Laparoscopic Endoscopic and Robotic Surgery最新文献

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.

Objective

While interest in elective robotic surgery is growing, use in emergency setting remains limited due to challenges posed by sicker patients, advanced pathology and logistical issues. During the COVID-19 pandemic, robotic surgery could provide the benefit of having the surgeon away from the bedside and reducing the number of directly exposed medical staff. The objective of this study was to report patient outcomes and initial learning experience of emergency robotic colorectal surgery during the COVID-19 pandemic.

Methods

A case series study was conducted, including patients undergoing emergency robotic colorectal surgery between February 2020 and February 2021 at Queen Alexandra Hospital in Portsmouth, UK. Patient data were collected from an ethics approved prospective database. Patient demographics, operative time, conversions and postoperative complications were recorded. In addition, readmissions, length of stay and short-term oncological outcomes were analyzed.

Results

Ten patients with median age 64 y (range, 36–83 y) were included. Four patients had robotic complete mesocolic resection for obstructing cancers. Six had colorectal resections for benign disease in emergency setting. All were R0 with a mean lymph node harvest of 54 ± 13. Mean operative time was 249 ± 117 min, the median length of stay was 9.4 d (range, 5–22 d). Only one patient was given a temporary diverting ileostomy. There were no grade III/V complications and no 30-day mortality.

Conclusions

Provided an experienced team and peri-operative planning, emergency robotic colorectal surgery can achieve favorable outcomes with benefits of radical lymph node dissection in oncological cases and avoidance of diverting stoma.

Acute abdomen is a common and sometimes dramatic clinical condition, which can be fatal if diagnosis is not made in time. Perforated peptic ulcer is a cause of an acute abdomen, which can be diagnosed by imaging investigations. However, erect chest X-ray and CT scan may not always establish the diagnosis. Herein we report a case of a patient with acute abdomen, where radiological imaging and CT scan were not able to provide a clear diagnosis. The patient was diagnosed with perforated peptic ulcer by esophago-gastro-duodenoscopy, and underwent laparotomy to repair the anterior wall duodenal perforation with an omental patch. Early endoscopic evaluation seems to be an essential tool for upper gastrointestinal evaluation in acute abdomen cases with inconclusive imaging results.

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.

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.