共查询到20条相似文献,搜索用时 437 毫秒
1.
F Al Jaafari AG Christofides CRW Bell JD Beatty 《Annals of the Royal College of Surgeons of England》2014,96(6):e6-e7
Losing a needle during laparoscopic surgery is an uncommon but potentially challenging scenario for the surgeon. The prolonged operative time to search for a small retained foreign body such as a needle can cause clinical and medicolegal complications. As a result, it is considered a ‘never event’. This report describes a case of a lost needle during a laparoscopic prostatectomy, when a meticulous and systematic search for the foreign body was initiated and completed with the use of x-rays, only to find it in an unusual place. 相似文献
2.
Christopher Compeau Natalie T. McLeod Artin Ternamian 《Canadian journal of surgery》2011,54(5):315-320
Background
Laparoscopic surgery has gained popularity over open conventional surgery as it offers benefits to both patients and health care practitioners. Although the overall risk of complications during laparoscopic surgery is recognized to be lower than during laparotomy, inadvertent serious complications still occur. Creation of the pneumoperitoneum and placement of laparoscopic ports remain a critical first step during endoscopic surgery. It is estimated that up to 50% of laparoscopic complications are entry-related, and most injury-related litigations are trocar-related. We sought to evaluate the current practice of laparoscopic entry among Canadian general surgeons.Methods
We conducted a national survey to identify general surgeon preferences for laparoscopic entry. Specifically, we sought to survey surgeons using the membership database from the Canadian Association of General Surgeons (CAGS) with regards to entry methods, access instruments, port insertion sites and patient safety profiles. Laparoscopic cholecystectomy was used as a representative general surgical procedure.Results
The survey was completed by 248 of 1000 (24.8%) registered members of CAGS. Respondents included both community and academic surgeons, with and without formal laparoscopic fellowship training. The demographic profile of respondents was consistent nationally. A substantial proportion of general surgeons (> 80%) prefer the open primary entry technique, use the Hasson trocar and cannula and favour the periumbilical port site, irrespective of patient weight or history of peritoneal adhesions. One-third of surgeons surveyed use Veress needle insufflation in their surgical practices. More than 50% of respondents witnessed complications related to primary laparoscopic trocar insertion.Conclusion
General surgeons in Canada use the open primary entry technique, with the Hasson trocar and cannula applied periumbilically to establish a pneumoperitoneum for laparoscopic surgery. This surgical approach is remarkably consistent nationally, although considerably variant across other surgical subspecialties. Peritoneal entry remains an important patient safety issue that requires ongoing evaluation and study to ensure translation into safe contemporary clinical practice. 相似文献3.
Background There are many different meshes available for laparoscopic repair of ventral hernias. A relatively new product is the Proceed
mesh with a bioresorbable layer against the bowels and a polypropylene layer against the abdominal wall. There are, however,
no human data available. The aim of this study was to evaluate the feasibility and outcome after laparoscopic ventral hernia
repair using the Proceed mesh in humans.
Methods Patients presenting for laparoscopic ventral hernia repair in our department from September 2004 to October 2006 were included
in the study. All patients had a standard laparoscopic ventral hernia repair using the Proceed mesh secured with tackers with
a double crown technique. Patients were discharged according to standard discharge criteria, and follow-up was performed with
a search in the national patient database and with manual search in the patients’ files.
Results Our study included 49 patients with a median age of 64 years (range 30–89) and body mass index of 27.8 (19.4–50.5). The dimensions
of the mesh varied from 4 × 4 cm to 30 × 40 cm (median 15 × 15 cm). One patient developed an uncomplicated wound infection
and none of the 49 patients developed mesh infections or postoperative seroma requiring surgical intervention. Thus, there
were no mesh-related complications. During the follow-up period of 17 months (3–27), we have not seen any postoperative recurrences.
The median length of stay was 1 day (range 0–63), and there was no mortality.
Conclusion Laparoscopic ventral hernia repair in humans using the Proceed mesh is feasible and has a low complication rate even in obese
patients or those with pulmonary disease. 相似文献
4.
Wind J Cremers JE van Berge Henegouwen MI Gouma DJ Jansen FW Bemelman WA 《Surgical endoscopy》2007,21(11):2094-2099
Background Installation of the pneumoperitoneum is an essential part of laparoscopic surgery. Creation can be performed by either the
open or a closed technique. The aim of this study was to assess the number of and contributing factors to entry-related complications
in medical liability insurance claims in the Netherlands.
Methods A retrospective chart review was performed, including all malpractice claims filed at MediRisk, which is presently the largest
medical liability mutual insurance company for institutions, mainly hospitals, in healthcare in the Netherlands.
Results From January 1993 to December 2005, 41 claims were identified as entry-related complications which comprised 18% of all laparoscopy-related
complications leading to claims. Most were young (median age = 35 years) female patients who had routine, nonadvanced, laparoscopic
procedures planned as short-stay or day-care procedures. The claims were equally divided between general surgery (n = 20) and gynecology (n = 21). A total of 51 structures were injured. There were 18 vascular structure injuries, 30 bowel injuries, and three other
injuries. An open entry technique was used in only two (5%) patients. Vascular injury was exclusively associated with closed
entry. In only 19 (46%) patients the entry-related complication was diagnosed peroperatively, consisting of 70% of the vascular
and 25% of the bowel injuries. Twenty-six patients (64%) were admitted to the intensive care unit for a median of five days.
There was no mortality. Besides conversion, the majority of the patients filed a claim to compensate for a longer hospital
stay and related costs. A payment was made in 17 (57%) of the 30 settled claims.
Conclusions Medical liability claims concerning laparoscopic entry-related complications comprised a fifth of all laparoscopy-related
claims. Claims concerning entry-related complications occurred in young patients who had routine, nonadvanced procedures.
In the investigated cases most claims involved the closed-entry technique.
Presented at the 14th International Congress of the European Association for Endoscopic Surgery (EAES), core scientific program,
Berlin, Germany, 13–16 September 2006 相似文献
5.
P. H. E. Teeuwen M. W. J. Stommel A. J. A. Bremers G. J. van der Wilt D. J. de Jong R. P. Bleichrodt 《Journal of gastrointestinal surgery》2009,13(4):676-686
Background For patients with acute colitis, the decision when and how to operate is difficult in most cases. It was the aim of this systematic
review to analyze early mortality and morbidity of colectomy for severe acute colitis in order to identify opportunities to
improve perioperative treatment and outcome.
Methods A systematic review of the available literature in the Medline and PubMed databases from 1975 to 2007 was performed. All articles
were assessed methodologically; the articles of poor methodological quality were excluded. Articles on laparoscopic colectomy
for acute colitis were analyzed separately.
Results In total, 29 studies met the criteria for the systematic review, describing a total of 2,714 patients, 1,257 of whom were
operated on in an acute setting, i.e., urgent or emergency colectomy. Reported in-hospital mortality was 8.0%; the 30-day
mortality was 5.2%. Morbidity was 50.8%. The majority of complications were of infectious and thromboembolic nature. Over
the last three decades, there was a shift in indications from toxic megacolon, from 71.1% in 1975–1984 to 21.6% in 1995–2005,
to severe acute colitis not responding to conservative treatment, from 16.5% in 1975–1984 to 58.1% in 1995–2007. Mortality
decreased from 10.0% to 1.8%. Morbidity remained high, exceeding 40% in the last decade. Mortality after laparoscopic surgery
was 0.6%. Complication rate varies from 16–37%.
Conclusion Colectomy for acute colitis is complicated by considerable morbidity. The incidence of adverse outcome has substantially decreased
over the last three decades, but further improvements are still required. The retrospective nature of the included studies
allows for a considerable degree of selection bias that limits robust and clinically sound conclusions about both conventional
and laparoscopic surgery.
Teeuwen and Stommel contributed equally. 相似文献
6.
Background Laparoscopic sleeve gastrectomy is an emerging bariatric procedure that typically necessitates five to seven small skin incisions
to place five to seven trocars. The senior author (Saber) has developed a single umbilical incision approach to laparoscopic
sleeve gastrectomy.
Methods Seven patients underwent single access transumbilical laparoscopic sleeve gastrectomy between March 2008 and July 2008. The
same surgeon performed all surgical interventions. The umbilicus was the sole point of entry for all patients, and the same
operative technique and perioperative protocol were used in all patients.
Results A total of seven single-incision laparoscopic sleeve gastrectomies were performed. The procedure was successfully performed
in all patients. Mean operating time was 125 min. None of the patients required conversion to an open procedure. There were
no mortalities or postoperative complications noted during the mean follow-up period of 3.4 months.
Conclusion Single-incision transumbilical laparoscopic sleeve gastrectomy is safe, technically feasible, and reproducible. 相似文献
7.
Background Laparoscopic ventral hernia repair may be an alternative to open mesh repair as it avoids a large abdominal incision, and
thus potentially reduces pain and hospital stay. This review aimed to assess the safety and efficacy of laparoscopic ventral
hernia repair in comparison with open ventral hernia repair.
Method A systematic review was conducted, with comprehensive searches identifying six randomised controlled trials (RCTs) and eight
nonrandomised comparative studies.
Results The laparoscopic approach may have a lower recurrence rate than the open approach and required a shorter hospital stay. Five
RCTs (Barbaros et al., Hernia 11:51–56, 2007; Misra et al., Surg Endosc 20:1839–1845, 2006; Navarra et al., Surg Laparosc Endosc Percutan Tech 17:86–90, 2007; Moreno-Egea et al., Arch Surg 137:266–1268, 2002; Carbajo et al., Surg Endosc 13:250–252, 1999) reported no conversion (0%) to open surgery, and four nonrandomised studies reported conversions to open surgery ranging
from 0% to 14%. Open approach complications generally were wound related, whereas the laparoscopic approach reported both
wound- and procedure-related complications and these appeared to be less frequently reported.
Conclusion Based on current evidence, the relative safety and efficacy of the laparoscopic approach in comparison with the open approach
remains uncertain. The laparoscopic approach may be more suitable for straightforward hernias, with open repair reserved for
the more complex hernias. Laparoscopic ventral hernia repair appears to be an acceptable alternative that can be offered by
surgeons proficient in advanced laparoscopic techniques. 相似文献
8.
Background The application of laparoscopic gastrectomy in management of gastric cancer is being propagated rapidly. Training and education
play important role during this process. The purpose of this study is to define the learning curve of laparoscopic gastrectomy
to obtain an insight into this training process.
Methods All 362 cases of laparoscopic gastrectomy from January 1998 to July 2007 were enrolled and divided into 12 groups of 30 cases
each in time sequence. The learning curve was defined with the split group method. Laparoscopic distal gastrectomy was extracted
from the 12 groups and the means of operation time and intraoperative blood loss were compared to define the learning curve.
Then general data and variables including occurrence of systematic inflammatory response syndrome (SIRS), complications, and
conversion to open surgery were compared among the phases of learning curve.
Results A three-phase learning curve of laparoscopic gastrectomy was defined from the laparoscopic distal gastrectomy-based analysis,
which included a training phase for the first 120 cases of operation, an intermediate phase for the following 90 cases, and
a well-developed phase for the last 152 cases. Learning was considered to be complete after 60–90 operations in the training
phase. For most variables, the differences among three phases were statistically significant except for the rate of complications.
Conclusions There was a significant learning curve, composed of three phases. Experience of about 60–90 cases of operation was required
for completion of learning. 相似文献
9.
Background Laparoscopic cholecystectomy is increasingly used on an ambulatory basis. This study aimed to examine its effectiveness for
carefully selected patients.
Methods A systematic review of Cochrane, Embase, and Medline using the keywords “ambulatory,” “laparoscopic,” and “cholecystectomy”
was performed. Postoperative complications leading to admissions and readmissions were compared between day care and inpatient
laparoscopic cholecystectomy groups. Postoperative quality of life, patient satisfaction, and cost effectiveness also were
analyzed.
Results The search process identified seven clinical trials suitable for meta-analysis. These trials, consisting of 598 patients,
compared day care and inpatient procedures. The unplanned admission rate in the ambulatory group was comparable with the prolonged
hospitalization of inpatients (odds ratio [OR], 1.979; 95% confidence interval [CI], 0.846–4.628). There was no significant
difference between the readmission rates of the two groups (OR, 0.964; 95% CI, 0.318–2.922). The quality-of-life indicators
were similar for the ambulatory and overnight-stay patients (p = 0.195). The cost effectiveness was better for the day care procedures because of the shorter mean hospital stay.
Conclusion Ambulatory laparoscopic cholecystectomy can be performed safely for selected patients, with reduced cost and a high level
of patient satisfaction. 相似文献
10.
Entirely laparoscopic radical gastrectomy for adenocarcinoma: lymph node yield and resection margins
Sarela AI 《Surgical endoscopy》2009,23(1):153-160
Background Laparoscopic assisted distal gastrectomy for adenocarcinoma has been widely reported from Japan and Korea but there are sparse
data for Western patients. This study aimed to describe and compare the perioperative outcomes and pathological staging for
consecutive patients who underwent laparoscopic or open gastrectomy by a single surgeon in the UK.
Methods During the period from April 2005 to May, 2007, patients with gastric adenocarcinoma were selected for open or laparoscopic
resection at the discretion of the surgeon. Gastric resections for gastrointestinal stromal tumour (GIST) or benign disease
were excluded. Laparoscopic gastrectomy was performed entirely laparoscopically with intracorporeal anastomosis, followed
by specimen retrieval via a suprapubic incision.
Results There were 21 men and 8 women, median age 75 years (range 45–88 years), with American Anaesthesiology Association scores of
3 or 4 in 19 patients. Gastrectomy was performed laparoscopically in 18 patients (62%; total gastrectomy, 6 patients) or open
in 11 patients (total gastrectomy, 7). Five laparoscopic gastrectomies were converted to open procedures, three patients had
re-laparoscopy and one patient had subsequent laparotomy. As compared with open gastrectomy, laparoscopic resection had longer
operation time and similar length of hospital stay. There was one postoperative mortality in each group. There was similar
lymph node retrieval for laparoscopic or open resection [23 (range 10–44) versus 26 (8–95), respectively; p = 0.40], with inadequate lymphadenectomy (<15 nodes) in two laparoscopic cases and one open case. R1 resection was limited
to patients with pT3 disease (laparoscopic, 4; open, 2).
Conclusions Perioperative outcomes were similar for laparoscopic or open gastrectomy. Lymphadenectomy was adequate in 89% of laparoscopic
gastrectomies. pT3 tumours were at risk of noncurative resection, as described in large Western series of open gastrectomy. 相似文献
11.
W. S. Richardson D. Stefanidis L. Chang D. B. Earle R. D. Fanelli 《Surgical endoscopy》2009,23(9):2073-2077
Background Diagnostic laparoscopy is minimally invasive surgery for the diagnosis of intraabdominal diseases. The aim of this review
is a critical examination of the available literature on the role of laparoscopy for chronic intraabdominal conditions.
Methods A systematic literature search of English-language articles on MEDLINE, the Cochrane database of evidence-based reviews, and
the Database of Abstracts of Reviews of Effects was performed for the period 1995–2006. The level of evidence in the identified
articles was graded. The search identified and reviewed six main categories that have received attention in the literature:
pelvic pain and endometriosis, primary and secondary infertility, nonpalpable testis, and liver disease.
Results The indications, contraindications, risks, benefits, diagnostic accuracy of the procedure, and its associated morbidity are
discussed.
Conclusions The limitations of the available literature are highlighted, and evidence-based recommendations for the use of laparoscopy
to stage intraabdominal cancers are provided. 相似文献
12.
《The surgeon》2023,21(3):e133-e141
BackgroundLaparoscopic cholecystectomy (LC) has become the procedure of choice for the removal of gallbladder within the paediatric population. The aim of this study was to perform a systematic review and meta-analysis of the literature spanning the last 20 years to understand the indications for and safety of LCs in children.MethodsA comprehensive search of the published English language literature from January 2000 to June 2020 was done on PubMed, MEDLINE, and Google Scholar.ResultsIn total, 76,524 LC cases were identified from 114 studies. 78.9% of the patients were female and average age was 12 years old. Associated haematological disorders were identified in 16% of cases. The commonest indication for LC was cholelithiasis (68.4% in 66 studies), followed by cholecystitis (59.2% in 53 studies). Median operating time was 77 min. Median hospital stay was 2 days. The overall postoperative complication rate was 3.4% Major complications included bile duct injury (0.4%) and intra- or post-operative bleeding (0.9%). The conversion rate to open procedure was 2%. When comparing post-operative outcomes between emergency and elective admissions, three papers lent themselves to meta-analysis demonstrating no significant difference (p = 0.42). There was no statistically significant difference in postoperative complication rate between “hot” and “cold” laparoscopic cholecystectomies (p = 0.6).ConclusionThis systematic review and meta-analysis is the largest collection of subjects on laparoscopic cholecystectomies in children. Laparoscopic cholecystectomy is a safe operation in children, with complication rates similar or comparable to the adult literature. Cholelithiasis, cholecystitis and biliary dyskinesia were the commonest indications for LC. 相似文献
13.
R. Santambrogio L. Aldrighetti M. Barabino C. Pulitanò M. Costa M. Montorsi G. Ferla E. Opocher 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2009,394(2):255-264
Background Laparoscopic surgery has gained growing acceptance, but this does not hold for laparoscopic surgery of the liver, above all
for patients with hepatocellular carcinoma (HCC) and cirrhosis. This approach mainly includes diagnostic procedures and interstitial
therapies. However, we believe there is room for laparoscopic liver resections in well-selected cases. The aim of this study
is to assess: (a) the risk of intraoperative bleeding and postoperative complications, (b) the safety and the respect of oncological
criteria, and (c) the potential benefit of laparoscopic ultrasound in guiding liver resection.
Methods A prospective study of laparoscopic liver resections for hepatocellular carcinoma was undertaken in patients with compensated
cirrhosis. Hepatic involvement had to be limited and located in the left or peripheral right segments (segments 2–6), and
the tumor had to be 5 cm or smaller. Tumor location and its transection margins were defined by laparoscopic ultrasound.
Results From January 1997, 22 out of 250 patients with HCC (9%) underwent laparoscopic liver resections. The mean patient age was
61.4 years (range, 50–79 years). In three patients, conversion to laparotomy was necessary. The laparoscopic resections included
five bisegmentectoies (2 and 3), nine segmentectomies, two subsegmentectomies and three nonanatomical resections for extrahepatic
growing lesions. The mean operative time, including laparoscopic ultrasonography, was 199 ± 69 min (median, 220; range, 80–300).
Perioperative blood loss was 183 ± 72 ml (median, 160; range, 80–400 ml). There was no mortality. Postoperative complications
occurred in two out of 19 patients: an abdominal wall hematoma occurred in one patient and a bleeding from a trocar access
in the other patient requiring a laparoscopic re-exploration. Mean hospital stay of the whole series was 6.5 ± 4.3 days (median,
5; range, 4–25), while the mean hospital stay of the 19 laparoscopic patients was 5.4 ± 1 (median, 5; range, 4–8).
Conclusion Laparoscopic treatment should be considered in selected patients with HCC and liver cirrhosis in the left lobe or segments
5 and 6 of the liver. It is clear that certain types of laparoscopic resection are feasible and safe when carried out by adequately
skilled surgeons with appropriate instruments. 相似文献
14.
Choi DH Jeong WK Lim SW Chung TS Park JI Lim SB Choi HS Nam BH Chang HJ Jeong SY 《Surgical endoscopy》2009,23(3):622-628
Background Laparoscopic surgery demands mastery of a steep learning curve. Defining a learning curve in laparoscopic surgery is useful
for planning training programs or clinical trials. This study aimed to define the learning curves for laparoscopic sigmoidectomy
used to manage curable sigmoid colon cancer by evaluating early surgical outcome data from three colorectal surgeons.
Methods This study analyzed data from 138 consecutive patients undergoing laparoscopic sigmoidectomy for curable sigmoid colon cancer
performed by three colorectal surgeons between May 2001 and November 2006. The learning curve for each surgeon were generated
using the moving average method to assess changes in operation time and cumulative sum (CUSUM) analysis to assess changes
in failure rates [(failure = conversion to open surgery, major perioperative complication, or failure to harvest an adequate
number of lymph nodes (<12 nodes)].
Results Learning curves generated with the moving average method indicated that the operation time reached a steady state after 42
cases for surgeon A, 35 cases for surgeon B, and 30 cases for surgeon C. The overall open conversion rate was 2.9%. There
was only one laparoscopy-related perioperative major complication (0.7%). An inadequate number of lymph nodes was harvested
in 10 cases (7.2%): 6 (10.5%) for surgeon A, 1 (2.4%) for surgeon B, and 3 (7.7%) for surgeon C. Learning curves generated
using CUSUM analysis based on a 90% success rate showed that adequate learning occurred after 10 cases for surgeon A, 17 cases
for surgeon B, and 5 cases for surgeon C.
Conclusion Pertinent learning curves for laparoscopic sigmoidectomy used to manage curable sigmoid colon cancer can be generated using
the moving average method and CUSUM analysis. These results are likely to be useful in designing laparoscopic training programs
and clinical trials aimed at investigating outcomes of laparoscopic colorectal cancer surgery.
Presented at the Congress of Endoscopic and Laparoscopic Surgeons of Asia 2006, Seoul, Korea, 20 October 2006 相似文献
15.
Luca Viganò Claude Tayar Alexis Laurent Daniel Cherqui 《Journal of Hepato-Biliary-Pancreatic Surgery》2009,16(4):410-421
Background Outcomes of laparoscopic liver resection (LLR) are not clarified. The objective of this article is to depict the state of
the art of LLR by means of a systematic review of the literature.
Methods Studies about LLR published before September 2008 were identified and their results summarized.
Results Indications for laparoscopic hepatectomy do not differ from those for open surgery. Technical feasibility is the only limiting
factor. Bleeding is the major intraoperative concern, but, if managed by an expert surgeon, do not worsen outcomes. Hand assistance
can be useful in selected cases to avoid conversion. Patient selection must take both tumor location and size into consideration.
Potentially good candidates are patients with peripheral lesions requiring limited hepatectomy or left lateral sectionectomy;
their outcomes, including reduced blood loss, morbidity, and hospital stay, are better than those of their laparotomic counterparts.
The same advantages have been observed in cirrhotics. Laparoscopic major hepatectomies and resections of postero-superior
segments need further evaluation. The results of LLR in cancer patients seem to be similar to those obtained with the laparotomic
approach, especially in cases of hepatocellular carcinoma, but further analysis is required.
Conclusions Laparoscopic liver resection is safe and feasible. The laparoscopic approach can be recommended for peripheral lesions requiring
limited hepatectomy or left lateral sectionectomy. Preliminary oncological results suggest non-inferiority of laparoscopic
to laparotomic procedures. 相似文献
16.
Background Laparoscopic inguinal hernia repair is becoming more common in many countries, but the quality of care, experience of the
operating surgeon, and details of the surgical technique are not known in detail on a national level in Denmark. In a period
of expanding surgical volume for laparoscopic inguinal hernia repair, it is important to know the typical indications for
surgery, re-operation rates, details of surgical technique, and status of surgical training on a national level in order to
rationalize interventions to improve outcome.
Methods Data from the National Hernia Database for the last 8 years regarding laparoscopic inguinal hernia repair were used in combination
with questionnaire data obtained from all surgical units in Denmark. The questionnaire included issues such as the number
of operating surgeons in the department, number of residents training in the laparoscopic technique, and the experience level
of the most experienced surgeon in the department regarding laparoscopic inguinal hernia repair. The questionnaire also included
details of the surgical technique.
Results The frequency of laparoscopic repair has been increasing over the last 8 years and now accounts for about 16% of the total
number of inguinal herniorrhaphies with the main indication nationwide being bilateral hernias and recurrent hernias. We found
slight variations in surgical technique although all departments used the TAPP repair. The majority used adequate mesh sizes
at or above 10 × 15 cm, and most departments used coils or tacks for mesh fixation and peritoneal closure. Fifteen of 25 departments
had only one or two surgeons performing laparoscopic inguinal hernia repair and 12 of 25 departments did not have any young
surgeons in training for laparoscopic inguinal hernia repair. Ten departments had one surgeon in training, and three departments
had two surgeons in training.
Conclusion Laparoscopic inguinal hernia repair in Denmark is increasing in prevalence. Indications for surgery as well as operative techniques
differ although all departments use the TAPP technique. Few surgeons are currently learning the laparoscopic technique, and
it is therefore important to initiate meetings and courses to ensure uniform indications for surgery and operative techniques
throughout the country. 相似文献
17.
Karl Y. Bilimoria MD MS Joseph D. Phillips MD Colin E. Rock BA Amanda Hayman MD MPH Jay B. Prystowsky MD MHPE David J. Bentrem MD MS 《Annals of surgical oncology》2009,16(7):1799-1808
Background Outcomes after cancer resections have been shown to be better for high-volume surgeons compared with low-volume surgeons;
however, reasons for this relationship have been difficult to identify. The objective of this study was to assess studies
examining the effect of surgeon training and experience on outcomes in surgical oncology.
Methods A systematic review of the literature was performed to assess articles examining the impact of surgeon training, certification,
and experience on outcomes. Studies were included if they examined cancer resections and performed multivariable analyses
adjusting for relevant confounding variables.
Results An extensive literature search identified 29 studies: 27 examined surgeon training/specialization, 1 assessed surgeon certification,
and 4 evaluated surgeon experience. Of the 27 studies examining training/specialization, 25 found that specialized surgeons
had better outcomes than nonspecialized surgeons. One study found that American Board of Surgery (ABS)-certified surgeons
had better outcomes than noncertified surgeons. Of the two studies examining time since ABS certification, both found that
increasing time was associated with better outcomes. Of the four studies that examined experience, three studies found that
increasing surgeon experience was associated with improved outcomes.
Conclusions Although numerous studies have examined the impact of surgeon factors on outcomes, only a few cancers have been examined,
and outcome measures are inconsistent. Most studies do not appear robust enough to support major policy decisions. There is
a need for better data sources and consistent analyses which assess the impact of surgeon factors on a broad range of cancers
and help to uncover the underlying reasons for the volume–outcome association. 相似文献
18.
Polignano FM Quyn AJ de Figueiredo RS Henderson NA Kulli C Tait IS 《Surgical endoscopy》2008,22(12):2564-2570
Introduction Reduction in hospital stay, blood loss, postoperative pain and complications are common findings after laparoscopic liver
resection, suggesting that the laparoscopic approach may be a suitable alternative to open surgery. Some concerns have been
raised regarding cost effectiveness of this procedure and potential implications of its large-scale application. Our aim has
been to determine cost effectiveness of laparoscopic liver surgery by a case-matched, case–control, intention-to-treat analysis
of its costs and short-term clinical outcomes compared with open surgery.
Methods Laparoscopic liver segmentectomies and bisegmentectomies performed at Ninewells Hospital and Medical School between 2005 and
2007 were considered. Resections involving more than two Couinaud segments, or involving any synchronous procedure, were excluded.
An operation-magnitude-matched control group was identified amongst open liver resections performed between 2004 and 2007.
Hospital costs were obtained from the Scottish Health Service Costs Book (ISD Scotland) and average national costs were calculated. Cost of theatre time, disposable surgical devices, hospital stay,
and high-dependency unit (HDU) and intensive care unit (ICU) usage were the main endpoints for comparison. Secondary endpoints
were morbidity and mortality. Statistical analysis was performed with Student’s t-test, χ
2 and Fisher exact test as most appropriate.
Results Twenty-five laparoscopic liver resections were considered, including atypical resection, segmentectomy and bisegmentectomy,
and they were compared to 25 matching open resections. The two groups were homogeneous by age, sex, coexistent morbidity,
magnitude of resection, prevalence of liver cirrhosis and indications. Operative time (p < 0.03), blood loss (p < 0.0001), Pringle manoeuvre (p < 0.03), hospital stay (p < 0.003) and postoperative complications (p < 0.002) were significantly reduced in the laparoscopic group. Overall hospital cost was significantly lower in the laparoscopic
group by an average of £2,571 (p < 0.04).
Conclusions Laparoscopic liver segmentectomy and bisegmentectomy are feasible, safe and cost effective compared to similar open resections.
Large-scale application of laparoscopic liver surgery could translate into significant savings to hospitals and health care
programmes. 相似文献
19.
Vivian E. Strong MD Nicolas Devaud MD Peter J. Allen MD Mithat Gonen PhD Murray F. Brennan MD Daniel Coit MD 《Annals of surgical oncology》2009,16(6):1507-1513
Objective The aim of this study is to compare technical feasibility and oncologic efficacy of totally laparoscopic versus open subtotal
gastrectomy for gastric adenocarcinoma.
Background Laparoscopic gastrectomy for adenocarcinoma is emerging in the West as a technique that may offer benefits for patients, although
large-scale studies are lacking.
Methods This study was designed as a case-controlled study from a prospective gastric cancer database. Thirty consecutive patients
undergoing laparoscopic subtotal gastrectomy for adenocarcinoma were compared with 30 patients undergoing open subtotal gastrectomy.
Controls were matched for stage, age, and gender via a statistically generated selection of all gastrectomies performed during
the same period of time. Patient demographics, tumor–node–metastasis (TNM) stage, histologic features, location of tumor,
lymph node retrieval, recurrence, margins, and early and late postoperative complications were compared.
Results Tumor location and histology were similar between the two groups. Median operative time for the laparoscopic approach was
270 min (range 150–485 min) compared with median of 126 min (range 85–205 min) in the open group (p < 0.01). Hospital length of stay after laparoscopic gastrectomy was 5 days (range 2–26 days), compared with 7 days (range
5–30 days) in the open group (p = 0.01). Postoperative pain, as measured by number of days of IV narcotic use, was significantly lower for laparoscopic patients,
with a median of 3 days (range 0–11 days) compared with 4 days (range 1–13 days) in the open group (p < 0.01). Postoperative early complications trended towards a decrease for laparoscopic versus open surgery patients (p = 0.07); however, there were significantly more late complications for the open group (p = 0.03). Short-term recurrence-free survival and margin status was similar between the two groups (p = not significant) with adequate lymph node retrieval in both groups.
Conclusions Laparoscopic subtotal gastrectomy for adenocarcinoma is comparable to the open approach with regard to oncologic principles
of resection, with equivalent margin status and adequate lymph node retrieval, demonstrating technically feasibility and equivalent
short-term recurrence-free survival. Additional benefits of decreased postoperative complications, decreased length of hospital
stay, and decreased narcotic use make this a preferable approach for selected patients. 相似文献
20.
Erica R. Podolsky Angela Mouhlas Andrew S. Wu Alexander E. Poor Paul G. Curcillo II 《Surgical endoscopy》2010,24(7):1557-1561