Background: Same-day discharge (SDD) after laparoscopic colectomy may further improve efficiency of enhanced recovery pathways, but there are few data from a Canadian population and setting. We ...sought to report the outcomes of a SDD program in patients undergoing elective laparoscopic colorectal resection. Methods: Adult patients undergoing elective laparoscopic colectomy or ostomy reversal between February 2020 and January 2022 were screened for eligibility. Patients were eligible if they lived within a 30-minute drive from the hospital, had an adequate support system at home, and owned a smartphone. Patients were discharged on postoperative day (POD) 0 if they tolerated clear liquids, had adequate oral analgesia, and were able to ambulate and urinate independently. All patients had postdischarge remote follow-up using a mobile application for 30 days following surgery. The main outcome of this study was the success rate of SDD, defined as discharge on POD 0 without an unplanned visit (emergency department ED ± readmission) within 72h. Outcomes of SDD were compared with a control group of contemporaneous patients meeting inclusion criteria who were not enrolled in SDD, managed with a mature enhanced recovery pathway (target length of stay LOS 3 d). Secondary outcomes included LOS, 30-day complications, and unplanned visits. Results: A total of 114 patients were enrolled for SDD, with 122 in the control group. Overall, 84% of SDD patients were discharged on POD 0, of whom only 5% required early unplanned visits, resulting in a success rate of 79%. There were no differences in 30-day complications, ED visits and readmissions rates when compared with the control group. Mean LOS was significantly shorter in the overall SDD cohort compared with controls. Patients in whom SDD failed had similar LOS as the control group. Conclusion: SDD is feasible in select patients undergoing elective laparoscopic colorectal surgery with remote follow-up without increasing unplanned visits after discharge. This may allow for more efficient health care resource utilization.
Objectives: Since the introduction of laparoscopic nephrectomies, laparoscopic surgeries in the field of urology have become increasingly popular. Laparoscopic surgery has its advantages but carries ...the risk of complications like all interventions. In our study, we aimed to discuss our complication rates according to difficulty level by presenting our experiences with urological laparoscopic procedures for the upper urinary system.
Methods: This retrospective study includes 942 laparoscopic urological procedures performed by a single surgeon. The procedures divided into three groups according to the European Scoring System (ESS) Classification. The complication rate of each group was calculated separately.
Results: A total of 127 (13.4%) complications were observed. Partial nephrectomy, nephroureterectomy and ureterolithotomy had the highest complication rates. Renal cyst excision, simple nephrectomy and radical nephrectomy had the lowest complication rates. According to the Clavien Complication Classification, the distributions of Grade 1, 2 and 3 complications were 29.1% (n =37), 57.4% (n = 73) and 13.3% (n = 17); respectively. The open conversion rate was 0.84%. When procedures were classified as “easy”, “difficult” and “very difficult” according to the ESS classification; complication rates were found 7.3% in the easy group, 13.3% in the difficult group and 16.6% in the very difficult group. There was no significant difference between the three groups in terms of complication rates (p = 0.329).
Conclusions: Performing easier operations according to ESS in the first years of the learning curve is beneficial in preventing complications. With increasing experience, more complicated procedures can be performed with similar complication rates.
Objective: With the increasing popularity of minimally-invasive surgery, laparoscopic pyeloplasty has become a staple in the armamentarium of urologists. However, the surgery has a steep learning ...curve and longer operative time. In this study, we aimed to evaluate the results of initial 53 cases of laparoscopic dismembered pyeloplasty in our institute. Materials and Methods: A total 52 of patients with pelvi-ureteric junction (PUJ) obstruction, 30 male and 22 female, with the mean age of 23.5 years were managed by transperitoneal laparoscopic dismembered pyeloplasty. The patients were placed in full lateral position and surgery was done using a minimum of three ports, retrograde pyelography was done in all; initial access was done by using a Veress needle. The ureter was spatulated first, first suture taken and then the PUJ was dismembered to avoid rotation of the ureter. Antegrade DJ stenting was done in all patients and one drain was left in the retroperitoneum after surgery. DJ stent was removed six weeks after surgery. Results: Fifty two patients were managed by dismembered pyeloplasty. Six patients required preoperative urinary diversion. Intrarenal pelvis was seen in seven, crossing vessel in ten, high insertion of ureter in six and associated calculus in five patients. Conversion to open surgery was required in six patients. Initially, the operative time was more than three hours but after sufficient experience of 25 cases, it reduced drastically and in last 28 cases, the mean operative time was 123 minutes, with shortest time reported 97 minutes. Reintervention was required in eight patients and overall success rate was 87%. Conclusion: Laparoscopic pyeloplasty is a safe, minimally-invasive and viable alternative to open pyeloplasty for the management of PUJ obstruction. Keywords: Laparoscopy, Pyeloplasty, PUJ, Obstruction, Dismembered Amac: Minimal invaziv cerrahinin artan popularitesiyle birlikte, Laparoskopik Piyeloplasti urologlarin temel araci haline gelmistir. Buna karsin cerrahi, dik bir ogrenme egrisine ve daha uzun operasyon surelerine sahiptir. Bu calismada, klinigimizde laparoskopik parcalanmis piyeloplasti gerceklestirilen ilk 52 olguya ait sonuclarin degerlendirilmesi amaclanmistir. Gerec ve Yontem: Pelvi-ureterik bileske (PUE) darligina sahip, 30 erkek ve 22 kadin olmak uzere yas ortalamasi 23,5 olan toplam 52 hastaya transperitoneal laparoskopik parcalanmis pyeloplasti uygulandi. Hastalar tam lateral pozisyona yerlestirildi ve en az uc port kullanilarak ameliyat yapildi, hepsinde retrograd piyelografi yapildi; ilk erisimde Veress ignesi kullanildi. Ureter ilk olarak spatule edildi; once sutur alindi ve daha sonra ureterin donusunu onlemek icin PUJ parcalandi. Antegrad DJ stentleme butun hastalara uygulandi ve operasyon sonrasi retroperitonda bir diren birakildi. Operasyondan 6 hafta sonra DJ stent cikarildi. Bulgular: Elli iki hasta parcalanmis piyeloplasti ile tedavi edildi. Alti hastaya ameliyat oncesi uriner diversiyon gerekti. Yedi hastada Intrarenal pelvis, 10 hastada damar gecisi, 6 hastada yuksek yerlesimli ureter ve 5 hastada iliskili kalkul gorulmustur. Alti hastada acik cerrahiye donulmesi gerekmistir. Baslangicta operasyon suresi 3 saatten daha uzunken, 25 olguda olusan yeterli deneyim sonrasi buyuk olcude azalmistir. Son 28 olgunun ortalama operasyon suresi 123 dakika olup bunlar icinde en kisa sure ise 97 dakikadir. Sekiz hastada tekrar mudahale gerekirken, genel basari orani %87'dir. Sonuc: Laparoskopik piyeloplasti; guvenilir, minimal invaziv ve PUE darlik yonetiminde acik piyeloplasti yerine uygulanabilir alternatif bir yontemdir. Anahtar Kelimeler: Laparoskopi, Piyeloplasti, PUE, Darlik, Parcalanmis
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Greater splanchnic nerves (GSNs) and lesser splanchnic nerves (LSNs) are the dominant nerves in the pain of advanced cancer patients, which provides the base of retroperitoneal laparoscopic ...splanchnicectomy. We dissected 25 cadavers to provide anatomic basis for the surgery. Most GSNs entered the abdominal cavity close to the medial crus of the diaphragm while most LSNs the middle one. The number of the branch varies from 1 (which was 80%) - 3. The abdominal segment length of LSNs and GSNs was 26 mm and 20 mm respectively. The mean diameter of the nerves was about 2 mm. The laparoscope was put through abdominal wall beneath the 12th rib at the posterior axillary line, best angles and distances for the surgery were 50 degrees and 80-110 mm respectively. The anatomic parameters of splanchnic nerves in the abdominal cavity as well as the angle and distance for the retroperitoneal laparoscopic splanchnicectomy and the anatomic landmarks were presented by the study. Besides the advantages of small incision, less pain and quick recovery, the anatomic parameters provided a practicable approach for the retroperitoneal laparoscopic splanchnicectomy.
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