JSLS : Journal of the Society of Laparoendoscopic Surgeons最新文献

{"title":"Systematic Review and Meta-Analysis of Perioperative Administration of Acetazolamide for Management of Postoperative Pain after Laparoscopy.","authors":"Kaitlin McGrail,&nbsp;Andrew G Chapple,&nbsp;Gabrielle Stone,&nbsp;Elizabeth F Sutton,&nbsp;Neil R Chappell","doi":"10.4293/JSLS.2022.00032","DOIUrl":"https://doi.org/10.4293/JSLS.2022.00032","url":null,"abstract":"<p><strong>Background and objective: </strong>To perform a systematic review and meta-analysis to evaluate the efficacy of perioperative acetazolamide (ACTZ) administration with laparoscopy for reducing postoperative referred pain.</p><p><strong>Methods: </strong>The following databases were searched from inception to March 1, 2020: Cochrane, PubMed, PubMed Central, Ovid, and Embase. Electronic search used: Acetazolamide AND (laparoscopy OR laparoscopic OR Celioscopy OR Celioscopies OR Peritoneoscopy OR Peritoneoscopies). No limits or filters were used. We included only studies of patients who underwent abdominal laparoscopy (LSC), had a pain assessment at approximately 24 hours postoperatively, and included a treatment with ACTZ group and a no-treatment or minimal-treatment comparison group.</p><p><strong>Results: </strong>Five studies met inclusion criteria, with a combined total of 253 participants, 116 in the ACTZ group and 137 in the control group. A Bayesian hierarchical model was assumed for the study specific treatment effects. Posterior sampling was conducted via Markov Chain Monte Carlo methods, and posterior inference carried out on the hierarchical treatment effect. ACTZ significantly decreased average pain scores compared to control group by -0.726 points (95% confidence interval -1.175-0.264). The posterior probability that ACTZ decreases mean pain scores by ≥ 0.5 was 0.846.</p><p><strong>Conclusion: </strong>Current available evidence demonstrates that perioperative ACTZ may provide a modest improvement in postoperative referred pain following LSC.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/14/e4/e2022.00032.PMC9385114.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33447684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Laparoscopic Ultrasound Increases Fibroid Detection During Laparoscopic Myomectomy.","authors":"Hency H Patel,&nbsp;Dipti Banerjee,&nbsp;Kathryn Goldrath,&nbsp;Jeremy Chang,&nbsp;Megha D Tandel,&nbsp;Lorna Kwan,&nbsp;Steve Yu","doi":"10.4293/JSLS.2022.00038","DOIUrl":"https://doi.org/10.4293/JSLS.2022.00038","url":null,"abstract":"<p><strong>Objective: </strong>To assess the utility of intraoperative laparoscopic ultrasound in detecting additional fibroids during laparoscopic myomectomy (LM).</p><p><strong>Methods: </strong>Forty-two patients were enrolled in this prospective cohort study. All cases were performed by the same surgeon at a university affiliated hospital between April 1, 2019 and February 29, 2020. Following routine laparoscopic myomectomy, the laparoscopic ultrasound was then introduced, and ultrasonography was performed directly on the uterus. Any additional fibroids discovered were enucleated.</p><p><strong>Results: </strong>Using the laparoscopic ultrasound, an additional 54 fibroids among 27 (64%) of the 42 patients were found, with a median of 2 additional fibroids per patient (interquartile range [IQR] 1,3). Median fibroid size detected by laparoscopic ultrasound was 1.5 centimeters (IQR 1-3) and the most common types were FIGO grades 3 and 2 (43% and 33% respectively). The median surgical time was longer among patients in whom additional fibroids were found (170 minutes (IQR 137-219) vs 150 minutes (IQR 120-193), p = .044). When ≥ 2 fibroids were removed by usual methods, the laparoscopic ultrasound found additional fibroids 80% of the time, compared to 25% when < 2 fibroids were removed by usual methods (p < .001).</p><p><strong>Conclusion: </strong>Intraoperative laparoscopic ultrasonography is a useful tool in detecting additional fibroids that would have otherwise been missed. It is particularly helpful in identifying smaller intramural fibroids and in patients with multiple fibroids. By detecting additional fibroids, laparoscopic ultrasonography can help maximize the effectiveness of laparoscopic myomectomy and help decrease the rates of residual fibroids.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/02/d4/e2022.00038.PMC9439285.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33447685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal Hand-Sewn vs. Intracorporeal Mechanic Anastomosis During Laparoscopic Right Colectomy.","authors":"Pasquale Lepiane,&nbsp;Andrea Balla,&nbsp;Eugenio Licardie,&nbsp;Federica Saraceno,&nbsp;Isaias Alarcón,&nbsp;Rosa Scaramuzzo,&nbsp;Anna Guida,&nbsp;Salvador Morales-Conde","doi":"10.4293/JSLS.2022.00039","DOIUrl":"https://doi.org/10.4293/JSLS.2022.00039","url":null,"abstract":"<p><strong>Background and objectives: </strong>To compare the outcomes of extracorporeal hand-sewn side-to-side isoperistaltic ileocolic anastomosis (EHSIA) versus intracorporeal mechanic side-to-side isoperistaltic ileocolic anastomosis (IMSIA) during laparoscopic right hemicolectomy for adenocarcinoma.</p><p><strong>Methods: </strong>This is a retrospective propensity score-matched analysis of prospectively collected data. Fifty-four patients who underwent surgery with EHSIA (intervention group) were paired with 54 patients who underwent surgery with IMSIA (control group) based on patients' demographics and type of surgery (standard right hemicolectomy or extended right hemicolectomy).</p><p><strong>Results: </strong>Fifty-four patients were included for each group. Statistically significant differences between groups were not observed in patients' demographics and type of surgery. Conversion occurred in three patients of the intervention group due to intra-abdominal adhesions for previous surgery (5.6%) (p = 0.079). Median operative time was statistically significant shorter in the control group in comparison to the intervention group (85 and 117.5 minutes, respectively, p ≤ 0.0001). In both groups one anastomotic leakage was observed (1.9%) (Clavien-Dindo grade III-a). In the control group one patient (1.9%) underwent reintervention for acute postoperative anemia (Clavien-Dindo grade III-b). Median number of harvested lymph-nodes was 17 and 12 (p ≤ 0.0001), in the intervention and the control group, respectively. Median hospital stay was statistically significant lower in the control group in comparison to the intervention group (5 and 6.5 days, respectively, p ≤ 0.013).</p><p><strong>Conclusion: </strong>IMSIA showed lower operative time and hospital stay in comparison to EHSIA. Further randomized studies are required to draw definitive conclusions about the best anastomotic technique during laparoscopic right hemicolectomy.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/35/52/e2022.00039.PMC9385111.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33448596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Port Cholecystectomy for Cholecystitis Versus Non-Cholecystitis.","authors":"Marco Casaccia,&nbsp;Marta Ponzano,&nbsp;Tommaso Testa,&nbsp;Sofia Paola Martigli,&nbsp;Cecilia Contratto,&nbsp;Franco De Cian","doi":"10.4293/JSLS.2022.00020","DOIUrl":"https://doi.org/10.4293/JSLS.2022.00020","url":null,"abstract":"<p><strong>Background and objectives: </strong>To assess the safety and efficacy of single-port laparoscopic cholecystectomy (SPLC) for the treatment of symptomatic cholelithiasis in different gallbladder pathologic conditions.</p><p><strong>Methods: </strong>All patients who underwent SPLC in our department between October 1, 2017 and March 31, 2020 were registered consecutively in a prospective database. Patients' charts were retrospectively divided according to histological diagnosis: normal gallbladder (NG) (n = 13), chronic cholecystitis (CC) (n =47), and acute cholecystitis (AC) (n = 10). The parameters for assessing the procedure outcome included operative time, blood loss, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and length of hospital stay. Patient groups were statistically compared.</p><p><strong>Results: </strong>Seventy patients underwent SPLC. Duration of surgery increased from NG (55 ± 22.7 min) to CC (70 ± 33.5 min), and to AC patients (110.5 ± 50.5 min), which is statistically significant (<i>P </i>=<i> </i>.001). Postoperative complication rates were 7.6% in NG patients, 17% in CC, and 30% in AC (<i>P </i>=<i> </i>.442). Length of hospitalization was shorter for NG patients (1.0 ± 0.6 days) versus CC (2.0 ± 1.1 days) and AC patients (2.0 ± 4.7 days), with statistical significance (<i>P </i>= .020). Multivariate analysis found that pathology type and the occurrence of postoperative complications were independent predictors for prolonged operative times and prolonged hospital stay, respectively.</p><p><strong>Conclusion: </strong>SPLC is feasible for acute and chronic cholecystitis with good procedural outcomes. Since SPLC technique itself can be sometimes challenging with the existing technology, its application, especially in cases of acute cholecystitis, should be done with caution. Only prospective randomized studies on this approach for acute and chronic gallbladder diseases will assess the complete reliability of this technique.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fc/f5/e2022.00020.PMC9355797.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40629055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Postoperative Narcotic Use in Benign, Minimally-Invasive Gynecologic Surgery.","authors":"Anja S Frost,&nbsp;Jaden Kohn,&nbsp;Karen Wang,&nbsp;Khara Simpson,&nbsp;Kristin E Patzkowsky,&nbsp;Harold Wu","doi":"10.4293/JSLS.2022.00041","DOIUrl":"https://doi.org/10.4293/JSLS.2022.00041","url":null,"abstract":"<p><strong>Background and objectives: </strong>To evaluate postoperative opioid use after benign minimally-invasive gynecologic surgery and assess the impact of a patient educational intervention regarding proper opioid use/disposal.</p><p><strong>Methods: </strong>Educational pamphlets were provided preoperatively. Patients underwent hysterectomy, myomectomy, or other laparoscopic procedures. Opioid prescriptions were standardized with 25 tablets oxycodone 5mg for hysterectomy/myomectomy, 10 tablets oxycodone 5mg for LSC (oral morphine equivalents were maintained for alternatives). Pill diaries were reviewed and patient surveys completed during postoperative visits.</p><p><strong>Results: </strong>Of 106 consented patients, 65 (61%) completed their pill diaries. Median opioid use was 35 OME for hysterectomy (∼5 oxycodone tablets; IQR 11.25-102.5), 30 OME for myomectomy (∼4 tablets; IQR 15-75), and 18.75 OME for laparoscopy (∼3 tablets; IQR 7.5-48.75). Median last post-operative day (d) of use was 3d for hysterectomy (IQR 2, 8), 4d for myomectomy (IQR 1, 7), and 2d for laparoscopy (IQR 0.5-3.5). One patient (myomectomy) required a refill of 5mg oxycodone. No difference was found between total opioid use and presence of pelvic pain, chronic pain disorders, or psychiatric co-morbidities. Overall satisfaction with pain control (>4 on a 5-point Likert scale) was 91% for hysterectomy, 100% for myomectomy, 83% for laparoscopy. Of the 33 patients who read the pamphlet, 32(97%) felt it increased their awareness.</p><p><strong>Conclusion: </strong>Most patients required <10 oxycodone 5mg tablets, regardless of procedure with excellent patient satisfaction. A patient education pamphlet is a simple method to increase knowledge regarding the opioid epidemic and facilitate proper medication disposal.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/87/c9/e2022.00041.PMC9385113.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33448594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophageal Achalasia: From Laparoscopic to Robotic Heller Myotomy and Dor Fundoplication.","authors":"Massimo Arcerito,&nbsp;M Mazen Jamal,&nbsp;Martin G Perez,&nbsp;Harpreet Kaur,&nbsp;Andrew Sundahl,&nbsp;John T Moon","doi":"10.4293/JSLS.2022.00027","DOIUrl":"https://doi.org/10.4293/JSLS.2022.00027","url":null,"abstract":"<p><strong>Objective: </strong>Laparoscopic Heller myotomy and Dor fundoplication has become the gold standard in treating esophageal achalasia and robotic surgical platform represents its natural evolution. The objective of our study was to assess durable long-term clinical outcomes in our cohort.</p><p><strong>Methods and procedures: </strong>Between June 1, 1999 and June 30, 2019, 111 patients underwent minimally invasive treatment for achalasia (96 laparoscopically and 15 robotically). Fifty-two were males. Mean age was 49 years (20 - 96). Esophageal manometry confirmed the diagnosis. Fifty patients underwent pH monitoring study, with pathologic reflux in 18. Preoperative esophageal dilation was performed in 76 patients and 21 patients received botulin injection. Dysphagia was universally present, and mean duration was 96 months (5 - 480).</p><p><strong>Results: </strong>Median operative time was 144 minutes (90 - 200). One patient required conversion to open approach. Four mucosal perforations occurred in the laparoscopic group and were repaired intraoperatively. Seven patients underwent completion esophageal myotomy and added Dor fundoplication. Upper gastrointestinal series was performed before discharge. Median hospital stay was 39 hours (24 - 312). Median follow up was 157 months (6 - 240), and dysphagia was resolved in 94% of patients. Seven patients required postoperative esophageal dilation.</p><p><strong>Conclusions: </strong>Minimally invasive Heller myotomy and Dor fundoplication are feasible. The operation is challenging, but excellent results hinge on the operative techniques and experience. The high dexterity, three-dimensional view, and the ergonomic movements of robotic surgery allow application of all the technical elements, achieving the best durable outcome for the patient. Robotic surgery is the natural evolution of minimally invasive treatment of esophageal achalasia.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/87/94/e2022.00027.PMC9355798.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40629052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-incisional Laparoscopic Preperitoneal Local Anesthetic Technique in Laparoscopic Sleeve Gastrectomy.","authors":"Abdullah Aldohayan,&nbsp;Sulaiman Alshammari,&nbsp;Ahmed Binjaloud,&nbsp;Fahad Bamehriz,&nbsp;Abdul Sattar Narejo,&nbsp;Mansoor Aqil,&nbsp;Nahlah Aldahian,&nbsp;Abdulaziz Aldabaeab,&nbsp;Abdelazeem Eldawlatly","doi":"10.4293/JSLS.2022.00049","DOIUrl":"https://doi.org/10.4293/JSLS.2022.00049","url":null,"abstract":"<p><strong>Background: </strong>The increasing prevalence of obesity is a significant concern worldwide. Laparoscopic sleeve gastrectomy (LSG) is an effective and standard procedure for sustained weight loss. However, optimal pain control is essential for enhanced recovery after surgery. The aim of this randomized controlled study was to investigate the efficacy of a pre-incisional laparoscopic preperitoneal local anesthetic technique (PLPLAT) on recovery characteristics following LSG.</p><p><strong>Methods: </strong>A total of 120 obese patients scheduled to undergo LSG were randomized into the PLPLAT or placebo group (n = 60 patients in both groups). All patients received conventional intravenous or other analgesics postoperatively, as required. The primary outcome was the postoperative pain score. The secondary outcomes included morphine consumption, other analgesics, length of stay in the postanesthesia care unit (PACU), hemodynamic changes, postoperative nausea and vomiting (PONV), early mobilization, and length of hospital stay.</p><p><strong>Results: </strong>Pain scores in the PACU and at 12 hours after surgery in the ward were significantly lower in the PLPLAT group than in the placebo group (P < 0.05). The morphine consumption was significantly less in PLPLAT group with mean dosage of 2.95 mg (± 0.39) compared to 6.0 mg (± 0.4) in placebo group. PONV, mean arterial pressure, and PACU stay were significantly higher in the placebo group than in the PLPLAT group (P < 0.05).</p><p><strong>Conclusion: </strong>Intraoperative PLPLAT provide effective postoperative pain relief for patients undergoing LSG. The findings indicated the efficacy of PLPLAT in reducing postoperative pain, enhancing recovery, and facilitating early discharge.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/95/da/e2022.00049.PMC9439284.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33447682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare and Indirect Cost of the Laparoscopic vs. Vaginal Approach in Benign Hysterectomy.","authors":"María Ángeles Martínez-Maestre,&nbsp;Francisco Jódar-Sánchez,&nbsp;Ana María Calderón-Cabrera,&nbsp;Carmen González-Cejudo,&nbsp;José Manuel Silván-Alfaro,&nbsp;Lidia María Melero-Cortés","doi":"10.4293/JSLS.2022.00048","DOIUrl":"https://doi.org/10.4293/JSLS.2022.00048","url":null,"abstract":"<p><strong>Background and objectives: </strong>The aim of this study was to analyze indirect costs of vaginal and laparoscopic routes for hysterectomy to determine whether this makes a difference in total costs when considering route for surgery.</p><p><strong>Methods: </strong>A five-year observational retrospective cohort study was conducted in an academic tertiary care center. A total of 517 patients scheduled for total laparoscopic hysterectomy (n = 137) and vaginal hysterectomy (n = 380) for benign conditions between January 1, 2008 and December 31, 2012 meeting inclusion criteria were reviewed.</p><p><strong>Results: </strong>Indirect costs were higher in the vaginal hysterectomy group compared to the laparoscopic hysterectomy group (mean cost €3,239.86 vs. €1,371.58; cost increase of €1,868.28; p < .001). Indirect costs due to lost-work-productivity were the most important, represented by 97.7% in the vaginal group and 93.6% in the laparoscopic group.</p><p><strong>Conclusion: </strong>Among women undergoing hysterectomy for benign disease, laparoscopic hysterectomy appears to be superior to vaginal hysterectomy when indirect costs are analyzed in a five-year temporal horizon. Laparoscopic hysterectomy is a good alternative to vaginal hysterectomy when technically feasible as both present comparable advantages. The surgical approach to hysterectomy should be decided in light of the relative benefits and hazards, which will depend on clinical circumstances and surgical expertise.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6a/0e/e2022.00048.PMC9521634.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33497146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mesenteric Vascular Evaluation with Pre-operative Multidetector Computed Tomographic Angiography and Intraoperative Indocyanine Green Angiography to Reduce Anastomotic Leaks after Minimally Invasive Surgery for Colorectal Cancer.","authors":"Tsanko Yotsov,&nbsp;Martin Karamanliev,&nbsp;Svilen Maslyankov,&nbsp;Sergey Iliev,&nbsp;Nikolai Ramadanov,&nbsp;Dobromir Dimitrov","doi":"10.4293/JSLS.2022.00022","DOIUrl":"https://doi.org/10.4293/JSLS.2022.00022","url":null,"abstract":"<p><strong>Background: </strong>The aim of this prospective study was to determine the effect of mesenteric vascular evaluation using pre-operative multidetector computed tomography angiography (MDCTA) and intraoperative indocyanine green (ICG) angiography on reducing the anastomotic leak rate of colorectal cancer patients undergoing minimally invasive resection.</p><p><strong>Methods: </strong>Twenty-seven consecutive patients with colorectal cancer were studied, 18 males and 9 females, average age 69.1 ± 3.9 years. All patients underwent pre-operative mesenteric vascular evaluation using MDCTA with three-dimensional (3D) reconstruction and intraoperative evaluation of perfusion using ICG angiography. Twelve patients underwent laparoscopic resection (Olympus Visera Elite II OTV-S200) and 15 patients underwent robotic resection (DaVinci Si). Colorectal resection lines and anastomoses were guided by intraoperative ICG perfusion. Postoperative anastomotic leaks were assessed.</p><p><strong>Results: </strong>Pre-operative MDCTA 3D reconstructions defined the left colic and sigmoid artery anatomy and guided operative planning. The intraoperative ICG angiography resulted in a change of the planned lines of resection in seven patients (26%). The rate of postoperative anastomotic leaks in this study was 0% (0/27), compared to a leak rate of 6.8% at our institution in the preceding two years.</p><p><strong>Conclusion: </strong>Pre-operative evaluation of mesenteric vascular anatomy using MDCTA with 3D reconstruction and intraoperative evaluation of perfusion using ICG angiography were found to be technically feasible and safe. An appropriately designed study should be undertaken to prove whether it was truly effective at reducing the postoperative anastomotic leak rate in colorectal cancer patients undergoing minimally invasive resection at our institution.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/26/5f/e2022.00022.PMC9355796.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40629051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Factors Associated with More Postoperative Opioid Use after Laparoscopic Hysterectomy.","authors":"Wenjia Zhang,&nbsp;Valencia Miller,&nbsp;Marron Wong,&nbsp;Megan Loring,&nbsp;Stephanie Morris","doi":"10.4293/JSLS.2022.00028","DOIUrl":"https://doi.org/10.4293/JSLS.2022.00028","url":null,"abstract":"<p><strong>Background and objectives: </strong>To identify intraoperative factors during laparoscopic hysterectomy associated with postoperative opioid use and increased pain scores during the acute postoperative period.</p><p><strong>Methods: </strong>This is a prospective survey-based cohort study at two teaching hospitals in the Boston metropolitan area. A total of 125 patients undergoing laparoscopic hysterectomy were enrolled. Surveys were administered by telephone at one-week postoperatively and in-person at their two-week postoperative visit to elicit opioid consumption converted to morphine milligram equivalents (MMEs) and pain scores.</p><p><strong>Results: </strong>The median total opioid consumption was 37.5 MME (range 0-960 MMEs). Intraoperative factors associated with increased total MME consumption were lower uterine weight and resection of endometriosis at the time of surgery. Patients with uteri less than 250 grams used twice as much opioid compared to participants with uteri greater than 250 grams (median of 49.8 MME (interquartile range [IQR] 7.5-120.5) vs. 22.5 MME (IQR 7.5-61.0). The median opioid consumption by patients with resection or ablation of endometriosis was three times that of those who did not undergo surgical treatment of endometriosis (97.0 MME (IQR 53.1-281.3) vs. 30.0 MMEs (IQR 7.5-81.3 MME)). Maximum pain scores and reported pain score at one and two-week interviews were also significantly higher in patients with these characteristics.</p><p><strong>Conclusion: </strong>Several easily identified intraoperative factors may be correlated with opioid requirements during the acute postoperative period. This can allow surgeons to set expectations and dispense patient-specific opioid prescriptions. Individualizing prescriptions may lower the amount of excess circulating opioids and help combat the opioid epidemic.</p>","PeriodicalId":17679,"journal":{"name":"JSLS : Journal of the Society of Laparoendoscopic Surgeons","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fa/9b/e2022.00028.PMC9355794.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40629053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}