Journal of minimally invasive surgery最新文献

Gastric remnant volvulus following Roux-en-Y gastric bypass (RYGB) surgery is rare, with only two previously reported cases. Herein, we present the first case of gastric remnant volvulus following gastric sleeve conversion to RYGB in a 32-year-old female. Management for gastric remnant volvulus has not been clearly described in the literature due to the rarity of cases; however, previously documented cases of gastric remnant volvulus following RYGB were managed with gastropexy or resection of the gastric remnant. Due to anatomical limitations, gastropexy was not an option for our patient, and the remnant stomach was resected. Although management options are still evolving, surgical intervention is likely indicated for gastric remnant volvulus that develops following RYGB. To improve patient outcomes and establish more comprehensive guidelines for this uncommon condition, further studies on the management of post-RYGB gastric remnant volvulus are warranted since gastric sleeve conversion to RYGB is becoming more prominent.

Central pancreatectomy (CP) is a viable option for low malignant tumors located in the neck or proximal body of the pancreas. This procedure has the advantage of minimizing impairment to pancreatic function. However, it is technically challenging and carries a relatively high risk of postoperative pancreatic fistula. Recently, minimally invasive CP surgery has gained popularity, with evidence supporting its safety and efficacy. Nevertheless, conventional laparoscopic CP presents technical difficulties, while robot-assisted CP is associated with higher costs. ArtiSential (LivsMed Inc.) is a device that has been successfully utilized in various surgical procedures, offering the ergonomic advantages of robotic surgery within a laparoscopic setting. In this article, we share our successful experience of performing laparoscopic CP using ArtiSential in a patient with intraductal papillary mucinous neoplasm.

Purpose: Postoperative nausea and vomiting (PONV) is a prevalent and distressing complication, especially in laparoscopic surgeries. This review compares the efficacy and safety of palonosetron and ondansetron in preventing PONV after laparoscopic surgery.

Methods: A systematic review was conducted in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library to identify comparative studies that reported the efficacy (nausea and vomiting) at three postoperative time points T1 (0-2 hours), T2 (2-6 hours), T3 (6-24 hours) and safety (incidence of adverse effects). Meta-analysis of relative risk was performed using a random effect model and subgroup analysis based on factors such as antiemetic dose and timing of administration, type of surgery, and anesthetic agents.

Results: Twenty-one randomized controlled trials were published between 2011 and 2022, involving 2,043 participants. Nineteen trials were included in the meta-analysis (efficacy, 17; safety, 11). The pooled risk ratio revealed that patients receiving palonosetron demonstrated significantly less likelihood of developing nausea and vomiting at various postoperative time points. Subgroup analysis indicated significantly less PONV when palonosetron was administered before intubation and in combination with isoflurane anesthesia. Headache, dizziness, constipation, and drowsiness were the most commonly reported. The safety profiles of palonosetron and ondansetron were comparable.

Conclusion: Palonosetron exhibits superior efficacy within the first 24 hours postoperatively and requires less rescue antiemetic intervention compared to ondansetron in laparoscopic surgery patients. Both demonstrate nearly comparable safety profiles. Future trials focusing on cardiac safety (QT interval) and cost consideration are needed.

Retrorectal tumors, although rare, pose diagnostic and treatment challenges due to their nonspecific symptoms and complex anatomical location. This single-center case series reports short-term outcomes of laparoscopic transabdominal resection as a surgical approach for large retrorectal tumors. Between 2017 and 2020, five patients underwent this procedure. The median patient age was 53.2 years (range, 34-60 years), and the median operating time was 130 minutes (range, 95-205 minutes). All tumors were located in the retrorectal space. The median tumor size was 5.8 × 4.3 cm (range, 3.5-7.5 cm). Biopsy results included epidermoid cysts, tailgut cyst, lipoma, and keratinous cyst. The median hospital stay was 7.8 days (range, 5-11 days), and the median follow-up duration was 78.0 days (range, 14-219 days). One patient developed a postoperative surgical site infection. Overall, laparoscopic transabdominal resection appears to be a minimally invasive and effective treatment option for retrorectal tumors.

In recent years, indocyanine green (ICG) and near-infrared (NIR) fluorescence-guided surgery has become a versatile and well-researched tool for gastric cancer treatment. Our narrative review aims to explore the applications, benefits, and challenges that are associated with this technique. Initially used to detect sentinel lymph nodes in early gastric cancer, its scope has broadened to include several clinical applications. Its most notable advantages are the ability to guide standard lymphadenectomy, intraoperatively localize tumors and define tumor margins. Despite these advantages, there are still ongoing discussions regarding its accuracy, lack of standardized administration, and oncologic safety in sentinel node navigation surgery. The limited tumor specificity of ICG has been especially put into question, hindering its ability to accurately differentiate between malignant and healthy tissue. With ongoing innovations and its integration into newer endoscopic and robotic systems, ICG-NIR fluorescence imaging shows promise in becoming a standard tool in the surgical treatment of gastric cancer.