Minimally Invasive Therapy & Allied Technologies最新文献

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.

Background: Robotic systems offer the great advantage of articulation; however, high cost is a limitation. ArtiSential^® is a laparoscopic forceps that combines the advantages of low cost and articulation. This study was conducted to determine the learning effect of ArtiSential^®.

Methods: Participants were divided into two groups: those who had performed >100 laparoscopic surgeries (experts) and those who had not (novices). The participants were assigned the task of peg transfer three times a day, for a total of 15 times over five days. The time spent on the task and the number of pegs that dropped during the transfer were recorded.

Results: Thirty surgeons (15 experts and 15 novices) participated in the study. Both the average time and the number of pegs dropped decreased progressively with practice. The learning effect for task completion time reached a plateau after 11 tasks (p < 0.05). There was no significant difference between experts and novices in either the time or the number of pegs dropped.

Conclusions: ArtiSential^® can be learned in a relatively short period of time and prior laparoscopic experience does not significantly affect the learning curve. Articulating forceps are inexpensive, easy to learn, and provide a valuable alternative to achieve greater freedom in surgery.

Background: In minimally invasive surgery, designing puncture needles with customizable structures to achieve personalized puncture performance is a significant challenge. Existing reverse design methods struggle to capture the complex nonlinear behavior of needle-tissue interactions.

Methods: This study proposes a machine-learning-based reverse design method aimed at achieving precise customization of needle mechanical behavior. We developed a rapid reverse design framework integrating machine learning and finite element analysis, capable of directly generating optimal structural parameters from target puncture force-penetration depth curves. Through training on large-scale finite element simulation data, deep learning neural network models captured the complex mapping relationship between needle structure and mechanical response.

Results: In rigorous cross-validation, the prediction results showed normalized root mean square errors (NRMSE) of 0.06381 and 0.06234 compared to the target curves and finite element analysis, respectively. The model achieved 98.2% classification accuracy for curve types, with loss functions converging to optimal values after sufficient training epochs.

Conclusion: This approach demonstrates high accuracy and robustness in needle-design customization. It not only opens new avenues for rapid, customized design of puncture needles but also provides an innovative paradigm for intelligent design of complex medical devices, potentially advancing precision medicine technologies and shortening design cycles.

Background: This study evaluates the clinical feasibility and perioperative outcomes of vaginal natural orifice transluminal endoscopic surgery (vNOTES) for adnexal procedures, with particular emphasis on postoperative sexual function and dyspareunia.

Methods: A retrospective cohort study was conducted at İzmir City Hospital between October 2023 and June 2025, including reproductive-aged patients without future fertility desire, an intact uterus, and indications for bilateral salpingectomy for gynecologic cancer prophylaxis. Patients underwent either vNOTES or conventional laparoscopic salpingectomy. Perioperative outcomes-including operative time, blood loss, complications, analgesic use, hospital stay, conversion to laparotomy, hemoglobin change, and pain scores at six and 24 hours-were compared. Postoperative sexual function was assessed using the Female Sexual Function Index (FSFI) and Couple Satisfaction Index-16 (CSI-16) at three and six months. Dyspareunia was evaluated using a standardized surgeon-designed questionnaire.

Results: A total of 467 patients were analyzed (vNOTES: 233; laparoscopy: 234). vNOTES was associated with significantly shorter operative time, reduced intraoperative blood loss, lower postoperative pain scores, and decreased analgesic requirements. No conversions to laparotomy occurred in either group. FSFI and CSI-16 scores showed no significant differences between groups at six months, and dyspareunia rates were comparable.

Conclusion: vNOTES salpingectomy demonstrates perioperative advantages over laparoscopy without adversely affecting sexual function. It represents a safe and effective alternative for appropriately selected patients.

Background: A new type of percutaneous gastrostomy device, designed not to use any guidewires during the procedure, is now available. This study aimed to evaluate the feasibility and clinical outcomes of this device for computer tomography-guided percutaneous gastrostomy (CT-PG).

Methods: Retrospective, single-center study reviewed patients who underwent CT-PG with the non-guidewire gastrostomy device between September 2020 and August 2024. CT-PG was indicated only for patients who had previously experienced failure of percutaneous endoscopic gastrostomy (PEG). The study assessed technical outcomes during the CT-PG procedure with the non-guidewire device and clinical outcomes following the CT-PG.

Results: A total of 24 patients were enrolled in this study. Technical success was achieved in all cases. The mean procedural time was 30.2 min, and the mean radiation dose was 548.9 mGy·cm. Minor hematoma in the greater omentum occurred in four cases, but none of them required transfusion or invasive intervention. No major complications were observed. The mean follow-up period after CT-PG was 253.6 days, with no gastrostomy-related complications affecting its function as a feeding route.

Conclusions: The non-guidewire gastrostomy device is a feasible option for gastrostomy formation under CT fluoroscopy, offering favorable clinical outcomes.

Background: At present, the microwave ablation needle used in clinic needs to add water circulation in the needle rod to reduce the rod temperature. However, the water circulation will take away a lot of heat during the ablation process, which requires increasing the ablation dose to achieve the expected thermal coagulation target volume. This undoubtedly increases the risk of carbonization.

Methods: A design scheme of non-water-cooled microwave ablation needle based on double-layer vacuum structure was proposed. Two types of non-water-cooled microwave ablation needles with long and short needles were designed, and the ablation simulation was carried out by establishing the finite element simulation model.

Results: Simulation and experimental results indicate that, at 20 W power, the long-needle vacuum tube ablation needle can create a carbonization-free solidification zone with a length of 34 mm after 180 s of ablation, whereas the short-needle vacuum tube ablation needle requires 300 s to form a similar zone with a length of 30 mm. Additionally, the axial ratio of the solidification zone created by the long-needle vacuum tube ablation needle exceeds that of the short-needle one. Consequently, the long-needle vacuum tube ablation needle is more apt for creating a larger solidification zone with minimal carbonization, while also achieving a more spherical shape.By comparing the ablation effects of long needle vacuum tube ablation needle and ky-2450b1 under low power,It is verified that the vacuum tube non-water-cooled ablation needle can ensure the effective ablation volume and non carbonization ablation under low-power and short-time ablation, which provides an important technical scheme for clinical optimization of the therapeutic effect of microwave ablation.

Conclusions: The LPH-W-F-MWA is more adept at creating a larger coagulation zone with minimal carbonization, achieving a more spherical shape to a greater extent. This ensures both an effective ablation volume and char-free ablation, offering a crucial technical solution for optimizing the therapeutic effect of MWA in clinical settings.