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.

scholarly journals Comparison of lateral transperitoneal and retroperitoneal approaches for homolateral laparoscopic adrenalectomy

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhao Liu ◽  
Da-wei Li ◽  
Lei Yan ◽  
Zhong-Hua Xu ◽  
Gang-li Gu
Keyword(s):  
Blood Loss ◽  
Laparoscopic Adrenalectomy ◽  
Operative Time ◽  
Oral Intake ◽  
Patient Characteristics ◽  
Retroperitoneal Approach ◽  
Perioperative Outcomes ◽  
Transperitoneal Approach ◽  
Operative Data

Abstract Background There is a lack of data regarding the appropriateness of transperitoneal and retroperitoneal approaches for homolateral laparoscopic adrenalectomy. The aim of this study is to compare lateral transperitoneal and retroperitoneal approach for left-sided and right-sided laparoscopic adrenalectomy respectively. Methods Between January 2014 and December 2019, 242 patients underwent left-sided and 252 patients underwent right-sided laparoscopic adrenalectomy. For left side, transperitoneal approach was used in 132 (103 with tumors < 5 cm and 29 with tumors ≥ 5 cm) and retroperitoneal approach in 110 (102 with tumors < 5 cm and 8 with tumors ≥ 5 cm). For right side, transperitoneal approach was used in 139 (121 with tumors < 5 cm and 18 with tumors ≥ 5 cm) and retroperitoneal approach in 113 (102 with tumors < 5 cm and 11 with tumors ≥ 5 cm). Patient characteristics and perioperative outcomes were recorded. For each side, both approaches were compared for tumors < 5 cm and ≥ 5 cm respectively. Results For left-sided tumors < 5 cm, transperitoneal approach demonstrated shorter operative time, less blood loss and longer time to oral intake. For left-sided tumors ≥ 5 cm, the peri-operative data of both approaches was comparable. For right-sided tumors < 5 cm, transperitoneal approach demonstrated shorter operative time and less blood loss. For right-sided tumors ≥ 5 cm, the peri-operative data was comparable. Conclusions Lateral transperitoneal and retroperitoneal approach are both effective for laparoscopic adrenalectomy. Lateral transperitoneal approach is faster with less blood loss for tumors < 5 cm.

scholarly journals The Optimal Approach for Laparoscopic Adrenalectomy through Mono Port regarding Left or Right Sides: A Comparative Study

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Wooseok Byon ◽  
Keehoon Hyun ◽  
Ji-Sup Yun ◽  
Yong Lai Park ◽  
Chan Heun Park
Keyword(s):  
Surgical Outcomes ◽  
Laparoscopic Adrenalectomy ◽  
Adrenal Glands ◽  
Operative Time ◽  
Oral Intake ◽  
Patient Characteristics ◽  
Posterior Retroperitoneal Approach ◽  
Optimal Approach ◽  
The Right ◽  
Length Of Hospitalization

Introduction.Several studies have shown the feasibility and safety of both transperitoneal and posterior retroperitoneal approaches for single incision laparoscopic adrenalectomy, but none have compared the outcomes according to the left- or right-sided location of the adrenal glands.Materials and Methods.From 2009 to 2013, 89 patients who received LAMP (laparoscopic adrenalectomy through mono port) were analyzed. The surgical outcomes attained using the transperitoneal approach (TPA) and posterior retroperitoneal approach (PRA) were analyzed and compared.Results and Discussion.On the right side, no significant differences were found between the LAMP-TPA and LAMP-PRA groups in terms of patient characteristics and clinicopathological data. However, outcomes differed in which LAMP-PRA group had a statistically significant shorter mean operative time (84.13 ± 41.47 min versus 116.84 ± 33.17 min;P=0.038), time of first oral intake (1.00 ± 0.00 days versus 1.21 ± 0.42 days;P=0.042), and length of hospitalization (2.17 ± 0.389 days versus 3.68 ± 1.38 days;P≤0.001), whereas in left-sided adrenalectomies LAMP-TPA had a statistically significant shorter mean operative time (83.85 ± 27.72 min versus 110.95 ± 29.31 min;P=0.002).Conclusions.We report that LAMP-PRA is more appropriate for right-sided laparoscopic adrenalectomies due to anatomical characteristics and better surgical outcomes. For left-sided laparoscopic adrenalectomies, however, we propose LAMP-TPA as a more suitable method.

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 COMPARISON OF PROPHYLACTIC IN-SITU SCREW FIXATION VERSUS OBSERVATION OF THE ASYMPTOMATIC CONTRALATERAL HIP IN SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE)

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0014
Author(s):  
Brian Haus ◽  
Lauren Agatstein ◽  
Akash R. Patel ◽  
Alton W. Skaggs ◽  
Jennette Boakes
Keyword(s):  
Operative Time ◽  
Screw Fixation ◽  
Treatment Options ◽  
Hip Pain ◽  
X Rays ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Length Of Hospitalization ◽  
Unilateral Group

BACKGROUND: Prophylactic fixation of the asymptomatic, radiographically-normal contralateral hip after unilateral (SCFE) is controversial. Children with unilateral SCFE whose contralateral hip is observed are at risk for having a contralateral slip and associated complications such as avascular necrosis (AVN). On the other hand, prophylactic pinning may be an unnecessary surgery that may also result in substantial complications. A comparison of the two treatment options has not been performed. This study seeks to compare the outcomes and nature of complications of patients whose contralateral hip was observed with those whose hip underwent prophylactic in-situ screw fixation. METHODS: We retrospectively reviewed 197 patients treated for a unilateral SCFE over 20 years between the 1997 and 2017 at two hospitals. Medical records and x-rays were reviewed, and variables of interest included age, sex, body mass index (BMI), Modified Oxford Bone Age Score (MOBA) at presentation, length of operation, estimated blood loss (EBL), and length of hospitalization. Additionally, postoperative complications/outcomes such as reoperation in the unaffected hip, pain in the unaffected hip, AVN, chondrolysis, infection. abnormal gait (limp), reslipped epiphysis (growth off of the implanted screw), degenerative joint disease, and development of a limb length discrepancy were recorded. RESULTS: Of the 197 total patients (mean age 11.8) treated for unilateral SCFE, 100 (51%) received prophylactic fixation of their unaffected, contralateral hip and 97 (49%) were observed. Average follow up was 24.5 months. A statistically significant difference was found between groups for age, MOBA Score, EBL, and operative time. No difference was found between groups for BMI, BMI %ile, and length of hospitalization. The unilateral group was older (p<0.001) and had a greater MOBA Score (p=0.006) compared to the prophylactic group (Table 1). Patients in the prophylactic group had greater EBL during surgery (p=0.004) and longer operative time (p<0.001) compared to the unilateral group. In those patients whose contralateral hip was observed, 19% developed a contralateral SCFE which required later in-situ fixation. Amongst those, 2/19 (10%) developed AVN or chondrolysis of the contralateral hip (2% overall). For the contralateral hip, 17/97 (17%) developed hip pain, 10/97 (10%) developed a leg length difference and 24/97 (24%) developed a limp. In those patients who had prophylactic fixation, for the contralateral hip 2/100 (2%) developed AVN, (3/100) 3% required reoperation, 1/100 (1%) developed an infection, 10/100 (10%) developed contralateral hip pain, 4/100 (4%) developed a LLD, and 26/100 (26%) developed a limp. CONCLUSIONS: Surgeons and patients should be able to compare outcomes when deciding whether or not to prophylactically fix the asymptomatic contralateral hip in SCFE. For patients with unilateral SCFE, there are similar rates of AVN (2%) of the asymptomatic contralateral hip whether the hip is prophylactically pinned or observed. Between the two treatment options, there are similar outcomes for length of hospital stay, EBL, rate of infection and development of a limp. There is a higher rate of a LLD and the need for another operation in patients whose contralateral asymptomatic hip is observed, rather than prophylactically pinned. [Table: see text]

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

scholarly journals Robotic, laparoscopic or open hemihepatectomy for giant liver haemangiomas over 10 cm in diameter

2020 ◽  
Author(s):  
Minggen Hu ◽  
Kuang Chen ◽  
Xuan Zhang ◽  
Chenggang Li ◽  
Dongda Song ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Oral Intake ◽  
Postoperative Recovery ◽  
Postoperative Outcomes ◽  
Intraoperative Blood Loss ◽  
Liver Remnant ◽  
Significant Difference

Abstract Background: To evaluate the clinical efficacy of robotic, laparoscopic, and open hemihepatectomy for giant liver haemangiomas.Methods: From April 2011 to April 2017, consecutive patients who underwent hemihepatectomy for giant liver haemangiomas were included in this study. According to the type of operation, these patients were divided into the robotic hemihepatectomy (RH) group, the laparoscopic hemihepatectomy (LH) group, and the open hemihepatectomy (OH) group. The perioperative and short-term postoperative outcomes were compared among the three groups. The study was reported following the STROCSS criteria.Results: There were no significant differences in age, sex, tumour location, body surface area (BSA), future liver remnant volume (FLR), standard liver volume (SLV), liver haemangioma volume, FLR/SLV, resected normal liver volume/resected volume, hepatic disease, rates of blood transfusion, liver function after 24 hours of surgery, operative morbidity and mortality among the three groups. Compared with patients in the RH group (n=19) and the LH group (n=13), patients in the OH group (n=25) had a significantly longer postoperative hospital stay (P< 0.05), time to oral intake (P < 0.05), and time to get-out-of-bed (P < 0.05); a higher VAS score after 24 hours of surgery (P < 0.05); and a shorter operative time (P < 0.05). There were no significant differences in these postoperative outcomes (P＞0.05) between the RH group and the LH group. When the setup time in the RH group was excluded, the operative time in the RH group was significantly shorter than that in the LH group (P＜0.05). There was no significant difference in the operative time between the RH group and the OH group (P＞0.05). The amount of intraoperative blood loss in the RH group was the lowest among the three groups (P＜0.05), and the amount of intraoperative blood loss in the LH group was less than that in the OH group (P＜0.05).Conclusion: Robotic and laparoscopic hemihepatectomies were associated with less intraoperative blood loss,better postoperative recovery and lower pain score. Compared with laparoscopic hemihepatectomy, robotic hemihepatectomy was associated with significantly less intraoperative blood loss and a shorter operative time.

scholarly journals Robotic, laparoscopic or open hemihepatectomy for giant liver hemangiomas of over 10 cm in diameter

2020 ◽  
Author(s):  
Minggen Hu ◽  
Kuang Chen ◽  
Xuan Zhang ◽  
Chenggang Li ◽  
Dongda Song ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Oral Intake ◽  
Postoperative Recovery ◽  
Postoperative Outcomes ◽  
Intraoperative Blood Loss ◽  
Liver Remnant ◽  
Significant Difference

Abstract Background To evaluate the clinical efficacy of robotic, laparoscopic, and open hemihepatectomy for giant liver hemangiomas.Methods From April 2011 to April 2017, consecutive patients who underwent hemihepatectomy for giant liver hemangiomas were included into this study. According to the type of operation, these patients were divided into the robotic hemihepatectomy (RH) group, the laparoscopic hemihepatectomy (LH) group, and the open hemihepatectomy (OH) group. The perioperative and short-term postoperative outcomes were compared among the three groups. The study was reported following the STROCSS criteria.Results There were no significant differences in age, sex, tumor location, body surface area (BSA), future liver remnant volume (FLR), standard liver volume (SLV), liver hemangioma volume, FLR/SLV, resected normal liver volume / resected volume, hepatic disease, rates of blood transfusion, liver function after 24 hours of surgery, operative morbidity and mortality among the three groups. Compared with patients in the RH group (n=19), and the LH group (n=13), patients in the OH group (n=25) had significantly longer postoperative hospital stay (P< 0.05), time to oral intake (P < 0.05), time to get-out-of-bed (P < 0.05), a higher VAS score after 24 hours of surgery (P < 0.05) and a shorter operative time (P < 0.05). There were no significant differences in these postoperative outcomes (P>0.05) between the RH group and the LH group. When the setup time in the RH group was excluded, the operative time of the RH group was significantly shorter than the LH group (P<0.05). There was no significant difference in the operative time between the RH group and the OH group (P>0.05). The intraoperative blood loss of the RH group was the least among the three groups (P<0.05) and the intraoperative blood loss of the LH group was less than the OH group (P<0.05).Discussion Robotic, laparoscopic, and open hemihepatectomy were safe and efficacious treatments for giant liver hemangiomas. Robotic and laparoscopic hemihepatectomy were significantly better than open hemihepatectomy in intraoperative blood loss, postoperative recovery and pain score. Compared with laparoscopic hemihepatectomy, robotic hemihepatectomy was associated with significantly less intraoperative blood loss and shorter operative time.

scholarly journals Laparoscopic Adrenalectomy for Potentially Malignant Adrenal Tumors Greater than 5 Centimeters

2006 ◽  
Vol 91 (8) ◽  
pp. 3080-3083 ◽  
Author(s):  
Chun-Hou Liao ◽  
Shih-Chieh Chueh ◽  
Ming-Kuen Lai ◽  
Po-Jen Hsiao ◽  
Jun Chen
Keyword(s):  
Tumor Size ◽  
Laparoscopic Adrenalectomy ◽  
Malignant Tumors ◽  
Adrenal Tumors ◽  
Benign Tumors ◽  
Conversion To Open Surgery ◽  
Open Conversion ◽  
Potentially Malignant ◽  
Adrenocortical Carcinomas

Abstract Purpose: Laparoscopic adrenalectomy (LA) is controversial for large, potentially malignant tumors. We report a series of LA or hand-assisted LA for large (&gt;5 cm) adrenal tumors. Patients and Methods: Among 210 LAs performed in 6 yr, 39 patients had potentially malignant tumors greater than 5 cm in diameter. Their perioperative and follow-up data were retrospectively analyzed. Results: All 39 patients had successful LAs without perioperative mortality, conversion to open surgery, or capsular disruption during dissection. The mean tumor size was 6.2 cm (range, 5–12 cm), operative time 207 min (115–315 min), and blood loss 75 ml (minimal–1400 ml). Complications included one intraoperative diaphragmatic perforation, three mild wound infections, and one pneumonia. Preoperatively there were 27 nonfunctioning tumors, seven pheochromocytomas, three cortisol-secreting tumors, and two virilizing tumors. Final pathology revealed eight malignant (four adrenocortical carcinomas and four metastatic carcinomas) and 31 benign tumors (14 cortical adenomas, eight pheochromocytomas, six myelolipomas, and three ganglioneuromas). Median follow-up was 39 months. Four patients (two adrenocortical carcinomas, one metastatic hepatoma, and one lymphoma) died 24, 10, 9, and 3 months after surgery, respectively. A hand-assisted device was used in 10 patients. Only the tumor size was larger and length of postoperative hospital stay longer for those in the hand-assisted group. Conclusions: LA is a reasonable option for selected large adrenal tumors when complete resection is technically feasible and there is no evidence of local invasion. Hand-assisted LA is a good alternative to open conversion if a difficult dissection is encountered intraoperatively.

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.

scholarly journals Robotic, laparoscopic or open hemihepatectomy for giant liver hemangiomas of over 10 cm in diameter

2019 ◽  
Author(s):  
Minggen Hu ◽  
Kuang Chen ◽  
Xuan Zhang ◽  
Chenggang Li ◽  
Dongda Song ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Oral Intake ◽  
Postoperative Recovery ◽  
Postoperative Outcomes ◽  
Intraoperative Blood Loss ◽  
Liver Remnant ◽  
Significant Difference

Abstract [EXSCINDED] Abstract Abstract Abstract Background To evaluate the clinical efficacy of robotic, laparoscopic, and open hemihepatectomy for giant liver hemangiomas.Methods From April 2011 to April 2017, consecutive patients who underwent hemihepatectomy for giant liver hemangiomas were included into this study. According to the type of operation, these patients were divided into the robotic hemihepatectomy (RH) group, the laparoscopic hemihepatectomy (LH) group, and the open hemihepatectomy (OH) group. The perioperative and short-term postoperative outcomes were compared among the three groups. The study was reported following the STROCSS criteria.Results There were no significant differences in age, sex, tumor location, body surface area (BSA), future liver remnant volume (FLR), standard liver volume (SLV), liver hemangioma volume, FLR/SLV, resected normal liver volume / resected volume, hepatic disease, rates of blood transfusion, liver function after 24 hours of surgery, operative morbidity and mortality among the three groups. Compared with patients in the RH group (n=19), and the LH group (n=13), patients in the OH group (n=25) had significantly longer postoperative hospital stay (P< 0.05), time to oral intake (P < 0.05), time to get-out-of-bed (P < 0.05), a higher VAS score after 24 hours of surgery (P < 0.05) and a shorter operative time (P < 0.05). There were no significant differences in these postoperative outcomes (P>0.05) between the RH group and the LH group. When the setup time in the RH group was excluded, the operative time of the RH group was significantly shorter than the LH group (P<0.05). There was no significant difference in the operative time between the RH group and the OH group (P>0.05). The intraoperative blood loss of the RH group was the least among the three groups (P<0.05) and the intraoperative blood loss of the LH group was less than the OH group (P<0.05).Discussion Robotic, laparoscopic, and open hemihepatectomy were safe and efficacious treatments for giant liver hemangiomas. Robotic and laparoscopic hemihepatectomy were significantly better than open hemihepatectomy in intraoperative blood loss, postoperative recovery and pain score. Compared with laparoscopic hemihepatectomy, robotic hemihepatectomy resulted in significantly less intraoperative blood loss and shorter operative time.

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