Laparoscopic Route Research Articles

Navigating the Pediatric Inguinal Hernia Repair Conundrum: Occult Bilaterality of Patent Processus Vaginalis as an Indication for Laparoscopy

ABSTRACT Introduction: Bilateral inguinal hernia is universally accepted as an indication to repair a pediatric inguinal hernia through the laparoscopic route. However, there is often a debate regarding whether laparoscopic inguinal hernia repair (LIHR) has a role in the management of unilateral inguinal hernia. The aim of the study was to ascertain the incidence of contralateral patent processus vaginalis (PPV) in patients undergoing LIHR. Materials and Methods: A retrospective review of the electronic medical records of cases of inguinal hernia who underwent laparoscopic hernia repair in the department during the period from September 2016 to August 2023. Parameters studied included age, gender, side of the hernia, incidence of contralateral PPV, recurrence rates, and complications. As per the protocol, all patients who had an occult bilaterality discovered intraoperatively were repaired in the same sitting after the repair of the presenting side. A review of the literature was also done to find the rationale behind laparoscopic pediatric inguinal hernia repair. Results: A total of 255 patients were included in the study. The mean age was 45.2 months and varied from 0 months to 192 months. Ligation of the sac was performed after division or without division, depending on the preference of the operating surgeon. The follow-up varied from 3 months to 7 years (mean 3.8 years). Ten (4.08%) patients had bilateral inguinal hernia at diagnosis, with left-side inguinal hernia in 95 (38.77%) and right-sided hernia in 150 (61.22%). Out of the 245 patients with unilateral inguinal hernia, a contralateral PPV was found in 48 (19.5%) patients. We had a total of seven recurrences in the cohort (2.7%), none of which were seen on the contralateral side, which was closed during the primary procedure itself. All of them occurred in patients aged between 1 and 3 years of age. Of the seven children who had recurrence, two patients had large inguinoscrotal swellings at presentation, and two patients had spinal dysraphism (repaired earlier) along with an inguinal hernia. Conclusion: Our results show that out of our cohort of 245 patients with unilateral inguinal hernia, approximately one-fifth of the patients have PPV on the contralateral side. This can be very well repaired in the same sitting via laparoscopy without increasing the morbidity and preventing metachronous hernia on the contralateral side.

Reviving forgotten techniques: Vaginal salpingectomy in public health system, a retrospective cohort study.

To evaluate the viability of the vaginal route as an alternative to laparoscopy for patients seeking permanent surgical contraception. We conducted a retrospective cohort study in 2021, dividing patients into two groups based on their preference: vaginal and laparoscopic salpingectomy. The statistical analysis was conducted using STATA, employing standard statistical methods based on the distribution of variables. The study included 64 patients, with 34 undergoing the vaginal approach and 30 the laparoscopic route. No statistically significant differences were observed in baseline characteristics or complications between the two groups. Both surgical methods were found to be feasible. The vaginal route demonstrated a significantly shorter mean surgical time (P < 0.001). The laparoscopic route exhibited significantly less intraoperative blood loss (P < 0.001) and fewer hospitalization hours (P = 0.008). Postoperative satisfaction and pain levels did not show statistically significant differences. Vaginal salpingectomy is a feasible technique with low complication rates, making it a potential option for gynecologists to offer their patients. We propose vaginal route inclusion in the training curriculum for gynecologic surgeons during the residency program, without any subspecialty requirements.

Novel Vaginal Cerclage Assisted Laparoscopic Cervico-Sacropexy Technique for Uterovaginal Prolapse.

Laparoscopic hysteropexy is a complicated procedure that requires specialized surgical skills, including precise dissection and suturing. The aim is to describe the technical considerations for performing a new, feasible, and minimally invasive technique to correct apical and concurrent apical and anterior vaginal wall defects. A retrospective analysis was conducted on 70 consecutive women who underwent surgery for stage ≥3 uterovaginal prolapse. As a part of the technique, an anterior 2-cm long transverse incision was made at the anterior cervicovaginal junction, and the bladder was dissected through blunt and sharp dissection to the level of the isthmus. A posterior colpotomy was performed. A polypropylene tape was inserted into the cervical connective tissue, and the free arms of the tape were inserted into the peritoneum via the posterior colpotomy. Two arms of the tape were passed from the tunnel parallel and medial to a right sacrouterine fold, then fixed to the anterior longitudinal ligament via the laparoscopic route. The tape can be inserted into the cervix in a median of 15min, and the laparoscopy procedure can be completed in 24min. No mesh erosion or long-term complications occurred. At a 1-year control, there were no cases of recurrence. This novel cervico-sacrocolpopexy technique is a feasible and safe, minimally invasive way to correct apical or multicompartment defects, with a short operation time and an anatomical result that mimics the normal sacrouterine ligament.

Aiming for zero: Success of the hysterectomy surgical site infection prevention bundle.

The Center for Disease Control's National Healthcare Safety Network (NHSN) reported increased Standardized Infection Ratios (SIRs) for hysterectomy at a large community hospital. To promote a surgical site infection (SSI) prevention bundle implemented to reduce hysterectomy-associated SSI. A multidisciplinary Workgroup implemented the Hysterectomy SSI Prevention Bundle in 2020 to enforce standardization of perioperative techniques. This study included all benign hysterectomies pre-implementation (n = 857) and post-implementation (n = 772). Per NHSN categorization guidelines, "abdominal hysterectomy" includes both open and laparoscopic routes. "Inpatient surgery" is date of discharge different from date of surgery; "outpatient surgery" is same date of discharge. "SSI" includes superficial, deep, and organ/space; "complex SSI" includes deep and organ/space. Patient demographics were categorized and evaluated for statistical significance. After implementation of the SSI bundle, SIRs for hysterectomy were reduced to <1.0, indicating infection prevention. Reductions in SIR were significant for outpatient abdominal hysterectomy (0.868 [p = .007]), inpatient vaginal hysterectomy (0 [p < .001]), inpatient complex abdominal hysterectomy (0 [p = .040]), and inpatient complex vaginal hysterectomy (0 [p < .001]). Differences between groups were significant for increased laparoscopic and decreased vaginal hysterectomies (p < .001), increased outpatient surgeries (p < .001), and longer procedure duration (p < .001). Implementation of an SSI prevention bundle at a large community hospital has significantly reduced SIR for inpatient vaginal hysterectomies, outpatient abdominal hysterectomies, and all inpatient complex hysterectomies.

Aiming for Zero: Success of the Hysterectomy Surgical Site Infection Prevention Bundle

Background: The Center for Disease Control’s National Healthcare Safety Network (NHSN) reported an increased Standardized Infection Ratio (SIR) at a large community hospital, calculated by the number of observed infections over the number of predicted infections. In response to the increased SIR, a multidisciplinary Hysterectomy Surgical Site Infection (SSI) Prevention Workgroup was formed in 2019. Objective: To promote a surgical site infection prevention bundle that was implemented at a large community hospital to reduce hysterectomy associated surgical site infections. Study Design: The Workgroup implemented an evidence-based Hysterectomy SSI Prevention Bundle which enforced standardization of measures and techniques at: The pre-operative clinic appointment, the day of surgery, the intra-operative time prior to incision, the intra-operative time from incision to closure, and in the immediate post-operative recovery. The Hysterectomy SSI Prevention Bundle was implemented November 2, 2020. This study included all hysterectomies for benign pathologies from 10/1/2018 to 9/30/2020 [pre-implementation (n=811)] and 1/1/2021 to 9/30/2022 [post-implementation (n=772)]. Per NHSN data categorization guidelines, a designation of abdominal hysterectomy includes both open and laparoscopic routes. Inpatient surgery was defined as that with a date of discharge different from date of operation; outpatient surgery was defined as the one with the same date of discharge. SSIs included superficial, deep and organ/space, while complex SSIs included deep and organ/space. Patient demographics were categorized and evaluated for statistical significance. Results: After implementation of the SSI bundle, SIR for hysterectomies was reduced to &lt; 1.0, indicating infection prevention. Outpatient abdominal hysterectomy SIR pre-implementation was 2.551 and post-implementation was 0.868 (p=0.007). The outpatient vaginal hysterectomy SIR pre-implementation was 0, and post-implementation remained 0 (p=0.364). Inpatient abdominal hysterectomy SIR pre-implementation was 1.554 and post-implementation was 0.443 (p=0.072). The inpatient vaginal hysterectomy SIR preimple-mentation was 1.064, and post-implementation was 0 (p &lt;0.001). The inpatient complex abdominal hysterectomy SIR pre-implementation was 1.757 and post-implementation was 0 (p=0.040). The inpatient complex vaginal hysterectomy SIR pre-implementation was 1.001, and post-implementation was 0 (p &lt;0.001). Differences between the pre- and post-implementation groups were significant for increased laparoscopic hysterectomies (p&lt;0.001), decreased vaginal hysterectomies (p&lt;0.001), increased number of same day discharges (p&lt;0.001), longer procedure duration (p&lt;0.001), and younger age (p=0.039). Conclusion: Implementation of an evidence-based surgical site infection prevention bundle at a large community hospital has significantly reduced SIR for inpatient vaginal hysterectomies, outpatient abdominal hysterectomies, and all inpatient complex hysterectomies.

A STUDY ON INDICATIONS, MODE OF HYSTERECTOMY AND HISTOPATHOLOGICAL ANALYSIS OF HYSTERECTOMY SPECIMENS

Objectives: To study the age distribution, indications, modes of hysterectomy, concurrent surgery done along with hysterectomy, and histopathological analysis of hysterectomized specimens. Methods: This study was conducted in the Department of Obstetrics and Gynecology, Mediciti Institute of Medical Sciences, a tertiary teaching hospital at Medchal. Medical records of 240 cases of hysterectomy performed from January 2015 to December 2021 were retrieved from the Medical Record Department. The age distribution, indications of hysterectomy, mode of hysterectomy, concurrent oophorectomy, and histopathological reports of hysterectomy specimens were analyzed in this study. Results: Out of the total 240 hysterectomies, 51.25% were in the age group of 40–49 years, followed by the age group of 50–59 years, i.e., 19.5%. Common indications for hysterectomy were AUB (36.25%), fibroids (34.58%), and UV prolapse (29.16%). Abdominal hysterectomy (62.5%) was performed more commonly than vaginal hysterectomy (29.16%). Histopathological analysis showed the most common pathologies as atrophic endometrium, leiomyoma in the myometrium, and inflammation in the cervix. Concurrent bilateral oophorectomy was done in 51.66%, unilateral oophorectomy was done in 10%, and ovaries were conserved in 38.33%. Conclusion: Hysterectomy is a common major gynecological surgery performed, most commonly in the perimenopausal age group. Although there is an increased trend toward the laparoscopic route, the abdominal route is still the preferred route. Leiomyoma is the most common pathology found in hysterectomized specimens. AUB being the most common indication for hysterectomy, there should be increased use of medical management, and patients should be counseled for conservative management in order to prevent increased surgical interventions.

Determining the need for a thoracoscopic approach to treat a giant hiatal hernia when abdominal access is poor.

Giant hernias present a significant challenge for digestive surgeons. The approach taken (laparoscopic vs thoracoscopic) depends largely on the preferences and skills of each surgeon, although in most cases today the laparoscopic approach is preferred. To determine whether patients presenting inadequate laparoscopic access to the intrathoracic hernial sac obtain poorer postoperative results than those with no such problem, in order to assess the need for a thoracoscopic approach. For the retrospective series of patients treated in our hospital for hiatal hernia (n = 112), we calculated the laparoscopic field of view and the working area accessible to surgical instruments, by means of preoperative imaging tests, to assess the likely outcome for cases inaccessible to laparoscopy. Patients with giant hiatal hernias for whom a preoperative calculation suggested that the laparoscopic route would not access all areas of the intrathoracic sac presented higher rates of perioperative complications and recurrence during follow-up than those for whom laparoscopy was unimpeded. The difference was statistically significant. Moreover, the insertion of mesh did not improve results for the non-accessible group. For patients with giant hiatal hernias, it is essential to conduct a preoperative evaluation of the angle of vision and the working area for surgery. When parts of the intrathoracic sac are inaccessible laparoscopically, the thoracoscopic approach should be considered.

Surgical Site Infection in Laparoscopic Hysterectomy versus Abdominal Hysterectomy in Gynecological Disease(s): An Overview.

Surgical site infection (SSI) is an unsettled complication seen in any surgery. The aim of this study is to assess the rate of postoperative SSIs between total laparoscopic hysterectomy (TLH) and total abdominal hysterectomy (TAH). Can the rate of SSI be reduced with the use of a laparoscopic mode of hysterectomy over abdominal? It was a retrospective comparative study. The study was conducted in the obstetrics and gynecology department at a tertiary care center from June 2016 to March 2020. A total of 300 patients who underwent hysterectomy either via laparoscopic or abdominal route were included in the study. They were subdivided into two groups: a total of 167 underwent TLH (Group 1) and 133 had TAH (Group 2). The results were compared. It included the age and body mass index of the patient, indication of surgery, size of the uterus, intraoperative blood loss, postoperative SSIs, duration of hospital stay, and readmission rates. It was found a high rate of SSI in TAH (82.4% vs. 17.6%, P < 0.001, Cramer's V-0.18), the operative time taken (75 ± 25 min vs. 128 ± 52 min, P < 0.001), and the mean blood loss during TLH (110 ± 30 ml vs. 160 ± 116 ml, P < 0.001) was found significant for patients. The hospital stay after TLH was found to be significantly shorter (4 ± 2.47 days vs. 7 ± 2.43, P < 0.001). TLH has improved the psychological, physical, and financial burden on the health care department. Thus, it has proved a preferred route over TAH.

Vaginal Vault Closure Following Total Laparoscopic Hysterectomy: Laparoscopic versus Conventional Technique - A Comparative Study.

Vault closure is the final step to hysterectomy, protecting the abdominal cavity from the exterior environment. Thus, closure becomes crucial in preventing ascend of infection to the peritoneal cavity. Our study aims to compare vault closure between laparoscopic and vaginal routes, their operating time, and postoperative complications. The ambispective comparative study was done in a tertiary care teaching center from June 2016 to December 2022. Three hundred and forty-four patients were included in the study that underwent a total laparoscopic hysterectomy. Interventions - Patients who had laparoscopic vault closure were in Group 1 (N = 198) and those who had vaginal closure were in Group 2 (N = 146). The results were compared. It included age, body mass index of the patient, the indication of surgery, intraoperative blood loss, size of the uterus, time taken during vault closure, and postoperative complications. The time taken by laparoscopic vault repair was significantly less than vaginal repair (19.7 ± 13.3 min vs. 30.1 ± 6.6 min, P < 0.001). There was postoperative vault infection (2.7%), vault hematoma (1.3%), and no vault prolapse seen in vaginal repair. The organisms isolated were mainly Pseudomonas aeruginosa, Escherichia coli, and Klebsiella. Laparoscopic vault closure has shown significantly improved results compared to vaginal route repair.

Racial Disparities in Hysterectomy Route for Benign Disease: Examining Trends and Perioperative Complications From 2007 to 2018 Using the NSQIP Database

(Abstracted from J Minim Invasive Gynecol 2023;30(8):627–634) One of the most common gynecological procedures performed within the United States, the trends of hysterectomy types have changed over the past 30 years, with the 1990s demonstrating predominantly abdominal hysterectomies, whereas current trends tend to favor minimally invasive hysterectomies (MIHs) using laparoscopic or vaginal routes. In addition, within the hysterectomy trend, it is notable that higher rates of abdominal hysterectomy and postoperative complications occur for Black and Hispanic women as seen across varying health care systems.

Incorporating laparoscopic interval cytoreductive surgery for advanced ovarian cancer-lessons learnt

ObjectiveTo assess the utility of laparoscopy for interval cytoreductive surgery (CRS) in patients with advanced ovarian cancer after Neo-Adjuvant Chemotherapy (NACT). MethodsA retrospective cohort study of interval CRS by laparoscopy in patients with advanced epithelial ovarian cancer treated at a single tertiary gynaecological cancer centre between October 2017 and September 2020. Results86 patients had interval CRS by the laparoscopic route during the study period. The optimal cytoreduction rate (R ​< ​1 ​cm) was 92%, and complete cytoreduction rate with no residual disease (R ​= ​0) was 35%. The intra-operative complication rate was 8% and the estimated blood loss (EBL) was 90 ​ml. The post-operative complication rate was 15%, mostly grade I-II, and the median length of hospital stay was 3 days. ConclusionFor most patients with advanced ovarian cancer after NACT, laparoscopic interval CRS is feasible and effective in achieving optimal cytoreduction while providing a favourable peri-operative outcome. In some cases, however, recourse to laparotomy will optimise complete macroscopic resection.

The Pros and Cons of Hystero-preservation on Pelvic Reconstructive Surgery.

In the "boat at the dock" theory, pelvic organ prolapse (POP) may happen when the ropes (uterine supportive ligaments) break and/or the water level drops (pelvic floor muscles). Thus, it causes the boat (uterus and other pelvic organs) to slip from normal position and protrude out of the vagina. Surgical intervention with or without hysterectomy (hystero-preservation) is the most effective treatment for POP. Both hysterectomy and hystero-preservation for POP had a high anatomic and clinical cure rate. There is an increasing trend of hystero-preservation for POP during the past decades. The choices of either hysterectomy or hystero-preservation depend on the surgical factors, psychosocial factors, self-esteem and sexuality factors, and surgeon factors. Pelvic reconstructive surgery, either hysterectomy or hystero-preservation, can be performed via different approaches, including abdominal, laparoscopic, and vaginal routes, with native tissue or with mesh. This review will elucidate their related pros and cons, with further discussion and comparison of hystero-preservation via different routes.

VNOTEsHC : Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopic for large uteri: study protocol for a multicentre randomised controlled trial.

In France, 62,000 hysterectomies are performed per year, 70% of which are benign. The choice of approach (laparotomy, laparoscopy or vaginal route) is particularly important in the case of large uterus (> 280g) which are associated with a higher risk of complications. The current data are not sufficient to favour one or other approach. A new medical device, the vNOTES (Natural Vaginal Orifice Transluminal Endoscopy System), offers the advantage of both laparoscopic and vaginal route for pelvic surgery. To demonstrate the superiority in terms of intraoperative and postoperative complications of the use of a natural orifice transluminal endoscopic hysterectomy system (vNOTES) versus laparoscopic hysterectomy for benign pathologies on estimated large volume uteri (>280g). A randomised, double-blind, superiority trial will be performed at five hospital centres. Women with benign uterine pathology requiring hysterectomy and with a large uterus (> 280g) will be randomised to receive either laparoscopic or vNOTES hysterectomy. The primary outcome will be the occurrence of intraoperative and postoperative complications within 6 weeks of surgery. Secondary outcomes will be conversion during surgery, duration of surgery and hospitalisation, postoperative pain, postoperative complications, resumption of sexual life and satisfaction with the surgical team. 248 women will be randomised. This trial will provide a better understanding of the approach to large uteri optimise the care of these thousands of women undergoing hysterectomy. This trial will evaluate the vNotes for large uteri.

Venous Thromboembolism After Abdominal and Minimally Invasive Large Specimen Hysterectomy

To investigatethe incidence of venous thromboembolism (VTE) in patients undergoing large specimen hysterectomy for benign indications. To evaluate the impact of route of surgery and operative time in the development of VTE in this population. Retrospective cohort study (Canadian Task Force Classification II2) of targeted hysterectomy data prospectively collected from the American College of Surgeons National Surgical Quality Improvement Program involving over 500 hospitals across the United States SETTING: National Surgical Quality Improvement Program Database PATIENTS: Women aged 18 years or older undergoing hysterectomy for benign indications between 2014 and 2019. Patients were further classified into four groups according to uterine weight: <100g, 100-249g, 250g-499g, and specimens ≥500g. Current Procedural Terminology codes were used to identify cases. Variables including age, ethnicity, body mass index, smoking status, diabetes, hypertension, blood transfusion, and American Society of Anesthesiologists classification system scores were collected. Cases were stratified by route of surgery, operative time, and uterine weight. A total of 122,418 hysterectomies occurring between 2014-2019 were included in our study, of which 28,407 (23.2%) patients underwent abdominal, 75,490 (61.7%) laparoscopic, and 18,521 (15.1%) vaginal hysterectomy. The overall rate of VTE in patients with large specimen hysterectomies (≥500g) was 0.64%. After multivariable adjustment, there was no significant difference in the odds of VTE between uterine weight groups. Only 30% of the surgeries with uterine weight above 500g were performed with minimally invasive surgical routes. Patients who underwent minimally invasive hysterectomy had lower odds of VTE via laparoscopic (aOR 0.62; CI:0.48-0.81) and vaginal (aOR 0.46; CI:0.31-0.69) routes compared to laparotomy. Prolonged operative time (>120 min) was associated with an increased odds of VTE (aOR 1.86; CI:1.51-2.29). The occurrence of VTE after benign large specimen hysterectomy is rare. The odds of VTE is higher with longer operative times and lower with minimally invasive approaches even for markedly enlarged uteri.

Surgical Morbidity of Laparoscopic Hysterectomy versus Abdominal Hysterectomy: A Retrospective Overview.

Laparoscopic skills are not an innate behavior, nor can they be easily mimicked, and can only be acquired through hands-on training. The need for reliable training and its assessment is becoming increasingly important with the course of time. A retrospective comparative study was done in a tertiary care center where all patients undergoing hysterectomy by laparoscopic and abdominal route were included in the study. Our study aims to compare the operative and postoperative complications of laparoscopic hysterectomy with abdominal hysterectomy. The study was conducted from June 2016 to October 2022. The mean operative time for uteri size lesser than 12 weeks was found significant in the total laparoscopic hysterectomy (TLH) group (75 ± 25 min) to total abdominal hysterectomy (TAH) (117 ± 28 min, P < 0.001). The mean blood loss in the TLH group was significant (110 ± 30 ml vs. 160 ± 116 ml, P < 0.002). The mean hospital stay was significantly shorter in TLH (4 ± 2.4 days vs. 7 ± 2.41 days, P < 0.002). The operative and postoperative complications observed were 3.1% in the TLH group and 11.7% in the TAH group. TLH when performed efficiently has proved to be a preferable route over other conventional hysterectomies.

TRAITEMENT LAPAROSCOPIQUE DE LA STENOSE PYLORO-DUODENALE D’ORIGINE ULCEREUSE AU SERVICE DE CHIRURGIE GENERALE DE L’HOPITAL GENERAL IDRISSA POUYE.

ABSTRACT Introduction: pyloro-duodenal ulcerative stenosis is the most common chronic complication of ulcer disease in developing countries. Its diagnosis calls upon fibroscopy (FOGD) and oeso-gastroduodenal transit (TOGD). The aim of our work was to report our indications and our results in the surgical treatment of ulcerative pyloro-duodenal stenosis by laparoscopic route in the general surgery department of the Idrissa POUYE general hospital. Patients and methods: We conducted a retrospective study (May 2006 to December 2021) of 73 patients with pyloro-duodenal stenosis of ulcerative origin. The surgical approach was an open laparoscopy. The gestures were a bilateral truncal vagotomy (VTB) associated with a gastric emptying procedure. Results: The average age of our patients was 43 years old (range 17 and 87 years old), with a sex ratio of 2.04. We found 52 cases of stenosis at the sthenic phase (71.2%) and 21 cases at the asthenic phase (28.8%). The average duration of evolution of the ulcerous syndrome was 7 months (extreme 3 and 120 months). All the patients had benefited from an esogastroduodenal fibroscopy and an esogastroduodenal transit. The stenosis was complete in 34.2% (n: 25) and incomplete in 65.8% (n: 48). Truncal vagotomy was performed in all patients. It was associated with gastroenteroanastomosis in 93.2% (n: 68) of cases, with pyloroplasty in 6.8% (n: 5) of cases. The average duration of intervention was 92 minutes with extremes of 45 and 107 minutes. Mortality was nil. Morbidity concerned 8.1% of patients (n:6). Functionally, the patients were classified as Visick I (89%, Visick II 7% and Visick III 4%. Conclusion: Surgery for ulcerative pyloroduodenal stenosis is still topical in developing countries. Thus, truncal vagotomy associated with laparoscopic gastric emptying seems to give good functional results with any mortality and low morbidity. Keywords: pyloro-duodenal stenosis; laparoscopy; truncal vagotomy.

Efficacy and Postoperative Outcomes of Laparoscopic Retrosternal Route Creation for the Gastric Conduit: Propensity Score-Matched Comparison to Posterior Mediastinal Reconstruction.

Retrosternal reconstruction has lower risks for severe postoperative morbidities, such as gastro-tracheal fistula or esophageal hiatal hernia. We have previously reported the laparoscopic retrosternal route creation (LRRC) method, but its safety and efficacy remain unclear. In total, 374 patients with esophageal carcinoma who underwent minimally invasive McKeown esophagectomy in the prone position between 2010 and 2021 were retrospectively reviewed. We performed a propensity score-matched analysis with the simple, nearest-neighbor method and no calipers to compare postoperative outcomes and reconstructed gastric conduit functionality between patients who underwent LRRC and counterparts who underwent posterior mediastinal reconstruction. After matching, 62 patients were included in the laparoscopic retrosternal group (LR group) or posterior mediastinal group (PM group). No significant differences were observed between the groups, apart from the number of robot-assisted surgeries, the extent of lymph node dissection, and the method of cervical anastomosis. There were no significant differences in the incidence of Clavien-Dindo grade ≥ 2 complications. Gastro-tracheal fistula (n = 1) and esophageal hiatal hernia (n = 2) occurred in the PM group but not in the LR group. There were no differences in the incidence of pulmonary embolism between the groups (5% vs. 5%). The postoperative anastomotic stenosis rate was similar (16% vs. 27%, p = 0.192). Endoscopic findings of reflux esophagitis (modified Los Angeles classification≥ M) at 1 year after surgery were significantly better in the LR group (p = 0.037). LRRC for gastric conduit reconstruction is safe and valuable. It is associated with good reconstructed gastric conduit function.

Development and validation of a video-assisted liver biopsy technique using a minimally-invasive device

BackgroundPercutaneous liver biopsy is the gold standard technique for establishing the cause of cirrhosis and liver disease activity assessment. However, some cases of steatohepatitis or other chronic liver diseases show a high number of false negative results in samples obtained via the percutaneous route. This fact justifies performing a liver biopsy via the laparoscopic route. However, this is an expensive technique, with morbidities associated with pneumoperitoneum and anesthetic complications. The main objective of this study is to develop a video-assisted technique that uses only a minimally-invasive device for the liver biopsy and the optical trocar. Without additional trocars, this technique constitutes a less invasive procedure than the existing techniques in clinical practice.MethodsThis is a device development and validation study and patients submitted to abdominal laparoscopic surgery and required liver biopsy for moderate to severe steatosis were recruited. The patients were randomized into two groups: laparoscopic liver biopsy technique (n = 10, control group) and mini-laparoscopic liver biopsy technique (n = 8, experimental group). The times associated with procedure performance in both groups were evaluated using the Mann–Whitney or Kruskal–Wallis tests according to data distribution.ResultsAt baseline, there was no statistical difference regarding gender and type of surgery. The experimental group had a significantly shorter time compared with the group that underwent the traditional procedure in mean procedure time (p = 0.003), biopsy time (p = 0.002) and hemostasis time (p = 0.003).ConclusionsThe mini-laparoscopic biopsy device and technique showed to be capable of safely obtaining sufficient tissue samples, which was minimally invasive and in a shorter time than the classic technique.

ASO Visual Abstract: Efficacy and Postoperative Outcomes of Laparoscopic Retrosternal Route Creation for the Gastric Conduit-Propensity Score-Matched Comparison to Posterior Mediastinal Reconstruction.

ASO Visual Abstract: Efficacy and Postoperative Outcomes of Laparoscopic Retrosternal Route Creation for the Gastric Conduit-Propensity Score-Matched Comparison to Posterior Mediastinal Reconstruction.

ASO Author Reflections: Laparoscopic Retrosternal Route Creation after Minimally Invasive Esophagectomy is Associated with Good Reconstructed Conduit Function without Increasing Risk of Surgical Complications.

ASO Author Reflections: Laparoscopic Retrosternal Route Creation after Minimally Invasive Esophagectomy is Associated with Good Reconstructed Conduit Function without Increasing Risk of Surgical Complications.