Videosurgery and Other Miniinvasive Techniques最新文献

Introduction: Inguinal hernia repair, particularly the transabdominal preperitoneal (TAPP) technique, is common worldwide. Obesity (body mass index [BMI] ≥30 kg/m²) can influence surgical outcomes, potentially resulting in longer operative time, higher complication rate, and prolonged hospital stay.

Aim: This study aimed to evaluate the impact of obesity on surgical outcomes following laparoscopic TAPP inguinal hernia repair.

Materials and methods: We retrospectively reviewed data from patients who underwent laparoscopic TAPP inguinal hernia repair between September 2021 and December 2023. We included patients aged 18 years or older who had elective unilateral TAPP repair for primary inguinal hernia. The patients were categorized based their BMI as obese (BMI ≥30 kg/m²) and nonobese (BMI <⁠30 kg/m²). Outcomes assessed included recurrence rate, surgical site infections (SSIs), operative time, and length of hospital stay.

Results: We analyzed 201 patients of whom 30 (14.8%) were obese and 171 (85.2%) were nonobese. Recurrence rates were 6.67% in the obese and 2.35% in the nonobese patients (P = 0.222). No SSIs were observed in the obese patients, as compared with 1.76% in the nonobese individuals (P = 1). Mean (SD) operative time was 78.87 (31.88) minutes for the obese and 70.28 (27.25) minutes for the nonobese patients (P = 0.203). Mean (SD) hospital stay was 3.13 (0.35) days for the patients with and 3.05 (0.28) days for those without obesity (P = 0.086).

Conclusions: There were no significant differences in recurrence rates, SSIs, operative time, or hospital stay between the obese and nonobese patients. Appropriate surgical expertise and perioperative management can result in comparable outcomes for both groups. Further research is recommended to understand the impact of obesity on hernia recurrence.

Introduction: As a clinically common urinary system disease, ureteral calculus mainly manifests as hematuria and colicky pain.

Aim: We aimed to explore the influence of the "five‑in‑one" mode on complications and compliance behaviors of patients with ureteral calculi after minimally invasive surgery.

Materials and methods: A total of 92 participants were enrolled from among the patients hospitalized for ureteral calculi and treated with minimally invasive surgery between April 2022 and April 2023. The patients were randomized into a control group (n = 46) and an experimental group (n = 46). The control group received rehabilitation guidance under routine nursing mode, while the experimental group was provided with the "five‑in‑one" nursing mode to strengthen communication in all aspects, in addition to synergistic therapy.

Results: The self‑rating depression scale scores declined in both groups after treatment in comparison with those before treatment (P <0.05), and the postoperative score was significantly lower in the experimental group (P <0.05). The experimental group had also decreased Visual Analog Scale scores in all time periods (1, 3, and 7 d) after treatment (P <0.05), and significantly elevated total nursing satisfaction rate, as compared with that of the control group (97.82% vs 82.6%; P <0.05).

Conclusions: The "five‑in‑one" mode can enhance patient confidence in rehabilitation and improve their quality of life and satisfaction with nursing.

Introduction: Accurate identification of lung lesions during lung biopsy (LB) surgery can be achieved with the use of computed tomography (CT) guidance. The rapid on‑site evaluation (ROSE) method allows for quick assessment of the features, cytomorphological traits, and appropriateness of the obtained tissue samples, and might further accelerate the diagnostic workup.

Aim: We aimed to investigate the diagnostic value of CT‑guided aspiration biopsy combined with ROSE for assessment of pulmonary lesions.

Materials and methods: A PubMed and Embase search was undertaken until October 2023 to find studies on lung lesion diagnosis utilizing CT‑guided needle biopsy and ROSE. The main method for assessing bias and relevance was the updated Quality Assessment of Diagnostic Accuracy Research 2 tool. The threshold effect and subgroup analysis were used to determine the source or heterogeneity. Sensitivity, specificity, diagnostic odds ratio (DOR), area under the summary receiver operating characteristics curve (SROC AUC), and the Q‑index were calculated. The Deek funnel plot was used to evaluate publication bias.

Results: A total of 6 studies (n = 951) with mild heterogeneity were included in this meta‑analysis, yielding a pooled sensitivity, specificity, and DOR of 0.94 (95% CI, 0.91-0.96), 0.95 (95% CI, 0.9-0.98), and 159.05 (95% CI, 69.59-363.49), respectively. The SROC AUC, calculated using a random‑effects model, was 0.98. Subgroup analysis showed that study design (prospective vs retrospective) had an impact on sensitivity. Further analysis of 3 studies that established control groups showed that the ROSE group had by 12% (95% CI, 0.08-0.16; I² = 0) higher sampling adequacy and diagnostic accuracy than the non‑ROSE group, while there was no significant difference in the rate of complications.

Conclusions: For assessment of pulmonary lesions, CT‑guided puncture biopsy combined with ROSE has high sensitivity, specificity, and diagnostic accuracy, and is a practical operational method that merits wide clinical application.

Introduction: Surgery is the principal treatment option for early colorectal cancer (CRC). Anesthesia plays a crucial role in any surgery as it allows for a painless procedure. Dexmedetomidine is a local anesthetic that reduces pain and discomfort during surgery.

Aim: The aim of this study was to investigate the efficacy of application of dexmedetomidine combined with total intravenous anesthesia in laparoscopic CRC surgery, with particular focus on its effects on patient hemodynamics and inflammatory factors.

Materials and methods: For the purposes of this study, 80 patients undergoing elective laparoscopic rectal cancer surgery were selected and subsequently divided into 2 groups: the experimental group (0.5 µg/kg dexmedetomidine infused at a constant speed for 20 minutes, followed by 0.4 µg/kg/h dexmedetomidine) and the control group (0.5 µg/kg sufentanil infused at a constant speed for 20 minutes, followed by 0.4 µg/kg/h sufentanil). Each group comprised 40 patients. Hemodynamic parameters were recorded 1 minute before pumping dexmedetomidine or sufentanil (S0), 1 minute after pneumoperitoneum position (S1), 1 hour after pneumoperitoneum (S2), and 1 minute after elimination of air from the patient's peritoneal cavity and position change (S3).

Result: Systolic blood pressure (SBP) and diastolic blood pressure (DBP) at S1 and S2 in the experimental group were lower than in the control group (P <0.05). Heart rate (HR) and mean arterial pressure (MAP) at S1, S2, and S3 in the experimental group were lower, as compared with the control group (P <0.05). The levels of serum inflammatory factors (tumor necrosis factor α [TNF‑α], interleukin [IL]‑8, and IL‑6) and stress response indicators (plasma epinephrine, norepinephrine, and plasma cortisol) at S1, S2, and S3 in the experimental group were lower than in the control group (P <0.05). The expressions of TNF‑α, IL‑8, and IL‑6 in the experimental group negatively correlated with SBP and DBP (P <0.05), and with MAP and HR (P <0.001).

Conclusion: Dexmedetomidine can effectively maintain hemodynamic stability and inhibit inflammatory and stress responses in patients undergoing laparoscopic CRC surgery, with its effect being superior to those of sufentanil.

Introduction: Endoscopic subcutaneous onlay approach (SCOLA) mesh repair in combination with anterior plication of diastasis has recently become a commonly performed procedure.

Aim: The aim of this study was to analyze the results of 1‑year follow‑up in patients after umbilical hernia with rectal abdominal muscle diastasis repair using endoscopic SCOLA.

Materials and methods: Our prospective cohort study included patients who underwent elective surgery for small‑ (<2 cm) and medium‑ (2-4 cm) size primary umbilical hernia with diastasis recti. The follow‑up period was 12 months. Hernia recurrence and postoperative seroma diagnosis were based on the patient's physical examination and ultrasound assessment. The Carolinas Comfort Scale questionnaire was used to evaluate the quality of life after the surgery.

Result: One hundred patients underwent surgery for umbilical hernia with rectal abdominal muscle diastasis repair. Their mean (SD) age was 39.6 (11.8) years. Most of the patients (n = 77) were women. We found no hernia or diastasis recurrence during 1‑year follow‑up. Seroma was found in 15 patients during the first month of follow‑up. The rate of seroma was 11% after 3 months and 2% after 6 months of follow‑up. Almost all the patients reported mild or moderate symptoms during daily activities after the surgery.

Conclusion: SCOLA is a safe and effective technique for patients with small umbilical hernia with diastasis. It provides an acceptable cosmetic result for carefully selected patients, low postoperative pain, and good quality of life.

Introduction: Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy. Lack of timely CSP treatment can lead to severe postpartum bleeding, affect fertility, and threaten patients' life and health.

Aim: This work explored the use of laparoscopic temporary uterine artery blocking (TUAB) and uterine artery embolization (UAE) in treating CSP.

Materials and methods: For the purpose of the study, 60 patients with CSP were selected and equally divided into the UAE group and the TUAB group. Both groups underwent cesarean scar lesion repair (CSLR) after the procedure. The differences in surgical outcomes, β‑human chorionic gonadotropin (β‑HCG) levels, ovarian reserve, endocrine function indicators, as well as the incidence of complications were compared between the groups.

Result: The TUAB group presented a shorter length of hospital stay, shorter vaginal bleeding time, shorter menstrual recovery time, and shorter mass disappearance time than the UAE group (all P <0.05). The patients in the TUAB group had lower β‑HCG, estradiol, and progesterone levels, and higher levels of luteinizing hormone and follicle‑stimulating hormone (all P <0.05). Furthermore, the TUAB patients had a larger mean ovary diameter, an increased antral follicle count, and an elevated level of anti‑Müllerian hormone, as compared with the individuals treated with UAE (all P <0.05). The total incidence of complications in the UAE and TUAB groups was 23.33% (7/30) and 6.67% (2/30), respectively (P <0.05).

Conclusions: Laparoscopic TUAB for CSLR proved to be a more effective and safer CSP treatment method than UAE.

Introduction: Cervical disc herniation (CDH) is a common condition, usually caused by excessive strain or trauma to the spine. Initially, it is treated conservatively; however, complex and resistant cases may require a surgical intervention.

Aim: We aimed to compare the clinical effect of endoscopy-assisted anterior cervical discectomy and fusion (ACDF) with internal fixation and conventional surgery in the treatment of CDH.

Materials and methods: Patients with CDH who underwent ACDF with fixation at the Zhoushan Dinghai Guanghua Hospital were enrolled. Of them, 10 individuals were treated with conventional ACDF (conventional surgery group), and the other 10 with endoscopy-assisted ACDF (endoscopy-assisted surgery group). The general characteristics, postoperative Japanese Orthopedic Association (JOA), visual analogue scale (VAS), 12-Item Short Form Survey Physical Component Summary (SF-12 PCS), and SF-12 Mental Component Summary (SF-12 MCS) scores, physiological stress response, rate of the improved JOA score (RIS), hemoglobin level, and bone graft fusion were compared between the groups.

Result: Outcomes of the patients treated with endoscopy-assisted surgery were clearly superior to those observed in the conventional surgery group. The postoperative JOA, VAS, SF-12 PCS, and SF-12 MCS scores and RIS in the endoscopy-assisted surgery group were higher than in the conventional surgery group (P <⁠0.05). Following operation, there were significant differences between the 2 groups with respect to RIS at 1 week and 6 months postsurgery and hemoglobin levels on postoperative day 2. Changes in heart rate and diastolic blood pressure in the endoscopy-assisted surgery group were less pronounced than in the conventional surgery group (P <⁠0.05), and the fusion rate was significantly higher in the former group (90% vs 80%, respectively).

Conclusion: Endoscopy-assisted ACDF with internal fixation has a greater clinical therapeutic effect than the conventional approach in the treatment of CDH. It is associated with a higher bone graft fusion rate and reduced intraoperative blood loss.

Introduction: Systemic targeted therapy options are commonly used in patients with metastatic renal cell carcinoma (mRCC). Histological verification is crucial for treatment of mRCC.

Aim: Our aim was to evaluate an optimal location for percutaneous computed tomography‑guided biopsy in a diagnosis of suspected mRCC.

Materials and methods: A total of 138 percutaneous biopsies for tumors ranging from 21 to 133 mm in diameter (median, 72 mm) were carried out in 134 patients with suspected mRCC over a 5‑year period. The biopsy location was variable, with kidney biopsy performed in 77 cases (55.8%), and other localizations (retroperitoneum, peritoneal cavity, liver, pelvis, pleural space, lung, mediastinum, chest or abdominal wall, and pancreas) in 61 cases (44.2%).

Results: As many as 288 biopsies (97.1%), yielded truepositive results, and 4 procedures (2.9%) yielded histologically falsenegative results that required confirmation through extended rebiopsy. RCC was the most common individual diagnosis (85.5%), with non‑RCC histology verified in 14.5% of cases. In total, 32 complications (23.2%) were confirmed, 2 of which were pneumothoraces, 29 were minor bleeding that needed only conservative management, and 1 case required angiography and embolization for hemorrhage treatment. While no significant relationship between the biopsy success and lesion localization (renal vs other) was found (P = 0.13), the relationship between complication rate and biopsy localization (renal vs other) was significant (P = 0.01).

Conclusions: Lesion localization (renal vs other) was not relevant to histological accuracy of the biop‑ sies performed in patients with suspected mRCC. However, the biopsies of lesions outside the kidney had a lower complication rate.

Introduction: Lung resection continues to be the most effective treatment for early‑stage lung cancer. Prediction of postoperative lung function is particularly important when evaluating patient eligibility for surgery, as it helps assess the likelihood of experiencing difficulty breathing after the operation.

Aim: We aimed to identify the most common methods used to predict postoperative lung function in clinical practice and to compare their accuracy.

Materials and methods: A systematic review and meta‑analysis were performed to synthesize research focused on the prediction of postoperative lung function. A total of 10 studies were included in the analysis. The Cochrane risk of bias tool was utilized to evaluate the risk of bias in the studies. Additionally, a meta‑analysis of the mean difference between the predicted and measured values of forced expiratory volume in 1 second (FEV₁) was conducted. The I² value was computed as a metric of coherence among studies, while funnel plots and the Begg test were used to evaluate the likelihood of publication bias.

Results: The analyzed studies had a low risk of bias. The meta‑analysis showed that computed tomography (CT) volume and density measurement had the highest level of accuracy for predicting postoperative FEV₁ , with a mean difference between the predicted and actual value of 83 ml (95% CI, 41-116).

Conclusions: The results indicate that using CT volume and density is the optimal method for predicting postoperative FEV₁ . Additional research is necessary to establish the connection between the type of surgical procedure, adopted thresholds, and outcomes reported by patients.

Introduction: With the continuous development of science and technology, robotics technology has gradually penetrated into various fields of application. In medicine, it is widely used in surgery to improve procedural accuracy and patient safety.

Aim: This paper aims to explore the application of robotics in endoscopic submucosal dissection (ESD) and to summarize the principles, techniques, advantages, and limitations of robot-assisted procedures.

Materials and methods: A comprehensive search of the PubMed database and was conducted since the database inception until March 2024. We performed the search using subject headings and key words to obtain relevant articles focused on the application of robotic systems in ESD.

Results: A total of 21 studies describing 9 robotic systems were found eligible. The systems were categorized into one-type endoscopic robots and integrated endoscopic robots, and individual systems were reviewed and compared in a narrative form.

Conclusions: Robotics technology has essential application value and development potential in ESD. Improving the accuracy and stability of the robotic arm, reducing its cost, and broadening its applica tion are the key challenges faced by this continuously advancing technology. It is necessary to further strengthen technology research, development, innovation, and interdisciplinary cooperation to promote the use and advancement of robotics technology in ESD.