Laparoscopic extraperitoneal adenomectomy (Millin): pilot study on feasibility

OBJECTIVE: The aim of the present work is to describe the surgical technique and to assess the feasibility of laparoscopic extraperitoneal adenomectomy in a pilot study. METHODS: Eighteen consecutive patients in whom an open adenomectomy was planned were operated on in a laparoscopic extraperitoneal fashion. In all patients indication was based on objective signs of obstruction. The laparoscopic approach was standard in all cases as follows: creation of a preperitoneal workspace, haemostatic control of lateral venous vesicoprostatic pedicles, transversal anterior incision of the prostate capsule, progressive enucleation of the adenoma with the help of an harmonic scalpel, suture of the posterior bladder neck to the prostate fossa, closure of the prostate capsule, and retrieval of the specimen.Feasibility was assessed by objective operative parameters (reconversion, operating time, and blood loss and transfusion requirements) and per operative complications. Data on short term follow-up are also available. RESULTS: Mean age of the patients was 67.8 years (S.D. 6.2) and mean prostatic weight calculated by TRUS 95.1cm(3) (S.D. 28.1). Mean maximal flow (Q(max)) was 4.3ml/s (S.D. 3.4) with four patients (22.2%) presenting in retention. Mean duration of intervention was 145min (S.D. 32.5) and mean blood loss 192ml (S.D. 178). Mean excised tissue was 47.6g (S.D. 30). Neither conversions to open prostatectomy nor transfusions were required. The urethral catheter remained in place an average of 3.0 days (S.D. 2.4) in 14 patients, while 4 needed a re-catheterization. Mean postoperative hospital stay was 5.9 days (S.D. 5.5). Five patients (27.7%) presented complications during follow-up, mild in most of the cases but one who required a secondary intervention for persistent obstruction. CONCLUSIONS: Laparoscopic extraperitoneal adenomectomy (Millin's procedure) is feasible with a reasonable complication rate. Although comparison with open adenomectomy is not yet available, this technique might have potential advantages in terms of blood loss and postoperative catheter time.     

Laparoscopic versus open surgery for extraperitoneal rectal cancer: a prospective comparative study

Background The role of laparoscopic resection (LR) in the management of extraperitoneal rectal cancer still is unclear. This study aimed to compare perioperative and long-term results of laparoscopic and open resection (OR) for low and midrectal cancer. Methods A prospective nonrandomized trial comparing patients submitted to OR or LR for low and midrectal cancer at a single institution was conducted. Results The study included 191 consecutive patients: 98 patients who underwent LR and 93 who underwent OR. The mean follow-up period was 46.3 months for LR and 49.7 months for OR. The conversion rate for LR was 18.4%. With the use of LR, the mean time for complete patient mobilization was shorter (1.7 vs 3.3 days; p < 0.001) and patients were earlier in passing flatus (2.6 vs 3.9 days; p < 0.001) and stools (3.8 vs 4.7 days; p < 0.01), and in resuming oral intake (3.4 vs 4.8 days; p < 0.001). The mean hospital stay was shorter for LR, but the difference did not reach significance (11.4 vs 13 days). Morbidity and mortality rates were similar: LR (24.4% and 1%) and OR (23.6% and 2.2%). Laparoscopic patients presented a higher rate of anastomotic fistulas (13.5% vs 5.1%) and reoperations (6.1% vs 3.2%) but the difference was statistically nonsignificant. Laparoscopic resection presented a significantly lower local recurrence rate (3.2% vs 12.6%; p < 0.05). The cumulative survival and disease-free rates at 5 years were, respectively, 80% and 65.4% after LR and 68.9% and 58.9% after OR (nonsignificant difference). Stage-by-stage comparison showed prolonged cumulative survival for stages III and IV cancer in LR (82.5% vs 40.5%; p = 0.006 and 15.8% vs 0%; p = 0.013, respectively) and a reduced rate of cancer-related death for stage III in LR (11.4% vs 51.9%; p = 0.001). Conclusions As compared with conventional open surgery, LR for low and midrectal cancer is characterized by a faster recovery and similar overall morbidity (but a higher rate of anastomotic leakages), and does not present any adverse oncologic effect.     

腹腔镜与开放性输尿管切开取石术的效果比较(附37例报告)

目的 :评价腹腔镜输尿管切开取石术与开放性输尿管切开取石术的临床价值。方法 :回顾分析腹腔镜输尿管切开取石术 15例 (A组 )及开放性输尿管切开取石术 2 2例 (B组 )的临床资料 ,并比较 2组的手术时间、术中出血量、术后肠功能恢复情况、术后下床活动时间、住院总天数、住院总费用、并发症等指标。结果 :A组在手术中出血、术后肠功能恢复情况、术后下床活动时间、住院总天数、并发症方面明显优于B组 ,差异有高度显著性 (P <0 .0 1)。B组在总住院费用优于A组 ,差异有高度显著性 (P <0 .0 1) ;手术时间两组差别无显著性意义 (P >0 .0 5 )。结论 :腹腔镜输尿管切开取石术同开放手术相比具有创伤小、恢复快、痛苦小的优点 ,中上段输尿管结石以腹膜后径路手术为佳。     

Laparoscopic versus open right hepatectomy: a comparative study

Background

The safety of laparoscopic major liver resections is still uncertain. The aim of this study was to compare our results for laparoscopic right hepatectomy (LRH) with those for open right hepatectomy (ORH).

Methods

Patients undergoing LRH were compared with retrospectively selected patients from our ORH database. The 2 groups were well matched for sex, age, American Society of Anesthesiologists score, body mass index, liver disease, and tumor size. Surgical and postsurgical outcomes were compared.

Results

Seventy-two patients were analyzed: 22 in the LRH group and 50 in the ORH group. Operating time was similar. Blood loss was significantly less in laparoscopic resections (P = .038). Specific morbidity rates were not different, general morbidity was lower after laparoscopy (P = .04), and the severity of postsurgical complications was not different. Mean hospital stay was significantly shorter after laparoscopy (P = .009).

Comments

Laparoscopy improved surgical and postsurgical outcomes for ORH in selected patients. This is the first comparative study to demonstrate an advantage of laparoscopy for a major liver resection. Prospective randomized studies with a greater number of cases are needed to confirm the role of laparoscopy in major liver resections.     

腹腔镜与开腹手术治疗结直肠癌的近期疗效观察

目的:对比分析腹腔镜与开腹手术治疗结直肠癌的近期临床疗效。方法:回顾分析2012年1月至2013年1月收治的91例结直肠癌患者的临床资料,根据住院号将患者分为两组,45例行开腹手术(开腹组),46例行腹腔镜手术(腹腔镜组),对比两组患者切口长度、手术时间、术中出血量、术后住院时间、术后切口感染率、术后止痛药使用人次、排气时间及淋巴结清扫数量等。采用SPSS 19.0统计软件进行统计分析。结果:腹腔镜组切口长度、术中出血量、手术时间、术后住院时间及术后止痛药应用人次优于开腹组,差异有统计学意义(P<0.05)。淋巴结清扫数量、排气时间、切口感染率两组相比差异无统计学意义(P>0.05)。结论:相较传统开腹手术,腹腔镜结直肠癌手术是安全、可行的,可取得与开腹手术相当的淋巴结清扫范围,且具有患者创伤小、术后疼痛轻等优点,但其远期效果尚需进一步研究。     

腹腔镜与开放手术治疗肾移植术后上尿路肿瘤的对比研究

目的:评价腹腔镜手术治疗肾移植术后上尿路肿瘤的应用价值.方法:回顾分析67例肾移植术后上尿路肿瘤患者施行手术治疗的临床资料.37例（A组）行腹腔镜根治性肾输尿管全长切除术,30例（B组）行开放手术,对比分析两组手术时间、术中出血量、术后肠功能恢复情况、术后下床活动时间、治疗费用、住院总费用、术后住院时间、并发症及术后肾...     

A comparative study on the short-term clinicopathologic outcomes of laparoscopic surgery versus conventional open surgery for transverse colon cancer

Background  The long-term oncologic stability of laparoscopic surgery for colon cancer was established, and laparoscopic surgery was accepted as an alternative to conventional open surgery for colon cancer. However, transverse colon cancer was excluded from the majority of the previous prospective studies. As a result, debate on laparoscopic surgery for transverse colon cancer continues. This study aimed to compare the clinicopathologic outcome of laparoscopic surgery with that of conventional open surgery for transverse colon cancer. Methods  From August 2004 to December 2007, 106 cases of transverse colon cancer were managed by resection at our institution, and 89 of these cases were included in this study. Age, sex, body mass index (BMI), operation time, blood loss, time to first flatus, time to start of diet, hospital stay, complications, tumor size, distal resection margin, proximal resection margin, and number of nodes harvested were compared between the two groups. Results  No significant differences were found between the laparoscopic and conventional groups in terms of age, sex, BMI, operation time, or hospital stay. The mean blood loss during the operations was significantly less in the laparoscopic group (113.8 ± 128.9 ml) than in the conventional group (278.8 ± 268.7 ml; p < 0.05). Moreover, the time to the first flatus was shorter (2.8 ± 0.9 days vs. 4.4 ± 2.0 days; p < 0.00) and the diet was started earlier (3.9 ± 1.7 days vs. 5.4 ± 1.9 days; p < 0.00) in the laparoscopic group. No intergroup differences in tumor size, proximal resection margin, or number of lymph nodes were observed. The mean distal resection margin was longer in the laparoscopic group (12.5 ± 4.1 cm vs. 9.2 ± 6.2 cm; p < 0.05). Conclusion  Laparoscopic and conventional open surgeries were found to have similar clinical outcomes in transverse colon cancer, and the oncologic quality of laparoscopic surgery was found to be acceptable compared with conventional open surgery.     

手助腹腔镜与开腹肝切除术的临床对照研究

目的：探讨手助腹腔镜肝切除术的可行性及微创性。方法：随机将60例肝切除患者分为两组,30例行手助腹腔镜肝切除术,30例行开腹肝切除术,比较两组的手术时间、术中出血量、切口长度、术后肛门排气时间、术后住院时间、术后并发症、术前及术后第1、4、7天C反应蛋白（CRP）及中性粒细胞的动态变化。结果：手助腹腔镜组与开腹组的平均手术时间（114.3minvs.105.8min）和切缘距肿瘤边缘（3.22cmvs.3.33cm）差异无统计学意义（P〉0.05）。手助腹腔镜组术中平均出血量明显少于开腹组（212mlvs.376.5ml,P〈0.05）,切口长度差异有统计学意义（6.95cmvs.22cm,P〈0.01）。手助腹腔镜组术后胃肠功能恢复时间明显早于开腹组（术后肛门排气时间2.34dvs.3.48d,P〈0.05）。手助腹腔镜组住院时间明显短于开腹组（8.35dvs.10.8d,P〈0.01）。手助腹腔镜组与开腹组均无严重并发症发生。两组术后第7天CRP值比较有显著差异（23.23vs.63.35,P〈0.05）。两组于术后第4天中性粒细胞值比较有显著差异（6.45vs.9.51,P〈0.05）。结论：手助腹腔镜肝切除安全可行,并且具有创伤小、术后康复快等特点,是值得选择的微创肝切除方式。     

腹腔镜与开腹手术治疗卵巢子宫内膜异位囊肿的比较

目的探讨卵巢子宫内膜异位囊肿腹腔镜手术的临床价值. 方法对52例卵巢内膜异位囊肿腹腔镜手术(腹腔镜组)与同期75例卵巢内膜异位囊肿开腹手术(开腹组)进行分析比较. 结果腹腔镜组手术时间(61.4±9.3)min比开腹组(72.6±7.1)min明显缩短(t=7.692,P=0.000);腹腔镜组术后排气时间(25.3±4.1)h明显早于开腹组(49.8±6.9)h(t=22.935,P=0.000);腹腔镜组术后病率(9/52)显著低于开腹组(31/75)(χ2=8.216,P=0.004);腹腔镜组术后痛经缓解率(26/37)与开腹组(34/51)无显著差别(χ2=0.128, P=0.818);腹腔镜组术后妊娠率(5/22)与开腹组(7/25)无显著差别(χ2=0.171,P=0.747). 结论腹腔镜手术治疗卵巢内膜异位囊肿疗效与开腹手术相同,是一种理想的治疗卵巢内膜异位囊肿的手术方式.     

Acquiring surgical skills: a comparative study of open versus laparoscopic surgery

OBJECTIVES: A preliminary study to evaluate the feasibility of a protocol for comparing the learning curves for open and laparoscopic surgical procedures. PARTICIPANTS AND METHODS: Thirteen pre-clinical medical students with no previous surgical training were given intensive coaching in open and laparoscopic surgical techniques for 12 weeks. At the end of this period, their open and laparoscopic skills were assessed by three independent examiners. Individual and aggregate ability scores in various aspects of open and laparoscopic surgery and the time taken to perform the procedures were compared using Student's t-test. RESULTS: There was no statistically significant difference in the overall scores by the two different techniques ( p=0.057 ). However, differences between the two techniques were significant in certain criteria including tissue dissection (p=0.024), tidiness of gall bladder (p=0.034 ) and liver ( p=0.016 ) specimens and the time taken for the two techniques ( p < or = 0.001 ). CONCLUSIONS: This study suggests that when inexperienced subjects are given equal training in laparoscopy and open surgery, the overall skills acquired were similar by both methods when assessed after 6 weeks. However, on detailed analysis of the different components of surgery, the laparoscopic skills were deficient in finer dissection, identification of correct planes and two-dimensional perception when compared to open surgery and required more operative time. Our study group perceived that laparoscopy was more difficult to learn than open surgery even after the training. The study group also felt that the training in basic surgical skills during their undergraduate careers would make them more interested in studying surgery and choosing it as a career.     

急性腹膜炎腹腔镜手术与开腹手术的对比研究

目的:探讨急性腹膜炎腹腔镜手术与开腹手术的临床效果.方法:回顾分析2005年1月至2011年1月为332例急性腹膜炎患者施行腹腔镜手术的临床资料,同期为253例急性腹膜炎患者施行开腹手术,并对比分析两组手术时间、术后下床时间、通气时间、住院时间、止痛剂使用、粘连性肠梗阻发生例数等.结果:两组均无相关脏器损伤等并发症发生...     

Laparoscopic appendicectomy versus open appendicectomy: a comparative study of clinical outcome and cost analysis — Institutional experience

Background  

Laparoscopic appendicetomy had not gained importance against open appendicectomy and it remains controversial in Indian perspective.     

腹腔镜与开放手术治疗急性穿孔性阑尾炎的对比研究

目的:探讨腹腔镜手术治疗急性穿孔性阑尾炎的手术效果及临床价值。方法:回顾分析2010年9月至2015年9月收治的253例穿孔性阑尾炎患者的临床资料,其中115例行腹腔镜阑尾切除术(laparoscopic appendectomy,LA),为LA组;138例行开腹阑尾切除术(open appendectomy,OA),为OA组,对比两组手术时间、肠道功能恢复时间、住院时间、切口感染率、腹腔脓肿发生率。结果:两组均无围手术期死亡病例,均无粪漏发生。LA组较OA组手术时间短[(59.07±11.38)min vs.(79.24±13.84)min,P0.001];肠功能恢复快[(16.77±2.49)h vs.(23.72±3.69)h,P0.001];住院时间短[(5.78±0.98)d vs.(7.24±1.17)d,P0.001],切口感染发生率低(2/115 vs.15/138,P=0.004),术后腹腔脓肿发生率两组差异无统计学意义(6/115 vs.5/138,P=0.536)。结论:LA治疗急性穿孔性阑尾炎较传统手术方式具有明显优势,具有临床推广价值。     

Pediatric inguinal hernia: laparoscopic versus open surgery

BACKGROUND AND OBJECTIVES: Herniotomy/open surgery (OS) has been the time honored treatment for pediatric inguinal hernia (PIH). Laparoscopic surgery (LS) has recently emerged as an alternative in its management. However, controversy is rife on its feasibility and wider adoption. The present need is to know whether a significant difference exists in the surgical outcomes following either technique. METHODS: In a prospective study between January and December 2006, 85 children underwent either LS (51) or OS (34) for PIH. Operation time, intra- and postoperative complications, postoperative pain, postoperative stay, cosmesis, and the size of testis were recorded and compared for differences in outcome. Patients were followed up for an average of 3.5 months. RESULTS: All in the open group had unilateral (UL) hernias. The laparoscopy group had 6 (11.8%) bilateral (BL) hernias, and 10 (22.2%) contralateral patencies of processus vaginalis (CPPV) were detected intraoperatively and repaired simultaneously. Bilateral repairs were excluded from comparative analysis. LS was slightly quicker than OS to perform [25.31 min vs 30.65 min (P=0.06)]. The difference in pain perception, between LS and OS, was insignificant. Immediate postoperative recovery was delayed in more children undergoing LS (P=0.02), but the duration of hospital stay was similar (P=0.37). Complication rates were similar (P=0.96). Cosmesis in LS was superior to that in OS. CONCLUSIONS: Well-performed conventional herniotomy yields results similar to those of laparoscopic repair. Cosmesis and the ability to detect and simultaneously repair CPPV are the 2 main advantages of LS over OS. Keeping in mind the low incidence of meta-chronicity in UL hernias, insignificance of cosmesis over the groin, and the constraints of the developing world, conventional open herniotomy can justly be performed for UL hernias, as the standard of care, in centers lacking laparoscopy.     

A comparative study of standard versus laparoendoscopic single-site surgery (LESS) totally extraperitoneal (TEP) inguinal hernia repair

Background  

Laparoscopic inguinal hernia repair has been around since the 1990s. A novel surgical approach known as laparoendoscopic single-site surgery (LESS) has been developed to reduce the port-related morbidities and improve the cosmetic outcomes of laparoscopic surgery, including totally extraperitoneal (TEP) inguinal hernia repair. The aim of the present study was to evaluate the safety and feasibility of the LESS TEP technique for inguinal hernia repair and compare the outcomes with the standard TEP approach.     

Laparoscopic vs open hepatic resection: a comparative study

Background: Although the feasibility of minor laparoscopic liver resections (LLR) has been demonstrated, data comparing the open vs the laparoscopic approach to liver resection are lacking. Methods: We compared 30 LLR with 30 open liver resections (OLR) in a pair-matched analysis. The indications for resection were malignant disease in 47% of the LLR and 83% of the OLR. The average size of the lesions was 42 mm for LLR and 41 mm for OLR. Five wedge resections, 12 segmentectomies, and 13 bisegmentectomies were performed in each group. Results: The conversion rate for LLR was nil. The mean operative time was 148 min for LLR and 142 min for OLR. Mean blood loss was minimal in the LLR group (320 vs 479 ml; p < 0.05). Postoperative complications occurred in 6.6% of the patients in each group; there were no deaths. The mean postoperative hospital stay was shorter for LLR patients (6.4 vs 8.7 days; p < 0.05). In tumors, the resection margin was <1 cm in 43% of the LLR patients and 40% of the OLR patients (p = NS). Conclusions: Minor LLR of the anterior segments has the same rates of mortality and morbidity as OLR. However, the laparoscopic approach reduces blood loss and postoperative hospital stay.     

后腹腔镜肾盂输尿管切开取石术技术改进的探讨

目的 :探讨对后腹腔镜肾盂输尿管切开取石术进行技术改进。方法 :分析 6 6例后腹腔镜肾盂输尿管切开取石术 (LS组 )与同期 5 0例开放取石术 (Open组 )患者资料 ,从手术学的角度比较两者差别 ,以改进后腹腔镜技术。结果 :LS组手术成功率 94 % ,Open组 10 0 %。手术时间LS组 6 5～ 2 4 0min ,平均 130min ,后期 2 0例平均 95min ;Open组 4 0～ 15 0min ,平均 6 8min(P <0 .0 1)。出血量LS组 10～ 4 0ml,平均 2 0ml;Open组 5 0～15 0ml,平均 10 0ml(P <0 .0 1)。术后留置导尿时间LS组 1～ 11d ,平均 4d ;Open组 1～ 11d ,平均 4d(P >0 .0 5 )。放置引流管时间LS组 2～ 2 1d ,平均 5d ;Open组 0～ 6d ,平均 3d(P <0 .0 1)。两组术后均留置输尿管支架管 ,双J管术后 1个月拔除。住院时间LS组 6～ 17d ,平均 10d ;Open组 6～ 12d ,平均 10d(P >0 .0 5 )。并发症LS组尿漏 3例 ,7～ 11d自愈 ,无伤口疼痛 ,康复时间 10d ;Open组有伤口疼痛 ,康复时间 30d ,并有切口区长期麻木、异感、肌肉瘫痪等。手术费用LS组平均 74 2 2元 /人 ,Open组平均 4 6 12元 /人 (P <0 .0 1)。结论 :后腹腔镜肾盂输尿管切开取石术微创、安全、有效 ,操作在改进 ,技术在进步     

Laparoscopic versus open splenectomy: a comparative study

Laparoscopic splenectomy (LS) is gaining wide acceptance as a safe, effective alternative to open splenectomy (OS) in the treatment of hematologic disorders in adult and pediatric patients, with low conversion rates and complications. The aim of this retrospective case-control study was to compare two cohorts of patients, with similar characteristics, who underwent OS or LS in a single institution. The medical records of the initial 20 consecutive patients who underwent LS were reviewed and compared with a control group of 28 patients undergoing OS, matched for age, gender, diagnosis, splenic size and weight, and American Society of Anesthesiologists score. Data were collected regarding operative time, blood loss, blood transfusions, pathologic findings, accessory spleen detection, complications, ileus duration, and postoperative hospital stay. Nineteen patients underwent attempted LS. One procedure (5%) was converted to OS for uncontrolled hilar bleeding. Accessory spleens were detected in two cases in the LS group compared with four cases in the OS group (14%). Mean operative time was 165 minutes (range: 100-240 minutes) for LS and 114 minutes (75-180 minutes) for OS (P < 0.001). In the LS group a regular diet was tolerated 36 hours (range: 24-48 hours) after surgery compared with 72 hours (range: 48-96 hours) for the OS group (P < 0.001), and mean postoperative hospital stay was 4.1 days (range: 3-8 days) for LS, compared with 8.1 days (range: 5-12 days) for OS (P < 0.001). No differences were observed in blood loss, complication rates, or transfusion requirements. Compared with OS, LS requires more operative time (showing a learning curve), is comparable in blood loss, transfusion requirements, complication rates, and detection of accessory spleens and appears to be superior in terms of return of bowel function and hospital stay.