Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

Purpose: Gastric cancer (GC) is the third leading cause of cancer deaths, with surgery as the primary treatment; however, the outcomes of different types of surgeries still need to be understood further. This study evaluated the surgical outcomes and prognosis after minimally invasive distal gastrectomy (MIDG) for GC in a multicenter retrospective cohort using propensity score matching.

Methods: This study retrospectively enrolled 688 patients who underwent curative MIDG for GC at five institutions between January 2018 and December 2024. Patients were categorized into Billroth-I reconstruction (B-I) and Roux-en-Y (R-Y) reconstruction groups. Propensity score matching was performed using the following covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, extent of lymph node dissection, Japanese Classification of Gastric Carcinoma stage, neoadjuvant chemotherapy, and adjuvant chemotherapy. Surgical outcomes and prognoses were compared.

Results: Three hundred propensity score-matched pairs were identified. The R-Y group had longer median operation time [309 (131 to 531) min vs. 265 (126 to 532) min; P <0.001], longer postoperative hospital stay [10 (5 to 110) d vs. 10 (5 to 43) d; P =0.042], and greater median blood loss ( P =0.047) than the B-I group. Complications of Clavien-Dindo (CD) grade II ( P <0.001) and grade III ( P =0.027) were more frequent in the R-Y group than in the B-I group. Five-year overall survival (OS) was significantly higher in the B-I group than in the R-Y group (91.1% vs. 83.4%; P =0.019), whereas 5-year relapse-free survival (RFS) showed no significant difference between these 2 groups ( P =0.056). Independent prognostic factors included reconstruction method, postoperative complications (≥CD III), and lymph node metastasis (pN) for OS and age (≥80), pT, and pN for RFS.

Conclusions: Patients who underwent R-Y reconstruction had more frequent postoperative complications than those who underwent B-I reconstruction after MIDG. Although not significantly associated with RFS, these complications may affect OS. The findings of this study could help develop strategies for improving GC treatment.

Purpose: To validate the construct validity of the avian model, a cost-effective and realistic simulator using chicken cadavers for neonatal laparoscopic surgery training.

Methods: Thirteen participants with varying experience levels (novices, residents, and seniors) performed laparoscopic suturing tasks on the avian model during a pediatric MIS course in Geneva. Performance was evaluated using a modified OSATS framework (specific and general scores).

Results: The avian model significantly distinguished between skill levels: specific (P=0.024) and general (P=0.016) scores improved with experience. Execution time decreased accordingly (P=0.019). Interobserver agreement was high (κ=0.87, κ=0.84). Seniors outperformed novices and residents in all metrics.

Conclusion: The avian model demonstrates strong construct validity and is effective in differentiating surgical skill levels. It offers a reliable, reproducible platform for pediatric laparoscopic training.

Background: Gastrointestinal endoscopes are essential for diagnosing and treating digestive disorders, although some drawbacks exist, such as patient discomfort and sedation.

Methods: Disposable, minimally invasive gastrointestinal endoscopes have garnered attention among endoscopists due to portability, improved patient comfort, and lack of post-procedural requirements. This innovation shows potential as an alternative to traditional endoscopy methods, with several studies confirming efficacy and safety in clinical settings.

Results: This review discusses the latest advances and ongoing research involving disposable gastrointestinal endoscopes with a focus on technological enhancements, patient outcomes, and the practical implications of integration into standard medical procedures.

Conclusions: Examining these developments provides a comprehensive analysis of the current disposable gastrointestinal endoscope technology status and future potential, emphasizing the role in enhancing patient care and procedural efficiency in gastroenterology.

Background: This study aims to evaluate the retrospective results of peptic ulcer perforation (PUP) treatment and assess the effectiveness and safety of early postoperative endoscopy.

Methods: Patients who underwent PUP surgery at Mersin University Hospital between 2010 and 2024 were analyzed. Demographic data, treatment methods, clinical outcomes, and early postoperative (6-8 wk) endoscopy results were evaluated for healing, complications, and recurrence. The correlation between treatment approach and clinical outcomes was statistically analyzed.

Results: A total of 176 patients underwent PUP surgery. A total of 70.4% (124) of the citizens are male. A total of 29.6% (52) of the patients are female. The average age was 61.2 years. Surgical interventions were performed by open surgery in 77.3% (136) and by laparoscopic method in 22.7% (40). Omental patching was performed in 93.8% (165) of the patients, simple closure was performed in 4.5% (8), and gastric resection was performed in 1.7% (3 patients). Peroperative biopsy was taken from all patients. In the biopsy results, Helicobacter pylori -positive ulcer was detected in 88.3% (156) of the patients, chronic inflammation was detected in 10.2% (18), and malignancy was detected in 1.1% (2). All patients were recommended a complete gastrointestinal endoscopy within 6 to 8 weeks after surgery. However, endoscopy was not performed in 54.6% of the patients (96 patients). In endoscopic evaluation, 15.6% (15) ulcers, 81.3% (78) normal findings, and 3.1% (3) malignancies were detected.

Conclusions: PUP can be effectively treated with laparatomy/laparoscopy, and omental patch repairment. Postoperative upper gastrointestinal endoscopy should be performed with an initial biopsy to avoid missing an underlying malignancy.

Background: Marginal ulcer (MU) remains a serious complication after Roux-en-Y gastric bypass (RYGB). This can be a life-threatening problem, even years after RYGB. Patients can present with pain or even with hemorrhage or perforation. There is no agreed-upon standard in prevention or treatment, although most perforated ulcers are treated with an omental patch. We present our results of treatment of MU with truncal vagotomy (TV).

Methods: A retrospective chart review identified patients who required surgical intervention for nonhealing MU or those presenting with perforated MU. Free perforation was treated with surgical intervention at the time of presentation. In patients with recalcitrant MU (without perforation), preoperative upper endoscopy confirmed the diagnosis. In all cases, the gastrojejunal anastomosis was revised or the marginal ulcer was resected, followed by laparoscopic TV. We reviewed operative time, ulcer recurrence, and complications in the cases identified.

Results: Forty-two patients underwent revision/resection following presentation with a recalcitrant ulcer or free perforation of a MU. Concomitant TV was performed in all cases. Average time from the RYGB was 71.8 months. There were no 30-day mortalities and no leaks. Average follow-up was 21 months. Sixty-two percent of patients had a follow-up endoscopy by 1 year with no recurrences. There were no reoperations or major complications.

Conclusion: Marginal ulceration remains a common complication after Roux-en-Y gastric bypass. Medical therapy is the first-line therapy but some patients will go on to develop refractory disease. This can be chronic, or acute with perforation or hemorrhage. Laparoscopic truncal vagotomy with revision of the gastrojejunal anastomosis is safe and effective in the treatment of marginal ulcers with low recurrence rates.

Background: Metabolic and bariatric surgery (MBS) has been an effective solution not only to obesity but also to metabolic diseases. As the demand for revisional surgery increases with the expansion of MBS, possible risks and complications of reoperation should be considered.

Method: We have collected and analyzed 3 patients diagnosed with class III obesity who underwent the single anastomosis sleeve ileal bypass (SASI) as a primary operation. Due to excessive weight loss or severe malnutrition, they were indicated for revisional surgery, where SASI was reversed to sleeve gastrectomy (SG) ( Fig. 1 ). The perioperative characteristics as well as outcomes after SASI and revisional surgery are reviewed.

Results: The confirmed measurement of their common channels in 3 patients with SASI revealed 350, 250, and 250 cm, respectively. The mean operative time was 42.3 minutes and blood loss was <20 mL. There were no intraoperative or postoperative complications. The patients had uneventful postoperative courses and the mean hospital stay was 2.3 days. There was no mortality in our cases. Malabsorption with nutrition issues was improved in each patient.

Conclusion: Laparoscopic revision of SASI to SG is a technically feasible and practical procedure for patients with excessive weight loss or malnutrition.

Objective: A comparative assessment of analgesic effectiveness and recovery quality between the anterior quadratus lumborum block at the lateral supra-arcuate ligament (QLB-LSAL) and the transversus abdominis plane block (TAPB) in patients undergoing laparoscopic partial hepatectomy (LPH).

Method: A total of 56 patients scheduled for LPH were randomly allocated to either the QLB-LSAL group or the TAPB group in a 1:1 ratio. Patients in the QLB-LSAL group received bilateral anterior quadratus lumborum block at the lateral supra-arcuate ligament, while those in the TAPB group received bilateral subcostal transversus abdominis plane block before surgery. The primary outcome was the morphine equivalent consumption (MEC) at 24 hours postoperatively. Secondary outcomes included MEC at 48 and 72 hours, as well as numeric rating scale (NRS) pain scores at rest and during movement, recorded at 2, 4, 6, 12, 24, and 48 hours postoperatively. The quality of recovery was assessed using QoR-15 scores, measured 1 day before surgery and on the first and third postoperative days.

Results: The QLB-LSAL group demonstrated significantly lower MEC at 24, 48, and 72 hours postoperatively compared with the TAPB group. NRS scores for pain at rest and during movement were also significantly lower in the QLB-LSAL group at 2, 4, 6, 12, and 24 hours following surgery. In addition, the QoR-15 scores, which assess the quality of recovery, were significantly higher in the QLB-LSAL group compared with the TAPB group on both the first and third postoperative days.

Conclusion: The QLB-LSAL method provides superior analgesia and enhances recovery quality compared with the TAPB approach in patients undergoing LPH.

Introduction: Peritoneal tears (PTs) are an intraoperative complication that may occur during extraperitoneal space opening or hernia sac dissection in laparoscopic total extraperitoneal hernia repair (TEP) surgeries and are an important cause of conversion. There is also no consensus on the prevention and causes of this condition in TEP. The aim of this study was to evaluate the risk factors underlying the development of peritoneal tears during TEP.

Materials and methods: We included 288 consecutive patients who underwent TEP between May 2019 and December 2023. All data were collected retrospectively. Patients who developed PTs and those who did not develop PTs were compared in 2 groups. The demographic characteristics of the patients, hernia types, hernia defect diameters, surgery times, and intraoperative and postoperative complications were compared. Multivariate analysis identified independent risk factors for PTs in TEP.

Results: The overall incidence of PTs was 22.2% (n=64). The median age was 50.4±14.5 years and the body mass index was 25.9±2.9 kg/m 2 . Significant clinical factors associated with PTs included body mass i̇ndex (BMI), previous surgery, presence of scrotal hernia, and the defect size of inguinal hernia. Multivariate analysis identified independent risk factors for PTs: previous lower abdominal surgery and scrotal hernia.

Conclusion: Peritoneal tears are an intraoperative event that is the most important reason for conversion in TEP surgeries. The most important independent risk factors for peritoneal tear formation were scrotal hernia and previous lower abdominal surgery.

Introduction: Robotic-assisted kidney autotransplantation (RAKAT) is a minimally invasive approach to managing complex renal pathologies. While increasingly utilized, experience with RAKAT in patients with prior renal surgery remains limited.

Methods: We present a case of recurrent nutcracker syndrome (NCS) in a 29-year-old female who had previously undergone left renal vein transposition. Due to recurrent symptoms, she underwent RAKAT with extracorporeal vascular reconstruction using cryopreserved allografts to manage the foreshortened renal vessels. The surgical technique involved a multiport robotic approach with a hand-assist device, extracorporeal bench surgery, and repositioning for the autotransplantation phase.

Results: The procedure was completed successfully with a total operative time of 779 minutes and estimated blood loss was 100 mL. The cold ischemic time was 90 minutes. Postoperative complications included urinary tract infections requiring intravenous antibiotics (Clavien-Dindo grade II). At 7 months follow-up, the patient had excellent graft function and no evidence of recurrent NCS.

Conclusion: This case demonstrates the feasibility of RAKAT with extracorporeal vascular reconstruction using allografts as a salvage therapy for recurrent NCS after prior open surgery. This approach requires advanced robotic and vascular expertise and careful preoperative planning.

Background: Inguinal hernias are among the most prevalent surgical problems worldwide. Preoperative and postoperative groin pain has the potential to affect quality of life (QOL) significantly. The purpose of this study is to identify whether the pain experienced by patients may be predicted by a number of preoperative and postoperative clinical and socioeconomic factors.

Methods: A retrospective review was conducted for all adult patients who underwent inguinal hernia repair with the study's senior author from January 1, 2016, to December 31, 2020. Data collected include medical history, groin pain ratings at preoperative and postoperative (2 wk) clinic visits, long-term pain, and quality of life (QOL) data >1 year after surgery. Median household income of the patient's residential zip code was used as a proxy for socioeconomic status (SES). Patient factors were evaluated for their correlation with pain ratings.

Results: Three hundred eighty patients were included in this study. Patients with higher preoperative pain (rated 5-10 out of 10, vs . 0-4 out of 10) had higher postoperative pain on average (3.18 vs . 1.0, P <0.001). Nearly all patients with preoperative pain had partial or complete pain relief long-term. Obesity ( P <0.05) and smoking history ( P <0.05) were both associated with higher preoperative pain and greater pain reduction through surgery. Lower income ( P <0.05) and younger age ( P <0.05) were associated with higher preoperative and postoperative pain.

Conclusions: Obesity, smoking history, lower income, and younger age were all significantly associated with higher pain levels before surgery, with obesity and smoking also linked to greater pain reduction after surgery. These findings highlight potential disparities, but patients with severe preoperative pain and comorbid conditions can still benefit from pain relief through surgery.