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PubMed2004

Comparison of recovery time after open and laparoscopic gastric bypass and laparoscopic adjustable banding.

BACKGROUND: Laparoscopy is believed to reduce recovery time and patient discomfort following bariatric surgical operations. This study tests that hypothesis. METHODS: 60 randomly selected bariatric surgery patients, consisting of 20 open Roux-en-Y gastric bypass (RYGBP), 19 lap RYGBP, and 21 laparoscopic adjustable banding, were studied. Outcome measures including hospital length of stay (LOS), days to return to normal activity, days to surgical recovery, and pain medication usage were defined by the patients' subjective responses to a retrospective questionnaire. Overall differences among the three surgeries were first determined using the Kruskal-Wallis test, and then individual comparisons were made between each of the three pairs of operations using a Wilcoxon rank-sum test when a significant difference existed. RESULTS: Patients reported an average LOS of 3.45 days following open RYGBP, 2.47 days following lap RYGBP, and 1.33 days following Lap-Band surgery. There was little difference in return to normal activity, with open RYGBP patients reporting a 17.55 day delay in return to normal activity, and lap RYGBP reporting an 18.16 day delay. In contrast, Lap-Band patients responded that the delay was only 7.24 days. Days to recovery were reported to be 29.05 for open RYGBP patients, 21.68 for lap RYGBP patients and 15.81 for Lap-Band patients. Hospital days (P=0.0002), days to normal activity (P=0.0115), and days to recovery (P<0.0001) differed significantly among the surgery types. Lap and open RYGBP did not differ significantly regarding days to resumption of normal activities. Open RYGBP and banding differed significantly regarding days to recovery (P <0.001). CONCLUSIONS: Lap-Band patients returned to normal activity levels earlier than gastric bypass patient's irrespective of approach. Lap-Band patients also reported recovering from surgery significantly sooner than open RYGBP patients. Perceived differences in recovery time between open and laparoscopic RYGBP patients did not affect their time to resumption of normal activity.

Gastric Bypass↗
PubMed2006

Short-term changes in insulin resistance following weight loss surgery for morbid obesity: laparoscopic adjustable gastric banding versus laparoscopic Roux-en-Y gastric bypass.

BACKGROUND: Laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric bypass (LRYGBP) both effectively treat the insulin resistance associated with type 2 diabetes mellitus (T2DM). Restriction of caloric consumption, alterations in the entero-insular axis or weight loss may contribute to lowering insulin resistance after these procedures. The relative importance of these mechanisms, however, following LAGB and LRYGBP remain unclear. The aim of this study was to compare directly the short-term changes in insulin resistance following LAGB and LRYGBP in similar populations of patients. METHODS: Patient preference determined operation type. The Homeostasis Model Assessment for Insulin Resistance (HOMA IR) was used to measure insulin resistance. Preoperative values were compared to postoperative levels obtained within 90 days of surgery. Significant differences between groups were tested by ANOVA. RESULTS: There were no significant preoperative differences between groups. The 56 LAGB patients had a mean age of 42.5 years (25.7-63), BMI of 45.5 kg/m(2) (35-66) and preoperative HOMA IR of 4.1 (1.4-39.2). 75% of LAGB patients were female and 43% had T2DM. The 61 LRYGBP patients had a median age of 39.9 years (22.1-64.3), BMI of 45.0 kg/m(2) (36-62), and preoperative HOMA IR of 5.0 (0.6-56.5). 79% of LRYGBP patients were women and 44.3% had T2DM. Median follow-up for LAGB patients was 45 days (18-90) and for LRYGBP patients 46 days (8-88 days). LAGB patients had a median of 14.8% excess weight loss (6.9%-37.0%) and LRYGB patients 24.2% (9.8%-51.4%). Postoperative HOMA IR was significantly less after LRYGBP, 2.2 (0.7-12.2), than LAGB, 2.6 (0.8-29.6), although change in HOMA IR was not significantly different. Change in HOMA IR for both groups did not vary with length of follow-up or weight loss but correlated best with preoperative HOMA IR (LAGB r=0.8264; LRYGBP r=0.9711). CONCLUSIONS: Both LAGB and LRYGBP significantly improved insulin resistance during the first 3 months following surgery. Both operations generated similar changes in HOMA IR, although postoperative HOMA IR levels were significantly lower after LRYGBP. These findings suggest that caloric restriction plays a significant role in improving insulin resistance after both LAGB and LRYGBP.

Adult↗
PubMedDate not supplied

An experimental assessment of suture techniques using Lapra-ty clips through the laparoscope and a case report: laparoscopic closure using Lapra-ty for a perforation of the sigmoid colon.

BACKGROUND/AIMS: As endoscopic procedures become various and complicated, it becomes necessary to develop alternative techniques for tissue suture and ligation. We have developed a new suture technique intracorporeal knotting. METHODOLOGY: An 8-cm suture material having a knot on the other side of a needle, was used in laparoscopic surgery. Furthermore, a 5-mm2 Vicryl mesh was pierced as a buttress. The Lapra-ty was used to secure the tissue. Under laparotomy, the forestomach of a male Donryu rat at 6 weeks of age was incised and sutured with 3-0 Vicryl. 3-0 Vicryl was secured with the knot substitute (group A) or three-throw knot (group B) under Nembutal anesthesia. The animals were sacrificed 7 days after operation. Specimens were taken from the forestomach. Those were fixed with 10% formalin and stained with hematoxylin eosin and Elastica Wangieson methods. The histological findings were compared between group A and group B. A successful laparoscopic closure using Lapra-ty is reported in a patient with a perforation of the sigmoid colon. RESULTS: Microscopically, in this method, neither erosion, ulcer nor microabscess is evidenced. This method may make an intracorporeal knot easy. Also we treated a patient who had a perforation of the sigmoid colon using Lapra-ty. The patient recovered without any trouble. CONCLUSIONS: This method could make ligation technique much easier and the operating time shorter.

Animals↗
PubMed1998

[Laparoscopic incidental diagnosis: treatment during laparoscopic surgery].

BACKGROUND: The authors consider the importance of laparoscopic exploration of the abdominal cavity for the diagnosis of mistaken preoperative pathologies, during laparoscopic surgery. RESULTS: In our series the incidental diagnosis is 5.3%. CONCLUSIONS: The additional treatment diagnosis is realized when there is no great surgical engagement or when there are risks for the patient's life (i.e.: hemorrhagic ovarian cyst). In case of incidental neoplasia diagnosis it would been more appropriate to do a biopsy only, for typing. The realization of demanding or non-programmed surgical operations must be consequent on written consent.

English Abstract↗
PubMed2006

Radical prostatectomy: a comparison of open, laparoscopic and robot-assisted laparoscopic techniques.

INTRODUCTION: Surgical approaches to prostate cancer continue to evolve and patient demand for prostatectomy continues to increase. Technical modifications have expanded beyond open surgical approaches to include laparoscopy and more recently robotics. It is important that the enthusiasm that accompanies the introduction of new technology to surgery be accompanied by tangible benefits in terms of comparable oncological or functional outcomes and treatment morbidity. MATERIALS AND METHODS: A literature review was performed comparing individual experiences in large clinical centers and where available comparisons within the same institute between open retropubic radical prostatectomy (RRP), laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RALP). RESULTS: Mortality was extremely low for each approach, with low post-operative pain-scores and analgesic requirements. Oncological outcomes as assessed by positive surgical margin rate were comparable between RRP (13%-21%), LRP (16%-26%) and RALP (6%-23%). Differences in the manner of data accrual and definition for continence and erectile dysfunction make comparison difficult between patient series, however in single institution series comparable continence rates and time to recovery of continence have been shown. CONCLUSIONS: Early data from LRP and RALP series are comparable to RRP in terms of margin-positivity and functional outcomes. Blood loss and transfusion rates appear to be lower for LRP and RALP compared to RRP, while financial costs remain higher than RRP. Long-term oncological results are keenly awaited. Ideally direct comparison between equally experienced surgeons in similar population groups will be required to demonstrate any inherent advantages or disadvantages of individual surgical approaches.

Adenocarcinoma↗
PubMed1991

Laparoscopic trancystic choledocholithotomy as an adjunct to laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is rapidly becoming the standard operation for symptomatic cholelithiasis. Initially, common duct stones presented a barrier to this treatment modality and are said to be unsuspected in 5-9 per cent of patients. A technique is described that removes common bile duct stones through the cystic duct with a flexible nephroureteroscope, thereby extending the range of laparoscopic cholecystectomy.

Adult↗
PubMed1998

[Is laparoscopic resection of a malignant corticoadrenaloma feasible? Case report of early, diffuse and massive peritoneal recurrence after attempted laparoscopic resection].

As surgeons wholeheartedly and intensely supporting (and deeply involved in) laparoscopic adrenal surgery, we think that laparoscopic resection of benign adrenal tumors is about to make conventional laparotomy obsolete. However, considering the many reported cases of tumor seeding after laparoscopy, we consider that proven or suspected adrenal cancer remains an absolute contra-indication for laparoscopy. It is precisely for this reason that we feel duty-bound to report the tragic and life-threatening case of a 25-year-old woman operated for malignant adrenal cancer and suffering from diffuse and massive peritoneal carcinomatosis diagnosed at the sixth postoperative month. A complete macroscopic debulking was carried out with removal of all visible tumor nodules followed by immediate intraperitoneal cisplatinum chemotherapy and six postoperative courses of systemic cisplatinum, etoposide and mitotane chemotherapy. This combined and aggressive therapy induced remission that perhaps could have been initially obtained with a more critical and proper surgical operation. We hope this paper will contribute in the future to avoiding similar catastrophes that could rapidly discredit such a promising new form of surgery.

Adrenal Cortex Neoplasms↗
PubMed1995

Laparoscopic ultrasonography as compared with static or dynamic cholangiography at laparoscopic cholecystectomy. A prospective multicenter trial.

We compared laparoscopic ultrasonography (LICU) with static (S) or dynamic (D) cholangiography (IOC) for assessment of duct anatomy an calculi in 209 patients. LICU visualized ducts in 88% compared with 93% for IOC (P = 0.046). Nineteen patients (9%) had stones: 17 were found by LICU (89%) and 10 (53%) by IOC (P = 0.032). Time to perform LICU (7 +/- 3 min) was less than IOC (13 +/- 6 min) (P < 0.0001). Time to perform SIOC (12 +/- 5 min) and DIOC (14 +/- 6 min) did not differ (P = 0.48), nor did these tests differ in accuracy. LICU provided useful anatomical information but IOC better defined anatomic anomalies. LICU required less time but was less reliable at defining anatomy and complete duct visualization. LICU was more sensitive for stones. SIOC and DIOC did not differ objectively. LICU and IOC are complementary.

Bile Duct Diseases↗
PubMed1996

The anterior abdominal wall in laparoscopic procedures and limitations of laparoscopic simulators.

BACKGROUND: Maneuvers involving two-handed techniques such as intracorporeal suturing and knot-tying during laparoscopy are intrinsically more difficult than ones performed during open surgery. METHODS: The use of simulators to practice and teach specialized techniques is established. However, simulators vary greatly, and few, as yet, represent the abdominal wall well. RESULTS: This study has shown that the working angle between instruments during laparoscopic cholecystectomy is 78 degrees, and this can be increased to 117 degrees by moving the instruments laterally. In contrast, the working angle in four trainers assessed was never greater than 77 degrees. CONCLUSIONS: This suggests that some maneuvers may be more difficult in trainers than at surgery. This has implications for training and the further development of more realistic simulators.

Abdominal Muscles↗
PubMed2006

Routine versus selective intraoperative cholangiography during laparoscopic cholecystectomy: a survey of 2,130 patients undergoing laparoscopic cholecystectomy.

BACKGROUND: Routine use of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is a matter of debate. METHODS: Data from 2,130 consecutive LCs and patients' follow-up during 9 years were collected and analyzed. During the first 4 years of the study, 800 patients underwent LC, and IOC was performed selectively (SIOC). Thereafter, 1,330 patients underwent LC, and IOC was routinely attempted (RIOC) for all. RESULTS: In the IOC group, 159 patients met the criteria for SIOC, which was completed successfully in 141 cases (success rate, 88.6%). Bile duct calculi were found in nine patients. All other patients with no criteria or failed SIOC were followed, and in nine patients retained stones were documented. Thus, the incidence of ductal stones was 1.1% and sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for the detection of ductal stones were 50, 100, 98.6, and 100%, respectively. In the RIOC group, IOC was routinely attempted in 1,330 patients and was successful in 1,133 (success rate, 90.9%; p = 0.015). Bile duct stones were detected in 37 patients (including 14 asymptomatic stones). In two cases, IOC failed to reveal ductal stones (false negative). There was no false-positive IOC. Therefore, with RIOC policy, the incidence of ductal stones, sensitivity, specificity, NPV, and PPV were 3.3, 97.4, 100, 99.8, and 100%, respectively (significantly higher for success rate, incidence, sensitivity, and NPV; p < 0.05). Abnormal IOC findings were also significantly higher in the RIOC group. Common bile duct injury occurred only in the SIOC group [two cases of all 2,130 LCs (0.09%)]. CONCLUSION: RIOC during LC is a safe, accurate, quick, and cost-effective method for the detection of bile duct anatomy and stones. A highly disciplined performance of RIOC can minimize potentially debilitating and hazardous complications of bile duct injury.

Adolescent↗
PubMed2005

Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic vertical banded gastroplasty for obesity.

BACKGROUND: Laparoscopic techniques have been developed for performing Roux-en-Y gastric bypass (LRYGBP) and vertical banded gastroplasty (LVBG) in patients with morbid obesity. It is not certain, however, which is the better technique in non-superobese patients (body mass index less than 50 kg/m(2)). METHODS: Eighty-three patients (LRYGBP 37, LVBG 46) were assessed in a randomized clinical trial. Perioperative complications were recorded together with preoperative and postoperative respiratory function and mobilization rate. Patients were monitored for 2 years after operation with regard to weight change and the need for remedial surgery. RESULTS: There were no conversions to open surgery. The mean operating time was longer for LRYGBP than LVBG (138 versus 105 min). Five early reoperations were performed after LRYGBP (three for haemorrhage, one for ileus and one suspected leak) and one after LVBG (suspected leak). There were no differences in postoperative respiratory function or mobilization. Weight reduction was greater after LRYGBP (excess weight loss 78.3 versus 62.9 per cent 1 year after surgery, P = 0.009; 84.4 versus 59.8 per cent at 2 years, P < 0.001). Remedial surgical intervention was required in eight patients after LVBG (conversion to Roux-en-Ygastric bypass) and none after LRYGBP. CONCLUSION: LRYGBP and LVBG were comparable in terms of operative safety and postoperative recovery, but weight reduction was better after LRYGBP.

Adult↗
PubMed2006

Randomized clinical trial of standard laparoscopic versus robot-assisted laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease.

BACKGROUND: Robotic systems for minimally invasive surgery may be of added value during extensive dissection and suturing in confined spaces, such as laparoscopic Nissen fundoplication (LNF). The purpose of this trial was to compare standard LNF with robot-assisted Nissen fundoplication (RNF). METHODS: Between 2003 and 2005, 50 patients with confirmed refractory gastro-oesophageal reflux disease were assigned to LNF (25) or RNF (25). Patients who had undergone previous antireflux surgery were excluded. Independent assessment of dysphagia, regurgitation, heartburn and general well-being was performed before and 6 months after surgery using questionnaires. Objective outcome was studied 6 months after surgery by oesophageal manometry, 24-h pH monitoring, barium oesophagram series and upper endoscopy. RESULTS: Operating time, blood loss, postoperative pain scores, hospital stay and complication rates did not differ significantly between the two groups. Reoperation rates were the same (one incisional hernia after LNF and one patient with repeat Nissen after RNF because of persistent dysphagia). Postoperative self-rated change in reflux symptoms and quality of life improved equally in both groups. The reduction in oesophageal acid exposure, increase in lower oesophageal sphincter tone and mucosal healing were comparable in both groups at follow-up. CONCLUSION: RNF yielded similar subjective and objective results to LNF in this study. Therefore no additive value of robotic systems for this procedure was detected up to 6 months after surgery.

Adult↗
PubMed2001

Hand-assisted laparoscopic surgery (HALS) for live donor nephrectomy is more time- and cost-effective than standard laparoscopic nephrectomy.

BACKGROUND: Hand-assisted laparoscopy (HALS) was introduced to increase the safety of living donor nephrectomies. Herein we evaluate the first HALS living donor nephrectomies performed at our center. METHODS: Traditional laparoscopic nephrectomies (TLS) (n = 11) and HALS nephrectomies (n = 11) were included in the study. One patient from the TLS group was excluded because the operation was converted to open nephrectomy. We compared the operating times (OT) and warm ischemia times (WIT) for the two procedures and calculated the operating costs. RESULTS: Mean OT was 270 min in the TLS group and 197 min in the HALS group; thus, there was, a significant reduction of 27% with HALS. WIT was 297 sec for the TLS group and 214 sec for the HALS group, for a reduction of 28%. Costs were also lowered for HALS. CONCLUSION: In addition to shortening both OT and WIT, HALS enhances the safety margin of the procedure, especially during trocar placement. It is further helpful in preventing torsion of the kidney and controlling potential bleedings, as well as during vascular stapling and kidney removal.

Adult↗
PubMed2001

Laparoscopic treatment of hemorrhage after vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy (LAVH).

BACKGROUND: This study examines the use of laparoscopy for the treatment of secondary hemorrhage following vaginal or laparoscopically assisted vaginal hysterectomies (LAVH). METHODS: Over a 5-year period, the incidence and management of postoperative bleeding following vaginal hysterectomies or LAVH were registered prospectively. RESULTS: The overall incidence of hemorrhage after vaginal hysterectomies or LAVH was 1.2% (17 of 1319). Over the 5-year period, it decreased from 2.4% (five of 209) to 0.6% (two of 315). Surgical revision was initiated transvaginally in nine patients and by laparoscopy in eight patients. Five of the eight patients profited from the prompt use of laparoscopy; inconclusive vaginal exploration was followed by laparoscopy in another five patients. CONCLUSION: Hemorrhage following vaginal hysterectomy or LAVH can be treated by laparoscopy in the majority of patients. Laparoscopy is recommended if the source of bleeding cannot be identified clearly by vaginal examination and/or if an intraabdominal bleeding source is suspected.

Adult↗
PubMed1999

Prospective audit of laparoscopic totally extraperitoneal inguinal hernia repair: a multicenter study of the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTC).

BACKGROUND: This article reports the results of a multicenter prospective audit of totally extraperitoneal (TEP) inguinal hernia repair conducted by the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTC) from May 1995 to August 1996. METHODS: At 29 Swiss centers 1,605 inguinal hernia repairs were performed in 1,186 patients. Half of the repairs were performed by operators whose experience consisted of fewer than 51 procedures. Patients were followed up for 1 year. RESULTS: Bilateral repairs were performed in 35% of the patients, and 15% of all repairs were for recurrent hernia. Conversion rates to the transabdominal preperitoneal (TAPP) technique and open surgery were 1.8% and 1.6%, respectively. Main postoperative complications were hematoma and urinary retention. At 3 months, seroma was more frequent with slit prosthesis. The recurrence rate was 0.6% at 3 months and 1.6% at 1 year, not depending on the type of implant. The rate for recurrent hernias did not differ from that for primary repairs. CONCLUSIONS: Total extraperitoneal (TEP) repair can be performed with low morbidity and a high level of patient satisfaction. The effects of the learning curve are not to be neglected. The 1-year recurrence rate is 1.6%. Published data on TEP suggest that late recurrences may be less frequent than after open repair.

Female↗
PubMed2005

Laparoscopic radical prostatectomy--the experience of the German Laparoscopic Working Group.

PURPOSE: To present the current status of laparoscopic radical prostatectomy (LRP) in Germany, Austria and Switzerland with respect to transferability, learning curve, and outcome. MATERIAL AND METHODS: The data of 5824 patients who underwent LRP in 18 centers by 50 urologists from March 1999 to August 2004 were analyzed retrospectively. Three centers performed more than 500, and six more than 250 cases. A transperitoneal descending technique with was used in 2701, a transperitoneal ascending in 1234, an extraperitoneal descending in 1814, and an extraperitoneal ascending modification in 75 cases. Specimen showed pT2 in 3535, pT3a in 1555, pT3b in 623, and pT4 in 111 cases. RESULTS: Mean operating time averaged 211 (131-292) minutes, with shorter duration of the extraperitoneal descending technique. Conversion to open surgery averaged 2.4 (0-14.1) %. Re-intervention rate amounted to 2.7 (0.3-7.7) %. Complication rate averaged 8.9 (1.8-10.8) % including bleeding (0.3-2.5%) and rectal lesion (1.5-2.5%). The rate of positive margins was 10.6 (3.2-18) % for pT2- and 32.7 (20-38.5) % for pT3a-tumors Continence after 12 months was 84.9 (72-94) %. Data about potency (7 centers) revealed 52.5 (35-67) % full erections following bilateral nerve preservation. 5 year-PSA recurrence rate (3 centers) was 8.6 (4-15.3) % for pT2-tumors and 17.5 (15-20.6) % for pT3a-stages. CONCLUSIONS: The results confirm the efficacy of the training program with safe transfer of LRP (i.e. low complication rate), however including all known problems of a retrospective study.

Adult↗