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

Background: An important step during laparoscopic cholecystectomy that has a proven effect on postoperative morbidity and outcomes is the site of gallbladder retrieval, which is either through the umbilical or epigastric port. Currently, no guidelines recommend the superiority of one port over the other, and it is mainly based on the surgeon's preference. This study aimed to address the outcomes and complications of gallbladder retrieval through the epigastric port in comparison with the umbilical port and to identify the associated risk factors.

Methods: A retrospective review of 658 patients who underwent laparoscopic cholecystectomy between 2020 and 2021 was conducted. Patient demographics, preoperative workups, intraoperative findings, and postoperative outcomes were compared between retrieval via the epigastric and umbilical ports.

Results: Gallbladder retrieval occurred through the epigastric port in 441 patients and through the umbilical port in 217 patients. The epigastric group had a greater mean age (44.2 ± 14.90 vs 41.3 ± 14.47 years; P = .0109), and most the study population was female (7.2%). Intraoperative duration and bleeding were comparable, but fascial plane extension was more common in the umbilical group (6.9%; P = .0179). Port site hernias occurred in 1.8% of patients, all of whom were females (P = .0222), and were associated with older age, higher body mass index (BMI), and gallbladder needle decompression (P = .0356). The length of hospital stay was similar across both groups.

Conclusion: Epigastric port retrieval during laparoscopic cholecystectomy offers comparable intraoperative outcomes to those of umbilical retrieval. However, hernia risk, which is linked to specific factors, warrants further research to improve outcomes.

Objective: The current study aimed to compare clinical outcomes and postoperative complications of two endoscopic treatments (endoscopic isolated papillary small balloon dilation [EIPSBD] and endoscopic sphincterotomy [EST]) with endoscopic papillary balloon dilation (EPBD) in patients with choledocholithiasis.

Methods: A total of 316 patients diagnosed with and treated for choledocholithiasis from January 2014 to December 2024 were enrolled in this nonrandomized study. The patients were divided into EIPSBD (n = 178) and EST + EPBD groups (n = 138). Postoperative morbidities, including pancreatitis, cholangitis, bleeding, and hyperamylasemia, were assessed at 3 and 24 hours. Stone clearance was also evaluated.

Results: The incidence of pancreatitis was 9.55% in the EIPSBD group and 7.97% in the EST + EPBD group (P = .5). Hyperamylasemia occurred in 41.57% of the patients in the EIPSBD group and 42.03% in the EST + EPBD group (P = .9). The incidence of cholangitis, bleeding, and stone clearance was not significantly different between the two groups. The incidence of pancreatitis in female patients was greater than male patients (χ² = 5.12, P = .025). The total complication rate was 10.67% and 10.14% in the EIPSBD and EST ± EPBD groups, respectively, and was not significantly different (P = .9).

Conclusion: EIPSBD and EST ± EPBD were shown to be equally effective in the treatment of choledocholithiasis with comparable postoperative complication rates. EIPSBD may be an acceptable alternative to traditional EST for stones ≤10 mm in size. Follow-up studies of longer duration will be helpful to assess long-term outcomes.

Background: With the rise in bariatric surgeries, conversions for issues like poor weight loss or reflux are becoming more common. Gastric bypass is a standard solution, but as robotic use grows, its advantage over laparoscopy remains in question.

Objective: Compare the short and long-term outcomes of robotic versus laparoscopic sleeve conversion to Roux-en-Y gastric bypass (RYGB) surgeries.

Methods: We conducted a retrospective analysis analyzing patients' demographics, comorbidities, reasons for conversion, preoperative body mass index (BMI), and perioperative metrics (operative time, blood loss, hospital stay). We compared surgical outcomes, including early complications, rehospitalization, reintervention, weight loss, and resolution of comorbidities, between the robotic and laparoscopic approaches.

Results: This cohort included 126 patients who underwent revisional surgery from sleeve gastrectomy to gastric bypass surgery. Out of which 27 underwent laparoscopic approaches and 99 robotic approaches. The mean age of patients was 52.5 (±11.6), and the mean pre-RYGB BMI was 36.1 (±7.1). Most patients were female (87.3%, n = 110), with 72.2% white. Robotic approach had a significantly shorter operative time than laparoscopic approach 184.1 vs 215.5 minutes, with P-value < .001, respectively. Other outcomes did not show any statistical significance between the two groups. However, the late reoperation rate revealed a significant difference, with 29.6% in the laparoscopic group required additional surgical intervention, whereas only 13.1% in the robotic group with P-value .041, suggesting advantage for the robotic approach.

Conclusion: Both techniques demonstrated similar complication rates. Notably, the robotic approach resulted in shorter operating times and fewer late reoperations. Further research is necessary to strengthen our findings.

Background and objectives: This study aimed to compare the outcomes of laparoscopic nephron-sparing surgery (LNSS) and laparoscopic radical nephrectomy (LRN) for treatment of T1 renal cell carcinoma (RCC).

Methods: A total of 69 T1 RCC were retrospectively analyzed and divided into an LRN group (n = 34) and an LNSS group (n = 35) according to differences in surgical methods.

Results: The 2 groups were not significantly different in length of surgery, intraoperative blood loss, postoperative drainage tube indwelling time, length of stay, RCC recurrence, RCC distant metastasis rates, RCC-related mortality, complication rate as well as blood urine nitrogen (BUN), serum creatinine (Scr), and glomerular filtration rate (GFR) levels before the surgery (P > .05); at 1, 3, 6, and 12 months after the surgery, BUN and Scr levels in the LNSS group were significantly lower than those in the LRN group, while GFR levels in the LNSS group were significantly higher than those in the LRN group (P < .05). The preoperative WHOQOL-BREF scores in the physiological, psychological, environmental, and social relationship domains showed no significant differences between the LNSS group and LRN group (P > .05). However, at 12 months postoperatively, all scores in the LNSS group were significantly higher than those in the LRN group (P < .05). However, renal function was better preserved in the LNSS group.

Conclusions: Both LNSS and LRN demonstrated favorable outcomes in terms of surgical safety and short-term tumor control in the laparoscopic treatment of T1 RCC. However, LNSS exhibited a distinct advantage in preserving renal function and enhancing the patients' quality of life.

Background and objectives: Acute appendicitis (AA) is a frequent surgical emergency. Although laparoscopic appendectomy (LA) is associated with favorable postoperative outcomes, open appendectomy (OA) remains widely used. Surgical site infection (SSI) is a common complication, with obesity recognized as a risk factor. However, body mass index (BMI) may not reliably reflect fat distribution. Subcutaneous fat thickness (SFT) measured on computed tomography (CT) may offer improved predictive value for surgical outcomes.

Methods: This retrospective study included 1,231 patients who underwent LA or OA for AA between 2017 and 2022. Preoperative SFT was measured on CT, and patients were analyzed by surgical technique and SFT subgroups. Postoperative complications, including SSI, were recorded. Receiver operating characteristic (ROC) analysis identified the SFT threshold associated with increased SSI risk.

Results: Despite similar BMI values between groups, SFT was significantly higher in LA patients (P < .001), highlighting the nonlinear relationship between BMI and SFT. LA was associated with shorter operative time (P = .004), reduced hospital stay (P = .009), and lower SSI rate (5.6% vs 13.5%, P < .001). Among patients with SFT ≥33 mm, LA resulted in significantly fewer SSIs (22 vs 50, P < .001) and shorter hospitalizations. ROC analysis confirmed SFT ≥33 mm as a strong predictor of SSI (area under the curve [AUC] = 0.841).

Conclusion: LA offers superior outcomes compared to open surgery, particularly in patients with higher SFT. The discrepancy between BMI and SFT underscores the need for direct fat measurement in surgical risk assessment. Incorporating SFT into preoperative evaluation can guide optimal surgical strategy and improve patient outcomes.

Background and objectives: Staple line leakage is a major complication after bariatric surgery, often requiring prolonged and complex treatment. While ultrasonography has been used for gastric cancer screening, its role in evaluating gastric wall before bariatric surgery is not well studied. This study aimed to measure antral gastric wall thickness preoperatively using ultrasonography to provide objective data that may guide stapler selection and reduce complication rates.

Methods: Between December 2024 and May 2025, 42 bariatric surgery patients underwent preoperative ultrasonography to measure the total thickness of the gastric antrum's 5 layers. Immediately after surgery, a pressure of 8 g/mm² was applied to the fresh specimen for 15 seconds, and antral wall thickness was measured using the micrometer.

Results: Mean antral, corpus, and fundus wall thicknesses measured by the micrometer under standardized pressure were 2.81 ± 0.36, 2.47 ± 0.27, and 1.71 ± 0.29 mm, respectively. A significant difference was found among these regions (P < .001). Mean antral wall thickness by ultrasonography was 3.97 ± 1.08 mm. No significant correlation was observed between ultrasonographic and micrometric antral measurements (P = .178).

Conclusion: Preoperative ultrasonography may be sufficient for measuring gastric wall thickness at rest; however, it is inadequate for estimating thickness under intraoperative conditions. Based on our findings and the limited existing literature, conventional ultrasonography does not reliably predict gastric wall thickness under compression. Therefore, noninvasive and cost-effective methods are still needed for accurate preoperative or intraoperative assessment of gastric wall thickness.

Background and objective: Laparoscopic suturing is a key skill in minimally invasive gynecologic surgery but remains technically demanding. Traditional training has relied on in-person courses, which became less accessible during the COVID-19 pandemic. This study compares the effectiveness of an online simulation-based suturing course with a conventional onsite training program.

Methods: A prospective observational study was conducted from January 2020 to October 2023. A total of 151 gynecology trainees participated. A total of 62 attended a 3-day onsite course using physical simulation systems with one mentor per 4 participants. A total of 89 completed a 5-day online course using home-based simulators with one mentor guiding the entire group. All trainees completed the same pre and postcourse assessments measuring precision, knot quality, and task completion time. Statistical analysis included paired and independent tests with significance set at a standard level.

Results: Both groups significantly improved in precision and time. The onsite group showed greater improvement in knot quality and total score. The online group had higher baseline precision and showed slightly greater precision gains. After adjusting for baseline scores, the onsite group had greater overall improvement.

Conclusions: Both onsite and online laparoscopic suturing courses significantly enhance technical performance. Onsite training showed a modest advantage, likely due to real-time feedback and hands-on guidance. Nonetheless, online simulation represents a viable, scalable option for surgical training, especially in resource-limited settings.

Objective: This study evaluates the long-term safety, efficacy, and recurrence of laparoscopic totally extraperitoneal (TEP) repair for bilateral inguinal hernias using a dual-mesh technique.

Background: TEP repair is a well-established approach for inguinal hernia, offering advantages such as reduced postoperative pain, faster recovery, and fewer wound complications.

Methods: A retrospective review was conducted of 426 patients with bilateral inguinal hernias who underwent TEP repair between January 2012 and May 2025. All procedures were performed by a single experienced surgeon using the standardized dual-mesh technique.

Results: The mean patient age was 48.46 years (range: 17-82). The mean operative time was 47.73 minutes, and the hospital stay was 27.45 hours. The mean follow-up was 74.2 months (range: 12-188). The overall complication rate was low: 34 (7.9%) cases of seroma, urinary retention 2 (0.47%), hematoma 6 (1.4%), hydrocele 3 (0.7%), and no mesh-related infections or chronic pain. Four recurrences (0.94%) were detected, attributed mainly to incomplete dissection, overlooked cord lipomas, or mesh shrinkage. No complications were attributable to the overlapping dual-mesh technique. No intensive care admissions, or deaths occurred.

Conclusion: Laparoscopic TEP repair with the novel dual-mesh technique provides reliable reinforcement of the myopectineal orifice (MPO), yielding low recurrence rates while avoiding vascular injury or mesh-related complications.

Background and objectives: Many patients with uterine fibroids turn to social media for information, where fibroid-related content has grown substantially. To effectively address misconceptions and deliver high-quality, patient-centered care, physicians should be aware of the online information their patients encounter. This study analyzes fibroid-related content on social media to better understand the information being consumed.

Methods: The top 100 "liked" posts using "#fibroids" were identified on Facebook, Instagram, and TikTok using a third-party web scraping tool. Post demographics and content were assessed by two reviewers and were included if they were in English and related to uterine fibroids. Information quality was measured with the DISCERN instrument; understandability and actionability were assessed using the Patient Education Materials Assessment Tool (PEMAT).

Results: A total of 300 social media posts were analyzed (100 per platform) from October 2019 to June 2024. TikTok posts had the highest engagement, with a median of 23,150 "likes" and 510,800 views. Content themes included promotional (51%), diet/supplements (41%), awareness (36%), and educational (33%). Alternative remedies were the most frequently mentioned treatment (46%), followed by surgery (29%) though with low mention of minimally invasive procedures (6.7%). DISCERN scores indicated poor information quality (mean 28.4), while PEMAT scores showed high understandability (mean 94.9%).

Conclusion: Social media contains a large volume of mostly low-quality fibroid-related content and especially lacks representation of minimally invasive surgical options. Improved efforts are needed to promote accurate, evidence-based information online.

Objective: This study evaluates emergency department (ED) visits within the first 30 days following hysterectomy for benign gynecologic conditions, identifying risk factors and strategies for prevention.

Methods: A retrospective cohort analysis was conducted on 2,119 patients who underwent hysterectomy at a high-volume tertiary center between January 2023 and December 2024. Demographic, perioperative, and postoperative variables were analyzed, and predictors of ED visits were assessed using multivariable logistic regression.

Results: ED visits occurred in 8.6% of patients, with older age, higher intraoperative blood loss, longer operative time, and prior abdominal surgery being significant predictors (P < .05). Vaginal cuff hematoma (29.7%) was the most common cause of hospitalization, whereas abdominal pain (39.3%) and nausea/vomiting (40.7%) were the most frequent nonhospitalized complaints. Minimally invasive techniques were associated with lower ED visit rates compared to total abdominal hysterectomy.

Conclusion: Identifying high-risk patients and implementing structured postoperative monitoring may reduce unnecessary ED visits. Optimizing surgical techniques, perioperative management, and patient education is crucial for enhancing outcomes and reducing healthcare burden. Multicenter prospective studies are needed to validate these findings and refine perioperative strategies.