Journal of the American College of Surgeons
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Randomized Controlled Trial Multicenter Study Comparative Study
Single-incision laparoscopic cholecystectomy is associated with improved cosmesis scoring at the cost of significantly higher hernia rates: 1-year results of a prospective randomized, multicenter, single-blinded trial of traditional multiport laparoscopic cholecystectomy vs single-incision laparoscopic cholecystectomy.
Minimally invasive techniques have become an integral part of general surgery with recent investigation into single-incision laparoscopic cholecystectomy (SILC). This study presents the final 1-year results of a prospective, randomized, multicenter, single-blinded trial of SILC vs multiport cholecystectomy (4PLC). ⋯ Results of this trial show SILC to be a safe and feasible procedure when compared with 4PLC, with similar total adverse events but with an identified significant increase in hernia formation. Cosmesis scoring and patient preference at 12 months continue to favor SILC, and more than half of the patients were willing to pay more for a single-site surgery over a standard laparoscopic procedure. Additional longer-term population-based studies are needed to clarify if this increased rate of hernia formation as compared with 4PLC will continue to hold true.
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Randomized Controlled Trial Multicenter Study Comparative Study
Virtual reality robotic surgery warm-up improves task performance in a dry laboratory environment: a prospective randomized controlled study.
Preoperative simulation warm-up has been shown to improve performance and reduce errors in novice and experienced surgeons, yet existing studies have only investigated conventional laparoscopy. We hypothesized that a brief virtual reality (VR) robotic warm-up would enhance robotic task performance and reduce errors. ⋯ We observed significant performance improvement and error reduction rates among surgeons of varying experience after VR warm-up for basic robotic surgery tasks. In addition, the VR warm-up reduced errors on a more complex task (robotic suturing), suggesting the generalizability of the warm-up.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective, blinded comparison of laparoscopic ultrasound with transabdominal ultrasound for the detection of gallbladder pathology in morbidly obese patients.
Transabdominal ultrasound (TAU) is the gold standard for detecting cholelithiasis. Morbid obesity can inhibit detection of gallbladder pathology due to increased subcutaneous and visceral fat. Laparoscopic ultrasound (LUS) has the potential to overcome these technical challenges. We hypothesized that LUS would have a sensitivity and specificity similar to TAU for detecting cholelithiasis and polyps in morbidly obese patients presenting for laparoscopic Roux-en-Y gastric bypass. ⋯ Laparoscopic ultrasound is equivalent to TAU in detecting cholelithiasis, however, LUS detected significantly more polyps. Intraoperative LUS is an appropriate alternative to TAU in patients undergoing laparoscopic Roux-en-Y gastric bypass.
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Randomized Controlled Trial Multicenter Study Comparative Study
Are results of bariatric surgery different in the Middle East? Early experience of an international bariatric surgery program and an ACS NSQIP outcomes comparison.
Bariatric operations performed at the Bariatric and Metabolic Institute Abu Dhabi are submitted randomly from the entire surgery volume at Sheikh Khalifa Medical City to the American College of Surgeons (ACS) NSQIP. Our aim is to report our early experience and compare our bariatric surgery outcomes with ACS NSQIP hospitals of similar size. ⋯ This is the first report comparing outcomes of an international bariatric surgery program (Bariatric and Metabolic Institute Abu Dhabi) with ACS NSQIP bariatric surgery programs. Our outcomes are equivalent to ACS NSQIP bariatric surgery programs.
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Randomized Controlled Trial Comparative Study
Prospective randomized controlled trial of operative rib fixation in traumatic flail chest.
Traumatic flail chest injury is a potentially life threatening condition traditionally treated with invasive mechanical ventilation to splint the chest wall. Longer-term sequelae of pain, deformity, and physical restriction are well described. This study investigated the impact of operative fixation in these patients. ⋯ Operative fixation of fractured ribs reduces ventilation requirement and intensive care stay in a cohort of multitrauma patients with severe flail chest injury.