JSLS : Journal of the Society of Laparoendoscopic Surgeons最新文献

Background: The adoption of laparoscopic single-site surgery (LESS) is limited by the high cost of commercial platforms. We present a self-designed glove-port for LESS ovarian teratoma resection.

Technique: A single-port platform was constructed from a surgical glove and rings from a disposable suction tube. A specimen retrieval bag was modified with a silk drawstring and a secondary opening to create a closed system. The teratoma was dissected within the closed bag and all contents were removed via the umbilicus.

Results: The procedure was successfully performed. The self-assembled port provided stable access, and the modified bag enabled complete specimen containment and extraction without spillage or auxiliary incisions.

Conclusion: This technique demonstrates a safe, feasible, and low-cost alternative for LESS. Utilizing ubiquitous materials improves the accessibility of minimally invasive, cosmetically favorable surgery in resource-constrained settings.

Aim: The body's hormonal response to stress during minimally invasive surgery has not yet been completely researched in all its aspects, so the aim of this study was to test the body's hormonal response by monitoring the thyroid hormone thyroxine (T4) during laparoscopic cholecystectomy (LC) using standard (12-15 mm/Hg) and low (6-8 mm/Hg) intraabdominal pressure, and in open cholecystectomy (OC).

Patients and methods: This cohort, observational study was conducted in the period from July 2022 to December 2024 and included 110 patients divided into 2 groups: 70 patients who underwent LC, and 40 patients who underwent OC. The first group of patients were divided into 2 subgroups of 35 patients each on the basis of the level of intraabdominal pressure during cholecystectomy (LC with standard, or LC with low intraabdominal pressure). T4 was monitored as the parameter of stress.

Results: The comparison between the LC and OC groups in terms of the concentrations of T4 in the postoperative days showed statistically significant higher values of this hormone in the group of patients treated using the open method (OC). Moreover, the body's response to stress was less intense during LC than during OC. The body's response to stress during LC with low insufflation pressure (6-8 mmHg) was lower than during LC with standard insufflation pressure (12-15 mmHg).

Conclusion: This study confirms from hormonal aspects the advantages of minimally invasive surgery in comparison with open surgery, and in particular the advantages of LC with low intraabdominal pressure in comparison with standard pressure.

Background and objectives: To compare the effectiveness of the Fundamentals of Laparoscopic Surgery (FLS) and Essentials in Minimally Invasive Gynecologic Surgery (EMIGS) manual skills curricula in preparing obstetrics and gynecology residents for laparoscopic vaginal cuff closure, using both objective performance metrics and subjective assessments.

Methods: A randomized, blinded, and controlled study was conducted in a single institution with an obstetrics and gynecology residency program. Nine residents without prior FLS or EMIGS certification were randomized to complete either the FLS or EMIGS manual skills curriculum over 28 days. Participants were video-recorded completing five curriculum-specific tasks, the opposing curriculum without prior practice, and a laparoscopic vaginal cuff closure using barbed suture. The primary outcome was performance on the cuff closure task, assessed using a modified Global Operative Assessment of Laparoscopic Skills (GOALS) questionnaire. Secondary outcomes included individual task scores, total manual skill scores, and post-training survey responses.

Results: There were no significant differences in total manual skills scores between groups (P = .62). FLS-trained participants scored significantly higher on intracorporeal knot tying (P = .0085). However, EMIGS-trained residents achieved higher scores on the vaginal cuff closure task across all postgraduate year (PGY) levels. Subjectively, though most participants found the programs dissimilar, all participants reported skill improvement. EMIGS trainees expressed lower confidence in knot tying, but most agreed EMIGS more closely resembled real-world laparoscopic surgery.

Conclusions: These findings support the use of EMIGS as a gynecologic-specific simulation tool in surgical education, although further research with larger numbers of participants are needed to confirm these observations.

Introduction: Obesity prevalence has nearly doubled globally in the past 30 years. Among treatment options, surgery remains the most effective. Staple line leaks are a major complication in bariatric surgery, often linked to mismatched stapler cartridge and gastric wall thickness (GWT). Understanding factors influencing this thickness is critical. This study evaluates previously known variables and additionally investigates waist circumference, duration of obesity, alcohol use, and asthma.

Methods: Between December 2024 and July 2025, patients who underwent bariatric surgery for obesity were evaluated. A total of 58 patients were included in the study. Immediately following laparoscopic sleeve gastrectomy (LSG), the freshly resected gastric specimens were assessed in the operating room. Prior to measurement, a standardized pressure of 8 g/mm² was applied to the gastric tissue for 15 seconds.

Results: Male sex was associated with increased thickness in the corpus and fundus, smoking with the fundus, and body mass index (BMI) with the antrum. Height affected all regions, while weight influenced the antrum and fundus. Waist circumference increased thickness in all areas. Overall, thickness decreased from antrum to fundus, but in 10% of patients, the corpus was thicker than the antrum.

Conclusion: There are few and conflicting studies in the literature regarding factors affecting GWT. In this study, waist circumference was found to increase GWT in all regions, while duration of obesity, alcohol consumption, and asthma had no significant effects. It may be reasonable for surgeons to consider waist circumference, in addition to BMI, height, weight, and male sex, when selecting staplers.

Background and objectives: To overcome the limitations of intraperitoneal mesh and technically demanding extraperitoneal techniques, the "Falciform Ligament Laparoscopic Approach for Preperitoneal Ventral Hernia Repair" method, enables direct optical entry into the preperitoneal space using the falciform fat as a safety buffer. This approach avoids fascial division to maintain structural integrity.

Methods: Between December 2018 and December 2024, 50 patients with primary, midline, medium-sized ventral hernias underwent repair using the technique. Primary outcomes included operative duration, complication rate and recurrence. Preperitoneal entry was achieved by a 5-mm optical trocar in the epigastrium. Upon space creation and hernia reduction, mesh was placed without fixation.

Results: Fifty patients (mean age 41.2 ±7.6 years; body mass index [BMI] 29.4 ±4.7 kg/m²) with umbilical/paraumbilical hernia (M3-European Hernia Society classification) and mean defect size 2.9 ±0.6 cm underwent repair using the technique. All surgeries were completed laparoscopically without intraoperative complications. Median operative time was 85 minutes; median hospital stay was 1 day. Pain scores (visual analogue scale) were low: 1.7 (evening), 1.3 (day 1), 0.8 (day 7). No complications occurred, except one hematoma-resolved after aspiration; two seromas-no intervention needed; no recurrences observed over a 41-month median follow-up.

Conclusion: It is a feasible, safe, structurally preserving technique with favorable outcomes. By eliminating mesh fixation and enabling early discharge with minimal postoperative pain, it offers a potential cost advantage. Further multicenter validation is warranted.

Background: Postoperative hypoparathyroidism is the most common complication of total thyroidectomy, often resulting from injury or devascularization of the parathyroid glands.

Objective: Indocyanine green fluorescence (ICG) technique has been applied in the last 10 years in different kinds of surgery including colorectal, oncological lymph node and endocrine surgery. Minimally invasive thyroidectomy, introduced more than 25 years ago, is a valid surgical option for selected benign and malignant thyroid disease with advantages in terms of cosmetic results and postoperative pain. Aim of this study is to evaluate the feasibility and safety of ICG during minimally invasive thyroidectomy to assess and predict parathyroid gland perfusion and guide preservation.

Methods: We report the initial experience in our center of ICG during minimally invasive video-assisted total thyroidectomy in a case series of 9 patients, using the Striker System® to assess parathyroid perfusion and guide preservation. Demographic and surgical data were registered with special attention to hypoparathyroidism.

Results: All patients underwent standard minimally invasive video-assisted total thyroidectomy; a standardized dose of ICG was administered intravenously. Real-time near-infrared imaging allowed for clear visualization of parathyroid vascularization, enabling the preservation of well-perfused glands and the auto transplantation of those removed into the sternothyroid muscle. Postoperative assessments, including serial measurements of serum calcium and parathyroid hormone levels, revealed a transient drop in two patients with overall correspondence to indocyanine green evaluation.

Conclusion: These findings suggest that ICG angiographic imaging is a valuable adjunct in thyroid surgery, potentially reducing the risk of hypocalcemia by optimizing parathyroid preservation. Further studies are needed to standardize the technique and the evaluation score to confirm preliminary results on definitive hypoparathyroidism.

Background and objectives: Robotic platforms are increasingly employed in colorectal surgery for their technical and ergonomic benefits. However, surgeons face a significant learning curve, and there is no standardized definition or threshold to proficiency. This systematic review aimed to evaluate published evidence on learning curves in robotic colorectal surgery, focusing on proficiency thresholds, analytic methodologies, and the effect of experience on clinical and oncological outcomes.

Methods: A systematic literature search of PubMed was performed through April 7, 2025. Studies reporting learning curve data for robotic colorectal procedures were included. Screening and selection were conducted using Rayyan. Extracted data included operative time, case numbers to proficiency, conversion and complication rates, and oncological metrics. Study quality was assessed using the Newcastle-Ottawa Scale. A narrative synthesis was undertaken due to heterogeneity in study design and outcomes.

Results: Nineteen studies met inclusion criteria. The number of cases required to reach proficiency ranged from 15-55, with operative time being the most analyzed parameter. CUSUM and RA-CUSUM were the predominant analytic methods. Improved outcomes such as reduced complications, lower conversion rates, and enhanced oncological quality were generally observed in the post-proficiency phase. Variability in learning curve definitions and analytic approaches was significant across studies.

Conclusion: Robotic colorectal surgery involves a measurable learning curve that impacts both technical and patient-centered outcomes. While most studies demonstrate improved metrics with experience, the lack of standardized methodology limits cross-study comparisons. Structured training pathways and consensus on learning curve analysis are needed to support safe adoption and credentialing in robotic colorectal surgery.

Background and objectives: This study aimed to compare the efficiency and diagnostic performance of carbon dioxide (CO₂) versus saline as a distension medium during routine cystoscopy performed after laparoscopic gynecologic surgery.

Methods: We conducted a prospective, comparative study involving patients undergoing total laparoscopic hysterectomy for benign indications. Participants were randomly assigned to undergo diagnostic cystoscopy using either CO₂ or saline for bladder distension. Primary outcomes included total cystoscopy duration and time to visualize bilateral ureteral jets. Secondary outcomes were intraoperative detection rates of lower urinary tract injuries and any postoperative urinary complications.

Results: A total of 529 patients were included (CO₂ group: 270; 51.1%; saline group: 259; 48.9%). Cystoscopy duration was significantly shorter in the CO₂ group compared to the saline group (150 vs 120 seconds; P < .001). Time to visualize ureteral jets was also reduced in the CO₂ group (43 seconds; P < .001). One bladder injury and 1 ureteral obstruction were identified intraoperatively and successfully repaired in the same surgical session. The use of CO₂ eliminated the need for diuretics or chromatic dyes, streamlining the diagnostic process and potentially reducing costs.

Conclusion: CO₂ cystoscopy is a safe, efficient, and diagnostically effective alternative to conventional saline cystoscopy following gynecologic laparoscopy. Its use significantly reduces procedural time without compromising the detection of urinary tract injuries and avoids the need for additional agents such as dyes or diuretics. These findings support the integration of CO₂ cystoscopy into routine intraoperative surveillance protocols during minimally invasive gynecologic surgery.

Objective: To assess the impact of laparoscopic treatment of endometriosis on pregnancy outcomes in women with infertility, performed either before or after failed fertility enhancement technology (FET). Secondary aims included evaluating the influence of age, body mass index (BMI), prior pregnancies, endometriosis stage, and the presence of endometriomas on reproductive outcomes.

Design: Retrospective cohort study of 95 women aged 18-45 with primary or secondary infertility who underwent treatment of endometriosis laparoscopically with or without robotic assistance between January 2015 and January 2023. All surgeries were performed by a single gynecologic surgeon. Patients were grouped based on whether they had prior FET failure or no prior FET. Comparisons were made between pregnant and nonpregnant patients across both groups.

Main outcome measures: Postsurgical pregnancy rates (spontaneous vs assisted reproductive technology [ART]) and factors associated with pregnancy outcomes, including age, BMI, endometriosis stage, and presence of endometriomas.

Results: Of 44 patients with prior failed FET, 82% conceived postsurgery, with 97% requiring ART. In the 51 patients without prior FET, 78% conceived, and 31% did so spontaneously. Younger age was significantly associated with pregnancy in the nonprior FET group (P = .011). Endometriosis stage did not significantly influence outcomes. Patients with endometriomas were more likely to be referred for surgery before FET.

Conclusions: Laparoscopic surgery for endometriosis is associated with high pregnancy rates, regardless of prior FET status. These findings support the role of surgery as a key component in fertility management for women with endometriosis, especially prior to initiating FET.