The Efficacy of Gasless Reduced-port Laparoscopic Surgery for Gynecological Diseases

Abstract Objective The purpose of this study was to examine the effectiveness of gasless reduced-port laparoscopic surgery (GRP-LS) using a 5 mm endoscopic port and one surgical port for the treatment of gynecological diseases Methods We compared GRP-LS and gasless 3-port laparoscopic surgery (G3P-LS), based on patient background, operative procedures, number of surgeries performed by the surgeon, length of surgery, blood loss, blood transfusion, conversion rate to open surgery, operative complications, and the number of surgeons involved in the procedure. We compared the two techniques in patients being treated for laparoscopic myomectomy (LM), laparoscopic ovarian cystectomy (LC), and laparoscopic salpingectomy (LT). Results GRP-LS was used in 2,338 cases and G3P-LS in 2,473 cases. GRP-LS was used in 980 LM cases (41.9%); 804 LC cases (34.4%); 240 LT cases (10.3%); 180 LA cases (7.7%); and 134 cases for other conditions (5.7%). GRP-LS was used by 78 surgeons; 85.9% of the surgeons had performed fewer than 50 GRP-LS surgeries in their careers; and those surgeons performed about half of all surgeries. The time required for GRP-LS was significantly less for LM, LC, LT, and the procedure also had less blood loss for LM and LC than G3P-LS. G3P-LS required a transition to open surgery in 0.69% of cases, whereas GRP-LS showed a very low rate of 0.09%. Conclusions GRP-LS is a new type of laparoscopic surgery that has overcome disadvantages of the previous lifting methods (G3P-LS) and is easier to learn, allowing inexperienced laparoscopic surgeons to effectively perform the surgery.

Download Full-text

Gynecologists May Underestimate the Amount of Blood Loss during Total Laparoscopic Hysterectomy

Obstetrics and Gynecology International ◽

10.1155/2018/3802532 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Masakazu Sato ◽

Minako Koizumi ◽

Kei Inaba ◽

Yu Takahashi ◽

Natsuki Nagashima ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Blood Loss ◽

Laboratory Testing ◽

Ovarian Tumor ◽

Open Surgery ◽

Laparoscopic Hysterectomy ◽

Total Laparoscopic Hysterectomy ◽

Before And After

Background. We considered the possibility of underestimation of the amount of bleeding during laparoscopic surgery, and we investigated comparing the amount of bleeding between laparoscopic surgery and open surgery by considering the concentration of hemoglobin before and after surgery as indicators. Methods. The following procedures were included: A, surgery for ovarian tumor; B, myomectomy; and C, hysterectomy either by laparoscopic surgery or open surgery. Patients who underwent the above procedures in between January 1, 2010, and December 31, 2017, were enrolled. We identified 1749 cases (A: 90, B: 105, and C: 325 of open surgery and A: 667, B: 437, and C: 125 of laparoscopic surgery). We considered the sum as an estimation of blood loss during surgery and the change in the value of hemoglobin in laboratory testing one day before and after surgery. Results. During laparoscopic surgery, the measurements of blood loss included the following: A: 59.8 ml; B: 168.6 ml; and C: 206.8 ml. During open surgery, measurements of blood loss included the following: A: 130.7 ml; B: 236.7 ml; and C; 280.9 ml. The reduction of hemoglobin after surgery compared with that before surgery was less in laparoscopic surgery than that in open surgery in A and B; however, this reduction was not significantly different in C. Conclusion. Our results suggest that the estimation of the bleeding in A and B was appropriate; however, the estimation might be underestimated in C during laparoscopic surgery.

Download Full-text

Laparoscopic versus open surgery for gastrointestinal stromal tumor in esophagogastric junction: A multi-center, retrospective cohort analysis with propensity score matching.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.11534 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 11534-11534

Author(s):

Wenjun Xiong ◽

Tao Chen ◽

Xingyu Feng ◽

Yuting Xu ◽

Jin Wan ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Propensity Score ◽

Blood Loss ◽

Gastrointestinal Stromal Tumor ◽

Propensity Score Matching ◽

Open Surgery ◽

Esophagogastric Junction ◽

Operative Time ◽

Liquid Intake

11534 Background: Laparoscopic resection is increasingly performed for Gastrointestinal stromal tumor (GIST). Nevertheless, laparoscopic approach for the GIST located in the esophagogastric junction (EGJ-GIST) represent a surgical challenge. This study aims to investigate the efficacy of laparoscopic surgery and open procedure for EGJ-GIST through the propensity score matching (PSM) method. Methods: Between April 2006 and April 2018, 1824 patients underwent surgery were finally diagnosed with primary gastric GIST at four medical centers in South China. EGJ-GIST was defined as a GIST with an upper border of less than 5 cm from the EG line. Among them, 228 patients were identified and retrospectively reviewed with regard to clinicopathological characteristics, operative information and long-term outcomes. The PSM methods was used to eliminate the selection bias. Results: After PSM, 102 cases, consisted of 51 laparoscopic (LA) and 51 open surgery (OP), were enrolled. The match factors contained year of surgery, gender, age, BMI, tumor size, mitotic rate, recurrence risk and adjuvant tyrosine kinase inhibitors treatment. The LA group was superior to the OP group in operative time (108.5±56.5 vs. 169.3±79.0 min, P <0.001), blood loss (54.6±81.9 vs. 104.9±156.4 ml, P = 0.042), time to liquid intake (3.1±1.8 vs. 4.3±2.2 d, P = 0.003), hospital stay (6.0±2.3 vs. 9.9±8.1, P = 0.001), and postoperative complication (5.9% vs. 25.5%, P = 0.006). The median follow-up was 55 (range, 2-153) months in the entire cohort. No significant differences were detected in either the relapse-free survival (RFS, P = 0.109) or overall survival (OS, P = 0.113) between two groups. The 1-, 3-, and 5-year RFS in the LA and OP groups were 100.0%, 95.5%, 91.0% and 100.0%, 90.8%, 85.7%, respectively. The 1-, 3-, and 5-year OS in the LA and OP group were 100%, 95.6%, 91.3% and 100.0%, 91.1%, 85.4%, respectively. Conclusions: Laparoscopic surgery for EGJ-GIST is associated with the advantages of shorter operative time, reduced blood loss, shorter time to liquid intake and shorter length of stay, all without compromising post-operative outcomes and long-term survival.

Download Full-text

Laparoscopic repair of perforated peptic ulcers without omental patch versus conventional open surgery

International Surgery Journal ◽

10.18203/2349-2902.isj20180805 ◽

2018 ◽

Vol 5 (3) ◽

pp. 927

Author(s):

Vaibhav Srivastava ◽

Gyanendra Singh ◽

Santosh K. Singh

Keyword(s):

Laparoscopic Surgery ◽

Minimally Invasive ◽

Hospital Stay ◽

Open Surgery ◽

Open Repair ◽

Laparoscopic Group ◽

Peptic Ulcers ◽

Omental Patch ◽

Operative Complications ◽

Repair Group

Background: Perforation of peptic ulcer usually presents as an acute abdomen. Nearly one third of the patients have no history of the disease. Laparoscopic surgery, a minimally invasive technique, has recently begun to be used on perforated peptic ulcers effectively and frequently. This study aimed to evaluate the efficacy, safety and outcome of laparoscopic surgery without omental patch for perforated ulcers in comparison with conventional open surgery.Methods: All patients diagnosed clinically with perforated peptic ulcers presenting within 24 hours of symptoms and undergoing surgery under a single surgeon during 1-year interval were included in this study and randomly assigned to laparoscopic and open repair group. Patients who had to be converted from laparoscopic surgery to open surgery, were excluded.Results: A total of 69 patients were included in this study. Number of doses of analgesics required in laparoscopic group was 9.48 ± 1.82, while those required in conventional open group was 18.16±2.24. In laparoscopic duodenal perforation repair group, duration of hospital stay (in days) was 8.42±1.44 as compared to 12.08±4.82 in open repair group. Laparoscopic group had significantly fewer post-operative complications but had longer mean operative time (101.90 minutes compared to 60.32 minutes in open repair group).Conclusions: Laparoscopic closure of perforated duodenal ulcer is a simple and safe procedure in experienced hands. It maintains the benefits of the minimally invasive approach. It is associated with longer operating time, less postoperative pain, less post-operative complications, a shorter postoperative hospital stay, and earlier returns to normal daily activities.

Download Full-text

Comparison of Clinical Efficacy and Complications Between Laparoscopic Versus Open Surgery for Low Rectal Cancer

Combinatorial Chemistry & High Throughput Screening ◽

10.2174/1386207322666190411113252 ◽

2019 ◽

Vol 22 (3) ◽

pp. 179-186 ◽

Cited By ~ 1

Author(s):

Jian Dai ◽

Zhou Yu

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Blood Loss ◽

Hospital Stay ◽

Complication Rate ◽

Open Surgery ◽

Operation Time ◽

Lower Rectal Cancer ◽

Surgery Group ◽

Stay Time

Aim: To compare the surgical outcomes of laparoscopic surgery for lower rectal cancer with open surgery. Methods: The multiple databases including PubMed, Springer, EMBASE, EMBASE, OVID were adopted to search for the relevant studies, and full-text articles involving the comparison of unilateral and bilateral PVP surgery were reviewed. Review Manager 5.0 was adopted to estimate the effects of the results among the selected articles. Forest plots, sensitivity analysis and bias analysis for the articles included were also conducted. Results: Finally, 1186 patients were included in the 10 studies, which eventually satisfied the eligibility criteria, and laparoscopic and open surgery group were 646 and 540, respectively. The meta-analysis suggested that there was no significant difference of the operation time between laparoscopic and open surgery group, while the time to solid intake, hospital stay time, blood loss and complication rate of laparoscopic group are much less than those of open surgery. Conclusion: Although both these two punctures provide similar operation time, we encourage the use of the laparoscopic surgery as the preferred surgical technique for treatment of lower rectal cancer due to less time to solid intake, hospital stay time, blood loss and lower complication rate.

Download Full-text

Introduction of gasless laparoscopic surgery as a minimally invasive procedure for endometrial cancer and its usefulness from the viewpoint of the learning curve

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02453-6 ◽

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.

Download Full-text

Pure Laparoscopic Living Donor Hepatectomy With/Without Fluorescence-Assisted Technology and Conventional Open Procedure: A Retrospective Study in Mainland China

Frontiers in Surgery ◽

10.3389/fsurg.2021.771250 ◽

2021 ◽

Vol 8 ◽

Author(s):

Kang He ◽

Yixiao Pan ◽

Hai Wang ◽

Jianjun Zhu ◽

Bijun Qiu ◽

...

Keyword(s):

Quality Of Life ◽

Laparoscopic Surgery ◽

Blood Loss ◽

Open Surgery ◽

Living Donor ◽

Operation Time ◽

Fluorescence Technique ◽

Donor Liver ◽

Donor Hepatectomy

Background: The application of laparoscopy in donor liver acquisition for living donor liver transplantation (LDLT) has become increasingly popular in the past decade. Indole cyanide green (ICG) fluorescence technique is a new adjuvant method in surgery. The purpose was to compare the safety and efficacy of laparoscopic and open surgery in living donor left lateral hepatectomy, and to evaluate the application of ICG in laparoscopy.Methods: Donors received LDLT for left lateral lobe resection from November 2016 to November 2020 were selected and divided into pure laparoscopy donor hepatectomy (PLDH) group, fluorescence-assisted pure laparoscopy donor hepatectomy (FAPLDH) group and open donor hepatectomy (ODH) group. We compared perioperative data and prognosis of donors and recipients. Quality of life were evaluated by SF-36 questionnaires.Results: The operation time of PLDH group (169.29 ± 26.68 min) was longer than FAPLDH group (154.34 ± 18.40 min) and ODH group (146.08 ± 25.39 min, p = 0.001). The blood loss was minimum in FAPLDH group (39.48 ± 10.46 mL), compared with PLDH group (52.44 ± 18.44 mL) and ODH group (108.80 ± 36.82 mL, p=0.001). The post-operative hospital stay was longer in PLDH group (5.30 ± 0.98 days) than FAPLDH group (4.81 ± 1.03 days) and ODH group (4.64 ± 1.20 days; p = 0.001). Quality of life of donors undergoing laparoscopic surgery was better.Conclusion: Laparoscopic approaches for LDLT contribute to less blood loss, better cosmetic satisfaction. The fluorescence technique can further reduce bleeding and shorten operation time. In terms of quality of life, laparoscopic surgery is better than open surgery. Laparoscopy procedure for living-donor procurement with/without fluorescence-assist can be performed as safely as open surgery.

Download Full-text

LAPAROSCOPIC SURGERY IN ACUTE GYNECOLOGICAL PATHOLOGY IN GIRLS

Российский педиатрический журнал ◽

10.18821/1560-9561-2018-21-4-196-202 ◽

2019 ◽

Vol 21 (4) ◽

pp. 196-202

Author(s):

Elena Yu. Dyakonova ◽

I. V. Poddubny ◽

T. M. Glybina ◽

S. P. Yatsyk ◽

A. S. Bekin

Keyword(s):

Laparoscopic Surgery ◽

Blood Loss ◽

Enteral Nutrition ◽

Postoperative Analgesia ◽

Open Surgery ◽

Reference Group ◽

Main Group ◽

Intraoperative Blood Loss ◽

Duration Of Stay

Data on the efficacy of laparoscopic and open operations in girls with various forms of gynecological pathology are presented. The study included 1771 girls aged from several days of life to 17 years with acute gynecological pathology. The main group included 1180 patients who underwent laparoscopic surgery. The reference group was 591 patients with gynecological pathology, who underwent open surgery. Laparoscopic operations were established to provide cosmetic advantages, a reduction in the duration of the operation and the volume of intraoperative blood loss, the duration of postoperative analgesia, the restoration of peristalsis, and the initiation of enteral nutrition. At the same time, the duration of stay of patients in the hospital was halved. The authors believe the treatment to be conducted with the joint participation of a child surgeon and a children’s gynecologist at all stages of the examination and treatment to ensure the effectiveness of laparoscopic surgery.

Download Full-text

One-Stage Total Laparoscopic Treatment for Colorectal Cancer With Synchronous Metastasis. Is It Safe and Feasible?

Frontiers in Surgery ◽

10.3389/fsurg.2021.752135 ◽

2021 ◽

Vol 8 ◽

Author(s):

Giuseppe Sena ◽

Arcangelo Picciariello ◽

Fabio Marino ◽

Marta Goglia ◽

Aldo Rocca ◽

...

Keyword(s):

Colorectal Cancer ◽

Laparoscopic Surgery ◽

Blood Loss ◽

Hospital Stay ◽

Open Surgery ◽

Disease Free Survival ◽

Long Term Outcomes ◽

Short Term ◽

One Stage

Liver is the main target organ for colorectal cancer (CRC) metastases. It is estimated that ~25% of CRC patients have synchronous metastases at diagnosis, and about 60% of CRC patients will develop metastases during the follow up. Although several teams have performed simultaneous laparoscopic resections (SLR) of liver and colorectal lesions, the feasibility and safety of this approach is still widely debated and few studies on this topic are present in the literature. The purpose of this literature review is to understand the state of the art of SLR and to clarify the potential benefits and limitations of this approach. Several studies have shown that SLR can be performed safely and with short-term outcomes similarly to the separated procedures. Simultaneous laparoscopic colorectal and hepatic resections combine the advantages of one stage surgery with those of laparoscopic surgery. Several reports compared the short-term outcomes of one stage laparoscopic resection with open resections and showed a similar or inferior amount of blood loss, a similar or lower complication rate, and a significant reduction of hospital stay for laparoscopic surgery respect to open surgery but much longer operating times for the laparoscopic technique. Few retrospective studies compared long term outcomes of laparoscopic one stage surgery with the outcomes of open one stage surgery and did not identify any differences about disease free survival and the overall survival. In conclusion, hepatic and colorectal SLR are a safe and effective approach characterized by less intraoperative blood loss, faster recovery of intestinal function, and shorter length of postoperative hospital stay. Moreover, laparoscopic approach is associated to lower rates of surgical complications without significant differences in the long-term outcomes compared to the open surgery.

Download Full-text

Laparoscopic Surgery vs. Open Surgery for Older Patients with Rectal Cancer: A Comparative Study of Propensity Score

10.21203/rs.3.rs-725883/v1 ◽

2021 ◽

Author(s):

Qiang Li ◽

Hong Gao ◽

Jin-Zhong Wang ◽

Yu-Bing Zhu

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Postoperative Complications ◽

Propensity Score ◽

Blood Loss ◽

Older Patients ◽

Open Surgery ◽

Postoperative Hospital Stay ◽

Cancer Surgery ◽

Rectal Cancer Surgery

Abstract Background The purpose of this study was to compare the efficacy of laparoscopic surgery to open rectal cancer surgery in patients aged 70 years and older. Methods Consecutive patients (≥70 years old) who underwent rectal cancer surgery were retrospectively selected. Based on the covariates (age, gender, body mass index (BMI), ASA, TNM staging), the propensity score was calculated for paired comparison. The Tumor Distance from the Anal Verge (TDAV), history of abdominal surgery, combined diseases, time of operation, amount of blood loss, anastomosis method, postoperative hospital stay, time to first exhaust, time to first oral diet, postoperative complications, postoperative 30-day mortality and postoperative pathological staging of two groups were collected. Results Shorter operating time, higher intraoperative blood loss, slower intestinal function, longer time to first exhaust, longer postoperative hospital stay, higher incidence of postoperative complications (no statistical difference), and shorter duration of analgesics were observed in the OS group (all P<0.05). The sphincter preserving rate was basically the same in the two groups. For low rectal cancer with TDAV < 5 cm, more patients tended to choose LS (P=0.051); for middle rectal cancer with TDAV of 5-10 cm, more patients tended to choose OS (P=0.032). There was no significant difference in postoperative survival rate between the two groups. Conclusions In older patients, laparoscopic rectal cancer surgery led to less trauma, and a faster recovery compared to open surgery, with significant short-term advantages and no significant long-term advantages. For low rectal cancer, the advantage of LS was more prominent.

Download Full-text

Improved Oncologic Outcomes Following Laparoscopic Surgery for Small T4 Colon Cancer : A Multi-center Comparative Study

10.21203/rs.3.rs-56052/v1 ◽

2020 ◽

Author(s):

Sung Sil Park ◽

Joon Sang Lee ◽

Hyoung-Chul Park ◽

Sung Chan Park ◽

Dae Kyung Sohn ◽

...

Keyword(s):

Colon Cancer ◽

Laparoscopic Surgery ◽

Blood Loss ◽

Open Surgery ◽

Disease Free Survival ◽

Laparoscopic Group ◽

Open Group ◽

Oncologic Outcomes ◽

Surgery Outcome ◽

T4 Colon Cancer

Abstract Background: Laparoscopic surgery for T4 colon cancer may be safe in selected patients. Based on the theory that small tumor size might preoperatively predict a good laparoscopic surgery outcome, we herein compare the clinicopathologic and oncologic outcomes of open and laparoscopic surgery in small T4 colon cancer.Methods: In a retrospective multicenter study, we reviewed the data of 449 patients, including 117 patients with tumors ≤4 cm, who underwent T4 colon cancer surgery between January 2014 and December 2017. We compared the clinicopathologic and 3-year oncologic outcomes between the laparoscopic and open surgery groups.Results: Blood loss, length of hospital stay, and postoperative morbidity were lower in the laparoscopic group than in the open group (86 mL vs. 278 mL, p < 0.001; 10.0 days vs. 12.5 days, p = 0.003; and 18.0% vs. 29.5%, p = 0.005, respectively). There were no intergroup differences in overall survival (OS) and 3-year disease-free survival (DFS; 87.8% vs. 83.2%, p = 0.117; 69.5% vs. 68.1%, p = 0.408, respectively). Among patients with tumors of size ≤4 cm, blood loss was lower in the laparoscopic surgery group than in the open group (80 mL vs. 208 mL, p = 0.001); despite no statistical difference observed in the 3-year OS (84.4% vs 78.7%, p = 0.442), the laparoscopic group had a better 3-year DFS (73.8% vs. 46.0%, p = 0.004).Conclusions: Laparoscopic surgery showed similar outcomes to open surgery in T4 colon cancer patients, and may have favorable short-term oncologic outcomes in patients with small T4 tumors.

Download Full-text