Minimally Invasive Therapy & Allied Technologies最新文献

Background: Esophagogastric junction (EGJ) cancer is becoming increasingly prevalent worldwide. Among surgical challenges, anastomotic leakage remains a significant concern. The optimal approach for Siewert type II tumors with an esophageal invasion of 2.1-4.0 cm is still debated. We employed a combined left thoracoscopic and laparoscopic approach with the patient in the right hemilateral position, enabling simultaneous thoracic and abdominal procedures without intraoperative repositioning.

Methods: We retrospectively reviewed patients with EGJ cancer and an esophageal invasion length of 2.1 to 4.0 cm who underwent the combined left thoracoscopic and laparoscopic approach between January 2021 and December 2024. Clinicopathological characteristics and surgical outcomes were evaluated and compared with those of patients treated with conventional laparoscopic transhiatal surgery during the same period.

Results: Eight patients underwent the combined approach. Surgical procedures included six proximal gastrectomies with single-flap esophagogastrostomy and two total gastrectomies. Compared with 12 patients who underwent conventional laparoscopic surgery, no anastomotic leakage was observed in the combined group, whereas leakage occurred in the conventional group.

Conclusions: The combined left thoracoscopic and laparoscopic approach appears to be a feasible and safe option for EGJ cancer with esophageal invasion of 2.1-4.0 cm. No anastomotic leakage was observed, and this approach allows for stable anastomosis under direct visualization without repositioning.

Background: This review assesses how fiber core size impacts energy delivery, degradation, safety, durability, fracture resistance, retropulsion, and flexibility.

Methods: A comprehensive search of PubMed and Cochrane databases identified 1,148 articles comparing fiber core sizes. After removing 109 duplicates and excluding 996 articles based on titles and abstracts, 43 full-text articles were reviewed. Of these, 30 were excluded for lacking relevant parameters or being review articles. One article was added manually, resulting in 14 studies in the final analysis.

Results: Smaller core fibers (≤300 μm) provide higher energy delivery and greater flexibility, making them ideal for lithotripsy. However, they are more prone to tip degradation and have lower durability under high-power conditions. Larger fibers (≥300 μm) demonstrate better energy efficiency, reduced degradation, and higher fracture resistance, making them suitable for high-energy applications like prostate enucleation. Thermal safety is influenced by both fiber size and irrigation; smaller fibers maintain safer temperatures with adequate irrigation. Retropulsion is less in small and large fibers compared to medium-core fibers (365-550 μm). Smaller fibers (150 μm) generate larger bubbles than larger fibers (272 μm).

Conclusion: Laser fiber core size influences energy delivery, durability, thermal safety, and flexibility, affecting endourological outcomes. Appropriate fiber selection improves procedural efficiency and safety.

Background: Preclinical training is essential for thermal ablation (TA) of thyroid nodules; however, there is a lack of optimal simulators. We aimed to create a training model for TA using live pigs, followed by neck surgery.

Methods: We recruited trainees from across China to participate in a workshop that included TA practice and subsequent transoral endoscopic thyroidectomy. The operative performance of trainees and any complications were documented. Following the workshop, participants completed online questionnaires using a 1-5 Likert Scale to evaluate their subjective experiences. The costs associated with the training were meticulously calculated.

Results: Five pigs were utilized for the workshop. Eighteen trainees and six mentors from seventeen institutions participated in the study. Seventeen trainees (94.4%; 95% CI, 74.2-99.0) successfully visualized the needle tips within the thyroid gland, while one was unsuccessful. Two trainees (11.1%; 95% CI, 2.0-30.8) experienced trachea injury during the subsequent thyroidectomy assessment. No cases of recurrent laryngeal nerve (RLN) injury were reported, as evaluated by neuromonitoring. Participants rated their operational experience with a score of 3.33 ± 1.05 compared to human procedures. Excluding labor costs, the average expense for each trainee for TA training was 50.4 ± 4.0 euros.

Conclusions: This study presents a cost-effective porcine training model for TA followed by neck surgery. The model provided a realistic simulation of human procedures and enabled immediate assessment of structural injuries, demonstrating its potential for use in TA training prior to human procedures.

Background: The factors associated with the success of each step of EUS-BD have not been fully explored. This study aimed to identify the factors associated with successful bile duct puncture for EUS-BD.

Methods: We retrospectively reviewed the data of patients with malignant biliary obstruction who underwent EUS-BD at a single institution between 2015 and 2025.

Results: EUS-BD was used to perform 46 bile duct punctures on 33 patients. The success rate of bile duct puncture was 80.4%. According to multivariate analysis, the angle of the scope and the puncture needle on the EUS monitor was identified as factors associated with the success of bile duct puncture (p < 0.01). The cutoff value for the angle between the scope and the puncture needle was 59 degrees, the area under the curve (AUC) was 0.86, the sensitivity of 75.7%, and the specificity was 100%.

Conclusions: The angle of the scope and the puncture needle was identified as factors associated with the success of bile duct puncture. Applying a strong up-angle to the scope and minimizing the use of the elevator to adjust the angle between the scope and the puncture needle may improve the success rate of bile duct puncture during EUS-BD.

Background: This study assesses a novel laparoscopic decompression technique supported by real-time multimodal neuromonitoring to improve surgical safety in sciatic and sacral nerve entrapments and to prevent motor deficits such as foot drop. The approach aims to address suspected neurovascular conflicts along the pelvic sidewall and sacral plexus.

Methods: A prospective observational study was performed between June 2023 and April 2024. Ten female patients with chronic pelvic neuropathic pain (including sciatica, pudendal neuralgia, and/or dyspareunia) unresponsive to at least one year of conservative treatment underwent laparoscopic nerve exploration and decompression of suspected pelvic nerve entrapments. Multimodal neuromonitoring involved transcranial motor evoked potentials (TcMEP), somatosensory evoked potentials (SEP), bulbocavernosus reflex (BCR), free-run EMG, and triggered EMG. Changes in neuromonitoring were recorded and correlated with postoperative neurological examinations and pain outcomes over a period of up to 12 months.

Results: Neurovascular conflict was identified in seven out of 10 patients (70%). After decompression, TcMEP amplitudes improved, BCR responses increased, and SEP signals remained stable, supporting the preservation of sensory pathways. No patient experienced new postoperative neurological deficits. Pain scores decreased significantly, and improvements were maintained throughout follow-up, with meaningful gains in daily functioning and a reduction in neuropathic symptom burden.

Conclusions: Laparoscopic nerve decompression assisted by real-time multimodal neuromonitoring appears feasible and safe for selected patients with refractory pelvic neuropathic pain. In this preliminary series, neuromonitoring provided actionable intraoperative feedback that may help optimise the extent of decompression while minimising the risk of motor impairment. These data support further multicentre evaluation to confirm efficacy, refine indications, and standardise monitoring-guided algorithms.

Background: As vaginal natural orifice transluminal endoscopic surgery (vNOTES) is gaining momentum and consolidating its position in minimally invasive surgery for various benign gynecologic conditions, we aimed to evaluate the feasibility, acceptability, and safety of vNOTES chromopertubation compared to laparoscopic chromopertubation in women with suspected tubal factor or unexplained infertility.

Methods: Women who underwent vNOTES or laparoscopic chromopertubation between January 2022 and June 2024 were retrospectively studied. After applying exclusion criteria, 58 eligible patients were identified and analyzed. The primary outcomes were surgical complications, overall satisfaction with the procedure, and postoperative pain. Secondary outcomes included the duration of the procedure and participants' postoperative experience of sexual discomfort or pain during intercourse.

Results: The basic preoperative demographic and clinical characteristics were comparable. No complications occurred in either surgical group (0/24 vs. 0/34). The duration of surgery (including additional interventions) and length of hospital stay were significantly shorter in the vNOTES CP group (p = 0.015 and 0.044, respectively). These differences were not observed when diagnostic-only cases were considered. The 6- and 12-h postoperative visual analogue scale (VAS) pain scores, as well as the total dose of non-narcotic analgesic used, were significantly lower in the vNOTES CP group (p = 0.004, <0.001, and 0.009, respectively). Changes in pre- and postoperative Female Sexual Function Index (FSFI) pain domain scores showed no statistically significant difference between the groups (p = 0.242). There were no differences in satisfaction with the method.

Conclusions: vNOTES chromopertubation appears to be an effective and feasible alternative to laparoscopy for chromopertubation, with greater operability in obese women, better esthetic outcomes, less postoperative pain, and a comparable impact on female sexual life. Larger, multicenter, prospective studies that also report subsequent fertility outcomes are needed to further quantify and determine the safety and broad applicability of vNOTES chromopertubation.

Background: This study aimed to develop and evaluate a novel sine-shaped electrode for reducing the thermal damage of intestinal anastomosis induced by radiofrequency energy.

Methods: An electrode with a sine-shaped structure was designed, and electrothermal simulations were conducted to evaluate the thermal damage to the welded intestine compared with the reference concave-convex electrode. Ex vivo tissue welding experiments were performed to investigate the temperature variation in the anastomotic stoma using an infrared thermal imager. The strength and microstructure of the anastomotic stoma were assessed using burst pressure measurements and histopathological observations, respectively.

Results: Simulation results revealed that the sine-shaped electrode reduced the maximum temperature, compared to the concave-convex electrode (81.5 vs. 93.2 °C). Ex vivo experiments indicated that the maximum temperatures of anastomotic stoma welded by the sine-shaped electrode and the concave-convex electrode were 80.3 °C and 96.8 °C, respectively, and the corresponding burst pressures of anastomotic stoma for the two groups were 55 ± 2 mmHg and 46 ± 2 mmHg, respectively. Histopathological results suggested that the tissues were anastomosed more tightly using the sine-shaped electrode.

Conclusion: The application of the sine-shaped electrode in RF tissue welding can protect the tissue from excessive thermal damage.

Background: Robotic gastrectomy (RG) is increasingly adopted for the treatment of gastric cancer due to its technical advantages. However, specific complications such as subcutaneous emphysema (SE) and port site dilation (PSD) may arise due to pneumoperitoneum and trocar manipulation. This study aimed to investigate the incidence and risk factors of SE and PSD, with a focus on differences between robotic platforms.

Methods: This retrospective study included 126 patients who underwent RG between April 2021 and April 2025. SE was defined as subcutaneous gas extending to the anterior chest wall on postoperative day 1. PSD was evaluated using intraoperative videos and defined as a visible gap between the trocar and abdominal wall. Multivariable logistic regression was performed to identify independent predictors of SE and PSD, including robotic system type (da Vinci Xi vs. hinotori^™).

Results: SE and PSD were observed in 20 (15.9%) and 21 (16.7%) patients, respectively. The use of the hinotori^™ was independently associated with a lower incidence of SE (OR: 0.085, 95% CI: 0.01-0.70, p = 0.02) and PSD (OR: 0.089, 95% CI: 0.016-0.39, p = 0.001). No significant association was found between SE or PSD and postoperative complications of Clavien-Dindo grade ≥ II or ≥ III.

Conclusions: The docking-free hinotori^™ platform significantly reduced the incidence of SE and PSD compared to the da Vinci Xi. Recognizing the mechanical features of each robotic system and tailoring platform selection to patient and procedural factors may improve surgical outcomes.

Background: This study aimed to compare the clinical outcomes, feasibility, and safety of three minimally invasive hysterectomy techniques-vaginal hysterectomy (VH), laparoscopic hysterectomy (LH), and transvaginal natural orifice transluminal endoscopic surgery (vNOTES)-in patients with benign uterine pathologies.

Methods: This single-center, pragmatic retrospective cross-sectional study was conducted at a tertiary care center in İzmir, Türkiye, between January 2024 and April 2025. A total of 1,146 patients who underwent hysterectomy for benign gynecological indications were included: 298 VH, 730 LH, and 118 vNOTES. Patients with advanced pelvic organ prolapse, severe intra-abdominal adhesions, or incomplete records were excluded. Evaluated outcomes included operative time, estimated blood loss, uterine weight, postoperative pain (visual analogue scale at 12 and 24 hours), complication rates (Clavien-Dindo classification), and length of hospital stay.

Results: VH had the shortest operative time, while vNOTES was faster than LH. Uterine weight was significantly higher in the LH and vNOTES groups. Postoperative pain at 12 hours was lowest in the vNOTES group, with no significant difference at 24 hours. The vNOTES group demonstrated the lowest overall complication rate (2.5%), and vaginal cuff complications were observed only in the VH and LH groups.

Conclusions: vNOTES hysterectomy was associated with lower early postoperative pain and fewer complications, supporting its safety and effectiveness in appropriately selected patients. Prospective multicenter studies are warranted to confirm these findings.

Background: Percutaneous endoscopic lumbar discectomy (PELD) is effective for far lateral lumbar disk herniation (FLLDH), requiring precise puncture. This study assessed 3D reconstruction combined with body-surface meshing for preoperative planning.

Methods: This prospective randomized controlled trial enrolled 53 FLLDH patients (L4-5/L5-S1) from 2023 to 2024, who were randomized to Group A (n = 29; CT-based 3D-planning with surface grids) or Group B (n = 24; conventional X-ray planning). Outcomes included puncture time, operative time, fluoroscopy frequency, and Oswestry Dysfunction Index (ODI).

Results: Baseline data were comparable (p > .05). Group A showed shorter puncture time (7.7 ± 2.1 min, 95% CI: 6.9-8.5 vs. 10.5 ± 3.8 min, 95% CI: 9.0-12.0), reduced operative time (48.7 ± 7.2 min, 95% CI: 46.2-51.2 vs. 55.2 ± 10.3 min, 95% CI: 51.0-59.4), and fewer fluoroscopy exposures (5.1 ± 1.9, 95% CI: 4.4-5.8 vs. 14.8 ± 3.9, 95% CI: 13.3-16.3; all p < .05). Both groups had improved ODI/VAS postoperatively (p < .05), with no intergroup clinical difference (p > .05).

Conclusions: 3D reconstruction enhances puncture precision and reduces intraoperative fluoroscopy reduction in FLLDH-PELD, with clinical outcomes comparable to those of conventional methods.