Standardized laparoscopic intracorporeal right colectomy for cancer: short-term outcome in 111 unselected patients.

PURPOSE: This study was designed to evaluate the impact of a standardized laparoscopic intracorporeal right colectomy on the short-term outcome of patients with neoplasia. METHODS: Consecutive patients with histologically proven right colon neoplasia underwent a standardized laparoscopic intracorporeal right colectomy with medial to lateral approach encompassing ten sequential steps: 1) ligation of ileocolic vessels, 2) identification of right ureter, 3) dissection along superior mesenteric vein, 4) division of omentum, 5) division of right branch of middle colic vessels, 6) transection of transverse colon, 7) mobilization of right colon, 8) transection of terminal ileum, 9) ileocolic anastomosis, 10) delivery of specimen. Values were medians (ranges). RESULTS: From July 2002 to June 2005, 111 laparoscopic intracorporeal right colectomies were attempted with a 5.4 percent conversion rate. There were 57 women and 54 men, aged 64.9 (range, 40-85) years, with body mass index of 33 (range, 20-43), American Society of Anesthesiology score of 2 (range, 2-4), 36.9 percent comorbidities, and 37.8 percent previous abdominal surgery. The indication for surgery was cancer in 109 patients. Operative time was 120 (range, 80-185) minutes. Estimated blood loss was 69 (range, 50-600) ml. Overall length of skin incisions was 66 (range, 60-66) mm; 29 (range, 2-41) lymph nodes were harvested. Length of stay was four (range, 2-30) days. Complication rate was 4.5 percent. CONCLUSIONS: A standardized laparoscopic intracorporeal right colectomy resulted in a favorable short-term outcome in unselected patients with neoplasia of the right colon

Complication rates after Hartmann\u27s reversal: open vs. laparoscopic approach.

PURPOSE: This study was performed to compare open Hartmann\u27s reversal to laparoscopic Hartmann\u27s reversal with regard to complication, readmission, and reoperation rates. METHODS: Data of patients who underwent open Hartmann\u27s reversal or laparoscopic Hartmann\u27s reversal between 1998 and 2004 at two institutions were collected. End points were complications in the hospital or after discharge, readmission to the hospital, and reoperation within 6 months after initial surgery. RESULTS: Sixty-one open Hartmann\u27s reversal and 61 laparoscopic Hartmann\u27s reversal patients were well matched except for American Society of Anesthesiology grade (1.9 vs. 1.6; P = 0.008), timing of Hartmann\u27s procedure (14 vs. 6 months; P = 0.001), operation time (210 vs. 154 minutes; P = 0.001), and estimated blood loss (363 vs. 254 ml; P = 0.01). Thirty-day complication rates did not differ (18 vs. 13 percent). At 6 month follow-up, open Hartmann\u27s reversal patients had increased complication (16.4 vs. 3.3 percent; P = 0.015) and reoperation (13.1 vs. 3.3 percent; P = 0.048) rates but the same readmission rates (16.4 percent). CONCLUSIONS: Compared with open Hartmann\u27s reversal, 6 month complication and reoperation rates were lower in laparoscopic Hartmann\u27s reversal patients. Most of the six-month complications and reoperations in open Hartmann\u27s reversal were abdominal wall-related. Readmission rates were similar, but reasons for readmission were surgical in open Hartmann\u27s reversal and medical in laparoscopic Hartmann\u27s reversal

Laparoscopic Intracorporeal Ileocolic Resection for Crohn\u27s Disease: Is It Safe?

PURPOSE: The aim of this study was to assess the impact of laparoscopic ileocolic resection with intracorporeal vascular division and anastomosis on the outcome of patients with terminal ileal Crohn\u27s disease. METHODS: Prospective data on patients undergoing laparoscopic ileocolic resection for Crohn\u27s disease confined to terminal ileum and cecum with or without fistulas were reviewed. Exclusion criteria were frozen abdomen, recurrent Crohn\u27s disease following resection, and perforated Crohn\u27s disease. Laparoscopic ileocolic resection involved a lateral-to-medial approach encompassing ten sequential steps. Values were medians (range). RESULTS: From January 1992 to June 2006, 80 laparoscopic ileocolic resections were attempted with a 1.2 percent conversion rate. Sixty-two women and 18 men, age 40 (19-55) years, had a body mass index of 26 (18-37) and an American Society of Anesthesiologists\u27 score of 1 (1-3), and 23.7 percent had previously undergone abdominal surgery. Operating time was 155 (130-210) minutes. Estimated blood loss was 250 (50-600) ml. Length of the skin incision at the specimen extraction site was 35 (30-44) mm. The complication/reoperation rate was 7.5 percent. The readmission rate was 3.7 percent. Except for smoking (P \u3c 0.005), there were no significant differences between patients with and those without complications. The recurrence rate was 30 percent (24 of 80). The median time to recurrence was 64 months. CONCLUSION: Laparoscopic ileocolic resection with intracorporeal vascular division and anastomosis resulted in a favorable outcome in selected patients with refractory terminal ileal Crohn\u27s disease

Robotic camera holder as good as expert camera holder: a randomized crossover trial.

INTRODUCTION: This study aimed to compare the impact of robotic camera holder (RCH) and human camera holder (HCH) on product quality and procedure effectiveness of a simulated laparoscopic procedure. METHODS: This was a prospective randomized crossover trial including voluntary surgical residents. Block randomization generated RCH-HCH or HCH-RCH sequence allocation. The task was suturing a duodenal perforation on foam stomach with intracorporeally knot tying in a simulator. The camera was operated by the same robot and same expert. Product quality was measured by accuracy error, tissue damage, sliding knot, and leak. Procedure effectiveness was measured by operating time, nongoal directed actions, and dangerous actions. Kendall\u27s coefficient tau_b was used for interrater reliability between 2 blinded assessors. RESULTS: Forty-four subjects performed their tasks as allocated. Product quality and procedure effectiveness were similar when first attempt of task was compared with the repeat task by same subject ignoring the type of camera holder. There was no evidence of significant unequal carryover effect when comparison was stratified by RCH-HCH or HCH-RCH sequences. There were no differences in product quality and procedure effectiveness when RCH was compared with HCH. Coefficient tau_b was \u3e or = 0.80 for all but dangerous actions (0.72, P=0.08). CONCLUSIONS: RCH and HCH had similar impact on product quality and procedure effectiveness of simulated laparoscopic procedure

Development of a total colonoscopy rat model with endoscopic submucosal injection of the cecal wall.

BACKGROUND: Experimental models of colorectal tumor require either laparotomy for induction or anastomosis following resection. The long murine cecum avoids the need for an anastomosis, making the cecum the preferred site for induction. This study aimed to evaluate total colonoscopy with submucosal injection of cecal wall (TCWI) in rats in terms of failure rate (FR), complication rate (CR), and reproducibility (R). METHODS: A bolus of bowel prep was given. Anesthesia was injected intraperitoneally. A video fiberscope (5.9 mm outer diameter, 180/90 degrees up/down bending, 100/100 degrees right/left bending, 103 cm working length, 120 degrees view field, and 2.0 mm channel) allowed for irrigation and suction. Saline 1 ml was injected in the cecal wall through a 4-mm-long, 23-gauge needle placed on a 3-mm wire, resulting in a blister. FR was a failure to reach and inject the cecum. Rats were allowed to recover. CR was measured at necropsy. R was assessed by comparing TCWI time, FR, and CR for three investigators. Sample size of 120 (type I error, 0.05; power, 80%) was based on a pilot study. Data are presented as median (range). RESULTS: A total of two of 122 rats (1.6%) died after prep or anesthesia. Bowel prep resulted in 99.1% evacuation of solid feces. A total of 120 male Sprague-Dawley retired breeders weighing 592 g (range, 349-780) underwent TCWI. Scope depth was 28 cm (range, 20-36). Irrigating fluid was 290 ml (range, 100-600). TCWI time was 7 min (range, 4-28). FR was 4%. In three failed cases, the scope reached the ascending colon. CR was 2%. There were two perforations in the ascending colon. All three operators had similar TCWI time (p = 0.673), FR (p \u3e 0.1), and CR (p \u3e 0.1). A total of 98.3% of rats survived to planned sacrifice. At 48-h necropsy, the injection site was macroscopically identified in 118 rats. CONCLUSIONS: A safe and reproducible TCWI rat model has been achieved, which may provide a valuable tool in the future for studies of solid colorectal tumors

Synthesis of science: findings on Canadian Prairie wetland drainage

This is an Accepted Manuscript of an article published by Taylor & Francis in Canadian Water Resources Journal on 13 Oct 2021, available at: https://doi.org/10.1080/07011784.2021.1973911.Canada First Research Excellence Fund, via Global Water Futures and the research program Prairie Water (grant no. 418474), Canada Research Chairs and Canada Excellence Research Chairs programs, and the University of Saskatchewan through a Centennial Enhancement Chair to HMBPeer ReviewedExtensive wetland drainage has occurred across the Canadian Prairies, and drainage activities are ongoing in many areas (Prairie Habitat Joint Venture 2014; Dahl 1990; Watmough and Schmoll 2007; Bartzen et al. 2010; Dahl 2014; Dumanski et al. 2015; Waz and Creed 2017). In 2017 the Global Water Futures program funded the Prairie Water project, with the broad goal of helping to foster improved water security in the region (Spence et al. 2018). Throughout the duration of this project, it has been clear that a diverse group of stakeholders (including river basin organizations, government agencies, and landowners) is seeking the same information — a synthesis of what is known and not known about the effects of wetland drainage. This synthesis of the state of the science on wetland drainage in the Canadian Prairies is aimed at assembling current knowledge based on western scientific methods to articulate what is known about the variability of drainage effects across the region. Traditional knowledge, which represents a different but complementary way of knowing the functioning of prairie watersheds (sometimes also termed catchments, or basins), and the processes driving change within them, is not discussed here. Instead, this synthesis is presented in the spirit of building such collaborations. It summarizes current western scientific knowledge on surface hydrology, groundwater interactions, nutrient export, biodiversity, carbon storage and greenhouse gas dynamics, and wetland conservation socioeconomics. The implications to water security now and in the future are also discussed