• artifical intelligence
• colon capsule endoscopy
• colorectal cancer
• computed tomographic colonography
• microsatellite instability

• Colon cancer
• Facility type
• Surgical outcomes

• Humans
• Colonic Neoplasms/surgery
• Colonic Neoplasms/mortality
• Colonic Neoplasms/pathology
• Female
• Male
• Aged
• Retrospective Studies
• Databases, Factual
• Middle Aged
• United States/epidemiology
• Colectomy/methods
• Colectomy/statistics & numerical data
• Laparoscopy/statistics & numerical data
• Patient Readmission/statistics & numerical data
• Treatment Outcome
• Conversion to Open Surgery/statistics & numerical data
• Survival Rate
• Robotic Surgical Procedures/statistics & numerical data
• Cancer Care Facilities/statistics & numerical data
• Aged, 80 and over

• Colon cancer
• Conversion
• Impact
• Minimally Invasive colectomy
• Open colectomy
• Predictors

• Humans
• Colectomy/methods
• Colonic Neoplasms/surgery
• Colonic Neoplasms/mortality
• Aged
• Male
• Female
• Laparoscopy/methods
• Middle Aged
• Robotic Surgical Procedures/methods
• Conversion to Open Surgery/statistics & numerical data
• Case-Control Studies
• Artificial Intelligence
• Risk Factors
• Minimally Invasive Surgical Procedures/methods
• Treatment Outcome
• Neoplasm Staging
• Length of Stay/statistics & numerical data

• colon cancer
• laparoscopic surgery
• outcomes
• robotic surgery
• surgery

Laparoscopic colorectal surgeries offer numerous advantages over their open counterparts. To compare these measurable short-time outcomes of open and laparoscopic resections in Hungary, data of colorectal surgeries were collected and analysed. The study focused on identifying patients’ characteristics that can influence the decision on laparoscopic colorectal resections and on comparing efficiency of Hungarian colorectal operations with international data.

Using patients’ data of laparoscopic and open colorectal surgery performed in 2015 and 2016 from the National Health Insurance Fund of Hungary, a countrywide retrospective comparative analysis was done. Logistic regression was used to explore main influencing factors for laparoscopic colorectal surgery.

A total of 17,876 colorectal surgical cases, including 14,876 open and 3,000 laparoscopic resections were selected and analysed. Laparoscopy was used only in 16.78% of all cases. Comparison of age groups showed that odds ratio (OR) of laparoscopic colorectal resections was significantly lower in over 40 years than in younger patients (18–39 years). In university institutes patients had higher odds (OR: 2.23 p<0.0001) for laparoscopic colorectal resections. Presence of comorbidity codes and preoperative treatment in internal medicine department decreased odds for laparoscopic colorectal operations.

Patients’ age, comorbidities and hospital type influenced the likelihood of decision on laparoscopic colorectal resection. Selection of patients contributed to improved laparoscopic outcomes.

• Cancer stage
• Colorectal cancer
• Laparoscopy
• Open surgery
• Outcome

• Colon/surgery
• Humans
• Laparoscopy
• Rectal Neoplasms/surgery
• Rectum/surgery
• Treatment Outcome

• Conversion surgery
• Laparoscopic splenectomy
• Propensity score matching
• Spleen volume
• Splenic hilum hanging maneuver

• Meta-analysis
• Natural orifice specimen extraction
• Oncological outcomes
• Postoperative recovery
• Sigmoid and rectal cancer
• Totally intra-abdominal laparoscopic surgery

• Black or African American
• Aged
• Female
• Healthcare Disparities/economics
• Hospitalization/economics
• Humans
• Male
• Medicaid
• Medically Uninsured
• Middle Aged
• Myocardial Infarction/economics
• Myocardial Infarction/epidemiology
• Myocardial Infarction/surgery
• Myocardial Revascularization/economics
• Myocardial Revascularization/methods
• Non-ST Elevated Myocardial Infarction/economics
• Non-ST Elevated Myocardial Infarction/epidemiology
• Non-ST Elevated Myocardial Infarction/surgery
• Percutaneous Coronary Intervention/economics
• Poverty
• Retrospective Studies
• Risk Factors
• ST Elevation Myocardial Infarction/economics
• ST Elevation Myocardial Infarction/epidemiology
• ST Elevation Myocardial Infarction/surgery
• United States/epidemiology
• White People

• R01 MD012422 NIMHD NIH HHS
• National Institutes of Health

Minimally invasive surgery (MIS) has profoundly changed standards of care and lowered perioperative morbidity, but its temporal implementation and factors favoring MIS access remain elusive. We aimed to comprehensibly investigate MIS adoption across different surgical procedures over 20 years, identify predictors for MIS amenability and compare propensity score-matched outcomes among MIS and open surgery.

Nationwide retrospective analysis of all hospitalizations in Switzerland between 1998 and 2017. Appendectomies (n = 186,929), cholecystectomies (n = 57,788), oncological right (n = 9138) and left hemicolectomies (n = 21,580), rectal resections (n = 13,989) and gastrectomies for carcinoma (n = 6606) were included. Endpoints were assessment of temporal MIS implementation, identification of predictors for MIS access and comparison of propensity score-matched outcomes among MIS and open surgery.

The rates of MIS increased for all procedures during the study period (p ≤ 0.001). While half of all appendectomies were performed laparoscopically by 2005, minimally invasive oncological colorectal resections reached 50% only by 2016. Multivariate analyses identified older age (p ≤ 0.02, except gastrectomy), higher comorbidities (p ≤ 0.001, except rectal resections), lack of private insurance (p ≤ 0.01) as well as rural residence (p ≤ 0.01) with impaired access to MIS. Rural residence correlated with low income regions (p ≤ 0.001), which themselves were associated with decreased MIS access. Geographical mapping confirmed strong disparities for rural and low-income areas in MIS access. Matched outcome analyses revealed benefits of MIS for length of stay, decreased surgical site infection rates for MIS appendectomies and cholecystectomies and higher mortality for open cholecystectomies. No consistent morbidity or mortality benefit for MIS compared to open colorectal resections was observed.

Unequal access to MIS exists in disfavor of older and more comorbid patients and those lacking private insurance, living in rural areas, and having lower income. Efforts should be made to ensure equal MIS access regardless of socioeconomic or geographical factors.

The online version of this article (10.1007/s00464-020-08123-0) contains supplementary material, which is available to authorized users.

• Appendectomy
• Cholecystectomy
• Colectomy
• Gastrectomy
• Laparoscopy
• Minimally invasive surgery
• Outcomes
• Rectal resection
• Robotic surgery

• Anti-Bacterial Agents
• Colon
• Digestive System Surgical Procedures
• Humans
• Single-Blind Method
• Surgical Wound Infection

• Colectomy
• Conversion
• Laparoscopic
• Open

• Aged
• Aged, 80 and over
• Anastomosis, Surgical/methods
• Colectomy/methods
• Colon, Transverse/surgery
• Colonic Neoplasms/diagnosis
• Colonic Neoplasms/surgery
• Female
• Humans
• Incidence
• Italy/epidemiology
• Laparoscopy/methods
• Male
• Middle Aged
• Neoplasm Staging
• Operative Time
• Postoperative Complications/epidemiology
• Propensity Score
• Retrospective Studies
• Survival Rate/trends
• Treatment Outcome

Laparoscopic surgery has become the standard of care for the most common surgical procedures performed. However, laparoscopic techniques have not reached this same penetrance in colorectal surgery. We wanted to determine the percentage of colon operations performed in Texas that were done via laparoscopic, robotic and open techniques.

The Texas Inpatient Public Use Data File (PUDF) was queried using ICD-9-CM diagnostic and procedure codes to determine overall utilization of laparoscopic colectomies (LC) in Texas between 2013-14 for reporting facilities. We specifically looked at cost and the length of stay for LC, open colectomy (OC) and robotic assisted colectomy (RAC).

In the state of Texas between 2013-14 there were 20,454 colectomies performed. Of these 12,328 (60.3%) were OC, 7,536 (36.8%) were LC, and 590 (3.9%) were RAC. Average total cost was $117,113 for OC, $75,741.9 for LC, and $81,996.2 for RAC. Average length of stay for each technique was 10.6 days for OC, 6.1 days for LC, and 5.1 days for RAC. The risk of a postoperative complication occurring was higher in the open procedure than a laparoscopic procedure.

LC accounted for only 36.8% of all colectomies performed in Texas between 2013-14. OC costs twice as much as LC and increased the length of stay by nearly 4 d. LC and RAC are both associated with significantly less cost and length of stay for patients undergoing surgery, while lowering perioperative complications.

None of the authors have any relevant disclosures.

• laparoscopic colectomy
• robotic colectomy
• trends in surgery

Nowadays laparoscopic right hemicolectomy is widely accepted as the standard of care for benign and malignant colon disease. There are wide variations among laparoscopic techniques. One of the most discussed topics is the ileocolic anastomosis. There are two different techniques: intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA).

To compare short-term outcomes of performing intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy.

A retrospective chart review was performed of 92 consecutive patients who underwent laparoscopic right hemicolectomy, with either an IA or EA, from January 2013 to December 2016.

Eighty-five patients were included in the analysis. There were 53 males and 32 females with a mean age of 67.1 ±13.2 years. Mean body mass index (BMI) was 27.7 ±4.8 kg/m². An intracorporeal anastomosis was performed in 51 patients, while an extracorporeal anastomosis was performed in 34. The duration of operations was significantly longer when intracorporeal anastomosis was performed, taking 154 ±58 min compared to 95 ±34 min (p < 0.001), in the extracorporeal group. No mortality was observed in the IA group. The postoperative mortality in the EA group was 8.8% (p = 0.060). The rate of reoperation in the intracorporeal anastomosis group was 7.8%, whereas in the extracorporeal anastomosis group it was 14.7% (p = 0.474). Length of hospital stay in the IA group was shorter in comparison to the EA group (5.3 ±3.7 vs. 11.2 ±19.8 days, p = 0.022).

Our results are encouraging to consider the intracorporeal approach as the better way to fashion the anastomosis after laparoscopic right hemicolectomy.

• anastomosis
• complications
• extracorporeal
• intracorporeal
• laparoscopic right hemicolectomy
• outcomes

• Laparoscopy
• colon cancer
• complications
• healthcare utilization
• survival

• Adult
• Aged
• Colectomy/adverse effects
• Colectomy/methods
• Colectomy/statistics & numerical data
• Colonic Neoplasms/mortality
• Colonic Neoplasms/surgery
• Female
• Hospitalization/statistics & numerical data
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Laparoscopy/statistics & numerical data
• Male
• Middle Aged
• Patient Acceptance of Health Care/statistics & numerical data
• Postoperative Complications/epidemiology
• Postoperative Complications/prevention & control
• Propensity Score
• Quality of Health Care
• Retrospective Studies
• Survival Analysis
• Taiwan/epidemiology
• Treatment Outcome

• Colectomy
• Colorectal
• Conversion
• Laparoscopic
• Robotic

• Acute Kidney Injury/etiology
• Aged
• Colonic Diseases/surgery
• Conversion to Open Surgery/adverse effects
• Conversion to Open Surgery/mortality
• Databases, Factual
• Digestive System Surgical Procedures/adverse effects
• Digestive System Surgical Procedures/methods
• Female
• Heart Diseases/etiology
• Humans
• Ileus/etiology
• Length of Stay/statistics & numerical data
• Male
• Middle Aged
• Operative Time
• Propensity Score
• Rectal Diseases/surgery
• Reoperation/statistics & numerical data
• Retrospective Studies
• Robotic Surgical Procedures/adverse effects
• Robotic Surgical Procedures/mortality
• Surgical Wound Infection/etiology
• Venous Thrombosis/etiology

• Best practice
• Colon cancer
• Delphi methodology
• Laparoscopy
• Mini-invasive surgery

• Colectomy/standards
• Colonic Neoplasms/surgery
• Delphi Technique
• Humans
• Laparoscopy/standards
• Quality Assurance, Health Care

• cost
• enhanced recovery
• laparoscopy
• rectal surgery

• Anastomosis
• Extracorporeal
• Intracorporeal
• Laparoscopic
• Recovery
• Right colectomy
• Right hemicolectomy

• Anastomosis, Surgical/methods
• Colectomy
• Humans
• Laparoscopy
• Recovery of Function
• Treatment Outcome

Implementation of the laparoscopic approach in colorectal surgery has not happened as rapidly as in cholecystectomy, because of concerns about oncological safety. The results of controlled trials in multiple centers showed the method to be safe. Consequently, surgeons decided to try the approach with colorectal surgery. This process, in our clinic, began in earnest about four years ago.

To analyze and present the clinical outcomes of applying the laparoscopic approach to colorectal surgery in a single center.

We retrospectively identified patients from a hospital database who underwent colorectal surgery – laparoscopic and open – between 2013 and 2016. Our focus was on laparoscopic cases. Study points included operative time, duration of the hospital stay, postoperative mortality and rates of complications, conversion, reoperation and readmission.

Of 534 cases considered, the results showed that the relation between open and laparoscopic procedures had reversed, in favor of the latter method (2013: open: 82% vs. laparoscopic: 18%; 2016: open: 22.4% vs. laparoscopic: 77.6%). The most commonly performed procedure was right hemicolectomy. The total complication rate was 22%. The total rate of conversion to open surgery was 9.3%. The postoperative mortality rate was 3%.

Use of the laparoscopic approach in colorectal surgery has increased in recent years world-wide – including in Poland – but the technique is still underused. Rapid implementation of the miniinvasive method in colorectal surgery, in centers with previous laparoscopic experience, is not only safe and feasible, but also highly recommended.

• colorectal surgery
• implementation
• laparoscopy
• miniinvasive surgery
• outcomes

• comparative effectiveness research
• cost
• laparoscopic surgery
• open surgery
• rectal cancer
• robotic surgery

• cost
• discharge destination
• laparoscopic colectomy
• length of stay
• readmissions

• Adhesive small bowel obstruction
• Admitting service
• Health services research
• Primary service

• Abdominal Cavity/physiopathology
• Abdominal Cavity/surgery
• Digestive System Surgical Procedures/adverse effects
• Digestive System Surgical Procedures/methods
• Disease Management
• Female
• Follow-Up Studies
• Health Care Surveys
• Humans
• Intestinal Obstruction/diagnostic imaging
• Intestinal Obstruction/etiology
• Intestinal Obstruction/surgery
• Intestine, Small/diagnostic imaging
• Intestine, Small/surgery
• Length of Stay
• Male
• Recovery of Function
• Reoperation/methods
• Risk Assessment
• Severity of Illness Index
• Tissue Adhesions/diagnostic imaging
• Tissue Adhesions/etiology
• Tissue Adhesions/surgery
• Tomography, X-Ray Computed/methods
• Treatment Outcome

• colon cancer
• disparity
• geographic variation
• hospital size
• laparoscopic resection utilization
• multilevel analysis
• seer-medicare

• Ascites
• Colon cancer
• Liver disease
• Partial colectomy

• Adult
• Aged
• Aged, 80 and over
• Ascites/complications
• Colectomy/methods
• Colonic Neoplasms/complications
• Colonic Neoplasms/surgery
• Databases, Factual
• Female
• Humans
• Laparoscopy
• Length of Stay/statistics & numerical data
• Linear Models
• Liver Diseases/complications
• Logistic Models
• Male
• Middle Aged
• Odds Ratio
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Postoperative Complications/prevention & control
• Retrospective Studies
• Risk Factors
• Treatment Outcome

• Incisional hernia
• Intracorporeal anastomosis
• Laparoscopy
• Propensity score matching
• Right colectomy

• Colorectal Neoplasms/epidemiology
• Colorectal Neoplasms/history
• Colorectal Neoplasms/mortality
• Colorectal Neoplasms/surgery
• Databases, Factual
• Female
• Health Care Surveys
• History, 21st Century
• Humans
• Incidence
• Inpatients
• Male
• Mortality
• Risk Factors
• Socioeconomic Factors
• Treatment Outcome
• United States

• Colon cancer
• Laparoscopic surgery
• Length-of-stay
• Morbidity
• Mortality
• Observational multicenter study
• Short-term outcome

• laparoscopic colectomy
• open colectomy
• transverse colon cancer

• colon and rectal surgery
• minimally invasive surgery
• previous abdominal surgery
• reoperative

• Colectomy
• Colonic neoplasms
• Laparoscopy
• Minimally invasive surgical procedures

• Complete mesocolic excision
• Intracorporeal anastomosis
• Learning curve
• Minimally invasive colorectal surgery
• Robotic right colectomy

There is limited data regarding the outcomes of patients who undergo conversion to open surgery during a laparoscopic operation in colorectal resection. We sought to identify the outcomes of such patients.

The NIS (National Inpatient Sample) database was used to identify patients who had conversion from laparoscopic to open colorectal surgery during the 2009 to 2012 period. Multivariate regression analysis was performed to identify risk-adjusted outcomes of conversion to open surgery.

We sampled 776 007 patients who underwent colorectal resection. 337 732 (43.5%) of the patients had laparoscopic resection. Of these, 48 265 procedures (14.3%) were converted to open surgery. The mortality of converted patients was increased, when compared with successfully completed laparoscopic operations, but was still lower than that of open procedures (0.6% vs. 1.4% vs. 3.9%, respectively; adjusted odds ratio [AOR], 1.61 and 0.58, respectively; P < .01). The most common laparoscopic colorectal procedure was right colectomy (41.2%). The lowest rate of conversion is seen with right colectomy while proctectomy had the highest rate of conversion (31.2% vs. 12.9%, AOR, 2.81, P < .01). Postsurgical complications including intra-abdominal abscess (AOR, 2.64), prolonged ileus (AOR, 1.50), and wound infection (AOR, 2.38) were higher in procedures requiring conversion (P < .01).

Conversion of laparoscopic to open colorectal resection occurs in 14.3% of cases. Compared with patients who had laparoscopic operations, patients who had conversion to open surgery had a higher mortality, higher overall morbidity, longer length of hospitalization, and increased hospital charges. The lowest conversion rate was in right colectomy and the highest was in proctectomy procedures. Wound infection in converted procedures is higher than in laparoscopic and open procedures.

• Colorectal resection
• Conversion
• Laparoscopic surgery

Laparoscopic splenectomy (LS) has been shown to offer superior outcomes when compared to open splenectomy (OS). Despite the potential advantages associated with the minimally invasive technique, laparoscopy appears to be underused. We sought to evaluate the nationwide trends in LS.

The Nationwide Inpatient Sample (NIS) database was queried for both OS and LS procedures performed from 2005 through 2010. Partial splenectomies and those performed for traumatic injury, vascular anomaly, or as part of a pancreatectomy were excluded. The included cases were examined for age of the patient and comorbid conditions. We then evaluated the postoperative complications, overall morbidity, mortality, and length of hospital stay.

A total of 37,006 splenectomies were identified. Of those, OS accounted for 30,108 (81.4%) cases, LS for 4,938 (13.3%), and conversion to open surgery (CS) for 1,960 (5.3%). The overall rate of morbidity was significantly less in the LS group than in the OS group (7.4% vs 10.4%; P < .0001). The LS group had less mortality (1.3% vs 2.5%, P < .05) and a shorter length of stay (5.6 ± 8 days vs 7.5 ± 9 days).

Despite the benefits conferred by LS, it appears to be underused in the United States. There has been an improvement in the rate of splenectomies completed laparoscopically when compared to NIS data from the past (8.8% vs 13%; P < .05). The conversion rate is appreciably higher for LS than for other laparoscopic procedures, suggesting that splenectomies require advanced laparoscopic skills and that consideration should be given to referring patients in need of the procedure to appropriately experienced surgeons.

• Conversion to open
• Laparoscopy
• NIS database
• Splenectomy

The introduction of laparoscopy is an example of surgical innovation with a rapid implementation in many areas of surgery. A large number of controlled studies and meta-analyses have shown that laparoscopic colorectal surgery is associated with the same benefits than other minimally invasive procedures, including lesser pain, earlier recovery of bowel transit and shorter hospital stay. On the other hand, despite initial concerns about oncological safety, well-designed prospective randomized multicentre trials have demonstrated that oncological outcomes of laparoscopy and open surgery are similar. Although the use of laparoscopy in colorectal surgery has increased in recent years, the percentages of patients treated with surgery using minimally invasive techniques are still reduced and there are also substantial differences among centres. It has been argued that the limiting factor for the use of laparoscopic procedures is the number of surgeons with adequate skills to perform a laparoscopic colectomy rather than the tumour of patients’ characteristics. In this regard, future efforts to increase the use of laparoscopic techniques in colorectal surgery will necessarily require more efforts in teaching surgeons. We here present a review of recent controversies of the use of laparoscopy in colorectal surgery, such as in rectal cancer operations, the possibility of reproducing complete mesocolon excision, and the benefits of intra-corporeal anastomosis after right hemicolectomy. We also describe the results of latest innovations such as single incision laparoscopic surgery, robotic surgery and natural orifice transluminal endoscopic surgery for colon and rectal diseases.

• Laparoscopy
• Inflammatory bowel disease
• Surgical innovations
• Colorectal cancer
• Single incision laparoscopic surgery
• Robotic surgery
• Natural orifice transluminal endoscopic surgery

• Colectomy/adverse effects
• Colectomy/methods
• Colon/surgery
• Diffusion of Innovation
• Humans
• Laparoscopy/adverse effects
• Postoperative Complications/etiology
• Rectum/surgery
• Treatment Outcome

• Colectomy
• Elderly
• Laparoscopic
• National Surgical Quality Improvement Program
• Outcomes

• Age Factors
• Aged
• Aged, 80 and over
• Chi-Square Distribution
• Colectomy/adverse effects
• Colectomy/methods
• Colectomy/mortality
• Databases, Factual
• Female
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/mortality
• Length of Stay
• Male
• Odds Ratio
• Postoperative Complications
• Propensity Score
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome
• United States