Surgical Laparoscopy, Endoscopy & Percutaneous Techniques最新文献

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.

Objective: This study aims to compare the outcomes of single stapling natural orifice specimen extraction surgery (ssNOSES) with double stapling natural orifice specimen extraction surgery (dsNOSES) in anterior resection for rectal cancer.

Methods: A total of 100 patients with rectal cancer were selected from the Colorectal Department of the Second Hospital of Hebei Medical University. These patients underwent Natural Orifice Specimen Extraction Surgery (NOSES) between July 2018 and July 2020. Fifty patients who underwent ssNOSES were compared with fifty patients who underwent dsNOSES. The comparison focused on patient demographics, surgical outcomes, and complications, with a particular emphasis on operative time, cost, and complications.

Results: Four cases of anastomotic leakage were observed in the dsNOSES group, and this group also incurred higher costs. Although the surgical time for ssNOSES was longer, the procedure was associated with lower costs and no cases of anastomotic leakage.

Conclusions: ssNOSES is a cost-effective and safer alternative to dsNOSES. Furthermore, the surgical time for ssNOSES can be reduced through training and experience.

Background: Gastrointestinal (GI) perforations typically occur as complications following endoscopic procedures or intestinal anastomosis surgery. Endoscopic closure of these perforations is desirable as it avoids the risks associated with surgery. Although several endoscopic devices have been developed to address this issue, none have yet demonstrated consistently effective clinical outcomes. This study introduces a novel endoscopic clip assembly designed to overcome these challenges.

Materials and methods: The Z-shaped clip, named the kinetic utility (KU) clip, was constructed with nitinol, allowing it to operate at 45 °C. When the clip is delivered endoscopically, it can close perforations with a predeformed configuration that is triggered by temperature. Ex vivo experiments were conducted using porcine stomach tissue to compare the performance of the KU clip with through-the-scope clips (TTSCs). Maximal force and area under the curve (AUC) on the force-displacement curve were measured to assess the retention capability of the clip in tissue. The in vivo experiment involved creating iatrogenic perforations in a pig, applying the KU clip, and monitoring its healing and safety outcomes.

Results: Ex vivo experiments showed a difference between the TTSC and KU groups with a P -value of 0.08 for maximal force and 0.01 for AUC. The in vivo experiment validates the effectiveness of the KU clip, as there was complete healing of the perforation site with no significant adverse reactions during the experimental period.

Conclusions: The KU clip demonstrates potential as a versatile and effective tool for endoscopic management of GI perforations.

Background and aim: Gastroesophageal reflux disease (GERD) is a widely prevalent disease that severely influences patients' quality of life and is a known risk factor for esophageal adenoma and carcinoma. Endoscopic submucosal dissection (ESD) is a tissue resection technique that involves circumferential en bloc resection of the mucosa that surrounds the tumor followed by dissection of the esophagogastric junction (EGJ) submucosa under the lesion. After mucosal resection, the mucosal healing results in scar formation, which in turn results in shrinkage and remodeling of gastric cardia flap valve, thereby theoretically reducing reflux events. This study investigated the safety and efficacy of ESD for GERD-related neoplasms.

Methods: We performed a retrospective analysis of data collected from 96 patients with GERD-related neoplasms treated with ESD between December 2018 and May 2023. Clinical, endoscopic, histologic, and follow-up data were collected.

Results: The overall rates of en bloc resection, complete resection, curative resection, and major complications were 100%, 99.0%, 95.8%, and 8.4%, respectively. During the follow-up period, all patients remained free from local recurrence and metastasis. The proportion of patients who remained alleviation of GERD symptom was 69.6% after 6 months. The proportion of the resected lumen circumference was the factor that affected the alleviation of GERD symptoms.

Conclusions: ESD is safe and effective for GERD-related neoplasms and is efficacious for the high probability of alleviation of GERD symptoms.

Objective: Traumatic pancreatic fistula is challenging and complicated to manage. Our aim was to assess the efficacy of endoscopic pancreatic duct stenting in the treatment of traumatic pancreatic fistula.

Methods: Patients with pancreatic trauma treated by endoscopic pancreatic duct stenting at Jinling Hospital from May 2016 to October 2022 were enrolled. We recorded clinical data, the cause of pancreatic trauma, the location of injuries, pancreatic injury grade, the timing and duration of stent placement and removal, and long-term outcomes.

Results: Twenty-six patients with traumatic pancreatic fistula who underwent 33 endoscopic pancreatic duct stenting procedures were enrolled. Most patients (20/26, 76.9%) were grade IV. The median time interval from injury to endoscopic stenting was 48 (range: 1 to 959) days. The main pancreatic duct (MPD) was visualized in all patients, and the average diameter of the MPD was 1.73±0.45 mm. Serum amylase levels, drain amylase levels, and drainage volume were significantly decreased after stent placement. One patient had a pancreatic duct stricture at the neck, 1 patient had poor drainage after stenting, and there were no other complications. The technical success rate was 93.9% (31/33), and the clinical efficacy rate was 76.9% (20/26). Univariate analysis revealed that the interval from injury to stenting (HR: 10.500, 95% CI: 1.115-98.914, P =0.040) was associated with stent success.

Conclusion: Pancreatic duct stenting is a safe and effective treatment modality and should be an optional treatment for the management of traumatic pancreatic fistula. Before stent placement, the duration of pancreatic fistula should be assessed since it is related to fistula healing.

Background: Minimally invasive surgery is recognized as the gold standard for cholecystectomy, with various approaches having been implemented over time. Since 2018, the da Vinci Single-Port (DVSP) robotic system (Intuitive) has been used in experimental surgical contexts, revitalizing interest in single-site surgical techniques. The authors' aim is to describe the learning curve associated with single-port robotic cholecystectomy (SPRC).

Methods: A prospective series of 266 consecutive off-label SPRC performed by a single surgeon experienced in laparoscopy, single-site surgery, and multiport robotic surgery was analyzed. These procedures were conducted under an Institutional Review Board-approved protocol. Preoperative, intraoperative, and postoperative data were collected and organized. Indications for SPRC included symptomatic cholelithiasis, acute cholecystitis, chronic cholecystitis, porcelain gallbladder, gallbladder polyps, choledocholithiasis, and gallstone pancreatitis. A learning curve was generated using the cumulative sum analysis (CUSUM) to assess changes in overall operation time, docking time, pre-console time, and surgeon console time.

Results: Our analysis demonstrated a statistically significant reduction in docking time and pre-console time ( P <0.001) in the 3 phases identified by the CUSUM analysis. The CUSUM analysis identified only 1 phase regarding the console time with a mean time of 20 (7 to 113) minutes. The average overall time was 59 (19 to 175) minutes. CUSUM analysis identified 3 phases for overall time, with reduction from 59 to 46 minutes ( P <0.001). The general characteristics of the groups identified for OT were homogeneous. Analysis of early surgical outcomes did not differ between the groups.

Conclusions: SPRC is a safe and feasible procedure, the docking time, pre-console time, and overall time were improving over time, meanwhile the console time was stable throughout the case series demonstrating a significant ability transfer between other mininvasive approaches and DVSP Platform.

Objective: To evaluate the treatment effect of endoscopic ligation and cap-assisted endoscopic sclerotherapy (CAES) for patients with internal hemorrhoids, symptom relief, complication rate and psychological condition, and the anorectal function were observed.

Methods: Thirty-two patients who underwent minimally invasive endoscopic treatment for internal hemorrhoids were recruited, with a 3-month follow-up. Patients were divided into 2 groups, with Group A undergoing endoscopic ligation (n=14) and Group B receiving CAES (n=18). The Clinical efficacy and anorectal function between the 2 groups before and after treatment were compared, and the psychological changes in patients before and after treatment were evaluated by various scales.

Results: There was no significant difference in the treatment effect of postoperative bleeding, prolapse, constipation, and complications between the 2 groups. However, Group A has certain advantages in the treatment of prolapse and constipation before and after treatment, and Group B has certain advantages in bleeding. The comprehensive multiscale psychological evaluation showed no significant difference between the 2 groups before and after treatment, but the psychological condition of patients in both groups was significantly improved after treatment. Besides, patients in Group A were better in the improvement of constipation scale, and patients in Group B had a greater improvement in the pain scale. As for anorectal function, there was no significant difference before and after treatment, except for the squeeze duration before treatment. In the comparison pretreatment and post-treatment, patients in Group A had significant differences in resting (average), first defecation and squeeze (average), while patients in Group B had significant differences in resting (average) and first defecation.

Conclusions: Two endoscopic therapies were effective in treating internal hemorrhoids, with no significant difference in terms of treatment effect, symptom relief, complication rate, psychological condition, and anorectal function when compared between 2 groups. However, when compared within each group, the different methods had their own advantages in the evaluation of treatment effect and anorectal function.