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World Journal of Surgical Oncology Dec 2017The objective of this study is to systematically assess the clinical efficacy of hand-assisted laparoscopic surgery (HALS) and laparoscopic right colectomy (LRC). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The objective of this study is to systematically assess the clinical efficacy of hand-assisted laparoscopic surgery (HALS) and laparoscopic right colectomy (LRC).
METHODS
The randomized controlled trials (RCTs) and non-RCTs were collected by searching electronic databases (Pubmed, Embase, and the Cochrane Library). The outcomes included intraoperative outcomes, postoperative outcomes, postoperative morbidity, and oncologic outcomes. Meta-analysis was performed using of RevMan 5.3 software.
RESULTS
A total of five studies involving 438 patients were finally included, with 202 cases in HALS group and 236 cases in LRC group. Results of meta-analysis showed that there was no statistical difference between HALS and LRC in terms of conversion rate, length of hospital stay, reoperation rate, postoperative morbidity, and oncologic outcomes. The operative time was 6.5 min shorter in HALS group; however, it was not a clinically significant difference. Although the incision length was longer in HALS, it did not influence the postoperative recovery.
CONCLUSIONS
HALS can be considered an alternative to LRC which combines the advantages of open as well as laparoscopic surgery.
Topics: Colectomy; Colonic Diseases; Controlled Clinical Trials as Topic; Conversion to Open Surgery; Hand-Assisted Laparoscopy; Humans; Laparoscopy; Length of Stay; Operative Time; Perioperative Period; Postoperative Complications; Treatment Outcome
PubMed: 29202820
DOI: 10.1186/s12957-017-1277-2 -
BJS Open Jul 2023A central lymphadenectomy in right-sided colon cancer involves dissection along the superior mesenteric axis, but the extent is debated due to a lack of consensus and... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
A central lymphadenectomy in right-sided colon cancer involves dissection along the superior mesenteric axis, but the extent is debated due to a lack of consensus and the fear of major complications. This randomized controlled trial compared the rate of postoperative morbidity in patients undergoing laparoscopic versus open right-sided colectomy with central lymphadenectomy.
METHODS
This open, prospective, randomized controlled trial compared patients operated on with open and laparoscopic right-sided colectomy (cStages I-III) with a central lymphadenectomy at two Norwegian institutions between October 2016 and December 2021. Dissections were conducted along the superior mesenteric vein in the laparoscopic group, and along the left anterior border of the superior mesenteric artery in the open group, both according to complete mesocolic excision principles. Surgery was standardized and performed by three experienced surgeons for each study group. The primary outcome of interest was to measure postoperative 30-day complications (Clavien-Dindo ≥ grade II).
RESULTS
Of 273 eligible patients, 135 were randomized and 128 analysed (63 operated on with open and 65 using laparoscopic procedures). Postoperative complications occurred in 42.8 per cent of the patients treated with open and 38.4 per cent of the patients treated using laparoscopic surgery, P = 0.372. The incidence of Clavien-Dindo grade IIIb complications was 7.9 per cent in the open versus 4.6 per cent in the laparoscopic group, P = 0.341. There were no grade IV or V complications, and no re-operations due to anastomotic leakages. There was no significant difference in the mean(s.e.m.) number of removed lymph nodes (open versus laparoscopic respectively: 31.9(1.8) versus 29.3(1.3); P = 0.235).
CONCLUSION
There was no significant difference in complications between the two groups. Standardized oncologic right-sided colectomy with central lymphadenectomy along the mesenterial root was performed safely, both open and laparoscopic, with incidence of major complications ranging between 4.6 and 7.9 per cent and no re-operations for anastomotic leakage. Radicality in terms of lymphadenectomy was comparable between the two groups.Registration number: NCT03776591 (http://www.clinicaltrials.gov).
Topics: Humans; Prospective Studies; Colonic Neoplasms; Lymph Node Excision; Laparoscopy; Colectomy; Anastomotic Leak
PubMed: 37643373
DOI: 10.1093/bjsopen/zrad074 -
Surgical Endoscopy Jun 2022Studies to date show contrasting conclusions when comparing intracorporeal and extracorporeal anastomoses for minimally invasive right colectomy. Large multi-center... (Observational Study)
Observational Study
BACKGROUND
Studies to date show contrasting conclusions when comparing intracorporeal and extracorporeal anastomoses for minimally invasive right colectomy. Large multi-center prospective studies comparing perioperative outcomes between these two techniques are needed. The purpose of this study was to compare intracorporeal and extracorporeal anastomoses outcomes for robotic assisted and laparoscopic right colectomy.
METHODS
Multi-center, prospective, observational study of patients with malignant or benign disease scheduled for laparoscopic or robotic-assisted right colectomy. Outcomes included conversion rate, gastrointestinal recovery, and complication rates.
RESULTS
There were 280 patients: 156 in the robotic assisted and laparoscopic intracorporeal anastomosis (IA) group and 124 in the robotic assisted and laparoscopic extracorporeal anastomosis (EA) group. The EA group was older (mean age 67 vs. 65 years, p = 0.05) and had fewer white (81% vs. 90%, p = 0.05) and Hispanic (2% vs. 12%, p = 0.003) patients. The EA group had more patients with comorbidities (82% vs. 72%, p = 0.04) while there was no significant difference in individual comorbidities between groups. IA was associated with fewer conversions to open and hand-assisted laparoscopic approaches (p = 0.007), shorter extraction site incision length (4.9 vs. 6.2 cm; p ≤ 0.0001), and longer operative time (156.9 vs. 118.2 min). Postoperatively, patients with IA had shorter time to first flatus, (1.5 vs. 1.8 days; p ≤ 0.0001), time to first bowel movement (1.6 vs. 2.0 days; p = 0.0005), time to resume soft/regular diet (29.0 vs. 37.5 h; p = 0.0014), and shorter length of hospital stay (median, 3 vs. 4 days; p ≤ 0.0001). Postoperative complication rates were comparable between groups.
CONCLUSION
In this prospective, multi-center study of minimally invasive right colectomy across 20 institutions, IA was associated with significant improvements in conversion rates, return of bowel function, and shorter hospital stay, as well as significantly longer operative times compared to EA. These data validate current efforts to increase training and adoption of the IA technique for minimally invasive right colectomy.
Topics: Aged; Anastomosis, Surgical; Colectomy; Colonic Neoplasms; Humans; Laparoscopy; Operative Time; Prospective Studies; Retrospective Studies; Robotic Surgical Procedures; Treatment Outcome
PubMed: 34724580
DOI: 10.1007/s00464-021-08780-9 -
Health Services Research Feb 2017To evaluate the comparative safety of laparoscopic and open colectomy across surgeons varying in experience with laparoscopy. (Comparative Study)
Comparative Study
OBJECTIVE
To evaluate the comparative safety of laparoscopic and open colectomy across surgeons varying in experience with laparoscopy.
DATA SOURCES
National Medicare data (2008-2010) for beneficiaries undergoing laparoscopic or open colectomy.
STUDY DESIGN
Using instrumental variable methods to address selection bias, we evaluated outcomes of laparoscopic and open colectomy. Our instrument was the regional use of laparoscopy in the year prior to a patient's operation. We then evaluated outcomes stratified by surgeons' annual volume of laparoscopic colectomy.
PRINCIPAL FINDINGS
Laparoscopic colectomy was associated with lower mortality (OR: 0.75, 95 percent CI: 0.70-0.78) and fewer complications than open surgery (OR: 0.82, 95 percent CI: 0.79-0.85). Increasing surgeon volume was associated with better outcomes for both procedures, but the relationship was stronger for laparoscopy. The comparative safety depended on surgeon volume. High-volume surgeons had 40 percent lower mortality (OR: 0.60, 95 percent CI: 0.55-0.65) and 30 percent fewer complications (OR: 0.70, 95 percent CI: 0.67-0.74) with laparoscopy. Conversely, low-volume surgeons had 7 percent higher mortality (OR: 1.07, 95 percent CI: 1.02-1.13) and 18 percent more complications (OR: 1.18, 95 percent CI: 1.12-1.24) with laparoscopy.
CONCLUSIONS
This population-based study demonstrates that the comparative safety of laparoscopic and open colectomy is influenced by surgeon volume. Laparoscopic colectomy is only safer for patients whose surgeons have sufficient experience.
Topics: Aged; Aged, 80 and over; Colectomy; Female; Humans; Laparoscopy; Male; Postoperative Complications; Surgeons; United States
PubMed: 26990210
DOI: 10.1111/1475-6773.12482 -
BioMed Research International 2022Pelvic abscess surgery consists mostly of open laparotomy and laparoscopic surgery. Open surgery is regarded as a classic procedure. With the rise and promotion of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pelvic abscess surgery consists mostly of open laparotomy and laparoscopic surgery. Open surgery is regarded as a classic procedure. With the rise and promotion of laparoscopic indications in recent years, comparative studies of the two's postoperative effectiveness have been limited.
OBJECTIVE
To compare the clinical effects of laparoscopic exploratory surgery and open surgery in the treatment of pelvic abscess.
METHODS
Through computer searches of PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases, we found publicly available case-control research on laparoscopic surgery and open surgery for treating pelvic abscess. The papers that met the evaluation criteria were screened, and meta-analysis was used to look at 8 papers on laparoscopic surgery and open surgery for treating pelvic abscess from 2010 to 2021.
RESULTS
The results of this study showed that compared with the open laparotomy group, the incidence of laparoscopic group in the incision infection rate (RR = 0.29, 95% CI (0.20, 0.41), and < 0.00001), the incidence of intestinal injury (RR = 0.08, 95% CI (0.04, 0.14), and < 0.00001), incidence of intestinal obstruction (RR = 0.26, 95% CI (0.08, 0.90), and = 0.03 < 0.05), and postoperative pelvic abscess recurrence rate (RR = 0.34, 95% CI (0.13, 0.86), and = 0.02 < 0.05) are lower than open surgery, and the difference of these four items is statistically significant. There was no difference in the risk of urinary tract injury between laparoscopic surgery and open surgery (RR = 0.92, 95% CI (0.27, 3.17), and = 0.89 > 0.05).
CONCLUSION
In terms of incision infection, intestinal damage, intestinal obstruction, and recurrence of pelvic abscess, the laparoscopic group clearly outperforms the open group, and it merits clinical promotion and use.
Topics: Abscess; Colectomy; Humans; Intestinal Obstruction; Laparoscopy; Laparotomy; Postoperative Complications; Treatment Outcome
PubMed: 35832848
DOI: 10.1155/2022/3650213 -
Journal of Visceral Surgery Dec 2017Hemicolectomy is the treatment of choice for intestinal obstruction from right colon cancer. This review compares the laparoscopic vs open access in hemicolectomy for... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Hemicolectomy is the treatment of choice for intestinal obstruction from right colon cancer. This review compares the laparoscopic vs open access in hemicolectomy for patients with right colon cancer.
METHODS
A systematic review and meta-analysis of clinical studies published after January 2017 was performed according to the Prisma guidelines. The study has been recorded on the Prospero register (CRD42016044108).
RESULTS
Five studies were included for review. Only one anastomotic leak was reported in conventional open anastomosis group (1.9%) and none of the studies included in the meta-analysis reported re-operations during the first 30 postoperative days. The 30-day postoperative mortality did not differ between the two groups. The length of incision, blood loss, early mobilization after surgery, the 30-day postoperative overall complication rate and hospital length of stay were significantly shorter in the laparoscopic group. The difference in the duration of procedure was statistically significant in favor of the open group. The number of dissected lymph nodes, the overall survival at 5 years and time to flatus were described only in one study, without any significant difference. Finally, none of the trials reported any information concerning differences in the costs between the two techniques.
CONCLUSIONS
The better outcomes described in this study achieved with laparoscopy, must be interpreted with caution because of the small number of patients involved, the selection and publication bias and the low level of evidence of the analysed trials. Indeed, the advantages of a minimally invasive approach, which have been demonstrated by the present meta-analysis, should encourage the use of laparoscopy also in emergency setting.
Topics: Colectomy; Colonic Neoplasms; Female; Humans; Intestinal Obstruction; Laparoscopy; Laparotomy; Male; Postoperative Complications; Prognosis; Randomized Controlled Trials as Topic; Reoperation; Survival Analysis; Treatment Outcome
PubMed: 29113714
DOI: 10.1016/j.jviscsurg.2017.09.002 -
Annals of Surgery Dec 2018To quantify the extent to which payments for laparoscopic and open colectomy are influenced by a surgeon's experience with laparoscopy. (Comparative Study)
Comparative Study
OBJECTIVE
To quantify the extent to which payments for laparoscopic and open colectomy are influenced by a surgeon's experience with laparoscopy.
BACKGROUND
Numerous studies suggest that healthcare costs for laparoscopic colectomy are lower than open surgery. None have assessed the importance of surgeon experience on the relative financial benefits of laparoscopy.
METHODS
We conducted a study of 182,852 national Medicare beneficiaries undergoing laparoscopic or open colectomy between 2010 and 2012. Using instrumental variable methods to account for selection bias, we compared Medicare payments for laparoscopic and open colectomy. We stratified our analysis by surgeons' annual experience with laparoscopic colectomy to determine the influence of provider experience on payments.
RESULTS
In the fully adjusted analysis, average episode payments per patient were $2640 [95% confidence interval (CI) -$4091 to -$1189] lower with the laparoscopic approach versus open. Surgeons in the highest quartile of laparoscopic experience demonstrated an average payment savings of $5456 per patient (CI -$7918 to -$2994) in their laparoscopic versus open cases. Among surgeons in the lowest quartile of laparoscopic experience, there was, however, no difference between laparoscopic and open cases (difference: $954, 95% CI -$731 to $2639). Differences in payments were explained by differences in complications rates. Both groups had similar rates of complications for open procedures (least experience, 21%, most experience, 21%; P = 0.45), but differed significantly on rates of complications for laparoscopic cases (least experience, 28%, most experience, 15%; P < 0.01).
CONCLUSIONS
This population-based study demonstrates that differences in payments between laparoscopic and open colectomy are influenced by surgeon experience. The laparoscopic approach does not reduce payments for patients whose surgeons have limited experience with the procedure.
Topics: Aged; Clinical Competence; Colectomy; Female; Health Expenditures; Humans; Laparoscopy; Male; Medicare; United States
PubMed: 28549007
DOI: 10.1097/SLA.0000000000002312 -
In Vivo (Athens, Greece) 2022Laparoscopic colectomy is a procedure which is being performed for three decades and is gaining popularity continuously over the traditional open colectomy. This study...
BACKGROUND/AIM
Laparoscopic colectomy is a procedure which is being performed for three decades and is gaining popularity continuously over the traditional open colectomy. This study was conducted in order to compare postoperative and oncologic results based on several factors in laparoscopic and open right colectomy for right colon cancer.
PATIENTS AND METHODS
This is a retrospective study of right colectomy at a single institution from 2015 until 2020. The factors that were studied included postoperative values of C-reactive protein (CRP), lactate dehydrogenase (LDH), creatine phosphokinase (CPK), the number of excised lymph nodes, the use of postoperative analgesics and the length of hospital stay.
RESULTS
We collected data from 21 open and 17 laparoscopic right colectomies through a 5-year period. Measurements on the second postoperative day revealed mean CRP and CPK values significantly lower in the laparoscopic group compared to the open group, while LDH levels did not affirm major differences between the two groups. The mean number of lymph nodes excised during the open procedure was superior to those harvested in the laparoscopic group. The use of analgesics throughout the entire hospital stay was a combination of pethidine and tramadol for the first three postoperative days in open procedures, while paracetamol and, occasionally, tramadol were administered upon patient request following laparoscopic procedures. The mean hospital stay was substantially shorter in the laparoscopic group compared to the open surgery group.
CONCLUSION
Laparoscopic right colectomy is superior compared to open right colectomy with regards to postoperative analgesia and length of hospital stay, but also in certain postoperative laboratory values. Despite these there was no supremacy considering oncologic clearance.
Topics: Colectomy; Colonic Neoplasms; Humans; Laparoscopy; Length of Stay; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 35241557
DOI: 10.21873/invivo.12788 -
Hernia : the Journal of Hernias and... Oct 2016Incisional hernia (IH) is a common complication after colectomy, with impacts on both health care utilization and quality of life. The true incidence of IH after... (Comparative Study)
Comparative Study
PURPOSE
Incisional hernia (IH) is a common complication after colectomy, with impacts on both health care utilization and quality of life. The true incidence of IH after minimally invasive colectomy is not well described. The purpose of this study was to examine IH incidence after minimally invasive right colectomies (RC) and to compare the IH rates after laparoscopic (L-RC) and robotic (R-RC) colectomies.
METHODS
This is a retrospective review of patients undergoing minimally invasive RC at a single institution from 2009 to 2014. Only patients undergoing RC for colonic neoplasia were included. Patients with previous colectomy or intraperitoneal chemotherapy were excluded. Three L-RC patients were included for each R-RC patient. The primary outcome was IH rate based on clinical examination or computed tomography (CT). Univariate and multivariate time-to-event analyses were used to assess predictors of IH.
RESULTS
276 patients where included, of which 69 had undergone R-RC and 207 L-RC. Patient and tumor characteristics were similar between the groups, except for higher tumor stage in L-RC patients. Both the median time to diagnosis (9.2 months) and the overall IH rate were similar between the groups (17.4 % for R-RC and 22.2 % for L-RC), as were all other postoperative complications. In multivariable analyses, the only significant predictor of IH was former or current tobacco use (hazard raio 3.0, p = 0.03).
CONCLUSIONS
This study suggests that the incidence of IH is high after minimally invasive colectomy and that this rate is equivalent after R-RC and L-RC. Reducing the IH rate represents an important opportunity for improving quality of life and reducing health care utilization after minimally invasive colectomy.
Topics: Aged; Aged, 80 and over; Colectomy; Colonic Neoplasms; Female; Humans; Incidence; Incisional Hernia; Laparoscopy; Male; Middle Aged; Quality of Life; Retrospective Studies; Robotic Surgical Procedures
PubMed: 27469592
DOI: 10.1007/s10029-016-1518-2 -
JSLS : Journal of the Society of... 2012To present our experience with a single-incision laparoscopic total colectomy, along with a literature review of all published cases on single-incision laparoscopic... (Review)
Review
BACKGROUND AND OBJECTIVES
To present our experience with a single-incision laparoscopic total colectomy, along with a literature review of all published cases on single-incision laparoscopic total colectomy.
METHODS
A total of 22 cases were published between 2010 and 2011, with our patient being case 23. These procedures were performed in the United States and United Kingdom. Surgical procedures included total colectomy with end ileostomy, proctocolectomy with ileorectal anastomosis, and total proctocolectomy with ileopouch-anal anastomosis. Intraoperative and postoperative data are analyzed.
RESULTS
Twenty-two of the 23 cases were performed for benign cases including Crohns, ulcerative colitis, and familial adenomatous polyposis. One case was performed for adenocarcinoma of the cecum. The mean age was 35.3 years (range, 13 to 64), the mean body mass index was 20.1 (range, 19 to 25), mean operative time was 175.9 minutes (range, 139 to 216), mean blood loss was 95.3mL (range, 59 to 200), mean incision length was 2.61cm (range, 2 to 3). Average follow-up was 4.6 months with 2 reported complications.
CONCLUSIONS
Single-incision laparoscopic total colectomy is feasible and safe in the hands of an experienced surgeon. It has been performed for both benign and malignant cases. It is comparable to the conventional multi-port laparoscopic total colectomy.
Topics: Adenomatous Polyposis Coli; Adolescent; Adult; Colectomy; Colitis, Ulcerative; Crohn Disease; Female; Humans; Laparoscopy; Middle Aged; Young Adult
PubMed: 22906326
DOI: 10.4293/108680812X13291597715826