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Article: Underneath Images and Robots, Looking Deeper into the Pneumoperitoneum: A Narrative Review.

Mazzinari, Guido / Rovira, Lucas / Albers-Warlé, Kim I / Warlé, Michiel C / Argente-Navarro, Pilar / Flor, Blas / Diaz-Cambronero, Oscar

Journal of clinical medicine

2024 Volume 13, Issue 4

Abstract: Laparoscopy offers numerous advantages over open procedures, minimizing trauma, reducing pain, accelerating recovery, and shortening hospital stays. Despite other technical advancements, pneumoperitoneum insufflation has received little attention, barely ...

Abstract	Laparoscopy offers numerous advantages over open procedures, minimizing trauma, reducing pain, accelerating recovery, and shortening hospital stays. Despite other technical advancements, pneumoperitoneum insufflation has received little attention, barely evolving since its inception. We explore the impact of pneumoperitoneum on patient outcomes and advocate for a minimally invasive approach that prioritizes peritoneal homeostasis. The nonlinear relationship between intra-abdominal pressure (IAP) and intra-abdominal volume (IAV) is discussed, emphasizing IAP titration to balance physiological effects and surgical workspace. Maintaining IAP below 10 mmHg is generally recommended, but factors such as patient positioning and surgical complexity must be considered. The depth of neuromuscular blockade (NMB) is explored as another variable affecting laparoscopic conditions. While deep NMB appears favorable for surgical stillness, achieving a balance between IAP and NMB depth is crucial. Temperature and humidity management during pneumoperitoneum are crucial for patient safety and optical field quality. Despite the debate over the significance of temperature drop, humidification and the warming of insufflated gas offer benefits in peritoneal homeostasis and visual clarity. In conclusion, there is potential for a paradigm shift in pneumoperitoneum management, with dynamic IAP adjustments and careful control of insufflated gas temperature and humidity to preserve peritoneal homeostasis and improve patient outcomes in minimally invasive surgery.
Language	English
Publishing date	2024-02-14
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm13041080
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Article ; Online: A restrictive stoma policy after colorectal anastomosis in ovarian cancer based on ghost ileostomy use.

Lago, Víctor / Albert, Manel Montesinos / Cruz, Marta Arnaez / Guijarro Campillo, Rafael Alberto / Padilla-Iserte, Pablo / Matute, Luis / Gurrea, Marta / Flor, Blas / Domingo, Santiago

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

2024 Volume 50, Issue 6, Page(s) 108325

Abstract: Background: The incidence of anastomotic leak after colorectal anastomosis in ovarian cancer has been reported to be much lower than that in colorectal cancer patients. Regarding the use of protective manoeuvres (diverting ileostomy) as suggested by ... ...

Abstract	Background: The incidence of anastomotic leak after colorectal anastomosis in ovarian cancer has been reported to be much lower than that in colorectal cancer patients. Regarding the use of protective manoeuvres (diverting ileostomy) as suggested by clinical guidelines, the goal should be the implementation of a restrictive stoma policy for ovarian cancer patients, given the low rate of anastomotic leakage in this population. Material and methods: Patients who underwent cytoreduction surgery in a single centre (University Hospital La Fe, Valencia Spain) due to ovarian cancer between January 2010 and June 2023 were classified according to two groups: a non-restrictive stoma policy group (Group A) and a restrictive stoma policy group (Group B). Results: A total of 256 patients were included in the analysis (group A 52 % vs group B 48 %). The use of protective diverting ileostomy was lower in the restrictive stoma policy group (14 % vs 6.6 %), and the use of ghost ileostomy was 32 % vs 87 % in groups A and B, respectively (p < 0.00001). No differences were found in the anastomotic leak rate, which was 5.2 % in the non-restrictive group and 3.2 % in the restrictive stoma policy group (p = 0.54). Conclusion: The use of a restrictive stoma policy based on the use of ghost ileostomy reduces the rate of diverting ileostomy in patients with ovarian cancer after colorectal resection and anastomosis. Furthermore, this policy is not associated with an increased rate of anastomotic leakage nor with an increased rate of morbi-mortality related to the leak.
Language	English
Publishing date	2024-04-11
Publishing country	England
Document type	Journal Article
ZDB-ID	632519-1
ISSN	1532-2157 ; 0748-7983
ISSN (online)	1532-2157
ISSN	0748-7983
DOI	10.1016/j.ejso.2024.108325
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Article ; Online: Ghost ileostomy: prevention, diagnosis, and early treatment of colorectal anastomosis leakage in advanced ovarian cancer.

Lago, Victor / Sala Climent, Lourdes / Segarra-Vidal, Blanca / Frasson, Matteo / Flor, Blas / Domingo, Santiago

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society

2021 Volume 32, Issue 1, Page(s) 109–110

MeSH term(s)	Anastomosis, Surgical ; Anastomotic Leak/diagnosis ; Anastomotic Leak/prevention & control ; Anastomotic Leak/surgery ; Colon/surgery ; Female ; Humans ; Ileostomy/methods ; Ovarian Neoplasms/surgery ; Rectum/surgery
Language	English
Publishing date	2021-11-16
Publishing country	England
Document type	Case Reports ; Journal Article ; Video-Audio Media
ZDB-ID	1070385-8
ISSN	1525-1438 ; 1048-891X
ISSN (online)	1525-1438
ISSN	1048-891X
DOI	10.1136/ijgc-2021-003060
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Article ; Online: Prognostic Value of the Circumferential Resection Margin After Curative Surgery for Rectal Cancer: A Multicenter Propensity Score-Matched Analysis.

Galvez, Ana / Biondo, Sebastiano / Trenti, Loris / Espin, Eloy / Kraft, Miquel / Farres, Ramón / Codina-Cazador, Antonio / Flor, Blas / Garcia-Granero, Eduardo / Enriquez-Navascues, Jose M / Borda-Arrizabalaga, Nerea / Kreisler, Esther

Diseases of the colon and rectum

2022 Volume 66, Issue 7, Page(s) 887–897

Abstract: Background: Recently, positive circumferential resection margin has been found to be an indicator of advanced disease with a high risk of distant recurrence rather than local recurrence.: Objective: The study aimed to analyze the prognostic impact of ...

Abstract	Background: Recently, positive circumferential resection margin has been found to be an indicator of advanced disease with a high risk of distant recurrence rather than local recurrence. Objective: The study aimed to analyze the prognostic impact of the circumferential resection margin on long-term oncological outcomes in patients with rectal cancer. Design: This was a multicenter, propensity score-matched (2:1) analysis comparing the positive and negative circumferential resection margins. Settings: The study was conducted at 5 high-volume centers in Spain. Patients: Patients who underwent total mesorectal excision with curative intent for middle-low rectal cancer between 2006 and 2014 were included. Main outcome measures: The main outcomes were local recurrence, distant recurrence, overall survival, and disease-free survival. Results: The unmatched initial cohort consisted of 1599 patients, of whom 4.9% had a positive circumferential resection margin. After matching, 234 patients were included (156 with a negative circumferential margin and 78 with a positive circumferential margin). The median follow-up period was 52.5 (22.0-69.5) months. Local recurrence was significantly higher in patients with a positive circumferential margin (33.3% vs 11.5%; p < 0.001). Distant recurrence was similar in both groups (46.2% vs 42.3%; p = 0.651). There were no statistically significant differences in 5-year overall survival (48.6% vs 43.6%; p = 0.14). Disease-free survival was lower in patients with a positive circumferential margin (36.1% vs 52.3%; p = 0.026). Limitations: This study was limited by its retrospective design. The different neoadjuvant treatment options were not included in the propensity score. Conclusions: The positive circumferential resection margin was associated with a higher local recurrence rate and worse disease-free survival in comparison with the negative circumferential resection margin. However, the positive circumferential resection margin was not a prognostic indicator of distant recurrence and overall survival. See Video Abstract at http://links.lww.com/DCR/B950 . Valor pronstico del margen de reseccin circunferencial despus de la ciruga curativa para el cncer de recto un anlisis multicntrico emparejado por puntaje de propensin: ANTECEDENTES:En los últimos años, se ha encontrado que el margen de resección circunferencial positivo es un indicador de enfermedad avanzada con alto riesgo de recurrencia a distancia más que de recurrencia local.OBJETIVO:El objetivo fue analizar el impacto pronóstico del margen de resección circunferencial sobre la recidiva local, a distancia y las tasas de supervivencia en pacientes con cáncer de recto.DISEÑO:Este fue un análisis multicéntrico emparejado por puntaje de propensión 2: 1 que comparó el margen de resección circunferencial positivo y negativo.AJUSTES:El estudio se realizó en 5 centros Españoles de alto volumen.PACIENTES:Se incluyeron pacientes sometidos a escisión total de mesorrecto con intención curativa por cáncer de recto medio-bajo entre 2006-2014. Las características clínicas e histológicas se utilizaron para el emparejamiento.PRINCIPALES MEDIDAS DE RESULTADO:Los resultadoes principales fueron la recurrencia local, la recurrencia a distancia, la supervivencia global y libre de enfermedad.RESULTADOS:La cohorte inicial no emparejada consistió en 1599 pacientes; El 4,9% tuvo un margen de resección circunferencial positivo. Tras el emparejamiento se incluyeron 234 pacientes (156 con margen circunferencial negativo y 78 con margen circunferencial positivo). La mediana del período de seguimiento fue de 52,5 meses (22,0-69,5). La recurrencia local fue significativamente mayor en pacientes con margen circunferencial positivo, 33,3% vs 11,5% [HR 3,2; IC 95%: 1,83-5,43; p < 0,001]. La recidiva a distancia fue similar en ambos grupos (46,2 % frente a 42,3 %) [HR 1,09, IC 95 %: 0,78-1,90; p = 0,651]. No hubo diferencias significativas en la supervivencia global a 5 años (48,6 % frente a 43,6 %) [HR 1,09, IC 95 %: 0,92-1,78; p = 0,14]; La supervivencia libre de enfermedad fue menor en pacientes con margen circunferencial positivo, 36,1% vs 52,3% [HR 1,5; IC 95%: 1,05-2,06; p = 0,026].LIMITACIONES:Este estudio estuvo limitado por el diseño retrospectivo. Las diferentes opciones de tratamientos neoadyuvantes no se han incluido en la puntuación de propensión.CONCLUSIONES:El margen de resección circunferencial positivo se asocia con una mayor tasa de recurrencia local y peor supervivencia libre de enfermedad en comparación con el margen de resección circunferencial negativo. Sin embargo, el margen de resección circunferencial positivo no fue un indicador pronóstico de recidiva a distancia ni de supervivencia global. Consulte el Video del Resumen en http://links.lww.com/DCR/B950 . (Traducción- Dr. Yesenia Rojas-Khalil ).
MeSH term(s)	Humans ; Prognosis ; Propensity Score ; Retrospective Studies ; Rectal Neoplasms/pathology ; Rectum/surgery ; Margins of Excision ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Recurrence, Local/pathology ; Neoplasm Staging
Language	English
Publishing date	2022-03-29
Publishing country	United States
Document type	Video-Audio Media ; Multicenter Study ; Journal Article
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000002294
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Article ; Online: Comparative study of three different managements after colorectal anastomosis in ovarian cancer: conservative management, diverting ileostomy, and ghost ileostomy.

Lago, Victor / Sanchez-Migallón, Amalia / Flor, Blas / Padilla-Iserte, Pablo / Matute, Luis / García-Granero, Álvaro / Bustamante, Marcos / Domingo, Santiago

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society

2019 Volume 29, Issue 7, Page(s) 1170–1176

Abstract: Objective: Anastomotic leak remains the main concern after colorectal anastomosis in ovarian cancer. Our objective was to compare the use of three different management approaches after colorectal resection and anastomosis in patients with ovarian cancer. ...

Abstract	Objective: Anastomotic leak remains the main concern after colorectal anastomosis in ovarian cancer. Our objective was to compare the use of three different management approaches after colorectal resection and anastomosis in patients with ovarian cancer. Methods: Between January 2010 and June 2018, a total of 133 patients with International Federation of Gynecology and Obstetrics (FIGO) stage II-IV ovarian cancer who underwent colorectal resection and anastomosis were included. According to the approach followed after colorectal anastomosis and during the post-operative period, patients were stratified into three groups: conservative management and observation, diverting ileostomy, or ghost ileostomy technique. Univariate analyses were performed for quantitative variables by applying Student's t test or Mann-Whitney U test and for qualitative variables by using the χ Results: A total of 145 patients underwent colorectal resection during cytoreduction for FIGO stage II-IV ovarian cancer. Twelve patients were excluded because a colostomy was required. Thus, 133 patients were included in the final analysis. Modified posterior pelvic exenteration was performed in 121 (91%) patients and recto-sigmoid resection in 12 (9%) patients with relapse. The approach after anastomosis was wait-and-see in 72 patients (54.1%), diverting ileostomy in 19 patients (14.4%), and ghost ileostomy in 42 patients (31.5%). There were no differences in diagnosis, age, body mass index, ECOG (Eastern Cooperative Oncology Group), histology, tumor grade, FIGO stage, or type of surgery between the groups. No differences were found regarding the anastomosis leak related factors or the rate of anastomotic leak between the three groups (5.6% vs 5.3% vs 4.8%; p=0.98). Two patients died because of the anastomotic leak in the wait-and-see group, and none died in the diverting ileostomy or ghost ileostomy group. In the diverting ileostomy group, a higher number of patients had complications compared with the ghost ileostomy group (78.9% vs 7.1%; p<0.01). Four patients (21.1%) developed dehydration due to high output stoma (>1500 mL) causing electrolyte imbalance in the diverting ileostomy group, and one patient (2.4%) in the ghost ileostomy group (p=0.03). The stoma reversal rate was 73.7% for the diverting ileostomy group and 100% for the ghost ileostomy group. Conclusions: There were no differences found in the rate of anastomotic leak among the three groups of patients. The use of ghost ileostomy avoids the drawbacks of diverting ileostomy and seems to have advantages over routine diverting ileostomy and wait-and-see approaches for ovarian cancer patients undergoing colorectal anastomosis. Rates of stoma reversal are lower after diverting ileostomy when compared with ghost ileostomy.
MeSH term(s)	Adult ; Aged ; Anastomosis, Surgical/adverse effects ; Anastomosis, Surgical/methods ; Anastomotic Leak ; Colon/surgery ; Conservative Treatment/methods ; Cytoreduction Surgical Procedures/methods ; Female ; Humans ; Ileostomy/methods ; Middle Aged ; Neoplasm Staging ; Ovarian Neoplasms/pathology ; Ovarian Neoplasms/surgery ; Rectum/surgery
Language	English
Publishing date	2019-07-10
Publishing country	England
Document type	Comparative Study ; Journal Article
ZDB-ID	1070385-8
ISSN	1525-1438 ; 1048-891X
ISSN (online)	1525-1438
ISSN	1048-891X
DOI	10.1136/ijgc-2019-000538
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Article ; Online: Ghost ileostomy in advanced ovarian cancer.

Lago, Víctor / Domingo, Santiago / Matute, Luis / Padilla, Pablo / Flor, Blas / García-Granero, Álvaro

Gynecologic oncology

2017 Volume 147, Issue 2, Page(s) 488

Language	English
Publishing date	2017-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	801461-9
ISSN	1095-6859 ; 0090-8258
ISSN (online)	1095-6859
ISSN	0090-8258
DOI	10.1016/j.ygyno.2017.08.017
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Article ; Online: Ghost Ileostomy in Advanced Ovarian Cancer: A Reliable Option.

Lago, Víctor / Flor, Blas / Matute, Luis / Padilla-Iserte, Pablo / García-Granero, Alvaro / Bustamante, Marco / Domingo, Santiago

International journal of gynecological cancer : official journal of the International Gynecological Cancer Society

2018 Volume 28, Issue 7, Page(s) 1418–1426

Abstract: Objective: Diverting ileostomy (DI) has been proposed to reduce the incidence and consequences anastomotic leakage after bowel resection. In colorectal cancer treatment, ghost ileostomy (GI) has been proposed as an alternative to DI. Our objective was ... ...

Abstract	Objective: Diverting ileostomy (DI) has been proposed to reduce the incidence and consequences anastomotic leakage after bowel resection. In colorectal cancer treatment, ghost ileostomy (GI) has been proposed as an alternative to DI. Our objective was to report the results of GI associated with colorectal resection in the treatment of ovarian cancer. Materials and methods: This is an observational pilot study performed in a single institution. The main objective sought was to report the results of GI associated with colorectal resection in the treatment of ovarian cancer: 26 patients were included. Results: Modified posterior exenteration was performed in 24 cases (92.3%) and rectum resection in the 2 cases of relapse (7.7%). After the main procedure GI was created, to check up the anastomosis status, a sequential postoperative rectoscopy was performed on postoperative day 5 ± 1 (range, 4-7). Serum levels were monitored in first and third postoperative days just with a descriptive intention to establish its relationship with the rectoscopy findings. In 2 cases, rectoscopy demonstrated a leakage. During postoperative course, no other complication related with the GI or DI was observed. No case of clinical anastomotic leakage was found. Conclusions: To the extent of our knowledge, this is the first study in which GI has been performed for the treatment of patients with ovarian cancer. Ghost ileostomy represents a real option that may reduce the number of ileostomies performed in ovarian cancer without increasing the morbimortality. Ghost ileostomy presents the advantages of DI while avoiding its drawbacks. It also seems to be a safe, feasible, and reproducible technique that does not add significant costs to the surgery.
MeSH term(s)	Adult ; Aged ; Anastomotic Leak/prevention & control ; Female ; Humans ; Ileostomy/adverse effects ; Ileostomy/methods ; Middle Aged ; Ovarian Neoplasms/surgery ; Pilot Projects ; Prospective Studies
Language	English
Publishing date	2018-06-19
Publishing country	England
Document type	Clinical Trial ; Journal Article
ZDB-ID	1070385-8
ISSN	1525-1438 ; 1048-891X
ISSN (online)	1525-1438
ISSN	1048-891X
DOI	10.1097/IGC.0000000000001299
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Article ; Online: Outpatient versus hospitalization management for uncomplicated diverticulitis: a prospective, multicenter randomized clinical trial (DIVER Trial).

Biondo, Sebastiano / Golda, Thomas / Kreisler, Esther / Espin, Eloy / Vallribera, Francesc / Oteiza, Fabiola / Codina-Cazador, Antonio / Pujadas, Marcel / Flor, Blas

Annals of surgery

2014 Volume 259, Issue 1, Page(s) 38–44

Abstract: Objective: We compare the results of 2 different strategies for the management of patients with uncomplicated left colonic diverticulitis and to analyze differences in quality of life and economic costs.: Background: The most frequent standard ... ...

Abstract	Objective: We compare the results of 2 different strategies for the management of patients with uncomplicated left colonic diverticulitis and to analyze differences in quality of life and economic costs. Background: The most frequent standard management of acute uncomplicated diverticulitis still is hospital admission both in Europe and United States. Methods: This multicenter, randomized controlled trial included patients older than 18 years with acute uncomplicated diverticulitis. All the patients underwent abdominal computed tomography. There were 2 strategies of management: hospitalization (group 1) and outpatient (group 2). The first dose of antibiotic was given intravenously to all patients in the emergency department and then group 1 patients were hospitalized whereas patients in group 2 were discharged. The primary end point was the treatment failure rate of the outpatient protocol and need for hospital admission. The secondary end points included quality-of-life assessment and evaluation of costs. Results: A total of 132 patients were randomized: 4 patients in group 1 and 3 patients in group 2 presented treatment failure without differences between the groups (P=0.619). The overall health care cost per episode was 3 times lower in group 2, with savings of €1124.70 per patient. No differences were observed between the groups in terms of quality of life. Conclusions: Outpatient treatment is safe and effective in selected patients with uncomplicated acute diverticulitis. Outpatient treatment allows important costs saving to the health systems without negative influence on the quality of life of patients with uncomplicated diverticulitis. Trial registration ID: EudraCT number 2008-008452-17.
MeSH term(s)	Adult ; Aged ; Ambulatory Care/economics ; Ambulatory Care/statistics & numerical data ; Diverticulitis, Colonic/economics ; Diverticulitis, Colonic/therapy ; Female ; Health Care Costs ; Hospitalization/economics ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Prospective Studies ; Quality of Life ; Spain ; Treatment Outcome
Language	English
Publishing date	2014-01
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	340-2
ISSN	1528-1140 ; 0003-4932
ISSN (online)	1528-1140
ISSN	0003-4932
DOI	10.1097/SLA.0b013e3182965a11
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Article ; Online: Integrating Downstaging in the Risk Assessment of Patients With Locally Advanced Rectal Cancer Treated With Neoadjuvant Chemoradiotherapy: Validation of Valentini's Nomograms and the Neoadjuvant Rectal Score.

Roselló, Susana / Frasson, Matteo / García-Granero, Eduardo / Roda, Desamparados / Jordá, Esther / Navarro, Samuel / Campos, Salvador / Esclápez, Pedro / García-Botello, Stephanie / Flor, Blas / Espí, Alejandro / Masciocchi, Carlotta / Valentini, Vincenzo / Cervantes, Andrés

Clinical colorectal cancer

2017 Volume 17, Issue 2, Page(s) 104–112.e2

Abstract: Background: Adjuvant chemotherapy is controversial in patients with locally advanced rectal cancer after preoperative chemoradiation. Valentini et al developed 3 nomograms (VN) to predict outcomes in these patients. The neoadjuvant rectal score (NAR) ... ...

Abstract	Background: Adjuvant chemotherapy is controversial in patients with locally advanced rectal cancer after preoperative chemoradiation. Valentini et al developed 3 nomograms (VN) to predict outcomes in these patients. The neoadjuvant rectal score (NAR) was developed after VN to predict survival. We aimed to validate these tools in a retrospective cohort at an academic institution. Patients and methods: VN and the NAR were applied to 158 consecutive patients with locally advanced rectal cancer treated with chemoradiation followed by surgery. According to the score, they were divided into low, intermediate, or high risk of relapse or death. For statistical analysis, we performed Kaplan-Meier curves, log-rank tests, and Cox regression analysis. Results: Five-year overall survival was 83%, 77%, and 67% for low-, intermediate-, and high-risk groups, respectively (P = .023), according to VN, and 84%, 71%, and 59% for low-, intermediate-, and high-risk groups, respectively (P = .004), according to NAR. When the score was considered as a continuous variable, a significant association with the risk of death was observed (NAR: hazard ratio, 1.04; P < .001; VN: hazard ratio, 1.10; P < .001). Conclusion: We confirmed the value of these scores to stratify patients according to their individual risk when designing new trials.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Chemoradiotherapy, Adjuvant/methods ; Chemoradiotherapy, Adjuvant/mortality ; Disease-Free Survival ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoadjuvant Therapy/methods ; Neoadjuvant Therapy/mortality ; Neoplasm Staging ; Nomograms ; Proportional Hazards Models ; Rectal Neoplasms/mortality ; Rectal Neoplasms/pathology ; Rectal Neoplasms/therapy ; Retrospective Studies ; Risk Assessment ; Treatment Outcome
Language	English
Publishing date	2017-10-28
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Validation Studies
ZDB-ID	2112638-0
ISSN	1938-0674 ; 1533-0028
ISSN (online)	1938-0674
ISSN	1533-0028
DOI	10.1016/j.clcc.2017.10.014
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Zs.A 5798: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Efficacy and cost-effectiveness of the UltraCision harmonic scalpel in thyroid surgery: an analysis of 200 cases in a randomized trial.

Ortega, Joaquín / Sala, Carlos / Flor, Blas / Lledo, Salvador

Journal of laparoendoscopic & advanced surgical techniques. Part A

2004 Volume 14, Issue 1, Page(s) 9–12

Abstract: Background: Thyroid surgery technique has undergone very few changes in the last century. The UltraCision harmonic scalpel (UHS) (Smithfield, RI) has been widely used in laparoscopic surgery and is documented to be safe and fast for cutting and ... ...

Abstract	Background: Thyroid surgery technique has undergone very few changes in the last century. The UltraCision harmonic scalpel (UHS) (Smithfield, RI) has been widely used in laparoscopic surgery and is documented to be safe and fast for cutting and coagulating tissue. We studied whether the use of the UHS could have advantages in thyroid surgery in terms of operative time, length of hospitalization, morbidity, and general costs. Method: Our study was a prospective randomized trial of thyroidectomies and lobectomies performed for benign thyroid diseases in an endocrine surgery unit between February 2001 and July 2002. Patients were randomized in two groups: group A (n=100) underwent thyroidectomy using UHS and group B (n=100) with the conventional clamp-and-tie technique. Main outcome measures were demographics, operating time, length of hospitalization, intra- and postoperative complications, sequelae, and general costs. We used the unpaired 2-tailed Student's t test and the chi2 test to compare the series. Results: The two groups were similar in age and sex. Mean +/- SD operative time was shorter in the UHS group compared with the conventional technique group for both lobectomy (61 +/- 06 vs. 78 +/- 10 minutes) and total thyroidectomy (86 +/- 20 vs. 101 +/- 16 minutes). Length of hospitalization was similar in both groups (1.07 vs. 1.15 days). We did not find statistical differences between the two techniques regarding transient postoperative complications. There were no deaths, no blood transfusions, no intraoperative complications, and no postoperative definitive sequelae. The global charges for every patient were significantly less in the UHS group (985.77 +/- 107.08 euro vs. 1148.40 +/- 153.25 euro). Conclusion: The use of ultrasonically activated shears resulted in a reduction of 15-20% in operative time and was cost-effective compared to the conventional technique group.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cost-Benefit Analysis ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Thyroid Diseases/surgery ; Thyroidectomy/economics ; Thyroidectomy/methods ; Treatment Outcome ; Ultrasonography/economics ; Ultrasonography/instrumentation
Language	English
Publishing date	2004-02
Publishing country	United States
Document type	Clinical Trial ; Comparative Study ; Journal Article ; Randomized Controlled Trial
ZDB-ID	1381909-4
ISSN	1092-6429
ISSN	1092-6429
DOI	10.1089/109264204322862289
Database	MEDical Literature Analysis and Retrieval System OnLINE

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