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MedGenMed : Medscape General Medicine May 2007
Topics: Colectomy; Colonic Neoplasms; Colonic Polyps; Humans; Laparoscopy; Male; Middle Aged; Treatment Outcome
PubMed: 17955092
DOI: No ID Found -
World Journal of Gastroenterology Jan 2016The introduction of laparoscopy is an example of surgical innovation with a rapid implementation in many areas of surgery. A large number of controlled studies and... (Review)
Review
The introduction of laparoscopy is an example of surgical innovation with a rapid implementation in many areas of surgery. A large number of controlled studies and meta-analyses have shown that laparoscopic colorectal surgery is associated with the same benefits than other minimally invasive procedures, including lesser pain, earlier recovery of bowel transit and shorter hospital stay. On the other hand, despite initial concerns about oncological safety, well-designed prospective randomized multicentre trials have demonstrated that oncological outcomes of laparoscopy and open surgery are similar. Although the use of laparoscopy in colorectal surgery has increased in recent years, the percentages of patients treated with surgery using minimally invasive techniques are still reduced and there are also substantial differences among centres. It has been argued that the limiting factor for the use of laparoscopic procedures is the number of surgeons with adequate skills to perform a laparoscopic colectomy rather than the tumour of patients' characteristics. In this regard, future efforts to increase the use of laparoscopic techniques in colorectal surgery will necessarily require more efforts in teaching surgeons. We here present a review of recent controversies of the use of laparoscopy in colorectal surgery, such as in rectal cancer operations, the possibility of reproducing complete mesocolon excision, and the benefits of intra-corporeal anastomosis after right hemicolectomy. We also describe the results of latest innovations such as single incision laparoscopic surgery, robotic surgery and natural orifice transluminal endoscopic surgery for colon and rectal diseases.
Topics: Colectomy; Colon; Diffusion of Innovation; Humans; Laparoscopy; Postoperative Complications; Rectum; Treatment Outcome
PubMed: 26811618
DOI: 10.3748/wjg.v22.i2.704 -
JSLS : Journal of the Society of... 2014Laparoscopic colectomies, with and without robotic assistance, are performed to treat both benign and malignant colonic disease. This study compared clinical and... (Comparative Study)
Comparative Study
BACKGROUND AND OBJECTIVES
Laparoscopic colectomies, with and without robotic assistance, are performed to treat both benign and malignant colonic disease. This study compared clinical and economic outcomes for laparoscopic colectomy procedures with and without robotic assistance.
METHODS
Patients aged ≥18 years having primary inpatient laparoscopic colectomy procedures (cecectomy, right hemicolectomy, left hemicolectomy, and sigmoidectomy) identified by International Classification of Diseases, Ninth Edition procedure codes performed between 2009 and the second quarter of 2011 from the Premier Hospital Database were studied. Patients were matched to a control cohort using propensity scores for disease, comorbidities, and hospital characteristics and were matched 1:1 for specific colectomy procedure. The outcomes of interest were hospital cost of laparoscopic robotic-assisted colectomy compared with traditional laparoscopic colectomy, surgery time, adverse events, and length of stay.
RESULTS
Of 25,758 laparoscopic colectomies identified, 98% were performed without robotic assistance and 2% were performed with robotic assistance. After matching, 1066 patients remained, 533 in each group. Lengths of stay were not significantly different between the matched cohorts, nor were rates of major, minor, and/or surgical complications. Inpatient procedures with robotic assistance were significantly more costly than those without robotic assistance ($17,445 vs $15,448, P = .001). Operative times were significantly longer for robotic-assisted procedures (4.37 hours vs 3.34 hours, P < .001).
CONCLUSION
Segmental colectomies can be performed safely by either laparoscopic or robotic-assisted methods. Increased per-case hospital costs for robotic-assisted procedures and prolonged operative times suggest that further investigation is warranted when considering robotic technology for routine laparoscopic colectomies.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Colectomy; Databases, Factual; Female; Hospital Costs; Humans; Laparoscopy; Male; Middle Aged; Operative Time; Robotic Surgical Procedures; United States; Young Adult
PubMed: 24960484
DOI: 10.4293/108680813X13753907291035 -
Scientific Reports Nov 2019This study investigated the differences in airway mechanics and postoperative respiratory complications using two mechanical ventilation modalities and the relationship... (Comparative Study)
Comparative Study Randomized Controlled Trial
This study investigated the differences in airway mechanics and postoperative respiratory complications using two mechanical ventilation modalities and the relationship between biomarkers and postoperative respiratory complications in patients with colorectal cancer who underwent laparoscopic colectomy. Forty-six patients with colorectal cancer scheduled for laparoscopic colectomy were randomly allocated to receive mechanical ventilation using either volume-controlled ventilation (VCV) (n = 23) or pressure-controlled ventilation (PCV) (n = 23). Respiratory parameters were measured and plasma sRAGE and S100A12 were collected 20 minutes after the induction of anesthesia in the supine position without pneumoperitoneum (T1), 40 minutes after 30° Trendelenburg position with pneumoperitoneum (T2), at skin closure in the supine position (T3), and 24 hours after the operation (T4). The peak airway pressure (Ppeak) at T2 was lower in the PCV group than in the VCV group. The plateau airway pressures (Pplat) at T2 and T3 were higher in the VCV group than in the PCV group. Plasma levels of sRAGE at T2 and T3 were 1.6- and 1.4-fold higher in the VCV group than in the PCV group, while plasma S100A12 levels were 2.6- and 2.2-fold higher in the VCV group than in the PCV group, respectively. There were significant correlations between Ppeak and sRAGE, and between Ppeak and S100A12. There were also correlations between Pplat and sRAGE, and between Pplat and S100A12. sRAGE and S100A12 levels at T2 and T3 showed high sensitivity and specificity for postoperative respiratory complications. Postoperative respiratory complications were 3-fold higher in the VCV group than in the PCV group. In conclusion, during laparoscopic colectomy in patients with colorectal cancer, the peak airway pressure, the incidence of postoperative respiratory complications, and plasma sRAGE and S100A12 levels were lower in the PCV group than in the VCV group. Intra- and postoperative plasma sRAGE and S100A12 were useful for predicting the development of postoperative respiratory complications.
Topics: Aged; Algorithms; Colectomy; Colorectal Neoplasms; Female; Head-Down Tilt; Humans; Laparoscopy; Male; Middle Aged; Postoperative Complications; Pressure; Receptor for Advanced Glycation End Products; Respiration, Artificial; Respiratory Mechanics; S100A12 Protein; Supine Position; Tidal Volume
PubMed: 31740727
DOI: 10.1038/s41598-019-53503-9 -
World Journal of Gastroenterology Nov 2014The advances of laparoscopic surgery since the early 1990s have caused one of the largest technical revolutions in medicine since the detection of antibiotics (1922,... (Review)
Review
The advances of laparoscopic surgery since the early 1990s have caused one of the largest technical revolutions in medicine since the detection of antibiotics (1922, Flemming), the discovery of DNA structure (1953, Watson and Crick), and solid organ transplantation (1954, Murray). Perseverance through a rocky start and increased familiarity with the chop-stick surgery in conjunction with technical refinements has resulted in a rapid expansion of the indications for minimally invasive surgery. Procedure-related factors initially contributed to this success and included the improved postoperative recovery and cosmesis, fewer wound complications, lower risk for incisional hernias and for subsequent adhesion-related small bowel obstructions; the major breakthrough however came with favorable long-term outcomes data on oncological parameters. The future will have to determine the specific role of various technical approaches, define prognostic factors of success and true progress, and consider directing further innovation while potentially limiting approaches that do not add to patient outcomes.
Topics: Colectomy; Colonic Diseases; Humans; Laparoscopy; Postoperative Complications; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 25386060
DOI: 10.3748/wjg.v20.i41.15119 -
World Journal of Gastroenterology Dec 2013To evaluate the fast-track rehabilitation protocol and laparoscopic surgery (LFT) vs conventional care strategies and laparoscopic surgery (LCC). (Meta-Analysis)
Meta-Analysis Review
AIM
To evaluate the fast-track rehabilitation protocol and laparoscopic surgery (LFT) vs conventional care strategies and laparoscopic surgery (LCC).
METHODS
Studies and relevant literature comparing the effects of LFT and LCC for colorectal malignancy were identified in MEDLINE, the Cochrane Central Register of Controlled Trials and EMBASE. The complications and re-admission after approximately 1 mo were assessed.
RESULTS
Six recent randomized controlled trials (RCTs) were included in this meta-analysis, which related to 655 enrolled patients. These studies demonstrated that compared with LCC, LFT has fewer complications and a similar incidence of re-admission after approximately 1 mo. LFT had a pooled RR of 0.60 (95%CI: 0.46-0.79, P < 0.001) compared with a pooled RR of 0.69 (95%CI: 0.34-1.40, P > 0.5) for LCC.
CONCLUSION
LFT for colorectal malignancy is safe and efficacious. Larger prospective RCTs should be conducted to further compare the efficacy and safety of this approach.
Topics: Chi-Square Distribution; Colectomy; Colorectal Neoplasms; Humans; Laparoscopy; Length of Stay; Linear Models; Odds Ratio; Patient Discharge; Patient Readmission; Postoperative Complications; Time Factors; Treatment Outcome
PubMed: 24379639
DOI: 10.3748/wjg.v19.i47.9119 -
Medicine May 2015Although laparoscopic surgery is readily used in the management of inflammatory bowel disease (IBD) in adults, its role in the surgical treatment of IBD in the pediatric... (Review)
Review
Although laparoscopic surgery is readily used in the management of inflammatory bowel disease (IBD) in adults, its role in the surgical treatment of IBD in the pediatric population is not well established. The aim of this narrative review was to analyze the published evidence comparing laparoscopic and open resection in the management of children and adolescents with IBD. The Pubmed and Embase databases were searched using the terms "inflammatory bowel disease," "children," "adolescents," "laparoscopic," and "colectomy." The review identified 10 appropriate studies. Even though laparoscopic surgery generally resulted in longer operating times (between a mean of 40 and 140 min), benefits included reduced postoperative pain (mean duration of opiate use 3 vs 6 days) and reduced length of stay (median length of stay 5-8 vs 10.5-19 days) compared with open surgery. Postoperative complication rates were similar following both approaches. Due to the limited available data and the small sample size of the published series, definite recommendations are not able to be drawn. Nevertheless, current evidence indicates that laparoscopic colorectal resection is safe and feasible in the management of IBD in the paediatric population, with reductions in postoperative pain and length of hospital stay achievable.
Topics: Adolescent; Child; Colectomy; Humans; Inflammatory Bowel Diseases; Laparoscopy; Length of Stay; Pain, Postoperative; Postoperative Care; Retrospective Studies; Time Factors
PubMed: 26020394
DOI: 10.1097/MD.0000000000000874 -
Journal of Visceral Surgery Dec 2013In primary Crohn's disease (CD), laparoscopic ileocolic resection has been shown to be both feasible and safe, and is associated with improved outcomes in terms of... (Meta-Analysis)
Meta-Analysis Review
In primary Crohn's disease (CD), laparoscopic ileocolic resection has been shown to be both feasible and safe, and is associated with improved outcomes in terms of postoperative morbidity and length of hospital stay. At this time, it is unclear whether the laparoscopic approach can be routinely proposed as a safe procedure for patients with complex CD involving localized abscess, fistula or recurrent disease. The aim of this systematic literature review was to assess the feasibility and safety of laparoscopic surgery for complex or recurrent CD. In the current literature, there are nine non-randomized cohort studies, two of which were case-matched. The mean rate of conversion to open laparotomy reported in these series ranged from 7% to 42%. Morbidity rate and hospital stay following laparoscopic resection for complex CD were similar to those for initial resection or for non-complex CD. In summary, even though strong evidence is lacking and more contributions with larger size are needed, the limited experiences available from the literature confirm that the laparoscopic approach for complex CD is both feasible and safe in the hands of experienced IBD surgeons with extensive expertise in laparoscopic surgery. Further studies are required to confirm these results and determine precisely patient selection criteria.
Topics: Colectomy; Crohn Disease; Disease Progression; Female; Hospital Mortality; Humans; Ileum; Laparoscopy; Length of Stay; Male; Postoperative Complications; Prognosis; Risk Assessment; Severity of Illness Index; Surgical Stomas; Survival Rate; Treatment Outcome
PubMed: 24119432
DOI: 10.1016/j.jviscsurg.2013.09.004 -
The British Journal of Surgery Jan 2014Laparoscopic surgery (LS) has become standard practice for a range of elective general surgical operations. Its role in emergency general surgery is gaining momentum.... (Comparative Study)
Comparative Study Review
BACKGROUND
Laparoscopic surgery (LS) has become standard practice for a range of elective general surgical operations. Its role in emergency general surgery is gaining momentum. This study aimed to assess the outcomes of LS compared with open surgery (OS) for colorectal resections in the emergency setting.
METHODS
A systematic review was performed of studies reporting outcomes of laparoscopic colorectal resections in the acute or emergency setting in patients aged over 18 years, between January 1966 and January 2013.
RESULTS
Twenty-two studies were included, providing outcomes for 5557 patients: 932 laparoscopic and 4625 open emergency resections. Median (range) operating time was 184 (63-444) min for LS versus 148 (61-231) min for OS. Median (range) length of stay was 10 (3-23) and 15 (6-33) days in the LS and OS groups respectively. The overall median (range) complication rate was 27.8 (0-33.3) and 48.3 (9-72) per cent respectively. There were insufficient data to detect differences in reoperation and readmission rates.
CONCLUSION
Emergency laparoscopic colorectal resection, where technically feasible, has better short-term outcomes than open resection.
Topics: Adult; Aged; Colectomy; Colonic Diseases; Emergencies; Emergency Treatment; Feasibility Studies; Female; Humans; Laparoscopy; Length of Stay; Male; Middle Aged; Operative Time; Postoperative Complications; Rectal Diseases; Reoperation; Treatment Outcome; Young Adult
PubMed: 24285040
DOI: 10.1002/bjs.9348 -
JSLS : Journal of the Society of... 2014This review focuses on health-related quality-of-life (HRQoL) assessment questionnaires and the influence of various parameters on HRQoL at distinct time points after... (Review)
Review
BACKGROUND AND OBJECTIVES
This review focuses on health-related quality-of-life (HRQoL) assessment questionnaires and the influence of various parameters on HRQoL at distinct time points after laparoscopic colectomy for cancer.
METHODS
A PubMed electronic database literature search was conducted.
RESULTS
Twenty studies (7 prospective randomized, 5 nonrandomized, 2 retrospective, 1 matched, and 3 observational studies) used the following HRQoL tools: European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ)-C30 (8 studies), EORTC QLQ-CR38 (6 studies), EORTC QLQ-CR29 (1 study), Short Form 36 (8 studies), Gastrointestinal Quality Life Index (2 studies), EuroQoL-5D (1 study), Symptoms Distress Scale (2 studies), Quality of Life Index (2 studies), and global quality of life (1 study). Long-term beneficial effects on patient HRQoL after laparoscopic colectomy for cancer have not been clearly shown compared with "open" resections. A physical function deterioration and emotional function improvement are observed during the first month. Most patients have recovered at 12 months. Distinct HRQoL domains may be affected in older, female, and chemotherapy-treated patients. HRQoL-related parameters of pain and cosmesis have been assessed in few of the current studies on hand-assisted and single-incision laparoscopic colectomy.
CONCLUSION
Studies' heterogeneity in terms of assessment tools and time points remains as the main obstacle to establish robust conclusions. The addition of more patients and extension of the follow-up period will improve our knowledge on HRQoL changes after laparoscopic colectomy for cancer.
Topics: Colectomy; Humans; Laparoscopy; Neoplasms; Quality of Life
PubMed: 24960485
DOI: 10.4293/108680813X13753907291152