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

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.

Background: In swimming, a combination of strength, endurance, and targeted skill training significantly enhances performance, particularly by balancing aerobic and anaerobic conditioning. Similarly, in surgery, improving motor control and stamina during lengthy operations, particularly for precise movements like suturing or tissue manipulation, is essential. This literature review aims to explore the parallels between the training paradigms of elite swimming and robotic-assisted surgical practice, focusing on skill acquisition, training methodologies, and performance-guided feedback systems. The hypothesis suggests a significant link between these training principles, offering opportunities to optimize surgeon training, particularly in robotic-assisted surgery.

Database: A systematic review was conducted following PRISMA guidelines. A thorough examination of existing literature in both elite swimming and robotic-assisted surgery training identified key elements of skill development, feedback mechanisms, and structured progression. Sources included peer-reviewed studies on swimming techniques, cognitive training in surgery, and simulation-based training programs that emphasize performance-driven improvements.

Conclusion: The review identified significant parallels between swimming and robotic-assisted surgery training, with both fields emphasizing structured, feedback-driven approaches to enhance precision and skill. Techniques such as video analysis in swimming and real-time digital feedback in surgery were found to be effective in improving outcomes. Simulation-based training also plays a crucial role in refining skills and promoting adaptability in both disciplines. Applying elite swimming methodologies, particularly those centered on feedback, precision, and structured progression, could help develop key metrics to enhance surgical training programs, in robotic-assisted surgery. Future research could further optimize surgeon training, potentially leading to improved performance and better patient outcomes in robotic procedures.

[This retracts the article on p. 267 in vol. 12.].

Objective: Determine whether the quadratus lumborum block (QLB) is an effective adjunct to control postoperative pain during the first 24 hours after minimally invasive hysterectomy.

Methods: Prospective cohort observational study of patients who underwent laparoscopic or robotic hysterectomy. Patients either received a QLB or did not. Initial postoperative pain scores were recorded in the postanesthesia recovery area using a numeric rating scale. Patients were then called to collect 24-hour scores and analgesic medication usage. The primary outcome was the 3-hour pain score. Secondary analysis evaluated use of analgesic medication.

Results: Fifty patients were enrolled in the study: 25 patients in the no-QLB cohort and 25 patients in the QLB group. The median postoperative pain scores (out of 10) were 4, 2, and 6 at 1, 3, and 24 hours in the no-QLB group. Scores were 5 (P = .541), 3 (P = .418), and 6 (P = .358), respectively, in the QLB group. A total of 11 of 25 patients at 1 hour, 8 of 25 patients at 3 hours, and 21 of 25 patients at 24 hours used analgesia postoperatively in the no-QLB group, compared to 11 of 25 patients at 1 hour (P = 1.0), 18 of 25 patients at 3 hours (P = .005), and 23 of 25 patients at 24 hours (P = .384) in the QLB group. Opioid, acetaminophen, and ibuprofen usage was not significantly different between groups.

Conclusion: There was no significant pain difference between the no-QLB and QLB groups. Patients who received a QLB were more likely to receive pain medication 3 hours after surgery. Thus, the use of a QLB does not appear to be a suitable adjunct for postoperative pain.