The Development of Laparoscopic Surgery in Spain

Feliu, Xavier; Targarona, Eduardo M.; García-Agustí, Ana; Pey, Albert; Carrillo, Ángel; Lacy, Antonio M.; Baena-Morales, Salvador; Salvador, José Luis Jiménez; Torres, Antônio; Veloso, E

doi:10.1159/000082722

Cited by 7 publications

(5 citation statements)

References 21 publications

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“…In the UK, only 11-20% of surgeons offer ELC 8,17 compared with 33-67% internationally. 9,10,18,19 NICE also recognised that success of implementing ELC may rest on providers' willingness to redesign their EGS services. 11 This is supported by our almost unique example of a redesigned ESU, which has not only enabled unprecedented compliance with NICE guidance on ELC but has also generated significant income and savings.…”

Section: Pre-esu (N=29)mentioning

confidence: 99%

“…This is more than double the highest reported national figure of 20% 17 and compares favourably with international reports (33-67%). 9,10,18,19 Furthermore, when patients unsuitable for ELC were excluded from analysis, the ELC rate rose to an impressive 82% in the post-ESU period. This is four times the highest reported national figure 17 and is the highest ELC rate reported even when considering large US centres where private funding incentives are clearly a factor.…”

Section: Pre-esu (N=29)mentioning

confidence: 99%

“…[5][6][7] The consensus on the optimal timing is still lacking, however, with 'early' being defined as ranging from 24 hours to 7 days from diagnosis or onset of symptoms. 7 Despite positive evidence, the rate of ELC remains low worldwide, [8][9][10] mainly on account of financial constraints, logistical difficulties and shortage of expertise. 6,8,11 Practice of early cholecystectomy in the UK is particularly poor by international standards [8][9][10] and possibly reflects the general provision of emergency surgical care.…”

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confidence: 99%

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Impact of a dedicated emergency surgical unit on early laparoscopic cholecystectomy for acute cholecystitis

Bokhari

Walsh

Qurashi

et al. 2016

annals

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INTRODUCTION Emergency general surgery (EGS) accounts for 50% of the surgical workload, and yet outcomes are variable and poorly recorded. The management of acute cholecystitis (AC) at a dedicated emergency surgical unit (ESU) was assessed as a performance target for EGS. METHODS The outcomes for AC admissions were compared one year before and after inception of the ESU. The impact on cost and compliance with national guidance recommending early laparoscopic cholecystectomy (ELC) within seven days of diagnosis was assessed. RESULTS The overall ELC rate increased from 26% for the 126 patients admitted in the pre-ESU period to 45% for the 152 patients admitted in the post-ESU period (p=0.001). With those unsuitable for ELC excluded, the ELC rate increased from 34% to 82% (p<0.001). The proportion of patients precluded from ELC for avoidable reasons, particularly owing to 'surgeon preference/skill', was reduced from 69% to 18% (p<0.001). The mean total length of stay (LOS) and postoperative LOS fell by 1.7 days (from 8.3 to 6.6 days, p=0.040) and 2 days (from 5.6 to 3.6 days, p=0.020) respectively. The higher ELC rate and the reduction in LOS produced additional tariff income (£111,930) and estimated savings in bed day (£90,440) and readmission (£27,252) costs. CONCLUSIONS A dedicated ESU incorporating national recommendations for EGS improves alignment of best practice with best evidence and can also result in financial rewards for a busy district general hospital.

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Section: Pre-esu (N=29)mentioning

confidence: 99%

Section: Pre-esu (N=29)mentioning

confidence: 99%

mentioning

confidence: 99%

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Impact of a dedicated emergency surgical unit on early laparoscopic cholecystectomy for acute cholecystitis

Bokhari

Walsh

Qurashi

et al. 2016

annals

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“…[ 5 6 ] National Institute for Health and Care Excellence (2014) recommended patients with acute cholecystitis to have a laparoscopic cholecystectomy (LC) within a week of diagnosis and patients with gallstone pancreatitis to have LC on index admission for its benefits of fewer complications and readmissions, lower hospital costs, fewer work days lost and greater patient satisfaction. [ 2 7 ] Despite positive evidence and recommendations, the rate of ELC still remains low worldwide,[ 8 9 10 ] possibly due to financial constraints, logistical difficulties and shortage of expertise. [ 2 5 8 ] Practice of ELC has been particularly poor in the UK offered only by 11%–20% surgeons as compared to 33%–67% internationally, once again reflecting the varied provision of emergency general surgical care.…”

Section: Introductionmentioning

confidence: 99%

‘Hot gall bladder service’ by emergency general surgeons

Imtiaz

Prakash²,

Iqbal³

et al. 2022

Journal of Minimal Access Surgery

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Background: Despite NICE/AUGIS recommendations, the practice of early laparoscopic cholecystectomy (ELC) has been particularly poor in the UK offered only by 11%–20% surgeons as compared to 33%–67% internationally, possibly due to financial constraints, logistical difficulties and shortage of expertise, thus, reflecting the varied provision of emergency general surgical care. To assess whether emergency general surgeons (EGS) could provide a 'Hot Gall Bladder Service' (HGS) with an acceptable outcome. Patients and Methods: This was a prospective HGS observational study that was protocol driven with strict inclusion/exclusion criteria and secure online data collection in a district general hospital between July 2018 and June 2019. A weekly dedicated theatre slot was allocated for this list. Results: Of the 143 referred for HGS, 86 (60%) underwent ELC which included 60 (70%) women. Age, ASA and body mass index was 54* (18–85) years, II* (I-III) and 27* (20–54), respectively. 86 included 46 (53%), 19 (22%), 19 (22%) and 2 (3%) patients presenting with acute calculus cholecystitis, gallstone pancreatitis, biliary colic, and acalculus cholecystitis, respectively. 85 (99%) underwent LC with a single conversion. Grade of surgical difficulty, duration of surgery and post-operative stay was 2* (1–4) 68* (30–240) min and 0* (0–13) day, respectively. Eight (9%) required senior surgical input with no intra-operative complications and 2 (2%) 30-day readmissions. One was post-operative subhepatic collection that recovered uneventfully and the second was pancreatitis, imaging was clear requiring no further intervention. Conclusion: In the current climate of NHS financial crunch, COVID pandemic and significant pressure on inpatient beds: Safe and cost-effective HGS can be provided by the EGS with input from upper GI/HPB surgeons (when required) with acceptable morbidity and a satisfactory outcome.

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“…Therefore, it is an alternative to open surgery provided that we can accurately use the same tenets applicable to open surgery in the laparoscopic approach. E. M. Targarona, X. Feliu 1…”

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confidence: 99%

Laparoscopic management of gastric cancer

Targarona

Feliu

Balagué

2006

Rev. esp. enferm. dig.

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The development of minimally invasive surgery following the first cholecystectomy performed nearly 20 years ago has favored the performance of increasingly aggressive procedures to reduce surgical trauma and improve quality of life during the postoperative period of time (1,2). The management of gastric cancer could not escape this trend, and various minimally invasive technical options have been currently described-early-stage endoscopic mucosal resection, partial resection with limited lymphadenectomy, and in recent years laparoscopy-assisted or fully laparoscopic partial or total gastric resection (3-11). However, no definite evidence is yet available on both their short-term and long-term clinical advantages as compared to open surgery, but we are obtaining increasingly more information in support of the potential benefits of such an approach (2), particularly that these procedures are oncologically appropriate-as suggested in the study by Ibáñez et al. (10)-both from a technical perspective and considering their long-term effects. The two main goals of gastric cancer management are prolonged survival and improved quality of life (12). It is widely accepted that surgical treatment is crucial in the therapeutic approach to gastric cancer, albeit no universal consensus has been reached regarding the specific procedure. This stems from the fact that surgery outcomes are better in Asia than in the West, where Asian-like results could not be reproduced. This has resulted in serious controversy, and some Western authors wonder whether these are distinct conditions with differing behaviours, whether patients are of a different type, and-from a surgical standpoint-which lymphadenectomy is oncologically most appropriate or which gastrointestinal reconstruction should be performed (13). Disease is probably the same in both the East and West, but Asian series indeed report patients with earlier stages and fewer comorbidities, whereas in Europe or the U.S. gastric cancer is diagnosed in more advanced stages, which confers a poorer prognosis (12). From a technical point of view there is no consensus regarding lymphadenectomy extent. While Asian teams support more extensive lymphadenectomies (D2 or D3), most Western groups prefer a more limited D1 dissection entailing a milder postoperative morbidity and lower mortality (12). The reasons for such differences stem from the fact that Japanese groups have reported better outcomes with extensive lymphadenectomy, whereas such results could not be reproduced in Europe or the U.S. (12,13). Thus, randomized studies performed in Europe by Cuschieri and Bonenkamp to compare D1 to D2 lymphadenectomy found that survival was not longer with the D2 approach, while patients treated this latter way did have greater morbidity and mortality (14-16). The possibility of treating gastric cancer laparoscopically adds a new dilemma to those existing: is it possible to reproduce using laparoscopy the same technique as Laparoscopic management of gastric cancer

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The Development of Laparoscopic Surgery in Spain

Cited by 7 publications

References 21 publications

Impact of a dedicated emergency surgical unit on early laparoscopic cholecystectomy for acute cholecystitis

Impact of a dedicated emergency surgical unit on early laparoscopic cholecystectomy for acute cholecystitis

‘Hot gall bladder service’ by emergency general surgeons

Laparoscopic management of gastric cancer

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