Journal of Minimal Access Surgery最新文献

Introduction: One of the critical steps involved is the distal transection of the rectum in rectal cancer surgeries. Multiple staple firings have been proven to increase the rate of anastomotic leakage. In this study, we intended to learn the effectiveness of the robotic SureForm SmartFire (SS) stapling system and its application in robotic sigmoid colon and rectal procedures performed at our institution.

Patients and methods: Prospective study of patients who underwent surgeries for sigmoid/rectal cancer at our centre was considered. During the surgery, SS staplers were used, and its internal data log with regard to reload selection by the colour, reloads, clamp attempts and staple fires was considered along with intra- and post-operative outcomes.

Results: 246 firings were done in 147 cases with mean body mass index of 26.3 ± 4.3 kg/m2; mean blood loss was 53.6 ± 21.8 ml. None of our patients had stapler-related complications, and the mean length of stay was 7.18 ± 1.5 days. Average reloads used in robotic-low anterior resection (LAR) were 1.73 with the fire attempts beyond lap angle occurring only in robotic-assisted LAR (RA-LAR)/abdominoperineal resection in 87 fires (41%) with 120 instances of controlled and sequential pauses occurred in 246 fires once fire pedal was activated.

Conclusion: Apart from oncological nodal and margin clearance in the carcinoma rectum surgery, obtaining adequate distal margin, sphincter preserving approach and distal transection of the rectum forms one of the key steps in the low anterior resection. Robotic SS staplers have 120° angulation in both axes with EndoWrist technology that has better manoeuvrability within the confines of the pelvis.

Introduction: The post-operative rehabilitation and prognostic indexes of thoracoscopic segmental resection and wedge resection in the treatment of early-stage non-small cell lung cancer (NSCLC) were retrospectively analysed. The objective of this study was to provide a theoretical basis for the treatment of early-stage NSCLC in the elderly.

Patients and methods: One hundred and twenty elderly patients diagnosed with early-stage NSCLC in our hospital from January 2018 to December 2021 were selected as study subjects. The patients were divided into the thoracoscopic segmental lung resection group and the thoracoscopic wedge resection group. Various clinical data were compared between the two groups of patients.

Results: In the thoracoscopic wedge resection group, operation time, anaesthesia time, intraoperative blood loss, post-operative chest tube volume, chest tube indwelling time and hospital stay were significantly higher compared to the thoracoscopic segmental lung resection group. Patients undergoing segmental resection also had higher Visual Analogue Scale scores and serum indices. In addition, the mini-mental state examination scores were lower in the segmental resection group compared to the wedge resection group.

Conclusions: Thoracoscopic segmental resection and thoracoscopic wedge resection were both safe and feasible for the treatment of NSCLC. However, thoracoscopic segmental resection had the advantage of effectively reducing the amount of intraoperative bleeding, shortening the operation time and having less impact on lung function and physical function. This was conducive to the patient's faster recovery after surgery.

Abstract: The synchronous occurrence of pancreatic neuroendocrine neoplasm (PNEN) and clear cell renal cell carcinoma (ccRCC) in one patient is extremely rare. Synchronous resection of both tumours is preferred over a two-stage procedure if possible. The robotic da Vinci Xi platform allows for multi-quadrant surgery with oncological outcomes comparable to those of laparoscopic or open surgery. We present the case report of an 80-year-old male who underwent synchronous resection of a PNEN in the tail of the pancreas and ccRCC in the left kidney. To the best of our knowledge, this is the first case report on this topic.

Abstract: Technical difficulties are often encountered in a laparoscopic cholecystectomy where a tense/distended/ turgid gall bladder prevents the surgeon from grasping the gall bladder properly which therefore necessitates the decompression of the turgid gall bladder. However, even if intraoperative decompression is done, the spillage of remnant stones, bile or fluid from the gall bladder is a possibility which can lead to undue complications. This is where following the simple technique of using a gauze piece with a radio-opaque marker to occlude the decompression puncture site helps in performing a safe decompression thereby preventing bile, fluid or stone spillage.

Introduction: Uniportal video-assisted thoracoscopic surgery (Uni-VATS) is an effective minimally invasive technique for pericardial drainage, biopsy and window creation in cases of pericardial effusion (PE).

Patients and methods: This retrospective study evaluated 73 patients with PE who underwent pericardial window procedures between 2012 and 2024. Intraoperative and post-operative data related to Uni-VATS were assessed.

Results: The mean age of the patients was 53.79 ± 17.79 years (10-82 years), with 34 (46.6%) females and 39 (53.4%) males. The mean volume of pericardial fluid drained after window creation was 446.23 ± 199.81 cc (75-1100 cc). The mean operation time was 42.87 ± 12.79 min, and chest drain removal occurred after an average of 1.8 ± 1.2 days. The mean duration until discharge or referral to the follow-up clinic was 5.98 ± 2.14 days. In addition to the pericardial window procedure, pleural biopsy was performed in 12 patients, mediastinal mass biopsy in eight patients and wedge resection for parenchymal nodules in six patients. Microbiologic and virologic cultures of the fluids were negative in all cases. Among the 41 patients with benign cytology, pericardial biopsy results indicated tuberculosis in four patients (5.4%), amyloidosis in one patient (1.3%) and chronic or subacute nonspecific pericarditis in the remaining patients.

Conclusion: Uni-VATS is a novel and safe technique that may be the preferred choice for pericardial window due to its diagnostic and therapeutic efficacy, ability to perform simultaneous procedures, favourable impact on operation duration/hospital stay, low complication rates and superiority compared to traditional methods.

Introduction: Post-operative pulmonary complications (PPCs) are a significant cause of morbidity following surgery. This study evaluated the effect of intraoperative positive end-expiratory pressure (PEEP) on PPCs in overweight patients undergoing elective laparoscopic hernia surgery.

Patients and methods: In this randomised controlled trial, 60 patients with a body mass index between 25 and 30 kg/m² were divided equally into a standard PEEP group (5 cm H2O) and a high PEEP group (10 cm H2O). The primary outcome was the incidence of PPCs, with secondary outcomes assessing intraoperative respiratory mechanics, haemodynamics and post-operative oxygenation levels.

Results: Both groups demonstrated comparable demographic and baseline characteristics. The results showed a significant reduction in the incidence of PPCs in the high PEEP group, with atelectasis observed in 16% of control patients versus 6% of those receiving higher PEEP. In addition, the high PEEP group exhibited improved dynamic lung compliance and oxygenation but had an increased mean arterial pressure, indicating haemodynamic effects associated with higher PEEP levels. While the Cabrini Respiratory Strain Score and air test scores were comparable, patients in the high PEEP group had shorter durations of supplemental oxygen therapy and improved post-operative oxygenation at 6, 12 and 24 h.

Conclusion: These findings suggest that high PEEP may enhance lung mechanics and oxygenation while reducing PPCs in overweight patients, although careful monitoring of haemodynamic stability is recommended.

Background: We aimed to assess the therapeutic effects of single-port thoracoscopic anatomical segmentectomy on early-stage non-small-cell lung cancer (NSCLC).

Patients and methods: Sixty patients with early-stage NSCLC admitted from December 2022 to July 2023 were selected and divided into a lobectomy group ( n = 30) and a segmentectomy group ( n = 30) according to the different procedures. Their perioperative indicators, pre-operative and post-operative pulmonary function indicators, pain degree 24 h, 48 h, 72 h and 7 day after operation, the incidence of post-operative complications and recurrence, survival and mortality rates 1 year after operation were compared.

Results: The segmentectomy group had significantly smaller intraoperative blood loss, shorter length of drainage and length of hospital stay and longer operation time than those of the lobectomy group ( P < 0.05). The pulmonary function decreased significantly in both groups 1 week, 1 month and 3 months after operation. Compared with the lobectomy group, the forced expiratory volume in 1 s per cent, forced-vital capacity per cent and maximal voluntary ventilation of the segmentectomy group significantly increased at each time point after operation ( P < 0.05). The Visual Analogue Scale scores 24 h, 48 h, 72 h and 7 days after operation were significantly lower in the segmentectomy group than those in the lobectomy group ( P < 0.05). There were no significant differences in the incidence of post-operative complications and recurrence, survival and mortality rates 1 year after operation between the two groups ( P > 0.05).

Conclusions: Single-port thoracoscopic anatomical segmentectomy has obvious therapeutic effects on early-stage NSCLC, characterised by smaller surgical trauma, milder post-operative pain and less impact on pulmonary function.

Abstract: Common bile duct (CBD) stones are usually caused by biliary tract infection, biliary stricture, duodenal peripapillary diverticulum, Oddis sphincter dysfunction, and so on. Treatment is preferably with endoscopic retrograde cholangiopancreatography (ERCP), where an iodine-containing contrast agent is injected into the CBD to display the stone under fluoroscopy and then to confirm complete removal of the stone(s). We described a 65-year-old woman with CBD stones who had undergone cardiac pacemaker implantation and was allergic to iodinated contrast media. We performed ERCP + lithotomy + stent implantation under local anesthesia, with injection of carbon dioxide instead of iodinated contrast into the CBD, and successfully visualized the stones under fluoroscopy and then confirmed complete removal of them. The patient was generally in good condition without complications. Thus, we have demonstrated in this case report that carbon dioxide can be used as a safe, economical, and effective alternative to iodinated contrast agent during ERCP.

Introduction: Patients with familial adenomatous polyposis (FAP) are characterised by the appearance of colorectal cancer if the disease is left to follow its natural course, which means they frequently undergo prophylactic colectomy at a young age. In these patients, duodenal cancer becomes the leading cause of death, which deems surveillance necessary. Gastric cancer, although rare, can also occur in these patients, and total gastrectomy is the usual treatment option.

Patients and methods: We used a pedicled isoperistaltic jejunal flap interposition technique to reconstruct the digestive tract after a total gastrectomy so that duodenal surveillance could be maintained in patients followed in outpatient consultation for genetic diseases. We also describe how this technique was performed fully through laparoscopy in two of these cases.

Results: We identified four patients with FAP who developed malignant or extensive pre-malignant gastric lesions which were not endoscopically resectable. Two patients were submitted to open surgery and the remaining two underwent laparoscopic surgery. There was no perioperative or post-operative morbidity, and all four patients are alive at the time of writing, with a minimum follow-up of 12 months. They were not diagnosed with major nutritional imbalances and were routinely submitted to endoscopic duodenal surveillance, sometimes including polypectomy, with ease.

Conclusion: In our experience, this surgical technique has good results, and all surgical steps can be done entirely through laparoscopy, with every advantage this approach entails.

Introduction: Pancreaticojejunostomy have been studied and modified for more than a hundred years. We investigated a new method of pancreaticojejunostomy to explore its value in laparoscopic pancreaticoduodenectomy.

Patients and methods: A retrospective analysis was conducted on the clinical data of 93 patients who underwent laparoscopic pancreaticoduodenectomy with 'Shunt-block combined' pancreaticojejunostomy at Ningbo Medical Center Lihuili Hospital from April 2017 to February 2023.

Results: All patients successfully completed the surgery, with two cases requiring conversion to open surgery. The average operation time was 328.5 (180-532) min, the average intraoperative blood loss was 182.9 (50-1000) mL and the average laparoscopic pancreaticojejunostomy time was 29.6 (20-39) min. There were no cases of grade C pancreatic fistula postoperatively, 10 cases of grade B pancreatic fistula, 43 cases of biochemical fistula and 40 cases without detected pancreatic fistula.

Conclusion: 'Shunt-block combined' pancreaticojejunostomy was a safe and effective method for pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy.