Journal of Investigative Surgery最新文献

Articulated laparoscopic instruments such as Artisential^® offer enhanced dexterity compared with conventional tools, but evidence for their use in benign gynecologic surgery remains limited. This multicenter, prospective, non-randomized comparative study evaluated the feasibility and perioperative safety of Artisential^® instruments using contemporaneous controls. Consecutive patients undergoing laparoscopic surgery for benign adnexal disease between December 2022 and August 2024 were enrolled in Korea, Taiwan, and Japan. Patients who consented underwent surgery using Artisential^®, while those who declined were treated with conventional laparoscopic instruments and included as retrospectively collected controls. Propensity score matching was performed based on age, body mass index, history of previous abdominal surgery, and type of surgery. Outcomes included operation time, estimated blood loss, postoperative hospital stay, and Clavien-Dindo-graded complications. A total of 184 patients were analyzed, and 112 matched patients were included after matching. No significant differences were observed between groups in operative outcomes. No conversions or transfusions occurred, and postoperative complications were infrequent and limited to grade I superficial port-site issues. These findings support the feasibility and short-term safety of Artisential^® instruments in benign adnexal surgery, although randomized trials are needed to further evaluate ergonomic and economic benefits.

Background: Abdominal aortic aneurysm (AAA) is a progressive vascular disorder that enlarges irreversibly and may ultimately rupture. Mendelian randomization (MR) provides a powerful approach to uncover biomarkers. We aimed to identify plasma proteins linked to AAA and evaluate their diagnostic potential.

Methods: We performed a proteome-wide MR analysis using genetic instruments for 2,940 plasma proteins from the UK Biobank Pharma Proteomics Project (UKB-PPP). Summary statistics for AAA were obtained from the Finnish R9 GWAS, comprising 4,083 cases and 420,324 controls.

Results: Eleven proteins showed significant causal associations with AAA risk (FDR < 0.05): seven positively and four negatively associated, highlighting their potential as diagnostic markers.

Conclusion: This study provides the first proteome-wide MR evidence linking plasma proteins to AAA, offering candidate biomarkers for diagnosis. As a hypothesis-generating work, further experimental and clinical validation is warranted.

Objective: This study evaluates the safety and efficacy of UBE-ULBD for severe thoracic stenosis caused by high-occupancy TOLF.

Methods: This was a retrospective comparative cohort study. 57 patients were divided into Group A and Group B. Perioperative variables, imaging findings, and clinical outcomes were compared.

Results: Group A showed better early (1-week/1-month) back pain VAS scores (p < 0.05), but not at 3 months. Statistically significant differences (p < 0.05) were observed between groups in the following parameters: wound length (MD: -7.6, 95% CI: -7.88 to -7.32, p < 0.001); number of intraoperative fluoroscopies (MD: 2.2, 95% CI: 1.82 to 2.58, p < 0.001); time to ambulation (MD: -4.1, 95% CI: -4.34 to -3.86, p < 0.001); length of hospital stay (MD: -3.4, 95% CI: -3.97 to -2.83, p < 0.001); time to full weight-bearing (MD: -19.5, 95% CI: -20.86 to -18.14, p < 0.001); posterior bone loss rate (MD: -34.6, 95% CI: -35.78 to -32.51, p < 0.001); and incidence of cerebrospinal fluid leakage (RD: -19.6%, 95% CI: -36.9% to -2.3%, p = 0.033). No other significant differences were found.

Conclusions: In this retrospective cohort, UBE-ULBD provided similar neurological recovery to open surgery with earlier recovery and fewer complications in patients with high-occupancy TOLF.

Background: Laparoscopic cholecystectomy (LC) is performed by surgeons from various specialties and remains central to minimally invasive surgical training. This study assessed whether surgeon subspecialty affects patient outcomes and explored aspects of LC education.

Methods: This population-based study included 46,700 LCs performed between 2020 and 2023, using data from the Swedish Registry for Gallstone Surgery (GallRiks). Surgeons were categorized as resident surgeons (RS), attending surgeons (AS), upper gastrointestinal/hepatopancreatobiliary surgeons (UGIS), acute care surgeons (ACS), or alternate subspecialty surgeons (ASS). Primary outcomes were 30-day adverse events (AE), bile duct injuries (BDI), and operative time (OT). Educational activity and subgroup analyses for elective and acute cholecystitis cases were evaluated.

Results: AE rates were higher for ACS (9.6%; OR 1.22, 95% CI 1.07-1.40) and AS (7.9%; OR 1.17, 95% CI 1.06-1.19) compared to UGIS (6.9%) but without increased BDI rates. RS demonstrated similar AE rates (6.1%) but lower BDI rates in elective cases (0.08%). OT was 24-33 min shorter for UGIS than for other surgeon types. Educational activity prolonged OT by 12 min (OR 1.06; 95% CI 1.05-1.08).

Discussion: Higher AE rates among ACS and AS likely reflect more complex cases. LC performed by RS appears equally safe and efficient, provided appropriate supervision is available.

Objective: This review aims to systematically assess and compare the efficacy, complication rates, and procedural characteristics of percutaneous interlaminar endoscopic discectomy (PIED), percutaneous transforaminal endoscopic discectomy (PTED), and unilateral biportal endoscopy (UBE) in the management of lateral recess stenosis (LRS).

Methods: A systematic search was conducted across six databases from inception to March 2025 to identify studies on endoscopic lumbar decompression for LRS. Primary outcomes were pain reduction (VAS) and functional improvement (ODI); secondary outcomes were perioperative metrics, complication rates, and patient satisfaction. Narrative synthesis was applied due to heterogeneity. Study quality was assessed using the Cochrane Risk of Bias Tool, ROBINS-I, and the Downs and Black checklist.

Results: Thirty-six studies involving 2341 patients with 6-60 months of follow-up were included. PIED achieved VAS reductions of 3-5 points and ODI reductions of 40-60%, but with higher complication rates, including dural tears (3-6%) and reoperation rates (5-9.7%). UBE produced VAS improvements of 5-7 points and ODI reductions of 50-70%, with satisfaction >92%, though operative times were longer (48-91 min) and dural tears occurred in 3-6%. PTED showed consistent pain relief (VAS 6-8 to 1-2) and ODI reductions >50%, with satisfaction 85-95%, short operative times (5-30 min), and low complication and reoperation rates (<5%). Overall study quality ranged from low to moderate risk of bias.

Conclusions: PIED, PTED, and UBE all provide effective decompression for LRS. PTED demonstrates the most consistent balance of symptom improvement, safety, and efficiency, while each technique offers distinct advantages for individualized patient selection.

Background: Ischemic preconditioning of parathyroid glands (IPCP) is biologically plausible but clinical evidence is limited. In this single-center randomized trial (ChiCTR2000039788), we compared IPCP versus control during total thyroidectomy with central neck dissection.

Methods: A total of 135 patients with differentiated thyroid carcinoma were analyzed (IPCP, n = 67; control, n = 68). IPCP consists of three cycles of 60-second occlusion followed by 60-second reperfusion of the ipsilateral superior and inferior thyroid arteries. The baseline characteristics, postoperative hypoparathyroidism (hypoPTH) and hypocalcemia, early parathyroid function recovery (PFR), and surgical complications, were compared between groups.

Results: The incidence of postoperative hypoPTH and protracted hypoPTH was not significantly different between the IPCP and control groups (50.8% vs 41.2%, p = 0.265; 6.0% vs 14.7%, p = 0.096). An exploratory analysis showed a higher rate of early PFR in the IPCP group (88.2% vs 64.3%; p = 0.025). The incidence of postoperative hypocalcemia was similar between groups (79.1% vs 82.4%; p = 0.632). Fewer inadvertent parathyroidectomy occurred in the IPCP group, though this difference was not statistically significant (4.5% vs 8.8%; p = 0.505). Other surgical complications were comparable.

Conclusions: IPCP did not reduce postoperative hypoPTH in this randomized trial. Earlier PFR is exploratory and warrants further investigation in adequately powered trials.

Background: Antiviral therapies for hepatitis B or C virus may be associated with reduced risk of tumor recurrence and mortality of patients with hepatocellular carcinoma (HCC) undergoing curative treatments, compared to untreated patients. Previous studies comparing survival outcomes between percutaneous radiofrequency ablation (RFA) and liver resection (LR) for treating patients with very early-stage HCC did not evaluate the effects of antiviral treatments on survival outcome. Our study aimed to clarify this issue.

Methods: From 2011 to 2021, 265 patients undergoing LR and 269 patients undergoing RFA for very early-stage HCC (i.e., a single tumor ≤2 cm without macrovascular invasion or extrahepatic metastasis, with Eastern Cooperative Oncology Group performance status = 0 and Child-Pugh class A liver disease) were included in this retrospective study. Survival analysis was performed using the Kaplan - Meier method after propensity score matching (PSM).

Results: After 1:1 PSM (n = 205 in both groups), the survival benefit of LR was significantly higher than that of RFA (five-year OS: 85% vs. 73%; p = 0.004; five-year RFS: 64% vs. 45%; p < 0.001).

Conclusions: For patients with very early-stage HCC, LR was associated with superior OS and RFS compared to RFA.

Objective: We aimed to explore the effects of applying edaravone dexborneol after intracranial vascular intervention on the levels of neuron-specific enolase (NSE), homocysteine (Hcy) and neurological function in elderly patients with acute ischemic cerebrovascular disease (AICVD).

Methods: The control group and study group were established. Serum levels of NSE, Hcy, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), malondialdehyde (MDA), and superoxide dismutase (SOD) activity were measured. Neurological function and hemorheological indices [plasma viscosity (PV), high-shear viscosity (HSV), low-shear viscosity (LSV)] were assessed. Adverse reactions and 6-month adverse outcomes were recorded.

Results: At 14 days postoperatively, the study group exhibited lower NSE, Hcy, IL-6, TNF-α, and MDA levels and higher SOD activity than the control group (all p < 0.05). NIHSS scores, PV, HSV, and LSV decreased in both groups at 7 and 14 days postoperatively (p < 0.05), with greater improvements in the study group (p < 0.05). The study group had a lower incidence of adverse outcomes (4.00% vs. 13.33%, p < 0.05).

Conclusion: Edaravone dexborneol after intracranial vascular intervention significantly reduces NSE and Hcy levels, mitigates inflammation and oxidative stress, improves neurological function and hemorheology, and lowers adverse outcome rates in elderly AICVD patients without increasing adverse reactions.

Background: The advantages of postoperative adjuvant chemotherapy (ACT) for gastric cancer patients with pT1N + M0 staging have been a subject of debate. This study aims to assess whether ACT can enhance the overall survival (OS) of postoperative pT1N + M0 gastric cancer patients when compared to surgery alone.

Methods: A total of 329 postoperative patients with pT1N + M0 gastric cancer were identified from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015). Patients were stratified into surgery-alone and surgery-plus-chemotherapy groups. Multivariate Cox regression identified prognostic factors, followed by subgroup analyses stratified by clinical characteristics.

Results: This study included 329 patients, of whom 80 received postoperative ACT and 249 underwent surgery alone. Multivariate analysis revealed that race, tumor primary site, differentiation grade, clinical stage, N stage, and ACT were independent prognostic factors for OS. Subgroup analysis demonstrated that the survival benefit of ACT was more pronounced in Asian/Pacific Islander (API) patients (hazard ratio [HR], 0.320; 95% confidence interval [CI], 0.140-0.732; P for interaction = 0.028) and in those with N1 stage (HR, 0.447; 95% CI, 0.272-0.737; P for interaction = 0.022).

Conclusion: ACT was associated with a survival benefit versus surgery-alone in pT1N + M0 gastric cancer, especially among API patients or those with N1 stage.

Background: Idiopathic retroperitoneal fibrosis (IRPF) is a rare fibroinflammatory condition that is challenging to distinguish from retroperitoneal malignancies based solely on imaging. We evaluated laparoscopic ultrasound-guided biopsy for diagnosing IRPF.

Methods: We retrospectively analyzed 12 patients with suspected retroperitoneal fibrosis who underwent laparoscopic ultrasound-guided biopsy. The surgical technique involved systematic laparoscopic exploration, intraoperative ultrasound to delineate the mass and its relation to great vessels, and targeted biopsy.

Results: Preoperative imaging suggested retroperitoneal masses in all 12 patients but failed to provide a definitive diagnosis in any case. Laparoscopic biopsy was successfully performed in all patients without conversion to laparotomy. Pathological examination confirmed IRPF in 11 patients and retroperitoneal adenocarcinoma in one. The procedure was safe, with minimal blood loss (20.4 ± 14.8 mL) and a short operative time (68.3 ± 19.0 min). All IRPF patients were treated with a combination of prednisone, tamoxifen, and mycophenolate mofetil, leading to significant lesion regression on follow-up imaging (median 37.9 months).

Conclusions: Laparoscopic ultrasound-guided biopsy is a safe and highly effective diagnostic procedure for IRPF. It provides definitive pathological diagnosis to guide appropriate therapy and should be considered when percutaneous biopsy is not feasible.