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Background Laparoscopic incisional and ventral hernia repair (LIVHR) is an alternative approach to conventional open incisional and ventral hernia repair (OIVHR). A consensus on outcomes of LIVHR when compared with OIVHR has not been reached. Methods As the basis for the present study, we performed a systematic review and meta-analysis of all randomized controlled trials comparing LIVHR and OIVHR. Results Eleven studies involving 1,003 patients were enrolled. The incidences of wound infection were significantly lower in the laparoscopic group than that in the open group (laparoscopic group 2.8 %, open group 16.2 %; RR = 0.19, 95 % CI 0.11–0.32; P  < 0.00001). The rates of wound drainage were significantly lower in the laparoscopic group than that in the open group (laparoscopic group 2.6 %, open group 67.0 %; RR = 0.06, 95 % CI 0.03–0.09; P  < 0.00001). However, the rates of bowel injury were significantly higher in the laparoscopic group than in the open group (laparoscopic group 4.3 %, open group 0.81 %; RR = 3.68, 95 % CI 1.56–8.67; P  = 0.003). There were no significant differences between the two groups in the incidences of hernia recurrence, postoperative seroma, hematoma, bowel obstruction, bleeding, and reoperation. Descriptive analyses showed a shorter length of hospital stay in the laparoscopic group. Conclusions Laparoscopic incisional and ventral hernia repair is a feasible and effective alternative to the open technique. It is associated with lower incidences of wound infection and shorter length of hospital stay. However, caution is required because it is associated with an increased risk of bowel injury compared with the open technique. Given the relatively short follow-up duration of trials included in the systematic review, trials with long-term follow-up are needed to compare the durability of laparoscopic and open repair.

Background Complete surgical resection is the mainstay of treatment for patients with adrenocortical cancer (ACC). Use of laparoscopy has been questioned in patients with ACC. This study compares the outcomes of patients undergoing laparoscopic versus open resection (OR) for ACC. Methods A retrospective review (2003–2008) of patients with ACC was performed. Data were collected for demographics, operative and pathologic data, adjuvant therapy, and outcome. Chi-square analysis was performed. Results Eighty-eight patients (66% women; median age, 47 (range, 18–81) years) were identified. Seventeen patients underwent laparoscopic adrenalectomy (LA). Median tumor size of those who underwent LA was 7.0 (range, 4–14) cm versus 12.3 (range, 5–27) cm for OR. Recurrent disease in the laparoscopic group occurred in 63% versus 65% in the open group. Mean time to first recurrence for those who underwent LA was 9.6 months (±14) versus 19.2 months (±37.5) in the open group ( p  < 0.005). Fifty percent of patients who underwent LA had positive margins or notation of intraoperative tumor spill versus 18% of those who underwent OR ( p  = 0.01). Local recurrence occurred in 25% of the laparoscopic group versus 20% in the open group ( p  = 0.23). Mean follow-up was 36.5 months (±43.6). Conclusions ACC continues to be a deadly disease, and little to no progress has been made from a treatment standpoint in the past 20 years. Careful and complete surgical resection is of the utmost importance. Although feasible in many cases and tempting, laparoscopic resection should not be attempted in patients with tumors suspicious for or known to be adrenocortical carcinoma.

Background Since its introduction, robotic surgery has been applied actively in several fields of minimally invasive surgery, and its use in the field of colorectal surgery is also increasing. In the studies to date, feasibility and safety have been the main focus, but the economics involved are important to examine. We compared the economics of robotic surgery with those of laparoscopic surgery for rectal cancer. Material and methods We analyzed the clinical characteristics, total hospital charges, payments, operating room costs, and hospital profits for patients who underwent robotic and laparoscopic resection of rectal cancer at Korea University Anam Hospital between July 2007 and August 2010. Results From July 2007 and August 2010, 154 robot-assisted and 150 laparoscopic rectal surgeries were performed. The patient demographics were similar in the two groups with the exception of tumor location (6.7 vs 8.7 cm distal to the anal verge; p  = 0.043), preoperative chemoradiotherapy (22.7 vs 8 %; p  = 0.001), and operative time (285.2 vs 219.7 min; p  = 0.018). Postoperative course and complications were also similar in the two groups. The total hospital charges in U.S. dollars ($14,647 vs $9,978; p  = 0.001) and payments made by patients ($11,540 vs $3,956; p  < 0.001) were significantly higher in the robotic group. Hospital profit was significantly lower in the robotic group than in the laparoscopic group ($689 vs $1,671; p  < 0.001). Conclusions Robot-assisted surgery is more expensive than laparoscopic surgery for rectal cancer. Considering that robotic surgery can be applied more easily for low-lying cancers, the cost-effectiveness of robotic rectal cancer surgery should be assessed based on oncologic outcomes and functional results from future studies.

Introduction Laparoscopic left lateral sectionectomy has been proven to be a safe and effective treatment for liver lesions. However, most of the literatures only reported this treatment method on benign lesion or colorectal metastases. The data on long-term outcome of laparoscopic left lateral section resection in patients with HCC and cirrhosis are still limited. The aim of this study is to analyze the survival outcome of laparoscopic left lateral sectionectomy when compared to open approach in patients with HCCs. Method Between January 2004 and September 2014, 967 patients had primary HCC with hepatectomy performed. Twenty-four patients had undergone pure laparoscopic left lateral sectionectomy for hepatocellular carcinoma (HCC). Twenty-nine patients with case-matched tumor characteristics and liver functions but received open left lateral sectionectomy for HCC were included for comparison. Results Comparing laparoscopic group to open resection group, the median operation time was 190.5 versus 195 min ( P  = 0.734); the median blood loss was 100 versus 300 ml ( P  < 0.001). Hospital stay was 5 days in laparoscopic group versus 6 days in the open group ( P  = 0.057). There was no difference between the two groups in terms of complications ( P  = 0.495). The median survival in laparoscopic group was >115 months versus >125 months in the open group ( P  = 0.853). Conclusion Laparoscopic left lateral sectionectomy for HCC is a safe and simple procedure associated with less blood loss. The survival outcome is comparable with conventional open approach. It is becoming a more favorable treatment option even for patients with HCC and cirrhosis.

Background The use of a robotic surgical system is claimed to allow precise traction and counter-traction, especially in a narrow pelvis. Whether this translates to improvement of the quality of the resected specimen is not yet clear. The aim of the study was to compare the quality of the TME and the short-term oncological outcome between robotic and laparoscopic rectal cancer resections. Methods 20 consecutive robotic TME performed in a single institution for rectal cancer (Rob group) were matched 1:2 to 40 laparoscopic resections (Lap group) for gender, body mass index (BMI), and distance from anal verge on rigid proctoscopy. The quality of TME was assessed by 2 blinded and independent pathologists and reported according to international standardized guidelines. Results Both samples were well matched for gender, BMI (median 25.9 vs. 24.2 kg/m 2 , p  = 0.24), and level of the tumor (4.1 vs. 4.8 cm, p  = 0.20). The quality of the TME was better in the Robotic group (complete TME: 95 vs. 55 %; p  = 0.0003, nearly complete TME 5 vs. 37 %; p  = 0.04, incomplete TME 0 vs. 8 %, p  = 0.09). A trend for lower positive circumferential margin was observed in the Robotic group (10 vs. 25 %, p  = 0.1). Conclusions These results suggest that robotic-assisted surgery improves the quality of TME for rectal cancer. Whether this translates to better oncological outcome needs to be further investigated.

Objective To compare outcomes of laparoscopic versus open hepatic resection (OHR) exclusively for hepatocellular carcinoma in terms of morbidity and cost. Background Laparoscopic hepatic resection (LHR) has become more prevalent with recent improvements in instrumentation and surgeon experience. Methods A review of multicenter, prospectively collected hepatobiliary databases from three institutions was performed from 12/1990 to 12/2009. Prospective evaluation of all patients undergoing hepatectomy for hepatocellular cancer was performed. Results A total of 354 patients who had resections for Hepatocellular carcinoma (HCC) were analyzed, 100 were performed laparoscopically. The two groups were similar in terms of demographics and comorbidities. Evaluation of outcomes showed significantly higher intraoperative estimated blood loss although postoperative transfusion rates were similar. The incidence of any complication (44 vs 44 %, p  = 0.23) and 90-day mortality (6 vs 6 %, p  = 0.8) were similar between the two groups, with a similar reoperation rate (4.0 vs. 2.4 %; p  = 0.9). Using Cox regression analysis, the laparoscopic approach had no effect on disease-free interval (OR 1.4, CI 0.31–6.3, p  = 0.66) or overall survival (HR 1.2, CI 0.59–2.5 p  = 0.6). Length of stay was significantly shorter in the laparoscopic group 6.2 vs. 9.3 days ( p  = 0.001). Adjusted operative charges ($41 vs. $39 k, p  = 0.601) and adjusted total hospital charges ($71 vs. $82 k, p  = 0.368) were similar in LHR versus OHR. Conclusion Our study confirms previous literature showing comparable perioperative outcomes and recurrence. We further show comparable cost with laparoscopic versus open liver resection for HCC.

Background Laparoscopic resection for gastric gastrointestinal stromal tumors (GISTs) is technically feasible, but the long-term effect remains uncertain. This study aims to compare the long-term oncologic outcomes of laparoscopic versus open resection of GISTs by larger cases based on tumor size–location-matched study. Methods Between 2006 and 2015, 63 consecutive patients with a primary gastric GIST undergoing laparoscopic resection were enrolled in and matched (1:1) to patients undergoing open resection by tumor size and location. Clinical and pathologic parameters and surgical outcomes associated with each surgical type were collected and compared. Results The operation time, intraoperative blood loss, return of bowel function and oral intake, nasogastric tube retention time and postoperative stay were all shorter/faster in laparoscopic group than those in open group ( P  < 0.001). Postoperative complications were comparable except for the higher incidence of abdominal/incision pain in open group (9.52 vs 27%, P  = 0.01). There was no statistical difference in recurrence rate (9.52 vs 15.87%, P  = 0.29) and long-term recurrence-free survival between the two groups ( P  = 0.39). Conclusions The long-term oncologic outcome of laparoscopic resection of primary gastric GISTs is comparable to that of open procedure, but laparoscopic procedure has the advantage of minimal invasion and is superior in postoperative recovery.

Background Laparoscopic surgery has become popular during the last decade, mainly because it is associated with fewer postoperative complications than the conventional open approach. It remains unclear, however, if this benefit is observed after laparoscopic correction of perforated peptic ulcer (PPU). The goal of the present study was to evaluate whether laparoscopic closure of a PPU is as safe as conventional open correction. Methods The study was based on a randomized controlled trial in which nine medical centers from the Netherlands participated. A total of 109 patients with symptoms of PPU and evidence of air under the diaphragm were scheduled to receive a PPU repair. After exclusion of 8 patients during the operation, outcomes were analyzed for laparotomy ( n  = 49) and for the laparoscopic procedure ( n  = 52). Results Operating time in the laparoscopy group was significantly longer than in the open group (75 min versus 50 min). Differences regarding postoperative dosage of opiates and the visual analog scale (VAS) for pain scoring system were in favor of the laparoscopic procedure. The VAS score on postoperative days 1, 3, and 7 was significant lower ( P  < 0.05) in the laparoscopic group. Complications were equally distributed. Hospital stay was also comparable: 6.5 days in the laparoscopic group versus 8.0 days in the open group ( P  = 0.235). Conclusions Laparoscopic repair of PPU is a safe procedure compared with open repair. The results considering postoperative pain favor the laparoscopic procedure.

Purpose The objective of the study was to evaluate peri- and postoperative outcomes, especially severe complications in adult incisional ventral hernia repair performed by open or laparoscopic surgery. Methods Adult patients who were operated for incisional ventral hernias in two tertiary hospitals in Finland during 2006–2012 were included in the study. Clinical data were collected from patient registers. Peri- and postoperative parameters were gathered and compared between open and laparoscopic groups. Postoperative complications were analyzed, and the focus was on major complications. Results The results of 818 hernioplasties were evaluated: 291 (36.3 %) open and 527 (63.7 %) laparoscopic operations. In the laparoscopic group, the number of patients with postoperative complications was slightly lower (18.4 vs. 23.4 %, p  = 0.090), and there were significantly fewer surgical site infections (3.2 vs. 8.6 %, p  = 0.001). Twelve major complications occurred. In the laparoscopic group, four of the five major complications were consequences of undetected enterotomies, leading to reoperations, longer hospital stays, and death of one patient. Major complications in the open group consisted of four cardiac infarctions and three septic surgical site infections. Complex adhesions had a significant influence on major complications, enterotomies, and surgical site infections. Laparoscopic operations had a lower mean blood loss (13 vs. 31.5 ml, p  = 0.028), and hospital stay (4 vs. 6 days, p  = 0.001) compared to open operations. Conclusions Laparoscopic incisional ventral hernia repair has a low rate of postoperative complications but it is associated with an increased risk of undetected enterotomies, in particular during cases involving adhesiolysis.

Background Case series suggest the feasibility and safety of emergency resection of colon cancer by laparoscopy. The present study compares short- and long-term outcomes of laparoscopic and open resection for colon cancers treated as emergencies. Methods The study was a propensity score-matched design based on a prospective database. From October 2006 to December 2011, emergency laparoscopic colon cancer resections were 1:2 propensity score-matched to open cases. Covariates for match-estimation were age, gender, American Society of Anesthesiologists grade, procedure type, tumor site, and reason for emergency surgery. Short-term outcomes included oncological quality surrogates (lymph node harvest and R stage), need for a stoma, length of hospital stay, and postoperative complications. For long-term outcomes, overall and recurrence-free survival rates were analyzed with Kaplan–Meier curves. Results During the study period, a total of 217 colon cancers were resected (181 open and 36 laparoscopic) as emergencies. The laparoscopic cases were matched to 72 open cases. Median follow-up was 3.6 [95 % confidence interval (CI) 2.3–4.3] years. The overall 3-year survival rate was 51 % (95 % CI 35–76) in the laparoscopic group versus 43 % (95 % CI 32–58) in the open group ( p  = 0.24). The 3-year recurrence-free survival rate in the laparoscopic group was 35 % (95 % CI 20–60) versus 37 % (95 % CI 27–50) in the open group (p = 0.53). Median lymph node harvest (17 vs. 13 nodes; p  = 0.041) and median length of hospital stay (7.5 vs. 11.0 days; p  = 0.019) favored laparoscopy. Conclusions Our data suggest that selective emergency laparoscopy for colon cancer is not inferior to open surgery with regard to short- and long-term outcomes. Laparoscopy resulted in a shorter length of hospital stay.