Videosurgery and Other Miniinvasive Techniques最新文献

Introduction: Bariatric surgery effectively contributes to substantial weight loss and improvement of obesity‑related comorbidities. Establishing new bariatric programs, particularly in hospitals without intensive care units, requires tailored implementation strategies and careful resource planning to ensure both safety and efficacy.

Aim: The aim of this study was to retrospectively assess the safety and efficacy outcomes of a newly implemented bariatric program the Military Institute of Aviation Medicine.

Materials and methods: This retrospective study evaluated all bariatric surgeries (n = 267) performed between September 2021 and December 2024 at our hospital following the establishment of a comprehensive bariatric program. The program included surgeon training, multidisciplinary team formation, protocol development, and infrastructure modifications. Patient demographics, operative details, complications, weight loss outcomes, and resolution of comorbidities were analyzed.

Result: Laparoscopic sleeve gastrectomy (LSG) was the predominant procedure (85.77%), followed by laparoscopic Roux‑en‑Y gastric bypass (LRYGB, 13.86%). Mean (SD) operative time was 145 (35) minutes for LRYGB and 77 (19) minutes for LSG. Overall, 93.1% of the patients had no complications, with the rate of serious complications requiring surgical intervention (Clavien-Dindo grade IIIB) decreasing from 7.69% in 2021 to 0.97% in 2024. No mortalities occurred. Among the 112 patients (68.3%) with available follow‑up data, mean (SD) percentage of total weight loss was 29.61% (12.08%) for LRYGB and 25.92% (10.57%) for LSG. High rates of comorbidity resolution were observed for type 2 diabetes mellitus (90.91%), hypertension (65.79%), dyslipidemia (70%), and metabolic syndrome (91.67%).

Conclusion: With careful planning, comprehensive team training, and adherence to established protocols, a new bariatric surgery program can achieve excellent safety and effectiveness outcomes from inception. The results validate our approach to program development and patient care.

Introduction: Minimally-invasive, organ-preserving techniques for uterine fibroid management have gained popularity. This study assesses the safety and effectiveness of combining transcervical fibroid ablation (TFA) with operative hysteroscopy (HSC).

Aim: We aimed to evaluate whether a combined approach that involves performing TFA and operative HSC during a single session increased the intra- and postoperative risks.

Materials and methods: A total of 200 women were included in this retrospective study. They were divided into 2 groups: 100 underwent combined TFA and operative HSC (group 1), and 100 underwent HSC alone (group 2). Surgical procedures included fibroid / polyp resection, endometrial ablation, and septum dissection. Outcomes assessed comprised intra- and postoperative complications and symptom improvement.

Result: Complication rates were low and comparable in both groups. Among the patients in group 1 with available follow-up (n = 60), 83.3% reported improvement in bleeding symptoms, particularly those treated with TFA combined with myomectomy (84%). The combined approach enabled treatment of a broader range of fibroid types (International Federation of Gynecology and Obstetrics score 0-6) and intrauterine pathologies in a single session. No severe or life-threatening complications were observed. The risk of bleeding during fibroid resection was reduced when the resection was preceded by TFA (P = 0.001).

Conclusion: Combining TFA and HSC appears to be a safe, effective, and versatile approach for treating uterine fibroids and intrauterine pathologies. It offers procedural efficiency, broadens treatment eligibility, and may reduce the need for reintervention.

Introduction: Preoperative assessment of ureteral adhesions related to stones is crucial for choosing the right surgical approach.

Aim: This study aimed to evaluate clinically significant factors for predicting the development of adhesions between the calculus and the mucosa in patients with ureteral stones undergoing retrograde intrarenal surgery.

Materials and methods: The study included 173 patients. Ureteroscopy was performed to accurately identify the presence of adhesions between the calculus and the mucosa. Univariate and multivariable logistic regression analyses were performed to identify independent factors predicting adhesions. An alignment diagram model was developed utilizing the independent factors identified. Discrimination and calibration of the model were evaluated via the receiver operating characteristic curve and further examined via calibration curves, decision curve analysis, and cumulative intervention curves.

Result: Adhesions between the calculus and the mucosa were confirmed on ureteroscopy in 48 patients (27.7%). Multivariable logistic regression analyses showed that ureteral wall thickness (UWT), hydronephrosis severity, perirenal fat stranding (PFS), and pain intensity were independent risk predictors of adhesions (P <⁠0.001; P <⁠0.001; P = 0.02; P = 0.02, respectively). The estimated area under the curve in the group with and without adhesions was 0.849 (95% CI, 0.742-0.832) and 0.888 (95% CI, 0.829-0.833), respectively, demonstrating an excellent predictive performance of the model.

Conclusion: UWT, PFS, hydronephrosis severity, and pain intensity are independent risk factors for the development of adhesions between the calculus and the mucosa. Our predictive model exhibited outstanding performance, and it may help clinicians choose the most appropriate surgical method.

Introduction: Papillary thyroid carcinoma (PTC) is a malignancy originating from the thyroid follicular epithelium, accounting for over 80% of thyroid cancer globally. It is often asymptomatic in its early stages, but over time, it may invade the unilateral recurrent laryngeal nerve (RLN), leading to hoarseness, weak speech, or dysphagia. In order to prevent further complications, prompt treatment is required, and surgery remains the primary and most effective option.

Aim: This study aimed to evaluate the protective effect of complete endoscopic thyroidectomy (CET) via different approaches on the RLN.

Materials and methods: The study analyzed clinical data of 100 patients with clinically node-negative PTC, who underwent CET via the breast approach from February 2023 to February 2025. The patients were divided into 2 groups: the control group (n = 55) which underwent CET via the axillary approach and the study group (n = 45), subjected to CET via the clavicular approach.

Result: Postoperative assessments showed considerable improvements in amplitude perturbation, fundamental frequency perturbation, harmonic-to-noise ratio, and normalized noise energy in both groups, with the study group demonstrating superior results (P <⁠0.05). One month after surgery, the voice handicap index score decreased in both groups, as compared with preoperative levels, the study group having obtained a lower score (P <⁠0.05). The Scar Cosmesis Assessment and Rating score increased postoperatively in both groups, with a higher score recorded in the study group (P <⁠0.05). The Short Form-36 Heath Status Questionnaire scores increased across all dimensions postoperatively in both groups, with the study group showing greater improvements (P <⁠0.05).

Conclusion: Compared with the axillary approach, CET via the clavicular approach results in greater postoperative improvements in acoustic parameters, lower voice handicap index scores, better scar appearance, and higher Short Form-36 health status scores.

Introduction: Both best medical treatment (BMT) and endovascular repair (ER) are viable treatment strategies in uncomplicated acute type B aortic dissection (TBAD). However, long-term outcomes of these 2 approaches remain a topic of debate.

Aim: This study was developed to compare the clinical efficacy, short-term outcomes, and long-term results of ER and BMT in the management of uncomplicated TBAD.

Materials and methods: This retrospective, single-center study included consecutive individuals diagnosed with uncomplicated TBAD who underwent ER or BMT between January 2019 and August 2024. Relative outcomes for these 2 treatment approaches were compared.

Result: In total, 165 and 148 patients who respectively received ER and BMT were enrolled in the analysis. Relative to BMT, ER significantly increased the thrombosed / obliterated false lumen rate (81.8% vs 16.2%, respectively; P = 0.001), reduced the rupture rate (1.8% vs 12.2%, respectively; P = 0.001), and decreased late mortality (4.8% vs 14.2%, respectively; P = 0.004). The rates of retrograde type A dissection, organ failure, and early mortality in the BMT and ER groups were similar (1.8% vs 3.4%; P = 0.48; 0.6% vs 2%; P = 0.35; 0.6% vs 4.1%; P = 0.06, respectively). In the ER group, the overall survival rates at 1, 3, and 5 years were 98.8%, 96.5%, and 94.6%, respectively, while the BMT group exhibited corresponding survival rates of 94.5%, 91.5%, and 84.7%.

Conclusion: In comparison with BMT, ER significantly reduces rupture rate and enhances thrombosed / obliterated false lumen rate, thereby improving long-term prognosis.

Introduction: Stents and decompression tubes (DTs) are both commonly utilized for preoperative decompression in patients with left-sided obstructive colorectal cancer (OCRC). However, the comparative effectiveness and oncological safety of these 2 approaches remain uncertain.

Aim: The aim of this study was to compare clinical performance and long-term oncological outcomes of preoperative stent and DT insertion in patients with left-sided OCRC.

Materials and methods: The study included 87 consecutive patients, diagnosed with left-sided OCRC between January 2022 and December 2024. All patients underwent preoperative decompression using either a stent or a DT. Clinical decompression efficacy, surgical outcomes, and oncological parameters were compared between the groups.

Results: Among the 87 patients enrolled, 45 received a stent and 42, a DT. Technical success rates were similar between the groups (stent, 95.6% vs DT, 97.6%; P >0.99), as were clinical success rates (stent, 88.9% vs DT, 90.5%; P >0.99). Perforation occurred in 3 patients (6.7%) in the stent group and 1 participant (2.4%) in the DT group (P = 0.62). Primary anastomosis was achieved in 84.4% of the stent patients and 81% of the DT patients (P = 0.67). Median disease-free survival was 32 (21-43) months in the stent group and 34 (25-43) months in the DT group (P = 0.35), while median overall survival was 38 (29-47) and 39 (34-44) months, respectively (P = 0.53), with no apparent differences between the groups.

Conclusions: Both stent and DT insertion are safe and effective strategies for preoperative left-sided OCRC management. No significant differences in either short-term clinical outcomes or long-term oncological results were observed between the 2 methods.

Introduction: Obliterative bronchiolitis, the clinical manifestation of bronchiolitis obliterans syndrome (BOS), is a major complication of lung transplantation and one of the primary causes of chronic lung allograft dysfunction leading to poor survival outcomes.

Aim: The aim of this study was to evaluate the safety and outcomes of antireflux surgery in lung transplant recipients (LTRs) with BOS and associated gastroesophageal reflux disease (GERD).

Materials and methods: This single-center study included 8 consecutive patients at a median (interquartile range [IQR]) age of 29 (25-46) years who underwent bilateral lung transplantation and subsequent antireflux surgery due to BOS. The decision to proceed with laparoscopic surgery was based on a diagnosis of GERD associated with a decline in pulmonary function, confirmed on bronchoscopy indicative of BOS. Follow-up lasted for 12 months.

Results: Median (IQR) time since transplantation was 27 (15-55.5) months. Significant improvements in spirometric parameters were observed at 3 and 12 months postoperatively, as compared with baseline, including forced expiratory volume in 1 second (FEV₁; P = 0.02), FEV₁% predicted (P = 0.02), forced vital capacity (FVC; P = 0.003), and FVC% predicted (P = 0.02). There were no differences in spirometric parameters between 3 and 12 months postoperatively. No surgical complications were observed within 30 days after surgery or during follow-up. Two patients developed pulmonary complications, and 1 patient with a history of kidney transplantation experienced renal complications. There were no postoperative deaths. Median (IQR) hospital stay was 12 (3-29) days.

Conclusions: The study suggests that antireflux surgery in LTRs is a safe and effective approach for GERD management, while improving lung function with minimal adverse effects.

Introduction: Perioperative sleep disorders constitute a recognized risk factor for multiple postoperative complications. Although dexmedetomidine (DEX) has been clinically employed to enhance perioperative sleep quality, its optimal administration protocol for postoperative sleep improvement remains undetermined.

Aim: The aim of this study was to comparatively evaluate the therapeutic effect of distinct perioperative DEX administration strategies on postoperative sleep quality in patients undergoing elective gastrointestinal tumor resection via laparoscopy.

Materials and methods: A total of 48 patients undergoing laparoscopic gastrointestinal resection between September 2024 and January 2025 were enrolled and randomly allocated to the intraoperative continuous DEX infusion group (group I; n = 24) and the group with DEX added to postoperative intravenous analgesia (group P; n = 24) using a double-blind method. Sleep quality was assessed using the Numerical Rating Scale during the first 3 postoperative days. A comparative analysis of intergroup differences in postoperative sleep quality was performed.

Results: Out of the 48 randomized participants, 47 were included in the analysis, as 1 patient from group P withdrew informed consent postoperatively. Baseline data were balanced between the 2 groups. In comparison with group I, on postoperative day 1, group P exhibited considerably higher sleep quality scores (P = 0.045), lower blood glucose levels at skin suture completion (P <⁠0.001), higher intraoperative norepinephrine doses (P <⁠0.001), and reduced intraoperative blood loss (P = 0.03). Multivariable linear regression identified group assignment (P = 0.03) and sex (P = 0.02) as significant predictors of sleep quality on postoperative day 1.

Conclusions: As compared with intraoperative continuous DEX infusion, addition of DEX to postoperative analgesia in laparoscopic gastrointestinal tumor surgery has better outcomes with regard to sleep quality on postoperative day 1. These findings suggest potential advantages of postoperative DEX administration in perioperative management.

Introduction: Sleeve gastrectomy (SG) is a safe metabolic and bariatric surgery but it often leads to postoperative gastrointestinal issues, such as constipation and bloating. The use of probiotics after SG seems to alleviate these symptoms.

Aim: The aim of this study was to assess the impact of probiotic supplementation on macro- and micronutrient levels, specifically glycated hemoglobin (HbA1c), 3 months after SG. The secondary objective was to analyze the effect of probiotics on gastrointestinal symptoms.

Materials and methods: This was a prospective, placebo-controlled study which included patients undergoing SG at a single center in Poland. Before the surgery, the patients did not note gastrointestinal diseases or symptoms. They were randomly assigned to the probiotics group (PG) or the control group (CG). Gastrointestinal symptoms and laboratory test results were assessed before surgery and 3 months postoperatively.

Results: A total of 24 patients were included in the study, of which 11 were assigned to the PG and 13, to the CG. Three months after surgery, the patients in the PG had slightly lower levels of HbA_1c than the CG participants (P = 0.01). The patients in the PG reported less constipation, better feeling of bowel movement completeness, and greater ease of defecation (P = 0.03; P = 0.01; P = 0.01, respectively) No differences in weight loss were found between the groups.

Conclusions: Probiotics may lower HbA1c levels, effectively reduce constipation, contribute to a better feeling of bowel movement, and facilitate defecation after SG.

Introduction: Fibroblasts are stromal and connective tissue cells that play crucial roles in the intracellular matrix and granulation tissue synthesis during tissue proliferation. They are also responsible for epithelialization and healing of skin lesions.

Aim: Our aim was to compare the use of allogeneic fibroblasts with conventional debridement after successful endovascular interventions (EVIs) for the treatment of chronic ulcers induced by peripheral artery disease (PAD).

Materials and methods: A total of 116 participants with chronic ulcers due to PAD were randomly assigned, after successful EVI, to receive either allogeneic fibroblasts (study group; n = 58) or conventional debridement (control group; n = 58) for treatment of the ulcers. The participant data were collected over 1 year of follow-up to compare the effectiveness of both methods.

Results: The mean (SD) duration of initial and complete healing of chronic ulcers after successful EVI was shorter in the allogeneic fibroblast group (2.59 [0.53] and 5.04 [0.58] months, respectively) than in the controls (3.56 [0.44] and 5.8 [0.35] months, respectively; P <⁠0.001 for all). A correlation analysis showed a moderately significant correlation between the healing of chronic ulcers (both initial and complete) after successful EVI and the use of allogeneic fibroblasts.

Conclusions: Allogeneic fibroblasts are an effective and noninvasive option for the treatment of chronic PAD-induced ulcers after successful EVI. The duration of initial and complete healing was significantly shorter in the allogeneic fibroblast group than in the conventional debridement group.