Surgical Endoscopy And Other Interventional Techniques最新文献

Background: Parastomal hernia (PSH) is the most common long-term complication of stoma creation during rectal resection, impacting the patients' quality of life to some degree. However, current clinical practice lacks accurate tools for predicting the occurrence of PSH. The present study aimed to develop a nomogram that could predict the occurrence of PSH in patients undergoing permanent colostomy during surgery for rectal cancer.

Methods: This study retrospectively enrolled a total of 430 eligible patients. The preliminary selection of predictive factors was performed using the Least Absolute Shrinkage and Selection Operator analysis. Subsequently, a predictive model was constructed using multivariable logistic regression and presented in the form of a nomogram. The nomogram's value was evaluated using receiver-operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). Internal validation was conducted by evaluating the model's performance on a validation cohort.

Results: Altogether, 133 cases (30.9%) were diagnosed with PSH. The diagnostic model incorporated seven factors, including elderly patients (age ≥ 65 years, odds ratio [OR]: 2.51; 95% confidence interval [CI]: 1.52-4.11), Female (OR: 2.43; 95% CI: 1.36-3.69), body mass index (BMI ≥ 25 kg/m²;OR: 2.52; 95% CI: 1.52-4.15), visceral fat area (VFA) (≥ 100 cm²; OR: 2.13; 95% CI: 1.18-3.85), subcutaneous fat area (SFA) (≥ 100 cm²;OR: 2.07; 95% CI: 1.14-3.73), surrounding parastomal fat tissue (SPFT) (≥ 43.2 ml; OR: 2.07; 95% CI: 1.14-3.73), and maximum abdominal wall defect diameter (≥ 4 cm; OR: 4.12; 95% CI: 2.46-6.89). The values of the area under the ROC curve for the training and validation sets were 0.826 (95% CI: 0.776-0.877) and 0.867 (95% CI: 0.804-0.933), respectively. The calibration curve showed a high degree of agreement between the predicted and observed outcomes. DCA indicated that the nomogram holds a substantial clinical value in predicting PSH in patients undergoing permanent colostomy during rectal cancer surgery.

Conclusion: We developed a model to predict the occurrence of PSH in patients with rectal cancer after permanent colostomy. This nomogram can help clinicians in assessing the risk of PSH occurrence in postoperative patients, thereby enabling personalized management of high-risk patients and guiding their lifestyle to improve their quality of life.

Introduction: Sleeve gastrectomy (SG) is the most performed bariatric operation in the United States. While weight loss following SG may lead to resolution of gastroesophageal reflux disease (GERD), it is also possible that SG anatomy can lead to new or worsening GERD. The purpose of our study was to determine if there is an association between a preoperative diagnosis of GERD and 30-day interventions following SG.

Methods: All adult patients undergoing first-time, elective, minimally invasive SG for morbid obesity from 2015 to 2019 were identified within the American College of Surgeons Metabolic and Bariatric Surgery Quality Improvement Program Database (ACS-MBSAQIP). The association between preoperative GERD and 30-day interventions, including treatment for dehydration, esophagogastroduodenoscopy (EGD), and reoperation, were investigated. To control for confounding variables and ensure a balanced comparison between cohorts, propensity score matching was used.

Results: A total of 502,995 patients met inclusion criteria; 137,518 (27.3%) had a preoperative diagnosis of GERD. After 1:1 matching, patients with a preoperative diagnosis of GERD were more likely to be evaluated in the emergency department, undergo outpatient treatment of dehydration, and to be admitted to the hospital for treatment of dehydration within 30 days of SG.

Conclusion: A preoperative diagnosis of GERD is associated with more 30-day re-interventions following SG. The sequela of these interventions with respect to the long-term success of SG requires further investigation.

Background: More than half of recurrences in advanced gastric cancer (AGC) occur within 2 years of curative surgery. Identifying predictive factors for early recurrence is crucial for improving patient survival. We aimed to evaluate the impact of extranodal extension (ENE) and the largest metastatic lymph-node (LLN) size on early recurrence in patients with AGC.

Methods: Data of patients who underwent adjuvant chemotherapy after radical gastrectomy were extracted from the registry. Clinicopathological characteristics were compared according to ENE status and LLN size. Cox proportional hazard models were used to assess associations between ENE, LLN size, and oncologic outcomes.

Results: This study included 244 patients (mean age, 61.4 ± 10.7 years; male, 75.0%). ENE positivity was significantly associated with higher T and N stages, and larger LLN size. In the univariable analysis, ENE (hazard ratio [HR]: 5.43, p < 0.001) and LLN size ≥ 5 mm (HR: 3.52, p = 0.001) were significant predictors of early recurrence. However, in the multivariable analysis, only ENE was an independent risk factor (HR: 3.34, p = 0.007). For 5-year RFS, ENE positivity (HR: 2.15, p = 0.003), higher T stage (HR: 1.93, p = 0.044), and advanced N stage (HR: 2.59, p = 0.007) were independent prognostic factors, whereas LLN size lost statistical significance. Similarly, ENE positivity remained an independent prognostic factor for OS (HR: 2.04, p = 0.015).

Conclusion: ENE is a strong independent prognostic factor for early recurrence and long-term survival in AGC, whereas LLN size, despite its association with tumour aggressiveness, loses prognostic significance after multivariable adjustment, highlighting ENE's clinical relevance in risk stratification and postoperative management strategies.

Introduction: Appendectomies are one of the most commonly performed procedures by general surgeons in the United States and the laparoscopic approach has been the standard for decades. However, adoption of robotic assistance for the treatment of appendiceal diseases continues to grow. Despite this growth, clinical outcomes regarding laparoscopic versus robotic appendectomy remain unclear.

Methods: We conducted a multi-hospital retrospective cohort study of patients who underwent appendectomy between August 1, 2021 and February 29, 2024. We compared preoperative clinical characteristics, intra-operative surgical details, and post-operative outcomes between laparoscopic and robotic groups. The post-operative outcomes analyzed included conversion to open, need for extended resection, 30-day return to the operating room, need for blood transfusion, 30-day readmission, abscess requiring drain, and death. Statistical analysis included chi-square tests, student t-tests, and multivariable logistic regression.

Results: A total of 1,431 patients (1,079 laparoscopic, 352 robotic) were included for analysis. The robotic group was found to have a higher proportion of Caucasian patients, more American Society of Anesthesiologist (ASA) class 1 patients, and a higher proportion of non-elective cases. We found that more robotic appendectomies were completed at community hospital sites rather than larger academic medical centers. Robotic assistance was associated with significantly lower rates of conversion to open (p < 0.001). Additionally, robotics was associated with significantly lower rates of unexpected extended resections (p = 0.015). We saw trends towards statistical significance for reduced need for blood transfusion and abscess requiring IR drain in the robotic group. To account for preoperative differences between the two groups, a multivariable logistic regression analysis was performed, and the robotic group was associated with a 66% decreased risk of any complication (OR = 0.34, 95% CI [0.17, 0.68]).

Conclusion: Robotic appendectomy demonstrates favorable clinical outcomes compared to the traditional laparoscopic approach. These findings support the possible advantages of a robotic-assisted appendectomy.

Background: Intraoperative hemodynamic instability (HDI) remains a significant challenge during surgery for pheochromocytomas and paragangliomas (PPGLs), despite preoperative preparation. Identifying predictive factors is crucial for risk stratification and management optimization.

Methods: This retrospective study analyzed 203 PPGLs patients undergoing surgery at Qilu Hospital of Shandong University (July 2019-February 2025). HDI was defined as systolic blood pressure ≥ 160 mmHg or mean arterial pressure < 60 mmHg during surgery. Patient demographics, clinical characteristics, tumor features (including maximum diameter measured on CT), preoperative catecholamine/metabolite levels, and preoperative preparation adequacy (based on BP/HR records) were evaluated. Univariate and multivariate logistic regression identified independent predictors. A predictive nomogram was constructed using significant factors and validated internally.

Results: Among 203 patients, 133 (65.5%) experienced intraoperative HDI. Multivariate analysis identified four independent preoperative predictors: maximum tumor diameter > 49.5 mm (odds ratio (OR) = 3.169, 95% confidence interval (CI): 1.531-6.562, P = 0.002), preoperative hypertension history (OR = 2.636, 95% CI: 1.293-5.375, P = 0.008), elevated plasma adrenaline level (OR = 4.803, 95% CI: 1.977-11.666, P = 0.001), and inadequate preoperative preparation (OR = 0.251 for adequacy, 95% CI: 0.107-0.590, P = 0.002). A nomogram incorporating these factors demonstrated good discrimination (AUC = 0.823, 95% CI: 0.761-0.886), significantly outperforming individual factors, and good calibration (Hosmer-Lemeshow p = 0.218). Decision curve analysis confirmed clinical utility.

Conclusion: Maximum tumor diameter > 49.5 mm, preoperative hypertension history, elevated plasma adrenaline, and inadequate preoperative preparation are key independent predictors of intraoperative HDI in PPGL surgery. The developed nomogram effectively integrates these factors to provide personalized preoperative risk assessment, aiding clinicians in identifying high-risk patients for intensified management strategies.

Background: Intracorporeal delta-shaped Billroth I (B-I) anastomosis following minimally invasive distal gastrectomy (DG) is a simple and highly reproducible gastroduodenostomy procedure. This study aimed to identify the technical pitfalls of this procedure and assess their influence on one-year outcomes.

Methods: This was a retrospective study including patients who underwent delta-shaped B-I anastomosis following minimally invasive DG at our institution between 2008 and 2022. Delta-shaped B-I anastomosis was performed by adhering to five fundamental elements. Data were collected from our prospectively maintained database and analyzed retrospectively. Intra- and postoperative complications were reviewed, and video analysis was performed to identify technical errors associated with these complications. One-year outcomes, including nutritional status and endoscopic findings, were compared between patients with and without complications within 30 days after surgery.

Results: A total of 749 patients were included in this study. A total of 36 operating surgeons were involved. Intraoperative anastomotic complications occurred in 0.8% of patients, mainly due to technical issues during linear stapling. Postoperative anastomosis-related complications occurred in 2.1% of patients, with anastomotic leakage, stricture, and delayed gastric emptying rates of 0.9%, 0.3%, and 0.9%, respectively. Most complications were managed conservatively or endoscopically. No late-onset strictures were observed at postoperative year 1, and no significant differences in nutritional and endoscopic findings were observed between patients with and without complications.

Conclusion: When performed according to five fundamental technical principles, intracorporeal delta-shaped B-I anastomosis following minimally invasive DG proved to be a safe, reproducible procedure associated with favorable one-year outcomes.

Background: Minimally invasive surgery improves patient outcomes but introduces ergonomic and workflow inefficiencies due to frequent instrument changes. Symphera GmbH developed a novel laparoscopic prototype enabling intracorporeal tool tip switching, aiming to enhance efficiency and reduce surgical interruptions.

Methods: Seven experienced surgeons evaluated the prototype during standardized tasks using excised animal tissue in a simulated laparoscopic environment. The tasks assessed precision, ergonomics, and tool-switching functionality. Quantitative data were obtained by video analysis; qualitative insights were gathered via semi-structured interviews and a post-procedural questionnaire.

Results: All participants completed the tasks successfully, with no safety concerns. A total of 148 tool changes were performed. The automated exchange sequence required a constant mechanical time of 2.6 s, with a median overall changing time of 3.4 s. A total of 148 tool changes were performed. Tool-changing errors occurred in 4.73% of the changes, and 6.08% of changes resulted in software errors that required reboots. Changing time had no significant impact on overall task duration. The precision of monopolar application was high, and all targets were accurately reached. Questionnaire responses rated tool exchange positively, while ergonomics were judged moderate; female participants highlighted weight and comfort limitations, reflecting gender-related differences in usability. Qualitative analysis revealed both device improvement needs and strong enthusiasm for its potential to streamline workflows and enhance surgical autonomy.

Conclusion: The prototype was safe, functional, and well-received. While software instability and ergonomic refinements remain necessary, the system demonstrated feasibility for rapid intracorporeal tool switching and showed promise for reducing operative inefficiencies. Further technical development and clinical trials are warranted to establish its clinical and economic value.

Introduction: Parastomal hernia is a common and challenging complication after stoma formation, often requiring complex surgical management. To address limitations of conventional techniques, we developed the Hybrid Parastomal Endoscopic Repair (HyPER) technique, which combines laparoscopic and open approaches. This case series aimed to evaluate the long-term safety, efficacy, and technical considerations of the HyPER method in a large, consecutive cohort of patients.

Methods: This retrospective, single-center case series included 200 consecutive patients treated between 2014 and 2024. Adult patients with symptomatic or recurrent parastomal hernias were included; exclusion criteria were severe comorbidities precluding surgery or lack of follow-up data. Demographic and operative variables, perioperative outcomes, and recurrence rates were analyzed. Descriptive statistics were used (mean, SD, range); no hypothesis testing was applied.

Results: The majority of patients had EHS Type III or IV hernias. The mean operative time was 171 min. In 10% of cases, a cost-effective "Baldachin modification" using polypropylene mesh was employed. Stoma relocation was required in 87% of Type IV cases. Postoperative complications occurred in 12.5%, primarily wound infections. The recurrence rate was 5.5%, and quality of life significantly improved (VAS score increased from 3.15 to 9.15). No mortality was observed.

Conclusion: HyPER proved to be a safe and effective technique for treating parastomal hernias, especially in complex and recurrent cases. The approach allowed for thorough anatomical correction and yielded low recurrence rates with acceptable morbidity. The Baldachin modification may offer a viable low-cost alternative in resource-limited settings. Further multicenter studies are warranted to validate these findings and establish standardized protocols.

Background: Minimally invasive liver resection and ablation depend on surgical planning and image guidance. Surgical planning is normally based on preoperative imaging. The position, shape, and volume of the abdominal organs change during laparoscopy, which challenges image registration and reduces surgical precision. This study aims to analyze the morphological changes of the liver and spleen from pre- to intraoperative (with pneumoperitoneum) computed tomography (CT) images.

Methods: We used portal venous phase pre- and intraoperative CT images from 15 patients who underwent laparoscopic liver ablation in general anesthesia under 12 mmHg pneumoperitoneum at Rikshospitalet, Oslo University Hospital, Oslo, Norway. A rigid registration, based on spinal landmarks, was used to register intraoperative to preoperative CT images. Morphological features were extracted and statistically analyzed for the liver and spleen.

Results: The liver volume decreased by 12% from the preoperative to the intraoperative CT scan. The mean cranial movement of the liver was 45 mm between pre- and intraoperative CT images. A few morphological radiomic features changed significantly for both liver and spleen.

Conclusion: To the best of our knowledge, this is the first published study in humans to analyze the morphological changes of the liver and spleen during pneumoperitoneum. The results show a significant reduction in liver volume and change in shape and position of the liver during such laparoscopy. This deformation from preoperative to intraoperative imaging poses significant challenges for image registration, which is crucial for surgical navigation. These findings highlight the need for updated intraoperative navigation using imaging and registration to ensure accurate surgical planning.

Background: The Da Vinci Single Port has received the CE marking for General Surgery in Europe in 2024. However, its role in hernia repair is largely unexplored. In this study, we present an IDEAL Stage 1 case series evaluating the Da Vinci SP system for hernia repair.

Methods: We report the first European case series of SP robotic hernia repair (Da Vinci SP system, Intuitive Surgical). Consecutive patients undergoing inguinal hernia repair (IHR) with concomitant umbilical hernia, or midline ventral hernia repair (EHS M1-M4), were included between October 2024 and July 2025. Inguinal repairs (TAPP/TEP) were performed via the umbilical defect, while ventral repairs employed a suprapubic extraperitoneal access. The primary outcome was intraoperative and postoperative complications; secondary outcomes included operative time, hospital stay, and 1-month morbidity.

Results: Twenty-two patients were treated (14 ventral, 8 inguinal with concomitant umbilical hernia). Median operative time was 87 min for IHR and 150 min for ventral repairs. No intraoperative complications, conversions, or additional ports were required. Median length of stay was 19.5 h; six patients (27%) required an unplanned overnight stay for pain management. Two minor complications (seroma, scrotal edema) occurred at 1-month follow-up; no recurrences or readmissions were observed.

Conclusions: This IDEAL Stage 1 case series demonstrates the technical feasibility of single-port (SP) robotic hernia repair in selected patients with inguinal and ventral hernias, with no intraoperative or early postoperative complications observed. These preliminary findings support further prospective IDEAL Stage 2-3 studies with larger cohorts, standardized techniques, and long-term follow-up to validate safety and comparative outcomes.