• OHCA
• aspiration
• insufflation
• resuscitation

• Colorectal surgery
• Laparoscopy
• Pneumoperitoneum
• Postoperative pain

• Humans
• Male
• Female
• Laparoscopy/methods
• Laparoscopy/adverse effects
• Aged
• Middle Aged
• Prospective Studies
• Pressure
• Length of Stay
• Postoperative Complications/etiology
• Cohort Studies
• Pain, Postoperative

• bibliometrics
• humans
• laparoscopy
• minimally invasive surgical procedures
• pneumoperitoneum
• pneumoperitoneum bibliometrics

• Intraabdominal pressure
• Laparoscopic colorectal surgery
• Meta-analysis
• Post-operative outcomes
• Systematic review

• Humans
• Abdomen/surgery
• Anastomotic Leak/etiology
• Colorectal Surgery/adverse effects
• Ileus/etiology
• Laparoscopy/adverse effects
• Length of Stay
• Operative Time
• Postoperative Complications/etiology
• Pressure
• Publication Bias
• Treatment Outcome

• AirSeal intelligent flow system
• Endoscopic thyroidectomy
• Gas insufflation thyroidectomy
• Minimally invasive thyroidectomy
• Total endoscopic thyroidectomy

• Kanae Foundation for the Promotion of Medical Science
• Yasuda Memorial Medical Foundation

• Clinical outcomes
• Laparoscopic cholecystectomy
• Low-pressure pneumoperitoneum
• Meta-analysis
• Pneumoperitoneum
• Standard-pressure pneumoperitoneum
• Systematic review

• Cholecystectomy, Laparoscopic/adverse effects
• Cholecystectomy, Laparoscopic/methods
• Humans
• Pain, Postoperative/etiology
• Pneumoperitoneum/etiology
• Pneumoperitoneum, Artificial/methods
• Randomized Controlled Trials as Topic

Laparoscopic surgery, a minimally invasive technique to treat abdominal conditions, has been shown to produce equivalent safety and efficacy with quicker return to normal function compared to open surgery. As such, it is widely accepted as a cost-effective alternative to open surgery for many abdominal conditions. However, access to laparoscopic surgery in rural North-East India is limited, in part due to limited equipment, unreliable supplies of CO₂ gas, lack of surgical expertise and a shortage of anaesthetists. We evaluate the cost-effectiveness of gasless laparoscopy as a means to increase provision of minimally invasive surgery (MIS) for abdominal conditions in rural North-East India. A decision tree model was developed to compare costs, evaluated from a patient perspective, and health outcomes, disability adjusted life years (DALYs), associated with gasless laparoscopy, conventional laparoscopy or open abdominal surgery in rural North-East India. Results indicate that MIS (performed by conventional or gasless laparoscopy) is less costly and produces better outcomes, fewer DALYs, than open surgery. These results were consistent even when gasless laparoscopy was analysed using least favourable data from the literature. Scaling up provision of MIS through increased access to gasless laparoscopy would reduce the cost burden to patients and increase DALYs averted. Based on a sample of 12 facilities in the North-East region, if scale up was achieved so that all essential surgeries amenable to laparoscopic surgery were performed as such (using conventional or gasless laparoscopy), 64% of DALYS related to these surgeries could be averted, equating to an additional 454.8 DALYs averted in these facilities alone. The results indicate that gasless laparoscopy is likely to be a cost-effective alternative to open surgery for abdominal conditions in rural North-East India and provides a possible bridge to the adoption of full laparoscopic services.

• Cost-Benefit Analysis
• Gastrointestinal Diseases
• Humans
• India
• Laparoscopy/methods
• Minimally Invasive Surgical Procedures

• 16/137/44 Department of Health
• National Institute for Health Research

Evidence suggests that the risk of recurrence and death in patients with early cervical cancer (ECC) undergoing minimally invasive surgery is significantly higher than that in patients undergoing open surgery. However, the mechanisms underlying such a difference remain unclear. Heart rate variability (HRV) represents autonomic nerve activity, which is related to tumorgenesis and can be used as a prognostic indicator for various cancers. The main purpose of this study was to explore the difference in the effects of laparoscopic and open surgery on HRV in ECC patients.

A total of 68 ECC (FIGO IA1 with lymphovascular space invasion -IIA2) patients undergoing radical hysterectomy for the first time (84% open group vs. 16% laparoscopic group) were included. A single-lead micro-ECG recorder was used to collect 5 min electrocardiograms 1 day before the operation and 3 days after the operation, and then HRV time domain and frequency domain indices were analyzed, including mean heart rate (MeanHR), maximum heart rate (MaxHR), minimum heart rate (MinHR), the standard deviation of all normal-to-normal intervals (SDNN), the root mean square of successive interval differences (RMSSD), very low-frequency power (VLF), low-frequency power (LF), high-frequency power (HF), total power (TP), and the ratio of LF to HF (LF/HF).

Heart rate (i.e., MeanHR, MaxHR, and MinHR) were significantly higher, and HRV (i.e., SDNN, RMSSD, LF, HF, and TP) were significantly lower after the operation than before the operation in both the laparoscopic and open groups (P < 0.05). The postoperative reduction in RMSSD and HF was significantly higher in the laparoscopic group than in the open group (P < 0.05).

These data suggest that radical hysterectomy can lead to increased heart rate and decreased HRV in patients with ECC, which can negatively affect cardiac autonomic regulation. Compared with open surgery, laparoscopic surgery has a greater negative impact on the HRV of ECC patients.

• autonomic nerve
• early cervical cancer
• heart rate variability
• laparoscopic surgery
• open surgery

This study aimed to observe the application and evaluate the feasibility and safety of indocyanine green (ICG) fluorescence technology in laparoscopic radical gastrectomy (LRG).

Patients who underwent LRG & D2 lymphadenectomy at Qilu Hospital of Shandong University were included between January 2018 and August 2019. According to whether endoscopic injection of ICG was performed, patients were assigned to the ICG group (n=107) and the control group (n=88). The clinicopathologic features, retrieved lymph nodes, postoperative recovery, and follow-up data were compared between the two groups.

Baseline characteristics are comparable. The ICG group had a significantly larger number of lymph nodes retrieved (49.55 ± 12.72 vs. 44.44 ± 10.20, P<0.05), shorter total operation time (min) (198.22 ± 13.14 vs. 202.50 ± 9.91, P<0.05), shorter dissection time (min) (90.90 ± 5.34 vs. 93.74 ± 5.35, P<0.05) and less blood loss (ml) (27.51 ± 12.83 vs. 32.02 ± 17.99, P<0.05). The median follow-up time was 29.0 months (range 1.5-43.8 months), and there was no significant difference between the ICG group and the control group in 2-year OS (87.8% vs. 82.9%, P>0.05) or DFS (86.0% vs. 80.7%, P>0.05).

ICG fluorescence technology in laparoscopic radical gastrectomy has advantages in LN dissection, operation time, and intraoperative blood loss. The 2-year OS and 2-year DFS rates between the two groups were comparable. In conclusion, ICG fluorescence technology is feasible and safe.

• Natural Science Foundation of Shandong Province

• Abdominal wall lift
• Clinical effectiveness
• Gasless laparoscopy
• General surgery
• Gynaecological surgery
• LMIC
• Low resource setting
• Open surgery
• Rural surgery

• Abdomen/surgery
• Female
• Gynecologic Surgical Procedures
• Humans
• Insufflation
• Laparoscopy
• Treatment Outcome

• Department of Health
• Programme Grants for Applied Research

• Acidosis
• Blood gases
• Insufflation gas
• Insufflation pressure
• Laparoscopy

Background: Malnutrition is a major health problem, which is common in hospitalized elderly patients and is associated with an increased risk of morbidity and mortality. However, studies on malnutrition and its effect on postoperative pain outcomes in elderly patients have been largely neglected. Here we investigated the relationship between nutritional risk and postoperative pain outcomes in elderly patients.

Methods: Between April 1, 2012, and August 31, 2015, 734 elderly patients (≥65 years) who underwent gastrointestinal surgeries were recruited and assigned into two groups according to geriatric nutritional risk index (GNRI). All patients received standard anesthesia procedures and postoperative patient-controlled analgesia for 48 h. The preoperative epidemiology data and postoperative outcome data including pain intensities at rest and movement, the cumulative consumption of analgesics and its common side effects were recorded.

Results: The total number of patients with high nutritional risk (GNRI < 92) was 533 out of 734 (72.62%). When compared with low nutritional risk individuals (GNRI ≥ 92), the incidence of inadequate analgesia was significantly higher in elderly patients with GNRI < 92 at different time points. In addition, the cumulative consumption of analgesics was also significantly higher in elderly patients with GNRI < 92 at 0–6 h postoperatively. Through logistic regression analysis, high nutritional risk (OR = 3.113, 95% CI: 1.661–5.834, P < 0.001) and female gender (OR = 0.606, 95% CI: 0.394–0.932, P = 0.023) were identified as significant predictors for postoperative inadequate analgesia. Further sensitivity analyses showed high nutritional risk as a predictor for postoperative inadequate analgesia was more prominent in female patients and early elderly patients. Moreover, 88 was determined as an optimal cut-off value of GNRI for postoperative inadequate analgesia using receiver operating characteristic curve analysis.

Conclusion: High nutritional risk is associated with poor postoperative pain outcomes in gastrointestinal elderly patients. Preoperative nutritional evaluation using simple nutritional screening instruments (e.g., GNRI) with the new suggested cut-off value (GNRI = 88) might be included as a standard procedure in routine clinical practice among these patients for postoperative analgesia.

• elderly patients
• gastrointestinal surgeries
• geriatric nutritional risk index
• postoperative inadequate analgesia
• postoperative pain

• Carbon dioxide pneumoperitoneum
• Gasless laparoscopic surgery
• Laparoendoscopic single-site surgery
• Laparoscopic cholecystectomy
• Randomized controlled trial

• Colored microspheres
• Continuous insufflation
• Randomized controlled trial
• Transanal total mesorectal excision

• interstitial lung disease
• laparoscopy
• postoperative complications

• Abdominal wall
• Efficiency
• Gasless laparoscopy
• Insufflation
• Laparotomy
• Minimally invasive surgery
• Pneumoperitoneum
• Safety

• Abdomen
• Anesthesia, General
• Humans
• Laparoscopy
• Pneumoperitoneum, Artificial
• Systematic Reviews as Topic
• United States

• Benign uterine disease
• hysterectomy
• laparoscopy
• low-pressure laparoscopy
• postoperative pain

• Abdominal trauma
• Algorithm
• Laparoscopy
• Laparotomy
• Polytrauma
• Severely injured

The benefits of lung-protective ventilation (LPV) with a low tidal volume (6 mL/kg of ideal body weight [IBW]), limited plateau pressure (< 28–30 cm H₂O), and appropriate positive end-expiratory pressure (PEEP) in patients with acute respiratory distress syndrome have become apparent and it is now widely adopted in intensive care units. Recently evidence for LPV in general anaesthesia has been accumulated, but it is not yet generally applied by anaesthesiologists in the operating room.

This study investigated the perception about intraoperative LPV among 82 anaesthesiologists through a questionnaire survey and identified the differences in ventilator settings according to recognition of lung-protective ventilation. Furthermore, we investigated the changes in the trend for using this form of ventilation during general anaesthesia in the past 10 years.

Anaesthesiologists who had received training in LPV were more knowledgeable about this approach. Anaesthesiologists with knowledge of the concept behind LPV strategies applied a lower tidal volume (median (IQR [range]), 8.2 (8.0–9.2 [7.1–10.3]) vs. 9.2 (9.1–10.1 [7.6–10.1]) mL/kg; p = 0.033) and used PEEP more frequently (69/72 [95.8%] vs. 5/8 [62.5%]; p = 0.012; odds ratio, 13.8 [2.19–86.9]) for laparoscopic surgery than did those without such knowledge. Anaesthesiologists who were able to answer a question related to LPV correctly (respondents who chose ‘height’ to a multiple choice question asking what variables should be considered most important in the initial setting of tidal volume) applied a lower tidal volume in cases of laparoscopic surgery and obese patients. There was an increase in the number of patients receiving LPV (V_T < 10 mL/kgIBW and PEEP ≥5 cm H₂O) between 2004 and 2014 (0/818 [0.0%] vs. 280/818 [34.2%]; p <  0.001).

Our study suggests that the knowledge of LPV is directly related to its implementation, and can explain the increase in LPV use in general anaesthesia. Further studies should assess the impact of using intraoperative LPV on clinical outcomes and should determine the efficacy of education on intraoperative LPV implementation.

The online version of this article (10.1186/s12871-018-0495-7) contains supplementary material, which is available to authorized users.

• Knowledge
• Lung-protective ventilation
• Mechanical ventilation
• Perioperative ventilation

To evaluate the safety and feasibility of a new technology combining low-pressure pneumoperitoneum (LPP) and abdominal wall lift (AWL) in laparoscopic total mesorectal excision (TME) for rectal cancer.

From November 2015 to July 2017, 26 patients underwent laparoscopic TME for rectal cancer using LPP (6-8 mmHg) with subcutaneous AWL in Qilu Hospital of Shandong University, Jinan, China. Clinical data regarding patients’ demographics, intraoperative monitoring indices, operation-related indices and pathological outcomes were prospectively collected.

Laparoscopic TME was performed in 26 cases (14 anterior resection and 12 abdominoperineal resection) successfully, without conversion to open or laparoscopic surgery with standard-pressure pneumoperitoneum. Intraoperative monitoring showed stable heart rate, blood pressure and paw airway pressure. The mean operative time was 194.29 ± 41.27 min (range: 125-270 min) and 200.41 ± 20.56 min (range: 170-230 min) for anterior resection and abdominoperineal resection, respectively. The mean number of lymph nodes harvested was 16.71 ± 5.06 (range: 7-27). There was no positive circumferential or distal resection margin. No local recurrence was observed during a median follow-up period of 11.96 ± 5.55 mo (range: 5-23 mo).

LPP combined with AWL is safe and feasible for laparoscopic TME. The technique can provide satisfactory exposure of the operative field and stable operative monitoring indices.

• Laparoscopic surgery
• Abdominal wall lift
• Low-pressure pneumoperitoneum
• Rectal cancer
• Total mesorectal excision

• Abdominal Wall/surgery
• Adult
• Aged
• Aged, 80 and over
• China
• Digestive System Surgical Procedures/adverse effects
• Digestive System Surgical Procedures/methods
• Feasibility Studies
• Female
• Follow-Up Studies
• Humans
• Intraoperative Complications/epidemiology
• Intraoperative Complications/etiology
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Lymph Node Excision/statistics & numerical data
• Male
• Margins of Excision
• Middle Aged
• Monitoring, Intraoperative
• Operative Time
• Pneumoperitoneum, Artificial/adverse effects
• Pneumoperitoneum, Artificial/methods
• Rectal Neoplasms/surgery
• Rectum/surgery

The incidence of gallstone increases with increasing age. No studies have been reported in the elderly population with laparoscopic cholecystectomy from developing nations. The aim of this study was to compare perioperative outcomes of laparoscopic cholecystectomy between the elderly (≥60 years old) and the young (<60 years old).

From July 2015 to June 2016, a retrospective review of medical records of 78 elderly patients (≥60 years old) and 164 young patients (<60 years old) who underwent laparoscopic cholecystectomy was done. The patients' demographics and perioperative outcomes were analyzed.

Median ages were 65 years (range: 60–80) and 45 years (range: 21–59) for the elderly group and the young group. The majority of patients were female (62.8 and 72%). There were no significant differences in the conversion rate (9 and 7.9%, P = 0.78), postoperative complications (17.9 and 14.6%, P = 0.50), and length of stay in the hospital (4 days for both groups, P = 0.35) between the two groups. There was no mortality in either of the groups.

Our results of laparoscopic cholecystectomy in elderly patients are comparable with those in young patients. Therefore, laparoscopic cholecystectomy is safe even in the elderly population.

• CR-POSSUM
• colorectal surgery
• mortality
• surgery in elderly

• Gallstones/diagnosis
• Gallstones/prevention & control
• Gallstones/therapy
• Humans
• Practice Guidelines as Topic

The safety and efficacy of laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer have been demonstrated in clinical studies. The aim of this study was to clarify the safety and efficacy of LADG in patients ≥80 years of age with early gastric cancer, an American Society of Anesthesiologists (ASA) classification of 1–2, and a performance status (PS) of 0–1.

From April 2009 to July 2011, 12 elderly patients aged ≥80 years and 43 younger patients underwent LADG for early gastric cancer. Seven of the 55 patients underwent LADG and simultaneous surgery including surgery for colorectal cancer, cholecystectomy, or other conditions. Forty-eight of the 55 patients who underwent only LADG were studied. Demographics and postoperative outcomes were compared.

The postoperative complication rate, time to first ambulation, time to first flatus, time to first fluid intake, and postoperative hospital stay were similar in these two groups. Nutritional status as assessed by body weight, serum albumin, and total protein at 1 and 3 months after surgery was also similar in these two groups.

Postoperative outcomes were acceptable in the elderly patients included in the study. LADG for early gastric cancer is a safe and effective treatment in elderly patients aged ≥80 years with an ASA status of 1–2 and PS of 0–1.

• Early gastric cancer
• Elderly patients
• LADG

• Clavien–Dindo classification
• Laparoscopic total gastrectomy
• Stomach neoplasm
• Surgical outcomes

• Aged
• Databases, Factual
• Female
• Gastrectomy/methods
• Humans
• Laparoscopy/methods
• Lymph Node Excision/methods
• Male
• Middle Aged
• Neoplasm Staging
• Operative Time
• Postoperative Complications/epidemiology
• Retrospective Studies
• Risk Factors
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Survival Rate
• Treatment Outcome

The advantages of laparoscopic adrenalectomy (LA) over open adrenalectomy are undeniable. Nevertheless, carbon dioxide (CO₂) pneumoperitoneum may have an unfavourable effect on the local immune response. The aim of this study was to compare changes in the systemic inflammation and immune response in the early post-operative (p.o.) period after LA performed with standard and low-pressure CO₂ pneumoperitoneum.

We studied, in a prospective randomised study, 51 patients consecutively with documented adrenal lesion who had undergone a LA: 26 using standard-pressure (12-14 mmHg) and 25 using low-pressure (6-8 mmHg) pneumoperitoneum. White blood cells (WBC), peripheral lymphocyte subpopulation, human leucocyte antigen-DR (HLA-DR), neutrophil elastase, interleukin (IL)-6 and IL-1, and C-reactive protein (CRP) were investigated.

Significantly higher concentrations of neutrophil elastase, IL-6 and IL-1 and CRP were detected p.o. in the standard-pressure group of patients in comparison with the low-pressure group (P < 0.05). A statistically significant change in HLA-DR expression was recorded p.o. at 24 h, as a reduction of this antigen expressed on the monocyte surface in patients from the standard group; no changes were noted in low-pressure group patients (P < 0.05).

This study demonstrated that reducing the pressure of the pneumoperitoneum to 6-8 mmHg during LA reduced p.o. inflammatory response and averted p.o. immunosuppression.

• Immune response
• laparoscopic adrenalectomy (LA)
• standard-pressure/low-pressure pneumoperitoneum

• Congenital heart disease
• Fundoplication
• Gastroesophageal reflux
• Gastrostomy

• Artificial pneumoperitoneum
• Gynecology
• Laparoscopy
• Pain
• Safety

• Female
• Gynecologic Surgical Procedures/methods
• Humans
• Insufflation/methods
• Laparoscopy/methods
• Pain, Postoperative/prevention & control
• Pressure

• Gynaecological laparoscopic surgery
• Trendelenburg
• cardiac enzymes
• liver enzymes

• Bowel
• CO2
• Clinical papers/trials/research
• Endoscopy
• Pneumoperitoneum

• Biliary Atresia/surgery
• Child Development
• Female
• Humans
• Infant
• Infant, Newborn
• Laparoscopy
• Liver Function Tests
• Male
• Pneumoperitoneum
• Portoenterostomy, Hepatic/methods
• Prospective Studies

• Applanation tonometry
• Hemodynamic changes
• Laparoscopic cholecystectomy

• Adnexal surgery
• elderly
• gynaecology
• laparoscopic hysterectomy
• safety