Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

Background: Chat Generative Pre-Trained Transformer (ChatGPT) has emerged as a widely accessible large language model (LLM) with potential applications in medicine. While early literature has explored ChatGPT's role in various surgical specialties, its impact on general surgery remains less defined. This systematic review evaluates current evidence on the educational, clinical, and research applications of ChatGPT within the field of general surgery.

Methods: A comprehensive search was performed of PubMed, Cochrane Central, Scopus, SciELO, and LILACS from inception to December 2023. Studies were included if they evaluated the utility of ChatGPT in general surgery across educational, research, and clinical domains. We included both analytic data and descriptive studies. Studies involving other AI platforms and conference abstracts were excluded.

Results: Of 550 screened studies, 23 met inclusion criteria and demonstrated ChatGPT's broad applicability across surgical domains. Specifically, 6 studies demonstrated its capability to answer common questions about surgical diseases, 7 assessed its utility in clinical practice, 11 focused on educational applications, and 5 examined its potential role in research. Notably, ChatGPT exhibited proficiency in providing anatomical explanations and answering open-ended questions, achieving up to 87% accuracy for colorectal surgical questions, though performance was more variable for appendicitis queries. In board exam-style assessments, its accuracy ranged from 48% to 66% for open-ended questions and 68% to 76.4% in multiple-choice formats. Patient-facing responses were generally rated favorably, particularly in bariatric, transplant, and pancreatic surgery domains, with several studies highlighting ChatGPT's clarity and comprehensiveness compared to traditional medical literature. In clinical decision-making scenarios, ChatGPT's concordance with clinical experts varied widely across studies, from 0% to 86.7% in colorectal surgery studies and 30% in bariatric cases. ChatGPT proved effective in drafting informed consent documents and comprehensive surgical notes. However, limitations were observed in its ability to provide accurate references and in data extraction, though it did show promise in generating research ideas. Overall, while ChatGPT shows potential across education, clinical practice, and research, its reliance on human evaluation remains crucial.

Conclusion: Overall, while ChatGPT shows significant potential across the realms of surgical education, clinical practice, and research, its outputs require ongoing human oversight and expert validation.PROSPERO Registration:CRD420251107155.

Background: Minimally invasive surgery in intravesical ureteral reimplantation has proven to be safe and successful in patients with vesicoureteral reflux. This study investigates a novel application of the Leadbetter-Politano procedure for primary obstructive megaureter, focusing on specific challenges in vesicoscopic reimplantation of ureters with large diameters in pediatric patients.

Methods: Between 2010 and 2024, 26 children underwent ureteral reimplantation according to Leadbetter-Politano without tapering for primary obstructive megaureter in our clinic. A total of 12 children were operated on vesicoscopically, 14 patients were operated on open-surgically. This retrospective single-center case-control study compares open and vesicoscopic groups with regard to perioperative data and postoperative course.

Results: All vesicoscopic Leadbetter-Politano reimplantations started were performed safely, even in young infants of 6 months. The operation time was longer for vesicoscopy (vesicoscopic: 149 minutes, open: 119 minutes, P = .013). Furthermore, vesicoscopic patients had a shorter hospital stay (vesicoscopic: 4.8 days, open: 10.4 days, P < .001), as well as a lower need for continuous analgesic administration (vesicoscopic: 0.5 days, open: 3.8 days, P < .001). There was no extravasation, recurrence, or postoperative vesicoureteral reflux found in any patient.

Conclusions: The vesicoscopic Leadbetter-Politano procedure proves to be feasible in reimplantation of primary obstructive megaureter, even in very young infants. Reduced need for pain medication, shorter bladder drainage, and faster mobilization, and thus shorter hospital stay, show that this method offers major advantages to patients at an equivalent success rate compared to its open counterparts.

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: Severe gastroesophageal reflux disease (GERD) following sleeve gastrectomy (SG) remains a major therapeutic challenge in bariatric surgery. The gold-standard surgical approach is represented by the conversion to Roux-en-Y gastric bypass (RYGB), which carries a significant risk of long-term complication rate. The present study evaluates the efficacy and safety of an alternative procedure-the Round Ligament Cardiopexy (Rampal Technique, RLC)-in patients with severe, invalidating reflux following SG.

Methods: This is a single-center, retrospective study reviewing all patients who underwent Rampal cardiopexy for severe reflux after SG between June 2020 and October 2024. Demographic data, clinical characteristics, pre- and postoperative findings, and quality-of-life outcomes (Reflux-Qual® Simplified, RQS®) were collected. The primary endpoint was improvement in reflux and regurgitation symptoms; secondary endpoints included morbidity and mortality.

Results: Six female patients (mean age: 40.8 ± 15.7 years) were included, with a mean interval of 6 ± 3 years between SG and CR. All procedures were completed laparoscopically. A significant improvement in reflux symptoms was observed postoperatively (P = .02), with complete resolution of regurgitations and marked reduction of acid reflux. RQS® scores improved from 21 ± 4.6 to 15.7 ± 7.5 (P = .52). No mortality occurred. Early morbidity was 33% (two transient dysphagias), and late morbidity was 17% (one stricture requiring dilation).

Conclusion: The Rampal cardiopexy could represent a safe, effective, and minimally morbid alternative to conversion to RYGB for refractory reflux following SG. Additional further evaluation in larger, prospective studies is needed to confirm its long-term benefits. This technique should be better known among bariatric surgeons to expand the therapeutic options for managing post-sleeve GERD.

Introduction: Red cell distribution width (RDW) has recently emerged as a potential biomarker reflecting nutritional and inflammatory status in surgical oncology. While anastomotic leakage (AL) remains a devastating complication after right hemicolectomy for colorectal cancer, the predictive role of RDW in this setting has not been clearly established. This study aimed to evaluate the prognostic significance of RDW in predicting AL and postoperative outcomes after right hemicolectomy.

Methods: This retrospective study included 234 patients who underwent right or extended right hemicolectomy for colorectal cancer between June 2020 and May 2025 at a tertiary referral center. Demographic, surgical, histopathological, and laboratory data were analyzed. Postoperative complications were graded according to the Clavien-Dindo classification.

Results: AL occurred in 3.4% of patients; however, RDW was not an independent predictor. Patients with elevated RDW-fL values (>46.1 fL) were significantly older and had higher American Society of Anesthesiologists' (ASA) scores, lower preoperative hemoglobin and albumin levels, and higher C-reactive protein levels. They also demonstrated shorter overall survival (47.7 versus 59.2 months, P = .027). High RDW-fL was independently associated with major postoperative complications and failure to complete adjuvant therapy.

Conclusion: Preoperative RDW did not predict AL but was strongly associated with postoperative complications, adverse survival, and incomplete adjuvant treatment. RDW may serve as a simple, cost-effective biomarker for perioperative risk stratification in colorectal cancer surgery.

Background: Postoperative leakage at the esophagogastric anastomosis is a well-recognized and significant complication following esophagectomy. In the past, treatment options were largely confined to either conservative, nonsurgical management or removal of the gastric conduit with construction of a cervical esophagostomy. Over the last decade, the development of endoluminal stents and endoscopic clipping techniques has provided a less invasive alternative, enabling effective closure of leaks without the need for further surgery and preserving the continuity of the reconstructed esophagus.

Methods: This report presents our initial clinical experiences with the combined use of stents and clips. It also reviews up-to-date evidence on patient selection, available stent designs, treatment success rates, procedure-related considerations, and the anticipated role of endoscopic approaches in managing postoperative esophagogastric anastomotic leakage.

Results: We report 3 cases who underwent endoscopic management for esophagogastric anastomotic leak with a combination of stent and clips. The success of the procedure was determined on the extent of the defect and source management, which frequently necessitated concurrent drainage and antibiotic therapy.

Conclusions: Conservative approaches have become increasingly significant in the treatment of anastomotic leaks following esophageal surgery. Our experience demonstrates that some challenging cases can be treated with a combination of endoscopic therapy methods.

Aim: This study aims to perform a comprehensive systematic review and meta-analysis to evaluate the impact of anticoagulation (AC) therapy on clinical outcomes during ventral hernia repair (VHR).

Materials and methods: A thorough online search was conducted using PubMed, Cochrane, and Embase databases. Studies comparing the use of AC therapy following VHR were included. The results analyzed were bleeding-related reoperation, hemorrhagic/thrombotic complications, length of stay, and transfusion rates. Statistical analysis was performed with Review Manager 5.4 using a random-effects model.

Results: From 1278 records, 4 studies were included, encompassing 41,868 patients (anticoagulants use = 4804; no AC = 32,649), with 25% on anticoagulant therapy submitted to minimally invasive surgery (MIS). Additionally, 90% of patients using anticoagulants underwent mesh placement. Overall analysis showed increased hemorrhagic/thrombotic complications (risk ratios [RR]: 2.3; 95% confidence interval [CI]: 1.13-4.8; P = .02), bleeding-related reoperation (RR: 6.5; 95% CI: 4.3-9.9; P < .00001), and longer hospital stays (mean difference: 1.69 days; 95% CI: .66 to 2.72 days; P = .001) in patients using anticoagulant medications. However, there was no increased risk of transfusion (RR: 2.14; 95% CI: 0.58-7.95; P = .26) between groups.

Conclusions: The use of anticoagulant therapy following VHR is associated with increased hemorrhagic/thrombotic complications, bleeding-related reoperations, prolonged hospitalization, and similar transfusion rates. Further research is still required to validate these findings and explore the impact of MIS on anticoagulated patients following VHR.

Large hepatic cysts can cause abdominal pain, pressure symptoms, or liver dysfunction. Although laparoscopic fenestration is the standard surgical approach, recurrence remains a concern. As laparoscopic hepatectomy techniques have advanced, we have adopted laparoscopic left lateral segmentectomy as a curative treatment for symptomatic cysts located in the left lateral segment. Between 2018 and 2023, 4 patients underwent laparoscopic left lateral segmentectomy for symptomatic hepatic cysts at our institution. All procedures were performed using five ports. Cystic fluid was aspirated as much as possible, and hepatic transection was conducted under the total Pringle maneuver using ultrasonic dissectors. Small vessels were sealed, while larger vessels and Glissonean pedicles were clipped or divided with linear staplers. Resected specimens were retrieved via an extended umbilical incision. Surgical and postoperative parameters were analyzed to evaluate the safety and efficacy of the procedure. The cohort included 1 male and 3 female patients, with a mean age of 63 years. Presenting symptoms included abdominal pressure (3 cases) and epigastric pain (1 case). The mean maximum cyst diameter was 16.3 cm, and the average aspirated volume was 950 mL. The mean operative time was 232 minutes, and the mean blood loss was 48 g. No postoperative complications were observed. The average postoperative hospital stay was 6 days. All patients experienced symptom resolution without delayed complications during follow-up. Laparoscopic left lateral segmentectomy might be a safe and curative surgical option for symptomatic hepatic cysts located in the left lateral segment.

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.

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.