Impact of surgeon laparoscopic training and case volume of laparoscopic surgery on conversion during elective laparoscopic colorectal surgery

2017 ◽  
Vol 19 (1) ◽  
pp. 76-85 ◽  
Author(s):  
H. Massarotti ◽  
F. Rodrigues ◽  
C. O'Rourke ◽  
S. A. Chadi ◽  
S. Wexner
Keyword(s):  
Laparoscopic Surgery ◽  
Colorectal Surgery ◽  
Laparoscopic Colorectal Surgery ◽  
Laparoscopic Training ◽  
Case Volume

scholarly journals Hand-assisted laparoscopic surgery for left-sided colon and rectal cancer: 10 Years single centre experience

2016 ◽  
Vol 63 (1) ◽  
pp. 23-28
Author(s):  
Rokas Rackauskas ◽  
Audrius Dulskas ◽  
Vygintas Aliukonis ◽  
Narimantas Samalavicius
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Colorectal Surgery ◽  
Laparoscopic Colorectal Surgery ◽  
Tertiary Care ◽  
Stage Iv ◽  
Operation Time ◽  
Minimal Invasive ◽  
Invasive Technique ◽  
Colon And Rectal Cancer

Introduction. Hand-assisted laparoscopic surgery (HALS) was introduced into clinical practice in the mid-1990s. Although this technique was established as a bridge to total laparoscopic colorectal surgery there are still those who oppose it. In this study we report our 10 year experience of practicing HALS. Methods. This study is a retrospective analysis of prospectively collected data of 426 patients undergoing hand-assisted laparoscopic colorectal surgery for left-sided colon and rectal cancer in a single tertiary care institution, the National Cancer Institute, from January, 2006, to July, 2016. All consenting patients with left sided colon and rectal cancer were included in the analysis. Results. Patient population showed a similar female and male ratio 212 (49.76%) vs. 214 (50.24%). Average age was 64.13 ? 9.92 years (from 26 to 91). Operation time was 108 minutes ? 44.1 min (30 - 320 min). The mean length of the postoperative hospital stay was 6.88, ranging from 2 to 34 days. The pathohistological examination revealed mean lymph node harvest was 16.4 ? 9.61, ranging from 0 to 54. Stage I and II cancer prevailed in the majority of cases, accounting for 129 (30.28%) for each, stage III - 135 (31.69%), and stage IV - 33 (7.74%). Complication rate was 7.27%. Surgical reintervention was required in 10 cases (2.35%). Mortality rate occurred only in two (0.47%) patients. Conclusion. In conclusion, the HALS technique combines the benefits of a minimal invasive technique for the patient and palpatory benefits for the surgeon, which makes surgery for left-sided colon and rectum cancer faster, and with a similar outcome to laparoscopic colectomy.

The Introduction of Laparoscopic Colorectal Surgery: Can It Improve Hospital Economics?

2020 ◽  
pp. 1-8
Author(s):  
Martijn Maassen van den Brink ◽  
Thaís T.T. Tweed ◽  
Patrick A. de Hoogt ◽  
A.G.M. Hoofwijk ◽  
Karel W.E. Hulsewé ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Colorectal Surgery ◽  
Laparoscopic Colorectal Surgery ◽  
Operating Time ◽  
Median Hospital Stay ◽  
Total Cost ◽  
Hospital Economics ◽  
Financial Benefits ◽  
Clinical Benefits ◽  
Improve Hospital

<b><i>Introduction:</i></b> Clinical benefits of laparoscopic surgery are well established, but evidence for financial benefits is limited. This study aimed to compare the financial impact of the introduction of laparoscopic colorectal surgery. <b><i>Methods:</i></b> This study included patients who underwent colorectal surgery between January 2010 and 2015. We collected a range of financial data and divided the patients into 2 groups. Primary outcome was total cost defined by surgical-related costs. <b><i>Results:</i></b> A total of 1,246 patients were included, of which 440 surgeries were performed laparoscopically. The total median cost of laparoscopy was higher compared to open surgery (EUR 4,665 vs. EUR 4,268, <i>p</i> = 0.001). Laparoscopy was associated with higher equipment costs (EUR 857 vs. EUR 232, <i>p</i> &#x3c; 0.001), longer operating time (3.2 vs. 2.5 hours, <i>p</i> &#x3c; 0.001), and more readmissions (10.9 vs. 8.5%, <i>p</i> &#x3c; 0.001). However, after adjusting for heterogeneity, no difference was found in total cost. Surgical-related costs were counterbalanced by lower costs associated with shorter median hospital stay (6 vs. 9 days, <i>p</i> &#x3c; 0.001), less morbidity (37.3 vs. 55.1%, <i>p</i> &#x3c; 0.001), and less mortality (1.8 vs. 5.6%, <i>p</i> = 0.013) for laparoscopy. <b><i>Conclusion:</i></b> During the introduction of laparoscopy for colorectal surgery, no significant differences were found in total cost between laparoscopic and open colorectal surgery. However, favorable postoperative outcomes were achieved with laparoscopic surgery.

scholarly journals Persistent Descending Mesocolon as a Risk Factor of Laparoscopic Surgery for Colorectal Cancer: A Single Institution Experience

2019 ◽  
Vol 104 (9-10) ◽  
pp. 439-445
Author(s):  
Hidekazu Takahashi ◽  
Nobuo Tanaka ◽  
Osamu Takayama ◽  
Masashi Baba ◽  
Masaru Murata ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Laparoscopic Surgery ◽  
Colorectal Surgery ◽  
Laparoscopic Colorectal Surgery ◽  
Three Dimensional ◽  
Tumor Location ◽  
Computed Tomographic ◽  
Preoperative Diagnostic ◽  
Tomographic Slice

The objectives of this study are to clarify the significance of persistent descending mesocolon (PDM), a kind of intestinal malrotation, in laparoscopic colorectal surgery and present potentially useful preoperative diagnostic methods for PDM. Although several risk factors for laparoscopic colorectal surgery have been convincingly reported, the impact of PDM on laparoscopic surgery for colorectal cancer remains less studied. This was an observational study with a retrospective analysis. A consecutive 110 patients undergoing laparoscopic colorectal surgery for colorectal cancer were included. To identify risk factors for operative time of laparoscopic surgery for colorectal cancer, we examined age, sex, body mass index, American Society of Anesthesiologists Performance Status score, tumor location, depth of tumor invasion, lymph node metastasis, and PDM as potential risk factors. For identification of appropriate preoperative diagnostic imaging, we reviewed three-dimensional vessel images reconstructed from computed tomographic slice data of all patients. During the study period, no effective pre- or intraoperative diagnoses of PDM were achieved. A total of 4 patients were diagnosed with PDM. Sex (P = 0.0032); tumor location (P = 0.0044); lymph node metastasis (P = 0.022); and PDM (P = 0.0007) were identified as risk factors based on multivariate analysis. A ventrally branched left colic artery visualized by three-dimensional imaging appeared to be a highly specific feature of PDM. Laparoscopic surgery for colorectal cancer with PDM was difficult without the recognition of PDM. PDM was well-defined preoperatively using three-dimensional vessels images reconstructed from computed tomographic slice data.

scholarly journals The single-incision laparoscopic surgery technique has questionable advantages in colorectal surgery

2018 ◽  
Vol 3 (1) ◽  
pp. 77-84
Author(s):  
Bernd Schneider ◽  
Anne Catharina Brockhaus ◽  
Marcos Gelos ◽  
Claudia Rudroff
Keyword(s):  
Laparoscopic Surgery ◽  
Colorectal Surgery ◽  
Hospital Stay ◽  
Single Incision ◽  
Laparoscopic Colorectal Surgery ◽  
Postoperative Hospital Stay ◽  
Colorectal Disease ◽  
Single Incision Laparoscopic Surgery ◽  
Surgery Technique ◽  
Significant Difference

AbstractBackground:Laparoscopic procedures have increasingly been accepted as standard in surgical treatment of benign and malignant entities, resulting in a continuous evolution of operative techniques. Since one of the aims in laparoscopic colorectal surgery is to reduce access trauma, one possible way is to further reduce the surgical site by the single-incision laparoscopic surgery technique (SLS). One of the main criticisms concerning the use of SLS is its questionable benefit combined with its technical demands for the surgeon. These questions were addressed by comparing SLS versus conventional laparoscopic multitrocar surgery (LMS) in benign and malignant conditions with respect to technical operative parameters and early postoperative outcome of the patients.Methods:Between 2010 and 2013, we performed SLS for colorectal disease. Of the 111 patients who underwent colorectal resection, 47 patients were operated by SLS and 31 using the LMS technique. The collected data for our patients were compared according to operating time, postoperative morbidity and mortality, pain score numeric rating scale on day 1 and day 5 postoperatively and postoperative hospital stay. To complement the pain scores, the required pain medication for adequate pain relief on these days was given.Results:There was no significant difference in age, BMI or sex ratio between the two groups. The intraoperative and early postoperative course was comparable as well. Postoperative hospital stay was the only parameter with a significant difference, showing an advantage for SLS.Conclusion:SLS is a feasible surgical method and a technical option in laparoscopic colorectal surgery. However, we were not able to identify substantial advantages of SLS that would favor this technique.

scholarly journals Could Telephone Reviews Reduce Read Mission Rates After Laparoscopic Colorectal Surgery?

2012 ◽  
Vol 94 (5) ◽  
pp. 162-164 ◽  
Author(s):  
J Stewart ◽  
GM Lloyd ◽  
JK Smith ◽  
AG Acheson ◽  
JP Williams ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Colorectal Surgery ◽  
Original Work ◽  
Enhanced Recovery ◽  
Laparoscopic Colorectal Surgery ◽  
Enhanced Recovery After Surgery ◽  
Length Of Hospital Stay ◽  
Oncological Outcome ◽  
Open Approach ◽  
Colorectal Resections

Significant advances have been made recently in the management of patients undergoing colorectal surgery. demonstration of the advantages of laparoscopic colorectal surgery over the open approach in terms of faster patient recovery, shorter length of hospital stay, less pain and fewer wound problems with identical oncological outcome has led to the widespread adoption of the technique. Simultaneously, based on the original work of Kehlet, enhanced recovery after surgery (ERAS) programmes that capitalise on the reduced physiological insult stimulated by laparoscopic surgery have gained in popularity. Coupled, laparoscopic surgery and ERAS allow many patients undergoing major colorectal resections to be discharged from hospital on the first to third post-operative day.

scholarly journals Short- and Long-Term Outcomes of Laparoscopic Surgery for Colorectal Cancer in the Elderly Aged Over 80 Years Old Versus Non-Elderly: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Yoshitake Ueda ◽  
Norio Shiraishi ◽  
Takahide Kawasaki ◽  
Tomonori Akagi ◽  
Shigeo Ninomiya ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Laparoscopic Surgery ◽  
Colorectal Surgery ◽  
Elderly Patients ◽  
Laparoscopic Colorectal Surgery ◽  
The Elderly ◽  
Long Term Outcomes ◽  
Short And Long Term ◽  
Surgery In Elderly

Abstract Background Recently, colorectal cancer has increased in elderly patients worldwide, with laparoscopic colorectal surgery increasing in elderly patients with colorectal cancer. However, whether laparoscopic colorectal surgery is an optimal procedure for colorectal cancer in the elderly remains unclear.Objective This study aimed to verify safety and curability of laparoscopic colorectal surgery in elderly patients ≥80 years old.Methods Patients undergoing curative colorectal surgery from 2006 to 2014 were enrolled and classified into the laparoscopic surgery in elderly patients aged ≥80 years (LAC-E) group, open surgery in elderly patients (OC-E) group, and laparoscopic surgery in non-elderly patients (LAC-NE) group. Short- and long-term outcomes were compared between these groups.Results The LAC-E, OC-E, and LAC-NE groups comprised 85, 25, and 358 patients, respectively. Intraoperative blood loss and incidence of postoperative complications were significantly lower in the LAC-E versus OC-E group (97 vs. 440 mL, p<.01 and 14% vs. 32%, p<.05, respectively). Long-term outcomes were not different between these two groups. Operation time was significantly shorter in the LAC-E versus LAC-NE group (249 vs. 288 min, p<.01). Intraoperative blood loss and postoperative complications were similar between the groups. Although the 5-year overall survival rate in the LAC-E group was lower than that in the LAC-NE group (64% vs. 80%, p<.01), there was no difference in 5-year disease-specific survival between the groups.Conclusions Laparoscopic colorectal surgery is technically and oncologically safe for colorectal cancer in the elderly as well as the non-elderly and can be an optimal procedure for colorectal cancer in the elderly.

scholarly journals A new ex vivo animal simulation model for skills training in laparoscopic colorectal surgery

2014 ◽  
Vol 96 (4) ◽  
pp. 122-124 ◽  
Author(s):  
J Ansell ◽  
S Goddard ◽  
V Gupta ◽  
N Warren ◽  
G Williams ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Colorectal Surgery ◽  
Simulation Model ◽  
Medical Training ◽  
Laparoscopic Colorectal Surgery ◽  
Clinical Skills ◽  
Ex Vivo ◽  
Skills Training

The opportunity for using simulation in medical training has expanded in recent years. 1–3 Laparoscopic surgery is an area that is ideally suited to the use of simulators for the acquisition of clinical skills. 4 Simulation allows educators to have control over pre-selected scenarios, without distressing patients or encountering complications. 5

scholarly journals Adipose tissue alleviates the stress response by releasing adiponectin during laparoscopic surgery in patients with colorectal cancer

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Wenjiao Shi ◽  
Jian Lou ◽  
Xiaodan Zhang ◽  
Yun Ji ◽  
Xiaojian Weng ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Colorectal Cancer ◽  
Adipose Tissue ◽  
Laparoscopic Surgery ◽  
Stress Response ◽  
Colorectal Surgery ◽  
Open Surgery ◽  
Laparoscopic Colorectal Surgery ◽  
Venous Blood ◽  
Serum Levels

Abstract Background and objectives Laparoscopic colorectal surgery causes a lower stress response than open surgery. Adiponectin is mainly derived from adipocytes and has antidiabetic, antioxidative, and anti-inflammatory capabilities. The objective of the present study was to investigate the protein expression of adiponectin in adipose tissue, and the serum levels of adiponectin, oxidative stress markers and proinflammatory factors during laparoscopic colorectal surgery and open surgery periods. Methods Forty patients aged 60 to 80, with American Society of Anesthesiologists (ASA) I ~ II who underwent radical resection of colorectal cancer were recruited to the study. Laparoscopic group and open group included 20 patients each. Mesenteric adipose tissue and venous blood before (T1) and at the end (T2) of surgery were collected to examine adiponectin levels, and venous blood was collected to examine serum levels of oxidative stress related markers (superoxide dismutase (SOD), glutathione (GSH), lipid peroxide (LPO), malondialdehyde (MDA)), and inflammation-related factors (interleukin (IL)-1β, interleukin (IL)-6, tumor necrosis factor-α (TNF-α)). Results Protein and serum levels of adiponectin were analyzed, and adiponectin levels were significantly increased at T2 than T1 in the laparoscopic surgery, while adiponectin levels were significantly higher in the laparoscopic surgery than in the open surgery at T2. In addition, the serum levels of SOD and GSH were significantly higher in the laparoscopic surgery than in open surgery at T2. However, the serum levels of LPO, TNF-α, IL-1β, and IL-6 were significantly lower in the laparoscopic group than in open group at T2. Conclusion Laparoscopic surgery induced higher levels of adiponectin in both adipose tissue and the bloodstream. Oxidative stress and the inflammatory response were lower during laparoscopic colorectal surgery than during conventional open surgery. These data suggest that adipose tissue may alleviate the stress response during laparoscopic surgery by releasing adiponectin in patients with colorectal cancer.

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