Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

Introduction: The focused use of a single-site port as an adjunct designed to decrease overall port site number and/or assist with specimen extraction in pediatric robotic surgery has not been fully elucidated. We aimed to describe the feasibility of using the single-site port as an adjunct during multi-port robotic-assisted minimally invasive surgery (RA-MIS). Methods: A single institution retrospective review of pediatric patients who underwent multiport RA-MIS with an adjunctive single-site (SS) port from August 2018 to October 2022 was performed. Demographic, perioperative, and postoperative variables were collected; descriptive analysis was performed. Results: A total of 13 patients were included; 46% were female, and 47% were Caucasian. Median age at surgery was 14.9 years of age (interquartile range [IQR] 10.6, 18); median weight was 61.1 kg (IQR 39.7, 73.6). Eleven patients (85%) underwent splenectomy; 2 patients (15%) underwent adrenalectomy. Four patients had a combined procedure (SS cholecystectomy with multi-port splenectomy [n = 3], multi-port bilateral adrenalectomy [n = 1]). The median total operative time was 197 minutes (IQR 131, 316); median console time was 59 minutes (IQR 40, 126). Two 8 mm robotic ports were utilized for all but 1 patient who required a third 8 mm port. The median length of stay was 2.1 days (IQR 2.0, 3.1). One readmission for fever occurred following a combined cholecystectomy/splenectomy. No hernias or wound infections were identified at the single-site port. Conclusion: Use of a SS port as an adjunct is a feasible option and should be considered for those with splenomegaly or need for combined procedures in different quadrants of the abdomen.

Introduction: Diastasis recti (DR) is characterized by an abnormal separation between the rectus abdominis muscles. Traditional repair includes only plication; however, complications may arise in the presence of concurrent ventral hernias (VH). This study aims to evaluate the safety and feasibility of diastasis repair in a United Arab Emirates (UAE) population. Methods and Procedures: This retrospective cohort study was conducted with IRB approval. All patients who underwent a DR repair (DRR) with concomitant ventral hernia repair between October 2022 and February 2024 were included. Results: A total of 20 patients were included in the study. The cohort was 80% female, with a mean overall age of 44.05 years. The mean body mass index was 27.4 kg/m². All patients (100%) presented with DR associated with an abdominal wall defect; 17 patients (85%) with umbilical hernia, 2 patients (10%) with umbilical and incisional hernia, and 1 patient (5%) with umbilical with epigastric hernia. A total of 12 (60%) patients underwent laparoscopic DRR concomitant with VH repair, 5 (25%) patients underwent open DRR with VH repair and abdominoplasty, and 1 patient (5%) underwent DRR with VH repair and liposuction. All cases were successful without complications or conversions. Complications within 30 days included only seromas in 6 patients (30%), one requiring drainage. Conclusion: Our initial experience suggests that DR repair with concomitant VH repair and/or abdominoplasty is feasible and safe in the UAE population. Our experience demonstrated surgical outcomes compared to other regions in the world.

Background: Patients with cardiogenic shock (CS) or heart failure can develop ischemic cholecystitis from a systemic low-flow state. Cholecystectomy in high-risk patients is controversial. Percutaneous cholecystostomy tube (PCT) is often the chosen intervention; however, data on PCT as definitive treatment are conflicting. Data on cholecystectomy in these patients are limited. This study discusses outcomes following laparoscopic cholecystectomy (LC) in this patient population. Methods: This is a retrospective review of patients who underwent LC from 2015 to 2019 while hospitalized for CS or heart failure. Surgical services are provided by fellowship-trained minimally invasive surgeons at a single, academic, tertiary-care center. Patient characteristics are reported as frequencies' percentages for categorical variables. Odds ratio is used to determine the association between comorbidities and complications. Results: Twenty-four patients underwent LC. Around 83% were white and 79% were male. Many were anticoagulated (88%), with Class IV heart failure (63%), and required vasopressors (46%) at the time of surgery. Fourteen of 24 (58%) had at least one circulatory device at the time of surgery: extracorporeal membrane oxygenation, left ventricular assist device, Impella, tandem heart, and total artificial heart. Four patients (17%) had PCT preoperatively. Fifteen days were the average interval between diagnosis and surgery. Pneumoperitoneum was tolerated by all, and 0% converted to open. Most common complication was bleeding (52%). Nine patients (37.5%) underwent 21 reoperations, one of which (4%) was related to cholecystectomy. Mortality occurred in 5 patients (20.8%); interval between cholecystectomy and mortality ranged 6-30 days. Conclusion: Although high risk, LC is a treatment option in patients with ischemic cholecystitis at risk for death from sepsis.

Objective: The aim of our study was to assess the learning curve of robotic assisted low anterior resection with diverting loop ileostomy (LARDLI) for low and mid rectal cancer performed by novice in robotic-assisted surgery colorectal surgeon in a public hospital with limited access to the robotic platform. Methods: A retrospective analysis of all low and mid rectal cancer robotic-assisted operations was conducted. All procedures were performed by a single surgeon with a once per week access to the Da Vinci^® Si™ Surgical System, Intuitive Surgical Inc. Demographic, clinical, and pathological data were reviewed. The cumulative sum (CUSUM) analysis was utilized to analyze learning curve for operative time. Results: A total of 107 consecutive patients who underwent LARDLI for lower and mid rectal cancer between November 2011 and July 2020 were included in the analysis. The median patients' age was 65 (range, 32-85) years, 72% were males (n = 77), and 91% (n = 97) received neoadjuvant therapy. Median operative time was 295.5 (range, 180-551) minutes. The conversion rate was 3.7% (n = 4). Median length of hospital stay was 6 (range, 1-41) days. There were 35 (32.7%) postoperative complications, of these 7 (6.5%) were major complications (≥Grade 3, according to the Clavien-Dindo classification). There was only one intraoperative complication (.9%). CUSUM analysis showed that the learning curve was 49 cases to achieve a plateau. Conclusions: The learning curve of robotic assisted low anterior resection for lower and mid rectal cancer for a novice in robotic surgery colorectal surgeon with limited access to the robotic platform is 49 cases. Surgeon and operative team dedication, alongside sufficient hospital support, may lower the number of cases of the learning curve.

Background: Contemporarily, transabdominal preperitoneal repair (TAPP) procedure in inguinal hernia treatment is counted among the routine minimal invasive general surgery practices. Increased patient's comfort, namely less postoperative pain, is considered to be its greatest advantage. However, pain following surgery can still be an important problem. Port site local anesthetic injection (PSLAI), iliohypogastric-/ilioinguinal nerve block (IINB), and preperitoneal local anesthetic spraying (PLAS) are relatively new techniques with sparse data to address this issue. Therefore, we conducted this prospective study to evaluate these three methods in patients who underwent TAPP for inguinal hernia repair. Methods: A total of 99 patients were enrolled and randomized equally into three groups. Every patient received a patient-controlled analgesia (PCA) device. PCA usage, total analgesic demands, and numerical rating scale values were recorded at 2, 6, 12, and 24 hours postoperatively (p.o). Results: Patients' demographic data (age, gender, BMI) did not reveal any significant difference between groups (P > .05). Procedure duration was found to be significantly longer in IINB group compared with others (p < .05). Number of PCA usages, total analgesic demand, additional analgesic requirement did not differ significantly between groups at 24-hour p.o (P > .05). PLAS group was found to have less average NSR score compared with other groups at 24 hours p.o (p < .05). Conclusions: All three procedures show promising outcomes with PLAS technique appearing to be slightly superior in terms of pain management in the immediate postoperative period. However, to reach a conclusion more randomized controlled trials covering various aspects and techniques of minimal invasive approach to inguinal hernia repair should be published.

Background: Small bowel bleeding (SB) comprises 5%-10% of gastrointestinal (GI) bleeding cases. This article describes the staged retrograde intraoperative enteroscopy (SRIE) surgical technique for the etiological diagnosis and treatment of small bowel bleeding. Methods: SRIE was performed on patients with persistent SB at a quaternary university hospital in Brazil from 2020 to 2023. The technique is described in 5 steps, alongside visual aids, including images and a depicting a portion of the procedure. Patients presenting with confirmed coagulopathies, pregnancy, or unwillingness for surgery were excluded. Surgical procedures were performed after informed consent. Case Series: Four participants were submitted to SRIE, including 2 females (64 and 83 years old), and 2 males (46 and 57 years old). Three out of four (75%) of the patients received a confirmed diagnosis of GI bleeding, attributed to angioectasia, acquired von Willebrand disease, and vitamin K deficiency. SRIE was conducted via enterotomy, involving a subsequent insufflation-inspection-deflation of 10 to 10 cm segments of the small bowel (Steps 1 to 5). The procedure was successfully executed in all four patients without complications, allowing confirmation of the etiological diagnosis of SB or exclusion of anatomical causes of hemorrhage. Conclusions: SRIE is a valuable but invasive tool for assessing SB hemorrhage when conventional imaging falls short. When performed systematically and standardized, it allows accurate visualization of SB using a standard endoscope.

Indocyanine green (ICG) is an inert polypeptide that almost totally binds to high molecular weight plasma proteins; it is cleared by the hepatocytes and directly excreted into the bile with a half-life of about 3-5 minutes. Specific systems are required to see fluorescent images. The use of this dye has been reported in different surgical specialties, and the applications in hepatobiliary surgery are widening. Being firstly used to evaluate the preoperative liver function, intra- and postoperative dynamic checking of hepatic activity has been reported and integrated within perioperative protocols allowing a tailored treatment allocation. Intravenous injection (IV) or injection into the gallbladder can ease difficult cholecystectomy. Biliary leakage detection could be enhanced by IV ICG injection. Although with some contrasting results, the use of ICG for both delineating the limits of the resection and tumor-enhanced visualization was demonstrated to improve short- and long-term outcomes. Although the lack of strong evidence still precludes the introduction of this tool in clinical practice, it harbors great potential in liver surgery.

Background: In order to prevent infectious complications following endourological procedure of upper urinary tract stones, it is essential to determine which patients are at high risk of developing this complication. We aimed to identify predictors that may cause systemic inflammatory response syndrome (SIRS) after the endourological procedure of upper urinary tract stones. Materials and Methods: Patients who underwent percutaneous nephrolithotomy (PNL), flexible ureteroscopy (F-URS), or semirigid ureteroscopy (SR-URS) in our center between January 2011 and June 2020 were evaluated retrospectively. After surgery, patients were pursued for SIRS criteria. Logistic regression analyses were applied to identify predictors of SIRS. Results: A total of 1471 patients were included in the study. The rates of SIRS after PNL, F-URS, and SR-URS were 12.9%, 6.3%, and 1.7%, respectively. In multivariate analysis, predictors for SIRS were determined to be stone volume, operative time, and history of recurrent urinary tract infection (UTI) in the PNL group; ipsilateral stone surgery history, stone volume, and operative time in the F-URS group; and stone volume, operative time, and history of recurrent UTI in the SR-URS group. Conclusion: Stone volume and operative time were determined to be independent predictors of SIRS in endourological surgery of upper urinary tract stones.

Purpose: Weight thresholds have historically determined timing of enterostomy closure (EC) in premature neonates. Recent evidence suggests that neonates less than 2 kg (L2K) can safely undergo EC. We evaluate our single-center experience with performing EC in preterm neonates at L2K versus greater than 2 kg (G2K) at time of EC. Methods: A retrospective review of neonates who underwent EC from January 2018 to 2020 was performed. Neonates who were greater than 90 days at initial operation were excluded. Demographics, clinical characteristics including gestational age (GA) and birth weight (BW), operative reports, and outcomes were reviewed. We compared 30-day complications between neonates who underwent EC at L2K and G2K. We also compared time to full feeds (FF) and postoperative length of stay (LOS). Results: Twenty-four neonates were included: 11 L2K and 13 G2K. The median GA and BW was 25.9 weeks (IQR 2.89) and 805 g (IQR 327), respectively. The most common intraoperative diagnosis during index operation was spontaneous perforation (70%), followed by necrotizing enterocolitis (8.69%). There were no significant differences in GA, BW, or diagnosis, between the L2K versus G2K cohort. We found no difference in complication rates, time to FF (12 days versus 10 days, P = .89), or postoperative LOS (31 days versus 36.5 days, P = .76) between patients who underwent EC at L2K versus G2K, respectively. Conclusion: Although weight gain may be an important indicator of perioperative nutrition status, this study shows that weight alone should not preclude otherwise appropriate patients from undergoing EC.

Background: Lumbar hernia is a rare disease with low incidence, and no golden standard surgical procedure has been established for lumbar hernias. The single-incision laparoscopic totally extraperitoneal sublay (SIL-TES) technique became a novel surgical technique for lumbar hernias. Methods: This retrospective study included 20 patients who underwent SIL-TES repair for lumbar hernia between April 2020 and March 2024. The baseline patient characteristics, intraoperative data, postoperative data, satisfaction score, and Carolina Comfort Scale scores were collected. Results: The results revealed that the SIL-TES technique for lumbar hernia repair is associated with a low complication rate, nonrecurrence, high satisfaction score, and high quality of life after surgery. Conclusions: The SIL-TES technique could be a feasible and effective surgical technique for lumbar hernias. A controlled study is needed for further confirmation.