Minimally Invasive Therapy & Allied Technologies最新文献

Background: The spread of colorectal cancer screening has increased the percentage of patients with early-stage rectal cancer; at least 30% of patients are diagnosed with a clinical-stage cT1 or pT1 after endoscopic excision. In this subgroup of patients, the real advantage of total mesorectal excision (TME) over local excision (LE) is the ability to remove mesorectal nodes, which are metastatic in less than 20% of cases.

Method: To solve the unmet need for accurate nodal staging in patients with cT0/cT1, cN0 rectal cancer, we designed a pilot study that associates LE with mesorectal fluorescence-guided nodal sampling. From November 2018 to November 2023, we enrolled a total of ten patients with T1N0M0 rectal cancer. After extensive staging and adequate information, patients underwent endoscopic indocyanine green (ICG) infiltration and transanal local excision associated with laparoscopic fluorescence-guided mesorectal nodal sampling.

Results: After a median follow-up of 24 months (range 1-63 months), no case of local or nodal recurrence was observed. All patients were spared from ostomy and lower anterior resection syndrome.

Conclusions: In selected cases of cT0-1cN0 rectal cancer, transanal local excision plus ICG lymph nodal sampling is a feasible surgical option that increases the rate of organ preservation. Further studies are needed to identify the patients most likely to benefit from this minimally invasive strategy.

Background: The optimal reconstruction route after esophagectomy remains controversial. The retrosternal route has the advantage of a lower risk of fatal complications. However, the blind maneuver to create a retrosternal route may cause bleeding and pleural injury. Herein, we report a novel robotic technique for creating a retrosternal route.

Methods: This study included 43 consecutive patients with esophageal cancer who underwent robot-assisted minimally invasive esophagectomy with robotic retrosternal route reconstruction between April 2021 and December 2023. Clinicopathological findings and perioperative outcomes, including the time required to create the retrosternal route, were retrospectively analyzed. The creation times were also compared among surgeons.

Results: The median age and body mass index of the patients were 68 years (range: 46-80) and 21.4 kg/m2 (range: 16.6-30.2 kg/m2), respectively. Twenty-six patients (60%) received neoadjuvant chemotherapy. The median time to create the retrosternal route was nine minutes (range, 5-14 min). No cases showed pleural injury or postoperative hemorrhage associated with this procedure. There was no significant difference in the time taken to create the retrosternal route between the four surgeons (p = 0.434).

Conclusions: Robotic creation of a retrosternal route for gastric conduit reconstruction is simple, easy to learn, and results in a safe and feasible procedure.

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: 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: The aim of this study was to verify the safety and efficacy of endoscopic resection (ER) for gastric gastrointestinal stromal tumors (GISTs).

Methods: Among a consecutive series of resections for gastric GISTs performed in a single center, the outcomes of patients who had ER were compared to standard surgical resection (SR).

Results: In the cohort, 329 consecutive primary localized gastric GISTs patients (n, ER/SR = 251/78) were enrolled. Patients receiving ER were revealed to have preferable post-treatment outcomes, prolonged overall survival (OS) and disease-free survival (DFS). Tumor diameter, the only independent risk factor for a complicated post-operative course, was utilized for propensity score matching (PSM). In the PSM cohort, patients receiving ER and SR with similar tumor size (4.0 [2.7-4.5] cm) shared similar aggressiveness in terms of stomach layers of tumor origination and invasion, and modified National Institutes of Health (mNIH) risk criteria. Shorter operative time, fewer economic costs, and shorter post-operative stay were still observed in the ER group (ER vs. SR: 80 [49-120] vs. 120 [98-160] minutes, p < 0.001; 44 [38-51] vs. 60 [49-84] thousand Renminbi [kRMB], p < 0.001; 7.0 [6.0-8.0] vs. 8.5 [6.0-12] days, p = 0.018, respectively). No significant difference in OS and DFS was demonstrated in the PSM cohort.

Conclusions: ER is safe and effective, thus a feasible treatment option for indicated gastric GISTs patients with the advantage of faster recovery and lower economic costs.

Endovascular interventions excel in treating cardiovascular diseases in a minimally invasive manner, showing improved outcomes over open techniques. However, challenges related to precise navigation - still relying on 2D fluoroscopy - persist. This review examines the role of robotics, highlighting commercial and research platforms, while exploring emerging trends like MRI compatibility, enhanced navigation, and autonomy. MRI-compatible systems offer radiation-free 3D imaging. Human-robot interaction evolves with task-specific interfaces, while autonomy ranges from partial to full, aiding clinical operators. Challenges include complexity and cost, emphasizing compatibility and navigation advancements. Integrating MRI-compatible robots, refining human-robot interaction, and enhancing autonomy promise advancements in endovascular surgery, fueled by AI and innovative imaging.

Background: Placental volume measurements can potentially identify high-risk pregnancies. We aimed to develop and validate a new method for placental volume measurements using tracked 2D ultrasound and automatic image segmentation.

Methods: We included 43 pregnancies at gestational week 27 and acquired placental images using a 2D ultrasound probe with position tracking, and trained a convolutional neural network (CNN) for automatic image segmentation. The automatically segmented 2D images were combined with tracking data to calculate placental volume. For 15 of the included pregnancies, placental volume was also estimated based on MRI examinations, 3D ultrasound and manually segmented 2D ultrasound images. The ultrasound methods were compared to MRI (gold standard).

Results: The CNN demonstrated good performance in automatic image segmentation (F1-score 0.84). The correlation with MRI-based placental volume was similar for tracked 2D ultrasound using automatically segmented images (absolute agreement intraclass correlation coefficient [ICC] 0.58, 95% CI 0.13-0.84) and manually segmented images (ICC 0.59, 95% CI 0.13-0.84). The 3D ultrasound method showed lower ICC (0.35, 95% CI -0.11 to 0.74) than the methods based on tracked 2D ultrasound.

Conclusions: Tracked 2D ultrasound with automatic image segmentation is a promising new method for placental volume measurements and has potential for further improvement.

Background: Several modified endoscopic mucosal resection (EMR) techniques have been reported for colorectal tumors. Precutting-EMR (PEMR) is a modification wherein a circumferential mucosal incision is made around a lesion to facilitate en bloc resection. This review compared the efficacy and safety of PEMR with conventional EMR for colorectal lesions.

Methods: PubMed, Embase, Scopus, and Web of Science were searched for comparative studies available before February 15, 2024. This systematic review and meta-analysis were recorded in PROSPERO, identified as CRD42024509143.

Results: Two hundred and eight studies underwent screening of which seven studies were found eligible. We found no significant difference in en bloc resection rates but complete resection rates were significantly better with PEMR. The duration of the procedure was significantly longer with PEMR as compared to EMR. There was no difference in the risk of delayed bleeding and recurrence between the two groups but the risk of perforation was significantly increased with PEMR.

Conclusions: The use of PEMR for colorectal lesions can improve complete resection rates, albeit at the cost of increased duration of the procedure and higher perforation rates compared to conventional EMR. PEMR may also have a tendency of better en bloc resection rates which needs to be confirmed by further studies.

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: In robot-assisted radical prostatectomy (RARP), the peritoneal edges isolate the extended pelvic lymph node dissection bed from the peritoneal cavity. We studied the effect of peritoneal re-configuration through peritoneal flap fixation (PFF) with curling technique on lymphocele development.

Method: We included 2087 patients who underwent RARP between 2010 and 2022. Two hundred and thirty patients whose operation was performed using the PFF with curling technique were matched in a 1:1 ratio with non-PFF patients based on age, body mass index, initial prostate-specific antigen, and number of removed lymph nodes. Demographic, clinical, intraoperative and postoperative characteristics were collected. Complications were classified using the Clavien-Dindo system and the presence of lymphocele was documented.

Results: The two groups were similar in respect to matching parameters. Fifteen (6.5%) patients in the non-PFF group and two (0.9%) patients in the PFF group suffered from symptomatic lymphocele with symptoms such as abdominal pain, fever, lower extremity and/or genital oedema (p = 0.001). Asymptomatic lymphocele was diagnosed by ultrasonography in 19 (8.3%) patients in the non-PFF group and eight (3.5%) patients in the PFF group (p = 0.029).

Conclusion: The results of our study support this concept by providing solid indications of the clinical benefits and safety of PFF with the curling technique.