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

Background and objectives: Robotic-assisted surgery advancements have paralleled growing bariatric surgery demands. The Senhance robotic platform offers an alternative to the da Vinci surgical system but there are limited studies evaluating the Senhance system in bariatric surgery. This study aims to review a single surgeon's experience comparing outcomes between traditional laparoscopic and Senhance-assisted sleeve gastrectomy.

Materials and methods: All sleeve gastrectomies performed laparoscopically, Senhance-assisted, or da Vinci-assisted by a single surgeon at an academic center from January 2019 to July 2021 were retrospectively reviewed. Primary outcomes and quality measures were 30-day complications, operative times and length of stay.

Results: A total of 268 patients, including 162 laparoscopic, 92 Senhance, and 14 da Vinci cases, were included. Operative times were significantly longer with Senhance (115.7 min) and da Vinci (122.7 min), compared to laparoscopic (94.8 min, P < .0001). Length of stay (measured in days) was significantly longer in the Senhance (1.8) and da Vinci (2.2) groups compared to laparoscopic cases (1.5, P < .0001). These differences remained significant after controlling for age, sex and body mass index. 30-day complication rates were 8.7% (n = 8) in the Senhance group, 7.1% (n = 1) in the da Vinci group and 2.5% (n = 4) in the laparoscopic group (P = .0567).

Conclusion: Senhance-assisted sleeve gastrectomy is safe in bariatric surgery and comparable to laparoscopic sleeve gastrectomy with respect to 30-day complications.

Spigelian hernias are an uncommon protrusion defect noted between the rectus abdominis and the transversus abdominis muscles, at the semilunar line, with a low incidence of approximately 0.12% to 2% of all ventral hernias. Furthermore, the incidence of bilateral cases is noted to be even lower in the general population. They are associated with bowel incarceration and strangulation; hence surgical repair is indicated. Therapeutic alternatives for Spigelian hernias include open repair, however laparoscopic repair stands as the standard of care in these cases. Feasible and successful robotic repair has been reported, with associated advantages in terms of visualization and surgical instrument dexterity. We present the first ever reported cases of bilateral Spigelian hernias repaired using robotic approach. Two female Puerto Rican patients referred to our institution complaining of abdominal pain, where imaging studies found bilateral Spigelian hernias. In both cases, a transabdominal preperitoneal repair was performed using the Da Vinci Surgical System. Both patients were discharged home tolerating oral intake with adequate wound healing. On follow up visits, patients denied abdominal discomfort and had adequate wound healing. Robotic surgery for Spigelian hernias poses an advantage over laparoscopic repair as improved visualization, mobility, and precision in movements allow for more gentle tissue manipulation. Furthermore, this is the first evidence of safe and effective repair in the uncommon entity of bilateral cases, providing a newer alternative in the setting of such presentation.

Background and objective: We operated on a series of mostly obese patients with diastasis recti abdominis using the "Slim-Mesh" technique to repair/reinforce the diastasis and linea alba/recti muscles without plicating and traumatizing them. Additional objectives were to decrease operation time and intra- and postoperative complications.

Methods: We considered T1 cases diastasis after pregnancy and T2 cases obesity (BMI ≥ 30 mg/kg²); D1, D2, and D3 when the diastasis measured 2-3, 3-5, and ≥ 5 cm, respectively; H0 and H1 without and concomitant umbilical and/or epigastric hernia, respectively. At our Department, between May 2010 and November 2022, 47 patients with diastasis recti were operated on with the "Slim-Mesh" technique to reinforce/repair the traumatized linea alba/recti muscles, without plicating them. This was a prospective (83%)-retrospective study.

Results: We studied 23 males and 24 females. Mean age and BMI was 58 years and 29 kg/m², respectively. Groups D1, D2, and D3 comprised 6, 23 and 18 patients, respectively; groups T1, T2, H0 and H1 comprised 22, 25, 13 and 34 patients, respectively. Mean operation time for all cases was 100 minutes. Mean length of hospital stay was 2.3 days and follow-up time was 5 years. We had 6 late postoperative complications: 3 hernia recurrences and 3 trocar site hernias.

Conclusion: Considering the lack of agreement on the best surgery for diastasis recti abdominis repair, in our experience the "Slim-Mesh" technique is a valid, safe and easy-to-reproduce way to save, repair and reinforce linea alba/recti muscles in diastasis recti patients, including the obese population (53%).

Sodium-glucose cotransporters (SGLT) and glucose transporters (GLUT) have been shown to influence diabetes management by modulating glucose uptake by the intestine. Therefore, alterations in gastrointestinal anatomy during bariatric surgery can change SGLT and GLUT receptor activity. These changes offer an additional mechanism for weight loss and may explain the differential impact of the various bariatric surgical procedures. This review examines the current literature on SGLT and GLUT receptors and their effects on weight loss through genetic studies, pharmacologic inhibition, and how SGLT/GLUT receptors impact surgical physiologic modulation. A better understanding of Type I sodium-glucose cotransport receptors (SGLT-1), GLUT-2, and GLUT-5 could provide insight for improved procedures and allow us to determine the best method to tailor operations to a patient's individual needs.

A Comparison of Ovarian Loss Following Laparoscopic versus Robotic Cystectomy As Analyzed by Artificial Intelligence-Powered Pathology Software.

Background and objective: To compare the area of ovarian tissue and follicular loss in the excised cystectomy specimen of endometrioma performed by laparoscopic or robotic technique.

Methods: Prospective observational study performed between April 2023 to August 2023. There were 14 patients each in Laparoscopic group (LC) and Robotic group (RC). Excised cyst wall sent was for to the pathologist who was blinded to the technique used for cystectomy. The pathological assessment was done by artificial intelligence-Whole Slide Imaging (WSI) software.

Results: The age was significantly lower in LC group; the rest of demographic results were comparable. The mean of the median ovarian area loss [Mean Rank, LC group (9.1 ± 15.1); RC (8.1 ± 12.4)] was higher in LC group. The mean of the median total follicular loss was higher in LC group (8.9 ± 9.2) when compared to RC group (6.3 ± 8.9) and was not significant. The area of ovarian loss in bilateral endometrioma was significantly higher in LC group (mean rank 7.5) as compared to RC group (mean rank 3) - (P = .016) despite more cases of bilateral disease in RC group. With increasing cyst size the LC group showed increased median loss of follicles when compared to RC group (strong correlation coefficient 0.347) but not statistically significant (P = .225). AAGL (American Association of Gynecologic Laparoscopists) score did not have any impact on the two techniques.

Conclusion: Robotic assistance reduces the area of ovarian and follicular loss during cystectomy of endometrioma especially in bilateral disease and increasing cyst size. It should be considered over the laparoscopic approach if available.

Background and objectives: Modified anterior preperitoneal (mAPP) repair for inguinal hernia (IH) was compared with Lichtenstein repair (LR) and laparoscopic transabdominal preperitoneal (TAPP) repairs.

Methods: IH patients, after exclusions and subsequent matching for age, type, and extent of hernia, were assigned randomly for mAPP, LR or TAPP repair. The same surgical team performed all operations. Data of predefined endpoints for all the three groups were statistically compared.

Results: One hundred thirty-five patients underwent mAPP, 91 patients LR, and 181 patients TAPP. The operating time for both unilateral and bilateral hernias in the mAPP group was significantly shorter than in LR and TAPP groups. mAPP patients were discharged in significantly less time than LR patients but later than TAPP patients. Postoperative visual analog scale (VAS) score at 24 hours in the mAPP patients was significantly less than LR but at 48 hours the difference was equivocal. But VAS score after mAPP at 24 and 48 hrs was more than in TAPP patients. However, the pain score across all the three groups was similar at 7 days. There was no surgical site infection (SSI) or mesh infection in any patient. Chronic postoperative inguinal pain was seen less often after mAPP than after LR but was least in TAPP patients. Recurrence across all the three groups was not much different.

Conclusion: mAPP appears to be a better choice for open IH repair than LR and matches the advantages of Laparoscopic repairs.

Background and objectives: Multiple vessel-sealing devices are available for use during laparoscopy. The objective of this study is to determine what surgeon-level and device characteristics influence the choice of advanced energy device during gynecologic laparoscopy.

Methods: This is a national cross-sectional study of gynecologic surgeons conducted via social media, utilizing an online, publicly-available, anonymous survey. Gynecologic surgeons who had completed residency training were approached for participation in the survey. Survey completion was voluntary and involved no further follow-ups. The web-based survey consisted of six questions with the option to answer three additional questions if time permitted. The institutional review board determined that this study qualified for exemption.

Results: There were 92 respondents who participated in the survey. Of these, 81 completed the survey and were included in the analysis. Female respondents were younger and more frequently reported a glove size of 6.5 or less. Surgeon-level characteristics, including gender, age, glove size, case volume, region, and practice setting, were not significantly associated with preferred energy devices. Device availability in the operating room was the only characteristic associated with preferred energy devices (P-value = .0076). Other device-level characteristics such as optimal thermal spread, reduced plume, ease of use, device reliability, and teachability had no statistically significant association with preferred energy devices.

Conclusion: Multiple advanced energy devices are available for use during gynecologic laparoscopy. These devices have varying energy profiles, thermal spread, and device size. Despite this diversity, only device availability in the operating room influenced the surgeon's preferred device selection.

Background and objectives: Minimally invasive approaches to benign hysterectomy are the current standard of care when feasible. Use of robotic-assisted laparoscopic hysterectomy (RA-LH) has been increasing; however, direct comparative data that accounts for uterine weight in conventional laparoscopic hysterectomy (CLH) and RA-LH is limited. We sought to examine the impact of uterine weight on immediate perioperative morbidity in CLH versus RA-LH. The primary outcome was a composite of complications including visceral injuries, conversions to abdominal procedures, and transfusions.

Methods: A retrospective cohort study of patients who underwent a minimally invasive laparoscopic hysterectomy (CLH and RA-LH) in a single hospital system between January 1, 2014 and December 31, 2017 as identified by Current Procedural Terminology codes. The primary exposure was CLH or RA-LH. Uterine weight was categorized into four groups: <150 g, 150 to < 250 g, 250 to < 450 g, and ≥ 450 g.

Results: A total of 1506 patients were included; 539 underwent CLH and 967 underwent RA-LH. Median uterine weight was higher in patients who underwent CLH (161.0 g) compared to RA-LH (147.0 g), P = .001. The odds of the composite of complications in CLH was 4.43 (2.84 - 6.92) higher than the odds of the composite in RA-LH. When stratified by the uterine weight, the odds of complications was significantly higher in CLH in the following categories: <150 g, 250 to < 450 g, and ≥ 450 g (OR: 4.41, 3.28, and 7.81, respectively).

Conclusion: Surgical morbidity was lower in RA-LH across the spectrum of uterine weights compared to CLH. Patients may particularly benefit from RA-LH at higher uterine weights.

Background and objectives: Important safety requirements for forceps used in surgical procedures are the ability to stably grasp fine tissue and to cause minimal tissue damage. Shark skin has the structural feature of circumpolar scales, which increase the frictional force of the scales by roughening their surface. We have developed and patented medical forceps with a shark skin pattern placed on the tip surfaces. The aim of this study was to examine the safety and efficacy of the shark skin forceps compared with existing forceps, both fundamentally and clinically.

Methods: To evaluate gripping power and usability, we compared bead transfer times for each forceps type. Grasping force and frictional force were measured quantitatively and compared among the types. To evaluate safety, we performed pathological examination of lung and urethral tissue after grasping, in an animal experiment. Subjective assessment of user experience was then performed using a questionnaire.

Results: In the dry lab assessment, transfer time was fastest using the shark skin forceps (34 s vs 61 s and 62 s, p < 0.05). Frictional force values were highest for the shark skin forceps (p < 0.05). In the animal experiment, there was no difference in pathological tissue damage to lung or ureter tissues among the forceps types after grasping. The questionnaire responses indicated advantages of the shark skin forceps in terms of ease of grasping membranes and lower degree of grasp failure.

Conclusion: Forceps with shark skin on the tips showed greater stability of tissue grasping and equivalent safety compared with existing forceps.