Conversion rates for laparoscopic colectomy are dependent on a multitude of factors that require appropriate adjustment including the learning curve (operative experience) for individual surgeons. The laparoscopic model described can be used as the basis for performance monitoring between or within institutions.
An international working party was convened in Rome, Italy on 16-17 June, 2005, with the purpose of developing a consensus on the application of the circular stapling instrument to the treatment of certain rectal conditions, the so-called Stapled Transanal Rectal Resection (STARR). Since the procedure has been submitted to only limited objective analysis it was felt prudent to hold a meeting of interested individuals for the purpose of evaluating the current status and to make conclusions and recommendations concerning the applicability of this new approach.
The CUSUM method was a useful tool for objectively measuring performance during the learning phase of IPAA surgery. With adequate training, supervision, and monitoring, the learning curve in IPAA surgery may be reduced even further.
These data define the metrics of performance for hand-assisted and straight laparoscopic colectomy on an augmented reality simulator. The improved scores with the hand-assisted approach suggest that with this simulator a hand-assisted model may be technically easier to perform, although it is associated with increased intraoperative errors.
Aims: Fast track postoperative protocols can yield a 4.3‐day (d) stay after intestinal surgery, compared to 7–10 d with traditional (TRAD) approaches. Patient satisfaction, quality of life and pain are poorly understood after abdominal surgery, and have not been compared after fast track and traditional care.
Methods: Sixty‐four intestinal resection cases were randomly allocated to CREAD (controlled rehabilitation with early ambulation and diet) or TRAD. CREAD cases received: no NG tubes; ambulation and liquids on d 1; soft diet, oral analgesia on d 2. TRAD patients had: NG tubes; liquids, oral analgesia and diet after bowel function; ambulated on d 2. Postoperative endpoints at discharge, d 10 and d 30 used the Short Form‐36 quality of life form, Cleveland clinic global quality of life scale (CGQL) and the McGill pain score.
Results: Length of stay including readmissions was 5.4 d in CREAD and 7.1 d in TRAD patients (P = 0.02). Changes in the mental component of the SF36 (reduced from 51 to 42, P < 0.01), and McGill score (increased from 3.9 to 7.6, P < 0.05) in CREAD patients at discharge, were resolved at d 10 and d 30, and are attributed to the shorter stay of CREAD patients. There were no differences in any other variable at any time.
Conclusions: Patients using the CREAD had a shorter postoperative stay, without altered quality of life or pain scores on d 10 and d 30 after surgery, when compared to patients managed by the TRAD approach. It should be considered as a primary care pathway for patients undergoing intestinal resection.
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