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  • 1
    Electronic Resource
    Electronic Resource
    Splenic artery embolization before laparoscopic splenectomy (1998)
    Springer
    Surgical endoscopy and other interventional techniques 12 (1998), S. 870-875 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Laparoscopic surgery, Splenectomy — Embolization — Laparoscopy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: This study assessed preoperative splenic artery embolization before laparoscopic splenectomy. Methods: Preoperative splenic artery embolization was used in 26 of 54 patients (48%) undergoing laparoscopic splenectomy. Between 1992 and 1994, this procedure was used in all patients with spleens shorter than 20 cm (group I), except the first two (18/20). An anterior surgical approach was used. After 1994 (group II), embolization was not used for these patients (0/26), and a lateral surgical approach was used. Throughout the study period, all patients with spleens longer than 20 cm had embolization (8/8). Results: Five complications occurred, three related to the use of small-particle embolic material (microspheres, gelatin foam powder). In group I, the conversion rate was lower than that of most current series, largely because of embolization. In group II, similar results were obtained because of experience and a better surgical approach (i.e., lateral). Conclusions: Preoperative splenic artery embolization is not necessary for spleens shorter than 20 cm. Increased experience and mostly the lateral surgical approach have permitted a shorter operation and a low conversion rate (4%) similar to the rate achieved with embolization and the anterior approach in the initial stages of the study. Embolization is used for 20- to 30-cm spleens. The conversion rate is higher (17%), and blood replacement is required frequently (83%). Despite embolization, laparoscopic splenectomy for spleens longer than 30 cm is futile at this time (100% conversion).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649900732
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  • 2
    Electronic Resource
    Electronic Resource
    Laparoscopic sigmoid resection for acute and chronic diverticulitis (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 649-653 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Laparoscopy — Laparoscopic colectomy — Diverticulitis — Colorectal disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Sigmoid diverticulitis is a common benign condition; however, cases of acute and chronic diverticulitis may be difficult for the surgeon to treat. We designed a study to compare the outcomes of patients who undergo laparoscopic resections for sigmoid diverticulitis with those who have similar resections for other indications. Methods: From a prospectively accumulated database of 397 consecutive laparoscopic colorectal procedures performed by three surgeons, we reviewed the outcomes of 178 patients who underwent laparoscopic sigmoid resections with primary anastomosis. Results: Laparoscopic sigmoid colectomies or anterior resections were performed in 22 patients with acute diverticulitis (AD), 70 patients with chronic diverticulitis (CD), and 86 patients with nondiverticular disease (ND). Patients with ND were significantly older than those with AD or CD (67 ± 14 year versus 55 ± 13 year, 55 ± 12 year, p 〈 0.05). Conversion to open surgery was required in three AD patients (14%), three CD patients (4%), and 17 ND patients (20%) (χ2= 8.23, p= 0.016). In cases completed laparoscopically, there was no significant difference in median operative time (AD, 165 min; CD, 150 min; ND, 165 min), proportion of patients with intraoperative complications (AD, one; CD, six; ND, one), or postoperative complications (AD, four; CD, 13; ND, 11). The occurrence of a postoperative complication significantly prolonged median time to full diet (4 days vs 3 days, p 〈 0.001) and discharge (9 days vs 5 days, p 〈 0.001) but not return to normal activity (16 days vs 15 days). Conclusions: In this study, patients who underwent laparoscopic sigmoid colectomies and anterior resections had similar outcomes regardless of diagnosis. This finding substantiates our view that laparoscopic resections for diverticulitis can be performed safely and with the same benefits as resections for other indications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649901066
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  • 3
    Electronic Resource
    Electronic Resource
    Laparoscopic splenectomy for hematologic malignancies (1999)
    Springer
    Surgical endoscopy and other interventional techniques 13 (1999), S. 865-868 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Hematologic malignancy — Hematologic neoplasms — Laparoscopic splenectomy — Laparoscopic surgery — Laparoscopy — Splenectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Patients with hematologic malignancy (HM) tend to have large spleens. The purpose of this study was to compare the outcomes of laparoscopic splenectomy for patients with HM to those with benign disease (BD). Methods: A review was conducted of a prospectively accumulated database of 64 consecutive, unselected laparoscopic splenectomies performed by two surgeons between March 1992 and August 1997. Results: Of 14 patients with HM (7 lymphoma, 6 leukemia, 1 myeloid metaplasia), three required conversion to open splenectomy (21%). In the remaining 11 patients, two had postoperation complications (18%), including one death from sepsis (9%). Of 50 patients with BD (36 idiopathic thrombocytopenic purpura [ITP], 5 spherocytosis, 4 hemolytic anemia, and 5 others), three were converted to open surgery (6%). Complications developed in 5 (11%) of the remaining 47 patients. No deaths occurred. All patients who had spleens larger than 27 cm in diameter required conversion. Patients undergoing laparoscopic splenectomy for HM were older (54 ± 16 years vs. 36 ± 18 years; p= 0.002), had larger spleens (median 17.0 cm vs. 11.0 cm; p 〈 0.001), and had lower preoperation hemoglobin levels (113 ± 30 g/L vs. 132 ± 23 g/L; p= 0.03) than patients with BD. The HM group required longer operation time (239 ± 73 min vs. 180 ± 61 min; p 〈 0.01), but showed no differences with respect to operation blood loss (median, 100 vs. 165 mL), requirement for transfusion (median, 0.0 vs. 0.0 units), and length of hospital stay (median 3.0 vs. 3.0 days). Conclusions: Although patients with HM had larger spleens and required longer operation time for laparoscopic splenectomy, surgical outcomes were equivalent. The laparoscopic approach should be preferred, even for patients with HM. The only limitation appears to be splenic size greater than 27 cm.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004649901121
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  • 4
    Electronic Resource
    Electronic Resource
    Predicting conversion to open surgery in laparoscopic colorectal resections (2000)
    Springer
    Surgical endoscopy and other interventional techniques 14 (2000), S. 1114-1117 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Colorectal surgery — Conversion — Laparoscopic surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Objective: The objective of this study was to develop a simple model for clinical use in predicting the individual risk of conversion to open surgery in patients undergoing laparoscopic colorectal resections. Methods: A multiple logistic regression analysis of 367 laparoscopic colorectal resections completed between 1991 and 1998 was performed. The following 13 factors were considered: patient-specific factors (age, gender, weight levels less than 60 kg 60–90 kg, 90 kg or more), disease-specific factors (Crohn's disease, diverticulitis, malignancy, fistula), and procedure-specific factors (resection of the hepatic flexure, splenic flexure, sigmoid, rectum, perineum, experience with less than 50 cases). A scoring system was developed on the basis of the three factors found to be predictive of the risk for conversion to open surgery: diagnosis of malignancy (odds ratio 3.23; p= 0.0037; one point), surgeon experience with 50 cases or less (odds ratio 2.26; p= 0.0363; one point), and weight level (odds ratio 3.42; p= 0.005; 60 to 90 kg, one point, 90 kg or more, two points). Results: The predicted conversion rates for the cumulative scores of 0 to 4 points were 1.1%, 3.3%, 9.8%, 25.4%, and 49.7%, respectively. No significant difference was found between predicted and actual conversion rates, indicating a good fit of the model (chi square = 1.774; p 〉 0.5). Conclusions: This novel scoring system is simple, accurate, and readily applicable in an office setting. It represents the large experience of one surgical group and remains to be validated by other centers.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004640000309
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  • 5
    Electronic Resource
    Electronic Resource
    Determinants of outcomes in laparoscopic colorectal surgery (2000)
    Springer
    Surgical endoscopy and other interventional techniques 14 (2000), S. 258-263 
    Details
    ISSN: 1432-2218
    Keywords: Key words: Colorectal surgery — Laparoscopic colectomy — Laparoscopy — Outcomes — Regression analysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: To date, most large series of laparoscopic colorectal procedures have been descriptive reports that do not account for the potentially complex interaction of outcome predictors. The purpose of this study was to identify the preoperative factors that predict operative time, conversion to open surgery, and intraoperative and postoperative complications in laparoscopic colorectal surgery. Methods: Multiple regression techniques were used to analyze 416 laparoscopic resections from a prospective database of laparoscopic colorectal procedures performed between April 1991 and April 1998. The preoperative factors considered were patient-specific (age, gender, weight) or disease-specific (diagnosis of cancer, Crohn's disease, diverticulitis, fistula). Surgical experience of ≤50 cases was also considered. Finally, all resections were represented by a combination of the following five procedure components: resections of the (a) hepatic flexure, (b) splenic flexure, (c) sigmoid, and (d) rectum, or (e) a perineal dissection. Results: Patient weight, Crohn's disease, and each of the five individual procedure components incrementally lengthened operative time. Conversion to open surgery was influenced by the patient's weight, malignancy, and early experience of the surgeon. The risk of a postoperative complication was increased by the patient's age, resection of the perineum, and the presence of a fistula. No factors significantly influenced the risk of an intraoperative complication. Conclusions: Several preoperative factors that significantly affect outcomes in laparoscopic colorectal resections have been identified. Consideration of these factors may help in case selection and estimation of operating time; they should also be valuable when patients are informed of their risk of conversion and complications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004640000050
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  • 6
    Electronic Resource
    Electronic Resource
    Laparoscopic splenectomy (1995)
    Springer
    Surgical endoscopy and other interventional techniques 9 (1995), S. 172-177 
    Details
    ISSN: 1432-2218
    Keywords: Splenectomy ; Laparoscopy ; Embolization ; Laparoscopic splenectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We describe the clinical course of 23 patients considered for laparoscopic splenectomy. One patient was excluded on the basis of preoperative angiography findings, and two (9%) were converted to open surgery. In the remaining 20 patients who successfully underwent laparoscopic splenectomy, no mortality was reported; four postoperative complications (20% morbidity) occurred. Mean operating time was 3 h 35 min (135–300 min). After a mean postoperative stay of 3.9 days (2–9 days), all patients except two were back to normal activities within 2 weeks of hospital discharge. Preoperative splenic artery embolization, begun with the third patient, helped to reduce operative blood loss and made the procedure easier to perform. Laparoscopic splenectomy has become our procedure of choice for elective removal of normalsized (〈11 cm long) or moderately enlarged (11–20 cm long) spleens.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00191961
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