A comparison of outcomes between open,laparoscopic and robotic pancreaticoduodenectomy

Background

The advantages and comparison of minimally invasive techniques for pancreaticoduodenectomies have not been fully explored using large national multicenter data.

Oncological outcomes of open,laparoscopic and robotic colectomy in patients with transverse colon cancer

Techniques in Coloproctology - Literature concerning surgical management of transverse colon cancer is scarce, since many key trials excluded transverse colon cancer. The aim of this study was to...     

Minimally invasive surgery for gastric cancer: A comparison between robotic,laparoscopic and open surgery

AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes.METHODS This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy(RG), laparoscopic gastrectomy(LG), open gastrectomy(OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided.RESULTS The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients(RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery(P = 0.42) and stage of the disease(P = 0.16). Intraoperative blood loss was significantly lower in the LG(95.93 ± 119.22) and RG(117.91 ± 68.11) groups compared to the OG(127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG(27.78 ± 11.45), LG(24.58 ± 13.56) and OG(25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay(P 0.0001). A similar complications rate was found(P = 0.13). The leakage rate was not different(P = 0.78) between groups.CONCLUSION Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.     

Comprehensive comparative analysis of cost-effectiveness and perioperative outcomes between open,laparoscopic, and robotic distal pancreatectomy

Background

NSQIP data show that half of distal pancreatectomies (DP) are performed by a minimally invasive approach (MIS). Advantages have been demonstrated for MIS DP, yet comparative cost data are limited. Outcomes and cost were compared in patients undergoing open (ODP), laparoscopic (LDP), and robotic (RDP) approaches at a single institution.

The short-term outcomes of robotic sphincter-preserving surgery for rectal cancer: comparison with open and laparoscopic surgery using a propensity score analysis

Purpose

The aim of this study is to clarify the short-term outcomes of robotic sphincter-preserving surgery for rectal cancer in a retrospective study.

Methods

The short-term outcomes of robotic sphincter-preserving surgery (n?=?130) were retrospectively compared to open (n?=?234) and laparoscopic surgery (n?=?318) by a propensity score analysis.

Results

Robotic surgery was performed more frequently for patients with lower rectal cancer (55%) than open (30%, p?<?0.0001) or laparoscopic surgery (36%, p?<?0.0001). None of the robotic surgery cases were converted to open surgery. After propensity score matching, robotic surgery was found to be associated with a longer operation time (342 vs. 230 min, p?<?0.0001) and less blood loss (7 vs. 420 mL, p?<?0.0001) than open surgery. The overall complication rate of robotic surgery was lower than that of open surgery (13 vs. 28%, p?=?0.032). Robotic surgery was associated with a lower incidence of surgical site infections (SSIs) than laparoscopic surgery (0 vs. 7%, p?=?0.028). There were no cases of anastomotic leakage after robotic surgery. The circumferential resection margin was involved in 0.8% of the patients who underwent robotic surgery; the incidence did not differ among the treatment groups.

Conclusions

Although robotic surgery for rectal cancer was associated with a longer operation time, it was associated with a very low incidence of SSIs. The degree of safety was comparable to both open and laparoscopic surgery.

     

经腹膜外腹腔镜前列腺癌根治术(附53例报告)

目的研究分析腹膜外腹腔镜前列腺癌根治术的手术方法和疗效。方法我院自2003年2月至2006年12月对53例前列腺癌患者行腹膜外腹腔镜前列腺癌根治术，术前均由病理检查确诊，Gleason评分≤7分，盆腔CT、MR和ECT示无瓮腔淋巴结、精囊和骨转移．手术经腹膜外顺行径路切除前列腺，标本自脐下切口处取出。12例术中行盆腔淋巴结活检．5例行保留性神经前列腺癌根治。结果手术平均时间190min（110～270min），出血120～1200ml，平均320ml，术中直肠损伤2例，4例术后病理示切缘阳性。术后12例出现不同程度尿失禁，均在术后3月内恢复尿控。12例行盆腔淋巴结活检者均未发现阳性淋巴结，5例保留性神经患者中3例术后随访勃起功能良好。随访3～30个月，无尿道狭窄和尿失禁。结论腹膜外腹腔镜前列腺癌根治术是一种安全有效的手术方法．手术创伤小、患者恢复快，取得与开放前列腺癌根治术同样效果，值得推广应用。     

Primary laparoscopic and open repair of paraesophageal hernias: a comparison of short-term outcomes

SUMMARY.   The choice of the optimal surgical approach for repairing paraesophaeal hernias (PEH) is debated. Our objective is to evaluate the short-term outcomes of primary laparoscopic and open repairs of PEH performed in the Calgary Health Region. A retrospective review of all patients undergoing repair of PEH between October 1999 and February 2005 was performed. The outcome measures evaluated included intra-operative parameters and post-operative variables, mortality rates, recurrence rates and patient satisfaction. A total of 93 patients underwent either a laparoscopic ( n  = 46) or open ( n  = 47) primary PEH repair. The laparoscopic approach was associated with a longer mean operative time (3.1 ± 1.2 hours vs. 2.5 ± 0.7 hours, P  = 0.005) but resulted in a shorter overall hospital stay (5 days [2–16 days] vs. 10 days [5–24 days]; P  < 0.001), and fewer post-operative complications (10/46 [22%] vs. 25/47 [53%] P  = 0.002). Although the follow-up was short (laparoscopic 16 months; open 18 months), a 9% recurrence rate was reported with both approaches. Patient satisfaction using the Gastroesophageal Disease Health-Related Quality Of Life questionnaire was similar in both groups ( P  = 0.861) with most patients reporting excellent outcomes (laparoscopic: 32/36 [89%]; open 27/35 [77%]). Our review suggests that the laparoscopic approach is safe with shorter hospital stay and recovery. Although early follow-up suggests that recurrence rates and patient satisfaction are similar, long-term follow-up is required to determine whether the laparoscopic approach will become the procedure of choice.     

Minimal invasiveness of radical laparoscopic prostatectomy:dreams or reality?

To determine the systemic response to extraperitoneal laparoscopic (eLRP) and open retropubic radical prostatectomy (RRP). MATERIALS AND METHODS. In all, 430 patients who had eLRP (200) or open RRP (230) were recruited; patients in both groups had similar preoperative staging. In addition to peri-operative variables (operative duration, complications, blood loss, transfusion rate, hospitalization, catheterization), oncological data (Gleason score, pathological stage, positive margins) were also compared. The extent of the systemic response to surgery-induced tissue trauma was measured in all patients, by assessing the levels of acute-phase markers C-reactive protein (CRP), serum amyloid A (SAA), interleukin-6 (IL-6) and IL-10 before, during and after RP. RESULTS. The duration of surgery, transfusion rate, hospital stay and duration of catheterization were comparable with those of previous studies. There was an increase in IL-6, CRP and SAA but no change in IL-10, and no differences between eLRP and RRP over the entire period assessed. CONCLUSION. The invasiveness of eLRP could not be substantiated objectively on the basis of the variables measured in this study. The surgical trauma and the associated invasiveness of both methods were equivalent.     

Comparison between laparoscopic and open partial nephrectomy: Surgical,oncologic, and functional outcomes

The surgical, oncologic, and functional outcomes were retrospectively compared of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) for the treatment of renal masses. Between January 2006 and November 2011, 115 LPNs and 97 OPNs were performed. The patients’ demographics were matched. Their intraoperative and postoperative data, oncologic and renal function outcomes were compared. Surgical time, renal arterial occlusion time, estimated blood loss, and postoperative hospitalization days were shorter in the LPN group (p < 0.01). The total complications were comparable; however, LPN had a higher intraoperative complication due to 12 subcutaneous emphysemas. The LPN group was followed up with a mean time of 29.3 ± 14.4 months and the OPN group with a mean time of 31.2 ± 12.6 months. All patients survived and no distant relapse or metastasis were observed. Kaplan–Meier estimates of 60-month local recurrence-free survival were comparable with 92.4% after LPN and 93.8% after OPN, respectively (p = 0.57). The reduction of glomerular filtration rate was more obvious after LPN at the 3-month follow-up (p < 0.01), but similar between the two groups at the 30.2-month follow-up. LPN provides similar results in oncologic and functional outcomes when compared to OPN. Long-term observations are still required to the oncologic and function outcomes.     

Oncological and functional results of laparoscopic radical prostatectomy after 100 procedures: our experience

Laparoscopic radical prostatectomy plays an emerging role in the surgical management of prostatic tumors. We present our experience of the first 100 cases of extraperitoneal laparoscopic radical prostatectomy. Our results about continence, erectile function and surgical margins are reported. MATERIALS AND METHODS. Between January 2005 and December 2007, 100 laparoscopic radical prostatectomies were performed by one surgeon. We retrospectively reviewed margins status, operative time, blood transfusion rates, time of catheterization, length of hospital stay, continence and potency rates. RESULTS. The operative time decreased during the learning curve. The mean duration of surgery was 240 minutes (in the first 25 procedures the median time was 320 minutes, while in the last 25 cases the mean duration was 200 minutes). Five conversions to open surgery were required owing to failure to progress. The overall rate of positive surgical margins was 15% in pT2 and 35% in pT3a tumors. We had 3 minor complications (two anastomotic leakage and one hemorrhage from the anastomosis) and 2 major complications (recto-urethral fistula). The mean intraoperative blood loss was 450 ml (range 200-1500). With regard to transfusion, 25 patients (25%) received their autologous units, while 2% of the patients required homologous units. The mean duration of catheterization was 7.8 days. The continence rate at 12 months was 85%; the potency rate was 55% at 12 months. CONCLUSIONS. The results of the present study show that by using a rational approach to training, a general urologist with low experience in laparoscopy is able to safely perform laparoscopic radical prostatectomy, and with oncological and functional results comparable to those of other published series.