Safety and efficiency of gasless laparoscopy: a systematic review protocol

Global scientific production on gasless laparoscopy: a bibliometric analysis

Objectives

To characterize the bibliometric characteristics of the global scientific production of original research on gasless laparoscopy in the Web of Science Core Collection (WoSCC) platform.

Materials and methods

A bibliometric study of original articles published up to the year 2023 was carried out. Articles were included following the selection criteria in the Rayyan web application, indexed in the Scopus database. The bibliometric analysis was performed using the Bibliometrix program in the R programming language and VOSviewer. The bibliometric characteristics evaluated were articles, journals, citations, publications, ten most mentioned articles, journals with the highest number of publications, authors and institutional affiliations; and cooccurrence of terms.

Results

A total of 223 publications were included, with the highest number of articles being published in the years 1999 and 2014. The publication with the most citations was found to be a randomized trial by Galizia G in 2001 with 132 citations. We identified 846 authors involved in the production of articles on gasless laparoscopy, with Nakamura H being the most productive author with 15 articles between the years 2007 and 2020, followed by Takeda A and Imoto S, all three affiliated with "Gifu Prefectural Tajimi Hospital". The country with the highest production was Japan with 64 publications, followed by China and Italy with 46 and 18 publications, respectively. In the top 10 journals with the highest number of publications, "Surgical Endoscopy-Ultrasound and Interventional Techniques" is in first place with 20 articles published on gasless laparoscopy; in addition, most of these are located in Q1 and Q2. Regarding the terms or keywords, it was found that the initial studies had terms related to the disadvantages of pneumoperitoneum and later focused on more specific topics of the application of gasless laparoscopy.

Conclusions

Production on gasless laparoscopy has stagnated, with the topics of interest currently being its application in new, less invasive techniques. The most productive countries are found in the Asian and European continents, with little information collected in Latin America. This fact makes it necessary to increase the production of studies to promote this technique and its possible advantages.

Gasless laparoscopic renal biopsy in canine cadavers: a preclinical study

In this study we aimed to analyze the feasibility of the gasless renal biopsy technique in canine cadavers. The cadavers were randomly divided into two groups: laparoscopic GCG, in which gasless laparoscopy was performed and GCP, laparoscopy with pneumoperitoneum was performed. The procedures were randomly performed on the right and left kidneys. The total surgical time, procedural steps, and intraoperative complications were recorded. The degree of difficulty of the surgical approaches was evaluated by the surgeon, assistant, and external evaluators. Renal samples were evaluated for quality, number of glomeruli, and proportion of renal cortex. The total operative time was higher in the GCG group than in the GCP group (p < 0.01). Additionally, positioning of the second portal and platform positioning took longer than the other steps. The surgical groups differed from each other in the Likert scale values for almost all the parameters regarding the difficulty of the surgical approaches (p < 0.05), with higher scores in the GCG group than in the GCP group. Based on the video recordings, the GCP group had higher scores than the GCG group for degrees of difficulty of the approach (p < 0.05). Renal histological parameters were similar between the surgical groups and surgical sides. Our study findings indicate that the proposed gasless renal biopsy technique is feasible. The longer operative time and technical difficulties in the gasless approach did not affect the quality of the renal specimens.

Cesena guidelines: WSES consensus statement on laparoscopic-first approach to general surgery emergencies and abdominal trauma

BACKGROUND

Laparoscopy is widely adopted across nearly all surgical subspecialties in the elective setting. Initially finding indication in minor abdominal emergencies, it has gradually become the standard approach in the majority of elective general surgery procedures. Despite many technological advances and increasing acceptance, the laparoscopic approach remains underutilized in emergency general surgery and in abdominal trauma. Emergency laparotomy continues to carry a high morbidity and mortality. In recent years, there has been a growing interest from emergency and trauma surgeons in adopting minimally invasive surgery approaches in the acute surgical setting. The present position paper, supported by the World Society of Emergency Surgery (WSES), aims to provide a review of the literature to reach a consensus on the indications and benefits of a laparoscopic-first approach in patients requiring emergency abdominal surgery for general surgery emergencies or abdominal trauma.

METHODS

This position paper was developed according to the WSES methodology. A steering committee performed the literature review and drafted the position paper. An international panel of 54 experts then critically revised the manuscript and discussed it in detail, to develop a consensus on a position statement.

RESULTS

A total of 323 studies (systematic review and meta-analysis, randomized clinical trial, retrospective comparative cohort studies, case series) have been selected from an initial pool of 7409 studies. Evidence demonstrates several benefits of the laparoscopic approach in stable patients undergoing emergency abdominal surgery for general surgical emergencies or abdominal trauma. The selection of a stable patient seems to be of paramount importance for a safe adoption of a laparoscopic approach. In hemodynamically stable patients, the laparoscopic approach was found to be safe, feasible and effective as a therapeutic tool or helpful to identify further management steps and needs, resulting in improved outcomes, regardless of conversion. Appropriate patient selection, surgeon experience and rigorous minimally invasive surgical training, remain crucial factors to increase the adoption of laparoscopy in emergency general surgery and abdominal trauma.

CONCLUSIONS

The WSES expert panel suggests laparoscopy as the first approach for stable patients undergoing emergency abdominal surgery for general surgery emergencies and abdominal trauma.