Laparoscopic Endoscopic and Robotic Surgery最新文献_第2页

A comparison of laparoscopic to open pancreaticoduodenectomy for pancreatic adenocarcinoma by propensity score matching analysis 通过倾向得分匹配分析比较腹腔镜与开腹胰十二指肠切除术治疗胰腺腺癌的效果

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-08-28 DOI: 10.1016/j.lers.2024.08.001

Jared Mount , Brandon Mount , Katherine Poruk , Mary Tice , John A. Stauffer

Objective

In previous studies, laparoscopic pancreaticoduodenectomy (LPD) has demonstrated safety and potential benefits over open pancreaticoduodenectomy (OPD) for pancreatic adenocarcinoma (PDAC). After performing both LPD and OPD procedures interchangeably in routine practice for a decade, the outcomes of LPD versus OPD for PDAC were analyzed and compared at a single institution. Our primary aim was to compare features of LPD and OPD in PDAC patients so that the suitable surgical approach may be chosen for each individual.

Methods

From January 2010 through December 2020, all patients undergoing pancreaticoduodenectomy (PD) were identified, and information was collected prospectively. At a single institution, PD was performed on 589 patients, of whom 347 were OPD patients and 242 were LPD patients. After excluding those who underwent pancreatectomy for indications other than PDAC, total pancreatectomy, major vascular or concomitant organ resection, there were 237 patients (OPD = 157, LPD = 80). Then propensity score matching was completed to analyze 77 OPD patients versus 77 LPD patients to create a similar group of patients who underwent either LPD or OPD for PDAC. A comparison of perioperative data and 90-day outcomes with subsequent statistical analysis was performed.

Results

Operative time (491 min vs. 281 min, p < 0.001) was longer for LPD than OPD. The rates of pancreatic fistula (11.7% vs. 0.0%, p < 0.001) and delayed gastric emptying (15.6% vs. 3.9%, p = 0.027) were higher for LPD than OPD respectively but overall morbidity was similar. Blood loss, mortality and post-pancreatectomy hemorrhage were also similar for both groups, but total costs ($60,245 vs. $50,900, p = 0.002) were significantly higher for LPD than OPD. Recurrence and overall survival were similar for the two groups.

Conclusion

In our experience, LPD does not offer any advantages over OPD for PDAC and is associated with a higher rate of complications and costs.

目的在以前的研究中，腹腔镜胰十二指肠切除术（LPD）已证明比开腹胰十二指肠切除术（OPD）治疗胰腺腺癌（PDAC）安全且具有潜在的优势。在常规实践中交替使用 LPD 和 OPD 手术十年之后，我们在一家医疗机构分析并比较了 LPD 和 OPD 治疗 PDAC 的结果。我们的主要目的是比较PDAC患者LPD和OPD的特征，以便为每个人选择合适的手术方法。方法从2010年1月到2020年12月，对所有接受胰十二指肠切除术（PD）的患者进行识别，并前瞻性地收集信息。在一家医疗机构中，共有589名患者接受了胰十二指肠切除术，其中347名为OPD患者，242名为LPD患者。在排除因 PDAC、全胰切除术、主要血管或伴随器官切除术以外的适应症而接受胰腺切除术的患者后，共有 237 例患者（OPD = 157 例，LPD = 80 例）。然后完成倾向评分匹配，对77名OPD患者和77名LPD患者进行分析，以建立一个相似的PDAC患者群体，即接受LPD或OPD的患者。结果LPD的手术时间（491分钟 vs. 281分钟，p < 0.001）长于OPD。LPD的胰瘘（11.7% 对 0.0%，p < 0.001）和胃排空延迟（15.6% 对 3.9%，p = 0.027）发生率分别高于 OPD，但总体发病率相似。两组的失血量、死亡率和胰腺切除术后出血量也相似，但LPD的总费用（60,245美元对50,900美元，p = 0.002）明显高于OPD。两组患者的复发率和总生存率相似。

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引用次数: 0

Revised in-depth meta-analysis on the efficacy of robot-assisted versus traditional free-hand pedicle screw insertion 机器人辅助椎弓根螺钉植入与传统徒手椎弓根螺钉植入疗效的深度荟萃分析修订版

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-08-28 DOI: 10.1016/j.lers.2024.08.002

Sorayouth Chumnanvej , Branesh M. Pillai , Jackrit Suthakorn , Siriluk Chumnanvej

Objective

Robot-assisted pedicle screw insertion has recently emerged as an alternative to the traditional free-hand technique. However, discrepancies in the accuracy of screw placement between the 2 methods have been highlighted by some comparative studies. This meta-analysis was conducted to synthesize evidence comparing these techniques.

Methods

Searches were conducted in 5 electronic databases adhering to specific eligibility criteria for randomized and observational studies. The data were analyzed using RevMan software and the results are presented as odds ratios (ORs), mean differences, or standard mean differences (SMDs) with 95% confidence intervals (CIs). Our analysis included 12 studies (7 randomized trials and 5 observational studies, involving 883 patients and 4903 screws).

Results

The results demonstrated a higher rate of Grade A Gertzbein and Robbins pedicle placement score (OR: 1.77; 95% CI: 1.10–2.87), a lower rate of revision surgeries (OR: 0.21; 95% CI: 0.09–0.52), and a shorter radiation exposure duration (SMD = −1.38, 95% CI: −2.32 to −0.44) in the robot-assisted group compared with the free-hand group. Nonetheless, the length of hospital stay, volume of intraoperative blood loss, postoperative visual analogue scale scores for back pain, and rate of wound infection were similar between the 2 groups. Significant heterogeneity was observed in some outcomes.

Conclusion

Compared with the free-hand method, the robot-assisted technique provides greater accuracy and reduced radiation exposure. The efficacy of the robot-assisted technique is expected to improve further as experience with its use in surgery grows.

目的机器人辅助椎弓根螺钉置入术是最近出现的一种替代传统徒手技术的方法。然而，一些比较研究强调了这两种方法在螺钉置入准确性上的差异。本荟萃分析旨在综合比较这两种技术的证据。方法按照随机和观察性研究的特定资格标准在 5 个电子数据库中进行搜索。数据使用 RevMan 软件进行分析，结果以几率比（OR）、平均差异或标准平均差异（SMD）及 95% 置信区间（CI）表示。我们的分析包括 12 项研究（7 项随机试验和 5 项观察性研究，涉及 883 名患者和 4903 颗螺钉）。结果结果显示，Gertzbein 和 Robbins A 级椎弓根置入评分率较高（OR：1.77；95% CI：1.10-2.87），翻修手术率较低（OR：0.21；95% CI：0.09-0.52），机器人辅助组与徒手组相比辐射暴露时间较短（SMD =-1.38，95% CI：-2.32 至-0.44）。不过，两组的住院时间、术中失血量、术后背痛视觉模拟量表评分和伤口感染率相似。结论与徒手方法相比，机器人辅助技术具有更高的准确性，并减少了辐射暴露。随着机器人辅助技术在手术中应用经验的增加，其疗效有望进一步提高。

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引用次数: 0

Large language models in laparoscopic surgery: A transformative opportunity 腹腔镜手术中的大型语言模型：变革性机遇

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-07-16 DOI: 10.1016/j.lers.2024.07.002

Partha Pratim Ray

This opinion paper explores the transformative potential of large language models (LLMs) in laparoscopic surgery and argues for their integration to enhance surgical education, decision support, reporting, and patient care. LLMs can revolutionize surgical education by providing personalized learning experiences and accelerating skill acquisition. Intelligent decision support systems powered by LLMs can assist surgeons in making complex decisions, optimizing surgical workflows, and improving patient outcomes. Moreover, LLMs can automate surgical reporting and generate personalized patient education materials, streamlining documentation and improving patient engagement. However, challenges such as data scarcity, surgical semantic capture, real-time inference, and integration with existing systems need to be addressed for successful LLM integration. The future of laparoscopic surgery lies in the seamless integration of LLMs, enabling autonomous robotic surgery, predictive surgical planning, intraoperative decision support, virtual surgical assistants, and continuous learning. By harnessing the power of LLMs, laparoscopic surgery can be transformed, empowering surgeons and ultimately benefiting patients.

本文探讨了大型语言模型（LLMs）在腹腔镜手术中的变革潜力，并主张将其整合到手术教育、决策支持、报告和患者护理中。LLM 可提供个性化的学习体验并加速技能掌握，从而彻底改变外科教育。由 LLM 支持的智能决策支持系统可以帮助外科医生做出复杂的决策、优化手术工作流程并改善患者预后。此外，LLM 还能自动生成手术报告和个性化患者教育材料，从而简化文档记录并提高患者参与度。然而，要成功整合 LLM，还需要解决数据稀缺、手术语义捕捉、实时推理以及与现有系统集成等难题。腹腔镜手术的未来在于 LLM 的无缝集成，从而实现自主机器人手术、预测性手术规划、术中决策支持、虚拟手术助手和持续学习。通过利用 LLM 的力量，腹腔镜手术可以发生变革，增强外科医生的能力，最终造福患者。

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引用次数: 0

Therapy for benign rectal anastomotic stricture after surgery for colorectal cancer: A systematic review 结直肠癌术后良性直肠吻合口狭窄的治疗方法：系统综述

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-07-03 DOI: 10.1016/j.lers.2024.06.004

Gaoyang Cao , Songtao Wu , Li Zhang , Xinjie Zhang , Wei Zhou

Objective

To evaluate various treatment methods for benign rectal anastomotic stricture (AS) following surgery for colorectal cancer.

Method

A systematic review of the literature was conducted, focusing on studies that reported outcomes of different treatment modalities for benign AS. The PubMed, Embase, Scopus, China National Knowledge Infrastructure, and Cochrane Library databases were searched from January 2000 to December 2023. The inclusion criteria were studies involving human subjects, published in English, and reporting on therapeutic outcomes for benign AS.

Results

A total of 19 papers identified a range of therapeutic strategies, including nonoperative anastomotic dilation, endoscopic balloon dilation (EBD), transanal minimally invasive surgery (TAMIS), self-expandable metal stents (SEMS), endoscopic incision (EI) and newer techniques such as prostate resection instrumentation. Nonoperative anastomotic dilation can serve as an initial treatment for lower AS. EI demonstrated promise in cases where EBD was ineffective, providing an alternative method for managing AS. TAMIS and SEMS showed higher efficacy in refractory cases, with TAMIS being particularly effective for severe fibrotic or completely closed AS. The use of rigid instrumentation with an electric knife for transanal incisions demonstrated precision but lacked the flexibility needed for complex procedures.

Conclusion

While traditional methods such as nonoperative anastomotic dilation and EBD remain first-line treatments for benign AS, advanced techniques such as EI, TAMIS, and SEMS offer promising alternatives, particularly in refractory cases. The choice of treatment should be tailored to individual patient conditions, with consideration for the technical expertise required and the potential for complications.

目的评估结直肠癌术后良性直肠吻合口狭窄（AS）的各种治疗方法。方法对文献进行了系统性回顾，重点关注报道良性 AS 不同治疗方法效果的研究。检索了 2000 年 1 月至 2023 年 12 月期间的 PubMed、Embase、Scopus、中国国家知识基础设施和 Cochrane 图书馆数据库。结果共有19篇论文确定了一系列治疗策略，包括非手术吻合口扩张术、内镜下球囊扩张术（EBD）、经肛门微创手术（TAMIS）、自膨胀金属支架（SEMS）、内镜下切开术（EI）以及前列腺切除器械等新技术。非手术吻合口扩张术可作为下部 AS 的初始治疗方法。在EBD无效的病例中，EI显示出良好的前景，为治疗强直性脊柱炎提供了另一种方法。TAMIS 和 SEMS 对难治性病例的疗效更高，其中 TAMIS 对严重纤维化或完全闭合的 AS 尤为有效。结论虽然非手术吻合口扩张术和 EBD 等传统方法仍是良性 AS 的一线治疗方法，但 EI、TAMIS 和 SEMS 等先进技术提供了前景广阔的替代方法，尤其是在难治性病例中。应根据患者的具体情况选择治疗方法，同时考虑到所需的专业技术和并发症的可能性。

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引用次数: 0

Assessing a complex patient with both colorectal cancer and diverticulitis of the sigmoid colon: A case report and literature review 评估一名同时患有结直肠癌和乙状结肠憩室炎的复杂患者：病例报告和文献综述

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-06-13 DOI: 10.1016/j.lers.2024.06.002

引用次数: 0

Interlayer repair with porcine small intestinal submucosa versus internal repair with tragus cartilage in endoscopic tympanoplasty 内窥镜鼓室成形术中使用猪小肠粘膜下层间修复与使用耳廓软骨进行内部修复的比较

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-06-01 DOI: 10.1016/j.lers.2024.05.001

Lina Zhao, Wenya Li, Lei Zhang

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.

目的内窥镜鼓室成形术包括多种手术方法，如内部修复、层间修复和外部覆盖。这种技术需要自体材料、异体材料和异种材料，用于修复鼓膜穿孔。为取得良好效果，应选择适当的手术方法和修复材料。方法对2022年1月至2022年9月期间在浙江大学医学院附属邵逸夫医院接受猪小肠粘膜下层（SIS）鼓膜穿孔修补术和耳廓软骨修补术的患者进行回顾性病历回顾。对穿孔大小、鼓膜状态、术前和术后症状、随访数据、伤口愈合率和听力改善情况进行了分析。结果在纳入研究的 115 例患者中，56 例接受了猪 SIS TM 层间修补术，59 例接受了外耳软骨内部修补术。两组患者在年龄、性别、病程、穿孔侧、鼓膜状态、基础疾病或术前感染等基线方面均无明显差异。猪 SIS 层间植入术的术后总有效率为 91.07%（51 例患者），而耳盖软骨内植入术的术后总有效率为 88.14%（52 例患者）。两种手术方法的移植成功率无明显差异（P = 0.887）。与术前相比，两组患者术后纯音听觉（PTA）和气骨间隙（ABG）密度均明显增加（p <0.05）。然而，两组患者术后 3 个月的纯音听觉（PTA）和气骨间隙（ABG）密度无明显差异（p > 0.05）。与内部植入组相比，夹层组患者的手术时间更短（51.36 ± 6.76 min vs. 59.71 ± 7.45 min，t = 6.298，p < 0.001），失血量更少（11.结论：我们的研究表明，猪 SIS 和耳廓软骨在修复不可逆的 TM 穿孔方面具有很高的成功率。通过猪 SIS 层间植入进行内窥镜鼓室成形术具有明显的优势，包括无需供体部位切口和疤痕形成，以及移植物易于修改和操作。

{"title":"Interlayer repair with porcine small intestinal submucosa versus internal repair with tragus cartilage in endoscopic tympanoplasty","authors":"Lina Zhao, Wenya Li, Lei Zhang","doi":"10.1016/j.lers.2024.05.001","DOIUrl":"10.1016/j.lers.2024.05.001","url":null,"abstract":"<div><h3>Objective</h3><p>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.</p></div><div><h3>Method</h3><p>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.</p></div><div><h3>Results</h3><p>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 (<em>p =</em> 0.887). Postoperative pure tone auditory (PTA) and air-bone gap (ABG) density significantly increased in both groups compared with before surgery (<em>p</em> < 0.05). However, the postoperative PTA and ABG density were not significantly different 3 months post-surgery between the two groups (<em>p</em> > 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, <em>p</em> < 0.001) and less blood loss (11.91 ± 2.61 mL vs. 15.27 ± 2.57 mL, t = 7.019, <em>p</em> < 0.001).</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":32893,"journal":{"name":"Laparoscopic Endoscopic and Robotic Surgery","volume":"7 2","pages":"Pages 79-86"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S246890092400029X/pdfft?md5=2a7eac7e9f74b3c2505076ef03f8744d&pid=1-s2.0-S246890092400029X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141032919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Robotic complete mesocolic excision for right colon cancer: Learning curve, training, techniques, approach, platforms, and future perspectives 右结肠癌的机器人结肠系膜全切除术：学习曲线、培训、技术、方法、平台和未来展望

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-06-01 DOI: 10.1016/j.lers.2024.04.001

Guglielmo Niccolò Piozzi , Sentilnathan Subramaniam , Rauand Duhoky , Werner Hohenberger , Jim S. Khan

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).

结肠癌在全球发病率排名第五，死亡率排名第六。与直肠癌相比，目前结肠癌 II 期和 III 期患者的 5 年总生存率最差。结肠系膜完全切除术是结肠癌切除术中标准化和最优化的手术技术。由于腹腔镜手术通常被认为在技术上具有挑战性，因此这项技术传统上都是通过开放式方法进行的。机器人方法在结肠癌手术中的应用较为缓慢，但最新的机器人平台可为右侧结肠癌手术提供更安全、更优化的方法。目前已开发并探索出多种机器人方法。当前机器人平台生态系统的扩展逐渐为应用机器人方法进行完整结肠系膜切除术提供了新的产出。本综述对现有的右结肠癌机器人全结肠系膜切除术文献（学习曲线、培训、技术、方法、平台和未来展望）进行了梳理。

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引用次数: 0

Results of selective decontamination with oral neomycin and metronidazole for major colorectal surgery in Australia: A cohort study 澳大利亚大肠手术中使用口服新霉素和甲硝唑进行选择性净化的结果：一项队列研究

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-06-01 DOI: 10.1016/j.lers.2024.03.002

James Wei Tatt Toh , Devansh Shah , Henry Wang , Charlotte Kwik , Joseph Do Woong Choi , Chelsie Leonie Beinke , Paul Morris , Eleni Baird-Gunning , Geoffrey Peter Collins , Fiona Gavegan , Karen Shedden , Toufic El-Khoury , Nimalan Pathma-Nathan , Kerry Hitos

Objective

The role of selective decontamination with oral antibiotics (OABs) and mechanical bowel preparation (MBP) prior to elective colorectal surgery is still widely debated. The objective of this study was to compare the outcomes of selective decontamination with neomycin, metronidazole and MBP compared to those of decontamination with MBP alone or with no preparation.

Methods

Selective decontamination with neomycin and metronidazole combined with bowel preparation was introduced prior to elective colorectal surgery as part of an enhanced recovery after surgery program at Westmead Hospital, a major Australian tertiary referral hospital, between June 2017 and January 2023. Comparisons between short-term outcomes of OAB + MBP and MBP/no preparation were made using prospectively collected data on length of stay (LOS), readmission, mortality within 30 days, anastomotic leakage (AL), surgical site infection (SSI), urinary tract infection, deep venous thrombosis and/or pulmonary embolism, pneumonia, and ileus. Follow-up was limited to hospital stays and subsequent presentations within the health district within thirty days of surgery. The Mann–Whitney U test was used to analyse continuous data, and the chi-square test was used for categorical data. Univariate and multivariate regression modelling was performed to identify risk factors associated with an increased likelihood of SSI and AL.

Results

Patients with oral neomycin and metronidazole combined with bowel preparation had reduced superficial SSI (2.7% vs. 7.6%, p = 0.043) and overall complications (32.7% vs. 44.6%, p = 0.020), particularly Clavien–Dindo 1 complications (7.3% vs. 16.5%, p = 0.009). However, the differences in AL (2.7% vs. 4.5%, p = 0.369) and organ/space SSI (1.3% vs. 3.7%, p = 0.327) were not statistically significant. The median LOS (6 d vs. 6 d, p = 0.370) was not different between the groups.

Conclusion

Selective decontamination with neomycin and metronidazole reduces the risk of SSIs and overall complications. There was a trend to toward a lower AL, but this difference was not statistically significant.

目的在择期结直肠手术前使用口服抗生素（OABs）和机械肠道准备（MBP）进行选择性净化的作用仍存在广泛争议。本研究的目的是比较使用新霉素、甲硝唑和机械肠道准备进行选择性去污与仅使用机械肠道准备或不进行准备进行去污的结果。方法2017 年 6 月至 2023 年 1 月期间，澳大利亚一家大型三级转诊医院韦斯特米德医院在择期结直肠手术前引入了新霉素和甲硝唑联合肠道准备的选择性去污，作为术后增强恢复计划的一部分。通过前瞻性收集的住院时间（LOS）、再入院率、30 天内死亡率、吻合口漏（AL）、手术部位感染（SSI）、尿路感染、深静脉血栓和/或肺栓塞、肺炎和回肠瘘等数据，对 OAB + MBP 和 MBP/无准备的短期疗效进行了比较。随访仅限于手术后三十天内的住院情况和随后在卫生区内的就诊情况。连续数据采用 Mann-Whitney U 检验，分类数据采用卡方检验。结果患者在口服新霉素和甲硝唑并进行肠道准备后，表皮SSI（2.7% vs. 7.6%，p = 0.043）和总体并发症（32.7% vs. 44.6%，p = 0.020）均有所减少，尤其是Clavien-Dindo 1并发症（7.3% vs. 16.5%，p = 0.009）。然而，AL（2.7% 对 4.5%，p = 0.369）和器官/空间 SSI（1.3% 对 3.7%，p = 0.327）的差异无统计学意义。结论使用新霉素和甲硝唑进行选择性净化可降低 SSI 和总体并发症的风险。AL值有降低的趋势，但差异无统计学意义。

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引用次数: 0

Laparoscopic plication for diaphragmatic eventration in adults: Unveiling the mystery of eventration 成人横膈膜偶发症的腹腔镜成形术：揭开横膈膜分离的神秘面纱

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-06-01 DOI: 10.1016/j.lers.2024.01.001

Balika Mahesan , Prasanna Kumar Reddy , K.S. Santhosh Anand , Muvva Sri Harsha M , Vijay N , Sudarsan Srikanth

Diaphragm eventration is the permanent elevation of a hemidiaphragm and can be due to congenital or acquired causes. It is a rather uncommon condition in adults and causes a spectrum of symptoms, ranging from asymptomatic incidental findings on imaging to life-threatening respiratory distress. Asymptomatic patients do not require any treatment, but plication is the conventional, well-known method for treating symptomatic patients. Management varies depending on the symptoms. In this article, we discuss two rare cases of diaphragmatic eventration that were treated with minimal access surgery.

横膈膜偶发症是指半膈永久性隆起，可由先天或后天原因引起。这种情况在成人中并不常见，会导致一系列症状，从影像学上无症状的偶然发现到危及生命的呼吸窘迫。无症状的患者不需要任何治疗，但对有症状的患者来说，切开术是众所周知的常规治疗方法。根据症状的不同，治疗方法也不尽相同。在本文中，我们将讨论两例罕见的膈肌分离病例，这两例病例均采用微创手术治疗。

引用次数: 0

Comparison of da Vinci 5 with previous versions of da Vinci and Sina: A review 达芬奇 5 与达芬奇和新浪以前版本的比较：回顾

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-06-01 DOI: 10.1016/j.lers.2024.04.006

Arya Asadizeidabadi, Seyedmohammadamin Hosseini, Fedor Vetshev, Sergey Osminin, Seyedali Hosseini

Robotic systems have become popular in modern surgical procedures. The option of telesurgery has effectively addressed geographic limitations. These systems are offered by numerous companies worldwide. In this review article, we discuss four models of robotic systems to determine their advantages: the Sina flex system from Iran and the da Vinci Xi, SP, and 5 systems from the USA. We compared aspects such as architecture, instruments, visualizations, clinical use, and costs. Our findings suggest that the da Vinci robot, which was introduced earlier than the Sina system, utilizes proprietary and limited-use EndoWrist instruments with diameters ranging from 8 to 12 mm and features advanced imaging capabilities, including three-dimensional optical, tomographic, and fluorescence imaging. It is well established and widely utilized in various surgical procedures. Conversely, the Sina flex system employs single-use 5 mm instruments and is equipped with two-dimensional optical imaging as a standard, with optional three-dimensional and fluorescence imaging upgrades available. Despite its affordability, the Sina flex system is relatively new and has not yet been clinically tested. Additionally, the Sina flex system is more user-friendly.

机器人系统已在现代外科手术中大行其道。远程手术的选择有效地解决了地域限制问题。这些系统由全球众多公司提供。在这篇综述文章中，我们讨论了四种型号的机器人系统，以确定它们的优势：伊朗的 Sina flex 系统和美国的达芬奇 Xi、SP 和 5 系统。我们对结构、器械、可视化、临床使用和成本等方面进行了比较。我们的研究结果表明，达芬奇机器人的问世时间早于Sina系统，它使用的是直径为8至12毫米的专有和有限使用的EndoWrist器械，并具有先进的成像功能，包括三维光学、断层扫描和荧光成像。该系统已在各种外科手术中得到广泛应用。相反，Sina flex 系统采用一次性使用的 5 毫米器械，标配二维光学成像，可选配三维和荧光成像升级。尽管价格低廉，但 Sina flex 系统相对较新，尚未经过临床测试。此外，Sina flex 系统更方便用户使用。

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引用次数: 0