Laparoscopic Radical Research Articles

Minimally Invasive Approach Provides Oncological Benefit in Patients with High Risk of Very Early Recurrence (VER) After Surgery for Intrahepatic Cholangiocarcinoma (iCCA).

Surgery for intrahepatic cholangiocarcinoma (iCCA) is jeopardized by significant risk of early recurrence (≤ 6 months). The aim of the present study is to analyze the oncological benefit provided by laparoscopic over open approach for iCCA in patients with high risk of very early recurrence (VER). A total of 532 liver resections (LR) were performed for iCCA [265 by minimally invasive surgery (MIS) and 267 with open approach, matched through a 1:1 propensity score] and stratified using the postoperative prediction model of VER. Outcomes were compared between open and laparoscopic approaches, specifically evaluating oncological benefit. The percentage of patients with high risk of VER was similar (32.7% in the laparoscopic group and 35.3% in the open group, pNS). The number of retrieved nodes as well as the rate and depth of negative resection margins were comparable between laparoscopic and open. The surgery-adjuvant treatment interval was shorter in laparoscopic patients in the overall series, as well in the subgroup of high risk of VER. The rate of patients starting adjuvant treatments within 2 months from surgery was higher in laparoscopic group compared with open group. In VER high-risk group both disease-free survival (DFS) and overall survival (OS) were significantly improved in MIS compared with open group (p = 0.032 and p = 0.026, respectively). In patients with high risk of VER, laparoscopy translates into an advantage in terms of recurrence-free survival, likely related to lower biological impact of surgery, together with a shorter interval between surgery and start of adjuvant treatments, even allowing for a higher number of patients to start adjuvant therapies within 2 months from resection.

Short-term outcomes after laparoscopic colorectal cancer surgery in patients over 90 years old: a Japanese multicenter study.

The effect of laparoscopic surgery on short-term outcomes in colorectal cancer patients over 90 years old has remained unclear. We reviewed 87 colorectal cancer patients aged over 90 years who underwent surgery between 2016 and 2022. Patients were divided into an open surgery group (n = 22) and a laparoscopic surgery group (n = 65). The aim of this study was to investigate the effect of laparoscopic surgery on postoperative outcome in elderly colorectal cancer patients, as compared to open surgery. Seventy-eight patients (89.7%) had comorbidities. Frequency of advanced T stage was lower with laparoscopic surgery (p = 0.021). Operation time was longer (open surgery 146min vs. laparoscopic surgery 203min; p = 0.002) and blood loss was less (105 mL vs. 20 mL, respectively; p < 0.001) with laparoscopic surgery. Length of hospitalization was longer with open surgery (22 days vs. 18 days, respectively; p = 0.007). Frequency of infectious complications was lower with laparoscopic surgery (18.5%) than with open surgery (45.5%; p = 0.021). Multivariate analysis revealed open surgery (p = 0.026; odds ratio, 3.535; 95% confidence interval, 1.159-10.781) as an independent predictor of postoperative infectious complications. Laparoscopic colorectal resection for patients over 90 years old is a useful procedure that reduces postoperative infectious complications.

Laparoscopy and Laparotomy for Endometrioid Adenocarcinoma: Short‐ and Long‐Term Outcomes’ Comparison

Aims. To analyze the short‐term and long‐term outcomes of laparoscopy versus laparotomy in treatment of endometrioid adenocarcinoma and examine the benefits of laparoscopy. Methods. From January 2012 to July 2020, 693 endometrioid adenocarcinoma patients undergoing laparoscopy versus laparotomy were retrospectively identified and enrolled in this study. Basic information for the patients, their perioperative indexes, and recurrence rates were reviewed to assess the therapeutic effect of these two approaches for endometrioid adenocarcinoma. Results. A total of 365 endometrioid adenocarcinoma patients underwent laparoscopy, and 328 patients underwent laparotomy. When compared with the laparotomic group, the laparoscopic group had longer operative times, lower intraoperative bleeding volumes, and shorter postoperative hospital stays. The rate of less‐radical hysterectomy and radical hysterectomy performed in the laparoscopic group (59/365, 16.16%) was significantly lower than that in the laparotomic group (162/328, 49.39%). There was no statistically significant difference in the local recurrence rate between the two groups; however, the remote recurrence rate in the laparotomic group (15/308, 4.87%) was significantly higher than that in the laparoscopic group (3/351, 0.85%). A further subgroup analysis revealed a higher survival benefit both in I/II patients (314/314, 100%, vs. 7/242, 28.93%) and III/IV patients (35/37, 94.59%, vs. 51/66, 77.27%) in the laparoscopic group, when compared with the laparotomic group. Conclusion. Patients who received laparoscopic surgery had a faster surgical recovery and a lower postoperative recurrence rate in the short term than patients who received laparotomic surgery. Laparoscopic surgery is a safe and effective treatment for endometrioid adenocarcinoma.

Robotic Versus Laparoscopic Abdominoperineal Resection for Locally Advanced Rectal Cancer Following Preoperative Chemoradiotherapy.

The usefulness of robotic surgery compared to laparoscopic surgery for rectal cancer has been reported; however, few reports exist on robotic abdominoperineal resection (APR). The aim of this study was to compare the outcomes of robotic and laparoscopic surgery to determine their usefulness in patients with locally advanced rectal cancer who had undergone preoperative chemoradiotherapy (CRT). This retrospective study included 43 patients with locally advanced rectal cancer who underwent preoperative CRT and robotic (22 patients) or laparoscopic APR (21 patients) between December 2012 and September 2022. We examined the short- and long-term outcomes in the robotic and laparoscopic groups. The median follow-up durations were 36 and 48 months for the robotic and laparoscopic groups, respectively. No significant differences in operative time, intraoperative blood loss, or overall complication rates were observed. However, the incidence of organ/space surgical site infection (SSI) was significantly lower in the robotic surgery group than in the laparoscopic group (9.1% vs. 38.1%, p=0.034) and the 3-year overall survival rate was significantly higher in the robotic surgery group than in the laparoscopic group (95% vs. 67%, p=0.029). Robotic APR was associated with a significantly lower rate of organ/space SSIs than the laparoscopic approach, indicating the usefulness of the robotic approach.

Laparoscopic vs open transcapsular adenomectomy (Millin): a comparative study of perioperative outcomes and complications.

Laparoscopic adenomectomy for prostates larger than 80 mL is still a topic of debate. The purpose of this study is to evaluate the perioperative outcomes and complications between open Millin (OM) and laparoscopic Millin (LM) adenomectomy. Perioperative data and complications were retrospectively collected from patients submitted to Millin procedure from August 2019 to August 2022 in a tertiary centre, and OM and LM were compared. Complications were classified according to Clavien-Dindo classification. A total of 205 patients were identified, 125 in the OM group and 80 in the LM group. Baseline characteristics were similar between the groups. Mean total blood loss (194 ±210 vs 477 ±389 mL, p <0.001), mean haemoglobin drop (1.40 ±1.16 vs 2.62 ±1.42 g/dL, p <0.001), duration of catheterisation (4.63 ±1.39 vs 5.37 ±1.99 days, p = 0.004), and hospital stay (4.59 ±1.72 vs 5.82 ±3.36 days, p = 0.003) were significantly lower in the laparoscopic group. The mean operative time was longer in the laparoscopic group (109.9 ±33.4 vs 68.7 ±18.0 min, p <0.001). The overall complication rate was significantly lower in the laparoscopic group (18.8% vs 36.8%; p = 0.012), and this difference was maintained only in Clavien-Dindo groups I (3.8% vs 13.6%; p = 0.018) and II (12.5% vs 21.6%; p = 0.049). Regarding individual complications, patients in the LM group had significantly less haematuria (1.3% vs 8.8%, p = 0.031), wound infections (0% vs 4.8%, p = 0.047), and blood transfusions (0% vs 6.4%, p = 0.024). Laparoscopic Miilin adenometomy is a safe technique, with less intraoperative blood loss, shorter length of hospital stay and catheterisation time, and fewer complications, including a lower transfusion rate, than its open counterpart.

A Safe Laparoscopic Approach for Ovarian Tumors during Pregnancy.

Surgery for pregnant women with ovarian tumors poses the risk of uterine irritation. We aimed to demonstrate the superiority of our laparoscopic technique over conventional methods and to compare the outcomes of laparoscopy with those of laparotomy for ovarian tumors during pregnancy. This retrospective study included 50 patients undergoing procedures for ovarian tumors during pregnancy at the Tokushima University Hospital between January 2005 and December 2021. We compared surgical outcomes between laparoscopic procedures and laparotomy, along with complications. In addition, we compared the frequency of uterine stimulation with the conventional trocar position to that with the currently used trocar position in laparoscopic surgery. Forty patients in the laparoscopy group and 10 in the laparotomy group underwent procedures. The laparoscopy group had less bleeding (16.4 ± 28.8 vs. 58 ± 72.2 mL, P < 0.05) and shorter hospital stays (7.6 ± 1.7 vs. 12.8 ± 13.1 days, P < 0.05) compared with those of the laparotomy group. The outcomes showed no significant differences between groups. All laparoscopies and laparotomies were successful and without complications. Furthermore, the current trocar position tended to stimulate the uterus less frequently. The results suggested that, compared to laparotomy, laparoscopy for ovarian tumors during pregnancy had better outcomes. The trocar position in our technique allows for easy operation of ovarian tumors without interference by forceps or cameras, resulting in minimal irritation of the uterus. Our original laparoscopic method may be safer with superior outcomes over the conventional method.

Clinical efficacy of laparoscopic treatment of pediatric inguinal hernia: a meta-analysis.

To evaluate operative outcomes and postoperative complications of laparoscopic treatment for pediatric inguinal hernia using meta-analysis. We conducted a comprehensive search of databases including the Chinese Journal Full-text Database, Wanfang, PubMed, Web of Science, ScienceDirect, VIP Chinese Science, and Technology Journal Database, ProQuest, JSTOR, Wiley, and IEEE Xplore. Relevant randomized controlled trials (RCTs) on laparoscopic surgery for pediatric inguinal hernia were collected, and data were analyzed using Review Manager 5.3. A total of 18 RCTs involving 5,750 children (3,357 in the laparoscopic group and 2,393 in the open surgery group) were included. Compared to the open surgery group, the laparoscopic group had significantly shorter operative times for bilateral hernias [(mean difference (MD) = -11.43, P = 0.04)], and lower incidences of metachronous contralateral inguinal hernia (MCIH) (MD = 0.17, P = 0.02) and testicular ascent (MD = 0.19, P = 0.03). However, there were no significant differences in operative time for unilateral hernia (MD = 0.47, P = 0.87), complication rate (MD = 0.87, P = 0.60), postoperative recurrence (MD = 1.46, P = 0.18), incision infection rate (MD = 2.54, P = 0.34), or testicular atrophy rate (MD = 0.36, P = 0.19). Laparoscopic surgery for pediatric inguinal hernia is effective, especially for bilateral cases, reducing operative time and lowering the risk of MCIH and testicular ascent.

Application value of laparoscopic surgery in elderly patients (≥ 75 years) with colorectal cancer and prognostic factors influencing 5-year overall survival.

To investigate the application value of laparoscopic surgery in elderly patients (≥ 75 years) with colorectal cancer, and to identify the prognostic factors influencing the long-term survival in this demographic, and to establish a predictive nomogram model. A retrospective analysis was conducted on 146 elderly (≥ 75 years old) colorectal cancer patients who underwent radical surgery in Baoji People's Hospital from August 2016 to February 2018, including 55 patients who underwent laparotomy and 91 patients who underwent laparoscopic surgery. Survival curves were plotted using the Kaplan-Meier method, and differences in prognosis were assessed using the Log-rank test. Prognostic impacts of various factors on 5-year survival were analyzed using a Cox proportional hazards model. Significant predictors identified in the Cox model were used to construct a nomogram for predicting survival, which was then validated for accuracy and clinical utility. Laparoscopic surgery was associated with shorter hospital stays (P = 0.022), although at a higher cost (P = 0.011). The laparoscopic group also had less intraoperative bleeding (P < 0.001), incision length (P < 0.001), time to first postoperative expectoration (P < 0.001), time to first postoperative feeding (P = 0.002), and time to postoperative peritoneal drainage (P = 0.003) compared to the open surgery group. Additionally, the rate of postoperative wound complications was also lower in the laparoscopic group (P = 0.014). There was no significant difference in the 5-year post-treatment survival between the two groups (P = 0.150). Multifactorial Cox regression analysis revealed that a history of diabetes mellitus (P = 0.037), vascular infiltration (P = 0.026), nerve bundle invasion (P = 0.001), and TNM stage (P = 0.001) were independent prognostic factors affecting the 5-year survival of patients with advanced colorectal cancer. The constructed nomogram showed high predictive accuracy for 1-, 3-, and 5-year survival, with AUC values of 0.91, 0.87, and 0.79, respectively. Calibration curves and decision curve analysis confirmed the model's clinical utility. Risk formula: History of diabetes mellitus * -0.696194503 + Vascular infiltration * -0.769736513 + Nerve bundle invasion * -1.1709777 + TNM staging * 1.201933691. Laparoscopic surgery can reduce intraoperative trauma and accelerate postoperative recovery in elderly colorectal cancer patients (≥ 75 years) compared to open surgery. The developed nomogram model based on independent prognostic factors such as diabetes history, vascular infiltration, nerve bundle invasion, and TNM staging, facilitates tailored prognostic assessment, enhancing individual patient management.

Health-related quality of life postventral hernia repair: Retrospective analysis

Abstract BACKGROUND: Laparoscopy has gained widespread adoption for ventral hernia repair, mirroring the trend seen in numerous intra-abdominal surgical procedures. The objective of this study was to evaluate the quality of life (QoL) of patients who underwent laparoscopic versus open surgical repair. MATERIALS AND METHODS: Patients who underwent surgery between January 2020 and December 2022 were included in this time-bound study. Of the 202 patients who underwent hernial repair over 3 years, all eligible patients were contacted and invited to participate in the study. The response rate was 77%, 155 patients completed the study questionnaire, which collected sociodemographic data, as well as the EORTC QLQ-C30 version 3.0 questionnaire, which assessed QoL. RESULTS: The mean age of the participants was 47.0 ± 13.0 years, with a range from 15.0 to 76.0 years. Among them, 67.7% were female, and 60.0% had comorbidities. Additionally, a lower proportion of laparoscopic cases required drain placement compared with the open group (12.9% vs. 26.9%). Patients who underwent laparoscopic surgery had shorter hospital stays within “1 day” (46.8% vs. 36.6%) or “2 days” (22.6% vs. 19%) and experienced a quicker return to activity, with a higher proportion resuming normalcy after 2 weeks (27.4% vs. 20.4%). Furthermore, patients in the open group reported higher pain scores, higher constipation, and insomnia scores than those in the laparoscopic group. CONCLUSIONS: This study showed that laparoscopic repair had fewer complications than open repair in terms of hospital stay, return to activities, and pain score. Regarding the QoL scale, the laparoscopic approach shows a far better QoL profile compared with the open technique.

Distal pancreatectomy.

Distal pancreatectomy is astandard surgical procedure for selected benign, premalignant, and malignant lesions localized in the pancreatic body or tail. Surgical resection remains the only curative option for patients diagnosed with adenocarcinoma of the pancreas. Perioperative and postoperative clinical courses were retrospectively assessed in patients, who underwent distal pancreatectomy during the 2011‒2021 period. During the 2011‒2021 period, atotal of 112 distal pancreatectomies were performed. 67 patients (59.8%) underwent laparoscopic distal pancreatectomy, and 45 patients (40.2%) open laparotomy. The conversion was necessary for 13 patients (11.6%). Distal pancreatectomies performed laparoscopically were associated more often with biochemical leak and the development of grade Bfistula, on the other hand grade Cfistula developed only in patients operated by open laparotomy (LPT). The mean operating time was slightly longer in the laparoscopic group (227.1 min vs 214.6 min). The mean estimated blood loss was significantly higher in the LPT group (540.4 ml vs 191.9 ml). The mean hospitalization time was slightly longer in the LPT group (11.8 days vs 9.3 days). The rates of early reoperations were comparable between both groups (6 vs 5). Laparoscopic techniques are preferred in centers around the world to bring patients benefits by using aminimally invasive approach. These techniques are also preferred in our center, in nearly 60% of all distal pancreatectomies performed during 10 years, but on the other hand, there is amuch more careful approach chosen in cases of malignant disease to achieve adequate radicality (Tab.4, Ref. 20).

Early Experience with the Senhance Surgical System in Bariatric Surgery.

Robotic-assisted surgery advancements have paralleled growing bariatric surgery demands. The Senhance robotic platform offers an alternative to the da Vinci surgical system but there are limited studies evaluating the Senhance system in bariatric surgery. This study aims to review a single surgeon's experience comparing outcomes between traditional laparoscopic and Senhance-assisted sleeve gastrectomy. All sleeve gastrectomies performed laparoscopically, Senhance-assisted, or da Vinci-assisted by a single surgeon at an academic center from January 2019 to July 2021 were retrospectively reviewed. Primary outcomes and quality measures were 30-day complications, operative times and length of stay. A total of 268 patients, including 162 laparoscopic, 92 Senhance, and 14 da Vinci cases, were included. Operative times were significantly longer with Senhance (115.7 min) and da Vinci (122.7 min), compared to laparoscopic (94.8 min, P < .0001). Length of stay (measured in days) was significantly longer in the Senhance (1.8) and da Vinci (2.2) groups compared to laparoscopic cases (1.5, P < .0001). These differences remained significant after controlling for age, sex and body mass index. 30-day complication rates were 8.7% (n = 8) in the Senhance group, 7.1% (n = 1) in the da Vinci group and 2.5% (n = 4) in the laparoscopic group (P = .0567). Senhance-assisted sleeve gastrectomy is safe in bariatric surgery and comparable to laparoscopic sleeve gastrectomy with respect to 30-day complications.

Disparities of tumour markers in intraperitoneal drainage fluid between laparoscopic and open radical gastrectomy for gastric cancer.

Despite the remarkable progress in minimally invasive surgery, the potential association between laparoscopic gastrectomy and the risk of peritoneal metastasis remains uncertain. To investigate variations in tumour markers in intraperitoneal drainage fluid between laparoscopic radical gastrectomy and open radical gastrectomy for gastric cancer. A total of 106 patients diagnosed with gastric cancer between July 2018 and November 2020 were included in this study, 45 of whom underwent laparoscopic radical gastrectomy (laparoscopic group) and 61 underwent open radical gastrectomy (open group). Variations in the levels of carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), cancer antigen 199 (CA199), and α-fetoprotein (AFP) in the intraperitoneal drainage fluid were compared and analysed on postoperative days (PODs) 1, 2, 3, and 5 between the two groups. Additionally, the postoperative 3-year survival rates between the two groups were compared and analysed. No significant differences in CEA, CA199, and AFP levels in the intraperitoneal drainage fluid were observed between the two groups on postoperative days (PODs) 1, 2, 3, and 5 (p > 0.05). However, the level of CA125 in the intraperitoneal drainage fluid of the laparoscopic group was notably higher than that of the open group on POD 2 (p < 0.05); however, there were no significant differences between the two groups on PODs 1, 3, and 5 (p > 0.05). There was no significant difference in the 3-year postoperative survival rates between the two groups. There were no significant differences in CEA, CA125, CA199, and AFP levels in the intraperitoneal drainage fluid between laparoscopic radical gastrectomy and open radical gastrectomy for gastric cancer, confirming from another perspective that laparoscopic radical gastrectomy does not increase the risk of intraperitoneal metastasis.

Early outcomes of single-port robotic left lateral sectionectomy in patients with hepatic tumor.

Laparoscopic left lateral sectionectomy (L-LLS) stands as a cornerstone procedure in hepatobiliary minimal surgery, frequently employed for various benign and malignant liver lesions. This study aimed to analyze the peri- and postoperative surgical outcomes of single-port robotic left lateral sectionectomy (SPR-LLS) vs. those of L-LLS in patients with hepatic tumors. From January 2020 through June 2023, 12 patients underwent SPR-LLS. During the same period, 30 L-LLS procedures were performed. In total, 12 patients in the robotic group and 24 patients in the laparoscopic group were matched. When the SPR-LLS and L-LLS groups were compared, the operation time was longer in the SPR-LLS group with less blood loss and shorter hospital stay. Postoperative complications were observed in 3 patients in the L-LLS group (12.5%) and 1 patient in the SPR-LLS group (8.3%). SPR-LLS using the da Vinci SP system was comparable to laparoscopic LLS in terms of surgical outcomes. SPR-LLS was associated with lower blood loss and less postoperative length of stay compared to L-LLS. These findings suggest that left lateral sectionectomy is technically feasible and safe with the da Vinci SP system in select patients.

Comparison of Costs, Re-Intervention Rates, and Length of Hospital Stay for Three Uterus Sparing Interventions for Uterine Fibroids: A 2-Year Retrospective Claims Analysis.

To describe two-year post-operative outcomes, and healthcare utilization of three uterus-sparing interventions used to treat women with intramural and/or subserosal uterine fibroids. This was a post-market, randomized, prospective, multi-center, longitudinal, interventional, and comparative clinical study to evaluate the costs and health outcomes of LAP-RFA vs the standard uterine conserving technologies (myomectomy and UAE) for the treatment of symptomatic uterine fibroids in women who desire uterine conservation. For this RCT study, 54 subjects were randomized on a 1:1 ratio across the three procedures and followed out to two years. Their results were compared to retrospective US insurance claims from the IBM MarketScan® Commercial Database from 2017-2020 for 96,854 women who underwent a uterus-sparing procedure for fibroids. Mean ambulatory surgical center costs and the mean out-patient hospital costs were lowest for LAP-RFA ($13,134 and $14,428) and highest for UAE ($28,214 and $19,131). The total two-year re-intervention rate of any subsequent procedure (AM, LM, LAP-RFA, or UAE) was lowest in AM group (0%) followed by LM (4.2%), LAP-RFA (11%), and UAE (33%). Mean peri-operative reintervention costs and the mean reintervention total costs were $2429 and $5939 for LAP-RFA, $2122 and $8368 for LM, $4410 and $11,942 for AM, and $8113 and $46,692 for UAE subjects. In the RCT study, the average length of hospital stay was significantly less for the LAP-RFA group subjects (8.2 hours) in contrast to both the laparoscopic myomectomy group subjects (16.0 hours) and the abdominal myomectomy group subjects (33.6 hours). Despite the small numbers, two-year reintervention rates followed a similar pattern as the IBM MarketScan data. In comparing these three non-invasive approaches, LAP-RFA was associated with the lowest peri-operative cost, and UAE was associated with the highest peri-operative cost. Further studies are needed to assess the cost, effectiveness, and subject satisfaction with each procedure.

Comparison of the different operation room environmental exposures on tear film function before and after operation

1.2 Previous studies have confirmed that air and light pollution can cause damage to a number of systems throughout the body, including the ocular surface and retina. However, the exact effect of air pollution and light pollution on tear film function is not clear. This study explored the different operation room environmental exposures on tear film function before and after operation. Sixty medical staff in the operating room were selected and divided into 4 groups according to different surgical methods to evaluate the tear film function before and after operation: Da Vinci surgery group (DVSS), Laparoscopic surgery group (LS), Traditional surgery group (TS), and Ophthalmic microsurgery group (OM). The results showed that the levels of light and air pollution were elevated in operating rooms during the operation and the changes of tear film function in the other three groups were statistically significant except for DVSS group. In TS group, particulate matter (pm) 1 (R = 0.61, p < 0.01), pm2.5 (R = 0.63, p < 0.01), and pm10 (R = 0.67, p < 0.01) were positively correlated with eye redness index, and first and average noninvasive tear film break-up times were positively correlated with illuminance (R = 0.54, p < 0.05; R = 0.97, p < 0.01). In OM group, there was a positive correlation between the operation time and the first (R = 0.69, p < 0.01) and average (R = 0.89, p < 0.01) noninvasive tear film break-up times. Our research found that exposure to different operating room environment will lead to damage of tear film function, but also provide a theoretical basis for the improvement of surgical environment.

CONVERSION OF LAPAROSCOPIC TO OPEN CHOLECYSTECTOMY

Background: Globally, gallstone disease (GS) is a significant health issue, especially for adults although cholecystitis is common, there is an evidence of variance in its diagnosis and course of therapy, including surgery. In place of open cholecystectomy, laparoscopic cholecystectomy is now the preferred course of treatment for symptomatic cholelithiasis. In situations where laparoscopic cholecystectomy is dangerous; a surgeon may be forced to change from laparoscopy to an open procedure. The aim of the study was to clarify the benefits and role of minimally invasive surgery in comparison to the open conventional method of cholecystectomy, with a focus on the postoperative phase and to compare the ratio of Laparoscopic and open cholecystectomy between male and female genders. Methods: 185 Patients of cholecystitis aged between 10 years to 80 years (86.5% males and 13.5% females) were presented to Zawia Medical Center during the period from March 2005 till April 2006 that randomly get an open or laparoscopic cholecystectomy. They were divided into open and laparoscopic Cholecystectomy group. Results: In this study, a total of 185 patients were included: 160 females (86.5% of the total) and 25 males (13.5% of the total). Whereas, 86 females (53.7%) were operated on by laparoscopic cholecystectomy, and 74 females (46%) were operated on by open cholecystectomy. In comparison, of a total of 25 males, 12 (48%) underwent laparoscopic cholecystectomy and 13 (52%) underwent open cholecystectomy. The conversion rate was eight cases (8.2%) due to technical, bleeding, or massive adhesion. Conclusion: From this study, we concluded that the laparoscopic cholecystectomy versus open cholecystectomy ratio (female: male ratio) was 86.5% to 13.5% of the total 185 patients, and laparoscopic cholecystectomy appears to be a safe procedure with quick recovery, early discharge from the hospital, and less postoperative pain as compared to open cholecystectomy.

Is robotic surgery beneficial for the treatment of endometrial cancer? A comparison with conventional laparoscopic surgery.

Objective: The objective of this study was to compare the oncologic outcomes between those who underwent robotic surgery or conventional laparoscopic surgery for endometrial cancer. Method: We performed a retrospective review of patients from a single institution who underwent either laparoscopic or robotic surgery for the treatment of endometrial cancer between January 2010 and December 2020. Tumor characteristics, recurrence rate, disease-free survival, and overall survival were compared according to surgical approach. Results: Among the 268 patients included in this study, 95 underwent robotic surgery (35.4%) and 173 underwent laparoscopic surgery (64.6%). The median follow-up durations were 51 and 59 months for the robotic surgery and laparoscopic surgery groups, respectively (p = 0.085). The recurrence rate did not differ significantly between the two groups. (p = 0.371). Disease-free survival (p = 0.721) and overall survival (p = 0.453) were similar between the two groups. In both univariate and multivariate analyses, the type of surgery was not related to disease-free survival. The median total cost per admission was significantly higher for RS than for LS (12,123 vs. 6,884 USD, p < 0.0001). Conclusion: With consistently greater costs and similar survival outcomes, robotic systems have few advantages compared with laparoscopy.

Laparoscopic nephrectomies and kidney resections in children

To present the experience of laparoscopic nephrectomies and kidney resections in children. There were 28 minimally invasive surgeries for renal tumors between July 2015 and March 2023 (92 months). There were 16 (57%) boys and 12 (43%) girls who underwent 22 nephrectomies and 6 kidney resections. The median age of patients was 54 (38; 76.5) months. In the laparoscopic nephrectomy group, the median surgery time was 135 (108-188) min, blood loss - 10 (3.75-15) ml. Total resection was confirmed in all patients. In the group of minimally invasive kidney resections, these values were 182.5 (157.5; 265) min and 50 (42.5; 117.5) ml, respectively. Histological examination confirmed total resection in all patients. In both groups, none patient developed postoperative complications. Event-free survival was 86.72% with a median follow-up of 82 months, and local recurrence-free survival was 95.8% with a median follow-up of 89.8 months. Minimally invasive nephrectomies and resections are safe in children in case of careful patient selection.

Comparing the efficacy and safety of three surgical approaches for total hysterectomy (TSATH): protocol for a multicentre, single-blind, parallel-group, randomised controlled trial

IntroductionHysterectomy is the most common surgical procedure in the field of gynaecology. The traditional multiport laparoscopy, transumbilical laparoendoscopic single-site surgery (TU-LESS) and transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy...

What is the applicability of tubal ligation with the vaginal natural orifice transluminal endoscopic surgery technique and its value in patient comfort?

The aim of this study was to observe the feasibility of the tubal/adnexal approach using vaginal natural orifice transluminal endoscopic surgery and compare its contribution with surgeon ergonomics and postoperative patient comfort with that of conventional laparoscopy. We completed this study retrospectively with 47 patients. Patients were followed at their postoperative first month. We analyzed the usability of the vaginal natural orifice transluminal endoscopic surgery method over conventional laparoscopy by comparing the demographics, surgical data, and postoperative findings collected between the two groups. Patients in the conventional laparoscopy group were older (39.1±3.3 years) than those in the vaginal natural orifice transluminal endoscopic surgery patient group (p=0.005). Pain intensity 24 h after surgery was lower in the vaginal natural orifice transluminal endoscopic surgery group (p=0.003), while sexual function and dyspareunia did not differ between the two groups in the first month. Patients in the vaginal natural orifice transluminal endoscopic surgery group were more relieved about painlessness and the comfort it brought than the conventional laparoscopy group (p=0.027, χ2=12.56). Patients subjected to the vaginal natural orifice transluminal endoscopic surgery procedure showed higher levels of satisfaction, less postoperative pain, and greater comfort than those subjected to conventional laparoscopy.