Laparoscopic Endoscopic and Robotic Surgery最新文献

Objective

When performing cervical conization in post-menopausal cervical intraepithelial neoplasia 3 (CIN3) patients, the positive rate of endocervical cone margin and the incidence of postoperative cervical stenosis increase. This study summarized a 4-year experience of total laparoscopic hysterectomy as a treatment option for peri-menopausal and post-menopausal CIN3 patients at a single institution. Furthermore, it shared the refinement strategies used during the surgery.

Methods

This study retrospectively analyzed the medical records of CIN3 patient aged ≥45 years and who underwent open or laparoscopic hysterectomy at our institution from January 1, 2017 to December 31, 2020. Totally, 30 CIN3 patients were enrolled and divided into abdominal hysterectomy group and laparoscopic hysterectomy based on surgery method, with 5 patients and 25 patients respectively.

Results: Compared to the abdominal hysterectomy group, the perioperative blood loss (20 mL vs. 220 mL, p = 0.004) was less and the duration of in-hospital stay (7 d vs. 11 d, p < 0.001) were significantly shorter in the laparoscopic hysterectomy group. However, no significant differences in age at hysterectomy (53 y vs. 77 y, p = 0.054) and operative time (154.4 ± 27.8 min vs. 161.0 ± 62.4 min, p = 0.826) were observed between them. Diagnostic conization was performed in advance for 12 patients, and among them, 10 (83.3%) patients had positive endocervical cone margin. Postoperative intestinal obstruction was noted in one abdominal hysterectomy patient, no other complications were observed in the remaining patients.

Conclusion

Compared to conization, hysterectomy is more invasive; however, it is an acceptable treatment option for peri-menopausal and post-menopausal CIN3 patients. In such cases, opting for total laparoscopic hysterectomy adopted the marionette technique might be preferable because the procedure is less invasive.

Laparoscopic cholecystectomy (LC) has gradually become the first choice for the treatment of cholecystolithiasis in recent years. Iatrogenic bile duct injury (IBDI) is an important clinical problem in LC. The anatomical variation of the cystic duct increases the probability of IBDI and the difficulty of operation. We present a case of a 44-year-old male with a anatomical variation of the cystic duct complicated with cholecystolithiasis and choledocholithiasis, who successfully underwent choledocholithotomy, choledochoscopic exploration and T-tube drainage surgery. The patient recovered well and was discharged home on postoperative day 10. The T-tube was removed at 1 month postoperatively after cholangiography examination of no choledocholithiasis left.

Pancreatic ductal adenocarcinoma (PDAC) is characterised by poor oncological outcome and is the seventh cause of cancer-related deaths worldwide. With the advances in surgical technology, oncological treatment, and critical care, extended pancreatic resections including vascular resections have become more frequently performed in specialised centres. Furthermore, the boundaries of resectability continue to be pushed in order to achieve a potentially curative approach in selected patients in combination with neoadjuvant and adjuvant treatment strategies. This review gives an overview on the current state of venous and arterial resections in PDAC surgery with particular attention given to the minimally invasive approach.

Screening and surveillance colonoscopy with removal of precancerous colon polyps has greatly reduced colon cancer morbidity and mortality and has become an important part of China's new strategy for colon cancer prevention. Colonoscopy with polypectomy could lead to complications such as post-polypectomy hemorrhage and incomplete polyp removal contributing to interval colon cancer development. Polypectomy techniques play an important role. The evolution of different polypectomy techniques and their advantages and disadvantages have been reviewed to help readers choose and apply the best suitable ones for their individual patient situation toward safer and more efficacious colonoscopy polypectomy.

Predictive analytics have been widely used in the literature with respect to laparoscopic surgery and risk stratification. However, most predictive analytics in this field exploit generalized linear models for predictive purposes, which are limited by model assumptions—including linearity between response variables and additive interactions between variables. In many instances, such assumptions may not hold true, and the complex relationship between predictors and response variables is usually unknown. To address this limitation, machine-learning algorithms can be employed to model the underlying data. The advantage of machine learning algorithms is that they usually do not require strict assumptions regarding data structure, and they are able to learn complex functional forms using a nonparametric approach. Furthermore, two or more machine learning algorithms can be synthesized to further improve predictive accuracy. Such a process is referred to as ensemble modeling, and it has been used broadly in various industries. However, this approach has not been widely reported in the laparoscopic surgical literature due to its complexity in both model training and interpretation. With this technical note, we provide a comprehensive overview of the ensemble-modeling technique and a step-by-step tutorial on how to implement ensemble modeling.

Objective

Ventral hernia is an anterior abdominal wall hernia, with an incidence of 2%–13%. Laparoscopic ventral hernia repair is the preferred method worldwide with all the advantages of the laparoscopic technique proven to be an effective treatment option. This study aims to assess the long-term outcomes of laparoscopic management of ventral hernia repair using intraperitoneal onlay mesh (IPOM) or intraperitoneal onlay mesh with defect closure (IPOM PLUS) technique with the usage of variety of synthetic meshes intraperitoneally.

Methods

A retrospective study of 821 patients of a single institution for a decade was conducted. Long-term outcomes such as pain, mesh infections, enterocutaneous fistula, bowel adhesions and recurrence were assessed.

Results

There were 801 primary, 12 incisional, and 8 recurrent hernia cases, including 532 females and 289 males with a mean age of 45.62±9.37 years. IPOM PLUS were underwent in 674 (82.10%) cases. Polypropylene, dual, titanium, composite meshes were applied in 473 (57.61%), 208 (25.33%), 82 (9.99%), and 58 (7.06%) cases respectively. Intraoperative bleeding occurred in 3 (0.37%) cases, seroma in 8 (0.97%), wound infection in 4 (0.49%), stitch abscess in 2 (0.24%). Recurrence was found in 8 (0.97%) cases, with 5 used polypropylene mesh and 3 used dual mesh. Mesh infections were discovered in 6 (2.88%) cases used dual, and foreign body sensation in 4 (0.85%) cases used polypropylene. Three (0.37%) patients had suture site hernia, and 3 (0.37%) had chronic sinus.

Conclusion

IPOM or IPOM PLUS holds good in small or medium sized ventral hernias. The safety and efficacy of intraperitoneal polypropylene mesh is comparable to that of other synthetic meshes. A mesh overlap of minimum 5 cm beyond defect edge is must to minimise hernia recurrence. Absorbable suture can be considered as alternative to tackers.