This is the first study to look at long-term (mean follow-up 6 months) health outcomes for patients undergoing RPN and HALN. The results show no greater long-term health benefit for one procedure over the other. This finding supports the data in the literature on the benefits of HALN over RPN in terms of a less protracted learning curve, greater technical ease, fewer intraoperative complications, and consequently reduced operating times with no loss of the long-term health benefit that is traditionally associated with the standard laparoscopic technique.
Acute cholecystitis (AC) affects over 20 million Americans annually, leading to annual costs exceeding USD 6 billion. Optimal treatment is early cholecystectomy. However, patients deemed high surgical risk undergo percutaneous cholecystostomy tube (PCT) placement as a bridge to surgery or more commonly as a definitive therapy. We hereby describe our experience with a new procedure named “Hybrid Percutaneous Endoscopic Removal (HPER) of cholelithiasis” that is meant for patients with chronic indwelling PCT. This procedure is an effective alternative to EUS-guided gallbladder drainage in high-risk patients. It does not require special expertise or technology and is simply performed by placing a fully covered metal stent conduit through the existing mature percutaneous tract allowing the endoscopic removal of gallstones through this conduit. This procedure can prevent the recurrence of gallstone-related complications as well as chronic PCT-related costs and adverse events. In our video, we present a case series and long-term follow-up of patients who underwent HPER as an alternative definitive therapy for calculous AC.
trajectory for drainage was planned on a separate workstation. Needle placement was done using fluoroscopic guidance with overlay on cone-beam CT images. Orthogonal views, along the needle axis and perpendicular to the needle, were used to advance the needle into the target. Conventional CT guided procedures were performed on a 64-slice CT (Philips), without the use of CT-fluoroscopy. Technical success and procedure time were compared between the two groups. Results: Average abscess size was similar in the two groups. For the n ¼ 30 cases performed under cone-beam CT guidance, 13 were pelvic and 17 abdominal fluid collections, compared with 16 pelvic and 14 abdominal fluid collections for conventional CT cases. All procedures in the study were technically successful, defined as the aspiration of fluid from the abscess location on imaging. Procedure times were similar between the two modalities (p¼0.16). Conclusion: Fluoroscopic/cone beam CT guidance of percutaneous abscess drain placement yields similar technical success with equivalent procedure times compared to conventional CT guidance.
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