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

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.

Background and objectives: With the continued development of advancements in minimally invasive surgery, aspirators have become increasingly slenderer to enable smooth insertion into narrow access ports. However, high-viscosity fluids, such as ovarian cyst contents and blood clots, may be difficult to aspirate using slender aspirators. Therefore, we developed a novel emulsification suction irrigator. This study aimed to verify the feasibility of this suction device and compare its suction efficiency with that of conventional devices.

Methods: The newly developed emulsification suction irrigator consists of a spoon-shaped tip and double-lumen shafts for water delivery and suction, which enable the aspiration of emulsified contents. We evaluated the aspiration efficiency by comparing the aspiration rates between the emulsification suction irrigator and conventional single-lumen suction irrigator. Three types of content were compared: viscous (mucinous cyst), highly fibrotic (blood clots), and content containing fat and debris (dermoid cysts). Each of the 3 types of fluids was examined in an artificial model.

Results: The emulsification suction irrigator significantly improved the suction efficiency compared with that of the single-lumen suction irrigator. For the 3 types of content, a significant difference in the median aspirated mass was found between the emulsification suction irrigator with water supply and single-lumen suction irrigator (P < .001).

Conclusion: Our new emulsification suction irrigator improved the removal efficiency of highly viscous liquids in artificial models.

Background and objectives: The LevaLap 1.0 (Core Access Surgical Technologies, Atlanta, GA) was designed to promote safer, more stable, and more predictable abdominal access when using the Veress needle for insufflation. We report on the first postmarket clinical study (PMCF) assessing experience with the use of the LevaLap 1.0 during gynecologic laparoscopic surgery.

Methods: Prospective multicenter study, including women ≥18 years old, excluding pregnancy, access site surgery in prior 10 days, abdominal hernia, contraindication to Veress needle or laparoscopy use, body mass index (BMI) >30 kg/m², and inability/unwillingness to provide consent.

Results: A total of 158 subjects were included, involving nine surgeons. Mean age was 43.6 ± 14.6 years and mean BMI: 24.7 ± 3.8 kg/m². Access site was 83.5% transumbilical, 15.2% periumbilical, and 1.2% other. Using the device 96.8% (95% confidence interval [CI]: 92.8-99.0%, n = 152/157) of patients' access was successfully achieved at first attempt and 99.4% (95% CI: 96.5-100.0, n = 156/157) within the first 2 attempts. One minor device-related adverse event was reported: a circular redness on the skin at the site of device application, resolving spontaneously. Surgeons noted easier access in 59.5%, increased confidence in 68.3%, increased access control in 67.1%, and increased access efficiency in 66.4% of cases.

Conclusion: This PMCF study indicates that the use of the LevaLap 1.0 resulted in easier, greater control and greater efficiency during abdominal access using the Veress needle. In 96.8% access was achieved at first attempt and in 99.4% within the first 2 attempts. The use of the LevaLap 1.0 may facilitate abdominal access when using the Veress needle for insufflation.

Background and objective: To evaluate the perioperative and long-term outcomes of surgical management of patients with endometriosis at a community hospital in a low socioeconomic district.

Methods: A total of 39 patients underwent surgical management for endometriosis between October 2022 and November 2024. Thirty-six patients were followed up for 1-24 months.

Results: Among the 39 cases, 18 (42.6%) were identified incidentally in operations for other indications, while 21 (53.8%) were clinically diagnosed or confirmed with previous laparoscopy. Twelve (30.8%) cases were classified as stage I-II and 27 (69.2%) as stage III-IV. Surgical approaches included laparoscopy in 23 (59.0%) cases, robotic assistance in 13 (33.3%), and 2 cases were converted from laparoscopy to laparotomy. Advanced techniques utilized included ureterolysis, enterolysis, diaphragm resection, bowel shaving, bowel disc resection, segmental bowel resection, appendectomy, partial bladder cystectomy, and hypogastric nerve sparing. Intraoperative complications included 1 ureteral thermal injury and 1 bladder laceration. Postoperative complications consisted of 1 pyelonephritis and 1 incisional cellulitis. No complications related to urinary or bowel functional disorders occurred postoperatively. Among the 19 patients who regularly used pain medication before surgery, 16 patients discontinued pain medications, while 3 patients reduced their usage after surgery. Eight patients are actively trying to conceive, and 1 patient conceived spontaneously. Sixteen patients are receiving various forms of hormonal suppression.

Conclusion: With excellent skills and collaboration, the surgical management of endometriosis resulted in minimal complications and optimal postoperative outcomes, significantly benefiting patients in low socioeconomic areas.

Objective: To determine complication rates after surgery for revision of pelvic organ prolapse mesh grafts, and to compare complication rates by surgical approaches.

Methods: A retrospective, population-based cohort study was conducted using the American College of Surgeons National Quality Improvement Program database. Patients undergoing mesh revision by gynecology or urology were classified into vaginal, abdominal, or laparoscopic approaches. Patients having a revision of a midurethral sling were excluded. A multivariable logistic regression analysis was completed. The primary outcome was a composite of surgical complications excluding urinary tract infections. Severe Clavien-Dindo IV complications, rates of readmission, rates of reoperation and urinary tract infections were secondary outcomes.

Results: Of 1,849 patients, 1,706 underwent vaginal, 78 underwent abdominal, and 65 underwent laparoscopic approach. The composite complication rate, excluding urinary tract infections, was 12.8% in the vaginal group, 21.8% in the abdominal group and 16.9% in the laparoscopic group (P = .052). Compared to a vaginal approach, the abdominal and laparoscopic groups had higher odds of complications (abdominal: adjusted odds ratio [OR] 2.70, 95% confidence interval [CI] 1.29-5.70; laparoscopic: adjusted OR 1.48, 95% CI 0.60-3.68). The abdominal and laparoscopic groups had higher odds of readmission compared to the vaginal group (abdominal: adjusted OR 2.36, 95% CI 0.81-6.90; laparoscopic: adjusted OR 4.12, 95% CI 1.49-11.40). Clavien-Dindo IV complications were rare and only seen after vaginal approach (0.4%, n = 6).

Conclusion: Complications were least common after vaginal mesh graft revision surgery, as compared to an abdominal or laparoscopic approach. Serious complications were rare.

Aim: Cystic duct stump remnant causing "postcholecystectomy syndrome" is an uncommon but clinically significant complication. Symptomatic cystic duct stump stones often necessitate redo completion cholecystectomy. Here, we share our experience with the clinical presentation and surgical management of this condition.

Patients and methods: This prospective study included 60 patients with residual cystic duct disease who underwent completion cholecystectomy between August 2016 and September 2024. Investigations included abdominal ultrasound and magnetic resonance cholangiopancreatography. The demographic, clinical, surgical and early post-operative variables of these patients were prospectively maintained and analyzed.

Results: The study included 43 women and 17 men with symptomatic cystic duct remnant. The median age was 43.5 years (range, 14-80 years). The median duration between index surgery and completion cholecystectomy was 66 months (range, 2-384 months) (interquartile range, 105 months). The initial surgery was open cholecystectomy in 44 and laparoscopic cholecystectomy in 16 patients. Fifty-six (93.3%) patients with residual stump stone presented with pain, while 24 (40%) patients complained of dyspepsia. Completion cholecystectomy could be performed laparoscopically in 47 cases, whereas 10 patients underwent open surgery. The mean operative time was 85 minutes (standard deviation = 32.1, confidence interval = 95%). The mean hospital stay was 3 days (interquartile range [IQR], 1-4.5 days). Iatrogenic bile duct injury occurred in 2 (3.3%) cases out of which one was repaired laparoscopically and the other required conversion to open and repair over T tube.

Conclusion: Laparoscopic completion cholecystectomy is feasible and safe, even in patients with prior open cholecystectomy. It is becoming the treatment of choice where expertise is available.

Background: The levonorgestrel-releasing intrauterine system (LNG-IUS) is a widely recognized method for contraception and the management of various gynecological conditions. However, the placement of LNG-IUS can be particularly challenging in patients with large or anatomically irregular uteri. The objective of this study was to evaluate the efficacy and safety of hysteroscopic cold-knife-assisted suture fixation of the LNG-IUS in the uteri of patients diagnosed with adenomyosis.

Methods: We retrospectively analyzed the data of patients who underwent LNG-IUS placement with the assistance of cold-knife hysteroscopy. The evaluation criteria included surgical success rates, postoperative complications, and subsequent follow-up of LNG-IUS.

Results: Our findings indicated that LNG-IUS placement was successfully achieved with cold-knife hysteroscopy, even in cases characterized by large uterine volume or abnormal uterine morphology. The procedure demonstrated a low incidence of postoperative complications, with no instances of device expulsion or displacement. Additionally, it resulted in a reduction of vaginal bleeding and alleviation of dysmenorrhea.

Conclusion: Hysteroscopic cold-knife-assisted suture fixation of LNG-IUS offers an effective solution for patients with a history of device expulsion, significantly reducing the expulsion rate and demonstrating high safety and efficacy.

Objective: Aim was to analyze and compare the oncological outcomes, genitourinary quality of life (QOL), disease-free survival (DFS), and overall survival (OS) of patients treated by laparoscopic radical hysterectomy (LRH) and laparoscopic nerve-sparing radical hysterectomy (LNSRH) for early cervical cancer.

Design: Retrospective study in patients of carcinoma cervix FIGO (2009) grade 1A to 2A1 from January 1, 2016 until the publication of Laparoscopic Approach to Cervical Cancer (LACC) trial in 2018, after which only 1A and 1B1 were included up to December 31, 2020.

Setting: Total of 285 patients operated over 5 years at the center were placed in 2 groups, LRH and LNSRH, based on surgical approach.

Measurements: Tumor characteristics, clinical profile, tumor clearance, histopathology, adjuvant treatment, period of follow-up and recurrence were compared. The QOL was analyzed in terms of bladder and sexual function.

Results: LNSRH group had significantly faster recovery of bladder (lesser number of days required for PVR <50 mL, quicker catheter removal time, less requirement of self-catheterization, less incidence of urinary retention and incontinence) and sexual function as compared to LRH group. There was no significant difference in radicality of the procedure. None of them had vault recurrences. DFS at 5 years for LRH and LNSRH was 95.3% and 94.1%, respectively. OS at 2 years for LRH and LNSRH was 95.9% and 96.3%, respectively, whereas the OS at 5 years was 95.3% and 94.1%, respectively.

Conclusion: LNSRH group had significantly better genitourinary QOL as compared to the LRH group without compromising on oncological clearance. The survival is comparable to the results of open surgery in LACC trial.