scholarly journals Impact of Procedure Time of Preceding Endoscopic Submucosal Dissection on the Difficulty of Laparoscopic Rectal Surgery

2021 ◽  
Vol 105 (1-3) ◽  
pp. 528-532
Author(s):  
Hiroaki Nozawa ◽  
Kazushige Kawai ◽  
Kazuhito Sasaki ◽  
Shigenobu Emoto ◽  
Koji Murono ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Blood Loss ◽  
Operative Time ◽  
Anal Verge ◽  
Rectal Surgery ◽  
Tumor Location ◽  
Intraoperative Blood Loss ◽  
Procedure Time ◽  
Laparoscopic Rectal Surgery

Objetive:  In this study, we addressed which factors, including endoscopic submucosal dissection (ESD)–related parameters, affect the difficulty of laparoscopic rectal surgery. Summary of background data:  Endoscopic treatment for gastrointestinal cancer can cause inflammation, edema, and fibrosis formation in the surrounding tissue. Recently, we reported that preceding endoscopic treatment increased the volume of intraoperative blood loss and slightly prolonged the operative time of laparoscopic surgery for rectal cancer. Methods:  We retrospectively reviewed 24 consecutive patients who underwent ESD followed by laparoscopic surgery for rectal cancer in our hospital. Short-term surgical outcomes were evaluated by intraoperative blood loss and operative time for laparoscopic surgery. The correlations between the surgical outcomes and preoperative parameter were analyzed by multiple linear regression analyses. Results:  The patient cohort comprised 12 men and 12 women. The median distance between primary cancer and anal verge was 7 cm. The median procedure time of ESD was 120 minutes (21 available cases). Based on multiple linear regression analyses, the ESD procedure time (P = 0.007) and tumor location from the anal verge (P = 0.046) were independently predictive of intraoperative blood loss. On the other hand, only tumor location was found to be an independent predictor of surgical time (P = 0.014). Conclusions:  A long session of ESD for rectal cancer may make subsequent laparoscopic surgery difficult based on intraoperative blood loss.

scholarly journals Impact of Procedure Time of Preceding Endoscopic Submucosal Dissection on the Difficulty of Laparoscopic Rectal Surgery

2020 ◽  
Author(s):  
Hiroaki Nozawa ◽  
Kazushige Kawai ◽  
Kazuhito Sasaki ◽  
Shigenobu Emoto ◽  
Koji Murono ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Blood Loss ◽  
Operative Time ◽  
Anal Verge ◽  
Rectal Surgery ◽  
Tumor Location ◽  
Intraoperative Blood Loss ◽  
Procedure Time ◽  
Laparoscopic Rectal Surgery

Abstract Background Endoscopic treatment for gastrointestinal cancer can cause inflammation, edema, and fibrosis formation in the surrounding tissue. Recently, we reported that preceding endoscopic treatment increased the volume of intraoperative blood loss and slightly prolonged the operative time of laparoscopic surgery for rectal cancer. In this study, we addressed which factors, including endoscopic submucosal dissection (ESD)- related parameters, affect the difficulty of laparoscopic rectal surgery. Methods We retrospectively reviewed 24 consecutive patients who underwent ESD followed by laparoscopic surgery for rectal cancer in our hospital. Short-term surgical outcomes were evaluated by intraoperative blood loss and operative time for laparoscopic surgery. The correlations between the surgical outcomes and preoperative parameter were analyzed by scatter diagrams and multiple linear regression analyses. Results The patient cohort comprised 12 men and 12 women. The median distance between primary cancer and anal verge was 7 cm. The median procedure time of ESD was 120 minutes (21 available cases). The scatter diagram graph revealed a positive correlation between the ESD procedure time and estimated blood loss during rectal surgery (rs = 0.26). There was no association between the ESD procedure time and operative time for rectal surgery. Based on multiple linear regression analyses, the ESD procedure time (p = 0.007) and tumor location from the anal verge (p = 0.046) were independently predictive of intraoperative blood loss. On the other hand, only tumor location was found an independent predictor of surgical time (p = 0.014). Conclusions A long session of ESD for rectal cancer may make subsequent laparoscopic surgery difficult based on intraoperative blood loss.

scholarly journals 4K ultra HD technology reduces operative time and intraoperative blood loss in colorectal laparoscopic surgery

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 106
Author(s):  
Giulio M. Mari ◽  
Jacopo Crippa ◽  
Pietro Achilli ◽  
Angelo Miranda ◽  
Letizia Santurro ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Comparative Analysis ◽  
Blood Loss ◽  
Operative Time ◽  
High Volume ◽  
Intraoperative Blood Loss ◽  
Surgical Performance ◽  
Operative Outcomes ◽  
Time Frames

Background: HD systems are routinely used in laparoscopic surgery, 4K ultra HD monitors are mainly available within specialized, high-volume laparoscopic centers. The higher resolution of 4K ultra HD video could upgrade the surgical performance improving intraoperative and post-operative outcomes. Methods: We performed a retrospective comparative analysis of intraoperative parameters and post-operative outcomes in a cohort of patients operated on for elective laparoscopic procedures for colo-rectal cancer during two different time frames: 2017 procedures performed using the Visera Elite full HD technology (® Olympus America, Medical) and the 2018 procedures performed the Visera 4K Ultra HD System (® Olympus America, Medical). Results: There was a statistically significant reduction in operative time in patients operated on with the 4K ultra HD technology compared to HD technology (p < 0.05). Intraoperative blood loss was significantly reduced in patients operated in 2018 (p < 0.05). There were no statistically significant differences in complication rate and postoperative outcomes between the two groups.

scholarly journals Single-Access Laparoscopic Rectal Surgery Is Technically Feasible

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Siripong Sirikurnpiboon ◽  
Paiboon Jivapaisarnpong
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Total Mesorectal Excision ◽  
Perioperative Complications ◽  
Rectal Surgery ◽  
Anal Canal Cancer ◽  
Mesorectal Excision ◽  
Single Access ◽  
Laparoscopic Rectal Surgery ◽  
The Mean

Introduction. Single-access laparoscopic surgery (SALS) has been successfully introduced for colectomy surgery; however, for mid to low rectum procedures such as total mesorectal excision, it can be technically complicated. In this study, we introduced a single-access technique for rectum cancer operations without the use of other instruments.Aims. To show the short-term results of single-access laparoscopic rectal surgery in terms of pathologic results and immediate complications.Settings and Design. Prospective study.Materials and Methods. We selected middle rectum to anal canal cancer patients to undergo single-access laparoscopic rectal resection for rectal cancer. All patients had total mesorectal excisions. An umbilical incision was made for the insertion of a single multichannel port, and a mesocolic window was created to identify the inferior mesenteric artery and vein. Total mesorectal excision was performed. There were no perioperative complications. The mean operative time was 269 minutes; the median hospital stay was 7 days; the mean wound size was 5.5 cm; the median number of harvested lymph nodes was 15; and all patients had intact mesorectal capsules.Statistical Analysis Used. Mean, minimum–maximum.Conclusion. Single-access laparoscopic surgery for rectal cancer is feasible while oncologic principles and patient safety are maintained.

Double-blind, randomized controlled trial of tranexamic acid in minor lumbar spine surgery: no effect on operative time, intraoperative blood loss, or complications

2019 ◽  
Vol 31 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Signe Elmose ◽  
Mikkel Ø. Andersen ◽  
Else Bay Andresen ◽  
Leah Yacat Carreon
Keyword(s):  
Placebo Group ◽  
Lumbar Spine ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Spine Surgery ◽  
Operative Time ◽  
Decompressive Surgery ◽  
Lumbar Spine Surgery ◽  
Intraoperative Blood Loss ◽  
Double Blind

OBJECTIVEThe purpose of this study was to investigate the effect of tranexamic acid (TXA) compared to placebo in low-risk adult patients undergoing elective minor lumbar spine surgery—specifically with respect to operative time, estimated blood loss, and complications. Studies have shown that TXA reduces blood loss during major spine surgery. There have been no previous studies on the effect of TXA in minor lumbar spine surgery in which these variables have been evaluated.METHODSThe authors enrolled patients with ASA grades 1 to 2 scheduled to undergo lumbar decompressive surgery at Middelfart Hospital into a double-blind, randomized, placebo-controlled, parallel-group study. Patients with thromboembolic disease, coagulopathy, hypersensitivity to TXA, or a history of convulsion were excluded. Patients were randomly assigned, in blocks of 10, to one of 2 groups, TXA or placebo. Anticoagulation therapy was discontinued 2–7 days preoperatively. Prior to the incision, patients received either a bolus of TXA (10 mg/kg) or an equivalent volume of saline solution (placebo). Independent t-tests were used to compare differences between the 2 groups, with statistical significance set at p < 0.05.RESULTSOf the 250 patients enrolled, 17 patients were excluded, leaving 233 cases for analysis (117 in the TXA group and 116 in the placebo group). The demographics of the 2 groups were similar, except for a higher proportion of women in the TXA group (TXA 50% vs placebo 32%, p = 0.017). There was no significant between-groups difference in operative time (49.53 ± 18.26 vs 54.74 ± 24.49 minutes for TXA and placebo, respectively; p = 0.108) or intraoperative blood loss (55.87 ± 48.48 vs 69.14 ± 83.47 ml for TXA and placebo, respectively; p = 0.702). Postoperative blood loss measured from drain output was 62% significantly lower in the TXA group (13.03 ± 21.82 ml) than in the placebo group (34.61 ± 44.38 ml) (p < 0.001). There was no significant difference in number of dural lesions or postoperative spinal epidural hematomas, and there were no thromboembolic events.CONCLUSIONSTranexamic acid did not have a statistically significant effect on operative time, intraoperative blood loss, or complications. This study gives no evidence to support the routine use of TXA during minor lumbar decompressive surgery.Clinical trial registration no.: NCT03714360 (clinicaltrials.gov)

scholarly journals Safety and effectiveness evaluation of a two-handed technique combining harmonic scalpel and laparoscopic Peng’s multifunction operative dissector in laparoscopic hemihepatectomy

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jingwei Cai ◽  
Guixing Jiang ◽  
Yuelong Liang ◽  
Yangyang Xie ◽  
Junhao Zheng ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Harmonic Scalpel ◽  
Peak Level ◽  
Bile Leakage ◽  
Liver Parenchyma ◽  
Control Group ◽  
Case Group ◽  
Intraoperative Blood Loss ◽  
And Control

Abstract Objectives This study was designed to evaluate the safety and effectiveness of a two-hand technique combining harmonic scalpel (HS) and laparoscopic Peng’s multifunction operative dissector (LPMOD) in patients who underwent laparoscopic hemihepatectomy (LHH). Methods We designed and conducted a case-control study nested in a prospectively collected laparoscopic liver surgery database. Patients who underwent LHH for liver parenchyma transection using HS + LPMOD were defined as cases (n = 98) and LPMOD only as controls (n = 47) from January 2016 to May 2018. Propensity score matching (1:1) between the case and control groups was used in the analyses. Results The case group had significantly less intraoperative blood loss in milliliters (169.4 ± 133.5 vs. 221.5 ± 176.3, P = 0.03) and shorter operative time in minutes (210.5 ± 56.1 vs. 265.7 ± 67.1, P = 0.02) comparing to the control group. The conversion to laparotomy, postoperative hospital stay, resection margin, the mean peak level of postoperative liver function parameters, bile leakage rate, and others were comparable between the two groups. There was no perioperative mortality. Conclusions We demonstrated that the two-handed technique combing HS and LPMOD in LHH is safe and effective which is associated with shorter operative time and less intraoperative blood loss compared with LPMOD alone. The technique facilitates laparoscopic liver resection and is recommended for use.

scholarly journals Securing the surgical field for mobilization of right-sided colon cancer using the duodenum-first multidirectional approach in laparoscopic surgery

2021 ◽  
Author(s):  
K. Nagayoshi ◽  
S. Nagai ◽  
K. P. Zaguirre ◽  
K. Hisano ◽  
M. Sada ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Operative Time ◽  
Right Colectomy ◽  
R0 Resection ◽  
Medial Approach ◽  
Total Operative Time ◽  
Advanced Tumors

Abstract Background The aim of this study was to compare the short-term outcomes of the duodenum-first multidirectional approach (DMA) in laparoscopic right colectomy with those of the conventional medial approach to assess its safety and feasibility. Methods This retrospective study enrolled 120 patients who had laparoscopic surgery for right-sided colon cancer in our institution between April 2013 and December 2019. Fifty-four patients underwent colectomy using the multidirectional approach; among these, 20 underwent the DMA and 34 underwent the caudal-first multidirectional approach (CMA). Sixty-six patients underwent the conventional medial approach. Complications within 30 days of surgery were compared between the groups. Results There were 54 patients in the multidirectional group [29 females, median age 72 years (range 36–91 years)] and 66 in the medial group [42 females, median age 72 years (range 41–91 years)]. Total operative time was significantly shorter in multidirectional approach patients than conventional medial approach patients (208 min vs. 271 min; p = 0.01) and significantly shorter in patients who underwent the DMA compared to the CMA (201 min vs. 269 min; p < 0.001). Operative time for the mobilization procedure was also significantly shorter in patients who underwent the DMA (131 min vs. 181 min; p < 0.001). Blood loss and incidence of postoperative complications did not differ. In 77 patients with advanced T3/T4 tumors, the DMA, CMA, and conventional medial approach were performed in 13, 21, and 43 patients, respectively. Total operative time and operative time of the mobilization procedure were significantly shorter in patients undergoing DMA. Blood loss and incidence of postoperative complications did not differ. R0 resection was achieved in all patients with advanced tumors. Conclusions The DMA in laparoscopic right colectomy is safe and feasible and can achieve R0 resection with a shorter operative time than the conventional medial approach, even in patients with advanced tumors.

Phẫu thuật nội soi 3D cắt bán phần xa dạ dày trong điều trị ung thư dạ dày

2021 ◽  
Author(s):  
Hai Thanh Phan
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Operative Time ◽  
Distal Gastrectomy ◽  
Three Dimensional ◽  
Oncologic Outcome ◽  
Intraoperative Blood Loss ◽  
3D Laparoscopy ◽  
Distal Gastric Cancer ◽  
The Mean

TÓM TẮT Đặt vấn đề: Những nghiên cứu gần đây cho thấy phẫu thuật nội soi với kỹ thuật 3D (three - dimensional) đã mang lại nhiều thuận lợi trong điều trị ung thư dạ dày khi so sánh với màn hình 2D truyền thống. Vì vậy chúng tôi thực hiện nghiên cứu này với mục đích đánh giá tính an toàn, kết quả ngắn hạn và kết quả ung thư học của phẫu thuật nội soi 3D trong điều trị ung thư phần xa dạ dày. Phương pháp nghiên cứu: Thực hiện nghiên cứu tiến cứu trên 37 bệnh nhân cắt phần xa dạ dày kèm nạo vét hạch điều trị ung thư dạ dày bằng phẫu thuật nội soi kỹ thuật 3D tại Khoa Ngoại nhi - cấp cứu bụng, Bệnh viện Trung Ương Huế từ 03/2018 đến 09/2021. Kết quả: Phẫu thuật nội soi 3D được thực hiện ở tất cả 37 bệnh nhân, không có trường hợp nào chuyển mổ mở. Thời gian phẫu thuật trung bình là 69,86 ± 20,46 phút, lượng máu mất trong mổ trung bình là 171,22 ± 15,47 ml, số hạch vét được trung bình là 20,49 ± 4,11 hạch và thời gian nằm viện sau phẫu thuật trung bình là 10 ngày (6 - 26 ngày). Tỷ lệ biến chứng là 8,1 % với 1 trường hợp (2,7%) dò mỏm tá tràng, không có trường hợp nào tử vong sớm sau mổ. Tỉ lệ sống còn sau 1 năm là 87,27% và sau 3 năm là 83,31%. Kết luận: Áp dụng phẫu thuật nội soi 3D trong cắt phần xa dạ dày có thể thực hiện an toàn và khả thi. Giúp giảm đáng kể thời gian mổ, lượng máu mất trong mổ và đảm bảo được nguyên tắc an toàn về ung thư học. ABSTRACT EFFICACY USING THREE - DIMENSIONAL LAPAROSCOPY IN THE TREATMENT OF DISTAL GASTRIC CANCER Background: Recent studies have supported that three - dimensional (3D) laparoscopy has advantages in treating gastric cancer compared with conventional two - dimensional (2D) screens. This study investigated the safety, short - term efficacy, and oncological outcome of three - dimensional (3D) laparoscopic distal gastric cancer surgery. Materials and Methods: We prospectively analyzed the clinical data from 37 patients treated with 3D laparoscopic systemic lymphadenectomy for distal gastric cancer at the Hue Central Hospital from March 2018 to September 2021. The effects on operative time, intraoperative blood loss, the number of lymph nodes removed, postoperative recovery time, complications, and oncologic outcome were analyzed. Results: Three - dimensional (3D) laparoscopic distal gastrectomy was successfully carried out in 37 patients. The mean operative time was 69,86 ± 20,46 minutes, mean intraoperative blood loss was 171,22 ± 15,47 ml, the number of harvested lymph nodes was 20,49 ± 4,11, and the mean postoperative hospital stay was 10 (6 - 26 days). The incidence of postoperative complications was 8,1%, with 1 case of duodenal stump fistula. The one - year overall survival rate was 87,27%, and the three - year overall survival rate was 83,31%. Conclusions: 3D laparoscopy distal gastrectomy could be performed safely and feasibly. They reducethe operative time and intraoperative blood loss in distal gastrectomy with a good oncologic outcome. Keywords: Laparoscopic gastrectomy, D2 lymphadenectomy, 3D laparoscopy

scholarly journals Laparoscopic Spleen-Preserving Distal Pancreatectomy (LSPDP) with Preservation of Splenic Vessels: An Inferior-Posterior Approach

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Yong Fei Hua ◽  
Dipesh Kumar Yadav ◽  
Xueli Bai ◽  
Tingbo Liang
Keyword(s):  
Blood Loss ◽  
Distal Pancreatectomy ◽  
Splenic Artery ◽  
Posterior Approach ◽  
Operative Time ◽  
The Other ◽  
Intraoperative Blood Loss ◽  
Spleen Preserving ◽  
Splenic Vessels ◽  
Approach Group

Objective. To summarize the operation experience of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with preservation of splenic vessels by an inferior-posterior dissection of the pancreatic body and evaluate its feasibility. Methods. Patients undergoing LSPDS at Ningbo Li Huili Hospital and Ningbo Li Huili Eastern Hospital from January 2014 to April 2017 were recruited in this study and were analyzed retrospectively. They were divided into two groups based on the surgical approach: the inferior-posterior approach group and the other approach group. We sought to compare outcomes of the two groups. Results. The LSPDP procedure was completed successfully in 49 cases, and 48 patients had their splenic artery and vein preserved, including 26 cases in the inferior-posterior approach group and 22 cases in the other approach group. There were no significant differences between the two groups with respect to age (p=0.18), sex (p=0.56), preoperative diabetes (p=1.00), ASA grading (p=1.00), tumor size (p=0.91), intraoperative blood loss (t=−0.01, p=0.99), hospital stay (t=−0.02, p=0.98), and pancreatic fistula rates (p=1.00). Patients undergoing LSPDP by the inferior-posterior approach had a shorter operative time (t=−4.13, p<0.001) than the other approach group. Conclusions. LSPDS by the inferior-posterior approach associated with shorter operative time is safe and feasible.

scholarly journals Our experience with laparoscopic total gastrectomy for gastric cancer: A case series

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Manash Ranjan Sahoo ◽  
Satyajit Samal ◽  
Jyotirmay Nayak
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Hospital Stay ◽  
Total Gastrectomy ◽  
Median Time ◽  
Operative Time ◽  
Laparoscopic Total Gastrectomy ◽  
Oral Feeding ◽  
Care Hospital ◽  
Intraoperative Blood Loss

Background: Though laparoscopic distal gastrectomy has become a standard procedure for treatment of gastric cancer, laparoscopic total gastrectomy has not been widely accepted as it requires more dexterity and lack of evidence about its feasibility and safety. Methods: Here retrospectively we review a series of 12 cases of gastric cancer undergone laparoscopic total gastrectomy with D1 or D2 lymphadenectomy over a period of 7 years at a tertiary care hospital. The patient demographic characteristics were reviewed and the outcomes after surgery was analyzed in terms of extent of lymphadenectomy, mean operative time, mean intraoperative blood loss median number of lymph nodes harvested, median time for postoperative ambulation, median time for postoperative oral feeding, median time of postoperative hospital stay, postoperative complications and mortality. Results: All patients had total gastrectomy entirely through laparoscopic method. Mean operative time was 282 minutes, mean intraoperative blood loss was 120 ml, median time for ambulation and oral feeding was 3 days and 6 days respectively. Median time of hospital stay was 16 days and 2 patients had complications as pancreatic fistula and port site abscess. No mortality was observed. Conclusion: With zero mortality and accepted rate of complications, laparoscopic total gastrectomy appears to be technically feasible and safe for management of gastric cancer. But more studies have to be conducted with comparison to other standard gastrectomies and long term follow up to be done to establish its standardized application.

Comparison of Postoperative Pain and Application Effect of High Tibial Osteotomy and Total Knee Replacement in Patients with Knee Arthritis

2021 ◽  
Vol 7 (5) ◽  
pp. 4013-4020
Author(s):  
Bingtao Shi ◽  
Wentao Gao ◽  
Haifang Li
Keyword(s):  
Postoperative Pain ◽  
Blood Loss ◽  
Knee Joint ◽  
Total Knee Replacement ◽  
Operative Time ◽  
Tibial Osteotomy ◽  
Intraoperative Blood Loss ◽  
Knee Arthritis ◽  
Total Knee ◽  
Better Than

Objective: To investigate the effects of high tibial osteotomy (HTO) and total knee replacement (TKR) on postoperative pain of patients with knee arthritis. Methods: From February 2017 to March 2019, 72 patients with knee arthritis in our unit were collected for the experiment. Patients in the control group (CG, 35 cases) were treated with HTO, and research group (RG, 37 cases) were treated with TKR. Clinical efficacy. Visual Analogue Scale (VAS) score. Knee Society Score (KSS), and Hospital for Special Surgery (HSS) knee rating score of the two groups of patients were observed. Intraoperative blood loss, operative time and hospitalization expenses were observed, as well as the effect of knee joint recovery after operation. Results: In terms of overall effective rate, RG was superior to CG (p < 0.05). VAS score of RG was notably lower at 1 week and 2 weeks after operation than that in CG (p < 0.05). KSS of RG was evidently higher than that of CG (p < 0.05). HSS score of RG was notably higher than that of CG after operation (p < 0.05). The intraoperative blood loss and operative time in RG were notably better than those in CG (p < 0.05). The effects of knee joint recovery in RG was considerably better than that in CG (p < 0.05). Conclusion: TKR has a better clinical effect on elderly patients, which can reduce postoperative pain, intraoperative blood loss and operative time, and improve the recovery effect of knee joint.

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