Advanced Laparoscopic Surgery in a Free-Standing Ambulatory Setting

Systematic review of day-case laparoscopic fundoplication

BACKGROUND

The aim of the current study is to review published literature on day-case laparoscopic fundoplication in adults.

DATA SOURCES

Medline, Embase, and Cochrane library was searched by using the medical subjects headings "ambulatory surgical procedures" and "fundoplication" with further free text search and cross references. All articles on planned day-case laparoscopic fundoplication that described patient selection criteria, same-day discharge, complications, and readmissions were reviewed.

CONCLUSIONS

Thirteen cohort studies were included in this review. Ten were on planned same-day discharge with a 93% (739 out of 792) success, 4% (34) complication, and 5% (39) readmission rate. Three studies were on planned 23 hour discharge with a 98% (571 out of 583) success, 4% (25) complications, and 1% (5) re-admission rate. Nausea, pain, fatigue, and pneumothorax were the commonest causes for overnight admission. Dysphagia and pain were the main reasons for readmission. Most patients were satisfied with day-case laparoscopic fundoplication.

Laparoscopic adrenalectomy: where do we stand now?

Laparoscopic adrenalectomy (LA) has become the procedure of choice for the surgical removal of the vast majority of small sized adrenal tumors (<or= 6 cm), because of its significant and multiple advantages: reduced hospital stay and wound morbidity, decreased transfusion requirements, postoperative pain and complications. The role of LA in patients with large adrenal lesions or potential malignancy remains controversial. The aim of this article is to review the current and up-to-date surgical approaches for LA, which include: 1) transabdominal anterior or flank approach and 2) retroperitoneal technique with the patient in either lateral or prone position. Specific advantages and disadvantages are referred to for each of them. The choice of each of these techniques is determined particularly by the preference and the experience of the surgeon, but other objective criteria must be taken into consideration, such as the size of the adrenal and history of previous abdominal surgeries.

Outpatient laparoscopic adrenalectomy: a Canadian experience

BACKGROUND

We report our experience at The Ottawa Hospital with outpatient laparoscopic adrenalectomy.

METHODS

We report a single surgeon experience. Seventeen consecutive outpatient laparoscopic adrenalectomy were performed between 1994 and 2006. Specific selection criteria were applied. Postoperatively patients were monitored and assessed before discharge. Full discharge instructions were provided. A prescription for analgesic was given. A call back system was put in place. The first postoperative office visit was scheduled within 7 days of surgery.

RESULTS

Twelve of 17 patients were females. The mean age was 52.4 years. Our average operating room time was 130 minutes with no conversions. The average stay was about 5.5 hours. Three patients had a 23-hour stay. One admitted with atelectasis. Tumor size ranged from 1 to 5.8 cm. There were no reoperations, late admissions up to 30 days, and no deaths. One patient required admission. Thirteen of 17 patients were contacted by phone after discharge. At our hospital we found a cost saving of C$1478 is made per case.

CONCLUSIONS

Laparoscopic adrenalectomy can be safely performed as an outpatient procedure. Strict selection criteria should be applied. Call back systems should be instituted. There is a cost benefit associated with this outpatient procedure.