Day-case laparoscopic cholecystectomy: results of 211 consecutive patients.

OBJECTIVES: The purpose of this work was to evaluate the feasibility and outcome of elective laparoscopic cholecystectomy as a day-case procedure in a French university hospital. METHODS: Since the creation of a surgical day-care centre in 1999, patients without severe chronic disease and anticoagulant therapy were selected for elective laparoscopic cholecystectomy. They were admitted and operated on in the morning hours and discharged after a double check by the surgeon and an anaesthetist 4 to 6 hours later. They were contacted by telephone the day subsequent to surgery and were seen in the outpatient unit 8 to 10 days after. RESULTS: Two hundred eleven laparoscopic cholecystectomies were performed in day-care surgery from January 1999 to December 2005. The proportion of day-case management increased during the six-year period from 32% to 53%. Eighteen percent of patients had an overnight admission. The overall complication rate was 1.8%. None of the patients had an emergency readmission. Incapacity duration went from 1 to 15 days. CONCLUSION: These results suggest that laparoscopic cholecystectomy can be routinely performed as a day-case procedure.

Transverse versus midline incision for upper abdominal surgery.

PURPOSE: Transverse and midline abdominal incisions are both commonly used for laparotomy to perform surgery on the pancreas and stomach, but comparative data are limited, especially from prospective randomized trials. METHODS: During a predefined 2-year recruitment period, 94 patients undergoing an elective major laparotomy for disorders of the pancreas or stomach were enrolled in this study. The outcome measures were pulmonary function, incisional pain, and wound characteristics. RESULTS: The operation groups were equally divided according to the type of incision used. The patients who underwent transverse incision laparotomy had significantly better postoperative pulmonary function and significantly less postoperative incisional pain than those who underwent midline incision laparotomy (P < 0.05), but there were no differences in morbidity and the incidence of wound complications. CONCLUSION: Performing a transverse incision for surgery on the pancreas or stomach results in better postoperative pulmonary function and less incisional pain than a midline incision, without affecting postoperative morbidity.

Comparative study of human and robotic camera control in laparoscopic biliary and colon surgery.

PURPOSE: Despite the growing clinical use of active robotic camera holders there is still a lack of clinical feasibility studies. PATIENTS AND METHODS: We compared the use of a voice controlled robotic camera holder (AESOP 3000, Computer Motion, Goleta, California) to a human camera holder in a series of laparoscopic cholecystectomies and colectomies. Compliance with AESOP, abnormal operative events or complications, operative time, and the duration of hospitalization were prospectively recorded and compared to data recorded before the introduction of the robotic system. RESULTS: Compliance with AESOP was good. There were no abnormal operative events, no differences in operative time, complications, or the mean duration of hospitalization between the patients operated with a robotic or a human camera holder. CONCLUSION: The use of a robotic camera holder does not alter the length of the operative procedure, the duration of hospitalization, or postoperative morbidity. It is a safe and feasible approach to laparoscopic cholecystectomy or colectomy.