Research & Evidence

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Comparison of laparoscopic and open surgeries


A Randomized Trial of Laparoscopic versus Open Surgery for Rectal Cancer

Laparoscopic resection of colorectal cancer is widely used. However, robust evidence to conclude that laparoscopic surgery and open surgery have similar outcomes in rectal cancer is lacking. A trial was designed to compare 3-year rates of cancer recurrence in the pelvic or perineal area (locoregional recurrence) and survival after laparoscopic and open resection of rectal cancer.

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Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial

Laparoscopic surgery as an alternative to open surgery in patients with rectal cancer has not yet been shown to be oncologically safe. The aim in the Colorectal cancer Laparoscopic or Open Resection (COLOR II) trial was to compare laparoscopic and open surgery in patients with rectal cancer.

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Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomized clinical trial

Laparoscopic surgery for colon cancer has been proven safe, but debate continues over whether the available long-term survival data justify implementation of laparoscopic techniques in surgery for colon cancer. The aim of the Colon cancer Laparoscopic or Open Resection (COLOR) trial was to compare 3-year disease-free survival and overall survival after laparoscopic and open resection of solitary colon cancer.

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A comparison of laparoscopically assisted and open colectomy for colon cancer

Minimally invasive, laparoscopically assisted surgery was first considered in 1990 for patients undergoing colectomy for cancer. Concern that this approach would compromise survival by failing to achieve a proper oncologic resection or adequate staging or by altering patterns of recurrence (based on frequent reports of tumor recurrences within surgical wounds) prompted a controlled trial evaluation.

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Laparoscopic versus open sigmoid colectomy for diverticulitis

This study compared laparoscopic with open sigmoid colectomy for patients with a diagnosis of diverticulitis. Increased use of less invasive techniques makes it vitally important to evaluate outcomes of these techniques as compared with standard open procedures.

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Laparoscopic colectomy for cancer: the tale of two studies

Law et al report a prospective database series of 1134 patients who underwent elective resection of a colon or upper rectal tumor in one of two periods: 1996 to mid 2000 (period 1) and mid 2000 to 2004 (period 2). In period 1, 478 patients had open surgery performed or supervised by 3 staff colorectal surgeons. In period 2, 656 patients underwent either open surgery (n = 401) by the same 3 surgeons or laparoscopic resection (n = 255) by 2 of the 3 surgeons.527 In describing their findings, the authors report their data as 2 studies: one a direct comparison of laparoscopic and open surgery and the other an observational study, examining trends following the introduction of laparoscopic surgery.

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Robotic-assisted versus laparoscopic colectomy: cost and clinical outcomes

Laparoscopic colectomies, with and without robotic assistance, are performed to treat both benign and malignant colonic disease. This study compared clinical and economic outcomes for laparoscopic colectomy procedures with and without robotic assistance.

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Interaction of devices on tissue


Surgical stapling device-tissue interactions: what surgeons need to know to improve patient outcomes

The introduction of both new surgical devices and reengineered existing devices leads to modifications in the way traditional tasks are carried out and allows for the development of new surgical techniques. Each new device has benefits and limitations in regards to tissue interactions that, if known, allow for optimal use. However, most surgeons are unaware of these attributes and, therefore, new device introduction creates a “knowledge gap” that is potentially dangerous. The goal of this review is to present a framework for the study of device-tissue interactions and to initiate the process of “filling in” the knowledge gap via the available literature. Surgical staplers, which are continually being developed, are the focus of this piece.

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Large-vessel sealing in laparoscopic colectomy with an ultrasonic device

The HARMONIC ACE®+7 with Advanced Hemostasis Mode is an ultrasonic device designed to transect and seal vessels up to 7mm in diameter. The device applies an algorithm that optimizes ultrasonic energy delivery combined with a longer sealing cycle. The purpose of this study was to assess the initial clinical experience with the Harmonic device by evaluating large-vessel sealing during laparoscopic colectomy in consecutive cases.

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Clinical utility of a new articulating tissue sealer in laparoscopic colorectal surgery

The fixed location of ports, complex anatomy, and deep/tight spaces limit exposure and continue to be a challenge with current energy devices in laparoscopic surgery. We describe the initial experience with an articulating advanced bipolar energy device.

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New Harmonic Scalpel versus conventional hemostasis in right colon surgery

The Harmonic Scalpel (HS) is a device that uses vibrations to coagulate and cut tissues simultaneously. Its advantages are represented by minimal lateral thermal tissue damage, less smoke formation, no neuromuscular stimulation and no transmission of electricity to the patient.

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Evaluation of adjunctive hemostasis agent


A randomized trial of aprotinin-free fibrin sealant versus absorbable hemostat

This study evaluated the safety and hemostatic effectiveness of a tranexamic acid- and aprotinin-free fibrin sealant versus an absorbable hemostat in soft tissue during elective retroperitoneal or intra-abdominal surgery.

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Efficacy and safety of Fibrin Pad as an adjunct to control soft tissue bleeding during abdominal, retroperitoneal, pelvic, and thoracic surgery

This study evaluated the hemostatic effectiveness and safety of Fibrin Pad (Omrix Biopharmaceuticals Ltd.) vs absorbable hemostat in patients undergoing nonemergent surgery. Fibrin Pad is a topical absorbable hemostat designed to be effective in a variety of soft tissues and across multiple bleeding intensities.

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Safety and hemostatic effectiveness of the Fibrin Pad for severe soft-tissue bleeding during abdominal, retroperitoneal, pelvic, and thoracic (non-cardiac) surgery

In surgery, rapid hemostasis can be required in various settings and bleeding intensities to minimize complications related to blood loss. While effective hemostats are available for mild-to-moderate surgical bleeding, few are effective against challenging severe hemorrhage. We report the effectiveness and safety of the Fibrin Pad (FP), a novel combination hemostat (device/human biologic), in controlling severe soft-tissue bleeding as compared to the standard of care (SoC).

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Economic analysis of anastomotic leaks


The burden of gastrointestinal anastomotic leaks: an evaluation of clinical and economic outcomes

To evaluate the clinical and economic burden associated with anastomotic leaks following colorectal surgery.

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An assessment of the clinical and economic impact of establishing ileocolic anastomoses in right-colon resection surgeries using mechanical staplers

To estimate and compare clinical outcomes and costs associated with mechanical stapling versus hand-sewn sutured technique in creation of ileocolic anastomoses after right-sided colon surgery. Mechanical stapling can be considered as a clinically and economically favorable option compared to suturing for establishing anastomoses in patients undergoing right colon surgery.

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Hemorrhoidectomy


Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy

Haemorrhoidectomy is commonly an inpatient procedure because it is frequently associated with postoperative pain. Day case haemorrhoidectomy is a similar operation to that used on inpatients but with different strategies for managing postoperative pain. Circumferential mucosectomy (stapled haemorrhoidectomy) may be associated with less postoperative pain than conventional haemorrhoidectomy. We compared stapled haemorrhoidectomy with conventional haemorrhoidectomy in patients with third degree haemorrhoids.

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Comparing stapled hemorrhoidopexy and Ferguson hemorrhoidectomy: perioperative and one-year results

There is a growing body of evidence supporting the lesser degrees of pain with stapled hemorrhoidopexy, also called the procedure for prolapse and hemorrhoids. However, there have been few randomized comparisons assessing both perioperative and long-term outcomes of the procedure for prolapse and hemorrhoids and Ferguson hemorrhoidectomy. Results are presented here from the first prospective, randomized, multicenter trial comparing these hemorrhoid procedures in the United States.

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Evaluation of two hemorrhoidectomy techniques: Harmonic scalpel and Ferguson's with electrocautery

The prevalence of symptomatic hemorrhoidal disease is a common disease that usually needs surgery for treatment. Although conservative treatment is often enough for early stages, late stage disease usually needs surgical treatment. The most common and effective approaches used for conventional surgical treatment are harmonic scalpel (HS) and Ferguson's with electrocautery hemorrhoidectomy (FEH). The review focused on comparing HS hemorrhoidectomy versus FEH with regards to operating time, postoperative pain, duration of disease, number of issued analgesics, length of hospital stay, time to return to normal activity, and postoperative complications.

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Harmonic Scalpel® haemorrhoidectomy at rural tertiary care centre: a review of 52 cases

Haemorrhoids is a common problem in spicy food loving population of India. Multiple modalities are available for management of grade II and grade III hemorrhoids. The main postoperative complications associated with any of these procedures are pain and bleeding per rectum. Harmonic Scalpel® (Ethicon Endosurgery) Haemorrhoidectomy was evaluated in this study for post-operative complications and symptomatic relief.

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Harmonic scalpel compared with conventional excisional haemorrhoidectomy: a meta-analysis of randomized controlled trials

Haemorrhoidectomy is the most effective and definitive treatment for grade 3 or 4 haemorrhoids despite being associated with considerable pain. The aim of this study was to search the literature, which compares outcomes of harmonic scalpel haemorrhoidectomy and traditional surgical procedures, and conduct a quantitative meta-analysis of the randomized trials.

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