Standardizing laparoscopic procedure time and determining the effect of patient age/gender and presence or absence of surgical residents during operation

Traverso, L. William; Koo, Kenny P.; Hargrave, K.; Unger, S. W.; Roush, Timothy S.; Swanström, Lee L.; Woods, Michael S.; Donohue, John H.; Deziel, Daniel J.; Simon, Irwin B.; Froines, Eric J; Hunter, John G.; Soper, Nathaniel J.

doi:10.1007/s004649900331

Cited by 43 publications

(39 citation statements)

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“…The difference was statistically (P = 0.001) ( Table 1). The mean operation time in our series was comparable with that reported by a multicenter study in the USA [11]. The number of complications increase as the duration of surgery increases.…”

Section: Discussionsupporting

confidence: 87%

The Impact of Nurse’s Experience on Operation Time in Laparoscopic Cholecystectomy

Kozanhan¹

2015

Ann Clin Anal Med

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ÖzetAmaç: Çalışmamızda hemşire tecrübesinin laparoskopik kolesistektomi ameliyatının süresi üzerine etkisini belirlemeyi amaçladık. Gereç ve Yöntem: Konya Eğitim ve Araştırma Hastanesi genel cerrahi ameliyathanesinde, on yıl-dan daha fazla laparoskopik ameliyat tecrübesi olan, bir genel cerrahi uzmanının, Ocak 2010-2013 tarihleri arasında yaptığı laparoskopik kolesistektomi vakalarının dosyaları geriye dönük olarak tarandı. Ultrasonografide safra kesesinde taş ve/veya polipi olduğu için ameliyat edilen hastalar çalışmaya alındı. Hastaların yaş, cins, safra kesesi patolojisi, ASA skoru, ameliyatı asiste eden hemşire ve ameliyat süresine ait bilgiler elde edildi. Ameliyatı asiste eden hemşireler, laparoskopik ameliyat tecrübesi 10 yıldan fazla olan tecrübeli dört hemşire (grup 1), 5 yıldan az tecrübesi olan dört hemşire (grup 2) olarak iki gruba ayrıldı. Veriler Excel ortamında kaydedildi, istatistiki hesaplama için SPSS 18.0 programı kullanıldı. P<0.05 anlamlı kabul edildi. Bulgular: Çalışmamıza dahil edilen 197 hastanın 38(%19) i erkek, 159(%81) u kadın, 17(%9) si 65 yaş üstünde, 180(%91) i altında olup, yaş ortalaması 46,7±13,8 idi. Tecrübeli hemşireler 104(%53) ameliyatı, az tecrübeli hemşireler 93(%47) ameliyatı asiste etmişlerdi. Tüm ameliyatlar için ortalama ameliyat süresi 63,2±20,1 dakika idi. Bu süre tecrübeli hemşire grubunda 51,5±9,0 dakika, az tecrübeli hemşire grubunda 73,0±5,6 dakika olarak tespit edildi. Aradaki fark anlamlı (P<0.05) idi. ASA kriterleri ve hasta yaşının ameliyat süresi üzeri-ne etkisi olmakla birlikte aradaki fark (P>0.05) anlamlı değildi. Tartışma: Laparoskopik kolesistektomide ameliyat hemşiresinin tecrübeli olması ameliyat süresini kısaltmaktadır. Anahtar KelimelerLaparoskopik Kolesistektomi; Hemşire Tecrübesi; Ameliyat Süresi Abstract Aim: The objective of the present study is to determine the impact of nurses experience's on operation time in laparoscopic cholecystectomy(LC). Material and Method: Data collected retrospectively in Konya Training and Research Hospital, by reviewing the files of LC cases, between January 2010-2013, operated by general surgeon whom has more than ten years of experience in laparoscopic surgery. Patients who has gallbladder polyps and/or gallstones on ultrasonography were included in the study. Age, sex, gall bladder pathology, ASA score, duration of surgery and surgical nurse who assisted surgery were obtained from hospital automation system. Nurses were divided into two groups, (group 1) having more than 10 years of experience in laparoscopic surgery, (group 2) having less than 5 years experience in laparoscopic surgery. Statistical analysis was performed using SPSS v.18.0. P value less than 0.05 was considered statistically significant. Results: 197 patients included in the study, 38(19%) were male, 159(81%) were female, 17(9%) were above 65 years of age, 180(91%) were under 65 years of age, mean age of patients was 46,7±13,8 years. 104(%53) patients' operation was assisted by experienced nurses while 93(%47) patients' operation was assisted by l...

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Section: Discussionsupporting

confidence: 87%

The Impact of Nurse’s Experience on Operation Time in Laparoscopic Cholecystectomy

Kozanhan¹

2015

Ann Clin Anal Med

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“…Entretanto, um estudo multicêntrico prospectivo com 359 doentes operados por laparoscopia, demostrou que 34% do tempo do procedimento foi relacionado à passagem e retirada dos trocartes 42 . Outros referiram tempo cirúr-gico maior na colecistectomia laparoscó-pica 43,44 .…”

Section: Discussionunclassified

“…Há ainda estudos com doentes idosos, em que o tempo cirúrgico foi semelhante ou pouco maior na cirurgia convencional 8,14,45 . Diversos são os fatores determinantes do tempo operatório, sendo a experiência do cirurgião um dos principais 33,42 . Neste trabalho, o maior tempo cirúrgico observado no grupo I esteve possivelmente relacionado às características próprias do nosso serviço, onde as cirurgias convencionais são preferencialmente realizadas pelos residentes do segundo ano do programa de cirurgia geral e as (10,6) 11 (10) 8(7,7) 11 (10) TRATAMENTO CIRÚRGICO DA LITÍASE VESICULAR NO IDOSO colecistectomias laparoscópicas por residentes do terceiro e quarto ano do programa de cirurgia do aparelho digestivo.…”

Section: Discussionunclassified

“…Estudos que comparam a morbidade entre os métodos apresentam taxas semelhantes 44,45,50 . No entanto, o mais habitualmente relatado são publicações com menores taxas de complicações na via laparoscópica 42,49,51,52 . Em uma série prospectiva de 264 doentes idosos submetidos à colecistectomia pelos dois méto-dos, detectou-se 23,6% de complicações na via convencional contra 13,5% na laparoscópica; ressaltando ainda a maior gravidade das complicações na colecistectomia aberta 14 .…”

Section: Discussionunclassified

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Tratamento cirúrgico da litíase vesicular no idoso: análise dos resultados imediatos da colecistectomia por via aberta e videolaparoscópica

Rêgo¹,

Campos²,

Moricz³

et al. 2003

Rev. Assoc. Med. Bras.

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RESUMO -O aumento da expectativa de vida faz com que os idosos sejam a faixa etária com maior crescimento. A colecistectomia é a cirurgia abdominal mais comum neste grupo. A associação de doenças crônicas e formas complicadas implica em preconizar o tratamento operatório eletivo nos idosos sintomáticos. Os bons resultados obtidos com a colecistectomia laparoscópica determinaram o surgimento de estudos comparando a cirurgia convencional com a videocirurgia, entretanto, nos idosos há poucas casuísticas analisadas, principalmente no nosso meio.OBJETIVOS. Analisar os resultados imediatos da morbidade da colecistectomia eletiva em doentes idosos, por duas vias de acesso.MÉTODOS. Estudamos, retrospectivamente, doentes com idade > 65 anos operados por incisão subcostal (grupo I) e videolaparoscópica (grupo II). Os grupos foram comparados em relação à presença de complicação até 30 dias e nas suas formas de apresentação: cirúrgica, cirúrgicas (intra e pós-operatórias) e sistêmicas e, posteriormente, com as variáveis sexo, faixa etária, doença associada, cardiovascular, metabólica, pulmonar e ASA. Na análise estatística, empregou-se o teste t de Student e a correlação de Spearman, considerando p < 0,05 como significância estatística. RESULTADOS. Foram 246 doentes distribuídos em dois grupos, INTRODUÇÃOA população de idosos é a que apresenta a maior projeção de crescimento mundial. No Brasil, estima-se o aumento dos idosos de 7,5 para 30 milhões em 2020, ocasião na qual o país terá a sexta população de idosos do planeta 1 . Em decorrência das características especí-ficas dos países de clima tropical, considera-se idoso o indivíduo acima de 60 anos de idade 2 . Entretanto, na literatura internacional, a idade de 65 anos é mais aceita [3][4][5][6][7][8][9][10][11][12][13][14] .A diminuição das reservas funcionais e a presença de doenças associadas em cerca da metade dessa população estabelecem um grupo de doentes com maior complexidade clínica. Concomitante às doenças crônicas, algumas enfermidades de tratamento cirúrgico apresentam aumento de incidência com a progressão da idade 15 . A colelitíase é a doença cirúrgica abdominal mais comum no doente idoso, sendo sua incidência relacionada à progressão da idade, com prevalência global de 9,3%; passando para 21,4% nos idosos de 60 a 69 e, na faixa etária acima de 70 anos, acomete 27,5% dos indivíduos 16 . As colecistectomias atualmente realizadas nessa população variam de 8,3% a 24% 6,7,12,13,18 . E, com publicações enfatizando o aumento de cirurgias em octagenários [19][20][21] .

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“…24,25 The one conversion to conventional laparoscopy was in a patient with acute cholecystitis. In this case, the 3-mm instruments were ineffective in grasping the edematous gallbladder, and therefore the anatomy could not be clearly delineated.…”

Section: Discussionmentioning

confidence: 99%

Telerobotic Laparoscopic Cholecystectomy: Initial Clinical Experience With 25 Patients

et al. 2001

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ObjectiveTo determine the safety and feasibility of performing telerobotic laparoscopic cholecystectomies. This will serve as a preliminary step toward the integration of computer-rendered three-dimensional preoperative imaging studies of anatomy and pathology onto the patient's own anatomy during surgery. Summary Background DataComputer-assisted surgery (CAS) increases the surgeon's dexterity and precision during minimally invasive surgery, especially when using microinstruments. Clinical trials have shown the improved microsurgical precision afforded by CAS in the minimally invasive setting in cardiac and gynecologic surgery. Future applications would allow integration of preoperative data and augmented-reality simulation onto the actual procedure. MethodsBeginning in September 1999, CAS was used to perform cholecystectomies on 25 patients at a single medical center in this nonrandomized, prospective study. The operations were performed by one of two surgeons who had previous laboratory experience using the computer interface. The entire dissection was performed by the surgeon, who remained at a distance from the patient but in the same operating room. The operation was evaluated according to time of dissection, time of assembly/disassembly of robot, complications, immediate postoperative course, and short-term follow-up. ResultsTwenty of the 25 patients had symptomatic cholelithiasis, 1 had a gallbladder polyp, and 4 had acute cholecystitis. Twenty-four of the 25 laparoscopic cholecystectomies were successfully completed by CAS. There was one conversion to conventional laparoscopic cholecystectomy. Set-up and takedown of the robotic arms took a median of 18 minutes. The median operative time for dissection and the overall operative time were 25 and 108 minutes, respectively. There were no intraoperative complications. There was one postoperative complication of a suspected pulmonary embolus, which was treated with anticoagulation. All patients were tolerating diet at discharge. ConclusionsLaparoscopic cholecystectomy performed by CAS is safe and feasible, with operative times and patient recovery similar to those of conventional laparoscopy. At present, CAS cholecystectomy offers no obvious advantages to patients, but the potential advantages of CAS lie in its ability to convert the surgical act into digitized data. This digitized format can then interface with other forms of digitized data, such as pre-or intraoperative imaging studies, or be transmitted over a distance. This has the potential to revolutionize the way surgery is performed.Computers and technology are increasingly interacting with surgeons both inside and outside of the operating room, as exemplified by the rapid adoption of laparoscopy into routine use. The computer's ability to enhance, modify, or transform electronic data is changing patient management before, during, and after surgery. As such, these technologic advancements are having an ever-increasing influence on the way surgery is planned and performed.

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Standardizing laparoscopic procedure time and determining the effect of patient age/gender and presence or absence of surgical residents during operation

Abstract: LC time was globally calibrated in 11 North American hospitals and was found to be affected by expertise but not by gender or age. The mean and standard deviation of LC time can be used for purposes of self-assessing quality performance.

Cited by 43 publications

References 3 publications

The Impact of Nurse’s Experience on Operation Time in Laparoscopic Cholecystectomy

The Impact of Nurse’s Experience on Operation Time in Laparoscopic Cholecystectomy

Tratamento cirúrgico da litíase vesicular no idoso: análise dos resultados imediatos da colecistectomia por via aberta e videolaparoscópica

Telerobotic Laparoscopic Cholecystectomy: Initial Clinical Experience With 25 Patients

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