Minimally Invasive Therapy & Allied Technologies最新文献

Background: Modernly, abdominal surgery has shifted to minimally invasive techniques with an inclination towards fewer incisions. This has made intra-abdominal retraction more challenging. Despite development in retracting instrumentation for solid organs, the mobilization of the bowel remains challenging due to its friable nature. Therefore, there is a need to investigate the safety profile of internal retractors such as the EndoGrab for small-bowel retraction.

Methods: Twenty locations of small bowel were selected for EndoGrab retraction in two pigs. The locations were studied for iatrogenic injury at acute and delayed stages. Evaluation of injury was assessed clinically and histologically.

Results: After the EndoGrab application, no immediate signs of perforation or ischemia were observed. The clinical post-operative course was uncomplicated. Histopathology findings included serosal compression and minimal mucosal ulceration. Long-term changes showed mild changes of focal edema and fibrosis, with inter-individual variability in severity.

Conclusion: While there were no signs of overt macroscopic acute injury, minimal microscopic changes were evident. According to this small-scale study, the EndoGrab can provide an effective and safe solution for small-bowel self-retractors. More research is needed to acquire a higher level of evidence for safety. Such a solution could eliminate ports or assistants previously designed for retraction only.

Background: Treatment of large symptomatic renal angiomyolipomas (AMLs) in patients with a solitary kidney poses a challenge in controlling the tumor while preserving renal function. This retrospective research examines the safety and long-term effects of transarterial embolization (TAE) using iodized oil-bleomycin emulsion plus N-Butyl cyanoacrylate (NBCA) for treating large symptomatic AMLs in patients with a solitary kidney.

Methods: Over 20 years, 12 female patients, who had a solitary kidney due to a previous radical nephrectomy for AMLs, underwent TAE. Indications included symptomatic AMLs (retroperitoneal hematoma, hematuria or flank pain) and patients considered very high-risk for surgery (≥5 cm). The study evaluated adverse events (AEs), renal function changes, symptom relief, and tumor size.

Results: The median follow-up was 96 months. No significant kidney function decline was noted. Symptoms resolved completely in all patients, with the mean lesion diameter reducing from 7.2 ± 2.5 cm to 0.7 ± 0.5 cm (p < 0.01). Complete resolution (CR) of AMLs occurred in nine patients (83.3%), with no recurrence during follow-up.

Conclusions: TAE with iodized oil-bleomycin emulsion plus NBCA for treatment with large symptomatic AMLs in solitary kidney is safe and durability effect, with complete resolution of the symptoms, high rate CR of the tumors, without deterioration of the renal function.

Trial registration: ChiCTR2100053296.

Background: The aim of this study was to report the institutional experience with robot-assisted trans-vesical vesico-vaginal fistula (VVF) repair focusing on technical points.

Methods: Patients diagnosed with VVF who came to our observation between December 2020 and January 2024 were included in the analysis. Beyond computed tomography scan, all patients underwent pre-operative cystoscopy; a cystography could also be executed. All patients were scheduled for robot-assisted repair with trans-vesical approach.

Results: Five VVFs were developed after previous gynecological surgery, while one occurred after a urological surgical procedure. The median operative time was 137 min [interquartile range (IQR) (99-150)]. Intraoperative blood loss was negligible. The average hospital stay was six days. The urinary catheter was removed within four weeks (median catheterization time, 16.5 days) (IQR 14-27) after cystography was negative for leakages. One patient reported fever within three months from surgery (Clavien II). Pathology reports were negative for malignancies in all cases. No recurrences were reported during the follow-up.

Conclusions: Robotic repair of VVF with a trans-vesical approach represents a safe and effective surgical option.

Background: In patients with malignant biliary and duodenal obstruction (MBDO), biliary and duodenal double stenting is necessary. However, whether the time to recurrent biliary obstruction (TRBO) can be extended with ERCP-guided biliary drainage (ERCP-BD) or EUS-guided BD (EUS-BD) has not been sufficiently elucidated. Therefore, the aim of this study was to determine whether ERCP-BD or EUS-BD was more useful for increasing the TRBO with duodenal stenting.

Methods: We compared the TRBO with duodenal stenting and other clinical outcomes between ERCP-BD and EUS-BD in MBDO patients. We matched the patient characteristics of the two groups using propensity scores.

Results: Technical success was greater in the EUS-BD group (n = 17/17, 100%) than in the ERCP-BD group (n = 32/52, 61.5%) (p < 0.01). After propensity score matching, 17 matched pairs were included for further analysis. There was no significant difference in the TRBO following duodenal stenting between the ERCP-BD group (median of 62 days) and the EUS-BD group (median of 68 days) (p = 0.94).

Conclusion: The TRBO following duodenal stenting was comparable between ERCP-BD and EUS-BD. The technical success of EUS-BD was superior to that of ERCP-BD; therefore, EUS-BD might be the optimal choice for endoscopic BD in MBDO patients.

Background: Advancements in transanal management of rectal tumours have improved outcomes in appropriately selected patients. However, variation exists regarding optimal perioperative investigational and surgical strategy. This survey captures current opinions and practices of surgeons managing rectal neoplasia transanally.

Methods: Electronic survey regarding theranostic approaches for the transanal management of rectal neoplasia distributed via European surgical associations' mailing lists.

Results: One hundred and thirty-four surgeons from 29 countries responded, 49%, 80% and 4.5% of whom respectively perform ≤5, ≤10, and >20 excisions/year. Transanal Minimally Invasive Surgery (TAMIS) was the most popular access method (75.4%), with rigid platforms (Transanal Endoscopic Microsurgery/Transanal Endoscopic Operation) and flexible methods being used similarly (42.5% vs. 43.3%). MRI was considered the most reliable preoperative investigation overall. Surgeons performing >10 cases/year were more likely to use submucosal (53.8% vs. 31.1%, p = 0.03) and intermuscular (38.5% vs. 14.2%, p = 0.005) planes of excision and narrow band imaging as an assessment requirement (p = 0.009) but less likely to insist on MRI (p < 0.001). Surgeons performing >5 cases/year were more likely to use multiple access methods (67.6% vs. 40.9%, p = 0.003). TAMIS users were more likely to perform full thickness and intermuscular excisions (p < 0.001) with surgeons who use flexible endoscopy more likely to use the submucosal plan (p < 0.001).

Conclusions: Various surgical and perioperative practices exist for significant rectal neoplasia with significant variance by caseload, access method, and geographical location.

Background: This systematic review reports the presently available evidence regarding the results of the minimally invasive surgery (MIS) approach for the treatment of inguinoscrotal hernias (ISHs).

Methods: After PROSPERO registration (CRD-42023493129), a search was performed in the MEDLINE, Embase, and Web of Science databases.

Results: One-thousand-fifty-two patients were included (78.3% and 21.7% underwent transabdominal preperitoneal repair [TAPP] and totally extraperitoneal repair [TEP], respectively). Twenty-one complications occurred during TAPP (2.5%), and 28 occurred during TEP (12.3%). Conversion to open surgery for TAPP procedure was reported in seven patients (0.8%). TEP procedure required conversion to TAPP in 19 patients (8.3%), and open surgery in 18 patients (7.9%) (overall conversion rate 16.2%). Postoperative complication rate was 30.1% (317 patients), with 193 after TAPP repair (23.4%) and 124 after TEP repair (54.4%) (including Clavien-Dindo I-IV). Length of hospital stay ranged between one to five days after both repairs. The overall recurrence rate was 1.6% (19 recurrences), of which 12 (1.3%) and seven (2.8%) recurrences after TAPP and TEP, respectively.

Conclusions: MIS approaches for ISH repair are technically challenging. TEP repair should be avoided in case of ISH repair, due to the high rate of postoperative complications, risk of conversion and recurrences.

Background: To optimize the design of the stent graft (SG) with a non-isopeak-ring, this study investigates the radial support and bending flexibility properties of SGs with different spacing, number of peaks, and peak heights.

Methods: Numerical simulation and physical experiments were used to compare the mechanical properties of isopeak-ring SGs and non-isopeak-ring SGs.

Results: Greater spacing of stent rings can provide greater bending flexibility; fewer peaks in the stent ring result in more radial support and less spring-back force. The SG design featuring a gradient of five wave peaks and a minimum stent ring spacing of 5 mm has the best flexibility. The relationship in terms of radial support force magnitude is as follows: isopeak-ring with heights of 13 mm > combination > gradient > isopeak-ring with heights of 16 mm. Additionally, the smaller the peak height, the greater its radial support.

Conclusions: It is found that the gradient SG with five peaks not only provides sufficient radial support but also demonstrates superior flexibility compared to other types of SGs.

Background: This study aimed to assess how embolization endpoints affect the efficacy of uterine artery embolization (UAE) for adenomyosis.

Methods: In this single-center retrospective cohort study, patients treated with UAE from 2014-2018 received the standard embolization endpoint (SEE), while those from 2019-2022 received the delayed embolization endpoint (DEE). Clinical outcomes, including embolic microsphere volume, uterine volume, CA125 levels, hemoglobin, menstrual flow, dysmenorrhea, and postoperative complications, were compared between the groups.

Results: At six months post-procedure, all patients showed significant improvement in clinical indicators (p < 0.01). Group DEE used significantly more embolic microspheres than Group SEE (p < 0.01) and achieved greater reductions in CA125, menstrual volume, and dysmenorrhea (p < 0.05). There were no significant differences in postoperative uterine volume, hemoglobin, or complication rates between the groups (p > 0.05).

Conclusions: UAE is a safe and effective treatment for adenomyosis. Compared to the standard approach, the delayed embolization endpoint provides superior symptom relief and warrants broader clinical adoption.

Background: This study compares vaginal natural orifice transluminal endoscopic surgery (vNOTES) and total laparoscopic hysterectomy (TLH) in terms of clinical outcomes, complications, and recovery.

Methods: A retrospective study was conducted on 143 patients who underwent hysterectomy for benign gynecologic conditions (vNOTES: 63; TLH: 80). Demographic, intraoperative, and postoperative outcomes were analyzed.

Results: vNOTES had a significantly shorter operative time (87 ± 22 vs. 103 ± 22 min, p < .001) and lower blood loss (138 ± 99 vs. 302 ± 132 cm³, p < .001). Postoperative pain scores were lower on days 1, 3, and 7 (p < .001). Patients ambulated earlier (5.87 ± 1.11 vs. 6.59 ± 1.28 h, p < .001) and resumed daily activities faster (6.83 ± 1.1 vs. 7.89 ± 1.17 days, p < .001). No significant differences were found in hospital stay (p = .10), intraoperative complications (p = 1.000), or re-intervention/readmission rates (p = 1.000).

Conclusions: vNOTES is a safe, effective alternative to TLH with advantages in efficiency, pain management, and recovery. However, its learning curve may limit widespread use. Further studies are needed to confirm long-term benefits.

Background: This multicenter retrospective study aimed to assess the surgical outcomes of vNOTES-HUSLS and sacrocolpopexy after vNOTES hysterectomy for apical pelvic organ prolapse (POP).

Methods: A total of 101 patients were included. Pre and postoperative modified POP-Q scores, postoperative Visual Analog Scale (VAS) scores and complications were among the information gathered. POP-Q-C score of less than -1 cm was considered an apical recurrence. 'Overall success' was defined as the absence of each of the following factors: ≥ Stage 2 POP (in any compartment), retreatment for prolapse.

Results: vNOTES-HUSLS (n = 78) achieved an overall success rate of 92.2%, accompanied by a low intraoperative complication rate of 2.6% (n = 2) at the 23-month median follow-up. vNOTES-sacrocolpopexy (n = 23) achieved an anatomical success rate of 78.3% and exhibited a low intraoperative complication rate of 4.3% (n = 1) at the 21-month median follow-up. The apical prolapse recurrence rate was 2.6% and 8.7% in the HUSLS and sacrocolpopexy groups, respectively (p = 0.185). Total duration of surgery and VAS scores were significantly lower in the vNOTES-HUSLS group than in the vNOTES-sacrocolpopexy group.

Conclusions: In POP surgery, HUSLS and sacrocolpopexy may be performed using the vNOTES technique depending on the patient's preference for natural tissue repair or mesh use.