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

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.

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.