Surgical Endoscopy And Other Interventional Techniques最新文献

Background: Single stapled anastomotic techniques have a growing interest in the field of colorectal surgery. This concept was developed to lower the leakage rate in colorectal anastomosis by avoiding cross stapling and eliminating dog ears. The bow tie technique is developed as an easier alternative to create a single stapled anastomosis because endoscopic suturing or transanal surgery is avoided.

Methods: A retrospective analysis of prospective observed data was performed in a cohort of all patients who underwent surgery with a colorectal anastomosis between 01-01-2023 and 31-12-2024. Primary outcome parameters were technical feasibility and anastomotic leakage defined as any clinical, radiologic or intraoperative sign of anastomotic leakage. Completeness of linear stapler line resection in the anastomotic donut and air leak test were secondary outcome parameters.

Results: Total of 184 patients with colorectal anastomosis were included. In 6 cases of TME the bow tie technique was not feasible. Anastomotic leakage occurred in 3.6% after sigmoidectomy, 0% after anterior resection with PME and in 9.6% after low anterior resection with TME. Linear stapler was completely resected in all cases and in 5 cases a positive air leak was reported.

Conclusion: The bow tie technique is technical feasible, facilitates a single stapled anastomosis and has promising results on anastomotic leakage in the high colorectal anastomosis. Limitation of the technique is a minimum length of the rectal stump.

Background: Robotic surgeries have become increasingly popular in the last 20 years, spurring technological innovations.

Objective: In this observational study, we compared the workload of Intuitive's da Vinci Single Port (SP) with the da Vinci Xi.

Methods: We evaluated two surgeons during 24 total low anterior resection surgeries at a large academic hospital, with 12 surgeries utilizing the SP and 12 with the Xi. Surveys were administered to both surgeons and their teams before and after each surgery. Surgeons self-evaluated their workloads (mental demand, physical demand, temporal demand, success/performance, effort, frustration, difficulty, fatigue) and the usability of each platform (efficiency and precision of the surgical instruments and camera, touchpad usage, confidence) via survey.

Results: Analysis revealed statistically significant differences in mental and physical workloads (p-value ≤ 0.05) during the vascular dissection subsection, with higher demands in the SP than the Xi and the circulating nurse noting greater effort levels in the SP than the Xi. The robot platform significantly affected robot usability, with surgeons stating that the Xi was more precise and efficient in surgical instrument and camera usage than the SP, leading to higher confidence scores in the Xi.

Limitations: Only two surgeons were surveyed, and the da Vinci SP was novel and likely associated with a learning curve.

Conclusions: Usability differences may explain differences in workloads and confidence. Understanding these differences between the robots can aid in selecting optimal cases for each platform.

Background: Head and neck squamous cell carcinoma (HNSCC) have poor outcomes in advanced stages. Early detection and minimally invasive treatment are essential. Endoscopic laryngo-pharyngeal surgery (ELPS), guided by narrowband imaging, is widely used in Asia, but its prognostic value remains unclear.

Methods: We retrospectively analyzed 111 patients with superficial HNSCC who were treated with ELPS between 2014 and 2023. Patient background, treatment results, complications, and prognostic factors were assessed.

Results: The median observation period was 56 months. En bloc resection was achieved in 96.4% of cases, and the 5-year overall survival (OS) was 91.6%. Tumor thickness > 1000 μm was associated with metastasis in univariate analysis, whereas multivariate analysis identified tumor size > 20 mm and lymphatic invasion as independent predictors. Patients with a body mass index < 18.5 had poorer OS, primarily owing to comorbidities rather than HNSCC. Adverse events occurred in 26.1% of patients, most of which were transient laryngeal edema. One patient required a temporary tracheotomy, but no permanent tracheostomy was needed. ELPS was feasible and safe, even in patients with prior chemoradiotherapy (CRT), as no fatal complications were observed.

Conclusions: ELPS provides favorable mid- to long-term outcomes and can be safely applied to selected patients, including those with prior CRT. Tumor size and lymphatic invasion are key prognostic factors. These findings support ELPS as a minimally invasive, function-preserving treatment option for superficial HNSCC with careful patient selection.

Background: The increasing use of advanced endoscopic resection techniques, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), brings significant post-procedural challenges, particularly delayed bleeding and impaired wound healing. This study aimed to evaluate the efficacy of PuraStat, a synthetic peptide hydrogel, in promoting mucosal healing following endoscopic resections in the oesophagus and stomach of a porcine model.

Methods: In this prospective, randomised, evaluator-blinded preclinical study, 21 pigs underwent EMR and ESD in both the oesophagus and stomach (2 EMR and 2 ESD per animal). Animals were randomised to receive either PuraStat or saline on each resection site. Healing was evaluated after 8 days using follow-up endoscopy, gross pathology, and histopathological analysis. The primary endpoint was re-epithelialisation-to-defect ratio; secondary outcomes included macroscopic wound size reduction and granulation tissue characteristics.

Results: A total of 84 lesions were assessed. Lesions treated with PuraStat demonstrated significantly greater re-epithelialisation/defect ratios compared to controls (p = 0.03), particularly after EMR. Endoscopic evaluation demonstrated a 33% mean reduction in wound size in the PuraStat group (p = 0.001). However, as endoscopic measurements carry an estimated error margin of up to ± 10%, its precision may be limited. Histopathological analysis of post-resection defect area reduction did not show statistically significant difference between groups (p = 0.055). No adverse events were observed, and PuraStat was well tolerated.

Conclusions: Application of PuraStat hydrogel after endoscopic resections was associated with improved re-epithelialisation, particularly in EMR-induced lesions. These findings indicate potential role of PuraStat in support of healing of mucosal post-resection defects in upper gastrointestinal tract, warranting its further validation in clinical trials.

Background and aims: We aimed to assess the efficacy of prophylactic mucosal defect closure in reducing delayed adverse events (AEs) after endoscopic resection (ER) of large-to-giant laterally spreading superficial non-ampullary duodenal epithelial tumors (SNADETs).

Materials and methods: We performed a retrospective review of 219 patients with 230 large-to-giant laterally spreading SNADETs who underwent ER at Zhongshan Hospital, Fudan University. The preoperative baseline information, procedure-related AEs and follow-up outcomes were compared between lesions with complete closure and those with incomplete closure or no closure.

Results: The mean maximal diameter was 22.8 ± 13.8 mm (mean ± SD), with 67 lesions (29.1%) ≥ 30 mm. A total of 42 lesions (18.3%) had an occupied circumference ≥ 50%. There were 32 lesions (13.9%) with incomplete closure or non-closure of the mucosal defect. A total of 18 lesions (7.8%) experienced delayed AEs, including delayed perforation in 6 cases (2.6%) and delayed bleeding in 12 cases (5.2%). Lesions with incomplete closure or non-closure had a higher incidence of delayed AEs than lesions with complete closure (34.4% vs 3.5%, P < 0.001). Multivariable regression analyses revealed that incomplete or no mucosal defect closure (OR = 5.154; 95% CI = 1.443-18.405; P = 0.012) and lesions located on the anal side of the major papilla (OR = 11.457; 95% CI = 1.404-93.499; P = 0.023) were independent risk factors for delayed AEs. Lesions with an occupied circumference ≥ 50% (OR = 3.171; 95% CI = 1.024-9.818; P = 0.045) and irregular shape (OR = 5.557; 95% CI = 1.226-25.184; P = 0.026) were independent risk factors for incomplete closure or non-closure.

Conclusions: Prophylactic mucosal defect closure is an effective technique for reducing delayed AEs after ER of large-to-giant laterally spreading SNADETs.

Introduction: Hypotension, hypoxia, and hypothermia tissue have unclear effects on postoperative outcomes. The Operating Room Black Box™ (ORBB) is a novel monitoring platform that automates "tagging" of intraoperative hypotension, hypoxia, and hypothermia. We hypothesized that intraoperative physiologic event tags would serve as predictive variables of adverse postoperative outcomes.

Methods: Using the ORBB, tags were prospectively applied for moderate and severe episodes of hypotension, hypothermia, and hypoxia. Regression modeling was performed to examine the association between intraoperative tags and adverse outcomes of surgical site infection, patient safety indicator (PSI) events, length of stay, readmission, return to OR, and mortality.

Results: 2875 cases were performed and monitored with the ORBB tag system between August 17, 2020 and September 3, 2022. 567 cases (19%) were tagged. Regression models had improved performance after adding in intraoperative physiologic data. Hypothermia and hypoxia were independent predictors of increased return to the operating room (p < 0.02, p < 0.01, respectively). Hypotension was an independent predictor of length of stay (p < 0.03) and patient safety indicator events (p = 0.03). Comorbidities, length of case, BMI, age, and ASA status played significant roles in the predictive models.

Conclusion: Intraoperative physiologic events are important variables to consider regarding postoperative complications and should be incorporated into quality and safety analysis. As real-time OR data monitoring becomes a reality, work must be done to identify the intraoperative events and patient factors that most affect outcomes. This retrospective modeling serves as the first step toward intraoperative predictive analytics that can provide decision support for postoperative care.

Background: Minimally invasive extended distal pancreatectomy (MIEDP) is often challenging for pancreatic ductal adenocarcinoma (PDAC) due to its aggressive invasion into adjacent organs or major blood vessels. This study aimed to compare the surgical and oncological outcomes of MIEDP and open-extended distal pancreatectomy (OEDP) for left-sided PDAC.

Methods: A retrospective data review was conducted for 798 patients with left-sided PDAC who underwent distal pancreatectomy between 2009 and 2020. Among these, 388 patients were included in the analysis who underwent extended distal pancreatectomy, as defined in the Miami International evidence-based guidelines.

Results: Of those 388 included patients, 217 underwent MIEDP and 171 OEDP. No significant differences were observed in the clinicopathological characteristics or 90-day mortality rates between the groups. Moreover, severe complications (CDC III or higher) were similar between groups (MIEDP: 11.1%; OEDP: 17.6%; P = 0.052). MIEDP was associated with a shorter time to adjuvant chemotherapy initiation relative to OEDP (5.9 vs. 6.6 weeks; P = 0.061). Multivariable analysis revealed that combined vessel resection was a significant factor for severe complications (OR: 3.642, 95% CI: 2.025-6.549; P < 0.001). The five-year survival rates were comparable (MIEDP: 25.5%; OEDP: 18.1%; P = 0.132). However, poorer survival was associated with pathological invasion of adjacent organs (HR: 1.479, 95% CI: 1.133-1.930; P = 0.004), postoperative complications, R0 resection, poor differentiation, lymphovascular invasion, perineural invasion, and failure to complete adjuvant chemotherapy.

Conclusions: MIEDP is feasible and safe in selected left-sided PDAC with suspected multiorgan invasion and shows oncologic outcomes comparable to OEDP, with faster recovery signals. Prognosis appears driven more by pathological invasion than by surgical approach or extent of concomitant resection.

Purpose: Bochdalek hernia (BH) is a rare congenital diaphragmatic defect in adults, often presenting with nonspecific symptoms and posing challenges in diagnosis and treatment. Traditional open surgery is associated with significant trauma, while minimally invasive techniques have gained popularity. This multicenter retrospective cohort study aimed to evaluate the feasibility and short-term efficacy of the retroperitoneal totally endoscopic prosthetic (R-TEP) repair technique for adult BHs.

Methods: A retrospective review was conducted on ten adult patients with BHs who underwent R-TEP repair from February 2022 to December 2023 across four tertiary hospitals. Patient demographics, hernia characteristics, operative details, perioperative complications, and follow-up outcomes were analyzed. Continuous variables are presented as median (range).

Results: The median age of the patients was 53.50 years (range: 23-66), with a median body mass index (BMI) of 25.01 kg/m² (range: 22.31-27.94). The majority of patients (80%) presented with left-sided hernias. The median defect area was 13.50 cm² (range: 6-42), with a median mesh area of 145.00 cm² (range: 130-170). The median operative time was 117.50 min (range: 90-180), with minimal intraoperative blood loss. One patient with a larger defect (42 cm²) required conversion to laparoscopic intraperitoneal onlay mesh (IPOM) repair due to excessive defect size, limited operative field, and peritoneal injury. All other operations were successfully performed without serious intraoperative complications. The median postoperative hospital stay was 2.50 days (range: 2-4). No major postoperative complications occurred, and no recurrence was observed during a median follow-up period of 29.5 months (range: 20-42). Compared with baseline, Carolina comfort scale (CCS) scores for pain, mesh sensation, and movement limitation all improved significantly at the 6-month follow-up.

Conclusion: The R-TEP repair technique for adult BHs is safe, effective, and reproducible. It offers a minimally invasive approach with favorable outcomes, including reduced postoperative pain, shorter hospital stays, and a low recurrence rate. This technique is a valuable addition to the surgical management of adult BHs and merits validation in larger prospective studies.

Introduction: Bariatric surgery remains underutilized despite rising global obesity rates, with less than 2% of eligible patients undergoing procedures annually. Magnetic compression anastomosis (MCA) offers potential advantages over traditional techniques, including reduced operative time and improved healing. However, delayed patency has limited its application. This study evaluates the novel OTOLoc™ system, which enables immediate patency in Roux-en-Y gastric bypass (RYGB) via self-forming magnets (SFMs), addressing a key limitation of prior MCA approaches.

Methods: A prospective, open-label, multicenter study (NCT06199635) was conducted across two centers (India and Chile). Fourteen patients with moderate-to-severe obesity underwent RYGB with SFM-assisted jejuno-jejunal anastomosis. Primary outcomes included 30-day freedom from anastomotic adverse events (AEs; leaks, bleeding, obstruction). Secondary outcomes encompassed weight loss, comorbidity resolution, and nutritional status. Technical success was defined as anastomosis creation without conversion to sutures/staplers.

Results: All 14 procedures (median age: 42 years, BMI: 41.4 kg/m²) were technically successful, with a median operative time of 55 min and magnet placement time of 12 min. No device-related AEs occurred. Four procedure-related serious AEs (e.g., pulmonary embolism, gastro-jejunostomy bleeding) resolved without reoperation. At 3 months, median weight loss was 24.4 kg (21.2% total body weight loss), with no anastomotic complications. All magnets were excreted naturally within 30 days.

Conclusion: The OTOLoc™ system safely facilitated immediate-patency magnetic anastomoses in RYGB, with no device-related complications and promising short-term efficacy. Larger studies comparing SFMs to stapled anastomoses are warranted to validate these findings and assess long-term outcomes.