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

Background and objectives: One of the responsibilities of the anesthesiologist is to maintain the physiologic anatomic position during surgery. Postoperative positional peripheral nerve injury (PPPNI) inevitably may occur during robot-assisted laparoscopic radical prostatectomy (RARP) in steep-Trendelenburg-lithotomy positioning. The primary aim of the study was to identify incidence and risk factors for the development of PPPNI in the RARP and the secondary aim was to identify the most common types and duration of PPPNI.

Methods: After ethics committee and patients approval, patients who underwent RARP in past 7 years were retrospectively evaluated. Patients with known peripheral neuropathy were excluded. Patient demographics, American Society of Anesthesiologists (ASA) score, body mass index (BMI), Charlson comorbidity index (CCI), operative time (OT), and Trendelenburg time (TT) were obtained from the records. Patients were asked if they had PPPNI and other descriptive questions.

Results: A total of 868 patients were included in the study. The mean age, BMI, ASA risk score, and CCI were 63.44 ± 6.68 years, 27.46 ± 2.75 kg/m², 1.76 ± 0.62, and 2.41 ± 0.89, respectively. PPPNI rate was 5.6% (49 patients). The mean OT, TT and recovery time were 168.83 ± 52.1 minutes, 110.74 ± 46.33 minutes, and 6.5 ± 2.81 months, respectively. The BMI, OT, and TT values of patients with PPPNI were significantly higher than those of patients without PPPNI (P < .01). The cutoff values were 29, 212, and 157 minutes, respectively. Of the 49 patients with PPPNI, 55.1% had upper extremity injuries (pain 51.9%), 51% had lower extremity injuries (motor deficit 58.3%), and 6.1% had injuries to both. Six patients claimed PPPNI.

Conclusion: The RARP is associated with an elevated risk of PPPNIs, particularly in cases of prolonged OT, TT, and high BMI.

Backgrounds and objectives: The enhanced-view totally extraperitoneal technique (eTEP) has gained popularity as a novel minimally invasive ventral hernia repair approach. However, this procedure becomes technically demanding once the view is no longer maintained, due to incidental pneumoperitoneum caused by peritoneal injury during the surgery. In an attempt to overcome this technical issue, we report laparoscopic extraperitoneal repair with upfront coring out of hernia defect (LERCO) where the intraperitoneal coring out of the hernia defect precedes the regular eTEP for the treatment of midline incisional ventral hernia.

Methods: A total of nine patients with midline incisional ventral hernia were treated by LERCO. In the first step, 3 ports are inserted into the peritoneal cavity. The half circumference of the hernia defect is cored out and the extraperitoneal space is further dissected. Then, an additional 3 ports are inserted in the dissected extraperitoneal space. The remaining half circumference of the hernia defect is cored out and the dissection of the extraperitoneal space around the hernia defect is completed. Subsequently, the hernia defect as well as posterior sheath and peritoneum are reapproximated and the mesh is deployed in the extraperitoneal space.

Results: In this series of patients, there was no open conversion during the surgery nor severe postoperative complications including hernia recurrence.

Conclusion: LERCO secures the procedure under the optimal field of view during midline incisional ventral hernia repair. Although our results are promising, further accumulation of clinical experiences is warranted.

Objective: This study examined the preoperative factors influencing the discharge of patients undergoing laparoscopic appendectomy and examined the impact of intraoperative and postoperative recovery on discharge.

Methods: We performed a retrospective analysis of clinical data from 158 patients who underwent laparoscopic appendectomy after admission to the emergency day-surgery ward of our hospital from January to December 2022. The patients were categorized into two groups based on the length of stay: the daytime group (length of stay ≤48 hours) and the routine group (length of stay >48 hours). We compared the effects of preoperative assessments, intraoperative variables, and postoperative outcomes on the discharge of the patients between the two groups.

Results: Preoperative analysis of general data revealed that the time to discharge of patients undergoing daytime laparoscopic appendectomy (P < .05) were significantly influenced age; leukocyte, monocyte, neutrophil, and lymphocyte counts; systemic inflammation response index (SIRI); and appendix diameter. Multivariate logistic regression analysis identified appendix diameter (P = .017), SIRI (P = .024), and white blood cell count (P = .037) as independent risk factors affecting postoperative discharge in patients after daytime laparoscopic appendectomy. Receiver operating characteristic (ROC) curve analysis revealed that SIRI (ROC: 0.876; cutoff: 4.74), white blood cell count (ROC: 0.692; cutoff: 11.995), and appendix diameter (ROC: 0.760; cutoff: 9.5) could predict short-term hospital discharge, with SIRI exhibiting the highest predictive value. Intraoperative operation times, placement of drainage tubes, and pathological type also significantly influenced the discharge time (P < .05).

Conclusion: : SIRI, white blood cell count, and appendix diameter are key factors influencing the discharge of patients undergoing emergency day-surgery appendicitis.

Background and objectives: To determine whether 1- versus 2-layer renorrhaphy affects renal function after partial nephrectomy.

Methods: A total of 18 patients undergoing robot-assisted partial nephrectomies for renal tumors at a single center were randomized to 1-layer or 2-layer renorrhaphy. All patients received a running base layer for hemostasis and collecting system closure. The 2-layer renorrhaphy group also underwent cortical closure with running suture, sliding clip method. Demographics and surgical outcomes were collected. Three-dimensional renal models were constructed using semiautomatic segmentation and planimetry pre- and 4 months postsurgery to determine renal volume loss. Welch's t test was used with statistical significance defined as P < .05.

Results: Of the 18 patients included in the study, 10 were randomized to 1-layer and 8 to 2-layer renorrhaphy. Demographic variables were matched. There was no difference in postoperative creatinine at 1 month (P = .11), 1 year (P = .28), or 3 years (P = .28) postoperatively. However, the change from pre to postoperative creatinine favored the 1-layer group at 1 month (-0.043 vs +0.11 P = .02) and 3 years (-0.0025 vs 0.244, P = .08) follow up. The 1-layer group had a smaller mean volume loss at 4 months postoperatively compared to the 2-layer group (12% vs 22%, P = .04).

Conclusion: This small, randomized trial found increased creatinine and volume loss after 2-layer cortical renorrhaphy. Omitting cortical renorrhaphy may result in better preservation of renal volume and function.

Objective: Explore the effect of laparoscopic limited anatomic hepatectomy (LLAH) on liver function and prognosis of patients with midstage gallbladder cancer.

Methods: The 82 cases of midstage gallbladder cancer patients admitted to First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University from August 2018 to August 2022 were divided into groups according to surgical methods. Among them, 40 cases underwent traditional laparoscopic anatomic hepatectomy were classified as the traditional group, and 42 cases underwent LLAH were classified as the LLAH group. The perioperative indexes, liver function before and after operation, the complications and prognosis were compared between 2 groups.

Results: Compared with the traditional group, the LLAH group had longer operation time, less intraoperative blood loss and less postoperative hospital stay (P > .05). After surgery for 3 months, the levels of albumin (ALB) in 2 groups were higher than before surgery, while the levels of total bilirubin (TBIL), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were lower than before surgery, and the ALB level in LLAH group was higher than traditional group, the levels of TBIL, AST, and ALT were lower than those in traditional group (P > .05). The incidence of postoperative complications in LLAH group was lower than that in traditional group (P > .05). However, there was no significant difference in the 2-year postoperative survival rate between 2 groups (P > .05).

Conclusion: The treatment effect of LLAH for patients with midstage gallbladder cancer is significant. It can reduce intraoperative bleeding, shorten postoperative hospital stay, improve liver function, and decrease complications.

Background and objectives: Endometriosis affects 10% of reproductive-age women globally, with bowel endometriosis in 3.8%-37% of cases, primarily involving the rectum and sigmoid. Surgical excision is the gold-standard treatment for deep infiltrating endometriosis (DIE). Our objective was to evaluate the feasibility, safety, and efficacy of a single-stapler laparoscopic resection and anastomosis technique for bowel DIE.

Methods: This retrospective study analyzed 17 cases managed from January 2023 to June 2024. Clinical presentation, surgical outcomes, and follow-up data were reviewed. Symptom improvement and complications were assessed during a minimum 3-month postoperative period.

Results: Patients primarily presented with preoperative symptoms, including progressive dysmenorrhea, dyspareunia, and dyschezia. All anastomoses were tension-free with negative margins; no diversion stomas were needed. Postoperative recovery was smooth, with significant symptom relief and no complications.

Conclusion: The single-stapler technique for laparoscopic rectosigmoid resection is a safe, effective approach for bowel DIE, offering excellent outcomes with significant symptom relief and minimal severe complications.

Background: This study aimed to assess the clinical and patient-reported outcomes of laparoscopic and robotic-assisted inguinal hernia repair in Indian real-world settings.

Methods: This is a single-center, prospective, nonrandomized, comparative study. Consecutive patients who were 18 years of age or older, and provided informed consent were included in the study between June 2023 and May 2024.

Results: In all, 83 patients were prospectively enrolled in this study: 24 patients were in the robotic-assisted surgery (RAS) group and 59 patients were in the laparoscopic surgery (LS) group. The baseline characteristics of the study cohorts were comparable. The mean total operating time for the RAS group was significantly longer than the LS group (89.83 ± 24.31 vs 67.71 ± 18.34 minutes, P = .0000). For the bilateral hernias, the RAS group's total operating time was significantly longer than that of the LS group; however, for the unilateral hernias, there was no discernible difference. Urine retention was the only early complication in 8.33% and 16.95% of patients, respectively, in the RAS and LS groups. The duration of hospital stay did not significantly differ between the 2 groups (P = .395). The pain scores of the RAS group were significantly lower on postoperative days 1, 4, and 7. Patients in the RAS group scored considerably higher on the quality of life (QoL) scale 1 month after surgery than patients in the LS group.

Conclusion: This study reports encouraging preliminary clinical outcomes of RAS inguinal hernia repairs in Indian settings, in terms of postoperative pain and QoL.

Background and objectives: As the availability of consumer-level virtual reality (VR) technology increases, an opportunity to enhance surgical education emerges. This study sought to evaluate the performance of immersive VR (iVR) against standard 2-dimensional (2D) training videos, vis-à-vis procedure knowledge, procedural confidence, and first-time hands-on performance, along with assessment of the user experience with iVR.

Methods: Participants naïve to the procedure for insertion of a central venous catheter underwent baseline assessment of their knowledge and confidence related to that procedure. They were then randomly assigned, in a 1:1:1 fashion, to 1 of 3 formats of a central line training video; standard 2D, desktop VR and iVR. Participants completed a postintervention knowledge and confidence assessment, as well as a live, hands-on simulation of the procedure. The simulation was scored by 2 blinded observers. Participants were also asked about their subjective experience with VR.

Results: Forty-three participants completed the full study protocol. With regard to knowledge and confidence assessment, using an immersive format was deemed more engaging by all participants, and did not negatively impact knowledge acquisition or procedural confidence. There was a trend toward significantly higher performance on hands-on simulation for participants training using an iVR format (P = .054).

Conclusions: iVR is a useful adjunct in procedural training. It is well-tolerated by users and more engaging than 2D video. It may improve hands-on skills acquisition without negatively impacting knowledge acquisition or artificially inflating procedural confidence. Larger scale studies are needed to assess this technology more thoroughly.

Background/objectives: To evaluate the impact of use of electrosurgery at the time of hysteroscopic resection of intrauterine adhesions on the need, if any, for repeat operative resection and embryo transfer outcomes in an infertile patient population.

Methods: Retrospective cohort study completed at a single academic center in which a total of 110 infertile patients underwent an operative hysteroscopic resection of intrauterine adhesions with (hot) or without (cold) the use of electrosurgery and subsequent embryo transfer between 2005 and 2019.

Results: A total of 85 patients underwent cold dissection, and 25 patients had hot dissection. There was no difference in the need for repeat hysteroscopy between groups (cold: n = 21 [24.71%], hot: n = 8 [32.00%]; adjusted relative risk [aRR]: 0.76, 95% confidence interval [CI]: 0.33-1.74), the number of repeat hysteroscopies performed in each group (cold: 1.52, hot: 1.50; aRR: 1.50, 95% CI: 0.37-6.05) and endometrial thickness prior to embryo transfer between groups (cold: 7.80 ± 2.42 mm, hot: 9.02 ± 5.54 mm; aRR: 1.13, 95% CI: 0.92-1.39). Lastly, there was no difference in implantation rate (RR 1.03, 95% CI 0.68-1.58), ongoing pregnancy rate (aRR 0.90, 95% CI 0.49-1.65) and live birth rate (aRR 1.00, 95% CI 0.52-1.89) at the time of first embryo transfer after adhesion resection.

Conclusion: The use of electrosurgery for surgical management of Asherman's syndrome in patients with infertility does not appear to have detrimental downstream effects on the need for repeat hysteroscopic adhesiolysis, endometrial thickness, or in vitro fertilization embryo transfer outcomes when compared to cold hysteroscopic adhesiolysis.

Objective: This study aims to assess the effectiveness of a haptic-enabled laparoscopic simulator in improving the surgical proficiency of residents across different experience levels.

Design: This prospective study was conducted to evaluate the effectiveness of a haptic laparoscopic simulator (LAP Mentor) for gynecological procedures among residents. Participants were divided into three groups based on experience: senior, midlevel, and junior residents, and completed simulations of bilateral tubal ligation and prophylactic oophorectomy, with performance metrics including time taken and instrument movements recorded.

Result: While group 1 generally scored higher, no statistically significant differences were found between groups. Major bleeding incidents were rare, occurring once in group 2 during tubal ligation and twice in group 3 during prophylactic oophorectomy. Within-group analysis revealed improvements for group 2, which showed reduced duration (P = .006), left-hand movements (P = .009), and right-hand movements (P = .002) and group 3 also achieved statistically significant decreases in duration (P = .004), left-hand movements (P = .001), and right-hand movements (P = .003), indicating skill development over time.

Conclusion: Limited but regular access to advanced simulators-offered two or three times annually-could empower residency programs to meet contemporary surgical training standards without incurring prohibitive costs, ensuring broader access to high-quality skills development.