Humans ; Laparoscopy/education* ; Female ; Gynecologic Surgical Procedures/education* ; Consensus ; Genital Diseases, Female/surgery* ; China ; Robotic Surgical Procedures/methods*

PURPOSE: This study was aimed at reporting our experience with single-incision laparoscopic appendectomies (SILA) performed by a surgical resident, and to evaluate the safety and feasibility of the procedure, together with a comparison of the outcomes of the same procedure performed by a staff surgeon. METHODS: We conducted a retrospective case series analysis of 60 consecutive patients who underwent SILA. Two surgeons, an attending staff surgeon and a second-year surgical resident, performed the SILA procedures. SILA procedures performed by the resident were intraoperatively guided and supervised by the staff surgeon. RESULTS: A total of 60 case-matched patients with acute appendicitis underwent a SILA performed by either the resident or attending staff. There was no difference in patient demographics between the two groups of patients. The mean operation time was longer in the resident group than in the staff group (43.2±6.0 minutes vs. 32.9±10.5 minutes, p<0.001). There was no significant difference in the operative data between the two groups. No conversion to an open procedure occurred in either group. Postoperative pain, time to onset of oral intake, and number of days of postoperative hospital stay were similar in both groups. CONCLUSION: SILA procedures performed by a resident are safe and feasible despite longer operation times. Perioperative supervision and guidance by an attending staff surgeon may facilitate surgical outcomes.
Appendectomy ; Appendicitis ; Conversion to Open Surgery ; Demography ; Education ; Humans ; Laparoscopy ; Length of Stay ; Organization and Administration ; Pain, Postoperative ; Retrospective Studies ; Surgeons

There are vast land and lots of people in western China, but the economy developing is relatively slow. However, the minimally invasive surgery was carried out firstly in China. Moreover, the type, number and difficulty of the minimally invasive surgery increased year by year. Especially, in the western area of China, Dr Zhou Zongguang, Yu Peiwu and Zheng Shuguo et al. have performed much pioneering work in laparoscopic surgery for rectal cancer, gastric cancer and laparoscopic liver resection. They led the standard development of minimally invasive in China. In the future, western China should continue to strengthen the standardized training of minimally invasive surgery, make great effort to carry out evidence-based research of minimally invasive surgery, provide evidences of high level of clinical application in minimally invasive surgery. At the same time, we should carry out the robotic and 3D laparoscopic surgery actively, leading the development of minimally invasive surgery more standardized and more widespread in western China.
China ; Digestive System Surgical Procedures ; methods ; trends ; Evidence-Based Medicine ; Hepatectomy ; methods ; Humans ; Laparoscopy ; methods ; Minimally Invasive Surgical Procedures ; education ; methods ; standards ; trends ; Rectal Neoplasms ; surgery ; Robotic Surgical Procedures ; Stomach Neoplasms ; surgery

With the development of laparoscopic techniques and equipments, laparoscopic-assisted, even total laparoscopic radical surgery for gastric cancer can be performed successfully. However, the incidence of postoperative complications is higher in the laparoscopy group as compared to the open-surgery group, which is still the barrier for the total laparoscopic radical gastrectomy. Similar to open surgery, the major complications of digestive tract reconstruction after laparoscopic radical gastrectomy are anastomotic leakage, anastomotic bleeding, anastomotic stricture and stenosis of input or output loop. Moreover, due to the lack of tactile feedback and a narrow field of vision, the laparoscopic operation may be associated with complications due to technical reasons. In clinic, we tried to reduce the incidence of these complications by improving surgical skills and strengthening the perioperative treatment of patients. According to our experience, the complications mainly occur in the early stage, and with the cumulative experience, the complications can be effectively reduced.
Anastomotic Leak ; prevention & control ; therapy ; Constriction, Pathologic ; prevention & control ; therapy ; Education, Medical, Continuing ; Gastrectomy ; adverse effects ; methods ; Gastrointestinal Hemorrhage ; prevention & control ; therapy ; Humans ; Laparoscopy ; adverse effects ; Perioperative Care ; Postoperative Complications ; prevention & control ; therapy ; Postoperative Hemorrhage ; prevention & control ; therapy ; Reconstructive Surgical Procedures ; adverse effects ; Stomach Neoplasms ; surgery

This study was conducted to evaluate the feasibility and therapeutic safety of laparoendoscopic single-site ovariectomy (LESS-OVE) and 3-portal laparoscopic ovariectomy (Lap-OVE) in dogs. Ten female mixed breed dogs were included in the study. Dogs were divided into group 1 (LESS-OVE; n = 5) and group 2 (Lap-OVE; n = 5). All procedures were performed by laparoscopic-skilled surgeons, and the anesthetic protocol was the same for all patients. In both groups, the ovarian vascular pedicle and ligaments were transected using a bipolar vessel sealer/divider device. The mean total surgical time was slightly longer in LESS-OVE (36.6 +/- 3.5 min) than Lap-OVE (32.0 +/- 3.0 min); however, the differences were not significant. Perioperative complications were not reported in any group. Both laparoscopic techniques were shown to be equally feasible and safe for patients. However, surgeons found LESS-OVE to require more skill than Lap-OVE. Therefore, additional studies should be conducted to evaluate this novel approach in clinical veterinary practice, and a proper laparoscopic training program for veterinary surgeons should be developed.
Animals ; Dogs* ; Education ; Female ; Humans ; Laparoscopy ; Ligaments ; Operative Time ; Ovariectomy* ; Surgical Procedures, Minimally Invasive

The da Vinci S surgical system (Intuitive Surgical) was approved as a medical device in 2009 by the Japanese Ministry of Health, Labour and Welfare. Robotic surgery has since been used in gastrointestinal, thoracic, gynecological, and urological surgeries. In April 2012, robotic-assisted laparoscopic radical prostatectomy (RALP) was first approved for insurance coverage. Since then, RALP has been increasingly used, with more than 3,000 RALP procedures performed by March 2013. By July 2014, 183 institutions in Japan had installed the da Vinci surgical system. Other types of robotic surgeries are not widespread because they are not covered by public health insurance. Clinical trials using robotic partial nephrectomy and robotic gastrectomy for renal and gastric cancers, respectively, have recently begun as advanced medical treatments to evaluate health insurance coverage. These procedures must be evaluated for efficacy and safety before being covered by public health insurance. Other types of robotic surgery are being evaluated in clinical studies. There are several challenges in robotic surgery, including accreditation, training, efficacy, and cost. The largest issue is the cost-benefit balance. In this review, the current situation and a prospective view of robotic surgery in Japan are discussed.
Cost-Benefit Analysis ; Esophageal Neoplasms/surgery ; Gastrectomy/*methods ; Gynecologic Surgical Procedures/methods ; Humans ; Japan ; Laparoscopy/*methods ; Nephrectomy/*methods ; Otolaryngology/methods ; Prospective Studies ; Prostatectomy/*methods ; Rectal Neoplasms/surgery ; Robotic Surgical Procedures/education/*trends ; Stomach Neoplasms/surgery ; Thymectomy/methods ; Thyroid Diseases/surgery

PURPOSE: The purpose of this study was to identify the effects of the patient controlled analgesics (PCA) education program (including practicum) on post-op pain suffered by patients who have undergone gynecologic laparoscopic surgery. METHODS: The research was designed for a nonequivalent control group before and after the test design. The subjects of this study were 54 in all and were divided into an experimental group and a control group. The program consisted of a brochure for PCA use and a practicum with an actual PCA instrument. Data were collected with questionnaires and observations and were analyzed on the basis of frequency, percentage, mean, standard deviation, chi2 and t-test. RESULTS: Complaints regarding pain by the experimental group were significantly less than those of the control group in both post-op 24-hour and post-op 48-hour reporting. The experimental group pressed the PCA button much less frequently than the control group in post-op 24 hours. However, there were no significant differences in side effects between the two groups. CONCLUSION: Based on the results of this study, this PCA education program can be useful in the clinical nursing field and helpful for patients who use PCA.
Analgesia, Patient-Controlled ; Analgesics ; Education* ; Humans ; Laparoscopy* ; Nursing ; Pamphlets ; Passive Cutaneous Anaphylaxis*

OBJECTIVETo introduce a training model for laparoscopic dismembered pyeloplasty.

METHODSThe model of ureteropelvic junction obstruction was simulated using pig kidney and chicken crop. With the model placed in a training box, 8 residents without laparoscopic experience but with basic technical training performed 10 rounds of anastomosis according to the standard operation procedures. For each resident, the operating time and quality of the operation were recorded and assessed.

RESULTSAll the 8 residents successfully completed the training. The operating time decreased from 72.70∓8.26 min in the first training session to 54.50∓7.69 min in the last training session, and the anastomosis error score decreased from 5.60∓1.35 to 2.50∓1.58 min, showing significant differences between the recordings (P<0.05).

CONCLUSIONThis simple training model allows effective simulation of the surgical procedures of laparoscopic pyeloplasty and is suitable for training surgeons without laparoscopic experiences.

Animals ; Chickens ; Crop, Avian ; surgery ; Kidney Pelvis ; surgery ; Laparoscopy ; methods ; Models, Animal ; Reconstructive Surgical Procedures ; education ; Suture Techniques ; education ; Urologic Surgical Procedures ; education

Laparoscopic surgery has become popular in the past few decades, owing to less postoperative pain, fast recovery, and better cosmetic outcomes. The laparoscopic approach has been employed in pediatric surgery for the same reasons. After the first attempts of single incision laparoscopic appendectomy in pediatrics in 1998, single incision laparoscopic surgery (SILS) has recently been proven to be safe and feasible for the pediatric population. However, limitations have been reported for SILS, such as the wide learning curve, compared to standard laparoscopic surgery, and the restricted number of hospitals with surgical training programs including SILS. In this study, we intend to present our initial experiences with SILS in children, and to describe the technique, instruments used, and outcomes. This is a retrospective study of 71 pediatric patients who underwent SILS, at a tertiary medical center, between September, 2012 and August, 2013. Electronic medical records were reviewed for demographics, type of procedure, operation time, use of additional ports, conversion to open surgery, complications and hospital stay. Additional ports were inserted in 4 cases, for the purpose of traction. Postoperative complications were noted in 13 cases, which were mostly related to wound inflammation or formation of granulation tissue. According to our analyses, patients with complications had significantly longer use and more frequent use of pain killers. Notwithstanding the small sample size, many of the procedures performed in pediatric patients seem to be possible with SILS.
Appendectomy ; Child ; Conversion to Open Surgery ; Demography ; Education ; Electronic Health Records ; Granulation Tissue ; Humans ; Inflammation ; Laparoscopy* ; Learning Curve ; Length of Stay ; Pain, Postoperative ; Pediatrics* ; Postoperative Complications ; Retrospective Studies ; Sample Size ; Traction ; Wounds and Injuries

BACKGROUNDLaparoscopic splenectomy (LS) for massive splenomegaly is more technically challenging than for a normal-sized spleen. The purpose of this study was to determine the effect of operative experience on perioperative outcomes of LS for massive splenomegaly.

METHODSBetween January 2008 and December 2010, 36 consecutive patients who were diagnosed with massive splenomegaly underwent LS in our department. The perioperative outcomes were evaluated for evidence of a learning curve effect. Patients were divided into three groups (1, 2, and 3) of 12 consecutive patients, and outcomes of each group were compared.

RESULTSThe mean operative time decreased significantly from 252 minutes of Group 1 to 179 minutes of Group 3. The estimated blood loss and length of post-operative hospital stay showed a similar trend. No significant differences were found in the splenic length and weight, transfusion rate, or average amount of drainage. In this cohort, there were three cases with surgical complications and one conversion to open laparotomy.

CONCLUSIONSThe first 24 cases constitute the early stage of the learning curve for LS for massive splenomegaly. LS for massive splenomegaly is a technically challenging operation with a long learning curve, and strategies for developing training programs must address these challenges.

Adult ; Female ; Humans ; Laparoscopy ; education ; Learning Curve ; Male ; Middle Aged ; Operative Time ; Retrospective Studies ; Splenectomy ; adverse effects ; education ; Splenomegaly ; surgery