Laparoscopic Endoscopic and Robotic Surgery最新文献

There have been nearly 60 years since Thomas Starzl’s first liver transplant. During this period, advancements in medical technology have progressively enabled the adoption of new methods for transplantation. Among these innovations, robotic surgery has emerged in recent decades and is gradually being integrated into transplant medicine. Robotic hepatectomy and liver implantation represent significant advancements in the field of transplant surgery. The precision and minimally invasive nature of robotic surgery offer substantial benefits for both living donors and recipients. In living donors, robotic hepatectomy reduces postoperative pain, minimizes scarring, and accelerates recovery. For liver recipients, robotic liver implantation enhances surgical accuracy, leading to better graft positioning and vascular anastomosis. Robotic systems provide more precise and maneuverable control of instruments, allowing surgeons to perform complex procedures with greater accuracy and reduced risk to patients. This review encompasses publications on minimally invasive donor liver surgery, with a specific focus on robotic liver resection in transplantation, and aims to summarize current knowledge and the development status of robotic surgery in liver transplantation, focusing on liver resection in donors and graft implantation in recipients.

Objectives

Robotic-assisted surgery (RAS) is a minimally invasive technique practiced in multiple specialties. Standard training is essential for the acquisition of RAS skills. The cost of RAS is considered to be high, which makes it a burden for institutes and unaffordable for patients. This systematic literature review (SLR) focused on the various RAS training methods applied in different surgical specialties, as well as the cost elements of RAS, and was to summarize the opportunities and challenges associated with scaling up RAS.

Methods

An SLR was carried out based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting guidelines. The PubMed, EBSCO, and Scopus databases were searched for reports from January 2018 through January 2024. Full-text reviews and research articles in the English language from Asia-Pacific countries were included. Articles that outlined training and costs associated with RAS were chosen.

Results

The most common training system is the da Vinci system. The simulation technique, which includes dry-lab, wet-lab, and virtual reality training, was found to be a common and important practice. The cost of RAS encompasses the installation and maintenance costs of the robotic system, the operation theatre rent, personnel cost, surgical instrument and material cost, and other miscellaneous charges. The synthesis of SLR revealed the challenges and opportunities regarding RAS training and cost.

Conclusions

The results of this SLR will help stakeholders such as decision-makers, influencers, and end users of RAS to understand the significance of training and cost in scaling up RAS from a managerial perspective. For any healthcare innovation to reach a vast population, cost-effectiveness and standard training are crucial.

Objective

Laparoscopic surgery has become a routine general surgery with many advantages, such as alleviating abdominal pain. However, postoperative pain caused by abdominal drainage tubes has attracted little attention from medical staff. The aim of this study was to explore the influence of a new abdominal drainage tube fixation method for 3-port laparoscopic cholecystectomy (LC) on patients’ postoperative quality of life.

Methods

Patients who underwent 3-port LC with abdominal drainage tubes in the Department of Hepatobiliary Surgery of Linyi People’s Hospital from March 1, 2023 to October 31, 2023 due to gallstones with chronic cholecystitis were selected for this study. The patients were randomly divided into an experimental group and a control group. In the experimental group, the new abdominal drainage tube fixation method was used, while in the control group, the traditional method was used. Afterward, the quality of life of patient in terms of pain, activity, recovery time, and mental health status was evaluated. The exudate around the patient’s drainage tube was collected for bacterial culture and analysis.

Results

A total of 139 patients were randomly divided into an experimental group (70 patients) and a control group (69 patients). The patients’ baseline characteristics were not significantly different. The patients in the experimental group had better outcomes in quality of life, with higher pain scores (24.03 ± 2.37 vs. 15.48 ± 2.29, p < 0.001) and activity scores (20.57 ± 1.78 vs. 14.13 ± 1.43, p < 0.001), and a shorter postoperative recovery time (2.36 ± 0.68 d vs. 2.96 ± 1.34 d, p < 0.001). The same results were shown in linear regression analysis scores of the 2 groups. The positive rate of bacterial culture in the exudate around the patient’s drainage tube in the experimental group was significantly lower than that in the control group (12.9% vs. 43.5%, p < 0.001); and furthermore, the positive rate of conditional pathogenic bacteria was even lower (7.1% vs. 33.3%, p < 0.001) in the experimental group than in the control group.

Conclusion

This new abdominal drainage tube fixation method can effectively promote patient rehabilitation and improve the quality of life for patient following 3-port LC with abdominal drainage tubes.

Objective

Traditionally tumors of the parapharyngeal space (PPS) are resected through transcervical approaches. More recent approaches include endoscopic approaches or transoral robotic surgery (TORS) without directions on when to use which approach. Our objective was to find objective parameters to choose the most suitable approach.

Methods

It is a retrospective study containing 6 patients from May 2019 to May 2021 with tumors of the PPS treated in the Department of Otolaryngology and Head-Neck Surgery at the Hospital of Lucerne, Switzerland.

Results

The data was analysed in average 53 months after surgery. Tumor resection was completed with TORS in 3 patients and endoscopically in 3 patients. Mean operation time was 114 min. No major complications occurred. No evidence of tumor was found in magnetic resonance imaging studies postoperatively in all patients.

Conclusion

We conclude that a resection via TORS or endoscopic technique is safe and effective. Furthermore, we postulate that the further a tumor is located in the upper lateral area of the PPS, an approach via TORS is less possible.

Objective

This study aimed to investigate the clinical efficacy of laparoscopic training using origami, a traditional Japanese papercraft, using laparoscopic forceps to create origami cranes.

Methods

In this retrospective study, 4 surgeons were randomly divided into 2 groups: The training group, consisting of surgeons 1 and 2, and the non-training group, consisting of surgeons 3 and 4. Over the course of a one-year study period, the training group regularly underwent laparoscopic surgery training with a dry box, wherein they folded a total of 1000 origami cranes using laparoscopic instruments. The non-training group periodically underwent common laparoscopic surgery training of techniques such as suturing and ligation. Each surgeon regularly performed the transabdominal preperitoneal approach for inguinal hernias. Each training was conducted concurrently with the surgeries. The procedure time (peritoneum detachment, mesh placement, and closure of the peritoneum), total operation time (time from peritoneum detachment to closure of the peritoneum), and surgical outcomes were examined.

Results

The training group showed greater improvement in the total operation time and more stable performance than the non-training group. Additionally, the time taken for peritoneum detachment was significantly shorter in the training group.

Conclusion

Laparoscopic training using origami has the potential to enhance laparoscopic surgical skills and improve surgical outcomes.

Objective

Endoscopic tympanoplasty includes various surgical methods, such as internal repair, interlayer repair, and external overlay. This technique requires autologous materials, allografts, and xenografts, which are used to repair tympanic membrane (TM) perforation. To obtain good results, appropriate surgical methods and repair materials should be selected. This study aims to assess the efficacy of repairing refractory TM perforations in the porcine small intestinal submucosa (SIS) during transcanal endoscopic type I tympanoplasty.

Method

A retrospective chart review was performed on patients who underwent TM perforation repair with porcine SIS and tragus cartilage between January 2022 and September 2022 at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. Perforation size, tympanic status, pre- and postoperative symptoms, follow-up data, wound healing rates, and hearing improvement were analysed.

Results

Of the 115 patients included in the study, 56 underwent interlayer repair with porcine SIS of the TM, and 59 patients underwent internal repair with tragus cartilage. No significant difference was found between the two groups at baseline in terms of age, sex, disease course, perforation side, tympanic status, underlying disease, or preoperative infection. The total postoperative effective rate of interlayer implantation with porcine SIS was 91.07% (51 patients), and that of internal implantation with tragus cartilage was 88.14% (52 patients). No significant difference was found in terms of the graft success rate between the two surgical methods (p = 0.887). Postoperative pure tone auditory (PTA) and air-bone gap (ABG) density significantly increased in both groups compared with before surgery (p < 0.05). However, the postoperative PTA and ABG density were not significantly different 3 months post-surgery between the two groups (p > 0.05). Compared to those in the internal implantation group, the patients in the interlayer group had a shorter operation duration (51.36 ± 6.76 min vs. 59.71 ± 7.45 min, t = 6.298, p < 0.001) and less blood loss (11.91 ± 2.61 mL vs. 15.27 ± 2.57 mL, t = 7.019, p < 0.001).

Conclusions

Our study suggests that the porcine SIS, as well as the tragus cartilage, has a high success rate in repairing irreversible TM perforation. Endoscopic tympanoplasty via interlayer implantation with porcine SIS offers distinct advantages, including the absence of donor-site incision and scar formation, and ease of graft modification and manipulation.

Colon cancer has the fifth highest incidence worldwide and has the sixth highest mortality. Compared with rectal cancer, colon cancer currently has the worst 5-year overall survival for patients with stage II and III disease. Complete mesocolic excision has been developed as a standardized and optimized surgical technique for the excision of colon cancers. This technique has traditionally been performed through an open approach since laparoscopy is generally considered technically challenging. The robotic approach has been slowly implemented for colon cancer, but the newest robotic platforms allow for a safer and optimized approach for right colon cancer. Several robotic approaches have been developed and explored. The expansion of the current robotic platform ecosystem is gradually providing new outputs in the application of the robotic approach to complete mesocolic excision. This review gains an oversight of existing literature on robotic complete mesocolic excision for right colon cancer (learning curve, training, techniques, approach, platforms, and future perspectives).