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Cawich SO, Plummer JM, Griffith S, Naraynsingh V. Colorectal resections for malignancy: A pilot study comparing conventional vs freehand robot-assisted laparoscopic colectomy. World J Clin Cases 2024; 12:488-494. [PMID: 38322459 PMCID: PMC10841952 DOI: 10.12998/wjcc.v12.i3.488] [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: 09/26/2023] [Revised: 12/06/2023] [Accepted: 12/29/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Laparoscopic colectomy is widely accepted as a safe operation for colorectal cancer, but we have experienced resistance to the introduction of the FreeHand® robotic camera holder to augment laparoscopic colorectal surgery. AIM To compare the initial results between conventional and FreeHand® robot-assisted laparoscopic colectomy in Trinidad and Tobago. METHODS This was a prospective study of outcomes from all laparoscopic colectomies performed for colorectal carcinoma from November 29, 2021 to May 30, 2022. The following data were recorded: Operating time, conversions, estimated blood loss, hospitalization, morbidity, surgical resection margins and number of nodes harvested. All data were entered into an excel database and the data were analyzed using SPSS ver 20.0. RESULTS There were 23 patients undergoing colectomies for malignant disease: 8 (35%) FreeHand®-assisted and 15 (65%) conventional laparoscopic colectomies. There were no conversions. Operating time was significantly lower in patients undergoing robot-assisted laparoscopic colectomy (95.13 ± 9.22 vs 105.67 ± 11.48 min; P = 0.045). Otherwise, there was no difference in estimated blood loss, nodal harvest, hospitalization, morbidity or mortality. CONCLUSION The FreeHand® robot for colectomies is safe, provides some advantages over conventional laparoscopy and does not compromise oncologic standards in the resource-poor Caribbean setting.
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Affiliation(s)
- Shamir O Cawich
- Department of Surgery, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Joseph Martin Plummer
- Department of General Surgery and Consultant General and Colorectal Surgeon, Department of Surgery, University of the West Indies, Kingston, KIN7, Jamaica
| | - Sahle Griffith
- Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Vijay Naraynsingh
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
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Cawich SO, Singh Y, Naraynsingh V, Senasi R, Arulampalam T. Freehand-robot-assisted laparoscopic colorectal surgery: Initial experience in the Trinidad and Tobago. World J Surg Proced 2022; 12:1-7. [DOI: 10.5412/wjsp.v12.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/11/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopic colorectal surgery is still developing in the Anglophone Caribbean, having been first performed in the region in the year 2011. We report the initial outcomes using a robot camera holder to assist in laparoscopic colorectal operations.
AIM To report our initial experience using the FreeHand® robotic camera holder (Freehand 2010 Ltd., Guildford, Surrey, United Kingdom) for laparoscopic colorectal surgery in Trinidad & Tobago.
METHODS We retrospectively collected data from all patients who underwent laparoscopic colorectal resections using the Freehand® (Freehand 2010 Ltd., Guildford, Surrey, United Kingdom) robotic camera holder between September 30, 2021 and April 30, 2022. The following data were recorded: patient demographics, robotic arm setup time, operating time, conversions to open surgery, conversions to a human camera operator, number and duration of intra-operative lens cleaning. At the termination of the operation, before operating notes were completed, the surgeons were administered a questionnaire recording information on ergonomics, user-difficulty, requirement to convert to a human camera operator and their ability to carry out effective movements to control the robot while operating.
RESULTS Nine patients at a mean age of 58.9 ± 7.1 years underwent colorectal operations using the FreeHand robot: Right hemicolectomies (5), left hemicolectomy (1), sigmoid colectomies (2) and anterior resection (1). The mean robot docking time was 6.33 minutes (Median 6; Range 4-10; SD ± 1.8). The mean duration of operation was 122.33 ± 78.5 min and estimated blood loss was 113.33 ± 151.08 mL. There were no conversions to a human camera holder. The laparoscope was detached from the robot for lens cleaning/defogging an average of 2.6 ± 0.88 times per case, with cumulative mean interruption time of 4.2 ± 2.15 minutes per case. The mean duration of hospitalization was 3.2 ± 1.30 days and there were no complications recorded. When the surgeons were interviewed after operation, the surgeons reported that there were good ergonomics (100%), with no limitation on instrument movement (100%), stable image (100%) and better control of surgical field (100%).
CONCLUSION Robot-assisted laparoscopic colorectal surgery is feasible and safe in the resource-poor Caribbean setting, once there is appropriate training.
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Affiliation(s)
- Shamir O Cawich
- Department of Surgery, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Yardesh Singh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Vijay Naraynsingh
- Department of Surgery, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Ramdas Senasi
- Department of Surgery, South Tyneside and Sunderland NHS Trust, South Shields NE34 0PL, United Kingdom
| | - Tan Arulampalam
- Department of General Surgery, Colchester Hospital University National Health Services Foundation Trust, Colchester, Essex, England, Colchester CO4 5JL, United Kingdom
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Singh Y, Cawich SO, Mohammed S, Kuruvilla T, Naraynsingh V. Totally Laparoscopic Whipple's Operation: Initial Report from the Caribbean. Cureus 2020; 12:e7401. [PMID: 32337127 PMCID: PMC7182051 DOI: 10.7759/cureus.7401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Oncologic surgery in the Caribbean has evolved over the past decade, with increasing reports of advanced minimally invasive operations being performed. However, the minimally invasive approach has not been used for peri-ampullary lesions. This is because a laparoscopic Whipple's operation is a technically demanding and time-consuming operation. We report the first case of a totally laparoscopic Whipple's operation to be performed in the Caribbean.
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Affiliation(s)
- Yardesh Singh
- Surgery, University of the West Indies, St. Augustine, TTO
| | | | | | | | - Vijay Naraynsingh
- Surgery, Medical Associates Hospital, St. Joseph, TTO.,Clinical Surgical Sciences, University of the West Indies, St. Augustine, TTO
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Cawich SO, Kabiye D. Developing Laparoscopic Surgery on the Caribbean Island of St. Lucia: A Model for Public-Private Partnership. Cureus 2019; 11:e6011. [PMID: 31815075 PMCID: PMC6881080 DOI: 10.7759/cureus.6011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 10/28/2019] [Indexed: 12/16/2022] Open
Abstract
The first recorded laparoscopic operation in the Caribbean was a cholecystectomy performed in 1991. After a temporary peak in basic laparoscopic operations in subsequent years, the initial interest waned. While laparoscopic surgery was being popularized in the developed world, there was a stagnation in the Caribbean. There were many reasons for this stagnation, including a lack of surgical expertise, the negative attitudes of health-care workers, active opposition from surgical leaders, and equipment deficiencies, all exacerbated by the global financial recession in the early twenty-first century. A similar situation existed on the Caribbean island of St. Lucia, where laparoscopic surgery remained relatively dormant. After a strong desire by community surgeons to incorporate advanced laparoscopy into surgical practice, surgical leaders in St. Lucia engineered a public-private partnership to achieve this. This review article evaluates the available data, documents the obstacles encountered, and explains the mechanisms to overcome these obstacles to incorporate advanced laparoscopy in St. Lucia. This information is important because it can serve as a template for other developing Caribbean countries.
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Liang SS, Ying AJ, Affan ET, Kakala BF, Strippoli GFM, Bullingham A, Currow H, Dunn DW, Yeh ZY. Continuous local anaesthetic wound infusion for postoperative pain after midline laparotomy for colorectal resection in adults. Cochrane Database Syst Rev 2019; 10:CD012310. [PMID: 31627242 PMCID: PMC6953380 DOI: 10.1002/14651858.cd012310.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Colorectal resection through a midline laparotomy is a commonly performed surgical procedure to treat various bowel conditions. The typical postoperative hospital stay after this operation is 6 to 10 days. The main factors hindering early recovery and discharge are thought to include postoperative pain and delayed return of bowel function.Continuous infusion of a local anaesthetic into tissues surrounding the surgical incision via a multi-lumen indwelling wound catheter placed by the surgeon prior to wound closure may reduce postoperative pain, opioid consumption, the time to return of bowel function, and the length of hospital stay. OBJECTIVES To evaluate the efficacy and adverse events of continuous local anaesthetic wound infusion for postoperative pain after midline laparotomy for colorectal resection in adults. SEARCH METHODS We searched the CENTRAL, MEDLINE and Embase databases to January 2019 to identify trials relevant to this review. We also searched reference lists of relevant trials and reviews for eligible trials. Additionally, we searched two clinical trials registers for ongoing trials. SELECTION CRITERIA We considered randomised controlled trials (including non-standard designs) or quasi-randomised controlled trials comparing continuous wound infusion of a local anaesthetic versus a placebo or a sham after midline laparotomy for colorectal resection in adults. We did not compare continuous local anaesthetic wound infusion to other techniques, such as transverse abdominis plane block or thoracic epidural analgesia. We allowed non-randomised analgesic co-interventions carried out equally in the intervention and control groups. DATA COLLECTION AND ANALYSIS Two review authors independently identified trials for inclusion and assessed their quality using the Cochrane 'Risk of bias' tool. We extracted data using standardised forms, including pain at rest and on movement (10-point scale), opioid consumption via a patient-controlled analgesia (PCA) system (mg morphine equivalent), postoperative opioid-related adverse events, the time to rescue analgesia, the time to first flatus and to first bowel movement, the time to ambulation, the length of hospital stay, serious postoperative adverse events, and patient satisfaction. We quantitatively synthesised the data by meta-analysis. We summarised and graded the certainty of the evidence for critical outcomes using the GRADEpro tool and created a 'Summary of findings' table. MAIN RESULTS This review included six randomised controlled trials that enrolled a total of 564 adults undergoing elective midline laparotomy for colorectal resection comparing continuous wound infusion of a local anaesthetic to a normal saline placebo. Due to 23 post-randomisation exclusions, a total of 541 participants contributed data to the analysis of at least one outcome (local anaesthetic 268; control 273). Most participants were aged 55 to 65 years, with normal body mass index and low to moderate anaesthetic risk (American Society of Anesthesiologists class I-III). Random sequence generation, allocation concealment, and blinding were appropriately carried out in most trials. However, we had to downgrade the certainty of the evidence for most outcomes due to serious study limitations (risk of bias), inconsistency, indirectness, imprecision and reporting bias.Primary outcomesOn postoperative day 1, pain at rest (mean difference (MD) -0.59 (from 3.1), 95% confidence interval (CI) -1.12 to -0.07; 5 studies, 511 participants; high-certainty evidence), pain on movement (MD -1.1 (from 6.1), 95% CI -2.3 to -0.01; 3 studies, 407 participants; low-certainty evidence) and opioid consumption via PCA (MD -12 mg (from 41 mg), 95% CI -20 to -4; 6 studies, 528 participants; moderate-certainty evidence) were reduced in the local anaesthetic group compared to the control group.Secondary outcomesThere was a reduction in the time to first bowel movement (MD -0.67 from 4.4 days, 95% CI -1.17 to -0.17; 4 studies, 197 participants; moderate-certainty evidence) and the length of hospital stay (MD -1.2 from 7.4 days, 95% CI -2.0 to -0.3; 4 studies, 456 participants; high-certainty evidence) in the local anaesthetic group compared to the control group.There was no evidence of a difference in any serious postoperative adverse events until hospital discharge (RR 1.04, 95% CI 0.68 to 1.58; 6 studies, 541 participants; low-certainty evidence) between the two study groups. AUTHORS' CONCLUSIONS After elective midline laparotomy for colorectal resection, continuous wound infusion of a local anaesthetic compared to a normal saline placebo reduces postoperative pain at rest and the length of hospital stay, on the basis of high-certainty evidence. This means we are very confident that the effect estimates for these outcomes lie close to the true effects. There is moderate-certainty evidence to indicate that the intervention probably reduces opioid consumption via PCA and the time to first bowel movement. This means we are moderately confident that effect estimates for these outcomes are likely to be close to the true effects, but there is a possibility that they are substantially different. The intervention may reduce postoperative pain on movement, however, this conclusion is based on low-certainty evidence. This means our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect. There is low-certainty evidence to indicate that the intervention may have little or no effect on the rates of any serious postoperative adverse events until hospital discharge. High-quality randomised controlled trials to evaluate the intervention with a focus on important clinical and patient-centred outcomes are needed.
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Affiliation(s)
- Sophie S Liang
- Westmead HospitalDepartment of AnaesthesiaCnr Hawkesbury & Darcy RdsWestmeadNew South WalesAustralia2145
- The University of SydneySydney Medical SchoolSydneyNew South WalesAustralia2006
| | - Andrew J Ying
- Blacktown HospitalDepartment of Surgery18 Blacktown RdBlacktownNew South WalesAustralia2148
| | - Eshan T Affan
- The University of SydneySydney Medical SchoolSydneyNew South WalesAustralia2006
- Blacktown HospitalDepartment of Surgery18 Blacktown RdBlacktownNew South WalesAustralia2148
| | - Benedict F Kakala
- The University of SydneySydney Medical SchoolSydneyNew South WalesAustralia2006
- Westmead HospitalGeneral SurgeryCnr Darcy Rd & Bridge StWestmeadNew South WalesAustralia2145
| | - Giovanni FM Strippoli
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
| | - Alan Bullingham
- Westmead HospitalDepartment of AnaesthesiaCnr Hawkesbury & Darcy RdsWestmeadNew South WalesAustralia2145
- Blacktown HospitalDepartment of Anaesthesia18 Blacktown RdBlacktownNew South WalesAustralia2148
| | - Helen Currow
- Blacktown HospitalDepartment of Anaesthesia18 Blacktown RdBlacktownNew South WalesAustralia2148
- University of Western SydneySchool of MedicineLocked Bag 1797PenrithNew South WalesAustralia2751
| | - David W Dunn
- Blacktown HospitalDepartment of Surgery18 Blacktown RdBlacktownNew South WalesAustralia2148
| | - Zeigfeld Yu‐Ting Yeh
- Blacktown HospitalDepartment of Surgery18 Blacktown RdBlacktownNew South WalesAustralia2148
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Spence D, Dyer R, Andall-Brereton G, Barton M, Stanway S, Argentieri MA, Bray F, Cawich S, Edwards-Bennett S, Fosker C, Gabriel O, Greaves N, Hanchard B, Hospedales J, Luciani S, Martin D, Nimrod M, Ragin C, Simeon D, Tortolero-Luna G, Wharfe G, Sarfati D. Cancer control in the Caribbean island countries and territories: some progress but the journey continues. Lancet Oncol 2019; 20:e503-e521. [PMID: 31395473 DOI: 10.1016/s1470-2045(19)30512-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 12/24/2022]
Abstract
Cancer causes a fifth of deaths in the Caribbean region and its incidence is increasing. Incidence and mortality patterns of cancer in the Caribbean reflect globally widespread epidemiological transitions, and show cancer profiles that are unique to the region. Providing comprehensive and locally responsive cancer care is particularly challenging in the Caribbean because of the geographical spread of the islands, the frequently under-resourced health-care systems, and the absence of a cohesive approach to cancer control. In many Caribbean countries and territories, cancer surveillance systems are poorly developed, advanced disease presentations are commonplace, and access to cancer screening, diagnostics, and treatment is often suboptimal, with many patients with cancer seeking treatment abroad. Capacity building across the cancer-control continuum in the region is urgently needed and can be accomplished through collaborative efforts and increased investment in health care and cancer control.
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Affiliation(s)
- Dingle Spence
- Hope Institute Hospital, Kingston, Jamaica; Jamaica Cancer Care and Research Institute, University of the West Indies, Mona, Jamaica.
| | - Rachel Dyer
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | | | - Michael Barton
- Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute for Applied Medical Research, University of New South Wales, NSW, Australia
| | | | - M Austin Argentieri
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; School of Anthropology and Museum Ethnography, University of Oxford, Oxford, UK; Jamaica Cancer Care and Research Institute, University of the West Indies, Mona, Jamaica
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Shamir Cawich
- Department of Surgery, University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | | | - Christopher Fosker
- Bermuda Cancer and Health Centre and Bermuda Hospitals Board, Hamilton, Bermuda
| | - Owen Gabriel
- Department of Oncology Victoria Hospital, Castries, Saint Lucia
| | - Natalie Greaves
- Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Barrie Hanchard
- Department of Pathology, University of the West Indies, Kingston, Jamaica
| | | | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Damali Martin
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marisa Nimrod
- Caribbean Association for Oncology and Hematology, Port of Spain, Trinidad and Tobago
| | | | - Donald Simeon
- Caribbean Centre for Health Systems Research and Development, University of the West Indies, St Augustine Campus, Trinidad and Tobago
| | - Guillermo Tortolero-Luna
- Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Centre, Puerto Rico
| | - Gilian Wharfe
- Department of Pathology, University of the West Indies, Mona, Jamaica
| | - Diana Sarfati
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
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Toward standardization of laparoscopic resection for colorectal cancer in developing countries: A step by step module. J Egypt Natl Canc Inst 2017; 29:135-140. [PMID: 28668495 DOI: 10.1016/j.jnci.2017.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/19/2017] [Accepted: 04/10/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite the proven benefits, laparoscopic colorectal surgery is still underutilized among surgeons especially in developing countries. Also a steep learning is one of the causes of its limited adoption. OBJECTIVE To explore the learning curve of single surgeon experience in laparoscopic colectomy and feasibility of implementing a well standardized step by step operative technique to overcome the beginning technical obstacles. PATIENTS AND METHODS This prospective study included 50 patients with carcinoma of the left colon and rectum recruited from the department of surgical oncology at National Cancer Institute, Cairo University in the period 2012-2016. All the procedures were performed through laparoscopic approach. Intra and post-operative data were recorded and analyzed. RESULTS The mean age was 49.7±10.6years (range: 33-74years). They were 29 males and 21 females. The mean operation time was 180min (range 100-370min), and the mean blood loss was 350ml (60-600ml). Six patients (12%) were converted to a laparotomy. The median lymph nodes harvest was 12 (range 7-25). The mean time of passing flatus after surgery was 2days (1-4days) and the mean time of passing stools was 3.3days (2-5) days. The median hospitalization period after surgery was 4days (3-12). 5 patients (10%) had postoperative morbidity, major morbidity occurred in one patient. CONCLUSION Laparoscopic colorectal surgery for colorectal cancer is safe and oncologically sound, standardized well-structured laparoscopic technique masters the procedure even in early learning curve setting.
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Liang SS, Ying AJ, Affan ET, Kakala BF, Strippoli GFM, Bullingham A, Currow H, Dunn DW, Yeh Z. Continuous local anaesthetic wound infusion for postoperative pain after midline laparotomy for colorectal resection in adults. Hippokratia 2016. [DOI: 10.1002/14651858.cd012310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Sophie S Liang
- Blacktown Hospital; Department of Anaesthesia; 18 Blacktown Rd Blacktown New South Wales Australia 2148
- University of Western Sydney; School of Medicine; Locked Bag 1797 Penrith New South Wales Australia 2751
| | - Andrew J Ying
- Blacktown Hospital; Department of Surgery; 18 Blacktown Rd Blacktown New South Wales Australia 2148
| | - Eshan T Affan
- Blacktown Hospital; Department of Surgery; 18 Blacktown Rd Blacktown New South Wales Australia 2148
- The University of Sydney; Sydney Medical School; Edward Ford Building A27 Sydney New South Wales Australia 2006
| | - Benedict F Kakala
- The University of Sydney; Sydney Medical School; Edward Ford Building A27 Sydney New South Wales Australia 2006
- Westmead Hospital; General Surgery; Cnr Darcy Rd & Bridge St Westmead New South Wales Australia 2145
| | - Giovanni FM Strippoli
- The Children's Hospital at Westmead; Cochrane Kidney and Transplant, Centre for Kidney Research; Westmead NSW Australia 2145
| | - Alan Bullingham
- Blacktown Hospital; Department of Anaesthesia; 18 Blacktown Rd Blacktown New South Wales Australia 2148
- Westmead Hospital; Department of Anaesthesia; Cnr Darcy Rd & Bridge St Westmead New South Wales Australia 2145
| | - Helen Currow
- Blacktown Hospital; Department of Anaesthesia; 18 Blacktown Rd Blacktown New South Wales Australia 2148
- University of Western Sydney; School of Medicine; Locked Bag 1797 Penrith New South Wales Australia 2751
| | - David W Dunn
- Blacktown Hospital; Department of Surgery; 18 Blacktown Rd Blacktown New South Wales Australia 2148
| | - Ziegfeld Yeh
- Blacktown Hospital; Department of Surgery; 18 Blacktown Rd Blacktown New South Wales Australia 2148
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Safety and feasibility of laparoscopic colo-rectal surgery for cancer at a tertiary center in a developing country: Egypt as an example. J Egypt Natl Canc Inst 2015; 27:91-5. [PMID: 25921235 DOI: 10.1016/j.jnci.2015.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 03/19/2015] [Accepted: 03/23/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Laparoscopic colectomy has been shown to have significant short- and long-term benefits compared to open approach. The incorporation of laparoscopy in developing countries is challenging, due to the high costs of equipment and lack of expertise. The aim of this study was to evaluate the safety and feasibility of laparoscopic colorectal surgery for cancer that could be performed in developing countries under different circumstances in developed countries. METHODS Thirty-seven patients (23 males and 14 females) with colorectal cancer with a median age of 46 years (39-72) have been enrolled for laparoscopic colo-rectal surgery in a tertiary center in Egypt (South Egypt Cancer Institute) with the trend of reuse of some disposable laparoscopic instruments. RESULTS The median operative time was 130 min (95-195 min). The median estimated blood loss was 70 ml (30-90 ml). No major intra-operative complications have been encountered. Two cases (5.5%) have been converted because of local advancement (one case) and bleeding with unavailability of vessel sealing device at that time (one case). The median time for passing flatus after surgery was 36 h (12-72 h). The median hospital stay was 4.8 days (4-7 days). The peri-operative period passed without events. Pathologic outcome revealed that the median number of retrieved lymph nodes was 14 (range 9-23 lymph node) and all cases had free surgical margin. CONCLUSION Laparoscopic colorectal surgery for cancer in developing countries could be safe and feasible. Safe reuse of disposable expensive parts of some laparoscopic instruments could help in propagation of this technique in developing countries.
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Cawich SO, Mohanty SK, Simpson LK, Bonadie KO. Is emergent laparoscopic cholecystectomy for acute cholecystitis safe in a low volume resource poor setting? Int J Surg 2014; 12:798-802. [PMID: 24947946 DOI: 10.1016/j.ijsu.2014.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/01/2014] [Accepted: 06/05/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The outcomes of emergent laparoscopic cholecystectomy (LC) for acute cholecystitis have not been documented in the low-volume, resource-poor Caribbean setting. SETTINGS AND DESIGN This study was carried out in a low-resource setting across three islands in the Anglophone Caribbean. METHODS AND MATERIALS The records of all consecutive patients who had emergency LC for acute cholecystitis over 82 months were examined. The data were extracted and analysed using SPSS version 14. RESULTS There were 74 patients with acute cholecystitis at a mean age of 45 (SD 11.8) years. The mean duration of operation was 99 (SD 45) min. There were 3 (4.1%) conversions and 6 (8.1%) complications. No bile duct injuries or deaths were recorded. There was more morbidity in patients with complicated disease, longer mean operation times and longer mean intervals between admission and operation. CONCLUSIONS Emergent LC for acute cholecystitis is effective and safe in a low-volume setting in the Caribbean. However, the operations are technically demanding and should be performed by trained laparoscopic surgeons.
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Affiliation(s)
- Shamir O Cawich
- The Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago.
| | - Sanjib K Mohanty
- The Department of Surgery, Cayman Islands Hospital, Grand Cayman, British West Indies, Cayman Islands
| | | | - Kimon O Bonadie
- Department of Surgery, McGill University Hospital, Montreal, Quebec, Canada
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Leake PA, Pitzul K, Roberts PO, Plummer JM. Comparative analysis of open and laparoscopic colectomy for malignancy in a developing country. World J Gastrointest Surg 2013; 5:294-299. [PMID: 24520427 PMCID: PMC3920117 DOI: 10.4240/wjgs.v5.i11.294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 10/01/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the short-term, including oncologic, outcomes of open vs laparoscopic colectomy for cancer in a developing country.
METHODS: The records of patients who underwent elective open and laparoscopic colectomies for cancer at the University Hospital of the West Indies between January 2005 and December 2010 were retrospectively reviewed. Demographic (age, gender, Charlson comorbidity index score), peri-operative, post-operative and oncologic data were collected for each patient. Specific oncologic variables included lymph node yield, pathologic stage, grade, proximal, distal and circumferential margin involvement. Fisher’s exact, Mann-Whitney, and binary logistic regression tests were used for analysis. Significance level was set at P < 0.05.
RESULTS: There were 87 cases for open colectomy (OC) and 17 cases for laparoscopic colectomy (LC). Demographics did not significantly differ between OC and LC groups. Intra-operative blood loss and post-operative analgesic requirements did not significantly differ between groups. There was a trend towards longer operating times in OC group and shorter hospital stay in the LC group. Lymph node yield (14 vs 14, P = 0.619), proximal (10 cm vs 7 cm, P = 0.353) and distal (8 cm vs 8 cm, P = 0.57) resection margin distance and circumferential margin involvement (9 vs 0, P = 0.348) did not significantly differ between groups. Thirty-day morbidity was equivalent between groups (22 vs 6, P = 0.774). There were 6 deaths within 30 d of initial procedure, all in the OC group (6.9%).
CONCLUSION: Laparoscopic colectomy in a developing country is oncologically safe and represents a option for colonic malignancies in these regions. Such data encourage the continued laparoscopic development.
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