Journal of minimally invasive surgery最新文献

Stoma formation for fecal diversion is a common procedure in patients with various complicated conditions after colorectal surgery, such as anastomotic leakage. The single-incision laparoscopic approach for stoma creation offers several advantages, including a reduction in surgical wounds and related complications as well as optimal visualization of the surgical field. This video demonstrates a single-port-assisted diverting ileostomy in a 61-year-old man with anastomotic leakage following low anterior resection for advanced rectal cancer.

Colorectal cancer (CRC) during pregnancy presents unique clinical challenges, particularly in balancing maternal treatment with fetal safety. This case series examines the role of minimally invasive surgery (MIS) in the management of CRC in pregnant patients. Through three detailed cases, we explore diagnostic approaches, surgical interventions, and post-operative outcomes. MIS techniques, including robotic and laparoscopic surgeries, were successfully employed in all cases, leading to favorable maternal recovery and the birth of healthy babies. The findings underscore the importance of a multidisciplinary approach, highlighting MIS as a viable and safe treatment option that facilitates rapid recovery and timely adjuvant therapy.

Purpose: The aim of the study was to investigate whether wearing a forearm compression sleeve during robotic surgery (RS) reduces muscle fatigue.

Methods: A randomized controlled study of consecutive RS cases was performed with three right-handed surgeons randomly allocated to wear a non-graduated compression sleeve over either his right or left forearm. Hand-grip strength was assessed at the beginning and at the 2-hour mark during the robotic console component of surgery, using a handgrip dynamometer. The maximum strength (F_max) and mean grip strength (F_mean) were calculated after 10 measurements. Effectiveness of the forearm sleeve was tested primarily by the difference in mean grip strength, and secondarily by the difference in fatigue ratio (F_max/F_mean) and recovery ratio at the two time points.

Results: Thirty-two robotic cases were performed during the study period. Wearing of a compression sleeve (compared with no sleeve) on the left forearm resulted in an increase (rather than a decrease) in mean hand-grip strength after 2 hours of RS (0.5 kg increase vs. 1.3 kg decrease, p = 0.03; 95% confidence interval, 0.20-∞). Wearing a compression sleeve (compared with no sleeve) on the right forearm did not result in an improvement in grip strength reduction (1.7 kg decrease vs. 1.1 kg decrease, p = 0.79).

Conclusion: There was a statistically significant reduction in muscle fatigue with wearing a forearm compression sleeve on the nondominant left forearm during RS.

Purpose: This study examined nationwide data regarding laparoscopic and robotic surgery for colorectal cancer (CRC) in Korea.

Methods: Nationwide data concerning patients who underwent surgery for CRC from 2019 to 2023 were obtained from the Health Insurance Review and Assessment Service database.

Results: From 2019 to 2023, a total of 109,573 patients with CRC underwent surgical resection in Korea. Among these, open, laparoscopic, and robotic surgery comprised 17.2%, 71.5%, and 11.3%, respectively. Open surgery decreased from 18.3% in 2019 to 15.2% in 2023, whereas robotic surgery increased from 10.3% in 2019 to 12.7% in 2023. Regarding rectal cancer, the rate of robotic surgery increased from 23.0% in 2019 to 28.2% in 2023, and the rate of minimally invasive surgery (MIS) increased from 86.9% in 2019 to 89.2% in 2023. Patients with National Health Insurance had significantly shorter lengths of hospital stay after surgery than those with medical aid for all surgical methods (p < 0.0001). With respect to hospital size, 74,282 CRC surgeries (67.8%) were performed in tertiary general hospitals and 33,050 (30.2%) in general hospitals. By the region, 47,140 cases (43.0%) were performed in Seoul, 19,961 (18.2%) in Gyeonggi, and 7,417 (6.8%) in Daegu. Ostomy was created in 16,222 CRC surgeries (14.8%).

Conclusion: The rate of MIS adoption for CRC in Korea has increased, reaching 84.7% in 2023. The rate of laparoscopic surgery exceeded 70% and has plateaued. In contrast, the rate of robotic surgery adoption has steadily increased, particularly for rectal cancer, where it surpassed 28% in 2023.

Surgery for a symptomatic epiphrenic esophageal diverticulum (EED) typically involves a diverticulectomy with myotomy and partial fundoplication. A 54-year-old male patients presented with postprandial retrosternal pain and regurgitation. A contrast-enhanced computed tomography scan revealed an 8 × 6 × 7 cm left-sided EED. We planned the EED excision using the da Vinci Xi robot (Intuitive Surgical) from an abdominal transhiatal approach. The lower esophagus was looped, followed by the mobilization of the diverticulum and division of its neck using a robotic stapler. A 7-cm long esophagogastric myotomy was performed on the right side with a Toupet fundoplication. The total operative time was 240 minutes with a blood loss of 200 mL. An oral contrast study on postoperative day 1 showed no leak, and the patient was discharged the next day on an oral soft diet. The robotic transhiatal approach to treat EED is safe and may successfully overcome the difficulties of exposure and reach encountered in conventional laparoscopic surgery.

Flexible gastrointestinal (GI) endoscopy is a fundamental skill in surgical practice, offering both diagnostic and therapeutic capabilities for a wide range of GI diseases. In Korea, the incidence estimates for gastric and colorectal cancers rank among the highest worldwide, underscoring the critical need for well-trained endoscopists. Surgeons play a pivotal role in managing GI diseases, reinforcing the necessity of systematic and comprehensive endoscopic education. This paper reviews the status of surgical endoscopy education in Korea, focusing on its historical evolution, structured training programs for residents and fellows, certification processes, and continuing medical education initiatives. Despite significant advancements led by organizations such as the Korean Surgical Society, challenges persist, including disparities in training opportunities across institutions and limited access to advanced therapeutic endoscopy. To address these issues, strategic recommendations include standardizing educational curricula, optimizing residency workloads for dedicated endoscopy training, enhancing simulation-based education through high-fidelity simulators and artificial intelligence, and fostering international collaboration to encourage global best practices. Implementing these strategies will strengthen Korea's GI endoscopy education system, ensuring that future surgeons are well-prepared to meet the evolving demands of patient care.

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.