Pub Date : 2022-12-15DOI: 10.7602/jmis.2022.25.4.121
Hee Joon Kim
Radical antegrade modular pancreatosplenectomy (RAMPS) was introduced in 2003 by Strasberg to improve survival outcomes in left-sided pancreatic ductal adenocarcinoma. Many investigators have shown the feasibility and safety of minimally invasive RAMPS (MI-RAMPS). However, the survival benefit of RAMPS is inconclusive, and possible risks following the procedure, such as exocrine and endocrine insufficiencies, cannot be ignored. Therefore, several modifications of RAMPS were designed. Modified RAMPS is not a specific technique but rather a reduced form of RAMPS that is undertaken without compromising oncologic principles. In this literature review, the surgical technique and strategies of MI-RAMPS were examined.
{"title":"Minimally invasive radical antegrade modular pancreatosplenectomy: routine vs. modified.","authors":"Hee Joon Kim","doi":"10.7602/jmis.2022.25.4.121","DOIUrl":"https://doi.org/10.7602/jmis.2022.25.4.121","url":null,"abstract":"<p><p>Radical antegrade modular pancreatosplenectomy (RAMPS) was introduced in 2003 by Strasberg to improve survival outcomes in left-sided pancreatic ductal adenocarcinoma. Many investigators have shown the feasibility and safety of minimally invasive RAMPS (MI-RAMPS). However, the survival benefit of RAMPS is inconclusive, and possible risks following the procedure, such as exocrine and endocrine insufficiencies, cannot be ignored. Therefore, several modifications of RAMPS were designed. Modified RAMPS is not a specific technique but rather a reduced form of RAMPS that is undertaken without compromising oncologic principles. In this literature review, the surgical technique and strategies of MI-RAMPS were examined.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"25 4","pages":"121-126"},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0f/1f/jmis-25-4-121.PMC9763487.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10490496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
With the advent of robotic surgery as an effective means of minimally invasive surgery in the last decade, more and more surgeries are being performed robotically in today's world. Robotic surgery has several advantages over conventional laparoscopic surgery, such as three-dimensional vision with depth perception, magnified view, tremor filtration, and, more importantly, degrees of freedom of the articulating instruments. While the literature is abundant on robotic cholecystectomy and highly complex hepatobiliary surgeries, there is hardly any literature on robotic small bowel resection with intracorporeal anastomosis. We present a case of a 50-year-old male patient with a symptomatic proximal jejunal ischemic stricture who underwent robotic-assisted resection and robot-sewn intracorporeal anastomosis in two layers. He did well in the postoperative period and was discharged on postoperative day 4 with uneventful recovery. We hereby discuss the advantages and disadvantages of robotic surgery in such a scenario with a review of the literature.
{"title":"Robotic-assisted resection of proximal jejunal ischemic stricture and intracorporeal robot-sewn anastomosis.","authors":"Vishu Jain, Peeyush Varshney, Subhash Chandra Soni, Vaibhav Kumar Varshney, B Selvakumar","doi":"10.7602/jmis.2022.25.4.152","DOIUrl":"https://doi.org/10.7602/jmis.2022.25.4.152","url":null,"abstract":"<p><p>With the advent of robotic surgery as an effective means of minimally invasive surgery in the last decade, more and more surgeries are being performed robotically in today's world. Robotic surgery has several advantages over conventional laparoscopic surgery, such as three-dimensional vision with depth perception, magnified view, tremor filtration, and, more importantly, degrees of freedom of the articulating instruments. While the literature is abundant on robotic cholecystectomy and highly complex hepatobiliary surgeries, there is hardly any literature on robotic small bowel resection with intracorporeal anastomosis. We present a case of a 50-year-old male patient with a symptomatic proximal jejunal ischemic stricture who underwent robotic-assisted resection and robot-sewn intracorporeal anastomosis in two layers. He did well in the postoperative period and was discharged on postoperative day 4 with uneventful recovery. We hereby discuss the advantages and disadvantages of robotic surgery in such a scenario with a review of the literature.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"25 4","pages":"152-157"},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/39/5c/jmis-25-4-152.PMC9763486.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10490495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-15DOI: 10.7602/jmis.2022.25.4.145
Ankit Shukla, Senthil Gnanasekaran, Raja Kalayarasan, Biju Pottakkat
Purpose: Robotic surgery for pancreatic diseases is currently on the rise, feasible, well-accepted, and safe. Frequently performed procedures in relation to pancreatic diseases include distal pancreatectomy and pancreatoduodenectomy. The literature commonly describes robotic lateral pancreaticojejunostomy; however, data on robot-assisted Frey's is scarce.
Methods: We herein, describe our series and technique of robot-assisted Frey's procedure at our tertiary care center between November 2019 and March 2022, and its short-term outcomes in comparison to the open Frey's. Patients with chronic pancreatitis having intractable pain, dilated duct, and no evidence of inflammatory head mass or malignancy were included in the study for robot-assisted Frey's.
Results: In our study, out of 32 patients, nine patients underwent robot assisted Frey's procedure. The duration of surgery was significantly longer in robotic group (570 minutes vs. 360 minutes, p = 0.003). The medians of intraoperative blood loss and postoperative analgesic requirement were lower in robotic group, but the difference was not statistically significant (250 mL vs. 350 mL, p = 0.400 and 3 days vs. 4 days, p = 0.200, respectively). The median length of hospital stay was shorter in the robotic group, though not significant (6 days vs. 7 days, p = 0.540). At a median follow-up of 28 months, there was no significant difference in the postoperative complications and short-term outcomes between the two groups.
Conclusion: Robotic surgery offers benefits of laparoscopic surgery in addition it has better visualization, magnification, dexterity, and ergonomics. Frey's procedure is possible robotically with acceptable outcomes in selected patients.
目的:胰腺疾病的机器人手术目前呈上升趋势,可行、被广泛接受和安全。与胰腺疾病相关的常用手术包括远端胰腺切除术和胰十二指肠切除术。文献通常描述机器人外侧胰空肠吻合术;然而,关于机器人辅助弗雷氏症的数据很少。方法:本文描述了我们在2019年11月至2022年3月期间在三级护理中心进行的机器人辅助Frey手术的系列和技术,以及与开放式Frey手术相比的短期结果。慢性胰腺炎患者伴有顽固性疼痛,导管扩张,无炎症性头部肿块或恶性肿瘤的证据被纳入机器人辅助Frey的研究中。结果:在我们的研究中,32名患者中,有9名患者接受了机器人辅助的Frey手术。机器人组手术时间明显更长(570分钟vs 360分钟,p = 0.003)。机器人组术中出血量和术后镇痛需求中位数较低,但差异无统计学意义(250 mL vs 350 mL, p = 0.400, 3 d vs 4 d, p = 0.200)。机器人组的中位住院时间较短,但不显著(6天对7天,p = 0.540)。中位随访28个月,两组术后并发症和短期预后无显著差异。结论:机器人手术不仅具有腹腔镜手术的优点,而且具有更好的可视化、放大、灵巧性和人体工程学。Frey的手术在选定的患者中可以通过机器人实现可接受的结果。
{"title":"Early experience with robot-assisted Frey's procedure surgical outcome and technique: Indian perspective.","authors":"Ankit Shukla, Senthil Gnanasekaran, Raja Kalayarasan, Biju Pottakkat","doi":"10.7602/jmis.2022.25.4.145","DOIUrl":"https://doi.org/10.7602/jmis.2022.25.4.145","url":null,"abstract":"<p><strong>Purpose: </strong>Robotic surgery for pancreatic diseases is currently on the rise, feasible, well-accepted, and safe. Frequently performed procedures in relation to pancreatic diseases include distal pancreatectomy and pancreatoduodenectomy. The literature commonly describes robotic lateral pancreaticojejunostomy; however, data on robot-assisted Frey's is scarce.</p><p><strong>Methods: </strong>We herein, describe our series and technique of robot-assisted Frey's procedure at our tertiary care center between November 2019 and March 2022, and its short-term outcomes in comparison to the open Frey's. Patients with chronic pancreatitis having intractable pain, dilated duct, and no evidence of inflammatory head mass or malignancy were included in the study for robot-assisted Frey's.</p><p><strong>Results: </strong>In our study, out of 32 patients, nine patients underwent robot assisted Frey's procedure. The duration of surgery was significantly longer in robotic group (570 minutes vs. 360 minutes, <i>p</i> = 0.003). The medians of intraoperative blood loss and postoperative analgesic requirement were lower in robotic group, but the difference was not statistically significant (250 mL vs. 350 mL, <i>p</i> = 0.400 and 3 days vs. 4 days, <i>p</i> = 0.200, respectively). The median length of hospital stay was shorter in the robotic group, though not significant (6 days vs. 7 days, <i>p</i> = 0.540). At a median follow-up of 28 months, there was no significant difference in the postoperative complications and short-term outcomes between the two groups.</p><p><strong>Conclusion: </strong>Robotic surgery offers benefits of laparoscopic surgery in addition it has better visualization, magnification, dexterity, and ergonomics. Frey's procedure is possible robotically with acceptable outcomes in selected patients.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"25 4","pages":"145-151"},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a5/b7/jmis-25-4-145.PMC9763489.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9134928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Trials comparing minimally invasive rectal surgery have uniformly excluded T4 tumors. The present study aimed to determine the safety of minimally invasive surgery (MIS) for locally-advanced rectal cancers requiring pelvic exenterations based on benchmarked outcomes from the international PelvEx database.
Methods: Consecutive patients of T4 rectal cancers with urogenital organ invasion that underwent MIS exenterations between November 2015 and June 2022 were analyzed from a single center. A safety threshold was set at 20% for R1 resections and 40% for major complications (≥grade IIIA) for the upper limit of the 95% confidence interval (CI).
Results: The study included 124 MIS exenterations. A majority had a total pelvic exenteration (74 patients, 59.7%). Laparoscopic surgery was performed in 95 (76.6%) and 29 (23.4%) had the robotic operation. Major complications were observed in 35 patients (28.2%; 95% CI, 20.5%-37.0%). R1 resections were found pathologically in nine patients (7.3%; 95% CI, 3.4%-13.4%). The set safety thresholds were not crossed. At a median follow-up of 15 months, 44 patients (35.5%) recurred with 8.1% local recurrence rate. The 2-year overall and disease-free survivals were 85.2% and 53.7%, respectively.
Conclusion: MIS exenterations for locally-advanced rectal cancers demonstrated acceptable morbidity and safety in term of R0 resections at experienced centers. Longer follow-up is required to demonstrate cancer survival outcomes.
{"title":"Minimally invasive surgery for maximally invasive tumors: pelvic exenterations for rectal cancers.","authors":"Mufaddal Kazi, Ashwin Desouza, Chaitali Nashikkar, Avanish Saklani","doi":"10.7602/jmis.2022.25.4.131","DOIUrl":"https://doi.org/10.7602/jmis.2022.25.4.131","url":null,"abstract":"<p><strong>Purpose: </strong>Trials comparing minimally invasive rectal surgery have uniformly excluded T4 tumors. The present study aimed to determine the safety of minimally invasive surgery (MIS) for locally-advanced rectal cancers requiring pelvic exenterations based on benchmarked outcomes from the international PelvEx database.</p><p><strong>Methods: </strong>Consecutive patients of T4 rectal cancers with urogenital organ invasion that underwent MIS exenterations between November 2015 and June 2022 were analyzed from a single center. A safety threshold was set at 20% for R1 resections and 40% for major complications (≥grade IIIA) for the upper limit of the 95% confidence interval (CI).</p><p><strong>Results: </strong>The study included 124 MIS exenterations. A majority had a total pelvic exenteration (74 patients, 59.7%). Laparoscopic surgery was performed in 95 (76.6%) and 29 (23.4%) had the robotic operation. Major complications were observed in 35 patients (28.2%; 95% CI, 20.5%-37.0%). R1 resections were found pathologically in nine patients (7.3%; 95% CI, 3.4%-13.4%). The set safety thresholds were not crossed. At a median follow-up of 15 months, 44 patients (35.5%) recurred with 8.1% local recurrence rate. The 2-year overall and disease-free survivals were 85.2% and 53.7%, respectively.</p><p><strong>Conclusion: </strong>MIS exenterations for locally-advanced rectal cancers demonstrated acceptable morbidity and safety in term of R0 resections at experienced centers. Longer follow-up is required to demonstrate cancer survival outcomes.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"25 4","pages":"131-138"},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/27/6b/jmis-25-4-131.PMC9763485.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10481471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-15DOI: 10.7602/jmis.2022.25.4.129
Dae Ro Lim
Various approaches can be used for performing laparoscopic right hemicolectomy for right-sided colon cancer. However, laparoscopic complete mesocolic excision with central vessel ligation using these approaches may sometimes present with difficulties of various factors. This video article presents a laparoscopic extended right hemicolectomy using a superior-to-inferior approach. The superior approach has potential benefits in that it exposes the superior mesenteric vessels and gastrocolic trunk.
{"title":"Potential benefit of superior to inferior dissection during laparoscopic extended right hemicolectomy.","authors":"Dae Ro Lim","doi":"10.7602/jmis.2022.25.4.129","DOIUrl":"10.7602/jmis.2022.25.4.129","url":null,"abstract":"<p><p>Various approaches can be used for performing laparoscopic right hemicolectomy for right-sided colon cancer. However, laparoscopic complete mesocolic excision with central vessel ligation using these approaches may sometimes present with difficulties of various factors. This video article presents a laparoscopic extended right hemicolectomy using a superior-to-inferior approach. The superior approach has potential benefits in that it exposes the superior mesenteric vessels and gastrocolic trunk.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"25 4","pages":"129-130"},"PeriodicalIF":0.0,"publicationDate":"2022-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/97/e5/jmis-25-4-129.PMC9763483.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10481475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-15DOI: 10.7602/jmis.2022.25.3.85
Sun Jin Park
The Journal of Minimally Invasive Surgery (JMIS) is the official journal of the Korean Society of Endo-Laparoscopic & Robotic Surgery (formerly the Korean Society of Endoscopic and Laparoscopic Surgeons). The editorial board of JMIS has been trying steadily for several years to be indexed by the international literature databases. As a first step, JMIS has been deposited into PubMed Central in 2022. Here I would like to show you the path that JMIS has been following over the years.
{"title":"<i>The Journal of Minimally Invasive Surgery</i> is indexed by PubMed Central in 2022.","authors":"Sun Jin Park","doi":"10.7602/jmis.2022.25.3.85","DOIUrl":"https://doi.org/10.7602/jmis.2022.25.3.85","url":null,"abstract":"<p><p><i>The Journal of Minimally Invasive Surgery</i> (JMIS) is the official journal of the Korean Society of Endo-Laparoscopic & Robotic Surgery (formerly the Korean Society of Endoscopic and Laparoscopic Surgeons). The editorial board of JMIS has been trying steadily for several years to be indexed by the international literature databases. As a first step, JMIS has been deposited into PubMed Central in 2022. Here I would like to show you the path that JMIS has been following over the years.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":" ","pages":"85-86"},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/93/0b/jmis-25-3-85.PMC9494017.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40386215","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-15DOI: 10.7602/jmis.2022.25.3.116
Gyung Mo Son, Tae Un Kim, Dong-Hoon Shin, Joo-Young Na, In Young Lee, Shin Hoo Park
The variant terminal trunk of the superior mesenteric artery (SMA) could be confused with the ileocolic artery (ICA) as it runs on the right side of the superior mesenteric vein. If the variant ileal branch of SMA is mistaken for the ICA, unintentional ligation could cause long-segment ischemia in the ileum. We encountered a rare case of ileal ischemia caused by unintentional ligation of the variant ileal branch of the SMA during laparoscopic right hemicolectomy, which was confirmed by indocyanine green (ICG) angiography and hyperspectral imaging (HSI). Intraoperative real-time perfusion monitoring using ICG angiography and tissue oxygen saturation monitoring using HSI could help detect segments of hypoperfusion and prevent hypoperfusion-related anastomotic complications.
{"title":"Ileal long-segment ischemia after the unintended ligation of variant ileal branch during laparoscopic right hemicolectomy.","authors":"Gyung Mo Son, Tae Un Kim, Dong-Hoon Shin, Joo-Young Na, In Young Lee, Shin Hoo Park","doi":"10.7602/jmis.2022.25.3.116","DOIUrl":"https://doi.org/10.7602/jmis.2022.25.3.116","url":null,"abstract":"<p><p>The variant terminal trunk of the superior mesenteric artery (SMA) could be confused with the ileocolic artery (ICA) as it runs on the right side of the superior mesenteric vein. If the variant ileal branch of SMA is mistaken for the ICA, unintentional ligation could cause long-segment ischemia in the ileum. We encountered a rare case of ileal ischemia caused by unintentional ligation of the variant ileal branch of the SMA during laparoscopic right hemicolectomy, which was confirmed by indocyanine green (ICG) angiography and hyperspectral imaging (HSI). Intraoperative real-time perfusion monitoring using ICG angiography and tissue oxygen saturation monitoring using HSI could help detect segments of hypoperfusion and prevent hypoperfusion-related anastomotic complications.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":" ","pages":"116-119"},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8b/60/jmis-25-3-116.PMC9494016.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40386216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-15DOI: 10.7602/jmis.2022.25.3.89
Kyung Ho Kang
With vocal cord palsy, hypoparathyroidism is one of the two major complications after thyroid surgery. Traditional approaches to preserving the parathyroid glands during thyroid surgery include identifying the glands precisely and preserving their vasculature with the naked eye, which mainly depend on the experience and skill of the surgeon. Recently, a relatively new technique, fluorescence image-guided surgery, has been widely researched and is becoming increasingly popular. The authors present a video clip of transoral robotic total thyroidectomy, which shows the three typical statuses of the parathyroid glands after thyroid surgery (well-perfused, poorly or non-perfused, and congested) and explains how to deal with each status of the parathyroid glands.
{"title":"Fluorescence imaging, an emerging tool for preserving the parathyroid glands during thyroidectomy.","authors":"Kyung Ho Kang","doi":"10.7602/jmis.2022.25.3.89","DOIUrl":"https://doi.org/10.7602/jmis.2022.25.3.89","url":null,"abstract":"<p><p>With vocal cord palsy, hypoparathyroidism is one of the two major complications after thyroid surgery. Traditional approaches to preserving the parathyroid glands during thyroid surgery include identifying the glands precisely and preserving their vasculature with the naked eye, which mainly depend on the experience and skill of the surgeon. Recently, a relatively new technique, fluorescence image-guided surgery, has been widely researched and is becoming increasingly popular. The authors present a video clip of transoral robotic total thyroidectomy, which shows the three typical statuses of the parathyroid glands after thyroid surgery (well-perfused, poorly or non-perfused, and congested) and explains how to deal with each status of the parathyroid glands.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":"25 3","pages":"89-90"},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/df/d4/jmis-25-3-89.PMC9494020.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10762689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-15DOI: 10.7602/jmis.2022.25.3.97
Seung Jae Lee, In Seok Choi, Ju Ik Moon, Dae Sung Yoon, Won Jun Choi, Sang Eok Lee, Nak Song Sung, Seong Uk Kwon, In Eui Bae, Seung Jae Roh, Sung Gon Kim
Purpose: The optimal indications for single-incision laparoscopic cholecystectomy (SILC) have not yet been established.
Methods: This single-center retrospective study included consecutive patients who underwent SILC between April 2010 and June 2020. Difficult surgery (DS) (conversion to multiport or open cholecystectomy, adjacent organ injury, operation time of ≥90 minutes, or estimated blood loss of ≥100 mL) and poor postoperative outcome (PPO) (postoperative hospital stay ≥ 7 days or Clavien-Dindo grade ≥ II postoperative complications) were defined to comprehensively evaluate surgical difficulty and postoperative outcomes, respectively.
Results: Of 1,405 patients (mean age, 51.2 years; 802 female [57.1%]), 427 (grade I, n = 358; grade II/III, n = 69) underwent SILC for acute cholecystitis (AC), 34 (2.4%) needed conversion to multiport (n = 33) or open cholecystectomy (n = 1), 7 (0.5%) had adjacent organ injury during surgery, and 49 (3.5%) developed postoperative complications. Of the patients, 89 and 52 had DS and PPO, respectively. In the multivariate analysis, grade I AC, grade II/III AC, and body mass index of ≥30 kg/m2 were significant predictors of DS. Age of ≥70 years and DS were significant predictors of PPO. In a subgroup analysis of patients with AC, DS (9.5% vs. 27.5%, p < 0.001) and PPO (5.0% vs. 15.9%, p = 0.001) were more frequent in patients with grade II/III AC than in those with grade I AC.
Conclusion: SILC is not recommended in patients with grade II/III AC and should be carefully performed by experienced and well-trained surgeons.
目的:单切口腹腔镜胆囊切除术(SILC)的最佳适应证尚未确定。方法:这项单中心回顾性研究纳入了2010年4月至2020年6月期间接受SILC治疗的连续患者。分别定义手术困难(DS)(转多口或开腹胆囊切除术、邻近脏器损伤、手术时间≥90分钟或估计失血量≥100 mL)和术后预后差(PPO)(术后住院时间≥7天或术后并发症Clavien-Dindo分级≥II),综合评价手术难度和术后结局。结果:1405例患者(平均年龄51.2岁;女性802例[57.1%]),427例(一级,n = 358;II/III级(n = 69)患者因急性胆囊炎(AC)接受了SILC手术,34例(2.4%)患者需要转行多腔胆囊切除术(n = 33)或开腹胆囊切除术(n = 1), 7例(0.5%)患者术中相邻器官损伤,49例(3.5%)患者出现术后并发症。在这些患者中,分别有89例DS和52例PPO。在多变量分析中,I级AC、II/III级AC和体重指数≥30 kg/m2是DS的显著预测因子。年龄≥70岁和DS是PPO的显著预测因子。在AC患者的亚组分析中,DS (9.5% vs. 27.5%, p < 0.001)和PPO (5.0% vs. 15.9%, p = 0.001)在II/III级AC患者中比在I级AC患者中更常见。结论:II/III级AC患者不推荐SILC,应由经验丰富且训练有素的外科医生谨慎操作。
{"title":"Optimal indication of single-incision laparoscopic cholecystectomy using Konyang Standard Method in benign gallbladder diseases.","authors":"Seung Jae Lee, In Seok Choi, Ju Ik Moon, Dae Sung Yoon, Won Jun Choi, Sang Eok Lee, Nak Song Sung, Seong Uk Kwon, In Eui Bae, Seung Jae Roh, Sung Gon Kim","doi":"10.7602/jmis.2022.25.3.97","DOIUrl":"https://doi.org/10.7602/jmis.2022.25.3.97","url":null,"abstract":"<p><strong>Purpose: </strong>The optimal indications for single-incision laparoscopic cholecystectomy (SILC) have not yet been established.</p><p><strong>Methods: </strong>This single-center retrospective study included consecutive patients who underwent SILC between April 2010 and June 2020. Difficult surgery (DS) (conversion to multiport or open cholecystectomy, adjacent organ injury, operation time of ≥90 minutes, or estimated blood loss of ≥100 mL) and poor postoperative outcome (PPO) (postoperative hospital stay ≥ 7 days or Clavien-Dindo grade ≥ II postoperative complications) were defined to comprehensively evaluate surgical difficulty and postoperative outcomes, respectively.</p><p><strong>Results: </strong>Of 1,405 patients (mean age, 51.2 years; 802 female [57.1%]), 427 (grade I, n = 358; grade II/III, n = 69) underwent SILC for acute cholecystitis (AC), 34 (2.4%) needed conversion to multiport (n = 33) or open cholecystectomy (n = 1), 7 (0.5%) had adjacent organ injury during surgery, and 49 (3.5%) developed postoperative complications. Of the patients, 89 and 52 had DS and PPO, respectively. In the multivariate analysis, grade I AC, grade II/III AC, and body mass index of ≥30 kg/m<sup>2</sup> were significant predictors of DS. Age of ≥70 years and DS were significant predictors of PPO. In a subgroup analysis of patients with AC, DS (9.5% vs. 27.5%, <i>p</i> < 0.001) and PPO (5.0% vs. 15.9%, <i>p</i> = 0.001) were more frequent in patients with grade II/III AC than in those with grade I AC.</p><p><strong>Conclusion: </strong>SILC is not recommended in patients with grade II/III AC and should be carefully performed by experienced and well-trained surgeons.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":" ","pages":"97-105"},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d6/58/jmis-25-3-97.PMC9494018.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40386213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-15DOI: 10.7602/jmis.2022.25.3.112
Jun Hyun Park, Jeeyeon Lee, Jin Hyang Jung, Ho Yong Park, Wan Wook Kim
In recent da Vinci robot systems (Intuitive Surgical), near-infrared fluorescence imaging (Firefly technology) has been used. With this technique, it is possible for surgeons to see important structures well beyond the limits of their eyes; hence, surgeons can safely operate and make critical decisions accurately using image-guided surgery. Because parathyroid glands (PTGs) are small and embedded in the surrounding tissues, such as lymph nodes and fat, it is often very hard for surgeons to identify PTGs. To preserve PTGs well, the surgeon must be able to accurately identify PTGs, preserve the vasculature surrounding, and maintain the perfusion to PTGs. Herein, we report an assessment of PTG perfusion using indocyanine green angiography in transoral robotic thyroidectomy.
{"title":"Intraoperative assessment of parathyroid perfusion using indocyanine green angiography in robotic thyroidectomy.","authors":"Jun Hyun Park, Jeeyeon Lee, Jin Hyang Jung, Ho Yong Park, Wan Wook Kim","doi":"10.7602/jmis.2022.25.3.112","DOIUrl":"https://doi.org/10.7602/jmis.2022.25.3.112","url":null,"abstract":"<p><p>In recent da Vinci robot systems (Intuitive Surgical), near-infrared fluorescence imaging (Firefly technology) has been used. With this technique, it is possible for surgeons to see important structures well beyond the limits of their eyes; hence, surgeons can safely operate and make critical decisions accurately using image-guided surgery. Because parathyroid glands (PTGs) are small and embedded in the surrounding tissues, such as lymph nodes and fat, it is often very hard for surgeons to identify PTGs. To preserve PTGs well, the surgeon must be able to accurately identify PTGs, preserve the vasculature surrounding, and maintain the perfusion to PTGs. Herein, we report an assessment of PTG perfusion using indocyanine green angiography in transoral robotic thyroidectomy.</p>","PeriodicalId":73832,"journal":{"name":"Journal of minimally invasive surgery","volume":" ","pages":"112-115"},"PeriodicalIF":0.0,"publicationDate":"2022-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fe/8c/jmis-25-3-112.PMC9494021.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40386217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}