Minimally Invasive Therapy & Allied Technologies最新文献

Background: This study aims to report the currently available evidence on minimally invasive surgery (MIS) in emergency settings for treating acute incarcerated/strangulated ventral, primary, or incisional hernias and compare it with the open approach.

Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement.

Results: Six articles were included. Results of the meta-analysis based on 1720 patients and two articles show that the mean operative time was shorter in the open repair group compared to the MIS group (mean difference [MD], 39.53 min; p < 0.0002). Overall, 116 (13.6%) and 181 (20.9%) postoperative complications were observed after MIS and open repair, respectively (relative risk [RR], 0.65; p = 0.61). MIS was associated with a statistically significantly lower wound complication rate than the open approach (RR, 0.43; p = 0.50). The two approaches showed equivalent results regarding return to the operative room (RR, 0.61; p = 0.13). The mean hospital stay in the MIS group was shorter than the open group (MD, -0.68; p = 0.99).

Conclusions: MIS in emergency settings seems feasible for treating acute incarcerated ventral hernias. However, due to the limitations of the included studies, the obtained evidence should be analyzed with caution. Further prospective studies are required to draw definitive conclusions.

Background: Magnesium alloys have great potentials as bioabsorbable implants, whereas the difficulty in evaluating hydrogen gas produced in the degradation process has hindered their research and development. In this study, we investigated the possibility of industrial microfocus X-ray computed tomography (micro-CT) for the precise evaluation of subcutaneous emphysematous changes in a rabbit implantation model.

Methods: Magnesium plates with/without porous venting were implanted under skin defects on the backs of rabbits. The graft sites were examined by industrial micro-CT after sacrificing. The captured images were reconstructed three-dimensionally for volumetric analyses. The tissues of the graft site were also examined in the traditional histological investigation.

Results: We were able to image and numerate the shape and volume of subcutaneous emphysema using industrial micro-CT. The volume of emphysema was suppressed by pores punched in samples, and this trend increased as the number of pores increased. In the traditional histological examination, inflammatory changes were observed, but the emphysema could not be measured quantitatively.

Conclusions: Industrial micro-CT imaging makes it possible to visualize and evaluate magnesium-induced subcutaneous emphysema in animal experiment. This cross-border technology has the potential to be widely applied to other life science fields.

Background: Full sternotomy is the standard approach for combined surgery. Evidence of the minimally invasive approach's advantages for aortic and mitral valve surgery has been reported. Our aim was to report our experience with minithoracotomy for elective patients presenting with aortic valve stenosis associated with right coronary artery disease.

Material and methods: Between January 2016 and August 2021, 17 patients underwent concomitant aortic valve replacement and right coronary artery bypass grafting by right anterior thoracotomy.

Results: The mean age was 73.3 years and the mean EuroSCORE 2 was 2.07 ± 1.24. Mean cardiopulmonary bypass and aortic cross-clamp times were 148 ± 29 min and 111 ± 20 min. Thirteen patients (76.0%) had femoral cannulation. Nine saphenous veins (53%), seven right internal thoracic arteries (41%), and one radial artery (6%) were used as a graft. Twelve patients benefited from ultrasonic flow measurements to control the graft. The mean flow rate was 47 ± 39 ml/min, and the mean pulsatility index was 2.4 ± 1.2. The mean postoperative transvalvular gradient was 10.9 ± 4 mmHg. Two patients presented with Grade 1 aortic insufficiency (12%). There was no 30-day mortality.

Conclusions: Combined aortic valve replacement and right coronary artery bypass grafting through right anterior thoracotomy is reliable and reproducible in selected patients.

Background: We conducted a retrospective cohort study of women with suspected tubal factor infertility who underwent vaginal natural orifice endoluminal surgery (vNOTES) chromopertubation and adnexal anatomy assessment at a large referral hospital.

Methods: Twelve women aged between 29 and 38 years with suspected tubal factor infertility who underwent vNOTES chromopertubation were retrospectively examined. Demographic data, as well as clinical and surgical characteristics, were reviewed and the surgical technique was defined.

Results: The mean BMI was 34.2 ± 7.12 kg/m² (range 24.7-42.6). No conversion to laparotomy or laparoscopy was required. The median operative time was 39 (26.5-42) minutes. The median VAS scores at six and 12 h postoperatively were 3.5 (3-4) and 2 (1-2), respectively. There were no complications and all patients were discharged at the 12th postoperative hour.

Conclusions: Considering the increased risk of surgical morbidity and mortality associated with increasing BMI and the difficulty in gaining access to the abdominal cavity not only in obese women but also in cases with previous extensive midline incisions, where dense intra-abdominal adhesions are likely, or in cases where esthetic considerations are important, vNOTES appears to be a useful alternative to assess tubal patency and adnexal anatomy and even to perform concomitant adnexal surgery.

Background: Our objective in this study was to evaluate the short-term clinical efficacy and safety of endoscopic cardiac mucosal ligation, a novel endoscopic procedure, in the treatment of gastroesophageal reflux disease (GERD).

Methods: Patients diagnosed with refractory GERD or recurrent patients due to drug withdrawal admitted to our hospital were recruited in this clinical trial. All GERD patients were treated with endoscopic cardiac mucosal ligation. Postoperatively, all patients received subsequent follow-ups for approximately four months to evaluate the efficacy and safety of this endoscopic procedure.

Results: A total of 13 GERD patients were enrolled. Endoscopic cardiac mucosal ligation was successfully performed in all cases. Postoperatively, relevant symptoms were significantly alleviated in 10 patients (76.9%). The average Gastroesophageal Reflux Disease Questionnaire (GERD-Q) score in all participants significantly decreased from preoperative 10.0 ± 3.5 to postoperative 7.8 ± 2.9 (p = .022). The average GERD symptom questionnaire score was 27.0 ± 12.0 prior to surgery, which significantly decreased to 18.3 ± 7.5 postoperatively (p = .032). No severe postoperative complications were observed during subsequent follow-ups.

Conclusions: Endoscopic cardiac mucosal ligation might be a novel effective and safe endoscopic procedure for GERD.

Background: The purpose of this study was to examine the association between video gaming experience, spatial cognition, and laparoscopic surgical skills in a cohort of 50 medical students.

Method: Participants were assessed for video gaming experience, spatial cognition, and laparoscopic skills. The number of hours played per week was also recorded. Structural equation modeling was used to determine the relationship between these variables.

Results: Our findings revealed that video gaming experience and spatial cognition exerted a positive influence on laparoscopic skills. Interestingly, students who excessively indulged in video games without concomitant improvements in spatial cognition experienced a negative impact on their laparoscopic skills.

Conclusions: These findings underscore the potential of video gaming as a tool for improving surgical skills, but also highlight the potential downsides of excessive gaming. The positive correlation between gaming and surgical skills suggests that video games could be integrated into surgical education. Future research should focus on identifying specific video games that effectively promote visuospatial skills as well as determining the optimal balance between gaming and traditional surgical training.

Background: Specific types of gastric tumors, including gastric linitis plastica and lymphoma, may cause extensive deep-layer infiltration, impeding an accurate diagnosis with endoscopic biopsy. This study aims to evaluate the efficacy of endoscopic ultrasound (EUS)-guided bite-on-bite biopsy and EUS-guided fine-needle aspiration (EUS-FNA) in diagnosing gastric malignancies with negative endoscopic biopsies.

Methods: We retrospectively analyzed suspicious malignant gastric lesion cases in our hospital from October 2017 to August 2023. Clinical manifestations, radiographical examinations, endoscopic examinations, histopathological results, and therapeutic strategies were recorded and analyzed.

Results: Forty malignant gastric tumor cases with negative endoscopic biopsies were incorporated into our study. EUS-guided bite-on-bite biopsy was performed in 16 cases exclusively, whereas 17 patients received EUS-FNA exclusively, and seven patients underwent both simultaneously. Among the 23 patients who received the EUS-guided bite-on-bite biopsy, 22 (95.7%) were diagnosed with malignancies. Among the 24 patients who received EUS-FNA, a total of 19 cases with malignancies (79.2%) were confirmed by EUS-FNA (p = 0.11): 13 gastric adenocarcinomas, five metastatic malignancies, and one malignant stromal tumor. No adverse events were observed in any of the cases.

Conclusions: EUS-guided bite-on-bite biopsy and EUS-FNA possess their advantages and disadvantages. EUS-guided bite-on-bite biopsy could serve as a reliable diagnostic method for shallow lesions with negative malignant endoscopic biopsies.

Introduction: The diagnostic workflow for endometrial carcinoma in postmenopausal asymptomatic women remains an ongoing dilemma. Whereas an ultrasonographic endometrial thickness greater than 4.0 or 5.0 mm is adequate for warranting further investigations in women with postmenopausal vaginal bleeding, there is still no unanimous consensus on what the ideal endometrial thickness cut-off should be, justifying additional inspection through endometrial sampling when bleeding is absent.

Methods: A comprehensive overview of the most recent literature to summarize the clinical pathway necessary for the diagnostic assessment of a postmenopausal asymptomatic woman with increased ultrasonographic endometrial thickness.

Results: An endometrial thickness cut-off between 3.0 and 5.9 mm seems to show the lowest specificity while also reducing the chances of missing malignancy. If endometrial thickness can be a valid starting point, a careful evaluation of the other ultrasonographic endometrial features and a thorough scrutiny of patients' risk factors are pivotal to standardizing the diagnostic process while avoiding overtreatment. Although preventing unnecessary procedures is crucial, stratifying the risk and proceeding with further investigations (preferably through outpatient or office hysteroscopically-guided targeted biopsies) should be the goal.

Conclusions: Closer collaboration between different fields of medicine (ultrasonography, hysteroscopy, and oncology) is strongly encouraged to facilitate early diagnosis of asymptomatic postmenopausal women at risk of developing endometrial malignancy.

Background: Narrow-band imaging (NBI) is a novel endoscopic imaging technology that improves the visibility of capillaries. The aim of this study was to evaluate the efficacy of NBI hysteroscopic excision in symptomatic post-cesarean scar diverticulum (PCSD) patients compared to conventional white light (WL) hysteroscopy.

Method: A total of 73 patients with symptomatic PCSD between January 2014 and December 2018 were enrolled. The enrolled patients were stratified into NBI and WL groups according to whether they received NBI or WL hysteroscopy. Postoperative menstrual patterns at one, six, and 12 months after the operation were collected and compared between the NBI and WL groups.

Results: A total of 32 patients underwent NBI hysteroscopy (NBI group), while 41 patients received WL hysteroscopy (WL group). The symptom-free remission rates in the NBI group were significantly higher than in the WL group at six months and 12 months post-hysteroscopy. At the final follow-up, the menstrual bleeding duration in the NBI group was significantly shorter than in the WL group.

Conclusion: The use of NBI hysteroscopy in treating symptomatic PCSD resulted in shorter menstrual bleeding days and longer symptomatic remission compared to conventional WL hysteroscopy.