Asian Journal of Endoscopic Surgery最新文献_第8页

Short-term surgical outcomes of open, laparoscopic, and robot-assisted pancreatoduodenectomy: A comparative, single-center, retrospective study 开腹、腹腔镜和机器人辅助胰十二指肠切除术的短期手术效果：单中心回顾性对比研究

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2024-10-20 DOI: 10.1111/ases.13397

Naohisa Kuriyama, Takehiro Fujii, Benson Kaluba, Tatsuya Sakamoto, Haruna Komatsubara, Daisuke Noguchi, Takahiro Ito, Aoi Hayasaki, Yusuke Iizawa, Yasuhiro Murata, Akihiro Tanemura, Masashi Kishiwada, Shugo Mizuno

Purpose

Although laparoscopic pancreaticoduodenectomy (LPD) and robot-assisted pancreaticoduodenectomy (RPD) are gradually gaining popularity, their advantages over open pancreaticoduodenectomy (OPD) remain controversial. This study aimed to compare the short-term outcomes of OPD, LPD, and RPD to elucidate the advantages and disadvantages of each procedure.

Methods

We retrospectively analyzed 16 LPD, 43 RPD, and 36 OPD procedures performed at a single center between April 2020 and May 2024. Clinical data, including operative time, estimated blood loss, postoperative complications, length of hospital stay, and hospitalization costs, were retrospectively collected and analyzed.

Results

RPD demonstrated a significantly longer operative time (553 min) than OPD (446 min) and LPD (453 min) but a significantly lower estimated blood loss than OPD (150 mL vs. 400 mL, p < .001). Postoperative complication rates (Clavien–Dindo grade ≥3) were lower for RPD (24.4%) than those for OPD (50.0%) and LPD (68.8%). RPD also showed a significantly lower rate of clinically relevant postoperative pancreatic fistula (14.6% vs. 38.9% for OPD and 43.8% for LPD) and a shorter duration of hospitalization (11 vs. 28 days for OPD and 21 days for LPD, p < .001). Hospitalization costs were higher for RPD (20 109 USD) than for OPD (18 487 USD, p < .001), with LPD (20 496 USD) and RPD costs being similar.

Conclusions

RPD appears to offer advantages in terms of reduced blood loss and postoperative complications and shortened hospital stay despite longer operative times and higher hospitalization costs. Therefore, RPD may be a more beneficial approach than OPD or LPD in pancreatic surgery.

目的虽然腹腔镜胰十二指肠切除术（LPD）和机器人辅助胰十二指肠切除术（RPD）逐渐受到欢迎，但它们与开腹胰十二指肠切除术（OPD）相比的优势仍存在争议。本研究旨在比较 OPD、LPD 和 RPD 的短期疗效，以阐明每种手术的优缺点。方法我们回顾性分析了 2020 年 4 月至 2024 年 5 月期间在一个中心进行的 16 例 LPD、43 例 RPD 和 36 例 OPD 手术。我们回顾性地收集并分析了临床数据，包括手术时间、估计失血量、术后并发症、住院时间和住院费用。结果 RPD 的手术时间（553 分钟）明显长于 OPD（446 分钟）和 LPD（453 分钟），但估计失血量明显低于 OPD（150 毫升对 400 毫升，p < .001）。术后并发症发生率（Clavien-Dindo 分级≥3），RPD（24.4%）低于 OPD（50.0%）和 LPD（68.8%）。RPD 的术后胰瘘临床相关率也明显较低（14.6% 对 OPD 的 38.9% 和 LPD 的 43.8%），住院时间也较短（11 天对 OPD 的 28 天和 LPD 的 21 天，p < .001）。RPD 的住院费用（20 109 美元）高于 OPD（18 487 美元，p < .001），LPD（20 496 美元）和 RPD 的费用相近。结论尽管手术时间较长，住院费用较高，但 RPD 似乎在减少失血量、术后并发症和缩短住院时间方面更具优势。因此，在胰腺手术中，RPD 可能是比 OPD 或 LPD 更为有益的方法。

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引用次数: 0

Comparison of the frequency of complications resulting from open and laparoscopic surgery for hydatid cyst 水囊肿开腹手术与腹腔镜手术并发症发生率的比较

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2024-10-15 DOI: 10.1111/ases.13391

Mohammad Shabani, Fatemeh Behnam, Hossein Akbari, Mohammad Eidy

Background and Objective

Hydatid cyst is a benign parasitic disease that is usually asymptomatic and is discovered incidentally. The gold standard for the treatment of this disease is surgery. Recently, a laparoscopic approach has been used to remove hydatid cysts. We decided to compare this new technique with an open conventional method.

Materials and Methods

Patients—This retrospective analytical study was conducted on patients with hepatic hydatid cysts who underwent surgery in Kashan during 2013–2020. A total of 58 patients were included in this study, 18 of whom underwent laparoscopic surgery and 40 underwent open surgery. The comparison of the two groups was performed using chi-square and Fisher's exact tests.

Results

The average duration of surgery in the laparoscopic and open surgery groups was 135 and 151.6 min, respectively, which was not statistically significant (p-value = .179). There was no significant difference in terms of the need for blood transfusion, conversion of laparoscopic surgery to open surgery, anaphylactic shock, infection, and death between the two groups (p > .05). However, the laparoscopic surgery group had a significantly shorter hospital stay compared with the open surgery group (p-value < .001), and more favorite patients.

Conclusion

Considering the lack of significant difference between the two surgical methods and the reduction in the duration of surgery by a laparoscopic approach, the reduction in hospital stay of patients, and consequently the reduction in the cost of patients, it is expected that this method is a more suitable method compared with open surgery.

背景和目的包虫囊肿是一种良性寄生虫病，通常无症状，偶然发现。治疗这种疾病的金标准是手术。最近，腹腔镜方法被用于切除包虫囊肿。我们决定将这种新技术与开放式传统方法进行比较。材料和方法患者--这项回顾性分析研究针对 2013-2020 年期间在卡尚接受手术的肝包虫囊肿患者。本研究共纳入 58 例患者，其中 18 例接受了腹腔镜手术，40 例接受了开腹手术。两组患者的比较采用了卡方检验和费雪精确检验。结果腹腔镜手术组和开腹手术组的平均手术时间分别为 135 分钟和 151.6 分钟，差异无统计学意义（P 值 = .179）。两组在输血需求、腹腔镜手术转为开腹手术、过敏性休克、感染和死亡方面没有明显差异（p >.05）。不过，腹腔镜手术组的住院时间明显短于开腹手术组（p 值为 0.001），而且更受患者喜爱。结论考虑到两种手术方法之间没有显著差异，而且腹腔镜方法缩短了手术时间，减少了患者的住院时间，从而降低了患者的费用，因此，与开腹手术相比，腹腔镜手术是一种更合适的方法。

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引用次数: 0

Evaluating the benefit of contact-force feedback in robotic surgery using the Saroa surgical system: A preclinical study 使用 Saroa 手术系统评估机器人手术中接触力反馈的益处：临床前研究

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2024-10-13 DOI: 10.1111/ases.13395

Yoshihiro Sakai, Masanori Tokunaga, Yoshimi Yamasaki, Hiroki Kayasuga, Teruyuki Nishihara, Kotaro Tadano, Kenji Kawashima, Shigeo Haruki, Yusuke Kinugasa

Introduction

Robotic surgery without contact-force feedback could be less safe, as forces exerted by the robot system may exceed tissue tolerance. This study aimed to evaluate the benefit of contact-force feedback.

Methods

Nine junior and 11 senior surgeons performed two tasks using Saroa, a robotic surgical system with a force feedback function. In Task A, the participants estimated the order of stiffness of substances when feedback was on and off. In Task B, the effect of feedback on compression with a designated force (3 N) was assessed.

Results

In Task A, the proportion of participants who correctly estimated the order of stiffness of the substances was similar when feedback was on and off. However, the median maximum force applied to the substances was significantly smaller when feedback was on than when it was off (5.0 vs. 6.9 N, p = .011), which was more obvious among the junior surgeons (5.0 vs. 7.7 N, p = .015) than among the senior surgeons (4.7 vs. 5.9 N, p = .288). In Task B, deviations from the designated force (3 N) for three substances were smaller when feedback was on (0, −0.1, and 0.7, respectively) than when it was off (−0.3, −0.5, and 1.3, respectively). Regarding the dispersion of the force to the substances, the interquartile range tended to be smaller with feedback; this trend was more obvious in the junior surgeons.

Conclusion

With contact-force feedback, tissue stiffness could be estimated with a small force, particularly by the junior surgeons; specified force could be accurately applied to the tissue.

导言：没有接触力反馈的机器人手术安全性可能较低，因为机器人系统施加的力可能会超过组织的耐受力。本研究旨在评估接触力反馈的益处。方法 9 名初级外科医生和 11 名高级外科医生使用具有力反馈功能的机器人手术系统 Saroa 完成了两项任务。在任务 A 中，参与者估算了反馈开启和关闭时物质硬度的顺序。在任务 B 中，评估了反馈对指定力（3 N）压缩的影响。结果在任务 A 中，当反馈开启和关闭时，正确估计物质硬度顺序的参与者比例相似。但是，当反馈开启时，施加在物质上的最大力的中位数明显小于反馈关闭时（5.0 N vs. 6.9 N，p = .011），这在初级外科医生中（5.0 N vs. 7.7 N，p = .015）比在高级外科医生中（4.7 N vs. 5.9 N，p = .288）更为明显。在任务 B 中，三种物质在开启反馈时（分别为 0、-0.1 和 0.7）与关闭反馈时（分别为 -0.3、-0.5 和 1.3）的指定力（3 N）偏差较小。关于力对物质的分散性，反馈时的四分位数间范围往往较小；这一趋势在初级外科医生中更为明显。结论通过接触力反馈，可以用很小的力来估计组织的硬度，尤其是初级外科医生；指定的力可以准确地施加到组织上。

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引用次数: 0

A case of laparoscopic spleen-preserving distal pancreatectomy for small solid pseudopapillary neoplasm in an adult male with anomalous splenic vein confluence 一例脾静脉汇合异常的成年男性因小型实性假乳头状瘤而接受腹腔镜保脾胰腺远端切除术的病例。

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2024-10-10 DOI: 10.1111/ases.13396

Sunao Uemura, Rikiya Daike, Kenji Yorita, Hiromichi Yamai, Mitsuteru Yoshida, Norihiro Hokimoto, Hisashi Matsuoka, Jun Iwabu, Fuyumi Izaki, Michiyo Okazaki, Nobuyuki Tanida

Although anomalies of the celiac and/or superior mesenteric arteries are occasionally encountered during abdominal surgery, anomalous venous confluence is seldom reported during pancreatic surgery. Herein, we present a rare case of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) for the treatment of a solid pseudopapillary neoplasm in an asymptomatic 37-year-old male with an anomalous splenic vein (SpV) confluence. Computed tomography angiography (CTA) revealed an anomaly of the SpV, which coursed transversely through the superior border of the pancreas, over the celiac artery and into the portal vein, along the superior line of the common hepatic artery. We successfully performed an LSPDP without peripancreatic vessel injury by exposing the SpV and splenic artery through an approach from the superior position of the pancreas. Preoperative imaging, especially CTA, is crucial to ensuring a safe, successful laparoscopic pancreatectomy.

虽然腹腔手术中偶尔会遇到腹腔动脉和/或肠系膜上动脉异常的情况，但胰腺手术中很少有静脉汇合异常的报道。在此，我们介绍了一例罕见的腹腔镜保脾远端胰腺切除术（LSPDP）治疗实性假乳头状瘤的病例，患者是一名无症状的 37 岁男性，同时伴有异常的脾静脉（SpV）汇合。计算机断层扫描血管造影术（CTA）显示脾静脉异常，它横向穿过胰腺上缘，越过腹腔动脉，沿着肝总动脉的上行线进入门静脉。我们通过从胰腺上端位置切入，暴露出 SpV 和脾动脉，成功实施了 LSPDP 手术，没有造成胰周血管损伤。术前成像，尤其是 CTA，对于确保安全、成功的腹腔镜胰腺切除术至关重要。

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引用次数: 0

One anastomosis gastric bypass in a patient with situs inversus totalis and severe obesity 为一名患有全坐失调症和重度肥胖症的患者实施单吻合器胃旁路手术。

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2024-10-09 DOI: 10.1111/ases.13394

Seyed Ali Jazaeri, Fahimeh Yarigholi, Abdolreza Pazouki

Introduction

Obesity is a widespread health concern, and bariatric surgery has shown promise as an effective treatment for addressing this issue. The increasing global prevalence of obesity has led to a rise in the occurrence of obesity alongside rare conditions such as situs inversus totalis (SIT). One of the most effective bariatric surgeries, one-anastomosis gastric bypass (OAGB), has gained popularity in recent years.

Materials and Surgical Technique

We report a successful case of OAGB in a patient with a body mass index (BMI) of 51.48 kg/m² and SIT.

Discussion

It is worth noting that in skilled hands, OAGB can be both effective and safe for patients with anatomical abnormalities like SIT.

引言肥胖症是一个普遍存在的健康问题，减肥手术是解决这一问题的有效治疗方法。肥胖症在全球的发病率不断上升，导致肥胖症与全坐位不全（SIT）等罕见疾病同时出现。近年来，最有效的减肥手术之一--单吻合胃旁路术（OAGB）越来越受欢迎：我们报告了一例成功的单吻合胃旁路手术，患者体重指数（BMI）为 51.48 kg/m2，患有 SIT：值得注意的是，在技术熟练的医生手中，OAGB 对 SIT 等解剖异常患者既有效又安全。

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引用次数: 0

Significance of resected stomach measurements in postoperative delayed gastric emptying following laparoscopic pylorus-preserving gastrectomy 腹腔镜保留幽门胃切除术后，切除胃的测量值对术后胃排空延迟的意义。

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2024-10-08 DOI: 10.1111/ases.13392

Nozomi Ito, Hironori Tsujimoto, Isao Kumano, Seiichiro Fujishima, Risa Kariya, Naoyuki Uehata, Yusuke Fukuoka, Takafumi Suzuki, Yujiro Itazaki, Hiroyuki Horiguchi, Yoshihisa Yaguchi, Hideki Ueno

Purpose

We investigated the relationship between the resected stomach measurements, the incidence of delayed gastric emptying (DGE), and food residue 1 year after surgery in patients who underwent laparoscopic pylorus-preserving gastrectomy (PPG).

Materials and Methods

The DGE group included 10 patients fasting due to nausea, vomiting, abdominal distension, or remnant stomach distension on radiographs; the control group included 36 patients without these symptoms. We compared the size and length of lesser and greater curvatures of the resected stomach and endoscopic findings after 1 year.

Results

No significant differences were observed between groups in terms of sex, body mass index, gross type, histology, tumor progression, number of dissected lymph nodes, operating time, or blood loss. The DGE group was older, had a longer postoperative stay, and showed a smaller size and shorter greater curvature of the resected stomach than the control group (p < 0.01 for all). No difference was observed in the length of the lesser curvature of the resected stomach. In addition, there were no disparities in residual food, degree and extent of gastritis, or bile reflux 1 year after gastrectomy.

Conclusions

Measurements of the resected stomach suggest that preventing DGE may be achievable by removing a larger area of the greater curvature and/or stomach during laparoscopic PPG. This implies potential surgical strategy improvements for better outcomes. Further multicenter trials are needed to validate and refine techniques.

目的：我们研究了腹腔镜保留幽门胃切除术（PPG）患者切除胃的测量值、延迟胃排空（DGE）发生率和术后1年食物残渣之间的关系：DGE组包括10名因恶心、呕吐、腹胀或X光片显示残胃膨胀而禁食的患者；对照组包括36名无上述症状的患者。我们比较了切除胃小弯和胃大弯的大小和长度以及一年后的内镜检查结果：结果：在性别、体重指数、大体类型、组织学、肿瘤进展、切除淋巴结数量、手术时间和失血量等方面，各组间无明显差异。与对照组相比，DGE 组年龄更大，术后住院时间更长，切除胃的体积更小，大弯更短（P对切除胃部的测量结果表明，在腹腔镜 PPG 手术中切除更大面积的胃大弯和/或胃部可以预防 DGE。这意味着有可能改进手术策略以获得更好的疗效。需要进一步的多中心试验来验证和完善技术。

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引用次数: 0

Laparoscopic colectomy for patients with poor American Society of Anesthesiology classifications 为美国麻醉学会分类不佳的患者实施腹腔镜结肠切除术。

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2024-10-01 DOI: 10.1111/ases.13393

Keisuke Noda, Takashi Nonaka, Tetsuro Tominaga, Yuma Takamura, Kaido Oishi, Shintaro Hashimoto, Toshio Shiraishi, Rika Ono, Mitsutoshi Ishii, Makoto Hisanaga, Hiroaki Takeshita, Hidetoshi Fukuoka, Shosaburo Oyama, Kazuhide Ishimaru, Masaki Kunizaki, Terumitsu Sawai, Keitaro Matsumoto

Introduction

The American Society of Anesthesiologists (ASA) classification is used to assess the fitness of a patient for surgery. Whether laparoscopic surgery is appropriate for colorectal cancer patients with poor ASA performance status (PS) remains unclear.

Methods

Among 4585 patients who underwent colorectal surgery between 2016 and 2023, this study retrospectively reviewed all 458 patients with ASA-PS ≥3. Patients were divided into two groups: patients treated by open surgery (O group, n = 80); and patients treated by laparoscopic surgery (L group, n = 378). We investigated the impact of surgical approach on postoperative complications in patients with colorectal cancer and ASA-PS ≥3.

Results

Operation time was longer (170 min vs. 233 min, p < .001), blood loss was less (156 mL vs. 23 mL, p < .001), postoperative complications were less frequent (40.0% vs. 25.1%, p = .008), and hospital stay was shorter (23 days vs. 14 days, p < .001) in L group. Univariate analysis revealed rectal cancer, open surgery, longer operation time, and blood loss as factors significantly associated with postoperative complications. Multivariate analysis revealed open surgery (odds ratio [OR] 2.100, 95% confidence interval [CI] 1.164–3.788; p = .013) and longer operation time (OR 1.747, 95% CI 1.098–2.778; p = .018) as independent predictors of postoperative complications.

Conclusion

Laparoscopic surgery provides favorable outcomes for colorectal cancer patients with poor ASA-PS.

导言：美国麻醉医师协会（ASA）分类用于评估患者是否适合手术。ASA表现状态（PS）较差的结直肠癌患者是否适合腹腔镜手术，目前仍不清楚：在2016年至2023年期间接受结直肠手术的4585名患者中，本研究对所有458名ASA-PS≥3的患者进行了回顾性研究。患者被分为两组：接受开腹手术治疗的患者（O 组，n = 80）；接受腹腔镜手术治疗的患者（L 组，n = 378）。我们研究了手术方式对ASA-PS≥3的结直肠癌患者术后并发症的影响：结果：手术时间更长（170 分钟 vs. 233 分钟，P 结论：腹腔镜手术为结肠癌患者提供了良好的术后并发症：腹腔镜手术为 ASA-PS 较差的结直肠癌患者提供了良好的治疗效果。

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引用次数: 0

Robotic extraperitoneal stoma closure with left hemicolectomy for descending colon cancer following abdominoperineal resection: A case report 腹腔镜切除术后用机器人腹膜外造口术关闭左半结肠切除术治疗降结肠癌：病例报告。

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2024-09-27 DOI: 10.1111/ases.13387

Shuhei Uehara, Hajime Ushigome, Hiroki Takahashi, Hiroyuki Asai, Akira Kato, Yoshiaki Fujii, Kaori Watanabe, Takeshi Yanagita, Takuya Suzuki, Ryo Ogawa, Yoichi Matsuo, Shuji Takiguchi

Extraperitoneal colostomy is often selected to reduce the risk of parastomal hernia. However, its closure surgery is rare and seldom reported. Here, we report our unique experience with robotic left hemicolectomy and extraperitoneal colostomy closure. An 83-year-old female was diagnosed with descending colon cancer with stenosis. She had previously undergone abdominoperineal resection with extraperitoneal colostomy. After improving the intestinal obstruction with a self-expanding stent, we performed robotic left hemicolectomy and extraperitoneal colostomy closure. Thanks to the multijoint function of the robot, which enables the forceps to be angled up to 90° in all directions, we could dissect the stoma from the abdominal wall up to just beneath the rectus abdominis in an intra-abdominal procedure without enlarging the skin incision. This case suggests that robotic surgery with the articulating function is beneficial for procedures near the abdominal wall ceiling and effective for extraperitoneal colostomy closure.

通常选择腹膜外结肠造口术是为了降低腹膜旁疝的风险。然而，其闭合手术却很少见，也很少有报道。在此，我们报告了机器人左半结肠切除术和腹膜外结肠造口关闭术的独特经验。一位 83 岁的女性被诊断出患有伴有狭窄的降结肠癌。她之前接受了腹腔镜切除术，并进行了腹膜外结肠造口术。在使用自膨胀支架改善肠梗阻后，我们进行了机器人左半结肠切除术和腹膜外结肠造口缝合术。由于机器人具有多关节功能，可以将镊子向各个方向倾斜达90°，因此我们可以在腹腔内手术中将造口从腹壁剥离至腹直肌下方，而无需扩大皮肤切口。本病例表明，具有铰接功能的机器人手术有利于腹壁天花板附近的手术，对腹膜外结肠造口的闭合也很有效。

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引用次数: 0

A case of robotic distal pancreatectomy for solitary fibrous tumor of the pancreas 一例机器人胰腺远端切除术治疗胰腺单发纤维瘤。

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2024-09-27 DOI: 10.1111/ases.13388

Rihito Nagata, Nobuyuki Takemura, Riki Ninomiya, Naganori Yamada, Shinichi Matsudaira, Akifumi Kimura, Natsuko Takayanagi, Hiroki Imada, Akira Maki, Yoshifumi Beck

Solitary fibrous tumor (SFT) is a spindle cell tumor driven by the NAB2-STAT6 fusion gene. While it can originate from any soft tissue, primary SFT of the pancreas is rare with limited reports. A 36-year-old man came to our department due to abdominal pain. Computed tomography revealed a circular mass with weak peripheral enhancement and an internal cyst in the pancreatic tail. Diagnosis was not confirmed through endoscopic ultrasound-guided biopsy, and differential diagnoses included acinar cell carcinoma and pancreatic neuroendocrine tumor. A robotic distal pancreatectomy with splenectomy was performed, and the patient was discharged 11 days postoperatively. Histopathological examination showed an irregular arrangement of spindle cells, and immunohistochemical staining was positive for CD34 and STAT6, confirming an SFT diagnosis with low metastatic risk. Robotic surgery effectively managed this tumor.

孤立性纤维瘤（SFT）是一种由 NAB2-STAT6 融合基因驱动的纺锤形细胞肿瘤。虽然它可以起源于任何软组织，但胰腺原发性 SFT 却非常罕见，且报道有限。一名36岁的男子因腹痛来我科就诊。计算机断层扫描显示，胰腺尾部有一圆形肿块，周围有弱强化，内部有囊肿。内镜超声引导下活检未能确诊，鉴别诊断包括尖细胞癌和胰腺神经内分泌肿瘤。患者术后11天出院。组织病理学检查显示纺锤形细胞排列不规则，免疫组化染色显示 CD34 和 STAT6 阳性，确诊为 SFT，转移风险较低。机器人手术有效地控制了该肿瘤。

引用次数: 0

Tackling global warming 应对全球变暖。

IF 0.9 Q4 ORTHOPEDICS

Asian Journal of Endoscopic Surgery

Pub Date : 2024-09-27 DOI: 10.1111/ases.13390

Yoshiharu Sakai

引用次数: 0