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Duran Espinoza V, Miguieles Schilling M, Gaete Dañobeitía MI, Vela Ulloa J, Silva Peña F, Jarry Trujillo C, Varas Cohen J, Achurra Tirado P, Inzunza Agüero M. Comparative study of video recordings of non-medical devices in laparoscopic surgery: a cross-sectional study. Surg Endosc 2023; 37:9533-9539. [PMID: 37715085 DOI: 10.1007/s00464-023-10441-y] [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: 04/20/2023] [Accepted: 09/01/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION Laparoscopic surgery is the approach of choice for multiple procedures, being laparoscopic cholecystectomy one of the most frequently performed surgeries. Likewise, video recording of these surgeries has become widespread. Currently, the market offers medical recording devices (MRD) with an approximate cost of 2000 USD, and alternative non-medical recording devices (NMRD) with a cost ranging from 120 to 200 USD. To our knowledge, no comparative studies between the available recording devices have been done. We aim to compare the perception of the quality of videos recorded by MRD and NMRD in a group of surgeons and surgical residents. METHODS A cross-sectional study was conducted using an online survey to compare recordings from three NMRDs (Elgato 30 fps, AverMedia 60 fps, Hauppauge 30 fps) and one MRD (MediCap 20 fps) during a laparoscopic cholecystectomy. The survey assessed: definition of anatomical structures (DA), fluidity of movements (FM), similarity with the operating room screen (ORsim), and overall quality (OQ). Descriptive and nonparametric analytical statistics tests were applied. Results were analyzed using JMP-15 software. RESULTS Forty surveys were collected (80% surgeons, 20% residents). NMRDs scored significantly higher than MRD in DA (p = 0.003), FM (p < 0.001), ORsim (p < 0.001), and OQ (p < 0.001). One NMRD was chosen as the highest quality device (70%), and MRD as the poorest (78%). No significant differences were found when analyzing by surgical experience. CONCLUSIONS In terms of recording laparoscopic procedures, non-medical video recording devices (NMRDs) outperformed medical-grade recording device (MRD) with a higher overall score. This suggests that NMRDs could serve as a cost-effective alternative with superior video quality for recording laparoscopic surgeries.
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Affiliation(s)
- Valentina Duran Espinoza
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mariana Miguieles Schilling
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Felipe Silva Peña
- Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Jarry Trujillo
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Marcoleta 377, Santiago, Chile
| | - Julian Varas Cohen
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Marcoleta 377, Santiago, Chile
| | - Pablo Achurra Tirado
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Marcoleta 377, Santiago, Chile
| | - Martín Inzunza Agüero
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Marcoleta 377, Santiago, Chile.
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Pio L, Tulelli B, Ali L, Carvalho L, Chalhoub M, Julien-Marsollier F, Bonnard A. Enhanced Recovery after Surgery Applied to Pediatric Laparoscopic Cholecystectomy for Simple Cholelithiasis: Feasibility and Teaching Insights. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1881. [PMID: 38136083 PMCID: PMC10742299 DOI: 10.3390/children10121881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/14/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Same-day discharge after a cholecystectomy is a common practice in the adult population and has been demonstrated as safe and viable for children as well. However, there is a lack of comprehensive teaching models for pediatric cholecystectomy. Drawing inspiration from standardized outpatient procedures, this study aimed to assess the clinical outcomes and feasibility of teaching programs and an Enhanced Recovery After Surgery (ERAS) protocol following ambulatory laparoscopic cholecystectomy in pediatric patients. METHODS In 2015, an ERAS pathway for laparoscopic cholecystectomy (LC) was implemented, focusing on admission procedures, surgery timing, anesthetic choices, analgesia, postoperative feeding, mobilization, and pain assessment. Day-case surgery was not applicable for acute cholecystitis, choledochal lithiasis, sickle cell disease, and hereditary spherocytosis cases. The protocol was employed for a group of attending surgeons and fellows, as well as a group of residents under the supervision of experienced surgeons. A retrospective analysis was conducted to evaluate the feasibility and effectiveness of ambulatory cholecystectomy in children and its utilization in training pediatric surgical trainees. RESULTS Between 2015 and 2020, a total of 33 patients were included from a cohort of 162 children who underwent LC, with 15 children operated on by senior surgeons and 18 by young surgeons. The primary diagnoses were symptomatic gallbladder lithiasis (n = 32) and biliary dyskinesia (n = 1). The median age at the time of surgery was 11.3 years (interquartile range (IQR) 4.9-18), and the median duration of surgery was 54 min (IQR 13-145). One intraoperative complication occurred, involving gallbladder rupture and the dissemination of lithiasis into the peritoneal cavity. Three patients (9%) required an overnight stay, while no postoperative complications or readmissions within 30 days were observed. ERAS was successfully implemented in 30 patients (91%). No significant differences in surgical outcomes were noted between senior and young surgeons. At an average follow-up of 55 months, no long-term sequelae were identified. CONCLUSIONS These findings align with the current trend of increasing use of outpatient laparoscopic cholecystectomy and underscore its feasibility in the pediatric population. The application of a structured ERAS protocol appears viable and practical for training the next generation of pediatric surgeons. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Luca Pio
- Department of General Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 75019 Paris, France; (B.T.); (L.A.); (L.C.); (M.C.); (A.B.)
- Paediatric Surgery Department, University Sorbonne Paris-Cité, 75006 Paris, France
| | - Berenice Tulelli
- Department of General Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 75019 Paris, France; (B.T.); (L.A.); (L.C.); (M.C.); (A.B.)
| | - Liza Ali
- Department of General Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 75019 Paris, France; (B.T.); (L.A.); (L.C.); (M.C.); (A.B.)
| | - Lucas Carvalho
- Department of General Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 75019 Paris, France; (B.T.); (L.A.); (L.C.); (M.C.); (A.B.)
| | - Marc Chalhoub
- Department of General Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 75019 Paris, France; (B.T.); (L.A.); (L.C.); (M.C.); (A.B.)
| | - Florence Julien-Marsollier
- Department of Anesthesia, Intensive Care and Pain Management, Robert Debré Children University Hospital, APHP, 75019 Paris, France;
| | - Arnaud Bonnard
- Department of General Pediatric Surgery and Urology, Robert Debré Children University Hospital, APHP, 75019 Paris, France; (B.T.); (L.A.); (L.C.); (M.C.); (A.B.)
- Paediatric Surgery Department, University Sorbonne Paris-Cité, 75006 Paris, France
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Gonçalves MR, Novo de Matos J, Oliveira A, Marinho R, Cadime I, Carlos Alves P, Morales-Conde S, Sousa MCB. Robotic4all project: Results of a hands-on robotic surgery training program. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2023. [DOI: 10.1016/j.lers.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Relationship between Preoperative Lower Back Pain and Severe Postoperative Pain after Gynecologic Laparoscopy: A Prospective Observational Study. J Clin Med 2022; 11:jcm11154295. [PMID: 35893385 PMCID: PMC9330406 DOI: 10.3390/jcm11154295] [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: 05/02/2022] [Revised: 07/19/2022] [Accepted: 07/22/2022] [Indexed: 12/10/2022] Open
Abstract
We hypothesized that preoperative lower back pain (LBP) may be associated with the severity of postoperative pain after gynecologic laparoscopy. This prospective observational study aimed to investigate the association between preoperative LBP and postoperative pain. We assessed the intensity of LBP before surgery and the postoperative pain after surgery. The abilities of preoperative LBP intensity, age, body mass index, and anesthetic duration time to predict moderate-to-severe postoperative pain were measured using receiver operating characteristic analysis. The data of 148 patients were analyzed. Only preoperative LBP intensity showed a significant association with moderate-to-severe postoperative pain (area under the curve, 0.71; 95% confidence interval, 0.63−0.79; p < 0.001). Preoperative LBP rated three on a numeric rating scale (NRS) had the highest combined sensitivity (75.3%) and specificity (58.3%). Patients with LBP above NRS 3 had more severe postoperative pain than those who did not (pain score 5.3 ± 2.2 vs. 3.9 ± 1.9, p < 0.001), leading to more opioid requirement in the recovery room (48.5% vs. 27.5%, p = 0.014). Preoperative LBP intensity is a useful factor for identifying patients at risk for pain after gynecologic laparoscopy.
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Inania M, Sharma P, Parikh M. Role of enhanced recovery after surgery in total laparoscopic hysterectomy. J Minim Access Surg 2022; 18:186-190. [PMID: 35046168 PMCID: PMC8973480 DOI: 10.4103/jmas.jmas_86_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction: Enhanced recovery after surgery (ERAS) principles is an evidence-based surgical management approach that requires cooperation across various medical specialties. In this study, we applied ERAS principles in total laparoscopic hysterectomy (TLH) and the post-operative outcomes like post-operative pain, nausea and vomiting, opioid requirement, day of discharge, and any other complaints were studied. Methods: The study was conducted in a private healthcare setup in Jodhpur, Rajasthan, India. In this non-randomised controlled study 103 patients who underwent TLH over a period of 1 year were alternatively allocated to the study group and the control group. There were 51 patients in the study group in whom ERAS principles were applied and 52 patients in control group in whom traditional post-operative care was given. Results: Post-operative nausea and vomiting and opioid requirement were significantly reduced in the study group (P < 0.05). The post-operative pain was similar in both groups. The majority of patients in study group were discharged within 24 h as compared to the routine discharge after 48 h. Conclusion: Following ERAS principles in TLH results in decrease in post-operative nausea and vomiting, post-operative opioid requirement and hospital stay. Hence, the ERAS principles should be the standard practice in TLH even in a developing country setup.
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Affiliation(s)
- Mili Inania
- Department of OBG, Medipulse Hospital, Jodhpur, Rajasthan, India
| | - Priyanka Sharma
- Department of OBG, Medipulse Hospital, Jodhpur, Rajasthan, India
| | - Manoj Parikh
- Department of Anesthesia, Balaji Hospital, Jodhpur, Rajasthan, India
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Madhok B, Nanayakkara K, Mahawar K. Safety considerations in laparoscopic surgery: A narrative review. World J Gastrointest Endosc 2022; 14:1-16. [PMID: 35116095 PMCID: PMC8788169 DOI: 10.4253/wjge.v14.i1.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/11/2021] [Accepted: 12/10/2021] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic surgery has many advantages over open surgery. At the same time, it is not without its risks. In this review, we discuss steps that could enhance the safety of laparoscopic surgery. Some of the important safety considerations are ruling out pregnancy in women of the childbearing age group; advanced discussion with the patient regarding unexpected intraoperative situations, and ensuring appropriate equipment is available. Important perioperative safety considerations include thromboprophylaxis; antibiotic prophylaxis; patient allergies; proper positioning of the patient, stack, and monitor(s); patient appropriate pneumoperitoneum; ergonomic port placement; use of lowest possible intra-abdominal pressure; use of additional five-millimetre (mm) ports as needed; safe use of energy devices and laparoscopic staplers; low threshold for a second opinion; backing out if unsafe to proceed; avoiding hand-over in the middle of the procedure; ensuring all planned procedures have been performed; inclusion of laparoscopic retrieval bags and specimens in the operating count; avoiding 10-15 mm ports for placement of drains; appropriate port closures; and use of long-acting local anaesthetic agents for analgesia. Important postoperative considerations include adequate analgesia; early ambulation; careful attention to early warning scores; and appropriate discharge advice.
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Affiliation(s)
- Brij Madhok
- Upper GI Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, United Kingdom
| | - Kushan Nanayakkara
- Upper GI Surgery, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 3NE, United Kingdom
| | - Kamal Mahawar
- Department of General Surgery, South Tyneside and Sunderland NHS Foundation Trust, Sunderland SR4 7TP, United Kingdom
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Preoperative Oral Carbohydrate Loading in Laparoscopic Gynecologic Surgery: A Randomized Controlled Trial. J Minim Invasive Gynecol 2020; 28:1086-1094.e1. [PMID: 33310170 DOI: 10.1016/j.jmig.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/18/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE To determine whether carbohydrate loading improves the postoperative quality of recovery (QoR) better than the midnight fasting policy in laparoscopic gynecologic surgeries. DESIGN Randomized, parallel-group trial. SETTING Tertiary university hospital. PATIENTS Female patients scheduled for laparoscopic gynecologic surgery for nonmalignant gynecologic diseases. INTERVENTIONS Eighty-eight women were randomly assigned to the midnight fasting group (nil per os, NPO group) or the carbohydrate loading group (carbohydrate group). Patients in both groups adhered to the enhanced recovery after surgery protocol except for carbohydrate intake in the carbohydrate group. MEASUREMENTS AND MAIN RESULTS The postoperative QoR was evaluated using the QoR 15-item questionnaire on postoperative day 2. The times to readiness for discharge of the groups were compared. The QoR 15-item questionnaire scores were 97.7 ± 23.0 in the NPO group and 99.6 ± 22.4 in the carbohydrate group; they were not statistically different (p = .702). The times to readiness for discharge of both groups were also not different: 36.8 ± 12.2 hours in the NPO group and 37.6 ± 11.8 hours in the carbohydrate group (p = .684). CONCLUSION The benefit of carbohydrate beverage intake was not significant in laparoscopic gynecologic surgeries when following the enhanced recovery after surgery protocol.
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Miao C, Yu A, Yuan H, Gu M, Wang Z. Effect of Enhanced Recovery After Surgery on Postoperative Recovery and Quality of Life in Patients Undergoing Laparoscopic Partial Nephrectomy. Front Oncol 2020; 10:513874. [PMID: 33178573 PMCID: PMC7592390 DOI: 10.3389/fonc.2020.513874] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 09/16/2020] [Indexed: 12/19/2022] Open
Abstract
Patients who underwent laparoscopic partial nephrectomy from the First Affiliated Hospital of Nanjing Medical University from May 2016 to May 2019 were randomly divided into enhanced recovery after surgery (ERAS) and control groups. The clinical indicators, preoperative and postoperative anxiety, depression, and postoperative quality of life were compared between the two groups. The recovery time, hospitalization cost, incidence of complications, and postoperative anxiety of patients in the ERAS group were lower than those of the control group. The satisfaction during hospitalization, scores of physical function, role function, emotional function, and general health status of the ERAS group were also significantly increased. Applying the ERAS to patients undergoing laparoscopic partial nephrectomy can improve their prognosis, experience of medical treatment, and life quality after surgery as well as have certain economic advantages.
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Affiliation(s)
- Chenkui Miao
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Division of Urology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Aimei Yu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Han Yuan
- Center for Quantitative Medicine, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Min Gu
- Department of Urology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zengjun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Chen B, He Y, Xiao Y, Guo D, Liu P, He Y, Sun Q, Jiang P, Liu Z, Liu Q. Heated fennel therapy promotes the recovery of gastrointestinal function in patients after complex abdominal surgery: A single-center prospective randomized controlled trial in China. Surgery 2020; 168:793-799. [PMID: 32682507 DOI: 10.1016/j.surg.2020.05.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Postoperative gastrointestinal dysfunction remains a major determinant of the duration of stay after complex abdominal surgery. This study was performed to evaluate the effectiveness of heated fennel therapy in accelerating the recovery of gastrointestinal function. METHODS This surgeon-blinded, prospective randomized controlled study included 381 patients with hepatobiliary, pancreatic, and gastric tumors who were divided into 2 groups. The patients in the experimental groups received heated fennel therapy, and those in the control groups received heated rice husk therapy. We compared the baseline characteristics, time to first postoperative flatus and defecation, fasting time, duration of postoperative hospital stay, grading of abdominal pain, classification of abdominal distension, inflammatory markers, and nutritional status indicators. RESULTS The time to first flatus and first defecation and the fasting time were statistically significantly less in the heated fennel therapy group than those in the control groups (P < .05 each); and abdominal distension was also relieved in the experimental groups (P < .001). Heated fennel therapy had no obvious beneficial effect on inflammatory markers but improved the serum albumin (ALB) level of the patients at postop day 9 (P < .001). Among the patients with alimentary tract reconstruction, those in the heated fennel therapy group had a clinically important, lesser hospital stay than those in the control group (9.2 5 ± 5.1 versus 11.1 ± 6.4; P < .023). CONCLUSION Heated fennel therapy facilitated the gastrointestinal motility function of patients early postoperatively.
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Affiliation(s)
- Baiyang Chen
- Department of General Surgery, Research Center of Digestive Diseases, Zhongnan Hospital of Wuhan University, Wuhan, PR China
| | - Yukun He
- Department of General Surgery, Research Center of Digestive Diseases, Zhongnan Hospital of Wuhan University, Wuhan, PR China
| | - Yusha Xiao
- Department of General Surgery, Research Center of Digestive Diseases, Zhongnan Hospital of Wuhan University, Wuhan, PR China
| | - Deliang Guo
- Department of General Surgery, Research Center of Digestive Diseases, Zhongnan Hospital of Wuhan University, Wuhan, PR China
| | - Pengpeng Liu
- Department of General Surgery, Research Center of Digestive Diseases, Zhongnan Hospital of Wuhan University, Wuhan, PR China
| | - Yueming He
- Department of General Surgery, Research Center of Digestive Diseases, Zhongnan Hospital of Wuhan University, Wuhan, PR China
| | - Quan Sun
- Department of General Surgery, Research Center of Digestive Diseases, Zhongnan Hospital of Wuhan University, Wuhan, PR China
| | - Ping Jiang
- Department of General Surgery, Research Center of Digestive Diseases, Zhongnan Hospital of Wuhan University, Wuhan, PR China
| | - Zhisu Liu
- Department of General Surgery, Research Center of Digestive Diseases, Zhongnan Hospital of Wuhan University, Wuhan, PR China
| | - Quanyan Liu
- Department of General Surgery, General Hospital of Tianjin Medical University, Tianjin, PR China.
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López-Torres López J, Cifuentes García B, Fernández Ruipérez L, Rodeles Criado A, Alcántara Noalles MJ, Peiró García R, Argente Navarro P. Predictive Factors of Admission in Outpatient Laparoscopic Surgery. Cir Esp 2020; 99:140-146. [PMID: 32499053 DOI: 10.1016/j.ciresp.2020.04.023] [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: 03/11/2020] [Revised: 04/11/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The aim of the study is to analyze the rate of no planificated hospitalization after ambulatory surgical procedures by laparoscopy, and identify associated risk factors to failure in the ambulatory manage of this patients. METHODS A prospective observational study was performed during 18 months and included 297 patients treated with ambulatory laparoscopies performed at University Hospital La Fe of Valencia. The need for hospital admission, same day after surgery, was considered the main variable. Variables were recorded for preoperatives, intraoperatives o postoperatives factors. To identify risk factors and variables associated with complications, statistical analyses were calculated with logistic regression models. RESULTS After laparoscopic surgery, the 8.1% of patients required hospitalization. This rate was significantly superior in gynecologic surgery, patients with previous surgery complications, superior ASA classified (II and III) and smokers. Likewise, patients with pneumoperitoneum time over 45minutes presented a higher hospitalization rate; also founded in patients with anesthetic or surgery complications (including conversion to laparotomy). At least, the rate of hospitalization was significantly superior in relation with postoperative nausea and vomiting (PONV). CONCLUSION The rate of patients who need hospitalization after ambulatory laparoscopic surgery was 8.1%, of which 5.5% were general surgeries and 12.1% were gynecologic surgeries. The mots relationated factors with ambulatory manage failure, analyzed with multiple regression, were the appearance of surgery complications, the pneumoperitoneum time over 100minutes and the PONV.
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Affiliation(s)
- Jaime López-Torres López
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, GAI de Albacete, Albacete, España.
| | - Belén Cifuentes García
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, GAI de Albacete, Albacete, España
| | - Laura Fernández Ruipérez
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, GAI de Albacete, Albacete, España
| | - Alberto Rodeles Criado
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, GAI de Albacete, Albacete, España
| | - María José Alcántara Noalles
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe de Valencia, Valencia, España
| | - Ramón Peiró García
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, GAI de Albacete, Albacete, España
| | - Pilar Argente Navarro
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe de Valencia, Valencia, España
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Thoracic epidural analgesia (TEA) versus patient-controlled analgesia (PCA) in laparoscopic colectomy: a systematic review and meta-analysis. Int J Colorectal Dis 2019; 34:27-38. [PMID: 30519843 DOI: 10.1007/s00384-018-3207-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE A meta-analysis of RCTs was designed to provide an up-to-date comparison of thoracic epidural analgesia (TEA) and patient-controlled analgesia (PCA) in laparoscopic colectomy. METHODS Our study was completed following the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. A systematic literature screening was performed in MEDLINE and Web of Science. Fixed effects (FE) or random effects (RE) models were estimated based on the Cochran Q test result. RESULTS Totally, 8 studies were introduced in the present meta-analysis. Superiority of PCA in terms of length of hospital stay (LOS) (WMD 0.73, p = 0.004) and total complication rate (OR 1.57, p = 0.02) was found. TEA had a lower resting pain visual analogue scale (VAS) score at Day 1 (WMD - 2.23, p = 0.005) and Day 2 (WMD - 2.17, p = 0.01). TEA group had also a systematically lower walking VAS. Moreover, first bowel opened time (first defecation) (WMD - 0.88, p < 0.00001) was higher when PCA was applied. CONCLUSIONS TEA was related to a lower first bowel opened time, walking, and resting pain levels at the first postoperative days. However, the overall complication rate and LOS were higher in the epidural analgesia group. Thus, for a safe conclusion to be drawn, further randomized controlled trials (RCTs) of a higher methodological and quality level are required.
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Jung HS, Huh J, Kim Y, Hong SH, Lee J. Continuous administration of ramosetron with patient-controlled analgesia after laparoscopic distal gastrectomy does not delay postoperative bowel function recovery: A prospective, randomized, double-blinded study. Medicine (Baltimore) 2018; 97:e11503. [PMID: 30075513 PMCID: PMC6081143 DOI: 10.1097/md.0000000000011503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Currently, 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are indicated to slow gastrointestinal motility in the diarrhea-predominant subtype of irritable bowel syndrome. They are commonly used to prevent or treat postoperative nausea and vomiting (PONV) and opioid-induced nausea and vomiting (OINV). We conducted a prospective, randomized, double-blinded study to investigate whether the continuous administration of ramosetron, a selective 5-HT3 receptor antagonist, for preventing PONV and/or OINV after laparoscopic distal gastrectomy (LDG) might influence bowel function recovery. METHODS Patients scheduled to undergo LDG were randomly assigned to 1 of 3 treatment regimens: no prophylactic ramosetron (Group C); ramosetron 0.6 mg added to 2-day intravenous patient-controlled analgesia (IV-PCA) (Group R0.6); and ramosetron 1.2 mg added to 2-day IV-PCA (Group R1.2). Postoperative recovery profiles of bowel function, incidence of postoperative nausea/vomiting and pain, and perioperative data that affected bowel function recovery were evaluated. RESULTS Seventy-three patients completed the study protocol. Parameters associated with postoperative recovery of bowel function, such as time to first flatus, time to first bowel movement, time to first defecation, and time to commencement of soft diet, were not significantly different between the 3 groups. The incidence of nausea 2 to 24 hours after surgery was significantly lower in Group R0.6 (20.0%) and Group R1.2 (12.5%) than in Group C (45.8%) (P < .022). The ratio of complete response 2 to 24 hours after surgery was significantly higher in Group R0.6 (80.0%) and Group R1.2 (87.5%) than in Group C (54.2%) (P < .022). The incidence of retching 24 to 48 hours after surgery was significantly lower in Group R0.6 (0.0%) and Group R1.2 (4.2%) than in Group C (16.7%) (P < .043). CONCLUSION Continuous administration of ramosetron with patient-controlled analgesia to prevent PONV and OINV after LDG did not delay postoperative bowel function recovery.
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Affiliation(s)
- Hong Soo Jung
- Department of Anesthesiology and Pain Medicine, St. Vincent's Hospital
| | - Jaewon Huh
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Youngchan Kim
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Sang Hyun Hong
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jaemin Lee
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Gao YS, Fan XJ, Huang JJ, Zhang YF, Chen P, Yan XZ, Sun JG, Wang YM. Correlation between clinical symptoms and pathological types in 197 cases of primary small intestinal tumors. Shijie Huaren Xiaohua Zazhi 2018; 26:1253-1258. [DOI: 10.11569/wcjd.v26.i20.1253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To improve the primary and preoperative diagnosis of different pathological types of primary small intestinal tumors.
METHODS The clinical and pathological data of 197 cases of primary intestinal tumors confirmed by surgery and pathology were retrospectively analyzed at the First Affiliated Hospital of Zhengzhou University from August 2011 to February 2017.
RESULTS The most common clinical symptoms of different types of primary small bowel tumors were different. Abdominal mass was the most common symptom of high risk stromal tumors (38/63). Gastrointestinal bleeding was the most common symptom of low/middle risk stromal tumors (35/60). Abdominal pain was the most common symptom of malignant lymphomas (25/32) and polyps (6/6), and abdominal distension (3/5) was the most common symptom of adenocarcinoma patients. The primary diagnosis rate of primary small bowel tumors was 11.2% (22/197), of which 90.91% (20/22) were confirmed by CT examination.
CONCLUSION The most common symptoms of different pathological types of primary small intestine tumor are different. Combining the imaging features of different pathological types of tumor and selecting the way of examination reasonably can improve the primary and preoperative diagnosis of tumor pathology, help choose the treatment plan reasonably, and improve the survival of the patients.
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Affiliation(s)
- Yong-Shun Gao
- Department of Gastrointestinal Surgery, Zheng Dong Hospital, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 45000, He'nan Province, China
| | - Xiao-Jin Fan
- Department of Gastrointestinal Surgery, Zheng Dong Hospital, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 45000, He'nan Province, China
| | - Jing-Jing Huang
- Department of General Surgery, The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 45000, He'nan Province, China
| | - Yun-Fei Zhang
- Department of Gastrointestinal Surgery, Zheng Dong Hospital, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 45000, He'nan Province, China
| | - Peng Chen
- Department of Gastrointestinal Surgery, Zheng Dong Hospital, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 45000, He'nan Province, China
| | - Xi-Zhong Yan
- Department of Gastrointestinal Surgery, Zheng Dong Hospital, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 45000, He'nan Province, China
| | - Jian-Gang Sun
- Department of Gastrointestinal Surgery, Zheng Dong Hospital, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 45000, He'nan Province, China
| | - Yi-Ming Wang
- Department of Gastrointestinal Surgery, Zheng Dong Hospital, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 45000, He'nan Province, China
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Shimomura A, Obi Y, Fazl Alizadeh R, Li S, Nguyen NT, Stamos MJ, Kalantar-Zadeh K, Ichii H. Association of pre-operative estimated GFR on post-operative pulmonary complications in laparoscopic surgeries. Sci Rep 2017; 7:6504. [PMID: 28747700 PMCID: PMC5529443 DOI: 10.1038/s41598-017-06842-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/19/2017] [Indexed: 12/22/2022] Open
Abstract
Despite a large body of evidence showing the pandemic of chronic kidney disease, the impact of pre-operative kidney function on the risk of post-operative pulmonary complications (PPCs) is not well known. We used multivariable logistic regression analyses with 3-level hierarchical adjustments to identify the association of pre-operative estimated glomerular filtration rate (eGFR) with PPCs in laparoscopic surgeries. Among 452,213 patients between 2005 and 2013 in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Database, a total of 3,727 patients (0.9%) experienced PPCs. We found a gradient association between lower eGFR and higher likelihood of PPCs in the unadjusted model. In the case-mix adjusted model, a reverse-J-shaped association was observed; a small albeit significant association with the highest eGFR category emerged. Further adjustment slightly attenuated these associations, but the PPCs risk in the eGFR groups of <30, 30-60, and ≥120 mL/min/1.73 m2 remained significant: odds ratios (95% confidence intervals) of 1.82 (1.54-2.16), 1.38 (1.24-1.54), and 1.28 (1.07-1.53), respectively (reference: 90-120 mL/min/1.73 m2). Our findings propose a need for careful pre-operative evaluation of cardiovascular and pulmonary functions and post-operative fluid management among patients with not only lower but also very high eGFR.
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Affiliation(s)
- Akihiro Shimomura
- Department of Surgery, University of California, Irvine, Orange, California, USA
| | - Yoshitsugu Obi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California, Irvine, Orange, California, USA.
| | - Reza Fazl Alizadeh
- Department of Surgery, University of California, Irvine, Orange, California, USA
| | - Shiri Li
- Department of Surgery, University of California, Irvine, Orange, California, USA
| | - Ninh T Nguyen
- Department of Surgery, University of California, Irvine, Orange, California, USA
| | - Michael J Stamos
- Department of Surgery, University of California, Irvine, Orange, California, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology & Hypertension, University of California, Irvine, Orange, California, USA
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
- Los Angeles Biomedical Research Institute, Harbor-University of California, Los Angeles, Torrance, California, USA
| | - Hirohito Ichii
- Department of Surgery, University of California, Irvine, Orange, California, USA.
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15
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Watson DS. The Benefits of Enhanced Recovery Pathways in Perioperative Care. AORN J 2016; 102:464-7. [PMID: 26514702 DOI: 10.1016/j.aorn.2015.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 09/22/2015] [Indexed: 12/15/2022]
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16
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Park SJ, Kim BG, Oh AH, Han SH, Han HS, Ryu JH. Effects of intraoperative protective lung ventilation on postoperative pulmonary complications in patients with laparoscopic surgery: prospective, randomized and controlled trial. Surg Endosc 2016; 30:4598-606. [PMID: 26895920 DOI: 10.1007/s00464-016-4797-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/03/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Respiratory functions are usually impaired during pneumoperitoneum for laparoscopic surgery. This randomized, controlled and single-blinded study was performed to evaluate whether intraoperative protective lung ventilation influences postoperative pulmonary complications after laparoscopic hepatobiliary surgery. METHODS Sixty-two patients were randomized to receive either conventional ventilation with alveolar recruitment maneuver (tidal volume of 10 ml/kg with inspiratory pressure of 40 cmH2O for 30 s after the end of pneumoperitoneum, group R), or protective lung ventilation (low tidal volume of 6 ml/kg with positive end-expiratory pressure [PEEP] of 5 cmH2O, group P). Induction and maintenance of anesthesia were done with balanced anesthesia. Respiratory complications such as atelectasis, pneumonia or desaturation were observed postoperatively. The length of hospital stay, arterial blood gas analysis, peak inspiratory pressure and hemodynamic variables were also recorded. Results are presented as mean ± SD or number of patients (%). RESULTS Postoperative pulmonary complications (P = 0.023) and desaturation below 90 % (P = 0.016) occurred less frequently in group P than in group R. Eight patients of group R and 3 patients of group P showed atelectasis. Pneumonia was diagnosed in 1 patient of group R. No differences were observed in the length of hospital stay, arterial blood gas analysis (pH, PaO2, PaCO2 and PAO2) and hemodynamic variables except PAO2, AaDO2 and peak inspiratory pressure between the two groups. CONCLUSION Protective lung ventilation (low tidal volume with PEEP) during pneumoperitoneum was associated with less incidences of pulmonary complications than conventional ventilation with alveolar recruitment maneuver after laparoscopic hepatobiliary surgery.
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Affiliation(s)
- S J Park
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Gumiro-Gil 173, Bundang-gu, Seong-Nam Si, Seoul, 13620, South Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-do, South Korea
| | - B G Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Gumiro-Gil 173, Bundang-gu, Seong-Nam Si, Seoul, 13620, South Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-do, South Korea
| | - A H Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Gumiro-Gil 173, Bundang-gu, Seong-Nam Si, Seoul, 13620, South Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-do, South Korea
| | - S H Han
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Gumiro-Gil 173, Bundang-gu, Seong-Nam Si, Seoul, 13620, South Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-do, South Korea
| | - H S Han
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-do, South Korea
| | - J H Ryu
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Gumiro-Gil 173, Bundang-gu, Seong-Nam Si, Seoul, 13620, South Korea.
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-do, South Korea.
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17
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Myriokefalitaki E, Smith M, Ahmed AS. Implementation of enhanced recovery after surgery (ERAS) in gynaecological oncology. Arch Gynecol Obstet 2015; 294:137-43. [PMID: 26525694 DOI: 10.1007/s00404-015-3934-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/21/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate the outcomes of enhanced recovery after surgery (ERAS) implementation in a gynaecological oncology centre. METHOD Non-randomised control trial, evaluating morbidity outcomes, before and after implementation of ERAS programme. All consecutive major gynaecological oncology operations performed during two specified periods were included. Data were collected prospectively for a study group in the initial 7.5 months of ERAS implementation and compared with a consecutive historic control group from the exact same period, the year before. Patients' characteristics and perioperative outcomes were compared. Further analysis stratified abdominal and laparoscopic surgery. RESULTS In total, 265 cases identified; 99 patients followed ERAS and 99 historic controls, managed with a traditional peri-operative approach, the exact same period the year before (vulval surgery excluded, 67 cases). Groups were comparable in demographics and co-morbidities (age, BMI, ASA, WHO), level of surgery and 30 days post-operative complication (grading Clavien-Dindo classification) and readmission rates (p > 0.05). Overall, the post-operative length of hospital stay (LOS) was significantly reduced for patients who followed ERAS (4.29 ± 2.78 days versus 7.23 ± 5.68 days, p < 0.001). Stratification to subgroups was based on the type of surgery, abdominal versus laparoscopic. Those who underwent abdominal surgery and followed ERAS benefited the maximum (LOS: 5.09 ± 2.74 days versus 8.70 ± 5.75, p < 0.001) CONCLUSIONS: ERAS programme is feasible and safe in Gynae-oncology. In this study, there was a reduction of 3.61 (SE: 0.78, CI 95 %) days in the total LOS, in major abdominal Gynae-oncology surgery (level 3 and 4) without affecting complication or readmission rates.
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Affiliation(s)
- Eva Myriokefalitaki
- Gynaecological Oncology, University Hospitals of Leicester, Leicester, UK.
- Gynaecological Oncology, University Hospitals of South Manchester, Manchester, UK.
| | - M Smith
- Gynaecological Oncology, University Hospitals of South Manchester, Manchester, UK
| | - A S Ahmed
- Gynaecological Oncology, University Hospitals of South Manchester, Manchester, UK
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Esemuede IO, Gabre-Kidan A, Fowler DL, Kiran RP. Risk of readmission after laparoscopic vs. open colorectal surgery. Int J Colorectal Dis 2015; 30:1489-94. [PMID: 26264049 DOI: 10.1007/s00384-015-2349-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE Laparoscopic colorectal resection (LC) is associated with known recovery benefits and earlier discharge when compared to open colorectal resection (OC). Whether earlier discharge leads to a paradoxical increase in readmission has not been well characterized. The aim of this study is to compare the risk of readmission after the two procedures in a large, nationally representative sample. METHODS Patients who underwent colorectal resection in 2011 were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database. LC and OC patients were compared for patient factors, complications, and readmission rates. A multivariable analysis controlling for significant factors was performed to evaluate factors associated with readmission. RESULTS Of 30,428 patients who underwent colorectal resection, 40.2% underwent LC. Length of stay (LOS) after LC was shorter than after OC (5.7 vs. 9.7 days, p < 0.001). LC was associated with a significantly lower rate of surgical site infections (SSI), bleeding, reoperation, 30-day mortality, and complications. Risk of readmission was greater for patients undergoing proctectomy than colectomy (12.7 vs. 10.6 %, p < 0.001), but was lower after laparoscopic than open for both procedures after controlling for confounding factors. Obesity, DM, operating time ≥180 min, steroid use, and ASA class 3-5 were found to be associated with readmission. CONCLUSION Despite its technical complexity, LC can be performed without concerns for increased complications or readmission. The shorter length of stay and the lower risk of readmissions underline the true benefits of the laparoscopic approach for colorectal resection.
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Affiliation(s)
- Iyare O Esemuede
- Division of Colorectal Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, 7 South Knuckle, New York, NY, 10032, USA
| | - Alodia Gabre-Kidan
- Division of Colorectal Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, 7 South Knuckle, New York, NY, 10032, USA
| | - Dennis L Fowler
- Division of Colorectal Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, 7 South Knuckle, New York, NY, 10032, USA
| | - Ravi P Kiran
- Division of Colorectal Surgery, Columbia University Medical Center, 177 Fort Washington Avenue, 7 South Knuckle, New York, NY, 10032, USA.
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Electroacupuncture for postoperative pain and gastrointestinal motility after laparoscopic appendectomy (AcuLap): study protocol for a randomized controlled trial. Trials 2015; 16:461. [PMID: 26466590 PMCID: PMC4606555 DOI: 10.1186/s13063-015-0981-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/28/2015] [Indexed: 01/26/2023] Open
Abstract
Background Acupuncture is a widely serviced complementary medicine. Although acupuncture is suggested for managing postoperative ileus and pain, supporting evidence is weak. The AcuLap trial is designed to provide high-level evidence regarding whether or not electroacupuncture is effective in promoting gastrointestinal motility and controlling pain after laparoscopic surgery. Methods/design This study is a prospective randomized controlled trial with a three-arm, parallel-group structure evaluating the efficacy of electroacupuncture for gastrointestinal motility and postoperative pain after laparoscopic appendectomy. Patients with appendicitis undergoing laparoscopic surgery are included and randomized into three groups: 1) electroacupuncture group, 2) sham acupuncture group, and 3) control group. Patients receive 1) acupuncture with electrostimulation or 2) fake electroacupuncture with sham device twice a day or 3) no acupuncture after laparoscopic appendectomy. The primary outcome is time to first passing flatus after operation. Secondary outcomes include postoperative pain, analgesics, nausea/vomiting, bowel motility, time to tolerable diet, complications, hospital stay, readmission rates, time to recovery, quality of life, medical costs, and protocol failure rate. Patients and hospital staff (physicians and nurses) are blinded to which group the patient is assigned, electroacupuncture or sham acupuncture. Data analysis personnel are blinded to group assignment among all three groups. Estimated sample size to detect a minimum difference of time to first flatus with 80 % power, 5 % significance, and 10 % drop rate is 29 × 3 groups = 87 patients. Analysis will be performed according to the intention-to-treat principle. Discussion The AcuLap trial will provide evidence on the merits and/or demerits of electroacupuncture for bowel motility recovery and pain relief after laparoscopic appendectomy. Trial registration The trial was registered in Clinical Research Information Service (CRiS), Republic of Korea (KCT0001486) on 14 May 2015.
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20
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Bakker N, Cakir H, Doodeman H, Houdijk A. Eight years of experience with Enhanced Recovery After Surgery in patients with colon cancer: Impact of measures to improve adherence. Surgery 2015; 157:1130-6. [DOI: 10.1016/j.surg.2015.01.016] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/18/2014] [Accepted: 01/22/2015] [Indexed: 12/20/2022]
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21
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The effect of enhanced recovery program for patients undergoing partial laparoscopic hepatectomy of liver cancer. Clin Transl Oncol 2015; 17:694-701. [DOI: 10.1007/s12094-015-1296-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 05/02/2015] [Indexed: 12/14/2022]
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22
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Segelman J, Nygren J. Evidence or eminence in abdominal surgery: Recent improvements in perioperative care. World J Gastroenterol 2014; 20:16615-16619. [PMID: 25469030 PMCID: PMC4248205 DOI: 10.3748/wjg.v20.i44.16615] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 07/23/2014] [Accepted: 09/19/2014] [Indexed: 02/06/2023] Open
Abstract
Repeated surveys from Europe, the United States, Australia, and New Zealand have shown that adherence to an evidence-based perioperative care protocol, such as Enhanced Recovery After Surgery (ERAS), has been generally low. It is of great importance to support the implementation of the ERAS protocol as it has been shown to improve outcomes after a number of surgical procedures, including major abdominal surgery. However, despite an increasing awareness of the importance of structured perioperative management, the implementation of this complex protocol has been slow. Barriers to implementation involve both patient- and staff-related factors as well as practice-related issues and resources. To support efficient and successful implementation, further educational and structural measures have to be made on a national or regional level to improve the standard of general health care. Besides postoperative morbidity, biological and physiological variables have been quite commonly reported in previous ERAS studies. Little information, however, has been obtained on cost-effectiveness, long-term outcomes, quality of life and patient-related outcomes, and these issues remain important areas of research for future studies.
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