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Hu Z, Wei X. A commentary on 'Augmented reality-assisted navigation system contributes to better intraoperative and short-time outcomes of laparoscopic pancreaticoduodenectomy: a retrospective cohort study'. Int J Surg 2024; 110:1327-1328. [PMID: 38016134 PMCID: PMC10871578 DOI: 10.1097/js9.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/30/2023]
Affiliation(s)
| | - Xiaoping Wei
- Department of HPB Surgery, The Second Affiliated Hospital of Kunming Medical University, The Second Clinical College at Kunming Medical University, Kunming, Yunnan, People’s Republic of China
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Mahan MA, Prasse T, Kim RB, Sivakanthan S, Kelly KA, Kashlan ON, Bredow J, Eysel P, Wagner R, Bajaj A, Telfeian AE, Hofstetter CP. Full-endoscopic spine surgery diminishes surgical site infections - a propensity score-matched analysis. Spine J 2023; 23:695-702. [PMID: 36708928 DOI: 10.1016/j.spinee.2023.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/15/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND CONTEXT Surgical site infections (SSI) are one the most frequent and costly complications following spinal surgery. The SSI rates of different surgical approaches need to be analyzed to successfully minimize SSI occurrence. PURPOSE The purpose of this study was to define the rate of SSIs in patients undergoing full-endoscopic spine surgery (FESS) and then to compare this rate against a propensity score-matched cohort from the National Surgical Quality Improvement Program (NSQIP) database. DESIGN This is a retrospective multicenter cohort study using a propensity score-matched analysis of prospectively maintained databases. PATIENT SAMPLE One thousand two hundred seventy-seven non-instrumented FESS cases between 2015 and 2021 were selected for analysis. In the nonendoscopic NSQIP cohort we selected data of 55,882 patients. OUTCOME MEASURES The occurrence of any SSI was the primary outcome. We also collected any other perioperative complications, demographic data, comorbidities, operative details, history of smoking, and chronic steroid intake. METHODS All FESS cases from a multi-institutional group that underwent surgery from 2015 to 2021 were identified for analysis. A cohort of cases for comparison was identified from the NSQIP database using Current Procedural Terminology of nonendoscopic cervical, thoracic, and lumbar procedures from 2015 to 2019. Trauma cases as well as arthrodesis procedures, surgeries to treat pathologies affecting more than 4 levels or spine tumors that required surgical treatment were excluded. In addition, nonelective cases, and patients with wounds worse than class 1 were also not included. Patient demographics, comorbidities, and operative details were analyzed for propensity matching. RESULTS In the non-propensity-matched dataset, the endoscopic cohort had a significantly higher incidence of medical comorbidities. The SSI rates for nonendoscopic and endoscopic patients were 1.2% and 0.001%, respectively, in the nonpropensity match cohort (p-value <.011). Propensity score matching yielded 5936 nonendoscopic patients with excellent matching (standard mean difference of 0.007). The SSI rate in the matched population was 1.1%, compared to 0.001% in endoscopic patients with an odds ratio 0.063 (95% confidence interval (CI) 0.009-0.461, p=.006) favoring FESS. CONCLUSIONS FESS compares favorably for risk reduction in SSI following spinal decompression surgeries with similar operative characteristics. As a consequence, FESS may be considered the optimal strategy for minimizing SSI morbidity.
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Affiliation(s)
- Mark A Mahan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | - Tobias Prasse
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA; Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Robert B Kim
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA
| | | | - Katherine A Kelly
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Osama N Kashlan
- Department of Neurological Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jan Bredow
- Department of Orthopedics and Trauma Surgery, Krankenhaus Porz am Rhein, University of Cologne, Cologne, Germany
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ralf Wagner
- Ligamenta Spine Center, Frankfurt am Main, Germany
| | - Ankush Bajaj
- The Warren Alpert Medical School of Brown University, RI, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown, Rhode Island, USA
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Clinical Application of 3D Visualization Technology in Pancreatoduodenectomy. SURGICAL TECHNIQUES DEVELOPMENT 2022. [DOI: 10.3390/std11030008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective: To explore the surgical effect of three-dimensional (3D) image reconstruction technology in pancreatoduodenectomy. Methods: The clinical records of 47 cases who underwent pancreatoduodenectomy between January 2018 and December 2019 at the department of hepatobiliary surgery of the General Hospital of Ningxia Medical University were retrospectively examined, including 23 males and 24 females, with an average age of 55.00 ± 10.06 years. All patients underwent enhanced computed tomography (CT), and the 3D images were reconstructed by uploading the CT imaging data. The pre-operation evaluation and treatment strategy were planned according to CT imaging and 3D data, respectively. The change of treatment strategy based on 3D evaluation, actual surgical procedure, tumor volume measured by 3D model, actual tumor volume, variants of hepatic artery, operation time, intraoperative blood loss, post-operation hospital stay and post-operation complications was recorded. Results: The treatment strategies were changed after 3D visualization in 10 (21.3%) out of 47 patients because of blood vessel and organ invasion by tumor. The surgical procedure was changed in three cases, and the surgical procedure was optimized and improved in seven cases. All surgical plans based on 3D visualization technology were matched with the actual surgical procedures. Tumor volume measured by 3D model was 19.69 ± 23.47 mL, post-operation actual tumor volume was 17.07 ± 20.29 mL, with no significant difference between them (t = 0.54, p = 0.59). Pearson’s correlation analysis showed statistical significance (r = 0.766, p = 0.00). The average operation time was 4.85 ± 1.75 h, median blood loss volume was 447.05 (50–5000) mL, and post-operation hospital stay was 26.13 ± 11.13 days. Six cases had pancreatic fistula, two cases had biliary leakage, and four cases had delayed gastric emptying. Ascites and pleural effusion was observed in three cases. Conclusions: 3D visualization technology can offer a precise and individualized surgical plan before operation, which might improve the safety of pancreatoduodenectomy, and has application value in preoperative planning.
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Khiem T, Hoi H, Hiep T, Khue K, Duy V, Inoue Y, Son H, Dung D. Total laparoscopic pancreaticoduodenectomy with left posterior superior mesenteric artery first-approach and plexus-preserving circumferential lymphadenectomy: step-by-step technique with a surgical case report (with video). World J Surg Oncol 2022; 20:269. [PMID: 36028841 PMCID: PMC9419321 DOI: 10.1186/s12957-022-02730-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/11/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Total laparoscopic pancreaticoduodenectomy (tLPD) for cancer of the Vater remains a challenging procedure. Recently, several meta-analyses showed the superior aspects of “superior mesenteric artery (SMA)-first approach,” “systematic mesopancreas dissection,” and “circumferential lymphadenectomy around SMA” in increasing R0 resection rate and reducing postoperative complications including pancreatic fistula and bleeding as well as improving overall survival particularly. Case presentation Our patient is a 70-year-old female with a no special medical history, recruited because of jaundice. She was referred for pancreaticoduodenectomy because of a 10-mm-sized mass in distal bile duct referred to as Vater’s tumor. We used 5 trocars, and the patient was placed in a Trendelenburg position. The transverse colon was lifted, the first loop of the jejunum was pulled to the left, and lymph node groups 14th and 15th were removed en bloc and then exposed the SMA from the anterior to the left posterior side from the caudal side to the origin. The first jejunal vessels and the posterior inferior pancreaticoduodenal artery were ligated as well as the extensive mobility of the duodenum and head of the pancreas from the left side. The systematic mesopancreas dissection from the right site of the SMA will be easily and conveniently done afterwards. Histopathological examination of ypT2N1 indicated that 1 of the 22 lymph nodes was positive, which was 1 of 7 LN no. 14. Pathological results showed a Vater adenocarcinoma with all margins being negative. Conclusions This technique was safe and effective to perform precise level 2 mesopancreas dissection and complete lymphadenectomy around SMA without dissection of pl-SMA in laparoscopic field. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02730-y.
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Affiliation(s)
- Thanh Khiem
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Ham Hoi
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Tuan Hiep
- Department of Surgery, Hanoi Medical University, 1st Ton That Tung Street, Dong Da, Ha Noi, 11521, Vietnam.
| | - Kim Khue
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Van Duy
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | - Yosuke Inoue
- Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan
| | - Hong Son
- Department of Oncology, Viet Duc University Hospital, Hanoi, Vietnam
| | - Duc Dung
- Department of Surgery, Thai Binh Medical University, Thai Binh, Vietnam
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Yin T, Qin T, Wei K, Shen M, Zhang Z, Wen J, Pan S, Guo X, Zhu F, Wang M, Zhang H, Hilal MA, Qin R. Comparison of safety and effectiveness between laparoscopic and open pancreatoduodenectomy: A systematic review and meta-analysis. Int J Surg 2022; 105:106799. [PMID: 35988720 DOI: 10.1016/j.ijsu.2022.106799] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Validity of the laparoscopic approach in pancreatic head lesion remains debatable. This study aims to compare the safety and effectiveness of laparoscopic pancreatoduodenectomy (LPD) and open pancreatoduodenectomy (OPD) and investigate the source of heterogeneity from surgeons' and patients' perspectives. METHOD We searched PubMed, Cochrane, Embase, and Web of Science for studies published before February 1, 2021. Of 6578 articles, 81 were full-text reviewed. The primary outcome was mortality. Three independent reviewers screened and extracted the data and resolved disagreements by consensus. Studies were evaluated for quality using ROB2.0 and ROBINS-I. According to different study designs, sensitivity and meta-regression analyses were conducted to explore the heterogeneity source. This meta-analyses was also conducted to explore the learning curve's heterogeneity. This study was registered with PROSPERO, CRD42021234579. RESULTS We analyzed 34 studies involving 46,729 patients (4705 LPD and 42,024 OPD). LPD was associated with lower (P = 0.025) in unmatched studies (P = 0.017). No differences in mortality existed in randomized controlled trials (P = 0.854) and matched studies (P = 0.726). Sensitivity analysis found no significant difference in mortality in elderly patients, patients with pancreatic cancer, and in high- and low-volume hospitals (all P > 0.05). In studies at the early period of LPD (<40 cases), higher mortality (P < 0.001) was found (all P < 0.05).LPD showed non-inferiority in length of stay, complications, and survival outcomes in all analyses. CONCLUSION In high-volume centers with adequate surgical experience, LPD in selected patients appears to be a valid alternative to LPD with comparable mortality, LOS, complications, and survival outcomes.
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Affiliation(s)
- Taoyuan Yin
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China; Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Tingting Qin
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Kongyuan Wei
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 420, Heidelberg, 69120, Germany
| | - Ming Shen
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Zhenxiong Zhang
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Jingjing Wen
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Shutao Pan
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Xingjun Guo
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Feng Zhu
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Min Wang
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Hang Zhang
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China
| | - Mohammad Abu Hilal
- Department of General Surgery, Fondazione Poliambulanza Instituto Ospedaliero, Brescia, Italy
| | - Renyi Qin
- Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, China.
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Wei ZG, Liang CJ, Du Y, Zhang YP, Liu Y. Learning curve for a surgeon in robotic pancreaticoduodenectomy through a "G"-shaped approach: A cumulative sum analysis. World J Clin Cases 2022; 10:4357-4367. [PMID: 35663072 PMCID: PMC9125268 DOI: 10.12998/wjcc.v10.i14.4357] [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: 02/22/2021] [Revised: 10/19/2021] [Accepted: 03/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Robotic pancreaticoduodenectomy (RPD) can achieve similar surgical results to open and PD; however, RPD has a long learning curve and operation time (OT). To address this issue, we have summarized a surgical path to shorten the surgical learning curve and OT. AIM To investigate the effective learning curve of a "G"-shaped surgical approach in RPD for patients. METHODS A total of 60 patients, who received "G"-shaped RPD (GRPD) by a single surgeon in the First Hospital of Shanxi Medical University from May 2017 to April 2020, were included in this study. The OT, demographic data, intraoperative blood loss, complications, hospitalization time, and pathological results were recorded, and the cumulative sum (CUSUM) analysis was performed to evaluate the learning curve for GRPD. RESULTS According to the CUSUM analysis, the learning curve for GRPD was grouped into two phases: The early and late phases. The OT was 480 ± 81.65 min vs 331 ± 76.54 min, hospitalization time was 22 ± 4.53 d vs 17 ± 6.08 d, and blood loss was 308 ± 54.78 mL vs 169.2 ± 35.33 mL in the respective groups. Complications, including pancreatic fistula, bile leakage, reoperation rate, postoperative death, and delayed gastric emptying, were significantly decreased after this surgical technique. CONCLUSION GRPD can improve the learning curve and operative time, providing a new method for shortening the RPD learning curve.
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Affiliation(s)
- Zhi-Gang Wei
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Chao-Jie Liang
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Yang Du
- Operating Room, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Yong-Ping Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
| | - Yu Liu
- Department of Hepatobiliary and Pancreatic Surgery, The First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
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