Laparoscopic Endoscopic and Robotic Surgery最新文献

Laparoscopic skills training has always been crucial for novice surgeons. Readily accessible equipment, as well as structured training curriculum should be provided to guarantee adequate practice hours and skill proficiency. Dry-lab training is typically adopted before animal model surgery, usually comprising of purpose-built bulky simulators that is neither accessible nor portable. In this technical note, we designed a home-made simulator, using two 4 L water jugs as operating space that are communicated inside, plus an observation hole taped in between to mimic the triangular working space of laparoscopic surgery. Imaging was achieved via smartphone camera, which was wirelessly connected to a laptop and a projector for real-time display on multiple screens, using built-in multi-screen collaboration software. A self-regulated and proficiency-based training curriculum was adopted. This dry-lab simulator is low-cost, highly portable and easily replicable for basic laparoscopic skills training for the beginners to intermediate surgeons, which may serve as a good way for the standardized residency and specialist training program.

Objective

Surgical resection of pancreatic cancer remains the only potentially curative treatment for pancreatic ductal adenocarcinoma. The robotic platform has been introduced to surgical practice and recent large studies from national registries have demonstrated similar or improved peri-operative outcomes compared to the standard open approach. Neo-adjuvant chemotherapy is increasingly being offered to patients with borderline resectable/locally advanced disease but this has led to more challenging resections. Numbers of patients undergoing minimally invasive resection following neo-adjuvant chemotherapy remain low. The aim of this review is to assess the current evidence for the peri-operative safety and long-term oncological outcomes associated with minimally invasive pancreatic resection following neo-adjuvant chemotherapy.

Methods

Medline, Embase and Cochrane Central Register for Clinical Trials were searched up until 31st October 2021. The search terms include “minimally invasive”, “robotic”, “laparoscopic”, “pancreatectomy”, “pancreatic resection”, “whipple's pancreaticoduodenectomy”, “distal pancreatectomy”, “chemotherapy”, “neo-adjuvant chemotherapy”, “radiotherapy”, “neo-adjuvant chemoradiotherapy”, “induction therapy”, and “conversion surgery”. All studies including patients undergoing pancreatic resections were included. Studies which did not clearly state the approach to resection (minimally invasive or open) were excluded.

Results

Seventy-eight studies were identified of which 8 compared open and minimally invasive resection following neo-adjuvant chemotherapy. There was insufficient data to perform a meta-analysis. Robotic surgery was associated with lower blood loss and shorter length of hospital stay. Three-year overall survival rates were similar between patients who underwent robotic or open resection however the robotic approach was associated with higher lymph node yield and a lower R1 resection rate.

Conclusion

Currently the evidence for minimally invasive surgery following neo-adjuvant chemotherapy is limited. Long-term oncological outcomes are similar to patients undergoing open resection and there is some evidence to suggest superior peri-operative outcomes. As numbers are limited, future studies analysing national and international databases on minimally invasive pancreatic resection are required to provide sufficient evidence to support the use of minimally invasive pancreatic resection following neo-adjuvant chemotherapy in high-risk groups.

Objective

Adhesion barriers have not traditionally been used during laparoscopic cholecystectomy (lap-chole), and so there are no data confirming the safety of the dextrin hydrogel adhesion barrier (AdSpray®) for the use during lap-chole. The aim of this prospective study is to investigate the safety of AdSpray® for elective lap-chole.

Methods

Between July 2019 and March 2021, we conducted a prospective study at Saiseikai Kumamoto Hospital to assess the safety of applying AdSpray® around the hepatoduodenal ligament, liver surface, and port area after extraction of the gallbladder during elective lap-chole. We assessed patient morbidity, mortality, and laboratory data on postoperative day 1 and at the outpatient follow-up visit.

Results

A total of 100 patients (43 men, 57 women) received AdSpray® application during elective lap-chole at our institution. The mean patient age was 56.5 ± 14.8 y, and the mean body mass index was 25.1 ± 4.8 kg/m². Preoperative gallbladder drainage was performed in 3 (3.0%) patients as conservative treatment for acute cholecystitis. The mean operative time was 91.7 ± 35.1 min, and the median blood loss was 5 mL (range, 5–120 mL). Intraoperative gallbladder perforation was observed in 4.0% of patients (n = 4). There was no intraoperative bile duct injury. One (1.0%) patient had a postoperative subhepatic fluid collection without bacterial infection. The mean white blood cell count and C-reactive protein level was significantly elevated on postoperative day 1 but returned to preoperative levels by the time of the follow-up visit. All patients were successfully discharged after surgery, and the median postoperative hospital stay was 2 d (range, 2–9 d).

Conclusion

Applying AdSpray® during elective lap-chole is safe, with an acceptable rate of postoperative complications.

With an incidence of 1/500, a horseshoe kidney is not uncommon. Tumours discovered in horseshoe kidney however are quite rare, and prove difficult to surgically manage due to complex vascular anatomy. With variable surgical approaches previously described, only a select few robot-assisted cases have been reported. This case describes one such robot-assisted laparoscopic heminephrectomy, with the use of indocyanine green and an endovascular stapler to successfully demarcate ischemia and achieve hemostasis intraoperatively. No complications were encountered, and pathology revealed a pT1bN0 clear cell renal cell carcinoma with negative surgical margins, demonstrating the feasibility of our approach.

Unlike other surgical residency training programs including thoracic surgery, robotic cardiac surgery skill training is minimal or absent in residency curricula. A review was conducted to identify residents' exposure to robotic cardiac surgery training based on databases including PubMed, MEDLINE and Google Scholar. Published papers and cardiothoracic surgical societies with robotic cardiac surgery training courses were reviewed. Robotic cardiac surgery training for residents is almost non-existent. Strategies to establish proper robotic cardiac surgical training for residents include implementing simulation training, implementing hour requirements and establishing wet/dry lab model training in a progressive fashion. As robot-assisted cardiac surgery becomes increasingly commonplace, it will be imperative to provide training for residents with dedicated opportunities to develop their skills in robotic cardiac surgery.

Interventional bronchoscopy has developed rapidly in the management of lung cancer. Besides ablative resection of various modalities and balloon dilation/stent placement, which have been widely used in the management of malignant central airway obstruction, bronchoscopic brachytherapy and transbronchoscopic local injection of drugs are also developing. For early-stage peripheral lung cancer, transbronchoscopic ablation and the assisted localization of preoperative peripheral lung nodules by bronchoscopy are the new techniques. In addition, interventional bronchoscopy can manage complications related to lung cancer. Overall, interventional bronchoscopy has been an indispensable component in the treatment of lung cancer and has vast space for development. The review summarizes the recent updates.