Journal of laparoendoscopic & advanced surgical techniques. Part A
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J Laparoendosc Adv Surg Tech A · Oct 2020
Meta Analysis Comparative StudyLaparoscopic Liver Surgery: What Are the Advantages in Patients with Cirrhosis and Portal Hypertension? Systematic Review and Meta-Analysis with Personal Experience.
Background: Laparoscopic surgery is a choice of treatment for liver diseases; it can decrease postoperative morbidity and length of hospital stay (LOS). Hepatocellular carcinoma (HCC) in patients with cirrhosis and portal hypertension may benefit from minimally invasive liver resections (MILRs) instead of open liver resections (OLRs). Whether minimally invasive approaches are superior to conventional ones is still a matter of debate. ⋯ Accordingly, patients who had undergone MILRs had significantly shorter postoperative hospitalization than patients who underwent conventional open surgery (2.4-36 days versus 4.2-19 days P < .00001). Both groups did not differ in terms of mortality rate and radicality of resection (OLR 93.8% versus 96.1% laparoscopic liver resection, P = .12). Conclusions: Based on the available evidence in the literature, laparoscopic resections rather than open liver ones for HCC surgery in cirrhotic patients seem to reduce postoperative overall morbidity, liver-specific complications, and LOS. The lack of randomized studies on this topic precludes the possibility of achieving defining statements.
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J Laparoendosc Adv Surg Tech A · Jan 2021
ReviewOperating Room Setup: How to Improve Health Care Professionals Safety During Pandemic COVID-19-A Quality Improvement Study.
Background: COVID-19 is a terrific pandemic and a potential risk for every health care professional (HCP), especially during emergency conditions where the right timing is essential for the correct treatment. During surgery the correct setting of operative room (OR) is mandatory to reduce the risk of contamination. Personal protection equipment (PPE), specific devices, and planned OR setting are essential during surgery in pandemic COVID-19. Methods: Medline, PubMed, Scientific societies recommendations, and guidelines were consulted to identify articles reporting the setup of OR during pandemic COVID-19. Results: OR must have a high-efficiency particulate air (HEPA) filter with negative pressure and a high air exchange cycle rate. ⋯ During laparoscopy low pneumoperitoneum pressures and aspiration systems must be provided. Conclusions: Emergency surgery during pandemic COVID-19 increases the risk for every HCP in the OR. A theoretical risk of transmission from the surgical field exists. It is mandatory the adoption of strong strategies to reduce the risk of contamination in the OR.
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J Laparoendosc Adv Surg Tech A · Jul 2020
Multicenter Study Comparative Study Controlled Clinical TrialTransanal Versus Laparoscopic Total Mesorectal Excision: A Comparative Prospective Clinical Trial from Two Centers.
Purpose: Laparoscopic total mesorectal excision (LapTME) faced many obstacles in obese male with narrow pelvis and bulky mesorectum with increased risk of incomplete mesorectal excision and positive circumferential resection margin (CRM) and distal resection margin (DRM). Transanal total mesorectal excision (TaTME) is reported to result in a better quality total mesorectal excision (TME) specimen, lower incidence of CRM and DRM involvement, and higher rates of sphincter preservation. To date, there is still a debate about the feasibility and efficacy of transanal versus the laparoscopic approach for TME in middle and low rectal cancer. ⋯ No significant differences were detected in CRM, DRM, peri- or postoperative complications, or conversion rates with more reported Clavien-Dindo grade III complications in the TaTME group (P = .29). Conclusions: TaTME facilitated rectal cancer surgery in obese patients and increased the chance of transanal specimen extraction with equivalent oncological outcomes to conventional LapTME. Further studies are recommended to build better evidence.
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J Laparoendosc Adv Surg Tech A · Apr 2020
Meta Analysis Comparative StudyIntracorporeal Versus Extracorporeal Anastomosis in Laparoscopic Right Colectomy: An Updated Systematic Review and Cumulative Meta-Analysis.
Purpose: The effect of intracorporeal anastomosis (IA) versus extracorporeal anastomosis (EA) in laparoscopic right hemicolectomy is controversial. The aim of this study was to evaluate the safety, effectiveness, and functional outcomes of IA compared with EA and to explore the timely tendency variations favoring one treatment over another. Materials and Methods: PubMed, EMBASE, and Web of Science were consulted. ⋯ The time to first flatus, time to defecation, time to liquid diet, and hospital length of stay were estimated to be lower. A statistically significant timely trend favoring IA was noticed for postoperative infectious complications, overall complications, and recovery parameters. Further studies are warranted to confirm these results and to deeply investigate the supposed timely tendency convergence in favor of IA.
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J Laparoendosc Adv Surg Tech A · May 2020
Case ReportsSurgical Considerations for an Awake Tracheotomy During the COVID-19 Pandemic.
Background: The current global COVID-19 pandemic is caused by the novel coronavirus Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). Given that SARS-CoV-2 is highly transmissible, surgical societies have recommended that procedures with a high risk of aerosolization be avoided or delayed. ⋯ Care must be taken during aerosol-generating procedures to minimize viral transmission as much as possible. Preoperative testing for COVID-19, limited operating room personnel, adequate personal protective equipment, and surgical technique are factors to consider for high-risk procedures. Methods: This article presents the case of an awake tracheotomy performed for a transglottic mass causing airway obstruction. Results: With detailed planning and specific techniques, the amount of aerosolization was reduced, and the procedure was performed as safely as possible. Conclusion: This case provides a template for future aerosol-generating procedures during respiratory pandemics.