The Hand-Assisted Laparoscopic Approach to Resection of Pancreatic Mucinous Cystic Neoplasms: An Underused Technique?

Pancreatic mucinous cystic neoplasms (MCNs) are rare tumors typically of the distal pancreas that harbor malignant potential. Although resection is recommended, data are limited on optimal operative approaches to distal pancreatectomy for MCN. MCN resections (2000–2014; eight institutions) were included. Outcomes of minimally invasive and open MCN resections were compared. A total of 289 patients underwent distal pancreatectomy for MCN: 136(47%) minimally invasive and 153(53%) open. Minimally invasive procedures were associated with smaller MCN size (3.9 vs 6.8 cm; P = 0.001), lower operative blood loss (192 vs 392 mL; P = 0.001), and shorter hospital stay(5 vs 7 days; P = 0.001) compared with open. Despite higher American Society of Anesthesiologists class, hand-assisted (n = 46) had similar advantages as laparoscopic/robotic (n = 76). When comparing hand-assisted to open, although MCN size was slightly smaller (4.1 vs 6.8 cm; P = 0.001), specimen length, operative time, and nodal yield were identical. Similar to laparoscopic/robotic, hand-assisted had lower operative blood loss (161 vs 392 mL; P = 0.001) and shorter hospital stay (5 vs 7 days; P = 0.03) compared with open, without increased complications. Hand-assisted laparoscopic technique is a useful approach for MCN resection because specimen length, lymph node yield, operative time, and complication profiles are similar to open procedures, but it still offers the advantages of a minimally invasive approach. Hand-assisted laparoscopy should be considered as an alternative to open technique or as a successive step before converting from total laparoscopic to open distal pancreatectomy for MCN.

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Nonstructural bone graft for single-segment lumbar tuberculosis: surgical indications, clinical efficacy, and preliminary experiences in 34 patients

Journal of International Medical Research ◽

10.1177/0300060520982780 ◽

2021 ◽

Vol 49 (1) ◽

pp. 030006052098278

Author(s):

Xing Du ◽

Yunsheng Ou ◽

Guanyin Jiang ◽

Yong Zhu ◽

Wei Luo ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Bone Graft ◽

Cobb Angle ◽

Clinical Efficacy ◽

Operative Time ◽

Bone Grafts ◽

Surgical Indications ◽

Operative Blood Loss ◽

The Mean

Objective This study was performed to evaluate the surgical indications, clinical efficacy, and preliminary experiences of nonstructural bone grafts for lumbar tuberculosis (TB). Methods Thirty-four patients with lumbar TB who were treated with nonstructural bone grafts were retrospectively assessed. The operative time, operative blood loss, hospital stay, bone graft fusion time, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) concentration, visual analog scale (VAS) score, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) impairment grade, and Cobb angle were recorded and analyzed. Results The mean operative time, operative blood loss, hospital stay, Cobb angle correction, and Cobb angle loss were 192.59 ± 42.16 minutes, 385.29 ± 251.82 mL, 14.91 ± 5.06 days, 9.02° ± 3.16°, and 5.54° ± 1.09°, respectively. During the mean follow-up of 27.53 ± 8.90 months, significant improvements were observed in the ESR, CRP concentration, VAS score, ODI, and ASIA grade. The mean bone graft fusion time was 5.15 ± 1.13 months. Three complications occurred, and all were cured after active treatment. Conclusions Nonstructural bone grafts may achieve satisfactory clinical efficacy for appropriately selected patients with lumbar TB.

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

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2019/9367868 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7 ◽

Cited By ~ 2

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.

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Comparison of surgical outcomes of Ultrasonic technique (Harmonic Focus™) with Conventional technique in open hemithyroidectomy

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v2i4.11774 ◽

2014 ◽

Vol 2 (4) ◽

pp. 175-180

Author(s):

Deepak Regmi ◽

Toran KC ◽

Meera Bista ◽

Sangita Shrestha

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Surgical Outcomes ◽

Operative Time ◽

Conventional Technique ◽

Ultrasonic Technique ◽

Operative Blood Loss ◽

Incision Size ◽

Post Operative Pain ◽

Harmonic Focus

Background: The option for dissection and haemostasis during thyroid surgery include either the modern ultrasonic technology (Harmonic Focus™) or the conventional technique using knot and ties, monopolar or bipolar electrocautery. Comparison between the surgical outcomes of open hemithyroidectomy using these two modalities was done.Objective: To compare the surgical outcomes of ultrasonic technique using Harmonic Focus™ (HS) with Conventional technique (CT) in open hemithyoidectomy.Method: Twenty consecutive patients undergoing open hemithyroidectomy for benign solitary thyroid nodule of ≤ 3 cm were randomly assigned into two groups; group HS (n=10) and group CT (n=10). Analysis of surgical outcomes performed by these two techniques, particularly: operative time, intra-operative blood loss, post operative pain, incision size, complications and hospital stay were done.Results: The age, sex and pathologies were comparable in both the groups. For the group HS, mean operative time was (mean ± SD=55 ± 5 min) 15 minutes shorter than group CT (mean ± SD= 70 ± 10 min) (P<0.01). Mean operative blood loss was (mean ± SD=20 ±10 ml) 16 ml less in group HS than CT (mean ± SD= 36 ±12 ml) (P<0.01). The group HS experienced less post operative pain (mean ± SD=4 ± 0.94 VAS) than CT (mean ± SD= 7 ± 0.81 VAS) (P<0.001). The incision size at the time of skin closure was 1.6 cm shorter in group HS ((mean ± SD= 3.95 ±0.61 vs. 5.5 ± 0.78cm) (P<0.01). Hospital stay (mean ± SD= 2.30 ± 0.48 vs. 4.20 ±0.42 days) was statistically significant (P<0.01) in group HS than CT. There were no major complications.Conclusion: In patients undergoing open hemithyroidectomy, HS is a faster, better cosmetic, safe and less morbid tool than CT. Its use reduces operative time, blood loss, post operative pain, scar size, along with hospital stay.DOI: http://dx.doi.org/10.3126/jkmc.v2i4.11774 Journal of Kathmandu Medical CollegeVol. 2, No. 4, Issue 6, Oct.-Dec., 2013Page: 175-180

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P191 MINIMALLY-INVASIVE ESOPHAGECTOMY IN TREATMENT FOR ESOPHAGEAL DISEASES

Diseases of the Esophagus ◽

10.1093/dote/doz092.191 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

Usenko Oleksandr ◽

Sydiuk Andriy ◽

Sydiuk Olena ◽

Savenko Georgiy ◽

Klimas Andriy

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Intestinal Obstruction ◽

Hospital Stay ◽

Operative Time ◽

Minimally Invasive Esophagectomy ◽

Transhiatal Esophagectomy ◽

Gastric Conduit ◽

Invasive Esophagectomy ◽

Average Operative Time

Abstract Aim to study the benefits of the mini-invasive approach. Background & Methods 115 esophagectomies were performed for the period from 2015 to 2018. Gastric conduit in 84 patients, colon - 2 and small intestine - 29. The study included 65 patients after I.Lewis, McKeown or transhiatal esophagectomy, who was performed esophageal replacement with gastric conduit. The first group consisted of 44 patients after open esophagectomy; second group - 21 patients after MIE (minimally invasive esophagectomy): included 8 patients - thoraco-laparoscopic McKeown surgery, 1 patient - laparoscopic transhiatal esophagectomy with anastomosis on the neck, 9 patients – hybrid minimally invasive I.Lewis surgery (laparoscopy+thoracotomy), and 3 patients – minimally invasive thoraco-laparoscopic I.Lewis surgery. The average age of patients was 53 years (13-64). 55 patients (84.6%) with esophageal cancer and 10 patients (15.4%) with benign strictures of the esophagus. There were anastomosis on the neck in 28 patients (43%) and intrathoracic anastomosis in 37 patients (57%). Results In the first group the average operative time was 286 minutes (240-370 min.), the average volume of blood loss was 345 ml (100-600 ml), the length of in-hospital stay was 15 days (9-29), complications: anastomosis leakage - 1 patient on the 5th postoperative day - EndoVAC system was used with a defect closure after 18 days; 1 patient - adhesive intestinal obstruction (relaparotomy, separation of adhesions). In the second group the average operative time was 400 min (370-480 min.), blood loss - 100 ml (50-200 ml), the length of in-hospital stay - 10 days (8-16), complications in 1 patient - acute strangulation with intestinal obstruction. There was no mortality in both groups. Conclusions The application of MIE helps to reduce the severity of postoperative pain, the length of in-hospital stay and intraoperative blood loss. This procedure should be performed in specialized hospitals with experience in miniinvasive surgery and esophageal surgery.

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Differences in radiographic and clinical outcomes of oblique lateral interbody fusion and lateral lumbar interbody fusion for degenerative lumbar disease: a meta-analysis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2972-7 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 4

Author(s):

Hui-Min Li ◽

Ren-Jie Zhang ◽

Cai-Liang Shen

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Interbody Fusion ◽

Operative Time ◽

Perioperative Complications ◽

Lumbar Interbody Fusion ◽

Operative Blood Loss ◽

Degenerative Lumbar Disease ◽

Oblique Lateral Interbody Fusion ◽

Lateral Interbody

Abstract Background In the current surgical therapeutic regimen for the degenerative lumbar disease, both oblique lateral interbody fusion (OLIF) and lateral lumbar interbody fusion (LLIF) are gradually accepted. Thus, the objective of this study is to compare the radiographic and clinical outcomes of OLIF and LLIF for the degenerative lumbar disease. Methods We conducted an exhaustive literature search of MEDLINE, EMBASE, and the Cochrane Library to find the relevant studies about OLIF and LLIF for the degenerative lumbar disease. Random-effects model was performed to pool the outcomes about disc height (DH), fusion, operative blood loss, operative time, length of hospital stays, complications, visual analog scale (VAS), and Oswestry disability index (ODI). Results 56 studies were included in this study. The two groups of patients had similar changes in terms of DH, operative blood loss, operative time, hospital stay and the fusion rate (over 90%). The OLIF group showed slightly better VAS and ODI scores improvement. The incidence of perioperative complications of OLIF and LLIF was 26.7 and 27.8% respectively. Higher rates of nerve injury and psoas weakness (21.2%) were reported for LLIF, while higher rates of cage subsidence (5.1%), endplate damage (5.2%) and vascular injury (1.7%) were reported for OLIF. Conclusions The two groups are similar in terms of radiographic outcomes, operative blood loss, operative time and the length of hospital stay. The OLIF group shows advantages in VAS and ODI scores improvement. Though the incidence of perioperative complications of OLIF and LLIF is similar, the incidence of main complications is significantly different.

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Minimally invasive resection of lumbar intraspinal synovial cysts via a contralateral approach: review of 13 cases

Journal of Neurosurgery Spine ◽

10.3171/2015.1.spine14996 ◽

2015 ◽

Vol 23 (4) ◽

pp. 444-450 ◽

Cited By ~ 14

Author(s):

Hamdi G. Sukkarieh ◽

Patrick W. Hitchon ◽

Olatilewa Awe ◽

Jennifer Noeller

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Hospital Stay ◽

Operative Time ◽

Synovial Cyst ◽

Contralateral Approach ◽

Estimated Blood Loss ◽

Synovial Cysts ◽

The Mean

OBJECT The authors sought to determine patient-related outcomes after minimally invasive surgical (MIS) lumbar intraspinal synovial cyst excision via a tubular working channel and a contralateral facet-sparing approach. METHODS All the patients with a symptomatic lumbar intraspinal synovial cyst who underwent surgery at the University of Iowa Hospitals and Clinics with an MIS excision via a contralateral approach were treated between July 2010 and August 2014. There was a total of 13 cases. Each patient was evaluated with preoperative neurological examinations, lumbar spine radiography, MRI, and visual analog scale (VAS) scores. The patients were evaluated postoperatively with neurological examinations and VAS and Macnab scores. The primary outcomes were improvement in VAS and Macnab scores. Secondary outcomes were average blood loss, hospital stay duration, and operative times. RESULTS There were 5 males and 8 females. The mean age was 66 years, and the mean body mass index was 28.5 kg/m2. Sixty-nine percent (9 of 13) of the cysts were at L4–5. Most patients had low-back pain and radicular pain, and one-third of them had Grade 1 spondylolisthesis. The mean (± SD) follow-up duration was 20.8 ± 16.9 months. The mean Macnab score was 3.4 ± 1.0, and the VAS score decreased from 7.8 preoperatively to 2.9 postoperatively. The mean operative time was 123 ± 30 minutes, with a mean estimated blood loss of 44 ± 29 ml. Hospital stay averaged 1.5 ± 0.7 days. There were no complications noted in this series. CONCLUSIONS The MIS excision of lumbar intraspinal synovial cysts via a contralateral approach offers excellent exposure to the cyst and spares the facet joint at the involved level, thus minimizing risk of instability, blood loss, operative time, and hospital stay. Prospective randomized trials with longer follow-up times and larger cohorts are needed to conclusively determine the superiority of the contralateral MIS approach over others, including open or ipsilateral minimally invasive surgery.

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Minimally Invasive versus Open Approach for Cervical Laminoforaminotomy

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100011446 ◽

2011 ◽

Vol 38 (2) ◽

pp. 262-267 ◽

Cited By ~ 37

Author(s):

Mark J. Winder ◽

Kenneth C. Thomas

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Hospital Stay ◽

Operative Time ◽

Length Of Hospital Stay ◽

Radicular Pain ◽

Complication Rates ◽

Open Approach ◽

Cervical Foraminotomy ◽

Analgesic Use

Background:Minimally invasive posterior cervical foraminotomy for radicular symptoms has become more prevalent. The reported experience with microscopic tubular assisted posterior cervical laminoforaminotomy (MTPF) for the treatment of radicular pain is lacking. Tubular assisted techniques have been considered to offer significant benefit, over open procedures, in terms of minimizing tissue damage, operative time, blood loss, analgesic requirements and length of hospital stay. We hypothesized that MTPF reduces post-operative analgesic requirements and length of hospital stay over the traditional open laminoforaminotomy, with no difference in complication rates and, secondly, that MTPF is comparable to endoscopic posterior foraminotomy (EPF).Methods:We conducted a retrospective review of 107 patients who underwent posterior cervical laminoforaminotomy for radicular pain between 1999 and 2009. Patient demographics, intra-operative parameters, length of hospitalization, post-operative analgesic use, complications and short-term neurological outcome were compared between groups.Results:Between 1999 and 2009, a total of 107 patients were identified to have undergone a cervical foraminotomy. An open approach was used in 65 patients, while 42 underwent MTPF. Operative time and complications were comparable between groups. Significant differences favoring MTPF were observed in operative blood loss, post-operative analgesic use and length of hospital stay (p<0.001). All results were comparable to previous reports utilizing EPF.Conclusions:MTPF for the treatment of cervical radiculopathy significantly reduces blood loss, post-operative analgesic use and length of hospital stay compared to the standard open approach. Operative time and complication rates were comparable between both techniques, whilst MTPF offered similar results compared to EPF.

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The Emerging Role of Robotic Single-site Approach for Myomectomy: A Systematic Review of the Literature

Surgical Innovation ◽

10.1177/1553350620988227 ◽

2021 ◽

pp. 155335062098822

Author(s):

Eirini Giovannopoulou ◽

Anastasia Prodromidou ◽

Nikolaos Blontzos ◽

Christos Iavazzo

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Complication Rate ◽

Operative Time ◽

Intraoperative Complications ◽

Single Site ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Robotic Myomectomy ◽

The Mean

Objective. To review the existing studies on single-site robotic myomectomy and test the safety and feasibility of this innovative minimally invasive technique. Data Sources. PubMed, Scopus, Google Scholar (from their inception to October 2019), as well as Clinicaltrials.gov databases up to April 2020. Methods of Study Selection. Clinical trials (prospective or retrospective) that reported the outcomes of single-site robotic myomectomy, with a sample of at least 20 patients were considered eligible for the review. Results. The present review was performed in accordance with the guidelines for Systematic Reviews and Meta-Analyses (PRISMA). Four (4) studies met the inclusion criteria, and a total of 267 patients were included with a mean age from 37.1 to 39.1 years and BMI from 21.6 to 29.4 kg/m2. The mean operative time ranged from 131.4 to 154.2 min, the mean docking time from 5.1 to 5.45 min, and the mean blood loss from 57.9 to 182.62 ml. No intraoperative complications were observed, and a conversion rate of 3.8% was reported by a sole study. The overall postoperative complication rate was estimated at 2.2%, and the mean hospital stay ranged from 0.57 to 4.7 days. No significant differences were detected when single-site robotic myomectomy was compared to the multiport technique concerning operative time, blood loss, and total complication rate. Conclusion. Our findings support the safety of single-site robotic myomectomy and its equivalency with the multiport technique on the most studied outcomes. Further studies are needed to conclude on the optimal minimally invasive technique for myomectomy.

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Holmium laser enucleation of the prostate with Virtual Basket mode: faster and better control on bleeding

BMC Urology ◽

10.1186/s12894-021-00797-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Giorgio Bozzini ◽

Matteo Maltagliati ◽

Umberto Besana ◽

Lorenzo Berti ◽

Albert Calori ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Operative Time ◽

Randomized Study ◽

Urine Volume ◽

Holmium Laser ◽

Laser Enucleation ◽

Holmium Laser Enucleation ◽

Irrigation Volume

Abstract Background To compare clinical intra and early postoperative outcomes between conventional Holmium laser enucleation of the prostate (HoLEP) and Holmium laser enucleation of the prostate using the Virtual Basket tool (VB-HoLEP) to treat benign prostatic hyperplasia (BPH). Methods This prospective randomized study enrolled consecutive patients with BPH, who were assigned to undergo either HoLEP (n = 100), or VB-HoLEP (n = 100). All patients were evaluated preoperatively and postoperatively, with particular attention to catheterization time, operative time, blood loss, irrigation volume and hospital stay. We also evaluated the patients at 3 and 6 months after surgery and assessed maximum flow rate (Qmax), postvoid residual urine volume (PVR), the International Prostate Symptom Score (IPSS) and the Quality of Life score (QOLS). Results No significant differences in preoperative parameters between patients in each study arm were found. Compared to HoLEP, VB-HoLEP resulted in less hemoglobin decrease (2.54 vs. 1.12 g/dl, P = 0.03) and reduced operative time (57.33 ± 29.71 vs. 42.99 ± 18.51 min, P = 0.04). HoLEP and VB-HoLEP detrmined similar catheterization time (2.2 vs. 1.9 days, P = 0.45), irrigation volume (33.3 vs. 31.7 l, P = 0.69), and hospital stay (2.8 vs. 2.7 days, P = 0.21). During the 6-month follow-up no significant differences in IPSS, Qmax, PVR, and QOLS were demonstrated. Conclusions HoLEP and VB-HoLEP are both efficient and safe procedures for relieving lower urinary tract symptoms. VB-HoLEP was statistically superior to HoLEP in blood loss and operative time. However, procedures did not differ significantly in catheterization time, hospital stay, and irrigation volume. No significant differences were demonstrated in QOLS, IPSS, Qmax and PVR throughout the 6-month follow-up. Trial Registration: Current Controlled Trials ISRCTN72879639; date of registration: June 25th, 2015. Retrospectively registred.

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Robotically Assisted Hysterectomy versus Vaginal Hysterectomy for Benign Disease: A Prospective Study

Minimally Invasive Surgery ◽

10.1155/2013/429105 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

M. Carbonnel ◽

H. Abbou ◽

H. T. N’Guyen ◽

S. Roy ◽

G. Hamdi ◽

...

Keyword(s):

Blood Loss ◽

Prospective Study ◽

Hospital Stay ◽

Vaginal Hysterectomy ◽

Operative Time ◽

Group Versus ◽

Length Of Hospital Stay ◽

Benign Disease ◽

Post Surgery ◽

A Prospective Study

Objectives. A prospective study was carried out to compare vaginal hysterectomy (VH) and robotically assisted hysterectomy (RH) for benign gynecological disease.Materials and Methods. All patients who underwent hysterectomy from March 2010 to March 2012 for a benign disease were included. Patients’ demographics per and post surgery results were collected from medical files. A questionnaire was also conducted 2 months after surgery.Results. Sixty patients were included in the RH group and thirty four in the VH one. Operative time was significantly longer in the RH group ( versus min; ). Blood loss and length of hospital stay were significantly reduced: versus ml; , and versus days; , respectively. Less pain was reported at D1 and D2 by RH patients, and levels of analgesia were lower compared to those observed in the VH group. No differences were found regarding the rate of conversion to laparotomy, intra- or postoperative complications.Conclusion. Robotically assisted hysterectomy appears to reduce blood loss, postoperative pain, and length of hospital stay, but it is associated with longer operative time and higher cost. Specific indications for RH remain to be defined.

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