01), and shorter hospital stay (6.2±7.2 versus 8.8±9.3, 0.04) than that of the OSPDP group. However, postoperative pancreatic fistula (P=0.64) and total postoperative complications (P=0.59) were not significantly different between the groups. The rate of pancreatic fistula and total postoperative complications occurred in 62.5% and 64.5%, respectively, in LSPDP group and, similarly, 70% and 70.0%, respectively, in OSPDP group. Conclusion. This study confirms that LSPDP is safe, feasible, and superior to OSPDP in terms of operative time, intraoperative blood loss, hospital stay, and postoperative recovery. Hence, it is worth popularizing LSPDP for benign and low-grade malignant tumors of the pancreas.

scholarly journals Comparison of open and intracorporeal modified ureterosigmoidostomy (Mainz II) after laparoscopic radical cystectomy with bladder cancer

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Duo Zheng ◽  
Junyao Liu ◽  
Gongjin Wu ◽  
Shujun Yang ◽  
Chuang Luo ◽  
...  
Keyword(s):  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Operation Time ◽  
Progression Free Survival ◽  
Postoperative Recovery ◽  
Oncologic Outcomes ◽  
Perioperative Outcomes ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Urinary Control

Abstract Objective To compare perioperative and oncologic outcomes of open modified ureterosigmoidostomy urinary diversion (OMUUD) and intracorporeal modified ureterosigmoidostomy urinary diversion (IMUUD) following laparoscopic radical cystectomy (LRC). Patients and methods We retrospectively reviewed our single institutional collected database patients undergoing LRC from October 2011 to October 2019. The perioperative characteristics were compared between OMUUD and IMUUD, and overall survival (OS) and progression-free survival (PFS) were evaluated by the Kaplan-Meier method. Results Overall, 84 patients were included. OMUUD and IMUUD were performed in 63 (75%) and 21 (25%) patients, respectively. IMUUD patients demonstrated shorter postoperative length of stay (16.24 ± 3.91 days vs. 18.98 ± 7.41 days, P = 0.033), similar operation time (498.57 ± 121.44 vs. 462.24 ± 99.71, P = 0.175), similar estimated blood loss [400 (200–475) ml vs. 400 (200–700) ml, P = 0.095], and similar overall complication rate within 30 days (19.05% vs. 25.40%, P = 0.848) and 90 days (23.81% vs. 17.46%, P = 0.748). Complete urinary control rate was 87.3% (55/63) in the OMUUD group. In IMUUD, the complete urinary control rate was 90.5% (19/21). There was no significant difference in OS (χ2 = 0.015, P = 0.901) and PFS (χ2 = 0.107, P = 0.743) between the two groups. Conclusion IMUUD postoperative recovery is faster; other perioperative outcomes and oncology results are not significantly different with OMUUD. It is indicated that IMUUD can be utilized safely and effectively in the urinary diversion after LRC.

scholarly journals Is the Lateral Decubitus Position Safe and Easy for Laparoscopic Distal Pancreatectomy?

2020 ◽  
pp. 1-6
Author(s):  
Cemil Yuksel ◽  
Serdar Culcu ◽  
Haydar Celasin
Keyword(s):  
Distal Pancreatectomy ◽  
General Surgery ◽  
Average Length ◽  
Operation Time ◽  
Distant Metastases ◽  
Surgical Oncology ◽  
Laparoscopic Distal Pancreatectomy ◽  
Lateral Decubitus Position ◽  
Perioperative Bleeding ◽  
Lateral Decubitus

Aims: In this study, we compared the results of laparoscopic distal pancreatic surgery performed in the classical supine position and lateral decubitus position. Study Design: Retrospective cohort study. Place and Duration of Study: The files of 12 patients who underwent laparoscopic distal pancreatectomy in the General Surgery Clinic of our hospital between January 2017 and June 2020 were found by scanning the electronic file system of the hospital. Methodology: Patients who underwent open surgery and whose data were not available, who had distant metastases, had a history of surgery due to other malignancies and those younger than 18 years were excluded from the study. All data were collected by the data collection assistant who was a general surgery and surgical oncology specialist. Clinicopathological records, inpatient treatment epicrisis, radiological examination reports, pathology reports and demographic information of the patients were reviewed. Results: LDP was applied to 9 (75%) patients and LDP + splenectomy procedure was applied to 3 (25%) patients. Postoperative complications were seen in 2 (12.6%) patients. The average operation time was 199.58 minutes. The amount of perioperative bleeding was 111.25 ml. The average length of stay in the hospital is 5.83 ± 0.6 days. All of the patients are alive and the mean survival time is 16.91 ± 2.38 months, with no recurrence. Conclusion: We think that LP provides a significant advantage to the surgeon, since it provides a better viewing angle and facilitates colon mobilization and stomach retraction. This argument can be supported by more patient numbers and studies.

scholarly journals The Learning Curve of Computer-Assisted Free Flap Jaw Reconstruction Surgery Using 3D-Printed Patient-Specific Plates: A Cumulative Sum Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Wang-yong Zhu ◽  
Wing Shan Choi ◽  
May Chun Mei Wong ◽  
Jingya Jane Pu ◽  
Wei-fa Yang ◽  
...  
Keyword(s):  
Learning Curve ◽  
Hospital Stay ◽  
Bone Graft ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Cumulative Sum ◽  
Jaw Reconstruction ◽  
Cumulative Sum Analysis ◽  
Total Operation Time ◽  
3D Printed

BackgroundComputer-assisted jaw reconstruction (CAJR) has benefits in reducing operation time and improving reconstruction accuracy, compared to conventional freehand jaw reconstruction. However, no information is available regarding learning curves in CAJR with the use of 3D-printed patient-specific surgical plates (PSSP). The purpose of this study was to assess surgical outcomes and learning curve for the first 58 consecutive CAJR using 3D-printed PSSP performed by a single surgical team in a single institution.MethodsIn a prospective study, consecutive patients who underwent free flap CAJR using 3D-printed PSSP were included. The determination of proficiency, based on the cumulative sum of surgical success (no major adjustment of 3D-printed PSSP, flap survival) passing the acceptable boundary line of cumulative sum analysis, was the primary outcome. To find out any potential factors influencing the learning curve, baseline characteristics of patients were compared before and after proficiency achievement. Secondary outcomes included inflexion points of the total operation time, blood loss, length of hospital stay, and bone graft deviation, measured by the cumulative sum analysis.ResultsFrom December 2016 to November 2020, 58 consecutive cases underwent surgery performed by a single surgical team. The overall surgical success rate was 94.8% (55/58). A three-stage learning curve of primary outcome was observed. The proficiency was achieved after 23 cases. The proportions of advanced tumor staging and concomitant surgery after obtaining proficiency were significantly higher than those before achieving proficiency (p = 0.046 and p &lt; 0.001, respectively). Mean values of operation time, intraoperative blood loss, length of hospital stay, and bone graft deviation were 532.5 ± 119.2 min, 1,006.8 ± 547.2 ml, 16.1 ± 6.3 days, and 0.9 ± 1.2 mm, respectively. Two trends of learning curve were observed in the CUSUM analyses of total operation time, length of hospital stay, and bone graft deviation, in which the first and second inflexion points occurred between 8 and 17 cases and between 43 and 46 cases, respectively.ConclusionOur results revealed a three-stage learning curve of CAJR with the use of PSSP, including initial learning, plateau, and overlearning. Based on CUSUM analysis, the surgical proficiency was achieved after 23 cases, and total operation time, length of hospital stay, and bone graft deviation stabilized after 8–17 cases.

scholarly journals Analysis of safety and efficacy of laparoscopic distal pancreatectomy in the treatment of left pancreatic malignant tumors

2021 ◽  
Vol 49 (12) ◽  
pp. 030006052110630
Author(s):  
Tang Hao ◽  
Jiang Shiming ◽  
Chen Yong
Keyword(s):  
Distal Pancreatectomy ◽  
Enhanced Recovery ◽  
Malignant Tumors ◽  
Enhanced Recovery After Surgery ◽  
Operation Time ◽  
Patient Characteristics ◽  
Laparoscopic Distal Pancreatectomy ◽  
Pancreatic Tumors ◽  
Open Distal Pancreatectomy ◽  
Minimal Trauma

Objective Distal pancreatectomy is the most extensive operation to treat malignant tumors of the left pancreas; however, malignant pancreatic tumors are prone to early invasion and metastasis. Methods The clinical data of 80 patients undergoing surgical treatment for malignant tumors of the pancreatic body or tail from January 2013 to December 2017 were retrospectively analyzed. The main clinical variables were compared between patients undergoing laparoscopic distal pancreatectomy (LDP) vs. open distal pancreatectomy (ODP). Results There were no significant differences in general patient characteristics, complications, and postoperative survival (χ2 = 0.09) between the groups. The operation time in the LDP group was significantly longer than that in the ODP group; however, the LDP group was superior to the ODP group regarding the length of postoperative hospital stay, diet recovery, and rectal exhaust and ambulation times. Conclusion LDP is a safe and feasible treatment for left pancreatic malignancies, with the same surgical efficacy as ODP. LDP also has the advantages of minimally invasive surgery, such as minimal trauma and enhanced recovery after surgery.

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