BACKGROUND AND OBJECTIVE

Robotic surgery for rectal malignancies in the Philippines is emerging. Evidence has shown promising results for robot-assisted (R) rectal surgery when compared to the laparoscopic (L) and open (O) approach. This study discussed the clinicopathologic outcomes of the first robotic rectal resections versus laparoscopic and open rectal resections at the Philippine General Hospital (PGH).

This was a retrospective cohort of 45 consecutive surgical resections for rectal malignancy done at the PGH from March 2019 to October 2019 that compared the outcomes of the first 15 robotic procedures done at the institution versus laparoscopic (n=15) and open (n=15) operations performed during the same time period. One-way ANOVA was done to determine significant differences among variables, while Bonferonni multiple comparison test was done to analyze differences among means.

The 45 patients in the study had a mean age of 56.04 ± 13.45 years. The patients were mostly male (60%). Most of the tumors were located in the low rectum (27/45; 60%). Most of the patients had locally-advanced (at least Stage IIIB) disease (27/45; 60%), and warranted neoadjuvant treatment (41/45; 91.11%). Most patients underwent a sphincter-saving procedure (34/45; 75.56%). All three groups had comparable baseline characteristics. The R-group had the longest operative time (438.07 ± 124.57; p value < 0.0001). Blood loss was significantly highest in the R-group (399 ± 133.07 cc; p value - 0.0020) as well, while no statistical difference was observed between the Oand L-groups (p value – 0.75). No conversion to open was noted in the R- and L-groups. Most of the patients had well-differentiated adenocarcinoma (22/45; 48.49%). All patients in the L- and O-groups had an R0 resection There were two R1 resections in the R-group. All patients who underwent an open surgery had a negative circumferential resection margin (CRM); L-group 93.99%, R-group 69.23%. All patients had adequate proximal and distal resection margins. Those who underwent an open surgery had the shortest post-operative length of stay (LOS) (p value – 0.0002). Post-operative ileus (7/45; 15.56%) was the most commonly encountered morbidity, and was seen mostly in the R-group (3/15; 20%). One patient in the R-group underwent a transanal repair of an anastomotic dehiscence and was discharged three days after reoperation. There was no reported mortality.

Our institution with a beginning robotic colorectal surgery program showed promise as its initial outcomes for rectal cancer were compared to the more often-performed open and laparoscopic procedures. The authors expect more favorable clinicopathological outcomes as our staff overcome the prescribed learning curve for robotic surgery.

OBJECTIVE: To explore the effect of auricular point pressure on anesthetic recovery in the patients undergoing laparoscopic cholecystectomy. METHODS: One hundred and forty patients undergoing laparoscopic cholecystectomy were randomized into a trial group (52 cases, 2 cases dropped out) and a control group (52 cases, 2 cases were eliminated). In the control group, the conventional anesthesia program and recovery intervention were adopted. In the trial group, on the basis of the regimen as the control group, the intervention of auricular point pressure was supplemented. The auricular points on the right side were selected, including sympathetic (AH_6a), brain (subcortex, AT₄), thalamus, exciting point, heart and sore center. One day before operation, the auricular point pressure started; and the auricular points were stimulated specially before anesthesia (T0), at the moment of operation ending (T1), when entering the recovery room, at the moment of the tube removal (T2) and in 10 min of the tube removal (T3), respectively; each auricular point was pressed for 1 min a time. The recovery time of spontaneous breathing, the time of eye opening, the removal time of endotracheal tube, the recovery time of orientation, and the time of exiting recovery room were compared between the two groups. The score of pain visual analogue scale (VAS) and that of Richmond agitation-sedation scale (RASS) at T2, T3 and when exiting recovery room (T4), and the relevant circulatory indexes (heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP] and mean arterial pressure [MAP]) at T0, T1, T2 and T3 were observed in the two groups. RESULTS: In the trial group, the recovery time of spontaneous breathing, the time of eye opening, the removal time of endotracheal tube, the recovery time of orientation, the time of exiting recovery room were shorter than those of the control group (P<0.01, P<0.05). The pain VAS and RASS scores at T2, T3 and T4, as well as HR, SBP, DBP and MAP at T0, T1, T2 and T3 were not different statistically between the two groups (P>0.05). CONCLUSION Auricular point pressure can shorten the recovery time from anesthesia in the patients undergoing laparoscopic cholecystectomy.
Humans ; Cholecystectomy, Laparoscopic ; Male ; Female ; Middle Aged ; Adult ; Anesthesia Recovery Period ; Acupuncture Points ; Aged ; Young Adult

Introduction: Laparoscopic Cholecystectomy uses carbon dioxide (CO2) which affects the respiratory, cardiovascular and renal system. The residual CO2 induces phrenic nerve irritation, manifesting as shoulder and abdominal pain. Recruitment maneuvers opens the lungs and helps expelling this residual carbon dioxide. However, there are limited studies on its role to hemodynamics especially in patients undergoing abdominal laparoscopic procedures. Methods: Sixty patients (51 15.1) scheduled for laparoscopic cholecystectomy under General Endotracheal Anesthesia were randomly allocated to two groups. The control group (Group C) underwent standard laparoscopic cholecystectomy procedures. The experimental group (Group R) was placed in a Trendelenburg and was given 4-5 manual pulmonary inflations at a pressure of 40cmH20. The blood pressure, heart rate, respiratory rate and oxygen saturation, as well as the post operative site pain and shoulder pain were measured using the Numerical Pain Scale (NPS) were monitored at 0, 1 and 2 hours post operatively. Results: The demographics and preoperative vital signs were comparable. The mean systolic blood pressure [119.5 vs 131.5; p=0.002], mean arterial pressure [91.8 vs 95.3; p=0.049], heart rate [74.9 vs 87.5; p <0.001] and respiratory rate [15.7 vs 16.2; p=0.02] were all differrent only during the immediate post operative period. The mean shoulder pain was lower in Group R immediately [1.9 ± 1.2; p=0.01] and 1 hour after surgery [0.7 ± 0.8; p=0.01]. Conclusion Recruitment maneuver significantly reduces the shoulder pain scores after laparoscopic cholecystectomy. It causes a decrease in blood pressure, heart rate and mean arterial pressure in the immediate post operative period.
Cholecystectomy, Laparoscopic ; Shoulder Pain ; Hemodynamics ; Carbon Dioxide

Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Common Bile Duct ; Humans ; Mirizzi Syndrome/surgery*

Aged ; Cholecystectomy, Laparoscopic ; methods ; Cholelithiasis ; complications ; diagnosis ; surgery ; Clinical Laboratory Techniques ; Coronavirus Infections ; complications ; diagnosis ; Elective Surgical Procedures ; methods ; Follow-Up Studies ; Humans ; Infection Control ; methods ; Male ; Pandemics ; Patient Safety ; Pneumonia, Viral ; complications ; diagnosis ; Postoperative Care ; methods ; Risk Assessment ; Singapore ; Treatment Outcome

Objective: This study aimed to compare the cost of hospitalization for open and laparoscopic cholecystectomy (OC and LC) among adult patients with cholelithiasis in the Philippine General Hospital. Methodology: The billing records of all patients admitted for elective cholecystectomy from February to July 2017, were reviewed. An item by item costing for room and board, laboratories, radiologic exams, surgical and anesthesia needs for each patient meeting the inclusion criteria was done. Results: From February to July 2017, a total of 391 cholecystectomies were performed; 156 cases (78 OC and 78 LC) were included in the analysis. There is no significant difference between the mean total cost for the laparoscopic group which was 20,549 +/- 4,972 pesos and 18,465 +/- 7,908 pesos (p < 0.05) for the open group. Conclusion Total cost of LC is comparable to OC. However, when the total expenses were divided into categories, the OC group incurred significantly bigger charges than the LC group in room and board, laboratories, radiology, pharmacy, and surgery needs. On the other hand, the LC group had significantly higher mean charges for the surgery needs inclusive of the laparoscopic machine and disposable instruments.
Cholecystectomy ; Cholecystectomy, Laparoscopic ; Laparoscopy

PURPOSE: Single incision laparoscopic cholecystectomy (SILC) is a surgical method to treat gallbladder disease designed to reduce postoperative pain and improve cosmetic results. However, pure SILC (pSILC) has several inherent limitations. In this study, we report the surgical outcomes of SILC with needlescopic grasper (nSILC) compared with those of pSILC and conventional three-port laparoscopic cholecystectomy (TPLC).METHODS: This retrospective study enrolled 103 patients who underwent laparoscopic cholecystectomy for benign gallbladder disease in our hospital between January 2013 and January 2015. Among them, 33 patients underwent pSILC, 35 underwent nSILC, and 35 underwent TPLC. We collected demographic characteristics and operative data to analyze outcomes between groups.RESULTS: All procedures were done by laparoscopy and the gallbladder of each patient was completely removed. Women and younger patients were more to undergo SILC than TPLC. Analysis showed that the operation time of the nSILC group was longer than that of the TPLC group, but shorter than that of the pSILC group (skin to skin operation time [pSILC: 65.2±19.1 min, nSILC: 49.7±12.9 min, and TPLC: 43.4±14.7 min, p<0.001], and major procedure time [pSILC: 42.2±18.7 min, nSILC: 25.9±8.9 min, and TPLC: 23.4±12.7 min, p<0.001]). There were no significant differences between the groups for patient visual analogue scale score, length of hospital stay, or intraoperative blood loss.CONCLUSION: nSILC is feasible surgical method in patients with benign gallbladder disease compared to TPLC, and that is an effective procedure to overcome the disadvantage of pSILC.
Cholecystectomy ; Cholecystectomy, Laparoscopic ; Female ; Gallbladder ; Gallbladder Diseases ; Humans ; Laparoscopy ; Length of Stay ; Methods ; Pain, Postoperative ; Retrospective Studies ; Skin

This study compared the surgical outcomes of single-incision with needlescopic grasper (nSILC) versus three-port (TPLC) versus pure single-incision laparoscopic cholecystectomies (pSILC). The present study showed similar surgical outcomes between the pSILC and nSILC procedures. However, the operative time for the nSILC group was longer than that for the TPLC group but shorter than that for the pSILC group. Therefore, nSILC is a feasible surgical procedure for patients with benign gallbladder disease compared to TPLC and an effective approach to overcome the limitations of pSILC.
Cholecystectomy, Laparoscopic ; Gallbladder ; Gallbladder Diseases ; Humans ; Operative Time

BACKGROUND: The supraglottic airway device is an appropriate alternative to tracheal intubation in laparoscopic surgery. We compared the Baska MaskⓇ with i-gelⓇ by measuring the oropharyngeal leak pressure (OLP) and hemodynamic and respiratory parameters during laparoscopic cholecystectomy.METHODS: A total of 97 patients were randomly allocated to either i-gel group (n = 49) or Baska Mask group (n = 48). Insertion time, number of insertion attempts, fiber-optic view of the glottis, and OLP were recorded. Heart rate, mean arterial pressure, peak airway pressure (PAP), lung compliance, and perioperative complications were assessed before, during, and after pneumoperitoneum.RESULTS: There were no significant differences between the two groups regarding demographic data, insertion time, fiber-optic view of the glottis, and the use of airway manipulation. The OLP was higher in the Baska Mask group than in the i-gel group (29.6 ± 6.8 cmH₂O and 26.7 ± 4.5 cmH₂O, respectively; P = 0.014). Heart rate, mean arterial pressure, PAP, and lung compliance were not significantly different between the groups. The incidence of perioperative complications was small and not statistically significant.CONCLUSIONS: Both the i-gel and Baska Mask provided a satisfactory airway during laparoscopic cholecystectomy. Compared with the i-gel, the Baska Mask demonstrated a higher OLP.
Arterial Pressure ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Glottis ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Intubation ; Laparoscopy ; Laryngeal Masks ; Lung Compliance ; Masks ; Pneumoperitoneum

BACKGROUND: With the popularity of laparoscopic cholecystectomy, common bile duct injury has been reported more frequently. There is no perfect method for repairing porcine biliary segmental defects.METHODS: After the decellularization of human arterial blood vessels, the cells were cultured with GFP⁺ (carry green fluorescent protein) porcine bile duct epithelial cells. The growth and proliferation of porcine bile duct epithelial cells on the human acellular arterial matrix (HAAM) were observed by hematoxylin-eosin (HE) staining, electron microscopy, and immunofluorescence. Then, the recellularized human acellular arterial matrix (RHAAM) was used to repair biliary segmental defects in the pig. The feasibility of it was detected by magnetic resonance cholangiopancreatography, liver function and blood routine changes, HE staining, immunofluorescence, real-time quantitative PCR (RT-qPCR), and western blot.RESULTS: After 4 weeks (w) of co-culture of HAAM and GFP? porcine bile duct epithelial cells, GFP⁺ porcine bile duct epithelial cells grew stably, proliferated, and fused on HAAM. Bile was successfully drained into the duodenum without bile leakage or biliary obstruction. Immunofluorescence detection showed that GFP-positive bile duct cells could still be detected after GFP-containing bile duct cells were implanted into the acellular arterial matrix for 8 w. The implanted bile duct cells can successfully resist bile invasion and protect the acellular arterial matrix until the newborn bile duct is formed.CONCLUSION: The RHAAM can be used to repair biliary segmental defects in pigs, which provides a new idea for the clinical treatment of common bile duct injury.
Bile ; Bile Ducts ; Blood Vessels ; Blotting, Western ; Cholangiopancreatography, Magnetic Resonance ; Cholecystectomy, Laparoscopic ; Coculture Techniques ; Common Bile Duct ; Duodenum ; Epithelial Cells ; Fluorescent Antibody Technique ; Humans ; Infant, Newborn ; Liver ; Methods ; Microscopy, Electron ; Polymerase Chain Reaction ; Swine ; Tissue Engineering