Videosurgery and Other Miniinvasive Techniques最新文献

Introduction: The obesity epidemic has led to an increased prevalence of related conditions, such as type 2 diabetes (T2D) and hypertension. While laparoscopic sleeve gastrectomy is the most common metabolic bariatric surgery, up to 50% of patients may require revisional procedures due to weight regain or comorbidity recurrence. Single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is emerging as an effective treatment option with promising short-term outcomes.

Aim: This study aimed to present the outcomes of patients who underwent SADI-S or revisional SADI.

Materials and methods: This retrospective, single-center cohort study included 12 patients who underwent SADI-S or SADI between February 2023 and March 2024. The patients were assessed for percentage of total weight loss (%TWL), remission of T2D and hypertension, length of hospital stay, operative time, and complications. All outcomes were reported according to the American Society for Metabolic and Bariatric Surgery standards.

Results: A total of 9 patients underwent primary SADI-S and 3 underwent revisional SADI. The mean (SD) %TWL was 27.9% (4.3%) at 6 months and 31.1% (5.9%) at 12 months after SADI and 21.2% (15.2%) and 14% (7.5%), respectively, after SADI-S. The mean (SD) preoperative body mass index was 42 (5.5) kg/m2 in the primary SADI-S group and 42.4 (9.3) kg/m2 in the revisional SADI group, and the mean (SD) follow-up was 10.1 (3.4) months. Full remission of T2D and hypertension was achieved in all patients within 6 months of surgery. There were no major complications, except for 1 case of intraoperative conversion to one-anastomosis gastric bypass.

Conclusions: SADI-S is associated with significant weight loss and comorbidity resolution with a low complication rate, though larger studies are needed for further validation of these results.

Introduction: Metabolic and bariatric surgery (MBS) is the most effective treatment for severe obesity, providing substantial weight loss and improvement in obesity-related comorbidities. In 2020, the MBS Chapter of the Association of Polish Surgeons issued the Bariatric and Metabolic Surgery Care Standards to guide patient management.

Aim: The aim of the study was to asses implementation of the standards in Polish surgical departments and identify factors associated with better compliance.

Materials and methods: An online survey was distributed between August and December 2022 to 46 Polish surgical departments performing MBS. The survey included 62 questions covering general center characteristics, and pre-, peri-, and postoperative care. Descriptive statistics summarized the center characteristics and linear regression models analyzed the factors influencing compliance.

Results: Thirty-six centers completed the survey, with a mean (SD) compliance score of 86.8% (9%) (29.5 of 34 criteria), and individual scores ranging from 70.6% to 100%. As many as 66.7% of the centers answered at least 80% of the questions. The areas with compliance below 80% included availability of adapted radiology facilities, constant availability of emergency radiology diagnostics, screening for metabolic markers, assessment of obstructive sleep apnea risk, obtaining patient declaration of abstaining from smoking, providing dates for at least 1 dietary consultation upon discharge, requiring at least 2 consultations with an experienced dietician, and employing a surgeon with bariatric certificate of excellence. Significant predictors of better compliance included the number of surgeons performing MBS and participation in the KOS-BAR program (a program of complex specialist care over patient undergoing bariatric surgery).

Conclusions: The Bariatric and Metabolic Surgery Care Standards are moderately well adopted by Polish surgical departments, with improvements needed in specific areas. Unifying the standards may enhance patient outcomes.

Introduction: Although laparoscopic common bile duct exploration (LCBDE) is considered a safe and effective method for treating choledocholithiasis, the absence of any biliary or abdominal drainage during surgery remains controversial.

Aim: This paper aims to investigate the feasibility and safety of LCBDE without drainage, particularly abdominal drainage.

Materials and methods: This retrospective analysis included 499 patients who underwent LCBDE with primary closure of the common bile duct and without any kind of biliary drainage during surgery. In 322 individuals, the surgery involved routine abdominal drainage (drainage group), whereas in 177 cases, no abdominal drainage was performed (nondrainage group). Baseline characteristics of the 2 groups were compared, followed by propensity score matching (PSM) to balance confounding factors. We compared effect indicators and complication rates between both groups.

Results: After PSM, each group included 124 patients. There were no significant differences between the 2 groups in terms of overall and individual complication rates, except for a lower incidence of hyperamylasemia in the nondrainage group. The surgery time, duration of postoperative antibiotic use, and the total and postoperative length of hospital stay was significantly shorter in the nondrainage group. Similarly, the total hospitalization cost and postoperative usage of analgesics and antispasmodics were also considerably lower in the nondrainage group.

Conclusions: Nondrainage LCBDE is associated with shorter recovery time and better patient outcomes, as compared with procedures involving abdominal drainage. In suitable cases, this approach is completely safe and feasible.

Introduction: Emergency endoscopy has proven remarkably effective in the treatment of gastrotestinal bleeding. However, its efficacy has not been extensively evaluated specifically in patients with cirrhosis‑associated esophagogastric variceal bleeding (EGVB). The patients may experience stress and anxiety before being subjected to the procedure.

Aim: This study aimed to investigate the effect of ventilator‑assisted emergency endoscopy in the treatment of cirrhosis‑associated EGVB.

Materials and methods: A total of 63 patients with cirrhosis‑associated EGVB were enrolled in the study and divided into 2 groups using the random number table method. The control group (n = 31) received conventional emergency endoscopic hemostasis, while the observational group (n = 32) underwent ventilator‑assisted emergency endoscopic hemostasis. The hemostatic success rate, post‑treatment rebleeding rate, postoperative complication rate, length of stay in the intensive care unit (ICU), cost of hospitalization, and the patients' feeling of comfort (eg, fever and anxiety) were assessed in both groups.

Results: There were no significant differences in the hemostatic success rate, rebleeding rate, mortality, length of stay in the ICU, or cost of hospitalization between the groups. The symptoms and feelings of anxiety and pain in the observational group were significantly less intense than in the control group. However, there was no significant difference in the frequency of postoperative fever between the groups.

Conclusions: In the emergency endoscopic treatment of patients with cirrhosis‑associated EGVB, using a ventilator ensures a smooth airway, keeps patients sedated throughout the procedure, and enhances their overall comfort. Ventilator‑assisted emergency endoscopy helps alleviate postoperative pain and reduces anxiety.

Introduction: Hook-wire (HW) localization is the most frequently employed approach for preoperative localization of pulmonary ground-glass nodules (GGNs); however, the relative outcomes of conventional and soft HW localization of GGNs remain poorly understood.

Aim: This study sought to compare the safety and efficacy of preoperative computed tomography-guided conventional and soft HW localization of pulmonary GGNs.

Materials and methods: Between January 2023 and June 2024, consecutive patients with pulmonary GGNs underwent conventional or soft HW localization prior to video-assisted thoracoscopic surgery. Safety and clinical efficacy of these 2 localization strategies were compared.

Results: In total, 88 patients underwent conventional HW localization of 95 GGNs, and 82 patients underwent soft HW localization of 88 GGNs. Technical success rates for the conventional and soft HW groups were 96.8% and 100%, respectively (P = 0.25), and the duration of localization was similar in both groups (mean [SD], 10.1 [4.5] vs 10 [5.9] min; P = 0.97). Complications were significantly more common in the conventional HW group than in the soft HW group (48.9% vs 32.9%, respectively; P = 0.04). Visual analog scale scores in the conventional HW group were significantly higher than those observed in the soft HW group (mean [SD], 4.6 [0.6] vs 3.4 [0.6]; P = 0.001). The rates of technical success for limited resection procedures were similar in both groups (96.8% vs 100% in the conventional and soft HW groups, respectively; P >0.99).

Conclusions: Conventional and soft HW strategies can both effectively facilitate preoperative pulmonary GGN localization, but the soft HW approach has a more favorable safety profile.

Introduction: The unilateral biportal endoscopic (UBE) technique has been widely adopted for treat‑ ment of lumbar disc herniation and lumbar spinal stenosis. Understanding its learning curve, as well as the factors that influence perioperative complications, is crucial for mastering and effectively learning this technique.

Aim: Our aim was to analyze the learning curve of UBE‑unilateral laminectomy bilateral decompression (ULBD) and risk factors associated with perioperative complications.

Materials and methods: Consecutive patients who underwent UBE from June 2021 to December 2023 at the Department of Orthopedics, Beijing Friendship Hospital, were retrospectively analyzed. Baseline information, perioperative data, and preoperative and postoperative subjective scores were recorded for all patients. The learning curve and identified risk factors for complications were analyzed.

Results: A total of 122 consecutive patients who underwent single‑segment UBE‑ULBD were included in this study. The surgical time curve fitting indicated that the surgeon nearly mastered the technique by the 38th case. Consequently, the cohort was divided into 2 distinct phases: a learning phase (cases 1-38) and a mastery phase (cases 39-122). Operative time, estimated blood loss, and drainage volume were higher in the learning phase group than in the mastery phase group, although hidden blood loss in the learning phase group was lower than in the mastery phase group. The visual analogue scale and Oswestry Disability Index scores at the last follow‑up showed significant improvement in both groups as compared with the preoperative period (P <0.05). Complication rate was 7.9% in the learning phase and 3.6% in the mastery phase. Univariate analysis showed that age, body mass index, alcohol consumption, and estimated blood loss were significantly associated with complication rate.

Conclusions: UBE is an effective minimally‑invasive spinal endoscopic technique for treating lumbar spinal stenosis, offering short time to achieving surgical mastery and a low complication rate.

Introduction: In patients with inoperable intrahepatic cholangiocarcinoma (ICC), both conventional transarterial chemoembolization (cTACE) and drug‑eluting bead TACE (DEB‑TACE) can be employed as therapeutic interventions. However, the relative advantages of these strategies remain to be clarified.

Aim: This meta‑analysis was performed to compare the safety and efficacy of DEB‑TACE and cTACE in the treatment of ICC.

Materials and methods: A comprehensive search of the Cochrane Library, PubMed, and Wanfang databases was conducted to identify publications that were pertinent to the present meta‑analysis. The primary outcome of interest was the overall survival (OS) rate. Secondary outcomes were progression‑free survival (PFS), disease control rate (DCR), objective response rate (ORR), and adverse event (AE) rate. Heterogeneity was evaluated using the I 2 statistic, while publication bias was assessed with the Egger test.

Results: A total of 6 articles involving 283 and 178 patients who received cTACE and DEB‑TACE treatment, respectively, were included in this study. DEB‑TACE was superior to cTACE in terms of DCR (P = 0.004), PFS (P <0.001), and OS (P = 0.004), despite comparable pooled ORRs. No intergroup differences were observed with respect to AE occurrence. The ORR, DCR, and OS end points showed significant heterogeneity (I2 = 79%, I² = 61%, and I² = 95%, respectively). Additionally, the OS end point was subject to substantial publication bias (Egger test, P = 0.002).

Conclusions: DEB‑TACE was shown to be superior to cTACE with respect to efficacy, while the safety profile of these 2 interventions was similar. Consequently, DEB‑TACE offers additional value in the management of inoperable ICC.

Introduction: The widespread use of ultrasound and cross‑sectional imaging has led to a steady increase in the incidental discovery of renal masses. Most of them are treated with partial nephrectomy (PN), as recommended by the European Association of Urology guidelines. However, this approach carries a risk of local recurrence. In such a case, surgical reintervention can be more challenging and is often associated with worse prognosis. In this context, percutaneous ablative therapies are a promising alternative.

Aim: This study presents our experience with using percutaneous cryoablation (PCA) to manage recurrences and new masses in previously operated kidneys.

Materials and methods: We conducted a retrospective data analysis to evaluate patients treated with PCA for tumor recurrence or residual disease in the postresection bed, excluding those with de novo or recurrent tumors in the contralateral kidney.

Results: A total of 23 individuals met the inclusion criteria. Of those, 14 initially underwent laparoscopic PN, and 9 were treated with open surgery. The median interval from the initial surgery to recurrence‑targeted PCA was 23 months (range, 7-228). The mean (SD) RENAL score on admission was 7.5 (1.9), and the median (interquartile range) tumor volume was 3 (1.6-4.5) ml. The median length of hospital stay was 23 hours (range, 6-55). There was no significant change in estimated glomerular filtration rate following cryoablation. All the recorded complications, except one, were grade I and resolved with hydration or treatment with nonsteroidal anti‑inflammatory drugs. No patient required dialysis in the perioperative period.

Conclusions: Imaging‑guided PCA is a feasible and effective treatment option for patients with renal tumor recurrences after PN.

Introduction: Fluid resuscitation is the primary sepsis management strategy aimed at reducing mortality and achieving better treatment outcomes in critically hypotensive patients. Still, there are significant ambiguities regarding the most suitable fluid type that would ensure optimization of patient outcomes.

Aim: The aim of this systematic review and meta-analysis was to assess the clinical effectiveness of different resuscitation fluids for sepsis management in critically hypotensive patients.

Materials and methods: A systematic search of 4 electronic databases (PubMed, EMBASE, Scopus, and Cochrane Library) was conducted to identify relevant papers published in peer-reviewed journals since database inception until June 30, 2024. Odds ratios (ORs) with 95% CIs were calculated to evaluate the impact of individual resuscitation fluids on improvements in hemodynamic parameters and all-cause mortality. Heterogeneity was assessed using the Cochran Q, I² statistic, and the appropriate P value.

Results: Our meta-analysis included 18 randomized controlled trials comparing the efficacy of different resuscitation fluids for sepsis management in 14 469 critically hypotensive patients. We found that Ringer's lactate solution was more effective than saline in reducing mortality (OR, 0.53; 95% CI, 0.41-0.7; χ²= 3.47; degree of freedom [df] = 6; Z = 4.6; I² = 0%; P <⁠0.001) and improving hemodynamic parameters (OR, 2.64; 95% CI, 2.45-2.86; χ² = 48.36; df = 6; Z = 24.84; I² = 18%; P <⁠0.001). However, saline was superior to albumin and hydroxyethyl starch in reaching these end points.

Conclusion: We showed that in critically hypotensive septic patients, Ringer's lactate solution reduces all-cause mortality and improves hemodynamic parameters more effectively than saline, hydroxyethyl starch, and albumin solutions.

Introduction: Hernia repair is a common procedure, especially among the elderly. In the face of rising life expectancy, adequate hernia management in older adults is crucial. Laparoscopic transabdominal preperitoneal patch plasty (TAPP) for hernia repair is minimally invasive, but poses challenges in the elderly due to a larger number of comorbidities.

Aim: The aim of this study was to evaluate the safety and efficacy of TAPP hernia repair in patients aged 70 years and older.

Materials and methods: Our retrospective study reviewed data of patients who underwent elective unilateral TAPP repair for primary inguinal hernia between September 2021 and December 2023. The patients were divided by age: 70 and older (cases) and younger than 70 (controls). Primary outcomes included recurrence rate, surgical site infections (SSIs), operative time, and hospital stay. Data were analyzed with descriptive statistics and inferential tests.

Results: The study included 201 patients (47 cases and 154 controls). The mean (SD) age was 75.74 (4.73) years for the cases and 53.47 (12.8) years for the controls. No recurrences were found in the elderly (cases) group, while the control group recorded a 3.92% recurrence rate (P = 0.34). SSIs affected 2.13% of the cases and 1.31% of the controls (P = 0.55). Operative times were similar (71.44 vs 71.96 min; P = 0.8). Hospital stay was 3.11 days for the cases and 3.04 days for the controls (P = 0.14).

Conclusions: Laparoscopic TAPP hernia repair is a safe and effective procedure in the elderly and its outcomes are comparable to those recorded in younger patients. Further studies are needed to validate these results.