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Ceccarelli G, Catena F, Avella P, Tian BW, Rondelli F, Guerra G, De Rosa M, Rocca A. Emergency robotic surgery: the experience of a single center and review of the literature. World J Emerg Surg 2024; 19:28. [PMID: 39154016 PMCID: PMC11330055 DOI: 10.1186/s13017-024-00555-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 07/22/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUNDS Laparoscopic surgery is widely used in abdominal emergency surgery (AES), and the possibility of extending this approach to the more recent robotic surgery (RS) arouses great interest. The slow diffusion of robotic technology mainly due to high costs and the longer RS operative time when compared to laparoscopy may represent disincentives, especially in AES. This study aims to report our experience in the use of RS in AES assessing its safety and feasibility, with particular focus on intra- and post-operative complications, conversion rate, and surgical learning curve. Our data were also compared to other experiences though an extensive literature review. METHODS We retrospectively analysed a single surgeon series of the last 10 years. From January 2014 to December 2023, 36 patients underwent urgent or emergency RS. The robotic devices used were Da Vinci Si (15 cases) and Xi (21 cases). RESULTS 36 (4.3%) out of 834 robotic procedures were included in our analysis: 20 (56.56%) females. The mean age was 63 years and 30% of patients were ≥ 70 years. 2 (5.55%) procedures were performed at night. No conversions to open were reported in this series. According to the Clavien-Dindo classification, 2 (5.5%) major complications were collected. Intraoperative and 30-day mortality were 0%. CONCLUSIONS Our study demonstrates that RS may be a useful and reliable approach also to AES and intraoperative laparoscopic complications when performed in selected hemodynamically stable patients in very well-trained robotic centers. The technology may increase the minimally invasive use and conversion rate in emergent settings in a completely robotic or hybrid approach.
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Affiliation(s)
- Graziano Ceccarelli
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Fausto Catena
- Division of General Surgery, Bufalini Hospital, Cesena, Italy
| | - Pasquale Avella
- Department of General Surgery and Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy.
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy.
| | - Brian Wca Tian
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Fabio Rondelli
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Germano Guerra
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
| | - Michele De Rosa
- Department of General Surgery, "San Giovanni Battista" Hospital, USL Umbria 2, Foligno, Perugia, Italy
| | - Aldo Rocca
- Department of General Surgery and Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Campobasso, Italy
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Huang Y, Fu R, Liu D, Wen K. Keys to successful laparoscopic adhesiolysis for adhesive small bowel obstruction: A scoping review. Heliyon 2024; 10:e34359. [PMID: 39149046 PMCID: PMC11324824 DOI: 10.1016/j.heliyon.2024.e34359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/05/2024] [Accepted: 07/08/2024] [Indexed: 08/17/2024] Open
Abstract
Background Adhesive small bowel obstruction (ASBO) is a common acute abdominal complication. Although non-surgical treatment is the primary treatment approach, more and more studies show that surgical treatment can reduce the incidence rate. Laparoscopic adhesiolysis (LA) has many advantages of minimally invasive surgery.But not all patients with ASBO are suitable for LA. Objective The aim of this scoping review was to summarize the keys to successful LA by analyzing the extensive literature. Methods A literature search was conducted in PubMed for articles on laparoscopic treatment of ASBO published between January 2000 and February 2024. This scoping review followed the framework suggested by Arksey and O'Malley for a scoping review. Results By analyzing the included studies we found that LA does have many advantages and can be performed safely. However, the prerequisite is to select patients with simple adhesions whenever possible and to focus on reasonable intraoperative measures. To improve the success rate of LA, we summarized the following characteristics of patients: no contraindications related to pneumoperitoneum, few previous abdominal operations (≤2), no pregnancy, bowel dilatation < 4 cm in diameter, simple adhesions, no diffuse peritonitis, no history of abdominal radiotherapy, <24 h of ASBO, limited previous abdominal surgery (appendix, cholecystectomy), no bowel strangulation ischemia, and bowel necrosis or bowel resection required for other reasons. In addition, we also summarized reasonable intraoperative measures. Conclusions Laparoscopic adhesiolysis has many advantages.Specific patients can benefit from LA. This scoping review Summarized the conditions for patient screening and reasonable intraoperative measures with the aim of providing a reference for surgeons, thereby ensuring that more patients benefit from LA.
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Affiliation(s)
- Yuanqi Huang
- Department of of Gastrointestinal Surgery, The Tenth Affiliated Hospital, Southern Medical University(Dongguan People's Hospital), China
- Department of of General Surgery, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi City, Guizhou Province, China
| | - Ruimin Fu
- Department of of Gastrointestinal Surgery, The Tenth Affiliated Hospital, Southern Medical University(Dongguan People's Hospital), China
- Department of of General Surgery, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi City, Guizhou Province, China
| | - Dandan Liu
- Department of of General Surgery, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Zunyi City, Guizhou Province, China
| | - Kunming Wen
- Department of of Gastrointestinal Surgery, The Tenth Affiliated Hospital, Southern Medical University(Dongguan People's Hospital), China
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Loudon AM, Landwehr HJ, Hinton JB, Posluszny JA, Radow BS, Moorman ML. Optimal Management of Traumatic Abdominal Wall Hernias Remains Unclear. Am Surg 2024:31348241268016. [PMID: 39042944 DOI: 10.1177/00031348241268016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
High-energy, blunt force trauma to the abdomen results in an abdominal wall injury (AWI) in up to 9% of patients. In 1% of blunt abdominal trauma, they result in a traumatic abdominal wall hernia (TAWH). Optimal management of these injuries remains unclear. Because they are the result of a high-energy mechanism, concomitant serious abdominal organ injuries are common. This has prompted some to advocate that the presence of a TAWH on physical exam mandates exploratory laparotomy. However, delayed repairs have better outcomes and nontherapeutic celiotomy should be avoided. Similarly debated is the expanding use of minimally invasive techniques and the use of mesh for hernia repairs. Overall, the presence of a TAWH is likely not an absolute indication for emergency surgery. Rather, it is an indicator of high-energy impact and associated with a high rate of visceral injury. These patients require a close observation for clinical decline and development of typical indicators for laparotomy.
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Affiliation(s)
- Andrew M Loudon
- Department of Surgery, University Hospitals, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
- Northeast Ohio Medical University, Rootstown, OH, USA
| | | | | | - Joseph A Posluszny
- Department of Surgery, University Hospitals, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
- Northeast Ohio Medical University, Rootstown, OH, USA
| | - Brandon S Radow
- Department of Surgery, University Hospitals, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Matthew L Moorman
- Department of Surgery, University Hospitals, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
- Northeast Ohio Medical University, Rootstown, OH, USA
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Sánchez-Rodríguez M, Tejedor P. Faecal peritonitis. Br J Surg 2024; 111:znae169. [PMID: 39041234 DOI: 10.1093/bjs/znae169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 06/16/2024] [Indexed: 07/24/2024]
Affiliation(s)
| | - Patricia Tejedor
- Colorectal Surgery Unit, University Hospital Gregorio Marañón, Madrid, Spain
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Shchatsko A, Swenson G, Vasyluk A. Robotic Evaluation and Repair of Penetrating Injury of the Abdominal Wall. Cureus 2024; 16:e63685. [PMID: 39092355 PMCID: PMC11293599 DOI: 10.7759/cureus.63685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 08/04/2024] Open
Abstract
This case demonstrated the feasibility of robotic-assisted exploratory laparoscopy in a hemodynamically stable trauma patient and abdominal wall repair with a favorable outcome. The patient presented with a stab wound at the left middle posterior flank. A computer tomography scan of the abdomen and pelvis demonstrated penetrating soft tissue injury to the left lateral abdominal wall with herniation of the omentum. A robotic-assisted laparoscopic approach was implemented to evaluate for visceral injury and to repair the abdominal wall. Diagnostic laparoscopy ruled out visceral and diaphragmatic injuries, and robotic primary tissue repair of the abdominal wall was performed. The patient was discharged home the following day. Laparoscopy for hemodynamically stable trauma patients has shown the benefit of decreased morbidity and decreased hospital stay compared to laparotomy. In turn, the robotic surgical approach has all the benefits of laparoscopy while bringing additional benefits of improved surgical dexterity, visualization, range of motion, and ergonomics.
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Affiliation(s)
| | - Gabriel Swenson
- Radiology, Mayo Clinic Scottsdale, Scottsdale, USA
- Surgery, Central Michigan University College of Medicine, Saginaw, USA
| | - Andrew Vasyluk
- Surgery, Central Michigan University College of Medicine, Saginaw, USA
- Surgery, Covenant Hospital, Saginaw, USA
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Obadiel YA, Albrashi A, Allahabi N, Sharafaddeen M, Ahmed F. Outcomes of Nonoperative Management of Penetrating Abdominal Trauma Injury: A Retrospective Study. Cureus 2024; 16:e58599. [PMID: 38765339 PMCID: PMC11102771 DOI: 10.7759/cureus.58599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND The treatment of penetrating abdominal injuries has changed in recent years with more focus on "nonoperative management" (NOM) to avoid unnecessary laparotomies while identifying injuries early. Although the NOM approach is widely used for stab wounds, its effectiveness in managing abdominal gunshot wounds is controversial. NOM of penetrating abdominal injuries is becoming more dependent on hemodynamic stability and improved noninvasive radiological interventions. The role of NOM is significantly underreported and underestimated in developing countries, particularly in fragile and conflict-affected states such as Yemen. The present study aims to evaluate the clinical outcomes of NOM in penetrating abdominal trauma injury patients and identify factors associated with NOM failure in a low-resource setting. METHODS A retrospective study from January 2021 to December 2022 including patients diagnosed with penetrating abdominal trauma at the General Military Hospital, Sana'a, Yemen, was conducted. Hemodynamically stable patients without peritonitis or clear indications for immediate laparotomy were candidates for NOM and were included in the study. Patients with blunt abdominal injuries, penetrating wounds outside the abdomen, particularly head injury, eviscerated structures, and gastrointestinal hemorrhage, or those pronounced dead on arrival were excluded. The primary outcome was the success and failure rate of NOM necessitating laparotomy. The secondary outcome was the factors associated with NOM failure. RESULTS During the study, 256 patients with penetrating abdominal injury were admitted, with 222 (86.7%) undergoing immediate laparotomy and 34 (13.3%) treated with NOM. The mean age was 27.6±7.4 years. Bump explosions, mostly sharp objects (secondary blast injuries), were the main causes of injury (n=18, 52.9%). Other causes were low-velocity gunshot wounds, stab wound injuries, and shotgun injuries in 14 (41.2%), one (2.9%), and one (2.9%), respectively. The majority of patients (n=25, 55.9%) were admitted within 6-24 hours of the incident. The abdominal computed tomography (CT) scan revealed various injuries in all patients, including hemoperitoneum in 11 (32.4%), pneumoperitoneum in five (14.7%), liver injury in 15 (44.1%), foreign body attached to the wall colon in 23 (67.6%), kidney injury in two (5.9%), and splenic injury in one (2.9%). NOM was successful in 31 (91.2%) patients. NOM failed in three (8.8%). One patient was treated via the laparoscopic procedure, and two patients were treated with laparotomy procedures. Five (14.7%) cases required intensive care unit (ICU) admission, with no deaths or major complications. In univariate analysis, the presence of free intra-abdominal fluid (pneumoperitoneum) on the initial CT scan and the need for ICU admission were associated with NOM failure and were statistically significant (p<0.05). CONCLUSION Our findings support that some penetrating abdominal trauma patients can benefit from NOM. The goal of preventing unnecessary laparotomies should be aligned with a comprehensive comprehension of the clinical signs and symptoms of NOM failure and the necessity for surgical intervention. Serial abdominal examinations remain the foundation of selected NOM; nevertheless, radiological and laboratory tests can be important tools in decision-making. In this study, free intra-abdominal fluid on the initial CT scan and the need for ICU admission were associated with NOM failure.
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Affiliation(s)
- Yasser A Obadiel
- General Surgery, Al-Thawra Modern General Hospital, Sana'a University, Sana'a, YEM
| | - Ali Albrashi
- Surgery, Faculty of Medicine, 21 September University, Sana'a, YEM
| | - Noman Allahabi
- Surgery, Faculty of Medicine, 21 September University, Sana'a, YEM
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Chae HC, Kim BJ, Choi YS, Suh SW, Lee SE. Efficacy of Filter Trocar for Clear Visualization during Laparoscopic Cholecystectomy: A Prospective Randomized Controlled Trial. J Pers Med 2024; 14:204. [PMID: 38392637 PMCID: PMC10890709 DOI: 10.3390/jpm14020204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/02/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024] Open
Abstract
Filter trocar designed to eliminate harmful smoke is also regarded as effective for improving surgical visualization. The aim of this study is to evaluate the efficacy of filter trocar in maintaining clear operative view. From 2019 to 2020, 100 patients underwent laparoscopic cholecystectomy and they were randomized to either the control or filter group. The primary end point was a laparoscopic operative view score (1, clear; 2, slightly blurry; 3, completely blurry) during gallbladder dissection from the liver bed when dissection was started (LV1), when dissection was half completed (LV2) and when dissection was completed (LV3). Between the control and filter groups, there were no significant differences in mean LV1 (1.44 vs. 1.40, p = 0.234) and LV3 (1.86 vs. 2.01, p = 0.880). There was no significant difference in the mean duration of suction after dissection (3.82 s vs. 3.67 s, p = 0.097) and the mean number of laparoscope removals from inside to outside the body to clean during gallbladder dissection from the liver bed (0.55 vs. 0.22, p = 0.963) or the mean amount of time required to dissect the gallbladder from the liver bed (221.58 s vs. 177.09 s, p = 0.253). The study demonstrated that filter trocar is not as effective as expected in the maintenance of clear operative view. Further study is needed to develop devices to improve clear surgical visualization.
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Affiliation(s)
- Ho-Chang Chae
- Samsung Medical Center, Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Beom-Jin Kim
- Department of Surgery, Seoul Song-do Hospital, Seoul 04597, Republic of Korea
| | - Yoo Shin Choi
- Department of Surgery, Chung-Ang University College of Medicine, Seoul 06974, Republic of Korea
| | - Suk-Won Suh
- Department of Surgery, Chung-Ang University College of Medicine, Seoul 06974, Republic of Korea
| | - Seung Eun Lee
- Department of Surgery, Chung-Ang University College of Medicine, Seoul 06974, Republic of Korea
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