Annals of Surgical Treatment and Research最新文献

Purpose: Accurate anatomical knowledge and precise visualization are critical during liver surgery. We developed augmented reality (AR) software that overlays digital 3-dimensional (3D) models onto laparoscopic or robotic views, providing real-time visual aids for surgical navigation during 3D laparoscopic and robotic liver surgeries. This study assesses the accuracy of manual registration and the subjective perception of this AR software by the operator.

Methods: Ten consecutive patients undergoing 3D laparoscopic or robotic liver surgery from December 2023 to February 2024 were selected for application of the AR software during surgery. Manual registration accuracy was quantified post-registration using the Dice similarity coefficient (DSC) to compare the stereoscopic and virtual liver images. A 6-question operator survey, using a 5-point Likert scale, was administered after each surgery to evaluate the software's helpfulness in clinical settings.

Results: Seven males and 3 females (mean age, 62.4 ± 6.4 years) underwent liver surgery (3D laparoscopic, 5; robotic, 5). Surgical procedures included 4 right hemihepatectomies, 1 extended left hemihepatectomy, 1 left lateral sectionectomy, and 4 segmentectomies. The mean tumor size was 4.4 ± 2.2 cm (range, 1.0-7.5 cm). The mean DSC was 0.912 ± 0.052 (range, 0.879-0.954). The operator rated registration alignment favorably before (mean score, 3.9 ± 1.1) and after mobilization (mean score, 4.1 ± 1.2). The software was reported as very helpful overall (mean score, 4.2 ± 0.8), and in locating blood vessels (4.2 ± 0.6) and tumors (4.3 ± 0.7).

Conclusion: Clinical application of the AR software during 3D laparoscopic and robotic liver surgery is feasible, with favorable registration accuracy and high operator perception of helpfulness.

Purpose: Diffuse sclerosing variant papillary thyroid carcinoma (DSV-PTC) is a rare and aggressive subtype of PTC. Preoperative diagnosis is challenging owing to the overlapping of imaging characteristics with those of other thyroid conditions. This study aimed to evaluate the accuracy of preoperative ultrasound (US) in predicting DSV-PTC and to identify significant diagnostic factors.

Methods: This retrospective study analyzed 34 patients who were preoperatively suspected of having DSV-PTC based on US findings and later underwent thyroidectomy. Patients were divided into 2 groups based on the final histopathological diagnosis: DSV-PTC and non-DSV-PTC. Demographic, radiological, and pathological characteristics were also compared.

Results: Only 32.4% of patients initially suspected of having DSV-PTC were confirmed postoperatively. Among the US features, the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) score 5 was significantly associated with DSV-PTC (P = 0.038), whereas other radiological factors, including echogenicity and microcalcifications, were not. The histopathological features, such as tumor size, BRAF and TERT mutations, vascular invasion, and lymph node metastasis, showed no significant differences between the groups.

Conclusion: Preoperative US has limited accuracy (32.4%) in diagnosing DSV-PTC. Because of the aggressive treatment recommendations based on preoperative suspicion, clinicians should carefully consider the limitations of imaging. Further studies incorporating fine-needle aspiration or core needle biopsy are required to improve diagnostic accuracy.

Purpose: Traditionally, 6-8 hours of fasting has been recommended before surgery to prevent respiratory complications. However, recent evidence suggests that intake of clear fluids up to 2 hours before general anesthesia may be safe. This study aimed to evaluate the safety and efficacy of reduced fasting time with clear liquid intake in surgical patients under general anesthesia.

Methods: In this randomized controlled trial, 60 adult patients undergoing elective endoscopic total extraperitoneal plasty under general anesthesia were divided into two groups (n = 30 each). The control group fasted overnight (nothing per oral), while the liquid group was allowed clear fluids until 2 hours before surgery. Gastric content volume and pH were measured after intubation. Thirst and hunger levels were assessed pre- and postoperatively using a visual analogue scale. Postoperative hoarseness, nausea, vomiting, and oxygen saturation were monitored in the recovery room.

Results: The liquid group consumed an average of 520 mL of fluid. No serious respiratory complications were observed in either group. Pre- and postoperative thirst and hunger scores were significantly lower in the liquid group (P < 0.001). Gastric content volume and acidity showed no significant differences between groups, with most patients having negligible volumes (<1 mL).

Conclusion: Permitting clear liquid intake up to 2 hours before general anesthesia is safe and does not increase the risk of respiratory complications. It effectively reduces thirst and hunger, improving patient comfort without compromising safety.

Purpose: This study evaluated the effectiveness of the extraperitoneal tunneling (EPT) method for drain fixation compared to conventional drain insertion following (low) anterior resection (AR).

Methods: A retrospective review was conducted on 334 patients who underwent AR with an anastomotic height ≤15 cm from the anal verge at a single center between January 2020 and May 2024. In patients with permanent stoma formation, no drain insertions were excluded.

Results: Of the 334 patients, 192 (57.5%) underwent drain insertion via the conventional method, while 142 (42.5%) underwent the EPT method. No drain-related complications were reported in either group. Drain displacement occurred in 81 patients (24.3%), with a significantly lower rate in the EPT group compared to the conventional group (2.8% vs. 40.1%, P < 0.001). Multivariate analysis identified EPT fixation as a significant factor in reducing drain displacement (odds ratio [OR], 0.043; 95% confidence interval [CI], 0.015-0.123; P < 0.001) whereas postoperative ileus was identified as a significant risk factor for increasing drain displacement (OR, 2.952; 95% CI, 1.594-5.465; P = 0.001). Anastomotic leakage (AL) occurred in 25 patients (7.4%). Among 18 patients with AL but no drain displacement, 16 (88.9%) were successfully treated with drain maintenance and antibiotics alone. Conversely, 4 of 7 patients (57.1%) with AL and drain displacement required surgery or interventional procedures.

Conclusion: This retrospective study suggests that the EPT method may be effective in securing drain tubes, potentially enhancing their clinical utility. Maintaining the drain in its original position could help reduce the need for additional surgical or interventional procedures in AL management.

Purpose: Ischemia and reperfusion (I/R) can cause significant functional impairments in cells and tissues depending on the duration of ischemia. To date, many alternative treatments have been utilized to address this damage. We aimed to research the protective efficacy of taxifolin (Tax), a natural antioxidant, against liver I/R injury in terms of biochemical, histopathologic, and immunohistochemical parameters.

Methods: The rats utilized in our study were randomly chosen and divided into four equal groups. Group 1 (n = 7), sham group received 1 mL saline orally; group 2 (n = 7), Tax group; Group 3 (n = 7), I/R group; group 4 (n = 7), Tax + I/R group as designated. The entire study was performed under general anesthesia with protection of animal welfare. Malondialdehyde (MDA) and interleukin-6 (IL-6) were analyzed from blood samples. Proapoptotic (B-cell lymphoma 2 [Bcl-2]-associated X protein [Bax]) and antiapoptotic (Bcl-2) amendments in cells were reviewed.

Results: MDA grades were lower in the Tax+I/R group compared to the I/R group. Likewise, IL-6 grades were lower in the Tax + I/R group, histologic examinations showed that Bax proteins were less expressed in the Tax + IR group, and Bcl-2 proteins were intensely expressed in the Tax group.

Conclusion: Taxifolin applied before liver I/R demonstrated favorable effects on inflammation, oxidative stress, and proapoptotic changes.

Purpose: Papillary thyroid carcinoma (PTC) is the most prevalent endocrine malignancy, and the global incidence has been steadily increasing over the years. Although PTC generally exhibits favorable prognosis, a subset of patients experiences aggressive progression and increased mortality. Current prognostic approaches, reliant on clinic-pathological factors, have limitations, underscoring the need for innovative biomarkers. MicroRNAs (miRs) have emerged as promising candidates due to their roles in cellular processes and cancer progression. Among them, the present study investigated the role of miR-18b in PTC, exploring its potential as a prognostic biomarker.

Methods: Utilizing PTC cell lines (TPC1, K1), we examined miR-18b expression and its regulatory effects. The present study used web-based tools to predict the target of miR-18b and to investigate the prognostic impact of miR-18b on thyroid cancer.

Results: Through a series of cell proliferation, invasion assay, gap closure, and colony formation assays, we identified that miR-18b suppresses PTC aggressiveness. Dual-luciferase assays confirmed that miR-18b directly targeted the 3'-untranslated region of CDK2 and suppressed the expression of CDK2. In addition, miR-18b significantly attenuates the interaction between cyclin A or cyclin E with cyclin-dependent kinase 2 according to co-immunoprecipitation assay. Western blotting of cell cycle proteins and flow cytometry revealed miR-18b-induced cell cycle arrest and apoptosis.

Conclusion: Our findings underscore miR-18b's potential as a biomarker for predicting the prognosis of PTC and suggest that it functions through direct regulation of CDK2, influencing cell cycle dynamics. This study not only enhances our understanding of miR-18b in thyroid cancer but also highlights its potential in refining prognostic evaluations and therapeutic strategies.

Purpose: Laparoscopic cholecystectomy is the standard surgical procedure for benign gallbladder disease. However, the analysis of risk factors for complications, including serious complications such as bile duct injury (BDI), has been largely overlooked. This study aimed to collect standardized prospective data from multiple centers and to develop a predictive model for laparoscopic cholecystectomy complications.

Methods: This study included 2,514 patients who underwent laparoscopic cholecystectomy for benign gallbladder disease at 18 academic institutes in Korea. Fifty-six preoperative and intraoperative variables were analyzed as risk factors for adverse postoperative outcomes, including overall complications. A surgical risk calculator was developed using a multivariate logistic regression analysis.

Results: Of the 2,514 patients, 62 (2.5%) experienced surgery-related complications, including BDI in 17 (0.7%). Various factors such as sex, age, smoking, emergency operation, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, preoperative endoscopic common bile duct stone removal, therapeutic antibiotics usage, American Society of Anesthesiologists physical status classification, and acute cholecystitis were found to be associated with postoperative adverse outcomes. Based on these variables, a surgical risk calculator was developed for overall complications, systemic complications, surgery-related complications, BDI, and delayed discharge, with the area under the curve values of 0.733, 0.775, 0.697, 0.857, and 0.833, respectively.

Conclusion: This study developed a surgical risk calculator using standardized variables from a multi-institutional prospective database to predict adverse outcomes after laparoscopic cholecystectomy. This tool can be used for risk stratification prior to cholecystectomy.

The Hemodialysis Reliable Outflow (HeRO) graft (Merit Medical Systems, Inc.), first approved by the U.S. Food and Drug Administration in 2008, provides an alternative vascular access option for patients with end-stage kidney disease who have exhausted upper extremity arteriovenous (AV) access. The first HeRO graft procedure was performed in South Korea in December 2023. Herein, we describe HeRO graft application in 2 complex vascular access scenarios: (1) establishing a new access pathway for a catheter-dependent patient with bilateral central venous occlusions and (2) bypassing recurrent central venous stenotic lesions to restore the function of a mature AV fistula. Given the potential risks, including thrombosis or infection, careful preoperative planning and meticulous patient selection are essential for optimizing HeRO graft outcomes. Further research is necessary to evaluate the long-term efficacy and complication profile of this technique.

Purpose: Robotic adrenalectomy was developed to address the limitations of laparoscopic adrenalectomy and enhance the visualization, dexterity, and control of surgeons performing this beneficial minimally invasive technique. This study compared the clinical and perioperative outcomes of lateral transperitoneal adrenalectomy using da Vinci SP and Xi robotic systems (Intuitive Surgical).

Methods: We retrospectively analyzed 84 patients who underwent robotic adrenalectomies at a single institution between January 2019 and July 2024. Sixty-two and 22 patients were treated with da Vinci Xi and SP systems, respectively.

Results: No significant differences in patient demographics, tumor size, or postoperative hospital stay between the 2 groups were observed. The SP system demonstrated significantly shorter operative times for right-sided adrenalectomy (81.0 ± 17.1 minutes vs. 113.3 ± 26.2 minutes, P < 0.001), whereas no significant differences were observed in overall operative time (104.9 ± 28.2 minutes for Xi vs. 93.5 ± 23.2 minutes for SP, P = 0.094) or left adrenalectomy (99.9 ± 28.4 minutes for Xi vs. 104.0 ± 23.0 minutes for SP, P = 0.253).

Conclusion: The da Vinci Xi and SP systems are both effective for robotic adrenalectomy, with the SP system showing particular advantages in right-sided procedures.

Purpose: Chemo-port insertion is performed by a radiologist or surgeon in an interventional radiology (IR) suite or an operating room (OR). The complication rate is approximately 3%-4%. However, there is still a lack of data for comparison when it is performed in different conditions such as IR suite and OR.

Methods: This study is for the safety of adult cancer patients after chemo-port implantation by comparing postoperative complication types and rates in different places. Among 375 patients who underwent chemo-port implantation, 203 patients underwent chemo-port implantation by radiologists in an IR suite, and 172 patients underwent the procedure by general surgeons in an OR. In both groups, early and late mortality were investigated. Early and late complication types and rates were also compared, and our study results were compared to the literature.

Results: Patients' characteristics showed no differences. Mortality after the procedure was 39 in OR vs. 72 in IR (P < 0.01). Early mortality at 7 days was 1 in IR, no patient in OR (P = 0.36). Catheter problems did not show a statistical difference in these 2 groups (1.16% vs. 0.49%, P = 0.47). Venous thrombosis happened in 4 and 7 (2.33% vs. 3.45%, P = 0.13), and the central line bloodstream infection was in 5 patients and 6 patients (2.91% vs.. 2.96%, P = 0.98), respectively. Skin problems were 6 and 7 (3.49% vs. 3.45%, P = 0.98). Port site infection happened in 6 patients in each group (3.49% vs. 2.96%, P = 0.77).

Conclusion: Chemo-port implantation can be performed in OR or IR without difference in complication rates.