Minimally Invasive Therapy & Allied Technologies最新文献

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.

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: 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.