One hand is better than two: conversion from pure laparoscopic to the hand-assisted approach during difficult nephrectomy

INTRODUCTION The incidence of conversion from a laparoscopic to an open approach during nephrectomy is reported at 6-8%. 1 Conversion to an open procedure may be necessary to control haemorrhage or allow progress in dissection but the well established benefits of minimally invasive surgery (MIS) are obviously lost. Hand-assisted laparoscopy (HAL) also offers the benefits to the patient of MIS. We have used HAL to convert from the pure laparoscopic approach during difficult nephrectomies, rather than converting to traditional open surgery. MATERIALS AND METHODS A review of our prospective database was carried out to identify any conversions from the pure laparoscopic approach during nephrectomy or nephroureterectomy for benign or malignant disease. RESULTS A total of 87 laparoscopic nephrectomies (LNs) were identified over a 3-year period. There were five conversions to the HAL approach (5.7%) and no conversions to open surgery. The reason for conversion was failure to progress in all five cases. Operative times averaged 190 minutes with blood loss of 180ml. Histology revealed xanthogranulomatous pyelonephritis in four cases and renal cell carcinoma in one case. The median postoperative stay was 4 days. CONCLUSIONS Conversion to HAL during LN maintains the benefits of MIS in difficult nephrectomy and should be considered prior to converting to open surgery.

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Method of forming a pancreatogastric anastomosis after pancreatoduodenal resection

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery ◽

10.16931/1995-5464.2021-4-97-104 ◽

2021 ◽

Vol 26 (4) ◽

pp. 97-104

Author(s):

V. Ya. Lishchishin ◽

A. G. Barishev ◽

A. N. Petrovsky ◽

A. N. Lishchenko ◽

A. Y. Popov ◽

...

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Open Surgery ◽

Surgical Approaches ◽

Open Approach ◽

Malignant Tumours ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Pancreatic Fistulas

Aim. To evaluate the reproducibility and safety of the developed pancreatogastric anastomosis with various surgical approaches during pancreatoduodenectomy.Materials and methods. The experience of surgical treatment of 47 patients with malignant tumours of the periampullary zone, who underwent pancreatoduodenectomy, was considered. The proposed variant of anastomose was performed to 14 (29.8%) patients: in 7 cases with a minimally invasive approach to perform pancreatoduodenectomy; and in 7 cases with an open approach. To compare retrospectively 33 (70.2%) patients who underwent pancreatogastric anastomosis according to the Bassi technique: 9 – with minimally invasive surgery, 24 – with open surgery. The frequency of pancreatic fistulas, the number of repeated interferences, and hospital mortality were taken into account.Results. A significant advantage of the new method of forming an anastomosis in the duration of the operation was noted in comparison with the Bassi technique. There were no statistically significant differences in blood loss while various types of anastomoses (p > 0.05). When using the proposed technique, the formation of pancreatic fistulas was not revealed. The development of pancreatic fistula was observed in 4 (16.7%) patients after open surgery and in 7 (77.8%) patients after minimally invasive Bassi anastomose formation. Reoperations were performed after open surgery in 3 (12.5%) cases and in 4 (44.4%) cases of minimally invasive surgery according to the Bassi technique. There were 2 (22.2%) deaths in the minimally invasive group.Conclusion. The proposed pancreatogastric anastomosis is applicable in clinical practice. This method allows to create relatively fast and less challenging anastomosis, including with a minimally invasive approach. The use of this technique makes it possible to reduce mortality and postoperative complications in patients with a “complex” pancreas.

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IS CONSERVATIVE AND MINIMALLY INVASIVE LIVER SURGERY SAFE IN THE APPROACH TO HEPATOCARCINOMA? ANALYSIS OF THE RESULTS IN OUR CENTER

British Journal of Surgery ◽

10.1093/bjs/znab160.057 ◽

2021 ◽

Vol 108 (Supplement_3) ◽

Author(s):

E Camarero ◽

A García-Botella ◽

R Avellana ◽

M J Pizarro ◽

S de la Serna ◽

...

Keyword(s):

Liver Resection ◽

Survival Data ◽

Open Surgery ◽

Laparoscopic Approach ◽

Open Approach ◽

Minimally Invasive Liver Surgery ◽

Oncological Safety ◽

Time To Recurrence ◽

The Relationship ◽

Type Of Surgery

Abstract INTRODUCTION We present the results of liver resection surgery for hepatocarcinoma (HCC), comparing morbidity, mortality, and survival data based on the type of surgical approach (open vs. laparoscopic) and the type of liver resection (anatomical vs. limited). MATERIAL AND METHODS Descriptive, prospective, and comparative study of 49 patients who underwent liver resection for HCC during the period 2013-2018 in our centre. RESULTS 16 laparoscopic resections were performed (32.7%) compared to 33 open surgeries (67.3%). Morbidity and mortality results according to the Clavien-Dindo classification (I 38 (77.6%); II 9 (18.4%), III 1 (2%), IV 1 (2%). Among the risk factors, the relationship between the preoperative Apri Index and the observed survival has been studied in our population, without observing statistically significant differences (p = 0.915). No statistically significant differences have been found between the laparoscopic versus the open approach (p = 0.78) or in anatomical surgery versus limited resections (p = 0.26) in terms of time to tumor recurrence. In our series, no significant differences in survival were found depending on the type of surgery (open vs laparoscopic, p = 0.57). CONCLUSIONS In our study, we have not been able to demonstrate the greater oncological safety of performing limited versus anatomic resections. The results of the laparoscopic approach are comparable, in terms of overall survival and time to recurrence, to the results of open surgery.

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Robotic radical hysterectomy for early-stage cervical cancer: A systematic literature review

Gynecologic Robotic Surgery ◽

10.36637/grs.2021.00038 ◽

2021 ◽

Vol 2 (2) ◽

pp. 33-42

Author(s):

Gun Oh Chong

Keyword(s):

Cervical Cancer ◽

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Invasive Surgery ◽

Radical Hysterectomy ◽

Open Surgery ◽

Early Stage ◽

Laparoscopic Approach ◽

Robotic Radical Hysterectomy ◽

Early Stage Cervical Cancer

Robotic technology has recently come into widespread use to overcome the limitations of laparoscopic radical hysterectomy in the treatment of early-stage cervical cancer. Most comparative studies showed that blood loss and hospital stays for patients undergoing minimally invasive surgery, including robotic procedures, were superior compared to open surgery. Moreover, the survival outcomes of robotic radical hysterectomy were not inferior to open radical hysterectomy. Unexpectedly, the Laparoscopic Approach to Cervical Cancer (LACC) trial, a randomized, open-label, noninferiority study that compared minimally invasive radical hysterectomy with open radical hysterectomy, revealed that minimally invasive surgery was associated with a higher risk of recurrence and death compared with open surgery. Strict guidelines for robotic radical hysterectomy for the treatment of early-stage cervical cancer should be established in accordance with objective Korean data. In addition, it is recommended that further studies should be performed on how to avoid the use of uterine manipulators and the dissemination of cancer cells by ensuring a more effective vaginal closure using a standardized approach.

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Laparoscopic versus Open Surgery for Acute Adhesive Small-Bowel Obstruction: A Propensity Score–Matched Analysis

Scandinavian Journal of Surgery ◽

10.1177/1457496916641341 ◽

2016 ◽

Vol 106 (1) ◽

pp. 28-33 ◽

Cited By ~ 19

Author(s):

T. Hackenberg ◽

P. Mentula ◽

A. Leppäniemi ◽

V. Sallinen

Keyword(s):

Small Bowel ◽

Propensity Score ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Open Surgery ◽

Laparoscopic Approach ◽

Length Of Hospital Stay ◽

Adhesive Small Bowel Obstruction ◽

Open Approach ◽

Laparoscopic Adhesiolysis

Background and Aims: The laparoscopic approach has been increasingly used to treat adhesive small-bowel obstruction. The aim of this study was to compare the outcomes of a laparoscopic versus an open approach for adhesive small-bowel obstruction. Material and Methods: Data were retrospectively collected on patients who had surgery for adhesive small-bowel obstruction at a single academic center between January 2010 and December 2012. Patients with a contraindication for the laparoscopic approach were excluded. A propensity score was used to match patients in the laparoscopic and open surgery groups based on their preoperative parameters. Results: A total of 25 patients underwent laparoscopic adhesiolysis and 67 patients open adhesiolysis. The open adhesiolysis group had more suspected bowel strangulations and more previous abdominal surgeries than the laparoscopic adhesiolysis group. Severe complication rate (Clavien–Dindo 3 or higher) was 0% in the laparoscopic adhesiolysis group versus 14% in the open adhesiolysis group ( p = 0.052). Twenty-five propensity score–matched patients from the open adhesiolysis group were similar to laparoscopic adhesiolysis group patients with regard to their preoperative parameters. Length of hospital stay was shorter in the laparoscopic adhesiolysis group compared to the propensity score–matched open adhesiolysis group (6.0 vs 10.0 days, p = 0.037), but no differences were found in severe complications between the laparoscopic adhesiolysis and propensity score–matched open adhesiolysis groups (0% vs 4%, p = 0.31). Conclusion: Patients selected to be operated by the open approach had higher preoperative morbidity than the ones selected for the laparoscopic approach. After matching for this disparity, the laparoscopic approach was associated with a shorter length of hospital stay without differences in complications. The laparoscopic approach may be a preferable approach in selected patients.

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Appendectomy in Women. Is the Laparoscopic Approach Always Better Than the “Open” Approach in Uncomplicated Appendicitis?

Surgical Laparoscopy Endoscopy & Percutaneous Techniques ◽

10.1097/sle.0000000000000063 ◽

2014 ◽

Vol 24 (5) ◽

pp. 406-409 ◽

Cited By ~ 1

Author(s):

Andrea Casarotto ◽

Fabio R. Zarantonello ◽

Matteo Rebonato

Keyword(s):

Laparoscopic Approach ◽

Open Approach ◽

Uncomplicated Appendicitis ◽

Better Than

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Feasibility of Transoral Thyroidectomy by Vestibular Approach

Bengal Journal of Otolaryngology and Head Neck Surgery ◽

10.47210/bjohns.2020.v28i1.176 ◽

2020 ◽

Vol 28 (1) ◽

pp. 67-70

Author(s):

Kshitij Shah ◽

Shivali Patekar ◽

Tejal Patel ◽

Renuka Bradoo

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Endoscopic Thyroidectomy ◽

Open Approach ◽

Initial Experience ◽

Transoral Thyroidectomy ◽

Open Procedure ◽

Endoscopic Thyroid Surgery ◽

Vestibular Approach ◽

Good Exposure

Introduction An open approach to thyroidectomies through neck provides good exposure and safe dissection however, the patient still has a scar. Endoscopic thyroid surgery has been practised since the late 90s. The latest addition is the transoral endoscopic thyroidectomy by vestibular approach. Materials and Methods We at our centre performed this surgery on 3 patients. Here we present our initial experience of transoral endoscopic thyroidectomy by vestibular approach (TOETVA). Results Two of the three patients did not have any complication. Diffuse bleeding was encountered during one instance and decision was taken to convert it into an open procedure. Conclusion The preliminary experience of transoral thyroidectomy by vestibular approach shows it to be a feasible and promising ‘scarless’ and ‘minimally invasive’ surgery.

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Comparison of Oncologic Outcomes in Laparoscopic versus Open Surgery for Non-Metastatic Colorectal Cancer: Personal Experience in a Single Institution

Journal of Clinical Medicine ◽

10.3390/jcm8060875 ◽

2019 ◽

Vol 8 (6) ◽

pp. 875 ◽

Cited By ~ 1

Author(s):

Chong-Chi Chiu ◽

Wen-Li Lin ◽

Hon-Yi Shi ◽

Chien-Cheng Huang ◽

Jyh-Jou Chen ◽

...

Keyword(s):

Colorectal Cancer ◽

Laparoscopic Surgery ◽

Blood Loss ◽

Metastatic Colorectal Cancer ◽

Surgical Complications ◽

Open Surgery ◽

Tumor Recurrence ◽

Laparoscopic Approach ◽

Open Approach ◽

Significant Difference

The oncologic merits of the laparoscopic technique for colorectal cancer surgery remain debatable. Eligible patients with non-metastatic colorectal cancer who were scheduled for an elective resection by one surgeon in a medical institution were randomized to either laparoscopic or open surgery. During this period, a total of 188 patients received laparoscopic surgery and the other 163 patients received the open approach. The primary endpoint was cancer-free five-year survival after operative treatment, and the secondary endpoint was the tumor recurrence incidence. Besides, surgical complications were also compared. There was no statistically significant difference between open and laparoscopic groups regarding the average number of lymph nodes dissected, ileus, anastomosis leakage, overall mortality rate, cancer recurrence rate, or cancer-free five-year survival. Even though performing a laparoscopic approach used a significantly longer operation time, this technique was more effective for colorectal cancer treatment in terms of shorter hospital stay and less blood loss. Meanwhile, fewer patients receiving the laparoscopic approach developed postoperative urinary tract infection, wound infection, or pneumonia, which reached statistical significance. For non-metastatic colorectal cancer patients, laparoscopic surgery resulted in better short-term outcomes, whether in several surgical complications and intra-operative blood loss. Though there was no significant statistical difference in terms of cancer-free five-year survival and tumor recurrence, it is strongly recommended that patients undergo laparoscopic surgery if not contraindicated.

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Parameters of radical resection in laparoscopic and open colon and rectal cancer surgery

Vojnosanitetski pregled ◽

10.2298/vsp180607127k ◽

2020 ◽

Vol 77 (5) ◽

pp. 532-538

Author(s):

Igor Krdzic ◽

Marko Kenic ◽

Milena Scepanovic ◽

Ivan Soldatovic ◽

Jelena Ilic-Zivojinovic ◽

...

Keyword(s):

Colorectal Cancer ◽

Rectal Cancer ◽

Lymph Nodes ◽

Open Surgery ◽

Rectal Surgery ◽

Laparoscopic Approach ◽

Resection Margins ◽

Rectal Cancer Surgery ◽

Open Approach ◽

Colon And Rectal Cancer

Background/Aim. In colon and rectal cancer surgery, resection is considered radical when circumferential, proximal and distal resection margins are without the presence of tumor cells. Concept of total mesorectal excision in rectal surgery involves complete removal of the tumor with mesorectal fascia which surrounds lymph nodes, lymphatics and blood vessels. The aim of this study was to determine whether laparoscopic approach provides all parameters of oncological radicality as open surgery of colorectal cancer. Methods. The study included 122 patients with carcinoma of colon and rectum, divided into two equal groups: patients operated on by laparoscopic and those operated on by open approach. In colon surgery we analyzed proximal and distal resection margins, and the number of removed lymph nodes, and in rectal surgery: proximal, distal and circumferential resection margins, and the number of removed lymph nodes. Results. Both groups were comparable in age, sex, American Society of Anesthesiologists (ASA) score, tumor localization, tumor size, and type of surgical operation performed. According to localization of the tumor, the most commonly performed operation was anterior resection of the rectum (60.7% vs. 59%). There was no case of the tumor involvement of the distal margin. Average proximal distance from the tumor on the fixed specimen was 100 vs. 120 mm with statistical significance (p < 0.001). Distal margins were not significantly different, 40 mm in both groups (p = 0.143). In two cases we had circumferential resection margin (CRM) of 1 mm (7.7%) in the laparoscopic group, and in three cases operated conventionally CRM was 1 mm (8.8%). The average number of removed lymph nodes was 15 vs. 16, respectively. Length of hospital stay for patients assigned to the laparoscopic surgery was significantly shorter than for patients operated on by the open approach. Concerning postoperative complications, no significant difference was found between groups. The overall postoperative morbidity was 18% vs. 21.3%, respectively. Conclusion. With laparoscopic approach it is possible to provide all parameters of oncological radicality similarly to the open surgery of colorectal cancer.

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