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Campbell RA, DeWitt-Foy ME, Tanaka H, Ye YL, Wang Y, Reese J, Krishnamurthi V, Dong W, Campbell SC. Functional Recovery From Prolonged Warm Ischemia: Compelling Case Scenarios. Urology 2019; 132:22-27. [PMID: 31128171 DOI: 10.1016/j.urology.2019.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 04/19/2019] [Accepted: 05/06/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Rebecca A Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Molly E DeWitt-Foy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH
| | - Hajime Tanaka
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yun-Lin Ye
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, Sun Yan-sen University Cancer Center, Guangzhou, China
| | - Yanbo Wang
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Department of Urology, First Hospital of Jilin University, Changchun, China
| | - Jeffrey Reese
- Department of Urology, Stanford University, Stanford, CA
| | | | - Wen Dong
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Steven C Campbell
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
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Berchiolli R, Tomei F, Marconi M, Mocellin DM, Morganti R, Mari M, Adami D, Ferrari M. Hand-assisted laparoscopic surgery versus endovascular repair in abdominal aortic aneurysm treatment. J Vasc Surg 2019; 70:478-484. [PMID: 30718111 DOI: 10.1016/j.jvs.2018.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 11/05/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Hand-assisted laparoscopic surgery (HALS) for the treatment of abdominal aortic aneurysm (AAA) has shown promising initial results compared with traditional surgery, but its efficacy remains highly debated. The aim of this monocentric, retrospective study was to investigate differences in morbidity, mortality, and reintervention rates between endovascular aneurysm repair (EVAR) and HALS, in the medium- and long-term follow-up in a highly selected population. METHODS We treated 977 patients consecutively for nonurgent AAA from January 2006 to December 2013; among them, 615 (62.9%) underwent open surgery, 173 (17.7%) HALS, and 189 (19.3%) EVAR. For this study, only patients treated with HALS or EVAR were considered. A subsequent selection process was carried out to identify the patients with clinical characteristics and aneurysm morphology amenable to either of these treatments. The final study cohort included 229 patients; 92 (40.2%) underwent HALS and 137 (69.8%) received EVAR. The two populations were homogeneous for clinical and demographic characteristics. RESULTS The mean duration of follow-up was 57 ± 28 months (50 ± 24 months in the EVAR group and 67 ± 29 months in the HALS group; range, 2-110 months). No deaths and no statistically significant differences in severe complications or reinterventions were observed over the perioperative period (30 days). Length of stay was significantly shorter after EVAR, because the need for and length of stay in the intensive care unit were decreased. Three postoperative deaths (in-hospital mortality >30 days: HALS, 2.2%; EVAR, 0.7%; P = .7268) occurred owing to respiratory failure (two patients, one in each group) and multiorgan failure secondary to a bowel ischemia (one patient in the HALS group). Other deaths in the study population were not related to the procedure. In both groups, the major causes of death were cancer (24 cases [36.9%]), cardiovascular causes unrelated to AAA (16 [24.6%]), and chronic obstructive lung disease (10 [15.4%]). In the long-term follow-up period, there was a difference in the overall survival in favor of HALS when compared with EVAR (P = .011). CONCLUSIONS This retrospective, single-center study shows that, within a population of similar clinical and anatomic characteristics, treatment of AAA with EVAR or HALS does not result in significant differences in early morbidity and mortality. EVAR presents significantly shorter hospital and intensive care unit length of stay, whereas HALS presents a lower aneurysm-related reintervention rate and lower perioperative cost. The strict patient selection in this trial, as is generally the case with AAA treatment, is likely the key to success for both of these techniques.
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Affiliation(s)
| | - Francesca Tomei
- Vascular Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Michele Marconi
- Vascular Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
| | | | - Riccardo Morganti
- Section of Statistics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marta Mari
- Vascular Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Daniele Adami
- Vascular Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Mauro Ferrari
- Vascular Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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Rouhani MJ, Thapar A, Maruthappu M, Munster AB, Davies AH, Shalhoub J. Systematic review of perioperative outcomes following laparoscopic abdominal aortic aneurysm repair. Vascular 2014; 23:525-53. [PMID: 25425618 DOI: 10.1177/1708538114561823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To collate information available in the literature regarding perioperative outcomes following elective laparoscopic abdominal aortic aneurysm repair. MATERIALS AND METHODS Electronic databases were searched and a systematic review was performed. In total, 1256 abstracts were screened, from which 10 studies were included for analysis. Perioperative and technical outcomes were analysed. RESULTS In the totally laparoscopic repair of infra-renal aneurysms (n = 302), 30-day mortality ranged between 0% and 6% and in the laparoscopic-assisted cases (n = 547) ranged between 0% and 7%. Of the former group, 5-30% of cases were converted to open repair, with 6% reintervention rate, whereas there was a 5-10% conversion and 3% reintervention rate in the latter group. CONCLUSIONS The outcomes from selected patients in selected centres demonstrate that elective laparoscopic repair of aortic aneurysms is feasible and comparable in safety to open repair; it remains unclear, however, whether there are substantial advantages of this method compared with open and endovascular repair.
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Affiliation(s)
| | - Ankur Thapar
- Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK
| | | | - Alex B Munster
- Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK
| | - Alun H Davies
- Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK
| | - Joseph Shalhoub
- Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, UK
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Economopoulos KP, Martinou E, Hakimian S, Schizas D, Georgopoulos S, Tsigris C, Bakoyiannis CN. An overview of laparoscopic techniques in abdominal aortic aneurysm repair. J Vasc Surg 2013; 58:512-20. [PMID: 23890444 DOI: 10.1016/j.jvs.2013.04.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 04/12/2013] [Accepted: 04/28/2013] [Indexed: 02/05/2023]
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Le Huu Nho R, Mege D, Ouaïssi M, Sielezneff I, Sastre B. Incidence and prevention of ventral incisional hernia. J Visc Surg 2012; 149:e3-14. [PMID: 23142402 DOI: 10.1016/j.jviscsurg.2012.05.004] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Ventral incisional hernia is a common complication of abdominal surgery. The incidence ranges from 2% to 20% and varies greatly from one series to another. The goal of this study was to determine the incidence, risk factors, and preventive measures for ventral incisional hernia. MATERIALS AND METHODS An analysis of the surgical literature was performed using the search engines EMBASE, Cochrane Library, and PubMed with the keywords: abdominal hernia, wound dehiscence, incisional hernia, incidence, trocar site hernia, and hernia prevention. RESULTS The overall incidence of incisional hernia after laparotomy was 9.9%. The incidence was significantly higher for midline incisions compared with transverse incisions (11% vs. 4.7%; P=0.006). In contrast, the incidence of ventral hernia was only 0.7% after laparoscopy. A compilation of all the studies comparing laparotomy to laparoscopy showed a significantly higher incidence of incisional hernia after laparotomy (P=0.001). Independent risk factors for incisional hernia included age and infectious complications. Only two meta-analyses were able to show a significant decrease in risk-related to the use of non absorbable or slowly absorbable suture material. No difference in incisional hernia risk was shown with different suture techniques (11.1% for running suture, 9.8% for interrupted sutures: NS). CONCLUSION A review of the literature shows that only the choice of incisional approach (transverse incision or laparotomy vs. midline laparotomy) allows a significant decrease in the incidence of ventral incisional hernia.
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Affiliation(s)
- R Le Huu Nho
- Aix-Marseille, UMR 911, Campus santé Timone, 13005 Marseille, France
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Modi P, Rizvi J, Pal B, Bharadwaj R, Trivedi P, Trivedi A, Patel K, Shah K, Vyas J, Sharma S, Shah K, Chauhan R, Trivedi H. Laparoscopic kidney transplantation: an initial experience. Am J Transplant 2011; 11:1320-4. [PMID: 21486384 DOI: 10.1111/j.1600-6143.2011.03512.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Laparoscopic donor nephrectomy has the advantages of less pain, early ambulation and shorter hospitalization compared to open donor nephrectomy. Kidney recipient surgery is, however, traditionally performed by open surgery. Our aim was to study feasibility and safety of laparoscopic kidney transplantation (LKT). After permission from Internal Review Board, LKT was performed in four patients. All kidneys were procured from deceased donors. Left kidney was used for LKT and transplanted in left iliac fossa while right kidney was used for standard open kidney transplantation (OKT). All transplantation procedures were performed successfully. Cold ischemia time varied between 4 h and 14 h. For LKT, mean time for anastomosis was 65 (range 62-72) min, mean operative time was 3.97 (range 3.5-5) h, mean blood loss was 131.25 mL (range 45-350) mL. Mean wound length was 7 cm in LKT group and 18.4 cm in OKT group. Delayed graft function was observed in one patient in each group. One patient was lost in OKT group due to posttransplant bacterial meningitis. At 6 months, both groups have comparable value of serum creatinine. In conclusion, LKT is technically feasible and safe. Long term outcome needs to be evaluated in a larger study.
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Affiliation(s)
- P Modi
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre and Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India.
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Howard A, Mackenzie S, Choksy S, Arulampalan T, Menzies D, Motson R, Backhouse C. Laparoscopic aortic surgery (Br J Surg 2010; 97: 1153–1154). Br J Surg 2010; 98:157-8; author reply 158. [DOI: 10.1002/bjs.7324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A Howard
- Department of Surgery, Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - S Mackenzie
- Department of Surgery, Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - S Choksy
- Department of Surgery, Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - T Arulampalan
- Department of Surgery, Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - D Menzies
- Department of Surgery, Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - R Motson
- Department of Surgery, Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - C Backhouse
- Department of Surgery, Colchester Hospital University NHS Foundation Trust, Colchester, UK
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Affiliation(s)
- T L Luk
- Department of Vascular Surgery, MP 103, Southampton General Hospital, Southampton SO16 6YD, UK
| | - C P Shearman
- Department of Vascular Surgery, MP 103, Southampton General Hospital, Southampton SO16 6YD, UK
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