Surgical Innovation最新文献

BackgroundNear-infrared fluorescence (NIF)-mapping with indocyanine green dye (ICG) facilitates the identification of the intersegmental plane during minimally invasive segmentectomy. Our pilot study showed that ICG is associated with an increase in oncological margin distance from the tumour, greater than the surgeon's best judgment. We hypothesized that, with greater experience, the surgeon's judgement will improve, and the benefit of ICG will diminish.MethodsThis is a phase 2 single-arm trial of patients undergoing robotic-assisted segmentectomy for NSCLC tumours less than 3 cm. After isolating the diseased segment(s), the predicted intersegmental plane (Dp) was identified by the thoracic surgeon. After intravenous ICG injection, the true intersegmental plane (Dt) was revealed using NIF. The primary outcome was the average distance between Dt and Dp (Dt-Dp). Comparisons were performed across 3 temporal tertiles: tertile 1 (t1) comprised of the first 30 participants, and the remaining participants were divided equally for tertiles 2 (t2) and 3 (t3). Kruskal-Wallis test was used to compare differences between tertiles (α = 0.05).ResultsA total of 190 patients were enrolled from October 2016 to June 2021. The median age was 68 (interquartile range:62-72), and 57.37%(109/190) were women. ICG injection occurred in 60.53%(115/190) of the participants, and intersegmental plane visualization was achieved in 88.70%(102/115). Dt-Dp diminished significantly across tertiles: t1 = 20.65 ± 15.82 mm, t2 = 2.42 ± 15.49 mm, and t3 = 1.36 ± 9.87 mm (P = 0.0001). Locally estimated scatterplot smoothing revealed that this distance approaches zero as the surgeon performs more cases.ConclusionIn our single-surgeon experience with robotic-assisted segmentectomy for NSCLC, the added value of NIF-mapping with ICG diminishes with surgeon experience.

BackgroundEarly 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.MethodsTotal 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.ResultsPolyps 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).ConclusionsOur 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.

BackgroundIntrahepatic cholangiocarcinoma (ICC) presents a significant clinical challenge due to its high fatality rate and limited surgical candidacy. With only 30-40% of patients eligible for surgery upon diagnosis, alternative therapies are imperative. This study assesses the efficacy of Yttrium-90 (Y-90) radioembolization for unresectable ICC patients in a non-university tertiary care center (NUTCC).MethodsA retrospective analysis of 15 unresectable ICC patients treated with Y-90 radioembolization was conducted. Tumor response, survival, and adverse events were evaluated using RECIST criteria.Results60% of patients exhibited partial response, and 20% showed stable disease, with notable tumor size reduction and a median survival of 14 months. Minimal adverse effects were observed, indicating Y-90's favorable safety profile.ConclusionY-90 radioembolization shows potential in reducing tumor burden and enhancing survival rates with minimal adverse effects for unresectable ICC. Larger prospective studies are needed to confirm its efficacy and define its role in ICC treatment protocols.

BackgroundAdvances 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).MethodsWe 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.ResultsWe 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).ConclusionsSDD 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.

BackgroundTransabdominal pre-peritoneal inguinal hernia repair using the da Vinci Single-Port robot (SP-TAPP) is currently performed in few centers. We aimed to define the learning curve for SP-TAPP by analyzing operative times.MethodsThe operative times of 122 SP-TAPP performed between 2019 and 2024 were retrospectively analyzed. The following phases were analyzed: docking time (DT); pre-robot time (PRT, from skin incision to side cart placement); flap closure time (FCT); console time (CT), and overall time (OT). Cumulative sum analysis (CUSUM) was used to analyze learning curves. Surgical and 30-day outcome were analyzed.ResultsThe DT has remained constant over time (P > 0.9). PRT was divided into 3 phases with n1 = 5, n2 = 95 and n3 = 4, in which there was a progressive decrease in time (14.8 vs 11.9 vs 6.8 min; P = 0.08). In FCT and CT, 3 phases were identified in which times remained stable (P > 0.9 and P = 0.7). CUSUM analysis of OT identified 3 phases consisting of n1 = 13, n2 = 100 and n3 = 9 in which there was a progressive decrease in times (82 vs 72 vs 62 min; P = 0.3). Analysis of complications and early surgical outcomes did not differ except for estimated blood loss, although this was a clinically insignificant finding.ConclusionsThe learning curve for SP-TAPP is rapid and it shows how the technical skills are transferable between the multiport platform and the da Vinci Single Port robotic system for an experienced surgeon. An improvement is evident in PRT and OT, also compared to multiport systems, showing a potential for the platform to increase surgical activity.

BackgroundGynecomastia, the enlargement of male breast tissue, significantly impacts both physical and psychological health. Surgical intervention is often necessary, utilizing various techniques to reduce glandular and fatty tissue. This paper introduces an innovative surgical method combining power-assisted liposuction with the stab-flatten technique to enhance precision and cosmetic results. We present our clinical experience and evaluate its effectiveness in gynecomastia treatment.MethodsFrom June 2021 to January 2023, 128 gynecomastia patients underwent power-assisted liposuction and the stab-flatten method via a single axillary incision. We collected demographic and clinical data, including surgery duration, complications, and patient satisfaction regarding physical appearance, mental state, and social interactions. The BODY-Q questionnaire was used preoperatively and 3 months postoperatively for assessment.ResultsThe study included 128 male patients, treating 252 breasts, with an average age of 35 years and a mean BMI of 27.7 kg/m². Most procedures were bilateral (96.9%), with an average fat removal of 224.5 mL and a surgery duration of 147 minutes. The complication rate was low at 2.0%, with bruises in 5 breasts. The average hospital stay was 2 days. Significant improvements were noted in BODY-Q scores for appearance satisfaction and health-related quality of life, with increased appearance satisfaction and reduced appearance-related distress.ConclusionSince June 2021, the combined use of power-assisted liposuction and the stab-flatten technique has been effective in managing gynecomastia. This synergistic approach not only achieves aesthetically pleasing outcomes but also minimizes the surgical risks associated with traditional methods.

BackgroudPerirenal hematoma (PRH) is a notable complication following percutaneous nephrolithotomy (PCNL) with significant implications for patient outcomes. This study aimed to develop a nomogram predictive model for PRH after PCNL.MethodsRetrospective data from patients who underwent PCNL were analyzed. Patient demographics, stone characteristics, and operative details were assessed for their association with PRH using univariate and multivariate analyses. A nomogram was constructed based on identified predictors.ResultsAmong 1047 patients, 6.2% developed PRH. Factors significantly associated with PRH included age, urine culture, stone surface area, operative time and estimate blood loss. These factors were incorporated into the nomogram, providing a user-friendly tool for preoperative risk assessment of PRH following PCNL.ConclusionWe developed a nomogram predictive model for PRH after PCNL, facilitating individualized risk assessment and preventive strategies. Implementation of this nomogram may enhance patient safety and optimize surgical outcomes in PCNL procedures. Further validation studies are warranted to assess its generalizability and accuracy.