Pub Date : 2024-06-01DOI: 10.1097/SLE.0000000000001281
Yanru Zhang, Tufeng Chen, Xiaofeng Yang, Yiquan Li, Purun Lei
Objective: The purpose of the current study was to statistically clarify the precise risk age in elderly patients undergoing colorectal surgery and to evaluate the safety and efficacy of laparoscopic colorectal resection in these patients.
Methods: Patients' clinical variables were extracted from the database of the Gastrointestinal Surgery Centre, Third Affiliated Hospital of Sun Yat-sen University, from 2015 to 2019. Logistic regression was conducted to identify independent risk factors of postoperative complications and ORs for each age. Curves of odds ratios (ORs) and CIs for each age were fitted by using a locally weighted scatterplot smoother, and a structural breakpoint was determined by the Chow test to identify a precise cutoff risk age for elderly patients. Comparison and subgroup analysis were conducted between surgical approach groups using the Student t test and χ 2 analysis.
Results: Locally weighted scatterplot smoother OR analysis manifested that patients aged 69 years old or older suffered a higher possibility of postoperative complications and should be defined as high-risk age. Comparison according to the high-risk age revealed laparoscopic colorectal surgery is better than laparotomic surgery for elderly individuals in terms of hospital stay (9.46 ± 5.96 vs 15.01 ± 6.34, P < 0.05), the incidence of intensive care unit transfer (4 vs 20, P < 0.05), and incidence of surgical site infection (15 vs 20, P < 0.05). Patients who underwent laparotomic surgery had a greater prevalence of Clavien-Dindo II/III complications ( P < 0.05). These findings remained stable even after propensity matching. Furthermore, such superiority was proved especially significant for patients who underwent left-side colorectal resection. In addition, overall survival was improved in the laparoscopic surgery group, whereas no differences were observed in disease-free survival.
Conclusion: In our study population, age 69 or older was a cutoff point age suggests a higher possibility of postoperative morbidity after colorectal surgery. Laparoscopic colorectal resection should be regarded as a superior therapeutic choice for these elderly individuals, especially for left-side colorectal surgeries.
研究目的本研究旨在统计明确老年结直肠手术患者的确切风险年龄,并评估腹腔镜结直肠切除术在这些患者中的安全性和有效性:从中山大学附属第三医院胃肠外科中心2015年至2019年的数据库中提取患者的临床变量。进行逻辑回归以确定术后并发症的独立风险因素及各年龄段的OR。使用局部加权散点图平滑器拟合了各年龄段的几率比(ORs)曲线和CIs,并通过Chow检验确定了结构断点,以确定老年患者的精确风险年龄临界点。采用Student ttest和χ2分析法对手术方法组间进行比较和亚组分析:结果:局部加权散点图平滑OR分析表明,69岁或以上的患者术后并发症发生的可能性更高,应被定义为高危年龄。根据高危年龄进行比较后发现,腹腔镜结直肠手术在住院时间(9.46 ± 5.96 vs 15.01 ± 6.34,P< 0.05)、转入重症监护室的发生率(4 vs 20,P< 0.05)和手术部位感染的发生率(15 vs 20,P< 0.05)方面均优于腹腔镜手术。接受开腹手术的患者出现 Clavien-Dindo II/III 并发症的比例更高(P< 0.05)。即使进行倾向匹配后,这些结果仍保持稳定。此外,这种优越性在接受左侧结直肠切除术的患者中尤为明显。此外,腹腔镜手术组的总生存率有所提高,而无病生存率方面则没有观察到差异:结论:在我们的研究人群中,69 岁或以上是一个分界点,表明结直肠手术后发病的可能性较高。腹腔镜结直肠切除术应被视为这些老年人的最佳治疗选择,尤其是左侧结直肠手术。
{"title":"Evaluation of Laparoscopic Colorectal Resection Among Elderly Individuals With Colorectal Malignancy: A Single-center Retrospective Analysis.","authors":"Yanru Zhang, Tufeng Chen, Xiaofeng Yang, Yiquan Li, Purun Lei","doi":"10.1097/SLE.0000000000001281","DOIUrl":"10.1097/SLE.0000000000001281","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of the current study was to statistically clarify the precise risk age in elderly patients undergoing colorectal surgery and to evaluate the safety and efficacy of laparoscopic colorectal resection in these patients.</p><p><strong>Methods: </strong>Patients' clinical variables were extracted from the database of the Gastrointestinal Surgery Centre, Third Affiliated Hospital of Sun Yat-sen University, from 2015 to 2019. Logistic regression was conducted to identify independent risk factors of postoperative complications and ORs for each age. Curves of odds ratios (ORs) and CIs for each age were fitted by using a locally weighted scatterplot smoother, and a structural breakpoint was determined by the Chow test to identify a precise cutoff risk age for elderly patients. Comparison and subgroup analysis were conducted between surgical approach groups using the Student t test and χ 2 analysis.</p><p><strong>Results: </strong>Locally weighted scatterplot smoother OR analysis manifested that patients aged 69 years old or older suffered a higher possibility of postoperative complications and should be defined as high-risk age. Comparison according to the high-risk age revealed laparoscopic colorectal surgery is better than laparotomic surgery for elderly individuals in terms of hospital stay (9.46 ± 5.96 vs 15.01 ± 6.34, P < 0.05), the incidence of intensive care unit transfer (4 vs 20, P < 0.05), and incidence of surgical site infection (15 vs 20, P < 0.05). Patients who underwent laparotomic surgery had a greater prevalence of Clavien-Dindo II/III complications ( P < 0.05). These findings remained stable even after propensity matching. Furthermore, such superiority was proved especially significant for patients who underwent left-side colorectal resection. In addition, overall survival was improved in the laparoscopic surgery group, whereas no differences were observed in disease-free survival.</p><p><strong>Conclusion: </strong>In our study population, age 69 or older was a cutoff point age suggests a higher possibility of postoperative morbidity after colorectal surgery. Laparoscopic colorectal resection should be regarded as a superior therapeutic choice for these elderly individuals, especially for left-side colorectal surgeries.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"281-289"},"PeriodicalIF":1.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140294593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1097/SLE.0000000000001279
Şerafettin Okutan, Serdar Saritaş
Aim: This research was conducted to identify the effect of virtual reality and music on patients' pain, comfort, and vital signs after laparoscopic abdominal surgery.
Methods: This study was designed as a prospective randomized controlled single-blind clinical trial. The research population consisted of adult patients who underwent laparoscopic abdominal surgery in surgery clinics. The research sample comprised 225 patients who had laparoscopic abdominal surgery. Experimental groups watched virtual reality videos and listened to music, whereas no intervention was administered to the control group. The research data were evaluated with descriptive statistics, the χ 2 test, the Friedman test, the one-way analysis of variance, the Kruskal-Wallis test, and Tukey's and Dunn's post hoc tests.
Findings: In the post-test phase after the 2 interventions, the virtual reality and music groups had lower pain and comfort levels than the control group, and this intergroup difference was statistically significant ( P <0.05). Results for vital signs in successively repeated post-test measurements after interventions were in general different, and these differences were statistically significant. Patients in the virtual reality group generally had higher pulse rate, diastolic blood pressure, respiratory rate, and body temperature values in successively repeated post-test measurements than patients in other groups ( P <0.05). Patients in the control group generally had higher systolic blood pressure and saturation values in successively repeated post-test measurements than patients in other groups ( P <0.05).
Conclusion: It was discerned that music and the virtual reality practice reduced patients' pain and comfort levels and had positive effects on their vital signs after laparoscopic abdominal surgery.
{"title":"The Effect of Virtual Reality Practice and Music on Patients' Pain, Comfort, and Vital Signs After Laparoscopic Abdominal Surgery.","authors":"Şerafettin Okutan, Serdar Saritaş","doi":"10.1097/SLE.0000000000001279","DOIUrl":"10.1097/SLE.0000000000001279","url":null,"abstract":"<p><strong>Aim: </strong>This research was conducted to identify the effect of virtual reality and music on patients' pain, comfort, and vital signs after laparoscopic abdominal surgery.</p><p><strong>Methods: </strong>This study was designed as a prospective randomized controlled single-blind clinical trial. The research population consisted of adult patients who underwent laparoscopic abdominal surgery in surgery clinics. The research sample comprised 225 patients who had laparoscopic abdominal surgery. Experimental groups watched virtual reality videos and listened to music, whereas no intervention was administered to the control group. The research data were evaluated with descriptive statistics, the χ 2 test, the Friedman test, the one-way analysis of variance, the Kruskal-Wallis test, and Tukey's and Dunn's post hoc tests.</p><p><strong>Findings: </strong>In the post-test phase after the 2 interventions, the virtual reality and music groups had lower pain and comfort levels than the control group, and this intergroup difference was statistically significant ( P <0.05). Results for vital signs in successively repeated post-test measurements after interventions were in general different, and these differences were statistically significant. Patients in the virtual reality group generally had higher pulse rate, diastolic blood pressure, respiratory rate, and body temperature values in successively repeated post-test measurements than patients in other groups ( P <0.05). Patients in the control group generally had higher systolic blood pressure and saturation values in successively repeated post-test measurements than patients in other groups ( P <0.05).</p><p><strong>Conclusion: </strong>It was discerned that music and the virtual reality practice reduced patients' pain and comfort levels and had positive effects on their vital signs after laparoscopic abdominal surgery.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"259-267"},"PeriodicalIF":1.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140306977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: This study investigated the frequency and impact of repeat endoscopy in patients with acute upper gastrointestinal bleeding (AUGIB) in a referral hospital in Southeast Iran.
Materials and methods: A cross-sectional descriptive-analytical study was conducted on the records of 190 patients who underwent endoscopy for AUGIB in 2019. The study compared the demographic and clinical characteristics, outcomes, and treatments of patients who had a second endoscopy (n=64) with those who did not (n=126). The data were analyzed with SPSS software, and a P value less than 0.05 was considered significant.
Results: The results showed that repeat endoscopy was not significantly associated with age, gender, initial symptoms, bleeding site, first endoscopy time, or disease outcome. However, repeat endoscopy was significantly associated with higher bleeding severity, different wound types, different bleeding causes, longer hospital stay, and different treatments in the first endoscopy. The main reasons for repeat endoscopy were poor visibility and recurrent bleeding. The majority of repeat endoscopies were performed within 2 days of the first one. Most patients who had a second endoscopy did not receive any treatment, and those who did received combined thermal and epinephrine injections.
Conclusions: The study concluded that routine second endoscopy is not necessary for all patients with AUGIB, but it may be beneficial for some cases. Further research is needed to clarify the indications and timing of repeat endoscopy in AUGIB.
{"title":"Examining the Frequency of Second Endoscopy and Its Effect on Patient Outcomes With Upper Gastrointestinal Bleeding in Southeast of Iran.","authors":"Fatemeh Alijani, Seyedeh Mahdieh Khoshnazar, Omid Eslami","doi":"10.1097/SLE.0000000000001290","DOIUrl":"10.1097/SLE.0000000000001290","url":null,"abstract":"<p><strong>Background: </strong>This study investigated the frequency and impact of repeat endoscopy in patients with acute upper gastrointestinal bleeding (AUGIB) in a referral hospital in Southeast Iran.</p><p><strong>Materials and methods: </strong>A cross-sectional descriptive-analytical study was conducted on the records of 190 patients who underwent endoscopy for AUGIB in 2019. The study compared the demographic and clinical characteristics, outcomes, and treatments of patients who had a second endoscopy (n=64) with those who did not (n=126). The data were analyzed with SPSS software, and a P value less than 0.05 was considered significant.</p><p><strong>Results: </strong>The results showed that repeat endoscopy was not significantly associated with age, gender, initial symptoms, bleeding site, first endoscopy time, or disease outcome. However, repeat endoscopy was significantly associated with higher bleeding severity, different wound types, different bleeding causes, longer hospital stay, and different treatments in the first endoscopy. The main reasons for repeat endoscopy were poor visibility and recurrent bleeding. The majority of repeat endoscopies were performed within 2 days of the first one. Most patients who had a second endoscopy did not receive any treatment, and those who did received combined thermal and epinephrine injections.</p><p><strong>Conclusions: </strong>The study concluded that routine second endoscopy is not necessary for all patients with AUGIB, but it may be beneficial for some cases. Further research is needed to clarify the indications and timing of repeat endoscopy in AUGIB.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"314-320"},"PeriodicalIF":1.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140898268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1097/SLE.0000000000001231
Renato D Pinto, Pedro Trauczynski, Diego L Lima, Leandro T Cavazzola
Background: Robotic ventral hernia repair has been increasing globally, with comparable outcomes to laparoscopic repair and lower rates of conversion to open surgery. Robotic surgery is increasing in popularity, and there is a number of new robotic systems entering the marketing. We report the first case of a Roboic eTEP using the Versius robotic system in a patient with an incisional hernia.
Methods: Surgery was performed using the Versius system from CMR surgical which consists of bedside units for each instrument and a console. The patient presented with an incisional hernia measuring 9.5×5 cm in the left flank.
Results: The patient was discharged on postoperative day (POD) 2 with a drain. There was no need for opioids. The drain was removed at POD 7. The patient presented at POD 10 with erythema and cellulitis in the area that previously had tape on it, and it was resolved with a short course of oral antibiotics.
Conclusion: The eTEP technique for hernia surgery was safe and feasible using the Versius robotic system. Implementation is possible in experienced hands with minimal changes to the surgical techniques.
{"title":"Implementation of the Versius Surgical System in Complex Abdominal Wall Repair: First Reported Case of an Robotic ETEP/TAR Procedure.","authors":"Renato D Pinto, Pedro Trauczynski, Diego L Lima, Leandro T Cavazzola","doi":"10.1097/SLE.0000000000001231","DOIUrl":"10.1097/SLE.0000000000001231","url":null,"abstract":"<p><strong>Background: </strong>Robotic ventral hernia repair has been increasing globally, with comparable outcomes to laparoscopic repair and lower rates of conversion to open surgery. Robotic surgery is increasing in popularity, and there is a number of new robotic systems entering the marketing. We report the first case of a Roboic eTEP using the Versius robotic system in a patient with an incisional hernia.</p><p><strong>Methods: </strong>Surgery was performed using the Versius system from CMR surgical which consists of bedside units for each instrument and a console. The patient presented with an incisional hernia measuring 9.5×5 cm in the left flank.</p><p><strong>Results: </strong>The patient was discharged on postoperative day (POD) 2 with a drain. There was no need for opioids. The drain was removed at POD 7. The patient presented at POD 10 with erythema and cellulitis in the area that previously had tape on it, and it was resolved with a short course of oral antibiotics.</p><p><strong>Conclusion: </strong>The eTEP technique for hernia surgery was safe and feasible using the Versius robotic system. Implementation is possible in experienced hands with minimal changes to the surgical techniques.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"330-333"},"PeriodicalIF":1.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140944285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1097/SLE.0000000000001278
Matthew Udine, Mallorie L Huff, Katherine Tsay, Abdul-Rahman F Diab, Joseph Sujka, Christopher DuCoin, Salvatore Docimo
<p><strong>Objective: </strong>Endoscopes are an essential tool in the diagnosis, screening, and treatment of gastrointestinal diseases. In 2019, the Food and Drug Administration issued a news release, recommending that duodenoscope manufacturers and health care facilities phase out fully reusable duodenoscopes with fixed endcaps in lieu of duodenoscopes that are either fully disposable or those that contain disposable endcaps. With this study, we systematically reviewed the published literature on single-use disposable gastrointestinal scopes to describe the current state of the literature and provide summary recommendations on the role of disposable gastrointestinal endoscopes.</p><p><strong>Materials and methods: </strong>For our inclusion criteria, we searched for studies that were published in the year 2015 and afterward. We performed a literature search in PubMed using the keywords, "disposable," "reusable," "choledochoscope," "colonoscope," "duodenoscope," "esophagoscope," "gastroscope," and "sigmoidoscope." After our review, we identified our final article set, including 13 articles relating to disposable scopes, published from 2015 to 2023.</p><p><strong>Results: </strong>In this review, we show 13 articles discussing the infection rate, functionality, safety, and affordability of disposable gastrointestinal scopes in comparison to reusable gastrointestinal scopes. Of the 3 articles that discussed infection rates (by Forbes and colleagues, Ridtitid and colleagues, and Ofosu and colleagues), each demonstrated a decreased risk of infection in disposable gastrointestinal scopes. Functionality was another common theme among these articles. Six articles (by Muthusamy and colleagues, Bang and colleagues, Lisotti and colleagues, Ross and colleagues, Kang and colleagues, and Forbes and colleagues) demonstrated comparable functionality of disposable scopes to reusable scopes. The most reported functionality issue in disposable scopes was decreased camera resolution. Disposable scopes also showed comparable safety profiles compared with reusable scopes. Six articles (by Kalipershad and colleagues, Muthusamy and colleagues, Bang and colleagues, Lisotti and colleagues, Luo and colleagues, and Huynh and colleagues) showed comparable rates of AEs, whereas 1 article (by Ofosu and colleagues) demonstrated increased rates of AEs with disposable scopes. Lastly, a cost analysis was looked at in 3 of the articles. Two articles (by Larsen et al and Ross and colleagues) remarked that further research is needed to understand the cost of disposable scopes, whereas 1 article (by Kang and colleagues) showed a favorable cost analysis.</p><p><strong>Conclusions: </strong>After a review of the literature published since the 2015 Food and Drug Administration safety communication, disposable scopes have been shown to be effective in decreasing infection risks while maintaining similar safety profiles to conventional reusable scopes. However, more research is required
{"title":"Disposable Gastrointestinal Scopes: A Systematic Review.","authors":"Matthew Udine, Mallorie L Huff, Katherine Tsay, Abdul-Rahman F Diab, Joseph Sujka, Christopher DuCoin, Salvatore Docimo","doi":"10.1097/SLE.0000000000001278","DOIUrl":"10.1097/SLE.0000000000001278","url":null,"abstract":"<p><strong>Objective: </strong>Endoscopes are an essential tool in the diagnosis, screening, and treatment of gastrointestinal diseases. In 2019, the Food and Drug Administration issued a news release, recommending that duodenoscope manufacturers and health care facilities phase out fully reusable duodenoscopes with fixed endcaps in lieu of duodenoscopes that are either fully disposable or those that contain disposable endcaps. With this study, we systematically reviewed the published literature on single-use disposable gastrointestinal scopes to describe the current state of the literature and provide summary recommendations on the role of disposable gastrointestinal endoscopes.</p><p><strong>Materials and methods: </strong>For our inclusion criteria, we searched for studies that were published in the year 2015 and afterward. We performed a literature search in PubMed using the keywords, \"disposable,\" \"reusable,\" \"choledochoscope,\" \"colonoscope,\" \"duodenoscope,\" \"esophagoscope,\" \"gastroscope,\" and \"sigmoidoscope.\" After our review, we identified our final article set, including 13 articles relating to disposable scopes, published from 2015 to 2023.</p><p><strong>Results: </strong>In this review, we show 13 articles discussing the infection rate, functionality, safety, and affordability of disposable gastrointestinal scopes in comparison to reusable gastrointestinal scopes. Of the 3 articles that discussed infection rates (by Forbes and colleagues, Ridtitid and colleagues, and Ofosu and colleagues), each demonstrated a decreased risk of infection in disposable gastrointestinal scopes. Functionality was another common theme among these articles. Six articles (by Muthusamy and colleagues, Bang and colleagues, Lisotti and colleagues, Ross and colleagues, Kang and colleagues, and Forbes and colleagues) demonstrated comparable functionality of disposable scopes to reusable scopes. The most reported functionality issue in disposable scopes was decreased camera resolution. Disposable scopes also showed comparable safety profiles compared with reusable scopes. Six articles (by Kalipershad and colleagues, Muthusamy and colleagues, Bang and colleagues, Lisotti and colleagues, Luo and colleagues, and Huynh and colleagues) showed comparable rates of AEs, whereas 1 article (by Ofosu and colleagues) demonstrated increased rates of AEs with disposable scopes. Lastly, a cost analysis was looked at in 3 of the articles. Two articles (by Larsen et al and Ross and colleagues) remarked that further research is needed to understand the cost of disposable scopes, whereas 1 article (by Kang and colleagues) showed a favorable cost analysis.</p><p><strong>Conclusions: </strong>After a review of the literature published since the 2015 Food and Drug Administration safety communication, disposable scopes have been shown to be effective in decreasing infection risks while maintaining similar safety profiles to conventional reusable scopes. However, more research is required ","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"321-329"},"PeriodicalIF":1.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141065639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1097/SLE.0000000000001286
Wei-Dong Zhang, Qi Le, Ke-Jie Yu, Ying-Chun Wang, Xian-Jiang Wu
Background: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is newly applied technology. Carbon nanoparticles (CNs) are novel lymph node tracers that have been widely used in China to help remove central lymph nodes (CLNs) and protect the parathyroid glands (PGs) in open thyroid cancer surgery. This study is to evaluate the effectiveness and safety of CNs in TOETVA.
Materials and methods: A total of 158 patients who underwent TOETVA with unilateral papillary thyroid carcinoma were enrolled in this study from March 2019 to February 2022. The participants were divided into a CNs group (n=88) and a control group (n=70), based on whether they received a intraoperative injection of CNs or not. Meanwhile, the CNs group were additionally divided into 2 subgroups, leakage subgroup (n=26) and standard subgroup (n=62). The 2 groups and subgroups were compared in terms of patient characteristics, perioperative clinical results, and postoperative outcomes.
Results: All common metrics had no significant differences were found between the CNs group and the control group ( P >0.05). The standard subgroup of CNs group had advantage over the control group on PGs identification (59/62 vs. 59/70 for superior PG, 56/62 vs. 52/70 for inferior PG, P <0.05). Moreover, the standard subgroup harvested more CLNs than the control group (8.97±2.96 vs. 7.47±2.93, P <0.05). More operation time was spent on the leakage subgroup of CNs group than the control group (160.00±17.61 vs. 140.00±13.32, P <0.05). Meanwhile, the leakage subgroup had disadvantage on intraoperative hemorrhage (26.15±10.80 vs. 21.21±7.09, P <0.05) and hospital durations (4.96±0.72 vs. 4.57±0.69, P <0.05). Furthermore, the leakage group identified fewer inferior PG than the control group (7/26 vs. 52/70, P <0.05). Contrary to the standard subgroup, the CLNs of the leakage subgroup was also unsatisfactory compared with the control group (4.96±1.84 vs. 7.47±2.93, P <0.05).
Conclusions: The application of CNs suspension tracing technology has a definite effect in TOETVA. It can improve the thoroughness of lymph node dissection in the central region and enhance recognition of the PG. However, refined extracapsular anatomy is indispensable to prevent CN leakage. Leaked CNs will also be counterproductive to the operation.
{"title":"Application of Carbon Nanoparticles in Transoral Endoscopic Thyroidectomy Vestibular Approach for Unilateral Papillary Thyroid Cancer.","authors":"Wei-Dong Zhang, Qi Le, Ke-Jie Yu, Ying-Chun Wang, Xian-Jiang Wu","doi":"10.1097/SLE.0000000000001286","DOIUrl":"10.1097/SLE.0000000000001286","url":null,"abstract":"<p><strong>Background: </strong>Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is newly applied technology. Carbon nanoparticles (CNs) are novel lymph node tracers that have been widely used in China to help remove central lymph nodes (CLNs) and protect the parathyroid glands (PGs) in open thyroid cancer surgery. This study is to evaluate the effectiveness and safety of CNs in TOETVA.</p><p><strong>Materials and methods: </strong>A total of 158 patients who underwent TOETVA with unilateral papillary thyroid carcinoma were enrolled in this study from March 2019 to February 2022. The participants were divided into a CNs group (n=88) and a control group (n=70), based on whether they received a intraoperative injection of CNs or not. Meanwhile, the CNs group were additionally divided into 2 subgroups, leakage subgroup (n=26) and standard subgroup (n=62). The 2 groups and subgroups were compared in terms of patient characteristics, perioperative clinical results, and postoperative outcomes.</p><p><strong>Results: </strong>All common metrics had no significant differences were found between the CNs group and the control group ( P >0.05). The standard subgroup of CNs group had advantage over the control group on PGs identification (59/62 vs. 59/70 for superior PG, 56/62 vs. 52/70 for inferior PG, P <0.05). Moreover, the standard subgroup harvested more CLNs than the control group (8.97±2.96 vs. 7.47±2.93, P <0.05). More operation time was spent on the leakage subgroup of CNs group than the control group (160.00±17.61 vs. 140.00±13.32, P <0.05). Meanwhile, the leakage subgroup had disadvantage on intraoperative hemorrhage (26.15±10.80 vs. 21.21±7.09, P <0.05) and hospital durations (4.96±0.72 vs. 4.57±0.69, P <0.05). Furthermore, the leakage group identified fewer inferior PG than the control group (7/26 vs. 52/70, P <0.05). Contrary to the standard subgroup, the CLNs of the leakage subgroup was also unsatisfactory compared with the control group (4.96±1.84 vs. 7.47±2.93, P <0.05).</p><p><strong>Conclusions: </strong>The application of CNs suspension tracing technology has a definite effect in TOETVA. It can improve the thoroughness of lymph node dissection in the central region and enhance recognition of the PG. However, refined extracapsular anatomy is indispensable to prevent CN leakage. Leaked CNs will also be counterproductive to the operation.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"301-305"},"PeriodicalIF":1.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140898079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1097/SLE.0000000000001187
Yan Tian, Weihao Zhang, Tingting Zhang, Lan Liu, Jianqiang Guo
Objective: To investigate the esophageal motility characteristics of gastroesophageal reflux disease (GERD) and their relationship with symptoms.
Patients and methods: We examined 101 patients diagnosed with GERD by endoscopy and divided them into 3 groups as follows: nonerosive reflux disease (NERD), reflux esophagitis, and Barrett esophagus. Esophageal high-resolution manometry and the GERD Questionnaire were used to investigate the characteristics of esophageal dynamics and symptoms. In addition, the reflux symptom index was completed and the patients were divided into 7 groups according to symptoms. We then determined the correlation between dynamic esophageal characteristics and clinical symptoms.
Results: Upper (UES) and lower (LES) esophageal sphincter pressures and the 4-second integrated relaxation pressure in the RE group were lower than those in the NERD group. The 4-second integrated relaxation pressure in the Barrett esophagus group was also lower than that in the NERD group. In the analysis of extraesophageal symptoms, high-resolution manometry showed significant differences in UES pressures among all groups. Further subgroup analysis showed that compared with the group without extraesophageal symptoms, the UES pressure of the groups with pharyngeal foreign body sensation, throat clearing, and multiple extraesophageal symptoms was lower.
Conclusions: As GERD severity increases, motor dysfunction of the LES and esophageal body gradually worsens, and the LES plays an important role in GERD development. Decreased UES pressure plays an important role in the occurrence of extraesophageal symptoms, which is more noticeable in patients with pharyngeal foreign body sensation and throat clearing.
{"title":"Analysis of the Correlation Between Dynamic Characteristics and Symptoms of Gastroesophageal Reflux Disease.","authors":"Yan Tian, Weihao Zhang, Tingting Zhang, Lan Liu, Jianqiang Guo","doi":"10.1097/SLE.0000000000001187","DOIUrl":"10.1097/SLE.0000000000001187","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the esophageal motility characteristics of gastroesophageal reflux disease (GERD) and their relationship with symptoms.</p><p><strong>Patients and methods: </strong>We examined 101 patients diagnosed with GERD by endoscopy and divided them into 3 groups as follows: nonerosive reflux disease (NERD), reflux esophagitis, and Barrett esophagus. Esophageal high-resolution manometry and the GERD Questionnaire were used to investigate the characteristics of esophageal dynamics and symptoms. In addition, the reflux symptom index was completed and the patients were divided into 7 groups according to symptoms. We then determined the correlation between dynamic esophageal characteristics and clinical symptoms.</p><p><strong>Results: </strong>Upper (UES) and lower (LES) esophageal sphincter pressures and the 4-second integrated relaxation pressure in the RE group were lower than those in the NERD group. The 4-second integrated relaxation pressure in the Barrett esophagus group was also lower than that in the NERD group. In the analysis of extraesophageal symptoms, high-resolution manometry showed significant differences in UES pressures among all groups. Further subgroup analysis showed that compared with the group without extraesophageal symptoms, the UES pressure of the groups with pharyngeal foreign body sensation, throat clearing, and multiple extraesophageal symptoms was lower.</p><p><strong>Conclusions: </strong>As GERD severity increases, motor dysfunction of the LES and esophageal body gradually worsens, and the LES plays an important role in GERD development. Decreased UES pressure plays an important role in the occurrence of extraesophageal symptoms, which is more noticeable in patients with pharyngeal foreign body sensation and throat clearing.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"268-274"},"PeriodicalIF":1.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11139230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140336907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-01DOI: 10.1097/SLE.0000000000001276
Deniz Guzey, Turgut Donmez, Mehmet Karabulut, Ahmet Surek, Nalan Saygi Emir, Can Ertug Cayirci, Hande Kandemir, Engin Hatipoglu
Background: Shoulder pain is a condition that seriously discomforts patients and develops caused by a peritoneal tear in laparoscopic extraperitoneal hernia repair (TEP) surgeries. Although surgeons generally prefer general anesthesia for the TEP technique, many studies have been carried out on the use of regional anesthesia in recent years. In our study, we aimed to investigate the efficacy and safety of the combined spinal/epidural anesthesia (CSEA) method to prevent shoulder pain in the TEP technique.
Methods: The patients who operated with the TEP procedure were divided into 2 groups; SA (group 1) and CSEA (group 2). The 2 patient groups were compared in terms of sex, age, body mass index, duration of surgery, total operation time, patient satisfaction, pain scores, length of hospital stay, adverse effects, intraoperative, and postoperative complications.
Results: The number of patients in group 1 was 42 and group 2 was 40. The mean operation time was recorded as 55.9 and 80.2 minutes in groups 1 and 2, respectively, which was statistically significantly shorter in group 1 ( P <0.001). Postoperative pain was significantly less in group 2 for the 4th hour ( P <0.0001) and the 12th hour ( P =0.047). There was no difference between the 2 groups in terms of peritoneal tear ( P =0.860). Intraoperative and postoperative shoulder pain was significantly less in group 2 ( P =0.038, P =0015, respectively).
Conclusion: CSEA is an effective and safe anesthesia method for preventing shoulder pain that develops after TEP surgeries.
背景:肩部疼痛是腹腔镜腹膜外疝修补术(TEP)手术中腹膜撕裂导致患者严重不适的一种症状。虽然外科医生通常倾向于在 TEP 技术中使用全身麻醉,但近年来也有许多关于使用区域麻醉的研究。在我们的研究中,我们旨在探讨脊髓/硬膜外联合麻醉(CSEA)方法在 TEP 技术中预防肩痛的有效性和安全性:将接受 TEP 手术的患者分为两组:SA 组(第 1 组)和 CSEA 组(第 2 组)。比较两组患者的性别、年龄、体重指数、手术时间、手术总时间、患者满意度、疼痛评分、住院时间、不良反应、术中和术后并发症:第一组患者人数为 42 人,第二组患者人数为 40 人。第 1 组和第 2 组的平均手术时间分别为 55.9 分钟和 80.2 分钟,第 1 组的手术时间明显短于第 2 组:CSEA 是一种有效且安全的麻醉方法,可有效预防 TEP 手术后出现的肩部疼痛。
{"title":"The Effect of Combined Spinal Epidural Anesthesia on Shoulder Pain in Laparoscopic Extraperitoneal Hernia Surgery.","authors":"Deniz Guzey, Turgut Donmez, Mehmet Karabulut, Ahmet Surek, Nalan Saygi Emir, Can Ertug Cayirci, Hande Kandemir, Engin Hatipoglu","doi":"10.1097/SLE.0000000000001276","DOIUrl":"10.1097/SLE.0000000000001276","url":null,"abstract":"<p><strong>Background: </strong>Shoulder pain is a condition that seriously discomforts patients and develops caused by a peritoneal tear in laparoscopic extraperitoneal hernia repair (TEP) surgeries. Although surgeons generally prefer general anesthesia for the TEP technique, many studies have been carried out on the use of regional anesthesia in recent years. In our study, we aimed to investigate the efficacy and safety of the combined spinal/epidural anesthesia (CSEA) method to prevent shoulder pain in the TEP technique.</p><p><strong>Methods: </strong>The patients who operated with the TEP procedure were divided into 2 groups; SA (group 1) and CSEA (group 2). The 2 patient groups were compared in terms of sex, age, body mass index, duration of surgery, total operation time, patient satisfaction, pain scores, length of hospital stay, adverse effects, intraoperative, and postoperative complications.</p><p><strong>Results: </strong>The number of patients in group 1 was 42 and group 2 was 40. The mean operation time was recorded as 55.9 and 80.2 minutes in groups 1 and 2, respectively, which was statistically significantly shorter in group 1 ( P <0.001). Postoperative pain was significantly less in group 2 for the 4th hour ( P <0.0001) and the 12th hour ( P =0.047). There was no difference between the 2 groups in terms of peritoneal tear ( P =0.860). Intraoperative and postoperative shoulder pain was significantly less in group 2 ( P =0.038, P =0015, respectively).</p><p><strong>Conclusion: </strong>CSEA is an effective and safe anesthesia method for preventing shoulder pain that develops after TEP surgeries.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"275-280"},"PeriodicalIF":1.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140294594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Postoperative pancreatic fistulas (POPFs) occur after 20% to 30% of laparoscopic distal pancreatectomies. This study aimed to evaluate the clinical efficacy of laparoscopic distal pancreatectomy using triple-row staplers in preventing POPFs.
Methods: Between April 2016 and May 2023, 59 patients underwent complete laparoscopic distal pancreatectomies. There were more females (n=34, 57.6%) than males (n=25, 42.4%). The median age of the patients was 68.9 years. The patients were divided into slow-compression (n=19) and no-compression (n=40) groups and examined for pancreatic leakage. Both groups were examined with respect to age, sex, body mass index (BMI), pancreatic thickness at the pancreatic dissection site, pancreatic texture, diagnosis, operative time, blood loss, presence of POPF, date of drain removal, and length of hospital stay. In addition, risk factors for POPF were examined in a multivariate analysis.
Results: Grade B POPFs were found in 9 patients (15.3%). Using univariate analysis, the operative time, blood loss, postoperative pancreatic fluid leakage, day of drain removal, and hospital stay were shorter in the no-compression group than in the slow-compression group. Using multivariate analysis, the absence of POPFs was significantly more frequent in the no-compression group (odds ratio, 5.69; 95% CI, 1.241-26.109; P =0.025). The no-compression pancreatic dissection method was a simple method for reducing POPF incidence.
Conclusions: The method of quickly dissecting the pancreas without compression yielded better results than the method of slowly dissecting the pancreas with slow compression. This quick dissection without compression was a simple and safe method that minimized postoperative pancreatic fluid leakage, shortened the operative time and length of hospital stay, and reduced medical costs. Therefore, this method might be a clinically successful option.
{"title":"Efficacy of Pancreatic Dissection With a Triple-row Stapler in Laparoscopic Distal Pancreatectomy: A Retrospective Observational Study.","authors":"Hideki Izumi, Hisamichi Yoshii, Rika Fujino, Shigeya Takeo, Eiji Nomura, Masaya Mukai, Hiroyasu Makuuchi","doi":"10.1097/SLE.0000000000001284","DOIUrl":"10.1097/SLE.0000000000001284","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pancreatic fistulas (POPFs) occur after 20% to 30% of laparoscopic distal pancreatectomies. This study aimed to evaluate the clinical efficacy of laparoscopic distal pancreatectomy using triple-row staplers in preventing POPFs.</p><p><strong>Methods: </strong>Between April 2016 and May 2023, 59 patients underwent complete laparoscopic distal pancreatectomies. There were more females (n=34, 57.6%) than males (n=25, 42.4%). The median age of the patients was 68.9 years. The patients were divided into slow-compression (n=19) and no-compression (n=40) groups and examined for pancreatic leakage. Both groups were examined with respect to age, sex, body mass index (BMI), pancreatic thickness at the pancreatic dissection site, pancreatic texture, diagnosis, operative time, blood loss, presence of POPF, date of drain removal, and length of hospital stay. In addition, risk factors for POPF were examined in a multivariate analysis.</p><p><strong>Results: </strong>Grade B POPFs were found in 9 patients (15.3%). Using univariate analysis, the operative time, blood loss, postoperative pancreatic fluid leakage, day of drain removal, and hospital stay were shorter in the no-compression group than in the slow-compression group. Using multivariate analysis, the absence of POPFs was significantly more frequent in the no-compression group (odds ratio, 5.69; 95% CI, 1.241-26.109; P =0.025). The no-compression pancreatic dissection method was a simple method for reducing POPF incidence.</p><p><strong>Conclusions: </strong>The method of quickly dissecting the pancreas without compression yielded better results than the method of slowly dissecting the pancreas with slow compression. This quick dissection without compression was a simple and safe method that minimized postoperative pancreatic fluid leakage, shortened the operative time and length of hospital stay, and reduced medical costs. Therefore, this method might be a clinically successful option.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"295-300"},"PeriodicalIF":1.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140912725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Despite the success of bariatric surgery in treating obesity, it can still lead to complications. The most serious and feared technical complications are bleeding and leakage from the gastric staple line. In this study, stapler line reinforcement was investigated to determine whether it affects postoperative leakage and bleeding rates and their management.
Materials and methods: Overall, 510 patients who underwent sleeve gastrectomy were evaluated retrospectively. They were divided into 2 groups according to whether reinforcement of the staple line with running imbricating sutures was performed.
Results: In the reinforcement group, there were two leaks (0.7%), which were diagnosed seven and eight days after surgery. In the non-reinforcement group, there were nine leaks (4%). There was no difference between the two groups in staple line bleeding.
Conclusions: This study shows that reinforcement with continuous imbricating sutures is associated with less stapler line leakage and a lower reoperation rate at the cost of increased operative time.
{"title":"Reinforcement in Laparoscopic Sleeve Gastrectomy: Is It Effective?","authors":"Mümin Coşkun, Tevfik Kivilcim Uprak, Ömer Günal, Aygün Aliyeva, Asim Cingi","doi":"10.1097/SLE.0000000000001283","DOIUrl":"10.1097/SLE.0000000000001283","url":null,"abstract":"<p><strong>Background: </strong>Despite the success of bariatric surgery in treating obesity, it can still lead to complications. The most serious and feared technical complications are bleeding and leakage from the gastric staple line. In this study, stapler line reinforcement was investigated to determine whether it affects postoperative leakage and bleeding rates and their management.</p><p><strong>Materials and methods: </strong>Overall, 510 patients who underwent sleeve gastrectomy were evaluated retrospectively. They were divided into 2 groups according to whether reinforcement of the staple line with running imbricating sutures was performed.</p><p><strong>Results: </strong>In the reinforcement group, there were two leaks (0.7%), which were diagnosed seven and eight days after surgery. In the non-reinforcement group, there were nine leaks (4%). There was no difference between the two groups in staple line bleeding.</p><p><strong>Conclusions: </strong>This study shows that reinforcement with continuous imbricating sutures is associated with less stapler line leakage and a lower reoperation rate at the cost of increased operative time.</p>","PeriodicalId":22092,"journal":{"name":"Surgical Laparoscopy, Endoscopy & Percutaneous Techniques","volume":" ","pages":"290-294"},"PeriodicalIF":1.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140912775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}