Laparoscopic Endoscopic and Robotic Surgery最新文献

Objective

Some studies have found that cholecystectomy may increase the risk of colorectal cancer (CRC), while others have reached inconsistent conclusions. We thus performed a systematic review and meta-analysis to assess the incidence rate of CRC after cholecystectomy for patients with gallstones or gallbladder diseases, and whether the geographical location of the patients affected the results.

Methods

We systematically searched PubMed, Embase, and Cochrane for studies reporting changes in the incidence rate of CRC after cholecystectomy published before January 12, 2023. Our main endpoint was the occurrence of CRC. Data were extracted and pooled, and the relative risk (RR) and 95% confidence interval (CI) were calculated. We assessed pooled data using a random-effects model.

Results

In total, 477 articles were identified, and 6 articles were eligible, including 7 studies that included 797,917 participants. Overall, the summarized research results showed that the risk of CRC was reduced in patients with gallbladder diseases who underwent cholecystectomy (RR: 0.80, 95% CI: 0.65 to 0.99, p = 0.040; I² = 85.0%). In the subgroup analysis based on different geographical locations, cholecystectomy was not associated with the risk of CRC in the Western population (RR: 0.90, 95% CI: 0.65 to 1.25, p = 0.522; I² = 86.5%), but there was a negative correlation between cholecystectomy and the risk of CRC (RR: 0.66, 95% CI: 0.60 to 0.73, p = 0.000) in the Chinese population.

Conclusions

Our findings support that for patients with gallstones or gallbladder diseases, the incidence of CRC after cholecystectomy is lower than that of patients who do not undergo cholecystectomy.

Objective

Single-incision laparoscopic surgery has emerged as a safe and less invasive approach to conventional multi-port laparoscopy. The present meta-analysis aimed to assess the collective outcomes of single-incision laparoscopic gastrectomy (SILG) compared to multi-port laparoscopic gastrectomy (MLG) for gastric cancer.

Methods

A PRISMA-compliant systematic review of randomized controlled trials (RCTs) that compared SILG and MLG for gastric cancer in PubMed and Scopus through January 2023 was conducted. The main outcomes of the review were complications, postoperative pain, conversion to open surgery, hospital stay, and recovery.

Results

Three RCTs including 301 patients (61.8% male) were included. A total of 151 patients underwent SILG, and 150 underwent MLG. SILG was associated with a shorter operative time (WMD = −16.39, 95% CI: −27.38 to −5.40, p = 0.003; I² = 0%) and lower pain scores at postoperative day 3 (WMD = −1.18, 95% CI: −2.27 to −0.091, p = 0.033; I² = 99%) than MLG. There were no statistically significant differences between the two groups in estimated blood loss (WMD = –16.95, 95% CI: −35.84 to 1.95, p = 0.078; I² = 82%), complications (OR = 0.71, 95% CI: 0.36 to 1.42, p = 0.337; I² = 0%), conversion to open surgery (OR = 0.33, 95% CI: 0.01 to 8.38, p = 0.504), hospital stay (WMD = 0.72, 95% CI: −0.92 to 2.36, p = 0.056; I² = 84%), time to first flatus (WMD = 0.06, 95% CI: −0.14 to 0.26, p = 0.566; I² = 0%), time to first defecation (WMD = −0.14, 95% CI: −0.46 to 0.18, p = 0.392; I² = 0%), or time to first oral intake (WMD = 0.37, 95% CI: −0.75 to 1.49, p = 0.520; I² = 94%).

Conclusions

SILG is associated with shorter operative times and less early postoperative pain than MLG. The odds of complications, blood loss, hospital stay, and gastrointestinal recovery were similar between the two procedures.

Objective

Robotic-assisted spine surgeries (RASS) have been shown to enhance precision, reduce operative time, prevent complications, facilitate minimally invasive spinal surgery, and decrease revision surgery rates, leading to improved patient outcomes. This study aimed to compare the cost-effectiveness of RASS and non-robotic-assisted surgery for degenerative spine disease at a single center.

Methods

This retrospective study, including 122 patients, was conducted at a single center from March 2015 to February 2022. Patients who underwent robot-assisted surgery were assigned to the robot group, and patients who underwent non-robotic-assisted surgery were assigned to the non-robot group. Various data, including demographic information, surgical details, outcomes, and cost-effectiveness, were collected for both groups. The cost-effectiveness was determined using the incremental cost-effectiveness ratio (ICER), and subgroup analysis was conducted for patients with 1 or 2 levels of spinal instrumentation. The analysis was performed using STATA SE version 15 and TreeAge Pro 2020, with Monte Carlo simulations for the cost-effectiveness acceptability curve.

Results

The overall ICER was $22,572, but it decreased to $16,980 when considering cases with only 1 or 2 levels of instrumentation. RASS is deemed cost-effective when the willingness to pay is $3000–$4000 if less than 2 levels of the spine are instrumented.

Conclusions

The cost-effectiveness of robotic assistance becomes apparent when there is a reduced need for open surgeries, leading to decreased revision rates caused by complications such as misplaced screws or infections. Therefore, it is advisable to allocate healthcare budget resources to spine robots, as RASS proves to be cost-effective, particularly when only two or fewer spinal levels require instrumentation.

Objective

Pelvic organ prolapse (POP) is a common gynecological disease in middle-aged and older women that seriously affects patients' physical health and quality of life, increases the financial burden for patients, and becomes a major public health concern. The aim of this study was to investigate the medium-term outcomes of laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach for patients with severe POP.

Methods

Patients with severe POP quantitation stage III–IV who underwent laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with a posterior approach at the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine between September 2016 and December 2020 were enrolled in this study. The results and complications were recorded. Data were retrospectively reviewed.

Results

In total, 124 patients were analyzed. Patients were followed up for 32.27 ± 12.90 months. The objective cure rate for patients who underwent hysterectomy was 91.7% (100/109), with 7 (6.4%) patients had anterior vaginal wall prolapse and 2 (1.8%) patients had posterior vaginal wall prolapse. The objective cure rate for patients who retained uterus was 66.7% (10/15). All 5 patients with recurrence had uterine prolapse, and 3 (20.0%) of them also had anterior vaginal wall prolapse.

Conclusions

Laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with the posterior approach is a safe, minimally invasive, and effective method for patients with severe POP. Long-term follow-up is needed to confirm the clinical effects.

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.

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

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.

Pancreatic neuroendocrine neoplasms are a rare and complex group of neoplastic lesions that develop from pancreatic islet cells. Their incidence has dramatically increased during the last two decades. Due to its complex nature and pathophysiological behaviour, surgical management continues to evolve. Surgery remains the cornerstone of treatment for most non-functional and functional pancreatic neuroendocrine tumours, while lymphadenectomy remains a controversial subject. Different techniques, such as pancreas-preserving and minimally invasive approaches, continue to evolve and offer the same overall outcomes as open surgery. This comprehensive review describes in detail the current and most up-to-date classification and staging of pancreatic neuroendocrine tumours, explores the rationale for non-surgical and surgical management, and focuses on surgical treatment and more specifically, on minimally invasive approaches.

Objective

Laparoscopic pelvic lymph node dissection (LPND), which is an effective therapy for endometrial cancer, is challenging because of the complexity of the procedure and the occurrence of postoperative complications. This study aimed to explore whether indocyanine green (ICG)-enhanced near-infrared (NIR) fluorescence-guided LPND is superior to LPND in the context of early-stage endometrial carcinoma.

Methods

In this retrospective study, we included the medical records of 190 patients with early-stage endometrioid adenocarcinoma who underwent LPND at the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine between January 2019 and January 2021. Depending on whether ICG-enhanced NIR fluorescence guidance was used, the patients were assigned to the ICG group or non-ICG group. Patients were followed-up for one year after surgery. Data on demographic characteristics, pathological results, operative outcomes, and complications were collected and analyzed.

Results

The baseline characteristics were comparable between the ICG group and non-ICG group, including age, BMI, pregnancy history, and preoperative hemoglobin. For surgical outcomes, the patients in ICG group had significantly lower intraoperative blood loss (50 mL vs. 120 mL, p < 0.001), less postoperative pelvic drainage time (4.14 ± 1.44 d vs. 5.70 ± 1.89 d, p = 0.001), shorter duration of hospital stay (5.26 ± 1.41 d vs. 7.37 ± 1.85 d, p = 0.003), higher number of positive pelvic lymph nodes (PLNs) (1 vs. 0, p = 0.003), and more PLN-positive cases (16.0% vs. 3.6%, p = 0.003) than the patients in non-ICG group. However, no significant differences were noted in blood transfusion requirement, operative time, hemoglobin level decreases, number of PLNs harvested, or the presence of lymphocysts between the two groups.

Conclusion

Our study showed that ICG-enhanced NIR fluorescence-guided operation may improve the accuracy and safety of LPND.