Laparoscopic versus robotic right colectomy: a single surgeon's experience.

There is increased interest in robotic techniques for colon resection, but the role of robotics in colorectal surgery has not yet been defined. The purpose of this study was to compare our recent experience with robotic right colectomy to that with laparoscopic right colectomy. From November 2008 to June 2011, a total of 47 consecutive patients underwent elective, right colectomy: 25 laparoscopic right colectomies (LRC) and 22 robotic right colectomies (RRC). All procedures in this study were performed by a single, board-certified colon and rectal surgeon (H.J.L.). Main outcomes recorded included conversion rate, operative time (OT), estimated blood loss (EBL), length of extraction sites, length of stay (LOS), and complications. Data studied were prospectively recorded in a database and were retrospectively reviewed. Mean OT for LRC was 107 ± 36.7 min (median 98, range 48-207) and for RRC was 189.1 ± 38.1 min (median 185, range 123-288, P < 0.001). Mean total operating room time (TORT) for LRC was 158.6 ± 38.1 min (median 149, range 104-274) and for RRC was 258.3 ± 40.9 (median 251, range 182-372, P < 0.001). The tendency lines for both OT and TORT decreased over time for RRC. EBL for LRC was 70.2 ± 52.9 ml (median 50, range 10-200) and for RRC was 60.8 ± 71.3 ml (median 40, range 10-300, P = 0.037). The mean extraction site length for the laparoscopic group was 5.3 ± 1.3 cm (median 5, range 4-11) and for the robotic group was 4.6 ± 0.7 cm (median 4.5, range 3.5-6, p = 0.008). LOS was similar for both groups, as were complications. No cases were converted to open. No leaks occurred and there was no 30-day mortality. RRC is safe and feasible, with similar outcomes to LRC. Operative times were longer for RRC; however, they compare favorably with times for LRC published in the literature. Extraction site length and EBL were less for RRC. However, further study is necessary to demonstrate the clinical relevance of these findings. We are optimistic that OT and TORT will continue to improve.

Failed restrictive surgery: is sleeve gastrectomy a good revisional procedure?

The aim of this study is to evaluate the safety and efficacy of converting failed restrictive procedures such as laparoscopic adjustable gastric banding (LAGB), non-adjustable gastric banding (NAGB), and vertical banded gastroplasty (VBG) to laparoscopic sleeve gastrectomy (LSG). A prospective database was maintained of 32 patients who failed restrictive procedures. Twenty-six patients failed LAGB, three patients failed NAGB, one of which was performed open, and three patients failed VBG. These patients were converted to LSG between January 2006 and May 2010. Post-conversion outcomes, BMI, and excess weight loss (EWL) were recorded. Four patients were excluded from the weight loss statistical data secondary to short follow-up (less than 6 months since conversion); however, these patients were included in the overall number of cases and in the discussion of complications. Causes of failed restrictive procedures in our series include inadequate weight loss, 15 (47%); weight gain, six (19%); slippage, five (16%); esophageal dilatation, one (3%); unhappy with device, one (3%); tear of silastic ring, one (3%); infection, one (3%), gastrogastric fistula with VBG and weight gain, one (3%); and intractable nausea and vomiting, one (3%). The average hospital stay was 1.5 days (range, 1-3). The average length of follow-up was 26 months. The mean pre-conversion BMI was 42.69, post-conversion to SG mean BMI was 33.3, mean EWL pre-conversion was 10%, and post-conversion mean EWL was 60%. There was no mortality, no conversion to open, and there was one complication, a contained leak resolved by antibiotic treatment. Conversion to LSG from a prior restrictive procedure may be a feasible and acceptable alternative for patients. Average EWL was 60% at an average of 26 months.

Laparoscopic sleeve gastrectomy: our first 100 patients.

BACKGROUND: Laparoscopic sleeve gastrectomy is becoming a popular procedure for the morbidly obese patient. Its utilization as a standalone procedure has good results with weight loss in short- and midterm reports. The aim of this study was to assess our technique and whether it warranted any modifications in the early postoperative period. METHODS: Our first 100 consecutive patients undergoing laparoscopic sleeve gastrectomy were retrospectively reviewed. Data analysis was conducted at 3 and 6 months to assess the percentage of excess body weight loss and comorbidity status change. RESULTS: The percentage of excess body weight loss at the 3- and 6-month marks was 34.2% and 49.1%, respectively. Comorbidities were also improved at the 3- and 6-month marks. Hypertension resolved in 38%, hyperlipidemia resolved in 19%, and diabetes in 46%. Complication rate during the first 6 months was 10%. Major complications included 2 patients with postoperative bleeding, 2 patients with acute renal failure from dehydration, and 1 postoperative bleeding patient who developed a gastric fistula. No surgical reintervention was required for any complication. CONCLUSION: Our technique is a safe method that is easily reproducible and does not require any modification. Laparoscopic sleeve gastrectomy is an excellent surgical option with a low complication rate.

Femororenal arteriovenous graft: a viable option for hemodialysis access.

There has been a significant increase in the number of patients with end-stage renal disease. The limited number of kidney transplants necessitates that most patients become dependent upon chronic dialysis. Due to the numerous complications associated with temporary access catheters, permanent arteriovenous access is more beneficial for long-term vascular access. However, with the restricted availability of sites for permanent vascular access, it is important to have a variety of possibilities. In this case report, we present an alternative choice for an arteriovenous graft, left common femoral artery to left renal vein, in a patient with limited vascular access options.