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Huang J, Chen H, Hu W, Liu J, Wei H, Tang X, Ran L, Fu X, Fang L. The feasibility and safety of laparoscopic transcystic common bile duct exploration after prior gastrectomy. Medicine (Baltimore) 2024; 103:e38906. [PMID: 38996129 PMCID: PMC11245270 DOI: 10.1097/md.0000000000038906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
The increased incidence of gallstones can be linked to previous gastrectomy (PG). However, the success rate of endoscopic retrograde cholangiopan-creatography after gastrectomy has significantly reduced. In such cases, laparoscopic transcystic common bile duct exploration (LTCBDE) may be an alternative. In this study, LTCBDE was evaluated for its safety and feasibility in patients with PG. We retrospectively evaluated 300 patients who underwent LTCBDE between January 2015 and June 2023. The subjects were divided into 2 groups according to their PG status: PG group and No-PG group. The perioperative data from the 2 groups were compared. The operation time in the PG group was longer than that in the No-PG group (184.69 ± 20.28 minutes vs 152.19 ± 26.37 minutes, P < .01). There was no significant difference in intraoperative blood loss (61.19 ± 41.65 mL vs 50.83 ± 30.47 mL, P = .087), postoperative hospital stay (6.36 ± 1.94 days vs 5.94 ± 1.36 days, P = .125), total complication rate (18.6 % vs 14.1 %, P = .382), stone clearance rate (93.2 % vs 96.3 %, P = .303), stone recurrence rate (3.4 % vs 1.7 %, P = .395), and conversion rate (6.8 % vs 7.0 %, P = .941) between the 2 groups. No deaths occurred in either groups. A history of gastrectomy may not affect the feasibility and safety of LTCBDE, because its perioperative results are comparable to those of patients with a history of No-gastrectomy.
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Affiliation(s)
- Jian Huang
- Department of Hepatobiliary Surgery, The Second Hospital of Longyan, Longyan, Fujian, China
| | - Huizhen Chen
- Department of Respiratory, Shanghang County Hospital, Fuzhou, Fujian, China
| | - Wei Hu
- Department of Hepatobiliary Surgery, Xiaogan Central Hospital, Xiaogan, Hubei, China
| | - Jinghang Liu
- Department of Hepatobiliary Surgery, Nanyang First People’s Hospital, Nanyang, Henan, China
| | - Huijun Wei
- Department of Hepatobiliary Surgery, The Second Hospital of Longyan, Longyan, Fujian, China
| | - Xinguo Tang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Longjian Ran
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaowei Fu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Lu Fang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
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Suwatthanarak T, Chinswangwatanakul V, Methasate A, Phalanusitthepha C, Tanabe M, Akita K, Akaraviputh T. Surgical strategies for challenging common bile duct stones in the endoscopic era: A comprehensive review of current evidence. World J Gastrointest Endosc 2024; 16:305-317. [PMID: 38946858 PMCID: PMC11212516 DOI: 10.4253/wjge.v16.i6.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/07/2024] [Accepted: 05/21/2024] [Indexed: 06/13/2024] Open
Abstract
While endoscopic retrograde cholangiopancreatography (ERCP) remains the primary treatment modality for common bile duct stones (CBDS) or choledocholithiasis due to advancements in instruments, surgical intervention, known as common bile duct exploration (CBDE), is still necessary in cases of difficult CBDS, failed endoscopic treatment, or altered anatomy. Recent evidence also supports CBDE in patients requesting single-step cholecystectomy and bile duct stone removal with comparable outcomes. This review elucidates relevant clinical anatomy, selection indications, and outcomes to enhance surgical understanding. The selection between trans-cystic (TC) vs trans-choledochal (TD) approaches is described, along with stone removal techniques and ductal closure. Detailed surgical techniques and strategies for both the TC and TD approaches, including instrument selection, is also provided. Additionally, this review comprehensively addresses operation-specific complications such as bile leakage, stricture, and entrapment, and focuses on preventive measures and treatment strategies. This review aims to optimize the management of CBDS through laparoscopic CBDE, with the goal of improving patient outcomes and minimizing risks.
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Affiliation(s)
- Tharathorn Suwatthanarak
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi 10700, Bangkok, Thailand
- Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo 113-8519, Tokyo, Japan
| | - Vitoon Chinswangwatanakul
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi 10700, Bangkok, Thailand
| | - Asada Methasate
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi 10700, Bangkok, Thailand
| | - Chainarong Phalanusitthepha
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi 10700, Bangkok, Thailand
| | - Minoru Tanabe
- Department of Hepatobiliary and Pancreatic Surgery, Tokyo Medical and Dental University, Bunkyo 113-8519, Tokyo, Japan
| | - Keiichi Akita
- Department of Clinical Anatomy, Tokyo Medical and Dental University, Bunkyo 113-8519, Tokyo, Japan
| | - Thawatchai Akaraviputh
- Minimally Invasive Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi 10700, Bangkok, Thailand
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Wang W, Feng S, Li Z, Qiao Z, Yang L, Han L, Xu F, Dong X, Sheng M, Sun D, Sun Y. Clinical application of indocyanine green fluorescence navigation technique in laparoscopic common bile duct exploration for complex hepatolithiasis. BMC Surg 2024; 24:117. [PMID: 38643065 PMCID: PMC11031942 DOI: 10.1186/s12893-024-02411-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/10/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND This study investigated the clinical application of the indocyanine green (ICG) fluorescence navigation technique in bile duct identification during laparoscopic common bile duct exploration (LCBDE) for complex hepatolithiasis. METHODS Eighty patients with complex hepatolithiasis were admitted to our department between January 2022 and June 2023 and randomly divided into control and observation groups. The control group underwent conventional LCBDE, while the observation group underwent LCBDE guided by ICG fluorescence. RESULTS Intraoperatively, the observation group had shorter operation and search times for the common bile duct (CBD), as well as reduced intraoperative blood loss and fewer complications, such as conversion to laparotomy and various injuries (gastroduodenal, colon, pancreatic, and vascular) than the control group, with statistical significance (P < 0.05). Postoperatively, the observation group had lower rates of postoperative bile leakage, abdominal infection, postoperative hemorrhage, and residual stone than the control group. Additionally, the observation group demonstrated significantly shorter times for resuming flatus, removal of the abdominal drainage tube, and hospitalization than the control group, with statistical significance (P < 0.05). CONCLUSION ICG fluorescence navigation technology effectively visualizes the bile duct, improves its identification rate, shortens the operation time, prevents biliary tract injury, and reduces the occurrence of complications.
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Affiliation(s)
- Wenfei Wang
- Department of general surgery, The Chinese People's Armed Police Forces Anhui Provincial Corps Hospital, Hefei, 230041, China
| | - Sanli Feng
- Department of general surgery, The Chinese People's Armed Police Forces Anhui Provincial Corps Hospital, Hefei, 230041, China
| | - Zhuang Li
- Department of general surgery, The Chinese People's Armed Police Forces Anhui Provincial Corps Hospital, Hefei, 230041, China
- 2The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Zhenyu Qiao
- Department of general surgery, The Chinese People's Armed Police Forces Anhui Provincial Corps Hospital, Hefei, 230041, China
| | - Liusheng Yang
- Department of general surgery, The Chinese People's Armed Police Forces Anhui Provincial Corps Hospital, Hefei, 230041, China
| | - Lin Han
- Department of general surgery, The Chinese People's Armed Police Forces Anhui Provincial Corps Hospital, Hefei, 230041, China
| | - Fei Xu
- Department of general surgery, The Chinese People's Armed Police Forces Anhui Provincial Corps Hospital, Hefei, 230041, China
| | - Xiangyu Dong
- Department of general surgery, The Chinese People's Armed Police Forces Anhui Provincial Corps Hospital, Hefei, 230041, China
| | - Minghui Sheng
- Department of general surgery, The Chinese People's Armed Police Forces Anhui Provincial Corps Hospital, Hefei, 230041, China.
| | - Dengqun Sun
- Department of general surgery, The Chinese People's Armed Police Forces Anhui Provincial Corps Hospital, Hefei, 230041, China.
| | - Yanjun Sun
- Department of general surgery, The Chinese People's Armed Police Forces Anhui Provincial Corps Hospital, Hefei, 230041, China.
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Nassar AHM, Sallam M, Khan KS, Kilpatrick R, Zino S, Katbeh TZ. A proposed difficulty grading system for laparoscopic bile duct exploration: benefits to clinical practice, training and research. Surg Endosc 2023; 37:7012-7023. [PMID: 37349591 PMCID: PMC10462500 DOI: 10.1007/s00464-023-10169-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/28/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND A gap remains between the mounting evidence for single session management of bile duct stones and the adoption of this approach. Laparoscopic bile duct exploration (LBDE) is limited by the scarcity of training opportunities and adequate equipment and by the perception that the technique requires a high skill-set. The aim of this study was to create a new classification of difficulty based on operative characteristics and to stratify postoperative outcomes of easy vs. difficult LBDE irrespective of the surgeon's experience. METHODS A cohort of 1335 LBDEs was classified according to the location, number and size of ductal stones, the retrieval technique, utilisation of choledochoscopy and specific biliary pathologies encountered. A combination of features indicated easy (Grades I and II A & B) or difficult (Grades III A and B, IV and V) transcystic or transcholedochal explorations. RESULTS 78.3% of patients with acute cholecystitis or pancreatitis, 37% with jaundice and 46% with cholangitis had easy explorations. Difficult explorations were more likely to present as emergencies, with obstructive jaundice, previous sphincterotomy and dilated bile ducts on ultrasound scans. 77.7% of easy explorations were transcystic and 62.3% of difficult explorations transductal. Choledochoscopy was utilised in 23.4% of easy vs. 98% of difficult explorations. The use of biliary drains, open conversions, median operative time, biliary-related complications, hospital stay, readmissions, and retained stones increased with the difficulty grade. Grades I and II patients had 2 or more hospital episodes in 26.5% vs. 41.2% for grades III to V. There were 2 deaths in difficulty Grade V and one in Grade IIB. CONCLUSION Difficulty grading of LBDE is useful in predicting outcomes and facilitating comparison between studies. It ensures fair structuring and assessment of training and progress of the learning curve. LBDEs were easy in 72% with 77% completed transcystically. This may encourage more units to adopt this approach.
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Affiliation(s)
- Ahmad H M Nassar
- Laparoscopic Biliary Unit, University Hospital Monklands, Airdrie, Scotland, UK.
- University of Glasgow, Glasgow, Scotland, UK.
- Golden Jubilee National Hospital, Glasgow, Scotland, UK.
| | - Mahmoud Sallam
- Laparoscopic Biliary Unit, University Hospital Monklands, Airdrie, Scotland, UK
| | - Khurram S Khan
- Laparoscopic Biliary Unit, University Hospital Monklands, Airdrie, Scotland, UK
- University of Glasgow, Glasgow, Scotland, UK
- University Hospital Hairmyres, Lanarkshire, UK
| | - Rhona Kilpatrick
- Laparoscopic Biliary Unit, University Hospital Monklands, Airdrie, Scotland, UK
| | - Samer Zino
- Laparoscopic Biliary Unit, University Hospital Monklands, Airdrie, Scotland, UK
- Department of Surgery, Ninewells Hospital and Medical School, Dundee, Scotland, UK
| | - Tarek Z Katbeh
- Laparoscopic Biliary Unit, University Hospital Monklands, Airdrie, Scotland, UK
- Department of Surgery, The Queen Elizabeth University Hospital, Glasgow, Scotland, UK
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Park SM, Paik KY. Laparoscopic common bile duct exploration following prior gastrectomy: surgical safety and feasibility. Langenbecks Arch Surg 2023; 408:287. [PMID: 37507500 DOI: 10.1007/s00423-023-03029-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/23/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE Previous gastrectomy (PG) can lead to an increased incidence of biliary stones. However, the success rate of endoscopic retrograde cholangiopancreatography after gastrectomy remains low. In such cases, laparoscopic common bile duct exploration (LCBDE) may be an alternative. The aim of this study was to evaluate the safety and feasibility of LCBDE for patients who underwent PG. METHODS A retrospective analysis of patients with a history of LCBDE was conducted. Patients were divided into two groups according to their PG status, and their perioperative data were compared. RESULTS The outcomes of 27 patients with a history of gastrectomy were compared with those of 155 without a history of gastrectomy who underwent LCBDE. PG patients experienced longer hospitalization times (P = 0.006), more postoperative bleeding (p = 0.021), a lower incidence of preoperative endoscopic retrograde cholangiopancreatography (P < 0.001), and a higher incidence of T-tube application (p = 0.002) than those without gastrectomy. However, there were no significant differences in estimated blood loss volume, operation time, bile leakage status, pancreatitis status, stone clearance rate, readmission rate, or recurrence rate. CONCLUSIONS Although LCBDE following gastrectomy may require laborious perioperative management, a history of gastrectomy might not influence the feasibility or safety of LCBDE, as its perioperative outcomes are comparable to those in patients without a history of gastrectomy.
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Affiliation(s)
- Sun Min Park
- Department of Surgery, Yeoiudo St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #10,63-Ro,Yeongdengpo-Gu, Seoul, 07345, Korea
| | - Kwang Yeol Paik
- Department of Surgery, Yeoiudo St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #10,63-Ro,Yeongdengpo-Gu, Seoul, 07345, Korea.
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Mao W, Guo S, Ye D, Cao Y, Jiang X, Huang Y, Yuan H, Jiao L. Surgical application of an implantable biliary access device in the treatment of refractory recurrent cholangiolithiasis. Quant Imaging Med Surg 2023; 13:3333-3342. [PMID: 37179917 PMCID: PMC10167432 DOI: 10.21037/qims-22-922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 02/14/2023] [Indexed: 03/21/2023]
Affiliation(s)
- Wei Mao
- Department of General Surgery, Nanchang University Infectious Disease Hospital, Nanchang, China
| | - Sixuan Guo
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Deqiang Ye
- Department of General Surgery, Nanchang University Infectious Disease Hospital, Nanchang, China
| | - Yong Cao
- Department of General Surgery, Nanchang University Infectious Disease Hospital, Nanchang, China
| | - Xinhua Jiang
- Department of General Surgery, Nanchang University Infectious Disease Hospital, Nanchang, China
| | - Yihua Huang
- Department of General Surgery, Nanchang University Infectious Disease Hospital, Nanchang, China
| | - Hang Yuan
- Department of General Surgery, Nanchang University Infectious Disease Hospital, Nanchang, China
| | - Leiming Jiao
- Department of General Surgery, Nanchang University Infectious Disease Hospital, Nanchang, China
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Xiong J, Xia S, Peng G, Sun Y, Chen J, Cao K. Preoperative three-dimensional magnetic resonance cholangiopancreatography for choledocholithotomy. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2023. [DOI: 10.1016/j.jrras.2022.100499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Yang S, Wu S, Dai W, Pang L, Xie Y, Ren T, Zhang X, Bi S, Zheng Y, Wang J, Sun Y, Zheng Z, Kong J. Laparoscopic surgery for gallstones or common bile duct stones: A stably safe and feasible surgical strategy for patients with a history of upper abdominal surgery. Front Surg 2022; 9:991684. [PMID: 36248372 PMCID: PMC9562259 DOI: 10.3389/fsurg.2022.991684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
Backgrounds/Aims A history of upper abdominal surgery has been identified as a relative contraindication for laparoscopy. This study aimed to compare the clinical efficacy and safety of laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration (LCBDE) in patients with and without previous upper abdominal surgery. Methods In total, 131 patients with previous upper abdominal surgery and 64 without upper abdominal surgery underwent LC or LCBDE between September 2017 and September 2021 at the Shengjing Hospital of China Medical University. Patients with previous upper abdominal surgery were divided into four groups: group A included patients with previous right upper abdominal surgery who underwent LC (n = 17), group B included patients with previous other upper abdominal surgery who underwent LC (n = 66), group C included patients with previous right upper abdominal surgery who underwent LCBDE (n = 30), and group D included patients with previous other upper abdominal surgery who underwent LCBDE (n = 18). Patient demographics and perioperative outcomes were retrospectively analyzed. Results The preoperative liver function indexes showed no significant difference between the observation and control groups. For patients who underwent LC, groups A and B had more abdominal adhesions than the control group. One case was converted to open surgery in each of groups A and B. There was no statistical difference in operation time, estimated blood loss, postoperative hospital stay, and drainage volume. For patients who underwent LCBDE, groups C and D had more estimated blood loss than the control group (group C, 41.33 ± 50.84 vs. 18.97 ± 13.12 ml, p = 0.026; group D, 66.11 ± 87.46 vs. 18.97 ± 13.12 ml, p = 0.036). Compared with the control group, group C exhibited longer operative time (173.87 ± 60.91 vs. 138.38 ± 57.38 min, p = 0.025), higher drainage volume (296.83 ± 282.97 vs. 150.83 ± 127.04 ml, p = 0.015), and longer postoperative hospital stay (7.97 ± 3.68 vs. 6.17 ± 1.63 days, p = 0.021). There was no mortality in all groups. Conclusions LC or LCBDE is a safe and feasible procedure for experienced laparoscopic surgeons to perform on patients with previous upper abdominal surgery.
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Affiliation(s)
- Shaojie Yang
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shuodong Wu
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wanlin Dai
- Innovation Institute of China Medical University, Shenyang, China
| | - Liwei Pang
- Breast Surgery Unit, Department of General Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yaofeng Xie
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tengqi Ren
- Department of Urinary Surgery, Taizhou Enze Medical Center (Group) Enze Hospital, Taizhou, China
| | - Xiaolin Zhang
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shiyuan Bi
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yuting Zheng
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jingnan Wang
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Sun
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhuyuan Zheng
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Kong
- Biliary Surgery (2nd General) Unit, Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
- Correspondence: Jing Kong
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Wang PY, Lee YC, Liu WM, Chen CH. Surgical outcome of benign cases with pelvic adhesions undergoing robotic total hysterectomy. J Chin Med Assoc 2022; 85:853-858. [PMID: 35666608 DOI: 10.1097/jcma.0000000000000760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Robotic total hysterectomies have been considered contraindicated for patients with intra-abdominal adherences, but the evidence for this is not strong, and we hypothesized that the procedure can be of benefit even in these cases. In our research, we analyzed how the severity of pelvic adhesions affects robotic total hysterectomy, and by comparing different types of adhesions, we can further identify the outcomes differences in between, which may aid in future surgical decision making. METHODS Prospective cohort study (Canadian Task Force classification II-2). All 410 patients with uterine myoma or adenomyosis undergoing robotic total hysterectomies between 2011 and 2016 using the da Vinci Si system by the same surgeon in Taipei Medical University Hospital were included in the study. RESULTS Baseline characteristics, blood loss, docking time, operation time, time to perform uterine artery ligation (UAL), pain score, hospital stay, complication rate, and laparotomy conversion rate were analyzed between benign cases with or without pelvic adhesions undergoing robotic total hysterectomy. Furthermore, in our subgroups analysis, we have divided the patients with adhesion into different groups according to the severity of adhesion. The abdomen and pelvic cavity was divided into nine sections, and the outcomes of different adhesion condition were compared. We found that patients with adhesions had increased docking time and operation time, but other differences between groups were not statistically significant. The results of the adhesion group showed no significant increases in blood loss, intra- and postoperative complications, and length of hospital stay. Only significantly longer surgical time compared with the normal group was noted. CONCLUSION Our results suggest that robotic total hysterectomies with UAL are effective and safe for patients with benign gynecologic conditions, and the surgical method should be considered even for patients with adhesion risks.
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Affiliation(s)
- Pei-Yi Wang
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan, ROC
| | - Yu-Chieh Lee
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan, ROC
| | - Wei-Min Liu
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Ching-Hui Chen
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan, ROC
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Wang L, Hou H, Zhou D, He L, Yu Z. Factors Influencing Suture Difficulty of T-tube Fixation and Closure in Laparoscopic Common Bile Duct Exploration. Surg Laparosc Endosc Percutan Tech 2022; 32:368-372. [PMID: 35583548 DOI: 10.1097/sle.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 11/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Suture under the laparoscopy was considered as one of the most difficult and time-consuming tasks in laparoscopic common bile duct (CBD) exploration. Difficult suturing can lead to prolonged suturing time and decreased suturing quality. The aim of this study was to identify preoperative factors associated with the difficulty of T-tube suture following laparoscopic bile duct exploration. MATERIALS AND METHODS Retrospective analysis of consecutive patients who experienced successful laparoscopic CBD exploration with T-tube drainage were collected. Perioperative outcomes and short-term and long-term complications were recorded. Associations of the average suture time per stitch with preoperative demographic data and laboratory tests in patients were analyzed. RESULTS A total of 106 cases (46 males and 60 females) were included in this study. The average suture time per stitch was between 3 and 7.5 minutes with a median of 4.5 minutes (4, 5). There were no biliary leakage and other T-tube-related complications in all patients during follow-up. Spearman correlation analysis revealed that biliary tract reoperation (r=0.384, P<0.0001) and a higher body mass index (r=0.486, P<0.0001) were positively correlated with the average suture time per stitch, while there was no association between the average suture time per stitch and other preoperative demographic data and preoperative blood parameters, including CBD diameter, age, sex, operative time, preoperative white cell count, alanine transaminase, total bilirubin, and gamma-glutamyl transpeptidase. CONCLUSIONS We have identified 2 preoperative variables (biliary tract reoperation and a higher body mass index) that were positively associated with the suture difficulty under laparoscopy. An adequately powered prospective multicentre study is needed to validate our findings.
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Affiliation(s)
- Lei Wang
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China
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Differences in Outcome and Comparison of Stress and Immune Status in Patients with Recurrent Common Bile Duct Stones after Biliary Tract Surgery Choosing Three Procedures (ERCP, OCBDE, and LCBDE) for Treatment. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9197990. [PMID: 35035527 PMCID: PMC8754667 DOI: 10.1155/2022/9197990] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/27/2021] [Accepted: 12/13/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare the effect of choosing ERCP, OCBDE, and LCBDE for the treatment of patients with recurrent common bile duct stones after biliary tract surgery. METHOD 115 patients with recurrent common bile duct stones after biliary surgery in our hospital were retrospectively analyzed and divided into three groups according to the procedure, 36 patients in the ERCP group, 38 patients in the OCBDE group, and 41 patients in the LCBDE group, and compared the efficacy, stress status, and immune status of the three groups. RESULT The stone removal rates were 91.67%, 97.37%, and 97.56% in the ERCP, OCBDE, and LCBDE groups, respectively (P > 0.05). There were statistical differences between the ERCP, OCBDE, and LCBDE groups in terms of operative time, postoperative recovery time of exhaustion, recovery time of defecation, recovery time of feeding, and hospitalization time (P < 0.05). The postoperative complication rates were 8.33%, 10.53%, and 7.32% in the ERCP, OCBDE, and LCBDE groups, respectively (P > 0.05). The recurrence rates within 1 year after surgery were 2.78%, 7.89%, and 2.44% in the ERCP, OCBDE, and LCBDE groups, respectively (P > 0.05). CONCLUSION ERCP has short operative time, short hospital stay, and rapid postoperative recovery. LCBDE has mild trauma, and OCBDE has a wide range of application. Each of the three procedures has its own advantages and shortcomings, and the most appropriate procedure should be selected on the basis of comprehensive evaluation.
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Maeda Y, Oiwa K, Matsumoto S, Nozawa A, Kawahira H. Years of experience is more effective in defining experts in the gaze analysis of laparoscopic suturing task than task duration. APPLIED ERGONOMICS 2021; 96:103474. [PMID: 34098406 DOI: 10.1016/j.apergo.2021.103474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 06/12/2023]
Abstract
In this study, the relationship between gaze patterns, task duration, and years of experience, which are commonly used to define and evaluate expert surgeons in laparoscopic surgery, was identified. Ten surgeons with 1-28 years of experience and six inexperienced students were included. Subjects used forceps to repeat the task of suturing a suture pad. Each subject wore an eye-marking recorder, and gaze points were recorded and analyzed. No significant relationship between task duration and gaze pattern was observed. However, there was a significant relationship between a surgeon's years of experience and the percentage of time spent gazing at the forceps. Subjects with more years of experience operated without looking at the forceps and fixed their gaze on the operational target. Therefore, when analyzing laparoscopic gazing patterns, it may be more appropriate to define an "expert" based on the years of experience rather than task duration.
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Affiliation(s)
- Yoshitaka Maeda
- Medical Simulation Center, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Kosuke Oiwa
- Department of Electrical Engineering and Electronics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, 252-5258, Japan.
| | - Shiro Matsumoto
- The Departments of Surgery, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Akio Nozawa
- Department of Electrical Engineering and Electronics, Aoyama Gakuin University, 5-10-1 Fuchinobe, Chuo-ku, Sagamihara-shi, Kanagawa, 252-5258, Japan.
| | - Hiroshi Kawahira
- Medical Simulation Center, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
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Kaida H, Miyasaka Y, Morishita M, Koreeda N, Hirano Y, Ohmiya T, Uwatoko S, Kawamoto M, Komono A, Sakamoto R, Shibata R, Higashi D, Nimura S, Watanabe M. Laparoscopic distal pancreatectomy for intraductal papillary mucinous neoplasm-associated pancreatic cancer: A case report. Int J Surg Case Rep 2021; 87:106376. [PMID: 34537524 PMCID: PMC8455712 DOI: 10.1016/j.ijscr.2021.106376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/25/2021] [Accepted: 09/02/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction and importance Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is often found incidentally during examination for other diseases. In addition to the risk of malignant transformation, patients with IPMN are at risk of developing pancreatic cancer. We report a case of pancreatic tail cancer that developed separately from a preexisting IPMN after minimally invasive esophagectomy for cancer of the esophagogastric junction and was resected successfully by laparoscopic distal pancreatectomy. Case presentation A 72-year-old man underwent thoracoscopic and laparoscopic esophagectomy for esophagogastric junction cancer. He had undergone surgery for ascending colon cancer 20 years ago. At that time, IPMN was confirmed in the pancreatic body by a preoperative examination. Computed tomography was regularly performed for postoperative work-up and follow-up of the IPMN, and a solid lesion with cystic components was detected in the pancreatic tail 9 months after the operation. On detailed examination, pancreatic ductal adenocarcinoma concomitant with IPMN, accompanied by a retention cyst, was considered. Laparoscopic distal pancreatectomy was successfully performed after neoadjuvant chemotherapy. Pathological diagnosis of the lesion in the pancreatic tail was of an invasive intraductal papillary mucinous carcinoma (ypT3ypN0yM0 ypStageIIA). Clinical discussion If an IPMN is detected during preoperative examination for malignancies of other organs, careful follow-up is necessary due to the high risk of pancreatic cancer development. Furthermore, initial operation with minimally invasive surgery may reduce adhesion and facilitate subsequent surgeries. Conclusion We have provided evidence that supports the importance of a careful follow-up of IPMNs, even if they are low risk. Intraductal papillary mucinous neoplasm of the pancreas is found incidentally. A pre-existing neoplasm led to pancreatic tail cancer in one patient. Due to careful follow-up of the neoplasm, the secondary cancer was detected rapidly. It was resected successfully by laparoscopic distal pancreatectomy. Careful follow is necessary if this neoplasm is detected.
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Affiliation(s)
- Hiroki Kaida
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushinoshi, Fukuoka 818-8502, Japan
| | - Yoshihiro Miyasaka
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushinoshi, Fukuoka 818-8502, Japan
| | - Marina Morishita
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushinoshi, Fukuoka 818-8502, Japan
| | - Nobuhiko Koreeda
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushinoshi, Fukuoka 818-8502, Japan
| | - Yousuke Hirano
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushinoshi, Fukuoka 818-8502, Japan
| | - Toshihiro Ohmiya
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushinoshi, Fukuoka 818-8502, Japan
| | - Shugo Uwatoko
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushinoshi, Fukuoka 818-8502, Japan
| | - Makoto Kawamoto
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushinoshi, Fukuoka 818-8502, Japan
| | - Akira Komono
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushinoshi, Fukuoka 818-8502, Japan
| | - Ryohei Sakamoto
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushinoshi, Fukuoka 818-8502, Japan
| | - Ryosuke Shibata
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushinoshi, Fukuoka 818-8502, Japan
| | - Daijiro Higashi
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushinoshi, Fukuoka 818-8502, Japan
| | - Satoshi Nimura
- Department of Pathology, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushinoshi, Fukuoka 818-8502, Japan
| | - Masato Watanabe
- Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushinoshi, Fukuoka 818-8502, Japan.
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Zhu J, Du P, He J, Tong F, Xiao W, Li Y. Laparoscopic common bile duct exploration for patients with a history of prior biliary surgery: a comparative study with an open approach. ANZ J Surg 2020; 91:E98-E103. [PMID: 33369850 DOI: 10.1111/ans.16529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Laparoscopic common bile duct exploration (LCBDE) is increasingly being used to treat choledocholithiasis. However, few studies have examined the treatment of recurrent common bile duct stones (CBDS) in patients with a history of prior biliary surgery. The current research aimed to compare the outcomes of laparoscopic versus open common bile duct exploration in patients with a history of prior biliary surgery. METHODS Between March 2010 and August 2019, 162 patients with recurrent CBDS after prior biliary surgery who underwent surgical management in our institution were enrolled in this study. The demographic, intraoperative and postoperative data were retrospectively analysed. RESULTS Among these 162 patients, 72 underwent laparoscopic approach (LCBDE group), and 90 underwent open surgery (open common bile duct exploration group). The LCBDE group was associated with significantly lower overall complication rate, incision infection rate and blood loss compared to open common bile duct exploration group (all P < 0.05). Moreover, the laparoscopic approach significantly reduced the length of postoperative hospital stay (P < 0.05). However, the operative time, stone clearance rate, and stone recurrence rate were not significantly different between the two groups (P > 0.05). The conversion rate of the laparoscopic approach was 6.9%. CONCLUSIONS LCBDE is superior to open procedure in terms of blood loss, hospital stay, overall complication and incision infection in patients with a history of prior biliary surgery, and it should be considered as a safe and effective treatment if it is performed by an experienced surgeon.
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Affiliation(s)
- Jisheng Zhu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Peng Du
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianpeng He
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Fengxiong Tong
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weidong Xiao
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Impact of choledochotomy techniques during laparoscopic CBD exploration on short- and long-term clinical outcomes: Time to change concepts (a retrospective cohort study). Int J Surg 2020; 83:102-106. [DOI: 10.1016/j.ijsu.2020.08.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 01/12/2023]
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