Comparative Analysis of Laparoscopic Gastrectomy Versus Laparoscopic-Assisted Gastrectomy : Postoperative Complications

The evolution of laparoscopic surgery in gastric cancer has advanced significantly, with benefits over open surgery initially demonstrated in early gastric cancer and later in advanced stages. This study aims to evaluate postoperative complications, surgical outcomes, and anastomosis safety by comparing laparoscopic gastrectomy and laparoscopic-assisted gastrectomy. This retrospective, observational, analytical study included patients diagnosed with gastric cancer who underwent laparoscopic gastrectomy at a university hospital from January 2006 to February 2018. Patients were initially divided into two groups based on the type of anastomosis: laparoscopic gastrectomy (intracorporeal anastomosis) and laparoscopic-assisted gastrectomy (extracorporeal anastomosis). Further secondary analysis was done with subgroups based on the type of gastrectomy and anastomosis performed. A total of 139 patients were analyzed, showing significant differences in postoperative complications between the two surgical approaches. The laparoscopic-assisted group exhibited a higher rate of complications. The laparoscopic approach (with intracorporeal anastomosis) was found to have a lower risk of complications and morbidity/mortality compared to the laparoscopic-assisted approach. Laparoscopic gastrectomy with intracorporeal anastomosis resulted in lower morbidity and mortality than laparoscopic-assisted gastrectomy. The technique of partial gastrectomy with intracorporeal anastomosis was associated with the lowest rate of postoperative complications

Surgical challenges and research priorities in the era of the COVID-19 pandemic: EAES membership survey

Background: Healthcare systems and general surgeons are being challenged by the current pandemic. The European Association for Endoscopic Surgery (EAES) aimed to evaluate surgeons’ experiences and perspectives, to identify gaps in knowledge, to record shortcomings in resources and to register research priorities. Methods: An ad hoc web-based survey of EAES members and affiliates was developed by the EAES Research Committee. The questionnaire consisted of 69 items divided into the following sections: (Ι) demographics, (II) institutional burdens and management strategies, and (III) analysis of resource, knowledge, and evidence gaps. Descriptive statistics were summarized as frequencies, medians, ranges, and interquartile ranges, as appropriate. Results: The survey took place between March 25th and April 16th with a total of 550 surgeons from 79 countries. Eighty-one percent had to postpone elective cases or suspend their practice and 35% assumed roles not related to their primary expertise. One-fourth of respondents reported having encountered abdominal pathologies in COVID-19-positive patients, most frequently acute appendicitis (47% of respondents). The effect of protective measures in surgical or endoscopic procedures on infected patients, the effect of endoscopic surgery on infected patients, and the infectivity of positive patients undergoing laparoscopic surgery were prioritized as knowledge gaps and research priorities. Conclusions: Perspectives and priorities of EAES members in the era of the pandemic are hereto summarized. Research evidence is urgently needed to effectively respond to challenges arisen from the pandemic

EAES Recommendations for Recovery Plan in Minimally Invasive Surgery Amid COVID-19 Pandemic

Background: COVID-19 pandemic presented an unexpected challenge for the surgical community in general and Minimally Invasive Surgery (MIS) specialists in particular. This document aims to summarize recent evidence and experts’ opinion and formulate recommendations to guide the surgical community on how to best organize the recovery plan for surgical activity across different sub-specialities after the COVID-19 pandemic. Methods: Recommendations were developed through a Delphi process for establishment of expert consensus. Domain topics were formulated and subsequently subdivided into questions pertinent to different surgical specialities following the COVID-19 crisis. Sixty-five experts from 24 countries, representing the entire EAES board, were invited. Fifty clinicians and six engineers accepted the invitation and drafted statements based on specific key questions. Anonymous voting on the statements was performed until consensus was achieved, defined by at least 70% agreement. Results: A total of 92 consensus statements were formulated with regard to safe resumption of surgery across eight domains, addressing general surgery, upper GI, lower GI, bariatrics, endocrine, HPB, abdominal wall and technology/research. The statements addressed elective and emergency services across all subspecialties with specific attention to the role of MIS during the recovery plan. Eighty-four of the statements were approved during the first round of Delphi voting (91.3%) and another 8 during the following round after substantial modification, resulting in a 100% consensus. Conclusion: The recommendations formulated by the EAES board establish a framework for resumption of surgery following COVID-19 pandemic with particular focus on the role of MIS across surgical specialities. The statements have the potential for wide application in the clinical setting, education activities and research work across different healthcare systems