scholarly journals Laparoscopic splenectomy: a personal series of 140 consecutive cases

2010 ◽  
Vol 92 (5) ◽  
pp. 398-402 ◽  
Author(s):  
Clare J Pattenden ◽  
Christopher D Mann ◽  
Matthew S Metcalfe ◽  
Martin Dyer ◽  
David M Lloyd
Keyword(s):  
Laparoscopic Splenectomy ◽  
Operative Time ◽  
Laparoscopic Approach ◽  
University Hospital ◽  
Safe Procedure ◽  
Median Hospital Stay ◽  
Open Procedure ◽  
Open Operation ◽  
Hand Assistance ◽  
Complications And Mortality

Laparoscopic splenectomy has emerged as a safe and effective treatment for a variety of haematological conditions. The objective was to review the results from a large personal series from the perspective of outcomes according to operative time, conversion to open operation, complications and mortality. The application of laparoscopic splenectomy to cases of splenomegaly without hand assistance is examined. A retrospective review of 140 patients undergoing laparoscopic splenectomy at a single university hospital by one surgeon during 1994-2006. Case notes were reviewed and data collected on operative time, conversion to open procedure, morbidity and mortality. Particular reference was made towards the results of cases of splenomegaly. In total 140 laparoscopic splenectomies were performed with a complication rate of 15% and no mortality. The median operative time was 100 min and conversion to open procedure was necessary in 2.1%. Conversion for cases of splenomegaly was only 5.7%. The median hospital stay was 3 days. Laparoscopic splenectomy is a safe procedure with acceptable morbidity. A laparoscopic approach for splenomegaly is feasible.

Laparoscopic or classic splenectomy?

2021 ◽  
Vol 75 (2) ◽  
pp. 134-137
Author(s):  
Aleš Zatloukal ◽  
Anton Pelikán ◽  
Peter Ihnát
Keyword(s):  
Hospital Stay ◽  
Laparoscopic Splenectomy ◽  
Operative Time ◽  
Operation Time ◽  
University Hospital ◽  
Duration Of Hospital Stay ◽  
Laparoscopic Operation ◽  
Open Operation ◽  
Laparotomy Group ◽  
Invasive Techniques

Introduction: With current development of mini-invasive techniques, laparoscopic splenectomy also gained its place under the sun. The goal of this study is to compare the results of open and laparoscopic splenectomy performed at Clinic of Surgery of University Hospital Ostrava in the period 2010–2019. Materials and Methods: A retrospective cohort study during the period 2010–2019 were counted: an operation time, a need of blood transfusions, weight, complications and duration of hospital stay. A group of patients with laparoscopic operation was compared to a group with an open operation, using the t-test. Results: During the period 2010–2019, we performed 23 laparoscopic splenectomies and 15 classic operations. Unfortunately, the comparison of both groups is difficult. The splenic weight differs in both groups statistically significantly (P = 0.0001). The patients in the classic laparotomy group had much bigger spleens and in four cases, the splenectomy was performed together with metastasectomy of the liver, diaphragmatic resection and resection of the tale of pancreas. Even then the operative time was significantly shorter than the operative time of laparoscopic operation – the operative times differ in both groups statistically significantly (P = 0.0001). The need of blood transfusion and operative complications appear to be comparable in both techniques. The duration of hospital stay was shorter in the patients with laparoscopic operation. Conclusion: Laparoscopic splenectomy off ers all the general benefi ts of mini-invasive operative techniques and is suitable method for patients undergoing elective splenectomy especially for spleens smaller than 20 cm in diameter. We consider portal hypertension and severe comorbidities of the patient to be a contraindication. It seems to us that the main problem of this method lies in a very small number of operated patients and thus in a limited possibility to obtain sufficient surgical erudition, which is probably the case of some complications and insufficient use of this method in practice. It is highly desirable to concentrate these services in the centers.

scholarly journals Learning curve for laparoscopic Roux-en-Y gastric bypass based on the experience of a newly created bariatric center

2020 ◽  
Vol 92 (4) ◽  
pp. 23-30
Author(s):  
Jadwiga Dworak ◽  
Michał Wysocki ◽  
Anna Rzepa ◽  
Michał Pędziwiatr ◽  
Dorota Radkowiak ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Gastric Bypass ◽  
Adverse Events ◽  
Learning Curve ◽  
Operative Time ◽  
Perioperative Complications ◽  
Safe Procedure ◽  
Experienced Surgeon ◽  
Institutional Learning ◽  
Complications And Mortality

ntroduction: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most common treatments for morbid obesity. The learning curve for this procedure is 50–75 cases for an independent surgeon, and it is considered the most important factor in decreasing complications and mortality. We present our experience and learning curve with LRYGB for a newly established bariatric center in Poland. Material and methods: A prospectively collected database containing 285 LRYGB procedures performed in the II Department of General Surgery of the Jagiellonian University MC in Krakow between 06.2010 and 03.2019 was retrospectively reviewed. Patients were divided into groups of 30 (G1–G10) in the order of the procedures performed by each surgeon. The study analyzed the course of the operation and patient hospitalization, comparing those groups. Learning curve for the newly created bariatric center was established. Results: Operative time in G1–G3 differed significantly from G4–G10 (P < 0.0001). The stabilization point was the 90th procedure. Perioperative complications were observed in 36 (12.63%) patients. Perioperative complications, intraoperative difficulties and adverse events did not differ importantly among groups. Liberal use of “conversions of the operator” from a surgeon to a senior surgeon provides reasonable safety and prevents complications. Conclusions: The institutional learning process stabilization point for LRYGB in a newly established bariatric center is around the 90th operation. LRYGB can be a safe procedure from the very beginning in newly established bariatric centers. Specific bariatric training with active proctoring by an experienced surgeon in a bariatric centre can improve the laparoscopic gastric bypass outcome during the learning curve.

scholarly journals Laparoscopic approach for pancreato-splenic abscess from disseminated melioidosis: Surgical outcome and review of literature

2021 ◽  
pp. 241
Author(s):  
Keyword(s):  
Operative Time ◽  
Case Reports ◽  
Demographic Data ◽  
Splenic Abscess ◽  
Laparoscopic Approach ◽  
Systemic Infection ◽  
Management Options ◽  
Distal Pancreatosplenectomy ◽  
Complications And Mortality ◽  
Median Operative Time

Melioidosis is a severe systemic infection caused by Burkholderia pseudomallei. It commonly affects the lungs, liver and kidneys. Pancreatic and splenic abscess from melioidosis is rare, with few reports in the literature. We present a series of 4 patients with disseminated melioidosis of pancreas and spleen who required surgical intervention. A MEDLINE database review was conducted. Relevant publications were evaluated and demographic data, clinical, radiological findings as well as management options were collected. We found 10 case reports describing this clinical condition. In our series, median age was 57. Median operative time 260 minutes. All four patients failed trial of antibiotic therapy and required surgery. Three underwent distal pancreatosplenectomy and one underwent splenectomy alone. Laparoscopic distal pancreatosplenectomy was successful in two patients. Median length of stay 11.5 days. No post-operative complications and mortality reported. Surgery is indicated in failed medical therapy and laparoscopic approach is safe and feasible.

Robot-Assisted Laparoscopic Fundoplications in Pediatric Surgery: Experience Review

2017 ◽  
Vol 29 (02) ◽  
pp. 173-178 ◽  
Author(s):  
Laurent Fourcade ◽  
Sarah Amar ◽  
Khalid Alzahrani ◽  
Ann-Rose Cook ◽  
Karim Braïk ◽  
...  
Keyword(s):  
Learning Curve ◽  
Pediatric Surgery ◽  
Operative Time ◽  
Operating Time ◽  
Laparoscopic Approach ◽  
Robot Assisted ◽  
Postoperative Rehabilitation ◽  
New Approach ◽  
Open Procedure ◽  
The Mean

Introduction Laparoscopic fundoplicature for gastroesophageal reflux disease has become the gold standard because of the improvement of postoperative rehabilitation compared with the open procedure. The robot-assisted surgery has brought new advantages for the patient and the surgeon compared with laparoscopy. We studied this new approach and the learning curve. Materials and Methods Sixty robot-assisted fundoplicatures were performed in two university pediatric surgery centers. Data of the patients were recorded, including peroperative data (operation length and complications), postoperative recoveries, and clinical evolution. The learning curve was evaluated retrospectively and each variable was compared along this learning curve. Results We observed a flattening of the learning curve after the 20th case for one surgeon. The mean operative time decreased significantly to 80 ± 10 minutes after 20 cases. There were no conversions to an open procedure. A revision surgery was indicated for 4.7% of the patients by a surgical robot-assisted laparoscopic approach. Conclusion The robotic system appears to add many advantages for surgical ergonomic procedures. There is a potential benefit in operating time with a short technical apprenticeship period. The setting up system is easy with a short docking time.

scholarly journals Impact of Spleen Size on Outcomes in Laparoscopic Splenectomy in Children

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Cetin Ali Karadag ◽  
Basak Erginel ◽  
Ozgur Kuzdan ◽  
Nihat Sever ◽  
Melih Akın ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Laparoscopic Splenectomy ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Time Rate ◽  
Open Procedure ◽  
Group I ◽  
Longitudinal Length ◽  
The Mean ◽  
Group Ii

Background. The aim of our study is to compare the efficacy of laparoscopic splenectomy (LS) between enlarged spleens and normal sized spleens.Methods. From June 2006 to September 2012, 50 patients underwent LS. The patients consisted of 24 girls and 26 boys with the mean age of 8.64 years (1–18). The patients are divided into two groups according to spleen’s longitudinal length on the ultrasonography. Group I consisted of the normal sized spleens; Group II consisted of spleens that are exceeding the upper limit. Groups are compared in terms of number of ports, operative time, rate of conversion to open procedure, and length of hospital stay.Results. The mean number of ports was 3.27 and 3.46, the mean length of the operation was 116.36 min and 132.17 min, rate of conversion to open procedure was 9.09% and 10.25%, and the mean length of hospital stay was 3.36 days and 3.23 days, respectively, in Group I and Group II. Although there is an increase in the number of the ports, the operative time, rate of conversion to open procedure, and the length of hospital stay, the difference was not significant between groups (P>0.05).Conclusion. LS is safe and effective in enlarged spleens as well as normal sized spleens.

scholarly journals Safety and efficacy of laparoscopic versus open surgery in management of common bile duct stones: experience at the Sohag University Hospital, Egypt

2018 ◽  
Vol 5 (11) ◽  
pp. 3727 ◽  
Author(s):  
Mena Z. Helmy ◽  
Ahmed E. Ahmed
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hospital Stay ◽  
Open Surgery ◽  
Operative Time ◽  
Bile Leak ◽  
University Hospital ◽  
Morbidity Rate ◽  
Safe Procedure ◽  
Cbd Stones

Background: Management of common bile duct (CBD) stones includes removal of the gallbladder and clearance of the ductal system which can be achieved through different approaches; endoscopic, laparoscopic or surgical.  Objective of this study is to assess the safety, efficacy, technical feasibility and surgical outcomes of laparoscopic common bile duct exploration (LCBDE) versus open surgery in the treatment of patients with cholidocholithiasis.Methods: From June 2015 to December 2017, 120 patients with CBD stones were prospectively treated at Sohag University Hospital, Upper Egypt. Patients were divided into two groups: the first one treated by LCBDE (60 patients), while the other group treated by open surgery (60 patients).Results: The ages of our patients were ranged from 20 to 80 (mean = 40) years, with a female predominance (female/male = 74/46). Patients in the first group were treated by laparoscopic approaches: transcystic approaches in four patients and transcholedochotomy approaches in 56 patients. Choledochoscop was routinely used to detect, extract the stones, in addition to assessment of CBD clearance. The conversion rate was done in two cases. The operative time was 120 (90-220) min, the clearance of CBD stones was achieved in 98.4% of cases (one case of missed stones). Hospital stay was 3 (2-4) days, with no mortality, morbidity rate was 5% including bile leak, and missed stone. The operative time in the second group was 100 (80-180) min, the clearance of CBD stones was achieved in 96.6% of cases (two cases of missed stones). Hospital stay was 8 (5-12) days, with no mortality; the morbidity rate was 15% in the form of wound infection, bile leak, missed stone and ileus.Conclusions: Management of cholidocholithiasis by laparoscopic approach is feasible, effective and safe procedure with good outcome and high success rate. 

RESULTS OF THE SUTURE OF THE PERFORATION BY SINGLE-PORT LAPAROSCOPIC SURGERY (SPLS) FOR THE PERFORATED DUODENAL ULCER TREATEMENT

2014 ◽  
pp. 126-132
Author(s):  
Huu Tri Nguyen ◽  
Van Lieu Nguyen
Keyword(s):  
Duodenal Ulcer ◽  
Laparoscopic Surgery ◽  
Single Port ◽  
Previous History ◽  
University Hospital ◽  
Safe Procedure ◽  
Perforated Duodenal Ulcer ◽  
Analgesic Requirement ◽  
Duodenal Ulcers ◽  
The Mean

Background Single-port laparoscopic surgery (SPLS) was increasingly used on several surgical diseases. The aim of this study is evaluation of the results of the suture of the perforation by SPLS for the perforated duodenal ulcer treatement. Methods From January 2012 to July 2014, 35 patients with perforated duodenal ulcers underwent simple suture of the perforations by SPLS at Hue University Hospital and Hue Central Hospital. Results The mean age was 45.9 ± 14.4 years. The sex ratio (male/female) was 16.5 and the mean of BMI was 19.2 ± 2.3. There was one patient (2.9%) with previous history of laparoscopic repair of perforated duodenal ulcer. The duration of the symptoms was 9.9 ± 12.3 hours. 97.1% of patients had the perforations of the anterior wall of the duodenum. The mean size of the perforation was 4.7 ± 3.4 mm (2 – 22mm). 2.9% of patients had the perforations of the posterior wall of the duodenum. The rate of the conversion to the open surgery was 2.9%. The mean operative time was 75.8 ± 33.7min, and the mean hospital stay was 5.8 ± 1.4 days. The mean of the analgesic requirement time was 2.9 ± 0.8 days. The wound length was 1.9 ± 0.1 cm. There was 5.9% of the patients had wound infection. There was no operation-related mortality. Conclusions Simple suture of the perforation by single-port laparoscopic surgery is a feasible and safe procedure, and it may be a scarless surgical technique for perforated duodenal ulcers treatement. Key words: single-port laparoscopic surgery, perforated duodenal ulcer

scholarly journals Challenges and Results of Laparoscopic Splenectomy for Hematological Diseases in a Developing Country

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Vikal Chandra Shakya ◽  
Bikram Byanjankar ◽  
Rabin Pandit ◽  
Anang Pangeni ◽  
Anir Ram Moh Shrestha ◽  
...  
Keyword(s):  
Laparoscopic Splenectomy ◽  
Operative Time ◽  
Hereditary Spherocytosis ◽  
Developed Countries ◽  
Beta Thalassemia ◽  
Hematological Diseases ◽  
Alpha Thalassemia ◽  
Steroid Dependent ◽  
The Mean ◽  
Surgery Department

Introduction. Though, in developed countries, laparoscopy is now a gold standard for splenectomy, we are lacking in this aspect in the eastern world. Splenectomy has mostly been performed by open surgery in our region. This is our effort to introduce laparoscopic splenectomy in our country.Methods. This is a retrospective cohort study done in patients presenting to hematology and surgery department of our hospital who underwent laparoscopic splenectomy for hematological diseases from January 2013 to December 2016.Results. There were 50 patients (38 females, 12 males). The diagnoses were idiopathic thrombocytopenic purpura in 31, (steroid/azathioprine-resistant, steroid dependent), hereditary spherocytosis in 9, alpha-thalassemia in 3, beta-thalassemia in 2, autoimmune hemolytic anemia in 4, and isolated splenic tuberculosis in 1. Average platelet counts preoperatively were62000±11000/mm3 (range 52000-325000/mm3). The mean operative time was130±49minutes (range 108-224 min). The mean postoperative stay was4±2.11days (range 3-9 days). Laparoscopic splenectomy could be completed in 45 (90%) patients.Conclusion. Laparoscopic splenectomy could be successfully contemplated in patients with hematological diseases, especially if spleen is normal or only mildly enlarged, and is an advantageous alternative to open splenectomy. Absence of ideal resources has not limited our progress in minimal access approach.

scholarly journals An assessment of the quality indicators of operative and non-operative times in a public university hospital

2015 ◽  
Vol 13 (4) ◽  
pp. 594-599 ◽  
Author(s):  
Altair da Silva Costa Jr ◽  
Luiz Eduardo Villaça Leão ◽  
Maykon Anderson Pires de Novais ◽  
Paola Zucchi
Keyword(s):  
Standard Deviation ◽  
Operating Room ◽  
Operative Time ◽  
Patient Flow ◽  
Cross Sectional Study ◽  
Public University ◽  
Major Effect ◽  
University Hospital ◽  
Cross Sectional ◽  
Using Data

ABSTRACT Objective To assess the operative time indicators in a public university hospital. Methods A descriptive cross-sectional study was conducted using data from operating room database. The sample was obtained from January 2011 to January 2012. The operations performed in sequence in the same operating room, between 7:00 am and 5:00 pm, elective or emergency, were included. The procedures with incomplete data in the system were excluded, as well as the operations performed after 5:00 pm or on weekends or holidays. Results We measured the operative and non-operative time of 8,420 operations. The operative time (mean and standard deviation) of anesthesias and operations were 177.6±110 and 129.8±97.1 minutes, respectively. The total time of the patient in operative room (mean and standard deviation) was 196.8±113.2. The non-operative time, e.g., between the arrival of the patient and the onset of anesthesia was 14.3±17.3 minutes. The time to set the next patient in operating room was 119.8±79.6 minutes. Our total non-operative time was 155 minutes. Conclusion Delays frequently occurred in our operating room and had a major effect on patient flow and resource utilization. The non-operative time was longer than the operative time. It is possible to increase the operating room capacity by management and training of the professionals involved. The indicators provided a tool to improve operating room efficiency.

scholarly journals Stapled haemorrhoidopexy: is it time to move on?

2015 ◽  
Vol 97 (7) ◽  
pp. 490-493 ◽  
Author(s):  
EH Aly
Keyword(s):  
Operative Time ◽  
Wound Care ◽  
Dentate Line ◽  
Safe Procedure ◽  
Stapled Haemorrhoidopexy ◽  
Short Operative Time ◽  
Stapled Haemorrhoidectomy ◽  
Life Threatening ◽  
Number Of Publications ◽  
Randomised Controlled

Stapled haemorrhoidectomy was proposed as an ‘ideal’ solution for symptomatic haemorrhoids, with minimal postoperative pain, no perianal wound requiring postoperative wound care and a relatively short operative time. Some randomised controlled trials and reviews confirmed these findings, claiming that stapled haemorrhoidopexy is the most effective and safe procedure for haemorrhoids. However, there are increasing number of publications highlighting that the technique is associated with serious and life threatening complications. Maybe it is now the time to accept that stapled haemorrhoidopexy has done its role in directing our attention to the fact that modern surgical treatment of haemorrhoids should avoid excision of anorectal skin but should instead aim at treatment intervention above the dentate line.

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