Cargando…
Experience and dissection device are more relevant than patient-related factors for operation time in laparoscopic sigmoid resection—a retrospective 8-year observational study
PURPOSE: Surgical outcome is influenced by multiple patient-specific factors and operative expertise of the surgeon. Clinical relevance of medical technical innovations often remains unclear even though laparoscopic surgical procedures are characterized by continual advancement of various devices. L...
Autores principales: | , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5691094/ https://www.ncbi.nlm.nih.gov/pubmed/28879419 http://dx.doi.org/10.1007/s00384-017-2896-3 |
_version_ | 1783279726055391232 |
---|---|
author | Weyhe, Dirk Uslar, Verena Nicole Tabriz, Navid Burkowski, Ina Heinzel, Ralf Müller, Andreas Belling, Annette Köckerling, Ferdinand |
author_facet | Weyhe, Dirk Uslar, Verena Nicole Tabriz, Navid Burkowski, Ina Heinzel, Ralf Müller, Andreas Belling, Annette Köckerling, Ferdinand |
author_sort | Weyhe, Dirk |
collection | PubMed |
description | PURPOSE: Surgical outcome is influenced by multiple patient-specific factors and operative expertise of the surgeon. Clinical relevance of medical technical innovations often remains unclear even though laparoscopic surgical procedures are characterized by continual advancement of various devices. Lately, in dissection and sealing technology, fast-cutting ultrasonic scissors are combined with simultaneous bipolar coagulation (bimodal dissection device (BDD)). We investigated how this new technology, operative expertise, and patient-specific factors (body mass index, age) influence operation time in laparoscopic-assisted sigmoid resection. METHODS: Between 2008 and 2016, 161 laparoscopic sigmoid resections (52% conventional dissection device (CDD); 48% BDD) performed in a single center were retrospectively evaluated. Biometric patient data, complication rates, and surgery duration, reflecting the learning curve, were analyzed. Operations were performed by experienced surgeons (n = 3) and trainees (n = 4). RESULTS: Minor postoperative complications (e.g., impaired wound healing, non-revisional secondary bleeding) occurred in 11 cases (6.8%). Major complications (e.g., bleeding requiring revision, anastomotic leakage) were observed in 3.7%. No heat-related coagulation damage was observed. BDD reduced operation time for both experienced (CDD 150 min, BDD 125 min; p < 0.001) and trainee surgeons (CDD 169 min, BDD 135 min; p = 0.036). Reduction of operation time (indicative of a learning curve in progress) was observed for all surgeons. The curve was steeper using BDD. CONCLUSIONS: Patient-specific factors did not have a significant effect on operation time. Even taking the learning curve into account, a combination of ultrasonic dissection and simultaneous bipolar coagulation reduces operation time of laparoscopic-assisted sigmoid resection, regardless of surgeon’s expertise. |
format | Online Article Text |
id | pubmed-5691094 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-56910942017-11-30 Experience and dissection device are more relevant than patient-related factors for operation time in laparoscopic sigmoid resection—a retrospective 8-year observational study Weyhe, Dirk Uslar, Verena Nicole Tabriz, Navid Burkowski, Ina Heinzel, Ralf Müller, Andreas Belling, Annette Köckerling, Ferdinand Int J Colorectal Dis Original Article PURPOSE: Surgical outcome is influenced by multiple patient-specific factors and operative expertise of the surgeon. Clinical relevance of medical technical innovations often remains unclear even though laparoscopic surgical procedures are characterized by continual advancement of various devices. Lately, in dissection and sealing technology, fast-cutting ultrasonic scissors are combined with simultaneous bipolar coagulation (bimodal dissection device (BDD)). We investigated how this new technology, operative expertise, and patient-specific factors (body mass index, age) influence operation time in laparoscopic-assisted sigmoid resection. METHODS: Between 2008 and 2016, 161 laparoscopic sigmoid resections (52% conventional dissection device (CDD); 48% BDD) performed in a single center were retrospectively evaluated. Biometric patient data, complication rates, and surgery duration, reflecting the learning curve, were analyzed. Operations were performed by experienced surgeons (n = 3) and trainees (n = 4). RESULTS: Minor postoperative complications (e.g., impaired wound healing, non-revisional secondary bleeding) occurred in 11 cases (6.8%). Major complications (e.g., bleeding requiring revision, anastomotic leakage) were observed in 3.7%. No heat-related coagulation damage was observed. BDD reduced operation time for both experienced (CDD 150 min, BDD 125 min; p < 0.001) and trainee surgeons (CDD 169 min, BDD 135 min; p = 0.036). Reduction of operation time (indicative of a learning curve in progress) was observed for all surgeons. The curve was steeper using BDD. CONCLUSIONS: Patient-specific factors did not have a significant effect on operation time. Even taking the learning curve into account, a combination of ultrasonic dissection and simultaneous bipolar coagulation reduces operation time of laparoscopic-assisted sigmoid resection, regardless of surgeon’s expertise. Springer Berlin Heidelberg 2017-09-06 2017 /pmc/articles/PMC5691094/ /pubmed/28879419 http://dx.doi.org/10.1007/s00384-017-2896-3 Text en © The Author(s) 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Original Article Weyhe, Dirk Uslar, Verena Nicole Tabriz, Navid Burkowski, Ina Heinzel, Ralf Müller, Andreas Belling, Annette Köckerling, Ferdinand Experience and dissection device are more relevant than patient-related factors for operation time in laparoscopic sigmoid resection—a retrospective 8-year observational study |
title | Experience and dissection device are more relevant than patient-related factors for operation time in laparoscopic sigmoid resection—a retrospective 8-year observational study |
title_full | Experience and dissection device are more relevant than patient-related factors for operation time in laparoscopic sigmoid resection—a retrospective 8-year observational study |
title_fullStr | Experience and dissection device are more relevant than patient-related factors for operation time in laparoscopic sigmoid resection—a retrospective 8-year observational study |
title_full_unstemmed | Experience and dissection device are more relevant than patient-related factors for operation time in laparoscopic sigmoid resection—a retrospective 8-year observational study |
title_short | Experience and dissection device are more relevant than patient-related factors for operation time in laparoscopic sigmoid resection—a retrospective 8-year observational study |
title_sort | experience and dissection device are more relevant than patient-related factors for operation time in laparoscopic sigmoid resection—a retrospective 8-year observational study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5691094/ https://www.ncbi.nlm.nih.gov/pubmed/28879419 http://dx.doi.org/10.1007/s00384-017-2896-3 |
work_keys_str_mv | AT weyhedirk experienceanddissectiondevicearemorerelevantthanpatientrelatedfactorsforoperationtimeinlaparoscopicsigmoidresectionaretrospective8yearobservationalstudy AT uslarverenanicole experienceanddissectiondevicearemorerelevantthanpatientrelatedfactorsforoperationtimeinlaparoscopicsigmoidresectionaretrospective8yearobservationalstudy AT tabriznavid experienceanddissectiondevicearemorerelevantthanpatientrelatedfactorsforoperationtimeinlaparoscopicsigmoidresectionaretrospective8yearobservationalstudy AT burkowskiina experienceanddissectiondevicearemorerelevantthanpatientrelatedfactorsforoperationtimeinlaparoscopicsigmoidresectionaretrospective8yearobservationalstudy AT heinzelralf experienceanddissectiondevicearemorerelevantthanpatientrelatedfactorsforoperationtimeinlaparoscopicsigmoidresectionaretrospective8yearobservationalstudy AT mullerandreas experienceanddissectiondevicearemorerelevantthanpatientrelatedfactorsforoperationtimeinlaparoscopicsigmoidresectionaretrospective8yearobservationalstudy AT bellingannette experienceanddissectiondevicearemorerelevantthanpatientrelatedfactorsforoperationtimeinlaparoscopicsigmoidresectionaretrospective8yearobservationalstudy AT kockerlingferdinand experienceanddissectiondevicearemorerelevantthanpatientrelatedfactorsforoperationtimeinlaparoscopicsigmoidresectionaretrospective8yearobservationalstudy |