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

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.

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.