Reimbursement for endoscopic innovations: the final hurdle

After the introduction of the cardiomyotomy by Dr Ernst Heller in 1913 for treating achalasia, surgeons have pursued a variety of different approaches to performing the procedure: transabdominal, transthoracic, thoracoscopic, and laparoscopic. But from the outset, the essence of the operation has remained the same: a longitudinal division of the lower esophageal sphincter. When the operation evolved to a per-oral endoscopic myotomy (POEM) in 2008, it was regarded as simply another iteration of Dr Heller ’s operation but by a less invasive route.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Original article Source Type: research

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AbstractBackgroundFew studies had been performed to concern the outcomes of pure laparoscopic Glissonian pedicle approach hepatectomy (LGAH) for hepatocellular carcinoma (HCC). The aim of this study was to compare the outcomes of LGAH versus open Glissonian pedicle approach hepatectomy (OGAH) for HCC, especially in patients with cirrhosis.MethodsHepatocellular carcinoma patients who underwent pure LGAH and OGAH between January 2015 and July 2017 in our institution were retrospectively enrolled in this study. Propensity score matching (PSM) of patients in a ratio of 1:1 was conducted to adjust the known confounders. The per...
Source: Surgical Endoscopy - Category: Surgery Source Type: research
ConclusionsICG-FI was associated with significantly lower odds of AL in laparoscopic LAR for rectal cancer.Clinical trialThe study was registered with the Japanese Clinical Trials Registry as UMIN000032654.
Source: Surgical Endoscopy - Category: Surgery Source Type: research
ConclusionShort-term outcomes of minimally invasive Ivor Lewis using thoracoscopy, prone position and two-lung ventilation are at least equivalent to the hybrid approach. Anastomotic leak after MIE-PP remains a major concern.
Source: Surgical Endoscopy - Category: Surgery Source Type: research
AbstractBackgroundThe aim of this study was to investigate the short- and long-term outcomes after elective laparoscopic surgery (LPS) for colorectal cancer patients over 80  years of age.MethodsThis was a retrospective study of all patients of 80 and above, who underwent elective colorectal resection, between January 2007 and January 2016. Data were analysed from a prospectively collected cancer database and cross checked with patient records. Determinants of survival were analysed using log-rank test and Kaplan –Meier curves.ResultsWe identified 293 patients; 110 underwent LPS. LPS had significantly better ove...
Source: Surgical Endoscopy - Category: Surgery Source Type: research
AbstractBackgroundWork-related pain and discomfort experienced by surgeons is widely reported in the literature. A survey was, therefore, conducted to explore this issue among members of the European Association for Endoscopic Surgery (EAES).MethodsThe survey was emailed to 2980 EAES members in 2017 enquiring about their working practice, musculoskeletal (MSK) pain and burnout.ResultsA total of 569 (19%) surgeons responded, of whom 556 were practicing surgeons; 86% were consultants, 84% were male, and 94% were right-handed. Respondents operated on average 3.3  days/week with 27% of their procedures lasting longer than...
Source: Surgical Endoscopy - Category: Surgery Source Type: research
ConclusionsThe single strategy using SI alone is as effective as the combined strategy of SI and RM for removing residual carbon dioxide and consequently preventing PLSP. Therefore, considering the potential risks of pulmonary or hemodynamic complications associated with RM, the single strategy using SI alone might be a better choice than the combined strategy.
Source: Surgical Endoscopy - Category: Surgery Source Type: research
ConclusionSynchronous VHR and BS in a bariatric unit is feasible with low recurrence rate. Laparoscopic VHR has lower complication rates than open, apart from seroma formation. Patients with diabetes have higher risk of infection.
Source: Surgical Endoscopy - Category: Surgery Source Type: research
AbstractBackground and purposeVenous thromboembolism (VTE) is a serious complication encountered in surgical practice. The purpose of this study was to identify changes in coagulation status and deep vein flow parameters, within 24  h postoperatively, for patients undergoing laparoscopic total extraperitoneal inguinal hernia repair (TEP).MethodsFor 144 patients undergoing TEP, coagulation markers including prothrombin time (PT), partial thromboplastin time, thrombin time, D-dimer, fibrinogen, fibrin degradation products (FDP), and international normalized ratio (INR) were monitored preoperatively and in the first morn...
Source: Surgical Endoscopy - Category: Surgery Source Type: research
ConclusionUse of the AutoLap ™ system shows improvement in ergonomics and posture of the first assistant, and ergonomics of the surgeon are not affected. Furthermore, the subjective work load is significantly reduced by using a robotic camera holder.Trial registration numberNCT0339960,https://clinicaltrials.gov/ct2/show/study/NCT03339960?term=autolap&rank=5.
Source: Surgical Endoscopy - Category: Surgery Source Type: research
Measures to reduce postoperative bleeding (POB) after bariatric surgery is skewed toward laparoscopic sleeve gastrectomy (LSG). We use 2015 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) to characterize the differences in bleeding rates between LSG and laparoscopic Roux-en-Y gastric bypasses (LRYGB). Propensity score matching and multivariable logistic regressions tested for independent differences in POB rates. A total of 168,093 patients from 742 centers were identified in the data set. After selection 36,925 patients with LRYGB and 20,020 patients with LSG were included in the an...
Source: Surgical Laparoscopy, Endoscopy and Percutaneous Techniques - Category: Surgery Tags: Original Articles Source Type: research
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