Laparoscopic Endoscopic and Robotic Surgery最新文献

Colorectal cancer accounts for 10% of diagnosed cancers globally and often presents as advanced disease, necessitating aggressive treatment. With both younger and healthier elderly patients being diagnosed, as well as potentially the need for salvage therapy post total neoadjuvant treatment, surgical options for cure include pelvic exenteration. Whilst typically performed via an open approach, there has been an increased utilisation of minimally invasive techniques including robotic surgery. Offering smaller incisions, reduced postoperative pain, and quicker recovery time than open surgery, robotic techniques have demonstrated lower blood loss, shorter hospital stays, and reduced morbidity. Moreover, the ergonomic design of robotic systems provides surgeons with comfort during long procedures and increased precision. It also offers an increased opportunity for organ preservation and reconstruction whilst maintaining adequate oncological outcomes. As robotic technology continues to evolve and combines with artificial intelligence, it is poised to play an even more significant role in the management of complex colorectal cancer cases, improving survival and long-term outcomes.

Objective

Laparoscopic anatomical hepatectomy has been proven to be achievable for segmentectomy, subsegmentectomy and multi-segmentectomy. The extraglissonian approach in the context of selective hepatic inflow occlusion has been skilled under laparoscopy. This study aims to examine the suitability of the technique stated above for laparoscopic anatomical hepatectomy.

Methods

This retrospective study analyzed the clinical data of 114 patients diagnosed with hepatocellular carcinoma who underwent laparoscopic anatomical hepatectomy using the extraglissonian hepatic inflow occlusion technique at the Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital between September 2020 and December 2022.

Results

The success rate of achieving the ischemic area using the described methods was determined to be 74.6%. Out of the 85 cases that underwent laparoscopic anatomical hepatectomy, 34 cases involved segmentectomy, 5 cases involved subsegmentectomy, and 46 cases involved multi-segmentectomy. The average duration of the operation, blood loss volume, and postoperative hospital stay were 229.0 ± 85.0 min, 133.0 ± 112.0 mL, and 5.4 ± 1.7 d, respectively. Notably, no intraoperative blood transfusions were necessary, and no postoperative complications were observed.

Conclusion

The extraglissonian hepatic inflow occlusion technique exhibits a notable advantage in terms of a high success rate, effectively guiding the selection process during laparoscopic parenchymal transection. Moreover, this technique has demonstrated safety, reproducibility, and significant potential for broader clinical adoption.

Objective

Adverse surgical events are a major cause of morbidity, mortality, and disability worldwide. The cause of many such events can be attributed to interruptions in the operating room (OR), multitasking by surgeons, etc. The objective of this study was to observe the types and frequency of intraoperative workflow interruptions in our ORs.

Method

This cross-sectional study was conducted from March to April of 2023. An observational approach using an audio-video recording device was employed to record OR flow disruptions. One elective OR and one emergency OR under the Department of General Surgery were selected for the study. All open and laparoscopic surgeries conducted in the selected ORs were included. An Internet Protocol camera was installed in the selected ORs with a view of the entire room, including the anesthesia station. Audio-video recording was started after the first incision and stopped after closure of the surgical site.

Result

Of the 51 cases that were studied, 45 (88.2%) were elective, and 18 (35.3%) were laparoscopic cases. They could be classified into 8 types of open procedures and 4 types of laparoscopic procedures. The mean maximum headcount inside the OR was 15.5 ± 3.6 and doors opened on average of 15.8 ± 6.0 times during a procedure. Other interruptions were surgeons attending phone calls (24, 47.1%), leaving the sterile area (21, 41.2%), technical disturbances (32, 62.7%), anesthetic interruptions (18, 35.3%), and faulty instruments (29, 56.9%). Elective procedures had a significantly higher average number of interruptions per operating hour than emergency procedures (17.5 ± 8.6 vs. 7.1 ± 2.9, p < 0.01).

Conclusion

Preventable factors such as faulty instruments, anesthetic interruption, and attending phone calls by the surgeon are commonly observed in ORs. They need to be addressed by timely surgical audits or the adoption of continued surveillance methods that can help take measures to minimize their occurrence.

Abdominal pregnancy is a rare and life-threatening form of ectopic pregnancy. It is defined as an ectopic pregnancy in a region of the peritoneal cavity that does not include the fallopian tubes, ovaries, or their associated ligamentous structures. Many abdominal pregnancies are caused by secondary implantation in the peritoneal cavity after tubal abortion, rupture, or uterine rupture. Here, we report a case of abdominal pregnancy resulting from iatrogenic uterine perforation during the induced abortion of an early intrauterine pregnancy, which had been misdiagnosed as a ruptured corpus luteum cyst due to the sudden rupture of the abdominal gestational sac, complicating intra-abdominal hemorrhage. The true diagnosis was missed by vaginal ultrasound and confirmed by laparoscopic exploration. We discuss the details of the case management and review the relevant literature.

Objective

The laparoscopic approach is becoming the standard of care for many surgical disorders. However, in the case of hydatid cysts, laparoscopic management is challenging due to the risk of spillage of hydatid fluid, which can cause an anaphylactic reaction and recurrence. Here, we report our initial experience with laparoscopic partial pericystectomy of hydatid cysts using long ribbon gauze to decrease intra-operative spillage.

Method

This was a retrospective study (between January 2010 and December 2021) in the Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Science, a tertiary care referral center in northern India. Here, we have included 37 consecutive patients with hydatid cysts of the liver and spleen. Diagnosis was made by laboratory and imaging findings (abdominal sonography or contrast enhanced CT scans). All patients were managed with laparoscopic partial pericystectomy. Intraoperatively, a betadine-soaked long ribbon gauze, high-pressure suction canula, and an endo-bag were used in all patients. The collected data included patient demography, location, size, and number of cysts, WHO type, operative time, blood loss, postoperative complications, hospital stay and follow-up.

Result

In our series, the mean age was 38.4 ± 13.6 years, 15 (40.5%) were men and 22 (59.5%) were women. The right lobe of the liver was the most commonly affected site (21, 56.8%). The mean operative time was 80.0 ± 32.0 min, and intraoperative blood loss was 23.6 ± 11.5 mL. Bile leak was present in 6 (16.2%) patients. There was no mortality. The hospital stay was 5 (3, 9) days, and no recurrence was observed at a median follow-up of 36 months.

Conclusion

Laparoscopic partial pericystectomy using this technique is safe in the management of hydatid cysts. Simply, proper packing and safe removal of soaked gauzes can minimize the incidence of postoperative complications and recurrence.

Objective

Smart insufflation (SI) techniques relying on valve and membrane-free insufflation are increasing in usage. Although considerable literature exists demonstrating the benefits of SI on procedural ease and patient outcomes, there remains a paucity describing the financial impact of these devices. The purpose of this study was to determine the financial and efficiency impact of these devices on the operating room and inpatient wards of a hospital.

Methods

A discrete event simulation model representing a typical mid-sized North American hospital comparing SI to traditional insufflation (TI) was generated. The National Surgical Quality Improvement database from 2015 to 2019 was used to populate the model with data supplemented from the literature. Outcomes included length of stay (LOS), duration of surgery (DOS), annual procedure volume, profit, return on investment (ROI), and gross profit margin (GPM). From the literature review, DOS savings were 10–32 minutes/case, while LOS savings were 0–3 days/case.

Results

Implementation of an SI led to an increase in annual throughput of 42–346 (4.4%–36.6%) cases for all procedures and 38 to 297 (4.3%–33.3%) cases for complex procedures. LOS was found to be decreased by 175–614 (18.3%–64.2%) days for all procedures and 231 to 614 (35.6%–77.9%) cases for complex procedures with the implementation of an SI. Together, this resulted in an increase in net profit of $104,685 per annum. The ROI of SI over the TI device was >1000%, and the GPM for the TI was 90.0%, while the GPM for the SI was 71.7%.

Conclusion

Despite the initial financial investment being greater, the implementation of SI offsets these expenses and yields significant financial benefits. Our study demonstrates the financial benefits of SI over TI and illustrates how granular operational and financial analyses of technologies are essential to aid in sound healthcare procurement decision making.

Objective

In the evolving era of minimal access surgery, low rectal cancers still pose a challenge to laparoscopic or robotic surgeons. Hence, at our institute we intended to demonstrate the oncological efficacy of intersphincteric resection and coloanal anastomosis in the treatment of distal rectal cancers, performing the abdominal part of the procedure which includes rectal mobilization, laparoscopically.

Methods

From February 2017 to March 2021, 125 patients who had undergone intersphincteric resection and coloanal anastomosis via the perineal approach at Galaxy Care Laparoscopic Institute, Pune, were included in this study. Transabdominal mobilization of the rectum was performed laparoscopically. All patients had a diversion ileostomy and a pelvic drain. Patients were followed-up for a period of 18 months post-surgery. Data on clinical and oncological outcomes were collected and analysed. The pre-operative and post-operative Wexner incontinence scores were compared.

Results

The mean time taken for surgery was 181.57 ± 30.00 min. The mean blood loss was 119.76 ± 42.53 mL. Most patients (103, 82.4%) had their tumour at a distance of 1–2 cm from the anal verge. A loco-regional recurrence rate of 12.8% (16/125) was noted in our study. For the post-surgery Wexner score, 74.4% of patients (93/125) had a score of 5 or less, depicting that three-quarters of the study population had satisfactory continence. Overall, 81.6% of patients were satisfied with the functional results of surgery.

Conclusion

Intersphincteric resection and coloanal anastomosis, with a 12.8% recurrence rate, can now be considered an oncological and technically feasible procedure with sphincter salvage and good continence.

Objective

Various materials have been used for tympanic membrane reconstruction in middle ear surgery. This study aimed to evaluate the difference between the tragal perichondrium and COOK artificial material in patients who underwent endoscopic type 1 tympanoplasty.

Method

This retrospective study included patients who underwent endoscopic type 1 tympanoplasty from June 2021 to June 2022 at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. Patients were divided into group A (tragal perichondrium) and group B (COOK artificial material) according to the material used in the operation. All patients were followed up for 6 months. The differences in age, gender, operation site, disease course, preoperative air-bone gap (ABG), operation time, blood loss, hearing gain, and wound healing rate were compared between the two groups.

Results

This study enrolled 197 patients, with 120 patients in group A and 77 patients in group B. There were no significant differences in age, gender, operation site, disease course, or preoperative ABG between groups A and B (p > 0.05). Both groups had significant postoperative improvement in hearing (group A: 30.98 ± 9.58 dB vs. 17.07 ± 9.92 dB, p < 0.001; group B: 29.75 ± 7.52 dB vs. 14.25 ± 9.07 dB, p < 0.001). The mean hearing gain in group A and group B was comparable (14.02 ± 11.91 dB vs. 15.50 ± 7.05 dB, p = 0.609). The wound healing rates of groups A and B were no differences (93.33% vs. 87.01%, p = 0.133). The patients in group B had a shorter operation duration (72.57 ± 11.32 min vs. 61.86 ± 9.27 min, p = 0.045) and less blood loss (12.38 ± 3.7 mL vs. 8.10 ± 2.43 mL, p = 0.004).

Conclusions

Tragal perichondrium and COOK artificial material are reliable for functional and anatomical outcomes in endoscopic type 1 tympanoplasty, and COOK artificial material can save operation time and blood loss in surgery compared to the tragal perichondrium.

In this technical note, a novel rating scale (abdominal integral index) was introduced for assessing the conditions of the working laparoscopic space based on linear measurements to select the optimal one or two-stage surgical treatment for super-obesity. Patients with the same height and similar BMI values had different rating scale scores, reflecting different conditions of laparoscopic bariatric surgery. The rating scale helps surgeons and patients make a safe option for surgery, depending on the experience of the surgeon and technical laparoscopic conditions.