Laparoscopic Endoscopic and Robotic Surgery最新文献

Objective

Liver cancer is very common in China, with cumulative five-year tumor recurrence rate after a microscopically margin-negative resection of hepatocellular carcinoma up to 70%. Postoperative recurrent hepatocellular carcinoma presents a challenge for surgeons because of the complexity of postoperative adhesion and the difficulty in of recognizing recurrent lesions. This study aims to introduce a method using an indocyanine green (ICG) fluorescent imaging technique to do repeated laparoscopic liver resection.

Method

Patients received repeated laparoscopic liver resection using ICG fluorescent imaging between January 2017 and December 2019 in the Department of General Surgery of Sir Run Run Shaw Hospital were analyzed retrospectively. Basic information, intraoperative information, complications, and follow-up time were collected and analyzed.

Results

Totally, 35 patients with a median age of 59 years (ranged 38–82 years) were included. All of the patients received minimally invasive surgery. One case was performed robotically, and only two cases were converted to open surgery due to severe adhesion. The median operating time was 174 minutes, and the median blood loss during surgery was 100 mL. The median hospital stay after surgery was 5 days, with a range of 3–55 days. In total, 32 (91.4%) patients showed staining by ICG fluorescent imaging, and lesions were visible on fluorescent camera. The median follow-up time was 19.7 months, with a range of 1–40.2 months. The median relapse-free survival time was 18.5 months.

Conclusion

Repeated laparoscopic liver resection using ICG fluorescent imaging is a safe and promising approach in the treatment of recurrent liver tumors in selected patients.

Transvaginal natural orifice transluminal endoscopic surgery (vNOTES), as a minimally invasive surgery technique, applies CO₂ for creating pneumoperitoneum, and uses a closed system to through smoke evacuation from a dedicated outlet or port. It has the potential to generate aerosol in the operation room, which can lead to an increased risk of transmission of SARS-CoV-2. This technical note introduces a new technique of gasless pure vNOTES to hysterectomy using silicone face mask as a modified vNOTES port.

Objective

When performing cervical conization in post-menopausal cervical intraepithelial neoplasia 3 (CIN3) patients, the positive rate of endocervical cone margin and the incidence of postoperative cervical stenosis increase. This study summarized a 4-year experience of total laparoscopic hysterectomy as a treatment option for peri-menopausal and post-menopausal CIN3 patients at a single institution. Furthermore, it shared the refinement strategies used during the surgery.

Methods

This study retrospectively analyzed the medical records of CIN3 patient aged ≥45 years and who underwent open or laparoscopic hysterectomy at our institution from January 1, 2017 to December 31, 2020. Totally, 30 CIN3 patients were enrolled and divided into abdominal hysterectomy group and laparoscopic hysterectomy based on surgery method, with 5 patients and 25 patients respectively.

Results: Compared to the abdominal hysterectomy group, the perioperative blood loss (20 mL vs. 220 mL, p = 0.004) was less and the duration of in-hospital stay (7 d vs. 11 d, p < 0.001) were significantly shorter in the laparoscopic hysterectomy group. However, no significant differences in age at hysterectomy (53 y vs. 77 y, p = 0.054) and operative time (154.4 ± 27.8 min vs. 161.0 ± 62.4 min, p = 0.826) were observed between them. Diagnostic conization was performed in advance for 12 patients, and among them, 10 (83.3%) patients had positive endocervical cone margin. Postoperative intestinal obstruction was noted in one abdominal hysterectomy patient, no other complications were observed in the remaining patients.

Conclusion

Compared to conization, hysterectomy is more invasive; however, it is an acceptable treatment option for peri-menopausal and post-menopausal CIN3 patients. In such cases, opting for total laparoscopic hysterectomy adopted the marionette technique might be preferable because the procedure is less invasive.

Pancreatic ductal adenocarcinoma (PDAC) is characterised by poor oncological outcome and is the seventh cause of cancer-related deaths worldwide. With the advances in surgical technology, oncological treatment, and critical care, extended pancreatic resections including vascular resections have become more frequently performed in specialised centres. Furthermore, the boundaries of resectability continue to be pushed in order to achieve a potentially curative approach in selected patients in combination with neoadjuvant and adjuvant treatment strategies. This review gives an overview on the current state of venous and arterial resections in PDAC surgery with particular attention given to the minimally invasive approach.

Objective

Ventral hernia is an anterior abdominal wall hernia, with an incidence of 2%–13%. Laparoscopic ventral hernia repair is the preferred method worldwide with all the advantages of the laparoscopic technique proven to be an effective treatment option. This study aims to assess the long-term outcomes of laparoscopic management of ventral hernia repair using intraperitoneal onlay mesh (IPOM) or intraperitoneal onlay mesh with defect closure (IPOM PLUS) technique with the usage of variety of synthetic meshes intraperitoneally.

Methods

A retrospective study of 821 patients of a single institution for a decade was conducted. Long-term outcomes such as pain, mesh infections, enterocutaneous fistula, bowel adhesions and recurrence were assessed.

Results

There were 801 primary, 12 incisional, and 8 recurrent hernia cases, including 532 females and 289 males with a mean age of 45.62±9.37 years. IPOM PLUS were underwent in 674 (82.10%) cases. Polypropylene, dual, titanium, composite meshes were applied in 473 (57.61%), 208 (25.33%), 82 (9.99%), and 58 (7.06%) cases respectively. Intraoperative bleeding occurred in 3 (0.37%) cases, seroma in 8 (0.97%), wound infection in 4 (0.49%), stitch abscess in 2 (0.24%). Recurrence was found in 8 (0.97%) cases, with 5 used polypropylene mesh and 3 used dual mesh. Mesh infections were discovered in 6 (2.88%) cases used dual, and foreign body sensation in 4 (0.85%) cases used polypropylene. Three (0.37%) patients had suture site hernia, and 3 (0.37%) had chronic sinus.

Conclusion

IPOM or IPOM PLUS holds good in small or medium sized ventral hernias. The safety and efficacy of intraperitoneal polypropylene mesh is comparable to that of other synthetic meshes. A mesh overlap of minimum 5 cm beyond defect edge is must to minimise hernia recurrence. Absorbable suture can be considered as alternative to tackers.

Objective

Training young physicians in gastrointestinal endoscopy through virtual reality (VR) simulators has become popular. It is important to evaluate the benefits and usefulness of this technology for teaching endoscopic skills. The objective of this literature review is to understand the benefits of VR technology through quantitative and qualitative examination of learning outcomes.

Methods

A literature search of 7 databases was conducted. Studies which compared the effects of learning through VR simulation and another method of learning were included. In addition, studies were included if they evaluated learning outcomes on clinical patients. Participants could be medical residents, fellows, physicians, or nurses. Common outcomes measured across studies included subjective overall performance scores, total procedure times, rate of successful procedure completion, error rates, patient pain or discomfort, and measures of independence.

Results

A total of 22 studies were included. Overall, VR simulation training was seen to be comparable or significantly better than clinical training, no training, other types of simulation, and another form of VR training. Many authors reported increasing patient safety, reducing stress and time constraints, and shortening the learning curve as advantages of VR simulation training. However, this form of training is also expensive and may result in the learning of bad habits.

Conclusion

VR simulation technology can be a valuable form of educating endoscopy novices if properly supervised during training, and if there is also integration of clinical training.