Journal of minimally invasive surgery最新文献

Laparoscopic right hepatectomy has gained acceptance for major oncologic hepatectomies. Preoperative sequential strategies for induced tumor downsizing and contralateral liver hypertrophy ensure the safety of these major hepatectomies, especially in cases of underlying liver disease. In this video, we present a sequential minimally invasive approach used to treat a large hepatocellular carcinoma (HCC) developed in steatotic liver using sequentially yttrium-90 liver radioembolization (transarterial radioembolization), liver venous deprivation (LVD), and minimally invasive surgery. A computed tomography scan 30 days after the LVD procedure showed a future liver remnant hypertrophy rate of 89.8% and a kinetic growth rate of 5.4 mL/day. A laparoscopic right hepatectomy was then performed. Postoperative course was uneventful with bilirubin normalization at postoperative day 2. Patient was discharged on postoperative day 8. In case of voluminous HCC on steatosis liver, we provide an innovative combination of preoperative liver radioembolization and LVD to generate maximal liver hypertrophy and to allow a safe laparoscopic right hepatectomy.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has affected healthcare systems worldwide, altering clinical practices and surgical outcomes. However, its specific impact on inguinal hernia repair (IHR) has not been extensively studied. This research investigates the effects of the pandemic on surgical outcomes and the evolution of surgical techniques during the COVID-19 era. The impact of the COVID-19 pandemic on surgical site infections (SSIs), secondary infections, postsurgical pain, edema, and the shift in surgical techniques in IHR patients.

Methods: This study is a retrospective cohort study involving 1,067 patients who underwent elective unilateral IHR from 2018 to 2024 at the Second Affiliated Hospital of Dalian Medical University, who were categorized into three groups based on the time of surgery: pre=pandemic (n = 239), pandemic (n = 592), and post-pandemic (n = 236).Clinical variables included surgical techniques, SSI classification, postsurgical pain, edema, hospitalization duration, and comorbid conditions.

Results: Significant decrease in superficial and organ/space SSIs during the pandemic, particularly with laparoscopic surgery (odds ratio [OR], 0.13; p = 0.002). Post-pandemic, there was a significant reduction in mild, moderate, and severe pain (OR, 0.085, 0.127, and 0.029; all p < 0.001). Additionally, there was a marked increase in the use of laparoscopic surgery, from 9.6% pre-pandemic to 77.1% post-pandemic (p < 0.001).

Conclusion: The post-pandemic group was associated with improved surgical outcomes, including reduced SSI rates, postsurgical pain, and shorter hospital stays, likely due to the increased use of laparoscopic surgery. These findings underscore the importance of adapting surgical approaches in response to crisis-driven changes.

An epigastric hernia may coexist with other abdominal wall hernias, resulting in the protrusion of abdominal organs through a defect in the linea alba. This case report presents a 46-year-old male with a body mass index of 37 kg/m², diagnosed with concurrent epigastric and umbilical hernias, as well as diastasis recti. The patient underwent simultaneous hernia repair using the enhanced-view total extraperitoneal (eTEP) technique, a minimally invasive approach that enhances surgical visualization and optimizes port placement while avoiding intraperitoneal mesh placement. The postoperative course was uneventful, with no reported complications. Although eTEP has been increasingly utilized for abdominal wall reconstruction, reports on its application in cases involving combined epigastric and umbilical hernias remain limited. This case contributes to the existing literature by demonstrating the feasibility and effectiveness of eTEP in managing complex abdominal wall defects, particularly in patients with multiple hernias and diastasis recti.

Purpose: The incidence of postoperative nausea and vomiting (PONV) is variable across different settings. In our setting, no standardized risk assessment strategies exist, leading to sporadic use of antiemetics. This study aims to assess the incidence of PONV in adult patients undergoing laparoscopic cholecystectomy (LC), its predictors, and the effectiveness of the Apfel score and Koivuranta score in predicting PONV after LC in Nepalese patients.

Methods: A prospective observational study was conducted among patients undergoing elective LC. Apfel score and Koivuranta score were calculated for each patient. Postoperatively, patients were monitored for nausea and vomiting for 24 hours. Bivariate and multivariate analyses were performed to find the predictors. The receiver operating characteristic (ROC) curve was constructed to compare the scores.

Results: A total of 100 patients were analyzed with mean age of 36 years and female predominance (82%). The mean hospital stay was 2.51 days. Incidence of PONV was 43%. Absence of smoking (odds ratio [OR], 7.66; 95% confidence interval [CI], 1.91-30.78), history of motion sickness (OR, 9.51; 95% CI, 2.63-34.38), and use of postoperative opioids (OR, 7.18; 95% CI, 2.24-23.01) were significantly associated with PONV. The Apfel score (area under the curve [AUC] of 0.809) had slightly superior performance than Koivuranta score (AUC of 0.79).

Conclusion: There is a higher incidence of PONV after LC, with a higher risk in nonsmokers, patients with history of motion sickness, and use of postoperative opioids. Apfel score is an accurate and simpler score than Koivuranta score that can be used for the risk stratification of these patients.

Minimally invasive surgery (MIS) has transformed surgical oncology practice over the past four decades. This narrative reflects on Korea's pioneering role in MIS, particularly in colorectal surgery, chronicling its evolution from early laparoscopic cholecystectomy to advanced robotic procedures. Through personal experience, institutional milestones, and landmark clinical trials-including the COREAN trial-this Presidential Lecture at KSERS 2025 reviews the challenges, milestones, and future direction of MIS. It underscores the need for evidence-based surgical innovation and sustained commitment to clinical trials.

Right posterior segment graft (RPSG) in cases of living donor hepatectomy expands the donor pool; however, obtaining RPSG laparoscopically makes the procedure technically challenging. The first pure laparoscopic RPSG was performed in 2021, and since then, only a few cases have been reported in the literature. We herewith elaborate on our technique of laparoscopic RPSG, which is the first case to be reported from India. A 30-year-old surgically fit gentleman was planned for RPSG given the low future liver remnant for the modified right lobe graft (25.9%). Details of the surgical steps were being described in the supplementary video. The duration of surgery was 630 minutes, and blood loss was 750 mL (bleeding from a slipped clip). He was discharged in a stable condition on postoperative day 7. Laparoscopic RPSG is challenging yet feasible.

A proximal gastrectomy is sufficient for patients with small gastroesophageal junction (GEJ) tumors. Continuity can be restored with an esophagojejunostomy with jejunal interposition, offering significant functional advantages. However, the primary challenge is creating a mediastinal anastomosis. This multimedia article demonstrates our technique for laparoscopic proximal gastrectomy with jejunal interposition and hand-sewn esophagojejunostomy, performed using ArtiSential wristed instruments, in a 76-year-old woman with Siewert type II gastroesophageal junction cancer staged as cT2N0M0.

Purpose: This study compared the accuracy, safety, and efficacy of standard-of-care (SOC) ultrasound and augmented reality needle guidance system (ARNGS) used adjunctively for percutaneous needle placement in porcine models.

Methods: Four live swine underwent a model creation procedure in which metallic fiducials were percutaneously implanted into the livers (n = 8 per animal; 32 total) and kidneys (n = 4 per animal;16 total) to serve as "lesions." Computed tomography was used to create three-dimensional volumetric images of the anatomy. Four physicians, with limited previous ARNGS experience and blinded to the target locations, positioned needles at the targets using either SOC alone or ARNGS + SOC.

Results: No adverse events occurred. Mean target registration error (TRE) was 3.0 mm (95% confidence interval [CI], 2.4-3.6 mm; n = 22) with SOC (an average needle depth, 8.0 cm) and 2.9 mm (95% CI, 2.2-3.5 mm; n = 24) with ARNGS + SOC (an average needle depth, 7.6 cm). The first-attempt success rate was 39.1% (9/23) for SOC and 41.7% (10/24) for ARNGS + SOC. There was not a significant difference in TRE or first-pass success rate between the two groups (p > 0.05). Needle repositions were significantly less when using the ARNGS + SOC (0.8 vs. 3.0, p = 0.01).

Conclusion: In a preclinical study, the ARNGS + SOC was as accurate and safe as SOC in needle targeting of implanted targets. A reduction in needle repositioning suggests its potential to streamline procedures and reduce the risk of complications. This novel image fusion method merits further evaluation.