Laparoscopic Endoscopic and Robotic Surgery最新文献

Objective

In the evolving era of minimal access surgery, low rectal cancers still pose a challenge to laparoscopic or robotic surgeons. Hence, at our institute we intended to demonstrate the oncological efficacy of intersphincteric resection and coloanal anastomosis in the treatment of distal rectal cancers, performing the abdominal part of the procedure which includes rectal mobilization, laparoscopically.

Methods

From February 2017 to March 2021, 125 patients who had undergone intersphincteric resection and coloanal anastomosis via the perineal approach at Galaxy Care Laparoscopic Institute, Pune, were included in this study. Transabdominal mobilization of the rectum was performed laparoscopically. All patients had a diversion ileostomy and a pelvic drain. Patients were followed-up for a period of 18 months post-surgery. Data on clinical and oncological outcomes were collected and analysed. The pre-operative and post-operative Wexner incontinence scores were compared.

Results

The mean time taken for surgery was 181.57 ± 30.00 min. The mean blood loss was 119.76 ± 42.53 mL. Most patients (103, 82.4%) had their tumour at a distance of 1–2 cm from the anal verge. A loco-regional recurrence rate of 12.8% (16/125) was noted in our study. For the post-surgery Wexner score, 74.4% of patients (93/125) had a score of 5 or less, depicting that three-quarters of the study population had satisfactory continence. Overall, 81.6% of patients were satisfied with the functional results of surgery.

Conclusion

Intersphincteric resection and coloanal anastomosis, with a 12.8% recurrence rate, can now be considered an oncological and technically feasible procedure with sphincter salvage and good continence.

Objective

Various materials have been used for tympanic membrane reconstruction in middle ear surgery. This study aimed to evaluate the difference between the tragal perichondrium and COOK artificial material in patients who underwent endoscopic type 1 tympanoplasty.

Method

This retrospective study included patients who underwent endoscopic type 1 tympanoplasty from June 2021 to June 2022 at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. Patients were divided into group A (tragal perichondrium) and group B (COOK artificial material) according to the material used in the operation. All patients were followed up for 6 months. The differences in age, gender, operation site, disease course, preoperative air-bone gap (ABG), operation time, blood loss, hearing gain, and wound healing rate were compared between the two groups.

Results

This study enrolled 197 patients, with 120 patients in group A and 77 patients in group B. There were no significant differences in age, gender, operation site, disease course, or preoperative ABG between groups A and B (p > 0.05). Both groups had significant postoperative improvement in hearing (group A: 30.98 ± 9.58 dB vs. 17.07 ± 9.92 dB, p < 0.001; group B: 29.75 ± 7.52 dB vs. 14.25 ± 9.07 dB, p < 0.001). The mean hearing gain in group A and group B was comparable (14.02 ± 11.91 dB vs. 15.50 ± 7.05 dB, p = 0.609). The wound healing rates of groups A and B were no differences (93.33% vs. 87.01%, p = 0.133). The patients in group B had a shorter operation duration (72.57 ± 11.32 min vs. 61.86 ± 9.27 min, p = 0.045) and less blood loss (12.38 ± 3.7 mL vs. 8.10 ± 2.43 mL, p = 0.004).

Conclusions

Tragal perichondrium and COOK artificial material are reliable for functional and anatomical outcomes in endoscopic type 1 tympanoplasty, and COOK artificial material can save operation time and blood loss in surgery compared to the tragal perichondrium.

In this technical note, a novel rating scale (abdominal integral index) was introduced for assessing the conditions of the working laparoscopic space based on linear measurements to select the optimal one or two-stage surgical treatment for super-obesity. Patients with the same height and similar BMI values had different rating scale scores, reflecting different conditions of laparoscopic bariatric surgery. The rating scale helps surgeons and patients make a safe option for surgery, depending on the experience of the surgeon and technical laparoscopic conditions.

Objective

Biliary colic is a condition treated with laparoscopic cholecystectomy. However, the outcomes of surgery depend on early or delayed time points. Few research findings reported no benefits of early over delayed, on contra, other reported benefits. This study aims to compare the benefits associated with early and delayed laparoscopic cholecystectomy among uncomplicated biliary colic patients.

Methods

This observational study included patients with right upper abdominal pain and abdominal ultrasound showing cholelithiasis. Patients who were admitted at the first and second visits (within 6 weeks of the first visit) were assigned to the early and delayed groups, respectively. All participants were followed up for one-week postsurgery. The diagnosis of the patient, postoperative hospital stay, duration of surgery and complications were noted and compared primarily.

Results

A total of 80 patients were included, 40 each in the early group and delayed group. The patients in the two groups had comparable mean ages (40.55 ± 13.12 y vs. 40.45 ± 12.06 y, p = 0.972). The early group had more female patients (72.5% vs. 45.0%, p = 0.012). The duration of hospital stay (2.18 ± 0.38 d vs. 2.68 ± 1.04 d, p = 0.009) and duration of surgery (61.63 ± 3.64 min vs. 71.13 ± 16.19 min, p = 0.001) were found to be significantly different between the early and delayed groups. Only 1 (2.5%) patient in both groups was converted to open cholecystectomy. Recurrent biliary colic requiring hospital admission was seen in 1 (2.5%) patient and 6 (15.0%) patients, acute cholecystitis in 2 (5.0%) and 6 (15.0%), biliary pancreatitis in 1 (2.5%) and 2 (5.0%), and obstructive jaundice in 1 (2.5%) and 1 (2.5%) in the early and delayed groups, respectively, with insignificant differences (p > 0.05).

Conclusion

Early laparoscopic cholecystectomy decreases the operating time and duration of hospital stay. In terms of postoperative complications, our study did not find any significant difference between the groups.

Objective

Radiation osteonecrosis of the skull base after radiotherapy for nasopharyngeal carcinoma is one of the most serious complications, affecting patient survival and quality of life. To date, surgical resection is the main treatment for radiation osteonecrosis. The repair after the operation is very important. Inappropriate repair or lack of repair can easily cause local infection that can even spread to the brain, aggravating osteonecrosis. This study aimed to verify the feasibility and safety of the anterolateral thigh free fascia flap in repairing large skull base defects.

Methods

From June 2021 to July 2022, a total of 12 patients with a history of radiotherapy for nasopharyngeal carcinoma received surgical treatment at the Department of Otolaryngology Head & Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine. All patients were diagnosed with radiation osteonecrosis of the skull base with large skull base defects. During the endoscopic operation, a free anterolateral thigh fascia flap was used to repair the skull base and complete vascular anastomosis reconstruction. The preoperative and postoperative pain scores were retrospectively analyzed, and the dynamic changes in endoscopic surgery sites were observed.

Results

The 12 patients had a median age of 58 y, with 8 (66.7%) males and 4 (33.3%) females. The median headache score for the patients was 5 (4–7) before surgery. The patient's headache was significantly relieved postoperatively, with 11 patients having a score of 0 and one patient having a score of 1. The stench was completely resolved after the operation. There were no serious complications during the perioperative period or 12 months after the operation.

Conclusion

The application of anterolateral thigh free fascia flap in skull base reconstruction is a safe and reliable reconstruction technique suitable for endoscopic surgical repair of large-scale skull base necrosis.

Objective

Robotic general surgery remains controversial, with some employing the technology for common laparoscopic procedures such as appendectomies. Very few studies have compared robotic appendectomy (RA) to existing techniques, partly due to the relative scarcity of data. The purpose of this study was to compare outcomes for RA versus laparoscopic appendectomy (LA).

Methods

This retrospective cohort study evaluated procedural specific databases of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) for appendectomy between January 2016 and December 2019 and included all available cases at the time of analysis (June 2021). Demographic and surgical outcomes including composite 30-day complications, specific complications, and length of operation were analyzed using a univariate analysis.

Results

In total, there were 52,559 appendectomies in the NSQIP database between 2016 and 2019. Analysis was restricted to those who underwent minimally invasive approaches. In total, 49,850 patients were included in the analysis. Of those, 49,800 patients underwent LA, and 50 patients underwent RA. Participants who underwent RA were older (35.8 ± 4.5 y vs. 23.0 ± 0.2 y, p < 0.01). There was no difference in the total number of comorbidities (92.0% vs. 73.4%, p = 0.32) or the severity of appendicitis (p > 0.90) between RA and LA cases. RA had a longer median operation time (71.0 min vs. 46.0 min, p < 0.01) but a shorter postoperative stay (0.7 d vs. 1.3 d, p < 0.01). There was no difference in the frequency of readmission likely related to procedure (4.0% vs. 3.0%, p = 0.88) or complications (18.0% vs. 23.8%, p = 0.88); however, RA was associated with increased 30-day mortality (2.0% vs. <0.1%, p < 0.01) compared to LA.

Conclusion

Our results demonstrated that LA and RA had a similar frequency and profile of complications. Robotic procedures took longer but resulted in shorter postoperative stays. Our study revealed that RA constituted a mere 0.1% of all cases, with only 50% showing pathology consistent with appendicitis, despite 92.2% of LA cases presenting with the condition. Despite our findings of RA offering some benefit, more research is necessary, particularly regarding outcomes and value delivery.

Objective

In robot-assisted minimally invasive surgery, proper port positioning ensures that surgical tools have adequate access to the surgical site and avoids mid-surgery collisions of robotic arms. To date, several guidelines have been proposed for more accurate port placement. However, challenges remain due to variations in patient morphology, anatomy, and, in particular, organ displacement due to insufflation in certain laparoscopic procedures. The objective of this study was to design and develop a decision aid for optimal port placement in robot-assisted hysterectomy that accounts for patient variability and organ displacement due to insufflation.

Methods

Three components were constructed: a robot model, a patient-specific model, and an optimization algorithm. The three components were integrated, and the system was verified using four different patients who underwent robotic hysterectomy. Once verified, two expert surgeons were asked to evaluate the decision aid for face and construct validity. A usability test was conducted using a torso phantom with target organs located in three different locations. Two expert surgeons performed a simulated hysterectomy task with and without the decision aid to evaluate performance and satisfaction.

Results

The optimization algorithm was sensitive to individual differences in anatomy in the four patients. Expert surgeons successfully established face and construct validity. Usability test results showed a 28%–40% reduction in time to task completion with the optimized ports compared to expert-determined port locations without using the decision aid.

Conclusions

The decision aid, based on an individualized patient-specific model, robot model, and optimization algorithm, was shown to be effective at addressing the challenges of displaced organs due to insufflation in robot-assisted hysterectomy. The face and construct validity of the decision aid was established by expert surgeons, while efficiency gains in task performance were demonstrated experimentally.

Objective

The popularization of gastroenteroscopy and the introduction of comfortable medical care have further promoted the growth of people's demand, especially the demand for painless endoscopy. This cross-sectional study aims to investigate the current situation and change in county people's demand for endoscopy to promote the development of endoscopy centers in county hospitals in southeast China.

Methods

From October to December 2021, patients and their family members who came to the Gastroenterology Department in Suichang County People's Hospital of Zhejiang Province were randomly selected to complete the questionnaire. A total of 838 valid questionnaires were collected. Additionally, the original software data of the Endoscopy Center were sampled and retrieved (from October to December every year from 2018 to 2021) for statistical analysis of real-world data. Those who would choose painless endoscopy the next time in the valid questionnaires were included in the painless endoscopy group, while those who would choose ordinary endoscopy the next time were included in the ordinary endoscopy group.

Results

The stepwise forward binary logistic regression model analysis showed that, patients with “secondhand smoke exposure” were more willing to choose painless endoscopy (OR = 1.459, 95% CI: 1.050–2.028, p = 0.025). However, patients with an education level of “primary and below” and “junior high school”, and patients who are suffering from “currently experiencing abdominal distension”, were more willing to choose ordinary endoscopy (OR = 0.270, 95% CI: 0.149–0.488, p < 0.001; OR = 0.528, 95% CI: 0.330–0.845, p = 0.008; OR = 0.536, 95% CI: 0.334–0.861, p = 0.010). Patients with previous experience in painless endoscopy tended to choose painless endoscopy the next time, while patients with previous experience in ordinary endoscopy tended to choose ordinary endoscopy the next time (χ² = 140.97, p < 0.001). From 2018 to 2021, the proportion of painless endoscopy has increased yearly (p < 0.001). Most patients indicated that they would “regularly review gastroenteroscopy” (477/838, 56.9%).

Conclusions

With Suichang County of Zhejiang Province as the representative, the demand for painless endoscopy for people's gastrointestinal cancer detection in southeast China has been increasing yearly. The development of endoscopy centers in county-level hospitals can basically meet the demand growth. Meanwhile, advanced concepts such as comfortable medical care and regular follow-up are gradually popularized at the grassroots level in southeast China.

Approximately 25% of goiters extend to the substernal area, and most of them can be removed through a cervical incision. Goiters that extend into the posterior mediastinum are very rare, and resection usually requires thoracotomy. In recent years, there have been several reports of resection of substernal goiters by minimally invasive surgery. Here, we present a 75-year-old female with a giant substernal goiter who successfully underwent resection of the goiter extending to the posterior mediastinum using low cervical incision combined with video-assisted thoracoscopy.

Objective

With the widespread application of robotic liver surgery, the body of literature related to robotic liver resection is growing. However, there is a lack of understanding of the publication activities surrounding robotic liver resection research. This bibliometric study aimed to detect the global publication distributions of robotic liver resection research over the past 20 years.

Methods

Articles on robotic liver resection published from January 1, 2003 to August 31, 2022 were extracted from the Web of Science Core Collection database. The publication language was restricted to English. Literature distribution analyses were performed at the country/region, institution, author, and journal levels. In addition, each author's productivity was assessed with Lotka's law. Academic influence was assessed by local citation score and global citation score. The keywords evolution was also analyzed. R software and HistCite were applied for the analyses.

Results

A total of 685 articles were identified, with 4107 local citations and 9458 global citations. These articles were published in 156 journals and written by 2449 authors from 785 institutions in 49 countries/regions. The cumulative publication number of the last 5 years accounted for 66.3% (454/685) of the total publication number. The USA played a leading role in the publication output (212, 30.9%), followed by Italy (120, 17.5%) and China (104, 15.2%). The three countries also had the most citations. Yonsei University from South Korea had the highest publication number (30, 4.4%). The Asian Journal of Surgery published the most articles (51, 7.4%), and Surgical Endoscopy and Other Interventional Techniques had the most local citations (575) and global citations (1115). Sucandy published 44 articles, ranking first in productivity. Choi had many more citations than other scholars, with 465 local citations and 1253 global citations. Lotka's law reflected that the majority of the authors (1783, 72.8%) wrote one document. The top 5 most prominent keywords were “surgery”, “hepatocellular-carcinoma”, “outcomes”, “hepatectomy”, and “experience”.

Conclusion

The number of publications on robotic liver resection research has been rapidly increasing over the last 20 years. The most prolific countries/regions and institutions also had strong academic influence. The articles, institutions and authors with high citations mainly came from USA, China, South Korea, Italy, and Singapore. The research hotspots shifted from survival to complications, mortality, and augmented reality.