Videosurgery and Other Miniinvasive Techniques最新文献

Introduction: Despite a lack of a well-defined concept of 'pelvic difficulties', pelvimetric parameters significantly influence surgical difficulty and outcomes in mid-low rectal cancer (MLRC).

Aim: The objective of this study was to explore the influence of pelvimetric parameters and surgical approaches on the difficulty of surgical procedures in MLRC.

Materials and methods: A retrospective analysis was performed at the Northern Jiangsu People's Hospital, including patients with a diagnosis of MLRC who underwent total mesorectal excision between January 2016 and June 2023. We analyzed the pelvimetric parameters and perioperative data.

Results: The study cohort comprised a total of 1138 individuals. Based on the surgical difficulty score, 374 patients were assigned to the difficult surgery (DS) group, and 764, to the non-difficult surgery group. Patients in the DS group were stratified into 2 groups based on the surgical approach: the robot-assisted laparoscopic surgery (RLS) group with 78 patients, and the conventional laparoscopic surgery group, including 296 patients. Multivariable analysis results showed that age, sex, pelvic inlet anteroposterior diameters (PIAPD), pubic symphysis height, pelvic depth, and angle A were independent influencing factors for DS.

Conclusions: Age, sex, PIAPD, pubic symphysis height, pelvic depth, and angle A were independent factors influencing DS in MLRC. In the DS group patients, RLS had certain advantages.

Introduction: Intraoperative indocyanine green (ICG) is increasingly used in surgery. In metabolic and bariatric surgery, it allows visualization of the tissues and blood supply to anastomoses in real time.

Aim: The objective of this prospective cohort study was to evaluate the safety and efficacy of ICG usage in metabolic and bariatric surgery.

Materials and methods: The study was conducted from July 2022 to December 2023. A total of 171 metabolic and bariatric procedures with ICG perfusion tests were performed, comprising 93 sleeve gastrectomies, 17 one-anastomosis gastric bypasses, 51 Roux-en-Y gastric bypasses, 7 primary single anastomosis duodeno-ileal bypasses with sleeve gastrectomies, and 3 redo surgeries.

Results: Out of 171 patients included in the study, 143 (83.6%) were women. Mean (SD) age of the participants was 41.8 (9.7) years, and mean (SD) body mass index was 44.6 (6.3) kg/m². Mean (SD) operation time was 92.9 (47.7) minutes, and mean (SD) length of hospital stay was 2.1 (0.8) days. Surgical complications occurred in 4 patients (2.3%). No local or general adverse symptoms or complications, including allergic reactions, were observed after intravenous administration of ICG. The patients' allergies did not influence adverse events related to the administration of the dye.

Conclusions: The use of intraoperative ICG in metabolic and bariatric surgery is safe, and adverse events and dye-related complications are very rare.

Introduction: Slit mesh (SM) is a technical modification used in laparoscopic total extraperitoneal (TEP) inguinal hernia (IH) repair. It aims to reduce recurrence by improving mesh anchoring and preventing cranial migration. However, its clinical effectiveness remains controversial.

Aim: The aim of this study was to compare clinical outcomes of SM and nonslit mesh (NSM) techniques in laparoscopic TEP IH repair.

Materials and methods: This retrospective study included 155 patients who underwent standardized TEP repair between June 2022 and February 2023. The patients were divided into 2 groups: SM (n = 80) and NSM (n = 75). Demographics, hernia characteristics, operative time, recurrence, complications, and postoperative pain were evaluated. Pain was assessed using the visual analogue scale (VAS) on postoperative day 1 (VAS1D), at 1 month (VAS1M), and 3 months (VAS3M).

Results: No significant differences were found in baseline characteristics. Median (interquaritle range [IQR]) operation time was longer in the SM group (46.5 [40-55] vs 38 [30-45] min; P <⁠0.001). Recurrence was observed in 6 SM and 3 NSM patients (odss ratio, 1.95; 95% CI, 0.47-8.08; P = 0.497). Median (IQR) VAS scores were: 4 (2-6) for VAS1D; 0 (0-1) for VAS1M; 0 (0-0) for VAS3M, with no significant differences. Complication and chronic postoperative inguinal pain rates were similar.

Conclusions: Although the SM technique was designed to improve outcomes, our findings show no it has no notable advantage over the NSM technique in reducing recurrence or postoperative pain. Moreover, the prolonged operation time associated with the SM method may represent a clinical drawback. Further research with larger cohorts and longer follow-up is needed to better clarify the potential risks and benefits of SM apporoach.

Introduction: The purpose of the informed consent (IC) form is to enable patients to make a conscious choice based on complete and comprehensible information about a planned surgical procedure, its risks, benefits, and alternative treatment methods. Obtaining information about other therapeutic options is particularly important in the case of laparoscopic surgeries which are becoming increasingly popular. Unfortunately, as the literature indicates, most patients do not read the IC form.

Aim: The aim of this study was to evaluate the impact of video material on encouraging patients to thoroughly read the IC form.

Materials and methods: This parallel design study comprised 102 patients referred for elective laparoscopic surgical procedures. The participants were randomized in a 1:1 ratio. The block randomization consisted of alternating, weekly assignment of patients to the intervention (video) group and the control group. Anxiety levels were evaluated using a translated version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS).

Results: The patients in the video group were more likely to read the entire IC form (83.67%) than those in the control group (33.96%; P = 0.003). However, according to the APAIS scale, reading the IC form had no impact on the level of anxiety (P = 0.72) and information demand (P = 0.9). The most frequently given reason for not reading the IC form was its excessive length (32.61% of the responses).

Conclusions: Video materials demonstrate a remarkable potential in enhancing the awareness of the IC process importance and should be increasingly implemented into everyday medical practice.

Introduction: Holmium laser enucleation of the prostate (HoLEP) is considered the best treatment for benign prostatic hyperplasia (BPH). This procedure offers effective symptom relief across varying prostate sizes.

Aim: This study aimed to evaluate preoperative and postoperative outcomes of HoLEP in patients with different prostate volumes in a multicenter comparative analysis conducted in Jordan.

Materials and methods: A cohort study was conducted in 3 private clinics in Amman, Jordan. It included 77 patients who were divided into 2 groups according to prostate volume: smaller than or equal to 40 ml (n = 37) and larger than 40 ml (n = 40). The data collected preoperatively and at 3 months postoperatively included urinary symptoms, quality of life (QoL) scores, and functional parameters. Statistical analyses included paired t tests and independent t tests.

Results: Both groups exhibited improvements in relation to initial values, as assessed after the procedure using the International Prostate Symptom Score (≤40 ml, 16 vs 7.6; >40 ml, 14.9 vs 4.6; P <⁠0.001). Their QoL scores also improved (≤40 ml, 3.2 vs 1.5; >40 ml, 3 vs 1.3; P <⁠0.001). The maximum urinary flow rate increased in both groups (≤40 ml, 8.2 ml/s vs 14 ml/s; >40 ml, 8.6 ml/s vs 13.6 ml/s; P <⁠0.001), with similar improvements in postvoid residual urine volume. Larger prostates required longer enucleation times (≤40 ml, 19.8 min; >40 ml, 39.3 min; P = 0.04) with more tissue removal (≤40 ml, 4.7 g; >40 ml, 17 g; P <⁠0.001).

Conclusions: HoLEP effectively improved various measured parameters, including urinary symptoms, QoL, and functional outcomes in patients with BPH across all prostate sizes. Larger prostates required procedures of increased complexity.

Introduction: Sleeve gastrectomy (SG) is the most frequently performed bariatric procedure in Poland. While considered technically straightforward, significant variation exists in the operative technique, which may affect safety outcomes.

Aim: This study aimed to analyze the technical aspects and complication rates of SG across Polish bariatric centers in 2023.

Materials and methods: This is a secondary analysis of a nationwide survey conducted among bariatric centers affiliated with the Metabolic and Bariatric Surgery Chapter of the Association of Polish Surgeons. As many as 54 centers participated, reporting detailed data on SG technique and outcomes. The centers were stratified by annual SG volume using a 50-procedure threshold, corresponding to the suggested learning curve.

Results: A total of 7450 SG procedures were reported. Calibration bougies of 36 French were used by 70% of the centers. Staple line reinforcement was routinely performed in 72.5% of the centers, with oversewing and clipping as the most common methods. Leak tests were performed by 84.3% of the centers, while 66.7% omitted routine drain placement. Postoperative complication rates included bleeding (0.98%), leak (0.33%), reoperation (1.04%), and mortality (0.16%). Although not significant, complication rates were consistently higher in the centers performing fewer than 50 SGs annually.

Conclusions: SG in Poland is characterized by favorable safety outcomes but notable procedural variability. While most centers follow recommended practices, a lack of standardization persists in key technical areas. Surgical volume may influence complication rates. National guidelines and structured training programs may help harmonize practice and improve outcomes.

Introduction: Sleeve gastrectomy (SG) is the most commonly performed bariatric procedure worldwide, offering significant weight loss and remission of obesity-related diseases. However, SG is associated with a high risk of gastroesophageal reflux disease (GERD). To mitigate this issue, a modified procedure combining SG with Nissen fundoplication (Nissen-sleeve gastractomy [NSG]) has been developed.

Aim: The primary aim of this study was to assess the effectiveness of NSG in GERD remission. Secondary objectives included the evaluation of short-term weight loss and the resolution of obesity-related diseases.

Materials and methods: We conducted s prospective analysis of 34 patients who underwent NSG between September 2023 and August 2024 at a single center in Poland. Inclusion criteria comprised age over 18 years, eligibility for metabolic and bariatric surgery, and GERD symptoms. Data on GERD severity and weight loss outcomes were collected before and after the surgery.

Results: Mean (SD) preoperative body mass index was 40.3 (4.4) kg/m². GERD symptom severity decreased from a median score of 8 to 1 (P <⁠0.001), with 97.1% of the patients achieving GERD remission. Mean (SD) percentage of total weight loss was 23% (6.3%) at 6 months and 30.3% (6.7%) at 12 months postoperatively. Type 2 diabetes remission was observed in 28.6% of the patients, and hypertension remission, in 58.3%. No postoperative complications were reported.

Conclusions: NSG is a safe and effective procedure that leads to GERD remission, while achieving short-term satisfactory weight loss and mitigating obesity-related diseases.

Introduction: Intermittent fluoroscopic controls are required during shock wave lithotripsy (SWL) to readjust the probe due to patients' movements, respiratory movement, and stone displacement within the kidney. However, there is still no consensus in the literature on the optimal frequency of fluoroscopic monitoring.

Aim: Our aim was to determine the optimal fluoroscopy activation interval in fluoroscopy‑guided SWL and examine its effect on fluoroscopy time and stone‑free status.

Materials and methods: This prospective randomized study included patients with opaque renal pelvic stones smaller than 2 cm, subjected to fluoroscopy‑guided SWL between July 2020 and January 2024. The patients were divided into 2 groups. Fluoroscopic control was performed every 250 shocks in group 1, and every 500 shocks in group 2. Demographic data, calculus volume and density, skin‑to‑stone distance, number of shots and sessions, fluoroscopy duration, and stone‑free status were analyzed.

Results: The data of 158 randomly included patients (equally divided between both groups) were analyzed. No differences were observed between the groups in terms of demographic data and stone parameters. However, there was a difference in fluoroscopy time, which was longer in group 1 than in group 2 (mean [SD], 217.9 [90.2] vs 117 [37] s, respectively; P <0.001). No differences in stone‑free status between the groups were observed (group 1; 64.5%; group 2, 67%; P = 0.87).

Conclusions: Reducing fluoroscopy activation interval in SWL does not affect stone‑free status, but it helps limit radiation exposure.

Introduction: Obesity, a chronic disease linked to premature aging, is increasingly managed through metabolic and bariatric surgery (MBS).

Aim: This study aimed to evaluate whether changes in biological age markers depended on the optimal weight loss rates resulting from MBS.

Materials and methods: In this prospective, observational study, 100 patients with obesity scheduled for MBS from July 2020 to May 2021 underwent a 24-month postoperative follow-up. The telomere length (TL) was assessed using quantitative polymerase chain reaction. We also evaluated DNA damage, C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α) levels, total oxidant status (TOS), and the metabolic age. We checked whether the percentage of total body weight loss (%TWL) and the percentage excess weight loss (%EWL) correlated with the changes in aging markers postsurgery.

Results: Forty patients completed follow-up, with 22 achieving optimal (%TWL ≥20%; %EWL ≥50%) and 18 suboptimal (%TWL <⁠20%; %EWL <⁠50%) surgical outcomes. Both groups showed a significant TL increase and a reduction of DNA damage, CRP, IL-6, and TNF-α levels, TOS, and the metabolic age. A greater change, however, was only observed for the metabolic age in the optimal outcome group. The Δ of change in the other aging markers did not differ between the groups.

Conclusions: Improvements in aging markers, such as TL, DNA damage, inflammatory parameters, and TOS occur independently of weight loss rates after MBS, suggesting that weight loss indices alone do not fully capture the therapeutic success of the procedure.