Videosurgery and Other Miniinvasive Techniques最新文献

Introduction: Computed tomography (CT)-guided suture anchor localizer (SAL) placement is increasingly used to facilitate preoperative localization of pulmonary nodules (PNs) before video-assisted thoracoscopic surgery (VATS). Although this approach is well established for single nodules, evidence regarding its application in multiple nodules remains limited.

Aim: We aimed to evaluate the safety and efficacy of CT-guided SAL placement for simultaneous localization of multiple PNs.

Materials and methods: A 2-center retrospective study was conducted enrolling patients who underwent CT-guided SAL placement for multiple PNs followed by VATS resection between January 2023 and December 2024. A contemporaneous cohort undergoing single PN localization served as the control group. Clinical outcomes and procedural complications were compared between the groups.

Results: A total of 49 patients underwent the localization of 106 PNs in the multiple-nodule group, whereas 163 patients underwent the localization of 163 single PNs in the single-nodule group. The technical success of SAL placement was 100% in both groups. Localization time was longer in the multiple-nodule group (P <⁠0.001). Pneumothorax and intrapulmonary hemorrhage occurred more frequently after multiple SAL placements (36.7% and 28.6%, respectively), as compared with single-nodule localization (18.9% and 16%; P = 0.007 and P = 0.048, respectively). Despite these differences, the technical success of VATS sublobar resection was 100% in both cohorts.

Conclusions: CT-guided SAL placement is a reliable and safe method for preoperative localization of multiple PNs. Our findings supportin its clinical utility in patients undergoing VATS.

Introduction: The necessity of mesh fixation in laparoendoscopic repair of large medial (classified by the European Hernia Society as M3) inguinal hernias (IHs) remains debated. Recent data, including the MEFISTO randomized controlled trial, suggest that rigid, anatomically contoured meshes may provide sufficient stability of hernia repair without mesh fixation, potentially reducing fixation-related complications. However, biomechanical performance of newly introduced anatomical meshes has not been thoroughly evaluated.

Aim: This study aimed to assess the mechanical stability of 2 newly introduced anatomically shaped meshes-SWING-Mesh and 3DMax MID Anatomical Mesh-in a validated pressure chamber model simulating M3 IH defects.

Materials and methods: A rigid 3-dimensionally (3D) printed groin model with a 4-cm medial defect was mounted in a sealed pressure chamber capable of generating intra-abdominal pressures of up to 70 kPa. Two meshes were tested: SWING-Mesh (lightweight polypropylene; 55 g/m²; 16 cm × 12 cm) and 3DMax MID Anatomical Mesh (medium-weight polypropylene; 78 g/m²; 17 cm × 12 cm). Both were positioned with an at least 3-cm overlap beyond the defect margins without fixation. Initial testing was performed at 36 kPa. If displacement occurred, lower pressures were applied; if stability was maintained, higher overload pressures were used. Each experiment was repeated 3 times, with outcomes documented on photo and video material. The primary end point was mesh displacement into the defect.

Results: SWING-Mesh consistently displaced into the defect at 36 kPa in all trials. Supplementary tests showed migration as early as at 10 kPa. In contrast, 3DMax MID Anatomical Mesh remained stable at 36 kPa in all repetitions. Overload testing confirmed its resistance at 53, 60, and 70 kPa-the maximum achievable pressure in the chamber-without measurable displacement.

Conclusions: SWING-Mesh failed to provide stability even under moderate intra-abdominal pressures, which questions its suitability for nonfixed repair of M3 hernias. 3DMax MID Anatomical Mesh demonstrated complete stability under both physiologic and supraphysiologic conditions, confirming the mechanical advantage of medium-weight 3D meshes. Implant design, weight, and stiffness appear more decisive for stability than fixation, supporting the selective use of nonfixation techniques when rigid meshes are applied.

Introduction: Biliary stenting with radioactive seed placement has become a frequently applied palliative intervention for patients with obstructive hilar cholangiocarcinoma (HC). Despite its increasing use, evidence comparing unilateral and bilateral stenting with radioactive seed placement remains limited.

Aim: This study aimed to compare clinical effectiveness and safety of unilateral and bilateral stenting with radioactive seed placement in patients with obstructive HC.

Materials and methods: A retrospective review of consecutive patients treated with a stent with radioactive seed placement for obstructive HC between January 2022 and December 2024 was conducted. The patients were categorized into the unilateral or bilateral groups based on the stent placement approach. Technical success, clinical response, stent patency, overall survival, and complications were compared between the groups.

Result: A total of 89 patients were analyzed, including 47 in the unilateral group and 42 in the bilateral group. Primary technical success was achieved in 91.5% and 95.2% of the patients, respectively (P = 0.68), while the secondary success rate was 100% for both groups. Clinical success rates were comparable (89.4% vs 90.5%; P >0.99). Median (interquartile range [IQR]) stent patency was 220 (160-256) days for unilateral placement and 210 (166-216) days for bilateral placement (P = 0.79). Median (IQR) overall survival was 255 (178-369) and 242 (175-362) days, respectively (P = 0.79). Incidence of cholangitis (10.6% vs 9.5%; P >0.99) and bleeding (4.3% vs 4.8%; P >0.99) did not differ between the groups.

Conclusion: Both unilateral and bilateral stenting with radioactive seed placement provide equivalent safety and efficacy in the management of obstructive HC.

Introduction: Unilateral biportal endoscopic (UBE) surgery enables precise treatment of lumbar spine pathologies due to its inherent advantages typical of minimally‑invasive endoscopic procedures, including reduced intraoperative blood loss and minimal soft tissue dissection. However, hidden blood loss (HBL) remains a significant challenge in UBE, with limited data regarding its incidence and risk factors.

Aim: This study aimed to investigate risk factors associated with HBL in UBE surgery.

Materials and methods: Original studies evaluating risk factors for HBL in UBE surgery were systematically searched in MEDLINE, Embase, China National Knowledge Infrastructure, Wanfang Data, and the Cochrane Central Register of Controlled Trials (up to March 2025). The included studies met the quality assessment criteria of the Newcastle‑Ottawa Scale.

Result: Six studies involving 601 patients subjected to lumbar UBE surgery were included. Our meta‑analysis identified that higher body mass index (BMI), prolonged surgical time, preoperative hypertension, and elevated preoperative hematocrit (HCT) levels were significant risk factors for increased HBL in UBE surgery (P <0.05). Sensitivity analysis confirmed the robustness of these findings, with no changes in the significance of the pooled results.

Conclusion: Higher BMI, prolonged surgical time, preoperative hypertension, and elevated preoperative HCT levels are associated with an increased risk of HBL in patients undergoing lumbar UBE surgery. This study serves as a baseline reference for developing public health strategies to mitigate HBL in UBE procedures.

To address the lack of standardized procedures for concurrent stress urinary incontinence (SUI), cystocele, and vaginal laxity, we developed a novel, integrated approach that employs a customized inverted T-shaped sling for bladder neck-to-midurethral suspension combined with modified posterior pelvic reconstruction. The widened sling design with posteriorly shifted suspension vector prevents postoperative voiding dysfunction associated with traditional slings. The modified reconstruction technique employs high-strength absorbable barbed sutures for bilateral levator ani plication and perineal body reinforcement, which reduces urogenital hiatus dimensions, corrects vaginal laxity, and prevents long-term recurrence through the enhanced level III support. A 46-year-old woman with concomitant SUI, stage II cystocele (according to the Pelvic Organ Prolapse Quantification system), and vaginal laxity successfully underwent the procedure. Magnetic resonance imaging performed 6 months portsurgery confirmed adequate bladder repositioning. During the 24-month follow-up, SUI symptoms were resolved, pelvic / perineal discomfort diminished, and vaginal laxity during intercourse improved. This technique appears to represent a feasible single-stage solution for women presenting with concurrent SUI, cystocele, and vaginal laxity, providing comprehensive anatomical and functional restoration.

Introduction: Hiatal hernia (HH) repair with mesh reinforcement is a commonly performed procedure to reduce the recurrence of HH. Mesh migration (MM) remains a rare but serious complication.

Aim: The aim of this study was to analyze the existing literature on MM after HH repair in the context of a clinical case discussion.

Materials and methods: This study is a nonsystematic narrative review supplemented by a case report.

Result: A 70-year-old woman who underwent HHR with partially absorbable Seramesh PA DRUM mesh was diagnosed with MM into the esophagus 9 months postoperatively. The esophageal fistula was treated successfully with endoscopic vacuum therapy. Three-month follow-up showed stable oral intake without symptoms. MM is influenced by mesh material, fixation technique, and esophageal dynamics. Clinical presentation often includes dysphagia, pain, and weight loss, while diagnosis relies on endoscopy imaging. Management strategies vary from observation to endoscopic or surgical removal, with minimally-invasive approaches preferred when feasible. This case is the first reported instance involving the Seramesh PA DRUM mesh, and highlights the potential role of immune dysregulation and hypersensitivity in MM.

Conclusion: Early recognition, individualized management, and the use of minimally-invasive techniques may improve outcomes. Continued research and long-term follow-up are essential to better understand risk factors and establish optimal treatment strategies.

Introduction: Vaginal natural orifice transluminal endoscopic surgery (vNOTES) for bilateral tubal ligation may cause notable early postoperative pain, leading to opioid use. Paracervical block (PBC) could support analgesia within enhanced recovery after surgery (ERAS) pathways.

Aim: The aim of this study was to evaluate whether the use of PBC improved postoperative pain scores, reduced analgesic requirements, and affected short-term sexual function.

Materials and methods: In this retrospective cohort study, 43 women underwent bilateral tubal ligation via vNOTES at the Iğdır Dr. Nevruz Erez State Hospital. Twenty patients received PBC with 10 ml of 0.5% bupivacaine injected at the 3 and 9 o'clock cervicovaginal junction, whereas 23 women served as controls. Outcomes included visual analog scale (VAS) pain scores at 1, 6 and 24 hours postoperatively, intra- and postoperative opioid use, and Female Sexual Function Index (FSFI) scores preoperatively and 1 month after surgery.

Result: PBC significantly lowered 24-hour VAS scores (mean [SD], 3 vs 4; P = 0.02) and intraoperative opioid requirement (mean [SD], 0 vs 10 mg morphine equivalent; P = 0.01). Total postoperative analgesic consumption and length of hospital stay were comparable. FSFI scores 1 month after surgery were higher in the PBC group than the controls (mean [SD], 206 vs 14.5 respectively; P = 0.001), indicating better short-term sexual function recovery.

Conclusion: Incorporating PBC into vNOTES enhances early pain control and decreases intraoperative opioid use without delaying discharge, while favorably influencing short-term sexual function. PBC is a simple, effective adjunct that aligns with ERAS goals in minimally-invasive gynecologic surgery.

Introduction: Adrenal hemorrhage (AH) is a rare and often underdiagnosed condition that can present with nonspecific symptoms and may be life-threatening. Accurate diagnosis and tailored management are essential.

Aim: The aim of this paper was to review the literature on AH with emphasis on etiology, diagnostic approaches, management strategies, and methodological quality of available studies.

Materials and methods: A structured search of the literature was performed. Forty-one relevant articles were included in the review. Risk of bias was assessed in 3 eligible studies (2 single-center series and 1 case series with literature review) using the Joanna Briggs Institute tools and adapted criteria.

Result: Trauma accounted for the majority of AH cases. Nontraumatic etiologies included anticoagulation, infection, stress, and adrenal tumors, such as pheochromocytoma, adrenocortical carcinoma, and metastases. Computed tomography and magnetic resonance imaging were the key diagnostic modalities. Management strategies ranged from conservative observation and embolization to laparoscopic or open adrenalectomy, guided by hemodynamic stability, capsule integrity, and suspicion of malignancy. All assessed studies had moderate risk of bias due to retrospective design and limited sample size.

Conclusion: AH requires high clinical suspicion and structured imaging / endocrine evaluation. Open adrenalectomy is recommended in unstable patients, in the cases of capsule rupture, or when malignancy is suspected. In patients with hemorrhage confined to the adrenal capsule, laparoscopic adrenalectomy represents the preferred surgical approach. Larger prospective multicenter studies are warranted to establish standardized guidelines.

Introduction: Colorectal cancer (CRC) is a leading cause of cancer-related death globally, where precise lymph node (LN) assessment remains critical for accurate staging and prognosis. Indocyanine green fluorescence imaging (ICG-FI) has emerged as a potential tool to enhance intraoperative lymphatic visualization and guide tailored lymphadenectomy.

Aim: This scoping review evaluated the current evidence on ICG-FI lymphatic mapping in CRC surgery, focusing on its impact on surgical outcomes and identifying research gaps.

Materials and methods: A comprehensive literature search of the MEDLINE database (2005-2025) was performed using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. The included studies investigated ICG-FI lymphatic mapping in adult CRC patients. A qualitative synthesis was conducted across the following thematic domains: mesenteric mapping, sentinel LN (SLN) assessment, and lateral pelvic LN dissection (LPLND).

Result: Of the 67 records identified, 34 studies met the inclusion criteria. Several studies demonstrated ICG-FI safety and feasibility, with high lymphatic flow visualization rates (75.4%-100%) and improved LN yield. Aberrant LN detection occurred in up to 50% of the cases, although these were rarely metastatic. SLN mapping showed high detection rates but variable sensitivity (63%-75%) and frequent false negatives. LPLND guided by ICG-FI showed a potential in reducing lateral recurrence, but not in improving overall survival.

Conclusion: ICG-FI enhances anatomical precision during CRC surgery and facilitates individualized lymphadenectomy. However, its oncologic benefit remains unproven. Standardization of protocols and further prospective studies are required to validate its clinical utility and long-term impact on patient outcomes.

Introduction: The unilateral biportal endoscopy (UBE) technique has demonstrated favorable outcomes in lumbar discectomy and decompressive laminectomy. IntraSPINE is an innovative interlaminar dynamic stabilization device providing a minimally-invasive alternative for the treatment of degenerative lumbar diseases.

Aim: The objective of this study was to describe the rationale, surgical technique, and preliminary results of an innovative approach involving integration of UBE discectomy and interlaminar stabilization using IntraSPINE for the treatment of huge lumbar disc herniation (LDH).

Materials and methods: We analyzed 5 consecutive patients with huge LDH who underwent UBE decompressive laminectomy and discectomy combined with IntraSPINE interlaminar dynamic stabilization at our hospital between May and August 2023. The IntraSPINE interlaminar spacer was implanted contralaterally to the symptomatic interlaminar space with the assistance of UBE. X-ray, computed tomography, and magnetic resonance imaging were used to evaluate the range of segmental movement, posterior disc height (PDH), and disc degeneration at the baseline, after surgery, and at the final follow-up. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI).

Result: The procedure was successfully completed in all patients. Postoperative radiological imaging showed an increase in PDH and no exacerbation of lumbar disc degeneration. The VAS and ODI scores recorded after surgery and at the final follow-up visit improved remarkably, as compared with the baseline values. No surgery-related complications were reported.

Conclusion: The combination of UBE and IntraSPINE technology demonstrated good short-term outcomes. The advantages of this hybrid approach include maintaining intervertebral height, preserving intervertebral disc structure, and minimal invasiveness.