Laparoscopic Endoscopic and Robotic Surgery最新文献

英文中文

The digital horizon in colorectal cancer surgery: A narrative review 结直肠癌手术中的数字视界：叙述性回顾

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2025-02-21 DOI: 10.1016/j.lers.2025.02.003

Atanu Pal

Digital surgery is being increasingly used in phraseology and clinical application, driven by the advancing tide of technology. Its scope in treating patients with colorectal cancer is reviewed. A search was performed to include a breadth of digital technologies, including virtual reality (VR), augmented reality (AR), artificial intelligence (AI), mobile health, and simulation. Many digital roles were identified in the 60 studies included. These were clinician-facing or patient-facing throughout the patient’s journey (screening, preoperative, intraoperative, postoperative) and involved the broader team (trainees, oncology, pathology). Colorectal cancer screening was improved via the use of digital technology, including virtual health assistants. Preoperative patient-facing VR enhances consent and reduces perioperative anxiety. For surgeons, enhanced awareness of vascular and visceral anatomy relative to the tumour helped with surgical planning, with the emerging concepts of ‘virtual colectomy’ and ‘digital clone’. Pathologically, AI more accurately predicts lymph node metastasis following endoscopic polyp cancer excision, thus reducing over-treatment with surgery, and assesses the response to neoadjuvant treatment to guide selective surgery. Intraoperatively, AI facilitates real-time detection of anatomical landmarks, including autonomic nerves, ureters, and areolar tissue, to indicate the dissection plane. These intraoperative studies lacked a control group and outcome reporting (intraoperative, clinical, oncological, or functional), highlighting that this technology requires further development and study. There is a paucity of evidence regarding AR, such as intraoperative holographic overlay. Postoperative patient-facing digital technology can promote enhanced recovery, improve physical activity, and reduce sick-role maladaptation. For clinicians, AI can predict the short-term (complications) and long-term (survival) patient prognosis. VR could play an increasing role in training, with some evidence from validated virtual curricula. In summary, digital surgery has potential applications throughout the patient journey and along the virtuality continuum, showing advantages over conventional approaches in the preoperative and postoperative phases. Intraoperative, AI and AR methods have not yet been shown to have clinically significant advantages. As its scope grows, there are emerging implications for training, regulation, and ethics.

在技术进步的推动下，数字外科越来越多地应用于短语学和临床应用。综述了其在结直肠癌治疗中的应用范围。我们进行了一项搜索，包括广泛的数字技术，包括虚拟现实（VR）、增强现实（AR）、人工智能（AI）、移动医疗和模拟。在这60项研究中发现了许多数字角色。在患者的整个过程中（筛查、术前、术中、术后），这些都是面向临床医生或面向患者的，并涉及到更广泛的团队（实习生、肿瘤学、病理学）。通过使用数字技术，包括虚拟健康助理，结直肠癌筛查得到了改善。术前面向患者的VR增强了患者的同意度，减少了围手术期的焦虑。对于外科医生来说，随着“虚拟结肠切除术”和“数字克隆”概念的出现，对与肿瘤相关的血管和内脏解剖学的认识增强有助于手术计划。病理上，AI更准确地预测内镜下息肉癌切除术后的淋巴结转移，从而减少手术过度治疗，并评估对新辅助治疗的反应，指导选择性手术。术中，AI有助于实时检测解剖标志，包括自主神经、输尿管、网状组织，以指示解剖平面。这些术中研究缺乏对照组和结果报告（术中、临床、肿瘤或功能），强调该技术需要进一步发展和研究。缺乏关于AR的证据，例如术中全息覆盖。术后面向患者的数字技术可以促进增强恢复，改善身体活动，减少疾病角色适应不良。对于临床医生来说，人工智能可以预测患者的短期（并发症）和长期（生存）预后。VR可以在培训中发挥越来越大的作用，一些证据来自经过验证的虚拟课程。综上所述，数字手术在整个患者过程和虚拟连续体中具有潜在的应用，在术前和术后阶段显示出优于传统方法的优势。术中、人工智能和AR方法尚未显示出具有临床显着优势。随着其范围的扩大，对培训、监管和道德规范也产生了新的影响。

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引用次数: 0

Simultaneous bilateral robotic-assisted partial nephrectomy using a dual stepwise transperitoneal and retroperitoneal approaches: A case report 同时双侧机器人辅助部分肾切除术采用双步经腹膜和腹膜后入路：一例报告

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2025-02-13 DOI: 10.1016/j.lers.2025.02.002

Francesco Dinale , Annalisa Patera , Tommaso Bocchialini , Giulia Di Marco , Giulio Guarino , Michele Slawitz , Francesco Ziglioli , Davide Campobasso , Umberto Vittorio Maestroni

引用次数: 0

Clinical review of robotic distal pancreatectomy 机器人胰腺远端切除术的临床回顾

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2025-02-05 DOI: 10.1016/j.lers.2025.02.001

Naeun Hwang , Sam Reddish , Jonathan Koea , Sanket Srinivasa

Robotic distal pancreatectomy (RDP) is being increasingly used in centres with access to the robot and offers technological improvements over conventional laparoscopy. Some studies have also shown superior outcomes compared with laparoscopic and open approaches. However, robotic technology is not widely available currently. This review aims to compare RDP with open and laparoscopic distal pancreatectomy, covering the basics of the RDP technique and highlighting the current nuances of the evidence pertaining to RDP with respect to clinical effectiveness and cost‒benefit analysis.

机器人远端胰腺切除术（RDP）越来越多地应用于有机器人的中心，并提供了传统腹腔镜技术的改进。一些研究也表明，与腹腔镜和开放方法相比，其效果更好。然而，机器人技术目前还没有广泛应用。这篇综述的目的是比较RDP与开放和腹腔镜远端胰腺切除术，涵盖RDP技术的基础知识，并强调当前与RDP相关的证据在临床效果和成本效益分析方面的细微差别。

引用次数: 0

Laparoscopic totally extraperitoneal groin hernia repair using a self-gripping mesh: A 5-year outcome and our techniques 腹腔镜腹股沟疝全腹膜外修补术：5年疗效及我们的技术

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2025-01-03 DOI: 10.1016/j.lers.2024.12.005

Sopon Lerdsirisopon , Suphakarn Techapongsatorn , Amarit Tansawet , Wisit Kasetsermwiriya , Issaree Laopeamthong

引用次数: 0

Endoscopic lumbar sympathectomy in the treatment of Buerger disease: A rare case report 内镜下腰交感神经切除术治疗伯格病：罕见病例报告

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-12-27 DOI: 10.1016/j.lers.2024.12.004

Juliana , Yosis Yohannes Motulo , Dhihintia Jiwangga , Henry Sintoro , Paul L. Tahalele

引用次数: 0

Use of indocyanine green fluorescence for triple gallbladder cholecystectomy: A case report 使用吲哚菁绿荧光进行三胆囊胆囊切除术：病例报告

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-09-12 DOI: 10.1016/j.lers.2024.09.002

Caterina Froiio, Laura Torselli, Luca Bottero, Nirvana Maroni, Dario Palmisano, Pasquale Chiacchio, Cristian Giuseppe Monaco, Laura Palvarini, Giovanni Pompili, Andrea Pisani Ceretti

引用次数: 0

Helicobacter pylori infection may result in poor gastric cleanliness in magnetically controlled capsule gastroscopy examination: A single-center retrospective study 幽门螺杆菌感染可能导致磁控胶囊胃镜检查中胃部清洁度不佳：单中心回顾性研究

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-09-03 DOI: 10.1016/j.lers.2024.09.001

Jingjing Xia, Jie Fang, Liying Chen, Yange Meng, Lin Su

Objective

Magnetically controlled capsule gastroscopy (MCCG) is an effective method for screening gastric diseases; however, its performance may be affected by gastric cleanliness. We aimed to explore the correlation between Helicobacter pylori infection and the degree of gastric cleanliness in the MCCG.

Methods

This retrospective study enrolled 297 participants from October 2020 to April 2024 at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. Participant characteristics, MCCG examination results, and (13) C-urea breath test (C13-UBT) results were collected. The gastric cleanliness in MCCG examinations was assessed using a gastric cleanliness score. Binary logistic regression was used to analyze the relationships among participant characteristics, H. pylori infection, and gastric cleanliness. Chi-square tests and Fisher's exact tests were used to analyze the relationships among gastric lesions, H. pylori infection, and gastric cleanliness.

Results

Among the participants, 24.2% had H. pylori infection, and 17.5% had poor gastric cleanliness. Hypertension (odds ratio [OR]: 2.63; 95% confidence interval [CI]: 1.36–5.09; p = 0.004) was associated with a greater likelihood of H. pylori infection. H. pylori infection (OR: 3.76; 95% CI: 1.99–7.09; p < 0.001) was an independent risk factor for poor gastric cleanliness in the MCCG. A significant disparity was noted in the prevalence of focal erosions (p < 0.001), gastric ulcers (p = 0.001), and positive gastric lesions (p = 0.027) between the 2 groups with and without H. pylori infection. The proportion of positive gastric lesions was not significantly different between the good gastric cleanliness group and the poor gastric cleanliness group (25.7% vs. 21.2%; p = 0.490).

Conclusion

The findings of this study revealed that H. pylori infection was associated with hypertension. H. pylori infection may lead to poor gastric cleanliness. Institutions are advised to perform C13-UBT before MCCG, and participants should be informed of the risk of poor gastric cleanliness if the results are positive. The decision to perform H. pylori eradication before MCCG should take into account patient willingness and the benefit-to-risk ratio.

目的磁控胶囊胃镜（MCCG）是筛查胃部疾病的有效方法，但其效果可能会受到胃部清洁度的影响。我们旨在探讨幽门螺杆菌感染与 MCCG 检查中胃部清洁度之间的相关性。方法这项回顾性研究于 2020 年 10 月至 2024 年 4 月在浙江大学医学院附属邵逸夫医院招募了 297 名参与者。研究收集了参与者的特征、MCCG检查结果和（13）C-尿素呼气试验（C13-UBT）结果。采用胃清洁度评分评估 MCCG 检查中的胃清洁度。采用二元逻辑回归分析参与者特征、幽门螺杆菌感染和胃清洁度之间的关系。采用卡方检验和费雪精确检验分析胃部病变、幽门螺杆菌感染和胃清洁度之间的关系。高血压（几率比 [OR]：2.63；95% 置信区间 [CI]：1.36-5.09；P = 0.004）与幽门螺杆菌感染的可能性较大相关。幽门螺杆菌感染（OR：3.76；95% 置信区间 [CI]：1.99-7.09；p = 0.001）是 MCCG 中胃部清洁度差的独立风险因素。在幽门螺杆菌感染和未感染幽门螺杆菌的两组中，局灶性糜烂（p <0.001）、胃溃疡（p = 0.001）和胃部阳性病变（p = 0.027）的发生率存在明显差异。胃清洁度良好组和胃清洁度较差组的阳性胃病变比例无明显差异（25.7% vs. 21.2%; p = 0.490）。幽门螺杆菌感染可能导致胃部清洁度差。建议医疗机构在进行 MCCG 检查前进行 C13-UBT 检查，如果结果呈阳性，应告知参与者胃清洁度差的风险。在决定是否在 MCCG 前进行幽门螺杆菌根除治疗时，应考虑患者的意愿和获益风险比。

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引用次数: 0

Managerial perspectives of scaling up robotic-assisted surgery in healthcare systems: A systematic literature review 在医疗系统中推广机器人辅助手术的管理视角：系统性文献综述

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-09-01 DOI: 10.1016/j.lers.2024.05.002

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.

目的机器人辅助手术（RAS）是一种微创技术，适用于多个专科。标准培训对于掌握 RAS 技能至关重要。RAS 的成本被认为很高，这使其成为医疗机构的负担，患者也难以承受。本系统性文献综述（SLR）侧重于不同外科专科应用的各种 RAS 培训方法以及 RAS 的成本要素，并总结了与推广 RAS 相关的机遇和挑战。在 PubMed、EBSCO 和 Scopus 数据库中搜索了 2018 年 1 月至 2024 年 1 月期间的报告。全文收录了亚太地区国家的英文综述和研究文章。结果最常见的培训系统是达芬奇系统。模拟技术包括干实验室、湿实验室和虚拟现实培训，被认为是一种常见和重要的做法。RAS 的成本包括机器人系统的安装和维护成本、手术室租金、人员成本、手术器械和材料成本以及其他杂项费用。本 SLR 的综述揭示了有关 RAS 培训和成本的挑战与机遇。结论本 SLR 的结果将有助于 RAS 的决策者、影响者和最终用户等利益相关者从管理角度理解培训和成本对扩大 RAS 规模的重要意义。任何医疗创新要想惠及广大人群，成本效益和标准培训都至关重要。

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引用次数: 0

Robotic surgery in living liver donors and liver recipients 活体肝脏捐献者和肝脏接受者的机器人手术

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-09-01 DOI: 10.1016/j.lers.2024.06.003

Konstantin Semash

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.

自托马斯-斯塔茨尔（Thomas Starzl）首次进行肝脏移植手术以来，已经过去了近 60 年。在此期间，医疗技术的进步使移植手术逐渐采用了新的方法。在这些创新中，机器人手术是近几十年来兴起的，并逐渐融入到移植医学中。机器人肝切除术和肝脏植入术代表了移植手术领域的重大进步。机器人手术的精确性和微创性为活体供体和受体都带来了巨大的益处。对于活体肝脏捐献者，机器人肝脏切除术可减少术后疼痛，最大限度地减少疤痕，并加快恢复。对于肝脏受体，机器人肝脏植入术提高了手术的准确性，使移植物定位和血管吻合更好。机器人系统对器械的控制更精确、更灵活，使外科医生能更准确地进行复杂的手术，并降低对患者的风险。本综述收录了有关微创供体肝脏手术的出版物，特别关注移植中的机器人肝脏切除术，旨在总结肝脏移植中机器人手术的现有知识和发展状况，重点关注供体肝脏切除术和受体移植物植入术。

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引用次数: 0

A new abdominal drainage tube fixation method for 3-port laparoscopic cholecystectomy improves patients’ postoperative quality of life 三孔腹腔镜胆囊切除术的腹腔引流管固定新方法可提高患者的术后生活质量

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-09-01 DOI: 10.1016/j.lers.2024.04.004

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.

目的腹腔镜手术已成为常规普外科手术，具有减轻腹痛等诸多优点。然而，腹腔引流管引起的术后疼痛却很少引起医务人员的重视。本研究旨在探讨三孔腹腔镜胆囊切除术（LC）腹腔引流管固定新方法对患者术后生活质量的影响。方法选取 2023 年 3 月 1 日至 2023 年 10 月 31 日在临沂市人民医院肝胆外科因胆结石合并慢性胆囊炎行三孔腹腔镜胆囊切除术并行腹腔引流管固定的患者为研究对象。将患者随机分为实验组和对照组。实验组采用新型腹腔引流管固定法，对照组采用传统方法。随后，从疼痛、活动、恢复时间和心理健康状况等方面对患者的生活质量进行评估。结果 139 名患者被随机分为实验组（70 名）和对照组（69 名）。两组患者的基线特征无明显差异。实验组患者的生活质量更好，疼痛评分（24.03 ± 2.37 vs. 15.48 ± 2.29，p < 0.001）和活动评分（20.57 ± 1.78 vs. 14.13 ± 1.43，p < 0.001）更高，术后恢复时间更短（2.36 ± 0.68 d vs. 2.96 ± 1.34 d，p < 0.001）。两组的线性回归分析评分显示了相同的结果。实验组患者引流管周围渗出液的细菌培养阳性率明显低于对照组（12.9% vs. 43.5%，p < 0.001）；此外，条件致病菌的阳性率更低（7.结论这种新的腹腔引流管固定方法能有效促进患者康复，提高腹腔引流管三腔LC术后患者的生活质量。

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