Pub Date : 2025-06-26DOI: 10.1016/j.lers.2025.06.002
Oral Ospanov , Shakhizada Ospanova
{"title":"Laparoscopic use excluded part of the stomach to prevent negative consequences after gastric bypass","authors":"Oral Ospanov , Shakhizada Ospanova","doi":"10.1016/j.lers.2025.06.002","DOIUrl":"10.1016/j.lers.2025.06.002","url":null,"abstract":"","PeriodicalId":32893,"journal":{"name":"Laparoscopic Endoscopic and Robotic Surgery","volume":"8 3","pages":"Pages 156-159"},"PeriodicalIF":2.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144830967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-30DOI: 10.1016/j.lers.2025.05.002
Atanu Pal
As robotic surgery provides clinical benefits and increases on a global scale, it also signifies the transition from direct manual control of surgical instruments to digital connectivity and teleoperation. The digital coupling between human control inputs and surgical motion replaces the previous physical link. Robotic surgery is therefore in effect ‘surgery-by-wire’, the term capturing the engineering phenomenon that has also occurred in the ‘fly-by-wire’ of aviation and ‘drive-by-wire’ of cars. This paper reviews the fundamental commonality across domains. Intrinsic to ‘by-wire’ control is digital processing, which generates the control signal to the effector. This processing enables a progressive spectrum of motion modulation, from precision and stability of motion, through assistance and envelope protection, to automation. Precision now manifests in all three domains. In modern aircraft and cars, higher-order assistance is commonplace, such as flight envelope protection, with analogous support in driving, as well as significant automation. In robotic surgery, such assistance and automation have not yet entered wider clinical practice, with concepts such as envelope protection requiring further definition. The digital interface combined with telecommunication has also enabled teleoperation in all domains. Therefore, motion ‘by-wire’ has enhanced performance across industries. A cross-domain perspective will be increasingly useful to facilitate technology transfer and catalyse progress in robotic surgery. As the pan-industry digital transformation evolves, important principles can be derived for application in robotic surgery.
{"title":"‘Surgery-by-wire’: A new cross-domain perspective on robotic control","authors":"Atanu Pal","doi":"10.1016/j.lers.2025.05.002","DOIUrl":"10.1016/j.lers.2025.05.002","url":null,"abstract":"<div><div>As robotic surgery provides clinical benefits and increases on a global scale, it also signifies the transition from direct manual control of surgical instruments to digital connectivity and teleoperation. The digital coupling between human control inputs and surgical motion replaces the previous physical link. Robotic surgery is therefore in effect ‘surgery-by-wire’, the term capturing the engineering phenomenon that has also occurred in the ‘fly-by-wire’ of aviation and ‘drive-by-wire’ of cars. This paper reviews the fundamental commonality across domains. Intrinsic to ‘by-wire’ control is digital processing, which generates the control signal to the effector. This processing enables a progressive spectrum of motion modulation, from precision and stability of motion, through assistance and envelope protection, to automation. Precision now manifests in all three domains. In modern aircraft and cars, higher-order assistance is commonplace, such as flight envelope protection, with analogous support in driving, as well as significant automation. In robotic surgery, such assistance and automation have not yet entered wider clinical practice, with concepts such as envelope protection requiring further definition. The digital interface combined with telecommunication has also enabled teleoperation in all domains. Therefore, motion ‘by-wire’ has enhanced performance across industries. A cross-domain perspective will be increasingly useful to facilitate technology transfer and catalyse progress in robotic surgery. As the pan-industry digital transformation evolves, important principles can be derived for application in robotic surgery.</div></div>","PeriodicalId":32893,"journal":{"name":"Laparoscopic Endoscopic and Robotic Surgery","volume":"8 3","pages":"Pages 123-127"},"PeriodicalIF":2.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144830913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-23DOI: 10.1016/j.lers.2025.05.001
Shanliang Shang , Wenhua Liu , Xiaona Lin
Objective
Female sterilization is a common contraceptive method, but with changing family dynamics, an increasing number of women seek to restore fertility after tubal sterilization. Current clinical practice lacks effective tools for predicting pregnancy rates in this population after tubal anastomosis. This study aims to develop and internally validate a novel nomogram for predicting the pregnancy rate in women with tubal ligation after tubal anastomosis.
Methods
We developed a prediction model based on a training dataset of 208 patients with tubal ligation after undergoing tubal anastomosis between January 2012 and August 2020 at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. The follow-up period for all patients was one year postsurgery, during which pregnancy outcomes were recorded. The LASSO regression model was used to optimize feature selection for the pregnancy rate risk model. The performance of the nomogram was assessed for its calibration, discrimination, and clinical usefulness. Internal validation was assessed.
Results
Predictors included in the prediction nomogram were age, type of anastomosis, sterilization duration, time of conception, and anti-Mullerian hormone (AMH) levels. The model displayed good discrimination, with a C-index of 0.924 (95% CI: 0.876–0.971), and good calibration. A high C-index value of 0.879 was still reached in the interval validation. Decision curve analysis revealed that the pregnancy rate nomogram was clinically useful when intervention was selected at the pregnancy rate possibility threshold of 1%.
Conclusion
This novel pregnancy rate nomogram incorporating age, type of anastomosis, sterilization duration, time of conception, and AMH could be conveniently used to predict the pregnancy rate in women with tubal ligation after tubal anastomosis.
{"title":"Development and validation of a predictive nomogram for the pregnancy rate after tubal anastomosis in women with tubal ligation","authors":"Shanliang Shang , Wenhua Liu , Xiaona Lin","doi":"10.1016/j.lers.2025.05.001","DOIUrl":"10.1016/j.lers.2025.05.001","url":null,"abstract":"<div><h3>Objective</h3><div>Female sterilization is a common contraceptive method, but with changing family dynamics, an increasing number of women seek to restore fertility after tubal sterilization. Current clinical practice lacks effective tools for predicting pregnancy rates in this population after tubal anastomosis. This study aims to develop and internally validate a novel nomogram for predicting the pregnancy rate in women with tubal ligation after tubal anastomosis.</div></div><div><h3>Methods</h3><div>We developed a prediction model based on a training dataset of 208 patients with tubal ligation after undergoing tubal anastomosis between January 2012 and August 2020 at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. The follow-up period for all patients was one year postsurgery, during which pregnancy outcomes were recorded. The LASSO regression model was used to optimize feature selection for the pregnancy rate risk model. The performance of the nomogram was assessed for its calibration, discrimination, and clinical usefulness. Internal validation was assessed.</div></div><div><h3>Results</h3><div>Predictors included in the prediction nomogram were age, type of anastomosis, sterilization duration, time of conception, and anti-Mullerian hormone (AMH) levels. The model displayed good discrimination, with a C-index of 0.924 (95% CI: 0.876–0.971), and good calibration. A high C-index value of 0.879 was still reached in the interval validation. Decision curve analysis revealed that the pregnancy rate nomogram was clinically useful when intervention was selected at the pregnancy rate possibility threshold of 1%.</div></div><div><h3>Conclusion</h3><div>This novel pregnancy rate nomogram incorporating age, type of anastomosis, sterilization duration, time of conception, and AMH could be conveniently used to predict the pregnancy rate in women with tubal ligation after tubal anastomosis.</div></div>","PeriodicalId":32893,"journal":{"name":"Laparoscopic Endoscopic and Robotic Surgery","volume":"8 3","pages":"Pages 140-145"},"PeriodicalIF":2.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-05-02DOI: 10.1016/j.lers.2025.04.002
Simon Byrns, Yun Wu, Bin Zheng
Objective
While there is consensus regarding a positive effect of video gaming on dexterity, little is known regarding how much traditional laparoscopic practice can or should be substituted with video gaming. This study was designed to assess the effects of varying the amount of traditional practice in a lap box trainer and video gaming on performance in two fundamentals of laparoscopic surgery core tasks.
Methods
Undergraduate and medical students were recruited and randomized into one of four groups: a control group, a lap box group, a video game group, and a combined group with 50% of the time allocated to each modality. Performance in the peg transfer and precision cutting tasks was assessed both prior to and following the 6 training sessions.
Results
Peg transfer performance significantly improved in the lap box group (168.4 ± 70.6 s vs. 332.9 ± 178.2 s, p < 0.001), video game group (176.7 ± 53.3 s vs. 300.0 ± 101.2 s, p < 0.001) and combined group (214.2 ± 86.9 s vs. 406.8 ± 239.5 s, p = 0.002) after training. Similar improvements were also observed in precision cutting performance in the lap box group (413.1 ± 138.4 s vs. 614.3 ± 211.4 s, p = 0.002), video game group (434.1 ± 150.8 s vs. 609.2 ± 233.2 s, p = 0.007) and combined group (469.2 ± 185.3 s vs. 663.8 ± 296.3 s, p = 0.020). When analyzing improvements in performance across three different training groups compared with the control group, we found that both the lap box group (p < 0.001) and the combined group (p < 0.001) showed better improvement in both tasks, and the video game group had significantly better outcomes in the precision cutting task (p = 0.003).
Conclusion
Traditional lap box training remains the most effective method for improving the performance of simulated laparoscopic surgery. Video games can be encouraged to enhance skills retention and supplement simulated practice outside of a formal training curriculum.
虽然人们一致认为电子游戏对灵活性有积极的影响，但对于传统的腹腔镜手术可以或应该用电子游戏代替多少，人们知之甚少。本研究旨在评估不同数量的传统训练和视频游戏对腹腔镜手术两项基本核心任务的影响。方法招募大学生和医学生，随机分为4组：对照组、lap box组、视频游戏组和组合组，每种模式各分配50%的时间。在6个培训课程之前和之后，对peg转移和精密切割任务的表现进行了评估。结果lap - box组超声传递性能显著提高(168.4±70.6 s vs. 332.9±178.2 s, p <；0.001)，电子游戏组(176.7±53.3秒vs. 300.0±101.2秒，p <；0.001)和联合组（214.2±86.9 s vs. 406.8±239.5 s, p = 0.002）。叠盒组（413.1±138.4 s vs. 614.3±211.4 s, p = 0.002）、电玩组（434.1±150.8 s vs. 609.2±233.2 s, p = 0.007）和组合组（469.2±185.3 s vs. 663.8±296.3 s, p = 0.020）的精密切割性能也有类似的改善。在分析三个不同训练组与对照组相比的表现改善时，我们发现，腿箱组(p <；0.001)和联合组(p <；0.001)在两项任务中都表现出更好的改善，而电子游戏组在精确切割任务中表现出明显更好的结果（p = 0.003）。结论传统的膝盒训练仍是提高模拟腹腔镜手术性能的最有效方法。可以鼓励玩电子游戏来提高技能的留存，并补充正规培训课程之外的模拟练习。
{"title":"Combining traditional laparoscopic box practice with video gaming: A randomized control trial","authors":"Simon Byrns, Yun Wu, Bin Zheng","doi":"10.1016/j.lers.2025.04.002","DOIUrl":"10.1016/j.lers.2025.04.002","url":null,"abstract":"<div><h3>Objective</h3><div>While there is consensus regarding a positive effect of video gaming on dexterity, little is known regarding how much traditional laparoscopic practice can or should be substituted with video gaming. This study was designed to assess the effects of varying the amount of traditional practice in a lap box trainer and video gaming on performance in two fundamentals of laparoscopic surgery core tasks.</div></div><div><h3>Methods</h3><div>Undergraduate and medical students were recruited and randomized into one of four groups: a control group, a lap box group, a video game group, and a combined group with 50% of the time allocated to each modality. Performance in the peg transfer and precision cutting tasks was assessed both prior to and following the 6 training sessions.</div></div><div><h3>Results</h3><div>Peg transfer performance significantly improved in the lap box group (168.4 ± 70.6 s vs. 332.9 ± 178.2 s, <em>p</em> < 0.001), video game group (176.7 ± 53.3 s vs. 300.0 ± 101.2 s, <em>p</em> < 0.001) and combined group (214.2 ± 86.9 s vs. 406.8 ± 239.5 s, <em>p</em> = 0.002) after training. Similar improvements were also observed in precision cutting performance in the lap box group (413.1 ± 138.4 s vs. 614.3 ± 211.4 s, <em>p</em> = 0.002), video game group (434.1 ± 150.8 s vs. 609.2 ± 233.2 s, <em>p</em> = 0.007) and combined group (469.2 ± 185.3 s vs. 663.8 ± 296.3 s, <em>p</em> = 0.020). When analyzing improvements in performance across three different training groups compared with the control group, we found that both the lap box group (<em>p</em> < 0.001) and the combined group (<em>p</em> < 0.001) showed better improvement in both tasks, and the video game group had significantly better outcomes in the precision cutting task (<em>p</em> = 0.003).</div></div><div><h3>Conclusion</h3><div>Traditional lap box training remains the most effective method for improving the performance of simulated laparoscopic surgery. Video games can be encouraged to enhance skills retention and supplement simulated practice outside of a formal training curriculum.</div></div>","PeriodicalId":32893,"journal":{"name":"Laparoscopic Endoscopic and Robotic Surgery","volume":"8 3","pages":"Pages 134-139"},"PeriodicalIF":2.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144830915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-09DOI: 10.1016/j.lers.2025.04.001
Vaishnavi J. Patel , Devki Patel , Kimberly Toumazos , Young Son , Komal Sharma , Virgil Kevin DeMario , Shelby Boock , Grace Lara , Alexandra McQuillen , Brianna Clark
Objectives
Salpingectomy and tubal ligation are commonly performed for permanent contraception in women. Salpingectomy has been suggested to reduce the risk of ovarian cancer, but its comparative operative and perioperative risks have not been well established. The objective of this study is to compare the peri- and postoperative complications of laparoscopic tubal ligation with those of salpingectomy for permanent contraception.
Methods
A retrospective review of 49,445 patients who underwent laparoscopic salpingectomy or tubal ligation for permanent contraception between 2017 and 2021 was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program database. Statistical analysis involved t test, chi-square test, and logistic regression analysis with the use of the random forest algorithm. The primary outcomes were perioperative and postoperative complications.
Results
Of the total cohort, 45,307 (91.6%) underwent laparoscopic salpingectomy, and 4138 (8.4%) received laparoscopic tubal ligation. There were significant differences between the salpingectomy and tubal ligation groups with respect to several demographic characteristics, including age, BMI, minority status, and variations in past medical history. These demographic characteristics were controlled for in the multivariate regression analysis. Salpingectomy had a higher rate of operative and postoperative complications than did tubal ligation (OR = 1.78, 95% CI: 1.46–2.20, p < 0.001). Salpingectomy was associated with a greater risk of longer operation time (OR = 2.03, 95% CI: 2.02–2.04, p < 0.001), longer hospital stay (OR = 5.26, 95% CI: 4.57–6.09, p < 0.001), increased readmission (OR = 3.15, 95% CI: 1.92–5.65, p < 0.001), and increased unplanned reoperation (OR = 2.42, 95% CI: 1.32–5.12, p = 0.010). In addition, the occurrence rates of organ space surgical site infection (OR = 2.68, 95% CI: 1.21–7.59, p = 0.032) and sepsis (OR = 3.93, 95% CI: 1.48–16.02, p = 0.020) were significantly greater in the salpingectomy group than in the tubal ligation group.
Conclusions
Laparoscopic tubal ligation and salpingectomy are both safe and effective procedures for permanent contraception; however, salpingectomy is more likely to be associated with peri- and postoperative complications. These findings may help guide clinical decision-making when selecting the optimal permanent contraception method for women.
目的输卵管切除术和输卵管结扎术是妇女永久避孕的常用方法。输卵管切除术已被建议降低卵巢癌的风险，但其手术和围手术期风险的比较尚未得到很好的确定。本研究的目的是比较腹腔镜输卵管结扎术与输卵管切除术的围手术期和术后并发症。方法回顾性分析2017年至2021年间49445例接受腹腔镜输卵管切除术或输卵管结扎的永久性避孕患者，数据来自美国外科医师学会国家手术质量改进计划数据库。统计分析采用t检验、卡方检验和logistic回归分析，采用随机森林算法。主要结果为围手术期和术后并发症。结果在整个队列中，45,307例（91.6%）接受了腹腔镜输卵管切除术，4138例（8.4%）接受了腹腔镜输卵管结扎。输卵管切除术组和输卵管结扎组在一些人口统计学特征方面存在显著差异，包括年龄、BMI、少数民族身份和既往病史的变化。这些人口统计学特征在多元回归分析中得到控制。输卵管切除术的手术和术后并发症发生率高于输卵管结扎术(OR = 1.78, 95% CI: 1.46-2.20, p <；0.001)。输卵管切除术与手术时间较长的风险相关(OR = 2.03, 95% CI: 2.02-2.04, p <；0.001)，更长的住院时间(OR = 5.26, 95% CI: 4.57-6.09, p <；0.001)，再入院率增加(OR = 3.15, 95% CI: 1.92-5.65, p <；意外再手术增加（OR = 2.42, 95% CI: 1.32-5.12, p = 0.010）。此外，输卵管切除术组器官间隙手术部位感染（OR = 2.68, 95% CI: 1.21 ~ 7.59, p = 0.032）和脓毒症（OR = 3.93, 95% CI: 1.48 ~ 16.02, p = 0.020）的发生率显著高于输卵管结扎组。结论腹腔镜下输卵管结扎和输卵管切除术是安全有效的永久避孕方法；然而，输卵管切除术更可能与围手术期和术后并发症相关。这些发现可能有助于指导临床决策时，选择最佳的永久避孕方法的妇女。
{"title":"Peri- and postoperative complications of laparoscopic tubal ligation versus salpingectomy for permanent contraception: An ACS-NSQIP analysis","authors":"Vaishnavi J. Patel , Devki Patel , Kimberly Toumazos , Young Son , Komal Sharma , Virgil Kevin DeMario , Shelby Boock , Grace Lara , Alexandra McQuillen , Brianna Clark","doi":"10.1016/j.lers.2025.04.001","DOIUrl":"10.1016/j.lers.2025.04.001","url":null,"abstract":"<div><h3>Objectives</h3><div>Salpingectomy and tubal ligation are commonly performed for permanent contraception in women. Salpingectomy has been suggested to reduce the risk of ovarian cancer, but its comparative operative and perioperative risks have not been well established. The objective of this study is to compare the peri- and postoperative complications of laparoscopic tubal ligation with those of salpingectomy for permanent contraception.</div></div><div><h3>Methods</h3><div>A retrospective review of 49,445 patients who underwent laparoscopic salpingectomy or tubal ligation for permanent contraception between 2017 and 2021 was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program database. Statistical analysis involved <em>t</em> test, chi-square test, and logistic regression analysis with the use of the random forest algorithm. The primary outcomes were perioperative and postoperative complications.</div></div><div><h3>Results</h3><div>Of the total cohort, 45,307 (91.6%) underwent laparoscopic salpingectomy, and 4138 (8.4%) received laparoscopic tubal ligation. There were significant differences between the salpingectomy and tubal ligation groups with respect to several demographic characteristics, including age, BMI, minority status, and variations in past medical history. These demographic characteristics were controlled for in the multivariate regression analysis. Salpingectomy had a higher rate of operative and postoperative complications than did tubal ligation (OR = 1.78, 95% CI: 1.46–2.20, <em>p</em> < 0.001). Salpingectomy was associated with a greater risk of longer operation time (OR = 2.03, 95% CI: 2.02–2.04, <em>p</em> < 0.001), longer hospital stay (OR = 5.26, 95% CI: 4.57–6.09, <em>p</em> < 0.001), increased readmission (OR = 3.15, 95% CI: 1.92–5.65, <em>p</em> < 0.001), and increased unplanned reoperation (OR = 2.42, 95% CI: 1.32–5.12, <em>p</em> = 0.010). In addition, the occurrence rates of organ space surgical site infection (OR = 2.68, 95% CI: 1.21–7.59, <em>p</em> = 0.032) and sepsis (OR = 3.93, 95% CI: 1.48–16.02, <em>p</em> = 0.020) were significantly greater in the salpingectomy group than in the tubal ligation group.</div></div><div><h3>Conclusions</h3><div>Laparoscopic tubal ligation and salpingectomy are both safe and effective procedures for permanent contraception; however, salpingectomy is more likely to be associated with peri- and postoperative complications. These findings may help guide clinical decision-making when selecting the optimal permanent contraception method for women.</div></div>","PeriodicalId":32893,"journal":{"name":"Laparoscopic Endoscopic and Robotic Surgery","volume":"8 2","pages":"Pages 84-89"},"PeriodicalIF":0.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144123660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-28DOI: 10.1016/j.lers.2025.03.003
Hongxia Xu , Yihong Xu , Gongjie Shi , Jiaqi Lu , Liping Zhu , Guibing He , Xiao Liang
Objective
Enhanced recovery after surgery (ERAS) protocols have revolutionized postoperative care by integrating minimally invasive techniques and patient-centered strategies to reduce physical and psychological trauma. However, the cognitive and experiential dimensions of surgical incisions under ERAS remain underexplored, particularly in non-Western populations. This study aims to explore patients’ perceptions and preferences regarding laparoscopic incisions under ERAS, providing evidence to optimize incision planning and perioperative education.
Methods
A qualitative descriptive study was conducted at the Department of Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, between November 2022 and February 2023. The participants were adults (≥18 years) who underwent elective laparoscopic abdominal surgery under ERAS, excluding those with cognitive impairments, language barriers, or emergency procedures. Semi-structured interviews, covering physical function, social function, emotional function, self and others’ acceptance, and confidence in the nature and treatment of the disease, were audio-recorded and transcribed verbatim and guided by a thematic framework co-developed by surgeons, nurses, and psychologists. The data were analyzed via the framework method to identify themes related to incision experiences.
Results
This qualitative study included 16 participants, 8 (50%) females and 6 (37.5%) cancer patients, with a mean age of 41.5 ± 12.2 years. Qualitative analysis revealed that the participants experienced minimal psychological distress and great emphasis on pain management and expressed specific concerns regarding the location, size, and cosmetic appearance of the incision. They also voiced high expectations for preventing incision complications and sought information regarding postoperative care. There was notable variation in preferences regarding the choice of incision site before surgery. Participants with cancer focused on disease cure rather than aesthetics.
Conclusion
Personalized preoperative discussions, incision site selection, and postoperative education are critical for increasing patient satisfaction. Laparoscopic incisions under ERAS minimally impact psychological well-being, but location-specific discomfort and aesthetic preferences require attention.
{"title":"Cognition and experience of surgical incisions in patients undergoing laparoscopic surgery with enhanced recovery after surgery protocol: A qualitative study","authors":"Hongxia Xu , Yihong Xu , Gongjie Shi , Jiaqi Lu , Liping Zhu , Guibing He , Xiao Liang","doi":"10.1016/j.lers.2025.03.003","DOIUrl":"10.1016/j.lers.2025.03.003","url":null,"abstract":"<div><h3>Objective</h3><div>Enhanced recovery after surgery (ERAS) protocols have revolutionized postoperative care by integrating minimally invasive techniques and patient-centered strategies to reduce physical and psychological trauma. However, the cognitive and experiential dimensions of surgical incisions under ERAS remain underexplored, particularly in non-Western populations. This study aims to explore patients’ perceptions and preferences regarding laparoscopic incisions under ERAS, providing evidence to optimize incision planning and perioperative education.</div></div><div><h3>Methods</h3><div>A qualitative descriptive study was conducted at the Department of Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, between November 2022 and February 2023. The participants were adults (≥18 years) who underwent elective laparoscopic abdominal surgery under ERAS, excluding those with cognitive impairments, language barriers, or emergency procedures. Semi-structured interviews, covering physical function, social function, emotional function, self and others’ acceptance, and confidence in the nature and treatment of the disease, were audio-recorded and transcribed verbatim and guided by a thematic framework co-developed by surgeons, nurses, and psychologists. The data were analyzed via the framework method to identify themes related to incision experiences.</div></div><div><h3>Results</h3><div>This qualitative study included 16 participants, 8 (50%) females and 6 (37.5%) cancer patients, with a mean age of 41.5 ± 12.2 years. Qualitative analysis revealed that the participants experienced minimal psychological distress and great emphasis on pain management and expressed specific concerns regarding the location, size, and cosmetic appearance of the incision. They also voiced high expectations for preventing incision complications and sought information regarding postoperative care. There was notable variation in preferences regarding the choice of incision site before surgery. Participants with cancer focused on disease cure rather than aesthetics.</div></div><div><h3>Conclusion</h3><div>Personalized preoperative discussions, incision site selection, and postoperative education are critical for increasing patient satisfaction. Laparoscopic incisions under ERAS minimally impact psychological well-being, but location-specific discomfort and aesthetic preferences require attention.</div></div>","PeriodicalId":32893,"journal":{"name":"Laparoscopic Endoscopic and Robotic Surgery","volume":"8 2","pages":"Pages 96-101"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144123662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-24DOI: 10.1016/j.lers.2025.03.002
Farzad Aghazadeh , Bin Zheng
Objective
Reliable and objective methods for assessing surgical skill are essential for improving surgical skills and clinical outcomes. While conventional methods rely on subjective evaluations, motion analysis can offer a quantitative alternative. This study aims to use motion tracking data to analyze the motion smoothness and bimanual coordination of various surgical skill levels during laparoscopic surgery.
Methods
The participants were recruited and grouped into an expert group, an intermediate group, and a novice group on the basis of their experience with laparoscopic surgery. They completed peg transfer, bimanual peg transfer, and rubber band translocation tasks. Motion smoothness was assessed via logarithmic dimensionless tooltip motion jerk, and the dynamic time warping metric of tooltips velocities was employed to assess bimanual coordination.
Results
Seventeen participants, with four experts, five intermediates, and eight novices, were included. Compared with novices, the experts exhibited smoother motion in both the dominant hand (peg transfer: 16.30 vs. 18.05, p = 0.004; bimanual peg transfer: 15.21 vs. 17.45, p = 0.004; rubber band translocation: 14.32 vs. 15.87, p = 0.004) and non-dominant hand (peg transfer: 16.32 vs. 18.22, p = 0.004; bimanual peg transfer: 15.32 vs. 17.52, p = 0.004; rubber band translocation: 14.33 vs. 15.77, p = 0.004), and superior bimanual coordination (peg transfer: 8.77 m/s vs. 13.28 m/s, p = 0.004; bimanual peg transfer: 6.29 m/s vs. 11.13 m/s, p = 0.004; rubber band translocation: 4.50 m/s vs. 7.13 m/s, p = 0.004) across all tasks. They also outperformed intermediates in motion smoothness in the non-dominant hand and bimanual coordination in the peg transfer (16.32 vs. 17.35, p = 0.016; 8.77 m/s vs. 11.89 m/s, p = 0.016) and bimanual peg transfer (15.32 vs. 16.22, p = 0.016; 6.29 m/s vs. 8.63 m/s, p = 0.032) tasks. Similarly, intermediates demonstrated smoother motion in the non-dominant hand (peg transfer: 17.35 vs. 18.22, p = 0.002; bimanual peg transfer: 16.22 vs. 17.52, p = 0.002) and dominant hand (bimanual peg transfer: 16.06 vs. 17.45, p = 0.011), and better bimanual coordination (peg transfer: 11.89 m/s vs. 13.28 m/s, p = 0.002; bimanual peg transfer: 8.63 m/s vs. 11.13 m/s, p = 0.002) than novices did in these tasks.
Conclusion
This study revealed that motion smoothness and bimanual coordination are capable of facilitating surgical skill differentiation across various skill levels. These findings underscore the utility of motion metrics for objective surgical skill assessment, potentially reducing the subjectivity, bias, and associated costs of conventional assessment approaches.
目的可靠、客观的评估手术技能的方法对于提高手术技能和临床效果至关重要。虽然传统的方法依赖于主观评价，但运动分析可以提供定量的替代方法。本研究旨在利用运动跟踪数据分析腹腔镜手术中不同手术技能水平的运动平滑度和双手协调性。方法根据患者的腹腔镜手术经验将其分为专家组、中级组和新手组。他们完成了钉钉转移、双手钉钉转移和橡皮筋转移任务。通过对数无因次工具提示运动抖动来评估运动平滑性，并采用工具提示速度的动态时间翘曲度量来评估手工协调。结果共纳入17人，其中专家4人，中级5人，新手8人。与新手相比，专家在优势手的运动中表现得更流畅(peg转移：16.30 vs. 18.05, p = 0.004；双手移钉：15.21 vs. 17.45, p = 0.004；橡皮筋移位：14.32 vs. 15.87, p = 0.004)和非优势手(木钉移位：16.32 vs. 18.22, p = 0.004；双手移钉：15.32 vs. 17.52, p = 0.004；橡皮筋移位：14.33 vs. 15.77, p = 0.004)，以及更好的双手协调能力(木钉转移：8.77 m/s vs. 13.28 m/s, p = 0.004；双手移钉：6.29 m/s vs. 11.13 m/s, p = 0.004；橡皮筋移位：4.50 m/s vs. 7.13 m/s, p = 0.004)。他们在非优势手的运动平滑度和双手协调方面也优于中间体(16.32 vs. 17.35, p = 0.016；8.77 m/s vs. 11.89 m/s, p = 0.016)和双手移钉(15.32 vs. 16.22, p = 0.016；6.29 m/s vs. 8.63 m/s, p = 0.032)。同样，中间体在非优势手中表现出更平滑的运动(peg转移：17.35 vs. 18.22, p = 0.002；双手木钉转移：16.22 vs. 17.52, p = 0.002)和优势手（双手木钉转移：16.06 vs. 17.45, p = 0.011），以及更好的双手协调性(木钉转移：11.89 m/s vs. 13.28 m/s, p = 0.002；在这些任务中，双手移钉：8.63 m/s vs. 11.13 m/s, p = 0.002)。结论运动平滑性和双手协调性有助于不同水平手术技能的区分。这些发现强调了运动指标在客观手术技能评估中的效用，潜在地减少了传统评估方法的主观性、偏倚和相关成本。
{"title":"A new approach to laparoscopic skill assessment: Motion smoothness and bimanual coordination","authors":"Farzad Aghazadeh , Bin Zheng","doi":"10.1016/j.lers.2025.03.002","DOIUrl":"10.1016/j.lers.2025.03.002","url":null,"abstract":"<div><h3>Objective</h3><div>Reliable and objective methods for assessing surgical skill are essential for improving surgical skills and clinical outcomes. While conventional methods rely on subjective evaluations, motion analysis can offer a quantitative alternative. This study aims to use motion tracking data to analyze the motion smoothness and bimanual coordination of various surgical skill levels during laparoscopic surgery.</div></div><div><h3>Methods</h3><div>The participants were recruited and grouped into an expert group, an intermediate group, and a novice group on the basis of their experience with laparoscopic surgery. They completed peg transfer, bimanual peg transfer, and rubber band translocation tasks. Motion smoothness was assessed via logarithmic dimensionless tooltip motion jerk, and the dynamic time warping metric of tooltips velocities was employed to assess bimanual coordination.</div></div><div><h3>Results</h3><div>Seventeen participants, with four experts, five intermediates, and eight novices, were included. Compared with novices, the experts exhibited smoother motion in both the dominant hand (peg transfer: 16.30 vs. 18.05, <em>p</em> = 0.004; bimanual peg transfer: 15.21 vs. 17.45, <em>p</em> = 0.004; rubber band translocation: 14.32 vs. 15.87, <em>p</em> = 0.004) and non-dominant hand (peg transfer: 16.32 vs. 18.22, <em>p</em> = 0.004; bimanual peg transfer: 15.32 vs. 17.52, <em>p</em> = 0.004; rubber band translocation: 14.33 vs. 15.77, <em>p</em> = 0.004), and superior bimanual coordination (peg transfer: 8.77 m/s vs. 13.28 m/s, <em>p</em> = 0.004; bimanual peg transfer: 6.29 m/s vs. 11.13 m/s, <em>p</em> = 0.004; rubber band translocation: 4.50 m/s vs. 7.13 m/s, <em>p</em> = 0.004) across all tasks. They also outperformed intermediates in motion smoothness in the non-dominant hand and bimanual coordination in the peg transfer (16.32 vs. 17.35, <em>p</em> = 0.016; 8.77 m/s vs. 11.89 m/s, <em>p</em> = 0.016) and bimanual peg transfer (15.32 vs. 16.22, <em>p</em> = 0.016; 6.29 m/s vs. 8.63 m/s, <em>p</em> = 0.032) tasks. Similarly, intermediates demonstrated smoother motion in the non-dominant hand (peg transfer: 17.35 vs. 18.22, <em>p</em> = 0.002; bimanual peg transfer: 16.22 vs. 17.52, <em>p</em> = 0.002) and dominant hand (bimanual peg transfer: 16.06 vs. 17.45, <em>p</em> = 0.011), and better bimanual coordination (peg transfer: 11.89 m/s vs. 13.28 m/s, <em>p</em> = 0.002; bimanual peg transfer: 8.63 m/s vs. 11.13 m/s, <em>p</em> = 0.002) than novices did in these tasks.</div></div><div><h3>Conclusion</h3><div>This study revealed that motion smoothness and bimanual coordination are capable of facilitating surgical skill differentiation across various skill levels. These findings underscore the utility of motion metrics for objective surgical skill assessment, potentially reducing the subjectivity, bias, and associated costs of conventional assessment approaches.</div></div>","PeriodicalId":32893,"journal":{"name":"Laparoscopic Endoscopic and Robotic Surgery","volume":"8 2","pages":"Pages 90-95"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144123661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-08DOI: 10.1016/j.lers.2025.03.001
Joseph Do Woong Choi , Talia Shepherd , Amy Cao , Nimalan Pathma-Nathan , Toufic El-Khoury , James Wei Tatt Toh
Surgery for ileocolic and colonic Crohn’s disease (CD) remains challenging. Over the past decade, there have been significant advances in surgical techniques, and the timing of surgery for CD patients has been debated. With advances in biological agents, the rate of surgery has significantly decreased, but early ileocolic resection has been advocated. Recently, there has been significant interest in the role of the mesentery in the pathogenesis of CD, with Kono-S mesenteric exclusion anastomosis and extended mesenteric excision advocated by various groups to minimise CD recurrence. There have also been controversies regarding the utility of ileal pouch anal anastomosis after total proctocolectomy. Compared with open surgery, most CD surgeries are now minimally invasive, with increasing evidence for improving short-term outcomes with conventional laparoscopic techniques. The evidence for robotic-assisted surgery in patients with CD is limited at present.
{"title":"Contemporary major abdominal surgical management of Crohn’s disease in the era of biologics and minimally invasive surgery","authors":"Joseph Do Woong Choi , Talia Shepherd , Amy Cao , Nimalan Pathma-Nathan , Toufic El-Khoury , James Wei Tatt Toh","doi":"10.1016/j.lers.2025.03.001","DOIUrl":"10.1016/j.lers.2025.03.001","url":null,"abstract":"<div><div>Surgery for ileocolic and colonic Crohn’s disease (CD) remains challenging. Over the past decade, there have been significant advances in surgical techniques, and the timing of surgery for CD patients has been debated. With advances in biological agents, the rate of surgery has significantly decreased, but early ileocolic resection has been advocated. Recently, there has been significant interest in the role of the mesentery in the pathogenesis of CD, with Kono-S mesenteric exclusion anastomosis and extended mesenteric excision advocated by various groups to minimise CD recurrence. There have also been controversies regarding the utility of ileal pouch anal anastomosis after total proctocolectomy. Compared with open surgery, most CD surgeries are now minimally invasive, with increasing evidence for improving short-term outcomes with conventional laparoscopic techniques. The evidence for robotic-assisted surgery in patients with CD is limited at present.</div></div>","PeriodicalId":32893,"journal":{"name":"Laparoscopic Endoscopic and Robotic Surgery","volume":"8 2","pages":"Pages 73-79"},"PeriodicalIF":0.0,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144123658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-06DOI: 10.1016/j.lers.2025.02.005
Bin Zheng , Xiujun Cai
Unlike earlier innovations that focused on manipulation and task precision, the latest surgical advancements emphasize data visualization and the acceleration of surgeons’ decision-making. Before entering the operating room, digital tools help surgeons develop patient-specific approaches, outline procedural steps, and prepare strategies for managing potential crises. During the operation, relevant data appear at the right moment to assist decision-making and guide performance in formats tailored to the surgeon’s physical and cognitive state, all without causing distractions. In the future operating room, performance data from surgeons will be gathered, integrated, and analyzed to interpret surgeons’ behavior and confidence. Advanced techniques, including artificial intelligence, can be employed to automatically detect moments of performance difficulty or cognitive overload. As a result, digital surgery provides timely, context-specific assistance to surgeons in high-stakes situations. Key components of digital surgery are highlighted in this narrative review.
{"title":"Fundamentals of digital surgery","authors":"Bin Zheng , Xiujun Cai","doi":"10.1016/j.lers.2025.02.005","DOIUrl":"10.1016/j.lers.2025.02.005","url":null,"abstract":"<div><div>Unlike earlier innovations that focused on manipulation and task precision, the latest surgical advancements emphasize data visualization and the acceleration of surgeons’ decision-making. Before entering the operating room, digital tools help surgeons develop patient-specific approaches, outline procedural steps, and prepare strategies for managing potential crises. During the operation, relevant data appear at the right moment to assist decision-making and guide performance in formats tailored to the surgeon’s physical and cognitive state, all without causing distractions. In the future operating room, performance data from surgeons will be gathered, integrated, and analyzed to interpret surgeons’ behavior and confidence. Advanced techniques, including artificial intelligence, can be employed to automatically detect moments of performance difficulty or cognitive overload. As a result, digital surgery provides timely, context-specific assistance to surgeons in high-stakes situations. Key components of digital surgery are highlighted in this narrative review.</div></div>","PeriodicalId":32893,"journal":{"name":"Laparoscopic Endoscopic and Robotic Surgery","volume":"8 3","pages":"Pages 115-122"},"PeriodicalIF":2.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144830912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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