1
|
Azuma K, Monnet E. Three-dimensional versus two-dimensional laparoscopy for cholecystectomy in a canine cadaveric study. Vet Surg 2024; 53:695-700. [PMID: 37985468 DOI: 10.1111/vsu.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/22/2023] [Accepted: 10/18/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To compare the effect of three-dimensional (3D) and two-dimensional (2D) laparoscopy on surgical time and intraoperative complications during cholecystectomies in canine cadavers. STUDY DESIGN Experimental prospective study. ANIMALS Twelve canine cadavers. METHODS The laparoscopic cholecystectomies were performed in canine cadavers with four cannulas and with either 2D or 3D cameras by a single surgeon. The following surgical times were recorded: time from insertion of laparoscopic instruments to first endoclip placement, time from first endoclip placement to second endoclip placement, time from second endoclip placement to complete gall bladder dissection, and total surgical time. The cystic duct length distal to the first endoclip, intraoperative complications, and the amount of liver attached to the gall bladder were also recorded. RESULTS Time from the insertion of the instruments to the application of the first endoclip was shorter for the 3D group than for the 2D group (p = .016). Other surgical times were not different between groups. There was no difference in the cystic duct length distal to the first endoclip, intraoperative complications, or the amount of liver attachment. CONCLUSION Three-dimensional laparoscopy shortened the time from insertion of the laparoscopic instruments to placement of the first endoclip. However, total surgical time was not affected by the type of camera in laparoscopic cholecystectomy. CLINICAL SIGNIFICANCE Three-dimensional laparoscopy may be beneficial when performing procedures requiring enhanced spatial orientation. However, this technique did not shorten the total surgical time in this cadaveric study. Further studies in a clinical setting are necessary for the optimization of the future use of 3D laparoscopy.
Collapse
Affiliation(s)
- Kazushi Azuma
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Science, Colorado State University, Fort Collins, Colorado, USA
| | - Eric Monnet
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Science, Colorado State University, Fort Collins, Colorado, USA
| |
Collapse
|
2
|
Deng M, Yan J, Zhang Z, Wang Z, Zhang L, Ren L, Fan H. Greater than or equal to 8 mm is a safe diameter of common bile duct for primary duct closure: single-arm meta-analysis and systematic review. Clin J Gastroenterol 2022; 15:513-521. [PMID: 35247181 DOI: 10.1007/s12328-022-01615-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 02/20/2022] [Indexed: 02/07/2023]
Abstract
Greater than or equal to 8 mm was often used as the safe diameter of primary duct closure (PDC) after laparoscopic common bile duct exploration (LCBDE) in previous studies, but it is impossible to verify the source of this safe diameter, and lack of evidence for the safe diameter of PDC. Hence, this study evaluates the incidence of postoperative complications by single-arm meta-analysis to demonstrate the feasibility of using 8 mm as the safe diameter of PDC, so as to provide reference for clinical selection. Eligible studies were searched by MEDLINE, the Cochrane Library, Embase, and Web of Science from January 1995 to May 2021, investigating eligible literature using PDC after LCBDE for methods of common bile duct closure. The single-arm meta-analysis was analyzed by "meta" package under R 4.0.5, and the pooled incidence of postoperative complications was calculated. Twelve literatures were enrolled in this single-arm meta-analysis including 792 patients. The pooled complications rate including total complications (13.1%, 95% CI 10.1-15.6%), total biliary duct-related complications (9.4%, 95% CI 7.4-11.6%), residual stones (1.3%, 95% CI 0.3-2.7%), bile leakage (5.1%, 95% CI 3.5-6.9%), postoperative pneumonia (2.1%, 95% CI 0.8-3.8%), postoperative acute pancreatitis (1.8%, 95% CI 0.2-4.3%), and stone recurrence (2.6%, 95% CI 1.1-4.4%). The clinical indication of PDC after LCBDE should follow that the diameter of common bile duct ≥ 8 mm as the safe diameter.
Collapse
Affiliation(s)
- Manjun Deng
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Tongren Road 27, Xining, 810001, Qinghai, People's Republic of China
- Qinghai Province Key Laboratory of Hydatid Disease Research, Xining, 810000, People's Republic of China
| | - Jingxin Yan
- Department of Interventional Therapy, Affiliated Hospital of Qinghai University, Xining, 810001, People's Republic of China
- Department of Postgraduate, Qinghai University, Xining, 810001, People's Republic of China
| | - Zheheng Zhang
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Tongren Road 27, Xining, 810001, Qinghai, People's Republic of China
- Department of Postgraduate, Qinghai University, Xining, 810001, People's Republic of China
| | - Zhixin Wang
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Tongren Road 27, Xining, 810001, Qinghai, People's Republic of China
- Qinghai Province Key Laboratory of Hydatid Disease Research, Xining, 810000, People's Republic of China
| | - Lingqiang Zhang
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Tongren Road 27, Xining, 810001, Qinghai, People's Republic of China
- Qinghai Province Key Laboratory of Hydatid Disease Research, Xining, 810000, People's Republic of China
| | - Li Ren
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Tongren Road 27, Xining, 810001, Qinghai, People's Republic of China.
- Qinghai Province Key Laboratory of Hydatid Disease Research, Xining, 810000, People's Republic of China.
| | - Haining Fan
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Tongren Road 27, Xining, 810001, Qinghai, People's Republic of China.
- Qinghai Province Key Laboratory of Hydatid Disease Research, Xining, 810000, People's Republic of China.
| |
Collapse
|
3
|
Bosley ME, Zamora IJ, Neff LP. Choledocholithiasis-a new clinical pathway. Transl Gastroenterol Hepatol 2021; 6:35. [PMID: 34423156 DOI: 10.21037/tgh-20-172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/18/2020] [Indexed: 01/07/2023] Open
Abstract
The incidence of cholecystectomy in children has increased considerably since the early 1990s. Management of gallbladder disease in children must include an awareness of choledocholithiasis treatment strategies. Both endoscopic retrograde cholangiopancreatography (ERCP) and common bile duct exploration (open or laparoscopic) are accepted management techniques for choledocholithiasis. Laparoscopic cholecystectomy with preoperative or postoperative ERCP is at least a two-procedure process while cholecystectomy with laparoscopic common bile duct exploration (LCBDE) can provide definitive treatment in a single procedure under one anesthetic. Despite this, the trend over the last decade continues towards less LCBDE utilization in favor of ERCP. This trend has resulted in decreased familiarity with LCBDE by adult and pediatric surgeons and their trainees. Access to the necessary tools and education on the technical aspects can allow for successful single-stage treatment of choledocholithiasis by surgeons during laparoscopic cholecystectomy. This may include a pre-defined stepwise algorithm and understanding of all the equipment and resources necessary to perform a LCBDE. Ultimately, increased understanding of the equipment and procedural steps necessary for LCBDE will result in widened adoption of the technique and thus confer advantages to the patient such as decreased length of stay and fewer required anesthetics.
Collapse
Affiliation(s)
- Maggie E Bosley
- General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Irving J Zamora
- Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lucas P Neff
- Pediatric Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
4
|
Single-stage management of choledocholithiasis: intraoperative ERCP versus laparoscopic common bile duct exploration. Surg Endosc 2020; 34:4616-4625. [PMID: 31617103 DOI: 10.1007/s00464-019-07215-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 10/09/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) is the criterion standard for treating patients with symptomatic gallstone disease; however, the optimal technique for extracting common bile duct stones remains unclear. Recent studies have noted improved outcomes with single-stage techniques, such as intraoperative endoscopic retrograde cholangiopancreatography (iERCP) and laparoscopic common bile duct exploration (LCBDE); however only few studies have directly compared those two single-stage techniques. OBJECTIVES Using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, we retrospectively analyzed the postoperative outcomes of all patients who underwent single-stage LC for choledocholithiasis from 2005 to 2017. Using Current Procedural Terminology (CPT) codes, as well as International Classification of Diseases, Ninth Revision (ICD-9) and 10th Revision (ICD-10) codes, we stratified patients into two cohorts: those who underwent iERCP and LCBDE. Applying univariate techniques, we evaluated baseline characteristics and postoperative outcomes for both cohorts. Our primary outcomes of interest were 30-day morbidity and 30-day mortality; our secondary outcomes included rates of reoperation, readmission, operative time, and hospital length of stay. RESULTS Of the 1814 single-stage LC patients during our 13-year study period, 1185 (65.3%) underwent LCBDE; 629 (34.6%) underwent iERCP. Our univariate analysis showed that the two cohorts were homogeneous in terms of baseline characteristics, including demographics, preoperative comorbidities, laboratory values, and American Society of Anesthesiologists (ASA) scores. 30-day postoperative morbidity (including infectious and noninfectious complications) and overall mortality between groups were low and comparable. The mean operative time was slightly longer with LCBDE (125.1 ± 62.0 min) than iERCP (113.5 ± 65.2 min; P < 0.001), however the mean hospital length of stay, readmission rate, and reoperation rate were similar. CONCLUSION We found that both iERCP and LCBDE resulted in low, comparable rates of morbidity and mortality. Centers with readily available endoscopic expertise might favor iERCP for its ease of access and shorter operative time. However, LCBDE remains an appropriate technique for patients with choledocholithiasis, especially when immediate endoscopic intervention is unavailable.
Collapse
|
5
|
Sbrocchi TJ, Watson WD, Ruiz O, Nguyen N. Efficacy of a Novel Cholangiogram Simulator for Training Laparoscopic Intraoperative Cholangiography. JOURNAL OF SURGICAL EDUCATION 2020; 77:683-689. [PMID: 31948865 DOI: 10.1016/j.jsurg.2019.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/11/2019] [Accepted: 12/14/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Determine the efficacy of a novel low-cost, reusable simulator for training fundamental skills associated with safe and effective intraoperative cholangiography (IOC). DESIGN The simulator uses a balloon and retention suture tubing (representing the gallbladder, cystic duct, common bile duct, and common hepatic duct) attached to a piece of wood and placed in a laparoscopic trainer (representing the abdominal cavity) covered by a piece of simulated skin to obscure it. Following a tutorial on performing a simulated IOC using this, simulation participants independently completed a video-recorded simulated IOC and a post-training survey about the appearance and perceived usefulness of the IOC simulator as a training tool. Two experienced surgeons assessed participants' IOC performance using an IOC procedural checklist developed for this purpose. Procedural time (in seconds) was recorded and used as an additional measure of performance. SETTING The OhioHealth Learning Center simulation facility in the Department of Surgery at Riverside Methodist Hospital, a large tertiary care independent medical center that is part of the OhioHealth care system. PARTICIPANTS Eleven attending surgeons and 16 general surgery residents of different levels participated in the simulation. Two experienced surgeons assessed participants' IOC performance. One participated in the simulation along with the other 10 surgeons; the other did not. RESULTS High-experience participants completed more steps and spent less time than low-experience individuals; however, differences were not statistically significant. There was substantial agreement between the 2 observers regarding participants' performance. Participants scored the simulator as realistic and useful in teaching relevant steps associated with IOC. CONCLUSIONS Despite differences between high- and low-experience participants in steps completed and time spent, these results did not prove statistically significant. Additional studies to increase sample size are warranted to determine if significant differences exist. However, participants did generally find the simulator to be an effective training tool.
Collapse
Affiliation(s)
- Tyler J Sbrocchi
- Department of Medical Education, OhioHealth Learning, Riverside Methodist Hospital, Columbus, Ohio.
| | - William D Watson
- OhioHealth Learning, Riverside Methodist Hospital, Columbus, Ohio
| | - Oscar Ruiz
- Department of Medical Education, OhioHealth Learning, Riverside Methodist Hospital, Columbus, Ohio
| | - Ngan Nguyen
- OhioHealth Learning, Riverside Methodist Hospital, Columbus, Ohio
| |
Collapse
|
6
|
Helton WS, Ayloo S. Technical Aspects of Bile Duct Evaluation and Exploration: An Update. Surg Clin North Am 2019; 99:259-282. [PMID: 30846034 DOI: 10.1016/j.suc.2018.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Consensus guidelines recommend patients with symptomatic cholelithiasis and suspected choledocholithiasis have common bile duct exploration (CBDE) at the time of cholecystectomy to prevent downstream problems. Despite superiority of single-stage cholecystectomy with CBDE, 2-stage precholecystectomy/postcholecystectomy with endoscopic clearance of the duct is commonly practiced. This is related to inadequate training in minimally invasive techniques, lack of technical support for efficient and safe CBDE, and surgeons' inexperience with complex biliary pathologic condition. This article provides a framework for evaluating and treating patients with CBD pathologic condition with an emphasis on technical aspects of CBDE and preoperative planning and preparation.
Collapse
Affiliation(s)
| | - Subhashini Ayloo
- Rutgers, New Jersey Medical School, 185 South Orange Avenue, MSB G586, Newark, NJ 07103, USA.
| |
Collapse
|
7
|
Kim EY, Hong TH. In vivo porcine training model of laparoscopic common bile duct repair with T-tube insertion under the situation of iatrogenic common bile duct injury. Ann Surg Treat Res 2018. [PMID: 29520348 PMCID: PMC5842086 DOI: 10.4174/astr.2018.94.3.142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose We introduce a training porcine model for laparoscopic common bile duct (CBD) repair with T-tube insertion. The model could be the feasible training tool for a surgeon learning hepatobiliary surgery. Methods Totally laparoscopic CBD repair with T-tube insertion was performed on 9 pigs by 9 trainees naïve in hepatobiliary surgery. Similar to the situation of iatrogenic injury, CBD was transected by laparoscopic scissors at the middle part about 1 cm in length, and the transected CBD was repaired through end-to-end anastomosis with T-tube insertion. A secureness of anastomosis was confirmed by saline leakage test and all animals were sacrificed after the surgery. Results All novice surgeons completed operations successfully without complications. Total mean operative time was 85 ± 1.7 minutes and the mean time spent performing the CBD repair with T-tube insertion was 71 ± 3 minutes. There was no bile leakage after primary anastomosis in all animals. Conclusion This porcine training model for laparoscopic CBD repair with T-tube insertion could be a feasible and effective training tool for surgeons with little experience in laparoscopic hepatobiliary surgery.
Collapse
Affiliation(s)
- Eun Young Kim
- Department of Trauma and Surgical Critical Care, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae Ho Hong
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
8
|
Zerey M, Haggerty S, Richardson W, Santos B, Fanelli R, Brunt LM, Stefanidis D. Laparoscopic common bile duct exploration. Surg Endosc 2017; 32:2603-2612. [DOI: 10.1007/s00464-017-5991-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 11/26/2017] [Indexed: 12/16/2022]
|
9
|
Sánchez R, Rodríguez O, Rosciano J, Vegas L, Bond V, Rojas A, Sanchez-Ismayel A. Robotic surgery training: construct validity of Global Evaluative Assessment of Robotic Skills (GEARS). J Robot Surg 2016; 10:227-31. [PMID: 27039189 DOI: 10.1007/s11701-016-0572-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/06/2016] [Indexed: 12/14/2022]
Abstract
The objective of this study is to determine the ability of the GEARS scale (Global Evaluative Assessment of Robotic Skills) to differentiate individuals with different levels of experience in robotic surgery, as a fundamental validation. This is a cross-sectional study that included three groups of individuals with different levels of experience in robotic surgery (expert, intermediate, novice) their performance were assessed by GEARS applied by two reviewers. The difference between groups was determined by Mann-Whitney test and the consistency between the reviewers was studied by Kendall W coefficient. The agreement between the reviewers of the scale GEARS was 0.96. The score was 29.8 ± 0.4 to experts, 24 ± 2.8 to intermediates and 16 ± 3 to novices, with a statistically significant difference between all of them (p < 0.05). All parameters from the scale allow discriminating between different levels of experience, with exception of the depth perception item. We conclude that the scale GEARS was able to differentiate between individuals with different levels of experience in robotic surgery and, therefore, is a validated and useful tool to evaluate surgeons in training.
Collapse
Affiliation(s)
- Renata Sánchez
- Robotic Surgery Program. University Hospital of Caracas, Medicine Faculty, Central University of Venezuela, Caracas, Venezuela.,Robotic and Minimally Invasive Surgery (UNIC), Caracas, Venezuela
| | - Omaira Rodríguez
- Robotic Surgery Program. University Hospital of Caracas, Medicine Faculty, Central University of Venezuela, Caracas, Venezuela. .,Robotic and Minimally Invasive Surgery (UNIC), Caracas, Venezuela.
| | - José Rosciano
- Robotic Surgery Program. University Hospital of Caracas, Medicine Faculty, Central University of Venezuela, Caracas, Venezuela
| | - Liumariel Vegas
- Robotic Surgery Program. University Hospital of Caracas, Medicine Faculty, Central University of Venezuela, Caracas, Venezuela
| | - Verónica Bond
- Robotic Surgery Program. University Hospital of Caracas, Medicine Faculty, Central University of Venezuela, Caracas, Venezuela
| | - Aram Rojas
- Robotic Surgery Program. University Hospital of Caracas, Medicine Faculty, Central University of Venezuela, Caracas, Venezuela
| | - Alexis Sanchez-Ismayel
- Robotic Surgery Program. University Hospital of Caracas, Medicine Faculty, Central University of Venezuela, Caracas, Venezuela.,Robotic and Minimally Invasive Surgery (UNIC), Caracas, Venezuela
| |
Collapse
|
10
|
Sánchez A, Rodríguez O, Sánchez R, Benítez G, Pena R, Salamo O, Baez V. Laparoscopic surgery skills evaluation: analysis based on accelerometers. JSLS 2016; 18:JSLS.2014.00234. [PMID: 25489218 PMCID: PMC4254482 DOI: 10.4293/jsls.2014.00234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background and Objective: Technical skills assessment is considered an important part of surgical training. Subjective assessment is not appropriate for training feedback, and there is now increased demand for objective assessment of surgical performance. Economy of movement has been proposed as an excellent alternative for this purpose. The investigators describe a readily available method to evaluate surgical skills through motion analysis using accelerometers in Apple's iPod Touch device. Methods: Two groups of individuals with different minimally invasive surgery skill levels (experts and novices) were evaluated. Each group was asked to perform a given task with an iPod Touch placed on the dominant-hand wrist. The Accelerometer Data Pro application makes it possible to obtain movement-related data detected by the accelerometers. Average acceleration and maximum acceleration for each axis (x, y, and z) were determined and compared. Results: The analysis of average acceleration and maximum acceleration showed statistically significant differences between groups on both the y (P = .04, P = .03) and z (P = .04, P = .04) axes. This demonstrates the ability to distinguish between experts and novices. The analysis of the x axis showed no significant differences between groups, which could be explained by the fact that the task involves few movements on this axis. Conclusion: Accelerometer-based motion analysis is a useful tool to evaluate laparoscopic skill development of surgeons and should be used in training programs. Validation of this device in an in vivo setting is a research goal of the investigators' team.
Collapse
Affiliation(s)
- Alexis Sánchez
- Medicine Faculty, Central University of Venezuela, Caracas, Venezuela
| | - Omaira Rodríguez
- Medicine Faculty, Central University of Venezuela, Caracas, Venezuela
| | - Renata Sánchez
- Medicine Faculty, Central University of Venezuela, Caracas, Venezuela
| | - Gustavo Benítez
- Medicine Faculty, Central University of Venezuela, Caracas, Venezuela
| | - Romina Pena
- Surgery Department III, University Hospital of Caracas, Caracas, Venezuela
| | - Oriana Salamo
- Surgery Department III, University Hospital of Caracas, Caracas, Venezuela
| | - Valentina Baez
- Surgery Department III, University Hospital of Caracas, Caracas, Venezuela
| |
Collapse
|
11
|
Training model for laparoscopic Heller and Dor fundoplication: a tool for laparoscopic skills training and assessment—construct validity using the GOALS score. Surg Endosc 2015; 30:3654-60. [DOI: 10.1007/s00464-015-4617-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/05/2015] [Indexed: 11/25/2022]
|