Minimally Invasive Therapy & Allied Technologies最新文献

Background: Urological repairs require secure suturing for effective healing. While conventional sutures like Vicryl are common, barbed sutures offer knotless options. This study aims to compare the histopathological effects of barbed and conventional sutures on the bladder.

Method: Forty-eight adult Wistar female rats underwent bladder suturing with one of three suture materials: V-Loc^™ 90, Quill^™, or Vicryl. Each rat's anterior bladder wall was sutured with the designated material, and rats were sacrificed at 6- and 9-weeks post-surgery for histopathological evaluation. Tissue reaction, inflammatory reaction, fibrosis, and suture dissolution were assessed by a blinded pathologist.

Results: Vicryl sutures showed significant reductions in tissue reaction, inflammatory reaction, and fibrosis from 6 to 9 weeks (p < 0.05). Quill sutures exhibited an increase in fibrosis over the same period (p < 0.001), while V-Loc sutures showed no significant changes. Comparative analysis revealed Vicryl had the best overall performance in terms of reduced tissue reaction and inflammation.

Conclusions: Vicryl sutures demonstrated superior long-term histopathological outcomes compared to barbed sutures, indicating their potential preference for reconstructive bladder surgeries. Our findings emphasize the necessity of conducting additional studies on different anatomical tissues as well as refining suture selection for various surgical situations.

Introduction: Hysteroscopy is a critical procedure in gynecology for diagnosing and managing intrauterine pathology. Traditional hands-on training faces ethical and safety challenges, leading to an increased reliance on simulation training. This review systematically assesses the effectiveness of hysteroscopic simulation training in enhancing the technical skills of obstetrics and gynecology residents and medical students.

Methods: A PRISMA-guided literature search was conducted, covering English-language articles from January 2000 to December 2023. Studies were selected based on pre-defined criteria, focusing on the impact of simulation training on the targeted educational group. Metrics for evaluating skill improvement included machine-recorded metrics, Objective Structured Assessment of Technical Skills (OSATS), and global rating scales.

Results: The review included nine studies with varied designs, demonstrating significant improvements in hysteroscopic skills following simulation training. Virtual reality (VR) simulators showed substantial benefits in skill acquisition, while physical simulators provided valuable tactile feedback. However, long-term skill retention and the impact on non-technical skills were not adequately assessed.

Conclusions: Simulation-based training effectively enhances hysteroscopic skills in medical students and residents. Further research is needed to explore long-term skill retention and the development of non-technical competencies. Robust studies, including randomized trials, are required for definitive validation.

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 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: Hysterectomy for endometrial hyperplasia and endometrial cancer in morbidly obese patients is challenging. Here, we reported data regarding three minimally invasive approaches.

Method: This is a multicenter retrospective study evaluating 30-day and 90-day surgery-related outcomes of morbidly obese patients (those with BMI > 40kg/m²) undergoing robotic-assisted, laparoscopic, and vaginal hysterectomy.

Results: Charts of 95 morbidly obese patients who underwent surgery for endometrial cancer were retrieved. Overall, robotic-assisted, laparoscopic, and vaginal surgeries were performed in 35 (36.8%), 38 (40%), and 22 (23.2%) patients, respectively. Patients having robotic-assisted surgery experienced longer operative time than patients having vaginal and laparoscopic approaches (p < 0.001). Surgical approaches did not influence the risk of having intraoperative and severe (Clavien-Dindo grade 3 or more) postoperative complications. No 90-day mortality occurred.

Conclusions: Robotic-assisted, laparoscopic, and vaginal surgery represent three safe and feasible minimally invasive approaches to manage morbidly obese patients with endometrial hyperplasia and endometrial 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: Targeted microwave ablation (TMA) is a novel modality of focal therapy to treat localized prostate cancer (PCa). We evaluated its short-term functional and oncologic outcomes.

Method: We performed a single-center, prospective, interventional phase I-II pilot trial (NCT04627896). TMA was performed in 11 patients with a single intracapsular MRI-visible lesion ≤12 mm, International Society of Urological Pathology (ISUP) grade ≤ 2, Prostate Specific Antigen (PSA) < 20 ng/mL, and a 5-mm safety distance from apex and rectum. Patients were treated with a 12 W very low-loss microwaves ablation system, guided by 3D ultrasound/MRI fusion imaging. Follow-up consisted in clinical visits, PSA and validated questionnaires. MRI was scheduled at five months and rebiopsy at six months. The primary endpoints of study were safety and efficacy (absence of tumour in the treated area).

Results: No severe complications were reported. All patients were discharged the same day of treatment without bladder catheter. No significant changes in PSA or questionnaires scores were reported. At rebiopsy, no cancer was found in five patients (45%); eight patients (73%) had an absence of in-field PCa and nine patients (82%) had an absence of in-field ISUP ≥ 2 PCa. New cancer foci outside the treated area were found in three patients (27%). Limitations of this study were the very limited sample size, the short follow-up, and the lack of a comparator.

Conclusions: TMA guided by fusion imaging is a safe modality with good ablative efficacy.

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.