Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

Background: Sleeve gastrectomy has become the most commonly performed bariatric procedure worldwide, yet staple line complications including bleeding and leakage remain significant concerns. The EnDrive Zero stapler features an innovative 4 × 2 configuration with B-Duo reinforced design, theoretically offering superior mechanical integrity and enhanced hemostasis compared with conventional staplers. Methods: Fourteen pigs underwent laparoscopic gastric stapling using either the EnDrive Zero test device (n = 6) or a conventional control stapler (n = 6). Gastric stapling was performed along the greater curvature under acute hypertension induced by epinephrine (8 μg/kg) to simulate demanding clinical conditions. Primary outcomes included intraoperative hemostasis scores, staple line integrity, and ex vivo burst pressure testing. Animals were followed for 28 days with comprehensive clinical, hematological, and histopathological evaluation. Results: Both devices achieved excellent hemostatic control with no significant differences in bleeding scores (stomach vessels: 2.3 ± 0.8 versus 1.7 ± 0.8, P = .183; gastric tissue: 1.3 ± 0.5 versus 1.1 ± 0.4, P = .552). All animals survived 28 days without adverse events, demonstrating 100% anastomotic success and complete healing. However, ex vivo burst pressure testing revealed significantly superior mechanical integrity for the test device (251.3 ± 15.6 mmHg versus 226.3 ± 16.3 mmHg, P = .013), representing an 11% improvement. Histopathological examination showed minimal tissue reactivity in both groups with no significant differences. Conclusion: The EnDrive Zero 4 × 2 stapler demonstrated hemostatic performance equivalent to conventional staplers while providing significantly superior mechanical strength in gastric stapling. This enhanced burst pressure, combined with the theoretical hemostatic advantages of four-row stapling, may offer additional safety margins against both bleeding and leak complications in sleeve gastrectomy, warranting clinical investigation in bariatric surgery.

This multicenter retrospective study investigates the utility of routine lower abdominal diagnostic laparoscopy (DL) during sleeve gastrectomy (SG) for identifying and managing incidental intra-abdominal pathologies in a high-risk obesity cohort. Data from 371 patients undergoing SG with concurrent DL across three Libyan centers (January 2021-December 2024) were analyzed. DL involved systematic abdominal exploration using a 180° camera rotation in a 45° reverse Trendelenburg position using a 300 lens. Incidental findings were detected in 6.5% (n = 24), including cysts/masses (45.8%, n = 11), adhesions (29.2%, n = 7), hernias (16.7%, n = 4), and other pathologies (8.3%, n = 2). These findings prompted and one procedure abortion, one precancerous mass excision through left side oophorectomy-pathology revealed mature teratoma-and was rescheduled for SG later. The median operative time increased by 3-7 minutes, with no morbidity or mortality related to DL. Two patients with incidental hernias required emergency repair within 90 days. Patients requiring intervention had similar hospital stays (1-2 days). Preoperative ultrasound failed to detect all laparoscopically identified pathologies. Routine DL during SG proved feasible and safe, adding minimal operative time while enabling timely interventions that potentially averted long-term morbidity. The findings underscore DL's critical role in detecting occult pathologies in obese populations, particularly where preoperative diagnostic accuracy is limited. Standardizing DL in bariatric protocols is advocated to enhance intraoperative decision-making and patient safety.

Background: Robotic-assisted laparoscopic adrenalectomy (RALA) became a useful tool for the treatment of adrenal lesions. This study aims to identify areas where RALA may offer better outcomes than laparoscopic techniques. Methods: We conducted a retrospective study between August 2014 and November 2024. We involved 321 patients who underwent adrenalectomy during this time. Among these patients, 170 had laparoscopic adrenalectomy (LA), and 151 underwent RALA. We grouped these patients according to the surgical approach, collected, and analyzed preoperative data, and compared their perioperative and postoperative outcomes. Results: In this study, we compared two groups, showing the robotic approach was associated with a significantly shorter operative time compared with the laparoscopic group, 100.5 (±51.7) minutes versus 117.9 (±67.4) minutes, P = .02. There were no significant differences in estimated blood loss (P = .97) or conversion to open (P = .6) between the two groups. But robotic patients did exhibit a shorter duration of hospital stay, a median of 1 versus 2 days in the case of the laparoscopic approach, P value <0.01, and statistically lower 30-day complication rates in the robotic approach, 7.3% versus 14.7%, P = .035. Other short- and long-term complications were comparable between the two groups. Subanalysis of large tumor mass (>5 cm) showed comparable outcomes, with robotic cases showing statistically lower early complication rates (P = .05). Conclusion: The study shows that RALA offers some advantages compared to the traditional LA, particularly with shorter operative time, lesser hospital stay, and fewer early complications. More randomized trials will help to confirm the findings and reach a more definitive conclusion.

Background: Biliary tree cysts (BTCs) are rare congenital dilatations of the bile ducts associated with an increased risk of acute cholangitis and cholangiocarcinoma (CCA). Over the past two decades, surgical resection has become the standard of care in the management of BTCs. The most widely accepted classification, introduced by Todani in 1977, is based on cyst morphology. However, from a surgical perspective, BTCs can also be categorized by location as intrahepatic, extrahepatic, or mixed. Methods: We conducted a retrospective analysis of 31 patients who underwent surgical resection for BTCs between 2005 and 2021 at two centers: Hospital de la Santa Creu i Sant Pau (Barcelona, Spain) and Ospedale San Paolo (Savona, Italy). Patients were divided into two groups based on cyst location: intrahepatic (IHG) and extrahepatic (EHG). Perioperative data, postoperative complications, oncological outcomes, and long-term survival were compared between groups. Results: A total of 31 patients were included: 15 in the IHG and 16 in the EHG. Baseline characteristics were similar across groups. The median operative time was 196 minutes (range: 120-300) in the IHG and 156 minutes (range: 90-240) in the EHG (P = .073). There were no significant differences in postoperative complications. Median postoperative hospital stay was 12 days (range: 5-34) in the IHG and 18 days (range: 7-39) in the EHG (P = .123). After a median follow-up of 68 months, 26 patients (83.9%) were alive and in good clinical condition. Three patients died from causes unrelated to surgery, while 2 patients-both with histologically confirmed CCA-died from disease progression. No significant difference in overall survival was observed between the two groups (P = .192). Conclusion: Surgical resection of BTCs is safe and feasible. Perioperative outcomes and long-term survival are comparable between intrahepatic and extrahepatic BTCs, supporting surgery as an effective treatment regardless of cyst location.

Background: Totally laparoscopic distal gastrectomy (TLDG) is a minimally invasive alternative to laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer. While both are widely used, it remains unclear which yields better outcomes. Therefore, this meta-analysis aimed to compare surgical outcomes and postoperative quality of life (QoL) between TLDG and LADG. Methods: We searched PubMed, Embase, and Cochrane Library databases in May 2025. Mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled for continuous and binary outcomes, respectively. Heterogeneity was assessed with I² statistics. Statistical analysis was performed using the R software. Results: Three studies involving a total of 954 patients were included, of whom 484 underwent TLDG. Compared with LADG, TLDG significantly reduced Clavien-Dindo (CD) grades I-II complications (RR = 0.54; 95% CI: 0.33-0.89) and intraoperative blood loss (MD = -13.97 mL; 95% CI: -23.71, -4.23). Additionally, TLDG was associated with improved postoperative QoL assessed with the Stomach Module questionnaire (QLQ-STO22) (MD = -5.96 points; 95% CI: -11.51, -0.40). No significant differences were found between the groups in CD grades III-IV complications, early complications, operative time, or QoL measured by Quality-of-Life questionnaire. Postoperative mortality was rare, with only one reported death across all studies. Conclusions: TLDG was associated with fewer low-grade complications and less intraoperative blood loss, compared with LADG. However, no significant differences were observed in major complications and operative time. Furthermore, there was an improvement in QoL assessed using the QLQ-STO22 in favor of TLDG. These findings support TLDG as a safe and effective alternative to LADG for early gastric cancer.

Background: Primary hyperhidrosis is a debilitating condition characterized by excessive focal sweating, most commonly affecting the axillae, palms, and soles, for which surgical intervention provides a durable solution in patients refractory to medical management. Methods: We present our outpatient surgical technique for video-assisted thoracoscopic sympathectomy (VATS) using a two-port, 3-mm incision approach and evaluate its efficacy and outcomes. A case series of 33 consecutive patients undergoing outpatient VATS sympathectomy between 2016 and 2023 was reviewed, with 9 patients excluded for lack of postoperative follow-up. All procedures were performed with electrocautery at the third and fourth ribs posteriorly (T3 and T4). Results: The technique demonstrated consistent efficacy in symptom resolution with short operative times, low postoperative pain, and rapid recovery. Mean operative time was 22.0 ± 3.7 minutes, with same-day discharge achieved in all patients. The average pain score at discharge was 2.0 ± 2.6, and no intraoperative or immediate postoperative complications occurred. Symptom severity scores improved across all regions, most notably in the palms (8.8 ± 2.1 to 1.3 ± 2.1, P < .001) and axillae (7.1 ± 2.9 to 2.2 ± 2.3, P < .001), with improvement also observed in plantar sweating (8.6 ± 2.0 to 4.8 ± 3.0, P < .001), while facial sweating showed a modest, nonsignificant change (2.3 ± 2.8 to 1.5 ± 2.2, P = .21). At 2-4 weeks, complication rates, including compensatory hyperhidrosis and pneumothorax, were comparable to conventional methods. Conclusion: This minimally invasive two-port VATS sympathectomy with 3-mm incisions appears safe, effective, and patient-centered, supporting its use as a surgical approach for primary hyperhidrosis.

Background: This study aimed to evaluate the safety and clinical efficacy of self-expelling biliary stents in elderly patients undergoing laparoscopic and cholangioscopic procedures for gallbladder and common bile duct (CBD) stones. Methods: Clinical data from 220 geriatric patients treated at Yixing People's Hospital from January 2019 to April 2025 for primary CBD stones were retrospectively analyzed. All patients underwent laparoscopic common bile duct exploration (LCBDE) with intraoperative placement of a 6F self-expelling J-stent under cholangioscopic guidance, followed by primary duct closure using 4-0 polyglycolic acid sutures. Both the safety and effectiveness of the treatment were observed. Outcomes included operative metrics, bile leakage rates (International Study Group for Liver Surgery criteria), and stent expulsion time. Results: All procedures were completed laparoscopically without conversion. Mean operative time was 95.3 ± 15.2 minutes, with blood loss of 35.0 ± 8.66 mL. Stents were spontaneously expelled within 4.4 ± 1.3 days. Postoperative liver function (alanine transaminase/aspartate transaminase) and inflammatory markers (interleukin-6) improved significantly (all P < .001). Complications included wound infection (2.2%, n = 5) and bile leakage (0.4%, n = 1). Hospital stay was shorter (5.2 ± 0.6) days compared with historical T-tube drainage (TTD) cohorts. Conclusion: For elderly patients, self-expelling biliary stents have shown promising therapeutic results when used during LCBDE. Elderly patients benefit from the stents' adequate biliary drainage and decompression, which promotes an early recovery following surgery. Its "no-tube" strategy may reduce TTD-related burdens. In the future, multicenter prospective randomized controlled trials will be needed to confirm its superiority.

Introduction: Laparoscopic gastrostomy (LG) tube placement is a minimally invasive technique increasingly used in pediatric patients requiring long-term enteral nutrition. While various approaches exist, technique standardization remains limited. This study aims to describe our institution's standardized LG technique and evaluate its surgical outcomes. Methods: We conducted a retrospective review of pediatric patients who underwent LG tube placement at a tertiary care center between August 2017 and September 2022. All procedures were performed using a uniform laparoscopic technique involving a purse-string suture and multiple fascial anchoring sutures. Clinical and perioperative data, including patient demographics, operative time, and time to first feed, were analyzed. Statistical analyses included Spearman correlation and Mann-Whitney U tests. Results: Twenty-five patients (56% female) with a median age of 48 months (range: 7-204 months) underwent LG placement. Neurological impairment was present in 76% of cases. The median operative time was 71 minutes, and the median time to first feed was within the same postoperative day. Notably, no patients experienced intraoperative or postoperative complications. There were no conversions to open surgery, no aborted procedures, and no requirement for postoperative anti-reflux surgery. Mann-Whitney U analysis showed no statistically significant differences in operative time or time to first feed based on neurological status (P = .086 and P = .568, respectively). Conclusion: Our standardized LG technique is safe, reproducible, and effective, with no complications and favorable outcomes across pediatric subgroups. This approach may offer a reliable alternative to percutaneous endoscopic gastrostomy or open gastrostomy placement in children.

Introduction: Esophagojejunal anastomotic leak is a serious complication following total gastrectomy for gastric cancer. Self-expanding metallic stents placed endoscopically offer a minimally invasive treatment option for managing this complication. While sarcopenia has been linked to adverse postoperative outcomes in various surgical fields, its impact on the success of endoscopic treatment for anastomotic leakage remains unclear. This study investigates whether sarcopenia predicts endoscopic treatment failure in patients with esophagojejunal leakage after total gastrectomy. Materials and Methods: A retrospective review was conducted of patients who underwent laparoscopic total gastrectomy and Roux-en-Y esophagojejunostomy due to gastric adenocarcinoma at our institution between January 2020 and May 2025. Among the 241 patients who underwent surgery during the specified period, 31 patients who developed esophagojejunal anastomotic leakage and were treated with self-expanding metallic stents were included in the study. Preoperative sarcopenia was assessed using the total psoas index, measured at the L3 vertebra level on computed tomography images. Patients were divided into two groups based on the presence of sarcopenia, and the clinical success of stent treatment was compared with postoperative outcomes. Results: The study cohort consisted of 31 patients with a median age of 59 years (interquartile range: 51-67). Sarcopenia was detected in 29% (n = 9) of the study population. The overall clinical success rate of stenting was 67.7%, and this rate was significantly lower in the sarcopenia group (33.3% versus 81.8%; P = .009). The length of hospital stay was significantly longer in sarcopenic patients (37.8 ± 21.3 days versus 25.2 ± 10.3 days; P = .033), but there was no statistically significant difference between the groups in terms of intensive care unit admission duration (5.89 ± 5.58 days versus 2.95 ± 3.08 days; P = .069). Conclusions: Preoperative sarcopenia is associated with lower clinical success rates in endoscopic stent treatment of esophagogastric anastomotic leakage after gastric cancer surgery.

Introduction: Few studies have compared conventional Roux-en-Y (RNY) reconstruction with oncometabolic surgical techniques for postoperative glycemic control in patients with gastric cancer and type 2 diabetes. This study evaluates the impact of long-limb (oncometabolic) RNY reconstruction on type 2 diabetes remission and glycemic control compared with the conventional method in patients undergoing laparoscopic radical gastrectomy. Materials and Methods: Between 2020 and 2024, 44 patients with gastric cancer and type 2 diabetes were enrolled at our institution. Of these, 19 patients underwent laparoscopic radical gastrectomy with oncometabolic RNY reconstruction, and 25 patients received conventional RNY reconstruction. Demographic data (age, gender, and BMI), preoperative glycemic parameters (fasting blood sugar and HbA1c), and tumor characteristics were recorded. Comparative analysis assessed diabetes treatment outcomes in the first postoperative year, including antidiabetic medication use, insulin requirements, and diabetes remission rates. Results: Diabetes remission occurred in 52.6% of the oncometabolic surgery group compared with 20% in the conventional RNY group (P = .024). Multivariate logistic regression showed that oncometabolic surgery increased remission likelihood by 5.75 times (OR = 5.75; 95% CI: 1.17 to 28.21; P = .03). Antidiabetic medication use decreased by 78.9% in the oncometabolic group versus 24% in the conventional group (P = .001). Insulin requirements dropped from 36.8% to 5.3% in the oncometabolic group (P = .031). Conclusions: Oncometabolic surgery provides significant advantages in gastric cancer patients not only from an oncological perspective but also from a metabolic perspective.