Laparoendoscopic single-site nephrectomy compared with conventional laparoscopic nephrectomy: a systematic review and meta-analysis of comparative studies. Eur Urol. 2012;62:601-612. [PMID: 22704730 DOI: 10.1016/j.eururo.2012.05.055]

Single Port Modified Partial Nephrectomy: Novel Simultaneous Access to Peritoneal and Retroperitoneal Partial Nephrectomy, Initial Clinical Experience

Introduction and Objective: Since its Food and Drug Administration (FDA) approval in 2018, Intuitive Surgical DaVinci single port (SP) robotic platform has been an effectively used technology for multiple urologic procedures. The purpose of this study is to share our early intraoperative and perioperative outcomes and potential benefits for performing a lower anterior access (LAA) incision for SP robot-assisted partial nephrectomy (SP-RAPN). The LAA incision enables performing a trans- or retroperitoneal (RP) approach through the same incision and eases the transition to a RP approach. Methods: This study is a prospective review of 78 SP-RAPN cases between March 2021 and January 2023 by an experienced robotic surgeon. A single 2-3 cm oblique incision parallel to the external oblique muscle, one-third of the distance between the iliac crest and umbilicus, was used to insert the multichannel port to perform the RAPN. We extracted intra- and perioperative data of these patients to share the outcomes of this approach. Results: SP-RAPN was effectively completed in 78 patients (38 females and 40 males) without conversion to open or laparoscopic techniques. The mean age was 61.2 ± 12.1 years. The mean tumor size was 3.0 ± 1.2 cm, 43 were right-sided masses, and 35 were left sided. The R.E.N.A.L Nephrometry score ranged from (4-11) with an average of 7.0 ± 1.9. Average operating room time was 90.5 ± 24.6 minutes, estimated blood loss was 88.3 ± 134 mL, and length of stay of 1.07 ± 0.7 days. Of the 78 cases, 40 required clamping of the renal artery with average warm ischemia time of 19.4 ± 6.7 minutes in patients who underwent clamping. No complications in all of 78 patients. Conclusions: This study demonstrates the feasibility and reproducibility of SP-RAPN using a LAA incision. This incision provides a standardized approach for surgeons to transition to the RP approach using the SP platform.

Robot-assisted single-port retroperitoneal partial nephrectomy with a novel purpose-built single-port robotic system with deformable surgical instruments

OBJECTIVE

To investigate the safety and feasibility of using a novel purpose-built single-port robotic system (the SHURUI Robotic Surgical System) with deformable surgical instruments to perform retroperitoneal single-port partial nephrectomy.

MATERIALS AND METHODS

A prospective study was conducted to recruit patients with a single renal tumor no more than 4 cm. Robot-assisted single-port partial nephrectomy was performed by using the novel purpose-built single-port robotic system with deformable surgical instruments. Patients' demographics, tumor characteristics, and perioperative parameters were recorded and analyzed.

RESULTS

Sixteen patients were recruited to the study. The median tumor size was 2.0 cm (IQR: 1.2-2.4 cm). The median R.E.N.A.L score was 6 (IQR: 4-4.5). In 3 cases, pure single-port surgery was carried out, and all the assistance was through the robotic port. Median docking time was 15.5 min (IQR: 14.25-22.25 min). Median operating time was 148.5 min (IQR: 178-238.5 min). Median console time was 107 min (IQR: 92.75-149.75 min). Median warm ischemic time was 26.5 min (IQR: 24.5-30 min). Median blood loss was 17.5 ml (IQR: 10-50 ml).

CONCLUSIONS

Retroperitoneal partial nephrectomy can be safely performed with this novel purpose-built single-port robotic system (SHURUI) with deformable surgical instruments. Further studies are needed to fully evaluate the role of this new platform.

Single-port versus multiport partial nephrectomy: a propensity-score-matched comparison of perioperative and short-term outcomes

The objective of this study was to compare the perioperative and short-term functional and oncological outcomes of single-port and multiport robotic-assisted laparoscopic partial nephrectomy using propensity-score analysis. We evaluated all patients who underwent robotic partial nephrectomy at our institution between January 2019 and October 2020. Patient demographics, intraoperative data, and postoperative outcomes were collected and analyzed. Propensity-score matching was performed on age, sex, body mass index, prior abdominal surgery, and nephrometry score using the optimal matching method. A post hoc sensitivity analysis was performed to examine the robustness of the results. In total, 48 and 238 patients underwent single-port and multiport robotic partial nephrectomy, respectively. Following propensity-score matching, 48 multiport cases were matched 1:1 to single-port cases. The single-port cohort had lower median opioid use at postoperative day 1 (4.6 vs 9.8 MME, p = 0.0209) and cumulative hospital stay (5.1 vs 9.3 MME, p = 0.0357). Single port also had a shorter median length of stay (1.4 vs 1.6 days, p = 0.0045), although the post hoc sensitivity analysis showed no difference between the groups [- 0.13 (95% CI; - 0.580, 0.315, p = 0.5607). There were no significant differences in operative time, estimated blood loss, ischemia time, transfusions received, or positive margin rates. In conclusion, based on our early experience, single-port robotic partial nephrectomy is a safe and acceptable alternative to multiport robotic partial nephrectomy, providing comparable perioperative and postoperative outcomes while reducing inpatient opioid use.

Single-port robotic partial nephrectomy: impact on perioperative outcomes and hospital stay

Single-port (SP) robotic surgery is a novel technology and is at the beginning of its adoption curve in urology. The goal of this narrative review is to provide an overview of SP-robotic partial nephrectomy (PN) 4 years after the introduction of the da Vinci SP dedicated platform, focusing on perioperative outcomes, length of stay, and surgical technique. A nonsystematic review of the literature was conducted. The research included the most updated articles that referred to SP robotic PN. Since its commercial release in 2018, several institutions have reproduced robotic PN by using the SP platform, both via a transperitoneal and a retroperitoneal approach. The published SP-robotic PN series are generally based on preliminary experiences by surgeons who had previous experience with conventional multi-arms robotic platforms. The reported outcomes are encouraging. Overall, three studies reported that SP-robotic PN cases had nonsignificantly different operative time, estimated blood loss, overall complications rate, and length of stay compared to the conventional 'multi-arms' robotic PN. However, in all these series, renal masses treated by SP had overall lower complexity. Moreover, two studies underlined decreased postoperative pain as a major pro of adopting the SP system. This should reduce/avoid the need for opioids after surgery. No study compared SP-robotic versus multi-arms robotic PN in cost-effectiveness. Published experience with SP-robotic PN has reported the feasibility and safety of the approach. Preliminary results are encouraging and at least noninferior with respect to those from the multi-arms series. Prospective comparative studies with long-term oncologic and functional results are awaited to draw more definitive conclusions and better establish the more appropriate indications of SP robotics in the field of PN.

Smoking and Risk of Urolithiasis: Meta-Analysis of Observational Studies

Background

Earlier studies have warned about the effects of smoking on urolithiasis. Some studies have deemed that smoking has a promoting effect on urolithiasis, whereas others have considered that no inevitable association exists between the two. Therefore, we conducted a meta-analysis to estimate whether smoking is associated with urolithiasis risk.

Methods

To identify publications from related observational studies, we performed a search on PubMed, Web of Science, Embase, and the Cochrane Library databases from inception until October 1, 2021. According to the heterogeneity, random-effect model was used to calculate the odds ratios (ORs) and corresponding 95% confidence intervals (CIs).

Results

Five articles were included in the meta-analysis, representing data for 20,402 subjects, of which 1,758 (8.62%) had urolithiasis as defined according to the criteria. Three articles are concerned with analysis between ex-smokers and non-smokers, in which a significant difference was observed (OR = 1.73, 95% CI: 1.48–2.01). Our comparison of current smokers with non-smokers in another meta-analysis of three articles revealed no significant difference between them (OR = 1.08, 95% CI: 0.94–1.23). Finally, we separated subjects into ever-smokers and never-smokers and found a significant difference between the two groups in the analysis of three articles (OR = 1.31, 95% CI: 1.17–1.47). Sensitivity analysis confirmed the stability of the current results.

Conclusion

Combined evidence from observational studies demonstrates a significant relation between smoking and urolithiasis. The trend of elevated urolithiasis risk from smoking was found in ever-smokers vs. never-smokers.

A comparison of surgical practice and operative outcomes between retroperitoneal and transperitoneal laparoscopic nephrectomies – 6 years of data from the BAUS Nephrectomy database

Objectives:

While the choice of surgical approach for laparoscopic nephrectomy is broadly split between transperitoneal and retroperitoneal options, the evidence for the impact of this decision on perioperative outcomes is built on relatively small volume data, with often inconsistent findings and conclusions. We aimed to assess the impact of operative approach on perioperative outcomes for laparoscopic radical, partial and simple nephrectomy and nephroureterectomy through analysis of the British Association of Urological Surgeons (BAUS) Nephrectomy database.

Patients and methods:

All patients added to the BAUS Nephrectomy database with laparoscopic surgery between 2012 and 2017 inclusively were included and subdivided by operation and surgical approach. Preoperative patient and tumour characteristics, as well as intraoperative and post-operative short-term outcomes, were assessed.

Results:

Overall, 26,682 operations were documented over the review window (81.6% transperitoneal). Small increases in blood loss ( p = 0.001), transfusion rate ( p = 0.02) and operative length ( p = 0.01) were seen for transperitoneal radical nephrectomies and longer hospital stays seen for retroperitoneal procedures (radical nephrectomy p = 0.00l; partial nephrectomy p = 0.04). Retroperitoneal procedures were associated with increased rates of conversion for simple nephrectomy ( p = 0.02), nephroureterectomy ( p = 0.03) and most notably partial nephrectomy (10.5% versus 4.4%; p = 0.001). No further variation in intraoperative complications, post-operative complications, tumour margin positivity rates, unintended ITU admission, or likelihood of death was identified related to surgical approach.

Conclusion:

Observed variations in perioperative outcomes were generally modest in nature, and little ground is seen to support a change in operative technique for those committed to one approach. A caveat to this exists with open conversion for retroperitoneal partial nephrectomies and requires careful consideration of patient selection by the individual surgeon.

Level of evidence:

4

Robotic Single-Port Donor Nephrectomy with the da Vinci SP® Surgical System

OBJECTIVES

The da Vinci SP® Surgical System received U.S. Food and Drug Administration approval for urological procedures in 2018. Here, we describe the first experience performing single-port robot-assisted donor nephrectomy (RADN) using the da Vinci SP® surgical system, present 90-day clinical outcomes, and discuss tips for operative success.

METHODS

Seven consecutive patients underwent single-port RADN at a single institution between September 1, 2020 and March 31, 2021. Surgery was performed through a single, 60 mm Pfannenstiel incision with a 12 mm periumbilical assistant port for suction and vascular stapling. Donor characteristics, operative details, 90-day donor clinical outcomes, and recipient renal function were retrospectively evaluated.

RESULTS

Four female and three male patients successfully underwent single-port RADN without conversion to standard multiport or open approach. Six cases were left-sided. Estimated blood loss for each procedure was ≤ 50 mL. Mean operative time, warm ischemia time, and extraction time were 218.3 minutes (standard deviation [SD]: 16.3 minutes), 5 minutes 4 seconds (SD: 56 seconds), and 3 minutes 37 seconds (SD: 38 seconds). Mean pre-operative creatinine and estimated glomerular filtration rate were 0.79 mg/dL and 107.3 mL/min/1.73m2, respectively. At six week's follow up, they were 1.22 mg/dL and 66.1 mL/min/1.73m2. Average pain score at 48 hours postoperatively was 1.7/10. There were no Clavien-Dindo grade ≥ III complications within 90 days. All recipients experienced immediate and sustained return of renal function post-transplant.

CONCLUSION

Single-port RADN is a technically feasible and safe procedure with the da Vinci SP® system and can confer acceptable functional and cosmetic outcomes. Future studies are needed to define long-term outcomes and compare with previously established techniques for donor nephrectomy.

Single Port Donor Nephrectomy Via Modified Pfannenstiel Incision: Initial Preclinical Experience in A Cadaveric Model and Description of Technique

OBJECTIVE

To describe the surgical technique for the single port (SP) transperitoneal donor nephrectomy through a modified Pfannenstiel incision using the da Vinci SP surgical system (Intuitive Surgical, Sunnyvale, CA, USA) on a cadaver.

PATIENTS & METHODS

In a male cadaver, the SP surgical system was used to perform transperitoneal donor nephrectomy. A 3 cm modified Pfannenstiel incision was made. Through the incision GelPOINT mini (Applied Medical, Rancho Santa Margarita, CA, USA) was inserted. The floating docking technique was used. Through the gel port, the dedicated 25 mm multichannel port and a 12 mm assistant port were introduced. The surgical steps for donor nephrectomy were performed in the following order. 1) Mobilization of the colon, 2) Identification of psoas muscle, ureter, and the gonadal vein, 3) hilum dissection, 4) perirenal dissection, 5) stapling the renal artery and renal vein, 6) removal of the kidney through the enlarged incision.

RESULTS

Transperitoneal SP donor nephrectomy was completed without any complications or capsulotomy. Additional ports were not needed. The total operative time was 63 minutes and 54 seconds. A good-quality kidney was harvested. Renal artery length was 4 cm.

CONCLUSION

We demonstrated the feasibility of single-port transperitoneal donor nephrectomy via modified Pfannenstiel incision, using the novel SP robotic platform. Further assessment is necessary in a clinical setting.

Systematic review and meta-analysis of tocilizumab in persons with coronavirus disease-2019 (COVID-19)

We performed a meta-analysis to determine safety and efficacy of tocilizumab in persons with coronavirus disease-2019 (COVID-19). We searched PubMed, Web of Science and Medline using Boolean operators for studies with the terms coronavirus OR COVID-19 OR 2019-nCoV OR SARS-CoV-2 AND tocilizumab. Review Manager 5.4 was used to analyze data and the modified Newcastle-Ottawa and Jadad scales for quality assessment. We identified 32 studies in 11,487 subjects including three randomized trials and 29 cohort studies with a comparator cohort, including historical controls (N = 5), a matched cohort (N = 12), or concurrent controls (N = 12). Overall, tocilizumab decreased risk of death (Relative Risk [RR] = 0.74; 95% confidence interval [CI], 0.59, 0.93; P = 0.008; I2 = 80%) but not of surrogate endpoints including ICU admission (RR = 1.40 [0.64,3.06]; P = 0.4; I2 = 88%), invasive mechanical ventilation (RR = 0.83 [0.57,1.22]; P = 0.34; I2 = 65%) or secondary infections (RR = 1.30 [0.97,1.74]; P = 0.08; I2 = 65%) and increased interval of hospitalization of subjects discharged alive(mean difference [MD] = 2 days [<1, 4 days]; P = 0.006; I2 = 0). RRs of death in studies with historical controls (RR = 0.28 [0.16,0.49; P < 0.001]; I2 = 62%) or a matched cohort (RR = 0.68 [0.53, 0.87]; P = 0.002; I2 = 42%) were decreased. In contrast, RRs of death in studies with a concurrent control (RR = 1.10 [0.77, 1.56]; P = 0.60; I2 = 85%) or randomized (RR = 1.18 [0.57,2.44]; P = 0.66; I2 = 0) were not decreased. A reduced risk of death was not confirmed in our analyses which questions safety and efficacy of tocilizumab in persons with COVID-19.

Single Port Robotic Surgery in Urology

PURPOSE

To provide a comprehensive review on the new da Vinci SP (single port) robotic surgical system. The published literature to date within urology and a description of the new system will be discussed.

FINDINGS

There are currently no high-quality published studies with the SP robotic system. All studies are case series, many with 10 or fewer patients. However, all studies have found the SP system to be safe and feasible in performing most urological procedures. Renal and pelvic surgery using the SP robotic system is safe and feasible in the hands of expert robotic surgeons. Long-term, high-quality data is lacking. While the current high price and the learning curve will limit the SP systems' use in many health care systems, new updates and the release of robotic surgical systems from other developers may help drive down costs and encourage uptake.

Systematic review and meta-analysis of the role of Faecalibacterium prausnitzii alteration in inflammatory bowel disease

BACKGROUND AND AIM

We comprehensively carry out a systematic review and meta-analysis of previous studies to determine the association between intestinal Faecalibacterium prausnitzii (F. prausnitzii) and inflammatory bowel disease (IBD) in human studies.

METHODS

A systematic literature search of PubMed, Embase, and the Cochrane Library database was conducted until April 1, 2020. Inclusion criteria were studies involving patients with Crohn's disease (CD) or ulcerative colitis (UC) with abundance of F. prausnitzii. The quality of the studies was assessed by the modified Newcastle-Ottawa scale.

RESULTS

A total of 1669 subjects (427 CD patients, 560 UC patients, and 682 healthy controls) were enrolled from 16 studies. Both CD (standardized mean difference [SMD]: -1.36; 95% CI, -1.74 to -0.98; P < 0.00001) and UC patients (SMD: -0.81; 95% CI, -1.21 to -0.42; P < 0.0001) had a lower abundance of F. prausnitzii than the healthy controls. Compared with the IBD remission patients, the IBD active patients had lower levels of F. prausnitzii (SMD: -0.56; 95% CI, -0.91 to -0.21; P = 0.002). In the subgroup analyses, the abundance of F. prausnitzii was reduced in both active CD patients (SMD: -0.78; 95% CI, -1.51 to -0.04; P = 0.04) and active UC patients (SMD:-0.44; 95%CI, -0.81 to -0.07; P = 0.02) when compared with the patients with CD or UC in remission, respectively.

CONCLUSION

A negative association between abundance of F. prausnitzii and IBD activity is observed, but a cut-off level of F. prausnitzii to diagnose and/or to start treating IBD is not determined.

Laparoendoscopic single-site simultaneous bilateral nephrectomy: first reported case series

Bilateral renal tumors in patients on dialysis are usually managed with bilateral nephrectomy. With traditional laparoscopy, this procedure requires the insertion of multiple trocars. Laparoendoscopic single-site surgery (LESS) uses a single umbilical incision to insert multiple instruments and is also employed for extraction of specimens. This technique appears especially useful for bilateral nephrectomy, since many access ports can be spared. We describe 5 cases of simultaneous bilateral radical nephrectomies performed at a single academic institution. We had no intraoperative complications and a mean operating time of 155 minutes. Four patients could be resected using this approach; one case was converted to a traditional laparoscopy. One case had a postoperative complication. We believe this technique is feasible, and can be accomplished with acceptable morbidity and ade-quate operative time.

Outcome of Kidney Transplantation With Transumbilical Laparoendoscopic Single-Site Donor Nephrectomy: A Single-Center Experience

AIM

The aim of this study is to present the outcome of kidney transplantation after laparoendoscopic single-site donor nephrectomy (LESS DN) compared with conventional laparoscopic donor nephrectomy (LDN) in a single-center experience.

METHODS

This retrospective study compares data from the initial experience with 110 consecutive LESS DN donors and their recipients (group A) with 205 consecutive conventional LDN donors and their recipients (group B).

RESULTS

This study compared 110 LESS DNs completed in an 18-month period with 205 LDNs completed in the immediately preceding 42-month period. All procedures were performed by the same surgeon. In groups A and B, respectively, the incidence of immediate graft function was 90% vs 91.2%, slow graft function was 9% vs 5.3%, delayed graft function was 0.9% vs 2.9%, graft loss was 0.9% vs 2.9%, and death with a functioning graft was 0.9% vs 1.5%. The mean serum creatinine levels were 1.3 ± 0.93 mg/dL vs 1.4 ± 1.2 mg/dL (P = .447), 1.1 ± 0.33 mg/dL vs 1.2 ± 0.75 mg/dL (P = .184), and 1.05 ± 0.25 mg/dL vs 1.1 ± 0.39 mg/dL (P = .224) at 7, 30, and 365 days after transplantation. The estimated glomerular filtration rate at 1 year was 88 ± 18.2 vs 83 ± 12.2 mL/min/1.73 m² (P = .004). The mean donor operative times in groups A and B were 175.9 ± 24.9 minutes vs 199.88 ± 37.06 minutes (P = .0001), respectively, and the mean warm ischemia time was 5.2 ± 1.02 minutes vs 3.64 ± 1.38 minutes, respectively (P = .0001). The mean body mass index, the incidence of complex vascular anatomy, and the rate of complications were the same in the 2 donor groups.

CONCLUSIONS

The outcome of kidney transplantation after LESS DN is comparable to conventional LDN. LESS DN can be employed as the primary approach for kidney donation with low donor risk and without compromising recipient outcomes.

Suprapubic-assisted laparoendoscopic single-site surgery versus standard laparoscopic nephrectomy: A propensity score-based analysis

OBJECTIVES

To compare suprapubic-assisted laparoendoscopic single-site surgery nephrectomy with standard laparoscopic nephrectomy.

METHODS

A retrospective case-control study comparing three surgeons' experience with 122 suprapubic-assisted laparoendoscopic single-site surgery nephrectomy and 107 standard laparoscopic nephrectomy was carried out. Operative time, estimated blood loss, intraoperative complications, intraoperative conversion, postoperative bowel recovery, postoperative analgesics, postoperative visual analog pain scale score, postoperative length of stay, days before going back to work, postoperative complications and Patient Scar Assessment Questionnaire were compared after propensity score matching.

RESULTS

A total of 97 matched pairs were obtained after propensity score matching. There were no statistically significant differences between the suprapubic-assisted laparoendoscopic single-site surgery nephrectomy and standard laparoscopic nephrectomy groups with respect to operative time, estimated blood loss, intraoperative complications, intraoperative conversion, postoperative bowel recovery, length of stay and postoperative complications. Suprapubic-assisted laparoendoscopic single-site surgery nephrectomy group had decreased postoperative analgesics (20.9 vs 23.5, P = 0.04), visual analog pain scale score at 24 h (4.28 vs 5.28, P = 0.000), visual analog pain scale score at discharge (1.01 vs 1.47, P = 0.000), days before going back to work (28.4 vs 31.9, P = 0.000) and Patient Scar Assessment Questionnaire score (34.0 vs 42.0, P = 0.000), compared with the standard laparoscopic nephrectomy group.

CONCLUSIONS

Suprapubic-assisted laparoendoscopic single-site surgery nephrectomy and standard laparoscopic nephrectomy are equivalent in terms of the safety and efficacy. However, suprapubic-assisted laparoendoscopic single-site surgery nephrectomy confers less postoperative pain, fewer days before going back to work and better cosmetic result when compared with standard laparoscopic nephrectomy.

Laser therapy versus intravitreal injection of anti-VEGF agents in monotherapy of ROP: a Meta-analysis

AIM

To compare the efficacy and safety between laser therapy and anti-vascular endothelial growth factor (VEGF) agents intravitreal injection monotherapy in type-1 retinopathy of prematurity (ROP) and aggressive posterior retinopathy of prematurity (APROP).

METHODS

A systematic literature search was performed in PubMed, Cochrane Library, and Embase for original comparable studies. We included studies that compare laser therapy and intravitreal injections of anti-VEGF agents monotherapy in ROP regardless of languages and publication types.

RESULTS

Complication incidence was significantly higher in laser therapy group (OR: 0.38; 95%CI: 0.19-0.75; P=0.005). Spherical equivalent (SE) was higher in laser therapy [weighted mean difference (WMD): 2.40, 95%CI: 0.88-3.93; P=0.002]. The time between treatment and retreatment was longer in laser therapy group (WMD: 8.45, 95%CI: 5.35-11.55; P<0.00001). Recurrence incidence (OR: 0.97; 95%CI: 0.45-2.09; P=0.93) and retreatment incidence (OR: 1.24; 95%CI: 0.56-2.73; P=0.59) were similar in two approaches. Subgroup analysis between type-1 ROP and APROP was not significant except SE reported in the included studies (P<0.0001).

CONCLUSION

This Meta-analysis outcome indicates anti-VEGF agents are as effective as laser treatment, and safer than laser in type-1 ROP and APROP. The degree of myopia in APROP is higher than type-1 ROP. More randomized controlled trials in large sample size should be conducted in the future.

Impact of corticosteroid therapy on outcomes of persons with SARS-CoV-2, SARS-CoV, or MERS-CoV infection: a systematic review and meta-analysis

We performed a meta-analysis to determine safety and efficacy of corticosteroids in SARS-CoV-2, SARS-CoV, and MERS-CoV infections. We searched PubMed, Web of Science, Medline, WanFang Chinese database, and ZhiWang Chinese database using Boolean operators and search terms covering SARS-CoV-2, SARS-CoV, OR MERS-CoV AND corticosteroids to find appropriate studies. Review Manager 5.3 was used to analyze results of meta-analysis. Observational studies were analyzed for quality using the modified Newcastle–Ottawa scale and randomized clinical trials, using the Jadad scale. Subjects were divided into those with severe-only and other (severe and not severe) cohorts based on published criteria. Efficacy endpoints studied included mortality, hospitalization duration, rates of intensive care unit (ICU) admission, use of mechanical ventilation, and a composite endpoint (death, ICU admission, or mechanical ventilation). We included 11 reports including 10 cohort studies and 1 randomized clinical trial involving 5249 subjects (2003–2020). Two discussed the association of corticosteroids and virus clearing and 10 explored how corticosteroids impacted mortality, hospitalization duration, use of mechanical ventilation, and a composite endpoint. Corticosteroid use was associated with delayed virus clearing with a mean difference (MD) = 3.78 days (95% confidence Interval [CI] = 1.16, 6.41 days; I² = 0%). There was no significant reduction in deaths with relative Risk Ratio (RR) = 1.07 (90% CI = 0.81; 1.42; I² = 80%). Hospitalization duration was prolonged and use of mechanical ventilation increased. In conclusion, corticosteroid use in subjects with SARS-CoV-2, SARS-CoV, and MERS-CoV infections delayed virus clearing and did not convincingly improve survival, reduce hospitalization duration or ICU admission rate and/or use of mechanical ventilation. There were several adverse effects. Because of a preponderance of observational studies in the dataset and selection and publication biases our conclusions, especially regarding SARS-CoV-2, need confirmation in a randomized clinical trial. In the interim we suggest caution using corticosteroids in persons with COVID-19.

Laparoendoscopic single-site surgery compared with conventional laparoscopic surgery for benign ovarian masses: a systematic review and meta-analysis

OBJECTIVE

We aimed to evaluate the safety, efficiency and preferred indication for laparoendoscopic single-site surgery (LESS) compared with conventional laparoscopic (CL) surgery for benign ovarian masses.

DESIGN

A systemic review and cumulative meta-analysis were performed in line with the criteria of Grading of Recommendations Assessment, Development and Evaluation: levels of evidence and grades of recommendation.

DATA SOURCES

We comprehensively searched the electronic databases including PubMed, Medline, Embase and the Cochrane Library in November 2018.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included all randomised controlled trials (RCTs) and retrospective studies published in recent 10 years, which investigated the performance of LESS versus CL in patients at all ages with benign ovarian masses.

RESULTS

Four RCTs and nine retrospective studies published in recent decade including 1542 cases (744 cases for LESS and 798 cases for CL) were identified. Perioperative complication was consisted of intraoperative and postoperative complications, including ileus, wound infection or dehiscence and incisional hernia. Although LESS has less postoperative analgesic consumption (46.78% and 79.25%; OR: 0.49; 95% CI: 0.33 to 0.74, p<0.001) and shorter hospital stay (weighted mean difference (WMD): -0.24 days; 95% CI: -0.35 to -0.14; p<0.001), CL has less perioperative complications (6.59% and 2.85%; OR: 2.08; 95% CI: 1.05 to 4.11, p=0.04) and shorter operative time (WMD: 3.43 min; 95% CI: -0.03 to 6.88; p=0.05). Body mass index, history of previous abdominal surgery, size of adnexal mass, estimated blood loss and postoperative pain scores did not differ significantly between two techniques.

CONCLUSIONS

The indications of LESS for benign ovarian masses are similar to CL and it has better postoperative recovery. However, with less perioperative complications, CL surgery is safer than LESS.

Cosmesis and Patient Satisfaction Following Laparoscopic Adnexal Surgery

Background and Objectives

Laparoendoscopic single site surgery (LESS), a minimally invasive procedure, is performed in many hospitals. Although its cosmetic superiority is widely touted, some authors have disputed this view. Here, we compare the surgical and long-term cosmetic outcomes of and patient satisfaction with postoperative wounds for LESS and over 2-port laparoscopy (OTPL), including 2-port laparoscopy (TPL) and standard laparoscopy (SL), after a 6-mo follow-up period.

Methods

A total of 125 patients who underwent adnexal surgery performed by the same surgeon at the same institution between March 2005 and May 2017 were included. The patients were divided into 2 groups: the LESS group and the OTPL group. The patients completed an evaluation using the Patient Scar Assessment Scale (PSAS, used to evaluate linear scars) and the Ultimate Question (UQ, used to determine overall patient satisfaction). We evaluated surgical scars using the Observer Scar Assessment Scale, which includes the Umbilical Scar Overall Shape Assessment Scale (USOSAS) and the Vancouver Scar Scale (VSS).

Results

There were no significant differences in the PSAS, UQ, USOSAS, and VSS results between the study groups. The USOSAS score was consistently correlated with VSS scores of 2, 3, and 4 and the total VSS score, indicating that the USOSAS score may be as effective as the VSS score.

Conclusions

Because the long-term patient satisfaction with and cosmetic wound outcomes of LESS were not significantly different from those achieved by OTPL, surgeons should consider performing LESS after weighing the pros and cons with regard to the patient's condition.

Parenchymal-sparing versus extended hepatectomy for colorectal liver metastases: A systematic review and meta-analysis

AIMS

To assess the safety and efficacy of parenchymal-sparing hepatectomy (PSH) as a treatment of colorectal liver metastases (CLM).

METHODS

A comprehensive medical literature search was performed. Perioperative and long-term survival outcomes were pooled. Subgroup analysis and meta-regression analysis were performed to identify potential sources of heterogeneity.

RESULTS

A total of 18 studies comprising 7081 CLM patients were eligible for this study. The PSH was performed on 3974 (56.1%) patients. We found that the OS (overall survival; hazard ratio [HR] = 1.01, 95% confidence interval [CI]: 0.94-1.08) and RFS (recurrence-free survival; HR = 1.00, 95% CI: 0.94-1.07) were comparable between non-PSH and PSH group. The perioperative outcomes were better in PSH than in non-PSH group. Non-PSH group was significantly associated with longer operative time (standard mean difference [SMD] = 1.17, 95% CI: 0.33-2.00), increased estimated blood loss (SMD = 1.36, 95% CI: 0.64-2.07), higher intraoperative transfusion rate (risk ratio [RR] = 2.27, 95% CI: 1.60-3.23), and more postoperative complications (RR = 1.39, 95% CI: 1.16-1.66). Meta-regression analyses revealed that no variable influenced the association between surgical types and the survival outcomes.

CONCLUSIONS

This study shows that PSH is associated with better perioperative outcomes without compromising oncological outcomes. Given the increasing incidence of hepatic parenchyma, the PSH treatment offers a greater opportunity of repeat resection for intrahepatic recurrent tumors. It should be considered as an effective surgical approach for CLM.

Comparison of modified transumbilical laparoendoscopic single-site nephroureterectomy and retroperitoneal laparoscopic nephroureterectomy: initial experience

Introduction

Owing to the development of the laparoendoscopic single-site (LESS) procedure, transumbilical LESS nephroureterectomy (LESS-NU) has become a new approach for treating upper tract urothelial carcinoma.

Aim

The aim of this study is to introduce a modified LESS-NU procedure with bladder cuff excision for treating upper tract urothelial carcinoma (UTUC). We compared its clinical efficacy and postoperative outcomes in terms of follow-up time with traditional retroperitoneal laparoscopic nephroureterectomy (RL-NU).

Material and methods

From May 2014 to May 2019, we performed nephroureterectomy on 42 patients using the retroperitoneal approach and a modified LESS approach. A retrospective analysis was conducted for the evaluation of the clinical and postoperative outcomes between the two groups.

Results

The study included 25 LESS-NU and 17 RL-NU patients. All the procedures were completed successfully. The LESS-NU group had a significantly shorter mean operative time than the RL-NU group (204.4 min, 236.18 min, p = 0.005). The differences in skin incision length (2.88 cm, 8.94 cm, p < 0.001) and oral analgesic dose (n = 1.12, n = 2.75, p < 0.001) between LESS-NU and RL-NU were statistically significant.

Conclusions

Modified LESS-NU is a feasible and safe procedure. Compared with the retroperitoneal laparoscopic approach, the single-site approach did not alter the patients' position. LESS-NU is a better procedure for treating UTUC than RL-NU in terms of cosmetic result and postoperative pain.

Laparoendoscopic single-site nephrectomy versus conventional laparoendoscopic nephrectomy for kidney tumor: a systematic review and meta-analysis

With the increasing application of laparoendoscopic single-site nephrectomy (LESS-N) in kidney tumor, accumulating studies compared it with conventional laparoendoscopic nephrectomy (CL-N). However, controversial outcomes were reported. Hence, this meta-analysis was carried out to clarify these issues. Online databases PubMed, EMBASE and the Cochrane Library were searched comprehensively for eligible studies published before 24 July 2018. Odds ratios (ORs) or standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were collected for evaluating the pooled results of relevant outcomes. Ultimately, 13 eligible articles were enrolled. Meanwhile, compared with CL-N, LESS-N was related to a longer operation time (SMD: 0.40; 95% CI, 0.23–0.58; P=0.000), a shorter length of hospital stay (LOS) (SMD: −0.32; 95% CI, −0.62 to −0.02; P=0.034), a lower visual analog scale (VAS) score (SMD: −0.89; 95% CI, −1.22 to −0.56; P=0.000) and a lower analgesic requirement (SMD: −0.55; 95% CI, −0.87 to −0.23; P=0.001). There was no statistical difference in the postoperative day of oral intake, estimated blood loss (EBL), conversion rate, perioperative complications, intraoperative complications, postoperative complications, minor complications and major complications between LESS-N and CL-N. Patients with LESS-N for kidney tumor could have a longer operation time and shorter LOS, and meanwhile could need less analgesics and suffer less pain after LESS-N.

Liver hanging maneuver versus conventional approach for open hepatectomy: a meta-analysis

BACKGROUND

This study aimed to compare the safety and efficacy of the liver hanging maneuver (LHM) versus conventional approach for open hepatectomy.

METHODS

A comprehensive medical literature search was performed. Perioperative outcomes and long-term survival outcomes were reported. Subgroup analyses were conducted according to surgical approaches, modification of LHM, geographical region and indications for liver resection.

RESULTS

A total of 16 studies including 1109 patients were enrolled. The LHM was performed on 471 (37%) patients. The pooled outcomes showed hepatectomy with the LHM was associated with less estimated blood loss [standard mean difference (SMD): -0.77, P < 0.001], lower intraoperative transfusion rate [odds ratio (OR): 0.28, P = 0.003], less transection time (SMD: -0.68, P = 0.01), shorter duration of hospitalization (SMD:-0.19, P = 0.004), lower total complication rate (OR: 0.63, P = 0.008) and longer overall survival [hazard ration (HR): 0.70, P = 0.002] compared to conventional open hepatectomy. Subgroup analyses showed similar outcomes to overall analyses.

CONCLUSIONS

The present meta-analysis suggested that the LHM was a safe and feasible alternative to conventional open hepatectomy with better perioperative and long-term outcomes. It was unnecessary to combine the LHM with anterior approach (AA) in consideration of perioperative outcomes.

Association between sepsis and retinopathy of prematurity: a systematic review and meta-analysis

OBJECTIVE

To explore the association between sepsis and retinopathy of prematurity (ROP) in premature infants.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

We performed a systematic search of PubMed, the Cochrane Library and Embase from 1 January, 2000, to 1 January, 2018, with no language restrictions and reported the relationship between sepsis and ROP.

ELIGIBILITY CRITERIA

Original observational studies, including cohort studies and case-control studies.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently completed the study selection and data extraction. The OR and corresponding 95% CI were used to measure the risk of sepsis in patients with ROP. The heterogeneity between studies was evaluated using Cochran's Q test and the I2 statistic. The Newcastle-Ottawa Scale was adopted to evaluate the quality of each of the included studies, and the Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the quality of the evidence.

RESULTS

Sixteen studies with a total sample size of 12 466 premature infants and 2494 cases of ROP were included in this meta-analysis. Adjusted analysis showed that sepsis was closely related to any stage of ROP (OR = 1.57, 95% CI 1.31 to 1.89) and severe stage of ROP (OR = 2.33, 95% CI 1.21 to 4.51) in premature infants, with 56.3% and 81.8% heterogeneity, respectively. Subgroup analyses showed that heterogeneity was obvious in prospective cohort studies (I2 = 62.1%, p<0.001). In a sensitivity analysis, we found that removing any single study did not significantly change the overall effect value. The quality of the evidence was rated as low for both any stage of ROP and severe stage of ROP.

CONCLUSIONS

Sepsis increases the risk of ROP in preterm infants. However, considering that all included studies are observational and causality can rarely be established, additional evidence is needed to substantiate this finding and provide advice for practice.

Postoperative pain and cosmetic results of minilaparoscopic nephrectomy compared to the conventional technique

INTRODUCTION

In recent years urology has been focussing on less invasive forms of laparoscopy with less impact on the abdominal wall. The minilaparoscopy (ML) is promising in this regard. Our objective is to compare the results of a series of patients who underwent minilaparoscopic nephrectomy with another series who underwent conventional laparoscopy (CL).

MATERIAL AND METHODS

We chose 8 nephrectomies performed by mini-laparoscopy in a single hospital (NmL group) from a total of 110 patients included in multiple centres and compared them retrospectively with a contemporary series of 16 patients who underwent CL (NL group). From 1 to 3 3mm and 5mm trocars were used for the NmL and the NL, respectively, one 10mm trocar in the pararectal edge of a Pfannenstiel incision and another 11mm paraumbilical trocar for the optics. Age, BMI, ASA, complications, analgesic requirements in the postoperative period and cosmetic satisfaction were recorded using the Patient Scar Assessment Questionnaire (PSAQ), one month after the intervention.

RESULTS

Both groups were comparable and there were no differences in terms of surgery time, number of ports used, hospital stay or intra-and postoperative complications. In only one patient from the NmL group, a 3mm trocar had to be replaced by a 5mm trocar and one patient in the NL group was converted to hand-assisted surgery due to severe adherences. The patients in the NmL group had less postoperative pain on the VAS (±0 vs. 4±25, P=.05) and were more satisfied with their appearance on the PSAQ (8.5±1.4 vs. 16.6±3.1, P=.05) compared to the NL group.

CONCLUSIONS

The results obtained with the ML instrument were similar to those obtained by CL, but with the advantages of less postoperative pain and better cosmetic results.

Sperm DNA fragmentation index influences assisted reproductive technology outcome: A systematic review and meta-analysis combined with a retrospective cohort study

Studies have explored the influence of DNA damage in assisted reproductive technology (ART), but the outcome remains controversial. To determine whether sperm DNA fragmentation index (DFI) has any effect on ART outcomes, we collected detailed data regarding 1,333 IVF cycles performed at our centre, and the data of our retrospective cohort study were extracted for this meta-analysis. We searched PubMed, Web of Science, EMBASE and Google Scholar and performed a systemic review and meta-analysis. Primary meta-analysis of 10 studies comprising 1,785 couples showed that live birth rate was no significantly different between low-DFI group and high-DFI group (p > 0.05). Secondary meta-analysis of 25 studies comprising 3,992 couples showed a higher miscarriage rate in high-DFI group than in low-DFI group (RR=1.57 [1.18, 2.09], p < 0.01). Meta-analysis of eight studies comprising 17,879 embryos revealed a lower good-quality embryo rate (RR=0.65 [0.62, 0.68], p < 0.01). Meta-analysis of 23 studies comprising 6,771 cycles showed that the high-DFI group had a lower clinical pregnancy rate than low-DFI group (RR=0.85 [0.75, 0.96], p < 0.01). Heterogeneity of included studies weakened our conclusions. Our study showed that DFI has adverse effects on ART outcome. More well-designed studies exploring the association between DFI and ART outcome are desired.

To compare the efficacy between fixation with tightrope and screw in the treatment of syndesmotic injuries: A meta-analysis

BACKGROUND

To compare the efficacy between fixation with suture-button and screw in the treatment of syndesmotic injuries: a meta-analysis.

METHODS

We comprehensively searched PubMed, Embase, and the Cochrane Library and performed a meta-analysis of randomized controlled trials (RCTs) and retrospective comparative studies (RTCs). We performed using Review Manager 5.2.

RESULTS

Three RCTs and six retrospective studies were conducted, including a total of 397 patients. The significant differences of the fixation of suture-button were reported for AOFAS scores (at 3, 6 and 12 months follow-up), full-weight time, reoperation, malreduction and the rate of failure of fixation. There were no significant differences between the groups regarding complications of infection, VAS, OMAS, range of motion, TFCS, TFO and MCS.

CONCLUSIONS

Neither the functional outcome nor complications significantly differed between the fixation methods, but suture-button might lead to a quicker return to work. This analysis needs to be confirmed and updated by larger sample data and rigorously designed RCTs.

Atypical antipsychotics for Parkinson's disease psychosis: a systematic review and meta-analysis

PURPOSE

To assess the present evidence regarding the efficiency, safety, and potential risks of pharmacotherapy used for Parkinson's disease psychosis (PDPsy) treatment.

PATIENTS AND METHODS

We searched the following databases: PubMed, the Cochrane Library, ISI Web of Science, and Embase using the following terms: atypical antipsychotics, pimavanserin, olanzapine, quetiapine, clozapine, Parkinson's disease and psychosis. We systematically reviewed all randomized placebo-controlled trials comparing an atypical antipsychotic with a placebo.

RESULTS

A total of 13 randomized placebo-controlled trials for a total 1142 cases were identified involving pimavanserin (n=4), clozapine (n=2), olanzapine (n=3), and quetiapine (n=4). For each atypical antipsychotic, a descriptive synthesis and meta-analyses was presented. Pimavanserin was associated with a significant improvement in psychotic symptoms compared to a placebo without worsening motor function. Clozapine was efficacious in alleviating psychotic symptoms and did not exacerbate motor function either. Quetiapine and Olanzapine did not demonstrate significant differences in reducing psychotic symptoms but may aggravate motor function.

CONCLUSIONS

There is strong evidence that pimavanserin is effective for the treatment of PDPsy. Clozapine is also recommended but should be used with caution due to its side effects. In the future, more well-designed randomized controlled trials (RCTs) are needed to confirm and update the findings reported in this meta-analysis.

First Canadian experience with robotic laparoendoscopic single-site vs. standard laparoscopic living-donor nephrectomy: A prospective comparative study

INTRODUCTION

We aimed to compare the outcomes of robotic laparoendoscopic single-site living donor nephrectomy (R-LESS LDN) vs. standard laparoscopic living donor nephrectomy (LLDN).

METHODS

Between October 2013 and November 2015, 39 patients were allocated to either standard LLDN (n=25) or R-LESS LDN (n=14). Patient demographics, perioperative outcomes, analgesic requirement, visual analogue scale of pain at postoperative days 1, 3, 7, and 30, and a health-related quality of life and body image questionnaire were prospectively collected.

RESULTS

There were no significant differences in demographics and intraoperative outcomes between the two cohorts. The R-LESS LDN cohort had lower analgesic requirement (p=0.002) and lower visual pain scores on days 1 and 3 (p=0.001). Additionally, body image and satisfaction scores in the R-LESS group were also superior compared to the LLDN cohort (p=0.008). There was no significant difference in the postoperative complications according to the Clavien-Dindo system. Recipient graft functional outcomes were equivalent.

CONCLUSIONS

This is the first evidence that R-LESS LDN is safe and associated with comparable surgical and early functional outcomes compared to LLDN, while pain, donor body image, and satisfaction scores were improved compared to LLDN.

The Association between LRRK2 G2385R and Phenotype of Parkinson's Disease in Asian Population: A Meta-Analysis of Comparative Studies

Numerous studies have investigated the relationship between the LRRK2 G2385R variant and clinical characteristics in Parkinson's disease (PD), but the results have been inconsistent. This study investigated whether the LRRK2 G2385R variant was associated with a unique clinical phenotype of PD in the Asian population, using a meta-analysis. The PubMed, Web of Science, EMBASE, CNKI, and WANFANG databases were searched until September 2017. The strict selection criteria and exclusion criteria were determined, and mean differences (MD) or odds ratios (OR) with 95% confidence intervals (CI) were used to assess the strength of associations. Statistical analyses and graphics were performed using Review Manager 5.3. Sixteen related case-control studies were included in the meta-analysis. The LRRK2 G2385R carriers significantly more often presented a family history (OR: 1.98; 95% CI: 1.16−3.39; P=0.01) and had a longer disease duration (MD = 0.47, 95% CI: 0.01−0.93, P=0.04) and a higher MMSE score (MD = 1.02, 95% CI: 0.43–1.62 P=0.0007) than LRRK2 G2385R noncarriers. There were no significant differences in sex distribution, age at onset, initial symptoms, motor symptoms, depression, levodopa-equivalent dose, and related complications between LRRK2 G2385R-carrier and LRRK2 G2385R-noncarrier PD patients. Our results suggested that most of the clinical characteristics of PD patients with LRRK2 G2385R mutations are similar to those of LRRK2 G2385R noncarriers among Asian PD patients, except for the more common family history, relatively longer disease duration, and higher MMSE scores in the former group.

Off-clamp partial nephrectomy has a positive impact on short- and long-term renal function: a systematic review and meta-analysis

Background

Ongoing efforts are focused on shortening ischemia intervals as much as possible during partial nephrectomy to preserve renal function. Off-clamp partial nephrectomy (off-PN) has been a common strategy for to avoid ischemia in small renal tumors. Although studies comparing the advantages between off-PN with conventional on-clamp partial nephrectomy (on-PN) have been reported, the impact on short- and especially long-term renal function of the two surgical methods has not been discussed seriously and remained unclear. Our purpose is to evaluate the impact on short- (within postoperative 3 months) and long-term (postoperative 6 months or longer) renal function of off-PN compared with that of on-PN.

Methods

We comprehensively searched databases, including PubMed, EMBASE, and the Cochrane Library, without restrictions on language or region. A systematic review and cumulative meta-analysis of the included studies were performed to assess the impact of the two techniques on short- and long-term renal function.

Results

A total of 23 retrospective studies and 2 prospective cohort studies were included. The pooled postoperative short-term decrease of estimated glomerular filtration rate (eGFR) was significantly less in the off-PN group (weighted mean difference [WMD]: 4.81 ml/min/1.73 m²; 95% confidence interval [CI]: 3.53 to 6.08; p < 0.00001). The short-term increase in creatinine (Cr) level in the on-PN group was also significant (WMD: − 0.05 mg/dl; 95%CI: − 0.09 to − 0.00; p = 0.04). Significant differences between groups was observed for the long-term change and percent (%) change of eGFR (p = 0.04 and p < 0.00001, respectively) but not for long-term Cr change (p = 0.40). The postoperative short-term eGFR and Cr levels, but not the postoperative long-term eGFR, differed significantly between the two groups. The pooled odds ratios for acute renal failure and postoperative progress to chronic kidney disease (stage≥3) in the off-PN group were found to be 0.25 (p = 0.003) and 0.73 (p = 0.34), respectively, compared with the on-PN group.

Conclusions

Off-PN exerts a positive impact on the short- and long-term renal function compared with conventional on-PN. Given the inherent limitations of our included studies, large-volume and well-designed RCTS with extensive follow up are needed to confirm and update the conclusion of this analysis.

Electronic supplementary material

The online version of this article (10.1186/s12882-018-0993-3) contains supplementary material, which is available to authorized users.

Outcomes of Controlled Donation After Cardiac Death Compared With Donation After Brain Death in Liver Transplantation: A Systematic Review and Meta-analysis

BACKGROUND

Controlled donation after cardiac death (CDCD) is increasingly common for liver transplantation due to donor shortage. However, the outcomes, in terms of grafts and recipients, remain unclear. The current study is a systematic review and meta-analysis that compared CDCD with donation after brain death (DBD).

METHODS

We conducted an electronic search of MEDLINE, EMBASE, and the Cochrane Database (from January 2007 to May 2017). Studies reporting Maastricht category III or IV CDCD liver transplantation were screened for inclusion. We appraised studies using the Newcastle-Ottawa scale and meta-analyzed using a fixed or random effects model.

RESULTS

A total of 21 studies, with 12,035 patients, were included in data analysis. CDCD did not differ from DBD in patient survival (hazard ration: 1.20; 95% confidence interval [CI]: 0.98 to 1.47; P = .07), graft survival (hazard ratio: 1.24; 95% CI: 0.99 to 1.56; P = .06), primary nonfunction (odds ratio [OR]: 1.74; 95% CI: 1.00 to 3.03; P = .05), hepatic artery thrombosis (OR: 1.17; 95% CI: 0.78 to 1.74; P = .45). However, CDCD was associated with biliary complications (OR: 2.48; 95% CI: 2.05 to 3.00), retransplantation (OR: 2.54; 95% CI: 1.99 to 3.26), and peak alanine aminotransferase (weighted mean difference: 330.88; 95% CI: 259.88 to 401.87). A subgroup analysis that included only hepatitis C virus (HCV)-positive recipients showed no significant difference between CDCD and DBD in biliary complications (P = .16), retransplantion (P = .15), HCV recurrence (P = .20), and peak alanine aminotransferase (P = .06).

CONCLUSIONS

CDCD transplantation is the most viable alternative to DBD transplantation in the current critical shortage of liver organs. HCV infection may not be the inferior factor of postoperative outcomes and survival.

Laparoendoscopic Single-site Plus 1-port Donor Nephrectomy: Division of Roles to Shorten Warm Ischemic Time

BACKGROUND

In this study we present our new surgical procedure, laparoendoscopic single-site surgery plus 1 for donor nephrectomy (LESS+1-DN), which shortens warm ischemic time (WIT) and improves surgical outcomes.

METHODS

From January 2013 to February 2017, 15 patients who underwent LESS-DN and 41 patients who underwent LESS+1-DN at our institution were evaluated retrospectively. Patients were divided into 3 groups: group A, 15 cases of LESS-DN; group B, the first 15 patients who underwent LESS+1-DN; and group C, 26 patients who underwent subsequent LESS+1-DN. To reduce WIT, we clearly defined the roles of the surgeon and first assistant in the 26 subsequent LESS+1-DN cases. The surgeon dissected the renal pedicle and harvested the kidney graft using a recovery bag and the first assistant held the recovery bag.

RESULTS

The mean operative time in group C (213.7 minutes) was significantly shorter than that in groups A (253.3 minutes) and B (253.8 minutes). The WIT in group C (195.2 seconds) was significantly shorter than that in groups A (389.8 seconds) and B (313.2 seconds). Open conversion was required in 1 case in group A. None of the donors required conversion to open surgery and no perioperative complications occurred in groups B and C. Linear regression analysis of the LESS+1-DN operative times and consecutive case numbers demonstrated a shallow learning curve (R² = 0.392, P < .05).

CONCLUSION

Our new procedure that divides the roles of the operator and the first assistant contributed significantly to a shortening of WIT. Dividing roles can facilitate a safer laparoscopic donor nephrectomy.

Efficacy and safety of anti-EGFR agents administered concurrently with standard therapies for patients with head and neck squamous cell carcinoma: a systematic review and meta-analysis of randomized controlled trials

Agents targeting epidermal growth factor receptor (EGFR) are used to treat head and neck squamous cell carcinoma (HNSCC); however, their efficacy and safety is poorly understood. Here we evaluated the efficacy and safety of anti-EGFR agents administered concurrently with standard therapies for HNSCC. Randomized controlled trials that evaluated addition of EGFR targeted therapy versus standard therapy alone were included. The primary outcome was overall survival (OS). Secondary outcomes were progression-free survival (PFS), overall response rate (ORR), locoregional control, and severe adverse events (SAEs, grade ≥ 3). Sixteen eligible trials with 4031 patients were included. Addition of anti-EGFR regimens to standard therapy significantly improved OS of patients with HNSCC (HR = 0.89; 95% CI, 0.82-0.96), with a moderately elevated rate of SAEs (RR = 1.08; 95% CI, 1.03-1.13). Subgroup analysis indicated that the survival benefit was observed when cetuximab was administered concurrently with radiotherapy (RT) for stage III/IV patients (HR = 0.76; 95% CI, 0.61-0.94; p = 0.01), or with chemotherapy for recurrent or metastatic (R/M) HNSCC (HR = 0.86; 95% CI, 0.78-0.95; p = 0.005). Significantly increased ORR (RR = 1.51; 95% CI 1.05-2.18) and PFS (HR = 0.72; 95% CI, 0.59-0.88) were found in R/M HNSCC patients treated with anti-EGFR plus chemotherapy, while no significant improvements were found in stage III/IV patients treated with anti-EGFR plus standard therapy. In conclusion, addition of cetuximab to standard therapy may improve outcomes for R/M HNSCC patients, while causing a moderate increase in SAEs. For stage III/IV patients, anti-EGFR mAb plus RT can improve OS compared with RT alone, while replacement of chemotherapy with EGFR mAb or adding EGFR mAb to combined chemotherapy and RT did not improve outcomes.

Assessment of Postural Ergonomics and Surgical Performance in Laparoendoscopic Single-Site Surgery Using a Handheld Robotic Device

Purpose. New laparoscopic devices are being continuously developed to overcome some of the technical and ergonomic limitations of laparoendoscopic single-site (LESS) surgery. This study aims to assess the surgeon’s surgical performance and ergonomics during the use of a handheld, robotic-driven, articulating laparoscopic instrument during LESS surgery. Methods. Seven right-handed experienced surgeons took part in this study. A set of basic suturing tasks and digestive and urological procedures in a porcine model were performed. Surgeons used both a conventional laparoscopic needle holder and a robotic device. The learning curve, execution time, and precision using the surgical needle were assessed. The surgeon’s posture was analyzed using a motion tracking system and a data glove. Results. After the training period, execution time on the intracorporeal suturing was significantly shorter using the conventional needle holder. The precision was higher using the conventional instrument in the horizontal plane, but the number of attempts to position the needle was lower using the robotic device (1.625 ± 0.250 vs 1.188 ± 0.375 attempts). The extension of the elbow (134.681 ± 14.35° vs 120.631 ± 13.134°) and the flexion of the shoulder (26.122 ± 7.411° vs 18.475 ± 14.166°) were significantly lower using the robotic instrument. The wrist posture using the robotic device was ergonomically acceptable during both surgical procedures. Conclusions. Results show a positive learning curve in ergonomics and surgical performance using the robotic instrument during LESS surgery. This instrument improves the surgeon’s body posture and the needle positioning errors. The use of the robotic instrument is feasible and safe during LESS partial nephrectomy and sigmoidectomy procedures.

Robot-assisted vs freehand pedicle screw fixation in spine surgery - a systematic review and a meta-analysis of comparative studies

BACKGROUND

Medical robotics has progressively become more compelling in modern orthopaedic surgery. Several studies comparing robot-assisted (RA) and freehand (FH) conventional techniques for pedicle screw fixation have been published, but the results are unclear. Here, we assessed current evidence regarding the efficiency, safety and accuracy of RA compared with FH techniques.

METHODS

A literature search of PubMed, Embase, the Cochrane Library and Web of Science was performed to compare the differences between RA and FH in spine surgery. Two reviewers independently reviewed included studies, conducted a risk of bias assessment, and extracted data.

RESULTS

Three randomized controlled trials (RCTs) and six retrospective comparative studies included a total of 750 patients (3625 pedicle screws). No significant differences were noted between RA and FH in pedicle screw accuracy (95.5% compared with 92.9%; odds ratio: 1.35; 95% confidence interval [CI], 0.55 to 3.30; P=0.51), overall complication rate (1.33% compared with 3.45%; odds ratio: 0.46; 95% CI, 0.15 to 1.43; P=0.18) and radiation exposure time (weighted mean difference [WMD]:8.49; 95% CI, -15.43 to 32.40; P=0.49). While RA was associated with a longer operative time (WMD: 39.63; 95% CI, 5.27 to 73.99; P= 0.02), percutaneous or minimal robot-assisted pedicle screw fixation (M-RA) had a shorter radiation exposure time than FH (WMD: -33.10; 95% CI, -38.18 to -28.02; P=0.00) CONCLUSIONS: The current literature did not prove that RA supersedes FH, although several studies are more optimistic about this procedure. Future well-designed RCTs assessing RA and FH are needed to confirm and update the findings of this analysis.

Laparoscopic VS open hepatectomy for hepatolithiasis: An updated systematic review and meta-analysis

AIM

To perform a meta-analysis on laparoscopic hepatectomy VS conventional liver resection for treating hepatolithiasis.

METHODS

We conducted a systematic literature search on PubMed, Embase, Web of Science and Cochrane Library, and undertook a meta-analysis to compare the efficacy and safety of laparoscopic hepatectomy VS conventional open liver resection for local hepatolithiasis in the left or right lobe. Intraoperative and postoperative outcomes (time, estimated blood loss, blood transfusion rate, postoperative intestinal function recovery time, length of hospital stay, postoperative complication rate, initial residual stone, final residual stone and stone recurrence) were analyzed systematically.

RESULTS

A comprehensive literature search retrieved 16 publications with a total of 1329 cases. Meta-analysis of these studies showed that the laparoscopic approach for hepatolithiasis was associated with significantly less intraoperative estimated blood loss [weighted mean difference (WMD): 61.56, 95% confidence interval (CI): 14.91-108.20, P = 0.01], lower blood transfusion rate [odds ratio (OR): 0.41, 95%CI: 0.22-0.79, P = 0.008], shorter intestinal function recovery time (WMD: 0.98, 95%CI: 0.47-1.48, P = 0.01), lower total postoperative complication rate (OR: 0.52, 95%CI: 0.39-0.70, P < 0.0001) and shorter stay in hospital (WMD: 3.32, 95%CI: 2.32-4.32, P < 0.00001). In addition, our results showed no significant differences between the two groups in operative time (WMD: 21.49, 95%CI: 0.27-43.24, P = 0.05), residual stones (OR: 0.79, 95%CI: 0.50-1.25, P = 0.31) and stone recurrence (OR: 0.34, 95%CI: 0.11-1.08, P = 0.07). Furthermore, with subgroups analysis, our results proved that the laparoscopic approach for hepatolithiasis in the left lateral lobe and left side could achieve satisfactory therapeutic effects.

CONCLUSION

The laparoscopic approach is safe and effective, with less intraoperative estimated blood loss, fewer postoperative complications, reduced length of hospital stay and shorter intestinal function recovery time than with conventional approaches.

Attitudes among transplant professionals regarding shifting paradigms in eligibility criteria for live kidney donation

BACKGROUND

The transplant community increasingly accepts extended criteria live kidney donors, however, great (geographical) differences are present in policies regarding the acceptance of these donors, and guidelines do not offer clarity. The aim of this survey was to reveal these differences and to get an insight in both centre policies as well as personal beliefs of transplant professionals.

METHODS

An online survey was sent to 1128 ESOT-members. Questions were included about several extended donor criteria; overweight/obesity, older age, vascular multiplicity, minors as donors and comorbidities; hypertension, impaired fasting glucose, kidney stones, malignancies and renal cysts. Comparisons were made between transplant centres of three regions in Europe and between Europe and other countries worldwide.

RESULTS

331 questionnaires were completed by professionals from 55 countries. Significant differences exist between regions in Europe in acceptance of donors with several extended criteria. Median refusal rate for potential live donors is 15%. Furthermore, differences are seen regarding pre-operative work-up, both in specialists who perform screening as in preoperative imaging.

CONCLUSIONS

Remarkably, 23.4% of transplant professionals sometimes deviate from their centre policy, resulting in more or less comparable personal beliefs regarding extended criteria. Variety is seen, proving the need for a standardized approach in selection, preferably evidence based.

Kinematic and ergonomic assessment of laparoendoscopic single-site surgical instruments during simulator training tasks

While laparoendoscopic single-site surgery (LESS) appears to be feasible and safe, instrument triangulation, tissue handling, and other bimanual tasks are difficult even for experienced surgeons. Novel technologies emerged to overcome LESS' procedural and ergonomic difficulties of "tunnel vision" and "instrument clashing." Surgeon kinematics, self-reported workload and upper body discomfort were used to compare straight, bent and two articulating instruments while performing two basic surgical tasks in a LESS simulator. All instruments resulted in bilateral elevation and rotation of the shoulders, excessive forearm motion and flexion and ulnar deviation of wrists. Surgeons' adopted non-neutral upper extremity postures and performed excessive joint excursions to compensate for reduced freedom of movement at the single insertion site and to operate the instrument mechanisms. LESS' cosmetic benefits continue to impact laparoscopic surgery and by enabling performance through improved instruments, ergonomic improvement for LESS can reduce negative impact on surgeon well-being and patient safety.

Laparoendoscopic single-site nephrectomy for hemodialysis patients with dialysis-related renal tumors

PURPOSE

The purpose of this study is to assess the efficacy of laparoendoscopic single-site (LESS) nephrectomy in hemodialysis patients, we compared outcomes between LESS nephrectomy and conventional laparoendoscopic nephrectomy in hemodialysis patients with dialysis-related renal tumors.

MATERIAL AND METHODS

A total of 16 hemodialysis patients who underwent LESS nephrectomy (LESS-N; n = 8) or conventional laparoendoscopic nephrectomy (C-N; n = 8) between November 2003 and July 2012 were retrospectively evaluated. Outcomes were compared between the two groups.

RESULTS

Patient and tumor characteristics were similar between the LESS-N and C-N groups. The mean operative duration was longer in the LESS-N than in the C-N group (231.0 ± 26.7 min versus 188.6 ± 36.4 min; p = .025). The mean estimated blood loss was lower in the LESS-N compared with the C-N group (26.4 ± 14.4 ml versus 65.6 ± 45.2 ml; p = .047). Postoperative complications were observed in three cases, comprising one case of retroperitoneal hematoma in the LESS-N group and one case each of peritoneal hematoma and retroperitoneal abscess in the C-N group. Surgical scarring was minimal in the LESS-N group.

CONCLUSIONS

Although there is a little extension of the operating time, LESS nephrectomy in hemodialysis patients is a feasible procedure compared with the conventional method.

Different techniques for harvesting grafts for living donor liver transplantation: A systematic review and meta-analysis

AIM

To perform a systematic review and meta-analysis on minimally vs conventional invasive techniques for harvesting grafts for living donor liver transplantation.

METHODS

PubMed, Web of Science, EMBASE, and the Cochrane Library were searched comprehensively for studies comparing MILDH with conventional living donor hepatectomy (CLDH). Intraoperative and postoperative outcomes (operative time, estimated blood loss, postoperative liver function, length of hospital stay, analgesia use, complications, and survival rate) were analyzed in donors and recipients. Articles were included if they: (1) compared the outcomes of MILDH and CLDH; and (2) reported at least some of the above outcomes.

RESULTS

Of 937 articles identified, 13, containing 1592 patients, met our inclusion criteria and were included in the meta-analysis. For donors, operative time [weighted mean difference (WMD) = 20.68, 95%CI: -6.25-47.60, P = 0.13] and blood loss (WMD = -32.61, 95%CI: -80.44-5.21, P = 0.18) were comparable in the two groups. In contrast, analgesia use (WMD = -7.79, 95%CI: -14.06-1.87, P = 0.01), postoperative complications [odds ratio (OR) = 0.62, 95%CI: 0.44-0.89, P = 0.009], and length of hospital stay (WMD): -1.25, 95%CI: -2.35-0.14, P = 0.03) significantly favored MILDH. No differences were observed in recipient outcomes, including postoperative complications (OR = 0.93, 95%CI: 0.66-1.31, P = 0.68) and survival rate (HR = 0.96, 95%CI: 0.27-3.47, P = 0.95). Funnel plot and statistical methods showed a low probability of publication bias.

CONCLUSION

MILDH is safe, effective, and feasible for living donor liver resection with fewer donor postoperative complications, reduced length of hospital stay and analgesia requirement than CLDH.

Is laparoscopic appendectomy feasible for complicated appendicitis ?A systematic review and meta-analysis

BACKGROUND

laparoscopic appendectomy(LA) has proved to be a safe alternative to open appendectomy(OA) in uncomplicated appendicitis; however, the feasibility of LA for complicated appendicitis(CA) has not been conclusively determined.

OBJECTIVES

To assess the feasibility and safety of LA for CA through a systematic review and meta-analysis.

METHODS

A literature search in PubMed, Embase, Cochrane Library, and web of Science was performed for eligible studies published from the inception of the databases to January 2016. All studies comparing LA and OA for CA were reviewed. After literature selection, data extraction and quality assessment were performed by two reviewers independently, and meta-analysis was conducted using Revman software, vision 5.2.

RESULTS

Two randomized controlled trials (RCTs) and 14 retrospective cohort studies(RCSs) were finally identified. Our meta-analysis showed that LA for CA could reduce the rate of surgical site infections (SSIs) (OR = 0.28; 95% CI: 0.25 to0.31, P < 0.00001), but LA did not increase the rate of postoperative intra-abdominal abscess(IAA) (OR = 0.79; 95% CI: 0.45 to 1.34, P = 0.40). The results showed that the operating time in the LA groups was much longer than that in the OA groups (WMD = 13.78, 95% CI: 8.99 to 18.57, P < 0.00001). However, the length of hospital stays in the LA groups were significantly shorter than those in the OA groups (WMD = -2.47, 95%CI: -3.75 to -1.19, P < 0.0002), and the time until oral intake(TTOI) was much earlier in the LA groups than in the OA groups (WMD = -0.88, 95% CI: -1.20 to -0.55, P < 0.00001). No significant difference was observed in the times of postoperative analgesia between the two groups(P > 0.05).

CONCLUSION

LA was feasible and safe for complicated appendicitis, and it not only could shorten the hospital stays and the time until oral intake, but it could also reduce the risk of surgical site infection.

Updated association of tea consumption and bone mineral density: A meta-analysis

BACKGROUND

Current studies evaluating the association of tea consumption and bone mineral density (BMD) have yielded inconsistent findings. Therefore, we conducted a meta-analysis to assess the relationship between tea consumption and BMD.

METHODS

The PubMed, Embase, and Cochrane Library databases were comprehensively searched, and a meta-analysis performed of all observational studies assessing the association of tea consumption and BMD. Forest plots were used to illustrate the results graphically. The Q-test and I statistic were employed to evaluate between-study heterogeneity. Potential publication bias was assessed by the funnel plot.

RESULTS

Four cohort, 1 case-control, and 8 cross-sectional studies including a total of 12,635 cases were included. Tea consumption was shown to prevent bone loss [odds ratio (OR): 0.66; 95% confidence interval (CI), 0.47-0.94; P = 0.02], yielding higher mineral densities in several bones, including the lumbar spine [standardized mean difference (SMD): 0.19; 95% CI, 0.08-0.31; P = 0.001], hip (SMD: 0.19; 95% CI, 0.05-0.34; P = 0.01), femoral neck [mean difference (MD): 0.01; 95% CI, 0.00-0.02; P = 0.04], Ward triangle (MD: 0.02; 95% CI, 0.01-0.04; P = 0.001), and greater trochanter (MD: 0.03; 95% CI, 0.02-0.04; P < 0.00001), than the non-tea consumption group.

CONCLUSION

This meta-analysis provided a potential trend that tea consumption might be beneficial for BMD, especially in the lumbar spine, hip, femoral neck, Ward triangle, and greater trochanter, which might help prevent bone loss.

Chronic Obstructive Pulmonary Disease as a Risk Factor for Cognitive Dysfunction: A Meta-Analysis of Current Studies

Cognitive dysfunction has been shown to be associated with many risk factors, such as smoking, diabetes, and body mass index. Chronic obstructive pulmonary disease (COPD), a common disease within the elderly population, has also been found to be related to cognitive decline. However, whether COPD is a risk factor of cognitive dysfunction is not well established. The purpose of this meta-analysis is to investigate the role COPD plays in cognitive dysfunction. PubMed, Cochrane library and Web of Science databases were searched. Three cohort studies and eleven cross-sectional studies were found to be eligible. According to our results, COPD patients had a higher risk of cognitive dysfunction than controls (OR [odds ratio]: 1.72; 95% CI, 1.12-2.65; p = 0.01). The exacerbation of COPD was strongly correlated with cognitive decline. COPD patients performed worse than controls on the Mini- Mental State Examination test, but the results were not statistically significant (OR: -0.79; 95% CI, [-1.78, 0.19]; p = 0.11). Thus, more attention should be given to the occurrence of cognitive decline in COPD patients. The prevention and control of COPD exacerbation are critical.

Comparative study of multiport laparoscopy and umbilical laparoendoscopic single-site surgery with reusable platform for treating renal masses

INTRODUCTION

Umbilical laparoendoscopic single-site (LESS) surgery is an increasingly used modality for treating renal masses. We present a prospective comparison between LESS renal surgery and conventional laparoscopy.

MATERIAL AND METHOD

A comparative paired study was conducted that evaluated the surgical results and complications of patients with renal neoplasia treated with LESS surgery (n=49) or multiport laparoscopy (n=53). The LESS approach was performed with reusable material placed in the navel and double-rotation curved instruments. An additional 3.5-mm port was employed in 69.4% of the cases. We assessed demographic data, the type of technique (nephrectomy, partial nephrectomy and nephroureterectomy), surgical time, blood loss, haemoglobin, need for transfusion, number and severity of complications (Clavien-Dindo), hospital stay, histological data and prognosis.

RESULTS

There were no differences in follow-up, age, sex, body mass index, preoperative haemoglobin levels or type of surgery. Conversion occurred in 2 cases (1 in each group). The surgical time was equivalent (P=.6). Intraoperative transfusion (P=.03) and blood loss (P<.0001) was lower with LESS, postoperative haemoglobin levels were higher (P<.0001) and haemostatic agents were used more frequently (P<.0001). There were no differences in the number (P=.6) or severity (P=.47) of complications. The length of stay (P<.0001), the proportion of patients with drainage (P=.04) and the number of days with drainage (P=.0004) were lower in LESS. Twenty-five percent of the lesions operated on with LESS were benign, but the mean size was similar in the 2 groups (P=.5). Tumour recurrence and/or progression were more frequent in multiport laparoscopy (P=.0013).

CONCLUSIONS

Umbilical LESS surgery with reusable platform enables various surgical techniques to be performed when treating renal masses, with time consumption and safety comparable to conventional laparoscopy. The LESS approach is advantageous in terms of blood loss and hospital stay.