Videosurgery and Other Miniinvasive Techniques最新文献

Introduction: Both virtual bronchoscopic navigation (VBN) and puncture with a 4‑hook localization needle are viable methods for localizing pulmonary nodules. However, there is a paucity of research that compares these 2 approaches.

Aim: This study aimed to assess and compare the efficacy of and complications associated with these 2 approaches to pulmonary nodule localization.

Materials and methods: We analyzed 223 patients who underwent VBN (n = 98) or needle localization (n = 125) of pulmonary nodules between April 2020 and December 2022. Each study group was divided into 2 subgroups, namely the solitary‑nodule group and the 2‑nodule group. We collected and analyzed data on localization time, accuracy, success rate, and complications in each group.

Results: In the solitary‑nodule subgroup, the mean (SD) distance between the localization point and the pulmonary nodule was 6.2 (6.1) mm for the needle‑localization group and 8.6 (4.8) mm for the VBN‑localization group (P = 0.01). In the 2‑nodule subgroup, the mean (SD) distance did not significantly differ and amounted to 8.7 (4.6) mm for the needle‑localization group and 8.4 (4.4) mm for the VBN‑localization group. However, the mean (SD) time required for localization was shorter in the VBN‑localization group (17.2 [2.6] min) than in the needle‑localization group (26.6 [3.9] min; P <0.001), which indicated that VBN was more efficient in 2‑nodule localization. The solitary nodule- and 2‑nodule-localization procedures differed significantly in terms of complications, such as pneumothorax and bleeding, with fewer complications reported in the VBN‑localization group.

Conclusions: In comparison with needle localization, VBN localization was associated with fewer complications. In the case of 2 pulmonary nodules, VBN localization outperformed the needle approach, with shorter localization time, fewer complications, and no radiation exposure.

Introduction: The prevalence and risk factors of portal vein thrombosis (PVT) are largely unclear, with an increasing number of studies reporting inconsistent results.

Aim: The current study aimed to evaluate the prevalence and risk factors of PVT following hepatectomy through a systematic review and meta‑analysis.

Materials and methods: A comprehensive literature search was conducted across multiple databases (PubMed, Embase, and the Cochrane Library) to identify relevant studies. Prospective and retrospective studies reporting on PVT following hepatectomy were included. The Newcastle‑Ottawa Scale (NOS) was used to assess study quality, and the random effects model was used to analyze the prevalence and risk factors.

Result: A total of 15 studies involving 5145 patients were included in the current meta‑analysis. The pooled prevalence of PVT following hepatectomy was 9% (95% CI, 7%-12%) with substantial heterogeneity (I2 = 93.1%). Subgroup analyses showed that a prospective design and larger sample size were associated with lower prevalence rates. PVT prevalence was higher among the patients undergoing simultaneous splenectomy and hepatectomy. Liver cirrhosis (odds ratio [OR], 5.18; 95% CI, 1.85-14.47), portal vein resection (OR, 5.07; 95% CI, 2.2-11.66), and right‑sided hepatectomy (OR, 6.26; 95% CI, 1.8-21.76) were significant risk factors for PVT.

Conclusions: PVT is a notable complication following hepatectomy, with an overall prevalence of 9%. Specific factors that significantly increase the risk of PVT include liver cirrhosis, portal vein resection, and right‑sided hepatectomy.

Introduction: Unilateral biportal endoscopy (UBE) is a minimally invasive technique that has gradually gained popularity in the field of spine surgery.

Aim: The aim of this study was to identify independent risk factors associated with the occurrence of perioperative complications following UBE surgery through a comprehensive retrospective analysis.

Materials and methods: Consecutive patients who underwent UBE at the Department of Orthopedics of Beijing Friendship Hospital between June 2021 and July 2024 were retrospectively analyzed. Data on demographic characteristics, comorbidities, surgery‑related parameters, and perioperative complications were extracted from medical records, and patients who did and did not develop complications were compared. Potential risk factors for perioperative complications were evaluated using univariable and multivariable logistic regression analyses.

Results: In a cohort of 322 patients, perioperative complications were observed in 20 individuals, yielding an overall incidence rate of 6.8%. Occurrence of perioperative complications was associated with higher body mass index (BMI >28 kg/m2; P <0.001), diabetes mellitus (P <0.001), depression (P <0.001), preoperative analgesia (P = 0.03), American Society of Anesthesiologists classifiation (P <0.001), and longer operative time (>180 minutes; P <0.001). In the multivariable logistic regression analysis, surgery duration longer than 180 minutes (odds ratio [OR], 2.8; 95% CI, 1.5-5.4), depression (OR, 2.5; 95% CI, 1.3-4.7), and BMI greater than 28 kg/m2 (OR, 3.1; 95% CI, 1.7-5.9) were identified as independent risk factors for complications.

Conclusions: This study demonstrates that UBE surgery is an effective and safe minimally invasive technique for the management of lumbar degenerative diseases, with a relatively low complication rate of 6.8%. Longer operative time, preoperative depression, and a higher BMI were identified as independent risk factors for the occurrence of perioperative complications.

Introduction: Meniscal tears and chondromalacia patellae (CP) are among the most common knee pathologies treated with arthroscopic partial meniscectomy. Chronic knee pain impairs mobility, functionality, and the overall quality of life (QOL).

Aim: The study evaluates the relationship between meniscus injury and early-stage CP found intraoperatively, and pre- and postoperative patient-reported QOL, perceived social support, and mental health. MATERIALS AND METHODS Patients who underwent knee arthroscopy for meniscal and cartilage abnormality, without reconstructive or restorative procedures, between 2019 and 2021, were prospectively enrolled in this study.

Methods: Patients who underwent knee arthroscopy for meniscal and cartilage abnormality, without reconstructive or restorative procedures, between 2019 and 2021, were prospectively enrolled in this study.

Results: We observed a significant rise in the pre- and postoperative scores on the World Health Organization QOL Brief Version (WHOQOL-BREF) scale for various meniscal tears and different types of CP (grade 0-IV) in almost all domains. Education level did not significantly affect the WHOQOL-BREF assessment, and we found no statistical correlation between preoperative WHOQOL-BREF score in all domains and waiting time for surgery. However, there were significant differences between white- and blue-collar employees in the domains 1 and 2, that is, physical and psychological health.

Conclusions: The study shows that the measured QOL improves in patients operated at the early stages of CP. Moreover, when both menisci are involved in the pathological process, the clinical outcomes are inferior. The education level and waiting time for surgery had no impact on QOL, contrary to the type of work, as white-collar workers had better outcomes in physical and psychological health domains.

Introduction: As the use of gastric bands diminishes in bariatric and metabolic surgery, we present the results of a 15-year randomized controlled trial comparing 2 distinct adjustable gastric bands.

Aim: The aim of this study was to compare long-term outcomes of bariatric surgery performed using 2 different adjustable gastric band types over a 15-year period.

Materials and methods: Between January 1, 2009, and January 31, 2010, a total of 103 patients with obesity underwent randomization to receive treatment with either a Swedish adjustable gastric band (SAGB; n = 49) or a MiniMizer Extra adjustable gastric band (n = 54). Weight loss outcomes, comorbidity resolution, long-term complications, and quality of life measures were assessed at 1, 5, and 15 years postoperatively.

Results: Baseline characteristics were similar between the groups, with a mean (SD) patient age of 45.9 (11.7) years and a mean (SD) preoperative body mass index of 47.5 (7.3) kg/m² . Of the 103 patients, 55 (53.3%) completed the 15-year follow-up. After 15 years, the mean total body weight loss was 25.6% in the SAGB group and 20.6% in the MiniMizer Extra group, with no significant difference. Complications occurred in 19 patients (18.4%), including 5 band erosions, 4 port-related issues, 3 cases of band slippage, and 3 instances of band intolerance. Nine bands were removed, and 3 patients underwent conversion to gastric bypass.

Conclusions: SAGB and MiniMizer Extra bands demonstrated comparable outcomes at both the 5- and 15-year follow-up with respect to weight loss, resolution of comorbidities, morbidity, and quality of life. However, most of the improvements in comorbidities observed at the 5-year follow-up significantly declined after 15 years.

Introduction: Computed tomography (CT)-guided core needle biopsy (CNB) is a common method for diagnosing pulmonary nodules (PNs). It is often performed using the coaxial technique (CAT) to streamline the process.

Aim: This study aimed to compare the safety and diagnostic performance of CT-guided CNB with and without CAT for diagnosing PNs.

Materials and methods: This retrospective analysis included patients undergoing CT-guided CNB for a diagnosis of PNs between January 2017 and December 2019. The study population was divided according to the use of CAT for the biopsy. Procedure-related data, diagnostic accuracy and yield, and complication rates were compared between the 2 groups.

Results: During the study period, a total of 111 and 108 patients underwent CT-guided CNB with and without CAT, respectively. As compared with the non-CAT group, the CAT group showed a lower mean needle pathway number (P <⁠0.001), a higher mean sample number (P <⁠0.001), and shorter procedural duration (P <⁠0.001). Diagnostic accuracy was similar between the 2 groups (98.3% vs 96.3%, respectively, for CAT vs non-CAT; P = 0.6), though the CAT group demonstrated a higher diagnostic yield than the non-CAT group (81.4% vs 68.5%; P = 0.03). Pneumothorax and pulmonary hemorrhage rates did not differ between the 2 groups (P = 0.09 and P = 0.16, respectively).

Conclusions: CT-guided CNB with CAT demonstrated greater procedural efficiency, with fewer needle pathways, shorter operative duration, and improved diagnostic yield, as compared with procedures performed without CAT.

A new trend toward the application robot-assisted minimally invasive esophagectomy (RAMIE) has started to develop in the field of gastrointestinal tract surgery. As compared with the current gold standard, minimally invasive esophagectomy, RAMIE facilitates more thorough upper mediastinal lymphadenectomy and reduces the risk of vessel damage. This study aimed to evaluate the technical feasibility and safety of RAMIE in patients with esophageal cancer based on the first 2 RAMIE procedures carried out in Poland. Both robotic procedures were successful, without the need for conversion to open surgery. There was no case of incomplete lesion removal or postoperative complications, indicating that RAMIE is a feasible and safe treatment option for patients with esophageal cancer and results in good postoperative recovery.

Introduction: With the advancement of minimally invasive techniques, percutaneous transluminal angioplasty with stenting (PTAS) has emerged as a significant treatment approach for lower limb arteriosclerosis obliterans (ASO).

Aim: The aim of this study was to evaluate the clinical efficacy of PTAS in patients with lower limb ASO.

Materials and methods: A total of 96 ASO patients admitted to our hospital between January 2021 and December 2022 were included in this study. They were divided into 2 groups according to the treatment method: the observation group (n = 48) received PTAS treatment, while the control group (n = 48) underwent percutaneous transluminal angioplasty (PTA). Treatment efficacy was evaluated 30 dayspostsurgery. Pre- and postoperative measurements included the ankle-brachial index (ABI), claudication distance, and quality of life scores derived from the 36-Item Short Form Health Survey (SF-36).Postoperative complications and the rate of target lesion revascularization (TLR) were also recorded.

Results: In the observation group, 29 patients experienced marked improvement and 17 were effectively treated, yielding the total effectiveness rate of 95.83%, which was higher than in the control group (83.33%; P = 0.045). Both groups showed significant improvement in ABI, claudication distance, and SF-36 scores after treatment, with the observation group presenting significantly better results than the control group. There was no difference in the total incidence of complications between the 2 groups (P = 0.24), however, the TLR occurrence rate was lower in the observation group (P = 0.04).

Conclusions: This study highlights the significant benefits of PTAS in the treatment of ASO, including improved overall effectiveness, enhanced functional indicators, and reduced rate of TLR, thus providing strong evidence for clinicians when selecting treatment methods for patients with lower limb ASO.

Introduction: Hirschsprung disease (HD) is a birth defect in which some of the intestinal nerve cells (ganglion cells) do not form completely. Improvements in laparoscopic skills among pediatric surgeons, along with technological advancements, have led to the widespread use of the natural orifice transluminal endoscopic surgery (NOTES) technique; however, reports on long-term outcomes and high-quality follow-up data on anorectal manometry in patients treated with this approach are scarce.

Aim: We aimed to compare the short-term and long-term efficacy of 2 surgical approaches to the treatment of common-type HD: total transanal laparoscopic pull-through (TTLP, which falls under the category of NOTES), and pure transanal endorectal pull-through (PTEP; not classified as NOTES) in order to provide a reference for clinical strategy selection.

Materials and methods: We retrospectively evaluated clinical data and follow-up results of 60 children with common-type HD who underwent TTLP or PTEP. The patients were divided into 2 equal-size groups according to the treatment method. Perioperative parameters were recorded, and regular follow-up was conducted by designated staff for over 10 years. The frequency and type of postoperative short- and long-term complications, pre- and postoperative anorectal manometry data, and daily bowel movement frequencies were recorded. The postoperative defecation function and quality of life scores were assessed and compared.

Results: The mean (SD) age of patients undergoing surgery was 16.75 (12.82) months in the TTLP group and 18.92 (11.55) months in the PTEP group. The incidence of perioperative and long-term complications did not differ between the groups. One month postsurgery, the TTLP group showed lower values of anorectal manometry indicators, as compared with the PTEP group. At 1 to 10 years postsurgery, except for lower anal resting pressure values in the TTLP patients, there was no significant difference in the anorectal manometry indicators between the groups. Both early and late postoperative defecation frequencies were similar between the 2 types of surgeries. Within the first 6 months postsurgery, the defecation function scores were higher in the TTLP group than in the PTEP group; however, after 1 year, there were no significant differences in these scores between the groups. The quality of life scores of the 2 groups showed no difference in the first 1 to 2 years of the surgery. However, the mean quality of life scores evaluated from 2 to 10 years postsurgery were higher in the TTLP group than in the PTEP group.

Conclusions: TTLP for common-type HD not only contributes to early postoperative recovery, but also enhances the long-term quality of life, as compared with PTEP.

Introduction: Bariatric surgery is an effective treatment for obesity and metabolic disorders. In Poland, the growing prevalence of obesity has led to an increase in the demand for these procedures. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most frequently performed surgeries, while newer techniques, such as single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), single-anastomosis sleeve ileal bypass (SASI), and Nissen sleeve gastrectomy (N-SG) are emerging. The Comprehensive Specialist Care in Bariatrics (KOS-BAR) program, introduced in 2021, aims to standardize bariatric care in Poland.

Aim: This study evaluates the state of bariatric surgery in Poland in 2023, focusing on procedure volumes, regional variations, and the role of KOS-BAR centers.

Materials and methods: A nationwide survey was conducted among bariatric surgery centers affiliated with the Metabolic and Bariatric Surgery Chapter of the Association of Polish Surgeons. Data on the number and types of surgeries performed in 2023 were collected and compared with previous reports to analyze trends.

Results: A total of 54 centers, including 18 KOS-BAR centers, participated in the survey, reporting a total of 9102 procedures performed in 2023. SG accounted for 82% of surgeries, followed by RYGB (9.7%) and one anastomosis gastric bypass (3.9%). Newer procedures, such as N-SG (0.4%), SASI (0.8%), and SADI-S (0.2%) were less frequently performed. Over a half of all surgeries (59.3%) were performed in KOS-BAR centers. Significant regional variations in procedure volumes were observed.

Conclusions: Bariatric surgery in Poland has seen substantial growth, with SG as the dominant procedure. However, regional disparities in access to care and the limited adoption of newer techniques persist. Expanding services to underserved regions and establishing a national registry are crucial for improving patient care and outcomes.