Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

Background: Single-incision laparoscopic cholecystectomy (SILC) offers excellent cosmetic results but is technically challenging. Robotic systems can overcome these limitations, and although the da Vinci Xi is designed for multiport surgery, it can be adapted for single-port procedures. This study reports our experience performing single-port robotic cholecystectomy (SPRC) with straight instruments, emphasizing technical optimization and perioperative outcomes.

Methods: SPRC was performed using an optimized umbilical port configuration and docking technique. Surgical steps were standardized to ensure stable traction and precise dissection, with a crossover method applied in difficult cases to improve exposure (see Supplemental Videos 1, Supplemental Digital Content 1, http://links.lww.com/SLE/A507 , and 2, Supplemental Digital Content 2, http://links.lww.com/SLE/A508 ). Eleven patients underwent SPRC, and demographic, operative, and perioperative data were analyzed.

Results: All procedures were completed without conversion to open or multiport surgery. The mean operative time was 116.7 ± 22.2 minutes, with minimal blood loss (13.8 ± 7.5 mL). No intraoperative complications or gallbladder perforations occurred, and only one patient required temporary drainage for minor oozing. Postoperative VAS scores averaged 3.1 ± 1.0 on day 0 and 1.6 ± 0.5 on day 1, with a mean hospital stay of 2.2 ± 1.1 days. No readmissions or port-site complications were observed.

Conclusions: SPRC with the da Vinci Xi system using straight instruments is feasible and safe. Optimized port placement and instrument coordination yield outcomes comparable to those reported for the SP system or single-site platform, providing an accessible alternative for centers without these platforms.

Background: Previous studies have reported deaths due to undiagnosed cardiac tamponade following hiatal hernia surgery, with an alarmingly high associated mortality rate. This review aims to raise awareness and improve the diagnostic accuracy of cardiac tamponade among surgeons who perform hiatal hernia repair.

Methods: A retrospective analysis was conducted on cases of cardiac tamponade following hiatal hernia repair. Data collected included patient age, surgical approach, mesh fixation method, timing of cardiac tamponade diagnosis, and treatment strategies.

Results: A total of 23 eligible articles reporting on 30 patients with cardiac tamponade after hiatal hernia repair were included in this review. The age of patients ranged from 40 to 84 years, with a median age of 66 years. Tacker was used in 20 patients (66.7%) for mesh fixation. In half of the cases (50.0%), cardiac tamponade was diagnosed within 48 hours after surgery. Treatment mainly included pericardiocentesis and open drainage. Seven (23.3%) patients died postoperatively. Cardiac tamponade was undiagnosed in 4 patients (13.3%), all of whom died. Mortality rates were 100.0% in the undiagnosed group and 4.3% in the diagnosed group.

Conclusions: Accurate diagnosis and prompt management are crucial for rescuing patients from life-threatening cardiac tamponade following hiatal hernia surgery.

Background and aims: Cold forceps biopsy (CFB) is commonly used for the suspected diagnosis of colorectal cancer (CRC). With larger pathologic specimens, cold snare biopsy (CSB) of CRC may be an attractive alternative. We performed a cohort study to compare the effectiveness and safety of CSB to CFB.

Methods: Suspected CRC patients were retrospective and prospectively included and assigned to CFB or CSB at a single tertiary center. The primary outcome was the diagnostic consistency between endoscopic visual diagnosis and final biopsy tissue based on the duration required to determine diagnosis. And the diagnostic consistency between surgical postoperative pathology and final biopsy tissue. Secondary outcomes were clinically significant CSB or CFB-related bleeding, perforation, and technical success.

Results: A total of 2000 suspected CRCs in 2000 patients were enrolled in CSB group (n=411) and CFB group (n=1589). The technical success rate of the 2 groups was 100%. Two groups were significantly different for diagnostic consistency: 411/411 (100.0%), 381/411 (92.7%) CSB versus CFB 1438/1589 (90.5%), 1388/1589 (87.35%) (OR 1.035 and 1.839; 95% CI: 1.026-1.045 and 1.233-2.744; P ＜0.001 and P = 0.002). Bleeding and perforation occurred similarly in the 2 groups (16/411, 2/411, 0/411, 0/411 vs. 73/1589, 11/1589, 0/1589, 0/1589; P ＞0.05).

Conclusions: Compared with CFB, CSB is more effective in diagnosing suspected CRC without increasing adverse events.

Background: Metabolic and bariatric surgery (MBS) is an established treatment for severe obesity and its related comorbidities. While long-term outcomes are often emphasized, early postoperative complications remain a critical metric of safety and resource utilization. Large database studies have reported national trends in MBS outcomes but are limited by lack of granularity, inconsistent definitions, and inclusion of heterogeneous surgical experience. This study aimed to provide a detailed analysis of 30-day postoperative complications following sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and duodenal switch (DS) over a 17-year period at a single high-volume quaternary academic center.

Materials and methods: A retrospective cohort study of adult patients who underwent primary laparoscopic SG, RYGB, or DS between 2008 and 2024. All procedures were performed by fellowship-trained, minimally invasive bariatric surgeons. Complications occurring within 30 days postoperatively were identified through comprehensive chart review and classified using the Clavien-Dindo grading system. Primary outcomes included incidence, severity, and type of complications, as well as rates of readmission, reoperation, and reintervention. Multivariable logistic regression was used to identify predictors of overall and major complications.

Results: Of 2190 patients included, 413 (18.9%) experienced at least 1 early complication, totaling 467 discrete events. DS had the highest complication rate (29.3%), followed by RYGB (18.4%) and SG (17.5%). RYGB was associated with a high burden of major complications, including anastomotic strictures, GI bleeding, and reoperations for obstruction or leak. The 30-day rates of readmission (2.0%) and reoperation (1.3%) were low across all groups. Independent predictors of major complications included venous stasis (aOR=3.22), renal insufficiency (aOR=2.65), and type 2 diabetes (aOR=1.96); both RYGB (aOR=2.25) and DS (aOR=2.77) carried higher risk than SG.

Conclusion: This study provides a granular, procedure-specific profile of early complications after SG, RYGB, and DS. While all 3 procedures demonstrated acceptable safety profiles, DS had the highest overall complication rate, and RYGB carried the greatest burden of major complications. These findings underscore the variability in early postoperative outcomes by procedure type and reflect the value of institutional experience in characterizing complication profiles.

Background: Gastroesophageal reflux (GERD) disease is a common condition. It is caused by different underlying causes, ranging from lower oesophageal sphincter (LOS) dysfunction to an impaired gastric emptying and esophageal motility disorders. Although initially representing a benign condition, persistent GERD can result in precancerous lesions. Over time, various surgical and endoscopic solutions have been proposed, particularly for patients in whom medical therapy is either ineffective or poorly tolerated. Both endoscopic and surgical techniques aim to enhance the function of the anti-reflux barrier.

Methods: We provided an extensive narrative review of the diagnosis and treatment of GERD treatment, exploring both endoscopic and surgical solutions.

Results: Endoscopic procedures generally involve techniques such as gastric plication, delivery of radiofrequency energy at the gastroesophageal junction (EGJ), and the injection bulking agents into the EGJ.

Conclusions: The efficacy of endoscopic treatments is not yet supported by robust scientific evidence. To date surgical fundoplication remains the gold standard for the treatment of GERD.

Background: Corrosive ingestion frequently leads to upper aerodigestive tract strictures, with the optimal surgical approach debated. This study investigates the safety and effectiveness of colonic interposition for this condition.

Methods: We retrospectively reviewed 21 patients with corrosive-induced esophageal stricture who underwent left colonic interposition between 2017 and 2024. Procedures involved cervical dissection, colonic mobilization, retrosternal tunnel creation, and reconstruction. Four patients underwent fully open surgical procedures, and 17 patients underwent laparoscopic colon mobilization and retrosternal tunnel creation. Outcomes included surgical complications and short-term and long-term feeding function.

Results: The mean age was 37 years, with a male predominance (14/21 patients). All had esophageal stricture secondary to chemical burn for >1 year, and 14 were malnourished. Stricture locations were cervical (5 patients), upper third (8 patients), middle third (8 patients), and lower third (3 patients). Laparoscopic surgery had longer mean operative times than open surgery (361 vs. 294 min). One patient developed gastric outlet obstruction due to an undiagnosed pyloric stenosis. All patients resumed oral feeding by postoperative day 2, and feeding jejunostomy were removed at 1 month. During a median 30-month follow-up, all maintained normal oral intake and survived.

Conclusions: Left colonic graft interposition for esophageal reconstruction in caustic strictures is safe and effective. However, the technique is complex, particularly laparoscopically. Adequate graft length, vascularity, and isoperistaltic anastomosis are crucial for success.

Background: We designed a study to determine the impact of transversalis fascia repair (TFR) during TEP surgery for inguinal hernias on hospital stay duration, recurrence rates, quality of life, and related adverse outcomes in a randomized, double-blinded, controlled clinical trial. We screened patients presenting with inguinal hernias requiring elective surgery.

Methods: Eligible patients were randomly allocated into 2 groups: the TFR group, whose inguinal ring defect was narrowed; and the Routine Treatment Group (RTG) group, whose defect left unchanged. The prespecified primary outcomes were the length of hospital stay and the time of surgery. Patients were followed for 6 months to be evaluated regarding the Visual Analogue Scale (VAS), the rate of recurrence and seroma formation, and their Carolina Comfort Scale (CCS) hernia-specific quality of life.

Results: A total of 60 patients were allocated to study arms with no significant differences in the baseline characteristics. The intervention did not have a significant impact on the duration of hospitalization. However, the operation time in the TFR group was significantly longer than in the RTG group (Cohen's d=-1.13, 95% CI: -1.67 to -0.58, P <0.001). In contrast, no statistically or clinically significant differences were noted between the groups concerning postoperative pain, analgesic usage, or rates of acute and chronic pain. Furthermore, the TFR group had a much lower risk of seroma formation during the first week after surgery compared with the routine nonclosing defect group, showing an almost 80% lower risk of seroma formation. However, this finding did not reach statistical significance.

Conclusion: Although the defect-closing approach resulted in longer operation times, our study did not demonstrate any beneficial effects on hospital stay duration, postoperative pain, or quality of life. However, this approach may reduce seroma formation in the first week postsurgery, which should be confirmed in future meta-analyses.

Trial registration: This trial was prospectively registered on the Iranian Registry of Clinical Trials on February 29, 2024 (IRCT20180312039067N2).

Background and objectives: The occurrence of anastomotic leakage (AL) and gastroparesis syndrome (GS), common and severe complications after laparoscopic radical gastrectomy, significantly impacts the prognosis of patients. The objective of this study was to investigate the risk factors associated with AL after laparoscopic radical gastrectomy and GS after laparoscopic distal gastrectomy.

Methods: In this retrospective cohort study, 3779 patients who underwent laparoscopic radical gastrectomy and met the inclusion criteria were included. Of the 3779 patients, 85 (2.2%) were diagnosed with AL. The diagnosis of GS was made in 35 (2.4%) patients who underwent laparoscopic distal gastrectomy. Subsequently, univariate and multivariate logistic regression analyses were performed to determine the risk factors associated with AL and GS.

Results: The presence of hypoalbuminemia [odds ratio (OR)=2.437, 95% CI: 1.416-4.196, P =0.001] and intraoperative blood loss >150 ml (OR=1.712, 95% CI: 1.073-2.731, P =0.024) could be used as independent risk factors for AL. Total gastrectomy (OR=0.461, 95% CI: 0.264-0.805, P =0.006) and distal gastrectomy (OR=0.488, 95% CI: 0.276-0.863, P =0.014) were identified as the protective factors for AL. The presence of smoking history (OR=2.022, 95% CI: 1.022-4.001, P =0.043), pyloric obstruction (OR=3.748, 95% CI: 1.476-9.518, P =0.005), and Roux-en-Y anastomosis (OR=4.432, 95% CI: 1.292-15.206, P =0.018) were proved to be independently associated with GS for patients who underwent laparoscopic distal gastrectomy.

Conclusions: This study delineates distinct risk factors for AL and GS after laparoscopic gastrectomy. Contrary to preservation paradigms, total gastrectomy reduced AL risk versus proximal gastrectomy, challenging current proximal tumor management strategies.

Background: Minimally invasive approaches have transformed ventral hernia management, with robotic platforms enhancing challenging techniques like the robotic Transabdominal Retromuscular Umbilical Prosthesis (r-TARUP). While traditionally performed using the da Vinci system, the introduction of the Medtronic Hugo RAS system offers a valuable alternative. We present our first case series with standardized surgical technique for r-TARUP using the Hugo RAS system, detailing operative setup, technical considerations, and initial outcomes.

Methods: Between September 2024 and February 2025, we performed 30 r-TARUP procedures using the Hugo RAS system. Preoperative evaluation included imaging and risk factor optimization. The technique involved a lateral retromuscular approach, ipsilateral posterior rectus sheath (PRS) closure, and mesh placement. Patients were discharged the following day, with follow-ups assessing complications and recurrences.

Results: The mean hernia dimensions were 3.1±1.0 cm in width and 2.6±0.8 cm in length. Rectus diastasis repair was performed in 57% of cases. Mean operating and docking times were 190.6±61.6 and 15±5.3 minutes, respectively. Two cases required conversion to laparoscopic surgery during peritoneal closure. No complications or recurrences were observed after a mean follow-up of 3.6 (1.7 to 5.3) months.

Conclusions: Despite the short follow-up, our experience demonstrates the feasibility and safety of r-TARUP with the Hugo RAS system. Comparable outcomes to other robotic platforms suggest that the Hugo RAS system is a viable alternative for ventral hernia repair, offering technical flexibility and promising short-term results.

Background: The clinical value of self-gripping mesh (SGM) in laparoscopic transabdominal preperitoneal (TAPP) repair for elderly patients with primary inguinal hernia remains unclear. This study aimed to compare the perioperative and postoperative outcomes between SGM and conventional mesh (CM) in this population.

Methods: Patients were divided into 2 groups: the SGM group and the CM group based on the type of mesh used during surgery. Preoperative, intraoperative, and postoperative data were collected and analyzed for 113 elderly patients (aged 60 y or older) with primary unilateral inguinal hernia.

Results: A total of 113 patients who underwent TAPP repair met the inclusion criteria without any exclusion criteria, with 60 in the SGM group and 53 in the CM group. Baseline characteristics, including mean age, sex distribution, body mass index (BMI), hernia type, defects, and location, were comparable between the 2 groups (P>0.05). No significant differences were observed in operative time, intraoperative blood loss, postoperative hospital stay, hospitalization costs, or the incidence of wound or pulmonary infections (P>0.05). However, the SGM group demonstrated a significantly lower postoperative pain score (NRS) (median (Q1/Q3): 1 (1, 2) vs. 3 (2.5, 4), P=0.001) and a reduced incidence of hematoma or seroma (8.33% vs. 20.75%, P=0.034). No cases of postoperative mortality, urinary complications, or mesh infections were observed in either group. Hernia recurrence occurred in 6 patients in the CM group and 1 patient in the SGM group during the follow-up period, though the difference was not statistically significant (1.67% vs. 11.32%, P=0.083). Chronic postoperative pain was significantly less frequent in the SGM group (3.33% vs. 16.98%, P=0.039). Subgroup analysis further revealed that patients with inguinal hernia defects <3 cm, the SGM group demonstrated significantly fewer recurrences compared with the CM group ( 0% vs. 14.29%, P=0.034). Whereas, in patients with defects ≥3 cm, the SGM group had a significantly lower incidence of postoperative hematoma or seroma (6.26% vs. 38.9%; P=0.043) and chronic pain (0% vs. 27.78%; P=0.046) compared with the CM group.

Conclusion: This study demonstrates that usage of SGM significantly reduces both acute and chronic postoperative pain, as well as the incidence of hematoma and seroma, in elderly patients undergoing laparoscopic TAPP repair for primary inguinal hernia. Moreover, SGM was associated with lower rates of both chronic pain and hematoma/seroma in patients with hernia defects ≥3 cm, as well as a lower recurrence rate in those with defects <3 cm. These results support the clinical value of SGM as a favorable mesh option in this population.