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

Background: Peptic ulcers are a common cause of upper gastrointestinal bleeding. In contrast, Dieulafoy's disease is a rare cause of upper gastrointestinal bleeding. Upper gastrointestinal arterial bleeding may lead to hemorrhagic shock and threaten the patient's life. Achieving effective hemostasis in patients with upper gastrointestinal arterial bleeding remains a challenge. This study determined the efficacy of endoscopic hemostatic forceps high-frequency (HF) electrocoagulation for the treatment of upper gastrointestinal arterial bleeding caused by peptic ulcers and Dieulafoy's disease.

Method: A retrospective analysis was performed involving 84 patients with upper gastrointestinal arterial bleeding caused by peptic ulcers and Dieulafoy's disease. The patients underwent endoscopic HF electrocoagulation treatment at our hospital between January 2018 and December 2023. The clinical data were collected and analyzed.

Results: The mean age of the 84 patients (53 men and 31 women) was 64.27 years. The main lesion sites were the duodenum (n = 37), gastric antrum (n = 28), and gastric body (n = 14). Among the 84 patients, 82 achieved hemostasis after endoscopic treatment with a success rate of 97.6%. The two patients in whom hemostasis was not achieved were treated with other methods and recovered well. The average time-to-hemostasis was 1.5 minutes. No complications, including perforation or rebleeding, occurred after treatment. During the 12-month follow period, no recurrent bleeding occurred in any of the patients.

Conclusion: Endoscopic hemostatic forceps HF electrocoagulation is a simple, effective, and reliable treatment for upper gastrointestinal arterial bleeding caused by peptic ulcers and Dieulafoy's disease.

Introduction: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is a novel minimally invasive technique that eliminates the need for abdominal incisions. Compared to conventional laparoscopy (CL), vNOTES may offer reduced postoperative pain and faster recovery. While laparoscopy is the standard method for bilateral tubal ligation (BTL), limited comparative data exist regarding vNOTES for this indication.

Aim: To compare postoperative outcomes, pain levels, and sexual function following BTL performed via vNOTES versus CL.

Material and methods: This retrospective comparative study included 43 women who underwent elective BTL between September 2023 and December 2024 (vNOTES: n = 23; CL: n = 20). Pain was assessed using a visual analog scale (VAS) at 1, 6, and 24 hours postoperatively. Shoulder pain incidence, intra-abdominal pressure, need for intraoperative opioids, and 6-item Female Sexual Function Index (FSFI-6) scores were also evaluated. Operative time, blood loss, and length of hospital stay were recorded.

Results: All procedures were completed without major complications. VAS pain scores at all measured time points were significantly lower in the vNOTES group (P < .05). Shoulder pain occurred in 15% of vNOTES cases versus 85% in the CL group (P < .001). Intra-abdominal pressure and intraoperative opioid requirements were significantly lower in the vNOTES group (P < .05). No significant differences were observed between groups in sexual function scores, operative time, blood loss, or hospital stay (P > .05).

Conclusions: vNOTES is a safe and effective alternative to CL for female sterilization. It offers significant benefits in terms of reduced early postoperative and shoulder pain, without negatively affecting sexual function or surgical safety. These findings highlight the potential advantages of vNOTES as a minimally invasive technique in gynecologic surgery.

Background and objectives: Electronic data capture may enhance efficiency and patient engagement in preoperative psychosocial evaluations for metabolic and bariatric surgery yet concerns persist about its feasibility in rural populations with historically lower mobile health adoption. This study evaluated the feasibility and acceptability of electronic patient-reported outcomes among metabolic and bariatric surgery patients in a rural setting.

Methods: In this quality improvement project, 202 patients undergoing presurgical psychosocial evaluation at an academic medical center in rural West Virginia completed a battery of psychological assessments on a clinic-provided tablet. Patients also completed a 9-item questionnaire assessing satisfaction, usability, and perceived impact on provider communication.

Results: Most patients reported high satisfaction with the tablet-based format (85%), and nearly all (96%) preferred it over paper-and-pencil forms. Usability ratings were strong, with the majority describing the tablet as "very easy" to read (86%), use (84%), and navigate (87%). Notably, 42% reported the tablet encouraged them to discuss eating or mental health concerns with their provider, and 49% indicated it helped them remember prior symptoms. Only 4% preferred paper-and-pencil assessments, and these patients were significantly older.

Conclusion: Tablet-based electronic patient-reported outcomes collection is a feasible and well-accepted method for presurgical psychosocial evaluations in rural metabolic and bariatric surgery patients. These findings challenge assumptions about digital hesitancy in rural populations and support broader implementation of electronic data capture in bariatric care workflows.

Background: Pudexacianinium chloride is a novel near-infrared fluorescence (NIR-F) imaging agent under evaluation for ureter visualization in patients undergoing abdominopelvic surgery.

Methods: Surgeons were trained to use the Likert scale. Each surgeon rated 36 color image pairs (white light and NIR-F on the same anatomical area) from the phase 2 trial (NCT04238481), in which adults undergoing abdominopelvic surgery received single doses of pudexacianinium. Surgeons rated a single-item question, "How conspicuous is the ureter?" using a 5-point Likert scale ranging from 1 = none (not self-evident) to 5 = excellent (extremely self-evident). Images were taken at the beginning (10-30 minutes postpudexacianinium, n = 18 pairs), middle (between 30 minutes postpudexacianinium and end of surgery, n = 13 pairs), and end of surgery (n = 5 pairs) and were displayed for 30 seconds. Inter-rater reliability at baseline and intra-rater reliability after 1 week from baseline were evaluated using intraclass correlation coefficients (ICCs) with target values set a priori as 0.70 and 0.80 for inter-rater and intra-rater reliability, respectively.

Results: Seventeen surgeons were enrolled and completed baseline ratings; 15 completed retest ratings. Mean (standard deviation) rating on the 5-point Likert scale with NIR-F was 3.77 (0.98) at baseline and 3.84 (0.97) at retest and 2.28 (0.98) at baseline and 2.16 (0.95) at retest with white light. Inter-rater reliability ICC was 0.70 (95% confidence interval [CI] = 0.63, 0.78) and intra-rater reliability ICC was 0.82 (95% CI = 0.80, 0.84).

Conclusions: The 5-point Likert scale had adequate inter- and intra-rater reliability among surgeons for assessing ureter conspicuity in patients who received pudexacianinium during abdominopelvic surgery.

Background and objectives: Minimally invasive surgery (MIS) offers faster recovery and smaller incisions but is limited by persistent visualization issues such as lens fogging, debris, and camera instability. These challenges compromise surgical performance, increase complications, and elevate healthcare costs. This review evaluates the clinical and economic impact of suboptimal visualization in MIS and explores potential solutions.

Methods: A systematic review was conducted using peer-reviewed literature from January 1990 to August 2024. Studies included those examining visualization challenges in laparoscopic and robotic MIS, clinical outcomes, surgeon-reported frustrations, and cost analyses. Exclusion criteria included studies with significant conflicts of interest, especially those funded by medical device companies.

Results: Surgeons spend an estimated 40% of MIS operating time under suboptimal visual conditions, contributing to nearly 20% of surgical complications. Lens cleaning adds $132-$493 per procedure, averaging $312.53 based on 9.7 cleaning events per case. Visualization-related complications contribute an additional $251 per case. Combined, these issues result in over $2.2 billion in annual costs in the U.S. Poor visualization also disrupts workflow, increases surgeon fatigue, and hinders integration of emerging technologies such as artificial intelligence (AI).

Conclusions: Suboptimal visualization in MIS stands to significantly affect patient safety and healthcare costs. Addressing these challenges through standardized cleaning protocols, improved surgeon training, and adoption of advanced technologies-including AI-driven imaging-is essential. Enhancing visualization is not just a technical upgrade but a critical step toward safer, more efficient, and cost-effective surgical care.

Background: Biological mesh derived from porcine small intestinal submucosa (SIS) has a higher porosity and is more hydrophilic than tissue derived from bovine and cow dermal tissues. Therefore, we believe SIS mesh will lead to a milder inflammatory reaction than other, polypropylene and polypropylene-polydioxanone meshes, fewer adhesions, and less mesh shrinkage.

Methods: Ninety rats were divided randomly into three groups: in group 1, polypropylene mesh was implanted; in group 2, polypropylene-polydioxanone; and in group 3, the SIS mesh. The meshes were fixed intra-abdominally, in the upper part of the abdomen. Ten animals from each group were sacrificed on days 7, 28, and 60 after the implantation. Relaparotomy was performed, with a left paramedial incision and the adhesions formed were assessed according to the Surgical Membrane Study Group (SMSG) score, along with the percentage of shrinkage of the mesh, and any inflammation.

Results: There were no differences in terms of inflammatory reaction or the formation of adhesions between the meshes tested on the 7th day after implantation. However, the shrinkage of the SIS mesh was more expressed. On days 28 and 60, the SIS mesh caused less inflammatory reaction and formation of adhesions in relation to the other meshes tested. On day 60, there was no significant difference in the size of the meshes.

Conclusion: This study confirmed that, despite conflicting views on biological mesh, SIS mesh results in less inflammatory reaction, less adhesion formation, and a lesser degree of shrinkage, and can take its place in hernia repair.

Background: We conducted a systematic review and meta-analysis to compare robotic versus open simultaneous resections for colorectal cancer and colorectal liver metastases.

Methods: On June 3, 2024, we searched on PubMed, Embase, and Cochrane. The eligibility criteria followed the PICO framework. The population included patients undergoing simultaneous resection of colorectal cancer and liver metastases. The intervention was robotic-assisted surgical resection, compared to open surgical resection as the control group. The outcomes were postoperative hospital stay, mortality, operative time, estimated intraoperative blood loss, intestinal anastomotic leakage, and bile leakage. Two authors independently extracted data regarding the characteristics of each study. We assess risk of bias using the ROBINS-I tool and RoB 2 tool.

Results: We included 4 studies with 1,722 patients, of whom 210 (12.2%) underwent a robotic surgery approach. The intraoperative blood loss (mean difference [MD] -87.48 mL; 95% confidence interval [CI] [-103.76, -71.21]; P < .0001) and postoperative hospital stay (MD -2.13 days; 95% CI [-2.99, -1.27]; P < .0001) were significantly lower in patients treated by the robotic approach. Operative time was higher in the robotic surgery group (MD 48.87 minutes; 95% CI [21.23, 76.50]; P = .0005). The incidence of intestinal anastomotic leakage and bile leakage had no significant difference.

Discussion: This study provides evidence that robotic approaches yield improved outcomes for patients undergoing simultaneous resection of colorectal cancer and liver metastases.

Three cases of atypical ectopic pregnancies requiring surgical evaluation are presented. The first case represents an undiagnosed heterotopic pregnancy who initially presented with a 1^st trimester spontaneous abortion and subsequently a ruptured ectopic pregnancy. The second case represents an omental ectopic pregnancy vs an extruded tubal ectopic pregnancy following a salpingectomy requiring omentectomy and appendectomy. The third case showcases a chronic cornual ectopic pregnancy incidentally found during a robotic myomectomy. These cases highlight uncommon presentations of atypical ectopic pregnancies, diagnostic challenges, and surgical treatment.

Purpose: To evaluate the impact of urethrovesical anastomotic leakage (UAL) on urinary incontinence (UI) in patients undergoing robot-assisted radical prostatectomy (RARP).

Methods: Data from 86 patients who underwent RARP between 2017 and 2023 were retrospectively analyzed. Cystography was performed on the seventh day, and urinary catheters were removed for patients with mild leakage. For patients with major leakage, cystography was repeated on the 14th day. Patients with UI and those using pads were identified separately and assessed for associated risk factors.

Results: The UAL rate was 32.6%, with an equal division between minor and major UAL. The average an follow-up period was 36 ± 22 months. UI was present in 28 patients (32.6%), of whom 11 (12.8%) required pads, while 17 patients (19.8%) had mild UI and did not use pads. Seventy-five patients (87.2%) did not use pads. Among pad users, 6 (7.0%) used 1 pad, 2 (2.3%) used 2 pads, and 3 (3.5%) used 3 pads daily. UAL did not significantly impact UI (P = .479), and no significant relationship was found between major UAL and UI (P = .727). None of the demographic or perioperative variables were associated with UI. Comparison between pad users and nonpad users revealed that neither UAL nor major UAL was a significant factor (P = .743 and P = .290, respectively).

Conclusion: UAL was not found to influence mid to long-term UI. However, in patients with major UAL, prolonged catheterization may have a protective effect against UI. Randomized studies comparing catheter removal on the seventh day versus later removal in patients with UAL could provide further insight.