Minimally Invasive Therapy & Allied Technologies最新文献

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: In robot-assisted radical prostatectomy (RARP), the peritoneal edges isolate the extended pelvic lymph node dissection bed from the peritoneal cavity. We studied the effect of peritoneal re-configuration through peritoneal flap fixation (PFF) with curling technique on lymphocele development.

Method: We included 2087 patients who underwent RARP between 2010 and 2022. Two hundred and thirty patients whose operation was performed using the PFF with curling technique were matched in a 1:1 ratio with non-PFF patients based on age, body mass index, initial prostate-specific antigen, and number of removed lymph nodes. Demographic, clinical, intraoperative and postoperative characteristics were collected. Complications were classified using the Clavien-Dindo system and the presence of lymphocele was documented.

Results: The two groups were similar in respect to matching parameters. Fifteen (6.5%) patients in the non-PFF group and two (0.9%) patients in the PFF group suffered from symptomatic lymphocele with symptoms such as abdominal pain, fever, lower extremity and/or genital oedema (p = 0.001). Asymptomatic lymphocele was diagnosed by ultrasonography in 19 (8.3%) patients in the non-PFF group and eight (3.5%) patients in the PFF group (p = 0.029).

Conclusion: The results of our study support this concept by providing solid indications of the clinical benefits and safety of PFF with the curling technique.

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: 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: The proliferation of several robotic platforms presents an opportunity to pinpoint the most suitable system for specific procedures and patient profiles. This study aims to explore differences in complications and functional outcomes among patients undergoing deep endometriosis excision with the da Vinci surgical system compared to the Hugo^™ RAS system.

Method: This is a retrospective, multicenter cohort study. Patients were categorized based on the surgical system used: the Da Vinci system and the Hugo^™ RAS system. Perioperative complications, functional outcomes (via validated questionnaire: BFLUTS, KESS, GIQLI), and pain symptoms both before and after surgery were compared between the two groups.

Results: A total of six postoperative complications were reported: four in the Da Vinci system group (20%) and two in the Hugo^™ RAS system group (12.5%). No difference in the mean operative time (p = 0.647), median estimated blood loss (p = 0.179), and hospital stay (p < 0.0001) was found between the two groups. A significant difference was reported in questionnaire score changes and dyspareunia severity in the da Vinci system arm.

Conclusions: Both robotic systems offer comparable performances in terms of intraoperative complications, although there was a higher incidence of postoperative complications in patients who underwent surgery with the Da Vinci system. Moreover, there was an improvement in dyspareunia, urinary, and gastrointestinal function in the same group.

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.

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: The objective of this study was to assess the application value of SOMATOM Force computed tomography (CT) in assisting the preoperative localization of colorectal cancer resection surgery.

Method: Retrospectively, the medical data of 120 inpatients with colorectal cancer were collected. The Kappa consistency test was used to evaluate diagnostic consistency in the localization and staging of colorectal cancer. The diagnostic value of preoperative SOMATOM Force CT detection was analyzed.

Results: In 120 colorectal cancer patients, the accuracy of SOMATOM Force CT for preoperative localization, T staging, and N staging of colorectal cancer were 91.7% (kappa = 0.837), 88.3% (kappa = 0.772) and 91.7% (kappa = 0.773), respectively. Among 45 rectum cancer patients, there were 19 positive cases with circumferential resection margin involvement, and the accuracy of SOMATOM Force CT detection was 86.7% (kappa = 0.767). The sensitivity, specificity, positive predictive value, and negative predictive value of SOMATOM Force CT detection in evaluating the circumferential resection margin involvement of rectum cancer were 78.95%, 96.15%, 93.75%, and 86.21%, respectively.

Conclusions: There was an important application value of SOMATOM Force CT in assisting the preoperative localization and tumor staging of colorectal cancer resection surgery. There was a good diagnostic value of preoperative SOMATOM Force CT detection in evaluating the circumferential resection margin involvement of rectum cancer.

Background: The aim of this study was to compare and analyze the clinical effects of endoscopic submucosal dissection (ESD) and endoscopic band electrocision ligation (EEL) in the removal of gastric submucosal tumors (SMTs).

Method: We analyzed the clinical data of 130 patients with gastrointestinal SMTs (diameter ≤10 mm) who underwent endoscopic resection, including 62 cases in the EEL group and 68 in the ESD group, and compared indicators such as surgical time, intraoperative and postoperative complications, postoperative hospital stay, and surgical cost, between the EEL and ESD group.

Results: EEL surgery time (8.9 ± 1.1 min) was significantly shorter than the ESD group (62.3 ± 2.8 min) (p < .05), EEL surgery cost (5126.8 ± 26.5 yuan) was significantly lower than the ESD group (15721.3 ± 39.6 yuan) (p < .05), and intraoperative blood loss was also markedly lower in the EEL group (5.6 ± 1.7 ml) compared to the ESD group (42.3 ± 3.5 ml) (p < .05). There was no statistically significant difference in postoperative hospitalization time or postoperative complication incidence between the two groups (p > .05).

Conclusions: In treating gastric muscular, mucosal, or submucosal tumors with a diameter of less than 10 mm, the EEL surgical method was superior to the ESD surgical method in terms of surgical time, intraoperative blood loss, and cost. There was no difference in hospital stay and postoperative complication rate between the two methods, which was worthy of clinical application.

Background: Intrahepatic bile duct stones, although common and benign, require varying therapeutic strategies due to their recurrent nature. Inadequate management can escalate to liver cirrhosis or cholangiocarcinoma. A surgical method merging indocyanine green fluorescence imaging (ICG-FI) with liver cone unit resection is optimal, ensuring complete lesion removal and healthy liver tissue conservation.

Method: A retrospective descriptive study was conducted on 15 patients with intrahepatic bile duct stones who were admitted to Sichuan Provincial People's Hospital from January 2021 to December 2023. All patients underwent laparoscopic anatomical liver resection guided by ICG-FI.

Results: Among the 15 patients included in the study, ten were male and five were female, with an average age of 52 years. All patients were free from underlying medical conditions. Intraoperatively, ICG-FI was good, with clear boundaries, and all patients successfully underwent surgery without any conversions to open surgery. The mean operative time was 236 ± 56 min, and the estimated blood loss was 320 ± 75 ml. Patients had a postoperative hospital stay of 5.5 ± 1.5 days. No severe complications occurred.

Conclusions: Real-time ICG-FI with anatomical liver resection is a safe and effective approach for managing intrahepatic bile duct stones.