E. Ugliono, Elisabetta Seno, M. Allaix, F. Rebecchi, M. Morino
Posterior partial fundoplication (PPF) was developed as an alternative surgical strategy to Nissen fundoplication, in attempt to reduce the rate of side-effects, mainly dysphagia and gas bloat syndrome. Allowing patients to maintain belching ability, this operation could lead to minor gas-related symptoms than total fundoplication. The procedure was first described by Andrè Toupet in 1963 and consisted of a posterior 180° wrap of the gastric fundus through a midline incision. After the first report of anti-reflux surgery performed with the laparoscopic approach, several authors have translated PPF into a minimally invasive approach. A review of literature has been performed to evaluate the results of minimally invasive PPF, focusing on the rate of dysphagia and gastro-esophageal reflux disease (GERD) recurrence. The evidence suggests that laparoscopic PPF is a safe and feasible procedure, and provides similar reflux control compared to laparoscopic total fundoplication, with lower risk of postoperative dysphagia. However, the duration of laparoscopic PPF effect on reflux control over time is questioned, as data on long-term results after laparoscopic Toupet fundoplication are lacking. Further studies are needed to provide long-term functional and clinical results of laparoscopic PPF in order to draw definitive conclusions. Therefore, the controversy regarding the optimal surgical strategy for the management of gastroesophageal reflux continues.
{"title":"Results after minimally invasive Toupet fundoplication technique: a narrative review","authors":"E. Ugliono, Elisabetta Seno, M. Allaix, F. Rebecchi, M. Morino","doi":"10.21037/LS-20-101","DOIUrl":"https://doi.org/10.21037/LS-20-101","url":null,"abstract":"Posterior partial fundoplication (PPF) was developed as an alternative surgical strategy to Nissen fundoplication, in attempt to reduce the rate of side-effects, mainly dysphagia and gas bloat syndrome. Allowing patients to maintain belching ability, this operation could lead to minor gas-related symptoms than total fundoplication. The procedure was first described by Andrè Toupet in 1963 and consisted of a posterior 180° wrap of the gastric fundus through a midline incision. After the first report of anti-reflux surgery performed with the laparoscopic approach, several authors have translated PPF into a minimally invasive approach. A review of literature has been performed to evaluate the results of minimally invasive PPF, focusing on the rate of dysphagia and gastro-esophageal reflux disease (GERD) recurrence. The evidence suggests that laparoscopic PPF is a safe and feasible procedure, and provides similar reflux control compared to laparoscopic total fundoplication, with lower risk of postoperative dysphagia. However, the duration of laparoscopic PPF effect on reflux control over time is questioned, as data on long-term results after laparoscopic Toupet fundoplication are lacking. Further studies are needed to provide long-term functional and clinical results of laparoscopic PPF in order to draw definitive conclusions. Therefore, the controversy regarding the optimal surgical strategy for the management of gastroesophageal reflux continues.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41428133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Rosenberg, H. Friis-Andersen, L. Jørgensen, K. Andresen
Department of Surgery, Herlev Hospital, Herlev, Denmark; University of Copenhagen, København, Denmark; Department of Surgery, Horsens Hospital, Horsens, Denmark; Department of Surgery, Bispebjerg Hospital, København, Denmark Contributions: (I) Conception and design: All authors; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Jacob Rosenberg. Department of Surgery, Herlev Hospital, Herlev, Denmark. Email: Jacob.rosenberg@regionh.dk.
{"title":"Variables in the Danish Hernia Databases: inguinal and ventral","authors":"J. Rosenberg, H. Friis-Andersen, L. Jørgensen, K. Andresen","doi":"10.21037/LS-20-125","DOIUrl":"https://doi.org/10.21037/LS-20-125","url":null,"abstract":"Department of Surgery, Herlev Hospital, Herlev, Denmark; University of Copenhagen, København, Denmark; Department of Surgery, Horsens Hospital, Horsens, Denmark; Department of Surgery, Bispebjerg Hospital, København, Denmark Contributions: (I) Conception and design: All authors; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Jacob Rosenberg. Department of Surgery, Herlev Hospital, Herlev, Denmark. Email: Jacob.rosenberg@regionh.dk.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41792230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Gyoda, Y. Mise, M. Terasawa, H. Ichida, T. Mizuno, R. Yoshioka, H. Imamura, A. Saiura
Indocyanine green (ICG) fluorescence imaging has come to be applied to hepatobiliary surgery not only visualization of bile duct but also for identification of subcapsular hepatic tumors and segmental boundaries. A large proportion of ICG molecules bind to high molecular-weight proteins such as albumin. ICG is selectively taken up to hepatocytes and excreted in the bile by an active transporter. Fusion ICG fluorescence images are obtained using a complementary metal-oxide semiconductor camera head and a near-infrared laser diode for ICG excitation. This method is helpful especially in cases of laparoscopic hepatectomy, wherein there is limited visual inspection and palpation in comparison with open surgery. ICG cholangiography is effective for visualizing the confluence of the left and right hepatic duct, decreasing the potential risks of bile duct stenosis or injury. ICG fluorescence imaging is also useful for the visualization of hepatic segment boundaries, which helps navigate the transection line in real time during hepatectomy. However, in the case of liver cirrhosis, the function of liver cells is depressed, and longtime ICG remains in the lesions; thus, the disappearance of fluorescence is delayed. ICG fluorescence imaging is a simple technology with the potential to improve the safety and quality of open, laparoscopic, and robotic
{"title":"Narrative review of fluorescence imaging-guided liver surgery","authors":"Y. Gyoda, Y. Mise, M. Terasawa, H. Ichida, T. Mizuno, R. Yoshioka, H. Imamura, A. Saiura","doi":"10.21037/LS-20-102","DOIUrl":"https://doi.org/10.21037/LS-20-102","url":null,"abstract":"Indocyanine green (ICG) fluorescence imaging has come to be applied to hepatobiliary surgery not only visualization of bile duct but also for identification of subcapsular hepatic tumors and segmental boundaries. A large proportion of ICG molecules bind to high molecular-weight proteins such as albumin. ICG is selectively taken up to hepatocytes and excreted in the bile by an active transporter. Fusion ICG fluorescence images are obtained using a complementary metal-oxide semiconductor camera head and a near-infrared laser diode for ICG excitation. This method is helpful especially in cases of laparoscopic hepatectomy, wherein there is limited visual inspection and palpation in comparison with open surgery. ICG cholangiography is effective for visualizing the confluence of the left and right hepatic duct, decreasing the potential risks of bile duct stenosis or injury. ICG fluorescence imaging is also useful for the visualization of hepatic segment boundaries, which helps navigate the transection line in real time during hepatectomy. However, in the case of liver cirrhosis, the function of liver cells is depressed, and longtime ICG remains in the lesions; thus, the disappearance of fluorescence is delayed. ICG fluorescence imaging is a simple technology with the potential to improve the safety and quality of open, laparoscopic, and robotic","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41944152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Endoscopic resection of GIST: feasible or fairytale?","authors":"M. Colombo, M. Spadaccini, R. Maselli","doi":"10.21037/ls-20-136","DOIUrl":"https://doi.org/10.21037/ls-20-136","url":null,"abstract":"","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42171271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ethical considerations when implementing new technology into the operating room","authors":"Ryan B Morgan, P. Angelos","doi":"10.21037/ls-22-19","DOIUrl":"https://doi.org/10.21037/ls-22-19","url":null,"abstract":"","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42940516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Cananzi, Laura Ruspi, L. Samà, S. Renne, F. Sicoli, V. Quagliuolo
The role of margin status as a prognostic factor in gastrointestinal stromal tumour (GIST) remains a matter of debate. It is clear that R2 resection is predictive of poor outcomes, but the impact of R1 versus R0 surgery on survival varies among studies. The occurrence of spontaneous or iatrogenic rupture may explain this heterogeneity in survival and recurrence rates in the literature. Even if residual disease and rupture do have an impact on the prognosis of GIST patients, their role needs to be better clarified, also in the perspective of introducing one or both of these parameters in a proper staging system. Again, the role of margin status should be deeply investigated in order to give clinicians a reliable safety when planning perioperative strategy. Although GIST should be managed by a multidisciplinary team in a referral center and there is no doubt that R0 surgery without rupture of the tumour is the gold standard, in everyday clinical practice this result is not always reasonably achievable: in some cases surgery may leave a microscopic residual and manipulation of large tumours may result in spillage of neoplastic cells in the abdominal cavity. In this review article, the effect of margins itself and the existence of other possible factors influencing prognosis of GIST patients are explored.
{"title":"The gist of surgical margins in GIST: a narrative review","authors":"F. Cananzi, Laura Ruspi, L. Samà, S. Renne, F. Sicoli, V. Quagliuolo","doi":"10.21037/LS-20-139","DOIUrl":"https://doi.org/10.21037/LS-20-139","url":null,"abstract":"The role of margin status as a prognostic factor in gastrointestinal stromal tumour (GIST) remains a matter of debate. It is clear that R2 resection is predictive of poor outcomes, but the impact of R1 versus R0 surgery on survival varies among studies. The occurrence of spontaneous or iatrogenic rupture may explain this heterogeneity in survival and recurrence rates in the literature. Even if residual disease and rupture do have an impact on the prognosis of GIST patients, their role needs to be better clarified, also in the perspective of introducing one or both of these parameters in a proper staging system. Again, the role of margin status should be deeply investigated in order to give clinicians a reliable safety when planning perioperative strategy. Although GIST should be managed by a multidisciplinary team in a referral center and there is no doubt that R0 surgery without rupture of the tumour is the gold standard, in everyday clinical practice this result is not always reasonably achievable: in some cases surgery may leave a microscopic residual and manipulation of large tumours may result in spillage of neoplastic cells in the abdominal cavity. In this review article, the effect of margins itself and the existence of other possible factors influencing prognosis of GIST patients are explored.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41390414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Esophageal gastrointestinal stromal tumor (GIST) is a rare neoplasm that arises from interstitial cells of Cajal that typically requires surgical resection due to its potential for aggressive behavior. These tumors can affect any site of the digestive tract, from the esophagus to the rectum. Though they arise from the submucosal layer, they can ulcerate through the mucosa or form pedunculated masses. Esophageal GIST generally has a worse outcome compared to tumors arising in the stomach. The preoperative evaluation includes imaging and endoscopic ultrasound (EUS) to obtain a tissue biopsy. For large, locally advanced, or metastatic tumors, neoadjuvant tyrosine kinase inhibitor therapy should be strongly considered. Tumor genotyping can help identify imatinib non-responders or those requiring a higher dose. Due to the rarity of regional nodal metastasis, surgical options include esophagectomy, tumor enucleation, and submucosal tunneling endoscopic resection (STER). Given a high risk of postoperative morbidity, esophagectomy should be avoided in favor of the less invasive enucleation or endoscopic resection. Thoracoscopic/laparoscopic and robotic-assisted enucleation and STER are minimally invasive operative approaches that appear to be safe with adequate oncologic outcomes based on currently available evidence. Adjuvant therapy should be considered for high-risk tumors, though the optimal duration of therapy remains under investigation. images and demonstrate enhancement after gadolinium administration. The marked tissue hypersignal visualized on T2-weighted images are strongly correlated with a diagnosis of a GIST (13,15). Similar to CT, MRI allows for measurement of the tumor, detection of locally advanced GIST, and evaluation of liver metastasis.
{"title":"Indications and limits of minimally invasive treatment of esophageal gastrointestinal stromal tumor: a narrative review","authors":"C. Aquina, S. Melo, C. Contreras","doi":"10.21037/LS-20-121","DOIUrl":"https://doi.org/10.21037/LS-20-121","url":null,"abstract":": Esophageal gastrointestinal stromal tumor (GIST) is a rare neoplasm that arises from interstitial cells of Cajal that typically requires surgical resection due to its potential for aggressive behavior. These tumors can affect any site of the digestive tract, from the esophagus to the rectum. Though they arise from the submucosal layer, they can ulcerate through the mucosa or form pedunculated masses. Esophageal GIST generally has a worse outcome compared to tumors arising in the stomach. The preoperative evaluation includes imaging and endoscopic ultrasound (EUS) to obtain a tissue biopsy. For large, locally advanced, or metastatic tumors, neoadjuvant tyrosine kinase inhibitor therapy should be strongly considered. Tumor genotyping can help identify imatinib non-responders or those requiring a higher dose. Due to the rarity of regional nodal metastasis, surgical options include esophagectomy, tumor enucleation, and submucosal tunneling endoscopic resection (STER). Given a high risk of postoperative morbidity, esophagectomy should be avoided in favor of the less invasive enucleation or endoscopic resection. Thoracoscopic/laparoscopic and robotic-assisted enucleation and STER are minimally invasive operative approaches that appear to be safe with adequate oncologic outcomes based on currently available evidence. Adjuvant therapy should be considered for high-risk tumors, though the optimal duration of therapy remains under investigation. images and demonstrate enhancement after gadolinium administration. The marked tissue hypersignal visualized on T2-weighted images are strongly correlated with a diagnosis of a GIST (13,15). Similar to CT, MRI allows for measurement of the tumor, detection of locally advanced GIST, and evaluation of liver metastasis.","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49043352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A novel concept on the origin of gastroesophageal reflux disease","authors":"M. Fanous","doi":"10.21037/ls-22-32","DOIUrl":"https://doi.org/10.21037/ls-22-32","url":null,"abstract":"","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49257223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Santambrogio, M. Vertemati, Edgardo Picardi, M. Zappa
{"title":"Planning the treatment: preoperative 3D reconstruction","authors":"R. Santambrogio, M. Vertemati, Edgardo Picardi, M. Zappa","doi":"10.21037/ls-22-6","DOIUrl":"https://doi.org/10.21037/ls-22-6","url":null,"abstract":"","PeriodicalId":92818,"journal":{"name":"Laparoscopic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44372249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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