Journal of Minimal Access Surgery最新文献

Abstract: Impaction of a mechanical lithotripsy basket during endoscopic retrograde cholangiopancreatography is a rare but serious complication resulting from technical failure. We describe a novel case of lithotripsy basket retrieval aided by laser fragmentation. This 87-year-old male underwent an emergency laparoscopic subtotal cholecystectomy, common bile duct (CBD) exploration and laser lithotripsy after attempts at endoscopic mechanical lithotripsy caused a stone-basket complex to become impacted within the CBD. In the absence of endoscopic salvage techniques, laparoscopic CBD exploration is a valid and safe option where surgical expertise permits.

Introduction: Corrosive ingestion is a common cause for benign oesophageal stricture in the developing countries. There is limited literature available on the minimally invasive surgical approach for the management of this condition. This study analyses our experience of managing corrosive oesophageal strictures by combined thoraco-laparoscopic approach.

Patients and methods: A retrospective analysis of 24 patients (22 - gastric conduit and 2 - colonic conduit) who underwent minimally invasive oesophagectomy for corrosive oesophageal strictures from January 2019 to December 2023 was done.

Results: The median age of the patients in the study group was 30.5 years (range 18-60 years). Eighteen patients had a history of accidental corrosive ingestion, and 6 patients with suicidal intent. Post-operative complications included chest infections in 6, recurrent laryngeal nerve paresis in 2, anastomotic leak in 2 and anastomotic stricture in 4 patients. There was one mortality.

Conclusion: Minimal invasive oesophagectomy for corrosive stricture is technically challenging and needs expertise. It not only permits the native and physiological route for conduit placement but also avoids complications related to retained diseased oesophagus.

Introduction: Robot-assisted kidney transplantation (RAKT) has demonstrated non-inferiority to open kidney transplantation (OKT), with particular benefits for obese patients. We report our single-centre initial experience implementing RAKT with technical modifications.

Patients and methods: This retrospective descriptive study analysed consecutive living donor kidney transplants performed between September 2020 and March 2021. From 75 potential candidates, patients were selected for RAKT based on exclusion criteria, including obesity (body mass index [BMI] >35 kg/m²), severe atherosclerosis and previous complex abdominal surgery. Ten patients underwent RAKT and were matched 1:3 with OKT controls using propensity score matching based on age, sex, BMI and diabetes status. Technical modifications included polyglactin mesh wrapping for graft stabilisation and continuous cooling and a custom robotic arterial punch device. The primary surgeon completed 35 RAKT procedures at a high-volume centre before initiating this programme.

Results: Ten RAKT patients (90% male, mean age 41.5 ± 10.2 years, mean BMI 27.0 ± 3.2 kg/m²) were compared to 30 matched OKT controls. Mean operative time was 263 ± 29 min for RAKT versus 185 ± 22 min for OKT (P < 0.001). Warm ischaemia time averaged 52.2 ± 16.8 min for RAKT versus 3.2 ± 1.1 min for OKT (P < 0.001). All grafts functioned immediately except one delayed graft function in each group. Hospital stay averaged 8.0 ± 1.5 days for RAKT versus 7.2 ± 1.8 days for OKT (P = 0.21). At median follow-up of 60 months, graft survival was 100% in both groups. No incisional hernias occurred in RAKT patients versus 2 (6.7%) in OKT. Overall, 30-day complications were 10% for RAKT versus 20% for OKT (P = 0.66).

Conclusions: This small descriptive study demonstrates RAKT feasibility with technical modifications at an experienced centre. While no definitive conclusions can be drawn from this limited experience, our results align with larger studies supporting RAKT safety. The polyglactin mesh technique for continuous cooling and manipulation, along with the absence of incisional hernias, warrants further investigation in larger cohorts.

Objective: Thyroidectomy is among the most commonly performed endocrine surgeries. Concerns regarding cosmetic outcomes and pain management have led to various surgical innovations. This study compares post-operative patient satisfaction based on cosmesis and expectations between open thyroidectomy (conventional open thyroidectomy [COT]) and transoral endoscopic thyroidectomy vestibular approach (TOETVA).

Patients and methods: Female patients aged 18-65 years who underwent thyroidectomy for benign conditions were included. Patients were divided into two groups: COT and TOETVA, with 20 patients in each. Post-operative evaluations were conducted on days 15 and 30 using the Vancouver Scar Scale, the modified Stony Brook Scar Evaluation Scale and general/visual satisfaction questionnaires.

Results: Participants rated their surgeries on a scale of 1 (poor) to 4 (excellent) on days 15 and 30. No significant difference in visual scores was observed between groups. However, overall satisfaction scores were higher in the COT group on day 15 (3.5 ± 0.5 vs. 2.7 ± 0.9, P = 0.004) and day 30 (3.7 ± 0.5 vs. 3.1 ± 0.8, P = 0.021). Satisfaction scores and incision site oedema showed no significant differences between groups, but hyperaemia was significantly lower in the TOETVA group on day 30. Scar length was also significantly shorter in the TOETVA group.

Conclusion: Higher satisfaction in the COT group may result from post-operative pain and transient chin numbness in the TOETVA group, alongside short follow-up period. Longer-term studies could better evaluate these differences. The lack of a significant difference in satisfaction suggests that patients' expectations-shaped by the surgical approach they independently choose-may significantly influence their overall satisfaction. While satisfaction scores were similar, TOETVA provides a notable cosmetic advantage due to hidden incisions, making it particularly appealing for patients with aesthetic concerns. This technique represents a significant advancement in achieving patient-centred outcomes.

Objective: The objective of the study was to explore the feasibility of ordinary laparoscopic instruments for completing laparoscopic intragastric resection of mass near the cardia and pylorus without endoscopic assistance.

Patients and methods: From March 2018 to October 2022, laparoscopic intragastric resection was performed to remove submucosal masses near the cardia (7 cases) and antrum (3 cases) that were difficult to remove under gastroscopy. The diameter of the tumour is 1.0-4.0 cm, with an average of 2.75 cm. The results showed that all 10 cases underwent surgery smoothly, with a surgical time of 66-134 min, an average of 97.6 min, intraoperative bleeding of 10-30 mL, an average of 18 mL and post-operative hospitalisation of 3-7 days, an average of 4.3 days. No complications were occurred.

Conclusion: It is safe and feasible to complete transabdominal and transgastric resection of gastric masses using ordinary laparoscopic instruments without the assistance of endoscopy.

Abstract: A 52-year-old female patient with a history of liver transplantation due to alcoholic liver cirrhosis presented with persistent post-prandial pain, leading to substantial weight loss of 16 kg. The findings of contrast-enhanced computed tomography were consistent with the diagnosis of chronic pancreatitis, and endoscopic treatment provided no functional improvement. The patient was scheduled for a robot-assisted lateral pancreaticojejunostomy which was performed after initial lysis of adhesions from her prior liver transplantation. The procedure was completed safely using the robotic da Vinci Xi platform in 180 min, with an estimated blood loss of 300 mL. During the post-operative course, anaemia was noted and treated with a blood transfusion, and the patient was discharged on the post-operative day 4. The patient fully recovered without post-prandial pain and began regaining weight 1 month after the procedure. To the best of our knowledge, this is the first report of a successful robot-assisted lateral pancreaticojejunostomy following prior liver transplantation.

Background: Laparoscopic gastrostomy has improved surgical and cosmetic outcomes. Our approach involves a strategy of reduced port surgery, wherein only the umbilicus and tube insertion site were incised, with an additional port inserted if manipulation is difficult. This study aimed to investigate the outcomes of our reduced port gastrostomy strategy.

Patients and methods: The paediatric patients who underwent gastrostomy at our institution from July 2013 to March 2023 were reviewed retrospectively. Surgical outcomes were compared between patients who underwent reduced port gastrostomy and those who underwent multiport gastrostomy with or without fundoplication.

Results: Of the 78 patients who underwent gastrostomy, 25 and 39 patients who underwent reduced port gastrostomy and multiport gastrostomy with or without fundoplication, respectively, were included. Five patients who underwent reduced port gastrostomy required an additional port. The operative time during gastrostomy was shorter in the multiport gastrostomy group (21.3 min vs. 17.2 min, P = 0.00). One splenic injury in the reduced port gastrostomy group and one split of the stomach in the multiport gastrostomy group occurred and were completely repaired intraoperatively. No patient required reoperation within 30 days after gastrostomy. Post-operative complications, such as infection with pus (1 vs. 2, P = 1.00), external leakage requiring nutritional management change or tube replacement (2 vs. 2, P = 0.64) and tube dislodgement (1 vs. 0, P = 0.39), were similar between the two groups.

Conclusions: The strategy of reduced port gastrostomy was safe and cosmetically favourable compared with multiport gastrostomy.

Introduction: Navigation skills for controlling the camera in the surgical field are critical for many minimally invasive surgery (MIS) procedures. Currently, endoscopes lack integrated navigation aids, making camera control a challenging task. This experimental study aims to investigate the effect of navigation guidance on the performance of beginners.

Patients and methods: A custom computer-based simulation environment was developed for this study, featuring two conditions - one with navigation guidance and one without - focussed on a camera-cleaning task. Participants (64 beginners) were randomly assigned to one of these groups and used two haptic devices to simulate the endoscope and surgical tools.

Results: Participants in the guided condition performed significantly better than those in the unguided condition. Notably, female participants completed the task in significantly less time under the guided condition compared to the unguided one.

Conclusion: These findings suggest that incorporating navigation aids into endoscope interfaces could improve user performance, especially for beginners. Medical device manufacturers should consider adding navigation features to enhance usability. In addition, simulation-based instructional systems should integrate navigation aids to better support surgical training.

Abstract: Splenectomy can be performed using various surgical approaches, including open, laparoscopic (LS), and robotic splenectomy (RS). While LS has been the mainstay for many years, it is associated with a steep learning curve and increased rates of morbidity and conversion to open surgery in complex cases such as splenomegaly, obesity, haematological malignancies, and patients with prior laparotomies. RS has emerged as a technique that facilitates a spleen-focused dissection, potentially reducing anatomical disruption and operative risk. This systematic review aimed to compare the peri-operative outcomes of LS and RS in non-traumatic indications for splenectomy. A comprehensive search was conducted in MEDLINE, Embase, CINAHL, and CENTRAL databases, along with searches for unpublished and ongoing studies through the World Health Organization platform. Data extraction was standardized using a pre-tested collection form, and statistical methods were employed to derive mean values where only medians and interquartile ranges were reported. The results demonstrated that the mean operative time was longer in the RS group, although the difference was not statistically significant. Conversion to open surgery occurred in 12 LS cases compared to 2 RS cases. Post-operative complications were more frequent in the LS group (9 patients) compared to the RS group (1 patient), with most complications observed after 24 hours. The mean length of hospital stay was similar between groups (6.0 days for RS vs. 6.5 days for LS; P = 0.89). RS was associated with lower mean intraoperative blood loss compared to LS. In conclusion, RS may offer advantages over LS in terms of reduced blood loss, lower conversion rates, and fewer postoperative complications, although it does not significantly impact hospital stay duration or cost-effectiveness and is associated with longer operative time.

Abstract: Caecal volvulus is a rare complication in the post-operative period which if missed can result in fatal complications. We present our experience with a 50-year-old female with complex ventral hernia (L3L4 W2 as per European Hernia Society Classification) who underwent extended view totally extraperitoneal repair with unilateral transversus abdominis release and developed post-operative caecal volvulus with acute small intestinal obstruction. She was taken up for emergency surgery and underwent diagnostic laparoscopy with open right hemicolectomy and mesh explantation. Surgeons must be aware of the possibility of such a rare complication, the means of diagnosis and modalities of treatment available for the treatment of caecal volvulus.