Surgical Innovation最新文献

Objective. This prospective comparative study evaluated the efficacy and relationship between laparoscopic origami crane training (LOCT) and the Fundamentals of Laparoscopic Surgery (FLS) score using 3D vs 2D laparoscopy.Methods. From 2020 to 2023, fourth-year medical students at Asahikawa Medical University created 20 origami cranes (1 per day) in a laparoscopic dry box. FLS scores were assessed 5 times, corresponding to every fifth crane. Primary outcomes included LOCT production time, quality, and FLS scores, analyzed using the Mann-Whitney U test and repeated-measures ANOVA.Results. Eighteen participants were divided into 2 groups: 8 in the 3D laparoscopy (3D) group and ten in the 2D laparoscopy (2D) group. At the end of the study, the 3D group (16.5 min) produced cranes significantly faster than the 2D group (27 min, P = 0.02). Repeated-measures ANOVA showed that the production time, origami crane score, and FLS score improved over time. The 3D group had a significantly shorter production time (F (1, 16) = 8, P = 0.01). The origami crane score was not significantly different between the groups (F (1, 7) = 3, P = 0.13) but tended to be higher in the 3D group. No significant differences were found in the FLS scores between the groups for any task. A significant negative correlation between LOCT production time and FLS score in both groups confirmed that shorter production time correlated with higher FLS scores.Conclusions. LOCT is effective for extraclinical laparoscopic training and correlates with FLS scores. 3D laparoscopy may help beginners develop depth perception, improve bimanual and hand-eye coordination, and enhance LOCT effectiveness.

Background: Early detection of colorectal cancer (CRC) is significantly associated with reduced morbidity and mortality. Virtual colonoscopy (VC) is a minimally invasive, safe and well-tolerated alternative procedure to traditional colonoscopy. Therefore, we aimed to evaluate the findings of VC particularly in supine and prone positions as well as to contribute to the practical challenges of procedure.

Methods: Total number of 20 patients who underwent VC were included in this retrospective study. After proper bowel cleansing was achieved, intestinal dilatation was performed by injecting air into the rectum. Two different shots were performed in the supine and prone positions. Additionally, intestinal diameters were measured from the cecum to the rectum at their widest point via 2-dimensional coronal reformat.

Results: Polyps were detected in 3 patients which were confirmed by optical colonoscopy. The mean cecum diameter was detected as the largest diameter in the supine and prone examinations. In both supine and prone examinations, the distal descending colon was the most challenging site. Additionally, the mean descending colon diameter calculated in the prone position (40.9 ± 6.4 mm) was found to be statistically larger than descending colon diameter calculated in the supine position (36.1 ± 5.3 mm) (P = 0.001).

Conclusions: Our findings clearly demonstrated that combination of prone and supine scanning provides clear field of vision on narrow parts of the colon which improves accurate estimation for polyp detection. Furthermore, VC appears to be more comfortable, safe, fast, and cost-efffective procedure for CRC screening with advantages of low radiation exposure, extracolonic findings and lack of sedation requirements.

Background: This study aimed to compare the outcomes of a modified submucosal ligation of the fistula tract (MSLOFT) technique with the hybrid seton technique for treating transsphincteric anal fistulas.

Material and methods: A retrospective analysis was conducted with ethical approval from Baskent University. Patients over 18 years of age with a diagnosis of transsphincteric fistula and complete data were included in the study. Patients with fistulas of non-cryptoglandular origin, incontinence, multiple fistula tracts, inflammatory bowel disease, or malignancy were excluded. The study involved 255 patients, divided into: MSLOFT (n = 31) and hybrid seton (n = 224) groups. Propensity score matching (PSM) was performed to balance age, gender, and body mass index between the groups, resulting in 30 patients per group.

Results: There was no significant difference between the MSLOFT and hybrid seton groups regarding Wexner scores, incontinence rates, recurrence, or reoperation rates, in the overall cohort and after PSM. However, in the overall cohort and after PSM analysis, the operation time (P = 0.047) and follow-up time (P < 0.001) of the MSLOFT group were significantly longer. Recurrence was noted in 3 MSLOFT patients and 2 hybrid seton patients after PSM.

Conclusion: MSLOFT is a feasible and effective sphincter-preserving technique for transsphincteric anal fistulas, providing low recurrence and incontinence rates similar to the hybrid seton technique.

Background: Advances in Enhanced Recovery After Colectomy protocols have enabled same day discharge (SDD) in some patients. Current literature is limited to single institutions limiting generalizability. We employed a nationally-representative dataset to compare outcomes between SDD patients and patients with a short-term hospital stay (discharged on postoperative day 1 or 2).

Methods: We conducted a retrospective study using the American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) Targeted Colectomy Participant User Files (2017-2021). We included patients ≥18 years who underwent elective minimally invasive colectomy. We excluded patients with severe comorbid conditions or in-hospital complications. We performed a 1:1 propensity-match adjusting for patient, diagnosis, and procedure- type characteristics. Our primary outcome was 30-day readmission and secondary outcome was post-discharge complications.

Results: We identified 22,482 patients, 740 (3.3%) of which were SDD patients. A higher proportion of patients with SDD underwent right colectomy (76.4% vs36.4%, P < 0.001) and carried a diagnosis of a benign neoplasm (53.0% vs18.1%, P < 0.001). After propensity matching there was no significant difference in the rate of 30-day readmission between the 2 groups (3.4% vs4.7%; P = 0.23). Additionally, there was no significant difference in rates of anastomotic leak (0.7% vs0.8%; P = 0.58) or colonic ileus (1.4% vs1.8%; P = 0.58). Post-discharge bleeding complications were higher in SDD patients (0.5% vs0%; P = 0.045).

Conclusions: SDD following minimally invasive colectomy is not associated with higher readmission, anastomotic leak, or SSI when compared to patients discharged on postoperative day 1/2. SDD after minimally invasive colectomy may be considered for patients without severe comorbid conditions.

Background: The Enhanced Recovery After Surgery (ERAS) protocol improved perioperative colorectal care. Although the protocol is firmly implemented across hospital settings, there are benefits to gain by actively involving patients in their recovery. The main objective of this study was to investigate whether compliance with selected items in the ERAS protocol could further improve by using a patient-centred mobile application.

Method: This multicentre, randomised controlled trial was conducted between October 2019 and September 2022. Patients aged 18 years or older who underwent elective colorectal surgery, and in possession of a smartphone were included. The intervention group used a mobile application combined with an activity tracker to be guided and supported through the ERAS pathway. The control group received standard care and wore an activity tracker to monitor their daily activities. The primary outcome was overall compliance with selected active elements of the ERAS protocol.

Results: In total, 140 participants were randomised to either the intervention (n = 72) or control group (n = 68). The use of the ERAS App demonstrated a significant improvement in overall compliance by 10%, particularly in early solid food intake by 42% and early mobilization by 27%. Postoperative or patient reported outcomes did not differ between groups.

Conclusion: The smartphone application 'ERAS App' is able to improve adherence to the active elements of the ERAS protocol for colorectal surgery. This is an important step towards optimizing perioperative care for colorectal surgery patients and enabling patients to optimize being in control of their own recovery. Trial registration: ERAS APPtimize, NTR7314 (https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON29410).

Background: Laparoscopic surgery has advanced significantly; however, effective communication within the surgical team remains challenging, particularly in training scenarios where misinterpretation of instructions can lead to errors. Virtual pointers, indicating the instructor's gaze through eye-tracking devices and overlaying it onto the screen using augmented reality (AR), can enhance understanding and reduce errors.

Methods: In a study involving 10 participants divided into experts and novices in laparoscopic surgery, various pointers (differing in shape, size and colour) were analysed in an AR environment using the HoloLens2 device. The aim was to assess the acceptance of these pointers by both groups, understand how their characteristics affect perception, and evaluate the AR device's usefulness.

Results: Initial results showed an 80% acceptance rate. After analysing the pointers, this decreased to 60%, as some experts changed their opinion from positive to neutral. The study revealed that the characteristics of the pointers significantly affect their perception, with large, thick-rimmed pointers being preferred. Orange was the best-performing colour. The device used also influenced perception, as experts who changed their perception criticised certain aspects of the head-mounted display.

Conclusions: The study highlights the potential of virtual pointers to improve communication in laparoscopic training, particularly when their size, shape, and colour are optimised. Further research with a larger sample size is needed to confirm these results and explore the HoloLens2's influence on users' perceptions. These insights could guide the development of more effective training tools for minimally invasive surgery.

Background: The choice of the deep inferior epigastric perforator (DIEP) flap for breast reconstruction has increased. Three-dimensional (3D) models of DIEP flaps have been introduced with advances in 3D technology to assist the tedious intramuscular dissection of the pedicle. This study presents the process of creating an ideal 3D model for a DIEP flap.

Methods: Collaboration among various professionals, including surgeons, radiologists, and 3D-printing model makers, is essential for manufacturing suitable 3D-printing DIEP models. Our team facilitated the collaboration process by sharing the virtual 3D model via a uniform resource locator (URL) using an online platform accessible on mobile devices.

Results: During collaboration in 3D DIEP model-making, we continuously upgraded the model to a better version. The model was modified according to the surgeon's preference from a 1:1 ratio size to a handheld size. Additionally, we achieved significant advancements over conventional methods, including improved visualization of detailed vessel pathways with separation of arteries and veins, tissue transparency, and superficial inferior epigastric vein (SIEV).

Conclusions: Through 3D model-making collaborations, our team successfully developed a 3D DIEP model with translucency and visualized arteries and veins separately with accentuation of the perforators, including SIEV tracing, which is more accurate. This ideal 3D model for the DIEP flap enables the selection of a perforator vessel that is safe and easy to dissect to lower complications and procedure time and will be of great help to less experienced surgeons.

Background: Roux-en-Y gastric bypass (RYGB) is considered the weight loss procedure of choice for obese patients with gastroesophageal reflux disease (GORD). The long-term prevalence of GORD after RYGB for obesity is underestimated as many post-RYGB patients can still complain of severe reflux symptoms, refractory to medications.

Methods: This is a narrative review using the patient, intervention, comparison, outcome and study strategy. The literature search was undertaken using PubMed, Medline, and Google Scholar databases with the following MeSH terms: Gastroesophageal reflux disease, GORD, Obesity, Gastric bypass, Roux-en-Y gastric bypass, complication, and fundoplication.

Results: Twelve original papers and case report studies on 57 patients who met the inclusion criteria were suitable for the present review. Reporting styles on successful treatment outcomes were heterogeneous. Treatment options for these patients are limited but include further surgical or endoscopic interventions. Careful follow-up and appropriate management are paramount for this population.

Conclusion: There is significant paucity in the available evidence on managing GORD after RYGB. This narrative review provides a detailed overview of the underlying causes, discusses the various endoscopic and surgical therapy options, and suggests strategies to provide tailored and appropriate therapy for this complex group of patients.

Background: There is still controversy regarding the treatment strategy for moderate acute cholecystitis (AC). Percutaneous transhepatic gallbladder drainage (PTGBD) followed laparoscopic cholecystectomy (LC) has shown advantages compared to emergency LC (ELC). However, the results are controversial. Therefore, we conducted this updated meta-analysis to clarify this issue.

Materials and methods: A comprehensive literature search for relevant studies comparing the PTGBD + LC and ELC for moderate AC was performed. The statistical analysis was conducted using Stata.

Results: A total of 14 studies were included. The pooled analysis revealed that PTGBD + LC group had a shorter operation time (SMD = -1.07, 95%CI = -1.19 to -0.95), lower amount of intraoperative bleeding (SMD = -0.93, 95%CI = -1.07 to -0.79), lower conversion rate (OR = 0.28, 95% CI = 0.17-0.44), lower postoperative complications (OR = 0.45, 95% CI = 0.23-0.88) shorter postoperative hospital stay (SMD = -1.20, 95%CI = -1.33 to -1.07), lower wound infection rate (OR = 0.41, 95%CI = 0.23-0.74) and higher hospitalization expenses (SMD = 1.13, 95%CI = 0.96 to 1.29) compared with ELC group. There was no significant difference in the incidence of bile leak, bile duct injury and total hospital stay.

Conclusion: This meta-analysis suggested that PTGBD + LC has significant advantages over ELC for moderate AC patients, including lower surgical difficulty, lower conversion rate, fewer postoperative complications, and shorter hospital stay.