Journal of minimally invasive surgery最新文献

Purpose: Esophagectomy for malignancy leads to decreased gastric conduit acidity due to bilateral vagotomy and fundic gland area reduction. However, reflux symptoms occur. The changes in pH of gastric conduit and esophageal remnant post-esophagectomy were studied and correlated clinically, endoscopically and with Helicobacter pylori positivity.

Methods: We studied 20 patients prospectively undergoing esophagectomy for malignancy from January 2022 to December 2023. The patients underwent pre- and postoperative clinical assessment, 24-hour pH monitoring, and esophagoduodenoscopy with H. pylori testing and analysis.

Results: Postoperatively, the total percent (%) time pH <4 was nonsignificantly increased to 17.95% (p = 0.754) in the esophageal remnant and significantly decreased to 53.5% (p = 0.012) in the stomach. Postoperatively, the H. pylori-positive patients had a non-significantly higher total % time pH <4 in the esophageal remnant than H. pylori-negative patients (29.47 ± 33.54 vs. 6.44 ± 11.58, p = 0.064) and slightly lower total % time pH <4 in the stomach (53.30 ± 46.08 vs. 53.71 ± 31.20, p = 0.982). The total % time pH <4 in the gastric conduit was significantly correlated with the esophageal remnant (p = 0.002), showing a correlation coefficient of 0.629.

Conclusion: There is a significant increase in gastric conduit pH post-esophagectomy with increased exposure to the esophageal remnant mucosa proportional to gastric acidity. H. pylori infection does not affect gastric aciditiy and acid reflux after esophagectomy.

Robotic ileal pouch-anal anastomosis offers improved ergonomics and dexterity, leading to increased use. This study presents our initial series, describing technique and outcomes from a nationally accredited district general hospital. Data of consecutive patients who underwent robotic restorative proctocolectomy, between January 2021 and August 2024 was presented. Da Vinci Xi system (Intuitive Surgical) was used for all cases. We usually use the ileostomy site as the extraction site and J pouch formation avoiding Pfannenstiel or lower midline incision. Eight patients with a median age of 38 years, and a mean body mass index of 20.65 kg/m² were included. Four had restorative proctectomy while one had restorative proctocolectomy. The median operative time was 407.5 minutes. One patient needed reoperation due to intraabdominal collection. The median length of stay was 6.5 days. One readmission was for adhesive obstruction. There were no mortalities. Our series demonstrates the technical feasibility and safety of our robotic technique.

Purpose: The rising rates of obesity across the United States, particularly among pediatric and elderly patients, have led to more bariatric surgeries among these populations. Previous studies have compared the outcomes between pediatric or elderly patients and adult patients, but none have studied all groups together. Therefore, we compared the outcomes of all three age groups following a laparoscopic sleeve gastrectomy.

Methods: The 2022 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) was utilized to identify pediatric (aged 13-17 years, n = 333), adult (aged 18-65 years, n = 118,444), and elderly (aged 66-80 years, n = 5,646) patients. Analyses were performed with the adult cohort serving as the reference group.

Results: Postoperatively, the elderly cohort experienced higher rates of mortality and complications, including sepsis, reoperations, and readmissions. Preoperatively, the elderly cohort also had higher rates of comorbidities, including sleep apnea, gastroesophageal reflux disease, and hypertension. After controlling for all variables, multivariate logistic regression analysis revealed that being pediatric, male, or having a preoperative body mass index (BMI) ≥45 kg/m² were associated with a BMI decrease of ≥2.5 kg/m² postoperatively within the 30-day follow-up period.

Conclusion: These findings highlight the varying clinical outcomes among age groups of patients undergoing bariatric surgery. The pediatric cohort saw the most significant decrease in postoperative BMI with minimal complications, while the elderly cohort saw the opposite trend.

Appendectomy, cholecystectomy, and inguinal herniorrhaphy are fundamental procedures in general surgery. These surgeries help trainees develop essential surgical skills, including technical proficiency and surgical planning. In this study, we aimed to design and produce modular laparoscopic surgical training models tailored to the needs of surgical education. Modular laparoscopic models for appendectomy, cholecystectomy, and inguinal herniorrhaphy were developed. The cholecystectomy and appendectomy models consisted of two components: a frame and a module, whereas the herniorrhaphy model included a pelvic cavity and peritoneum. A surgical resident with two years of laparoscopic experience at the Department of Surgery at Severance Hospital evaluated the simulators. The modular laparoscopic surgical training models developed in this study are cost-effective, realistic, and capable of precisely simulating surgical environments. These models provide an effective educational tool for enhancing surgical training.

Purpose: Virtual reality (VR) has emerged as a transformative tool in surgical education, offering a controlled and repeatable training environment that mitigates ethical and legal challenges associated with traditional apprenticeship models. By simulating real-life surgical scenarios, VR allows trainees to practice procedures safely while improving skill acquisition and procedural efficiency. In this study, we systematically reviewed research trends in VR-based surgical education to provide insights into its current applications and future potential.

Methods: A comprehensive literature search was conducted on PubMed, identifying 395 studies. Of these, 92 studies met predefined inclusion criteria and were selected for analysis. The selected studies were analyzed based on publication period, surgical procedure, medical specialty, country of origin, and outcome measures.

Results: Study findings revealed that research on VR surgical simulation peaked between 2005 and 2009, followed by a decline in recent years. Laparoscopic and endoscopic training were the most frequently studied procedures, with general surgery and gastroenterology being the most predominant specialties. The United States contributed the highest number of publications. Common outcome measures for evaluating VR training effectiveness included time, movement economy, subject evaluation, error rates, proficiency scales, and accuracy.

Conclusion: These findings illustrate the historical trajectory and current landscape of VR use in surgical training. While the initial surge in interest has waned, VR remains a valuable tool for procedural skill development, particularly in laparoscopic and endoscopic training, and its future potential may depend on improvements in realism, cost-efficiency, and curriculum integration.

Hepatopancreatoduodenectomy (HPD) is a definitive, yet highly complex surgical approach for treating extensive cholangiocarcinoma, characterized by substantial morbidity and mortality. Recent advancements in minimally invasive surgery, particularly robotic platforms, have demonstrated potential in overcoming the technical challenges associated with HPD. Here, we present a case of a 69-year-old male with hilar cholangiocarcinoma extending to the mid and distal common bile duct, successfully managed with robotic left hepatectomy, caudate lobectomy, and pancreaticoduodenectomy (HPD). The operation, performed using the da Vinci Xi system (Intuitive Surgical), lasted 543 minutes with an estimated blood loss of 500 mL. Postoperative complications, including a hepaticojejunostomy leakage, were managed conservatively, and the patient was discharged. This case highlights the feasibility and safety of robotic HPD for complex biliary malignancies, emphasizing its potential as a minimally invasive alternative in select patients when performed by experienced surgeons.

Purpose: An open Hartmann (OH) procedure generally remains the standard of care for several emergent colorectal conditions. There is a perception that the laparoscopic approach is limited to large subspecialist centers. This study aimed to investigate the outcomes of these emergency procedures in a non-subspecialized regional center.

Methods: We conducted a retrospective cohort analysis on patients who underwent an emergency Hartmann procedure between 2019 and 2023 within a general surgery unit at a regionally located tertiary-level Australian hospital. Patients were classified as having undergone either OH or laparoscopic Hartmann (LH) procedures. Our primary outcome of interest was length of hospital stay (LOS). Secondary outcomes included time to return of gut function, morbidity, and reversal. Differences between the OH and LH groups were assessed descriptively and using confounder-adjusted regression.

Results: We identified 115 patients (83 underwent OH, 32 underwent LH) during the study period. The adjusted estimated mean LOS for patients undergoing an OH procedure was 15.8 days (95% confidence interval [CI], 13.7-17.9) compared to 9.6 days (95% CI, 7.4-11.9) for patients undergoing an LH procedure. The mean time taken for the return of gut function was estimated to be 34% longer following an OH procedure compared to an LH procedure (adjusted incidence rate ratio, 1.34 days; 95% CI, 1.00-1.81). Morbidity was similar between groups. The LH group had higher rates of laparoscopic reversal (91.7% vs. 33.3%).

Conclusion: The expected benefits of laparoscopic surgery may extend to the emergency colorectal setting and LH procedures can be performed safely in a non-subspecialized center.

Purpose: We aimed to evaluate the precision of preoperative colonoscopic tattooing and intraoperative colonoscopic tumor localization in determining distal surgical margins for left-sided colorectal cancer surgery.

Methods: This retrospective study included 30 patients who underwent laparoscopic colorectal surgery, preoperative colonoscopic tattooing, and intraoperative colonoscopic localization for colorectal cancer at our center between July 2020 and March 2024. Clinical data were collected, and the precision of these methods was assessed by measuring the differences between the target resection margin and the actual pathological resection margin.

Results: In four patient cases, the indocyanine green tattoo was not visible in the laparoscopic surgical field. The average stained length of the tattoo was 2.89 cm, with a mean distance of 1.18 cm between the low margin of the tattoo and the cancer. The difference between the target distal resection margin by intraoperative colonoscopic localization and the actual pathological resection margin was 0.88 cm. No complications related to the intraoperative colonoscopy were observed.

Conclusion: Preoperative tattooing showed limitations, such as spreading and occasional invisibility. Intraoperative colonoscopic localization proved to be an effective method for achieving more precise distal surgical margins in left-sided colorectal cancer surgery.