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Clinical And Scientific Perspectives for Laparoscopic Meso-Rectal Excision

Lap Trainer Box

Laparoscopic Abdominal Surgery

Laparoscopic abdominal surgery is still in rapid development, and most procedures technically performs laparoscopically. Following this initial ‘run-in phase’, where technical developments have made it possible to perform even very advanced procedures, the advantages, and disadvantages of laparoscopic versus open surgery now evaluates in several randomized studies around the world. Lap Trainer Box.

For many reasons use of simulators is a prudent choice like Lap Trainer Box.

Useful About Laparoscopic Surgery

In the field of laparoscopic surgery. The main goal is to show techniques in laparoscopic procedures. It shows a rich selection of these in an excellent way. It mainly aims at surgeons in the special field of gastro-surgery, but also surgeons in general education will find useful information here.

The content covers diagnostics, hepatobiliary surgery, surgery on the esophagus, ventricle, upper and lower gastrointestinal tract, and hernia surgery. In each of the 42 subchapters, where a procedure describes, brief indications and contraindications for the procedure, patient conditions, preoperative preparations, anesthesia selection and instrument review reviews.

Procedural Descriptions

This can excuse as the intention is procedural descriptions, which does very well. The detailed description of the procedures is very accurate, and rich in good advice in expected difficult situations. The illustrations are in the form of line drawings, and therefore easy to understand. Lap Trainer Box.

Long-Term Results Surgery

In both benign and malignant colon surgery, it now clarifies that there are several benefits in the immediate postoperative course of laparoscopic surgery. And the long-term results for the laparoscopically operated colon cancer patients are at least not worse than for the open surgery.

However, most randomized studies in colon cancer conducts without the use of accelerated patient courses. But nevertheless, shows advantages in the laparoscopic surgical technique, e.g., In the form of reduced blood loss and reduced postoperative morbidity. With accelerated course in open surgery, comparable hospitalization times probably achieves. But the effect on postoperative complications, on operative mortality and the long-term oncology results are still unclear for surgery in accelerated course. The overall conclusion for colon cancer is that one can offer laparoscopic surgery if the technique masters.

Within rectal cancer, things are a bit different, as there has been no scientific focus on laparoscopic versus open surgery to the same degree as for colon cancer. This article is a review of a recent review on laparoscopic versus open total meso-rectal excision for rectal cancer.

Analysis Meso-Rectal Excision

The purpose of the assay was to evaluate the pros and cons of laparoscopic versus open surgery for rectal cancer using total meso-rectal excision (TME). The analysis included all randomized trials, controlled clinical trials, and prospective series comparing laparoscopic and open surgery. Due to the limited literature, they also chose to include case reports. Lap Trainer Box.

The search strategy includes searches in Current Contents from 1990 to December 2005. During these searches, 80 articles find, of which 48 includes. The remaining 32 articles excludes primarily due to confusion of colon and rectum surgeries in the articles (24 articles) and due to double publication of data (five articles).

In the included 48 articles, a total of 4,224 patients (range 5-308) describes. The 38 were prospective, three were retrospective, and in the remaining seven articles, it not states how data collects. The exclusion criteria in the individual studies were broadly similar and included T4 tumors, recurrence surgery, patients with synchronous or metachronous colorectal cancers, patients with metastases, acute surgery, ileus, or perforation.

Results Of the Analysis

In 17 studies, data on three- and five-year survival after laparoscopic versus open surgery reports, but only one study randomizes. The randomized study found a five-year survival of 75% and 78%, respectively, after laparoscopic versus open surgery (p = 0.45). In the studies with a lower degree of evidence, no significant differences in survival finds between laparoscopic and open surgery.

There was no significant difference in secondary recurrence parameters between laparoscopic surgery and laparotomy for local recurrence. Number of surgical and disease deaths, anatomical leaks, and surgically resected lymph nodes.

In the analysis, it finds that there was less blood loss, faster resumption of oral nutrition, less postoperative pain, and less immunosuppression at laparoscopic than at open surgery, while the operation time was longer at the laparoscopic operation. Lap Trainer Box.

Direct Costs Laparoscopic Surgery

This is consistent with what describes in many types of benign laparoscopic abdominal surgery as well as in laparoscopic surgery for colon cancer. The length of hospital stays in the analysis finds to be shorter for laparoscopic surgery than for open surgery in two of the three randomized studies, while in the third study no difference finds in the length of hospital stay. A single study reported direct costs and found that laparoscopic surgery was $ 2,100 more expensive than open surgery.

Weaknesses Of Analysis

As there were only three randomized trials, it was not possible to perform a regular meta-analysis. The biggest weakness in the analysis is therefore the lack of studies with evidence grade 1b, and it therefore choses to also include studies with lower degrees of evidence. Unfortunately, there were only very few data regarding the primary efficacy parameters, survival after three years and five years. Therefore, one cannot conclude anything definitive regarding this.

Furthermore, there were several problems in many of the included studies, e.g. Some of the studies involved ‘high’ or ‘partial’ TME resections, typically rectosigmoid resections, while others included regular TME low anterior resections and / or rectum extirpations. For minimally invasive surgery technique, many of them have not received practical training with simulators resembling Lap Trainer Box.

The results of the analysis must therefore take with caution, as precisely when implementing a new surgical technique such as this, where there a lot of enthusiasm among some surgeons, there may be bias, where it ends up that predominant data that are positive for laparoscopy, publishes. None of the studies blinds, and in none of them the principles of accelerated patient courses apply, why e.g., hospitalization times not interprets. In one study, hospitalization times of 13 days versus 18 days finds for laparoscopic and open surgery, respectively. But as we now know that patients sent to home significantly faster after both laparoscopic and open surgery.

Clinical And Scientific Perspectives

Despite the above significant reservations about d a scientific quality, it must emphasize that in the literature included in this analysis, there are no data indicating that laparoscopic surgery should be worse for patients than the corresponding open surgery. This is especially true for the immediate postoperative period, where data even suggest that e.g., blood loss, pain, and immune function may be better after laparoscopic surgery than after open surgery. The very significant long-term effects in the form of the occurrence of ventral hernias and ileus after the primary operation are not asses yet, but also assume to fall out in favor of laparoscopy.

The long-term oncological results after laparoscopic versus open resection are unknown, but the number of lymph nodes removed in the analysis was similar in the two groups. The English prospective, randomized study has shown an increased, though not significant, the incidence of tumor tissue in the lateral resection margin in laparoscopically low anterior surgeons 16 out of 129 (12%) versus four out of 64 (6%), which may be of concern. This underscores the need for thorough training in the laparoscopic technique prior to implementation as a routine offering to patients. Lap Trainer Box.

Conclusion

Two ongoing large-scale randomized trials, respectively, focus on the long-term oncological results after laparoscopic versus open surgery for rectal cancer. Departments that have the necessary expertise to perform laparoscopic surgery for rectal cancer therefore encourage to join the study. Participation in the study also provides an opportunity for quality assurance of the surgical technique.

In laparoscopic surgery, and in my opinion this one comes out well. Mainly due to the detailed review of the procedures. It recommends for specialist candidates in general and gastrointestinal surgery, but also for finished specialists who further develop their laparoscopic skills.

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