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1.
Background
The feasibility and safety of low-pressure pneumoperitoneum in laparoscopic cholecystectomy remain unclear.Methods
A meta-analysis of randomized controlled trials comparing low-pressure with standard-pressure pneumoperitoneum was performed.Results
A total of 1,263 patients were included. Low-pressure pneumoperitoneum was associated with significantly decreased postoperative pain. The requirement for increased pressure was significantly greater in the low-pressure group (risk ratio = 6.16; P < .001). Operative time was similar, with only a slight statistical significance (weighted mean difference = 2.07; P < .001). Length of hospital stay was shorter in the low-pressure group (weighted mean difference = −.27; P = .01). No significant differences were found in surgical complications or conversion to open surgery.Conclusions
Low-pressure pneumoperitoneum is feasible and safe and results in reduced postoperative pain and near-equal operative time compared with standard-pressure pneumoperitoneum. More studies are required to investigate the potential benefits of the reduced length of hospital stay. 相似文献2.
Krambeck AE DiMarco DS Rangel LJ Bergstralh EJ Myers RP Blute ML Gettman MT 《BJU international》2009,103(4):448-453
OBJECTIVE
To assess the perioperative complications and early oncological results in a comparative study matching open radical retropubic (RRP) and robot‐assisted radical prostatectomy (RARP) groups.PATIENTS AND METHODS
From August 2002 to December 2005 we identified 294 patients undergoing RARP for clinically localized prostate cancer. A comparison RRP group of 588 patients from the same period was matched 2:1 for surgical year, age, preoperative prostate‐specific antigen level, clinical stage and biopsy Gleason grade. Perioperative complications were compared. Patients completed a standardized quality‐of‐life questionnaire. Pathological features were assessed and Kaplan‐Meier estimates of biochemical progression‐free survival (PFS) were compared.RESULTS
There was no significant difference in overall perioperative complications between the RARP and RRP groups (8.0% vs 4.8%, P = 0.064). Wound herniation was more common after RARP (1.0% vs none, P = 0.038), and development of bladder neck contracture was more common after RRP (1.2% vs 4.6%; P < 0.018). The hospital stay was less after RARP (29.3% vs 19.4%, P = 0.004, for a stay of 1 day). At the 1‐year follow‐up there was no significant difference in continence (RARP 91.8%, RRP 93.7%, P = 0.344) or potency (RARP 70.0%, RRP 62.8%, P = 0.081) rates. The biochemical PFS was no different between treatments at 3 years (RARP 92.4%, RRP 92.2%; P = 0.69).CONCLUSION
There was no significant difference in overall early complication, long‐term continence or potency rates between the RARP and RRP techniques. Furthermore, early oncological outcomes were similar, with equivalent margin positivity and PFS between the groups. 相似文献3.
The impact of nerve‐sparing robot‐assisted radical prostatectomy on lower urinary tract function: Prospective assessment of patient‐reported outcomes and frequency volume charts
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Nobuhiro Haga Junya Hata Kanako Matsuoka Tomoyuki Koguchi Hidenori Akaihata Masao Kataoka Yuichi Sato Soichiro Ogawa Kei Ishibashi Yoshiyuki Kojima 《Neurourology and urodynamics》2018,37(1):322-330
Aims
To elucidate the effects of a nerve‐sparing (NS) procedure on lower urinary tract symptoms (LUTS) and urinary function after robot‐assisted radical prostatectomy (RARP), the associations between the NS procedure and LUTS and urinary function were investigated.Methods
The participants in this study were 200 consecutive patients who underwent RARP. These patients were categorized into unilateral and bilateral NS groups and the non‐NS group. The International Prostate Symptom Score (IPSS), quality of life (QOL) index, frequency‐volume chart, uroflowmetry, 1‐h pad test, and the 5‐item International Index of Erectile Function (IIEF‐5) questionnaire were evaluated before and after RARP.Results
The total IPSS score was significantly lower in the unilateral (P = 0.03) and bilateral NS groups (P = 0.03) than in the non‐NS group after RARP. Diurnal maximum voided volume (MVV) values were significantly greater in the bilateral NS group than in the non‐NS group after RARP (P = 0.002). Nocturnal frequency was significantly decreased in the unilateral NS group than in the non‐NS group after RARP (3 months P = 0.01, 12 months P = 0.01). Erectile function was significantly better in both the unilateral NS group (P < 0.0001) and the bilateral NS group (P = 0.02) than in the non‐NS group 12 months after RARP.Conclusions
The NS procedure in RARP has the possibility to improve not only erectile function, but also LUTS, owing to both the increase of MVV and the decrease of nocturia. Therefore, the NS procedure is also recommended from the viewpoint of early improvement of LUTS and lower urinary tract dysfunction after RARP. 相似文献4.
Gianduzzo T Colombo JR Haber GP Hafron J Magi-Galluzzi C Aron M Gill IS Kaouk JH 《BJU international》2008,102(5):598-602
OBJECTIVES
To examine the feasibility of using laser energy during nerve‐sparing robotically assisted radical prostatectomy (RARP), as the energy sources currently used for haemostasis in RARP adversely affect cavernous nerve function, while clips require application by a skilled assistant, but laser energy potentially allows precise dissection with minimal collateral tissue injury.MATERIALS AND METHODS
We used laser‐based RARP in 10 dogs, using the da Vinci S system (Intuitive Surgical, Sunnyvale, CA, USA) and a prototype robotic laser instrument. The potassium‐titanyl‐phosphate laser was used for dissection at 2–6 W, with intermittent use of the neodymium‐doped yttrium‐aluminium‐garnet laser at 5 W for coagulating larger vessels. The peak intracavernosal pressure response to nerve stimulation was recorded as a percentage of mean arterial pressure (ICP%MAP) before and after RARP. Five dogs were killed immediately after RARP and five were maintained alive for 72 h; the haemoglobin and haematocrit levels were measured before and after RARP in the latter five dogs.RESULTS
All 10 procedures were performed solely using laser energy and no additional haemostatic manoeuvres. The median prostate excision time was 65 min. The ICP%MAP before and after RARP (median 98.5% and 77.0%, P = 0.12) were not significantly different; similarly, the respective haemoglobin (median 14.4 vs 12.6 g/dL, P = 0.06) and haematocrit levels (45.1% vs 40.2%, P = 0.06) were not significantly different. Two dogs had catheter‐related complications and one had an anastomotic leak. There were no laser‐related complications or postoperative haemorrhage.CONCLUSIONS
Laser RARP is feasible in dogs and further assessment is warranted. 相似文献5.
Bernardo Rocco Deliu‐Victor Matei Sara Melegari Juan Camilo Ospina Federica Mazzoleni Giacomo Errico Mauro Mastropasqua Luigi Santoro Serena Detti Ottavio De Cobelli 《BJU international》2009,103(7):991-992
OBJECTIVE
To compare the early oncological, perioperative and functional outcomes of robotic‐assisted radical prostatectomy (RARP) vs open retropubic RP (RRP) in a laparoscopically naive centre, as robotic assistance aids the laparoscopically naive surgeon in minimally invasive prostate surgery, by offering magnification and superior dexterity.PATIENTS AND METHODS
From 1 November 2006 to 31 December 2007, 120 patients had RARP; this group was followed prospectively and evaluated for early oncological, perioperative and functional outcomes (measured at 3, 6 and 12 months after surgery), and compared to a historical control group of consecutive patients who had RRP from 20 May 2004 to 28 February 2007. All patients were operated by the same laparoscopically naive surgeons. The comparison was by matched‐pair analysis.RESULTS
The baseline characteristics of the two groups were equivalent, although there was a higher percentage of patients with pT3/pT4 disease in the RRP group. As a proxy for oncological outcome, positive surgical margins were equivalent in the two groups (22% RARP vs 25% RRP, P = 0.77). The overall mean (range) surgical duration was significantly longer in RARP group, at 215 (165–450) min vs 160 (90–240) min in the RRP group (P < 0.001). However, RARP had a statistically significant advantage over RRP for estimated blood loss, of 200 vs 800 mL (P < 0.001), duration of catheterization (6 vs 7 days P < 0.001) and length of stay (3 vs 6 days, P < 0.001) The 3, 6 and 12‐month continence rates were 70%, 93% and 97% vs 63%, 83% and 88% after RARP and RRP, respectively (P = 0.15, 0.011 and 0.014). The 3, 6 and 12 month overall potency recovery rate was 31%, 43% and 61% vs 18%, 31% and 41%, after RARP and RRP, respectively (P = 0.006, 0.045 and 0.003).CONCLUSION
Our initial experience showed the feasibility of RARP in a laparoscopically naive centre. RRP seems to be a faster procedure, whereas RARP provided better results in terms of estimated blood loss, hospitalization and functional results. The early oncological outcome seemed to be equivalent in the two groups. 相似文献6.
Sandhu T Yamada S Ariyakachon V Chakrabandhu T Chongruksut W Ko-iam W 《Surgical endoscopy》2009,23(5):1044-1047
Background Post-laparoscopic pain syndrome is well recognized and characterized by abdominal and particularly shoulder tip pain; it occurs
frequently following laparoscopic cholecystectomy. The etiology of post-laparoscopic pain can be classified into three aspects:
visceral, incision, and shoulder. The origin of shoulder pain is only partly understood, but it is commonly assumed that the
cause is overstretching of the diaphragmatic muscle fibers owing to a high rate of insufflations. This study aimed to compare
the frequency and intensity of shoulder tip pain between low-pressure (7 mmHg) and standard-pressure (14 mmHg) in a prospective
randomized clinical trial.
Methods One hundred and forty consecutive patients undergoing elective laparoscopic cholecystectomy were randomized prospectively
to either high- or low-pressure pneumoperitoneum and blinded by research nurses who assessed the patients during the postoperative
period. The statistical analysis included sex, mean age, weight, American Society of Anesthesiologists (ASA) grade, operative
time, complication rate, duration of surgery, conversion rate, postoperative pain by using visual analogue scale, number of
analgesic injections, incidence and severity of shoulder tip pain, and postoperative hospital stay. p < 0.05 was considered indicative of significance.
Results The characteristics of the patients were similar in the two groups except for the predominance of males in the standard-pressure
group (controls). The procedure was successful in 68 of 70 patients in the low-pressure group compared with in 70 patients
in the standard group. Operative time, number of analgesic injections, visual analogue score, and length of postoperative
days were similar in both groups. Incidence of shoulder tip pain was higher in the standard-pressure group, but not statistically
significantly so (27.9% versus 44.3%) (p = 0.100).
Conclusions Low-pressure pneumoperitoneum tended to be better than standard-pressure pneumoperitoneum in terms of lower incidence of shoulder
tip pain, but this difference did not reach statistical significance following elective laparoscopic cholecystectomy. 相似文献
7.
Matthew R. Cooperberg Christopher J. Kane Janet E. Cowan Peter R. Carroll 《BJU international》2010,105(1):88-92
Study Type – Therapy (case series)Level of Evidence 4
OBJECTIVE
To compare rates of lymph node dissection (LND) and nodal yields between patients treated with open radical retropubic prostatectomy (ORRP) and robot‐assisted RRP (RARP) in a contemporary single‐institution series.PATIENTS AND METHODS
Data from 1278 consecutive patients (716 ORRP and 562 RARP) from one institution were accrued prospectively in an institutional database, and the data analysed retrospectively. Disease risk was assessed using the Cancer of the Prostate Risk Assessment (CAPRA) score. The likelihood of LND, nodal yield, and likelihood of node positivity were compared between ORRP and RARP.RESULTS
Of patients treated with ORRP and RARP, 47.8% and 31.8% had LND, respectively, with more receiving LND over time in both surgical approaches. Men undergoing LND had a higher disease risk than those not undergoing LND (mean CAPRA score 4.3 vs 2.1, P < 0.01), and there was no difference in risk between those undergoing ORRP or RARP (mean CAPRA score 3.0 vs 2.9, P = 0.29). The mean (sd ) nodal yield was 14.4 (8.7) for ORRP and 9.3 (5.4) for RARP (P < 0.01). Among patients undergoing LND, 5.8% of ORRP and 4.1% of RARP patients had positive nodes (P < 0.01).CONCLUSIONS
The indications for LND and template dissection should be the same regardless of surgical approach. The nodal yield was adequate using both approaches; the yield was higher among ORRP than RARP patients, but the difference was not large, and is less remarkable than the wide variation in yield within each approach. Several factors might explain this variation. 相似文献8.
S. Ciechanowicz T. Setty E. Robson C. Sathasivam M. Chazapis J. Dick B. Carvalho P. Sultan 《British journal of anaesthesia》2019,122(1):69-78
Background
Whilst validated quality-of-recovery (QoR) tools exist for general surgery, there is no specific obstetric equivalent. We aimed to develop and evaluate a modified QoR score after elective Caesarean delivery.Methods
Twenty-two obstetric specific items were selected following review and modification of the QoR-40 survey by 16 experts and interviews with 50 stakeholders. Item selection was based on relevance to Caesarean delivery and endorsement by >66% of stakeholders. Items were tested on women pre-delivery, at 24 h, and 25 h post-delivery. An 11-item obstetric-specific QoR score (ObsQoR-11) was created based on correlation with a numerical rating scale (NRS) of global health status (r>0.20) at all time points. Reliability, responsiveness, acceptability, and feasibility were tested.Results
One hundred and fifty-two women responded to the 22-item questionnaire pre-delivery (complete in 146), 100 at 24 h, and 10 at 25 h. The ObsQoR-11 correlated with the global health status NRS (r=0.53; 95% confidence interval: 0.43–0.62; P<0.0001) and discriminated good vs poor recovery (NRS score ≥70 vs <70 mm) at 24 h. There was a negative correlation between the ObsQoR-11 score at 24 h and hospital length of stay (r=–0.39; P=0.003). ObsQoR-11 was reliable (internal consistency: 0.85; split-half 0.76; test–retest intra-class correlation coefficient ri>0.6 in 82% of items) and responsive (Cohen effect size: 1.36; standardised response mean: 0.85). A longer 22-item ObsQoR had high (97%) completion rates and short (median: 2 min) completion times.Conclusions
The ObsQoR-11 provides a valid, reliable, and responsive global assessment of recovery after elective Caesarean delivery. 相似文献9.
Vipul R. Patel Rafael F. Coelho Sanket Chauhan Marcelo A. Orvieto Kenneth J. Palmer Bernardo Rocco Ananthakrishnan Sivaraman Geoff Coughlin 《BJU international》2010,106(5):696-702
Study Type – Therapy (case series)Level of Evidence 4
OBJECTIVE
? To evaluate early trifecta outcomes after robotic‐assisted radical prostatectomy (RARP) performed by a high‐volume surgeon.PATIENTS AND METHODS
? We evaluated prospectively 1100 consecutive patients who underwent RARP performed by one surgeon. In all, 541 men were considered potent before RARP; of these 404 underwent bilateral full nerve sparing and were included in this analysis. ? Baseline and postoperative urinary and sexual functions were assessed using self‐administered validated questionnaires. ? Postoperative continence was defined as the use of no pads; potency was defined as the ability to achieve and maintain satisfactory erections for sexual intercourse >50% of times, with or without the use of oral phosphodiesterase type 5 inhibitors; Biochemical recurrence (BCR) was defined as two consecutive PSA levels of >0.2 ng/mL after RARP. ? Results were compared between three age groups: Group 1, ≤55 years, Group 2, 56–65 years and Group 3, >65 years.RESULTS
? The trifecta rates at 6 weeks, 3, 6, 12, and 18 months after RARP were 42.8%, 65.3%, 80.3%, 86% and 91%, respectively. ? There were no statistically significant differences in the continence and BCR‐free rates between the three age groups at all postoperative intervals analysed. ? Nevertheless, younger men had higher potency rates and shorter time to recovery of sexual function when compared with older men at 6 weeks, 3, 6 and 12 months after RARP (P < 0.01 at all time points). ? Similarly, younger men had higher trifecta rates at 6 weeks, 3 and 6 months after RARP compared with older men (P < 0.01 at all time points).CONCLUSION
? RARP offers excellent short‐term trifecta outcomes when performed by an experienced surgeon. ? Younger men had higher overall trifecta rates when compared with older men at 6 weeks, 3 and 6 months after RARP. 相似文献10.
Study Type – Therapy (content analysis) Level of Evidence 3
OBJECTIVE
To define the nature of information posted on websites related to radical prostatectomy (RP), specifically its accuracy and comprehensiveness, as RP is associated with erectile dysfunction (ED).METHODS
We reviewed 70 robotic RP (RARP) and 20 open RP (ORP) medical centres. Their websites were reviewed for various factors, by two separate reviewers whose reviews were not seen by each other. Websites were graded based on accuracy and comprehensiveness of information by the senior investigator.RESULTS
Of the academic and community‐based RARP centres, 55% and 79% had specific websites (P < 0.05); 45% of RARP sites had generic information copied directly from the website of Intuitive Surgical (Sunnyvale, CA, USA; the manufacturer of the robotic system). ED was mentioned by only 54% of RARP sites and 45% of ORP sites; 17% of RARP sites were deemed accurate, compared with 30% of ORP sites (P < 0.05). Just over 1% of RARP sites were considered comprehensive, vs 10% of ORP sites (P < 0.05). A third of RARP sites had a direct link to the Intuitive Surgical website (16% academic vs 53% community, P < 0.05), compared to 10% of open sites (P < 0.05). Of most interest was that half of the RARP sites suggested that ED rates were lower for RARP than for ORP; this compared to ED rates being cited as lower for ORP on 5% of the ORP sites (P < 0.05).CONCLUSIONS
Despite the stature of RP as a treatment option for men with prostate cancer, and the recent increase in the use of RARP, the accuracy of information pertaining to sexual health on RP websites is poor, with many making false statements about the long‐term outcomes for erectile function. This inadequacy appears to be greater on RARP than on ORP websites. 相似文献11.
Dennie Meijer Rosemarijn H. Ettema Pim J. van Leeuwen Theo H. van der Kwast Henk G. van der Poel Maarten L. Donswijk Daniela E. Oprea-Lager Elise M. Bekers André N. Vis 《BJU international》2023,131(3):330-338
Objectives
To investigate whether patients with suspected pelvic lymph node metastases (molecular imaging [mi] N1) on staging prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) had a different oncological outcome compared to those in whom the PSMA PET/CT did not reveal any pelvic lymph node metastases (miN0).Patients and Methods
All patients with pelvic lymph node metastatic (pN1) disease after robot-assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection (ePLND) between January 2017 and December 2020 were included. To assess predictors of biochemical progression of disease after RARP, a multivariable Cox regression analysis was performed, including number of tumour-positive lymph nodes, diameter of the largest nodal metastasis, and extranodal extension.Results
In total, 145 patients were diagnosed with pN1 disease after ePLND. The median biochemical progression-free survival in patients with miN0 on PSMA PET/CT was 13.7 months, compared to 7.9 months in patients with miN1 disease (P = 0.006). On multivariable Cox regression analysis, both number of tumour-positive lymph nodes (>2 vs 1–2: hazard ratio [HR] 1.97; P = 0.005) and diameter of the largest nodal metastasis (HR 1.12; P < 0.001) were significant independent predictors of biochemical progression of disease.Conclusion
Patients in whom pelvic lymph node metastases were suspected on preoperative PSMA imaging (miN1), patients diagnosed with >2 tumour-positive lymph nodes, and patients with a larger diameter of the largest nodal metastasis had a significantly increased risk of biochemical disease progression after surgery. 相似文献12.
OBJECTIVE
To determine the risk factors (clinical, pathological and technical) for positive surgical margins (PSMs) after robotically assisted radical prostatectomy (RARP), as a PSM is associated with an increased risk of biochemical recurrence and often responsible for significant patient anxiety.PATIENTS AND METHODS
Between November 2003 and March 2007, 216 consecutive patients had an RARP by one fellowship‐trained urological oncologist. The surgical pathological specimens were fixed and processed using standard techniques, and assessed by a pathologist at the same institution. A PSM was defined as the presence of cancer adjacent to the inked margin. The clinical charts were reviewed retrospectively under an approved institutional review board protocol. Univariable and multivariable methods, including logistic regression models, were used to analyse the clinical, pathological and technical risk factors for PSM.RESULTS
The overall prevalence of PSM was 14.8% (32/216), and 5.4% (8/149) for pT2 cancers. The only preoperative factor that was associated with a greater risk of a PSM was the serum prostate‐specific antigen (PSA) level (P = 0.012) and PSA density (P = 0.005). Age, clinical stage and clinical Gleason grade were not predictors of a PSM. The overall and pT2 PSM rate remained constant throughout the series of 216 patients (P = 0.371), indicating that the initial experience for RARP was not associated with a significantly greater risk of a PSM. However, there was a small independent ‘learning curve’ effect, with a lower rate of PSM associated with each increment of 25 patients (odds ratio 0.8, 95% confidence interval 0.6–1.0), supported by the significantly decreasing trend in PSM for pT3 cancers over time (P = 0.031) Although there was no significant increase over time in PSM with the use of an endostapler to control the dorsal venous complex (DVC), there was a significant learning effect, with a decrease in the PSM rate specifically in pT3 cancers using the suture technique (P = 0.005). A nerve‐sparing procedure increased the risk of PSM in multivariable analysis (P = 0.03). As expected, pathological stage and pathological Gleason grade were the strongest predictors of PSM (P < 0.001).CONCLUSION
The most important risk factors for a PSM after RARP are the preoperative PSA level, PSA density, pathological stage and Gleason grade. PSM rates for a surgeon in their initial experience can be comparable to that of a surgeon experienced in RARP. Using a stapling device to control the DVC does not appear to increase the risk of a PSM, although nerve‐sparing increases the rates of PSM in extraprostatic prostate cancer. 相似文献13.
Amihai Rottenstreich Ram Elazary Jonathan B. Yuval Galia Spectre Geffen Kleinstern Yosef Kalish 《Surgery for obesity and related diseases》2018,14(1):1-7
Background
Bariatric surgery is associated with increased thromboembolic risk, which may extend well beyond hospital stay. The hemostatic mechanisms implicated in this risk are not well established.Objectives
We aimed to determine the dynamics of hemostatic changes and procoagulant potential among patients undergoing laparoscopic sleeve gastrectomy, during both the early and late postoperative periods.Setting
A university hospital.Methods
Patients who underwent laparoscopic sleeve gastrectomy were recruited consecutively to this study. Blood samples were taken preoperatively, before discharge (postoperative day [POD] 3), and at the first follow-up visit (POD10). All samples were tested for complete blood count, C-reactive protein, von Willebrand factor, factor VIII, fibrinogen, and thrombin generation.Results
The median preoperative body mass index of the 26 participants was 41.3 (38.7–43.3) kg/m2. Compared with preoperative evaluation, fibrinogen, von Willebrand factor antigen and activity, and factor VIII levels were significantly higher at POD3 and POD10 (P<.0001 for all comparisons). Peak thrombin levels and endogenous thrombin potential (ETP) were higher at POD3 (P = .005 for both comparisons) and POD10 (P = .0009 and<.0001) compared with baseline. ETP and peak thrombin, as well as fibrinogen, von Willebrand factor, and factor VIII levels, were comparable between POD3 and POD10. Multivariate analysis showed that the only predictor of postoperative ETP was the preoperative ETP level (β = .55, P = .007).Conclusions
As determined by thrombin generation, laparoscopic sleeve gastrectomy was associated with hypercoagulability, which persisted during POD10. This finding suggests a possible benefit of extended thromboprophylaxis. Nevertheless, our results should be interpreted with caution due to the lack of a control group. 相似文献14.
Yoko Komori Yukio Iwashita Masayuki Ohta Yuichiro Kawano Masafumi Inomata Seigo Kitano 《Surgical endoscopy》2014,28(8):2466-2473
Background
A recent study demonstrated that high pressure of carbon dioxide (CO2) pneumoperitoneum before liver resection impairs postoperative liver regeneration. This study was aimed to investigate effects of varying insufflation pressures of CO2 pneumoperitoneum on liver regeneration using a rat model.Methods
180 male Wistar rats were randomly divided into three groups: control group (without preoperative pneumoperitoneum), low-pressure group (with preoperative pneumoperitoneum at 5 mmHg), and high-pressure group (with preoperative pneumoperitoneum at 10 mmHg). After pneumoperitoneum, all rats were subjected to 70 % partial hepatic resection and then euthanized at 0 min, 12 h, and on postoperative days (PODs) 1, 2, 4, and 7. Following outcome parameters were used: liver regeneration (liver regeneration rate, mitotic count, Ki-67 labeling index), hepatocellular damage (serum aminotransferases), oxidative stress [serum malondialdehyde (MDA)], interleukin-6 (IL-6), and hepatocyte growth factor (HGF) expression in the liver tissue.Results
No significant differences were observed for all parameters between control and low-pressure groups. The liver regeneration rate and mitotic count were significantly decreased in the high-pressure group than in control and low-pressure groups on PODs 2 and 4. Postoperative hepatocellular damage was significantly greater in the high-pressure group on PODs 1, 2, 4, and 7 compared with control and/or low-pressure groups. Serum MDA levels were significantly higher in the high-pressure group on PODs 1 and 2, and serum IL-6 levels were significantly higher in the high-pressure group at 12 h and on POD 1, compared with control and/or low-pressure groups. The HGF tissue expression was significantly lower in the high-pressure group at 12 h and on PODs 1 and 4, compared with that in control and/or low-pressure groups.Conclusions
High-pressure pneumoperitoneum before 70 % liver resection impairs postoperative liver regeneration, but low-pressure pneumoperitoneum has no adverse effects. This study suggests that following laparoscopic liver resection using appropriate pneumoperitoneum pressure, no impairment of liver regeneration occurs. 相似文献15.
Kaibo Sun MD Jinkui Pi MM Yuangang Wu MD Yi Zeng MD Jiawen Xu MD Limin Wu MD Mingyang Li MD Bin Shen MD 《Orthopaedic Surgery》2023,15(5):1249-1255
Objective
The implications of the interval of staged bilateral total knee arthroplasty (TKA) procedures for postoperative complications and costs are not clear. We aimed to determine the optimal time interval between the two stages of bilateral TKA procedures under the enhanced recovery after surgery (ERAS) protocol.Methods
This retrospective study of collected data included bilateral TKA cases under the ERAS protocol performed between 2018 and 2021 at the West China Hospital of Sichuan University. The staged time was subdivided into three groups according to the interval between the first TKA and second contralateral TKA: group 1: 2- to 6-month, group 2: 6- to 12-month, and group 3: >12 months. The primary outcome was the incidence of postoperative complications. The secondary outcomes were the length of hospital stay (LOS), hemoglobin (Hb) decrease, hematocrit (Hct) decrease, and albumin (Alb) decrease.Results
We analyzed 281 patients who underwent staged bilateral TKAs between 2018 and 2021 at the West China Hospital of Sichuan University. Regarding postoperative complications, there were no statistically significant differences among the three groups (P = 0.21). For the mean LOS, the 6- to 12-month group had a significantly shorter LOS compared with the 2- to 6-month group (P < 0.01). There was also a significant decrease in Hct of the 2- to 6-month group compared with the 6- to 12-month group and the >12 months group (P = 0.02; P < 0.05, respectively).Conclusion
Staging the second arthroplasty for more than a half year seems to offer a reduction in the rate of postoperative complications and LOS under ERAS protocol. ERAS shortens the interval of staged bilateral TKA by at least 6 months for patients who might receive their second surgery without the need to wait for an extended period. 相似文献16.
Rolf Svedjeholm Gabriele Ferrari Farkas Vanky Örjan Friberg Jonas Holm 《Acta anaesthesiologica Scandinavica》2023,67(10):1373-1382
Background
Glutamate plays a key role for post-ischaemic recovery of myocardial metabolism. According to post hoc analyses of the two GLUTAMICS trials, patients without diabetes benefit from glutamate with less myocardial dysfunction after coronary artery bypass surgery (CABG). Copeptin reflects activation of the Arginine Vasopressin system and is a reliable marker of heart failure but available studies in cardiac surgery are limited. We investigated whether glutamate infusion is associated with reduced postoperative rises of plasma Copeptin (p-Copeptin) after CABG.Methods
A prespecified randomised double-blind substudy of GLUTAMICS II. Patients had left ventricular ejection fraction ≤0.30 or EuroSCORE II ≥3.0 and underwent CABG ± valve procedure. Intravenous infusion of 0.125 M L-glutamic acid or saline at 1.65 mL/kg/h was commenced 10–20 min before the release of the aortic cross-clamp and then continued for another 150 min P-Copeptin was measured preoperatively and postoperatively on day one (POD1) and day three. The primary endpoint was an increase in p-Copeptin from the preoperative level to POD1. Postoperative stroke ≤24 h and mortality ≤30 days were safety outcomes.Results
We included 181 patients of whom 48% had diabetes. The incidence of postoperative mortality ≤30 days (0% vs. 2.1%; p = .50) and stroke ≤24 h (0% vs. 3.2%; p = .25) did not differ between the glutamate group and controls. P-Copeptin increased postoperatively with the highest values recorded on POD1 without significant inter-group differences. Among patients without diabetes, p-Copeptin did not differ preoperatively but postoperative rise from preoperative level to POD1 was significantly reduced in the glutamate group (73 ± 66 vs. 115 ± 102 pmol/L; p = .02). P-Copeptin was significantly lower in the Glutamate group on POD1 (p = .02) and POD 3 (p = .02).Conclusions
Glutamate did not reduce rises of p-Copeptin significantly after moderate to high-risk CABG. However, glutamate was associated with reduced rises of p-Copeptin among patients without diabetes. These results agree with previous observations suggesting that glutamate mitigates myocardial dysfunction after CABG in patients without diabetes. Given the exploratory nature of these findings, they need to be confirmed in future studies. 相似文献17.
Isaiah Levy Mark Finkelstein Khawaja Hassan Bilal Michael Palese 《Urologic oncology》2017,35(6):425-431
Objective
To determine the effect of frailty on patient outcomes including any complication, Clavien-Dindo IV (CDIV) (intensive care unit-level) complications, and 30-day mortality for robotic-assisted radical prostatectomies (RARP) patients in comparison to other predictive indices using the modified frailty index (mFI).Material and methods
Patients undergoing RARP from 2008 to 2014 for a prostate cancer–related diagnosis were queried using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. The mFI was developed using the Canadian Study of Health and Aging Frailty Index as a model. The mFI was compared with other associative indices such as the American Society of Anesthesiology (ASA) classification and the Charlson comorbidity index (CCI). Rates of CDIV complications and 30-day mortality were analyzed based on mFI score using SAS version 9.22.Results
A total of 23,104 patients undergoing RARP were queried. RARP patients with the highest frailty score (≥3) had an adjusted odds for CDIV complications of Odds ratio of 12.107 (CI: 2.800–52.351, P< 0.005) in comparison with nonfrail RARP patients. These odds were higher than the ASA and Charlson comorbidity index. Additionally, a variable combining mFI and ASA had fair sensitivity and specificity for predicting 30-day mortality in RARP patients (C-statistic = 0.7097, P<0.0001).Conclusion
Increasing mFI scores are associated with worsening outcomes for patients undergoing RARP. A combined mFI and ASA variable can be used to predict 30-day mortality for RARP patients better than mFI or ASA alone. 相似文献18.
Jonathan J. Aning Kenneth R. MacKenzie Michael Fabricius Elaine McColl Mark I. Johnson Zafer Tandogdu Naeem A Soomro Christopher Harding 《Urologic oncology》2018,36(8):364.e15-364.e22
Objective
To prospectively evaluate short- to medium-term patient-reported lower urinary tract symptoms (LUTS) and their effect on health-related quality of life (HRQoL) using validated questionnaires in a large cohort of patients following robotic-assisted radical prostatectomy (RARP) for prostate cancer.Materials and methods
HRQoL and LUTS outcomes were prospectively assessed in 357 consecutive men undergoing RARP at a single center from 2012 to 2015 using the functional assessment of cancer therapy—prostate (FACT-P) and the international consultation on incontinence modular questionnaire—male LUTS (ICIQ-MLUTS). Questionnaires were administered at baseline, 6, 12, and 18 months. Data were analyzed using paired t-tests and ANOVA.Results
Questionnaire completion rates were high (over 60% of eligible men completed 18-month follow-up). Mean Total FACT-P did not significantly change after RARP: 125.95 (standard deviation [SD] = 19.82) at baseline and 125.86 (SD = 21.14) at 18-months (P = 0.55). Mean total ICIQ-MLUTS also remained unchanged: 18.69 (SD = 10.70) at baseline and 18.76 (SD = 11.33) at 18-months (P = 0.11). Mean voiding score significantly reduced from 10.34 (SD = 5.78) at baseline to 6.33 (SD = 3.99) at 6 months after RARP (P<0.001). A reciprocal significant increase in storage score was observed: 5.34 (SD = 4.26) at baseline, 9.65 (SD = 5.71) at 6 months (P<0.001). Subanalyses of ICIQ-MLUTS scores revealed increases in storage symptoms were exclusively within urinary incontinence domains and included significant increases in both urge and stress urinary incontinence scores.Conclusion
Overall, patient-reported outcome measures evaluating HRQoL and LUTS do not significantly change after RARP. Detailed analysis reveals significant changes within LUTS domains do occur after surgery which could be overlooked if only total LUTS scores are reported. 相似文献19.
Randomized clinical trial of intraoperative parathyroid gland angiography with indocyanine green fluorescence predicting parathyroid function after thyroid surgery
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J. Vidal Fortuny S. M. Sadowski V. Belfontali S. Guigard A. Poncet F. Ris W. Karenovics F. Triponez 《The British journal of surgery》2018,105(4):350-357
Background
Hypoparathyroidism, the most common complication after thyroid surgery, leads to hypocalcaemia and significant medical problems. An RCT was undertaken to determine whether intraoperative parathyroid gland angiography with indocyanine green (ICG) could predict postoperative hypoparathyroidism, and obviate the need for systematic blood tests and oral calcium supplementation.Methods
Between September 2014 and February 2016, patients who had at least one well perfused parathyroid gland on ICG angiography were randomized to receive standard follow‐up (measurement of calcium and parathyroid hormone (PTH) on postoperative day (POD) 1 and systematic supplementation with calcium and vitamin D; control group) or no supplementation and no blood test on POD 1 (intervention group). In all patients, calcium and PTH levels were measured 10–15 days after thyroidectomy. The primary endpoint was hypocalcaemia on POD 10–15.Results
A total of 196 patients underwent ICG angiography during thyroid surgery, of whom 146 had at least one well perfused parathyroid gland on ICG angiography and were randomized. None of these patients presented with hypoparathyroidism, including those who did not receive calcium supplementation. The intervention group was statistically non‐inferior to the control group (exact 95 per cent c.i. of the difference in proportion of patients with hypocalcaemia –0·053 to 0·053; P = 0·012). Eleven of the 50 excluded patients, in whom no well perfused parathyroid gland could be identified by angiography, presented with hypoparathyroidism on POD 1, and six on POD 10–15, which was significantly different from the findings in randomized patients (P = 0·007).Conclusion
ICG angiography reliably predicts the vascularization of the parathyroid glands and obviates the need for postoperative measurement of calcium and PTH, and supplementation with calcium in patients with at least one well perfused parathyroid gland. Registration number: NCT02249780 ( http://www.clinicaltrials.gov ). 相似文献20.
Aaron D. Martin Premal J. Desai Rafael N. Nunez George L. Martin Paul E. Andrews Robert G. Ferrigni Scott K. Swanson Anna Pacelli Erik P. Castle 《BJU international》2009,103(12):1696-1698