Laparoscopic Endoscopic and Robotic Surgery最新文献

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.

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).

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.

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.

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.

Surgery for lesions of the proximal part of the pancreatic body or neck can be challenging, and when enucleation is not possible, central pancreatectomy is an option. Laparoscopic central pancreatic resection is rarely described worldwide; it is considered a difficult procedure mainly because of the risk of double pancreatic fistula developing at two sites of resection. However, it seems to be an excellent alternative to distal pancreatectomy or pancreaticoduodenectomy, with the advantages of preserving functioning parenchyma and reducing endocrine and exocrine failure. Nevertheless, patients with pancreatic lesions requiring central resection are often managed with the open approach in many hospitals due to the complexity of total laparoscopic central pancreatectomy, which requires advanced laparoscopic skills, expertise and experience. Here, we report a case of a 29-year-old female who underwent total laparoscopic central pancreatic resection with gastro-pancreatic anastomosis for symptomatic serous cystadenoma. We discuss the details of case management and review the relevant literature.

Objective

Esophageal and gastric lesions are effectively managed with minimally invasive upper endoscopic procedures such as endoscopic mucosa resection (EMR) and endoscopic submucosal dissection (ESD), offering patients alternatives to invasive interventions. While ESD is well established in Eastern Asia, its adoption in Denmark for superficial esophageal cancer is recent. This study presents real-world data on the feasibility, safety, and hospitalization duration associated with ESD and EMR for esophageal and gastric lesions.

Methods

A retrospective analysis was conducted on patients who underwent ESD or EMR at a specialized center in Denmark from October 2016 to June 2022. Data on treatment, indication, lesion location, hospitalization duration, procedure duration, specimen size, complications, recurrence, and one-year overall survival were collected. Statistical comparisons utilized the Mann–Whitney U test, independent sample median test, and chi-squared test.

Results

The study included 130 patients (144 procedures): 72 underwent ESD and 58 underwent EMR. Compared with EMR, ESD resulted in greater percentages of en bloc and R0 resections (98.8% vs. 64.1%, p < 0.001; and 83.9% vs. 23.8%, p < 0.001), greater complication rates (28.7% vs. 3.1%, p < 0.001) and longer procedure times (119.5 min vs. 37.0 min, p < 0.001). The ESD procedure time significantly decreased over time (p = 0.01). The local recurrence rates were 14.5% for ESD and 23.8% for EMR (p = 0.767). The one-year overall survival rates were similar between the groups (95.8% vs. 94.8%, p = 0.553).

Conclusion

Both ESD and EMR are safe and viable for treating esophageal and gastric lesions. ESD offers advantages but requires more time and skill. These findings support the literature, emphasizing the importance of considering patient-specific factors and surgeon proficiency in selecting the appropriate procedure.

Objective

Robotic-assisted surgery (RAS) is continuing to expand in use in surgical specialties, including foregut surgery. The available data on its use in large hiatal hernia (HH) repair are limited and conflicting. This study sought to determine whether there are significant differences in adverse outcomes following HH repair performed with a robotic approach vs. a laparoscopic approach. This study was limited to outcomes in patients with type II, III, and IV HHs, as these hernias are typically more challenging to repair.

Methods

A retrospective analysis was performed from data obtained from TriNetX, a large deidentified clinical database, over a 10-year period. Adult patients who underwent type II, III, or IV HH repair were included in the study. HH with robotic repair was compared to laparoscopic repair. Cohorts were propensity score matched for demographic information and comorbidities. Risk ratios, risk differences (RDs) with 95% confidence intervals (CIs), and t test for each examined adverse outcome were used to estimate the effects of robotic repair vs. laparoscopic repair.

Results

In total, 20,016 patients who met the inclusion criteria were identified; 1,515 patients utilized RAS, and 18,501 used laparoscopy. Prior to matching, there were significant differences in age, sex, comorbidity, and BMI between the two cohorts. After 1:1 propensity score matching, analyses of 1,514 well-matched patient pairs revealed no significant differences in demographics or comorbidities. Patients who underwent robotic repair were more likely to experience major complications, including venous thromboembolism (RD: 0.007, 95% CI: 0.003, 0.011; p = 0.002), critical care (RD: 0.023, 95% CI: 0.007, 0.039; p = 0.004), urinary/renal complications (RD: 0.027, 95% CI: 0.014, 0.041; p < 0.001), and respiratory complications (RD: 0.046, 95% CI: 0.028, 0.064; p < 0.001). RAS was associated with a significantly shorter length of stay (32.4 ± 27.5 h vs. 35.7 ± 50.1 h, p = 0.031), although this finding indicated a reduction in the length of stay of less than 4 hours. No statistically significant differences in risk of esophageal perforation, infection, postprocedural shock, bleeding, mortality, additional emergency room visits, cardiac complications, or wound disruption were found.

Conclusions

Patients who undergo robotic-assisted large HH repair are at increased risk of venous thromboembolism, need critical care, urinary or renal complications and respiratory complications. Due to variations in RAS technique, experience, and surgical volumes, further study of this surgical approach and complication rates is warranted.

Robotic surgery systems, as emerging minimally invasive approaches, have been increasingly applied for the treatment of esophageal cancer because they provide a high-definition three-dimensional surgical view and mechanical rotating arms that surpass the limitations of human hands, greatly enhancing the accuracy and flexibility of surgical methods. Robot-assisted McKeown esophagectomy (RAME), a common type of robotic esophagectomy, has been gradually implemented with the aim of reducing postoperative complications, improving postoperative recovery and achieving better long-term survival. Multiple centers worldwide have reported and summarized their experiences with the RAME, and some have also discussed and analyzed its perioperative effects and survival prognosis compared with those of video-assisted minimally invasive esophagectomy. Compared to traditional surgery, the RAME has significant advantages in terms of lymph node dissection although there seems to be no difference in overall survival or disease-free survival. With the continuous advancement of technology and the development of robotic technology, further development and innovation are expected in the RAME field. This review elaborates on the prospects of the application and advancement of the RAME to provide a useful reference for clinical practice.