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Outcome Comparison of Single-port Versus Multiport Versus Under Direct View Completion Proctectomy With Ileal-Pouch Anal Anastomosis for Patients With Ulcerative Colitis. Surg Laparosc Endosc Percutan Tech 2019; 29:373-377. [PMID: 31107848 DOI: 10.1097/sle.0000000000000674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Whether the reported theoretical benefits of single-port laparoscopic (SPL) approach can be converted to superior clinical outcomes is still unknown for ulcerative colitis (UC) patients undergoing second-stage proctectomy. This study aimed to compare the short-term postoperative and long-term pouch-related functional outcomes of SPL, multiport laparoscopic (MPL), and direct view (DV) completion proctectomy with ileal-pouch anal anastomosis (CP/IPAA). MATERIALS AND METHODS Patients who underwent either SPL, MPL, or under DV CP/IPAA for UC between August 2009 and August 2014 were identified from an institutional review board-approved, prospectively maintained institutional database and reviewed. Demographics, patient characteristics, short-term and long-term complications, and morbidity were compared between the 3 groups. Multivariate logistic or Cox regression analysis was conducted for covariate adjustments. RESULTS Groups (SPL: n=36; MPL: n=67; DV: n=97) were comparable in terms of preoperative characteristics and demographics except for age. The SPL group was associated with reduced estimated blood loss, reduced length of stay compared with the MPL and DV groups, and shorter operating time compared with the MPL group (P<0.001). Similar short-term postoperative and long-term pouch-related functional outcomes were noted without significant differences in quality of life scores among the 3 groups. CONCLUSIONS SPL CP/IPAA for UC can be safely performed with superior short-term outcomes such as reduced intraoperative blood loss and length of hospital stay compared with MPL and under direct view approaches, and shorter operating time compared with MPL.
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Doumouras AG, Saleh F, Gmora S, Anvari M, Hong D. The value of surgical experience: excess costs associated with the Roux-en-Y gastric bypass learning curve. Surg Endosc 2018; 33:1944-1951. [DOI: 10.1007/s00464-018-6472-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/20/2018] [Indexed: 10/28/2022]
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Increased Postoperative Morbidity Associated With Prolonged Laparoscopic Colorectal Resections Is Not Increased by Resident Involvement. Dis Colon Rectum 2018. [PMID: 29528909 DOI: 10.1097/dcr.0000000000000934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although longer operative times are associated with increased postoperative morbidity, the influence of surgical residents on this association is unclear. OBJECTIVE The purpose of this study was to evaluate whether morbidity associated with operative times in laparoscopic colorectal surgery is increased by resident training. DESIGN This was a retrospective cohort study. SETTINGS The study was conducted using a national database. PATIENTS Laparoscopic ileocolectomies, partial colectomies, and low anterior resections were identified in the National Surgical Quality Improvement Project (2005-2012). This cohort was stratified by the presence of resident involvement (postgraduate clinical year ≤5) and then divided into tertiles of operative time (low, medium, and high), allowing comparisons of cases by duration with resident involvement with cases of similar length without resident involvement. MAIN OUTCOME MEASURES Postoperative morbidity (infectious and noninfectious), length of hospital stay, and unplanned reoperations were the primary study outcomes. RESULTS A total of 20,785 procedures were identified. In aggregate, prolonged operative time was associated with both infectious (OR = 1.49, p < 0.001 with residents; OR = 1.38, p < 0.001 without residents) and noninfectious complications (OR = 1.51, p < 0.001 with residents; OR = 1.48, p < 0.001 without residents) when compared with short cases without residents. Longer hospital stay was observed both within the highest (additional 1.2 days (p < 0.001) with residents; 1.1 days (p < 0.001) without residents) and middle (additional 0.4 days (p < 0.001) with residents; 0.4 days (p = 0.001) without residents) tertiles of operative time. Within the highest tertile of operative length, there was no statistically significant difference in complication rates between cases with and without resident participation. LIMITATIONS The study was limited by its retrospective design and inability to define the complexity of case and extent of resident involvement. CONCLUSIONS Although longer operative times confer increased postoperative morbidity, there was no significant difference in complication rates within the highest tertile between cases with and without resident participation. Resident involvement does not appear to add to the risk of morbidity associated with longer and more complicated surgeries. See Video Abstract at http://links.lww.com/DCR/A440.
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Tillou J, Nagle D, Poylin V, Cataldo T. The impact of surgeon choices on costs associated with uncomplicated minimally invasive colectomy: you are not as important as you think. Gastroenterol Rep (Oxf) 2017; 6:108-113. [PMID: 29780598 PMCID: PMC5952919 DOI: 10.1093/gastro/gox035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/25/2017] [Accepted: 08/07/2017] [Indexed: 01/17/2023] Open
Abstract
Background There is increasing public discussion about the escalating cost of healthcare in America. There are no published data regarding the contribution of individual surgeons’ choices on the cost of uncomplicated minimally invasive colectomy. Methods A review of a hospital cost-accounting database of the direct costs related to the index operation and post-operative care of all patients who underwent elective minimally invasive segmental colectomy over a 1-year period was performed. Results A total of 111 cases were enrolled in this study, 18 of which were performed robotically. The average direct cost after minimally invasive colectomy was $5536. The cost of robotic colectomy was 53% greater than laparoscopic ($7806 vs $5096, p < 0.001). There was no statistically significant difference in overall costs among laparoscopic cases performed by three surgeons ($5099 vs $5108 vs $5055, p = 0.987). Average operating room supply costs among the three surgeons were $1236, $1105 and $1030, respectively (p = 0.067), with a standard deviation of $328 (6.4% of overall cost). Conclusions No significant difference in overall costs between surgeons was demonstrated despite varied training, experience levels and operative techniques. Total costs are relatively institutionally fixed and minimally influenced by variations in individual surgeon preferences.
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Affiliation(s)
- John Tillou
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Deborah Nagle
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Vitaliy Poylin
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Thomas Cataldo
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Abstract
Laparoscopic colorectal surgery has now become widely adopted for the treatment of colorectal neoplasia, with steady increases in utilization over the past 15 years. Common minimally invasive techniques include multiport laparoscopy, single-incision laparoscopy, and hand-assisted laparoscopy, with the choice of technique depending on several patient and surgeon factors. Laparoscopic colorectal surgery involves a robust learning curve, and fellowship training often lays the foundation for a high-volume laparoscopic practice. This article provides a summary of the various techniques for laparoscopic colorectal surgery, including operative steps, the approach to difficult patients, and the learning curve for proficiency.
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Affiliation(s)
- James Michael Parker
- Department of Surgery, Middlesex Hospital Surgical Alliance, 520 Saybrook Road, Suite S-100, Middletown, CT 06457, USA
| | - Timothy F Feldmann
- Department of Surgery, Capital Medical Center, 3900 Capital Mall Drive Southwest, Olympia, WA 98502, USA
| | - Kyle G Cologne
- Division of Colorectal Surgery, University of Southern California Keck School of Medicine, 1441 Eastlake Avenue, Suite 7418, Los Angeles, CA 90033, USA.
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de'Angelis N, Lizzi V, Azoulay D, Brunetti F. Robotic Versus Laparoscopic Right Colectomy for Colon Cancer: Analysis of the Initial Simultaneous Learning Curve of a Surgical Fellow. J Laparoendosc Adv Surg Tech A 2016; 26:882-892. [PMID: 27454105 DOI: 10.1089/lap.2016.0321] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Robotic surgery was introduced to overcome laparoscopic drawbacks. This study aimed to compare the learning curve of robotic-assisted right colectomy (RRC) versus laparoscopic-assisted right colectomy (LRC) for colon cancer with respect to operative times and perioperative outcomes. In addition, the health-related costs associated with both procedures were analyzed and compared. METHODS Between 2012 and 2015, 30 consecutive patients underwent RRC and 50 patients LRC for colon cancer. All procedures were performed by a surgical fellow novice in minimally invasive colorectal surgery. The operative time and the cumulative sum method were used to evaluate the learning curve of RRC versus LRC. RESULTS The mean operative times were 200.5 minutes for RRC and 204.1 minutes for LRC (P = .408) and showed a significant decrease over consecutive procedures (P < .0001). The number of cases necessary to identify a drop in the operative time was 16 for RRC and 25 for LRC. RRC procedures were associated with significantly reduced blood loss (P = .012). Two patients (4%) in the LRC group were converted to laparotomy, whereas no conversion was required in the RRC group. Surgery-related costs were significantly more expensive for RRC, but when combined with the hospitalization-related costs, LRC and RRC did not differ (P = .632). CONCLUSIONS Both robotic and laparoscopic operative times decrease rapidly with practice. However, RRC is associated with a faster learning curve than LRC. The simultaneous development of these two minimally invasive approaches appears to be safe and feasible with acceptable health-related costs.
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Affiliation(s)
- Nicola de'Angelis
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital , AP-HP, Université Paris Est-UPEC, Créteil, France
| | - Vincenzo Lizzi
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital , AP-HP, Université Paris Est-UPEC, Créteil, France
| | - Daniel Azoulay
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital , AP-HP, Université Paris Est-UPEC, Créteil, France
| | - Francesco Brunetti
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery, and Liver Transplantation, Henri Mondor Hospital , AP-HP, Université Paris Est-UPEC, Créteil, France
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Characteristics of learning curve in minimally invasive ileal pouch-anal anastomosis in a single institution. Surg Endosc 2016; 31:1083-1092. [DOI: 10.1007/s00464-016-5068-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 06/20/2016] [Indexed: 02/07/2023]
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Short-Term Outcome of Three-Dimensional Versus Two-Dimensional Video-Assisted Thoracic Surgery for Benign Pulmonary Diseases. Ann Thorac Surg 2016; 101:1297-302. [DOI: 10.1016/j.athoracsur.2015.10.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 08/25/2015] [Accepted: 10/13/2015] [Indexed: 01/10/2023]
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Sheetz KH, Norton EC, Birkmeyer JD, Dimick JB. Provider Experience and the Comparative Safety of Laparoscopic and Open Colectomy. Health Serv Res 2016; 52:56-73. [PMID: 26990210 DOI: 10.1111/1475-6773.12482] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the comparative safety of laparoscopic and open colectomy across surgeons varying in experience with laparoscopy. DATA SOURCES National Medicare data (2008-2010) for beneficiaries undergoing laparoscopic or open colectomy. STUDY DESIGN Using instrumental variable methods to address selection bias, we evaluated outcomes of laparoscopic and open colectomy. Our instrument was the regional use of laparoscopy in the year prior to a patient's operation. We then evaluated outcomes stratified by surgeons' annual volume of laparoscopic colectomy. PRINCIPAL FINDINGS Laparoscopic colectomy was associated with lower mortality (OR: 0.75, 95 percent CI: 0.70-0.78) and fewer complications than open surgery (OR: 0.82, 95 percent CI: 0.79-0.85). Increasing surgeon volume was associated with better outcomes for both procedures, but the relationship was stronger for laparoscopy. The comparative safety depended on surgeon volume. High-volume surgeons had 40 percent lower mortality (OR: 0.60, 95 percent CI: 0.55-0.65) and 30 percent fewer complications (OR: 0.70, 95 percent CI: 0.67-0.74) with laparoscopy. Conversely, low-volume surgeons had 7 percent higher mortality (OR: 1.07, 95 percent CI: 1.02-1.13) and 18 percent more complications (OR: 1.18, 95 percent CI: 1.12-1.24) with laparoscopy. CONCLUSIONS This population-based study demonstrates that the comparative safety of laparoscopic and open colectomy is influenced by surgeon volume. Laparoscopic colectomy is only safer for patients whose surgeons have sufficient experience.
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Affiliation(s)
- Kyle H Sheetz
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Edward C Norton
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI.,Department of Health Management and Policy, Department of Economics, University of Michigan, Ann Arbor, MI.,National Bureau of Economic Research, Cambridge, MA
| | | | - Justin B Dimick
- Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.,Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI
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Toledano Trincado M, Sánchez Gonzalez J, Blanco Antona F, Martín Esteban ML, Colao García L, Cuevas Gonzalez J, Mayo Iscar A, Blanco Alvarez JI, Martín del Olmo JC. How to reduce the laparoscopic colorectal learning curve. JSLS 2016; 18:JSLS-D-13-00321. [PMID: 25392640 PMCID: PMC4154430 DOI: 10.4293/jsls.2014.00321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: The laparoscopic approach for colorectal pathologies is becoming more widely used, and surgeons have had to learn how to perform this new technique. The purpose of this work is to study the indicators of the learning curve for laparoscopic colectomy in a community hospital and to find when the group begins to improve. Methodology: From January 1 2005 to December 31 2012, 313 consecutive laparoscopic colorectal surgeries were performed (105 rectal and 208 colonic) by at least 60% of the same surgical team (6 members) in each operation. We evaluate the learning curve by moving averages and cumulative sums (CUSUM) for different variables related to the surgery outcomes. Results: Moving average curves for postoperative stay, fasting, and second step analgesia show a stabilizing trend toward improvement as we get more experience. However, intensive care unit stay, number of lymph nodes achieved, and operating time did not show a clear decreasing tendency. CUSUM curves of conversion, specimens <12 lymph nodes, and complications all show a clear turning point marked on all the charts around the procedure 60, accumulating a positive trend toward improvement. The CUSUM curve of the “learning variable” shows this improvement point at procedure 70. Conclusions: The laparoscopic colectomy learning curve accelerates with a collective team involvement in each procedure. The CUSUM and moving average curves are useful for initial and ongoing monitoring of new surgical procedures. The markers of the learning curve evidenced in our study are the conversion rate, postoperative surgical morbidity, and the number of patients with a lymph node count <12. What is new in this paper? The significance of this study is the evaluation of the learning curve, in laparoscopic colorectal surgery, of a surgical team in a community hospital, using moving average and CUSUM curves. This study demonstrated that the number of patients needed to achieve skilful practice decreased when there is collective team involvement in each procedure.
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Affiliation(s)
| | | | | | | | - Laura Colao García
- Department of Digestive Surgery, Hospital Medina del Campo, Valladolid, Spain
| | | | - Agustin Mayo Iscar
- Department of Statistics and Operational Research, University of Valladolid, Spain
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Yang C, Mo L, Ma Y, Peng G, Ren Y, Wang W, Liu Y, He J. A comparative analysis of lung cancer patients treated with lobectomy via three-dimensional video-assisted thoracoscopic surgery versus two-dimensional resection. J Thorac Dis 2015; 7:1798-805. [PMID: 26623103 DOI: 10.3978/j.issn.2072-1439.2015.10.59] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Three-dimensional (3D) vision systems are now available for thoracic surgery. It is unclear whether 3D video-assisted thoracic surgery (VATS) is superior to 2D VATS systems. This study aimed to compare the operative and perioperative data between 2D and 3D VATS lobectomy (VTL) and to identify the actual role of 3D VTL in thoracic surgery. METHODS A two-institutional comparative study was conducted from November 2013 to November 2014 at Liaoning Cancer Hospital & Institute and the First Affiliated Hospital of Guangzhou Medical University, China, of 300 patients with resectable non-small cell lung cancer (NSCLC). Patients were assigned to receive either the 3D VATS (n=150) or 2D VATS (n=150) lobectomy. The operative and perioperative data between 2D VATS and 3D VATS were compared. RESULTS Although there was no significant difference between the two groups regarding the incidence of each single complication, a significantly less operative time was found in the 3D VATS group (145 min) than in the 2D VATS group (176 min) (P=0.006). Postoperative mortality rates in 3D VATS and 2D VATS groups were both 0%.No significant difference was found between groups for estimated blood loss (P=0.893), chest drainage tube placement time (P=0.397), length of hospital stay (P=0.199), number of lymph nodes resected (P=0.397), postoperative complications (P=0.882) and cost of care (P=0.913). CONCLUSIONS Early results of this study demonstrate that the 3D VATS lobectomy procedure can be performed with less operative time. 3D VATS and 2D VATS lobectomy are both safe procedures in first-line surgical treatment of NSCLC.
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Affiliation(s)
- Chengliang Yang
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Lili Mo
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yegang Ma
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Guilin Peng
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yi Ren
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Wei Wang
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Yongyu Liu
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
| | - Jianxing He
- 1 Department of Thoracic Surgery, Liaoning Cancer Hospital & Institute, Shenyang 110042, China ; 2 Dalian Medical University Clinical Oncology College, Shenyang 110042, China ; 3 Department of Cardiothoracic Surgery, 4 State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 511436, China ; 5 Key cite of National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China
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Buskens CJ, Sahami S, Tanis PJ, Bemelman WA. The potential benefits and disadvantages of laparoscopic surgery for ulcerative colitis: A review of current evidence. Best Pract Res Clin Gastroenterol 2014; 28:19-27. [PMID: 24485252 DOI: 10.1016/j.bpg.2013.11.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 11/20/2013] [Accepted: 11/23/2013] [Indexed: 01/31/2023]
Abstract
Up to 35% of patients with ulcerative colitis will require surgery during the course of their disease. Nowadays, a total colectomy with ileal pouch-anal anastomosis is the preferred procedure, which can be performed open or via laparoscopic approach. Since the early '90s, minimally invasive techniques have gained popularity, but the extend of restorative procedures in these patients has restricted the use of laparoscopic approaches mainly to elective procedures in specialised centres. This review discusses the benefits and disadvantages of laparoscopic surgery when compared to open surgery. It presents the current evidence on short-term and long-term post-operative results, functional outcome, fecundity, and costs, for both elective and emergency indications. In addition, the value of new techniques (including single port surgery) and alternative laparoscopic approaches (e.g. ileo-rectal anastomosis, Kock-pouch and appendectomy) will be discussed.
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Affiliation(s)
- Christianne J Buskens
- Department of Surgery, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - Saloomeh Sahami
- Department of Surgery, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Pieter J Tanis
- Department of Surgery, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands
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Shi HY, Lee KT, Chiu CC, Lee HH. The volume-outcome relationship in laparoscopic cholecystectomy: a population-based study using propensity score matching. Surg Endosc 2013; 27:3139-45. [PMID: 23620382 DOI: 10.1007/s00464-013-2867-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 02/06/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND The volume-outcome relationship has been validated previously for surgical procedures and cancer treatments. However, no studies have longitudinally compared the relationships between volume and outcome, and none have systematically compared laparoscopic cholecystectomy (LC) surgery outcomes in Taiwan. This study purposed to explore the relationship between volume and hospital treatment cost after LC. METHODS This cohort study retrospectively analyzed 247,751 LCs performed from 1998 to 2009. Hospitals were classified as low-, medium-, and high-volume hospitals if their annual number of LCs were 1-29, 30-84, ≥85, respectively. Surgeons were classified as low-, medium-, and high-volume surgeons if their annual number of LCs were 1-10, 11-24, ≥25, respectively. Hierarchical linear regression model and propensity score were used to assess the relationship between volume and hospital treatment cost. RESULTS The mean hospital treatment cost was US $2,504.53, and the average hospital costs for high-volume hospitals/surgeons were 33/47% lower than those for low-volume hospitals and surgeons. When analyzed by propensity score, the hospital treatment cost differed significantly between high-volume hospitals/surgeons and low/medium-volume hospitals/surgeons (2,073.70 vs. 2,350.91/2,056.73 vs. 2,553.76, P < 0.001). CONCLUSIONS Analysis using a hierarchical linear regression model and propensity score found an association between high-volume hospitals and surgeons and hospital treatment cost in LC patients. Moreover, the significant factors associated with hospital resource utilization for this procedure include age, gender, comorbidity, hospital type, hospital volume, and surgeon volume. Additionally, analysis of the treatment strategies adopted at high-volume hospitals or by high-volume surgeons may improve overall hospital treatment cost.
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Affiliation(s)
- Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
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Koh FH, Tan KK, Tsang CB, Koh DC. Laparoscopic versus an open colectomy in an emergency setting: a case-controlled study. Ann Coloproctol 2013; 29:12-6. [PMID: 23586009 PMCID: PMC3624978 DOI: 10.3393/ac.2013.29.1.12] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 01/26/2013] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Laparoscopy continues to be increasingly adopted for elective colorectal resections. However, its role in an emergency setting remains controversial. The aim of this study was to compare the outcomes between laparoscopic and open colectomies performed for emergency colorectal conditions. METHODS A retrospective review of all patients who underwent emergency laparoscopic colectomies for various surgical conditions was performed. These patients were matched for age, gender, surgical diagnosis and type of surgery with patients who underwent emergency open colectomies. RESULTS Twenty-three emergency laparoscopic colectomies were performed from April 2006 to October 2011 for patients with lower gastrointestinal tract bleeding (6), colonic obstruction (4) and colonic perforation (13). The hand-assisted laparoscopic technique was utilized in 15 cases (65.2%). There were 4 (17.4%) conversions to the open technique. The operative time was longer in the laparoscopic group (175 minutes vs. 145 minutes, P = 0.04), and the duration of hospitalization was shorter in the laparoscopic group (6 days vs. 7 days, P = 0.15). The overall postoperative morbidity rates were similar between the two groups (P = 0.93), with only 3 patients in each group requiring postoperative surgical intensive-care-unit stays or reoperations. There were no mortalities. The cost analysis did not demonstrate any significant differences in the procedural (P = 0.57) and the nonprocedural costs (P = 0.48) between the two groups. CONCLUSION Emergency laparoscopic colectomy in a carefully-selected patient group is safe. Although the operative times were longer, the postoperative outcomes were comparable to those of the open technique. The laparoscopic group did not incur a higher cost.
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Affiliation(s)
- Frederick H Koh
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore. ; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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15
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Liu Z, Wang GY, Chen YG, Jiang Z, Tang QC, Yu L, Muhammad S, Wang XS. Cost Comparison Between Hand-Assisted Laparoscopic Colectomy and Open Colectomy. J Laparoendosc Adv Surg Tech A 2012; 22:209-13. [PMID: 22288882 DOI: 10.1089/lap.2011.0446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Zheng Liu
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Gui-yu Wang
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ying-gang Chen
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zheng Jiang
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qing-chao Tang
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lei Yu
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shan Muhammad
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xi-shan Wang
- Cancer Center, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
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Steele SR, Stein SL, Bordeianou LG, Johnson E, Herzig DO, Champagne BJ. The impact of practice environment on laparoscopic colectomy utilization following colorectal residency: a survey of the ASCRS Young Surgeons. Colorectal Dis 2012; 14:374-81. [PMID: 21689306 DOI: 10.1111/j.1463-1318.2011.02614.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM It is often thought that practice patterns are different in private (PP) vs university hospital (UH) settings. We aimed to describe the impact of practice environment on the type of laparoscopic colectomy procedures performed by graduating colorectal surgeons. METHOD A review was carried out of prospectively gathered self-reported questionnaire data. Graduates of American Society of Colon and Rectal Surgeons' (ASCRS)-approved colorectal residencies from 2004 to 2008 underwent an on-line survey, developed by the ASCRS Young Surgeons' Committee. RESULTS About 177 (52%) of 342 graduates surveyed responded. Practice setting data were available for 157 (89%) surgeons. Gender, geographical location and age were similar in both cohorts. PP surgeons utilized a laparoscopic approach more often for rectal cancer (37% vs 19%; P=0.003). There was no significant difference in the rate of laparoscopic surgery in colon cancer, diverticular disease, inflammatory bowel disease, Clostridium difficile or emergency surgery. PP surgeons operated more often with a partner (43% vs 8%) or surgical assistant (13% vs 4%; both P<0.001), while UH surgeons had a colorectal resident (10% vs 21%) or general surgery resident (15% vs 55%; both P<0.001). Impediments to performing laparoscopic surgery for PP surgeons included a perceived lack of hospital equipment (33% vs 20%) and support (29% vs 17%; both P<0.05). Perception of personal experience, access to trained assistants, financial reimbursement, length of surgery and patient availability were equivalent in both groups. CONCLUSION While differences such as type of assistant and impediments to laparoscopic utilization exist between PP- and UH-based practices, early laparoscopic practice patterns remain similar. PP surgeons more frequently perform laparoscopic resection for rectal cancer and with hand-assistance. Despite differences, newly trained colorectal surgeons in both settings utilize and require laparoscopic skills.
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Affiliation(s)
- Scott R Steele
- Department of Surgery, Madigan Army Medical Center, Tacoma, Washington, USA.
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Staged restorative proctocolectomy: laparoscopic or open completion proctectomy after laparoscopic subtotal colectomy? Surg Endosc 2011; 25:3294-9. [PMID: 21533970 DOI: 10.1007/s00464-011-1707-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 03/28/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this study was to compare outcomes of laparoscopic and open completion proctectomy (CP) and ileal-pouch anal anastomosis (IPAA) after a previous laparoscopic subtotal colectomy (STC). METHODS From a prospectively maintained ileal pouch database, outcomes for patients who underwent laparoscopic CP after laparoscopic STC (LSTC-LCP group) for ulcerative or indeterminate colitis were compared to those for patients who underwent open CP (LSTC-OCP group). A control group of open CP after open STC (OSTC-OCP group) was case-matched to LSTC-OCP at a ratio of 1:2 for age at surgery, gender, body mass index (BMI), year of operation, and American Society of Anesthesiologists (ASA) classification. Demographics, perioperative data, and pouch function were compared. Quality of life was evaluated using the Cleveland Global Quality of Life Scale (CGQL). RESULTS Between 1997 and 2009, 47 patients underwent LSTC followed by LCP (LSTC-LCP), and 48 patients underwent OCP after LSTC (LSTC-OCP); the latter group was matched to 96 open-open patients (OSTC-OCP). There were no significant differences in demographic and preoperative data among the three groups, except that the OSTC-OCP group patients were younger. Postoperative morbidity, pouch function, and CGQL were similar. LSTC-LCP patients had lower estimated blood loss (EBL) (p < 0.001), less commonly described intraoperative adhesiolysis (p < 0.001), reduced length of hospital stay (LOS) (p = 0.002) but longer operating time (p = 0.001) at CP/IPAA when compared with open-open patients. For patients with previous LSTC, LCP was associated with less commonly described intraoperative adhesiolysis (p = 0.003) and shorter LOS (p = 0.003) than OCP but a longer operating time (p = 0.036). CONCLUSIONS Laparoscopic CP and IPAA can be performed with safety comparable to that of open surgery after previous laparoscopic STC. The laparoscopic approach is associated with advantages including reduced intraoperative blood loss and earlier recovery as demonstrated by shorter length of hospital stay.
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