Minimally Invasive Therapy & Allied Technologies最新文献

Background: Few studies have analyzed the effect of the size of the working space in training on the acquisition of endoscopic skills. In this study, adult- and infant-sized dry boxes (DBs) were used to verify how the size of the working space in training affects forceps manipulation and learning curve.

Material and methods: Seventy-two medical students were enrolled. The task was peg transfer. The training environment was divided into adult- and infant-sized DBs. Skill evaluations were also divided into adult- and infant-sized DBs (four groups in total). The forceps manipulation characteristics and task completion time were compared before and after training.

Results: Regarding skill evaluations using adult-sized DBs, there were no significant differences between the infant- and adult-sized DB-trained groups. Regarding skill evaluations using infant-sized DBs, there were no significant differences between the groups before training. After training, there was no significant difference in the total path length or average acceleration of the forceps between the groups. However, the infant-sized DB-trained group had a significantly faster average forceps velocity and faster task completion time than the adult-sized DB-trained group.

Conclusion: Training with a small DB is more efficient in acquiring smoother and faster forceps manipulation in a small working space.

Background: Specific types of gastric tumors, including gastric linitis plastica and lymphoma, may cause extensive deep-layer infiltration, impeding an accurate diagnosis with endoscopic biopsy. This study aims to evaluate the efficacy of endoscopic ultrasound (EUS)-guided bite-on-bite biopsy and EUS-guided fine-needle aspiration (EUS-FNA) in diagnosing gastric malignancies with negative endoscopic biopsies.

Methods: We retrospectively analyzed suspicious malignant gastric lesion cases in our hospital from October 2017 to August 2023. Clinical manifestations, radiographical examinations, endoscopic examinations, histopathological results, and therapeutic strategies were recorded and analyzed.

Results: Forty malignant gastric tumor cases with negative endoscopic biopsies were incorporated into our study. EUS-guided bite-on-bite biopsy was performed in 16 cases exclusively, whereas 17 patients received EUS-FNA exclusively, and seven patients underwent both simultaneously. Among the 23 patients who received the EUS-guided bite-on-bite biopsy, 22 (95.7%) were diagnosed with malignancies. Among the 24 patients who received EUS-FNA, a total of 19 cases with malignancies (79.2%) were confirmed by EUS-FNA (p = 0.11): 13 gastric adenocarcinomas, five metastatic malignancies, and one malignant stromal tumor. No adverse events were observed in any of the cases.

Conclusions: EUS-guided bite-on-bite biopsy and EUS-FNA possess their advantages and disadvantages. EUS-guided bite-on-bite biopsy could serve as a reliable diagnostic method for shallow lesions with negative malignant endoscopic biopsies.

Background: The purpose of this study was to examine the association between video gaming experience, spatial cognition, and laparoscopic surgical skills in a cohort of 50 medical students.

Method: Participants were assessed for video gaming experience, spatial cognition, and laparoscopic skills. The number of hours played per week was also recorded. Structural equation modeling was used to determine the relationship between these variables.

Results: Our findings revealed that video gaming experience and spatial cognition exerted a positive influence on laparoscopic skills. Interestingly, students who excessively indulged in video games without concomitant improvements in spatial cognition experienced a negative impact on their laparoscopic skills.

Conclusions: These findings underscore the potential of video gaming as a tool for improving surgical skills, but also highlight the potential downsides of excessive gaming. The positive correlation between gaming and surgical skills suggests that video games could be integrated into surgical education. Future research should focus on identifying specific video games that effectively promote visuospatial skills as well as determining the optimal balance between gaming and traditional surgical training.

Objective: This research is aimed at evaluating the efficacy and safety of ablation of ventricular tachyarrhythmias using high-density mapping in patients with non-ischemic etiology.

Material and methods: This study analyzed 60 patients with ventricular tachyarrhythmias, using diagnostic tools like electrocardiography and MRI. Treatment involved epicardial ablation following the E. Sosa method, with efficacy evaluated through the SF-36 survey and MRI. Success rates were categorized, and post-treatment care included troponin monitoring and aspirin. Data was analyzed using Excel and Statistika 11.0.

Results: Of the 60 patients, 30 underwent surgery at the City Cardiological Center in Almaty and 30 patients were operated on at the National Research Cardiac Surgery Center in Astana. Prior to surgery, all patients underwent a standard clinical diagnostic examination followed by ablation of ventricular tachyarrhythmias using high-density mapping. After six and 12 months from the beginning of the study, all patients underwent a follow-up examination, with an assessment of the effectiveness of the above treatment. After 12 months, follow-up examination of patients showed good results. Left ventricular ejection fraction in patients after 12 months increased from 47 ± 2.4 to 58 ± 4.5%. The end-diastolic diameter of the left ventricle decreased from 61.2 ± 2.31 to 50.1 ± 1.9 mm.

Conclusion: In summary, the study highlights the efficacy and safety of high-density mapping ablation in treating ventricular tachyarrhythmias, especially from the right ventricular outflow tract in patients with reduced left ventricular ejection fraction. The success rate of the procedure was 95%. This approach proves beneficial for patients unresponsive to antiarrhythmic therapy, enhancing both the quality of life and potentially reducing mortality in patients with ventricular arrhythmias.

We report a case of postoperative pseudoaneurysm, successfully treated with selective arterial embolization, using a steerable microcatheter and triaxial system via retrograde approach. A pseudoaneurysm was detected in the dorsal pancreatic artery, a severely narrow and steeply inverted branch of the superior mesenteric artery, making microcatheter insertion via the antegrade approach challenging. However, a steerable microcatheter was advanced beyond the orifice and the tip was reversed, changing the route to retrograde allowing for easy insertion of the microguidewire. Subsequently, a small microcatheter was advanced beyond the pseudoaneurysm into the dorsal pancreatic artery, and arterial embolization was successfully completed without complications.

Background: We report a new real-time navigation system for laparoscopic hepatectomy (LH), which resembles a car navigation system.

Material and methods: Virtual three-dimensional liver and body images were reconstructed using the "New-VES" system, which worked as roadmap during surgery. Several points of the patient's body were registered in virtual images using a magnetic position sensor (MPS). A magnetic transmitter, corresponding to an artificial satellite, was placed about 40 cm above the patient's body. Another MPS, corresponding to a GPS antenna, was fixed on the handling part of the laparoscope. Fiducial registration error (FRE, an error between real and virtual lengths) was utilized to evaluate the accuracy of this system.

Results: Twenty-one patients underwent LH with this system. Mean FRE of the initial five patients was 17.7 mm. Mean FRE of eight patients in whom MDCT was taken using radiological markers for registration of body parts as first improvement, was reduced to 10.2 mm (p = .014). As second improvement, a new MPS as an intraoperative body position sensor was fixed on the right-sided chest wall for automatic correction of postural gap. The preoperative and postoperative mean FREs of 8 patients with both improvements were 11.1 mm and 10.1 mm (p = .250).

Conclusions: Our system may provide a promising option that virtually guides LH.

Introduction: The purpose is to clarify the safety and clinical contribution of computed tomography (CT)-guided percutaneous needle-biopsy for patients with cervical spine lesion.

Material and methods: Between June 2015 and August 2022, CT-guided percutaneous needle biopsies were performed for 15 cervical spine lesions of 15 patients (8 male, 7 female; 2-81 years old). The technical success, clinical contribution, and safety were evaluated. Technical success was defined as the completion of the biopsy procedure. Clinical contribution was defined as any contribution to the therapeutic strategy. Safety was assessed by the Common Terminology Criteria for Adverse Events, version 5.0.

Results: The technical success rate was 100%. In all 15 patients, nontarget organs (e.g., major vessels, spinal cord) could be avoided. The post-biopsy histological diagnoses were myeloma (n = 2), metastatic adenocarcinoma (n = 2), chordoma (n = 2), Langerhans cell histiocytosis (n = 3), and one case each of malignant lymphoma, schwannoma, pyogenic spondylitis, non-pyogenic spondylitis, degenerative change, and non-pathological fracture. All of these diagnoses contributed to the therapeutic strategy decisions. One case of grade 2 pain was observed, but no complications with grade 3 or more were observed during or after the biopsies.

Conclusion: CT-guided percutaneous needle biopsies for cervical spine lesions were safe and clinically beneficial.

Background and aim: Comparison of the applicability, safety, and surgical outcomes of total vaginal NOTES hysterectomy (TVNH) using natural orifice transluminal endoscopic surgery, which is considered a natural orifice surgery for hysterectomy with bilateral salpingo-oophorectomy (HBSO) in virgin transgender men, with conventional total laparoscopic hysterectomy (TLH).

Material and methods: A retrospective cohort study was conducted between 2019 and 2021. The results of transgender male individuals who underwent HBSO operations using TVNH (n = 21) were compared with those who underwent operations using TLH (n = 62).

Results: TVNH was performed in 21 individuals, while TLH was performed in 62 individuals. Patients in the TVNH approach group had a longer operation duration than those in the TLH group (p = .001). Patients in the TVNH group experienced less pain at two hours (5 ± 1.56), six hours (4 ± 1.57), 12 h (2 ± 0.91), and 24 h (1 ± 0.62) postoperatively (p = .001). The postoperative hospitalization duration was shorter in the TVNH group (1.6 ± 1.01) than in the TLH group (2.9 ± 0.5) (p = .001).

Conclusions: For the HBSO operation of female-to-male transgender individuals, TVNH, which is completely endoscopically performed, can be preferred and safely conducted as an alternative surgical method to conventional laparoscopy.

Introduction: To evaluate the safety and efficacy of ureteroscopic lithotripsy with pressure-measuring ureteral access sheath (PM-UAS) for large ureteral stones.

Material and methods: A total of 258 consecutive patients with large ureteral stones ≥15 mm was enrolled. They were treated by ureteroscopic lithotripsy with PM-UAS in the oblique supine lithotomy position. The technology can precisely monitor and automatically control cavity pressure. The cavity pressure control value was set at -15 mmHg∼-5 mmHg. The cavity pressure limit value was set at 30 mmHg. Infusion flow rate was set at 100-200 ml/min. Postoperative data such as stone-free rate and complications were analyzed.

Results: PM-UAS was successfully implanted in 225 patients at one stage. Eighteen cases of patients who had failed the first surgery were successfully treated with a second operation. Fifty-one cases with stones migrating up to the kidney were converted to flexible lithotripsy. The other 15 cases were converted to percutaneous nephrolithotomy due to significant ureteral stenosis. The operative time was 49.5 ± 11.2 min. The stone-free rates after one month and three months were 87.2% (212/243) and 94.2% (229/243), respectively. Complications from grade I to II were observed in 25(10.3%) patients. No other complications from grade III to V were noted.

Conclusion: The ureteroscopic lithotripsy with PM-UAS is safe and efficacious for large ureteral stones.

Objective: To present long-term results of our laparoscopic intracorporeal ileal ureter replacement (LIUR) cohort, including more complex cases of laparoscopic ileocalycostomy.

Material and methods: We collected records of patients undergoing LIUR. Follow-up included a chemical profile and urine cultures. Imaging consisted of renal ultrasonography, excretory urography, cystography, and computer tomographic or magnetic resonance urography.

Results: One hundred and two patients were included. Stricture location was left (46.1%), right (39.2%), or bilateral (14.7%). No open conversion was performed. Seventy-four patients (72.5%) underwent a total ureteral unit removal. The mean operative time was 289.4 (120 - 680) minutes. The estimated blood loss was 185.2 (10-400) mL. Three patients had intraoperative complications, and fifteen had early postoperative complications. The mean postoperative hospital stay was 12.2 (7-35) days. The mean follow-up duration period was 37.7 (12-162) months. Most patients' follow-up was uneventful (88%), and seven patients presented with Grade 2 late complications.

Conclusions: Intracorporeal laparoscopic ileal ureteral replacement in cases of extensive ureteral lesions offers optimal long-term outcomes and a low complication rate. Ileocalycostomy constitutes a viable option in the small group of patients with long proximal ureteral strictures and intrarenal pelvis.