Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

Objective: Our aim was to evaluate patient-related factors and compare the techniques used for surgical specimen removal [trocar extension (TE) and Pfannenstiel incision (PF)] in terms of incisional hernia (IH) occurrence in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALRP). Materials and Methods: The records of 219 patients who underwent RALRP in our clinic between November 2017 and March 2021 were analyzed retrospectively. Postoperative complication data and functional (continence and potency status) and oncological outcomes were recorded. Hernia type, location, and treatments applied were also noted. Results: After exclusion, complete data were available on 192 patients undergoing RALRP between the specified dates. The TE technique for removing the surgical specimen was performed in 135 patients, and the lower abdominal transverse incision technique (PF) in 57 patients. Preoperative patient- and tumor-related characteristics (age, body mass index [BMI], American Society of Anesthesiologists (ASA) score, T stage, and prostate size) were similar in both surgical groups. IH was detected in 16 patients (14 in the TE group and 2 in the PF group) (P = .156). Thirteen patients underwent surgery for IH, and three were followed up clinically. Conclusion: In our study, no statistically significant demographic or surgical technique-related factors were found to explain the occurrence of IH in patients who underwent RALRP for prostate cancer. It was observed that IH occurred more frequently in the cases where the surgical specimen was removed with the TE technique compared with the PF incision, but this result was not statistically significant. There was also no statistically significant difference between these two groups regarding oncological and functional outcomes in the early postoperative period.

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.

Introduction: Laparoscopic lavage and drainage (LLD) emerged as an alternative to Hartmann's procedure (HP) for patients with diverticulitis and uncontained perforation. Although initially popular as a less invasive approach, its use in modern practice is in question. This summary will review the available literature to show techniques, outcomes, and indications. Methods: The literature was reviewed for relevant case studies, randomized trials, prospective series, retrospective analyses, and meta-analyses to define peritoneal lavage and determine the clinical outcomes of peritoneal lavage. Results: LLD can be considered on an individual basis for Hinchey III diverticulitis (purulent peritonitis), but there are several contraindications. The extent of adhesionolysis (limited versus extensive) as well as the management of sites of perforation found during surgery are debated. Most surgeons continue lavage with warm saline until water runs clear and place drains in the operation. Three randomized controlled trials (RCTs), the LADIES, SCANDIV, and DILALA trials compared LLD with either resection and anastomosis or Hartmann's procedure. One other RCT (the LapLAND trial) is still with results pending. The LADIES trial studied LLD versus primary anastomosis and resection in Hinchey III diverticulitis and was terminated early secondary to higher 30-day morbidity in the LLD arm; however, 3-year data showed no significant difference in morbidity and mortality. The SCANDIV trial compared LLD with resection in acute diverticulitis (Hinchey I-III) and saw no difference in 90-day morbidity or mortality; however, it noted higher rates of reoperation in the LLD group. The DILALA trial compared Hinchey III diverticulitis patients undergoing LLD with open HP and found that the LLD group had a lower rate of reoperation at 2 years, but no difference in rates of readmission or mortality. Conclusions: Debate still remains over the technique of LLD and specific indications, as well as outcomes compared with resection and primary anastomosis or HP.

Introduction: Historically, colon resection was recommended after one episode of complicated diverticulitis. However, current trends favor a more individualized approach. This review examines elective sigmoidectomy for complicated diverticulitis as well as robotic approaches for diverticular disease. Methods: The literature was reviewed for timely (post 2000) and relevant articles regarding robotics and diverticulitis. The articles included large prospective series, retrospective analysis, meta-analyses and randomized controlled trials. Results: Primary anastomosis with or without protective ileostomy has emerged as an alternative to the Hartman's procedure in emergent or urgent surgery in patients without significant comorbidities. Elective sigmoidectomy after an episode of complicated diverticulitis should be decided on a case-by-case basis considering patient characteristics, continued subacute symptoms, complications from the disease, and chance of recurrence episodes. Conclusions: There are several variations techniques for robotic sigmoidectomy outlined in this article, and familiarity with all can help depending on the logistics of the case. Minimally invasive colectomy provides superior patient satisfaction and outcomes.

Introduction: The sleeve gastrectomy (SG) often requires conversion to Roux-en-Y gastric bypass (RYGB) due to gastroesophageal reflux disorder (GERD). Many postbariatric patients seek body-contouring surgery such as abdominoplasty to remove unwanted skin and fat. Although the number of abdominoplasties performed in postbariatric patients is increasing each year, the number of conversion surgeries is increasing in accordance. This study evaluates the impact of abdominoplasties in patients with prior SG on the development of GERD and the need for conversion to RYGB. Methods: A retrospective study was conducted with 630 patients who underwent conversions from SG to RYGB at our institution between January 2014 and December 2023. Outcomes were stratified for comparison between patients with GERD as an indication for conversion and patients with inadequate weight loss as an indication for conversion. Between the two groups we compared the number of patients with post-SG abdominoplasty and the number of hiatal hernias (HH) seen during conversion surgery. A logistic regression analysis was performed to identify factors independently associated with GERD. Results: There was a statistically significant higher number of abdominoplasties in patients who underwent conversion to RYGB for GERD (29 patients, 8.6%) compared to inadequate weight loss (12 patients, 4.1%), P value .034. However, these patients also had statistically significantly more HH (98 patients, 28.9%) compared to patients with inadequate weight loss as an indication for conversion (46 patients, 15.8%), P value <.001. In the logistic regression comparing these two variables, only the presence of HH seen during surgery was found to be a significant predictor of GERD (odds ratio 2.7, confidence interval 1.7-4.1, P < .001). Conclusion: Our data shows that abdominoplasty surgery does not directly influence the development of GERD in post-SG patients. However, the presence of HH in this population significantly impacts the development of GERD, often necessitating conversion to RYGB.

Background: Esophageal cancer surgery aims for curative intent but carries high complication rates. Transthoracic esophagectomy is the dominant approach, however, transhiatal esophagectomy (THE) offers selective advantages in certain clinical scenarios. Minimally invasive THE (MI-THE) is an evolving technique with limited data. Methods: This retrospective study reviewed 38 patients with esophageal cancer who underwent MI-THE using "Antegrade Inversion Technique" between 2013 and 2023 at a tertiary care center. Perioperative outcomes were analyzed. Data were presented as mean with standard deviation, median with interquartile range, and percentages. Results: Most patients (86.8%) had early-stage cancer. Median operative time was 375 minutes, hospital stay was 8 days, and intensive care unit stay was 3 days. All patients achieved a negative resection margin. Pleural effusion (57.9%) was the most common complication, followed by pneumothorax (31.6%) and surgical site infection (15.8%). Anastomotic leak rate was 13.2%. There was no mortality. Conclusions: MI-THE appears safe and feasible with encouraging perioperative outcomes, particularly for early-stage disease and high-risk patients. While potentially offering advantages over open THE, further research is needed to definitively establish its role compared to traditional approaches.

Background: With the rising demand for minimally invasive and cosmetically appealing surgeries, transumbilical single-incision laparoscopic cholecystectomy (SILC) has been increasingly adopted, albeit in a limited number of medical centers. Our team has successfully executed transumbilical SILC for benign gallbladder diseases. This study retrospectively analyzed and compared the efficacy of transumbilical SILC with that of conventional laparoscopic cholecystectomy (CLC). Methods: We analyzed data from 358 cases of laparoscopic cholecystectomy performed at Shanghai East Hospital of Tongji University between January 2021 and October 2023. Of these, 186 cases underwent SILC (observation group), while 172 cases underwent CLC (control group). We compared patient demographics, perioperative outcomes, and satisfaction with incision scars. Primary outcomes included surgical efficacy and safety, whereas secondary outcomes encompassed postoperative hospitalization duration, pain levels, hospital costs, and scar satisfaction. Results: No significant differences were observed in patient demographics between the two groups. Both the SILC and CLC groups exhibited similar operative times (39.56 ± 14.55 minutes versus 41.82 ± 16.13 minutes, P = .164) and intraoperative blood loss (11.34 ± 3.90 mL versus 11.28 ± 3.87 mL, P = .885). The single-incision approach led to earlier postoperative bowel function recovery (22.03 ± 3.60 hours versus 24.17 ± 3.22 hours, P < .01), lower 24-hour postoperative pain scores (2.06 ± 0.84 versus 2.35 ± 0.72, P < .01), shorter postoperative hospital stays (2.88 ± 0.86 days versus 3.33 ± 0.96 days, P < .01), comparable hospitalization costs (3411.67 ± 790.86$ versus 3494.50 ± 558.76$, P = .257), and better Scar Cosmesis Assessment and Rating scores (1.78 ± 0.70 versus 2.17 ± 0.89, P < .01). Patient satisfaction was higher with the single-incision technique (8.52 ± 0.79 versus 7.80 ± 0.75, P < .01). Both groups experienced one case of incision infection (SILC 0.54%, CLC 0.58%), and there was one case of postoperative bile leakage in the CLC group (0.58%). However, the difference in complications was not statistically significant (P > .05). Conclusion: Transumbilical SILC demonstrates safe and effective near-term efficacy, offering benefits such as reduced postoperative pain and improved cosmetic outcomes, which support its clinical adoption.

Introduction: Umbilical surgical site infection (U-SSI) is the most common complication of laparoscopic percutaneous extraperitoneal closure (LPEC) for the treatment of inguinal hernia in children. Prolonged operative time is known to increase the risk of SSI in general pediatric surgery; however, the association between prolonged operative time and post-LPEC U-SSI is unclear. The present study aimed to elucidate the association between umbilical port insertion time and the incidence of U-SSI. Materials and Methods: The present study included all patients <16 years of age who underwent LPEC for the treatment of inguinal hernia between June 2018 and May 2023 at our institution. Those who underwent umbilical hernia repair or other procedures were excluded. We retrospectively collected and analyzed the following: patient demographics; operative data; and U-SSI data. The cutoff value for the umbilical port insertion time was determined using receiver operating characteristic analysis, and the incidence of U-SSI was compared based on the cutoff value, determined to be 8 minutes. Results: A total of 232 patients (133 boys; mean age, 4.6 ± 3.3 years) were eligible for the present study, 7 (3.0%) of which developed superficial incisional post-LPEC U-SSI within a median of 7.5 [4-19] days. The incidence of U-SSI was 20.0% in the long (≥8 minutes) versus 2.3% in the short (<8 minutes) umbilical port insertion time group (P = .03). Conclusion: Prolonged umbilical port insertion time (≥8 minutes) increases the incidence of post-LPEC U-SSI during the treatment of inguinal hernia in children.

Introduction: Laparoscopic cholecystectomy (Lap-C) is the standard of care for patients requiring cholecystectomy in the acute setting. Although robotic-assisted cholecystectomy (RA-C) performance has increased, utilization in the acute setting has not been widely reported. We describe the feasibility of RA-C for pediatric patients undergoing acute inpatient cholecystectomy. Methods: A single institutional retrospective review of patients receiving RA-C while admitted for acute cholecystitis and/or choledocholithiasis (June 2017-June 2022) was compared with a matched cohort who underwent traditional multiport Lap-C (June 2021-June 2022). Demographic, perioperative, and postoperative data were analyzed. Results: Fifty patients were included: 25 each in the RA-C and Lap-C groups. Fifty-four percent were female; 66% were non-Hispanic white. Median age (15.7 years [interquartile range, IQR 14.7, 17.3] versus 15.3 years [IQR 14.5, 16.9], P = .91) and preoperative weight (92.6 kg [IQR 60, 105.9] versus 72.3 kg [IQR 61.6, 85.6], P = .15) were similar between the RA-C and Lap-C groups, respectively. No differences were observed in median operating time (89 minutes [IQR 76, 103] versus 88 minutes [IQR 77, 137], P = .70), postoperative length of stay (22.5 hours [21.4, 24.9] versus 20.6 hours [18.0, 25.1], P = .06), or 30-day complications (12% versus 16%, P = .69). Although opioid utilization (.23 milliequivalents/kilogram [MME/kg] [IQR .03, .30] versus .03 MME/kg [0, .09], P = .02) was higher in the RA-C cohort overall, no differences were detected during an analysis of the most recent 2 years (P = .96). Conclusion: RA-C in the acute setting can be performed safely in the pediatric population with comparable procedural times as well as perioperative and 30-day outcomes.

Objective: To investigate the predictors of persistent prostate-specific antigen (PSA) after radical prostatectomy (RP). Methods: From January 2019 to December 2022, 212 patients with prostate cancer who underwent RP were retrospectively analyzed. According to the PSA value at 4-8 weeks postoperatively, the patients were divided into the PSA <0.1 ng/mL group (n = 142) and PSA ≥0.1 ng/mL group (n = 70). Logistic regression was used to analyze the independent risk factors of persistent PSA, and the logistic regression equation was established to predict the probability of persistent PSA. Results: Total PSA (tPSA) levels at diagnosis >49.73 ng/mL, free PSA (fPSA) levels at diagnosis >2.07 ng/mL, or clinical T stage >T3a were independent risk factors for PSA persistence after RP. Conclusion: Patients with tPSA at diagnosis >49.73 ng/mL, fPSA at diagnosis >2.07 ng/mL, and T3b prostate cancer showed strong associations with persistent PSA.