Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

Background: Direct peroral cholangioscopy (DPOC) offers enhanced visualization and therapeutic capabilities in biliary tract procedures. However, comparative data on intubation methods and procedural efficiency remain limited. This study aimed to evaluate the success rate, complication rate, and intubation time across five different biliary intubation techniques used in DPOC. Methods: This retrospective study analyzed 36 consecutive patients who underwent DPOC between December 2021 and March 2024. Indications included cholelithiasis, cholangiocarcinoma, proximal migration of biliary prostheses, and self-expandable metallic stent (SEMS) occlusion. Five intubation methods were assessed: freehand, freehand with overtube, intraductal balloon, intraductal balloon with overtube, and intraductal balloon with overtube plus SEMS. Primary outcomes were technical success, intubation time, and complications. Results: All 36 procedures achieved successful biliary intubation (100% technical success) with no reported complications (0%). Mean intubation time differed significantly between methods (P < .001), with the shortest time observed in the intraductal balloon group (mean 73.3 seconds) and the longest in the freehand group (mean 202.25 seconds). No significant differences in intubation time were observed across clinical indications (P = .31). Conclusions: DPOC is a safe and effective procedure for various biliary pathologies, with accessory-assisted methods-particularly balloon-based techniques-demonstrating greater procedural efficiency. These findings support broader adoption of DPOC and tailored selection of intubation strategies based on anatomical and clinical context.

Purpose: This study aimed to assess the effectiveness, safety, and feasibility of a novel robotic surgical system-the KangDuo Surgical Robot-01 (KD-SR-01)-for treating clinical stage I-III distal gastric cancer (GC) by comparing it to conventional laparoscopic gastrectomy (LG). Methods: From September to December 2023, 15 patients with distal GC underwent gastrectomies using the KD-SR-01 (KD group). An additional 15 cases of LG performed by the same surgeon during the same period were selected as the control group (LG group). Preoperative, intraoperative, and postoperative data were analyzed and compared between the two groups. Results: Both groups achieved the same surgical success rate, with no conversions to open surgery. The KD group exhibited significantly less blood loss (30 [20-60] mL versus 50 [30-200] mL, P < .001) and reported a lighter workload (27.5 ± 3.0 versus 30.1 ± 2.6, P = .011) compared to the LG group. Although the operation time in the KD group was significantly longer (213.3 ± 30.1 minutes versus 166.0 ± 32.8 minutes, P < .001), it was not significantly different from the LG group when excluding the device docking time of KD-SR-01 (179.7 ± 24.5 minutes versus 166.0 ± 32.8 minutes, P = .207). There were no significant differences in postoperative hospital stay (7.7 ± 1.5 days versus 7.3 ± .8 days, P = .357) and complication rates (26.7% versus 40.0%, P = .700) between the two groups. Conclusion: The KD-SR-01 is safe and effective for treating distal GC and may be a viable alternative to conventional LG.

Introduction: Single-port robotic surgery (SPRS) provides a single-incision alternative to multiport robotic surgery (MPRS), preserving benefits such as enhanced visualization, dexterity, and ergonomics while reducing the number of incisions. Earlier single-site platforms were limited by instrument mobility and steep learning curves. The da Vinci SP® system addresses these limitations with independently articulated robotic arms that improve precision and maneuverability. Methods: We retrospectively reviewed 5 adolescent patients who underwent SPRS using the da Vinci SP® system at our institution between November 2024 and March 2025. Perioperative and postoperative outcomes were assessed, with follow-up conducted in the clinic within 3 weeks. Data were analyzed using Microsoft Excel. Results: Procedures included cholecystectomy (n = 3), femoral hernia repair (n = 1), and left ovarian cystectomy (n = 1). All procedures were completed via a single 20-25 mm umbilical incision without additional ports or conversion to open. The mean age was 16.4 years (range: 14-18), and the mean weight was 60.8 kg (range: 45.5-77.6). Console times ranged from 32 to 54 minutes (mean 41). All patients were discharged the same day, received no narcotics, and experienced no postoperative complications at 3 weeks. Conclusion: SPRS using the da Vinci SP® system appears technically feasible in carefully selected adolescent patients, with favorable short-term outcomes in this small case series. While encouraging, these results should be interpreted as preliminary. Further studies with larger cohorts and longer follow-up are needed to determine long-term safety, outcomes, and cost-effectiveness.

Background: Lymphocele is an important condition commonly seen in the follow-up of patients who underwent radical prostatectomy and extended pelvic lymph node dissection (ePLND) for prostate cancer. Since the formation and treatment of lymphocele may have negative consequences in terms of patient-care and health expenditure. Several techniques have been used to prevent lymphocele. In this study, we aimed to investigate the efficacy of the previously described preventing lymphocele ensuring absorption transperitoneally (P.L.E.A.T.) technique and compare the outcomes of patients who underwent this technique. Methodology: The data of patients who underwent robot-assisted laparoscopic radical prostatectomy with ePLND for prostate cancer between 2017 and 2023 in our institution were retrospectively analyzed. Patients were divided into two groups according to the application of the P.L.E.A.T. technique in their operations. All patients were followed up with the same protocol. Patient characteristics and postoperative follow-up data were statistically analyzed. Results: Data of 78 patients (26 patients in the P.L.E.A.T. group and 52 patients in control group) were evaluated retrospectively. There were no statistically significant differences between the groups in terms of demographic and clinical characteristics, including age, prostate-specific antigen levels, body mass index, American Society of Anaesthesiologists score, D'Amico risk classification, or the number of lymph nodes removed. Analysis of postoperative data revealed statistically significant differences between the two groups in total amount of drainage (P < .05), drain removal day (P < .05), and length of hospital stay (P < .05). Conclusions: Our experience with the P.L.E.A.T. technique showed potential advantages in line with the literature, with a considerable reduction in total drain amount, drain removal day, and length of stay.

Background: Traditional open surgical repairs, including flap techniques, are associated with high recurrence rates and significant morbidity. Robotic-assisted techniques have emerged as promising alternatives to conventional methods due to improved visualization, precision, and reduced postoperative complications. The robotic transanal minimally invasive surgery (R-TAMIS) technique offers a new route for rectovaginal fistula (RVF) repair, providing enhanced dexterity and access through the transanal approach. Methods: An R-TAMIS technique was employed for same-day repair of RVF using the da Vinci Xi® system. After bowel preparation and prophylactic antibiotics, the patient was positioned in prone Jackknife. The GelPOINT Path was used for transanal access, and robotic ports were placed. The fistula tract was identified and dissected circumferentially. The vaginal wall was closed with absorbable barbed sutures, reinforced with fibrin sealant and acellular dermal mesh. The rectal wall was then closed, and patency was confirmed via endoscopic inspection. Results: The procedure was well tolerated, and the patient was discharged the next day. Minimal postoperative pain was reported but didn't require analgesics. No major complications were observed in the immediate postoperative period. The robotic approach provided enhanced visualization and dexterity, facilitating precise dissection and suturing. The technique has already been successfully applied to benign RVFs and select rectourethral fistulas. Conclusion: Robotic-assisted transanal repair using the R-TAMIS technique is a feasible and effective minimally invasive option for selected patients with benign RVFs. With proper patient selection and dedicated surgical technique, this approach may reduce morbidity and improve outcomes compared to traditional open or laparoscopic methods.

Background: This study aimed to compare the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB) in patients aged 60 and older, focusing on postoperative weight loss, improvement in obesity-related comorbidities, and perioperative outcomes. Methods: This was a retrospective analysis of data from three bariatric surgery centers with surgeries performed between January 2019 and September 2024. The study included patients aged ≥60 years who underwent either LSG or RYGB. The primary outcome was the comparison of weight loss metrics (excess weight loss [%EWL] and total weight loss [%TWL]) between LSG and RYGB. Secondary outcomes included the remission or improvement of type 2 diabetes mellitus (T2DM) and hypertension (HTN), 30-day postoperative complications, operative time, and length of hospital stay. Results: A total of 168 patients aged ≥60 who underwent LSG (n = 130) or RYGB (n = 38) were included. Both procedures resulted in similar weight loss outcomes, with a median %EWL of 58.6% for LSG and 61.2% for RYGB. The median %TWL was 23.1% for LSG and 26% for RYGB, with no significant differences between the groups (P = .275). The operative time was significantly shorter for LSG (60 minutes versus 110 minutes for RYGB, P < .001), and LSG patients had a shorter hospital stay (2 versus 3 days, P < .001). The 30-day complication rate was low for both groups, with no significant difference in complications between LSG and RYGB. Regarding comorbidity resolution, 90.7% of patients with T2DM and 93.6% with HTN experienced improvement or remission. Complete remission was achieved in 39% of all T2DM cases (37.5% in LSG, 42.9% in RYGB) and in 33% of all HTN cases (33.3% in LSG, 31.6% in RYGB), with no statistically significant differences between the groups. Conclusions: Bariatric surgery appears safe in older adults when guided by careful patient and procedure selection through multidisciplinary assessment. Both LSG and RYGB yielded comparable weight loss and remission outcomes for T2DM and HTN in this population.

Background: We describe a novel extracorporeal knotting approach (ECKA) that enables secure mesh fixation via extracorporeal suture manipulation, anchoring the mesh firmly within the abdominal cavity. Methods: A retrospective analysis was conducted on 17 patients (14 males, 3 females) who underwent laparoscopic herniorrhaphy with mesh fixation using the ECKA technique. Key parameters included patient demographics, method of hernia repair (totally extraperitoneal [TEP] or transabdominal preperitoneal [TAPP]), laterality, and operative duration. Hernias were classified by procedure, with each side analyzed independently. Results: From April 2024 to July 2025, a total of 21 hernia procedures were performed on 17 patients using the ECKA technique. The average patient age was 70.3 years (range: 47.1-88.5 years), with a mean body weight of 65.9 kg. Of the hernia types, 15 were direct, 3 were indirect, and 3 were mixed. Laterality distribution was as follows: right-sided (n = 6), left-sided (n = 7), and bilateral (n = 4). Nine procedures utilized the TAPP approach, while 12 were performed using the TEP approach. The average operative time was 88.4 minutes (range: 60.4-145.4 minutes). Postoperative analgesia consisted of diclofenac sodium administered three times daily for three days. No recurrences were observed during a mean follow-up period of 10.3 months (range: 2-17 months). Conclusions: The ECKA technique provides a reproducible, minimally invasive solution for fixing mesh in direct, indirect, and combined hernias via either TEP or TAPP approaches. Its extracorporeal knotting system streamlines mesh fixation, ensures consistent clinical outcomes, and enhances operative efficiency across various hernia configurations.

Background: Intestinal perforation (IP) is one of the most critical surgical emergencies in neonates. It most often occurs in premature infants, with necrotizing enterocolitis (NEC) as the leading cause. Hirschsprung's disease (HD) is another important etiology. In this study, we aimed to investigate the frequency of HD among neonates with non-NEC IP and assessed the value of performing rectal biopsy in these patients. Methods: Neonates who were treated for non-NEC IPs between 2005 and 2021 were evaluated retrospectively. Demographic data, clinical features, operative details, and rectal biopsy results were collected. These features were compared according to the histopathological results of rectal biopsy (aganglionic versus ganglionic). Results: Rectal biopsies were performed in 48 neonates with non-NEC IP (33 preterm [68.8%], 15 term [31.2%]). The most common perforation site was the ileum (52.4%). Rectal biopsy revealed aganglionosis in 12.5% of the patients. Gestational age was higher in aganglionic than ganglionic cases (36.7 versus 32.5 weeks; P = .026). The perforations were colonic in all aganglionic cases (n = 6) and 47.6% (n = 20) of the ganglionic cases (P = .025). Conclusion: This study highlights the importance of considering HD in the differential diagnosis of neonatal IPs. Rectal biopsy should be considered in non-NEC perforations; particularly in term (or near-term) neonates and in cases of colonic perforation, to help identify underlying aganglionosis and guide timely management. Level of Evidence: Level 3 b.

Introduction: Laparoscopic pyeloplasty (LP) for treatment of ureteropelvic junction obstruction (UPJO) in children offers advantages over open surgical correction, including reduced hospitalization times and lower perioperative morbidity, but presents a long learning curve. Robotic-assisted laparoscopic pyeloplasty (RALP) offers the same advantages with reduced technical operative complexity but entails higher costs. No clear superiority of laparoscopy versus robotic surgery has been established. Materials and Methods: We conducted a retrospective comparative cohort study including pediatric patients who underwent minimally invasive pyeloplasty at two tertiary-level centers, those at Evelina Children's Hospital in London (UK) receiving LP and those at Policlinico San Matteo in Pavia (Italy) undergoing RALP. Data concerning preoperative variables and obstruction severity; intraoperative variables and surgical techniques; degree of postoperative obstruction reduction, complications, and redo surgeries were analysed. Results: A total of 75 patients were included, with 47 undergoing LP and 28 receiving RALP, with similar preoperative characteristics across groups. The Anderson-Hynes surgical technique was employed in 71/75 cases (94.7%) with universal stent use. No conversions were recorded. Mean operatives times and postoperative length of stay were longer for RALP. Complications took place in 7/28 (25.0%) of RALP patients and 6/47 (12.7%) of LP patients. Redo surgery was needed for 1/28 (3.6%) RALP and 3/47 (6.4%) LP patients. These differences were not statistically significant. Symptoms resolution and postoperative pelvic diameter decrease were comparable between groups. Conclusions: RALP and LP appeared comparable in terms of safety and efficacy. Adoption of one technique over the other may be justified by the surgeon's preference and the availability of a robot.

Introduction: Benign prostatic hyperplasia is a leading cause of lower urinary tract symptoms in aging men. When medical therapy fails, surgery is indicated. This study evaluates the safety and efficacy of Aquablation compared with transurethral resection of the prostate (TURP) and Holmium laser enucleation of the prostate (HoLEP) in patients with bladder outlet obstruction. Methods and Materials: A prospective analysis of 318 Aquablation patients (2023-2025) was conducted and compared with 83 TURP and 83 HoLEP patients from a retrospective database. Functional outcomes were assessed using International Prostate Symptom Score (IPSS), ICIQ-UI, EF-IIEF, and MSHQ-EJD SF. Complications were graded using the Clavien-Dindo classification. Follow-ups were performed at 3, 6, and 12 months. Results: Aquablation patients had larger prostates than TURP (94 versus 54.7 cc; P < .0001) but smaller than HoLEP (105 cc; P = .002) patients. More Aquablation patients had indwelling catheters and were on anticoagulants (P < .0001). IPSS improvement was the greatest in Aquablation (18.9 points) versus TURP (13.8) and HoLEP (14.7; P = .000). Erectile function was preserved in Aquablation (P = .859), with significantly better ejaculatory function (82.8% preserved) than TURP (36%) and HoLEP (18%). Furthermore, Clavien-Dindo grade 1-2 complications were higher in Aquablation, but serious events (CD 3-4) were comparable. Complication rates declined significantly after the first 30 Aquablation cases. Conclusion: Aquablation is an effective surgical option for medium to large prostates, offering superior symptom relief and preservation of sexual function. Although its learning curve is shorter than HoLEP's, proper training is essential to minimize early complications.