Browsing by Subject "Laparoscopy"

Now showing 1 - 5 of 5
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    A Small Bowel Perforation in a Goalkeeper: A Case Report and Return-to-Play Progression.
    (Journal of athletic training, 2021-11) Johnston, Kenzie; Condon, Tara A; Ciocca, Mario; Aguilar, Alain
    Sport-related intra-abdominal injuries are rare and may be associated with significant morbidity if missed. We present the case of a 21-year-old male collegiate goalkeeper who sustained a small bowel perforation after colliding with a teammate in practice. The athlete underwent laparoscopic primary repair of his small bowel perforation, a relatively uncommon type of surgical intervention for this injury given that similar patients are typically treated via laparotomy. Due to the rarity of small intestine injuries in athletes, information regarding the success of surgical interventions and return-to-play (RTP) standards is lacking, as is information on outcomes and return to sport after a laparoscopic repair. In this case report, we discuss the unique challenge of constructing an RTP protocol for this high-level athlete and propose a protocol for RTP after an intra-abdominal injury treated laparoscopically.
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    Incidence of lower urinary tract injury at the time of total laparoscopic hysterectomy.
    (JSLS, 2007-10) Jelovsek, J Eric; Chiung, Chi; Chen, Grace; Roberts, Soldrea L; Paraiso, Marie Fidela R; Falcone, Tommaso
    OBJECTIVES: To determine the incidence of and risk factors for injury to the lower urinary tract during total laparoscopic hysterectomy. METHODS: All patients who underwent total laparoscopic hysterectomy for benign disease from January 1, 2002 to December 31, 2005, at an academic medical center are included. Subjects undergoing laparoscopic-assisted vaginal hysterectomy, supracervical hysterectomy, or hysterectomy for malignancy were excluded. Intraoperative cystoscopy with intravenous indigo carmine was routinely performed. Relevant data were abstracted to determine the incidence of lower urinary tract injury, predictors of injury, and postoperative complications. RESULTS: Total laparoscopic hysterectomy was performed in 126 consecutive subjects. Two (1.6%) cystotomies were noted and repaired before cystoscopy was performed. Two (1.6%) additional cystotomies were detected during cystoscopy. Absent ureteral spill of indigo carmine was detected in 2 subjects: 1 (0.8%) with previously unknown renal disease and 1 (0.8%) with ureteral obstruction that was relieved with subsequent suture removal. Only 40% (2/5) of injuries were recognized without the use of cystoscopy with indigo carmine. The overall incidence of injury to the lower urinary tract was 4.0%. No subjects required postoperative intervention to the lower urinary tract within the 6-week perioperative period. Performing a ureterolysis was associated with an increased rate (odds ratio 8.7, 95%CI, 1.2-170, P=0.024) of lower urinary tract injury. CONCLUSION: Surgeons should consider performing cystoscopy with intravenous indigo carmine dye at the time of total laparoscopic hysterectomy.
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    Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial.
    (Obstet Gynecol, 2011-11) Paraiso, Marie Fidela R; Jelovsek, J Eric; Frick, Anna; Chen, Chi Chung Grace; Barber, Matthew D
    OBJECTIVE: To compare conventional laparoscopic and robotic-assisted laparoscopic sacrocolpopexy for vaginal apex prolapse. METHODS: This single-center, blinded randomized trial included participants with stage 2-4 posthysterectomy vaginal prolapse. Participants were randomized to laparoscopic or robotic sacrocolpopexy. The primary outcome was total operative time from incision to closure. Secondary outcomes were postoperative pain, functional activity, bowel and bladder symptoms, quality of life, anatomic vaginal support, and cost from a health care system perspective. RESULTS: A total of 78 patients enrolled and were randomized (laparoscopic n=38; robotic n=40). Total operative time was significantly longer in the robotic group compared with the laparoscopic group (+67-minute difference; 95% confidence interval [CI] 43-89; P<.001). Anesthesia time, total time in the operating room, total sacrocolpopexy time, and total suturing time were all significantly longer in the robotic group. Participants in the robotic group also had significantly higher pain at rest and with activity during weeks 3 through 5 after surgery and required longer use of nonsteroidal anti-inflammatory drugs (median, 20 compared with 11 days, P<.005). The robotic group incurred greater cost than the laparoscopic group (mean difference +$1,936; 95% CI $417-$3,454; P=.008). Both groups demonstrated significant improvement in vaginal support and functional outcomes 1 year after surgery with no differences between groups. CONCLUSION: Robotic-assisted sacrocolpopexy results in longer operating time and increased pain and cost compared with the conventional laparoscopic approach.
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    Reduced length of hospital stay in colorectal surgery after implementation of an enhanced recovery protocol.
    (Anesth Analg, 2014-05) Miller, TE; Thacker, JK; White, WD; Mantyh, C; Migaly, J; Jin, J; Roche, AM; Eisenstein, EL; Edwards, R; Anstrom, KJ; Moon, RE; Gan, TJ
    BACKGROUND: Enhanced recovery after surgery (ERAS) is a multimodal approach to perioperative care that combines a range of interventions to enable early mobilization and feeding after surgery. We investigated the feasibility, clinical effectiveness, and cost savings of an ERAS program at a major U. S. teaching hospital. METHODS: Data were collected from consecutive patients undergoing open or laparoscopic colorectal surgery during 2 time periods, before and after implementation of an ERAS protocol. Data collected included patient demographics, operative, and perioperative surgical and anesthesia data, need for analgesics, complications, inpatient medical costs, and 30-day readmission rates. RESULTS: There were 99 patients in the traditional care group, and 142 in the ERAS group. The median length of stay (LOS) was 5 days in the ERAS group compared with 7 days in the traditional group (P < 0.001). The reduction in LOS was significant for both open procedures (median 6 vs 7 days, P = 0.01), and laparoscopic procedures (4 vs 6 days, P < 0.0001). ERAS patients had fewer urinary tract infections (13% vs 24%, P = 0.03). Readmission rates were lower in ERAS patients (9.8% vs 20.2%, P = 0.02). DISCUSSION: Implementation of an enhanced recovery protocol for colorectal surgery at a tertiary medical center was associated with a significantly reduced LOS and incidence of urinary tract infection. This is consistent with that of other studies in the literature and suggests that enhanced recovery programs could be implemented successfully and should be considered in U.S. hospitals.
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    Which Cholecystectomy Technique Would Surgeons Prefer on Themselves?
    (Surgical laparoscopy, endoscopy & percutaneous techniques, 2020-12) Lima, Diego L; Lima, Raquel Nogueira CL; Dos Santos, Dalmir C; Shadduck, Phillip P; Carvalho, Gustavo L; Malcher, Flavio

    Background

    As the minimally invasive surgery revolution approaches 30 years, many techniques are now available for cholecystectomy: open, conventional laparoscopy, ini-laparoscopy, single incision, robotic, and natural orifice. Although much has been published about patient preferences regarding these techniques, less is known about surgeon perceptions and preferences. The aim of this study was to survey attending and trainee surgeons about which cholecystectomy technique they would prefer for themselves and what factors determine their decision.

    Methods

    Attending fellow and resident surgeons globally completed a Google Forms online questionnaire that was posted in 3 closed groups for surgeons on Facebook and WhatsApp.

    Results

    The online questionnaire was completed by 600 surgeons (453 attending surgeons and 147 residents/fellows). Most respondents were male individuals (87.6% of attending surgeons, 78.2% of trainee surgeons). The most common age range of respondents was 31 to 40 years. Surgeon response was global, with especially good representation from North American, Asian, and European physicians. When conventional laparoscopy, mini-laparoscopy, and robotic surgery were the options offered for cholecystectomy, 58.5% of trainees and 45.7% of surgeons chose conventional laparoscopy. When asked if they would consider a single-incision or natural orifice transluminal endoscopic surgery approach, 91.5% answered no. When asked which technique they would prefer if hypothetically all techniques were equally safe, about three-fourths chose either conventional laparoscopy (46%) or mini-laparoscopy (27%). When asked to rank which factors they considered most important in choosing a surgical technique, surgeon experience (52%) and safety of the procedure (45%) were the 2 most important factors.

    Conclusions

    When an international sample of 600 attending and trainee surgeons were asked about undergoing a cholecystectomy on themselves, most chose either conventional laparoscopy or mini-laparoscopy as their preferred access technique. Single-incision and natural orifice transluminal endoscopic surgery approaches were unpopular. Surgeons ranked the experience of the operating surgeon and safety of the procedure as the most important factors guiding their decision.