Minimally Invasive Therapy & Allied Technologies最新文献

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.

Background: The purpose of this study was to evaluate the feasibility, safety, and efficacy of robotic single-port hysterectomy (R-SPH) with the da Vinci SP in low-risk endometrial cancer.

Methods: Patients with clinically confirmed endometrioid endometrial cancer, FIGO stages IA-IB, were enrolled for R-SPH. All surgical procedures were performed through a single 2.5 cm umbilical incision. An Intuitive Access Port of small size was placed into the incision, and pneumoperitoneum was established. Robotic instruments were inserted as described below through the Intuitive Access Port, which has four different channel ports: in the superior channel, a three-dimensional 8.5 mm optics; in channel 1, Cadiere Forceps; in channel 2, a Maryland Bipolar; and in channel 3, monopolar scissors.

Results: From June 24 to November 13, 2024, a total of 25 patients were included in the study. The median age was 61 years, and median BMI was 25.9 kg/m². The median docking time, console time, and total operative time were 10, 65, and 115 min, respectively. The median blood loss was 67.0 mL, and the median hemoglobin drop was 1.2 g/dL.

Conclusions: R-SPH seems safe and feasible in endometrial cancer. The true benefit of the technique should be sought in larger comparative studies. ClinicalTrials.gov Protocol Record: NCT06681831.

Background: To validate whether the SATA-LRS, a novel reusable articulating laparoscopic instrument, fits surgical practice, a pre-clinical study was performed.

Methods: Thirteen medical doctors used the instrument in a laparoscopic endoscopic inguinal hernia repair (TEP)-like task inside a cadaver. A set of sensors on the instrument handle detected motion and articulation of the instrument tip. Data from the sensors and video recordings were used to assess the amount and type of movement of the instrument and the time spent on tasks. questionnaire was used to gain insight into the participants' perception of the contextual factors.

Results: There was no difference between task time and instrument tip velocities when using articulation (or not) and all participants used articulation at least half of the task time. Instrument-handle movement, indicating the user's hand and arm movement, was significantly reduced when using articulation. The questionnaire indicated strong acceptance of the instrument and the experimental setup, and a desire to use the instrument in surgery by most participants.

Conclusions: The added articulation feature of the SATA-LRS instrument was deemed beneficial by the participants, showed no increased handling complexity or time spent on the task and was used frequently when enabled, indicating intuitiveness.

Background: This pilot study investigates the adaptability of the articulating instrument (ArtiSential) among surgeons with different levels of experience in conventional laparoscopic surgery.

Methods: From June to November 2023, 18 laparoscopic surgeons participated in peg transfer and suture training using ArtiSential instruments. Participants were categorized into novice, intermediate, and expert groups. Peg transfer was repeated three times, comparing dominant and non-dominant hand. Suture training was conducted at four directional positions (1, 12, 3, and 5 o'clock) and analyzed across three trials.

Results: In terms of peg transfer timing analysis, there are significant differences between the three groups in the first (p < 0.001) and second trials (p = 0.011). However, in the third trial, the gap between the three groups decreased. In all three groups, the suture times at 3 o'clock and 5 o'clock were consistently lower compared to the 1 o'clock and 12 o'clock directions. As the trials progressed, the time decreased for suturing in all directions. Among them, the novice group had reduced suture times at 3 o'clock and 5 o'clock direction.

Conclusions: The ArtiSential instrument is adaptable even for novices. Its articulating features facilitate suturing in traditionally difficult directions (3 o'clock and 5 o'clock) for right-handed users.

Background: The purpose of this study was to illustrate the technique of our full retroperitoneoscopic radical nephroureterectomy (frRNU) involving an intracorporeal, extravesical bladder cuff excision (BCE) and assess its safety and early oncological outcomes.

Methods: Between June 2020 and November 2023, 27 patients underwent frRNU for upper tract urothelial carcinoma. Surgical and oncological outcomes were assessed.

Results: Two (7%) patients were converted to open distal ureterectomy due to extensive fibrosis of the iliac ureter. Lymph node dissection (LND) was performed in 85% of procedures. Median operative time and blood losses were 230 (IQR: 188, 255) minutes and 125 (IQR: 100, 150) mL, respectively. Complication rate was 33%, with only two (7%) Clavien Dindo ≥ 3 complications and two (7%) patients experienced urinary fistula. Catheter was removed after six (IQR: 5, 7) days. All patients had negative surgical margins and three (11%) were pN+, with 6.5 (IQR: 3, 14) nodes removed. At a median follow-up of 11 (IQR: 3, 25) months, four (15%) patients had bladder recurrence, while no retroperitoneal recurrence occurred.

Conclusions: Our frRNU is feasible and safe, allowing for appropriate BCE and LND. Surgical outcomes are optimal, complication rate acceptable and short-term oncological outcomes promising.

Background: Laser lithotripsy is a minimally invasive procedure performed by a urologist using a ureteroscope, a device composed of a flexible laser fiber and a camera. The camera is used to physically view and manually target the stone ablated by the laser. The procedure involves the risk of unintentional trauma caused by the laser when the stones are out of target due to their retro-pulsive movement.

Methods: To minimize clinical complications, we propose a Level I/II autonomous system in robotic lithotripsy. The system consists of a robotic catheter and an integrated U-Net segmentation method. The system aims to automatically target the stones during lithotripsy and guide ureteroscope navigation autonomously.

Results: The proposed system is designed and validated using a phantom specifically manufactured to investigate the feasibility of autonomous stone ablation. An overall target accuracy of 99.97% (leave-one-out: 99.971 min, 99.975 max) was reported.

Conclusions: We successfully implemented a stone targeting method and integrated it with our robotic system to evaluate the level of success in autonomously targeting the stones. The results, indicate that autonomy in robot assisted lithotripsy is feasible.