scholarly journals Bariatric fellowship positively influences early outcomes for laparoscopic Roux-en-Y gastric bypass surgery over seven years of independent practice

2018 ◽  
Vol 100 (8) ◽  
pp. 657-661 ◽  
Author(s):  
A Ilczyszyn ◽  
W Lynn ◽  
S Rasheed ◽  
J Davids ◽  
R Aguilo ◽  
...  
Keyword(s):  
Gastric Bypass ◽  
Learning Curve ◽  
Perioperative Complications ◽  
Length Of Hospital Stay ◽  
Risk Scores ◽  
Perioperative Outcomes ◽  
First Year ◽  
Independent Practice ◽  
Conversion To Open Surgery ◽  
Significant Difference

Introduction Laparoscopic Roux-en-Y gastric bypass (LRYGB) is technically demanding and has an associated learning curve. We published previously that bariatric fellowship reduces the learning curve of primary LRYGB and improves patient outcomes after one year of independent practice. However, the long-term effect of fellowship is unknown. We therefore aimed to compare the 30-day outcomes of LRYGB between the first year of a surgeon’s independent practice with the subsequent six years. Materials and methods A prospective database of patients undergoing primary LRYGB under a single surgeon from March 2010 until February 2017 was analysed. Two groups were studied: first year (< 1 year) and the subsequent six years (≥ 1 year) of independent practice. Patient demographics, length of hospital stay, conversion to open surgery, perioperative complications and mortality were compared. Results Among 279 eligible patients, 74 (26.5%) were in the < 1 year group and 205 (73.5%) in ≥ 1 year group. The preoperative risk scores, American Society of Anesthesiologists (ASA) grade, P = 0.00; obesity surgery mortality risk score (OS-MRS), P = 0.04) were significantly higher in ≥ 1 year group. There was no significant difference in perioperative outcomes (length of stay, P = 0.38; total complications, P = 0.20; readmissions, P = 1.00; reoperations, P = 0.60) between the two groups. Conclusions Bariatric fellowship reduces the learning curve for LRYGB and helps to achieve excellent outcomes in the first and subsequent years of independent practice. The higher risk profile of ≥ 1 year group did not equate to an increase in complications, suggesting that experience and standardisation may help in handling complex cases. To our knowledge, this represents the only such study in the literature.

scholarly journals Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a multi-institutional comparative study

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Amr A. Faddan ◽  
Mahmoud M. Shalaby ◽  
Mohamed Gadelmoula ◽  
Younis Alshamsi ◽  
Daniar K. Osmonov ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Complication Rate ◽  
Perioperative Complications ◽  
Statistical Significance ◽  
Operating Time ◽  
Perioperative Outcomes ◽  
Academic Institutions ◽  
Robot Assisted ◽  
Surgical Specimen ◽  
Significant Difference

Abstract Background The standard surgical treatment of localized prostate cancer (PCa) has been rapidly changed along the last two decades from open to laparoscopic and finally robot-assisted techniques. Herein, we compare the three procedures for radical prostatectomy (RP), namely radical retropubic (RRP), laparoscopic (LRP), and robot-assisted laparoscopic (RALRP) regarding the perioperative clinical outcome and complication rate in four academic institutions. Methods A total of 394 patients underwent RP between January 2016 and December 2018 in four academic institutions; their records were reviewed. We recorded the patient age, BMI, PSA level, Gleason score and TNM stage, type of surgery, the pathological data from the surgical specimen, the perioperative complications, unplanned reoperating, and readmission rates within 3 months postoperatively. Statistical significance was set at (P < 0.05). All reported P values are two-sided. Results A total of 123 patients underwent RALRP, 220 patients underwent RRP, and 51 underwent LRP. There was no statistically significant difference between the three groups regarding age, BMI, prostatic volume, and preoperative PSA. However, there were statistically significant differences between them regarding the operating time (P < .0001), catheterization period (P < .001), hospital stay (P < .0001), and overall complications rate (P = .023). Conclusions The minimally invasive procedures (RALRP and LRP) are followed by a significantly lower complication rate. However, the patients’ factors and surgical experience likely impact perioperative outcomes and complications.

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 Global Benchmark Values for Laparoscopic Roux-en-Y-Gastric Bypass: a Potential New Indicator of the Surgical Learning Curve

2020 ◽  
Author(s):  
Guillaume Giudicelli ◽  
Michele Diana ◽  
Mickael Chevallay ◽  
Benjamin Blaser ◽  
Chloé Darbellay ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Gastric Bypass ◽  
Learning Curve ◽  
Operative Time ◽  
High Volume ◽  
Perioperative Outcomes ◽  
Morbidity Rate ◽  
Bariatric Surgeon ◽  
Senior Surgeon ◽  
Surgical Learning

Abstract Background Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a technically demanding procedure. The learning curve of LRYGB is challenging and potentially associated with increased morbidity. This study evaluates whether a general laparoscopic surgeon can be safely trained in performing LRYGB in a peripheral setting, by comparing perioperative outcomes to global benchmarks and to those of a senior surgeon. Methods All consecutive patients undergoing primary LRYGB between January 2014 and December 2017 were operated on by a senior (A) or a trainee (B) bariatric surgeon and were prospectively included. The main outcome of interest was all-cause morbidity at 90 days. Perioperative outcomes were compared with global benchmarks pooled from 19 international high-volume centers and between surgeons A and B for their first and last 30 procedures. Results The 213 included patients had a mean all-cause morbidity rate at 90 days of 8% (17/213). 95.3% (203/213) of the patients were uneventfully discharged after surgery. Perioperative outcomes of surgeon B were all within the global benchmark cutoffs. Mean operative time for the first 30 procedures was significantly shorter for surgeon A compared with surgeon B, with 108.6 min (± 21.7) and 135.1 min (± 28.1) respectively and decreased significantly for the last 30 procedures to 95 min (± 33.7) and 88.8 min (± 26.9) for surgeons A and B respectively. Conclusion Training of a new bariatric surgeon did not increase morbidity and operative time improved for both surgeons. Perioperative outcomes within global benchmarks suggest that it may be safe to teach bariatric surgery in peripheral setting.

scholarly journals Impact of Robotic Fellowship Experience on Perioperative Outcomes of Robotic-Assisted Laparoscopic Partial Nephrectomy

2015 ◽  
Vol 9 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Michael A. Moriarty ◽  
Kenneth G. Nepple ◽  
Chad R. Tracy ◽  
Michael E. Strigenz ◽  
Daniel K. Lee ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Perioperative Complications ◽  
Positive Margin ◽  
Warm Ischemia ◽  
Laparoscopic Partial Nephrectomy ◽  
Perioperative Outcomes ◽  
Initial Experience ◽  
Robotic Assisted ◽  
Nephrometry Score ◽  
Significant Difference

Background: We analyzed differences in patient selection and perioperative outcomes between robotic-fellowship trained and non-fellowship trained surgeons in their initial experience with robotic-assisted laparoscopic partial nephrectomy. Methods: Data through surgeon case 10 was analyzed. Forty patients were identified from two fellowship trained surgeons (n = 20) and two non-fellowship trained surgeons (n = 20). Results: Fellowship trained surgeons performed surgery on masses of higher nephrometry score (8.0 vs. 6.0, p = 0.007) and more posterior location (60 vs. 25%, p = 0.03). Retroperitoneal approach was more common (50 vs. 0%, p = 0.0003). Fellowship trained surgeons trended toward shorter warm ischemia time (25.5 vs. 31.0 min, p = 0.08). There was no significant difference in perioperative complications (35 vs. 35%, p = 0.45) or final positive margin rates (0 vs. 15%, p = 0.23). Conclusion: Fellowship experience may allow for treating more challenging and posterior tumors in initial practice and significantly more comfort performing retroperitoneal robotic-assisted laparoscopic partial nephrectomy.

scholarly journals Enhanced recovery care versus traditional non- ERAS  care following osteotomies in developmental dysplasia of the hip in children : a retrospective case-cohort study

2020 ◽  
Author(s):  
Jin Li ◽  
Saroj Rai ◽  
Renhao Ze ◽  
Xin Tang ◽  
Ruikang Liu ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Perioperative Complications ◽  
Length Of Hospital Stay ◽  
Developmental Dysplasia ◽  
Control Group ◽  
Postoperative Fever ◽  
Vas Score ◽  
Significant Difference ◽  
Dysplasia Of The Hip

Abstract Background: Enhanced recovery after surgery (ERAS) has been shown to shorten the length of hospital stay and reduce the incidence of perioperative complications in many surgical fields. However, there has been a paucity of research examining the application of ERAS in major pediatric orthopedic surgeries. This study aims to compare the perioperative complications and length of hospital stay after osteotomies in children with developmental dysplasia of the hip (DDH) between ERAS and traditional non-ERAS group. Methods: The ERAS group consisted of 86 patients included in the ERAS program from January 2016 to December 2017. The Control group consisted of 82 DDH patients who received osteotomies from January 2014 to December 2015. Length of hospital stay, physiological function, postoperative visual analogue scale (VAS) score, and postoperative complications were compared between the two groups. Results: The mean duration of hospital stay was significantly reduced from 10.0±3.1 in the traditional care group to 6.0±0.8 days in the ERAS(P<0.001). The VAS score in 3-day was significantly lower in ERAS group (2.9±0.8) than traditional non-ERAS group (4.0±0.8) (P<0.001). However, there was no significant difference in the frequency of breakout pain (VAS >4) between two groups (29.5±6.3 vs.30.6±6.5, P=0.276). The frequency of postoperative fever was lower in the ERAS group. The frequency of urinary tract infection in both groups were not noticeable because the catheter was removed promptly after the surgery. Conclusion: The ERAS protocol is both safe and feasible for pediatric DDH patients undergoing osteotomies, and it can shorten the length of hospital stay without increasing the risk of perioperative complications.

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 Enhanced recovery care versus traditional care following osteotomies in developmental dysplasia of the hip in children: a retrospective case-cohort study

2020 ◽  
Author(s):  
Jin Li ◽  
Saroj Rai ◽  
Renhao Ze ◽  
Xin Tang ◽  
Ruikang Liu ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Enhanced Recovery ◽  
Perioperative Complications ◽  
Length Of Hospital Stay ◽  
Developmental Dysplasia ◽  
Care Group ◽  
Vas Score ◽  
Significant Difference ◽  
Traditional Care ◽  
Dysplasia Of The Hip

Abstract Background: Enhanced recovery after surgery (ERAS) has been shown to shorten the length of hospital stay and reduce the incidence of perioperative complications in many surgical fields. However, there has been a paucity of research examining the application of ERAS in major pediatric orthopedic surgeries. This study aims to compare the perioperative complications and length of hospital stay after osteotomies in children of developmental dysplasia of the hip (DDH) between ERAS and traditional care group.Methods: The ERAS group consisted of 86 patients included in the ERAS program from January 2016 to December 2017. The Control group consisted of 82 DDH patients who received osteotomies from January 2014 to December 2015. Length of hospital stay, physiological function, postoperative visual analogue scale (VAS) score, and postoperative complications were compared between the two groups.Results: The mean duration of hospital stay was significantly reduced from 10.0±3.1 in the traditional care group to 6.0±0.8 days in the ERAS(P<0.001). Pain response was better in the ERAS group than traditional care group in terms of mean 3-day VAS score (2.9±0.8 vs. 4.0±0.8, P<0.001) and maximum VAS score (4.1±0.8 vs. 4.9±0.8, P<0.001). However, there was no significant difference in the frequency of break-out pain (VAS >4) between two groups (29.5±6.3 vs.30.6±6.5, P=0.276 ). The frequency of fever is lower in the ERAS group, possibly due to better temperature monitoring and management in the operating room. The frequency of urinary infection in both groups were not noticeable because the catheter was removed promptly after the surgery. Conclusion: The ERAS protocol is both safe and feasible for pediatric DDH patients undergoing osteotomies, and it can shorten the length of hospital stay without increasing the risk of perioperative complications.

scholarly journals Robot-assisted lobectomy versus completely portal robotic lobectomy: What is the difference?

2020 ◽  
Vol 28 (4) ◽  
pp. 648-655
Author(s):  
Murat Akkuş
Keyword(s):  
Pulmonary Resection ◽  
Lung Resection ◽  
Length Of Hospital Stay ◽  
Operation Time ◽  
Lymph Node Staging ◽  
Robot Assisted ◽  
Conversion To Open Surgery ◽  
Significant Difference ◽  
The Difference ◽  
Lung Deflation

Background: This study aims to compare robot-assisted lobectomy versus completely portal robotic lobectomy. Methods: Between January 2014 and December 2019, a total of 41 patients (10 males, 31 females; median age 62 years; range, 50 to 68 years) underwent robotic anatomical pulmonary resection in our institution were retrospectively analyzed. The patients were consecutively divided into two groups: the first 20 (48.8%) patients underwent pulmonary resection by robot-assisted lobectomy technique, while the next 21 (51.2%) patients underwent pulmonary resection by completely portal robotic lobectomy with four arms. Data including age, sex, diagnosis, surgery type and duration, rate of conversion to open surgery, and length of stay of the patients were recorded. The operation time, docking time, console time, and closure duration for each patient were also noted. Results: There was no statistically significant difference in age, sex, comorbidities, complications, length of hospital stay, adequate lymph node staging, or tumor size and side between the two groups (p>0.05). However, the mean console and operation times were statistically significantly shorter in the patients receiving completely portal robotic lobectomy with four arms (p=0.001). Conclusion: The advantage of completely portal robotic lobectomy with four arms is relative, although it significantly shortens the operation time. Based on our experiences, this technique may be preferred in case of inadequate lung deflation, as carbon dioxide insufflation allows sufficient workspace for robotic lung resection.

scholarly journals Trifecta Outcomes in Open, Laparoscopy or Robotic Partial Nephrectomy: Does the Surgical Approach Matter?

2019 ◽  
Vol 6 (1) ◽  
pp. 8-12 ◽  
Author(s):  
Ketan Mehra ◽  
Ramanitharan Manikandan ◽  
Lalgudi Narayanan Dorairajan ◽  
Sreenivasan Sreerag ◽  
Amit Jain ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Perioperative Complications ◽  
Renal Tumors ◽  
Perioperative Outcomes ◽  
Robotic Partial Nephrectomy ◽  
Open Partial Nephrectomy ◽  
Significant Difference ◽  
Important Position ◽  
The Cost ◽  
Preoperative Creatinine

This retrospective study evaluated perioperative outcomes of open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), and robot-assisted partial nephrectomy (RAPN) and identified predictive factors of Trifecta achievement for renal tumors that underwent partial nephrectomy (PN) in a single institutional cohort. The study involved patients who underwent PN from January 2011 to July 2018. Trifecta was defined as absence of perioperative complications, no positive surgical margins, and ischemia time <30 min. Fifty-five PN procedures were reviewed: 28 OPN, 14 LPN, and 13 RAPN. OPN, LPN and RAPN had similar median tumor size (5.75, 5.25, and 5 cm), nephrometry score (7, 6, and 6), and preoperative creatinine (1.09, 1.1, and 1.1 mg/dl, respectively). Blood loss was higher for OPN (550 ml) than for LPN (400 ml) and RAPN (300 ml), P = 0.042. Drain was removed after 6 days in OPN which was higher than LPN and RAPN (4.5 and 4 days, respectively), P = 0.008. OPN, LPN, and RAPN had similar median operative time (190, 180, and 180 min, respectively), P = 0.438. Median postoperative stay for OPN, LPN, and RAPN was 5, 6.5, and 10 days, respectively. Trifecta outcomes of 73.1%, 64.3%, and 61.53% were achieved in OPN, LPN, and RAPN, respectively, P = 0.730. It was concluded that Trifecta outcomes had no significant difference among OPN, LPN, and RAPN. LPN can produce as good results as RAPN. Keeping in mind the cost-effectiveness, LPN holds an important position in developing countries where expenditure by patient is a major factor.

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