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[PMID]:29428040
[Au] Autor:Jia B; Liu K; Tan L; Jin Z; Fu Y; Liu Y
[Ti] Título:Evaluation of the Safety and Efficacy of Percutaneous Transhepatic Gallbladder Drainage Combined with Laparoscopic Cholecystectomy for Treating Acute Complicated Cholecystitis.
[So] Source:Am Surg;84(1):133-136, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The rate of acute cholecystitis in patients with severe underlying diseases is currently increasing. Several studies have reported percutaneous transhepatic gallbladder drainage (PTGBD) combined with laparoscopic cholecystectomy (LC) as a safe and reliable therapeutic option in such patients. This study aimed to elucidate the optimal time interval between PTGBD and LC. In total, 65 patients with acute complicated cholecystitis from our hospital were divided into two groups, short-term LC (sLC) and postponed LC (pLC) group according to whether the procedure was performed within 5 days of gallbladder drainage or after 5 days, respectively. The complications after PTGBD, rate of conversion to open surgery, and complications and mortality after LC were compared between the groups. The sLC group showed significantly lesser operating time, blood loss, postoperative peritoneal drainage time, postoperative oral intake time, and complications compared to the pLC group (P < 0.05). Other factors such as the length of hospital stay (LOS), conversion to open cholecystectomy, and mortality were not statistically significant between the groups. Combined treatment with PTGBC and sLC showed superior outcomes compared to PTGBC and pLC for acute cholecystitis in severely ill patients, thus constituting a feasible and secure treatment option in specialized centers.
[Mh] Termos MeSH primário: Colecistectomia Laparoscópica
Colecistite Aguda/cirurgia
Drenagem
[Mh] Termos MeSH secundário: Idoso
Colecistectomia Laparoscópica/métodos
Colecistite Aguda/mortalidade
Colecistostomia/métodos
Conversão para Cirurgia Aberta
Estudos de Viabilidade
Feminino
Seres Humanos
Masculino
Meia-Idade
Duração da Cirurgia
Fatores de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE


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[PMID]:29428014
[Au] Autor:Fry DE; Pine M; Nedza SM; Reband AM; Huang CJ; Pine G
[Ti] Título:Comparison of Risk-Adjusted Outcomes in Medicare Open Laparoscopic Cholecystectomy.
[So] Source:Am Surg;84(1):12-19, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:More than 90 per cent of cholecystectomies are performed laparoscopically and this has resulted in concern that surgeons will not have sufficient experience to perform open procedures when clinical circumstances require it. We reviewed the open cholecystectomies (OCs) of Medicare patients from 2010 to 2012 in hospitals with 20 or more cases, created risk-adjusted models for adverse outcomes which were evaluated for 90-days after discharge, and compared the hospital-level outcomes with laparoscopic cholecystectomy performed in the same hospitals for the same period of time. Results demonstrated that inpatient deaths, inpatient prolonged length-of-stay outliers, 90-day postdischarge deaths without readmission, and 90-day readmissions were statistically the same with an overall adverse outcome rate of 21.6 per cent in OC versus 20.9 per cent in laparoscopic cholecystectomy. Conversion of laparoscopic to open procedures was not associated with increased adverse outcomes. Laparoscopic cholecystectomy provides patients with many advantages, but when clinical circumstances are necessary, OC continues to be performed with the same overall adverse outcome rates, and the conversion process is not associated with poorer results in this high-risk population of patients.
[Mh] Termos MeSH primário: Colecistectomia
Mortalidade Hospitalar
Tempo de Internação
Medicaid
Medicare
Alta do Paciente
Readmissão do Paciente
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Colecistectomia/efeitos adversos
Colecistectomia Laparoscópica/efeitos adversos
Conversão para Cirurgia Aberta
Seres Humanos
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Resultado do Tratamento
Estados Unidos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180212
[St] Status:MEDLINE


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[PMID]:29391088
[Au] Autor:Spence LH; Schwartz S; Kaji AH; Plurad D; Kim D
[Ad] Endereço:Department of Surgery, Harbor UCLA Medical Center, Torrance, California, USA.
[Ti] Título:Concurrent Biliary Disease Increases the Risk for Conversion and Bile Duct Injury in Laparoscopic Cholecystectomy: A Retrospective Analysis at a County Teaching Hospital.
[So] Source:Am Surg;83(10):1024-1028, 2017 Oct 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Biliary tract disease remains a common indication for operative intervention. The incidence of concurrent biliary tract disease (>2 biliary tract disease processes) is unknown and the impact of more than one biliary tract diagnosis on outcomes remains to be defined. The objective of this study was to determine the effect of concurrent biliary tract disease on conversion rate and outcomes after laparoscopic cholecystectomy. A 5-year retrospective analysis of all patients who underwent a laparoscopic cholecystectomy was performed comparing those with a single biliary diagnosis to patients with concurrent biliary tract disease. Variables analyzed were conversion to open cholecystectomy, incidence of bile duct injury, use of endoscopic retrograde cholangiopancreatography and/or intraoperative cholangiogram, length of surgery, and duration of hospitalization. The incidence of concurrent biliary tract disease was 9 per cent and a conversion to open cholecystectomy was performed in 16 per cent of patients. After adjusting for confounding factors, concurrent biliary tract disease was predictive of conversion (odds ratio 1.6, 95% confidence interval 1.1-2.3, P = 0.03) and bile duct injury (odds ratio 2.5, 95% confidence interval 0.8-5, P = 0.01). Concurrent biliary tract disease patients were more likely to undergo intraoperative cholangiogram or endoscopic retrograde cholangiopancreatography, as well as longer operation and length of stay.
[Mh] Termos MeSH primário: Ductos Biliares/lesões
Doenças Biliares/cirurgia
Colecistectomia Laparoscópica/efeitos adversos
Conversão para Cirurgia Aberta/estatística & dados numéricos
Complicações Intraoperatórias/etiologia
[Mh] Termos MeSH secundário: Adulto
Idoso
Ductos Biliares/cirurgia
Feminino
Hospitais de Condado
Hospitais de Ensino
Seres Humanos
Incidência
Complicações Intraoperatórias/epidemiologia
Modelos Logísticos
Masculino
Meia-Idade
Razão de Chances
Estudos Retrospectivos
Fatores de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE


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[PMID]:27778169
[Au] Autor:Fung A; Trabulsi N; Morris M; Garfinkle R; Saleem A; Wexner SD; Vasilevsky CA; Boutros M
[Ad] Endereço:Department of Surgery, Colorectal Surgery, Sir Mortimer B. Davis Jewish General Hospital, 3755 Cote Ste Catherine, G-317, Montreal, QC, H3T 1E2, Canada.
[Ti] Título:Laparoscopic colorectal cancer resections in the obese: a systematic review.
[So] Source:Surg Endosc;31(5):2072-2088, 2017 05.
[Is] ISSN:1432-2218
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Laparoscopic colorectal cancer operations in obese patients pose technical challenges that may negatively impact oncologic adequacy. A meta-analysis was performed to assess the oncologic outcomes of laparoscopic colorectal cancer resections in obese compared to non-obese patients. Short- and long-term outcomes were assessed secondarily. METHODS: A systematic literature search was conducted from inception until October 01, 2014. Studies that compared outcomes of laparoscopic colorectal malignant neoplasms in obese and non-obese patients were selected for meta-analysis. Studies that defined obesity as body mass index (BMI) ≥ 30 kg/m were included. Oncologic, operative, and postoperative outcomes were evaluated. Pooled odds ratios (OR) and weighted mean differences (WMD) with 95 % confidence intervals (CI) were calculated using fixed-effects models. For oncologic and survival outcomes, a subgroup analysis was conducted for rectal cancer and a secondary analysis was conducted for Asian studies that used a BMI cutoff of 25 kg/m . RESULTS: Thirteen observational studies with a total of 4550 patients were included in the meta-analysis. Lymph node retrieval, distal, and circumferential margins, and 5-year disease-free and overall survival were similar in the obese and non-obese groups. Conversion rate (OR 2.11, 95 % CI 1.58-2.81), postoperative morbidity (OR 1.54, 95 % CI 1.21-1.97), wound infection (OR 2.43, 95 % CI 1.46-4.03), and anastomotic leak (OR 1.65, 95 % CI 1.01-2.71) were all significantly increased in the obese group. CONCLUSIONS: Laparoscopic colorectal cancer operations in obese patients pose an increased technical challenge as demonstrated by higher conversion rates and higher risk of postoperative complications compared to non-obese patients. Despite these challenges, oncologic adequacy of laparoscopic colorectal cancer resections is comparable in both groups.
[Mh] Termos MeSH primário: Neoplasias Colorretais/cirurgia
Laparoscopia
Obesidade/complicações
Complicações Pós-Operatórias
[Mh] Termos MeSH secundário: Fístula Anastomótica
Conversão para Cirurgia Aberta
Seres Humanos
Infecção da Ferida Cirúrgica
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180127
[Lr] Data última revisão:
180127
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE
[do] DOI:10.1007/s00464-016-5209-y


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[PMID]:29067426
[Au] Autor:Jayne D; Pigazzi A; Marshall H; Croft J; Corrigan N; Copeland J; Quirke P; West N; Rautio T; Thomassen N; Tilney H; Gudgeon M; Bianchi PP; Edlin R; Hulme C; Brown J
[Ad] Endereço:Department of Academic Surgery, Leeds Institute of Biological and Clinical Sciences, University of Leeds, Leeds, United Kingdom.
[Ti] Título:Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer: The ROLARR Randomized Clinical Trial.
[So] Source:JAMA;318(16):1569-1580, 2017 10 24.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Robotic rectal cancer surgery is gaining popularity, but limited data are available regarding safety and efficacy. Objective: To compare robotic-assisted vs conventional laparoscopic surgery for risk of conversion to open laparotomy among patients undergoing resection for rectal cancer. Design, Setting, and Participants: Randomized clinical trial comparing robotic-assisted vs conventional laparoscopic surgery among 471 patients with rectal adenocarcinoma suitable for curative resection conducted at 29 sites across 10 countries, including 40 surgeons. Recruitment of patients was from January 7, 2011, to September 30, 2014, follow-up was conducted at 30 days and 6 months, and final follow-up was on June 16, 2015. Interventions: Patients were randomized to robotic-assisted (n = 237) or conventional (n = 234) laparoscopic rectal cancer resection, performed by either high (upper rectum) or low (total rectum) anterior resection or abdominoperineal resection (rectum and perineum). Main Outcomes and Measures: The primary outcome was conversion to open laparotomy. Secondary end points included intraoperative and postoperative complications, circumferential resection margin positivity (CRM+) and other pathological outcomes, quality of life (36-Item Short Form Survey and 20-item Multidimensional Fatigue Inventory), bladder and sexual dysfunction (International Prostate Symptom Score, International Index of Erectile Function, and Female Sexual Function Index), and oncological outcomes. Results: Among 471 randomized patients (mean [SD] age, 64.9 [11.0] years; 320 [67.9%] men), 466 (98.9%) completed the study. The overall rate of conversion to open laparotomy was 10.1%: 19 of 236 patients (8.1%) in the robotic-assisted laparoscopic group and 28 of 230 patients (12.2%) in the conventional laparoscopic group (unadjusted risk difference = 4.1% [95% CI, -1.4% to 9.6%]; adjusted odds ratio = 0.61 [95% CI, 0.31 to 1.21]; P = .16). The overall CRM+ rate was 5.7%; CRM+ occurred in 14 (6.3%) of 224 patients in the conventional laparoscopic group and 12 (5.1%) of 235 patients in the robotic-assisted laparoscopic group (unadjusted risk difference = 1.1% [95% CI, -3.1% to 5.4%]; adjusted odds ratio = 0.78 [95% CI, 0.35 to 1.76]; P = .56). Of the other 8 reported prespecified secondary end points, including intraoperative complications, postoperative complications, plane of surgery, 30-day mortality, bladder dysfunction, and sexual dysfunction, none showed a statistically significant difference between groups. Conclusions and Relevance: Among patients with rectal adenocarcinoma suitable for curative resection, robotic-assisted laparoscopic surgery, as compared with conventional laparoscopic surgery, did not significantly reduce the risk of conversion to open laparotomy. These findings suggest that robotic-assisted laparoscopic surgery, when performed by surgeons with varying experience with robotic surgery, does not confer an advantage in rectal cancer resection. Trial Registration: isrctn.org Identifier: ISRCTN80500123.
[Mh] Termos MeSH primário: Conversão para Cirurgia Aberta/estatística & dados numéricos
Procedimentos Cirúrgicos do Sistema Digestório/métodos
Laparoscopia
Neoplasias Retais/cirurgia
Procedimentos Cirúrgicos Robóticos
[Mh] Termos MeSH secundário: Idoso
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos
Procedimentos Cirúrgicos do Sistema Digestório/economia
Custos Diretos de Serviços/estatística & dados numéricos
Feminino
Seres Humanos
Laparoscopia/efeitos adversos
Laparotomia
Masculino
Meia-Idade
Complicações Pós-Operatórias/etiologia
Neoplasias Retais/mortalidade
Risco
Procedimentos Cirúrgicos Robóticos/efeitos adversos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171101
[Lr] Data última revisão:
171101
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171026
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.7219


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[PMID]:28969898
[Au] Autor:Gossot D; Lutz JA; Grigoroiu M; Brian E; Seguin-Givelet A
[Ad] Endereço:Thoracic Department, Institut du Thorax Curie-Montsouris, Institut Mutualiste Montsouris, Paris, France. Electronic address: dominique.gossot@imm.fr.
[Ti] Título:Unplanned Procedures During Thoracoscopic Segmentectomies.
[So] Source:Ann Thorac Surg;104(5):1710-1717, 2017 Nov.
[Is] ISSN:1552-6259
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Thoracoscopic sublobar resections (TSLRs) are gaining popularity, but are challenging. However, despite technical difficulties, the reported rate of adverse events, complications, and unplanned procedures is low. To understand this paradox, we have studied our series of TSLRs. METHODS: We reviewed our prospective and intention-to-treat database on videothoracoscopic anatomical resections and extracted all planned thoracoscopic segmentectomies from January 2007 to July 2016. Intraoperative and postoperative data were analyzed. Unplanned procedures were defined as a conversion into thoracotomy or an unplanned additional pulmonary resection. RESULTS: During the study period 284 thoracoscopic anatomical segmentectomies were performed in 280 patients. There were 124 men and 156 women with a mean age of 64 years (range, 18 to 86 years). Indication for segmentectomy was a proven or suspected non-small cell lung carcinoma in 184 patients, suspected metastasis in 51 patients, and benign lesion in 49 patients. In total, 23 patients had an unplanned procedure (8%). There were 10 unplanned thoracotomies (9 conversions and 1 reoperation; 3.1%) mainly for vascular injuries, and 15 unplanned additional resections (5.1%) distributed among oncological reasons (n = 7), per operative technical issues (n = 6) and postoperative adverse events (lingular ischemia, n = 2). Considering only the 235 patients operated on for cancer, the unplanned additional pulmonary resection rate for an oncological reason was 3%. CONCLUSIONS: Although lower than for thoracoscopic lobectomies, the rate of unplanned procedure during TSLRs is of concern. It could most likely be reduced by technical refinements, such as a better preoperative planning.
[Mh] Termos MeSH primário: Complicações Intraoperatórias/cirurgia
Neoplasias Pulmonares/patologia
Neoplasias Pulmonares/cirurgia
Pneumonectomia/métodos
Cirurgia Torácica Vídeoassistida/métodos
Toracotomia/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Estudos de Coortes
Conversão para Cirurgia Aberta/efeitos adversos
Conversão para Cirurgia Aberta/métodos
Bases de Dados Factuais
Feminino
Seres Humanos
Imagem Tridimensional
Achados Incidentais
Complicações Intraoperatórias/diagnóstico por imagem
Complicações Intraoperatórias/mortalidade
Neoplasias Pulmonares/mortalidade
Masculino
Meia-Idade
Invasividade Neoplásica/patologia
Estadiamento de Neoplasias
Pneumonectomia/efeitos adversos
Prognóstico
Estudos Retrospectivos
Medição de Risco
Taxa de Sobrevida
Cirurgia Torácica Vídeoassistida/efeitos adversos
Tomografia Computadorizada por Raios X/métodos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171004
[St] Status:MEDLINE


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[PMID]:28891856
[Au] Autor:Hüscher CGS; Lirici MM
[Ad] Endereço:1 Department of Surgery, Rummo Hospital, Benevento, Italy 2 Department of Surgery, San Giovanni Hospital, Rome, Italy.
[Ti] Título:Transanal Total Mesorectal Excision: Pneumodissection of Retroperitoneal Structures Eases Laparoscopic Rectal Resection.
[So] Source:Dis Colon Rectum;60(10):1109-1112, 2017 Oct.
[Is] ISSN:1530-0358
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Laparoscopic total mesorectal excision is effective and safe but often technically challenging because of inadequate exposure. Transanal total mesorectal excision was introduced to mitigate this limitation and improve the quality of mesorectal dissection in even the most challenging cases. Currently, the technique for transanal total mesorectal excision dissection is not standardized. TECHNIQUE: The sequential approach to transanal total mesorectal excision mirrors the principles of the transanal abdominal transanal procedure. It begins with the transanal step, followed by the laparoscopic step, and then the transanal total mesorectal excision. The perirectal space is entered via a full-thickness dissection of the anterior rectal wall. Carbon dioxide is left flowing, widening the embryonic planes between the mesorectal and pelvic fascias, then moving upward through the retroperitoneal space. The surgeon switches to the abdominal field and begins laparoscopic dissection, consisting of inferior mesenteric artery dissection and division, inferior mesenteric vein dissection and division, and possible splenic flexure dissection. Pneumodissection facilitates this procedure by distancing the inferior mesenteric artery from the hypogastric nerves and opening the embryonic fusion plane between the Toldt and Gerota fascias to allow faster division of the left colon lateral attachments. The operation continues with a switch to the perineal field and mesorectal excision. RESULTS: A total of 102 patients underwent transanal total mesorectal excision as described. Mean operative time was 185.0 + 87.5 minutes (range, 60-480 min), and there was no conversion to open surgery. Postoperative morbidity was 33.3%. Mortality rate at 30 days was 1.96% (2 cases). Quality of mesorectal excision according to Quirke was assessed in all of the specimens and found to be complete in 99 cases (97.1%) and nearly complete in 2.9% of cases. CONCLUSIONS: Transanal total mesorectal excision may benefit from pneumodissection, expedites the laparoscopic step, and the sequential approach facilitates the visualization of the correct dissection planes. The safety and cost-effectiveness of the procedure still warrant consideration. See Video at http://links.lww.com/DCR/A418.
[Mh] Termos MeSH primário: Adenocarcinoma
Colectomia
Laparoscopia
Complicações Pós-Operatórias
Neoplasias Retais
Cirurgia Endoscópica Transanal
[Mh] Termos MeSH secundário: Adenocarcinoma/patologia
Adenocarcinoma/cirurgia
Idoso
Colectomia/efeitos adversos
Colectomia/métodos
Pesquisa Comparativa da Efetividade
Conversão para Cirurgia Aberta/métodos
Conversão para Cirurgia Aberta/estatística & dados numéricos
Feminino
Seres Humanos
Itália
Laparoscopia/efeitos adversos
Laparoscopia/métodos
Masculino
Meia-Idade
Estadiamento de Neoplasias
Duração da Cirurgia
Avaliação de Processos e Resultados (Cuidados de Saúde)
Períneo/cirurgia
Complicações Pós-Operatórias/diagnóstico
Complicações Pós-Operatórias/etiologia
Neoplasias Retais/patologia
Neoplasias Retais/cirurgia
Reto/cirurgia
Cirurgia Endoscópica Transanal/efeitos adversos
Cirurgia Endoscópica Transanal/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170921
[Lr] Data última revisão:
170921
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170912
[St] Status:MEDLINE
[do] DOI:10.1097/DCR.0000000000000893


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[PMID]:28866314
[Au] Autor:Hua Y; Javed AA; Burkhart RA; Makary MA; Weiss MJ; Wolfgang CL; He J
[Ad] Endereço:Department of Surgery, Johns Hopkins Hospital, Baltimore, MD; Department of Surgery, Lihuili Eastern Hospital, Ningbo, China.
[Ti] Título:Preoperative risk factors for conversion and learning curve of minimally invasive distal pancreatectomy.
[So] Source:Surgery;162(5):1040-1047, 2017 Nov.
[Is] ISSN:1532-7361
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Although laparoscopic distal pancreatectomy is considered a standard approach, 10% to 40% of these are converted. The preoperative risk factors for conversion are not well described. The aim of this study was to identify risk factors associated with conversion. METHODS: Clinicopathological variables of 211 consecutive patients who underwent laparoscopic distal pancreatectomy between January 2007 and December 2015 at Johns Hopkins were analyzed to identify factors associated with conversion. Furthermore, the learning curve for laparoscopic distal pancreatectomy was studied. RESULTS: On univariate analysis of diabetes mellitus, preoperative diagnosis of malignant disease, multiorgan resection, surgeons' years and case experience were significantly associated with conversion (all P < .05). Risk factors independently associated with conversion included diagnosis of malignant disease (odds ratio = 5.40; 95% confidence interval, 1.93-15.12, P = .001), multiorgan resection (odds ratio = 7.10; 95% confidence interval, 1.60-31.53, P = .01), and surgeons' case experience (odds ratio = 0.32; 95% confidence interval, 0.12-0.85, P = .023). Intraoperative reasons for conversion included presence of excessive intraabdominal and retroperitoneal fat (N = 10, 32.3%), adhesions (N = 10, 32.3%), extent of tumor invasion (N = 8, 25.8%), anatomy of vessels (N = 6, 19.4%), and intraoperative bleeding (N = 2, 6.5%). CONCLUSION: Patients undergoing laparoscopic distal pancreatectomy with a preoperative diagnosis of malignant disease or possible multiorgan resection are at a higher risk of conversion. Surgeon experience of performing >15 procedures significantly reduces the risk of conversion.
[Mh] Termos MeSH primário: Conversão para Cirurgia Aberta/estatística & dados numéricos
Curva de Aprendizado
Pancreatectomia/estatística & dados numéricos
Neoplasias Pancreáticas/cirurgia
[Mh] Termos MeSH secundário: Idoso
Feminino
Seres Humanos
Laparoscopia/estatística & dados numéricos
Masculino
Meia-Idade
Pancreatectomia/métodos
Estudos Retrospectivos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170904
[St] Status:MEDLINE


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[PMID]:28628713
[Au] Autor:Liu R; Liu Q; Zhao ZM; Tan XL; Gao YX; Zhao GD
[Ad] Endereço:Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
[Ti] Título:Robotic versus laparoscopic distal pancreatectomy: A propensity score-matched study.
[So] Source:J Surg Oncol;116(4):461-469, 2017 Sep.
[Is] ISSN:1096-9098
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Robotic distal pancreatectomy (RDP) is considered a safe and feasible alternative to laparoscopic distal pancreatectomy (LDP). However, previous studies have some limitations including small sample size and selection bias. This study aimed to evaluate whether the robotic approach has advantages over laparoscopic surgery in distal pancreatectomy. METHODS: Demographics and perioperative outcomes among patients undergoing RDP (n = 102) and LDP (n = 102) between January 2011 and December 2015 were reviewed. A 1:1 propensity score matched analysis was performed between both groups. RESULTS: Both groups displayed no significant differences in perioperative outcomes including operative time, blood loss, transfusion rate, and rates of overall morbidities and pancreatic fistula. Robotic approach reduced the rate of conversion to laparotomy (2.9% vs 9.8%, P = 0.045), especially in patients with large tumors (0% vs 22.2%, P = 0.042). RDP improved spleen (SP) and splenic vessels preservation (SVP) rates in patients with moderate tumors (60.0% vs 35.5%, P = 0.047; 37.1% vs 12.9%, P = 0.025), especially in patients without malignancy (95.5% vs 52.4%, P = 0.001; 59.1% vs 19.0%, P = 0.007). RDP also reduced postoperative hospital stay (PHS) significantly (7.67% vs 8.58, P = 0.032). CONCLUSIONS: RDP is associated with less rate of conversion to laparotomy, shorter PHS, and improved SP and SVP rates in selected patients than LDP.
[Mh] Termos MeSH primário: Laparoscopia
Pancreatectomia/métodos
Procedimentos Cirúrgicos Robóticos
[Mh] Termos MeSH secundário: Perda Sanguínea Cirúrgica/estatística & dados numéricos
Transfusão de Sangue/estatística & dados numéricos
China/epidemiologia
Conversão para Cirurgia Aberta/estatística & dados numéricos
Seres Humanos
Tempo de Internação/estatística & dados numéricos
Masculino
Análise por Pareamento
Meia-Idade
Duração da Cirurgia
Tratamentos com Preservação do Órgão
Fístula Pancreática/epidemiologia
Neoplasias Pancreáticas/cirurgia
Pontuação de Propensão
Baço
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170620
[St] Status:MEDLINE
[do] DOI:10.1002/jso.24676


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[PMID]:28580776
[Au] Autor:Doenst T; Lamelas J
[Ad] Endereço:Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany - doenst@med.uni-jena.de.
[Ti] Título:Do we have enough evidence for minimally-invasive cardiac surgery? A critical review of scientific and non-scientific information.
[So] Source:J Cardiovasc Surg (Torino);58(4):613-623, 2017 Aug.
[Is] ISSN:1827-191X
[Cp] País de publicação:Italy
[La] Idioma:eng
[Ab] Resumo:Reducing surgical trauma by minimizing skin incisions has transformed abdominal surgery resulting in significant improvements in outcome. In cardiac surgery, such efforts have also been made, but similar benefits could not be demonstrated. In addition, any potential benefit comes at the cost of increased cardiopulmonary bypass and clamp times, leading to questions regarding the safety of minimally invasive cardiac surgery (MICS). Nevertheless, outcomes have been equivalent to matched sternotomy cases and there is no doubt that the number of patients undergoing minimally-invasive mitral or aortic procedures is slowly increasing. To date almost half of all isolated mitral cases in Germany and roughly one fourth in the USA are performed through a minimized access. These numbers were less than half 10 years ago. So how can this development be justified, if the evidence for it seems to be questionable or even missing? We will attempt to provide some answers to this question by critically reviewing the available publications and by looking at the topic from other perspectives, including from a competitive and a patient standpoint. We will conclude that there is enough evidence to support minimally-invasive access as the primary approach to a valve in the majority of patients. We will further suggest that modern cardiac surgery may have difficulties to prevail in its full width, if these novel techniques are not embraced. Finally, we will demonstrate that minimally invasive cardiac surgery is associated with substantial improvements in patient care, however, in areas that are unlikely to be tested with randomized controlled trials.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Cardíacos/métodos
Medicina Baseada em Evidências
Doenças das Valvas Cardíacas/cirurgia
Valvas Cardíacas/cirurgia
Procedimentos Cirúrgicos Minimamente Invasivos/métodos
[Mh] Termos MeSH secundário: Procedimentos Cirúrgicos Cardíacos/efeitos adversos
Procedimentos Cirúrgicos Cardíacos/mortalidade
Conversão para Cirurgia Aberta
Difusão de Inovações
Doenças das Valvas Cardíacas/mortalidade
Seres Humanos
Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos
Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade
Duração da Cirurgia
Complicações Pós-Operatórias/etiologia
Fatores de Risco
Esternotomia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170619
[Lr] Data última revisão:
170619
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170606
[St] Status:MEDLINE
[do] DOI:10.23736/S0021-9509.16.09446-5



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