Laparoscopic Endoscopic and Robotic Surgery最新文献_第7页

Laparoscopic management of remnant gall bladder with stones: Lessons from a tertiary care centre's experience 残余胆囊结石的腹腔镜治疗：一家三级医疗中心的经验之谈

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-03-01 DOI: 10.1016/j.lers.2024.02.004

Gilbert Samuel Jebakumar , Jeevanandham Muthiah , Loganathan Jayapal , R. Santhosh Kumar , Siddhesh Tasgaonkar , K.S. Santhosh Anand , J.K.A. Jameel , Sudeepta Kumar Swain , K.J. Raghunath , Prasanna Kumar Reddy , Tirupporur Govindaswamy Balachandar

Objective

Laparoscopic cholecystectomy is currently the gold standard for treating symptomatic gallstone disease. Despite its success, approximately 10% of patients may experience persistent biliary symptoms, leading to the post-cholecystectomy syndrome. A remnant gallbladder with cystic duct or bile duct stones is one of the causes of this syndrome. The objective of this study was to shed light on the clinical manifestations, evaluation, therapeutic strategies, and outcomes associated with laparoscopic management of symptomatic remnant gallbladders.

Methods

This was a retrospective study, conducted over a five-year period (January 2017 to December 2022) at Apollo Hospitals in South India. All patients who underwent laparoscopic completion cholecystectomy for a remnant gall bladder were included. The following data were collected: patient demographics, symptoms, preoperative investigations, intraoperative details and post operative outcomes.

Results

In total, 36 patients were included and analysed. The majority of patients were male (25, 69.4%), with a mean age of 50.7 ± 12.1 years. The most common presentation was pain in the upper abdomen or right upper quadrant region (24, 66.7%). The laparoscopic approach was attempted in all patients, with a success rate of 94.4%. Two patients required conversion to open surgery. Cholecystoenteric fistula to the colon was observed in one patient. Choledocholithiasis was observed in 7 patients (19.4%), and stone clearance was successfully achieved using endoscopic retrograde cholangiopancreatography in all patients preoperatively.

Conclusion

Incomplete gall bladder removal either intentionally or unintentionally leaves a remnant gall bladder that is at risk for stone formation and infection. Patients who have this clinical entity with symptoms require a redo or complete cholecystectomy, a complex procedure associated with certain risks. This study highlights the feasibility and safety of laparoscopic completion cholecystectomy for the management of remnant gallbladder with cystic duct or bile duct stones.

目的腹腔镜胆囊切除术是目前治疗无症状胆石症的金标准。尽管取得了成功，但约有 10% 的患者可能会出现持续的胆道症状，从而导致胆囊切除术后综合征。伴有胆囊管或胆总管结石的残余胆囊是导致这种综合征的原因之一。本研究旨在揭示无症状残余胆囊的临床表现、评估、治疗策略和腹腔镜治疗的相关结果。方法这是一项回顾性研究，在印度南部的阿波罗医院进行，为期五年（2017 年 1 月至 2022 年 12 月）。纳入了所有因残余胆囊而接受腹腔镜胆囊切除术的患者。收集的数据包括：患者人口统计学、症状、术前检查、术中详情和术后结果。大多数患者为男性（25 人，占 69.4%），平均年龄（50.7 ± 12.1）岁。最常见的症状是上腹部或右上腹疼痛（24 例，66.7%）。所有患者均尝试过腹腔镜手术，成功率为 94.4%。两名患者需要转为开腹手术。一名患者出现胆囊肠瘘直达结肠。7 名患者（19.4%）出现胆总管结石，所有患者术前均通过内镜逆行胰胆管造影成功清除了结石。有这种临床症状的患者需要重新进行胆囊切除术或完全胆囊切除术，这是一种复杂的手术，存在一定的风险。本研究强调了腹腔镜完整胆囊切除术治疗残余胆囊伴胆囊管或胆总管结石的可行性和安全性。

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引用次数: 0

Thank you to our wonderful peer reviewers and authors 感谢我们优秀的同行评审员和作者

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-03-01 DOI: 10.1016/j.lers.2023.12.001

Qingjie Zeng, Jin Wang

引用次数: 0

Identification of clinical subphenotypes of sepsis after laparoscopic surgery 腹腔镜手术后败血症临床亚型的鉴定

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-03-01 DOI: 10.1016/j.lers.2024.02.001

Jie Yang , Bo Zhang , Chaomin Hu , Xiaocong Jiang , Pengfei Shui , Jiajie Huang , Yucai Hong , Hongying Ni , Zhongheng Zhang

Objective

Some patients exhibit septic symptoms following laparoscopic surgery, leading to a poor prognosis. Effective clinical subphenotyping is critical for guiding tailored therapeutic strategies in these cases. By identifying predisposing factors for postoperative sepsis, clinicians can implement targeted interventions, potentially improving outcomes. This study outlines a workflow for the subphenotype methodology in the context of laparoscopic surgery, along with its practical application.

Methods

This study utilized data routinely available in clinical case systems, enhancing the applicability of our findings. The data included vital signs, such as respiratory rate, and laboratory measures, such as blood sodium levels. The process of categorizing clinical routine data involved technical complexities. A correlation heatmap was used to visually depict the relationships between variables. Ordering points were used to identify the clustering structure and combined with Consensus K clustering methods to determine the optimal categorization.

Results

Our study highlighted the intricacies of identifying clinical subphenotypes following laparoscopic surgery, and could thus serve as a valuable resource for clinicians and researchers seeking to explore disease heterogeneity in clinical settings. By simplifying complex methodologies, we aimed to bridge the gap between technical expertise and clinical application, fostering an environment where professional medical knowledge is effectively utilized in subphenotyping research.

Conclusion

This tutorial could primarily serve as a guide for beginners. A variety of clustering approaches were explored, and each step in the process contributed to a comprehensive understanding of clinical subphenotypes.

目的有些患者在腹腔镜手术后出现败血症症状，导致预后不良。在这些病例中，有效的临床分型对于指导量身定制的治疗策略至关重要。通过确定术后脓毒症的易感因素，临床医生可以实施有针对性的干预措施，从而改善预后。本研究概述了亚表型方法在腹腔镜手术中的工作流程及其实际应用。方法本研究利用临床病例系统中的常规数据，提高了研究结果的适用性。这些数据包括呼吸频率等生命体征和血钠水平等实验室指标。临床常规数据的分类过程涉及复杂的技术问题。相关热图用于直观地描述变量之间的关系。我们的研究强调了腹腔镜手术后临床亚型识别的复杂性，因此可作为临床医生和研究人员在临床环境中探索疾病异质性的宝贵资源。通过简化复杂的方法，我们旨在弥合专业技术与临床应用之间的差距，营造一个在亚表型研究中有效利用专业医学知识的环境。我们探索了多种聚类方法，过程中的每一步都有助于全面了解临床亚表型。

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引用次数: 0

“A stitch in time”: Intraoperative diaphragmatic injury during laparoscopic nephrectomy - A case of immediate recognition and expert management "一针见血腹腔镜肾切除术中的术中横膈膜损伤--一例即时识别和专家处理的病例

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-03-01 DOI: 10.1016/j.lers.2024.02.002

Prakash Gyandev Gondode, Sridhar Panaiyadiyan, Neha Garg, Sakshi Duggal

引用次数: 0

Construction and validation of a risk-prediction model for anastomotic leakage after radical gastrectomy: A cohort study in China 根治性胃切除术后吻合口漏风险预测模型的构建与验证：中国的一项队列研究

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2024-03-01 DOI: 10.1016/j.lers.2024.02.003

Jinrui Wang , Xiaolin Liu , Hongying Pan , Yihong Xu , Mizhi Wu , Xiuping Li , Yang Gao , Meijuan Wang , Mengya Yan

Objectives

Anastomotic leakage (AL) stands out as a prevalent and severe complication following gastric cancer surgery. It frequently precipitates additional serious complications, significantly influencing the overall survival time of patients. This study aims to enhance the risk-assessment strategy for AL following gastrectomy for gastric cancer.

Methods

This study included a derivation cohort and validation cohort. The derivation cohort included patients who underwent radical gastrectomy at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, from January 1, 2015 to December 31, 2020. An evidence-based predictor questionnaire was crafted through extensive literature review and panel discussions. Based on the questionnaire, inpatient data were collected to form a model-derivation cohort. This cohort underwent both univariate and multivariate analyses to identify factors associated with AL events, and a logistic regression model with stepwise regression was developed. A 5-fold cross-validation ensured model reliability. The validation cohort included patients from August 1, 2021 to December 31, 2021 at the same hospital. Using the same imputation method, we organized the validation-queue data. We then employed the risk-prediction model constructed in the earlier phase of the study to predict the risk of AL in the subjects included in the validation queue. We compared the predictions with the actual occurrence, and evaluated the external validation performance of the model using model-evaluation indicators such as the area under the receiver operating characteristic curve (AUROC), Brier score, and calibration curve.

Results

The derivation cohort included 1377 patients, and the validation cohort included 131 patients. The independent predictors of AL after radical gastrectomy included age ≥65 y, preoperative albumin <35 g/L, resection extent, operative time ≥240 min, and intraoperative blood loss ≥90 mL. The predictive model exhibited a solid AUROC of 0.750 (95% CI: 0.694–0.806; p < 0.001) with a Brier score of 0.049. The 5-fold cross-validation confirmed these findings with a calibrated C-index of 0.749 and an average Brier score of 0.052. External validation showed an AUROC of 0.723 (95% CI: 0.564–0.882; p = 0.006) and a Brier score of 0.055, confirming reliability in different clinical settings.

Conclusions

We successfully developed a risk-prediction model for AL following radical gastrectomy. This tool will aid healthcare professionals in anticipating AL, potentially reducing unnecessary interventions.

目的吻合口漏（AL）是胃癌手术后普遍存在的严重并发症。它经常引发其他严重并发症，严重影响患者的总体生存时间。本研究旨在加强胃癌胃切除术后 AL 的风险评估策略。衍生队列包括2015年1月1日至2020年12月31日期间在浙江大学医学院附属邵逸夫医院接受根治性胃切除术的患者。通过广泛的文献查阅和小组讨论，制定了一份循证预测问卷。根据调查问卷收集住院患者数据，形成模型衍生队列。对该队列进行了单变量和多变量分析，以确定与 AL 事件相关的因素，并建立了一个逐步回归的逻辑回归模型。5 倍交叉验证确保了模型的可靠性。验证队列包括 2021 年 8 月 1 日至 2021 年 12 月 31 日在同一家医院就诊的患者。我们使用相同的估算方法整理了验证队列数据。然后，我们采用研究前期建立的风险预测模型来预测验证队列中受试者的 AL 风险。我们将预测结果与实际发生率进行了比较，并使用接收者操作特征曲线下面积（AUROC）、Brier 评分和校准曲线等模型评价指标评估了模型的外部验证性能。根治性胃切除术后AL的独立预测因素包括年龄≥65岁、术前白蛋白<35 g/L、切除范围、手术时间≥240 min和术中失血量≥90 mL。预测模型的 AUROC 为 0.750 (95% CI: 0.694-0.806; p < 0.001)，Brier 得分为 0.049。5 倍交叉验证证实了这些结果，校准 C 指数为 0.749，平均 Brier 得分为 0.052。外部验证结果显示，AUROC 为 0.723 (95% CI: 0.564-0.882; p = 0.006)，Brier 评分为 0.055，证实了在不同临床环境下的可靠性。该工具将帮助医护人员预测 AL，从而减少不必要的干预。

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引用次数: 0

The effect of cholecystectomy on the risk of colorectal cancer: A systematic review and meta-analysis 胆囊切除术对结直肠癌风险的影响：系统回顾和荟萃分析

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2023-12-01 DOI: 10.1016/j.lers.2023.11.003

Zhuoneng Chen , Chaohui Yu , Zheyong Li

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.

目的一些研究发现胆囊切除术可能会增加结直肠癌（CRC）的风险，而其他研究得出的结论却不一致。因此，我们进行了一项系统性回顾和荟萃分析，以评估胆结石或胆囊疾病患者胆囊切除术后 CRC 的发病率，以及患者的地理位置是否会影响研究结果。方法我们系统检索了 PubMed、Embase 和 Cochrane 中 2023 年 1 月 12 日之前发表的报告胆囊切除术后 CRC 发病率变化的研究。我们的主要终点是 CRC 的发生率。我们提取并汇总了数据，计算了相对风险 (RR) 和 95% 置信区间 (CI)。我们使用随机效应模型对汇总数据进行了评估。结果共发现 477 篇文章，其中 6 篇符合条件，包括 7 项研究，共纳入 797,917 名参与者。总体而言，汇总的研究结果显示，接受胆囊切除术的胆囊疾病患者罹患 CRC 的风险降低（RR：0.80，95% CI：0.65 至 0.99，P = 0.040；I2 = 85.0%）。在基于不同地理位置的亚组分析中，西方人群的胆囊切除术与 CRC 风险无关（RR：0.90，95% CI：0.65 至 1.25，p = 0.522；I2 = 86.5%），但胆囊切除术与 CRC 风险呈负相关（RR：0.结论我们的研究结果表明，对于胆结石或胆囊疾病患者，胆囊切除术后 CRC 的发病率低于未接受胆囊切除术的患者。

{"title":"The effect of cholecystectomy on the risk of colorectal cancer: A systematic review and meta-analysis","authors":"Zhuoneng Chen , Chaohui Yu , Zheyong Li","doi":"10.1016/j.lers.2023.11.003","DOIUrl":"10.1016/j.lers.2023.11.003","url":null,"abstract":"<div><h3>Objective</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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, <em>p</em> = 0.040; <em>I</em><sup>2</sup> = 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, <em>p</em> = 0.522; <em>I</em><sup>2</sup> = 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, <em>p</em> = 0.000) in the Chinese population.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":32893,"journal":{"name":"Laparoscopic Endoscopic and Robotic Surgery","volume":"6 4","pages":"Pages 134-141"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468900923000634/pdfft?md5=93bf4ba1bc11f4431ac83d03acde1913&pid=1-s2.0-S2468900923000634-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135670483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Short-term outcomes of single-incision compared to multi-port laparoscopic gastrectomy for gastric cancer: A meta-analysis of randomized controlled trials 单切口与多切口腹腔镜胃切除术的短期疗效比较：随机对照试验荟萃分析

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2023-12-01 DOI: 10.1016/j.lers.2023.10.001

Sameh Hany Emile , Samer Hani Barsom

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.

目的与传统的多孔腹腔镜手术相比，单切口腹腔镜手术是一种安全且创伤较小的方法。本荟萃分析旨在评估单切口腹腔镜胃切除术（SILG）与多孔腹腔镜胃切除术（MLG）治疗胃癌的综合疗效。方法对截至2023年1月在PubMed和Scopus上收录的比较SILG和MLG治疗胃癌的随机对照试验（RCT）进行了符合PRISMA标准的系统综述。综述的主要结果是并发症、术后疼痛、转为开放手术、住院时间和恢复情况。结果共纳入了 3 项 RCT，包括 301 名患者（61.8% 为男性）。共有151名患者接受了SILG手术，150名患者接受了MLG手术。与 MLG 相比，SILG 的手术时间更短（WMD = -16.39，95% CI：-27.38 至 -5.40，p = 0.003；I2 = 0%），术后第 3 天的疼痛评分更低（WMD =-1.18，95% CI：-2.27 至 -0.091，p = 0.033；I2 = 99%）。两组在估计失血量（WMD = -16.95，95% CI：-35.84 至 1.95，p = 0.078；I2 = 82%）、并发症（OR = 0.71, 95% CI: 0.36 to 1.42, p = 0.337; I2 = 0%）、转为开放手术（OR = 0.33, 95% CI: 0.01 to 8.38, p = 0.504）、住院时间（WMD = 0.72, 95% CI: -0.92 to 2.36, p = 0.056；I2 = 84%）、首次胀气时间（WMD = 0.06，95% CI：-0.14 至 0.26，p = 0.566；I2 = 0%）、首次排便时间（WMD = -0.14，95% CI：-0.46 至 0.18，p = 0.结论与 MLG 相比，SILG 的手术时间更短，术后早期疼痛更轻。两种手术的并发症几率、失血量、住院时间和胃肠道恢复情况相似。

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引用次数: 0

A degradable intestinal diversion device 可降解的肠道转流装置

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2023-12-01 DOI: 10.1016/j.lers.2023.09.001

Qingjie Zeng, Jin Wang

引用次数: 0

Cost-effectiveness of robotic-assisted spinal surgery: A single-center retrospective study 机器人辅助脊柱手术的成本效益：单中心回顾性研究

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2023-12-01 DOI: 10.1016/j.lers.2023.11.004

Sorayouth Chumnanvej , Krish Ariyaprakai , Branesh M. Pillai , Jackrit Suthakorn , Sharvesh Gurusamy , Siriluk Chumnanvej

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.

目的机器人辅助脊柱手术（RASS）已被证明可提高精确度、缩短手术时间、预防并发症、促进微创脊柱手术并降低翻修手术率，从而改善患者预后。这项研究旨在比较单一中心的机器人辅助手术和非机器人辅助手术治疗退行性脊柱疾病的成本效益。方法这项回顾性研究于2015年3月至2022年2月在单一中心进行，共纳入122名患者。接受机器人辅助手术的患者被分配到机器人组，接受非机器人辅助手术的患者被分配到非机器人组。收集了两组患者的各种数据，包括人口统计学信息、手术细节、结果和成本效益。成本效益采用增量成本效益比（ICER）确定，并对脊柱器械植入1层或2层的患者进行了亚组分析。分析使用 STATA SE 15 版和 TreeAge Pro 2020 进行，并对成本效益可接受性曲线进行了蒙特卡罗模拟。结果总体 ICER 为 22,572 美元，但考虑到只有 1 或 2 层器械的病例，ICER 降至 16,980 美元。当脊柱器械植入少于 2 个层次时，当支付意愿为 3000 美元至 4000 美元时，RASS 被认为具有成本效益。因此，将医疗预算资源分配给脊柱机器人是明智之举，因为 RASS 被证明是具有成本效益的，尤其是当只有两个或更少的脊柱水平需要器械时。

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引用次数: 0

Medium-term outcomes of laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with posterior approach for a pelvic organ prolapse: A retrospective study of 124 cases 腹腔镜耻骨宫颈筋膜重建和骶棘韧带固定术（后入路）治疗盆腔脏器脱垂的中期疗效：124 例病例的回顾性研究

Q3 Medicine

Laparoscopic Endoscopic and Robotic Surgery

Pub Date : 2023-12-01 DOI: 10.1016/j.lers.2023.11.005

Yunshan Zhu , Xiao Zhang , Danxia Chen , Guangxiao Li , Shanliang Shang , Jianqiong Li , Jianhua Yang

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.

目的盆腔脏器脱垂（POP）是中老年妇女常见的妇科疾病，严重影响患者的身体健康和生活质量，增加患者的经济负担，成为重大的公共卫生问题。本研究旨在探讨腹腔镜耻骨宫颈筋膜重建术和后路骶棘韧带固定术对重度POP患者的中期疗效。方法纳入2016年9月至2020年12月期间在浙江大学医学院附属邵逸夫医院妇产科接受腹腔镜耻骨宫颈筋膜重建术和后路骶棘韧带固定术的重度POP定量III-IV期患者。记录结果和并发症。结果共分析了 124 例患者。患者的随访时间为（32.27±12.90）个月。接受子宫切除术的患者客观治愈率为 91.7%（100/109），其中 7 例（6.4%）患者阴道前壁脱垂，2 例（1.8%）患者阴道后壁脱垂。保留子宫患者的客观治愈率为 66.7%（10/15）。结论腹腔镜耻骨宫颈筋膜重建和后路骶棘韧带固定术是一种安全、微创、有效的治疗重度POP患者的方法。临床效果需要长期随访来确认。

{"title":"Medium-term outcomes of laparoscopic pubocervical fascia reconstruction and sacrospinous ligament fixation with posterior approach for a pelvic organ prolapse: A retrospective study of 124 cases","authors":"Yunshan Zhu , Xiao Zhang , Danxia Chen , Guangxiao Li , Shanliang Shang , Jianqiong Li , Jianhua Yang","doi":"10.1016/j.lers.2023.11.005","DOIUrl":"https://doi.org/10.1016/j.lers.2023.11.005","url":null,"abstract":"<div><h3>Objective</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":32893,"journal":{"name":"Laparoscopic Endoscopic and Robotic Surgery","volume":"6 4","pages":"Pages 154-159"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2468900923000658/pdfft?md5=2d8ff7ecaf4f8f82677faab1990ece7d&pid=1-s2.0-S2468900923000658-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139033675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0