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PubMed1996

Laparoscopic nephrectomy for benign disease: comparison of the transperitoneal and retroperitoneal approaches.

We report our experience with the transperitoneal (TP) and retroperitoneal (RP) approaches for performing laparoscopic nephrectomy for benign disease. Thirty-three patients with benign renal disease underwent laparoscopic nephrectomy, 23 by the TP and 10 by the RP approach. The average age of the patient, ASA score, and specimen weight were similar for the two groups. The average operating time for the TP approach was 5.6 hours v 5 hours for the RP approach. The average hospital stay was 2.8 and 3 days for TP and RP groups, respectively. The use of postoperative analgesics was similar in the two groups (37 mg of morphine sulfate equivalent v 39 mg of morphine sulfate equivalent for the TP and RP groups, respectively). However, the RP group required less time to resume normal oral intake than the TP group (0.3 v 0.6 days). When assessed according to specimen weight of 100 or less, there was a significant reduction in the postoperative analgesia requirements for the RP group of patients (11 mg of morphine sulfate equivalent v 28 mg of morphine sulfate equivalent for the TP group). In this subgroup of patients, the resumption of oral intake also occurred more quickly in the RP than the TP group (0.4 v 0.5 days). The hospital stay and total convalescence time were similar for the two groups. Four complications occurred in the 33 patients: 2 patients (1 TP and 1 RP), required conversion to open surgery, 1 asthenic patient developed a vastus lateralis bruise undergoing a TP approach, and a brachial nerve palsy occurred in a morbidly obese patient who failed a TP approach. The RP approach to laparoscopic nephrectomy reduces the time to resuming normal oral intake for patients postoperatively and, in those patients with a small specimen, may significantly reduce their postoperative analgesia requirements. However, the RP approach for laparoscopic nephrectomy for benign disease does not significantly improve the length of hospital stay or the patient's ultimate postoperative return to normal activity in comparison to the TP approach. There does appear to be a trend toward a shorter operative time for the RP approach. The RP laparoscopic approach is our method of choice for patients with benign renal disease.

Adolescent↗
PubMed2001

Laparoscopic live donor nephrectomy: a comparison with the conventional open approach.

PURPOSE: Laparoscopic live donor nephrectomy is an emerging technique that has not yet gained widespread acceptance in the transplant community due to perceived technical difficulties. However, the potential advantages of decreasing donor morbidity, decreasing hospital stay and improving convalescence while producing a functional kidney for the recipient may prove to enhance living related renal transplantation. We report our early experience with laparoscopic live donor nephrectomy. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 50 consecutive laparoscopic nephrectomies performed from October 1998 to May 2000 and compared them with 50 consecutive open donor nephrectomies, which served as historical controls. RESULTS: Donor age, donor sex and number of HLA mismatches did not differ statistically in the 2 groups. In the laparoscopic and open nephrectomy groups mean followup was 109 and 331 days (p = 0.0001), mean operative time was 234 and 208 minutes (p = 0.0068), mean estimated blood loss was 114 and 193 ml (p = 0.0001), and mean hospital stay was 3.5 and 4.7 days (p = 0.0001), respectively. Average renal warm ischemia time was 2.8 minutes in the laparoscopic nephrectomy group. Serum creatinine did not differ statistically in the 2 groups preoperatively or postoperatively at days 1 and 5, and 1 month. The rate of recipient ureteral complications in the laparoscopic and open nephrectomy groups was 2% (1 of 50 cases) and 6% (3 of 50), respectively (not significant). CONCLUSIONS: Laparoscopic live donor nephrectomy is an attractive alternative to open donor nephrectomy. Laparoscopic nephrectomy results in less postoperative discomfort, an improved cosmetic result and more rapid recovery for the donor with equivalent functional results and complications.

Adult↗
PubMed1988

Support of wives of myocardial infarction patients.

Seventy-six wives of patients suffering a first myocardial infarction were studied by questionnaire 6 weeks after their husbands went home. Despite the routine provision of support and information to spouses during their husband's stay in hospital, a high proportion reported physical and emotional symptoms of stress. The majority of wives felt they were poorly informed about myocardial infarction, had not had enough opportunity to ask the experts questions, and had received most support from relatives. The reasons for these findings are discussed and suggestions for early and systematic nursing intervention are made in an attempt to reduce stress and prevent the development of unhealthy patterns of behaviour.

Adult↗
PubMed1994

Gonadotropin-releasing hormone agonist use before hysterectomy.

OBJECTIVE: Our purpose was to compare the effects of leuprolide acetate in patients with symptomatic uterine leiomyoma before hysterectomy. STUDY DESIGN: Group I (n = 90) included patients with a pretreatment uterine size of 14 to 18 gestational weeks and group II (n = 60) included patients with uteri > 18 weeks' gestational size. Patients in both groups were randomized to either immediate hysterectomy or 2 months of preoperative gonadotropin-releasing hormone agonist. RESULTS: All patients in the two groups with a pretreatment hemoglobin < 11.0 gm/dl randomized to agonist had a significant (p < 0.05) increase (> or = 1.5 gm/dl) in hemoglobin level. Patients in group I who received preoperative agonist were more likely to undergo vaginal hysterectomy (80% vs 13%, p < 0.05) than were patients who did not receive preoperative agonist. Patients undergoing vaginal hysterectomy had a shorter hospital stay, decreased operative blood loss, and a shorter convalescence period than did those undergoing abdominal hysterectomy. In group II, in spite of a mean uterine volume reduction of 51.3%, intraoperative morbidity, operative blood loss, hospital stay, and postoperative convalescence period did not differ between treatment arms. CONCLUSION: The preoperative administration of gonadotropin-releasing hormone agonist in patients with a uterus of 14 to 18 weeks' size increases the use of vaginal hysterectomy, decreases intraoperative blood loss, and shortens hospital stay and convalescence. Preoperative gonadotropin-releasing hormone agonist for patients with a preoperative hemoglobin < 11.0 gm/dl reduces the risk of preoperative transfusion. Preoperative gonadotropin-releasing hormone use in the nonanemic patient with a uterine size > or = 18 weeks' gestational size doses not appear to lower operative morbidity.

Adult↗
PubMedDate not supplied

Adolescents with anorexia nervosa: multiple perspectives of discharge readiness.

PROBLEM: Little is known about the conditions that must be in place to help adolescent patients and their families gain the confidence needed to continue recovery at home, following the adolescents' hospitalization for anorexia nervosa. METHODS: Beliefs about discharge readiness were obtained through an open-ended questionnaire following the patients' first weekend pass home from an in-patient unit. The perceptions of patients, parents, and registered nurses were obtained using parallel versions of a questionnaire. FINDINGS: An examination of the responses revealed four themes; medical stability, education, psychological changes, and community resource planning, that were common to all respondents, as well as themes specific to adolescents and to nurses. CONCLUSIONS: The findings suggest that each group of respondents has unique discharge readiness needs and that registered nurses have an important role to play in helping patients and families make the transition home as successful as possible. Implications for nursing practice are highlighted.

Adolescent↗
PubMed2001

Substantial variability in postoperative treatment, and convalescence recommendations following vaginal repair. A nationwide questionnaire study.

BACKGROUND: Postoperative care and convalescence recommendations following vaginal surgery are generally not evidence based. The aim of this study was to describe pre and postoperative treatment, and advice and restrictions for the convalescence period, given by Danish hospital-employed gynecologists, and gynecologists in private practice, to patients undergoing vaginal repair. METHOD: In 1999 all Danish gynecologists (n=433) received a tested questionnaire about postoperative treatment and convalescence recommendations following vaginal repair. Non-responders received one reminder. OUTCOME MEASURES: Pre and postoperative treatment, and expected hospital stay. Furthermore, lifting restrictions, sick leave, and convalescence before resumption of defined activities. RESULTS: The overall response rate was 82%. The expected postoperative hospital stay was median 3 days (range, 1-7) following anterior repair, and 2 days (range, 1-7) following posterior repair. The recommended sick leave was median 6 weeks (range, 2-12) for patients with work with heavy lifts. There were substantial differences in recommendations. Recommended lifting restrictions were median 3 kg (range, 0-20) for median 4 weeks (range, 1-12), and the recommended time till recommencement of sexual intercourse was median 4 weeks (range, 0-12). The recommended convalescence was median 4-5 weeks for strenuous activities, and median 1-2 weeks for non-strenuous activities, with ranges from 0-24 weeks. The overall, great variance could not be explained by demographic differences between gynecologists. CONCLUSION: Postoperative treatment, and convalescence recommendations given by Danish gynecologists following vaginal repair, show substantial variability and are based on individual viewpoints. Evidence based guidelines and consensus are desirable.

Convalescence↗
PubMed1999

Parainfluenza virus infection among adults hospitalized for lower respiratory tract infection.

To better define the contribution of human parainfluenza viruses (HPIVs) to lower respiratory tract infection in adults, we tested acute- and convalescent-phase serum specimens from hospitalized adults participating in a population-based prospective study of lower respiratory tract infection during 1991-1992. We tested all available specimens from the epidemic seasons for each virus and approximately 300 randomly selected specimens from the corresponding off-seasons for antibodies to HPIV-1, HPIV-2, or HPIV-3. During the respective epidemic season, HPIV-1 infection was detected in 18 (2.5%) of 721 and HPIV-3 infection in 22 (3.1%) of 705 patients with lower respiratory tract infection. Only 2 (0.2%) of 1,057 patients tested positive for HPIV-2 infection. No HPIV-1 infections and only 2 (0.7% of 281 patients tested) HPIV-3 infections were detected during the off-seasons. HPIV-1 and HPIV-3 were among the four most frequently identified infections associated with lower respiratory tract infection during their respective outbreak seasons.

Adult↗
PubMed1996

Human albumin solder supplemented with TGF-beta 1 accelerates healing following laser welded wound closure.

BACKGROUND AND OBJECTIVE: We examined the possibility that human albumin solder can be used as a vehicle for site specific delivery of growth factors for the purpose of accelerating tissue repair following laser welded wound closure. Certain human recombinant growth factors have been shown to accelerate wound healing in model systems. Pilot in vitro studies have established that several growth factors, including TGF-beta 1, maintain bioactivity following exposure to temperatures achieved during laser tissue welding. Using a temperature controlled laser delivery system (TCL) to precisely maintain welding temperatures, it is now possible to avoid thermal denaturation of exogenous bioactive molecules such as growth factors. STUDY DESIGN/MATERIALS AND METHODS: HB-EGF, bFGF, and TGF-beta 1 were tested in vitro for maintenance of bioactivity after exposure to 80 degrees C. In vivo experiments using porcine skin determined the efficacy of solders augmented with growth factors. Incisions were repaired using human albumin alone or supplemented with HB-EGF (2 micrograms), bFGF (10 micrograms), or TGF-beta 1 (1 microgram). Wounds were excised at 3, 5, and 7 days post-operatively. Tensile strength, total collagen content, and histology were performed. RESULTS: At 3 days, tensile strength (TS) of TGF-beta 1 wounds were 36% (P < 0.05) and 20% (n.s.) stronger than laser alone and suture closures, respectively. By 5 days the TS of the TGF-beta 1 group increased by 50% (P < 0.05) and 59% (P < 0.02) over laser alone and suture groups, respectively. At 7 days the TGF-beta 1 group was 50% (P < 0.05) and 79% (P < 0.01) stronger than laser solder alone or suture, respectively. The HB-EGF and bFGF groups were equivalent to the laser solder group at all time points. Total collagen TGF-beta 1 Accelerates Healing Following Laser Welding content at 7 days increased in the TGF-beta 1 group by 7% (n.s.) over the suture group and 21% (P < 0.05) in the laser group. CONCLUSION: Human albumin solder supplemented with TGF-beta 1 increases the early post-operative strength of laser welded wounds. This novel application of laser tissue soldering augmented with a growth factor has the potential to bring about immediate fluid tight seals while providing site specific delivery of biological modifiers. This may lead to an overall improvement in post-operative convalescence, wound infections, and hospital costs.

Albumins↗
PubMed1991

Combined inguinal herniorrhaphy and transurethral prostatectomy.

Between January 1979 and June 1988, 41 men underwent combined inguinal herniorrhaphy and transurethral prostatectomy at the Instituto Nacional de la Nutrición in México. These cases (group 1) were compared retrospectively with 100 consecutive cases of inguinal herniorrhaphy alone (group 2) and 100 consecutive cases of transurethral prostatectomy alone (group 3) during the same period. Group 1 had the highest incidence of preoperative risk factors because of age and associated medical problems. However, there were no significant differences in the rate of operative or postoperative complications between groups. No recurrences of inguinal hernia were recorded in group 1 after a follow-up period of 47.1 months. The length of hospitalization was similar between groups, and no patient died. Our observations suggest that when an inguinal hernia and symptomatic prostatism occur together, combined inguinal herniorrhaphy and transurethral prostatectomy is a practical, safe and effective operative procedure. The advantages of this combined procedure include one anaesthetic period, one operative procedure, one hospital stay and one convalescence with morbidity and mortality rates that are comparable to those of inguinal herniorrhaphy or transurethral prostatectomy alone.

Age Factors↗
PubMedDate not supplied

Prospective nonrandomized study of conventional versus laparoscopic appendectomy.

With the introduction of laparoscopic appendectomy a prospective study was started. Patients with suspected appendicitis were selected for conventional appendectomy or laparoscopy according to the preference of the surgeon on call. During a 1-year period 233 patients were included, of whom 97 underwent conventional appendectomy and 136 laparoscopy. Among the patients selected to laparoscopy, laparoscopic appendectomy was carried out in 72 cases, conventional appendectomy in 32, and only diagnostic laparoscopy in the remaining 32. Removal of a normal appendix was significantly more common in the group of patients directly selected for conventional appendectomy compared to laparoscopy (p < 0.01). The duration of the operation was shorter (p < 0.05) and the postoperative hospital stay and the convalescence longer (p < 0.05) with conventional than with laparoscopic appendectomy. Peroperative problems and minor postoperative complications were more common (p < 0.01) with laparoscopic than conventional appendectomy. However, the clinical impact of these problems were limited. The difference between the procedures regarding major complications was not significant. Laparoscopic appendectomy seems to be at least as good as conventional appendectomy. However, randomized controlled trials are needed to decide which of the procedures to recommend.

Adolescent↗
PubMed1993

The optimal treatment of lymphoceles following renal transplantation.

Lymphoceles are well-recognized complications following kidney transplantation. The authors describe their experience with the treatment of eight clinically significant lymphoceles (incidence 2.7%). In seven patients percutaneous needle aspiration was attempted, often repeatedly, both for diagnostic and therapeutic purposes. In all of the patients the lymphocele recurred within days and internal marsupialization was therefore performed, in the last two patients utilizing minimal access surgery through laparoscopy. There were no postoperative complications or signs of a recurrence of the lymphocele. Patients following the laparoscopic marsupialization had a much briefer hospital stay and postoperative convalescence. Our results confirm that internal marsupialization is the procedure of choice for most post-transplant lymphoceles. Internal marsupialization through laparoscopy should be used in patients who meet the standard criteria for laparoscopy.

Adult↗
PubMed2000

Laparoscopic management of renal cystic disease.

Renal cystic disease, ranging from simple cysts to autosomal dominant polycystic kidney disease (ADPKD), can lead to significant complications such as pain, hypertension, infection, upper urinary tract obstruction, and even renal failure. For patients with preserved renal function, laparoscopic ablation of renal cysts is a recent, though safe and effective alternative to open surgery in patients who have failed conservative measures. Likewise, for symptomatic patients with renal failure, laparoscopic nephrectomy offers a less invasive option to open nephrectomy. Both laparoscopic cyst decortication and laparoscopic nephrectomy offer patients the benefits of minimal intraoperative blood loss, minimal postoperative pain, brief hospital stay, and rapid convalescence while offering a short-term outcome equivalent to open surgery. Further study and follow-up are indicated to assess the long-term effect of these procedures on the outcome of ADPKD with regard to durability of pain relief, preservation of renal function, and impact on renal hypertension.

Humans↗
PubMed2003

Advancements in minimally invasive treatments for female stress urinary incontinence: radiofrequency and bulking agents.

Continuous advancements in materials technology have provided the possibility that multiple new urethral bulking agents will be available soon. Experience continues to accrue in clinical trials for urethral bulking with these agents. Parallel use for the indication of pediatric vesicourethral reflux also has provided evidence of biologic activity related to these compounds. All of the agents closest to complete analysis are synthetic and represent a variety of material types and characteristics. As these materials evolve, understanding of the preferential injection technique is being gained. Delivery methods and sites may prove to alter the biologic activity of these compounds substantially. Emphasis on other minimally invasive options for the surgical treatment of stress incontinence also has resulted in the development of radiofrequency vesicourethral suspension. Improved understanding of thermal application to tissue, acute and chronic tissue response to this application, and accumulating human experience with this method of therapy has provided an acceptable tolerability profile for this therapy. This profile may provide application of this method of therapy to an in-office treatment setting, precluding hospitalization and substantially decreasing convalescence times.

Administration, Intravaginal↗
PubMed1979

Survival after recovery from acute myocardial infarction. Two and five year prognostic indices.

A prognostic index for two year survival following recovery from acute myocardial infarction has been verified in an independent group of 105 patients. Five variables comprise the index: systolic blood pressure level on admission, highest blood urea nitrogen level in the cardiac care unit; atrial arrhythmias in the cardiac care unit; angina pectoris for more than three months or a previous myocardial infarction; and more than one ventricular ectopic beat per hour recorded on an 8 hour dynamic electrocardiogram during convalescence just prior to hospital discharge. One hundred twenty-six patients have also been followed for five or more years, and we now report a five year prognostic index. Discriminant analysis indicates that the same five variables, although weighted differently, continue to be significant for prognostic assessment and may be utilized in the identification of patients at high and lower risk.

Actuarial Analysis↗
PubMed2005

Laparoscopic partial nephrectomy versus laparoscopic cryoablation for the small renal tumor.

We sought to compare perioperative and short-term outcomes of laparoscopic partial nephrectomy versus laparoscopic cryoablation in patients with peripheral small renal tumors. Prospectively accrued data of patients with a small renal tumor (< or = 3 cm) undergoing laparoscopic partial nephrectomy (group 1, n = 153) or laparoscopic cryoablation (group 2, n = 78) were compared retrospectively. Patients undergoing laparoscopic partial nephrectomy were younger (mean age, 60.6 vs 65.6 years; P = 0.005), healthier (American Society of Anesthesiologists class 3/4 present in 46% vs 75%; P = 0.001), had a lower baseline serum creatinine (90.1 vs 106.0 micromol/L [1.02 vs 1.2 mg/dL]; P = 0.01), a larger tumor size (2.3 vs 2.1 cm; P = 0.02), and fewer cases of solitary kidneys (5% vs 23%; P = 0.000). Laparoscopic partial nephrectomy was associated with greater blood loss (211 vs 101 mL; P = 0.000) and a higher incidence of delayed complications after hospital discharge (16.3% vs 2.2%; P = 0.01) compared with cryoablation. Both groups were comparable with regard to operative time (P = 0.77), intraoperative complications (P = 0.1), postoperative complications (P = 0.55), hospital stay (P = 0.13), convalescence (P = 0.96), and postoperative serum creatinine (112.2 vs 123.7 micromol/L [1.27 vs 1.4 mg/dL]; P = 0.31). Local recurrence was detected over a mean follow-up time of 5.8 months in group 1 (0.6%) and 24.6 months in group 2 (3%). Although the technical simplicity, decreased blood loss, and somewhat lower complication rate are attractive features of renal cryotherapy, this must be balanced against the current lack of long-term follow-up data that are needed to confirm the oncologic adequacy of this developmental procedure. Laparoscopic partial nephrectomy, albeit a technically advanced procedure, duplicates established open principles and has therefore evolved to become our current minimally invasive nephron-sparing procedure of choice in the majority of patients with a small renal tumor.

Adolescent↗
PubMed1994

Optimal therapy for the distal ureteral stone: extracorporeal shock wave lithotripsy versus ureteroscopy.

Extracorporeal shock wave lithotripsy (ESWL not equal to) is the optimal therapy for renal calculi less than 2 cm. in diameter and for proximal ureteral calculi. Controversy continues over the initial approach to distal ureteral calculi (that is below the bony pelvis): in situ ESWL versus ureteroscopy. Since February 1990, 76 distal ureteral calculi were treated at our institution using either in situ ESWL (Dornier HM3 ESWL with a Stryker frame modification in 27 patients or Siemen's Lithostar electromagnetic ESWL in 22) or ureteroscopy (27 patients). Patient age and stone size were similar among the groups. All ESWL treatments were performed with the patient under intravenous sedation and on an outpatient basis. Stone-free rates were 96% for the HM3 device, 84% for the Lithostar and 100% for ureteroscopy. Retreatment was required in 3 Lithostar cases (14%) and 1 HM3 case (4%). When compared to ESWL ureteroscopy for distal ureteral stones was more time-consuming, entailed routine placement of a ureteral stent, often required general anesthesia, more often led to hospitalization and doubled the convalescence period. From a cost standpoint, ESWL on an HM3 unit was a few hundred dollars more expensive than ureteroscopy. In summary, we believe that in situ ESWL provides optimal first line therapy for distal ureteral calculi, while ureteroscopy is better reserved as a salvage procedure should ESWL fail.

Adult↗
PubMed1993

Laparoscopic correction of vesicoureteral reflux.

Major advances have been made in the area of laparoscopic surgery. The advantages of this approach include smaller incisions, shorter hospitalizations, a more rapid convalescence and decreased postoperative discomfort. To explore the technical feasibility of performing antireflux surgery laparoscopically, we conducted a pilot study in 4 mini-pigs in which bilateral vesicoureteral reflux had been created surgically. We applied a modification of the Lich extravesical ureteral approach to perform laparoscopic antireflux surgery. All mini-pigs underwent successful unilateral mobilization, creation of a bladder wall trough and creation of a new ureteral tunnel laparoscopically. Examinations were performed postoperatively, and then serially at 1, 2, 3 and 5 months after repair. Fluoroscopic cystograms demonstrated the resolution of reflux in the corrected ureters and persistence of reflux in the uncorrected control ureters in all animals. Excretory urography showed no evidence of obstruction. Laparoscopic correction of vesicoureteral reflux appears to be technically feasible in the animal model. Long-term followup is necessary to determine the possible applicability of this technique in humans.

Animals↗
PubMed2000

Hand-assisted laparoscopic nephroureterectomy for the treatment of transitional cell carcinoma of the upper urinary tract.

OBJECTIVES: Nephroureterectomy with removal of the bladder cuff is the standard of care for patients with upper tract transitional cell carcinoma. Historically, it has been performed using two separate incisions or one large incision extending from the lateral flank to the symphysis pubis. We describe an alternative technique using endoscopic and hand-assisted laparoscopic techniques and present our experience. METHODS: During the past 18 months, 22 patients at two institutions underwent hand-assisted laparoscopic nephroureterectomy. In 19 patients, the distal ureter and bladder cuff were managed endoscopically. In 3 patients, the distal ureter and the bladder cuff were removed by an extravesical, laparoscopic technique. The intraoperative parameters assessed included operative time, estimated blood loss, specimen weight, surgical margin status, pathologic grade and stage, and acute complications. Postoperative endpoints included the time to sustained fluid intake, parenteral narcotic requirement (milliequivalents of morphine sulfate), oral narcotic requirement (number of tablets), length of stay, time until return to normal activity, and rate of tumor recurrence. RESULTS: The average age of our patient population was 65 years (range 42 to 86), 10 patients were men and 12 were women, and the average American Society of Anesthesiologists classification was 2.2. All but 2 patients had their specimens removed en bloc. No intraoperative complications occurred. The average operative time was 272 minutes (range 190 to 440), and the average blood loss was 180 mL (range 50 to 400); no patient required a transfusion. The mean specimen weight was 457 g (range 190 to 1420). All 22 patients had negative surgical margins. Postoperatively, the time to sustained fluid intake averaged 2.1 days (range 1 to 7), the mean parenteral narcotic requirement was 55 mEq (range 12 to 107.8) of morphine sulfate, the mean oral narcotic requirement was 5.8 tablets (range 1 to 14), and the average length of stay was 4.1 days (range 3 to 14). One patient developed thrombophlebitis of the right external jugular vein from a central line and required 2 weeks of intravenous antibiotics. The mean time to return to normal activity was 19 days; the mean follow-up was 13 months. Six patients had disease recurrence: four low-grade, low-stage bladder tumors and two metastatic tumors. All patients were alive at 18 months. CONCLUSIONS: Hand-assisted laparoscopic nephroureterectomy with endoscopic management of the bladder cuff is a viable and efficacious alternative to open nephroureterectomy. The technique allows the surgeon to perform an en bloc resection of the kidney, ureter, and bladder cuff without compromising oncologic principles. Patients benefit from a decrease in pain and hospital stay and quicker convalescence. Longer follow-up and comparative studies to standard open techniques are underway.

Adult↗