Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

Background: Abdominal perineal resection (APR) remains the gold standard for lower rectal cancer involving the anal sphincter. However, the optimal patient position remains unclear. While lithotomy or Lloyd-Davies are commonly used, APR and extra-levator abdominal perineal excision (ELAPE) in a prone jackknife position have been linked to better oncological outcomes. Methods: We searched PubMed, Embase, the Central Register of Clinical Trials, and Web of Science for randomized controlled trials (RCTs) and observational studies published up to February 2024. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using I² statistics. Statistical analysis was performed with R Software version 4.4.1. Results: Two RCTs and 26 observational studies, including 4529 patients, were analyzed. Among them, 2249 (49.7%) underwent APR or ELAPE in the prone position and 2280 (50.3%) in the supine position. The prone position was associated with reduced surgical specimen perforation (5.3% versus 9.4%; OR: 0.44; 95% CI: 0.39-0.78; P < .001), lower positive circumferential resection margins (CRMs) rates (9.8% versus 14.3%; OR: 0.69; 95% CI: 0.53-0.89; P < .001), and decreased intraoperative bleeding (mean difference: -63.7 mL; 95% CI: -104.5, -22.8; P < .01). No significant differences were observed in operative time, urinary retention, urinary injury, wound infections, perineal dehiscence, Clavien-Dindo ≥3, reoperation, local recurrence, distal recurrence, or overall survival. Conclusion: The prone position during APR is associated with reduced specimen perforation, lower positive CRM rates, and less intraoperative bleeding without significant differences in other clinical outcomes.

Background: Laparoscopic cholecystectomy (LC) is one of the most frequently performed operations in surgical practice. Despite increasing experience and technological advances, conversion to open surgery is still necessary in some cases. Although several studies have identified factors associated with increased risk of conversion, debates continue in the literature. This study aimed to evaluate the factors affecting the risk of conversion to open cholecystectomy. Materials and Methods: Patients who underwent surgery for cholelithiasis between 2020 and 2023 were analyzed retrospectively. Patients who underwent open cholecystectomy, those who had cholecystectomy as part of another surgical procedure, and patients with gallbladder malignancy (except incidental cases) were excluded from the study. Patients were analyzed based on demographic, clinical, laboratory, radiological, and histopathological data. This study was registered at ClinicalTrials.gov (NCT06244589). Results: A total of 1695 patients were included in the study. The median age was 50 years, and 66.6% of patients were female. Conversion from LC to open surgery occurred in 44 patients (2.6%). Multivariate analysis identified male sex, a history of major abdominal surgery, the need for emergency surgery due to acute cholecystitis, an elevated leukocyte count, and gallbladder wall thickening on abdominal ultrasonography as independent risk factors for conversion to open cholecystectomy. Conclusion: Male gender, previous major abdominal surgery, emergency surgery due to acute cholecystitis, high leukocyte count, and gallbladder wall thickening on abdominal ultrasonography are independent risk factors for conversion from LC to open surgery. It should be kept in mind in the treatment of patients planned for LC.

Background: Video-assisted thoracoscopic surgery (VATS) is considered the treatment of choice in children with subpleural bullous lesions, in which endoscopic staplers are routinely used. Recently, a new generation of electronically powered stapling systems was developed. Our aim is to compare the use of a new 8-mm electronic endostapler with a 12-mm nonelectronic conventional device in thoracoscopic sublobar resection in children. Methods: We performed a retrospective single-center study in patients under 18 years who underwent VATS sublobar resection of subpleural bullae in our institution between January 2022 and December 2023. They were divided into two groups according to the type of endostapler used (8 mm electronic or 12 mm non-electronic). Demographic, clinical, intraoperative and postoperative outcomes were analyzed. Results: We included 8 patients (4 in each group), with a median age of 13.2 years (interquartile range [IQR]: 10.7-15.4 years), without demographic or clinical differences between them. Median surgery time was 42 minutes (IQR 35-55 minutes) in the 8-mm electronic group compared with 53 minutes (IQR 45-65 minutes) in the 12-mm group. There were no intraoperative complications and no reconversions to open surgery. Median length of drainage therapy did not show significant differences between them (3 days in both groups; P = .512). No postoperative complications were reported. Conclusion: Preliminary results of the 8-mm electronic endostapler appear to be comparable with the conventional mechanical stapler. Advantages include smaller incisions, as well as one-handed, push-button operation, which eliminates the manual firing force and possibly enables more precise resection. Further studies are still needed.

Background: Morgagni hernia (MH), a rare type of congenital diaphragmatic hernia, does not have an established protocol for surgical repair. Materials and Methods: A MEDLINE search with terms related to various surgical approaches to repair MH in children was conducted. Articles comprising robotic-assisted surgery, laparoscopy, laparotomy, thoracoscopy, and thoracotomy over the last 20 years were assessed. Results: This narrative review provides an overview of MH in the pediatric population, covering the epidemiology, diagnosis, and management of this rare diaphragmatic hernia. We discuss various surgical techniques, including open and minimally invasive approaches, and compare their advantages and limitations in childhood MH repair. In addition, we address arguments for and against controversial topics such as hernia sac excision and patch reinforcement. Conclusions: Regarding MH in children, transabdominal repair is superior to transthoracic due to improved visualization of bilateral defects and easier reduction of the hernia contents. Laparoscopy has been reported as a popular approach. Single-site laparoscopy has gained attention due to better outcomes than standard three-port laparoscopy. Considering a limited number of children in the literature who underwent robotic MH repair, perioperative complications were reported to be minor.

Background/Objectives: Advancements in surgical stapling devices play a crucial role in improving outcomes for bariatric procedures. This study evaluates the performance and safety of a new endoscopic stapler (EnDrive® Beluga^TM) regarding perioperative results across multiple bariatric surgery types. Methods: A retrospective analysis was conducted on 112 patients who underwent bariatric procedures using the Beluga stapler at two centers in the United Arab Emirates and Kenya over a 6-month period (June-December 2023). Procedures included laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), one anastomosis gastric bypass-mini gastric bypass (OAGB-MGB), and revisions. Perioperative outcomes, complications, and hemoglobin changes were assessed. Results: The cohort included 29 males and 83 females, with a mean age of 32.8 years and preoperative body mass index of 41.1 kg/m². Procedures performed were 88 primary LSG, 3 primary LRYGB, 12 primary OAGB-MGB, and 9 revision surgeries. No conversions, deaths, bleeding, or leaks occurred. Minor complications were observed in 4 patients. One patient required reoperation for intestinal obstruction. The mean hospital stay was 1.5 days. Hemoglobin levels showed minimal change from preoperative (12.8 g/dL) to postoperative day 1 (12.3 g/dL). Conclusions: The new Beluga endoscopic stapler demonstrated safe and effective performance across various bariatric procedures through this retrospective study, with low complication rates and minimal blood loss. Its enhanced articulation capabilities may offer advantages in specific cases. Further studies with larger groups, control groups, and longer follow-up periods are warranted to compare long-term outcomes with established stapling devices.

Background: Laparo-endoscopic hernia surgery is recommended by various international bodies. However, its uptake by general surgeon is low. We aim to assess the impact of Three Dimensional (3D) endovision system in learning laparoscopic transabdominal preperitoneal (TAPP) repair of groin hernia and transferability of skills acquired from 3D to the Two Dimensional (2D) environment. Methodology: Senior resident doctor with no previous experience in laparoscopic hernia surgery did 20 consecutive cases of TAPP repair using 3D endovision system followed by another five cases of TAPP repair using 2D endovision system. Total operating time, operating time during different phases of hernia surgery, faculty take over time, path length of needle holder, and scissors were recorded. Cumulative sum (CUSUM) and split group analysis were done to assess the learning process. Trainee's operating time was compared with that of experts' from previously published study of the same group. Data were compared between last block of five cases done using 3D system and cases done using 2D system for skill transferability. Results: CUSUM method provided inflection points of total operating time, hernia dissection and mesh placement at 9th case, and peritoneal suturing at 11th case in learning TAPP hernia. After 10th case, trainee's operating time was within the middle 50 percentage of experts operating time. Total operating time in last block of cases done under 3D vision and that of 2D endovision comparable, although peritoneal closure was significantly longer in 2D vision (P = .074, .2, .145, .001). Conclusion: Reduction on operating time appears after ninth case of TAPP hernia repair using the 3D endovision system. The skills acquired under 3D endovision system are transferable to perform the procedure under 2D endovision system, albeit incompletely. Use of 3D technology may facilitate adaptation of TAPP hernia repair by young surgeons.

Background: Incisional hernias (IHs) represent a frequently encountered postoperative complication in patients undergoing liver transplantation. Traditionally, these hernias have been addressed through open surgical techniques. However, laparoscopic repair has been increasingly recognized for its association with a reduced complication rate in the management of ventral hernias. Our objective is to conduct a comparative analysis of the outcomes associated with open versus laparoscopic repair techniques in liver transplant recipients. Methods: We conducted a comprehensive literature review across multiple databases, including PubMed, Cochrane, LILACS, SciELO, and EMBASE, to identify studies that compare the efficacy of open and laparoscopic repair methods for IHs postliver transplantation. For the statistical analysis of gathered data, we used the Review Manager software, version 5.4. To evaluate the variability among the study outcomes, we assessed heterogeneity using the I² statistic. Results: After an initial screening of 334 studies, 6 studies with a combined total of 338 patients fulfilled our inclusion criteria. Our analysis revealed that laparoscopic repair tends to be associated with longer operation times, with a mean difference of 20.30 minutes (confidence interval [CI]: 2.14-38.46; P = .03). We observed no significant differences between laparoscopic and open repair regarding infection rates, recurrence rates, overall surgical complications, or hospital stay duration. Conclusion: Both surgical approaches yield comparable postoperative outcomes. However, laparoscopic repair is associated with an increased operation time duration. To substantiate these findings, further research involving prospective, randomized studies is necessary.

Background: Extrathoracic congenital lung lesions (CLLs) are a rare anomaly of lung development. Management and surgical approach are variable. We present our institutional experience with extrathoracic CLLs for the past 18 years. Methods: We retrospectively reviewed all patients younger than 18 years diagnosed with a CLL from January 2005 to June 2023. Only patients with suspected extrathoracic CLLs on prenatal imaging were included. Results: A CLL was identified in 381 patients and was extrathoracic in 25 patients (6.6%). Six patients (24%) with other congenital anomalies were excluded, and 3 were lost to follow-up. The prenatal course and delivery of the 16 study patients were unremarkable and all were asymptomatic. Larger lesions, both prenatally and postnatally, were more likely to undergo surgical resection (11.8 ± 8.2 cm³ versus 3.9 ± 3.3 cm³, P = .05; 6.1 ± 5.1 cm³ versus 2.5 ± 2.5 cm³, P = .10, respectively). Seven patients (7/16; 44%) underwent resection-5 thoracoscopic and 2 laparoscopic. Thoracoscopic transdiaphragmatic approach was favored for lesions extending >50% above the diaphragm. Five lesions were intradiaphragmatic, one infradiaphragmatic, and one intrathoracic. Four lesions (4/7; 57%) were hybrid lesions on pathology. No malignancy was identified. Nine patients (9/16; 56%) underwent surveillance. Imaging modality for surveillance varied. Duration of follow-up ranged from 0.5 to 83 months. Conclusions: We provide the largest case series to date describing both operative and nonoperative management of extrathoracic CLLs. Surveillance appears to be appropriate for small lesions. If surgical excision is pursued, the thoracoscopic approach is safe and preferred if diaphragmatic involvement is suspected.

Introduction: Laparoscopic common bile duct exploration (LCBDE) is a well-established and effective minimally invasive surgical approach for managing choledocholithiasis. However, its safety in the elderly population is not well established. Therefore, this study compares surgery-related outcomes in elderly patients undergoing LCBDE. Methods: We systematically searched PubMed, Embase, and Cochrane Library for studies comparing elderly and young patients undergoing LCBDE. Binary outcomes were compared using odds ratios (ORs), with 95% confidence intervals (CIs). Heterogeneity was assessed with I² statistics. Statistical analysis was performed using Software R, version 4.3.3. Results: Twelve studies comprising 3791 patients were included, of whom 1411 patients (37%) were from the elderly group. Elderly patients were associated with an increase in mortality (OR: 3.42; 95% CI: 1.08-10.85; P = .04; I² = 0%), overall postoperative complications (OR: 1.60; 95% CI: 1.11-2.22; P = .01; I² = 52%), and pneumonia (OR: 4.37; 95% CI: 2.00-9.55; P < .01; I² = 0%) rates. However, there were no significant differences between groups in remnant stones (OR: 1.37; 95% CI: 0.70-2.68; P = .36; I² = 0%) and recurrent stones (OR: 1.37; 95% CI: 0.64-2.95; P = .42; I² = 0%) pancreatitis (OR: 0.98; 95% CI: 0.16-5.95; P = .98; I² = 0%) and bile leakage (OR: 1.24; 95% CI: 0.75-2.07; P = .40; I² = 0%). Conclusion: In this meta-analysis, elderly patients who underwent LCBDE experienced increased mortality, overall complications, and pneumonia rates compared with young patients. Furthermore, there were no significant differences between the groups in remnant and retained stones, pancreatitis, and bile leakage.

Background: Single-port laparoscopic choledochal cyst (CDC) excision and Roux-en-Y hepaticoenterostomy (SPCH) exhibits several advantages over conventional laparoscopic techniques in the management of CDCs. However, performing small-diameter hepaticojejunostomy during single-port laparoscopy presents significant challenges, thereby increasing the risk of anastomotic complications. In this study, we employed the mucosal eversion (ME) technique to alleviate the difficulties associated with executing small-diameter hepaticojejunostomy during SPCH and report the preliminary outcome of a prospective case cohort. Methods: Patients diagnosed with CDC and found common hepatic duct diameter was smaller than 5 mm during SPCH were included. ME was performed on these patients. Clinical information, Magnetic resonance imaging image data, and surgical information data were collected, and patients were followed up for at least 1 year to assess surgical outcomes and postoperative complications. Results: A consecutive cohort of 16 patients was included from August 2020 to July 2023. All 16 patients successfully underwent ME during SPCH. The median age at surgery was 14.25 months, with an average hepaticojejunostomy diameter of 6.75 mm (ranging from 5 to 8 mm). The mean operation time was 266.25 minutes, and the average posthospital stay was 6.31 days (ranging from 4 to 9 days). During a follow-up period of 12-47 months, no cases of anastomotic leakage or stenosis were observed in this cohort. Conclusions: The ME technique is easy to execute and outcomes are reliable. It constitutes an efficacious approach to enhancing the prognosis of small-diameter biliary-enteric anastomosis in patients with CDCs undergoing SPCH.