Laparoscopic Equipment Research Articles

Laparoscopic Subtotal Splenectomy: A Feasible Option in the Treatment of Splenic Metastasis.

Laparoscopic subtotal splenectomy (LSS) is a procedure that helps avoid the consequences of asplenia. Given the spleen's importance and functionality, there may be specific indications and patient conditions in which partial splenectomy is beneficial. This case report aims to clarify the indications for LSS and outline the surgical technique. This multimedia article provides a comprehensive overview of the surgical procedure, emphasizing key steps to avoid postoperative bleeding and complications. The patient was hospitalized for 3 days without any complications observed. Postoperative hemoglobin levels were 11.2g/dL, with no signs of anemia. The patient was discharged with a follow-up visit after 2 weeks, showing no evidence of postoperative complications. The anatomopathological study revealed a nodular area with extensive tumoral necrosis. LSS is a safe surgical option that might help to mitigate the consequences of total splenectomy. Innovative technology in hemostasis, such as COOLINGBIS© (a monopolar electrosurgical electrode designed for hemostatic sealing and coagulation) can help manage this risk. Identifying the vascular pedicle via computed tomography scan is crucial to prevent unexpected bleeding. In selected cases, LSS is a feasible and safe procedure when performed with appropriate laparoscopic equipment and by experienced surgeons.

Trial of an Inexpensive Training Simulation Model for Laparoscopic Appendicectomy.

Introduction Laparoscopic surgery is now the gold standard for many common procedures; however, there has been a lack of emphasis on laparoscopic training at the junior level. Simulation is an effective form of training in surgery, but surgical simulation models and courses can be expensive and inaccessible to medical students and foundation doctors. With procedures becoming more minimally invasive, it is key that we train laparoscopic skills at an earlier stage; and to do so, we need to remove the barriers of cost and accessibility. Our study aims to develop and assess the effectiveness of a simulated laparoscopic appendicectomy training model in developing laparoscopic knowledge, skills, and confidence in a cohort of foundation doctors. Methods A simulated mesoappendix model was fashioned from supermarket chicken wings with the bone removed, and it was put inside a laparoscopic box trainer with laparoscopic tools and equipment. This was trialed in a surgical-themed hub day for foundation doctors in the East of England Deanery, UK, and the simulated model was set up as a workshop following a teaching session detailing the steps of a laparoscopic appendicectomy. Participants completed questionnaires pre- and post-session to assess perceived skills, experience, and confidence in laparoscopic surgery, laparoscopic skills, and the usefulness of this training model. Results A total of 29 foundation doctors with limited formal surgical training completed the survey. The model is quick to prepare and assemble, costing around £0.30 ($0.40). Trainees found the model acceptable and helpful in developing their laparoscopic skills and knowledge of laparoscopic surgery. There was also an increase in self-perceived confidence in performing laparoscopic procedures under supervision. Discussion This modification to the model allows the dissection and division of a simulated mesoappendix using only laparoscopic scissors and forceps in a box trainer. This simulation model is a promising and inexpensive tool which can be used for early-stage laparoscopic training for medical students and junior doctors.

Clinical applications of handheld robotic devices in general surgery: A mini-review

Laparoscopy has evolved the surgical field around the world. Although this has defined minimally invasive surgery, there are limitations. Lack of articulating instrument tips restricts their use in difficult cases. Ergonomic challenges risk occupational injury. Although there is now an increasing use of robotics, these platforms have significant costs. Articulating laparoscopic instruments, termed handheld robotic devices, pose a potential solution to this problem. We aimed to perform a mini-review the clinical applications of handheld robotic devices in general surgery. A limited literature search of the MEDLINE, EMBASE, and Cochrane databases were performed to identify handheld robotic devices with clinical trial data. Primary outcomes were operative time, complication rate, and conversion to laparoscopy or open surgery. Three devices were identified. Noninferiority was demonstrated with respect to laparoscopic instruments in terms of operative time and postoperative complications. This is despite the devices being in their relative infancy with learning curves. Subgroup analysis in a comparative trial with robotics for inguinal hernia repair revealed no significant difference in operative duration during unilateral flap closure. There were no cases requiring conversion. The need for cost-effective robotic devices is clear. Handheld robotic devices have been engineered to provide articulating instrument tips while using existing laparoscopic equipment. They have been demonstrated to be safe and effective. The amalgamation of precision-enhancing robotic instruments with the fiscal advantages of laparoscopic tools has the potential to fundamentally alter the field of minimally invasive surgery.

A retrospective study of 3D laparoscopy and 2D laparoscopy in transabdominal preperitoneal (TAPP) for unilateral inguinal hernia in elderly patients.

This study aims to explore the safety and efficacy of 3D laparoscopy in elderly patients undergoing transabdominal preperitoneal (TAPP) surgery for inguinal hernia. Patients were divided into two groups based on the laparoscopic equipment used during surgery. Clinical data preoperatively, intraoperatively, and postoperatively were collected and subjected to statistical analysis. From January 2020 to August 2023, a total of 127 patients with primary unilateral inguinal hernia were evaluated in this study, 61 in the 3D TAPP group and 66 in the 2D TAPP group. There were no statistically significant differences in baseline data, including average age, gender distribution, BMI index, hernia type, hernia defect size and location, comorbidities, and usage of anticoagulant drugs between the two groups (P > 0.05). In terms of operative indicators, the 3D group showed shorter mean operation time (51.61 ± 7.16min vs. 78.59 ± 13.51min, P < 0.001), mean mesh placement time (6.07 ± 1.40min vs. 9.77 ± 1.21min, P < 0.001), and mean peritoneal suture time (7.34 ± 1.85min vs. 9.73 ± 1.32min, P < 0.001) compared to the 2D group. However, there were no statistically significant differences in mean blood loss, postoperative pain scores, postoperative hospital stay, and total hospital costs between the two groups (P > 0.05). The incidence of postoperative complications did not differ significantly between the two groups (P > 0.05). No adverse reactions such as dizziness or nausea were reported by surgeons during the procedures in either group. Three-dimensional laparoscopy in TAPP surgery provides high-definition, three-dimensional surgical images, reducing the difficulty of operations and effectively shortening the operation time.

Abstract CT106: First-in-human phase 1 study of paclitaxel-eluting PTM-101 film in subjects with borderline resectable or locally advanced pancreatic cancers

Abstract Background Unlike many other types of cancer, improvements in the treatment of pancreatic cancer have been very limited, in part due to the inability to deliver chemotherapy to the tumor at efficacious concentrations for a prolonged time. PTM-101 is a novel biodegradable film containing paclitaxel and is designed to continuously release high concentrations of paclitaxel precisely to the site of a pancreatic tumor over one month. Methods This first in human study was conducted at one center in Australia to assess the safety, toxicity, and surgical feasibility of a single administration of PTM-101 containing 100 mg of paclitaxel. PTM-101 was sutured directly onto the pancreatic surface overlying the tumor by a surgical oncologist using standard laparoscopic equipment during a disease-staging assessment. Approximately 3 weeks after PTM-101 placement, all participants began standard of care therapy which included mFOLFIRINOX. This study enrolled 3 subjects that had treatment naïve, borderline resectable or locally advanced, pancreatic adenocarcinoma. Subjects were monitored closely for local and systemic toxicities, as well as for preliminary signals of efficacy. An independent central imaging lab reviewed CT scans to determine changes in tumor volume. Results PTM-101 was successfully implanted over the tumor site in all three subjects. In all cases, there were no adverse events reported during the procedure. Overall, PTM-101 was well tolerated with a total of five Grade 1 adverse events judged at least possibly related to the procedure or the mFOLFIRINOX. No serious adverse events (SAEs) or deaths occurred. Paclitaxel was undetectable in the circulation at all time points. Subjects were followed for 6 months. Best overall response rate according to RECIST was stable disease (2 subjects) and partial response (1 subject). An independent analysis showed that all tumors had a reduction in size in the anterior/posterior diameter, which was consistent with unidirectional paclitaxel release from PTM-101. Two of the 3 subjects had a &amp;gt;30% tumor volume reduction, importantly, with the initial decrease in tumor size detected prior to mFOLFIRINOX. Conclusion PTM-101 was readily implanted during diagnostic laparoscopy and was well tolerated with no SAEs or deaths reported during 6 months of follow up. This study demonstrated that a PTM-101 implant was surgically feasible, safe, resulted in no systemic paclitaxel exposure, and caused a tumor size reduction in all 3 subjects. Additional studies may demonstrate the potential for PTM-101 to be a first-line adjunct prior to neoadjuvant therapy in treatment naïve, borderline resectable or locally advanced, pancreatic cancer. Citation Format: Charles Pilgrim, Marty Smith, Ee-Jun Ban, Samantha Ellis, John Zalcberg, Benjamin Markman, Margaret Lashof-Sullivan, Laura Indolfi. First-in-human phase 1 study of paclitaxel-eluting PTM-101 film in subjects with borderline resectable or locally advanced pancreatic cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT106.

129 LaparoscopiX: Expanding Minimally Invasive Surgery Training in Kenya

OBJECTIVES/GOALS: Open surgery prevails in low- and middle-income countries (LMICs) due to scarcity of laparoscopic equipment and poor access to training. LaparosopiX is a box trainer system designed for teaching hospitals in LMICs; it includes an open-source laser print design and an app to allow surgical trainees to receive feedback from laparoscopic experts. METHODS/STUDY POPULATION: This study aims to assess the usability of Laparoscopix for surgical trainees and mentors at five large teaching hospitals in Kenya. Surgical trainees and mentors who participate in this study will be observed while setting up and using the app to identify natural pain-points. A post-session survey will be conducted to assess immediate perceptions of the platform including ease of navigation and intuitive design. Over three months, aggregate data regarding platform usage at these hospital sites will be collected and analyzed to assess user retention rates, usage and traffic patterns, and skill progression over time. Surveys will be sent out to assess attitudes towards the platform and to elucidate any aspects of the system we can improve. RESULTS/ANTICIPATED RESULTS: We hope to find overall positive impressions towards the LaparoscopiX system during this study. We expect there to be some pain-points that arise during navigation of the app, but we expect no large changes to the application architecture required. We anticipate an immediate increase and eventual plateau of users recruited. We hope to see that surgical trainees are advancing through the app while gaining practice and confidence. We will gather insightful data on which aspects of the app were helpful for trainees, and which can be improved. We also hope to learn what factors may play into trainee and mentor retention in the system. DISCUSSION/SIGNIFICANCE: Through this study, we hope to elucidate ways in which we can improve the LaparoscopiX platform, identify which features to prioritize, and determine the direction of future app development. We believe and hope that LaparoscopiX can expand access to laparoscopic surgical mentorship to improve surgical outcomes and health equity worldwide.

Patient-reported outcome, perception and satisfaction after laparoscopic cholecystectomy in Kigali, Rwanda

BackgroundLaparoscopic surgery is the gold standard for many abdominal surgeries. Laparoscopic programs in low- and middle-income countries (LMICs) and in sub-Saharan Africa face many constraints, although its use is safe, feasible, and clinically beneficial. The authors assessed patient-reported outcomes and the experience of patients operated on at the University Teaching Hospital of Kigali (CHUK). MethodsThis is a retrospective cross-sectional study combining medical data from medical files and information collected from telephone calls to 288 patients who underwent laparoscopic cholecystectomy at CHUK from January 2015 to December 2020. ResultsAmong 446 laparoscopic surgeries performed at CHUK over 6 years, cholecystectomies accounted for 64.6 % of cases (288/446). Postoperative complications and mortality after laparoscopic cholecystectomy were low, respectively 1.7 % and 0.7 %, while the median length of stay was 3 days. About 74 % of surveyed patients had never heard of laparoscopic surgery prior to their procedure. Knowledge of laparoscopic surgery was associated with patient education level (p < 0.001). Half of patients had not been involved in the choice of the surgical technique. Overall satisfaction was over 95 % and >90 % of patients consider laparoscopic surgery as the best surgical approach in Rwanda, and for this reason they declared to be ready to promote this new technology despite its higher cost. However, patients reported some weaknesses and made recommendations for improving public awareness of laparoscopy and its benefits, patient-provider relationships, training of surgical workforce, laparoscopic equipment, and infrastructure. ConclusionLaparoscopic cholecystectomy can be performed with a low rate of postoperative complications in a resource-limited setting like Rwanda. Patient satisfaction was high, but efforts should be made to improve public awareness of laparoscopic surgery, improve surgical capacity, laparoscopic equipment, and infrastructure.

Exploring Laparoscopic Surgery Training Opportunities in the College of Surgeons of East, Central, and Southern Africa region

The resource-limited environment in Sub-Saharan countries, with a lack of expert trainers, impedes the progress of laparoscopic training. This study aimed to identify the opportunities and limitations of laparoscopic surgery training in the College of Surgeons of East, Central, and Southern Africa (COSECSA) countries. A multicountry online survey was conducted from January 2021 to October 2021 in COSECSA-accredited training hospitals within 16 countries. Available resources and challenges faced in order to set up well-structured laparoscopic training programs were explored. Ninety-four surgeons answered the questionnaire. The average resources reported per hospital were 3 trained laparoscopic surgeons, 2 laparoscopic towers, and 2 sets of laparoscopic instruments. The training of the majority of these surgeons has been in local institutions (53%), a further 37% within African countries and only 10% outside Africa. Approximately 45% of them declared that laparoscopic modules were planned within the University Curricula, while only 18% of surgeons recognized that laparoscopic modules are only planned within the COSECSA program. About 57% of participants reported that at the end of residency training, graduating surgeons were not able to perform basic laparoscopic procedures. The quoted barriers included: limited laparoscopic equipment, absence of simulation lab, lack of qualified trainers, lack of training programs and time for teaching by skilled doctors, and lack of institutional support. The well-structured set up of laparoscopic training programs in the COSECSA region is hindered due to the lack of qualified personnel and insufficient resources for the acquisition of equipment and simulation laboratories. Ongoing efforts to set up laparoscopic programs through the development of adaptive curricula, innovative strategies for reduction of equipment cost and adequate training of surgeons are crucial for patient safety and the development of laparoscopy.

Robotic Transanal Minimally Invasive Surgery for Rectal Polyps.

Transanal minimally invasive surgery (TAMIS) can be utilized to manage a wide variety of rectal lesions but can be technically demanding with traditional laparoscopic equipment. Robotic platforms such as the da Vinci Single Port system can reduce the technical barriers of TAMIS and allow more complicated lesions to be addressed. Robotic TAMIS with the SP system follows similar indications for local excision of benign and malignant lesions as conventional TAMIS or even transanal endoscopic microsurgery. We describe our initial experience using the SP system and provide technical suggestions for how to incorporate this technology. We also address innovations in flexible endoscopic robotic surgery that we anticipate will allow for increased use of organ preservation of the colon and rectum, as well as possibly expand the use of natural orifice surgery.

Surgical approaches to the adrenal gland.

Review the literature on the surgical management of adrenal diseases, highlighting the various surgical approaches and their respective pros and cons. Minimally invasive adrenalectomy is commonly used for small and benign adrenal tumors, whereas open adrenalectomy is preferred for larger tumors and primary adrenal malignancy. Although minimally invasive adrenalectomy results in shorter recovery and fewer complications compared with open, the latter offers better oncologic outcomes in the setting of primary adrenal malignancy. Adrenalectomy is performed transabdominally or retroperitoneoscopically, both yielding equivalent results and recovery. Traditional laparoscopic or robotic equipment can be utilized for either minimally invasive approach. Subtotal adrenalectomy may be appropriate for patients with genetically associated pheochromocytoma to preserve cortical function and reduce the risk of adrenal insufficiency. However, the potential benefits of sparing adrenal function must be weighed against the risk of recurrence. Adrenalectomy is becoming increasingly common worldwide. For benign and small adrenal tumors, minimally invasive adrenalectomy is generally considered the standard approach, while open adrenalectomy is preferred for primary adrenal malignancy and larger tumors. Subtotal adrenalectomy may be appropriate for patients with bilateral adrenal pheochromocytoma, as it can reduce the need for lifelong glucocorticoid dependency.

MP80-15 3D LAPAROSCOPIC VERSUS ROBOT ASSISTED LAPAROSCOPIC PROSTATECTOMY: 1-YEAR FUNCTIONAL RESULTS OF a RANDOMIZED PROSPECTIVE STUDY

You have accessJournal of UrologyCME1 Apr 2023MP80-15 3D LAPAROSCOPIC VERSUS ROBOT ASSISTED LAPAROSCOPIC PROSTATECTOMY: 1-YEAR FUNCTIONAL RESULTS OF a RANDOMIZED PROSPECTIVE STUDY Henry Haapiainen, Teemu Murtola, Juha Koskimäki, Jarno Riikonen, Tomi Pakarainen, Mika Raitanen, and Antti Kaipia Henry HaapiainenHenry Haapiainen More articles by this author , Teemu MurtolaTeemu Murtola More articles by this author , Juha KoskimäkiJuha Koskimäki More articles by this author , Jarno RiikonenJarno Riikonen More articles by this author , Tomi PakarainenTomi Pakarainen More articles by this author , Mika RaitanenMika Raitanen More articles by this author , and Antti KaipiaAntti Kaipia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003357.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recent evidence suggests that robot assisted laparoscopic prostatectomy (RALP) results in faster recovery of continence compared to conventional laparoscopic prostatectomy (LRP). One main difference of robot assisted surgery is 3D vision which gives an advantage over conventional 2D laparoscopic surgery. Modern laparoscopic equipment with high quality 3D vision may narrow the reported differences of outcomes between robot assisted and 2D laparoscopic surgery. Therefore, we undertook a randomized prospective study to compare the 1-year functional results of RALP and 3D LRP. METHODS: 145 patients were recruited between June 2018- July 2021 and randomized 1:1 between RALP (n:75) and 3D LRP (n:70) arm. 3D LRP procedures were performed by one and RALP procedures by 3 surgeons. The 1-year functional results were evaluated with the EPIC-26 questionnaire and by usage of safety pads. The data was analyzed with IBM SPSS statistic version 27. RESULTS: Preoperative parameters (Age, BMI, Prostate size, PSA) and oncological results (ISUP, pT) are shown in Table 1. A boxplot of 1-year functional results is shown in Figure 1. In statistical analysis, no significant differences between surgical modalities were seen in any of the 5 domains of EPIC-26. At 1 year post operatively 56.7% / 58.3% of the patients that had undergone RALP / 3D LRP did not wear any safety pad. CONCLUSIONS: Our results suggest that 3D LRP and RALP result in similar functional outcomes at 1 year post-operatively. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1158 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Henry Haapiainen More articles by this author Teemu Murtola More articles by this author Juha Koskimäki More articles by this author Jarno Riikonen More articles by this author Tomi Pakarainen More articles by this author Mika Raitanen More articles by this author Antti Kaipia More articles by this author Expand All Advertisement PDF downloadLoading ...

Current status and hotspot of minimally invasive surgery for pancreatic head carcinoma

With the improvement of laparoscopic equipment and surgical technology,pancreatic surgery has entered the "minimally invasive era".However,the use of minimally invasive pancreaticoduodenectomy in patients with pancreatic head cancer remains controversial.In recent years,China's pancreatic surgeons have been at the forefront of the world in terms of surgical technology,however,surgical philosophy, selection of indication,and perioperative management should be further stregthened. Additionally, the development of medical standards in various regions of China is seriously uneven,and minimally invasive pancreaticoduodenectomy still needs to be further standardized and popularized.Through this article,the author discusses the development status of minimally invasive surgery for pancreatic head cancer and related hot topics with fellow surgeons,in order to further improve the standard diagnosis and treatment of pancreatic cancer in China.

Application of Retrocolic Approach with Uncinate Process Priority in Laparoscopic Pancreaticoduodenectomy

Background: Pancreaticoduodenectomy (PD) is a complex operative procedure, which remains the primary curative treatment for pancreatic, distal bile duct, and periampullary cancers. In recent years, with the continuous development of laparoscopic technology and equipment, laparoscopic pancreaticoduodenectomy (LPD) has been performed gradually in many high-volume surgical centers. However, it is still challenging even for experienced pancreatic surgeons to perform LPD, at the same time, with the accumulation of surgical experience, different surgical approaches are also constantly discussed. Methods: We retrospectively analyzed the clinical data of 323 patients who received LPD at a single institution. Among them, 200 patients received operations with retrocolic approach, 123 patients were treated with traditional approach. In this study, we analyzed perioperative data and compared survival time for patients with pancreatic cancers in two groups. Result: Compared with traditional approach, retrocolic approach with uncinate process priority has a shorter operative time (94.25 ± 6.46 minutes versus 116.43 ± .4.78 minutes, P = .009) and less intraoperative blood loss (80 mL versus 150 mL, P = .562). However, there is no statistical significance in the incidence of postoperative complications (≥ Clavien-Dindo [CD] III) (65 [32.5%] versus 45 [36.58%], P = .871), R0 resection rates (41 versus 38, P = .826), and the number of lymph nodes harvested (16.64 ± 5.93 versus 15.37 ± 4.65, P = .785) between two groups. Meanwhile, the median survival time of patients with pancreatic cancers in posterior approach group was longer than those in traditional approach group (30.34 months versus 28.54 months, P > .05); however, there was no statistical significance between them. Conclusion: Retrocolic approach with uncinate process priority is a feasible method for pancreatic cancer, which could reduce operating time and intraoperative bleeding, meanwhile, not increase the incidence of postoperative complications. Retrocolic approach with uncinate process priority can be generalized to larger group sizes.

An Outcomes-Focused Analysis of Laparoscopic and Open Surgery in a Nigerian Hospital.

The benefits of laparoscopic surgery such as swifter recovery and fewer wound complications, elude much of the developing world. Nigeria, a lower middle-income country, is the most populous sub-Saharan nation; an excellent model for studying the impact of laparoscopy in resource-constrained environments. The Department of Surgery at the Obafemi Awolowo University Teaching Hospital and the University of Utah's Center for Global Surgery present a study of laparoscopic surgery cases in sub-Saharan Africa. A retrospective chart review of 261 patients compared open and laparoscopic surgical outcomes for three common general surgery procedures: open versus laparoscopic cholecystectomy and appendectomy, and open laparotomy versus diagnostic laparoscopy for biopsy of intra-abdominal mass. The primary outcome was total length of stay (LOS); secondary outcomes included wound complications, analgesia and antibiotic use, time to oral intake, and patient charges. Total LOS for laparoscopic surgery was significantly shorter compared to analogous open procedures (4.7 vs 11.5 days). Postoperative LOS was also shorter (2.6 vs 8.2 days). There were no differences in wound complications. Median charges to patients were lower for laparoscopic versus open procedures ($184 vs $217 USD). The introduction of laparoscopy allows for significantly shorter LOS and equivalent wound complications in the context of a sub-Saharan teaching hospital. Concerns regarding higher costs of care for patients do not appear to be a significant issue. Further work is needed to evaluate costs to the hospital system as a whole, including procurement and maintenance of laparoscopic equipment.

Current status of laparoscopic surgery usage in Türkiye: A middle-income country.

This study aimed to determine the usage status of laparoscopic procedures in general surgical practice in Türkiye, which is a sample of middle-income countries. The questionnaire was sent to general surgeons, gastrointestinal surgeons, and surgical oncologists who have completed their residency training and are actively working in university, public or private hospitals. Demographic data, laparoscopy training and the period of education, the rate of laparoscopy use, the type and volume of laparoscopic surgical procedures, their views on the advantages and disadvantages of laparoscopic surgery, and the reasons for preferring laparoscopy were determined with a 30-item questionnaire. Two hundred and forty-four questionnaires from 55 different cities of Türkiye were evaluated. The responders were mainly males, younger surgeons (F/M= 11.1/88.9 % and 30-39 y/o), and graduated from the university hospital residence program (56.6%). Laparoscopic training was frequently taken during residency (77.5%) in the younger age group, while the elderly participants mostly received additional training after specialization (91.7%). Laparoscopic surgery was mostly not available in public hospitals for advanced procedures (p <0.0001) but was available for cholecystectomy and appendectomy operations (p= NS). However, participants working in university hospitals mostly stated that the laparoscopic approach was the first choice for advanced procedures. The results of this study showed that the surgeons working in MICs spent strong effort to use laparoscopy in daily practice, especially in university and high-volume hospitals. However, inappropriate education, cost of laparoscopic equipment, healthcare policies, and some cultural and social barriers might have negatively impacted the widespread use of laparoscopic surgery and its usage in daily practice in MICs such as Türkiye.

Applications of Indocyanine Green-Guided Near-Infrared Fluorescence Imaging in Pediatric Minimally Invasive Surgery Urology: A Narrative Review.

Background: Indocyanine green (ICG) is a fluorescent dye used for several indications in adult surgery, and, more recently, adopted also in the pediatric patients. This study aimed to review the literature published on the use of ICG near-infrared fluorescence (NIRF) in pediatric urology, to address its shortcomings and disadvantages and to detect the future perspectives. Materials and Methods: An electronic literature search of PubMed on all studies reporting use of ICG-NIRF in pediatrics was performed. We included only studies reporting ICG-NIRF application in minimally invasive surgery (MIS) for pediatric urology indications. Results: Forty-two articles reporting MIS procedures performed using ICG-NIRF in children were obtained, but only 15 studies that focused on urological applications of ICG-NIRF in children were included in this review. The included studies described use of ICG-NIRF for kidney malformations such as duplex system, kidney tumors, renal cysts, ureteral pathology, bladder malformations, varicocele, and lymph node sampling in tumors. The pediatric urological applications in which ICG-NIRF provided significant advantages included partial nephrectomy, lymphatics sparing varicocele repair, and oncological procedures. The ICG-NIRF use was clinically safe, without reported adverse systemic reactions in all pediatric series. The main drawback of this technology is the need of specific laparoscopic equipment such as camera system, light sources, and telescopes or the da Vinci Xi Robot, with the software for ICG-NIRF, Firefly®, already integrated within. Conclusions: ICG-enhanced fluorescence-guided surgery is gaining growing popularity among pediatric surgeons due to the excellent results that have been published until now. ICG-NIRF technology has proven to be safe, easy to use, not time-consuming, cheap, and very effective to improve intraoperative view and surgical ability. Nonetheless, further evidence, including larger series, longer follow-up, and more specific assessments, is necessary to confirm the preliminary results and enlarge the applications.

Interstitial Pregnancy: Surgical Management by Laparoscopic Cornuostomy

<h3>Study Objective</h3> Our objective is to add to current literature support for laparoscopic cornuostomy as a safe and effective minimally invasive surgical management for interstitial (cornual) ectopic pregnancy. <h3>Design</h3> Surgical video. <h3>Setting</h3> Highland Hospital, Alameda Health System (safety-net county hospital). Patient was positioned in dorsal lithotomy with both arms tucked at the side. Standard laparoscopic and hysteroscopic equipment was used including four 5mm laparoscopic ports. <h3>Patients or Participants</h3> A single patient was involved in this surgical video. <h3>Interventions</h3> Same-day laparoscopic cornuostomy and diagnostic hysteroscopy with attempted tubal cannulation. <h3>Measurements and Main Results</h3> Multiple telephone visits with the patient to monitor clinical symptoms and post-op recovery, including Beta hCG measurements until Beta hCG level was undetectable. Beta hCG levels: 11, 783 (pre-op) -> 47 (15 days post-op) -> 7 (34 days post-op) -> undetectable (44 days post-op). <h3>Conclusion</h3> Laparoscopic cornuostomy for the surgical management of interstitial pregnancy, as opposed to cornual wedge resection, should be considered, particularly in stable patients with intact ectopic pregnancy. The minimally invasive techniques we demonstrate in this video are reproducible, effective, and efficient. Additional study is required to understand how this surgical approach could impact ipsilateral tubal patency and pregnancy outcomes such as uterine rupture.

OC-007 RELIABLE AND COST-EFFECTIVE METHOD OF GROIN HERNIA SURGERY, BASED ON OPEN PRE-PERITONEAL APPROACH AND ORIGINAL MESH FIXATION

Abstract Aim To analyze the results of original technique for groin hernia (GH) repair, via open preperitoneal approach (OPPA) had proposed by L.M.Nyhus. Material &amp; Methods There were 161 patients 22–87 years old; in 25 cases GH were recurrent. After OPPA, the spermatic cord, inguinal ligament, interior inguinal ring and abdominal wall defect were always in full vision. GH sack was removed into abdominal cavity. The mesh, having spermatic cord got through a special orifice in it, was fixed to inguinal ligament along it full length, and to rectus abdominis muscle’ lateral edge. Inguinal abdominal wall defect was covered from within by mesh under visual and palpable control. Results Operation time takes 42.5±9.1 minutes for simple GH, and 103.5±21.4 minutes for irreducible inguinal-scrotal hernia. General burden of surgery was correspondent to minimal invasive. Follow-up to work became from 3–5th day. For 12 months 107 (60.9%) patients were followed, no hernia recurrence was found. Conclusions Our method has basic prevalence over: i) possibility of one-day surgery (longer hospitalization if comorbidities); ii) cost-saving because needn't in laparoscopic equipment; iii) simplicity and high reliability because of visual anatomic controlled mesh fixation and positioning for the total closing of groin gap. It may pretend for a proper approval at EHS guidelines. The learning curve and additional points, such as type and quantity of fixation points, best of mesh to be used, should be discussed after the further evaluation.

Robot-Assisted Resection of Intestinal Duplication in Children.

Background: Intestinal duplication is the most common type of alimentary tract duplications in childhood. Laparoscopic-assisted surgery has become the main surgical procedure, but robot-assisted resection has rarely been reported; the aim of this study was to retrospectively present our experience with robot-assisted intestinal duplication excision using the Da Vinci Xi surgical system and discuss the technical points. Methods: In total, 49 patients who were diagnosed with intestinal duplication and underwent surgery from April 2020 to February 2022 in the Children's Hospital, Zhejiang University School of Medicine, were retrospectively analyzed. The data were collected including the clinical information of the patients, operative details, and postoperative outcomes. Results: Among these 49 patients, a total of 15 underwent robot-assisted surgery and 34 underwent laparoscopic-assisted surgery. For the robot-assisted surgery group, all the cysts were peeled off by complete endoscope, the integrity of the intestine was preserved and intestinal resection and anastomosis were not required. The operation time of 80 minutes for the robot-assisted group was not significantly longer than the 90 minutes for the laparoscopic-assisted surgery group(P > .05), but the mean time to take the liquid diet after surgery and the average length of postoperative hospital stay were significantly shorter (P < .05). Conclusion: Robot-assisted resection of intestinal duplication is safe and feasible and the refinement of the Da Vinci Xi surgical system was much better than that of the conventional laparoscopic equipment, resulting in significantly improved intraoperative and postoperative outcomes.

Laparoendoscopic two-site myomectomy (LETS-M) using conventional laparoscopic instruments and the glove-port technique

To evaluate the perioperative outcome of laparoendoscopic two-site myomectomy (LETS-M). The medical records of 204 women receiving LETS-M in a tertiary referral center, including 183 surgeries performed by the experienced surgeon and 21 surgeries performed by 3 well-supervised trainees were retrospectively reviewed. The age of the participants was 39.3±6.4 years. The mean diameter of the largest myoma and the mean number of myomas were 8.5±2.2cm and 1.7±1.1, respectively. Thirty-one (15%) operations removed more than 2 myomas larger than 5cm in diameter. The mean weight of the myomas was 281.1±183.1g. The operation time was 97.6±40.2min, and the intraoperative blood loss was 99.3±115.2mL. There were 3 (1%) cases of excessive blood loss (more than 500mL) and 2 (1%) of postoperative hematoma. The only significant difference between the experienced surgeon and trainees was the operation time (92.3±32.2min vs. 141.2±54min, p<.001), while the myoma number, myoma diameter, myoma weight, and intraoperative blood loss were not significantly different. The operation time did not differ among different myoma locations. In multivariate analysis, virginity, myoma number, more than 2 large myomas, and myoma size were independent variables for longer operation times. No patient experienced any major complications. LETS-M using conventional laparoscopic equipment is a minimally invasive surgical method that is safe, effective, and easy to learn for managing uterine myoma. It is useful to achieve a favorable perioperative outcome with acceptable operation time.