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

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.

Background and objectives: After hysterectomy, patients are counseled on behavioral limitation, such as avoiding vaginal intercourse and heavy lifting, to try to optimize healing. There are limited data on the benefits of these restrictions and on the impact on patients. This study aimed to evaluate patients' adherence to and perception of behavioral restrictions after total laparoscopic hysterectomy.

Methods: A cross-sectional survey study of patients who underwent total laparoscopic hysterectomy and completed the survey at their postoperative appointment between January 3 and March 31, 2023. Patients had been counseled to avoid submersion in water, strenuous exercise, and lifting > 10 pounds for at least 6 weeks, and to avoid vaginal penetration for 12 weeks after surgery. Convenience sampling was used.

Results: A total of 71 patients were eligible and 50 (70%) participated. The mean time to postoperative appointment was 32 days. Participants reported inconsistent adherence to behavioral guidelines. 49/50 (98%) patients avoided vaginal penetration, 46/50 (92%) avoided submerging in water, 21/49 (43%) avoided lifting > 10 pounds. Within 4 weeks, > 90% of patients returned to driving, housework, and shopping and 21/36 (58%) of employed patients returned to work. 21/47(45%) of participants reported that adhering to postoperative restrictions was at least "a little bit challenging," with home responsibilities cited as the primary challenge.

Conclusion: Patients inconsistently followed behavioral restrictions after total laparoscopic hysterectomy and described them as difficult to follow due to other responsibilities. Future studies should explore the necessity of postoperative restrictions and strategies for improving adherence to restrictions that optimize patient safety.

Objective: This study aimed to investigate the effects of the pressure-controlled volume-guaranteed ventilation (PCV-VG) mode on pulmonary function in patients with pneumoconiosis undergoing laparoscopic cholecystectomy.

Methods: Forty patients with pneumoconiosis scheduled for elective laparoscopic cholecystectomy under general anesthesia were randomly divided into two groups using a random number table method: the PCV-VG mode group and the volume-controlled ventilation (VCV) mode group. The primary outcome was lung ultrasound score (LUS) after entering the operating room (T0), at the end of surgery (T3), 30 minutes after tracheal extubation (T4), and 2 hours postoperatively (T5). Peak airway pressure (Ppeak) and plateau pressure (Pplat) were recorded 2 minutes before (T1) and 20 minutes after the initiation of artificial pneumoperitoneum (T2). Arterial blood gas analyses were performed at T0, T2, and T4 to calculate the oxygenation index (OI).

Results: Compared to the VCV group (n = 20), the PCV-VG group (n = 20) exhibited significantly improvement of median LUS at T3, T4, and T5 (all P < .05). Significantly lower Ppeak and Pplat were found in PCV-VG group at T1 (16.2 ± 1.81 and 14.6 ± 1.85) and T2 (24.3 ± 2.75 and 19.7 ± 3.08) (P < .05). Additionally, median OI significantly improved at T2 and T4 in PCV-VG group (P < .05). No early postoperative pulmonary complications were found in both groups.

Conclusion: For patients with pneumoconiosis undergoing laparoscopic cholecystectomy, the PCV-VG mode can reduce intraoperative airway pressures and early postoperative LUS values, decrease ventilation loss, and improve perioperative oxygenation.

Objective: Artificial intelligence (AI) is a turning point in medical advancement. Despite the burgeoning research in this field, there exists a general lack of overview of where AI is being most utilized. This study reviews and describes techniques and trends of AI in the major medical specialties.

Method: A literature search was conducted through PubMed in 2024 using two different search methods. Twenty-nine medical specialties were included, including all 24 major medical board specialties and five additional subspecialties.

Results: There were 143,578 publications involving AI identified with most these (87%) published in the last ten years (124,206) and 52% (74,239) in the last two years. Radiology and Pathology publications were the largest cohorts, 18% (25,319) and 17% (23,828), respectively. Plastic Surgery (1,053), Hepatobiliary (662), and Allergy/Immunology (449) were the least published. There has been a 10,859% growth rate in annual publications across all medical specialties, with Ophthalmology and Preventative Medicine being the fastest-growing areas of research despite Radiology and Pathology being the most researched to date.

Conclusion: This review underscores AI's profound impact on medical research, highlighting its significant growth and utilization across various specialties. AI's influence is most pronounced in Radiology and Pathology, but the substantial increase in publications in Ophthalmology and Preventative Medicine suggests new emerging areas of focus. The ongoing expansion of AI in medicine presents a promising horizon for addressing complex healthcare challenges, fostering a deeper and more comprehensive integration across all specialties.

Objective: The aim is to evaluate and contrast the effectiveness of single-port versus conventional laparoscopic appendectomy in pediatric cases, providing a rigorous assessment of their respective therapeutic impacts.

Methods: A retrospective study was performed on pediatric appendicitis cases operated on by a single primary surgeon using either single-port or conventional laparoscopic techniques between July 2015 and June 2024. The study encompassed variables such as age, onset timing, operative duration, hospital stay, and pathological classification, to compare the therapeutic outcomes of both surgical approaches.

Results: The retrospective review included 1,435 pediatric cases of acute appendicitis, with 1,239 in the conventional laparoscopic group and 196 in the single-port laparoscopic group. The conventional laparoscopic procedure utilized a 3-port technique, whereas the single-port laparoscopic group employed a silicone 3-port Trocar. Statistical analysis of age, onset timing, operative duration, and hospital stay revealed no significant differences between the 2 groups. Pathological examination of appendicitis types, as determined by the χ² test, indicated no significant disparities in distribution across the groups.

Conclusion: Given that pediatric surgeons possess adept laparoscopic surgical skills, single-port laparoscopic surgery is a viable alternative to conventional laparoscopic surgery for the treatment of acute appendicitis in children, offering comparable therapeutic benefits.

Background and objectives: The safety and effectiveness of laparoscopic approaches for emergency colorectal surgery are not yet fully established, though their use is increasing with studies reporting laparoscopic colectomy is safe and feasible for appropriately selected patients. Hand-assisted laparoscopy (HAL) involves inserting one hand into the abdomen through a small incision, offering advantages that may facilitate laparoscopic procedures in emergencies. This study reports our experience with emergency HAL colectomy.

Methods: This was a retrospective review of consecutive colorectal emergency cases treated with HAL colectomy in a tertiary referral center. Patient demographics, indications for surgery, operative details, and postoperative outcomes were analyzed. Survival rates were calculated for cases with malignancy.

Results: From February 2015 to July 2019, HAL was applied to all emergency colectomy cases in patients with an American Society of Anesthesiologists (ASA) score of I-III. A total of 50 patients treated with HAL colectomy for complicated colorectal disease were reviewed. Twenty-five patients (50%) had an obstruction which required an intraoperative decompression procedure or intraoperative antegrade colonic irrigation. Thirty-eight patients (76%) had perforation. There were 2 cases of open conversion (4%). The median duration of the operation was 160 minutes. The median amount of estimated blood loss was 250 mL. The median time of postoperative stay was 12 days. The postoperative complication rate associated with the operation was 26% (13/50). There were 2 postoperative mortalities.

Conclusion: HAL appears to be a feasible option in emergency colectomy for ASA I-III patients and may be beneficial in specific surgical practice contexts.

Background: Management of left-sided colorectal Grade C anastomotic leak (AL) has traditionally been managed via laparotomy. However, with the growing adoption of minimally invasive techniques, recent literature suggests that laparoscopic surgery provides a safe and viable alternative for managing Grade C leaks.

Methods: This study is a case series that consists of 7 adults that underwent laparoscopic reintervention of purulent or feculent peritonitis from left-sided colorectal AL during the period of 2016-2024 at our institution. Outcomes measured included days to presentation, operative times, hospital stay, morbidity, mortality, and rates of stoma closure.

Results: Of the 7 patients, 6 of them had purulent peritonitis and one had feculent peritonitis. The average time from index operation to clinically evident AL was 6 days. The patients were managed with laparoscopic with drainage, colorrhapy and Hartmann's procedure.Complications include subhepatic fluid collection, hematoma, infected seroma. The average operative time was 145.3 min. The average length of hospital stay (LOS) after reoperation was 11 days. All patients had their stoma reversed within an average of 90 days. No deaths occurred.

Conclusion: MIS approach to Grade C AL in left-sided colorectal resection is safe and feasible. It can be performed with low morbidity and mortality and high rates of stoma closure.