PubMed · 10167934
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S Hensley. 1997-06-09. Gallbladder technique set trend.. https://pubmed.ncbi.nlm.nih.gov/10167934/
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BACKGROUND: Although clinical pathways have become popular strategies to improve the quality of medication in the field of laparoscopic surgeries, their economical effectiveness is not well defined. The aim of this study was to investigate the effect of clinical pathways for laparoscopic surgeries on cost and length of hospital stay. METHODS: From January 2000 to June 2001, clinical pathways were introduced for laparoscopic surgeries, such as laparoscopic cholecystectomy (Lap. C, n = 210), laparoscopically assisted distal gastrectomy with Billroth-I reconstruction (Lap. B-I, n=33), and laparoscopically assisted colectomy (Lap. colon, n=34). We compared total lengths of hospital stay and the economical efficiency before and after pathway implementation at Wakayama Medical University Hospital. RESULTS: The length of hospital stay in Lap. C was shortened from 7.8+/-2.6 (mean+/-SD) days to 6.9+/-2.0 days (p = 0.03) and the total costs during hospitalization decreased from yen 509,320+/-58,800 to yen 489,130+/-43,860 (p=0.009), resulting in less burden for patients. At the same time, the daily costs were increased from yen 66,230+/-8920 to yen 70,840+/-6820 (p=0.0001), indicating that more efficient medical care was being given to patients. Similar results were obtained in Lap. B-I and Lap. colon groups. CONCLUSIONS: In our study, the implementation of clinical pathways in the field of laparoscopic surgeries produced significant decreases in length of total hospital stay and cost while maintaining the quality of patient outcomes.
BACKGROUND: Manipulating tissue with laparoscopic forceps is more difficult than using the hands. This study investigates the effectiveness of grasping and the duration of tissue-clamping using laparoscopic forceps. METHODS: Video recordings of 10 laparoscopic colectomies and 15 cholecystectomies were analyzed using time-action analysis. RESULTS: The results indicated that 62% of the grasping actions were successful: the tissue was clamped sufficiently to perform an action. Of all the clamping actions on the colon, 10% were repeated actions. On the gallbladder 7% were repeated actions. The bowel slipped out of the grasper in 7% of the clamping actions, whereas the gallbladder slipped in 17%. In 89%, the colon was clamped less than 1 min. The maximum clamping time for colon clamps was 7 min for the colon, and 55 min for the gallbladder. CONCLUSION: The low percentage of successful grasping actions indicates that the design of laparoscopic graspers is not optimal.
BACKGROUND: We previously evaluated the effects of pneumoperitoneum and patient position on hemodynamics during laparoscopic cholecystectomy and found that patient position had no effect on cardiac index (CI), stroke volume (SV), and left ventricular end diastolic volume (LVEDV). Analysis of that data showed that the hemodynamic depression associated with pneumoperitoneum was transient with values trending toward baseline during the operative period. The purpose of this study was to examine the duration of the adverse hemodynamic effects of pneumoperitoneum during laparoscopic cholecystectomy. METHODS: Thirty-eight patients undergoing laparoscopic cholecystectomy by a single surgeon were enrolled in the study. Hemodynamic data was collected via a transthoracic bioimpedance monitor. Baseline readings were taken prior to establishing pneumoperitoneum. Data was then collected continuously over the course of each case. Patients were compared to their baseline values. Data was analyzed every 5 min with the paired t-test used to determine statistical significance. RESULTS: All parameters were compared to baseline values. Baseline was defined as 5 min after the induction of anesthesia. With insufflation to 15 mmHg CO2, CI fell from a baseline value of 2.82 L/min/m2 to 2.66 L/min/m2 (p = 0.04), SV from 71.58 mL to 65.44 mL (p = 0.002), and LVEDV from 111.46 mL to 102.68 mL (p = 0.003). At 5 min, all values were further depressed. At 10 min all values were no longer significantly different from baseline. Values returned to baseline at 15 min and did not walver for the remainder of each case or the next 35 min. CONCLUSION: Patients undergoing laparoscopic cholecystectomy experience significant hemodynamic depression with pneumoperitoneum. These changes are short-lived and lose their statistical significance at 10 min from the time a patient undergoes pneumoperitoneum.