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He JH, Han YP, Hang T, Lin ZC, Lu SJ, Wang JF, Hong ZH. <Editors' Choice> Advantages of gasless single-port transumbilical extracorporeal laparoscopic-assisted appendectomy in the treatment of uncomplicated acute appendicitis in children in China: a multi-institutional retrospective study. NAGOYA JOURNAL OF MEDICAL SCIENCE 2022; 84:848-856. [PMID: 36544610 PMCID: PMC9748331 DOI: 10.18999/nagjms.84.4.848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/27/2022] [Indexed: 12/24/2022]
Abstract
Gasless transumbilical extracorporeal laparoscopic-assisted appendectomy is an approach used increasingly to treat uncomplicated acute appendicitis (UAA). However, there is limited information on its clinical effects and value in the Chinese pediatric population. This study retrospectively reviewed patients with UAA treated in two pediatric institutions from January 2018 through October 2021. Enrolled patients were divided into two groups by operative technique: gasless transumbilical laparoscopic-assisted appendectomy (gasless-TULAA, n=142) and conventional laparoscopic appendectomy (CLA, three-port, n=126). The perioperative clinical data, including age, sex, body mass index (BMI), operation time, time to postoperative ambulation, time to first postoperative exhaust, hospitalization expenses, and postoperative complications (incision infection, intestinal obstruction, and residual abdominal abscess), were compared between the two groups. Operations in both groups were successfully conducted without converting to open surgery. There were no significant differences (p > 0.05) in age and BMI in the two groups. Compared with CLA, gasless-TULAA showed significantly shorter operation time, earlier postoperative ambulation, shorter postoperative exhaust time, and lower hospital cost (p < 0.001). All patients were followed for 3 months, and postoperative complications were observed in three patients: two patients in the gasless-TULAA group (one with surgical wound effusion, one with intra-abdominal abscess), and one patient in the CLA group (surgical wound infection); there was no significant difference between the groups. Notably, 38 patients initially treated by gasless-TULAA were converted because of intraoperative factors. The gasless-TULAA technique had potential benefits: shortened operation time, better outcome, and greater cost-efficiency. These superiorities are worthy of future large-scale prospective study.
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Affiliation(s)
- Jian-Hua He
- Department of Pediatric Surgery, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Yi-Peng Han
- Department of Neurosurgery, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Tian Hang
- Department of Pediatric Surgery, Women and Children’s Hospital Affiliated, Jiaxing University, Jiaxing, China
| | - Zhi-Cai Lin
- Department of Pediatric Surgery, Women and Children’s Hospital Affiliated, Jiaxing University, Jiaxing, China
| | - Shi-Jiao Lu
- Department of Pediatric Surgery, Women and Children’s Hospital Affiliated, Jiaxing University, Jiaxing, China
| | - Jian-Feng Wang
- Department of Pediatric Surgery, Women and Children’s Hospital Affiliated, Jiaxing University, Jiaxing, China
| | - Zhi-Hua Hong
- Department of Pediatric Surgery, Women and Children’s Hospital Affiliated, Jiaxing University, Jiaxing, China
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Aruparayil N, Bolton W, Mishra A, Bains L, Gnanaraj J, King R, Ensor T, King N, Jayne D, Shinkins B. Clinical effectiveness of gasless laparoscopic surgery for abdominal conditions: systematic review and meta-analysis. Surg Endosc 2021; 35:6427-6437. [PMID: 34398284 PMCID: PMC8599349 DOI: 10.1007/s00464-021-08677-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/07/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND In high-income countries, laparoscopic surgery is the preferred approach for many abdominal conditions. Conventional laparoscopy is a complex intervention that is challenging to adopt and implement in low resource settings. This systematic review and meta-analysis evaluate the clinical effectiveness of gasless laparoscopy compared to conventional laparoscopy with CO2 pneumoperitoneum and open surgery for general surgery and gynaecological procedures. METHODS A search of the MEDLINE, EMBASE, Global Health, AJOL databases and Cochrane Library was performed from inception to January 2021. All randomised (RCTs) and comparative cohort (non-RCTs) studies comparing gasless laparoscopy with open surgery or conventional laparoscopy were included. The primary outcomes were mortality, conversion rates and intraoperative complications. SECONDARY OUTCOMES operative times and length of stay. The inverse variance random-effects model was used to synthesise data. RESULTS 63 studies were included: 41 RCTs and 22 non-RCTs (3,620 patients). No procedure-related deaths were reported in the studies. For gasless vs conventional laparoscopy there was no difference in intraoperative complications for general RR 1.04 [CI 0.45-2.40] or gynaecological surgery RR 0.66 [0.14-3.13]. In the gasless laparoscopy group, the conversion rates for gynaecological surgery were high RR 11.72 [CI 2.26-60.87] when compared to conventional laparoscopy. For gasless vs open surgery, the operative times were longer for gasless surgery in general surgery RCT group MD (mean difference) 10 [CI 0.64, 19.36], but significantly shorter in the gynaecology RCT group MD - 18.74 [CI - 29.23, - 8.26]. For gasless laparoscopy vs open surgery non-RCT, the length of stay was shorter for gasless laparoscopy in general surgery MD - 3.94 [CI - 5.93, - 1.95] and gynaecology MD - 1.75 [CI - 2.64, - 0.86]. Overall GRADE assessment for RCTs and Non-RCTs was very low. CONCLUSION Gasless laparoscopy has advantages for selective general and gynaecological procedures and may have a vital role to play in low resource settings.
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Affiliation(s)
- N Aruparayil
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK. .,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK.
| | - W Bolton
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
| | - A Mishra
- Maulana Azad Medical College, Delhi, India
| | - L Bains
- Maulana Azad Medical College, Delhi, India
| | | | - R King
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
| | - T Ensor
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
| | - N King
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - D Jayne
- Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
| | - B Shinkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.,NIHR Global Health Research Group, Surgical Technologies, Clinical Sciences Building, Level 7, Room 7.19, Leeds, LS9 7TF, UK
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Evaluation of Gasless Laparoscopy as a Tool for Minimal Access Surgery in Low-to Middle-Income Countries: A Phase II Noninferiority Randomized Controlled Study. J Am Coll Surg 2020; 231:511-519. [PMID: 32827645 PMCID: PMC7435287 DOI: 10.1016/j.jamcollsurg.2020.07.783] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 06/30/2020] [Accepted: 07/28/2020] [Indexed: 01/11/2023]
Abstract
Background Minimal access surgery is not available to most people in rural areas of low-to middle-income countries. This leads to an increase in morbidity and economic loss to the poor and marginalized. Gasless laparoscopic (GAL) procedures are possible in rural areas because they can be performed under spinal anesthesia. In most cases, it does not require the logistics of providing gases for pneumoperitoneum and general anesthesia. The current study compares GAL with conventional laparoscopic (COL) operations for general surgical procedures. Methods A single-center, nonblinded randomized controlled trial was conducted to evaluate noninferiority of GAL vs COL at a teaching hospital in New Delhi, India. Patients were allocated into 3 groups and underwent minimal access surgery (cholecystectomies and appendectomies). The procedures were performed by 2 surgeons choosing randomly between GAL and COL. The data were collected by postgraduates and analyzed by a biostatistician. Results One hundred patients who met the inclusion criteria were allocated into 2 groups. No significant difference was observed in the mean operating time between the GAL group (52.9 minutes) and the COL group (55 minutes) (p = 0.3). Intraoperative vital signs were better in the GAL group (p < 0.05). The postoperative pain score was slightly higher in the GAL group (p = 0.01); however, it did not require additional analgesics. Conclusions No significant differences were found between the 2 groups. GAL can be considered as noninferior compared with COL and has the potential to be adopted in low-resource settings.
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Shoman H, Sandler S, Peters A, Farooq A, Gruendl M, Trinh S, Little J, Woods A, Bolton W, Abioye A, Ljungman D. Safety and efficiency of gasless laparoscopy: a systematic review protocol. Syst Rev 2020; 9:98. [PMID: 32354349 PMCID: PMC7193343 DOI: 10.1186/s13643-020-01365-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Gasless laparoscopy, developed in the early 1990s, was a means to minimize the clinical and financial challenges of pneumoperitoneum and general anaesthesia. It has been used in a variety of procedures such as in general surgery and gynecology procedures including diagnostic laparoscopy. There has been increasing evidence of the utility of gasless laparoscopy in resource limited settings where diagnostic imaging is not available. In addition, it may help save costs for hospitals. The aim of this study is to conduct a systematic review of the available evidence surrounding the safety and efficiency of gasless laparoscopy compared to conventional laparoscopy and open techniques and to analyze the benefits that gasless laparoscopy has for low resource setting hospitals. METHODS This protocol is developed by following the Preferred Reporting Items for Systematic review and Meta-Analysis-Protocols (PRISMA-P). The PRISMA statement guidelines and flowchart will be used to conduct the study itself. MEDLINE (Ovid), Embase, Web of Science, Cochrane Central, and Global Index Medicus (WHO) will be searched and the National Institutes of Health Clinical Trials database. The articles that will be found will be pooled into Covidence article manager software where all the records will be screened for eligibility and duplicates removed. A data extraction spreadsheet will be developed based on variables of interest set a priori. Reviewers will then screen all included studies based on the eligibility criteria. The GRADE tool will be used to assess the quality of the studies and the risk of bias in all the studies will be assessed using the Cochrane Risk assessment tool. The RoB II tool will assed the risk of bias in randomized control studies and the ROBINS I will be used for the non-randomized studies. DISCUSSION This study will be a comprehensive review on all published articles found using this search strategy on the safety and efficiency of the use of gasless laparoscopy. The systematic review outcomes will include safety and efficiency of gasless laparoscopy compared to the use of conventional laparoscopy or laparotomy. TRIAL REGISTRATION The study has been registered in PROSPERO under registration number: CRD42017078338.
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Affiliation(s)
- Haitham Shoman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Simone Sandler
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Alexander Peters
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Weill Cornell Medical College, New York, USA
| | - Ameer Farooq
- Division of General Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Magdalen Gruendl
- Department of Epidemiology, Technical University Munich, Munich, Germany
| | - Shauna Trinh
- Department of Surgery, Riverside University Health System-Medical Center, Moreno Valley, CA, USA
| | - James Little
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alex Woods
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - William Bolton
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | | | - David Ljungman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Laparoscopic versus open appendectomy for perforated appendicitis in adults: randomized clinical trial. Surg Endosc 2019; 34:907-914. [PMID: 31139982 DOI: 10.1007/s00464-019-06847-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/18/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The advantages of laparoscopic appendectomy did not meet the same acceptance in the setting of perforated appendicitis as in uncomplicated appendicitis in the general surgical community. The aim of this study was to compare the clinical outcome of laparoscopic and open appendectomy in perforating appendicitis. METHODS A randomized controlled study was conducted on 126 patients presenting with perforated appendicitis. Sixty patients were subjected to laparoscopic appendectomy (LA) and 66 patients underwent traditional open appendectomy (OA). RESULTS 65 (51.6%) patients were female, and 61 (48.4%) patients were male in whom the mean age was 37.6 + 8.5 years. A significant difference was calculated in the domains of postoperative pain, less need for analgesics, hospital stay, and return to daily activities. The mean operative time was shorter in OA 94 ± 10.4 min than LA 120.6 ± 17.7 min. No statistically significant difference between both groups was detected as regard occurrence of intra-abdominal collection. CONCLUSION In view of its clinical outcomes, laparoscopy should be considered in the context of perforated appendicitis. The possibility of intra-abdominal collection should not be a barrier against the widespread practice of this surgical procedure amidst laparoscopic surgeons if adequate precautions are employed.
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Yu MC, Feng YJ, Wang W, Fan W, Cheng HT, Xu J. Is laparoscopic appendectomy feasible for complicated appendicitis ?A systematic review and meta-analysis. Int J Surg 2017; 40:187-197. [PMID: 28302449 DOI: 10.1016/j.ijsu.2017.03.022] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/27/2017] [Accepted: 03/09/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND laparoscopic appendectomy(LA) has proved to be a safe alternative to open appendectomy(OA) in uncomplicated appendicitis; however, the feasibility of LA for complicated appendicitis(CA) has not been conclusively determined. OBJECTIVES To assess the feasibility and safety of LA for CA through a systematic review and meta-analysis. METHODS A literature search in PubMed, Embase, Cochrane Library, and web of Science was performed for eligible studies published from the inception of the databases to January 2016. All studies comparing LA and OA for CA were reviewed. After literature selection, data extraction and quality assessment were performed by two reviewers independently, and meta-analysis was conducted using Revman software, vision 5.2. RESULTS Two randomized controlled trials (RCTs) and 14 retrospective cohort studies(RCSs) were finally identified. Our meta-analysis showed that LA for CA could reduce the rate of surgical site infections (SSIs) (OR = 0.28; 95% CI: 0.25 to0.31, P < 0.00001), but LA did not increase the rate of postoperative intra-abdominal abscess(IAA) (OR = 0.79; 95% CI: 0.45 to 1.34, P = 0.40). The results showed that the operating time in the LA groups was much longer than that in the OA groups (WMD = 13.78, 95% CI: 8.99 to 18.57, P < 0.00001). However, the length of hospital stays in the LA groups were significantly shorter than those in the OA groups (WMD = -2.47, 95%CI: -3.75 to -1.19, P < 0.0002), and the time until oral intake(TTOI) was much earlier in the LA groups than in the OA groups (WMD = -0.88, 95% CI: -1.20 to -0.55, P < 0.00001). No significant difference was observed in the times of postoperative analgesia between the two groups(P > 0.05). CONCLUSION LA was feasible and safe for complicated appendicitis, and it not only could shorten the hospital stays and the time until oral intake, but it could also reduce the risk of surgical site infection.
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Affiliation(s)
- Man-Cheng Yu
- Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China.
| | - Yao-Jun Feng
- Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China
| | - Wei Wang
- Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China
| | - Wei Fan
- Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China
| | - Hong-Tao Cheng
- Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China
| | - Juan Xu
- Department of Breast Cancer, Hubei Cancer Hospital, Wuhan, Hubei 430079, PR China
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Gnanaraj J, Rhodes M. Laparoscopic surgery in middle- and low-income countries: gasless lift laparoscopic surgery. Surg Endosc 2015; 30:2151-4. [DOI: 10.1007/s00464-015-4433-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 07/10/2015] [Indexed: 01/08/2023]
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Application of laparoscopy in the combined surgical procedures of gynecological and digestive disorders in obese women: A retrospective cohort study. Int J Surg 2015; 16:83-87. [DOI: 10.1016/j.ijsu.2015.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 01/20/2015] [Accepted: 02/12/2015] [Indexed: 01/22/2023]
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Moga MA, Arvatescu CA, Pratilas GC, Bigiu NF, Dinas K, Burtea V. The role of gasless laparoscopy in differential diagnosis of acute abdomen. Hippokratia 2015; 19:69-72. [PMID: 26435651 PMCID: PMC4574591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND The diagnosis of acute abdomen in the emergency setting, still remains a challenging problem. In these cases timely diagnosis and management is of great importance, while the anesthetic risk is high. The combination of the risk of an open laparotomy and the relative high likelihood of negative findings when performed, creates the need for a better approach. The alternative actually exists since 1911 when Eruheim made the first gasless laparoscopy. The aim of this study is to put back into the spotlight, gasless laparoscopy in the differential diagnosis of acute abdomen and to underline the advantages of this simple, cheap and very useful technique, especially in patients that require prompt diagnosis and have relative or absolute contraindications to general anesthesia or pneumoperitoneum. METHODS This study included 49 patients that were managed with gasless laparoscopy for the diagnosis of acute abdomen, from 2011 to 2013. Two techniques were used: the mechanical lift of the anterior abdominal wall and the LapVision device. RESULTS From the 49 patients included in the study, 41 were diagnosed with gasless laparoscopy while in eight the results were uncertain or there wasn't any pathology involved. With both techniques used, sample of the intraperitoneal fluid or biopsy could be obtained. CONCLUSION The gasless technique for laparoscopy is an extremely useful mean of diagnosis in emergency conditions, or for patients with contraindications to undergo laparoscopy by pneumoperitoneum. Requiring only local or regional anesthesia, this technique could easily find application in diagnosis and treatment, while avoiding unnecessary laparotomies. Hippokratia 2015, 19 (1): 69-72.
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Affiliation(s)
- M A Moga
- Faculty of Medicine, Transilvania University of Brasov, Brasov, Romania
| | - C A Arvatescu
- Faculty of Medicine, Transilvania University of Brasov, Brasov, Romania
| | - G C Pratilas
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - N F Bigiu
- Faculty of Medicine, Transilvania University of Brasov, Brasov, Romania
| | - K Dinas
- Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - V Burtea
- Faculty of Medicine, Transilvania University of Brasov, Brasov, Romania
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