Minimally Invasive Therapy & Allied Technologies最新文献

Background: There is still no clear consensus on long-term follow-up data for uterine leiomyoma (UL) recurrence and the major risk factors for recurrence after UL resection. This study aimed to investigate UL recurrence and related factors after laparoscopic myomectomy (LM).

Methods: The local and international literature on UL recurrence rates and related factors after LM was systematically collected, with the search period up to December 31st, 2024. Stata 16.0 software was used for meta-analysis. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model with the Hartung-Knapp-Sidik-Jonkman adjustment, regardless of the I²value.

Results: A total of eight studies were included, and 2,160 patients receiving LM were followed up for more than 12 months. The total number of recurrence cases was 497, and the crude recurrence rate was 23.0%. The meta-analysis results indicated that preoperative UL size ≥ 10 cm (OR = 2.15, p < 0.001), uterine size >10 or 14 weeks (OR = 2.40, p = 0.001), and preoperative UL number ≥2 (OR = 2.46, p < 0.001) were risk factors for UL recurrence after LM. There was no statistically significant association between age ≥35 years, BMI ≥ 24 or 25 kg/m², postoperative delivery or pregnancy, and post-LM UL recurrence.

Conclusions: In this study, the risk factors for UL recurrence after LM were obtained through meta-analysis, which is more stable and reliable than the results of a single study and can provide a reference and basis for clinically identifying the risk factors related to LM recurrence after surgery, fully evaluating the risk of recurrence before surgery and predicting high-risk groups.

Background: The incidence of rectal neuroendocrine tumors (rNETs) is increasing due to widespread colonoscopy screening. Conventional endoscopic techniques have difficulties in achieving complete resection of rNETs with deep submucosal invasion. Endoscopic intermuscular dissection (EID) enables removal of the mucosa, submucosa, and inner circular muscle layer while preserving rectal wall integrity.

Methods: We retrospectively analyzed the patients diagnosed with rNETs between May 2022 and May 2025 at our hospital. Clinical data, endoscopic findings, histopathological results, and follow-up outcomes were reviewed.

Results: A total of 13 patients underwent EID for rNETs were enrolled, with 13 ESD cases included for paired comparison. Both groups demonstrated sufficient histologically complete resection rates (92.3% vs 100%, p>0.99). EID required longer procedure time (38.31 ± 12.84 vs. 29.54 ± 4.75 min, p=0.036). Hospitalization costs showed no significant difference (14795.92 ± 2946.61 vs. 12363.00 ± 2585.15, p=0.105).1 case of delayed bleeding occurred in each group, respectively, with no other serious adverse events. No recurrence was reported in 25 cases that achieved histologically complete resection.

Conclusions: EID is safe and effective for rNET resection without increasing costs compared to ESD. It may be a feasible option for selected rNETs with suspected deep submucosal invasion requiring adequate vertical margins.

Background: The objective of this study was to evaluate the technical feasibility, perioperative safety, and surgical workflow of the Toumai^® Laparoscopic Surgical Robot System in gynecology by reporting the first Robot-Assisted Total Hysterectomy (RATH) using this platform in Europe.

Methods: A total hysterectomy with bilateral salpingo-oophorectomy was performed on a patient with recurrent HPV-related CIN 3 at AZORG Hospital (Aalst, Belgium) in May 2025. The procedure was conducted by a surgeon with > 200 prior robotic hysterectomies. All surgical team members underwent formal system training. Preoperative, intraoperative, and postoperative data were collected, including operative times, complications, estimated blood loss, and hospital stay. The setup, port placement, and docking process were detailed to serve as a reference for future users.

Results: The procedure was completed without intraoperative complications, conversions, or need for additional ports. Total operative time was 70 min: 6 min for port placement, 9 min for docking, 46 min of console time, and 9 min for closure. Estimated blood loss was 30 mL The patient was discharged on postoperative day one, and follow-up at 14 days was unremarkable. The surgical setup provided adequate ergonomics and workflow efficiency, with all robotic arms functioning without issue. Instrumentation was comparable to existing platforms.

Conclusion: In this first European experience, Toumai^® enabled a safe and efficient multi-port RATH with 70 min' total time and 30 mL blood loss, without complications or conversion. These feasibility data warrant a prospective series to assess reproducibility, learning curve, and cost-effectiveness.

Background: Performing an intestinal anastomosis is a challenging part of laparoscopic surgery, and ensuring adequate closure is essential to prevent anastomotic leakage. The aim of this study was to develop an objective method for quantitative assessment of laparoscopic intestinal anastomosis during simulation training.

Methods: A modular intraluminal air leakage device, the LeakChecker, was designed and validated by comparing laparoscopic intestinal anastomoses performed by laparoscopic novices and experts. The MaxForce, MeanNon-zero force, PathLength and DepthPerception parameters from the Lapron box-trainer vs MaxPressure and PressureArea from the LeakChecker were used for comparison.

Results: A functional prototype was built and the data of 10 laparoscopic novices and seven experts were included. Anastomoses made by the experts tolerated a higher MaxPressure (3,10(2,51-7,24)kPa vs 0,98(0,81-1,35)kPa; p=0.010) and showed a higher pressureArea (24,89(16,13-100,04)kPa*t vs 5,99(4,78-9,23)kPa*t; p=0.032). The Lapron box trainer data showed significant differences between the experts and novices for almost all including force and motion parameters.

Conclusion: The LeakChecker can quantify anastomotic leakage during training as it objectively distinguishes between novices and experts. Implementing this kind of smart training task in a training program with objective skill assessment would inform participants of both their instrument handing skills and the quality of their execution.

Background: Hysteroscopy allows direct inspection of the uterine cavity for many conditions. Despite being widely adopted, its diagnostic accuracy largely depends on surgeon expertise, leading to potentially misleading diagnoses. Artificial intelligence (AI) has shown robust performance in many areas of medical imaging. The application of AI to hysteroscopy can improve diagnostic reliability and clinical decision-making.

Methods: We carried out a systematic review following PRISMA guidelines to summarize current evidence on the use of AI in hysteroscopy. Eligible studies involved human subjects undergoing hysteroscopy in which AI models were applied to image or video data for diagnostic, classification, or prognostic purposes. Literature searches were conducted in PubMed, Scopus, and Web of Science up to August 2025. We extracted details on design, patient population, AI architecture, dataset characteristics, validation approach, and performance outcomes. Study quality and risk of bias were assessed with the Newcastle-Ottawa Scale.

Results: Fifteen studies published between 2021 and 2025 met the inclusion criteria. Applications of AI in hysteroscopy clustered around three major domains: intrauterine adhesions (IUAs), chronic endometritis (CE), and intracavitary lesions. For IUAs, predictive models demonstrated strong performance, with AUC values up to 0.99 for fertility and recurrence outcomes, highlighting the potential for AI to support tailored postoperative care. For CE, both Convolutional Neural Network-based methods and spectroscopy-assisted approaches achieved diagnostic concordance with histopathology exceeding 80-90%, suggesting that AI could potentially reduce the need for biopsy. In lesion classification, models achieved accuracies above 85% and, in some cases, outperformed gynecologists in distinguishing benign from malignant findings. Early work on real-time video analysis also demonstrated promise for intraoperative support. Overall, the quality of the studies included was moderate to high.

Conclusions: AI applied to hysteroscopy shows considerable promise for enhancing diagnostic accuracy, consistency, and intraoperative decision-making. To enable translation into practice, future research should emphasize multicenter collaborations, standardized imaging protocols, external validation, and the development of explainable models that can be trusted in clinical settings.

Aim: This study evaluated the feasibility and surgical outcomes of transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for retroperitoneal sentinel lymph node biopsy (SLNB), specifically targeting obese and morbidly obese patients diagnosed with endometrial cancer (EC).

Methods: Pathohistological evaluation confirmed the diagnosis of either Grade I or II endometrioid EC in all participants.

Results: In total, 31 patients participated in this study. The median age was 56 [43-75] years and the median BMI was 34 [30-54] kg/m2. Near-infrared fluorescence imaging utilizing ICG was implemented in 17 cases (54.8%), while methylene blue dye was used in 14 cases (45.2%). A median, 4 sentinel lymph nodes (SLNs) were excised per patient, with numbers ranging from 1 to 7. The overall SLN detection rate was 90.3%, with unilateral detection in 9.7% of patients and bilateral detection in 80.6%. During the surgery, two complications occurred, and an additional two developed afterward. In 3.2% of cases, it was required to switch to a conventional laparoscopic procedure. Lymphatic metastases were identified in 3 patients (9.7%). The median hospital stay was 2 days.

Conclusion: vNOTES can be a viable alternative to retroperitoneal SLNB, providing distinct benefits, especially for obese and morbidly obese patients with EC.

Background: The aim of this study was to evaluate factors causing difficulty in internal carotid artery (ICA) access using the left transradial approach for diagnostic cerebral angiography.

Methods: This was a prospective, single-centre, analytical study (n = 32 enrolled, n = 31 analysed) with an indication for diagnostic cerebral angiography. Diagnostic angiography via left transradial access was performed in all cases. Factors influencing the bilateral ICA catheterisation were evaluated.

Results: Diagnostic angiography was successfully completed in all 31 analysed patients (100%). Successful RICA catheterisation was observed in 25 (80.6%) cases, and LICA catheterisation was observed in 77.43% (24/31) of cases. Reflecting the hydrophilic guidewire off the aortic root/valve to gain support and advance the catheter into the ICA was required in 17/24 (70.8%) of LICA and 9/25 (36%) of RICA cases to facilitate catheterisation. Positive correlation was observed between BCA-LCCA, left CCA-left subclavian artery angles and inability to cannulate LICA. A Type III arch was associated with an increased LICA cannulation time. The presence of a bovine aortic arch necessitated the use of the reflected-wire technique to cannulate the LICA.

Conclusions: The reflected-wire technique can be used to facilitate ICA catheterisation via the left radial approach.

Background: Flexible needle puncture is a critical minimally invasive technique where path planning accuracy directly impacts clinical outcomes. Traditional finite element methods are computationally complex and inadequate for real-time procedures.

Methods: We propose a physics-informed neural network (PINN) approach for soft tissue puncture path planning. PINN models generate puncturable regions where rapidly-exploring random tree star (RRT*) performs path optimization using neural network-derived soft tissue mechanics models, avoiding collision risks. Progressive learning control strategies provide real-time path optimization, ensuring accurate needle targeting.

Results: Experimental results demonstrate dynamic puncture path correction with errors <1 mm, meeting clinical requirements. The progressive learning control strategy effectively optimizes path prediction models through data analysis.

Conclusion: The combined PINN-RRT* approach addresses modeling complexity, path planning difficulty, real-time adaptability, and expert dependence in traditional puncture techniques, significantly improving safety and efficiency.

Background: This study aimed to compare the clinical efficacy and prognosis of transcervical resection of polyp (TCRP) combined with levonorgestrel-releasing intrauterine system (LNG-IUS) or oral desogestrel and ethinyl estradiol tablets (DET) in patients with endometrial polyps (EMP).

Methods: A total of 100 EMP patients undergoing TCRP were divided into LNG-IUS (n = 50) and DET (n = 50) groups. Hemoglobin, endometrial thickness, FSH, E2, and LH levels were monitored pre-surgery and post-surgery. Clinical symptom improvement, adverse reactions, and recurrence rates were assessed over 12 months.

Results: Both treatments improved hemoglobin levels and reduced endometrial thickness, but the LNG-IUS group showed superior outcomes. At 12 months, it achieved higher improvement rates for dysmenorrhea (72.0% vs. 34.0%), abnormal cycles (60.0% vs. 24.0%), and blood loss (52.0% vs. 30.0%), with fewer adverse reactions (4.0% vs. 24.0%) and a lower recurrence rate (0% vs. 16.0%, all p < .05).

Conclusions: LNG-IUS with TCRP outperformed DET in reducing endometrial thickness, alleviating symptoms, lowering side effects, and preventing recurrence in EMP.

Background: This study evaluates outcomes of less invasive surgery (LIS) versus full sternotomy (FS) for left ventricular assist device (LVAD) implantation.

Methods: We retrospectively analyzed 115 consecutive adult patients receiving HeartMate 3 (HM3) or HeartWare (HVAD) intrapericardial centrifugal left ventricular assist device (LVAD) implantation (2010-2023) stratified by LIS vs. FS. Primary endpoint was one-year survival; secondary endpoints included right heart failure (RHF), temporary right ventricular assist device (t-RVAD) use, rethoracotomy for bleeding, driveline infection (DLI), cerebral stroke (CS), pump thrombosis (PT), gastrointestinal bleeding (GIB), and extubation time.

Results: The cohort included 24 LIS and 91 FS patients. LIS patients exhibited higher pulmonary artery pressures, pulmonary vascular resistance, and tricuspid regurgitation rate, along with lower pulmonary artery compliance index (all p < 0.05). LIS had significantly lower cardiopulmonary bypass (CPB) use (62.5% vs. 100%), and duration (60 vs. 92.5 min), and reduced blood product utilization (all p < 0.05). No cases of rethoracotomy for bleeding occurred (p = 0.037). A trend toward lower RHF and t-RVAD use was observed. Kaplan-Meier analysis revealed no significant differences in one-year survival and LVAD-related adverse events.

Conclusions: LIS showed comparable outcomes to FS, representing a potential alternative for selected LVAD recipients.