Choosing the cosmetically superior laparoscopic access to the abdomen: the importance of the umbilicus

Background: Single-incision laparoscopy (SIL) is a rapidly growing procedure in the field of surgery. The most frequent site of abdominal access is the umbilicus. Its appearance can be altered during SIL procedures. The literature suggests that the umbilicus plays an important role in the overall physical appearance of patients. This study therefore investigated the perception of the general population regarding the cosmetics of the umbilicus. Methods: An online survey with 10 questions about the aesthetic importance of the umbilicus was circulated worldwide in both the English and French languages. All the answers then were gathered and analyzed. Results: The majority of the participants considered both their umbilicus and that of their partner as "unimportant.” The total loss of their umbilicus and any undesired changes in its size, shape, and skin color were considered disturbing by most participants, but not its depth. In this survey, 39% of the women and 29% of the men agreed on a negative impact of an undesired change in their umbilicus, whereas 19% of the women and 36% of the men agreed on a negative impact of such a change in the umbilicus of their partner. The majority of the participants did not consider the umbilicus as playing a major role in sexual attractiveness. Conclusions: The majority of the participants gave a limited cosmetic role to the umbilicus and would therefore be good candidates for an umbilical surgical access. Among the minority of participants who considered the umbilicus to be cosmetically important, the men tended to be more concerned about the aesthetic aspect of their partner's umbilicus, and a one-third of them agreed on its role in sexual appeal. Although not the majority, a significant proportion of participants were sensitive about the aspect of their umbilicus. Special care should be given to identify this population and choose the appropriate minimally invasive acces

Reducing Cost of Surgery by Avoiding Complications: the Model of Robotic Roux-en-Y Gastric Bypass

Background: Robotic surgery is a complex technology offering technical advantages over conventional methods. Still, clinical outcomes and financial issues have been subjects of debate. Several studies have demonstrated higher costs for robotic surgery when compared to laparoscopy or open surgery. However, other studies showed fewer costly anastomotic complications after robotic Roux-en-Y gastric bypass (RYGBP) when compared to laparoscopy. Methods: We collected data for our gastric bypass patients who underwent open, laparoscopic, or robotic surgery from June 1997 to July 2010. Demographic data, BMI, complications, mortality, intensive care unit stay, hospitalization, and operating room (OR) costs were analyzed and a cost projection completed. Sensitivity analyses were performed for varied leak rates during laparoscopy, number of robotic cases per month, number of additional staplers during robotic surgery, and varied OR times for robotic cases. Results: Nine-hundred ninety patients underwent gastric bypass surgery at the University Hospital Geneva from June 1997 to July 2010. There were 524 open, 323 laparoscopic, and 143 robotic cases. Significantly fewer anastomotic complications occurred after open and robotic RYGBP when compared to laparoscopy. OR material costs were slightly less for robotic surgery (USD 5,427) than for laparoscopy (USD 5,494), but more than for the open procedure (USD 2,251). Overall, robotic gastric bypass (USD 19,363) was cheaper when compared to laparoscopy (USD 21,697) and open surgery (USD 23,000). Conclusions: Robotic RYGBP can be cost effective due to balancing greater robotic overhead costs with the savings associated with avoiding stapler use and costly anastomotic complication

Guide to Interpreting the Spring 2008 MCAS Reports for Schools and Districts

The role of intraoperative cholangiogram (IOC) during cholecystectomy is debated. The aim of the present study was to evaluate the feasibility, benefit and risk of performing systematic IOC in patients undergoing cholecystectomy for acute gallstone-related disease

Patients’ related sexual outcomes in colorectal surgery

BackgroundPatients undergoing colorectal surgery (CRS) have an increased risk of developing sexual disorders, attributed to different mechanisms. In this context, sexual function (SF) assessment of patients before and after surgery is essential: to identify risk factors for sexual disorders as well as to minimize their impact on overall quality of life (QoL), allowing them a satisfying relationship and sexual life.Material and methodsPatients over 18 years of age who underwent a CRS in the University Hospital of Geneva, Switzerland, between June 2014 and February 2016 were included. Our main objective was to compare and analyze the evolution of SF, QoL, and marital satisfaction (MS) before and after CRS. Specific and standardized tests were used.ResultsA cohort of 72 patients with a median age of 58.73 was analyzed. The majority of CRS was elective (91.5%). A percentage of 52.8% of patients underwent surgery for oncological reasons. There was no statistical difference in SF, sexual QoL, and MS before and after elective or emergency CRS for men. Interestingly, a significant decrease in women’s SF (FSFI) as well as their satisfaction within their couple (Locke–Wallace) until 12 months after surgery was found (p = 0.021). However, they showed a steady SF (GRISS) within their couple until 12 months after surgery.ConclusionRegarding knowledge about difficulties to talk about this intimate topic and gender differences, this general overview raises the question of the necessity to introduce in a long-course follow-up different methods of sexual health assessment with specific stakeholders

Global benchmarks in primary robotic bariatric surgery redefine quality standards for Roux-en-Y gastric bypass and sleeve gastrectomy

BACKGROUND Whether the benefits of the robotic platform in bariatric surgery translate into superior surgical outcomes remains unclear. The aim of this retrospective study was to establish the 'best possible' outcomes for robotic bariatric surgery and compare them with the established laparoscopic benchmarks. METHODS Benchmark cut-offs were established for consecutive primary robotic bariatric surgery patients of 17 centres across four continents (13 expert centres and 4 learning phase centres) using the 75th percentile of the median outcome values until 90 days after surgery. The benchmark patients had no previous laparotomy, diabetes, sleep apnoea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, history of thromboembolic events, BMI greater than 50 kg/m2, or age greater than 65 years. RESULTS A total of 9097 patients were included, who were mainly female (75.5%) and who had a mean(s.d.) age of 44.7(11.5) years and a mean(s.d.) baseline BMI of 44.6(7.7) kg/m2. In expert centres, 13.74% of the 3020 patients who underwent primary robotic Roux-en-Y gastric bypass and 5.9% of the 4078 patients who underwent primary robotic sleeve gastrectomy presented with greater than or equal to one complication within 90 postoperative days. No patient died and 1.1% of patients had adverse events related to the robotic platform. When compared with laparoscopic benchmarks, robotic Roux-en-Y gastric bypass had lower benchmark cut-offs for hospital stay, postoperative bleeding, and marginal ulceration, but the duration of the operation was 42 min longer. For most surgical outcomes, robotic sleeve gastrectomy outperformed laparoscopic sleeve gastrectomy with a comparable duration of the operation. In robotic learning phase centres, outcomes were within the established benchmarks only for low-risk robotic Roux-en-Y gastric bypass. CONCLUSION The newly established benchmarks suggest that robotic bariatric surgery may enhance surgical safety compared with laparoscopic bariatric surgery; however, the duration of the operation for robotic Roux-en-Y gastric bypass is longer

Temps d'installation et d'amarrage du système chirurgical da Vinci® : analyse prospective des données préliminaires

L'installation et l'amarrage du système chirurgical da Vinci sont considérés comme chronophages. L'hypothèse de ce travail était que ces tâches pouvaient être réalisées en un temps acceptable. Une étude prospective a donc été menée dans ce but et les temps d'installation et d'amarrage de toutes les procédures chirurgicales menées avec le système da Vinci ® dans le service de chirurgie viscérale des Hôpitaux Universitaires de Genève ont été analysés prospectivement entre 2006 et 2008. En 30 mois, 96 interventions chirurgicales ont été réalisées avec le système da Vinci ®. Les temps médians d'installation et d'amarrage furent de 22 et 10 minutes respectivement. Les chirurgiens avec expérience préalable furent significativement plus rapides dans leurs amarrages que les chirurgiens inexpérimentés (temps médian de 8 versus 17.5 minutes respectivement). Ces données indiquent que l'installation et l'amarrage peuvent être réalisés en des temps adéquats, avec un impact faible sur les temps opératoires

The advent of minimally invasive approaches in bariatric surgery: an example of surgical revolution

Introduction: Bariatric surgery is currently the only validated treatment option for obesity that provides significant and long-term weight loss. Even though initially performed with open techniques, the vast majority of bariatric procedures are nowadays performed using minimally invasive surgery (MIS). The objective of the present systematic review was to compare postoperative outcomes after open and MIS bariatric procedures. Methods: A systematic search of MEDLINE, EMBASE, PUBMED, Web of Science and Cochrane databases was performed to identify studies comparing open and MIS bariatric surgery among adult patients. The primary outcome was the rate of 30-day postoperative complications. Secondary outcomes included operative times, conversion to open surgery, length of hospital stay (LOS), readmissions and reoperations. Results: A total of 35 studies were included, reporting on 82’843 participants who underwent open and 152’398 participants who underwent MIS bariatric surgery. The overall early postoperative complication rate was 21.9% (18’175/82’843) in the open group and 18.2% (27’767/152’398) in the MIS group (p&lt;0.0001). The rate of early severe complications was 2.4% in the open group and 1.1% in the MIS group (OR 2.17, 95% CI 1.61-2.91, p&lt;0.0001). Rates of individual postoperative complications were all lower among MIS patients in the pooled and subgroup analyses, except for a comparable rate of hemorrhagic complications. Participants who underwent open surgery had higher mortality, reoperation and readmission rates and a longer LOS. Conclusion: Postoperative outcomes were significantly better after MIS compared to open bariatric surgery. These findings support the use of MIS as the gold-standard for bariatric procedures.</p