Minimally Invasive Therapy & Allied Technologies最新文献

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.

Background: Esophageal cancer is a common malignancy in China, with anastomotic fistula being a major postoperative complication. This study compares the clinical outcomes of end-to-end anastomosis and end-to-end anastomosis with mucosal folding and burying in minimally invasive esophageal cancer surgery.

Methods: From October 2020 to March 2023, patients with esophageal cancer who underwent laparoscopic three-incision cervical anastomosis at the Fourth People's Hospital of Zigong City, were radomly assigned to receive either end-to-end anastomosis or end-to-end anastomosis followed by mucosal folding and burying. Clinical indicators, including hospitalization time, operation time, intraoperative blood loss, anastomotic fistula, and anastomotic stenosis, were compared between the two groups.

Results: A total of 107 patients werencluded, with 56 in the end-to-end anastomosis with mucosal folding and burying technique group. There were no statistically significant differences between the two groups in operation time, intraoperative blood loss, anastomotic fistula rate, and anastomotic stenosis. However, for patients who received preoperative chemoradiotherapy or chemotherapy combined with immunotherapy, the incidence of anastomotic fistula was significantly lower in the group with end-to-end anastomosis with mucosal folding and burying.

Conclusions: End-to-end anastomosis followed by mucosal folding and burying helps reduce the occurrence of anastomotic fistula, especially in patients receiving neoadjuvant chemoradiotherapy.

Background: This study aims to report the currently available evidence on minimally invasive surgery (MIS) in emergency settings for treating acute incarcerated/strangulated ventral, primary, or incisional hernias and compare it with the open approach.

Methods: A systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement.

Results: Six articles were included. Results of the meta-analysis based on 1720 patients and two articles show that the mean operative time was shorter in the open repair group compared to the MIS group (mean difference [MD], 39.53 min; p < 0.0002). Overall, 116 (13.6%) and 181 (20.9%) postoperative complications were observed after MIS and open repair, respectively (relative risk [RR], 0.65; p = 0.61). MIS was associated with a statistically significantly lower wound complication rate than the open approach (RR, 0.43; p = 0.50). The two approaches showed equivalent results regarding return to the operative room (RR, 0.61; p = 0.13). The mean hospital stay in the MIS group was shorter than the open group (MD, -0.68; p = 0.99).

Conclusions: MIS in emergency settings seems feasible for treating acute incarcerated ventral hernias. However, due to the limitations of the included studies, the obtained evidence should be analyzed with caution. Further prospective studies are required to draw definitive conclusions.

Background: This study compared two minimally invasive hysterectomy techniques-single-port umbilical laparoscopy (SPLS) and vaginal natural orifice transluminal endoscopic surgery (vNOTES)-in terms of operating time, blood loss, postoperative pain, and hospitalization duration.

Methods: We retrospectively analyzed patients who underwent hysterectomy via SPLS or vNOTES. Inclusion criteria were patients who had a hysterectomy with bilateral salpingectomy, with additional procedures such as salpingo-oophorectomy or sentinel lymph node dissection as indicated.

Results: Among the 121 patients studied, 63 underwent SPLS and 58 underwent vNOTES. The mean operative time was 67.3 ± 15.9 min for vNOTES and 75.7 ± 12.1 min for SPLS. Six patients (9.5%) in the SPLS group and four (6.9%) in the vNOTES group underwent sentinel lymph node biopsies for endometrial cancer. Pain assessment at six, 12, and 24 h after surgery indicated lower visual analog scale (VAS) scores in the vNOTES group. Notably, patients in that group reported reduced shoulder and umbilical pain at 24 h postoperatively. Those patients also showed improved sexual function index scores and reduced dyspareunia, although the differences were not statistically significant.

Conclusions: The vNOTES approach to hysterectomy is a viable alternative, characterized by shorter operative times and decreased postoperative pain without increasing complication rates.

Background: Laparoscopic surgery requires a complex set of motor skills. Currently, basic laparoscopic skills training is performed in a static environment, while intraoperatively, abdominal tissue is often moving. The aim of this study was to develop a dynamic training platform and evaluate its impact on laparoscopic skills acquisition in a box trainer.

Methods: The Dynamic Laparoscopic Platform (DyLaP) includes a moving base which has been intergrated with the Lapron box trainer and the ForceSense objective measurement system. Dynamic training was evaluated in a comparative study where novices were divided into a static and dynamic training group, performing six training trials of a peg transfer task with the DyLaP. Afterwards, both groups performed a dynamic exam task. Task manipulation (force) and instrument efficiency (path length and time) were measured.

Results: Participants (n = 12) exhibited a significant difference (p < 0.05) in time, path length, and maximum force between the static and dynamic groups in the first trial. Learning curves were most prevalent in the dynamic group.

Conclusions: The DyLaP can be used to provide a challenging and realistic training environment. From the comparative peg transfer study, it can be concluded that dynamic training significantly affects laparoscopic skill acquisition. More research is needed to evaluate dynamic training effects in force-based training tasks.

Background: Robotic-assisted endoluminal systems are rapidly evolving within the field of minimally invasive surgery. The IDEAL framework (Idea, Development, Exploration, Assessment, and Surveillance) can be used to evaluate novel technologies. This review provides a summary of current and emerging endoluminal systems using the IDEAL framework.

Methods: A scoping review was conducted to include all existing and developing robotic-assisted endoluminal systems. Data was collected via virtual interviews, questionnaires, biomedical databases, company websites, and peer-reviewed articles. Key metrics were reported, enabling the assignment of each system to an IDEAL stage.

Results: The review identified 17 distinct systems from 16 companies. Nine systems received regulatory approval in their respective countries. Our evaluation showed that two systems were at the pre-IDEAL Stage 0. Seven systems were in the Idea stage (Stage 1), six systems were in the Development stage (Stage 2) and two systems completed Stage 3. No system underwent long-term study evaluation (Stage 4).

Conclusions: There is a gap in long-term clinical data of robotic-assisted endoluminal systems, indicated by the absence of systems at Stage 4. Collaborative efforts amongst the medical community, regulatory bodies, and industry specialists are vital to ensure the delivery of evidence-based medicine in the discipline of robotics.