Laparoscopic Endoscopic and Robotic Surgery最新文献

Recent advances in artificial intelligence (AI) have sparked a surge in the application of computer vision (CV) in surgical video analysis. Laparoscopic surgery produces a large number of surgical videos, which provides a new opportunity for improving of CV technology in laparoscopic surgery. AI-based CV techniques may leverage these surgical video data to develop real-time automated decision support tools and surgeon training systems, which shows a new direction in dealing with the shortcomings of laparoscopic surgery. The effectiveness of CV applications in surgical procedures is still under early evaluation, so it is necessary to discuss challenges and obstacles. The review introduced the commonly used deep learning algorithms in CV and described their usage in detail in four application scenes, including phase recognition, anatomy detection, instrument detection and action recognition in laparoscopic surgery. The currently described applications of CV in laparoscopic surgery are limited. Most of the current research focuses on the identification of workflow and anatomical structure, while the identification of instruments and surgical actions is still awaiting further breakthroughs. Future research on the use of CV in laparoscopic surgery should focus on applications in more scenarios, such as surgeon skill assessment and the development of more efficient models.

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.

Objective

Biliary colic is a condition treated with laparoscopic cholecystectomy. However, the outcomes of surgery depend on early or delayed time points. Few research findings reported no benefits of early over delayed, on contra, other reported benefits. This study aims to compare the benefits associated with early and delayed laparoscopic cholecystectomy among uncomplicated biliary colic patients.

Methods

This observational study included patients with right upper abdominal pain and abdominal ultrasound showing cholelithiasis. Patients who were admitted at the first and second visits (within 6 weeks of the first visit) were assigned to the early and delayed groups, respectively. All participants were followed up for one-week postsurgery. The diagnosis of the patient, postoperative hospital stay, duration of surgery and complications were noted and compared primarily.

Results

A total of 80 patients were included, 40 each in the early group and delayed group. The patients in the two groups had comparable mean ages (40.55 ± 13.12 y vs. 40.45 ± 12.06 y, p = 0.972). The early group had more female patients (72.5% vs. 45.0%, p = 0.012). The duration of hospital stay (2.18 ± 0.38 d vs. 2.68 ± 1.04 d, p = 0.009) and duration of surgery (61.63 ± 3.64 min vs. 71.13 ± 16.19 min, p = 0.001) were found to be significantly different between the early and delayed groups. Only 1 (2.5%) patient in both groups was converted to open cholecystectomy. Recurrent biliary colic requiring hospital admission was seen in 1 (2.5%) patient and 6 (15.0%) patients, acute cholecystitis in 2 (5.0%) and 6 (15.0%), biliary pancreatitis in 1 (2.5%) and 2 (5.0%), and obstructive jaundice in 1 (2.5%) and 1 (2.5%) in the early and delayed groups, respectively, with insignificant differences (p > 0.05).

Conclusion

Early laparoscopic cholecystectomy decreases the operating time and duration of hospital stay. In terms of postoperative complications, our study did not find any significant difference between the groups.

Objective

Radiation osteonecrosis of the skull base after radiotherapy for nasopharyngeal carcinoma is one of the most serious complications, affecting patient survival and quality of life. To date, surgical resection is the main treatment for radiation osteonecrosis. The repair after the operation is very important. Inappropriate repair or lack of repair can easily cause local infection that can even spread to the brain, aggravating osteonecrosis. This study aimed to verify the feasibility and safety of the anterolateral thigh free fascia flap in repairing large skull base defects.

Methods

From June 2021 to July 2022, a total of 12 patients with a history of radiotherapy for nasopharyngeal carcinoma received surgical treatment at the Department of Otolaryngology Head & Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. All patients were diagnosed with radiation osteonecrosis of the skull base with large skull base defects. During the endoscopic operation, a free anterolateral thigh fascia flap was used to repair the skull base and complete vascular anastomosis reconstruction. The preoperative and postoperative pain scores were retrospectively analyzed, and the dynamic changes in endoscopic surgery sites were observed.

Results

The 12 patients had a median age of 58 y, with 8 (66.7%) males and 4 (33.3%) females. The median headache score for the patients was 5 (4–7) before surgery. The patient's headache was significantly relieved postoperatively, with 11 patients having a score of 0 and one patient having a score of 1. The stench was completely resolved after the operation. There were no serious complications during the perioperative period or 12 months after the operation.

Conclusion

The application of anterolateral thigh free fascia flap in skull base reconstruction is a safe and reliable reconstruction technique suitable for endoscopic surgical repair of large-scale skull base necrosis.