Journal of Laparoendoscopic & Advanced Surgical Techniques最新文献

Introduction: A JJ stent placed before retrograde intrarenal surgery (RIRS) may passively dilate the ureter and facilitate ureteral access sheath (UAS) implantation. No studies have examined the significance of preoperative JJ stent diameter, even though numerous studies have shown that UAS insertion is simpler in patients with them. Our study examines the relationship between preoperative ureteral stent caliber and UAS placement and RIRS results. Materials and Methods: A total of 655 patients with known preoperative double-J stent size before RIRS were analyzed. The patients were categorized into two groups based on their preoperative stent diameter (Group 1: 4.8 Fr and Group 2: 6 Fr). Demographic and clinical data of the patients, stone characteristics, surgical data, perioperative and postoperative complications, duration of hospitalization, and stone-free rates (SFRs) were analyzed for comparison. Results: The groups contained 323 and 332 patients. The demographic data of the two groups were similar. There was no statistically significant difference between SFR, UAS insertion rate, hospitalization time, and complications. The success rate of placing a UAS with a higher caliber was statistically significantly higher in those with a 6 Fr JJ stent than in those with a 4.8 Fr stent (P = .001). The operation time was also shorter in the group with a thicker stent (P = .003). Conclusions: Our data suggest that while the preoperative JJ stent diameter does not significantly affect overall UAS insertion success, complication rates, or postoperative stone-free status, using a 6 Fr stent facilitates the placement of larger UAS calibers and may decrease operation time. Consequently, although both stent diameters are efficacious, selecting a 6 Fr stent may provide procedural benefits without jeopardizing safety or results.

Background: Laparoscopic adjustable gastric banding (LAGB) was once a widely adopted bariatric procedure due to its reversibility and minimally invasive nature. However, concerns about long-term complications, particularly intragastric migration and slippage, have led to a decline in its use. Methods: We conducted a retrospective review of 411 patients who underwent LAGB between 2002 and 2010 at a tertiary care center. Data on demographics, complication rates, time to onset, and management strategies were analyzed. Follow-up data were available for 178 patients over a 15-year period. Results: Band migration was diagnosed in 33 patients (18.5%), with a median detection time of 74 months post-implantation. Most cases (54.5%) were diagnosed between 6 and 10 years postoperatively. Common clinical presentations included weight regain (45.4%) and port-site infection with fever (33.3%), while 21.2% were asymptomatic. Surgical removal was performed in all migration cases, with a laparoscopic approach successfully used in 84.8%. Conversion to open surgery was necessary in 2 patients, and primary laparotomy was used in 3 early cases. Band slippage occurred in 10.7% of patients, with 63.2% requiring surgical intervention. Postoperative complications were minimal and managed conservatively. Conclusions: Our findings confirm that LAGB is associated with a significant long-term risk of complications, particularly band migration, which may occur more than a decade postoperatively. Long-term follow-up is essential, and routine upper GI imaging should be considered in all patients with LAGB, especially in those presenting with port-site infections. These results highlight the importance of individualized management and long-term vigilance in patients undergoing LAGB.

Background: This study aimed to identify the biomarkers that was associated with the postoperative incisional pain in patients with acute cholecystitis undergoing laparoscopic cholecystectomy surgery (ACC-LC). Methods: Sixty ACC-LC patients were enrolled and divided into mild pain (MP) and moderate-to-severe pain (MSP) groups based on their visual analog scale (VAS) scores 24 hours postoperatively. RNA sequencing was used to screen the potential pain associated markers, and ELISA were used to analyze the expression of one identified marker, CXCR5 in peripheral blood mononuclear cells (PBMCs). Single nucleotide polymorphism genotyping for CXCR5 rs3922 was performed, and its correlation with pain levels, inflammatory markers, and perioperative clinical features were assessed. Results: CXCR5 expression was significantly upregulated in the MSP group compared to the MP group. Higher CXCR5 levels correlated with increased VAS scores and were predictive of pain severity. The CXCR5 rs3922 G allele was associated with elevated CXCR5-associated pain levels, together with the increased Interleukin-6 (IL-6) levels, and decreased Transforming Growth Factor-beta (tgf-β) levels. Patients carrying the GG genotype also exhibited higher Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) levels, indicating greater liver damage, and experienced a longer time to anal exhaust and more postoperative complications. Conclusion: CXCR5 expression and the rs3922 polymorphism were associated with incisional pain and inflammatory damage in ACC-LC patients. These findings suggest that CXCR5 may serve as a biomarker for pain prediction and personalized pain management strategies.

Purpose: This study aimed to identify predictive clinical factors and computed tomography (CT) findings for difficult laparoscopic cholecystectomy (LC) in patients with acute cholecystitis (AC). Methods: We retrospectively reviewed 549 patients with AC who underwent LC following preoperative CT scans from January 2011 to August 2020. Difficult LC was defined as requiring conversion to laparotomy or subtotal cholecystectomy, blood loss >500 mL, operative time significantly exceeding average, or bile duct injury. Clinical characteristics and specific CT findings were analyzed using univariate and multivariate logistic regression. Results: Twenty-seven patients (4.9%) experienced difficult LC. Multivariate analysis identified body mass index (BMI) >30 kg/m² (odds ratio [OR] = 4.70, 95% confidence interval [CI]: 1.86-11.92; P = .004) and C-reactive protein (CRP) ≥60 mg/L (OR = 3.12, 95% CI: 1.31-7.44; P = .01) as independent predictors. Radiological findings from CT, such as peri-gallbladder fluid and fat stranding, demonstrated no significance statistically. Conclusions: High BMI and elevated CRP levels were significant independent predictors for difficult LC in patients with AC. Preoperative CT findings alone did not predict surgical difficulty, suggesting clinical factors should remain the primary consideration in preoperative assessment.

Aim: This study aims to evaluate the descending and ascending approaches in laparoscopic adrenalectomy, focusing on their impact on surgical outcomes. Methods: This retrospective study included patients who underwent transperitoneal laparoscopic adrenalectomy for indications other than pheochromocytoma between 2018 and 2025. Patients were divided into two groups: those who underwent the descending approach (Group D) and those who underwent the ascending approach (Group A). Preoperative, intraoperative, and postoperative data were collected, including age, the American Society of Anesthesiology scores, tumor characteristics, operative time, blood loss, blood pressure variations, and hospital stay duration. Statistical analyses were performed using SPSS 25.0, with P < .05 considered statistically significant. Results: A total of 63 patients were analyzed (Group D: 30, Group A: 33). The mean operative time was significantly shorter in Group D (92 versus 110 minutes, P = .027). Blood loss was lower in Group D (80 versus 120 mL, P = .022), with a smaller hemoglobin decrease (1.2 versus 1.8 g/dL, P = .025). There was no significant difference in intraoperative blood pressure fluctuations, hospital stay, or major complications. Conclusions: The descending approach may offer advantages in reducing operative time and blood loss in laparoscopic adrenalectomy. However, both techniques remain viable options with comparable complication rates. Further studies are needed to confirm these findings in larger cohorts.

Introduction: Minimally invasive lens cleaning remains a persistent problem. Several internal and external cleaning devices are available, but most products are expensive, interrupt operative flow, require additional materials, or lack universal clinical efficacy. This study evaluates a novel minimally invasive lens cleaner. Methods: Patients undergoing a laparoscopic procedure from April to July 2025 were included. The number of times the laparoscope was removed for cleaning during the operation was measured. The duration of cleaning time was measured also. The cleaning time included removal, cleaning, reinsertion, and resumption of the operation. A control group utilized the Clearify^© while an experimental group utilized the novel device. The mean number of lens cleaning episodes and duration of lens cleaning were compared using a t test between the two groups with a P < .05 as significant. Results: Twenty control and 20 experimental cases were compared, including foregut, biliary, and bariatric procedures. The mean number of cleaning episodes/case for the control group during biliary, bariatric, and foregut procedures was 5.3 ± 1.5, 11.4 ± 6.2, and 11.8 ± 2.7, respectively. The mean number of cleaning episodes/case for the experimental group during bariatric and foregut procedures was .5  ±  0.9 and .3  ± 0 .5, respectively. The mean number of wipes in the foregut and bariatric group was significantly lower for the experimental group (P < .05). The lens cleaner was applicable for 5 mm and 10 mm angled laparoscopes. Longer operations in the control group required more cleaning episodes. However, operative time did not impact the number of cleaning episodes in the experimental group. The mean total time per case in the control group was significantly longer versus the experimental group (P < .05). Conclusion: The novel lens cleaner was clinically efficacious and significantly decreased the number of cleaning episodes. The product provided a clear view of the operative field while enhancing procedural efficiency by decreasing the number of times operative flow was disrupted.

Purpose: There has been a longstanding debate regarding whether lower pole renal crossing vessels on the pelvi-ureteric junction preclude the need for a dismembered pyeloplasty. A retroperitoneoscopic technique for a transposition of these vessels has not yet been described in the literature. We report our early experience of the retroperitoneoscopic vascular hitch procedure for transposition of lower pole renal crossing vessels, including technique and outcomes. Methods: Single-center retrospective review of all children who had a retroperitoneoscopic vascular hitch procedure for pelvi-ureteric junction obstruction from March 2022 to April 2024. Data on symptom resolution, change in sonographic anterior-posterior diameter (APD), MAG-3 (mercaptoacetyltriglycine) renogram curves, postoperative length of stay, complications, and further surgical interventions were collected. Results are reported as median and interquartile range. Results: Ten patients (70% male, median age 11.7 years, range 8-13 years) with preoperative APD of 34 mm (23-40) over the 2-year period were included. One patient received an on-table diuretic stress test. Seven out of 10 patients had day-case surgery, and 3 patients had an overnight stay. The follow-up period was 343 days (122-456). Postoperative APD was 13 mm (6-23), and the change in APD was -18 mm (-25 to -10). No loss of function or uptake areas on MAG-3 scans were observed. Two patients received antibiotics for a presumed urinary tract infection in the postoperative period. Symptom resolution was achieved in 90% of patients, and 1 patient underwent robotic-assisted dismembered pyeloplasty 10 months later. Conclusion: Retroperitoneoscopic vascular hitch for lower pole renal crossing vessels is an acceptable alternative to dismembered pyeloplasty in selected pediatric cases.

Background: Early rectal tumors can be effectively managed using transanal endoscopic microsurgery (TEM) and endoscopic submucosal dissection (ESD). This study aimed to compare ESD and TEM in the resection of early rectal tumors concerning en bloc resection rates, R0 resection rates, mean procedural times, perforation rates, bleeding rates, adverse events/complication rates, and mean length of stay (LOS). Methods: We conducted a systematic literature review in accordance with PRISMA guidelines to identify studies directly comparing ESD and TEM for the resection of early rectal tumors. A pairwise meta-analysis was performed using a random-effects model, reporting odds ratios and mean differences. Results: The R0 resection rate was lower in the ESD group. Subgroup analysis indicated that the reduced R0 resection rate in ESD remained significant in the subepithelial subgroup but not in the epithelial subgroup, with the subgroup difference reaching statistical significance (P = .05) but didn't meet conventional statistical significance (P < .05). The number needed to treat with ESD to result in one additional missed R0 resection (harmful event) compared to TEM was 10 (95% CI 4-162). The ESD group demonstrated significantly shorter mean procedural times and LOS, with no significant subgroup differences between epithelial and subepithelial tumors. Conclusions: This study suggests that ESD is associated with a lower R0 resection rate compared to TEM, but offers a shorter mean LOS and procedural time. To date, no randomized controlled trials (RCTs) have been published. Large-scale RCTs that also involve operators who have achieved technical mastery in ESD and TEM are necessary to reach more definitive conclusions. Until such RCTs are published, strong recommendations cannot be made. Additionally, further studies are required to assess whether tumor origin (epithelial versus subepithelial) impacts the R0 resection rate in ESD.

Background: Robotic-assisted proctectomy (RAP) has been reportedly associated with lower rates of conversion to laparotomy than laparoscopy in several cohort studies. This st0udy aimed to assess the temporal trends in conversion from RAP to laparotomy stratified by patient and treatment-related factors. Methods: This retrospective observational study was undertaken to analyse the temporal trends in unplanned conversion from RAP to laparotomy. Changes in the rates of conversion over time were plotted as line graphs, and the significance of each trend was calculated with the Cochran-Armitage trend test. A case-control analysis of factors associated with conversion to open surgery was conducted. Results: The study included 23,644 patients (62.3% male, median age: 60 years). 1280 (5.4%) patients were converted to laparotomy. There was a significant linear trend of decreased conversion over time (3.9% in 2021 compared with 10.4% in 2010; P < .001). The reduction in conversion rates was significant in all patients except in patients <50 years (P = .838), Black patients (P = .358), patients with a Charlson comorbidity index score >1 (P = .053), patients with governmental insurance other than Medicaid and Medicare (P = .629), and patients undergoing abdominoperineal resection (APR) (P = .129) or pelvic exenteration (PE) (P = .326). The independent predictors for increased conversion were male sex, higher Charlson scores, community cancer programs, comprehensive community cancer programs, household income of <$63,000, tumors ≥5 cm, and PE. Conclusions: Unplanned conversion from RAP to laparotomy showed a linear trend of reduction over time, which was statistically significant except in young patients, Black patients, patients with significant comorbidities, and patients undergoing APR or PE.

Purpose: In refractory Crohn's disease, the terminal ileum is a common site requiring excision. Laparoscopic ileocecectomy is the procedure of choice and we use a single-incision laparoscopic technique (SILS). We have previously reported our experience with SILS ileocecectomy with a sizeable cohort compared to other series. This project aims to expand on our single-institutional experience and evaluate the impact of operative experience. Methods: We completed a single-institution retrospective review of patients who underwent SILS ileocecectomy for Crohn's disease from January 1, 2009 to March 31, 2024. Operative and inpatient characteristics were collected to determine complication rates. Subgroup analysis was completed comparing previously studied patients (January 1, 2009 to February 1, 2013) to our updated cohort. Results: Seventy-eight patients underwent SILS ileocecectomy for Crohn's disease and had a median age of 16.5 years (interquartile range: 15.0, 17.8). The median length of stay (LOS) was 96 hours (72, 186). The overall complication rate was 17%. On subgroup analysis, patients operated on after 2013 were older (P = .012), had a longer disease length before operating room (OR) (P = .051) and were more likely to be on anti-tumor necrosis factor therapy (P = .014). Mean operative time was significantly lower in the newer cohort (70 mins versus 85 mins, P = .007). The patients in the newer cohort had a shorter median LOS (72 hours compared to 108 hours, P = .149) and had a lower complication (13% versus 23%, P = .283) and re-operation rate (4% versus 15%, P = .159). Conclusions: SILS ileocecectomy is effective and safe in pediatric patients with Crohn's disease. As operative experience increases, we have observed a clinically significant decrease in operative time and complication rates. Level of Evidence: III, Retrospective study.