ABSTRACT
Objective:To analyze the effects of umbilical laparoendoscopic single-site surgery (U-LESS) and conventional laparoscopic appendectomy (CLS) on the treatment of acute appendicitis in children by using Meta-analysis. To evaluate the effectiveness and safety of U-LESS in treating acute appendicitis in children.Methods:The English databases Pubmed, Web of Science, the Cochrane Library, Clinical trials, CNKI, Weipu Database, Wanfang Medical Network Database, CBM literature and other Chinese databases were retrieved, and the relevant literature of the comparative study of U-LESS and CLS in the treatment of pediatric acute appendicitis was found, and the quality analysis and application of the selected comparative studies were carried out. RevMan5.3 and stata software were employed to compare the operation time, intraoperative blood loss, postoperative exhaust time, postoperative intestinal recovery time, incision length, postoperative hospital stay time, postoperative complications, etc. of different surgical procedures.Results:A total of 19 literature were included in this study, and a total of 2133 cases were included, including 1021 cases in the U-LESS group and 1112 cases in the CLS group, all of which were retrospective case-control studies. Meta analysis showed that the operation time in U-LESS was shorter than that in CLS (95%CI [-9.05, -3.17], Z=4.07, P<0.001) , and the intraoperative bleeding volume of U-LESS was less than that of CLS (95%CI [-15.28, -5.01], Z=3.87, P<0.001) , incision length was shorter in U-LESS than in CLS (95%CI [-1.40, -1.27], Z=39.30, P<0.001) , the postoperative exhaust time of U-LESS was shorter than that of CLS (95%CI [-8.63, -5.89], Z=10.37, P<0.001) , and the recovery time after U-LESS was shorter than that after CLS (95% CI, 95% CI, P<0.001) . U-LESS and CLS did not differ significantly in postoperative length of stay (95%CI [-1.33, -0.64], Z=5.61, P<0.001) . U-LESS had fewer postoperative complications compared with CLS (95%CI [0.24,0.52], Z=5.27, P<0.001) . Conclusion:For pediatric acute appendicitis, U-LESS is safe and feasible, and has the advantages of shortening the operation time and reducing intraoperative bleeding.
ABSTRACT
Introduction: Idiopathic clubfoot or congenital talipesequinovarus is characterized by an excessively turned-infoot and a high medial longitudinal arch is the commonestcongenital foot deformities having 1 in every 1000 childrenborn worldwide. Though described long back, there has beenan interest towards Ponseti method of conservative treatmentof clubfoot recently. Our study was aimed to assess theefficacy of Ponseti technique in correcting congenital talipesequinovarus deformity of foot.Material and methods: 65 patients were enrolled in the studyout of which 47 patients were available for final follow-up. Allpatients presenting with CTEV with age up to 2 years wereincluded and patients more than 2 years, operated cases andsyndromic clubfoot were excluded. We treated all patientswith Ponseti method of serial casting and tenotomy.Results: Out of the total 65 feet studied, 42 feet (64.62%)required tendo achilles tenotomy and 23 feet (35.38%) weretreated with casting alone and tenotomy was not required.In our study, there were 8 cases of relapes (12.31%).Out ofthese, 7 were idiopathic and 1 was syndromic. Out of these 8relapses, 2 required repeat tenotomy and 6 were treated withcasting as per ponseti technique. Complications due to plasterwere minimal in our study. Incidence of rocker bottom feet inour study is nil because of dedicated clubfoot manipulation inclubfoot clinic and patients were followed up regularly.Conclusion: To conclude, this study showed that clubfootdeformity can be managed successfully provided the techniqueand details of manipulation described by Ponseti are followedstrictly and patients can be followed up regularly by a team ofdedicated orthopedic surgeons.
ABSTRACT
PURPOSE: Single incision laparoscopic appendectomy (SILA) is a widely used surgical procedure for treatment of appendicitis with better cosmesis. However, many surgeons generally tend to choose conventional multiport laparoscopic appendectomy regarding with complicated appendicitis. The aim of this study is to demonstrate the safety and feasibility of SILA for treatment of complicated appendicitis by comparison with 3-ports conventional laparoscopic appendectomy (CLA). METHODS: Retrospective chart review of patients diagnosed appendicitis at single hospital during January 2015 to May 2017 collected 500 patients. Among 134 patients with complicated appendicitis, we compared outcomes for 29 patients who got SILA and 105 patients who got CLA. RESULTS: 179 and 321 patients were treated by SILA and CLA, respectively. 134 (26.8%) patients were treated for complicated appendicitis, 29 patients by SILA and 105 patients by CLA, respectively. There was no case converted to open or added additional trocar in both groups. There were no differences in demographics with regard to age, sex, body mass index (BMI), and American society of anesthesiologists (ASA) scores. There was no difference in mean operating time (58.97±18.53 (SILA) vs. 57.57±21.48 (CLA), p=0.751). The drain insertion rate (6.9% vs 37.1%, p=0.001) and the length of hospital stay (2.76±1.41 vs. 3.97±2.97, p=0.035) were lower in SILA group with significance. There was no significant difference in the rate of surgical site infection (6.9% vs. 6.7%, p=1.000). CONCLUSION: This study demonstrates that SILA is a feasible and safe procedure for treatment of complicated appendicitis.
Subject(s)
Humans , Appendectomy , Appendicitis , Body Mass Index , Demography , Length of Stay , Retrospective Studies , Surgeons , Surgical Instruments , Surgical Wound InfectionABSTRACT
Objective To evaluate the safety, feasibility and other potential advantages of laparoendoscopic single-site surgery (LESS) compared to conventional laparoscopic surgery (CLS) for tubal pregnancy. Methods We manually searched Pubmed, the Cochrane Library, web of science, CNKI and China Biology Medicine for the relevant references about comparison of single-port laparoscopic salpingectomy with multi-port laparoscopic salpingectomy in the treatment of tubal pregnancy. The quality of the studies was evaluated, then meta-analysis was conducted using RevMan 5.3 software. Result Eventually, 2 RCTS and 14 retrospective studies including a total of 1541 cases were identi昀ed. The results of the meta-analysis for LESS versus CLS were as follows: a longer operative time [WMD=8.54, 95%CI (2.43, 14.64), P = 0.006], no significant differences in terms of total complications [OR= 0.68, 95%CI (0.27,1.71), P = 0.410]/operative blood loss [WMD = -0.01, 95%CI (-2.51,2.48), P = 0.990]/gastrointestinal function recovery time [WMD = -0.45, 95%CI (-1.72,0.82), P = 0.490], but shorter hospital stay [WMD=-0.40, 95% (-0.75, -0.06), P = 0.020], less postoperative analgesic treatment [OR= 0.38, 95%CI (0.22,0.67), P = 0.000]. Conclusions LESS for surgical treatment of tubal pregnancy is safe and feasible with shorter hospitalstay, less postoperative pain. LESS may therefore be a feasible alternative of CLS in the surgical approach of tubal pregnancy.
ABSTRACT
The present meta-analysis was conducted to compare the clinical effect and patient experience of laparoendoscopic single-site varicocelectomy (LESSV) and conventional laparoscopic varicocelectomy. The candidate studies were included after literature search of database Cochrane Library, PubMed, EMBASE, and MEDLINE. Related information on essential data and outcome measures was extracted from the eligible studies by two independent authors, and a meta-analysis was conducted using STATA 12.0 software. Subgroup analyses were conducted by study design (RCT and non-RCT). The odds ratio (OR) or standardized mean difference (SMD) and their 95% confidence intervals (95% CIs) were used to estimate the outcome measures. Seven articles were included in our meta-analysis. The results indicated that patient who had undergone LESSV had a shorter duration of back to work (overall: SMD = -1.454, 95% CI: -2.502-0.405, P = 0.007; non-RCT: SMD = -2.906, 95% CI: -3.796-2.017, P = 0.000; and RCT: SMD = -0.841, 95% CI: -1.393-0.289, P = 0.003) and less pain experience at 3 h or 6 h (SMD = -0.447, 95% CI: -0.754-0.139, P = 0.004), day 1 (SMD = -0.477, 95% CI: -0.905-0.05, P = 0.029), and day 2 (SMD = -0.612, 95% CI: -1.099-0.125, P = 0.014) postoperatively based on RCT studies. However, the meta-analyses based on operation time, clinical effect (improvement of semen quality and scrotal pain relief), and complications (hydrocele and recurrence) yielded nonsignificant results. In conclusion, LESSV had a rapid recovery and less pain experience over conventional laparoscopic varicocelectomy. However, there was no statistically significant difference between the two varicocelectomy techniques in terms of the clinical effect and the incidence of hydrocele and varicocele recurrence. More high-quality studies are warranted for a comprehensive conclusion.
ABSTRACT
PURPOSE: Laparoscopic surgery for left-sided colon cancer is one of the most frequent procedures performed in laparoscopic colorectal surgery. In this study, we analyzed clinical and long-term oncological outcomes of left-sided colon cancer patients who underwent conventional laparoscopic surgery (CLS) and hand-assisted laparoscopic surgery (HALS).METHODS: A total of 172 CLS patients and 72 HALS patients for left-sided colon cancer from July 2001 to December 2011 were included in this study. The collected data included the clinical and oncological outcomes. We analyzed overall survival and disease-free survival by tumor, node, metastasis (TNM) stage.RESULTS: The mean age of the patients was 64 years, and male patients were predominant. The mean follow-up period was 58.1 months. The number of patients that belong in each TNM stage 0, I, II, III, and IV was as follows: 17 (7%), 47 (19.2%), 70 (28.7%), 80 (32.8%), and 30 (12.3%), respectively. Overall 5-year survival rate for TNM stage I, II, III, and IV was 87.1%, 82.8%, 82%, and 12%, respectively. Overall 5-year survival rate for CLS group and HALS group was 90.2% and 66.7%, 86.5% and 77%, 88.7% and 67.4%, and 18.9% and 0%, respectively. Disease-free 5-year survival rate for TNM stage I, II, and III was 97.7%, 90.7%, and 72.8%, respectively. Disease-free 5-year survival rate for CLS group and HALS group was 97.3% and 100%, 100% and 78.8%, and 81% and 55.1%, respectively.CONCLUSION: These data show the feasibility and safety of laparoscopic surgery for left-sided colon cancer in terms of long-term oncological outcomes.
Subject(s)
Humans , Male , Colon , Colonic Neoplasms , Colorectal Surgery , Disease-Free Survival , Follow-Up Studies , Hand-Assisted Laparoscopy , Laparoscopy , Neoplasm Metastasis , Survival RateABSTRACT
PURPOSE: Currently the substantial clinical benefits of single-port laparoscopic appendectomy (SLA) over conventional three-port laparoscopic appendectomy (CLA) are equivocal. The aim of this study was to compare surgical outcomes between SLA and CLA in children with acute appendicitis. METHODS: A single blind prospective randomized single center study was performed to compare the surgical outcomes of SLA and CLA. A total of 105 patients were randomized and various parameters were analyzed, 52 patients with SLA and 53 patients with CLA between July 2013 and March 2014. Patients with sonographically confirmed acute appendicitis were randomly assigned to receive either SLA or CLA. The outcome measurements were operating time, wound complication, and intraperitoneal morbidities, postoperative pain score and cosmetic result score. RESULTS: Operating time is significantly longer in SLA (70.4+/-26.7 minutes vs. 58.0+/-23.4 minutes; p=0.016). There were no significant differences in the postoperative wound complication rate and intraperitoneal morbidities between two groups. There were no significant differences in postoperative resting pain score (6.6+/-2.5 vs. 6.3+/-2.5; p=0.317) and activity pain score (6.9+/-2.4 vs. 6.3+/-2.5; p=0.189), and the cosmetic result score (9.2+/-1.1 vs. 9.1+/-1.4; p=0.853). CONCLUSION: Although SLA would be a safe and feasible procedure in children, SLA could not demonstrate the clear benefit over CLA.
Subject(s)
Child , Humans , Appendectomy , Appendicitis , Pain, Postoperative , Prospective Studies , Wounds and InjuriesABSTRACT
Objective To compare the therapeutic effects of embryonic nature orifice transumbilical endoscopic surgery(ENOTES) with conventional laparoscopic(CL) surgery in Hirschsprung disease(HD).Methods A total of 111 children from Sep.2009 to Dec.2010 were included in the retrospective study.The patients were divided into 2groups:ENOTES group (66 cases) and CL group (45 cases).The general conditions of children were reviewed operative situation,postoperative complications and defecation 1 year after operation.Results In the left colectomy,there was no difference between 2 groups in age,weight,operative blood loss and postoperative stay (all P ＞ 0.05),but ENOTES took up less time than CL(P ＜ 0.05) ;in the subtotal colectomy,no significant difference existed in all series.All children underwent primary radical surgery,neither transfer to open surgery nor dead case.In ENOTES group,there were 9 cases suffering from enterocolitis postoperatively (13.6％),while 7 cases (15.6％) in CL group.Twenty-eight patients in ENOTES group and 12 in CL group were followed up for 1 year.Less abdominal distension postoperatively was noted in ENTOES group than CL group(P ＜ 0.05),but no other difference in other available data.In addition,no obvious operative scar was noted on the abdomen in ENOTES group,what meant better cosmetic benefit than CL.Conclusion HD treated with ENOTES can gain the same outcomes with CL with better cosmetic effect.
ABSTRACT
ObjectiveTo summarize the initial experience of transumbilical laparoendoscopic single-site surgery of urology.MethodsFrom February 2010 to March 2011,21 patients underwent laparoendoscopic single-site surgery using transumbilical single-site and common surgical instruments of laparoendoscopic.Nine patients underwent single-site laparoscopic ureterolithotomy,5 underwent transumbilical single-site laparoscopic ureteral stricture resection and anastomosis,5 underwent transumbilical single-site laparoscopic renalcyst unroofing and 2 had a nephrectomy.All of the cases were definitely diagnosed.A single umbilical incision of 1.5 cm to 2.5 cm was made for Triport.The procedures were performed according to the methods used in classical laparoscope methods using general instruments.ResultsAll the operations were successfully completed without conversion to open surgery.The mean operative time of ureterolithotomy was 143 (120-230) min,the mean operative time of ureteral stricture resection and anastomosis was 157 (120 -180) min,the mean operative time of unroofing of renal cysts was 110 (95 -132) min,and the operative time of the nephrectomy was from 95 to 120 min.The intestinal tract function recovered within 1 -2 d,the drainage tube was removed within 2 -3 d and the postoperative hospitalization duration was 4 -7 d.The symptoms were reduced or disappeared and no major intraoperative or postoperative complications occurred within 4 - 6 months.Conclusions Transumbilical laparoendoscopic single-site surgery represents a safe and feasible operation for urologic patients.With more clinical practice,laparoendoscopic single-site surgery could be generally applied.
ABSTRACT
La colecistectomía laparoscópica convencional ha presentado muchas modificaciones con el advenimiento de los desarrollos tecnológicos. Presentamos la colecistectomía laparoscópica con reducción de puertos que agrega una alternativa segura y confiable. Objetivo: Proporcionar una alternativa a la colecistectomía convencional laparoscópica y también a las técnicas que utilizan sólo el ombligo, con sus diferentes dispositivos y pinzas especiales. Trabajo realizado en el Centro Médico "Rafael Guerra Méndez". (CMGR) y Clínica Docente Los Jarales. (CDLJ). Pacientes y métodos: Entre agosto del 2010 y abril del 2011, ochenta y cinco pacientes fueron sometidos a colecistectomía con reducción de puertos. Se incluyeron en el estudio casos agudos y casos crónicos: litiasis vesicular, colecistitis aguda, pólipo vesicular, discinesia biliar e hidrocolecisto. A la totalidad de los pacientes se les realizó la colecistectomía laparoscópica con reducción de puertos. Conclusión: La colecistectomía con reducción de puertos es una técnica segura y confiable, que no amerita dispositivos ni pinzas especiales. Además posee una curva de aprendizaje menor que otras técnicas transumbilicales puras(AU)
Conventional laparoscopic cholecystectomy has brought many changes with the advent of technological developments. We introduce laparoscopic cholecystectomy by port reduction that adds a safe and reliable alternative. Study performed at Centro Médico "Rafael Guerra Méndez" (CMGR) y Clínica Docente Los Jarales. (CDLJ). Objective: To provide an alternative to conventional laparoscopic cholecystectomy as well as techniques that uses only one incision, with its different devices and special laparoscopic devices. Patients and methods: Between August 2010 and April 2011, eighty-five patients underwent cholecystectomy with port reduction. Acute and chronic cases were included in the study such as gallstones, acute cholecystitis, gallbladder polyp, hydrocholecystis and biliary dyskinesia. For all the patients we performed laparoscopic cholecystectomy with port reduction. Conclusion: The cholecystectomy with port reduction is a safe and reliable technique, which does not merit special devices or clips. In addition, it has a smaller learning curve than other techniques transumbilical purely(AU)
Subject(s)
Humans , Male , Female , Surgical Instruments , Cholecystectomy, Laparoscopic , Umbilicus , Gallstones , Acute Disease , Equipment and Supplies , GallbladderABSTRACT
PURPOSE: The aim of our study was to compare single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC) with respect to clinical outcomes. METHODS: Patients with less than a 28 body mass index (BMI) and a benign gall bladder disease were enrolled in this study. From January 2011 to February 2012, 30 consecutive patients who underwent SILC were compared with 30 patients who underwent CLC during the same period. In this study, all operations were performed by one surgeon. In each group, patient characteristics and perioperative data were collected. RESULTS: There was no significant difference in the preoperative characteristics. There was no significant difference in the postoperative laboratory result (alanine aminotransferase, aspartate aminotransferase, and alanine aminotransferase), number of conversion and complication cases, and length of hospital stay. The operation time was significantly longer in the SILC group (78.5 +/- 17.8 minutes in SILC group vs. 34.9 +/- 5.75 minutes in CLC group, P < 0.0001). The total nonsteroidal antiinflammatory drug usage during perioperative period showed significantly higher in SILC groups (162 +/- 51 mg in the SILC group vs. 138 +/- 30 mg in the CLC group), but there was no statistically significant difference in opioid usage between two groups. The postoperative pain score was significantly higher in the SILC group at second, third, and tenth postoperative day. Satisfaction of postoperative wound showed superiority in SILC group. CONCLUSION: SILC seems to be an acceptable alternative to CLC with acceptable results. However, it is not enough to propose any real benefits of SILC when compared with CLC in terms of operation time and postoperative pain.
Subject(s)
Humans , Alanine , Aspartate Aminotransferases , Body Mass Index , Cholecystectomy, Laparoscopic , Gallbladder Diseases , Length of Stay , Pain, Postoperative , Perioperative Period , Prospective StudiesABSTRACT
OBJECTIVE: To evaluate the safety and feasibility of single-port access laparoscopically assisted vaginal hysterectomy (SPA-LAVH) using conventional laparoscopic instruments compared to multi-port access laparoscopically assisted vaginal hysterectomy (MPA-LAVH). METHODS: We reviewed the medical records of 220 patients with uterine leiomyoma or adenomyosis who underwent 110 SPA-LAVH and 110 MPA-LAVH in Incheon St. Mary's Hospital between April 2007 and November 2009. We performed SPA-LAVH with conventional rigid straight laparoscopic instruments in all cases. We also performed a new vaginal cuff closure method, Kim's Vaginal Vault Suspension Method, named after the operator (Kim, YW) in both SPA-LAVH and MPA-LAVH. RESULTS: There was no significant difference in patients' age, operating time, uterine weight, hemoglobin change, frequency of blood transfusion, and incidence of postoperative fever between the two groups. The patients' mean age was 46.1+/-7.0 years (SPA-LAVH) and 45.5+/-6.3 years (MPA-LAVH). The mean operating time was 87.2+/-21.0 minutes (SPA-LAVH) and 83.3+/-20.3 minutes (MPA-LAVH). The mean uterine weight was 261.4+/-139.7 g (SPA-LAVH) and 257.8+/-132.9 g (MPA-LAVH). The mean hemoglobin change was 1.1+/-0.7 g/dL (SPA-LAVH) and 1.2+/-0.6 g/dL (MPA-LAVH). Neither bowel injury nor urinary tract injury occurred during the operation in the two groups. One of the SPA-LAVH and one of the MPA-LAVH cases were converted to abdominal total hysterectomy. The mean hospital stay time was shorter with SPA-LAVH (2.6+/-0.6 days [SPA-LAVH] and 3.3+/-0.7 days [MPA-LAVH], P<0.05). CONCLUSION: SPA-LAVH using conventional rigid straight laparoscopic instruments can be offered as a safe and feasible alternative to MPA-LAVH.
Subject(s)
Female , Humans , Adenomyosis , Blood Transfusion , Fever , Hemoglobins , Hysterectomy , Hysterectomy, Vaginal , Incidence , Leiomyoma , Length of Stay , Medical Records , Urinary TractABSTRACT
Purpose: Laparoscopic colorectal surgery is technically demanding and needs a longer learning curve than open surgery. HALS (hand-assisted laparoscopic surgery) is a useful alternative to conventional laparoscopic surgery (CLS) because of its palpability and hand dissection. We compared the learning curves between HALS and CLS for colorectal surgery. Methods: A prospective study without randomization was conducted with the participation of two colorectal surgeons who had not experienced a laparoscopic colorectal operation. The collected data included operative features, oncologic outcomes, and early clinical outcomes. Fifty patients were enrolled in each group, the HALS group and the CLS group. Results: None of the operations converted to open surgery. The operative time was significantly shorter in the HALS group than in the CLS group (149.6+/-34.6 minutes versus 179.1+/-36.5 minutes, P<0.001). On a subgroup analysis of the operative time in the anterior resection, the operative time was consistent after the 13th operation in HALS group. However, in CLS group, there was a continuous fluctuation of the operative time until 25 cases. In regard to the oncologic outcome, the numbers of total harvested lymph nodes and the proximal and the distal margins in the anterior resection showed no statistical differences (P=0.400, P=0.908, and P=0.073, respectively). The early clinical results were similar in both groups. Conclusions: In the learning curve study, the HALS group had a shorter operative time and reached a learning curve plateau earlier than the CLS group. Other parameters, such as the oncologic results and the early postoperative clinical outcomes, showed no differences between the two groups.