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Marichez A, Eude A, Martenot M, Celerier B, Capdepont M, Rullier E, Denost Q, Fernandez B. Low-impact laparoscopy in colorectal resection-A multicentric randomised trial comparing low-pressure pneumoperitoneum plus microsurgery versus low-pressure pneumoperitoneum alone: The PAROS II trial. Colorectal Dis 2023; 25:2403-2413. [PMID: 37897108 DOI: 10.1111/codi.16787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/22/2023] [Accepted: 09/17/2023] [Indexed: 10/29/2023]
Abstract
INTRODUCTION Low-pressure pneumoperitoneum (LLP) in laparoscopy colorectal surgery (CS) has resulted in reduced hospital stay and lower analgesic consumption. Microsurgery (MS) in CS is a technique that has a significant impact with respect to postoperative pain. The combination of MS plus LLP, known as low-impact laparoscopy (LIL), has never been applied in CS. Therefore, this trial will assess the efficacy of LLP plus MS versus LLP alone in terms of decreasing postoperative pain 24 h after surgery, without taking opioids. METHOD PAROS II will be a prospective, multicentre, outcome assessor-blinded, randomised controlled phase III clinical trial that compares LLP plus MS versus LLP alone in patients undergoing laparoscopic surgery for colonic or upper rectal cancer or benign pathology. The primary outcome will be the number of patients with postoperative pain 24 h after the surgery, as defined by a visual analogue scale rating ≤3 and without taking opioids. Overall, PAROS II aims to recruit 148 patients for 50% of patients to reach the primary outcome in the LLP plus MS arm, with 80% power and an 5% alpha risk. CONCLUSION The PAROS II trial will be the first phase III trial to investigate the impact of LIL, including LLP plus MS, in laparoscopic CS. The results may improve the postoperative recovery experience and decrease opioid consumption after laparoscopic CS.
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Affiliation(s)
- Arthur Marichez
- Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
- University Bordeaux, INSERM, BRIC, U 1312, Bordeaux, France
| | - Audrey Eude
- Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Mathieu Martenot
- Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Bertrand Celerier
- Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Maylis Capdepont
- Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
- University Bordeaux, INSERM, BRIC, U 1312, Bordeaux, France
| | - Eric Rullier
- Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
| | - Quentin Denost
- Bordeaux Colorectal Institute, Tivoli Hospital, Bordeaux, France
| | - Benjamin Fernandez
- Department of Digestive Surgery, Colorectal Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, Pessac, France
- University Bordeaux, INSERM, BRIC, U 1312, Bordeaux, France
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Oshita K, Yoshimitsu M, Yunoki K, Imaoka K, Yano T, Idani H, Okajima M. Reduced-port surgery for right paraduodenal hernia in an adult patient: A case report and review of the literature. Asian J Endosc Surg 2021; 14:598-601. [PMID: 33491293 DOI: 10.1111/ases.12908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/26/2020] [Accepted: 11/23/2020] [Indexed: 01/20/2023]
Abstract
Paraduodenal hernia (PDH) is a congenital internal hernia caused by an abnormal rotation of the midgut during embryotic life; it is characterized as right- or left-sided according to the hernial sac location. Herein, we describe a case of a 30-year-old male patient who was preoperatively diagnosed with right PDH and underwent successful laparoscopic repair using reduced-port surgery (RPS). The patient presented with postprandial nausea, vomiting, and upper abdominal pain. Contrast-enhanced CT and an upper gastric series led to the preoperative diagnosis of right PDH associated with intestinal malrotation. Thereafter, laparoscopic repair using RPS was performed. After the small bowels were reduced from the hernial sac, the hernial orifice was opened widely and laterally. The postoperative course was uneventful. This is the first report of a successful laparoscopic surgery on right PDH using RPS.
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Affiliation(s)
- Ko Oshita
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.,Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masanori Yoshimitsu
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.,Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kosuke Yunoki
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kouki Imaoka
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Takuya Yano
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.,Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hitoshi Idani
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Masazumi Okajima
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.,Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Umemura A, Suto T, Fujiwara H, Sasaki A. Invention of novel scoring system for reduced port laparoscopic colorectal surgery to secure surgical safety and quality: A prospective clinical trial. Asian J Surg 2021; 44:1120-1122. [PMID: 34172382 DOI: 10.1016/j.asjsur.2021.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022] Open
Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan.
| | - Takayuki Suto
- Department of Surgery, Morioka Municipal Hospital, Japan
| | | | - Akira Sasaki
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
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Effects of needlescopic surgery on postoperative pain in intersphincteric or abdominoperineal resection. Langenbecks Arch Surg 2020; 406:301-307. [PMID: 33221943 DOI: 10.1007/s00423-020-02035-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Laparoscopic surgery allows minimally invasive treatment of rectal cancer, and needlescopic surgery (NS) offers even more minimally invasive operations beyond the scope of conventional laparoscopic surgery (CS). The aim of this study was to compare short-term outcomes of NS for intersphincteric resection (ISR) or abdominoperineal resection (APR) to treat anal or rectal cancer without an abdominal incision for specimen extraction and to measure abdominal wound pain compared to CS. METHODS Between September 2014 and December 2016, a total of 134 patients underwent laparoscopic ISR or APR. Of these, 26 patients underwent NS, and 108 patients underwent CS. Postoperative abdominal wound pain was estimated using the numerical rating scale. Short-term outcomes were compared between NS and CS. RESULTS No conversion to CS or open surgery was required. Median operation time was significantly shorter with NS (295 min) than with CS (331.5 min; p = 0.020). Median estimated blood loss was significantly lower with NS (30 ml) than with CS (50 ml; p = 0.011). Postoperative pain score on postoperative day (POD)5 was significantly lower with NS than with CS (p = 0.025), and frequencies of analgesic use were significantly lower with NS than with CS on POD0, POD2, and POD3 (p = 0.032, p = 0.017, p = 0.045, respectively). The postoperative complications occurred at similar frequencies between groups (p = 0.655). CONCLUSION NS for ISR or APR offers comparable short-term outcomes to CS, with better pain outcomes.
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