Comparison of iatrogenic splenectomy during open and laparoscopic colon resection.

Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
Surgical laparoscopy, endoscopy & percutaneous techniques (Impact Factor: 0.94). 11/2007; 17(5):385-7. DOI: 10.1097/SLE.0b013e3180dc93aa
Source: PubMed

ABSTRACT Iatrogenic splenic injury requiring splenectomy is a well-recognized and potentially serious complication of colon resection. Iatrogenic splenectomy is associated with significant morbidity and mortality, including bleeding and the postsplenectomy sepsis syndrome. Our study aims to compare the incidence of iatrogenic splenectomy in laparoscopic colon resection with that of open colon resection over an 11-year-period at Mount Sinai. A retrospective chart review of all patients undergoing colon resection at Mount Sinai Medical Center during the last 11 years was performed to identify patient demographics, procedure, indication, and outcome. There was a significant difference (P=0.03) in the incidence of iatrogenic splenectomy during open colectomy (13/5477, 0.24%) versus laparoscopic colectomy (0/1911, 0%). All cases complicated by iatrogenic splenectomy involved splenic flexure mobilization. Laparoscopy has many recognized advantages over open procedures, including shorter recovery and length of stay. This retrospective review of our experience at Mount Sinai presents another potential benefit of the laparoscopic approach to colon resection.

1 Follower
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: We present our experience in the design and development of a training program in laparoscopic radical prostatectomy, and the validation of the first steps of the program by objective measurement of the attendants' skills improvement and subjective evaluation of its contents. Material and methods: Our training model on Laparoscopic Radical Prostatectomy has a total duration of 42 hours, divided in two modules of 21 hours each, carried out 1 month apart. Data included in the present study was obtained from the first module of our Course. It begins with acquisition of basic knowledge in ergonomics and instrument concepts, after which the attendants develop essential laparoscopic dexterities through the performance of hands-on physical simulator tasks. During the second and third day urologists performed urethrovesical anastomoses also in physical simulator. Attendants' skills improvement was measured during the first module by registering surgical times and suturing quality of the anastomoses, the latter by means of a leak test. At the end of the training program, a subjective evaluation questionnaire on the different didactic and organizational aspects was handed out to the attendants. Results: By comparing first and last anastomoses, we observed a significant decrease in surgical times (minutes) (T1 40.1±4.6 vs T6 24.01±3.34; p≤0.005) and an increase in intraluminal leak pressure (mmHg) (T1 8.27±7.33 vs T6 21.09±6.72; p≤0.005). We obtained a highly positive score on all questions concerning the different topics and techniques included in the training program (≥9 points over 10). Regarding the attendants' self assessment of acquired abilities, 78.3% considered themselves capacitated to perform the trained procedures on live patients. Conclusions: Training obtained during the first module of our training model significantly decreased performance times for ex vivo urethrovesical anastomosis, simultaneously increasing its quality. In addition, validation of the training model was also demonstrated by the highly scored evaluation resulting from the attendants' assessment.
    Journal of endourology / Endourological Society 03/2014; DOI:10.1089/end.2014.0050 · 2.10 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Nearly half of all incidental splenectomies caused by iatrogenic splenic injury occur during colorectal surgery. This study evaluates factors associated with incidental splenic procedures during colorectal surgery and their impact on short-term outcomes using a nationwide database. Methods Patients who underwent colorectal resections between 2005 and 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Program database according to Current Procedural Terminology codes. Patients were classified into two groups based on whether they underwent a concurrent incidental splenic procedure at the time of the colorectal procedure. All splenic procedures except a preoperatively intended splenectomy performed in conjunction with colon or rectal resections were considered as incidental. Perioperative and short-term (30 day) outcomes were compared between the groups. Results In total, 93633 patients who underwent colon and/or rectal resection were identified. Among these, 215 patients had incidental splenic procedures (153 open splenectomy, 17 laparoscopic splenectomy, 36 splenorraphy, and 9 partial splenectomy). Open colorectal resections were associated with a significantly increased likelihood of incidental splenic procedures (OR 6.58, p p p = 0.02), transfusion requirement (OR: 3.84, p p = 0.005), and sepsis (OR: 2.03, p = 0.001). Short-term advantages of splenic salvage (splenorraphy or partial splenectomy) included shorter length of total hospital stay (p = 0.001) and decreased need for re-operation (p Conclusions Incidental splenic procedures during colorectal resections are associated with worse short-term outcomes. Use of the laparoscopic technique decreases the need for incidental splenic procedures.
    Surgical Endoscopy 08/2014; DOI:10.1007/s00464-014-3774-5 · 3.31 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: : The first aim of this study is to analyze the muscle activity in back and forearm muscles in surgeons during laparoscopic dissection and suturing maneuvers. The second aim is to determine the influence of the surgeons' previous experience in laparoscopic surgery. : A total of 30 laparoscopic surgeons were divided in 3 groups: novice suturing, novice dissecting, and experts suturing. Electromyography data were collected from the trapezius, forearm flexors, and forearm extensors muscles, during the proposed tasks on physical simulator. : Muscle activity was significantly lower in the expert group. Moreover, muscle activity in the trapezius was significantly higher during the completion of intracorporeal suturing when compared with that during dissection. : Results obtained in this study show that the surgeons with a higher degree of laparoscopic experience exhibit a lower level of muscle activity when compared with the novice surgeons. Moreover, in accordance to our results, laparoscopic suturing involves a higher degree of muscle effort than during laparoscopic dissection.
    Surgical laparoscopy, endoscopy & percutaneous techniques 04/2013; 23(2):203-7. DOI:10.1097/SLE.0b013e3182827f30 · 0.94 Impact Factor