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Xu L, Bian X, Yang J, Xu H, Fang Y, Yang J, Jiang L, Wen P. Safety and effectiveness of laparoscopic renal biopsy: a single-center review and meta-analysis. Ren Fail 2024; 46:2312536. [PMID: 38305211 PMCID: PMC10840595 DOI: 10.1080/0886022x.2024.2312536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/27/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND While renal biopsy remains the preferred diagnostic method for assessing proteinuria, hematuria, or renal failure, laparoscopic renal biopsy (LRB) can serve as an alternative for high-risk patients when percutaneous kidney biopsy (PKB) is not recommended. This study was aimed to evaluate the safety of LRB. METHODS In study 1, Fourteen patients from January 2021 to January 2023 had a LRB taken for various indications, such as morbid obesity, abnormal kidney construction, uncontrolled hypertension, and coagulopathy. We also conducted a Meta-analysis of the success rate and complication rate of previous LRB in study 2. RESULTS All the patients completed biopsies and adequate renal tissues were obtained. The success rate was 100%. The median number of glomeruli obtained was 22.5 (range:12.0, 45.0). The complication rate was 7.1% (urinary tract infection). There were no significant differences between levels of hemoglobin, serum creatinine, and urinary NAGL before and after surgery. In the meta-analysis, the success rate of operation, satisfactory rate of sample, and complication rate of surgery were 99.9%, 99.1%, and 2.6% respectively. CONCLUSION LRB can achieve a good success rate and specimen retrieval and does not increase the risk of complications for high-risk patients. It can present as one of the alternative methods for patients with glomerular diseases.
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Affiliation(s)
- Lingling Xu
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Jiangsu, China
| | - Xueqin Bian
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Jiangsu, China
| | - Jian Yang
- Department of Urology, Second Affiliated Hospital, Nanjing Medical University, Jiangsu, China
| | - Hongying Xu
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Jiangsu, China
| | - Yi Fang
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Jiangsu, China
| | - Junwei Yang
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Jiangsu, China
| | - Lei Jiang
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Jiangsu, China
| | - Ping Wen
- Center for Kidney Disease, Second Affiliated Hospital, Nanjing Medical University, Jiangsu, China
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2
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Sarno G, Iacone B, Tedesco A, Gargiulo A, Ranieri A, Giordano A, Tramontano S, Bracale U. End-colostomy parastomal hernia repair: a systematic review on laparoscopic and robotic approaches. Hernia 2024:10.1007/s10029-024-03026-8. [PMID: 38625435 DOI: 10.1007/s10029-024-03026-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/08/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION Parastomal hernia (PSH) is the most common and challenging complication after stoma creation, with an estimated 50% incidence 2 years after the index surgery. Mesh repair is the treatment of choice. Laparoscopic and/or robotic approaches allow acceptable outcomes. MATERIALS AND METHODS A systematic literature review from January 2012 to November 2023 was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Embase, PubMed, and Scopus search were performed to select articles dealing with minimally invasive surgical treatment for PSH after end colostomy. RESULTS 603 studies were found, and 24 were chosen. When compared to open surgery, laparoscopy showed decreased postoperative complications and recurrence. The main laparoscopic approaches are the keyhole (KH), the Sugarbaker (SB), and the sandwich technique. Continuous improvement in surgery, mesh technology, and surgeons' expertise led to an amelioration of surgical outcome and recurrence rate after repair. Recent studies showed comparable outcomes for SB and KH techniques, while novel surgical approaches have been proposed in an attempt to further increase the operative and long-term results. Reports on PSH robotic repairs are scarce and describe small series results, suggesting a role of the initial learning curve as a risk factor for complications. CONCLUSION End-colostomy PSH surgical repair still represents a challenge for surgeons. Recent evidence has not shown a significant advantage in postoperative complications and recurrence with a specific repair among SB, KH, and sandwich technique. The paucity of data on robotic surgery does not allow to draw definitive conclusion. Further primary, multicentric, and larger cohort studies are needed.
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Affiliation(s)
- G Sarno
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy.
| | - B Iacone
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
| | - A Tedesco
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
| | - A Gargiulo
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
| | - A Ranieri
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
| | - A Giordano
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
| | - S Tramontano
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
| | - U Bracale
- General and Emergency Surgery Unit, Department of Medicine, Surgery and Dentistry, "Salerno Medical School", San Giovanni di Dio e Ruggi d'Aragona University Hospital, Scuola Medica Salernitana, University of Salerno, Faculty of Medicine and Surgery, Campus di Baronissi (SA), "Gaetano Fucito" Facility, Mercato San Severino (SA), Salerno, Italy
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3
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Gu J, Cao J, Cao W, Chen Y, Wei F. Optimized reusable modular 3D-printed models of choledochal cyst to simulate laparoscopic and robotic bilioenteric anastomosis. Sci Rep 2024; 14:8807. [PMID: 38627503 DOI: 10.1038/s41598-024-59351-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
Laparoscopic and robotic surgery is a challenge to the surgeon's hand-eye coordination ability, which requires constant practice. Traditional mentor training is gradually shifting to simulation training based on various models. Laparoscopic and robotic bilioenteric anastomosis is an important and difficult operation in hepatobiliary surgery. We constructed and optimized the reusable modular 3D-printed models of choledochal cyst. The aim of this study was to verify the ability of this optimized model to distinguish between surgeons with different levels of proficiency and the benefits of repeated practice. A total of 12 surgeons with different levels participated in the study. Operation completion time and OSATS score were recorded. The model was validated by Likert scale. Surgeons were shown the steps and contents before performing laparoscopic or robotic bilioenteric anastomosis using the model. Surgeons with different levels of experience showed different levels when performing laparoscopic bilioenteric anastomosis on this model. Repeated training can significantly shorten the time of laparoscopic bilioenteric anastomosis and improve the operation scores of surgeons with different levels of experience. At the same time, preliminary results have shown that the performance of surgeons on the domestic robotic platform was basically consistent with their laparoscopic skills. This model may distinguish surgeons with different levels of experience and may improve surgical skills through repeated practice. It is worth noting that in order to draw more reliable conclusions, more subjects should be collected and more experiments should be done in the future.
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Affiliation(s)
- Jing Gu
- Department of General Surgery, Cancer Center, Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang Province, China
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China
| | - Jie Cao
- Ningbo Chuangdao 3D Medical Technology Co., Ltd., Ningbo, 315336, Zhejiang Province, China
| | - Wenli Cao
- Department of General Surgery, Cancer Center, Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang Province, China
- Department of Public Health, Hangzhou Medical College, Hangzhou, 310059, Zhejiang Province, China
| | - Yusuo Chen
- Department of General Surgery, Cancer Center, Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang Province, China
- Department of Clinical Medicine, Hangzhou Medical College, Hangzhou, 310059, Zhejiang Province, China
| | - Fangqiang Wei
- Department of General Surgery, Cancer Center, Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang Province, China.
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4
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Huang WK, Lu ZK, Deng F, Chen XX, Zhuo XY, Liu KX, Liu WF. Comparison of three concentrations of ropivacaine in posterior quadratus lumborum block: A randomized clinical trial. Heliyon 2024; 10:e28434. [PMID: 38560099 PMCID: PMC10981130 DOI: 10.1016/j.heliyon.2024.e28434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
Background A conclusive evidence regarding the optimal concentration and volume of local anesthetic for quadratus lumborum block is lacking. Methods In this single-center, prospective, randomized, controlled study, 60 patients scheduled for laparoscopic colorectal surgery were randomly assigned to 3 different combinations of volume and concentration of ropivacaine (3 mg/kg) - Group 0.25%, Group 0.375% and Group 0.5%. All subjects received ultrasound-guided posterior quadratus lumborum block prior to the induction. The primary outcome was the complete sensory block rate of surgical site measured at 30 min after quadratus lumborum block, after extubation, at 12, 24, and 48 h after operation. Secondary outcomes were the changes in hemodynamic parameters before and after incision (ΔSBP, ΔDBP and ΔHR), postoperative pain score, the sufentanil consumption after surgery, length of stay and adverse reactions. Results The sensory block rate of surgical site at 5 time points differed significantly among the three groups (P < 0.001). Both Group 0.375% (P < 0.001) and Group 0.5% (P < 0.001) had a higher sensory block rate than Group 0.25%, but no significant difference was observed between the former two. Group 0.375% and Group 0.5% had lower postoperative pain scores, lower sufentanil consumption after surgery and shorter length of stay. No statistical difference was observed in ΔSBP, ΔDBP, ΔHR and the incidence of adverse reactions. Conclusions 0.375% and 0.5% ropivacaine in posterior quadratus lumborum block provide better sensory block of surgical site when compared to 0.25% in laparoscopic colorectal surgery. Trial registration number Chinese Clinical Trials Registry (ChiCTR2100043949).
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Affiliation(s)
- Wen-Kao Huang
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhao-Kai Lu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Anesthesiology, Houjie Hospital of Dongguan, Dongguan, China
| | - Fan Deng
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xing-Xia Chen
- Department of Anesthesiology, Houjie Hospital of Dongguan, Dongguan, China
| | - Xiao-Yu Zhuo
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ke-Xuan Liu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wei-Feng Liu
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Vega EA, Martí-Cruchaga P, Salehi O, Benito A, Zozaya G, López-Olaondo L, Lapuente F, Rotellar F. Enucleation of Sporadic Insulinoma in the Posterior Side of the Head of the Pancreas: The Retro laparoscopic Approach. Ann Surg Oncol 2024:10.1245/s10434-024-15215-x. [PMID: 38565752 DOI: 10.1245/s10434-024-15215-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Eduardo A Vega
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA.
| | - Pablo Martí-Cruchaga
- Department of Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Omid Salehi
- Department of Surgery, St. Elizabeth's Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Alberto Benito
- Department of Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Gabriel Zozaya
- Department of Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Luis López-Olaondo
- Department of Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Fernando Lapuente
- Department of Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain
| | - Fernando Rotellar
- Department of Surgery, Clinica Universidad de Navarra, Universidad de Navarra, Pamplona, Spain.
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Ito K, Kataoka K, Takenaka Y, Beppu N, Tsukasaki Y, Kohno K, Tsubamoto H, Shinohara H, Hirono S, Yamamoto S, Ikeuchi H, Ikeda M. Subcutaneous emphysema associated with laparoscopic or robotic abdominal surgery: a retrospective single-center study. Surg Endosc 2024; 38:1969-1975. [PMID: 38379005 DOI: 10.1007/s00464-024-10701-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/14/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Subcutaneous emphysema (SCE) is a common complication in laparoscopic surgery. However, its precise incidence and impact on the clinical course are partially known. In this study, the incidence and risk factors of SCE were retrospectively analyzed. METHODS Patients who underwent laparoscopic/robotic abdominal surgery (e.g., gastrointestinal, hepatobiliary, gynecologic, and urologic surgery) between October 2019 and September 2022 were retrospectively analyzed. The presence of SCE was confirmed by either conclusive findings obtained through chest/abdominal X-ray examination immediately after operation, or intraoperative palpation conducted by nurses. X-ray examination was performed in the operation room before extubation. RESULTS A total of 2503 patients treated with laparoscopic/robotic abdominal surgery between October 2019 and September 2022 were identified and all of them were included in the analysis. SCE was confirmed in 23.1% of the patients (i.e., 577/2503). SCE was identified by X-ray examination in 97.6% of the patients. Extubation failure was observed in 10 patients; however, pneumothorax was not observed. Female sex (odds ratio [OR]: 2.09; 95% confidence interval [95%CI]: 1.69-2.57), age ≥ 80 years (OR 1.63; 95%CI 1.19-2.22), body mass index < 20 (OR 1.32; 95%CI 1.06-1.65), operation time > 360 min (OR 1.97; 95%CI 1.53-2.54), robotic surgery (OR 2.54; 95%CI 1.91-3.38), maximum intraabdominal pressure with CO2 > 15 mmHg (OR 1.79; 95%CI 1.02-3.16), and endo-tidal CO2 > 50 mmHg (OR 1.32; 95%CI 1.08-1.62)were identified as independent factors of SCE. Regarding the extubation failure due to SCE, age (OR 5.84; 95%CI 1.27-26.8) and maximum intraabdominal pressure with CO2 (OR 21.7; 95%CI 4.76-99.3) were identified as risk factors. CONCLUSION Although the presence of SCE is associated with a low risk of severe complications, monitoring of the perioperative intraabdominal pressure is essential for performing safe laparoscopic/robotic surgery, particularly in elderly patients.
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Affiliation(s)
- Kazuma Ito
- Division of Lower GI, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan
| | - Kozo Kataoka
- Division of Lower GI, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan.
| | - Yuya Takenaka
- Division of Lower GI, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan
| | - Naohito Beppu
- Division of Lower GI, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan
| | - Yurie Tsukasaki
- Nursing Department, Hyogo Medical University, Nishinomiya, Japan
| | - Koichi Kohno
- Nursing Department, Hyogo Medical University, Nishinomiya, Japan
| | - Hiroshi Tsubamoto
- Department of Obstetrics and Gynecology, Hyogo Medical University, Nishinomiya, Japan
| | - Hisashi Shinohara
- Division of Upper GI, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan
| | - Seiko Hirono
- Department of Hepato-Biliary-Pancreatic Surgery, Hyogo Medical University, Nishinomiya, Japan
| | - Shingo Yamamoto
- Department of Urology, Hyogo Medical University, Nishinomiya, Japan
| | - Hiroki Ikeuchi
- Division of Inflammatory Bowel Disease Surgery, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan
| | - Masataka Ikeda
- Division of Lower GI, Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya, Japan
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Codjia T, Marique L, Aussilhou B, Ftériche FS, de Mestier L, Rebours V, Cros J, Ruszniewski P, Lévy P, Lesurtel M, Sauvanet A, Dokmak S. Outcome and survival were similar with laparoscopic and open pancreatectomy in 102 solid pseudopapillary neoplasms. Surg Endosc 2024; 38:2169-2179. [PMID: 38448620 DOI: 10.1007/s00464-024-10708-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/21/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Solid pseudopapillary neoplasms of the pancreas (SPNP) are rare tumors predominantly in young women. We report the largest single-center cohort study comparing resection of SPNP by laparoscopic approach (LA) and the open approach (OA). METHOD Between 2001 and 2021, 102 patients (84% women, median age: 30) underwent pancreatectomy for SPNP and were retrospectively studied. Demographic, perioperative, pathological, early and the long-term results were evaluated between patients operated by LA and those by OA. RESULTS Population included 40 LA and 62 OA. There were no significant differences in demographics data between the groups. A preoperative biopsy by endoscopic ultrasound was performed in 45 patients (44%) with no difference between the groups. Pancreatoduodenectomy (PD) was less frequently performed by LA (25 vs 53%, p = 0.004) and distal pancreatectomy (DP) was more frequently performed by LA (40 vs 16%, p = 0.003). In the subgroup analysis by surgical procedure, LA-PD was associated with one mortality, less median blood loss (180 vs 200 ml, p = 0.034) and fewer harvested lymph nodes (11 vs 15, p = 0.02). LA-DP was associated with smaller median tumor size on imaging (40 vs 80mm, p = 0.048), shorter surgery (135 vs 190 min, p = 0.028), and fewer complications according to the median comprehensive complication index score (0 vs 8.7, p = 0.048). LA-Central pancreatectomy was associated with shorter surgery (160 vs 240, p = 0.037), less median blood loss (60 vs 200, p = 0.043), and less harvested lymph nodes (5 vs 2, p = 0.025). After a median follow-up of 60 months, two recurrences (2%) were observed and were unrelated to the approach. CONCLUSIONS The LA for SPNP appears to be safe, should be applied cautiously in case of PD for large lesion, and was not associated with recurrence.
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Affiliation(s)
- Tatiana Codjia
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Lancelot Marique
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Béatrice Aussilhou
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Fadhel Samir Ftériche
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Louis de Mestier
- AP-HP, Hôpital Beaujon, Department of Gastroenterology and Pancreatic Diseases, DMU DIGEST, University Paris Cité, Clichy, France
| | - Vinciane Rebours
- AP-HP, Hôpital Beaujon, Department of Gastroenterology and Pancreatic Diseases, DMU DIGEST, University Paris Cité, Clichy, France
| | - Jérome Cros
- AP-HP, Hôpital Beaujon, Department of Pathology, University Paris Cité, Clichy, France
| | - Philippe Ruszniewski
- AP-HP, Hôpital Beaujon, Department of Gastroenterology and Pancreatic Diseases, DMU DIGEST, University Paris Cité, Clichy, France
| | - Philippe Lévy
- AP-HP, Hôpital Beaujon, Department of Gastroenterology and Pancreatic Diseases, DMU DIGEST, University Paris Cité, Clichy, France
| | - Mickael Lesurtel
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Alain Sauvanet
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France
| | - Safi Dokmak
- AP-HP, Hôpital Beaujon, Department of HPB Surgery and Liver Transplantation, DMU DIGEST, University Paris Cité, Clichy, France.
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8
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Clark CR, Kelly ML, Palamuthusingam P. Spigelian hernia: a multi-site review of operative outcomes of surgical repair in the adult population. Hernia 2024; 28:537-546. [PMID: 38261159 PMCID: PMC10997718 DOI: 10.1007/s10029-023-02946-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE Spigelian hernias arise at the linear semilunaris and account for approximately 1-2% of abdominal hernias. The aetiology is due to a defect of the aponeurosis of the transverse abdominis and when discovered, management is surgical intervention. The aim of this study was to observe operative outcomes for open and minimally invasive repair. METHODS A retrospective chart review was conducted at two hospitals in Townsville, The Townsville University Hospital and The Mater Private Hospital over a 10-year period (2010 to 2020). A surgical database search (ORMIS & IEMR) was performed at both locations using key search terms, including "spigelian hernia", "laparoscopic", "open". Descriptive statistics were utilised to analyse patient factors and operative outcomes in the public and private setting. RESULTS 43 cases of Spigelian hernias (25 female, 18 male) were reported over the study period. The average age was 66. There were 36 elective cases and 7 emergency cases. A laparoscopic approach was the preferred method of repair, occurring in 74% of cases. Of these cases, the predominant hernial content was fat only. 65% of cases had a history of prior abdominal surgery unrelated to the "Spigelian belt" location. Complications occurred in 19% of cases. Other variables, such as ethnicity, smoking status, defect size, predisposing factors and recurrence rate, were analysed and did not yield statistical significance. CONCLUSION Although a small sample size, the data suggest there is no statistically significant difference between operative outcomes, complication rate and predisposing factors between open and minimally invasive case groups.
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Affiliation(s)
- C R Clark
- Department of General Surgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4029, Australia.
- Department of General Surgery, Townsville University Hospital, Townsville, QLD, 4814, Australia.
- Department of General Surgery, Mater Hospital Townsville, Townsville, QLD, 4812, Australia.
- James Cook University, Townsville, QLD, Australia.
| | - M L Kelly
- Department of General Surgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4029, Australia
| | - P Palamuthusingam
- Department of General Surgery, Royal Brisbane and Women's Hospital, Brisbane, QLD, 4029, Australia
- Department of General Surgery, Townsville University Hospital, Townsville, QLD, 4814, Australia
- Department of General Surgery, Mater Hospital Townsville, Townsville, QLD, 4812, Australia
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9
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Zhang Z, Tao K, Zhang Y, Xu G. The proper hepatic artery was severed by the linear stapler during modified delta-shaped anastomosis for patients undergoing laparoscopic distal gastrectomy. Asian J Surg 2024; 47:1841-1842. [PMID: 38160159 DOI: 10.1016/j.asjsur.2023.12.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Zhenxing Zhang
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Kelong Tao
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing, 312000, China.
| | - Yu Zhang
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Guangen Xu
- Department of Gastrointestinal Surgery, Shaoxing People's Hospital, Shaoxing, 312000, China.
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Awad PBA, Hassan BHA, Kashwaa MFA, Abdel-Maksoud IM. A comparative study between open pre-peritoneal approach versus laparoscopic trans-abdominal pre-peritoneal approach in recurrent inguinal hernia repair: a prospective cohort study. Hernia 2024; 28:629-635. [PMID: 38300399 PMCID: PMC10997692 DOI: 10.1007/s10029-024-02967-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND The repair of recurrent inguinal hernias after prosthetic mesh repair is challenging due to the technical complexity and complications associated with it. As well as the increased risk of recurrence due to weakened tissues and distorted anatomy. The Posterior Pre-Peritoneal Approach yields significantly better results than the anterior approach due to its distance from previously scarred tissue. OBJECTIVE To compare the open pre-peritoneal approach and Laparoscopic trans-abdominal pre-peritoneal approach in the management of recurrent inguinal hernia which was previously managed through an open anterior approach regarding their intra-operative time, the postoperative outcomes in the form of hematoma, wound infection and finally the recurrence within 1-year follow-up. PATIENTS AND METHODS The current study is a prospective cohort study, a single-center trial conducted from June 2021 to June 2022 in the general surgery department in Ain Shams University Hospitals, which included 74 patients presented with recurrent inguinal hernia who had previous open anterior approach 68(91.8%) males and 6(8.1%) females including a 1-year follow-up postoperative. RESULTS There were 74 patients in our study with 37 patients in each group. Group (I) underwent an open pre-peritoneal approach and group (II) underwent a Laparoscopic trans-abdominal pre-peritoneal approach. The mean age of the group (I) is 39.51 with a standard deviation of ± 3.49. While in group (II) the mean age is 39.37 with standard deviation ± 3.44 (p = 0.881). From the included 74 patients 67(91.8%) were males and 6(8.1%) were females. As regards the co-morbidities, in group (I) 17(45.9%) patients have no co-morbidities, 11(29.7%) patients have diabetes mellitus, 6(16.2%) patients have hypertension, and 3(8.1%) patients have diabetes and hypertension. Andin group (II) 26(70.3%) patients have no co-morbidities, 6(16.2%) patients have diabetes mellitus, 3(8.1%) patients have hypertension, and 2(5.4%) patients have diabetes and hypertension (p = 0.207). Regarding intra-operative time, the mean time in minutes in the group (I) is 63.33 with a standard deviation of ± 11.95. While in group (II) the mean time in minutes is 81.21 with a standard deviation of ± 18.03 (p = 0.015). The postoperative outcomes were assessed for 1-year follow-up in the form of hematoma, wound infection, and recurrence within 1 year. Regarding the hematoma occurred in 4(10.8%) patients in group (I). While in 2(5.4%) patients in group (II) (p = 0.674). The wound infection was found in 5(13.5%) patients in group(I) and zero patients in group (II) (p = 0.021). Finally, we followed up with the patients for about 1 year to detect the recurrence. Which was found in 3(8.1%) patients in group (I) and 1(2.7%) patient in group (II) (p = 0.615). CONCLUSION The results of this study demonstrate that both the laparoscopic approach and the open posterior approach are effective for recurrent inguinal hernia following anterior approach mesh hernioplasty, with comparable results. Laparoscopy has been associated with a lower rate of recurrence and overall complications compared to open technique, however, it is difficult to draw definitive conclusions about the preferred option due to its lengthy learning curve and difficulty to perform. Furthermore, the results of this study confirm the previously reported positive results of the posterior pre-peritoneal for recurrent inguinal hernia, particularly when performed by experienced surgeons. Therefore, further prospective randomized population-based trials are necessary to better assess the decision-making for recurrent hernia management and the impact of specialization in abdominal wall surgery in terms of recurrence and complications.
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Affiliation(s)
- P B A Awad
- General Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - B H A Hassan
- General Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - M F A Kashwaa
- General Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - I M Abdel-Maksoud
- General Surgery Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Sergi W, Libia A, Chiappini A, D'Ugo S, Romano S, Spampinato M. Emergency totally laparoscopic surgery for appendicitis in right Amyand's hernia associated to symptomatic left inguinal hernia: A case report. Int J Surg Case Rep 2024; 117:109542. [PMID: 38531291 PMCID: PMC10979189 DOI: 10.1016/j.ijscr.2024.109542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Amyand's hernia is a rare type of inguinal hernia which contains vermiform appendix in the inguinal sac, seldom complicated by acute appendicitis. It is usually repaired by open inguinal approach, but laparoscopic technique has been increasingly described in literature; nevertheless, standard of care is far from being defined. Here we report the case of Amyand's hernia complicated by acute appendicitis and simultaneous symptomatic left inguinal hernia, both repaired by laparoscopic technique. CASE PRESENTATION A 85-years-old man presented with acute appendicitis in Amyand's hernia and simultaneous incarcerated left inguinal hernia. CLINICAL DISCUSSION After complete preoperative work-up, the patient underwent laparoscopic appendectomy and laparoscopic bilateral hernia repair with mesh. CONCLUSION Laparoscopic approach may be safe and feasible for Amyand's hernia treatment in emergency setting when performed by expert hands, with minimized risk of surgical site infection (SSI), quick recovery and reduced hospital stay. Laparoscopic hernia repair with mesh can be a reasonable approach in selected cases of bilateral or recurrent hernia, and concomitant intrabdominal inflammation, especially when contamination is scarse and limited to a restricted area.
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Affiliation(s)
- William Sergi
- Dept. of Surgery - "Vito Fazzi" Hospital, Piazza Filippo Muratore 73100, Lecce, Italy.
| | - Annarita Libia
- Dept. of Surgery - "Vito Fazzi" Hospital, Piazza Filippo Muratore 73100, Lecce, Italy
| | - Ambra Chiappini
- Dept. of Surgery - "F. Ferrari" Hospital, viale F. Ferrari, 73042 Casarano, Italy
| | - Stefano D'Ugo
- Dept. of Surgery - "Vito Fazzi" Hospital, Piazza Filippo Muratore 73100, Lecce, Italy
| | - Stefania Romano
- Dept. of Surgery - "F. Ferrari" Hospital, viale F. Ferrari, 73042 Casarano, Italy
| | - Marcello Spampinato
- Dept. of Surgery - "Vito Fazzi" Hospital, Piazza Filippo Muratore 73100, Lecce, Italy
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Perivoliotis K, Tzovaras G, Tepetes K, Baloyiannis I. Comparison of intracorporeal and extracorporeal anastomosis in laparoscopic right colectomy: an updated meta-analysis and trial sequential analysis. Updates Surg 2024; 76:375-396. [PMID: 38216794 DOI: 10.1007/s13304-023-01737-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 12/19/2023] [Indexed: 01/14/2024]
Abstract
This meta-analysis was conducted to provide updated evidence regarding perioperative safety and efficacy, of IC and EC anastomosis in laparoscopic right colectomies. In this study, the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines were applied. The study protocol received a PROSPERO registration (CRD42020214596). A systematic literature search of the electronic scholar databases (Medline, Web of Science and Scopus) was performed. To reduce type I error, a trial sequential analysis (TSA) algorithm was introduced. The quality of evidence was evaluated based on the GRADE methodology. In total, 46 studies were included in this meta-analysis, Pooled comparisons and TSA confirmed that IC is superior in terms of incisional hernia (0.29; 95%CI: 0.19, 0.44), open conversion (0.45; 95%CI: 0.30, 0.67), reoperation (0.62; 95%CI: 0.46, 0.84]), LOS (- 0.76; 95%CI: - 1.03, - 0.49), blood loss (- 11.50; 95%CI: - 18.42, - 4.58), and cosmesis (- 1.71; 95%CI: - 2.01, - 1.42). Postoperative pain and return of bowel function were, also, shortened when the anastomosis was fashioned intracorporeally. The grading of most evidence ranged from 'low' to 'high'. Due to the discrepancy in the results of RCTs and non-RCTs, and the proportionally smaller sample size of the former, further randomized trials are required to increase the evidence of this comparison.
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Affiliation(s)
| | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - Konstantinos Tepetes
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
| | - Ioannis Baloyiannis
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110, Larissa, Greece
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13
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Ribeiro M, Espinel Y, Rabbani N, Pereira B, Bartoli A, Buc E. Augmented Reality Guided Laparoscopic Liver Resection: A Phantom Study With Intraparenchymal Tumors. J Surg Res 2024; 296:612-620. [PMID: 38354617 DOI: 10.1016/j.jss.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Augmented reality (AR) in laparoscopic liver resection (LLR) can improve intrahepatic navigation by creating a virtual liver transparency. Our team has recently developed Hepataug, an AR software that projects the invisible intrahepatic tumors onto the laparoscopic images and allows the surgeon to localize them precisely. However, the accuracy of registration according to the location and size of the tumors, as well as the influence of the projection axis, have never been measured. The aim of this work was to measure the three-dimensional (3D) tumor prediction error of Hepataug. METHODS Eight 3D virtual livers were created from the computed tomography scan of a healthy human liver. Reference markers with known coordinates were virtually placed on the anterior surface. The virtual livers were then deformed and 3D printed, forming 3D liver phantoms. After placing each 3D phantom inside a pelvitrainer, registration allowed Hepataug to project virtual tumors along two axes: the laparoscope axis and the operator port axis. The surgeons had to point the center of eight virtual tumors per liver with a pointing tool whose coordinates were precisely calculated. RESULTS We obtained 128 pointing experiments. The average pointing error was 29.4 ± 17.1 mm and 9.2 ± 5.1 mm for the laparoscope and operator port axes respectively (P = 0.001). The pointing errors tended to increase with tumor depth (correlation coefficients greater than 0.5 with P < 0.001). There was no significant dependency of the pointing error on the tumor size for both projection axes. CONCLUSIONS Tumor visualization by projection toward the operating port improves the accuracy of AR guidance and partially solves the problem of the two-dimensional visual interface of monocular laparoscopy. Despite a lower precision of AR for tumors located in the posterior part of the liver, it could allow the surgeons to access these lesions without completely mobilizing the liver, hence decreasing the surgical trauma.
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Affiliation(s)
- Mathieu Ribeiro
- Department of Digestive and Hepatobiliary Surgery, Hospital Estaing, CHU de Clermont-Ferrand, Clermont-Ferrand, France; UMR6602, Endoscopy and Computer Vision Group, Faculté de Médecine, Institut Pascal, Clermont-Ferrand, France
| | - Yamid Espinel
- UMR6602, Endoscopy and Computer Vision Group, Faculté de Médecine, Institut Pascal, Clermont-Ferrand, France
| | - Navid Rabbani
- UMR6602, Endoscopy and Computer Vision Group, Faculté de Médecine, Institut Pascal, Clermont-Ferrand, France
| | - Bruno Pereira
- Biostatistics Unit (DRCI), University Hospital Clermont-Ferrand, Clermont-Ferrand, France
| | - Adrien Bartoli
- UMR6602, Endoscopy and Computer Vision Group, Faculté de Médecine, Institut Pascal, Clermont-Ferrand, France
| | - Emmanuel Buc
- Department of Digestive and Hepatobiliary Surgery, Hospital Estaing, CHU de Clermont-Ferrand, Clermont-Ferrand, France; UMR6602, Endoscopy and Computer Vision Group, Faculté de Médecine, Institut Pascal, Clermont-Ferrand, France.
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14
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Zhao D, Sun L, Tao C, Tang D, Chen G. Ureteropelvic Junction Obstruction Caused by Crossing Vessels in Infants and Young Children. J Pediatr Surg 2024:S0022-3468(24)00205-7. [PMID: 38631999 DOI: 10.1016/j.jpedsurg.2024.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/26/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND To analyze the clinical characteristics of ureteropelvic junction obstruction (UPJO) caused by crossing vessels (CV) in infants and young children. METHODS A retrospective analysis was performed on children with UPJO who underwent primary surgery. Patients were classified into laparoscopic pyeloplasty (LP) and open pyeloplasty (OP) groups and classified as ≤3 or >3 (years old) groups. Children with CV-caused UPJO were identified. RESULTS A total of 747 patients were included. Ninety cases of CV were identified. The CV discovery rate was higher in the LP group (78/457, 17.1%) than in the OP group (12/290, 4.1%) (P < 0.001). In the ≤3 group, the CV discovery rate in the LP group (27/144, 18.8%) was higher than that in the OP group (11/274, 4.0%) (P < 0.001). In the LP group, there was no significant difference between ≤3 (27/144, 18.8%) and >3 (51/313, 16.3%) groups in the CV discovery rate. The rate in children with UPJO was not significantly different at any age (P > 0.05). Progressive aggravation of hydronephrosis (21/27, 77.8%) and symptomatic hydronephrosis (44/51, 86.3%) were the main surgical indications in the ≤3 and > 3 groups, respectively. There were no preoperatively confirmed cases of CV in the ≤3 group. In the OP group, five patients underwent reoperation, three of whom were due to failure to detect CV during the initial operation. CONCLUSIONS The CV distribution is similar in children with UPJO across all ages; CV in infants and young children are not rare. LP should be considered as CV are prone to being missed during OP. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Dongyan Zhao
- Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310000, China
| | - Long Sun
- Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310000, China
| | - Chang Tao
- Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310000, China
| | - Daxing Tang
- Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310000, China
| | - Guangjie Chen
- Department of Urology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310000, China.
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15
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Ishida J, Toyama H, Asari S, Goto T, Nanno Y, Yoshida T, So S, Urade T, Fukushima K, Gon H, Tsugawa D, Komatsu S, Yanagimoto H, Kido M, Fukumoto T. Optimal cutoff values of drain amylase for predicting pancreatic fistula are different between open and laparoscopic distal pancreatectomy. Surg Endosc 2024:10.1007/s00464-024-10781-3. [PMID: 38528262 DOI: 10.1007/s00464-024-10781-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/07/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Drainage fluid amylase (DFA) is useful for predicting clinically relevant postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP). However, difference in optimal cutoff value of DFA for predicting CR-POPF between open DP (ODP) and laparoscopic DP (LDP) has not been investigated. This study aimed to identify the optimal cutoff values of DFA for predicting CR-POPF after ODP and LDP. METHODS Data for 294 patients (ODP, n = 127; LDP, n = 167) undergoing DP at Kobe University Hospital between 2010 and 2021 were reviewed. Propensity score matching was performed to minimize treatment selection bias. Receiver operating characteristic (ROC) analysis was performed to determine the optimal cutoff values of DFA for predicting CR-POPF for ODP and LDP. Logistic regression analysis for CR-POPF was performed to investigate the diagnostic value of DFA on postoperative day (POD) three with identified cutoff value. RESULTS In the matched cohort, CR-POPF rates were 24.7% and 7.9% after ODP and LDP, respectively. DFA on POD one was significantly lower after ODP than after LDP (2263 U/L vs 4243 U/L, p < 0.001), while the difference was not significant on POD three (543 U/L vs 1221 U/L, p = 0.171). ROC analysis revealed that the optimal cutoff value of DFA on POD one and three for predicting CR-POPF were different between ODP and LDP (ODP, 3697 U/L on POD one, 1114 U/L on POD three; LDP, 10564 U/L on POD one, 6020 U/L on POD three). Multivariate analysis showed that DFA on POD three with identified cutoff value was the independent predictor for CR-POPF both for ODP and LDP. CONCLUSIONS DFA on POD three is an independent predictor for CR-POPF after both ODP and LDP. However, the optimal cutoff value for it is significantly higher after LDP than after ODP. Optimal threshold of DFA for drain removal may be different between ODP and LDP.
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Affiliation(s)
- Jun Ishida
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hirochika Toyama
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Sadaki Asari
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tadahiro Goto
- Department of Surgery, Konan Medical Center, 1-5-16 Kamokogahara, Higashinada-ku, Kobe, 658-0064, Japan
| | - Yoshihide Nanno
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Toshihiko Yoshida
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shinichi So
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takeshi Urade
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kenji Fukushima
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hidetoshi Gon
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Daisuke Tsugawa
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shohei Komatsu
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hiroaki Yanagimoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Masahiro Kido
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takumi Fukumoto
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Scharf VF. Laparoscopic Treatment of Peritoneal-Pericardial Diaphragmatic Hernia. Vet Clin North Am Small Anim Pract 2024:S0195-5616(24)00004-4. [PMID: 38519368 DOI: 10.1016/j.cvsm.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
Laparoscopic herniorrhaphy provides a feasible minimally invasive treatment option for dogs with peritoneal-pericardial hernias with careful case selection. This article describes the techniques, instrumentation, and challenges associated with laparoscopic peritoneal-pericardial diaphragmatic hernia repair.
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Affiliation(s)
- Valery F Scharf
- Department of Clinical Sciences, NC State University, 1052 William Moore Drive, Raleigh, NC 27607, USA.
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de Almeida Leite RM, Araujo SEA, de Souza AV, Cauley C, Goldstone R, Francone T, Barchi LC, Callado GY, Fagundes L, Ribeiro U, Bossie H, Ricciardi R. Surgical and medical outcomes in robotic compared to laparoscopic colectomy global prospective cohort from the American college of surgeons national surgical quality improvement program. Surg Endosc 2024:10.1007/s00464-024-10717-x. [PMID: 38498211 DOI: 10.1007/s00464-024-10717-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/28/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Evidence regarding the outcomes benefits of robotic approach, when compared to a laparoscopic approach, in colectomy remain limited. OBJECTIVE This study aimed to analyze the value of robotic approach compared to laparoscopic approach in minimally invasive colectomy. DESIGN Cohort study of the National Surgical Quality Improvement Program (NSQIP). SETTING This study included data from the NSQIP from 1/2016 to 12/2021. PATIENT Adult patients undergoing minimally invasive (laparoscopic or robotic) colorectal surgery. INTERVENTION Robotic versus laparoscopic colectomy. OUTCOME MEASURES Risk ratios for the incidence of medical and surgical morbidity and overall mortality. RESULTS Compared to laparoscopic, robotic colectomy was associated with a significant decrease in postoperative morbidity [RR 0.84 (95%CI 0.72-0.96), P < 0.001], a significant reduction in postoperative mortality [RR 0.83 (95%CI 0.79-0.90), P 0.010)], and in post operative ileus [RR: 0.80 (95%CI 0.75-0.84), P < 0.001]. Yet, robotic approach was associated with a significant increase in total operative time despite a significant decrease in total length of stay. No benefit was observed regarding anastomotic leak. LIMITATIONS Observational nature of the study cannot exclude residual bias. CONCLUSIONS In this prospective cohort from the NSQIP, robotic colectomy was associated with a significant reduction in postoperative ileus, unplanned conversion to open surgery, morbidity, and overall mortality when compared to laparoscopic colectomy.
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Affiliation(s)
- Rodrigo Moisés de Almeida Leite
- Colon and Rectal Surgery Department, Massachussets General Hospital, 15 Parkman Street, WACC 460, Boston, MA, 02114, USA
- Colon & Rectal Surgery Resident, Albert Einstein Israelite Hospital, Sao Paulo, Brazil
| | - Sergio Eduardo Alonso Araujo
- Staff Colorectal Surgeon and Medical Director, Oncology Division, Albert Einstein Israelite Hospital, São Paulo, Brazil
| | | | - Christy Cauley
- Department of Surgery, Massachussets General Hospital, Boston, MA, 02214, USA
| | - Rob Goldstone
- Department of Surgery, Massachussets General Hospital, Boston, MA, 02214, USA
| | - Todd Francone
- Department of Surgery, Massachussets General Hospital, Boston, MA, 02214, USA
| | - Leandro Cardoso Barchi
- Gastrointestinal Surgery Division, University of Sao Paulo Medical School, São Paulo, Brazil
| | | | | | - Ulysses Ribeiro
- Gastrointestinal Surgery Division, University of Sao Paulo Medical School, São Paulo, Brazil
| | | | - Rocco Ricciardi
- Colon and Rectal Surgery Department, Massachussets General Hospital, 15 Parkman Street, WACC 460, Boston, MA, 02114, USA.
- Department of Surgery, Massachussets General Hospital, Boston, MA, 02214, USA.
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18
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Wu QR, Zhao ZZ, Fan KM, Cheng HT, Wang B. Pulse pressure variation guided goal-direct fluid therapy decreases postoperative complications in elderly patients undergoing laparoscopic radical resection of colorectal cancer: a randomized controlled trial. Int J Colorectal Dis 2024; 39:33. [PMID: 38436757 PMCID: PMC10912221 DOI: 10.1007/s00384-024-04606-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE The use of goal-directed fluid therapy (GDFT) has been shown to reduce complications and improve prognosis in high-risk abdominal surgery patients. However, the utilization of pulse pressure variation (PPV) guided GDFT in laparoscopic surgery remains a subject of debate. We hypothesized that utilizing PPV guidance for GDFT would optimize short-term prognosis in elderly patients undergoing laparoscopic radical resection for colorectal cancer compared to conventional fluid therapy. METHODS Elderly patients undergoing laparoscopic radical resection of colorectal cancer were randomized to receive either PPV guided GDFT or conventional fluid therapy and explore whether PPV guided GDFT can optimize the short-term prognosis of elderly patients undergoing laparoscopic radical resection of colorectal cancer compared with conventional fluid therapy. RESULTS The incidence of complications was significantly lower in the PPV group compared to the control group (32.8% vs. 57.1%, P = .009). Additionally, the PPV group had a lower occurrence of gastrointestinal dysfunction (19.0% vs. 39.3%, P = .017) and postoperative pneumonia (8.6% vs. 23.2%, P = .033) than the control group. CONCLUSION Utilizing PPV as a monitoring index for GDFT can improve short-term prognosis in elderly patients undergoing laparoscopic radical resection of colorectal cancer. REGISTRATION NUMBER ChiCTR2300067361; date of registration: January 5, 2023.
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Affiliation(s)
- Qiu-Rong Wu
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zi-Zuo Zhao
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Ke-Ming Fan
- Department of Anesthesiology, Yongchuan District People's Hospital of Chongqing, Chongqing, 400016, China
| | - Hui-Ting Cheng
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Bin Wang
- Department of Anesthesiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Zhang Y, Zhu Q, Wu P, Wu H, He L, Hua L, Zhou J. Thirty-eight cases of paraovarian cysts in children and adolescents: a retrospective study. Pediatr Surg Int 2024; 40:62. [PMID: 38430253 DOI: 10.1007/s00383-024-05656-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE Paraovarian cysts in children and adolescents can be challenging to accurately diagnose prior to surgery. Our objective is to outline the clinical characteristics of paraovarian cysts and enhance the precision of diagnosing paraovarian cysts in this age group. METHODS We retrospectively analyzed all patients with paraovarian cysts who underwent surgery in our department from 2013 to 2021. The review focused on demographic characteristics, clinical manifestations, intraoperative findings, and postoperative pathology of these patients. RESULTS This cohort was composed of 38 children with paraovarian cysts. The average diameter of the cysts was 4.8 cm (range 0.5-10 cm). Among the cases, 25 (65.8%) had adnexal torsion. Postoperative pathology showed that all cases were simple cysts with serous fluid. After the procedure, the patients were monitored for a period ranging from 12 to 108 months. B-ultrasound and physical examination did not reveal any significant abnormalities. CONCLUSIONS B-ultrasound can help diagnose paraovarian cysts by detecting slight deviation movement between the cyst and the uterus. The presence of adnexa torsion in children and adolescents with paraovarian cysts does not depend on BMI, but rather on the size of cysts. Laparoscopic cyst removal has proven to be an effective surgical approach with favorable outcomes.
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Affiliation(s)
- Yang Zhang
- Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qiang Zhu
- Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Peng Wu
- Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Haiyan Wu
- Department of Pathology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lili He
- Department of Pathology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lichun Hua
- Department of Ultrasound Diagnosis, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jun Zhou
- Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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20
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Lee CU, Yu J, Chung JH, Song W, Kang M, Sung HH, Jeon HG, Seo SI, Jeon SS, Jeong BC. Comparison of perioperative outcomes between robot-assisted adrenalectomy and laparoscopic adrenalectomy: a propensity score matching analysis. J Robot Surg 2024; 18:105. [PMID: 38430326 DOI: 10.1007/s11701-023-01779-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 03/03/2024]
Abstract
This study aimed to evaluate and compare the perioperative outcomes of robot-assisted adrenalectomy (RAA) and laparoscopic adrenalectomy (LA) using propensity score matching. This retrospective study included 395 patients who underwent minimally invasive adrenalectomy: 354 who underwent LA and 41 who underwent RAA between February 2015 and March 2023. To mitigate potential confounding factors, 2:1 propensity score matching was conducted based on age, sex, body mass index, American Society of Anesthesiologists score, tumor laterality, and tumor size. Perioperative outcomes and complications were compared between the two groups, and prognostic factors for complications were analyzed. Propensity score matching analysis identified 123 patients, with 82 and 41 in the LA and RAA groups, respectively. Operative time (81.4 ± 26.6 min vs. 83.5 ± 25.9 min, P = 0.675), estimated blood loss (77.7 ± 68.3 mL vs. 83.2 ± 73.9 mL, P = 0.683), and post-operative stay (3.8 ± 1.0 days vs. 4.0 ± 0.9 days, P = 0.211) showed no significant differences between two groups. Intraoperative complications occurred in 8 patients (9.8%) in the LA group, while no patients (0%) experienced intraoperative complications in the RAA group (P = 0.051). In both groups, post-operative complications occurred in 2.4% (P = 1). The only factor contributing to complications after adrenalectomy was tumor size (OR 1.026, 95% CI 1.001-1.051, P = 0.042). RAA exhibited comparable perioperative outcomes and presented an improved intraoperative complication rate compared with LA. Tumor size was the only factor that contributed to complications after adrenalectomy.
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Affiliation(s)
- Chung Un Lee
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Jiwoong Yu
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Hoon Chung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wan Song
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minyong Kang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Wu X, Yang B, Zheng J, Zhang X, Yu P, Ji G, Wang S. Total laparoscopic technique overcomes the adverse impact of abdominal parameters on surgical process of laparoscopic radical distal gastrectomy. J Gastrointest Surg 2024; 28:287-290. [PMID: 38445923 DOI: 10.1016/j.gassur.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/15/2023] [Accepted: 12/23/2023] [Indexed: 03/07/2024]
Affiliation(s)
- Xiao Wu
- Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Bin Yang
- Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Jiyang Zheng
- Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Xiaoxia Zhang
- Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Pengfei Yu
- Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Gang Ji
- Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China
| | - Shiqi Wang
- Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, China.
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Chang-Patel EJ, Wong JMK, Gould CH, Demirel S. The Effect of Transversus Abdominis Plane Block Timing on Milliequivalents of Opioid Use and Immediate Postoperative Pain Scores in Patients Undergoing Minimally Invasive Hysterectomy: A Retrospective Cohort Study. J Minim Invasive Gynecol 2024; 31:237-242. [PMID: 38151093 DOI: 10.1016/j.jmig.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/17/2023] [Accepted: 12/22/2023] [Indexed: 12/29/2023]
Abstract
STUDY OBJECTIVE To examine the effect of transversus abdominis plane (TAP) block timing (preoperative or postoperative) on postoperative opioid use (quantified via morphine milligram equivalents; MME) and pain scores in patients undergoing minimally invasive hysterectomy for benign indications. DESIGN Retrospective, single-institution cohort study SETTING: Academic-affiliated community hospital PATIENTS: A total of 2982 patients were included who underwent a minimally invasive total hysterectomy between January 2018 and December 2022, excluding patients with a malignancy diagnosis, concurrent urogynecological procedure, vaginal hysterectomy, supracervical hysterectomy, or those with baseline narcotic use (opioid use within the 3 months before surgery). Patients were separated into 3 groups: no TAP blocks (n = 1966, 65.9%), preoperative TAP blocks (854, 28.6%), and postoperative TAP blocks (162, 5.4%). INTERVENTIONS Summary statistics and mixed-effects regression methods were used for data analysis. MEASUREMENTS AND MAIN RESULTS There was a statistically significant lower mean use of opioids (MME 43.2 vs 53.9, p = .002) among patients who received a TAP block (either pre or postoperatively) than those who did not receive a block. However, when comparing preoperative vs postoperative patients with TAP block, there was no statistically significant difference in mean opioid use (MME 43.4 vs 42.1, p = .752). There were no differences in postoperative pain scores between patients with and without a TAP block, however, more opioids were required in patients who did not receive a TAP block to achieve the same pain scores as those who did receive a TAP block. There was a statistically significant shorter time to discharge for TAP versus patients without TAP block(median 5.5 vs 6.3 hours, p ≤ .001) as well as preoperative versus postoperative patients with TAP block (median 5.3 vs 6.2 hours, p = .001). CONCLUSION While TAP block use at the time of minimally invasive hysterectomy reduced use of postoperative opioids, the timing of TAP block, either preoperatively or postoperatively, did not significantly affect opioid use. Preoperative compared with postoperative TAP block administration significantly shortened the time to discharge.
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Affiliation(s)
- Erica J Chang-Patel
- Department of Obstetrics and Gynecology, Division of Gynecology (Drs Chang-Patel and Gould).
| | - Jacqueline M K Wong
- Department of Obstetrics and Gynecology, Oregon Health and Science University (Dr Wong), Portland, Oregon
| | - Claire H Gould
- Department of Obstetrics and Gynecology, Division of Gynecology (Drs Chang-Patel and Gould)
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23
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Obayemi JE, Donkersloot J, Kim E, Thelander K, Byrnes M, Kim GJ. A needs assessment for simulation in African surgical education. Surg Endosc 2024; 38:1654-1661. [PMID: 38326586 DOI: 10.1007/s00464-023-10665-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/28/2023] [Indexed: 02/09/2024]
Abstract
INTRODUCTION There is a critical need for comprehensive surgical training in African countries given the unmet surgical burden of disease in this region. Collaborative and progressive initiatives in global surgical education will have the greatest impact on trainees. Little is known about surgical education needs from the perspective of practicing surgeons and trainees in low-middle-income countries (LMICs). Even less is known about the potential role for simulation to augment training. METHODS A modified Delphi methodology with 2 rounds of responses was employed to survey program directors (PD) and associate program directors (APD) of Pan-African Association of Christian Surgeons (PAACS) general surgery residency programs across eight low-middle-income countries in Africa. 3 PD/APDs and 2 surgical residents participated in semi-structured interviews centered around the role of simulation in training. Descriptive analysis was performed to elicit key themes and illustrative examples. RESULTS The survey of program directors revealed that teaching residents the psychomotor skills need to perform intracorporeal suturing was both high priority and desired in multiple training sites. Other high priority skills were laparoscopic camera driving and medial visceral rotation. The interviews revealed a specific desire to perform laparoscopic surgery and a need for a simulation curriculum to familiarize staff and trainees with laparoscopic techniques. Several barriers to laparoscopic surgery exist, such as lack of staff familiarity with the equipment, lack of public buy in, and lack of generalizable and adaptable educational modules. Trainees saw utility in the use of simulation to optimize time in the operating room and sought opportunities to improve their laparoscopic skills. CONCLUSION Faculty and surgical trainees in LMICs have interest in learning advanced surgical techniques, such as laparoscopy. Developing a simulation curriculum tailored to the trainees' local context has the potential to fill this need.
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Affiliation(s)
- Joy E Obayemi
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109-5331, USA.
| | - John Donkersloot
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109-5331, USA
| | - Erin Kim
- University of Michigan Medical School, University of Michigan, Ann Arbor, USA
| | - Keir Thelander
- Pan-African Academy of Christian Surgeons, Palatine, IL, USA
| | - Mary Byrnes
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109-5331, USA
| | - Grace J Kim
- Department of Surgery, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109-5331, USA
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Mudgway R, Tran Z, Quispe Espíritu JC, Bong WB, Schultz H, Vemireddy V, Kannappan A, Michelotti M, Mukherjee K, Quigley J, Scharf K, Srikureja D, Lum SS, Wu E. A Medium-Term Comparison of Quality of Life and Pain After Robotic or Laparoscopic Cholecystectomy. J Surg Res 2024; 295:47-52. [PMID: 37988906 DOI: 10.1016/j.jss.2023.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 07/29/2023] [Accepted: 08/29/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION We sought to compare medium-term outcomes between robotic-assisted cholecystectomy (RC) and laparoscopic cholecystectomy (LC) using validated quality of life (QoL) and pain assessments. MATERIALS AND METHODS Patients who underwent RC or LC between 2012 and 2017 at a single academic institution were examined. Cases converted to open were excluded. Patients were contacted by telephone in 2019 and completed two standardized surveys to rate their QoL and pain. RESULTS Of those screened, 122 (35.8%) completed both surveys. Ninety three (76.2%) underwent RC and 29 (23.8%) underwent LC. The groups (RC versus LC) were similar based on mean age (47.9 versus 45.5 y, P = 0.48), gender (66.7% versus 72.4% female, P = 0.56), race (86.0% White/5.4% Black versus 72.4% White/13.8% Black, P = 0.2), insurance status (98.9% versus 100.0% insured, P = 0.58), median body mass index (31.8 versus 31.3, P = 0.43), and median Charlson Comorbidity Index (1 versus 0, P = 0.14). Fewer RC patients had a history of steroid use compared to LC (16.1% versus 34.5%, P = 0.03). No overall significant difference in QoL was demonstrated. LC group had higher severity of "tiring-exhausting pain" (P = 0.04), "electric-shock pain" (P = 0.003), and "shooting pain" (P = 0.05). The "overall intensity" of pain in the "gallbladder region" between the groups was similar at the time of follow-up (P = 0.31). CONCLUSIONS QoL over 2-7 y following time of surgery is comparable for robotic-assisted versus conventional laparoscopic cholecystectomies. The laparoscopic approach may be associated with a higher severity of subset categories of pain, but overall pain between the two approaches is comparable.
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Affiliation(s)
- Ross Mudgway
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Zachary Tran
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | | | - Woo Bin Bong
- Loma Linda University School of Medicine, Loma Linda, California
| | - Hayden Schultz
- Loma Linda University School of Medicine, Loma Linda, California
| | - Vamsi Vemireddy
- Loma Linda University School of Medicine, Loma Linda, California
| | - Aarthy Kannappan
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Marcos Michelotti
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Kaushik Mukherjee
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Jeffrey Quigley
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Keith Scharf
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Daniel Srikureja
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Sharon S Lum
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Esther Wu
- Department of Surgery, Loma Linda University Health, Loma Linda, California.
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25
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Song XQ, Liu XH, Li RJ. A rare internal hernia caused by acute appendicitis. Asian J Surg 2024; 47:1720-1721. [PMID: 38123394 DOI: 10.1016/j.asjsur.2023.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Affiliation(s)
- Xian-Qing Song
- General Surgery Department, Baoan Central Hospital, Affiliated Baoan Central Hospital of Guangdong Medical University, Shenzhen, 518000, China.
| | - Xiao-Hui Liu
- General Surgery Department, Baoan Central Hospital, Affiliated Baoan Central Hospital of Guangdong Medical University, Shenzhen, 518000, China
| | - Rong-Jiang Li
- General Surgery Department, Baoan Central Hospital, Affiliated Baoan Central Hospital of Guangdong Medical University, Shenzhen, 518000, China.
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26
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Radtke S, Arms R, Son MA, Sanchez S, Singh V, Bencomo M, Mccall E, Rodriguez S, Olivas-Cardiel K. Reducing patient's perception of postoperative vaginal bleeding after laparoscopic hysterectomy via independent closure of the vaginal cuff angles (RCT). Eur J Obstet Gynecol Reprod Biol 2024; 294:111-116. [PMID: 38237308 DOI: 10.1016/j.ejogrb.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/06/2024] [Accepted: 01/12/2024] [Indexed: 02/21/2024]
Abstract
STUDY OBJECTIVE Determine if independently suturing the vaginal cuff angles in addition to running barbed suture has an effect on patients' perception of postoperative bleeding after laparoscopic hysterectomy. DESIGN Randomized controlled trial. SETTING University-based medical center. PATIENTS Females ages 18-60 undergoing laparoscopic hysterectomy. INTERVENTIONS Patients were randomly assigned to either cuff closure via single layer of barbed suture (control) vs adding figure-of-eight stitches at each angle (intervention). A survey was given between 10 and 25 days after surgery inquiring about bleeding and dyspareunia. A second survey was given between postoperative days 90-114. Chart review was performed to record emergency room visits, complications, infections, and reoperations during the first 90 postoperative days. RESULTS n = 117 patients were analyzed. 62 (control) and 55 (intervention). Groups were similar in terms of age (42.92 v 44.29p =.35), BMI (33.79 v 34.06p =.85), diabetes (5.26 % (3/55) v 15.09 % (8/53) p =.08) p =.97). Bleeding was decreased in intervention arm (24.19 % (15/62) v 9.09 % (5/55) p =.03). Median (IQR) pelvic pain score was similar (2.0 (0-5.0) v 2.0 (0-4.0) p =.26). Median total operative time (IQR) (129 min (102, 166) v 139 min (120, 163) p =.39) and median EBL (IQR) (50 mL (30-75) vs 50 mL (20-75) p =.43) were similar. Cuff closure in seconds (IQR) was higher in intervention group (373 sec (323, 518) v 571 sec (520, 715) p <.01). 8/60 control patients visited the ED (13.33 %) v 7/54 (12.96 %) p =.95. Readmissions (1.67 % (1/60) v 1.85 % (1/55) p = 1), re-operations (0 % (0/60) v 1.85 % (1/55) p =.47) and postoperative infections (5.0 % (3/60) v 1.85 % (1/54) p =.62) were similar. Secondary survey showed no significant difference in bleeding (15.38 % (4/26) v 4.35 % (1/23) p =.35) and SF-36 results were similar. CONCLUSION Independently suturing the vaginal cuff angles reduces patients' perception of vaginal bleeding in the early postoperative period. Incidence of complications, reoperations, and long-term quality of life are similar.
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Affiliation(s)
- Steven Radtke
- Texas Tech University Health Sciences Center El Paso, USA.
| | - Richard Arms
- Texas Tech University Health Sciences Center El Paso, USA
| | - Mary Ann Son
- Texas Tech University Health Sciences Center El Paso, USA
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Al-Azzawi M, Abouelazayem M, Parmar C, Singhal R, Amr B, Martinino A, Atıcı SD, Mahawar K. A systematic review on laparoscopic subtotal cholecystectomy for difficult gallbladders: a lifesaving bailout or an incomplete operation? Ann R Coll Surg Engl 2024; 106:205-212. [PMID: 37365939 PMCID: PMC10904265 DOI: 10.1308/rcsann.2023.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Laparoscopic subtotal cholecystectomy (LSTC) is a bailout procedure that is undertaken when it is not safe to proceed with a laparoscopic total cholecystectomy owing to dense adhesions in Calot's triangle. The main aim of this review was to investigate the early (≤30 days) and late (>30 days) morbidity and mortality of LSTC. METHODS A literature search of the PubMed® (MEDLINE®), Google Scholar™ and Embase® databases was conducted to identify all studies on LSTC published between 1985 and December 2020. A systematic review was then performed. RESULTS Overall, 45 studies involving 2,166 subtotal cholecystectomy patients (51% female) were identified for inclusion in the review. The mean patient age was 55 years (standard deviation: 15 years). Just over half (53%) of the patients had an elective procedure. The conversion rate was 6.2% (n=135). The most common indication was acute cholecystitis (49%). Different techniques were used, with the majority having a closed cystic duct/gallbladder stump (71%). The most common closure technique was intracorporeal suturing (53%), followed by endoloop closure (15%). Four patients (0.18%) died within thirty days of surgery. Morbidity within 30 days included bile duct injury (0.23%), bile leak (18%) and intra-abdominal collection (4%). Reoperation was reported in 23 patients (1.2%), most commonly for unresolving intra-abdominal collections and failed endoscopic retrograde cholangiopancreatography to control bile leak. Long-term follow-up was reported in 30 studies, the median follow-up duration being 22 months. Late morbidity included incisional hernias (6%), symptomatic gallstones (4%) and common bile duct stones (2%), with 2% of cases requiring completion of cholecystectomy. CONCLUSIONS LSTC is an acceptable alternative in patients with a "difficult" Calot's triangle.
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Affiliation(s)
| | - M Abouelazayem
- St George’s University Hospitals NHS Foundation Trust, UK
| | - C Parmar
- Whittington Health NHS Trust, UK
| | - R Singhal
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - B Amr
- University Hospitals Plymouth NHS Trust, UK
| | | | - SD Atıcı
- Izmir Tepecik Training and Research Hospital, Turkey
| | - K Mahawar
- South Tyneside and Sunderland NHS Foundation Trust, UK
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28
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Corzo MP, Tomey D, Martinino A, Secchi R, Elzein S, Lee YK, Abou-Mrad A, Oviedo RJ. Feasibility of robotic cholecystectomy at an academic center with a young robotic surgery program: a retrospective cohort study with umbrella review. J Robot Surg 2024; 18:93. [PMID: 38411776 PMCID: PMC10899271 DOI: 10.1007/s11701-024-01824-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/10/2024] [Indexed: 02/28/2024]
Abstract
Laparoscopic cholecystectomy (LC) has been standard of care for surgical treatment of benign gallbladder pathology for decades. With the advent of robotic surgical technology, robotic cholecystectomy (RC) has gained attention as an alternative to conventional laparoscopy. This study introduces a single-surgeon experience with laparoscopic versus robotic cholecystectomy and an umbrella systematic review of the outcomes of both approaches. A retrospective chart review was performed at a single institution on a prospectively maintained database of patients undergoing laparoscopic or robotic cholecystectomy for benign gallbladder pathology. An umbrella systematic review was conducted using PRISMA methodology. A total of 103 patients were identified; 61 patients underwent LC and 42 underwent RC. In the RC cohort, 17 cases were completed using a four-port technique while 25 were completed using a three-port technique. Patients undergoing RC were older compared to the LC group (44.78 vs 57.02 years old; p < 0.001) and exhibited lower body mass index (29.37 vs 32.37 kg/m2, p = 0.040). No statistically significant difference in operative time or need for postoperative ERCP was noted. Neither this series nor the umbrella systematic review revealed significant differences in conversion to open surgery or readmissions between the LC and RC cohorts. Three-port RC was associated with reduced operative time compared to four-port RC (101.28 vs 150.76 min; p < 0.001). Robotic cholecystectomy is feasible and safe at a young robotic surgery program in an academic center setting and comparable to laparoscopic cholecystectomy clinical outcomes.
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Affiliation(s)
| | - Daniel Tomey
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | | | - Roberto Secchi
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Steven Elzein
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Yoon Kyung Lee
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Adel Abou-Mrad
- Département de Chirurgie, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Rodolfo J Oviedo
- Nacogdoches Center for Metabolic & Weight Loss Surgery, Nacogdoches, TX, USA
- University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, USA
- Sam Houston State University College of Osteopathic Medicine, Conroe, TX, USA
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29
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Pan SB, Wu CL, Zhou DC, Xiong QR, Geng XP, Hou H. Total laparoscopic partial hepatectomy versus open partial hepatectomy for primary left-sided hepatolithiasis: study protocol for a randomized controlled trial. Trials 2024; 25:137. [PMID: 38383461 PMCID: PMC10882851 DOI: 10.1186/s13063-023-07476-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/26/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The advantages of laparoscopic left-sided hepatectomy (LLH) for treating hepatolithiasis in terms of the time to postoperative length of hospital stay (LOS), morbidity, long-term abdominal wall hernias, hospital costs, residual stone rate, and recurrence of calculus have not been confirmed by a randomized controlled trial. The aim of this trial is to compare the safety and effectiveness of LLH with open left-sided hepatectomy (OLH) for the treatment of hepatolithiasis. METHODS Patients with hepatolithiasis eligible for left-sided hepatectomy will be recruited. The experimental design will produce two randomized arms (laparoscopic and open hepatectomy) at a 1:1 ratio and a prospective registry. All patients will undergo surgery in the setting of an enhanced recovery after surgery (ERAS) programme. The prospective registry will be based on patients who cannot be randomized because of the explicit treatment preference of the patient or surgeon or because of ineligibility (not meeting the inclusion and exclusion criteria) for randomization in this trial. The primary outcome is the LOS. The secondary outcomes are percentage readmission, morbidity, mortality, hospital costs, long-term incidence of incisional hernias, residual stone rate, and recurrence of calculus. It will be assumed that, in patients undergoing LLH, the length of hospital stay will be reduced by 1 day. A sample size of 86 patients in each randomization arm has been calculated as sufficient to detect a 1-day reduction in LOS [90% power and α = 0.05 (two-tailed)]. The trial is a randomized controlled trial that will provide evidence for the merits of laparoscopic surgery in patients undergoing liver resection within an ERAS programme. CONCLUSIONS Although the outcomes of LLH have been proven to be comparable to those of OLH in retrospective studies, the use of LLH remains restricted, partly due to the lack of short- and long-term informative RCTs pertaining to patients with hepatolithiasis in ERAS programmes. To evaluate the surgical and long-term outcomes of LLH, we will perform a prospective RCT to compare LLH with OLH for hepatolithiasis within an ERAS programme. TRIAL REGISTRATION ClinicalTrials.gov NCT03958825. Registered on 21 May 2019.
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Affiliation(s)
- Shu-Bo Pan
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Furong Road 678#, Shushan District, Hefei, 230601, Anhui, China
| | - Chun-Li Wu
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Furong Road 678#, Shushan District, Hefei, 230601, Anhui, China
| | - Da-Chen Zhou
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Furong Road 678#, Shushan District, Hefei, 230601, Anhui, China
| | - Qi-Ru Xiong
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Furong Road 678#, Shushan District, Hefei, 230601, Anhui, China
| | - Xiao-Ping Geng
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Furong Road 678#, Shushan District, Hefei, 230601, Anhui, China
| | - Hui Hou
- Department of General Surgery, The Second Affiliated Hospital of Anhui Medical University, Furong Road 678#, Shushan District, Hefei, 230601, Anhui, China.
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Sujka J, Ahmed A, Kang R, Grimsley EA, Weche M, Janjua H, Mi Z, English D, Martinez C, Velanovich V, Bennett RD, Docimo S, Saad AR, DuCoin C, Kuo PC. Examining surgeon stress in robotic and laparoscopic surgery. J Robot Surg 2024; 18:82. [PMID: 38367193 DOI: 10.1007/s11701-024-01834-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/14/2024] [Indexed: 02/19/2024]
Abstract
Robotic surgery may decrease surgeon stress compared to laparoscopic. To evaluate intraoperative surgeon stress, we measured salivary alpha-amylase and cortisol. We hypothesized robotic elicited lower increases in surgeon salivary amylase and cortisol than laparoscopic. Surgical faculty (n = 7) performing laparoscopic and robotic operations participated. Demographics: age, years in practice, time using laparoscopic vs robotic, comfort level and enthusiasm for each. Operative data included operative time, WRVU (surgical "effort"), resident year. Saliva was collected using passive drool collection system at beginning, middle and end of each case; amylase and cortisol measured using ELISA. Standard values were created using 7-minute exercise (HIIT), collecting saliva pre- and post-workout. Linear regression and Student's t test used for statistical analysis; p values < 0.05 were significant. Ninety-four cases (56 robotic, 38 laparoscopic) were collected (April-October 2022). Standardized change in amylase was 8.4 ± 4.5 (p < 0.001). Among operations, raw maximum amylase change in laparoscopic and robotic was 23.4 ± 11.5 and 22.2 ± 13.4; raw maximum cortisol change was 44.21 ± 46.57 and 53.21 ± 50.36, respectively. Values normalized to individual surgeon HIIT response, WRVU, and operative time, showing 40% decrease in amylase in robotic: 0.095 ± 0.12, vs laparoscopic: 0.164 ± 0.16 (p < 0.02). Normalized change in cortisol was: laparoscopic 0.30 ± 0.44, robotic 0.22 ± 0.4 (p = NS). On linear regression (p < 0.001), surgeons comfortable with complex laparoscopic cases had lower change in normalized amylase (p < 0.01); comfort with complex robotic was not significant. Robotic may be less physiologically stressful, eliciting less increase in salivary amylase than laparoscopic. Comfort with complex laparoscopic decreased stress in robotic, suggesting laparoscopic experience is valuable prior to robotic.
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Affiliation(s)
- Joseph Sujka
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA.
| | - Abrahim Ahmed
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Richard Kang
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Emily A Grimsley
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Mcwayne Weche
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Haroon Janjua
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Zhiyong Mi
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Diana English
- Department of Gynecologic Surgery, Tampa General Hospital, Tampa, FL, USA
| | - Carolina Martinez
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Vic Velanovich
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Robert D Bennett
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Salvatore Docimo
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Adham R Saad
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Christopher DuCoin
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
| | - Paul C Kuo
- Department of Surgery, University of South Florida Morsani College of Medicine, Harbourside Medical Tower, 5 Tampa General Circle, Suite 410, Tampa, FL, 33606, USA
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Wang L, Chen Y, Chen S, Gao Z, Qian Y, Chen Q. Gastrointestinal trichobezoars in the pediatric population: a retrospective study. BMC Pediatr 2024; 24:124. [PMID: 38365624 PMCID: PMC10870568 DOI: 10.1186/s12887-023-04489-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/16/2023] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Trichobezoar is an extremely rare condition characterized by a foreign body in the gastrointestinal tract (GIT) among children. The foreign body may exist in the digestive tract for several years, and it becomes evident if complications develop. The current study aimed to present 21 cases of GIT trichobezoars. METHODS Retrospective analysis of children who were diagnosed with trichobezoars between August 2012 and December 2022. Patient demographics, clinical presentation, diagnosis, and therapy were collected and analyzed.Twenty-one patients had GIT trichobezoars. Data were collected and analyzed retrospectively. RESULTS Twenty-one patients were identified. All patients were female. Their mean age at admission was 8.9 ± 1.9 years. Furthermore, 19 (90.5%) patients presented with abdominal pain, 16 (76.2%) with vomiting, and 13 (61.9%) with a palpable mass. Sixteen patients underwent gastroduodenoscopy. Among them, 15 had gastric trichobezoars. Moreover, 12 patients underwent computed tomography scan. Eight patients presented with gastric and small intestinal BZs, one presented with increased small intestinal contents with dilation, and one presented with abundant gastric contents. Then, 20 patients underwent surgery. Among them, five underwent laparoscopic-assisted minilaparotomy (LAML), and the rest underwent laparotomy. The results showed that 10 (50%) patients had gastric trichobezoars; 7 (35%), Rapunzel syndrome; and 3 (15%), small bowel trichobezoars. Two patients developed superficial wound infection postoperatively. One patient had a recurrent gastric trichobezoar. CONCLUSION Trichobezoar should be considered in young girls with a history of hair eating or those with hair in the vomit or feces. Timely diagnosis and aggressive treatment are the keys to reducing complications and improving prognosis. Laparoscopic-assisted minilaparotomy is a safe, feasible, and effective surgical method for treating trichobezoars.
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Affiliation(s)
- Linyan Wang
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, 310052, China
| | - Yi Chen
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, 310052, China
| | - Sai Chen
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, 310052, China
| | - Zhigang Gao
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, 310052, China
| | - Yunzhong Qian
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, 310052, China
| | - Qingjiang Chen
- Department of General Surgery, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center For Child Health, Hangzhou, 310052, China.
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Huang J, Xu D, Li A. Laparoscopic Resection of the Middle Bile Duct for Cholangiocarcinoma (with Video). Ann Surg Oncol 2024; 31:1264-1267. [PMID: 37907702 DOI: 10.1245/s10434-023-14500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Surgical resection remains the sole approach to achieving long-term survival in cholangiocarcinoma cases. The universally recognised standard procedures for such cases include pancreaticoduodenectomy (PD) or hemihepatectomy accompanied by bile duct reconstruction. Nevertheless, some patients may still attain curative intent through bile duct segmental resection (BDR). However, these procedures are still in the experimental stage and should only be recommended for carefully chosen patients. METHODS A 57-year-old male patient was admitted to our department after two weeks of escalating jaundice and abdominal discomfort. Upon admission, his total bilirubin was recorded at 102 μmol/L, and his direct bilirubin was 87 μmol/L. His carbohydrate antigen 19-9 (CA 19-9), carcinoembryonic antigen (CEA) and alpha fetoprotein (AFP) levels were normal. Enhanced computed tomography (CT) and magnetic resonance imaging (MRI) scans revealed a thickened and enhanced biliary tree extending from the cystic duct junction to the common hepatic duct no vascular invasion indicated by three-dimensional reconstruction. RESULTS The patient underwent laparoscopic resection of the extrahepatic bile duct, accompanied by radical lymphadenectomy with skeletonisation and biliary reconstruction, was successfully conducted within 320 min, with a minimal blood loss of only 50 ml. The histological grading of the procedure was T2bN0M0 (stage II). The patient was discharged on the sixth postoperative day without complications. Following this, he underwent a regimen of single-agent capecitabine chemotherapy. After an 18-month follow-up period, no recurrence was observed. CONCLUSIONS Our experience suggests that in selected patients diagnosed with middle bile duct cholangiocarcinoma, laparoscopic resection could potentially reach the standard of lymphadenectomy through skeletonisation.
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Affiliation(s)
- Jie Huang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
| | - Dingwei Xu
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Ao Li
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
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Liagre A, Martini F, Debs T, Barone SC, Petrucciani N. Roux en Y gastric bypass and iterative intussusception at the jejuno-jejunal anastomosis: Conversion into one anastomosis gastric bypass (with video) - A case report. Int J Surg Case Rep 2024; 115:109244. [PMID: 38215577 PMCID: PMC10821620 DOI: 10.1016/j.ijscr.2024.109244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION The aim of this article is to describe a rare complication of Roux en Y gastric bypass (RYGB): recurrent intestinal intussusception of the biliary limb, and an original treatment: the removal of the jejuno-jejunal anastomosis with conversion into "short limb" one anastomosis gastric bypass (OAGB). PRESENTATION OF CASE A 25-year-old patient underwent RYGB fashioned with a 50 cm-length biliary loop and a 150 cm-length alimentary loop. She was hospitalized other 3 times in the following months for episodes of acute abdominal pain and excessive weight loss, with CT scans showing intussusception at the jejuno-jejunal anastomosis. Conversion from RYGB to OAGB with "short biliary limb" was performed. The patient at 60-month follow-up has no bile reflux and regained weight. DISCUSSION Small bowel intussusception is a rare complication that can occur following Roux-en-Y gastric bypass (RYGB) surgery, leading to symptoms like acute or chronic abdominal pain. Treatment options reported in medical literature include resection and re-fashioning of the jejuno-jejunal anastomosis, simple reduction (with a risk of recurrence), and imbrication/plication of the jejuno-jejunal anastomosis. Given the rarity of this complication, there are no standardized recommendations, and the best treatment should be determined on a case-by-case basis, taking into consideration the patient's unique circumstances and the medical team's expertise. CONCLUSION Intestinal intussusception at the jejuno-jejunal anastomosis responsible for chronic abdominal pain is a rare complication after RYGB. One of the possible treatments is conversion into OAGB.
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Affiliation(s)
- Arnaud Liagre
- Clinique Des Cedres, Bariatric Surgery Unit, Ramsay Générale de Santé, Cornebarrieu, France
| | - Francesco Martini
- Clinique Des Cedres, Bariatric Surgery Unit, Ramsay Générale de Santé, Cornebarrieu, France
| | - Tarek Debs
- Institut Arnault Tzanck, 116 Rue du Commandant Gaston Cahuzac, 06700 Saint-Laurent-du-Var, France
| | - Sara Claudia Barone
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy
| | - Niccolo Petrucciani
- Department of Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, St Andrea Hospital, Sapienza University, Rome, Italy.
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Pastier C, Sauvanet A, Dokmak S. Laparoscopic longitudinal pancreatico-jejunal anastomosis for chronic pancreatitis. J Visc Surg 2024; 161:47-52. [PMID: 38129279 DOI: 10.1016/j.jviscsurg.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Clément Pastier
- Department of HPB Surgery and Liver Transplantation, DMU DIGEST, Hospital Beaujon, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - Alain Sauvanet
- Department of HPB Surgery and Liver Transplantation, DMU DIGEST, Hospital Beaujon, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France; Université Paris Cité, Paris, France
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, DMU DIGEST, Hospital Beaujon, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France; Université Paris Cité, Paris, France.
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Ng KKC, Cheng KC, Kung JWC, Ho KM, Lok HT, Fung AKY, Chong CCN, Cheung SYS, Lee KF, Wong J, Lai PBS. Comparison of clinical outcome between laparoscopic and open hepatectomy of high difficulty score for hepatocellular carcinoma: a propensity score analysis. Surg Endosc 2024; 38:857-871. [PMID: 38082015 DOI: 10.1007/s00464-023-10634-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/29/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) of high difficulty score is technically challenging. There is a lack of clinical evidence to support its applicability in terms of the long-term survival benefits. This study aims to compare clinical outcomes between LLR and the open liver resection of high difficulty score for hepatocellular carcinoma (HCC). MATERIALS AND METHODS From 2010 to 2020, using Iwate criteria, 424 patients underwent liver resection of high difficulty score by the laparoscopic (n = 65) or open (n = 359) approach. Propensity score (PS) matching was performed between the two groups. Short-term and long-term outcomes were compared between PS-matched groups. Univariate and multivariate analyses were performed to identify prognostic factors affecting survival. RESULTS The laparoscopic group had significantly fewer severe complications (3% vs. 10.8%), and shorter median hospital stays (6 days vs. 8 days) than the open group. Meanwhile, the long-term oncological outcomes were comparable between the two groups, in terms of the tumor recurrence rate (40% vs. 46.1%), the 5-year overall survival rate (75.4% vs. 76.2%), and the 5-year recurrence-free survival rate (50.3% vs. 53.5%). The high preoperative serum alpha-fetoprotein level, multiple tumors, and severe postoperative complications were the independent poor prognostic factors associated with worse overall survival. The surgical approach (Laparoscopic vs. Open) did not influence the survival. CONCLUSION LLR of high difficulty score for selected patients with HCC has better short-term outcomes than the open approach. More importantly, it can achieve similar long-term survival outcomes as the open approach.
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Affiliation(s)
- Kelvin K C Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong.
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, 30 - 32 Ngan Shing Street, New Territories, Hong Kong.
| | - Kai-Chi Cheng
- Department of Surgery, Kwong Wah Hospital, Hong Kong, Hong Kong
| | - Janet W C Kung
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Kit-Man Ho
- Department of Surgery, Kwong Wah Hospital, Hong Kong, Hong Kong
| | - Hon-Ting Lok
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Andrew K Y Fung
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Charing C N Chong
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Sunny Y S Cheung
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Kit-Fai Lee
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - John Wong
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
| | - Paul B S Lai
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Department of Surgery, Prince of Wales Hospital, New Territories, Hong Kong
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Xie Q, Qiu G, Liao M, Hou Z, Jin Z, Mi S, Huang J, Liu C. Transhepatic arterial approaches for ICG injection to guide laparoscopic anatomical hepatectomy: A case series study. Asian J Surg 2024; 47:916-922. [PMID: 38110326 DOI: 10.1016/j.asjsur.2023.10.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 09/20/2023] [Accepted: 10/27/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Laparoscopic anatomical hepatectomy guided by near-infrared fluorescence imaging (NIR-FI) has been utilized extensively. However, it is difficult to resect "cone units" above the third branch of the Glissonean pedicle in the right posterior lobe using the laparoscopic positive or negative staining techniques. Therefore, we undertook a new laparoscopic segmentectomy based on the concept of "cone unit" assisted by interventional radiology combined with NIR-FI. METHODS Laparoscopic segmentectomy guided by NIR-FI via super-selective hepatic arteriography and trans-arterial injection of ICG was carried out on 13 patients with early-stage HCC between September 2020 and January 2022.11 of cases were successful, and relevant pathological characteristics and perioperative outcomes were retrospectively analyzed. RESULTS Two cases failed NIR-FI out of which one case involved over-staining to the non-target segment, and in the other case, which was to undergo laparoscopic segment V resection, only the ventral segment was stained while the imaging of the dorsal segment failed. In the intraoperative conditions, the tumor safe margin was 1.1 (0.7-1.55) cm, the interventional operation time was 50 (45.5-60.5) minutes, the operation time was 280 (242.5-307.5) minutes, the blood loss was 100 (50-200) ml, the postoperative hospital stay was 5 (4.5-5.5) days. No cases converted to laparotomy, and no serious postoperative complications developed. CONCLUSIONS NIR-FI through super-selective hepatic arteriography and trans-arterial injection of ICG can provide a clear and lasting navigation aid for laparoscopic segmentectomy, which may have positive implication for early-stage HCC with poor preoperative liver reserves.
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Affiliation(s)
- Qingyun Xie
- Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, And State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Guoteng Qiu
- Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, And State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Mingheng Liao
- Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, And State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Ziqi Hou
- Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, And State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaoxing Jin
- Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, And State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Shizheng Mi
- Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, And State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Jiwei Huang
- Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, And State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
| | - Chang Liu
- Division of Liver Surgery, Department of General Surgery and Laboratory of Liver Surgery, And State Key Laboratory of Biotherapy and Collaborative Innovation Center of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.
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Ramanathan N, Mikulski MF, Perez Coulter AM, Seymour NE, Orthopoulos G. Investigation of optimal hernia repair techniques in patients with inflammatory bowel disease. Surg Endosc 2024; 38:975-982. [PMID: 37968385 DOI: 10.1007/s00464-023-10537-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 10/12/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION Multiple laparotomies, immunosuppressive therapy, wound infection, and malnutrition are risk factors for incisional hernia development, which places inflammatory bowel disease (IBD) patients at high risk. With advances in minimally invasive techniques, this study assesses incisional hernia repair techniques and complications in the IBD population. METHODS A single-center, retrospective review of adults with IBD who underwent incisional hernia repair from 2008 to 2022. Complications relative to operative approach and mesh placement location were assessed using descriptive and univariate statistics. RESULTS Eighty-eight IBD patients underwent incisional hernia repair. Fifty-two (59.1%) were on immunomodulators and 30 (34.1%) were repaired primarily. Thirty-five (39.7%) hernias recurred, of whom 19 (33%) had mesh placed. Three (30%) occurred in onlay repairs and 16 (33%) occurred in underlay repairs. Subdivision of underlay repairs into intraperitoneal, preperitoneal and retrorectus mesh placement revealed recurrence rates of 35.1%, 50%, and 14.3%, respectively. Patients with open repair were more likely to have intraoperative bowel injury (28.6% vs 9.7%, p = 0.041) and develop postoperative seromas/abscesses (12.5% vs 0%, p = 0.001) and wound complications (17.9% vs 0%, p = 0.012) compared to laparoscopic. Seromas/abscesses developed more frequently in onlay repairs compared to underlay (40% vs 2.13%, p = 0.001). Twelve (13.6%) patients presented with postoperative small bowel obstruction (SBO), 7 (58.3%) of whom had mesh placed, and 6 (85.7%) were underlay. All SBO after underlay repair had intraperitoneally placed mesh. When comparing surgeons, hernias were more likely to recur performed by colorectal surgeons compared to hernia surgeons (63.3% vs 21.3%, p < 0.001). CONCLUSION In IBD patients, minimally invasive approaches lead to fewer perioperative complications compared to open. Underlay mesh placement demonstrated decreased incidence of seroma/abscess formation compared to onlay. When sub-grouped, underlay placements were similar in terms of complications. Retrorectus placement, however, had fewer recurrences and no readmissions for SBO. This suggests a minimally invasive approach or placement of retrorectus mesh may provide the optimal repair in this patient population.
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Affiliation(s)
- Nikita Ramanathan
- Department of Surgery, University of Massachusetts Chan Medical School - Baystate Medical Center, 759 Chestnut St., Springfield, MA, 01199, USA.
| | - Matthew F Mikulski
- Department of Surgery, University of Massachusetts Chan Medical School - Baystate Medical Center, 759 Chestnut St., Springfield, MA, 01199, USA
| | - Aixa M Perez Coulter
- Department of Surgery, University of Massachusetts Chan Medical School - Baystate Medical Center, 759 Chestnut St., Springfield, MA, 01199, USA
| | - Neal E Seymour
- Department of Surgery, University of Massachusetts Chan Medical School - Baystate Medical Center, 759 Chestnut St., Springfield, MA, 01199, USA
| | - Georgios Orthopoulos
- Department of Surgery, Beth Israel Lahey Health -Winchester Hospital, Boston, USA
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White B, Naffouje S, Grunvald M, Bhama A, Dahdaleh F. Effect of prolonged operative time on short-term outcomes of open vs minimally invasive proctectomy. J Gastrointest Surg 2024; 28:141-150. [PMID: 38445935 DOI: 10.1016/j.gassur.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/19/2023] [Accepted: 11/30/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND Minimally invasive proctectomy (MIP) may offer advantages over open proctectomy (OP). Increased operative times (OTs) are linked to inferior outcomes for various operations; however, the interplay between OT and approach for proctectomy is not well-established. This study aimed to evaluate associations of increasing OT on 30-day morbidity in OP and MIP cohorts. METHODS The American College of Surgeons National Quality Improvement Program Targeted Proctectomy Dataset was used to identify patients undergoing proctectomy. Cases were stratified by open or minimally invasive surgical approach and following propensity score matching between the groups, and OT quartiles were established for each group. Perioperative outcomes were compared among quartiles, and multivariate regression was used to identify factors associated with prolonged OT. RESULTS The median OT was longer for MIP (271 vs 232 min; P < .01). Although increased OT was associated with higher overall morbidity for both open and minimally invasive approaches, this effect was more pronounced in OP than in MIP (63.2% vs 38.4%, respectively; P < .001). Factors associated with prolonged OT included the procedure performed, male sex, higher body mass index scores, diverting ileostomy, and, in malignant disease, mid or lower and T4 tumors (all P < .05). CONCLUSION Herein, prolonged OT was associated with worse short-term outcomes for both OP and MIP cases; however, its detrimental effect was more pronounced for open surgery than for minimally invasive surgery. Our data suggested that MIP may offer short-term advantages for demanding cases requiring longer OTs.
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Affiliation(s)
- Bradley White
- Department of Surgery, University of Illinois Chicago, Chicago, Illinois, United States
| | - Samer Naffouje
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio, United States
| | - Miles Grunvald
- Department of Surgery, Rush University Medical Center, Chicago, Illinois, United States
| | - Anurhada Bhama
- Department of Surgery, Cleveland Clinic, Cleveland, Ohio, United States
| | - Fadi Dahdaleh
- Department of Surgical Oncology, Edward-Elmhurst Health, Naperville, Illinois, United States.
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Huang J, Hu W, Liu J, Tang X, Fan Y, Ran L, Li B, Zhang J, Xiong H, Li W, Liang B, Fang L, Fu X. Real-time fluorescence imaging with indocyanine green during laparoscopic duodenum-preserving pancreatic head resection. Pancreatology 2024; 24:130-136. [PMID: 38016861 DOI: 10.1016/j.pan.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Laparoscopic duodenum-preserving pancreatic head resection (LDPPHR) is a surgical method used to treat benign and low-grade malignant pancreatic head tumors. This study aimed to determine the protective effect of common bile duct in LDPPHR using indocyanine green (ICG) fluorescence imaging. METHODS A retrospective analysis of 30 patients treated with LDPPHR at the Second Affiliated Hospital of Nanchang University between January 2015 and November 2022 was performed. Patients were divided into two groups based on ICG use: ICG and non-ICG. RESULTS Thirty patients received LDPPHR, 11 males and 19 females, and the age was 50.50 (M (IQR)) years (range: 19-76 years). LDPPHR was successfully performed in 27 (90 %) patients, LPD was performed in 1 (3 %) patient, and laparotomy conversion was performed in 2 (7 %) patients. One patient (3 %) died 21 days after surgery. The incidence of intraoperative bile duct injury in the ICG group was lower than that in the non-ICG group (10 % vs 60 %, P = 0.009), and the operation time in the ICG group was shorter than that in the non-ICG group (311.9 ± 14.97 vs 338.05 ± 18.75 min, P < 0.05). Postoperative pancreatic fistula occurred in 16 patients (53 %), including 10 with biochemical leakage (62.5 %), four with grade B (25 %), and two with grade C (12.5 %). Postoperative bile leakage occurred in four patients (13 %). CONCLUSIONS The ICG fluorescence imaging technology in LDPPHR helps protect the integrity of the common bile duct and reduce the occurrence of intraoperative bile duct injury, postoperative bile leakage, and bile duct stenosis.
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Affiliation(s)
- Jian Huang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang University School of Medicine, Jiangxi, China
| | - Wei Hu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang University School of Medicine, Jiangxi, China
| | - Jinghang Liu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang University School of Medicine, Jiangxi, China
| | - Xinguo Tang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang University School of Medicine, Jiangxi, China
| | - Yuting Fan
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang University School of Medicine, Jiangxi, China
| | - Longjian Ran
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang University School of Medicine, Jiangxi, China
| | - Bowen Li
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang University School of Medicine, Jiangxi, China
| | - Jia Zhang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang University School of Medicine, Jiangxi, China
| | - Hu Xiong
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang University School of Medicine, Jiangxi, China
| | - Wen Li
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang University School of Medicine, Jiangxi, China
| | - Bo Liang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang University School of Medicine, Jiangxi, China
| | - Lu Fang
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang University School of Medicine, Jiangxi, China.
| | - Xiaowei Fu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang University School of Medicine, Jiangxi, China.
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Sigg S, Lehner F, Keller EX, Saba K, Moch H, Sulser T, Eberli D, Mortezavi A. Outcomes of robot-assisted laparoscopic extended pelvic lymph node dissection for prostate Cancer. BMC Urol 2024; 24:24. [PMID: 38287319 PMCID: PMC10823685 DOI: 10.1186/s12894-024-01409-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/16/2024] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION Extended pelvic lymph node dissection (ePLND) in men undergoing robot-assisted laparoscopic radical prostatectomy (RARP) is a widely used procedure. However, little is known about anatomical site-specific yields and subsequent metastatic patterns in these patients. PATIENTS AND METHODS Data on a consecutive series of 1107 patients undergoing RARP at our centre between 2004 and 2018 were analysed. In men undergoing LN dissection, the internal, external and obturator nodes were removed and sent in separately. We performed an analysis of LN yields in total and for each anatomical zone, patterns of LN metastases and complications. Oncological outcome in pN+ disease was assessed including postoperative PSA persistence and survival. RESULTS A total of 823 ePLNDs were performed in the investigated cohort resulting in 98 men being diagnosed as pN+ (8.9%). The median (IQR) LN yield was 19 (14-25), 10 (7-13) on the right and 9 (6-12) on the left side (P < 0.001). A median of six (4-8) LNs were retrieved from the external, three (1-6) from the internal iliac artery, and eight (6-12) from the obturator fossa. More men had metastatic LNs on the right side compared to the left (41 vs. 19). Symptomatic lymphoceles occurred exclusively in the ePLND group (2.3% vs. 0%, p = 0.04). Postoperatively, 47 (47.9%) of men with pN+ reached a PSA of < 0.1μg/ml. There was no association between a certain pN+ region and postoperative PSA persistence or BCRFS. The estimated cancer specific survival rate at 5 years was 98.5% for pN+ disease. CONCLUSION Robot-assisted laparoscopic ePLND with a high LN yield and low complication rate is feasible. However, we observed an imbalance in more removed and positive LNs on the right side compared to the left. A high rate of postoperative PSA persistence and early recurrence in pN+ patients might indicate a possibly limited therapeutical value of the procedure in already spread disease. Yet, these men demonstrated an excellent survival.
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Affiliation(s)
- Silvan Sigg
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Fabienne Lehner
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Karim Saba
- Urologiezentrum Hirslanden, Hirslanden Klinik Aarau, Aarau, Switzerland
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Tullio Sulser
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ashkan Mortezavi
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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Liu Y, Wang XX, Li YL, He WT, Li H, Chen H. Clinical effect of laparoscopic radical resection of colorectal cancer based on propensity score matching. World J Gastrointest Surg 2024; 16:124-133. [PMID: 38328309 PMCID: PMC10845282 DOI: 10.4240/wjgs.v16.i1.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/16/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The incidence of colorectal cancer (CRC) is increasing annually. Laparoscopic radical resection of CRC is a minimally invasive procedure preferred in clinical practice. AIM To investigate the clinical effect of laparoscopic radical resection of CRC on the basis of propensity score matching (PSM). METHODS The clinical data of 100 patients who received inpatient treatment for CRC at Changde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City) were analyzed retrospectively. The control group included patients who underwent open surgery (n = 43), and those who underwent laparoscopic surgery formed the observation group (n = 57). The baseline information of both groups was equipoised using 1 × 1 PSM. Differences in the perioperative parameters, inflammatory response, immune function, degree of pain, and physical status between the groups were analyzed. RESULTS Thirty patients from both groups were successfully matched. After PSM, baseline data showed no statistically significant differences between the groups: (1) Perioperative parameters: The observation group had a longer surgery time, less intraoperative blood loss, earlier first ambulation and first anal exhaust times, and shorter gastric tube indwelling time than the control group; (2) Inflammatory response: 24 h after surgery, the levels of interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α) between groups were higher than preoperatively. IL-6, CRP, and TNF-α levels in the observation group were lower than in the control group; (3) Immune function: At 24 h after surgery, counts of CD4-positive T-lymphocytes (CD4+) and CD4+/CD8-positive T-lymphocytes (CD8+) in both groups were lower than those before surgery, whereas CD8+ was higher than that before surgery. At 24 h after surgery, both CD4+ counts and CD4+/CD8+ in the observation group were higher than those in the control group, whereas CD8+ counts were lower; (4) Degree of pain: The visual analog scale scores in the observation group were lower than those in the control group at 24 and 72 h after surgery; and (5) Physical status: One month after surgery, the Karnofsky performance score in the observation group was higher than that in the control group. CONCLUSION Laparoscopic radical resection of CRC has significant benefits, such as reducing postoperative pain and postoperative inflammatory response, avoiding excessive immune inhibition, and contributing to postoperative recovery.
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Affiliation(s)
- Yang Liu
- Department of General Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
| | - Xian-Xue Wang
- Department of Anesthesiology, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
| | - Yu-Lin Li
- Department of General Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
| | - Wen-Tao He
- Department of General Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
| | - Hong Li
- Department of General Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
| | - Hua Chen
- Department of General Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
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Cawich SO, Plummer JM, Griffith S, Naraynsingh V. Colorectal resections for malignancy: A pilot study comparing conventional vs freehand robot-assisted laparoscopic colectomy. World J Clin Cases 2024; 12:488-494. [PMID: 38322459 PMCID: PMC10841952 DOI: 10.12998/wjcc.v12.i3.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/06/2023] [Accepted: 12/29/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Laparoscopic colectomy is widely accepted as a safe operation for colorectal cancer, but we have experienced resistance to the introduction of the FreeHand® robotic camera holder to augment laparoscopic colorectal surgery. AIM To compare the initial results between conventional and FreeHand® robot-assisted laparoscopic colectomy in Trinidad and Tobago. METHODS This was a prospective study of outcomes from all laparoscopic colectomies performed for colorectal carcinoma from November 29, 2021 to May 30, 2022. The following data were recorded: Operating time, conversions, estimated blood loss, hospitalization, morbidity, surgical resection margins and number of nodes harvested. All data were entered into an excel database and the data were analyzed using SPSS ver 20.0. RESULTS There were 23 patients undergoing colectomies for malignant disease: 8 (35%) FreeHand®-assisted and 15 (65%) conventional laparoscopic colectomies. There were no conversions. Operating time was significantly lower in patients undergoing robot-assisted laparoscopic colectomy (95.13 ± 9.22 vs 105.67 ± 11.48 min; P = 0.045). Otherwise, there was no difference in estimated blood loss, nodal harvest, hospitalization, morbidity or mortality. CONCLUSION The FreeHand® robot for colectomies is safe, provides some advantages over conventional laparoscopy and does not compromise oncologic standards in the resource-poor Caribbean setting.
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Affiliation(s)
- Shamir O Cawich
- Department of Surgery, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Joseph Martin Plummer
- Department of General Surgery and Consultant General and Colorectal Surgeon, Department of Surgery, University of the West Indies, Kingston, KIN7, Jamaica
| | - Sahle Griffith
- Department of Surgery, Queen Elizabeth Hospital, Bridgetown, Barbados
| | - Vijay Naraynsingh
- Department of Surgery, Port of Spain General Hospital, Port of Spain, Trinidad and Tobago
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Hamdi JT, Munshi S, Azam S, Omer A. Development of a master-slave 3D printed robotic surgical finger with haptic feedback. J Robot Surg 2024; 18:43. [PMID: 38236452 PMCID: PMC10796619 DOI: 10.1007/s11701-024-01819-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/01/2024] [Indexed: 01/19/2024]
Abstract
Robotic surgery started nearly 30 years ago. It has achieved telepresence and the performance of repetitive, precise, and accurate tasks. The "master-slave" robotic system allows control of manipulators by surgeon at distant site. Robotic surgical fingers were developed to allow surgeons to move them with accuracy through sensors fixed on surgeon's hand. Also, haptic sensors were developed to allow transmission of sensation from robotic finger to surgeon's finger. A complete system of a, 3D printed by a stereolithography (SLA) 3D printer, robotic surgical finger with haptic feedback system is proposed. The developed system includes a master glove that controls the motion of a 3DOF robotic slave finger while getting haptic feedback of force/pressure exerted on it. The precise control of the slave robotic finger was achieved by applying a Proportional Integral and Derivative (PID), fast and robust, control algorithm using an Arduino based hardware and software module. The individual joint angles, metacarpophalangeal joint (MCP) and proximal interphalangeal joint (PIP), and wrist were measured using rotatory and inertial sensors respectively. The degree of movement for MCP, PIP, and Wrist joints were measured to be 0-86°, 0-71°, and 0-89° respectively. Motion to the robotic finger is mimicked by a glove motion requiring minimal learning curve for the device. The collected data for the slave motion is in good agreement with the master-glove motion data. The vibro-tactile haptic feedback system was developed to distinguish between three different materials to mimic human flesh, tumor, and bone. The master-slave system using robotic surgical finger with good simultaneous movement to surgeon's finger and good haptic sensation will provide the surgeon with the opportunity to perform finger dissection in laparoscopic and robotic surgery, as it used to be in open surgery. 3D bio printing will make this process even cheaper with the added advantage of making surgical tools locally according to the need of the surgery. An ongoing work is to develop silicone based 8 mm robotic surgical finger with multiple type haptic feedback.
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Affiliation(s)
- Jamal T Hamdi
- Surgical Department, Umm Al-Qura University, Makkah, Saudi Arabia.
| | - Shadi Munshi
- Mechanical Engineering Department, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Sufyan Azam
- Mechanical Engineering Department, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Aiman Omer
- School of Science and Engineering, Waseda University, Tokyo, Japan
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Yang Z, He Y, Chen P, Zhang T, Ke Z, Sun F, Zhou G, Zhao W, Li S. Advantages of single-site laparoscopic orchiopexy for palpable undescended testes in children: a prospective comparison study. Pediatr Surg Int 2024; 40:34. [PMID: 38214758 PMCID: PMC10786978 DOI: 10.1007/s00383-023-05630-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE To evaluate the feasibility of single-site laparoscopic orchiopexy for palpable undescended testes in children. METHODS We prospectively studied patients with undescended testes between July 2021 and June 2022. In total, 223 patients were included in our study: 105 underwent single-site laparoscopic orchiopexy and 118 underwent conventional laparoscopic orchiopexy. During single-site laparoscopic orchiopexy, 3 ports were inserted within the umbilicus. RESULTS No differences were observed between the groups in terms of age and laterality. For unilateral undescended testes, the operating time was longer in the single site group than in the conventional group at the early stages (55.31 ± 12.04 min vs. 48.14 ± 14.39 min, P = 0.007), but it was similar to the conventional group at the later stages (48.82 ± 13.49 min vs. 48.14 ± 14.39 min, P = 0.78). Testicular ascent occurred in one patient from each group. There was no significant difference in the success rate between the single-site group and the conventional group (99.0% vs. 99.2%, P = 0.93). In the single-site group, no visible abdominal scarring was observed, while in the conventional group, there were two noticeable scars on the abdomen. CONCLUSION Single-site laparoscopic orchiopexy offers superior cosmetic results and comparable success rates compared to conventional laparoscopic orchiopexy for palpable undescended testes.
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Affiliation(s)
- Zhilin Yang
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Yingying He
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
- Department of Urology, Shenzhen Children's Hospital, China Medical University, Shenzhen, Guangdong, 518000, P.R. China
| | - Pengyu Chen
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Tiejun Zhang
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Zhicong Ke
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Fenghao Sun
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Guanglun Zhou
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Weiguang Zhao
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China
| | - Shoulin Li
- Department of Urology and Laboratory of Pelvic Floor Muscle Function, Shenzhen Children's Hospital, Futian District, Shenzhen, Guangdong, 518000, P.R. China.
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Yao Q, Sun QN, Wang DR. Laparoscopic versus open distal gastrectomy for advanced gastric cancer in elderly patients: a propensity-score matched analysis. World J Surg Oncol 2024; 22:13. [PMID: 38191399 PMCID: PMC10775460 DOI: 10.1186/s12957-023-03269-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Scarce research has reported the efficacy and safety of laparoscopic distal gastrectomy in elderly patients. This retrospective study aimed to compare the outcomes of laparoscopic and open distal gastrectomy for advanced gastric cancer in elderly patients. METHODS A total of 303 elderly patients who underwent distal gastrectomy for advanced gastric cancer from June 2017 to June 2021 were enrolled. Variables used to calculate propensity score matching included sex, age, body mass index, American Society of Anesthesiologists, history of diabetes, and history of hypertension. The statistical significance of continuous variables was tested using an independent sample t test. chi-square or Fisher's exact tests were used for categorical variables. Kaplan-Meier curve and log-rank test were used for the evaluation of 3-year overall survival and recurrence-free survival. RESULTS After performing 1:1 propensity score matching, 248 patients were included for analysis (laparoscopic = 124, open = 124). Compared with the open group, the laparoscopic group showed significant advantages in estimated blood loss (P < 0.001), pain scale on the first postoperative day (P = 0.002), time to first flatus (P = 0.004), time to first liquid diet (P = 0.005), hospital stays (P < 0.001), and total complications (P = 0.011), but devoted much more operation time (P < 0.001). No statistical difference was observed between the two groups in 3-year recurrence-free survival (P = 0.315) or overall survival (P = 0.159). CONCLUSIONS Our analysis demonstrated that laparoscopic surgery had the advantages of less intraoperative blood loss, fewer postoperative complications, and faster postoperative recovery in distal gastrectomy for advanced gastric, indicating that laparoscopic distal gastrectomy is safe and effective for treating elderly patients with distal gastric cancer.
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Affiliation(s)
- Qing Yao
- Northern Jiangsu People's Hospital Affiliated to Dalian Medical University, Yangzhou, 225001, China
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China
- Yangzhou, Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
| | - Qian-Nan Sun
- Yangzhou, Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China
- Medical Research Center of Northern Jiangsu People's Hospital, Yangzhou, 225001, China
| | - Dao-Rong Wang
- Northern Jiangsu People's Hospital Affiliated to Dalian Medical University, Yangzhou, 225001, China.
- Northern Jiangsu People's Hospital, No.98 Nantong West Road, Yangzhou, Yangzhou, 225001, China.
- General Surgery Institute of Yangzhou, Yangzhou University, Yangzhou, 225001, China.
- Yangzhou, Key Laboratory of Basic and Clinical Transformation of Digestive and Metabolic, Yangzhou, 225001, China.
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Maloney M, Zhao K, Hilden P, Turner AL, Merchant AM, Agarwalla PK. Outcomes of ventriculoperitoneal shunt placement with or without laparoscopic assistance: An analysis of the national inpatient sample. World Neurosurg X 2024; 21:100266. [PMID: 38204764 PMCID: PMC10776436 DOI: 10.1016/j.wnsx.2023.100266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 07/09/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024] Open
Abstract
Background Ventriculoperitoneal shunt (VPS) can be placed solely by a neurosurgeon often via an open-laparotomy approach, or laparoscopically as a collaborative effort between a neurosurgeon and a general surgeon. Prior studies have shown conflicting results when examining outcomes regarding infection, revision rate, hospital charges, length of stay, and mortality between the open mini-laparotomy and the laparoscopic approaches. Objective The current study uses the National Inpatient Sample (NIS) to compare outcomes of open mini-laparotomy vs. laparoscopic collaborative approach in VPS placement. Methods We performed a retrospective database study of the NIS from October 2015-December 2017 utilizing International Classification of Diseases, 10th Revision coding to identify all cases of VPS placement. All analyses accounted for the sampling design of the NIS. Results A total of 6580 cases (4969 with open mini-laparotomy approach and 1611 with laparoscopic collaborative approach) met inclusion criteria. Hospital charges, infection rates, and revision rates were similar between approaches. There were no significant differences in length of stay, mortality, or complication rates between the two approaches. Conclusion The collaborative, laparoscopic approach to VPS placement has similar outcomes and is non-inferior to the traditional open mini-laparotomy approach.
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Affiliation(s)
- Monica Maloney
- Department of Surgery, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Kevin Zhao
- Department of Neurosurgery, Rutgers New Jersey Medical School, USA
| | - Patrick Hilden
- Department of Biostatistics, Cooperman Barnabas Medical Center, Livingston, NJ, USA
| | - Amber L. Turner
- Department of Surgery, Cooperman Barnabas Medical Center, Livingston, NJ, USA
| | - Aziz M. Merchant
- Department of Surgery, Hackensack Meridian Health JFK University Medical Center, Edison, NJ, USA
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Sanderfer VC, Arnold MR, Mulvaney GG, Wang H, McLanahan CS, Wait SD, Van Poppel MD, Cosper G, Schmelzer T, Schulman AM, Jernigan SC, Reinke CE. Outcomes of laparoscopic and open ventriculoperitoneal shunt placement. Am J Surg 2024; 227:123-126. [PMID: 37827869 DOI: 10.1016/j.amjsurg.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/29/2023] [Accepted: 10/01/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Ventriculoperitoneal (VP) shunt placement requires a concurrent abdominal procedure. For peritoneal access laparoscopic or open approach may be utilized. Our aim was to compare patient/procedure characteristics and outcomes by peritoneal approach for VP shunts in children. METHODS NSQIP-Pediatric procedure targeted cerebral spinal fluid shunt Participant Use Data Files from 2016 to 2020 were queried. Patients were grouped into laparoscopic vs open abdominal approach. Patient demographics, procedure characteristics and 30-day outcomes were compared. RESULTS 7742 NSQIP-Pediatric patients underwent VP shunt placement. Patients undergoing laparoscopic approach were older and required less preoperative support. Mean operative time was longer with laparoscopy (mean(SD): 74.2(48.1) vs. 64.6(39) minutes, p < 0.0001) but had shorter hospital LOS. There was no difference in SSI, readmissions, or reoperation rates. CONCLUSION Patients undergoing laparoscopy for distal VP shunts are older with less support needs preoperatively. While laparoscopic approach had a shorter hospital LOS, there was no demonstratable difference in SSI, readmissions or reoperations between approaches. Further studies are needed to assess long-term outcomes.
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Affiliation(s)
| | - Michael R Arnold
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Graham G Mulvaney
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Huaping Wang
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | | | - Scott D Wait
- Carolina Neurosurgery & Spine Associates, Charlotte, NC, USA
| | | | | | | | | | | | - Caroline E Reinke
- Department of Surgery, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA.
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Mannava S, Hafezi N, Turk F, Colgate C, Askegard-Giesmann J, Markel T, Horn N, Gray B. Transversus Abdominis Plane Block VS. Local Wound Infiltration for Elective Minimally Invasive Cholecystectomy in Children: A Prospective Randomized Trial. J Pediatr Surg 2024; 59:96-102. [PMID: 37863700 DOI: 10.1016/j.jpedsurg.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/06/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND The efficacy of transversus abdominis plane (TAP) block versus local anesthetic wound infiltration (LWI) in pediatric laparoscopic surgery is largely unknown. The objective of this study was to prospectively analyze this in minimally invasive cholecystectomy. We hypothesized that TAP block would be superior to LWI in terms of pain control and post-operative complications. METHODS We conducted a prospective, randomized, single-blinded, controlled trial between 2017 and 2022 after obtaining Institutional Review Board (IRB) approval. After randomization, patients received a standard amount of ropivacaine via either 1) ultrasound-guided TAP block after general anesthesia induction or 2) local injection at port insertion by the operating surgeon. We collected data including operative time, pain scores, and medication usage post-operatively. We used descriptive statistics to report all endpoints and compared data with t-tests and Fisher's exact tests. A p-value less than 0.05 was considered statistically significant. RESULTS We enrolled 85 patients (43 LWI, 42 TAP). Mean [standard deviation] age and body mass index (BMI) in the LWI and TAP groups were 14.8 [1.9] and 14.7 [2] years and 29.9 [7.2] and 27.4 [8.2] kilogram/meter2 (kg/m2) respectively. We did not find any significant differences in postoperative opioid use, pain scores, and gastrointestinal symptoms. TAP patients had significantly longer time between anesthesia-start and procedure-start (p < 0.001), although total time under anesthesia was not significantly different (p = 0.540). CONCLUSION There are no significant differences between equal administration of local anesthetic by TAP block and surgeon administered LWI during minimally invasive cholecystectomy. TYPE OF STUDY Randomized clinical trial. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Sindhu Mannava
- Indiana University School of Medicine, Department of Surgery, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN, USA.
| | - Niloufar Hafezi
- Indiana University School of Medicine, Department of Surgery, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN, USA
| | - Farheen Turk
- Indiana University School of Medicine, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN, USA
| | - Cameron Colgate
- Indiana University School of Medicine, Center for Outcomes Research in Surgery, 545 Barnhill Drive, Emerson Hall, Indianapolis, IN, USA
| | | | - Troy Markel
- Indiana University School of Medicine, Department of Surgery, Division of Pediatric Surgery, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN, USA
| | - Nicole Horn
- Indiana University School of Medicine, Department of Anesthesia, 1130 W Michigan Street, Fesler Hall Room 204, Indianapolis, IN, USA
| | - Brian Gray
- Indiana University School of Medicine, Department of Surgery, Division of Pediatric Surgery, 705 Riley Hospital Drive, Suite 2500, Indianapolis, IN, USA
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Wang C, Wang Y, Zhong M, Li R, Shen Z. Logistic analysis of the recurrence of laparoscopic percutaneous extraperitoneal repair of pediatric inguinal hernia: A report of 486 cases. Asian J Surg 2024; 47:134-139. [PMID: 37225568 DOI: 10.1016/j.asjsur.2023.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/17/2023] [Accepted: 05/05/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Although the laparoscopic treatment of pediatric inguinal hernia (PIH) has more benefits than traditional surgery, it is difficult to completely avoid the problem of recurrence. The aim of this study was to use a logistic regression model to investigate the causes of recurrence after laparoscopic percutaneous extraperitoneal repair (LPER) of PIH. PATIENTS AND METHODS From June 2017 to December 2021, 486 cases of PIH were performed using LPER in our department. We utilized a two-port approach to implement LPER for PIH. All cases were followed up and the recurrent cases were recorded in detail. We used a logistic regression model to analyze the clinical data in order to find the reasons for recurrence. RESULTS We completed 486 cases with an internal inguinal ostium high ligation using laparoscopic surgery without conversion. Patients were followed for 10-29 months with an average of 18.2 months and 8 cases had recurrent ipsilateral hernia, including 4 recurrent cases in 89 cases (4.49%) using absorbable suture, 1 in 7 cases (14.29%) with internal inguinal ostium larger than 25 mm, 2 in 26 cases (7.69%) with BMI greater than 21, 2 in 41 cases (4.88%) with postoperative chronic constipation. The total recurrence rate was 1.65%. A foreign body reaction occurred in 2 cases, there were no complications such as scrotal hematoma, trocar umbilical hernia and testicular atrophy, and no deaths in this study. Univariate logistic regression analysis showed that patient BMI, ligation suture, diameter of the internal inguinal ostium and postoperative chronic constipation were significant variables (P values 0.093, 0.027, 0.060 and 0.081). The multivariate logistic regression analysis showed that the ligation suture and the diameter of the internal inguinal ostium were the main risk factors for postoperative recurrence, the odds ratio (OR) value were 5.374 and 2.801, the P values 0.018 and 0.046, and the 95% CI were 2.513-11.642 and 1.134-9.125. The area under ROC curve (AUC) for the logistic regression model was 0.735 (the 95% CI 0.677-0.801, P < 0.01). CONCLUSION An LPER for PIH is a safe and effective operation, but there still remains a small probability of recurrence. In order to reduce the recurrence rate of LPER, we should improve surgical skills, choose an appropriate ligature and avoid using LPER for a huge internal inguinal ostium (especially over 25 mm). It is appropriate to be converted to open surgery for the patients with a very wide internal inguinal ostium.
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Affiliation(s)
- Changyuan Wang
- Department of Pediatric Surgery, Fujian Medical University Union Hospital, China.
| | - Yang Wang
- Department of Pediatric Surgery, Fujian Medical University Union Hospital, China
| | - Min Zhong
- Department of Pediatric Surgery, Fujian Medical University Union Hospital, China
| | - Renfu Li
- Department of Pediatric Surgery, Fujian Medical University Union Hospital, China
| | - Zhiyong Shen
- Department of Pediatric Surgery, Fujian Medical University Union Hospital, China.
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Yang XY, Yang XG, Zhao PJ, Yang JW. An experience of laparoscopic-assisted D2 radical gastrectomy with uncut Roux-en-Y anastomosis for distal gastric cancer. Asian J Surg 2024; 47:576-577. [PMID: 37838550 DOI: 10.1016/j.asjsur.2023.09.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/22/2023] [Indexed: 10/16/2023] Open
Affiliation(s)
- Xi-Yang Yang
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, 200032, China; Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Xing-Guang Yang
- Department of General Surgery, the First Affiliated Hospital of Dali University, Dali, 671000, China
| | - Peng-Ju Zhao
- Department of General Surgery, the First Affiliated Hospital of Dali University, Dali, 671000, China
| | - Ji-Wu Yang
- Department of General Surgery, the First Affiliated Hospital of Dali University, Dali, 671000, China.
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