Impact of Three-Dimensional Laparoscopy in a Bariatric Surgery Program: Influence in the Learning Curve

Padin, Esther Mariño; Santos, Raquel Sánchez; Fernández, Sonia González; Jiménez, Antonia Brox; Estévez-Fernández, Sergio; Dacosta, Ester Carrera; Duran, Agata Rial; Rial, María Artime; Sánchez, Iván Domínguez

doi:10.1007/s11695-017-2687-5

Cited by 18 publications

(25 citation statements)

References 14 publications

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“…The superiority of 3D over 2D laparoscopy was observed at early and later stages in the learning curve . In Polish and Dutch studies , the involvement of residents in training with an experienced teacher does not compromise complication rates or weight‐reduction outcomes after bariatric surgery. On the other hand, mastery refers to having outcomes significantly better than the average surgeon, whereas competency (the learning curve figure discussed above) refers to having outcomes comparable to the average surgeon.…”

Section: Executive Summarymentioning

confidence: 97%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

326

464

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Objective The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), American Society for Metabolic and Bariatric Surgery (ASMBS), Obesity Medicine Association (OMA), and American Society of Anesthesiologists (ASA) Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results New or updated topics in this CPG include: contextualization in an adiposity‐based chronic disease complications‐centric model, nuance‐based and algorithm/checklist‐assisted clinical decision‐making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusions Bariatric procedures remain a safe and effective intervention for higher‐risk patients with obesity. Clinical decision‐making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues.

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Section: Executive Summarymentioning

confidence: 97%

Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

Mechanick

Apovian

Brethauer

et al. 2020

Obesity

326

464

View full text Add to dashboard Cite

show abstract

“…Guebbels et al (379) found that bariatric surgery learning curves depend on mentorship and improve as the preceding surgeon's skill improves. The superiority of 3D over 2D laparoscopy was observed at early and later stages in the learning curve (380). In Polish (381) and Dutch studies (382), the involvement of residents in training with an experienced teacher does not compromise complication rates or weight-reduction outcomes after bariatric surgery.…”

Section: R5 (2019*)mentioning

confidence: 97%

Clinical Practice Guidelines For The Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures – 2019 Update: Cosponsored By American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society For Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists

et al. 2019

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Objective: The development of these updated clinical practice guidelines (CPGs) was commissioned by the American Association of Clinical Endocrinologists (AACE), The Obesity Society, American Society of Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists Boards of Directors in adherence with the AACE 2017 protocol for standardized production of CPGs, algorithms, and checklists. Methods: Each recommendation was evaluated and updated based on new evidence from 2013 to the present and subjective factors provided by experts. Results: New or updated topics in this CPG include: contextualization in an adiposity-based chronic disease complications-centric model, nuance-based and algorithm/checklist-assisted clinical decision-making about procedure selection, novel bariatric procedures, enhanced recovery after bariatric surgery protocols, and logistical concerns (including cost factors) in the current health-care arena. There are 85 numbered recommendations that have updated supporting evidence, of which 61 are revised and 12 are new. Noting that there can be multiple recommendation statements within a single numbered recommendation, there are 31 (13%) Grade A, 42 (17%) Grade B, 72 (29%) Grade C, and 101 (41%) Grade D recommendations. There are 858 citations, of which 81 (9.4%) are evidence level (EL) 1 (highest), 562 (65.5%) are EL 2, 72 (8.4%) are EL 3, and 143 (16.7%) are EL 4 (lowest). Conclusion: Bariatric procedures remain a safe and effective intervention for higher-risk patients with obesity. Clinical decision-making should be evidence based within the context of a chronic disease. A team approach to perioperative care is mandatory, with special attention to nutritional and metabolic issues. Abbreviations: A1C = hemoglobin A1c; AACE = American Association of Clinical Endocrinologists; ABCD = adiposity-based chronic disease; ACE = American College of Endocrinology; ADA = American Diabetes Association; AHI = Apnea-Hypopnea Index; ASA = American Society of Anesthesiologists; ASMBS = American Society of Metabolic and Bariatric Surgery; BMI = body mass index; BPD = biliopancreatic diversion; BPD/DS = biliopancreatic diversion with duodenal switch; CI = confidence interval; CPAP = continuous positive airway pressure; CPG = clinical practice guideline; CRP = C-reactive protein; CT = computed tomography; CVD = cardiovascular disease; DBCD = dysglycemia-based chronic disease; DS = duodenal switch; DVT = deep venous thrombosis; DXA = dual-energy X-ray absorptiometry; EFA = essential fatty acid; EL = evidence level; EN = enteral nutrition; ERABS = enhanced recovery after bariatric surgery; FDA = U.S. Food and Drug Administration; G4GAC = Guidelines for Guidelines, Algorithms, and Checklists GERD = gastroesophageal reflux disease; GI = gastrointestinal; HCP = health-care professional(s); HTN = hypertension; ICU = intensive care unit; IGB = intragastric balloon(s); IV = intravenous; LAGB = laparoscopic adjustable gastric band; LAGBP = laparoscopic adjustable gastric banded plication; LGP = laparoscopic greater curvature (gastric) plication; LRYGB = laparoscopic Roux-en-Y gastric bypass; LSG = laparoscopic sleeve gastrectomy; MetS = metabolic syndrome; NAFLD = nonalcoholic fatty liver disease; NASH = nonalcoholic steatohepatitis; NSAID = nonsteroidal anti-inflammatory drug; OA = osteoarthritis; OAGB = one-anastomosis gastric bypass; OMA = Obesity Medicine Association; OR = odds ratio; ORC = obesity-related complication(s); OSA = obstructive sleep apnea; PE = pulmonary embolism; PN = parenteral nutrition; PRM = pulmonary recruitment maneuver; RCT = randomized controlled trial; RD = registered dietician; RDA = recommended daily allowance; RYGB = Roux-en-Y gastric bypass; SG = sleeve gastrectomy; SIBO = small intestinal bacterial overgrowth; TOS = The Obesity Society; TSH = thyroid-stimulating hormone; T1D = type 1 diabetes; T2D = type 2 diabetes; VTE = venous thromboembolism; WE = Wernicke encephalopathy; WHO = World Health Organization

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“…Literature search yielded 656 articles. Through the screening, 3 RCTs [106-108], 3 retrospective cohort studies [113,114,124] and 2 meta-analyses [68,94] were included in this review. The subjects of surgical procedures were hiatal hernia repair in 1 RCT, 1 bariatric surgery in 1 RCT and 1 retrospective cohort study, gastric cancer surgery in 1 RCT and 1 retrospective study, and esophagectomy in 1 retrospective study, respectively.…”

Section: D Laparoscopy In Sleeve Gastrectomy Offers No Advantage Over...mentioning

confidence: 99%

The use of 3D laparoscopic imaging systems in surgery: EAES consensus development conference 2018

et al. 2018

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After a Health Technology Assessment on 3D vision technology completed last year, the aim of one of the consensus meetings 2018 of the EAES was to generate a guideline on the same topic based on best available evidence and expert opinions of EAES Technology Committee members. After a systematic review of the literature by an international group of research fellows, an expert panel with extensive engineering and clinical experience in the use of 3D vision technology discussed statements and recommendations. Twenty-two statements and 2 recommendations were obtained unanimously by the experts and were discussed and voted at the consensus meeting of the EAES in London in May 2018 by the attendees of the meeting. The most important regarding general topics were: a) 3D vision improves outcomes for junior trainees in performing standardized tasks in box trainers, only when 3D systems with HD screen and passive polarized glasses are used and only when properly set up; b) The use of 3D imaging systems improves laparoscopic box trainer task completion time and error rate but this benefit has not been studied in clinical practice. The most important regarding clinical setting were: a) 3D laparoscopy shortens the operating time in all the analysed surgical settings (general surgery, urology and gynaecology); b) The pooling of data from the different settings seems to suggest a lowering in the overall rate of complications after surgical procedures involving suturing in 3D laparoscopy, especially in the gynaecology setting; indeed data are too heterogeneous and weak to sustain any recommendation, other than implications for future research. These produced 2 recommendations: a) 3D laparoscopy might shorten operative times; b) Future research is recommended to demonstrate that 3D vision may lower complications rate in laparoscopy. The majority of the EAES members supported these statements.These consensus proceedings provide additional guidance to surgeons and surgical residents providing help when using 3D vision technology.

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Impact of Three-Dimensional Laparoscopy in a Bariatric Surgery Program: Influence in the Learning Curve

Abstract: The use of 3D laparoscopy in bariatric surgery in our center has helped reducing the operating time and hospital stay, and improving the safety of the surgery, either in GB or SG, being equally favorable in novice or more experienced surgeons.

Cited by 18 publications

References 14 publications

The use of 3D laparoscopic imaging systems in surgery: EAES consensus development conference 2018

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