Minimally Invasive Therapy & Allied Technologies最新文献

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.

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.

Background: Different reconstruction techniques after total mesorectal excision have been described, such as straight coloanal anastomosis, colonic J-pouch, side-to-end anastomosis and transverse coloplasty pouch. Establishing which technique is the best in functional terms is essential to improving a patient's quality of life.

Methods: We compared benefits and harms of different reconstructive techniques. The primary outcome was to compare functional results at 18 months after surgery (long-term). Secondary outcomes were the same as primary but at different time intervals (short-term and medium-term) and perioperative morbidity and mortality.

Results: Forty-one reports of 36 trials were included in the analysis. According to primary outcome, no significant difference was observed in terms of bowel frequency, while colonic J-pouch resulted in a lower incidence of faecal urgency only compared to side-to-end. Only up to 18 months after bowel restoration bowel frequency, fecal urgency and the number of individuals using anti-diarrheal medications were reduced in the colonic J-pouch group. No difference in mortality/morbidity could be assessed among the techniques, but a lower rate of anastomotic leak after side-to-end compared to straight coloanal anastomosis was observed.

Conclusions: Evidence suggests that reconstruction with colonic J-pouch offers similar long-term benefits to straight coloanal anastomosis and Transverse coloplasty pouch, while superior to side-to-end.

Background: This review aimed to provide evidence on the efficacy of liposomal bupivacaine as compared to standard bupivacaine for intercostal nerve blocks (ICB) in patients undergoing minimally invasive thoracic surgery.

Methods: Randomized controlled trials (RCTs) and comparative observational studies published on the databases of PubMed, CENTRAL, Web of Science, and Embase up to June 20, 2024, were included. Total opioid consumption in morphine equivalents, pain scores, and length of hospital stay (LOS) were compared.

Results: Two RCTs and eight observational studies were included. Eight hundred and four patients received liposomal bupivacaine while 631 patients received standard bupivacaine in the included studies. The meta-analysis showed that the use of liposomal bupivacaine for ICB did not reduce opioid consumption as compared to standard bupivacaine at 24 h, 48 h, and for the total duration of hospitalization. Pain scores were also not significantly different between the two groups at 24 h and 48 h. Meta-analysis showed that there was no difference in the LOS between intervention and control groups. Subgroup analysis based on study design also generated similar results.

Conclusions: Mostly low-quality evidence shows that liposomal bupivacaine does not offer additional benefits over standard bupivacaine when used for ICB in patients undergoing minimally invasive thoracic surgery.

Background: The aim of this study was to investigate the clinical outcomes after a transumbilical single-site laparoscopic-assisted Soave operation (TSLSO) for Hirschsprung disease (HD) in children, with a 10-year follow‑up results assessment.

Methods: We retrospectively analyzed the clinical data of 165 children with HD from January 2013 to January 2023. The operation method was a TSLSO. The operation time, intraoperative bleeding, postoperative abdominal drainage time, postoperative hospitalization time, and postoperative complications were analyzed.

Results: All 165 cases were successfully completed using the TSLSO. The median operative time was 160 (120-210) minutes, and the median volume of bleeding was 9 mL (3-15 mL). The median length of the resected intestine was 25 cm (20-32 cm), and the median postoperative peritoneal drainage time was 4.2 days (3-6 days). Postoperative defecation function generally recovered well, there was no recurrence of constipation. There were three cases of anal stenosis, 12 cases of perianal dermatitis, two cases of adhesive intestinal obstruction, 14 cases of soiling, and 18 cases of enterocolitis.

Conclusion: The TSLSO is a safe and feasible surgical method for the treatment of HD in children. It has the advantages of little bleeding, a good cosmetic effect, and fast postoperative recovery. However, it does require skilled laparoscopic technique by the surgeon.

Background: We conducted a retrospective cohort study of women with suspected tubal factor infertility who underwent vaginal natural orifice endoluminal surgery (vNOTES) chromopertubation and adnexal anatomy assessment at a large referral hospital.

Methods: Twelve women aged between 29 and 38 years with suspected tubal factor infertility who underwent vNOTES chromopertubation were retrospectively examined. Demographic data, as well as clinical and surgical characteristics, were reviewed and the surgical technique was defined.

Results: The mean BMI was 34.2 ± 7.12 kg/m² (range 24.7-42.6). No conversion to laparotomy or laparoscopy was required. The median operative time was 39 (26.5-42) minutes. The median VAS scores at six and 12 h postoperatively were 3.5 (3-4) and 2 (1-2), respectively. There were no complications and all patients were discharged at the 12th postoperative hour.

Conclusions: Considering the increased risk of surgical morbidity and mortality associated with increasing BMI and the difficulty in gaining access to the abdominal cavity not only in obese women but also in cases with previous extensive midline incisions, where dense intra-abdominal adhesions are likely, or in cases where esthetic considerations are important, vNOTES appears to be a useful alternative to assess tubal patency and adnexal anatomy and even to perform concomitant adnexal surgery.

Background: Magnesium alloys have great potentials as bioabsorbable implants, whereas the difficulty in evaluating hydrogen gas produced in the degradation process has hindered their research and development. In this study, we investigated the possibility of industrial microfocus X-ray computed tomography (micro-CT) for the precise evaluation of subcutaneous emphysematous changes in a rabbit implantation model.

Methods: Magnesium plates with/without porous venting were implanted under skin defects on the backs of rabbits. The graft sites were examined by industrial micro-CT after sacrificing. The captured images were reconstructed three-dimensionally for volumetric analyses. The tissues of the graft site were also examined in the traditional histological investigation.

Results: We were able to image and numerate the shape and volume of subcutaneous emphysema using industrial micro-CT. The volume of emphysema was suppressed by pores punched in samples, and this trend increased as the number of pores increased. In the traditional histological examination, inflammatory changes were observed, but the emphysema could not be measured quantitatively.

Conclusions: Industrial micro-CT imaging makes it possible to visualize and evaluate magnesium-induced subcutaneous emphysema in animal experiment. This cross-border technology has the potential to be widely applied to other life science fields.

Background: Full sternotomy is the standard approach for combined surgery. Evidence of the minimally invasive approach's advantages for aortic and mitral valve surgery has been reported. Our aim was to report our experience with minithoracotomy for elective patients presenting with aortic valve stenosis associated with right coronary artery disease.

Material and methods: Between January 2016 and August 2021, 17 patients underwent concomitant aortic valve replacement and right coronary artery bypass grafting by right anterior thoracotomy.

Results: The mean age was 73.3 years and the mean EuroSCORE 2 was 2.07 ± 1.24. Mean cardiopulmonary bypass and aortic cross-clamp times were 148 ± 29 min and 111 ± 20 min. Thirteen patients (76.0%) had femoral cannulation. Nine saphenous veins (53%), seven right internal thoracic arteries (41%), and one radial artery (6%) were used as a graft. Twelve patients benefited from ultrasonic flow measurements to control the graft. The mean flow rate was 47 ± 39 ml/min, and the mean pulsatility index was 2.4 ± 1.2. The mean postoperative transvalvular gradient was 10.9 ± 4 mmHg. Two patients presented with Grade 1 aortic insufficiency (12%). There was no 30-day mortality.

Conclusions: Combined aortic valve replacement and right coronary artery bypass grafting through right anterior thoracotomy is reliable and reproducible in selected patients.