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

Background: This study examines the efficacy of robotic colorectal surgery across a large health system, focusing on factors such as hospital stay, operative time, pain management, and postoperative complications. The objective of this study is to compare outcomes of colorectal surgery by robotic, laparoscopic, and open techniques in a multicenter study.

Methods: A retrospective cohort study analyzed patients undergoing colorectal surgery from 2016 to 2022 using a clinical database from a large United States hospital system. Multivariable regression adjusted outcomes for various patient factors and institutional practices.

Results: Among 19,769 patients, robotic surgery was associated with shorter hospital stays (5.6 days vs 7.9 for laparoscopic and 11.2 for open, P < .0001), fewer postoperative complications, and lower pain levels. Despite longer operating room (OR) times, robotic surgery showed favorable trends in mortality, hospice discharge, and readmission rates compared to other approaches.

Conclusion: Robotic-assisted colorectal surgery may lead to decreased hospital stays, readmission rates, and improved patient outcomes across various healthcare settings.

Objectıve: In this study, we aimed to investigate the effectiveness of preperitoneal closed suction drainage in reducing postoperative complications in total extraperitoneal (TEP) repair inguinal hernia repair.

Methods: Between May 2021 and February 2023, 125 patients aged 18-80 years who were admitted to our hospital with primary unilateral (PM2, PM3 and PL2, PL3) inguinal hernia were included in preperitoneal drainage (group 1, n = 45) and no drainage groups (group 2, n = 80). Hematoma and seroma size, early postoperative bleeding, postoperative hospital stay, pain score and recurrence were recorded on the 6th day and 3rd month after surgery.

Results: A total of 114 of the patients were male and 11 were female. Hematoma and seroma were detected in 5 patients in Group I and 15 patients in Group II on the 6th day after surgery (P < .024). Two patients in Group I were re-explored on the first postoperative day due to the amount of drain and hemodynamic instability. There was no difference between the groups in terms of seromas seen in the third postoperative month. There was no difference between the groups in terms of VAS scores and hospital stay.

Conclusion: Especially for young surgeons who are new to surgical procedures, the placement of a drain that is removed after 24 hours will both reduce the development of hematoma and seroma and contribute to early diagnosis and timely intervention in case of serious bleeding.

Background: Inguinal hernia repair (IHR) is a common procedure, and patients with a history of IHR may later require radical prostatectomy. Prior IHR can complicate prostatectomy by altering anatomy, but its impact on extraperitoneal laparoscopic radical prostatectomy (ELRP) remains unclear. This study evaluates the feasibility and outcomes of ELRP in patients with prior IHR.

Materials and methods: This retrospective cross-sectional study included male patients aged 40-80 who underwent ELRP for localized prostate cancer between 2019 and 2024. Patients were stratified into two groups based on prior IHR status (group 1: without IHR; group 2: with IHR). Comparative analyses were performed on demographic data, perioperative metrics, and oncological outcomes to assess the impact of prior IHR on ELRP. Statistical significance was accepted as P < .05.

Results: A total of 255 patients (group 1: 220, group 2: 35) were included. No significant differences were found between the groups in terms of age and demographic characteristics. However, the operation duration was longer in group 2 (194.86 vs 176.87 minutes, P = .002), and peritoneal opening occurred more frequently (34.3% vs 9.1%, P < .001). There was no significant difference in the rates of pelvic lymph node dissection (PLND) (25.9% vs 28.5%, P = .149).

Concluison: ELRP outcomes in patients with a history of IHR are similar to standard ELRP. However, when planning surgery for this group, the risk of peritoneal opening, prolonged operation time, and the careful execution of lymph node dissection should be considered.

Objective: To describe clinical, surgical, and cosmetic outcomes in patients with germline mutations undergoing endoscopic nipple- and skin-sparing mastectomy (eNSM) with immediate reconstruction.

Methods: We conducted a retrospective review of 6 patients (11 breasts) treated between March 2022 and May 2024. All patients had confirmed BRCA1, BRCA2, CHEK2, or MUTYH mutations. Data on operative time, bleeding, specimen weight, reconstruction satisfaction (BRECON 31), complications, and recurrence were collected.

Results: All surgeries were completed without conversion to open surgery. Mean age was 41 ± 9.2 years; mean surgical time was 115.6 ± 11.0 minutes; mean blood loss was 110 ± 70.9 mL. No complications were reported. BRECON 31 satisfaction score at 6 months was 15.3/16. Median follow-up was 13 months with no recurrences.

Conclusions: eNSM is a feasible and effective option for patients with high-risk genetic mutations, offering oncologic safety and high satisfaction in our initial Latin American experience.

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.