Videosurgery and Other Miniinvasive Techniques最新文献

Introduction: Robot‑assisted surgery is becoming increasingly popular and its application is expanding to various spinal surgical procedures, including endoscopic spinal surgery.

Aim: The aim of this study was to describe a novel small parallel orthopedic surgical robot and evaluate its feasibility in assisting surgeons during percutaneous lumbar laminectomy on cadaveric specimens.

Materials and methods: The authors of the study developed a new orthopedic surgical navigation system (R‑Pharos, Rossum Robot Co., Ltd, Beijing, China), consisting of a navigation cart and a hybrid serial‑parallel bedside robotic arm. The system is equipped with interactive software for selecting and planning the percutaneous lumbar laminectomy target and path. A cadaveric specimen was selected for a right‑side partial laminectomy at L4. During the procedure, the surgeon used the robotic arm to guide the saw to the target lamina and perform the percutaneous resection. Postoperative cone beam computed tomography (CBCT) and endoscopic assessments were used to confirm the resection outcome.

Results: After optimizing the precision of the small parallel orthopedic surgical robot to 1 mm, it was shown to meet the navigational requirements for percutaneous lumbar laminectomy. The surgeon utilized the interactive software to design the resection range and path for the right L4 lamina which was successfully resected, as confirmed by endoscopic observation. A postoperative CBCT scan revealed that the resection area precisely matched the preoperative design.

Conclusions: This study demonstrated that the small parallel orthopedic surgical robot was capable of preoperatively planning the lamina resection area and could assist the surgeon in performing percutaneous lumbar laminectomy with high navigational precision.

Introduction: Transarterial chemoembolization (TACE) is frequently used to treat patients with hepa‑ tocellular cancer (HCC) who are not eligible for surgery. The efficacy of TACE treatment can be improved by percutaneous insertion of 125I seeds after the procedure.

Aim: This meta‑analysis aimed to assess the relative safety and efficacy of TACE with 125I seed insertion (TACE‑I) as compared with TACE alone for the management of inoperable HCC.

Materials and methods: The PubMed, Cochrane Library, and Wanfang databases were searched for relevant studies published since the database inception through October 2024. The primary study outcome was objective response rate (ORR), while secondary outcomes comprised disease control rate (DCR), progression‑free survival (PFS), overall survival (OS), and adverse event incidence.

Results: This meta‑analysis ultimately included 5 articles, all of which were published in China. In all these studies, TACE‑I outperformed TACE alone with respect to patient ORR (P <0.001), PFS (P <0.001), and OS (P <0.001). DCR values were similar in both groups (P = 0.77), as were the rates of adverse events, including fever (P = 0.75), vomiting (P = 0.83), and myelosuppression (P = 0.23). The only outcome exhibiting significant heterogeneity was OS (I2 = 73%). Based on the Egger test, the end points affected by publication bias were ORR, DCR, and OS (P = 0.01, P = 0.03, and P = 0.04, respectively).

Conclusions: In patients with inoperable HCC, TACE‑I is associated with significantly better efficacy and longer survival than TACE alone, and has a good safety profile.

Introduction: Two decades ago, laparoscopic adjustable gastric banding was a leading bariatric sur‑ gery. However, its popularity has declined, with sleeve gastrectomy becoming the predominant choice. The MiniMizer Extra band used in our clinic from 2008 to 2020 was associated with band erosion primarily at its lower edge. In 2014, we started using a modified band fixation technique by placing sutures only on the upper part of the band.

Aim: The aim of this study was to compare 2 different fixation techniques for the MiniMizer Extra adjustable gastric band to identify any potential differences in outcomes.

Materials and methods: In this study, we compared 54 patients who underwent adjustable gastric banding with the MiniMizer Extra band between January 1, 2009, and January 31, 2010, with a group of 54 patients who were subjected to the procedure between January 1, 2014, and January 31, 2019, using a different band fixation method.

Results: Weight loss results significantly favored the modified fixation group, with an average total weight loss of 24.2%. The overall complication rate was 12% and was significantly higher in the original fixation group. Complications included 6 cases of band erosion, 4 port‑related issues, 1 case of band slippage, and 2 cases of band intolerance.

Conclusions: The modified fixation group demonstrated improved weight loss results with fewer com‑ plications, suggesting a potential advantage in safety and efficacy of the modified technique.

Inflammatory myofibroblastic tumors (IMTs) of the bladder are rare, with a limited number of cases reported in the literature. Complete resection with negative margins is essential to reduce the risk of recurrence, while bladder function preservation is also crucial for the patient. This study describes a 56‑year‑old patient with a bladder dome IMT managed using robot‑assisted partial cystectomy facili‑ tated by perioperative cystoscopic tattooing to precisely demarcate the tumor margins. The procedure began with cystoscopic tattooing of the lesion using Black Eye dye, followed by robotic resection with the da Vinci Xi system. Complete transmural resection and a 2‑layer bladder closure were performed, with preservation of the bladder capacity. The patient experienced minimal blood loss, no intraopera‑ tive complications, and was discharged 2 days after the procedure. Follow‑up examinations, including cystoscopy and computed tomography, confirmed no recurrence 12 months after surgery. Cystoscopic tattooing facilitated clear intraoperative tumor localization, enabling precise resection and minimal bladder wall loss. This approach addressed a key challenge of robotic bladder surgery-lack of tactile feedback-while maintaining functional outcomes. Robot‑assisted partial cystectomy with cystoscopic tattooing represents a promising alternative to maximal transurethral resection, especially in the context of bladder‑sparing trimodal therapy, for patients who are not eligible for or unwilling to undergo radical cystectomy. This technique is particularly relevant given the increasing focus on minimally invasive procedures and advancements in systemic therapy. In the future, this method could be adapted for ureteral robotic surgeries to enhance lesion localization.

Robot‑assisted surgical management of mid‑urethral sling (MUS) erosion into the bladder represents a novel approach in urological surgery. This study reports the first 2 cases in Poland treated using the transperitoneal robotic extensive approach for total mesh excision (TREATME). Both procedures were performed successfully, with complete mesh removal. No intra‑ or postoperative complications occurred, and conversion to open surgery was not required. These initial findings suggest that TREATME may be a feasible and safe option for managing complex MUS complications, necessitating further evaluation in larger studies.

Introduction: The anterior cruciate ligament (ACL) rupture frequently leads to instability of the knee joint, which subsequently damages other intra‑articular structures. The combination of ACL reconstruction (ACLR) with concurrent lateral extra‑articular tenodesis (LET) improves rotational stability and reduces the risk of subsequent ACL rupture. However, there is not much research that specifically outlines LET hardware and surgical methods.

Aim: This study aimed to describe and evaluate clinical outcomes of a mini‑open modified Lemaire technique using a self‑punching all‑suture anchor.

Materials and methods: In this study, 32 patients underwent primary or revision ACLR combined with LET via the mini‑open modified Lemaire technique using a self‑punching all‑suture anchor. All individuals completed the following pre‑ and postoperative questionnaires to evaluate their functional performance: the Knee Injury and Osteoarthritis Outcome Score, assessing several domains, the International Knee Documentation Committee subjective knee evaluation form, the Lysholm knee scoring scale, and the Western Ontario and McMaster Universities Arthritis Index. Complication rates were also assessed.

Results: Each patient's functional score values increased, as compared with preoperative measure‑ ments. There were no early post‑ or intraoperative complications associated with the technique described.

Conclusions: This is the first study that evaluated clinical outcomes, intraoperative, and early post‑ operative complications of the mini‑open modified Lemaire technique using a self‑punching all‑suture anchor. Our study indicates that this procedure is effective, safe, and associated with better cosmesis than classic LET techniques.

Introduction: While robotic prostatectomies are gaining popularity, laparoscopic and open surgeries remain prevalent in Central and Eastern Europe due to their cost‑effectiveness. In Poland, many urology residents report insufficient laparoscopic training. This study retrospectively evaluated the learning curve for laparoscopic radical prostatectomy (LRP).

Aim: This paper aimed to assess the learning curve of a single resident performing extraperitoneal LRP.

Materials and methods: We analyzed 72 patients who underwent LRP between 2016 and 2020 at a single center, divided into 5 groups (G1-G5) according to chronological order. The procedures were per‑ formed by a single urologist without on‑site supervision. Outcomes included operative duration, length of hospital stay, complications, transfusion rates, histopathology findings, biochemical recurrence, and urinary incontinence.

Results: Patient characteristics were similar across all groups. The median (interquartile range [IQR]) age ranged from 61 (54-66) to 68 (66-70) years, and the median (IQR) prostate‑specific antigen con‑ centration, from 6.7 (5.4-8.5) to 15 (6.3-19.3) ng/ml. Higher Gleason scores were more common in the G3 and G4 groups (P = 0.05) than in the other groups. Surgery time decreased from 183 minutes in the G1 group to 130 minutes in the G5 group (P <0.001). The rates of positive surgical margins were the highest in the G3 and G4 groups (53.3% and 46.7%, respectively; P = 0.02). The rate of urinary continence improved from 66.7% in the G1 group to 86.7% in the G4 group (P = 0.36); however, without any significant difference among all groups. Biochemical recurrence rates tended to be lower in the G4 and G5 groups (6.7% and 8.3%, respectively), but the difference across all groups was nonsignificant. Grade III-V complications occurred only in the G1 group.

Conclusions: Surgical outcomes improved after 15 procedures, and the oncological outcomes, after 45, with functional improvement observed later. Performing hundreds of surgeries may be required to achieve high proficiency in performing LRP.

Introduction: Primary palmar hyperhidrosis (PPH) impairs the quality of life. Video‑assisted thoracoscopic sympathicotomy is an effective treatment method; however, the impact of sex on surgical outcomes accord‑ ing to the denervation level (T3 vs T3-T4 sympathicotomy) remains unclear.AIM This study investigated the efficacy, complications, and symptom relief rates of isolated T3 vs combined T3-T4 sympathicotomy for PPH, focusing on sex differences.

Materials and methods: A retrospective analysis of 327 patients undergoing bilateral uniportal video‑assisted thoracoscopic sympathicotomy for PPH between 2012 and 2022 was performed. The patients were divided into 2 groups depending on the procedure type (isolated T3 sympathicotomy [n = 167] vs T3-T4 combined sympathicotomy [n = 160]). Demographic data, procedure outcomes, and complications were compared.

Results: Success rates were 95.8% in the T3 sympathicotomy group and 93.8% in the T3-T4 sympathicotomy group, with no significant difference. The most common complication was dryness of the hands. The overall complication rate was lower in the T3 than in the T3-T4 sympathicotomy group (9.6% vs 14.4%; P = 0.04). Compensatory sweating occurred in 2.4% and 3.1% of the participants in the T3 and T3-T4 sympathicotomy groups, respectively (P = 0.52). The frequency of compensatory sweating, chest pain, and dryness of the hands was significantly higher in men. Age, sex, and duration of surgery had no independent influence on the occurrence of complications.

Conclusions: Isolated T3 sympathicotomy is an effective and safe option for the treatment of PPH, and is associated with fewer complications than combined T3-T4 sympathicotomy. Higher complication rates in men emphasize the need for sex‑specific surgical planning and patient counseling.

Introduction: Endoscopic hand suturing (EHS) has emerged as a promising modality in gastrointestinal (GI) endoscopic procedures. Reports on its effectiveness in clinical practice remain limited due to its recent adoption.

Aim: This study aimed to describe a single- center experience regarding EHS and its outcomes.

Materials and methods: This single -center retrospective study analyzed individuals that underwent advanced endoscopic procedures in the upper and lower GI tract followed by EHS. Defined features (suturing time and speed) and outcomes (postprocedural bleeding, abdominal pain) were assessed.

Results: Thirty- one patients were included in the analysis. The median (interquartile range [IQR]) size of the resected lesions was 20 (20-30) mm, and the median (IQR) diameter of the sutured defects was 25 (20-31) mm. The overall suturing time was 25 minutes, with a mean (SD) speed of 1.12 (0.5) mm/min. It varied in different locations, with the fastest closure in the proximal stomach (mean [SD], 25 [13.1] min; 1.27 [0.32] mm/min) and the longest in the rectum (mean [SD], 33 [16.2] min; 0.92 [0.4] mm/min). No symptoms of GI bleeding were reported during early and 4-week follow-up. One case (4.5%) of abdominal pain was reported for the upper GI tract, and none for the lower GI tract.

Conclusions: EHS is a safe and effective technique for managing defects in both gastric and rectal advanced endoscopic procedures. Its potential application in preventing post-endoscopic submucosal dissection bleeding in high-risk patients is promising. The duration and complexity of the procedure remain the challenges that may limit its broader adoption. Further research and standardized training are imperative to optimize EHS outcomes and establish it as a routine practice in endoscopic surgery.

This document presents a comprehensive update to the Polish national recommendations on metabolic and bariatric surgery, developed by a panel of experts based on the latest clinical and scientific evidence. In light of a nearly 500% increase in the number of bariatric procedures in Poland since 2014 and significant technological advancements, it became necessary to revise national guidelines in line with international standards set by the International Federation for the Surgery of Obesity and Metabolic Disorders and the American Society for Metabolic and Bariatric Surgery. A pivotal development in Poland was the implementation of the Comprehensive Specialist Care in Bariatrics (KOS‑BAR) program in 2021, which ensured more accessible and safer care for patients with severe obesity through a structured and multidisciplinary approach. The consensus covers the full scope of care: from the epidemiology of obesity, surgical eligibility criteria, and preoperative preparation, to the choice of surgical technique, postoperative care, management of complications, and revisional procedures. The document also includes guidance on pharmacological treatment as an addition or alternative to surgery, and addresses the needs of specific patient groups, such as pediatric patients, elderly individuals, women of reproductive age, and those with comorbid conditions. The aim of this update is to provide Polish patients with access to safe, effective, and evidence‑based treatment for obesity, while also aligning the health care system with the growing public health challenge posed by the obesity epidemic.