scholarly journals Advanced Robotic Surgery: Liver, Pancreas, and Esophagus – The State of the Art?

2021 ◽  
pp. 1-6
Author(s):  
Pasquale Scognamiglio ◽  
Björn-Ole Stüben ◽  
Asmus Heumann ◽  
Jun Li ◽  
Jakob R. Izbicki ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
State Of The Art ◽  
Operating Time ◽  
Esophageal Surgery ◽  
Robotic Systems ◽  
Open Approach ◽  
Robotic Approach ◽  
Advantages And Disadvantages ◽  
Randomized Controlled ◽  
Meta Analyses

<b><i>Background:</i></b> The trend in performing robotic-assisted operations in visceral surgery has been increasing in the last decade, also reaching the challenging field of hepatic, pancreatic, and esophageal surgery. Nevertheless, solid data about advantages and disadvantages of the robotic approach are still missing. The aim of this review is to analyze the benefit and impact of robotic surgery in the field of hepatic, pancreatic, and esophageal surgery, focusing on the comparison with the conventional laparoscopic or open approach. <b><i>Summary:</i></b> The well-known advantages of laparoscopic surgery in comparison to the open approach are also valid for robotic surgery, with the addition of a 3D-view camera, wristed instrumentation, and an ergonomic console. On the other hand, the use of a robotic system leads to longer operating time and higher costs. Randomized controlled trials comparing the robotic approach with the laparoscopic one are still missing. <b><i>Key Message:</i></b> Recent meta-analyses show promising results of the usage of robotic systems in advanced surgical procedures, like hepatic, pancreatic, and esophageal resections. Further randomized studies are needed to validate the postulated benefit.

Thirty Years of Minimally Invasive Surgery in Children: Analysis of Meta-Analyses

2019 ◽  
Vol 30 (05) ◽  
pp. 420-428 ◽  
Author(s):  
Joachim F. Kuebler ◽  
Jens Dingemann ◽  
Benno M. Ure ◽  
Nagoud Schukfeh
Keyword(s):  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Randomized Controlled Trials ◽  
Invasive Surgery ◽  
Pediatric Surgery ◽  
Controlled Trials ◽  
Advantages And Disadvantages ◽  
Randomized Controlled ◽  
Lower Complication ◽  
Meta Analyses

Abstract Introduction In the last three decades, minimally invasive surgery (MIS) has been widely used in pediatric surgery. Meta-analyses (MAs) showed that studies comparing minimally invasive with the corresponding open operations are available only for selected procedures. We evaluated all available MAs comparing MIS with the corresponding open procedure in pediatric surgery. Materials and Methods A literature search was performed on all MAs listed on PubMed. All analyses published in English, comparing pediatric minimally invasive with the corresponding open procedures, were included. End points were advantages and disadvantages of MIS. Results of 43 manuscripts were included. MAs evaluating the minimally invasive with the corresponding open procedures were available for 11 visceral, 4 urologic, and 3 thoracoscopic types of procedures. Studies included 34 randomized controlled trials. In 77% of MAs, at least one advantage of MIS was identified. The most common advantages of MIS were a shorter hospital stay in 20, a shorter time to feeding in 11, and a lower complication rate in 7 MAs. In 53% of MAs, at least one disadvantage of MIS was found. The most common disadvantages were longer operation duration in 16, a higher recurrence rate of diaphragmatic hernia in 4, and gastroesophageal reflux in 2 MAs. A lower native liver survival rate after laparoscopic Kasai-portoenterostomy was reported in one MA. Conclusion In the available MAs, the advantages of MIS seem to outnumber the disadvantages. However, for some types of procedures, MIS may have considerable disadvantages. More randomized controlled trials are required to confirm the advantage of MIS for most procedures.

scholarly journals Systematic review of laryngocele and pyolaryngocele management in the age of robotic surgery

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052094044
Author(s):  
Ravjit Singh ◽  
William Karantanis ◽  
Matthew Fadhil ◽  
Shivani Angelique Kumar ◽  
Julia Crawford ◽  
...  
Keyword(s):  
Systematic Review ◽  
Robotic Surgery ◽  
Meta Analysis ◽  
Rare Condition ◽  
Cochrane Library ◽  
Surgical Approaches ◽  
Randomized Controlled ◽  
Initial Description ◽  
Laryngeal Saccule ◽  
Meta Analyses

Objective A laryngocele is a space that develops as a result of pathological dilatation of the laryngeal saccule. However, the reported management of laryngoceles varies. We conducted a systematic review of the literature regarding the surgical management of laryngoceles and pyolaryngoceles, to understand the evolving nature of treatment for this rare condition. Methods We searched for publications in the PubMed, Cochrane Library, JBI Library of Systematic Reviews, and Ovid databases using the terms “laryngocele”, “pyolaryngocele”, and “laryngopyocele”, and reviewed the identified articles. Results After removal of repeated studies and filtering for relevance and studies written in English, a total of 227 studies were included in this review. No meta-analyses or randomized controlled trials have been published. The identified studies have been summarized in 14 reviews conducted since 1946. The meta-analysis determined that endoscopy was the preferred approach for internal laryngoceles, while combined laryngoceles benefited from both internal and external surgical approaches. Conclusions Laryngocele management has progressed since its initial description, from open surgery to an endoscopic approach, and more recently to a robotic-assisted surgical approach. The uptake of robotic surgery as a possible treatment modality over the last decade shows much promise for the treatment of these conditions.

scholarly journals A Comparative Study on the Bilateral Areolar Endoscopic Approach Versus the Conventional Open Approach for Thyroidectomy

2021 ◽  
Author(s):  
xiao ma ◽  
Qi-Jun Xia ◽  
Yun-Tao Song ◽  
Tian-Xiao Wang
Keyword(s):  
Blood Loss ◽  
Lymph Nodes ◽  
Hospital Stay ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Endoscopic Approach ◽  
Open Approach ◽  
Advantages And Disadvantages ◽  
Removal Time ◽  
Conventional Open Approach

Abstract Background: To compare the safety, advantages and disadvantages of thyroidectomy for differentiated thyroid carcinoma (DTC) via the bilateral areolar endoscopic approach (BAA) and the conventional open approach (COA).Methods: Eighty-six female patients who underwent thyroidectomy were enrolled and divided into two groups, 42 in the BAA group and 44 in the COA group, according to aesthetic requirements. The operating time, blood loss during surgery, number of dissected lymph nodes, length of hospital stay, drainage removal time and surgical complications between the two surgical approaches were compared. The pain score and cosmetic results of operative incisions were evaluated with the visual analog scale (VAS).Results: Patients in the BAA group had significantly less intraoperative blood loss and a significantly shorter scar length (P < 0.001) than those in the COA group. However, the operation time of 97.6 minutes in the BAA group was significantly longer than that in the COA group (76.4 minutes; P < 0.001). Comparison of the number of central lymph nodes (CLNs) dissected, drainage removal time and length of hospital stay revealed no significant differences (P>0.05). Patients in the BAA group experienced significantly less pain than those in the COA group (P<0.001). Similarly, patients were significantly more satisfied with the cosmetic outcomes resulting from the BAA than from the COA (P <0.001).Conclusions: These results show that BAA thyroidectomy exhibits superior advantages in clinical outcomes, such as causing less pain and achieving better cosmetic satisfaction, compared with COA thyroidectomy. Therefore, BAA thyroidectomy is a safe and ideal surgical method for DTC.

scholarly journals Neonatal Resuscitation: State of the Art

2019 ◽  
Vol 36 (S 02) ◽  
pp. S29-S32
Author(s):  
Daniele Trevisanuto ◽  
Alfonso Galderisi
Keyword(s):  
Umbilical Cord ◽  
State Of The Art ◽  
Scientific Evidence ◽  
Neonatal Resuscitation ◽  
Lung Inflation ◽  
Randomized Controlled ◽  
The Past ◽  
Cord Clamping ◽  
Umbilical Cord Clamping ◽  
Meta Analyses

AbstractThe objective of this study is to revise novel evidence and forthcoming clinical trials that focused on the gap of knowledge raised during the 2015 guidelines for neonatal resuscitation. Literature search on main topics on neonatal resuscitation published after 2015 edition of the consensus on science and guidelines was performed. Only relevant articles (mainly randomized controlled trials [RCTs] and meta-analyses) were included and presented as descriptive review. In the past years, new RCTs and/or meta-analyses have become available on umbilical cord clamping and umbilical cord milking, oxygen concentrations to start resuscitation in term and preterm infants, use of laryngeal mask, sustained lung inflation, less invasive surfactant administration, and heart rate assessment. Despite the increasing available literature on neonatal resuscitation in the past years, many interventions are still performed without robust scientific evidence. Adequately powered and well-designed RCTs are needed to optimize management of neonates at birth.

Platelet monitoring for PCI

2009 ◽  
Vol 29 (04) ◽  
pp. 376-380 ◽  
Author(s):  
D. Capodanno ◽  
D. J. Angiolillo
Keyword(s):  
Interindividual Variability ◽  
State Of The Art ◽  
Coronary Intervention ◽  
Functional Tests ◽  
Treatment Regimens ◽  
Advantages And Disadvantages ◽  
Coronary Syndrome ◽  
Combined Use ◽  
Increased Risk ◽  
Percutaneous Coronary

SummaryDespite the clinical benefit associated with the combined use of aspirin and clopidogrel in patients with acute coronary syndrome or those undergoing percutaneous coronary intervention, a considerable interindividual variability in response to these drugs have been consistently reported. There is a growing interest on applying platelet functional tests with the goal of identifying patients at increased risk of recurrent ischaemic events and potentially tailoring antiplatelet treatment regimens.This manuscript will review the state of the art on the most commonly available platelet functional tests, describing their advantages and disadvantages and exploring their applicability in clinical practice.

Advantages and limitations of the endoscopic tympanoscopy a prospective study

2020 ◽  
Vol 1 (1) ◽  
pp. 012-017
Author(s):  
Najib Zouhair ◽  
Anass Chaouki ◽  
Amine M’khatri ◽  
Youssef Oukessou ◽  
Sami Rouadi ◽  
...  
Keyword(s):  
Middle Ear ◽  
Operating Time ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Invasive Approach ◽  
Intraoperative Bleeding ◽  
Advantages And Disadvantages ◽  
Early Return ◽  
The Mean ◽  
Endoscopic Tympanoplasty

Tympanoplasty is one of the most performed procedures in ENT. The aggressiveness of its microscopic approach has led otologists to adopt the endoscopic approach as a less invasive alternative. The purpose of this work is to appreciate the advantages and disadvantages of this surgical technique. We conducted a prospective descriptive cross-sectional study on 20 interventions within the ENT department of August the 20th 1953 Hospital of Casablanca from April 2019 to June 2019. The average age of operated patients was 36.3 years. Perforations were unilateral in (71%) of the cases with a predominance of the anterior (29%) and subtotal (36%) locations. The tympanoplasties were performed by 3 different senior otologic surgeons, and were left in (57%). The mean operating time was (59.5 min) and the mean anesthesia duration was 75.1 min. Intraoperative vision allowed us to fully visualize the margins of all perforations (100%) and anatomical structures of the middle ear in almost all interventions. The first procedures carried out were filled with difficulties whose management of intraoperative bleeding was the main one in (42.8%) of the cases. (57%) procedures were described as easy. No complication was detected intraoperatively or immediately postoperatively. Endoscopic tympanoplasty has several advantages, including: Minimally invasive approach to the middle ear; panoramic perioperative vision; Gain of operating time; decrease in the duration of anesthesia; Valuable educational tool; postoperative comfort; Decrease in hospital stay and early return to daily activities; Better aesthetic rendering; cost and transportability. However, we also note a number of disadvantages of endoscopic tympanoplasty, particularly: performing the procedure with one hand; difficulty passing through the EAC; 2D vision that alters the perception of depth; management of intraoperative bleeding; fogging; learning curve.

scholarly journals Pre-Procedural Lumbar Neuraxial Ultrasound—A Systematic Review of Randomized Controlled Trials and Meta-Analysis

Healthcare ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 479
Author(s):  
Tatiana Sidiropoulou ◽  
Kalliopi Christodoulaki ◽  
Charalampos Siristatidis
Keyword(s):  
Systematic Review ◽  
Lumbar Spine ◽  
Randomized Controlled Trials ◽  
Success Rate ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Technical Failure ◽  
Obese Patients ◽  
Randomized Controlled ◽  
Meta Analyses

A pre-procedural ultrasound of the lumbar spine is frequently used to facilitate neuraxial procedures. The aim of this review is to examine the evidence sustaining the utilization of pre-procedural neuraxial ultrasound compared to conventional methods. We perform a systematic review of randomized controlled trials with meta-analyses. We search the electronic databases Medline, Cochrane Central, Science Direct and Scopus up to 1 June 2019. We include trials comparing a pre-procedural lumbar spine ultrasound to a non-ultrasound-assisted method. The primary endpoints are technical failure rate, first-attempt success rate, number of needle redirections and procedure time. We retrieve 32 trials (3439 patients) comparing pre-procedural lumbar ultrasounds to palpations for neuraxial procedures in various clinical settings. Pre-procedural ultrasounds decrease the overall risk of technical failure (Risk Ratio (RR) 0.69 (99% CI, 0.43 to 1.10), p = 0.04) but not in obese and difficult spinal patients (RR 0.53, p = 0.06) and increase the first-attempt success rate (RR 1.5 (99% CI, 1.22 to 1.86), p < 0.0001, NNT = 5). In difficult spines and obese patients, the RR is 1.84 (99% CI, 1.44 to 2.3; p < 0.0001, NNT = 3). The number of needle redirections is lower with pre-procedural ultrasounds (SMD = −0.55 (99% CI, −0.81 to −0.29), p < 0.0001), as is the case in difficult spines and obese patients (SMD = −0.85 (99% CI, −1.08 to −0.61), p < 0.0001). No differences are observed in procedural times. Ιn conclusion, a pre-procedural ultrasound provides significant benefit in terms of technical failure, number of needle redirections and first attempt-success rate. Τhe effect of pre-procedural ultrasound scanning of the lumbar spine is more significant in a subgroup analysis of difficult spines and obese patients.

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