Longer Operative Time Research Articles

Predictors and Impact of Ileus on Outcomes After Laparoscopic Right Colectomy: A Case-Control Study.

Ileus is a common complication of major abdominal surgery, including colorectal resection. The present study aimed to assess the predictors of ileus after laparoscopic right colectomy for colon cancer. This study was a retrospective case-control analysis of a prospective IRB-approved database of patients who underwent laparoscopic right colectomy at the Department of Colorectal Surgery, Cleveland Clinic Florida. Patients who developed ileus after right colectomy were compared to patients without ileus to determine the risk factors of ileus. The present study included 270 patients with a mean age of 68.7years. Thirty-six patients (13.3%) experienced ileus after laparoscopic right colectomy. The median duration of ileus was 6 days. Factors associated with ileus were age (71.6 vs 68.2years, P = .158), emergency colectomy (11.1% vs 3.9%, P = .082), extended hemicolectomy (19.4% vs 6.8%, P = .021), green gastrointestinal anastomosis (GIA) 4.8mm staple height cartridge (19% vs 8.1%, P = .114), and longer operative time (177.9 vs 160.4 minutes, P = .157). The only independent predictor of ileus was extended colectomy (OR: 16.7, P = .003). Increased age, emergency surgery, green GIA cartridge, and longer operative times were associated with ileus, yet the only independent predictor of ileus was extended right hemicolectomy.

Minimally invasive hysterectomy same-day discharge: systematic review and meta-analysis of predictors.

Same-day discharge (SDD) is increasingly prevalent following minimally invasive hysterectomy (MIH). However, consensus guidelines for selecting SDD eligibility criteria for MIH remain unexplored. This study aims to identify predictive factors for non-SDD following MIH (registered in PROSPERO CRD42022350373). PubMed, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials. All original studies that involve patients who were discharged on the same day are compared with those who were not (not failure to discharge / not intended to discharge). Categorical and continuous variables were reported as risk ratios with 95% confidence intervals and weighted mean differences with 95% CIs, respectively. Heterogeneity among the included studies was assessed using the I2 statistics. We conducted sensitivity analysis to identify the reason(s) for this heterogeneity. Ten studies (59,589 patients) were included, with a mean SDD rate of 20.28%. The predictors of overnight observation included factors such as American Society of Anesthesiologists classification (ASA) > II (P = .02; I2 = 92%), increased estimated blood loss (EBL) (P < 0.00001; I2 = 87%), surgeries starting later in the day (P < 0.00, I2 = 15%), and longer operation times (P = .002; I2 = 96%). In sensitivity and subgroup analyses, uterus weight emerged as a potential factor (P < 0.00; I2 = 50%), while the results concerning ASA, uterine weight, and EBL appeared to be homogeneous. However, the operation time remained heterogeneous. These factors could assist surgeons in the decision-making process regarding the performance of SDD subsequent to MIH procedures for patients.

Risk Factors and Risk Prediction Model of Poor Prognosis in Patients with Chronic Dacryocystitis Treated by Endoscopic Nasal Dacryocystostomy.

Chronic dacryocystitis often leads to a poor prognosis due to factors like chronic inflammation resulting in lacrimal duct obstruction and recurrent infections. Therefore, this study aims to investigate the risk factors of poor prognosis in patients with chronic dacryocystitis treated by endoscopic nasal dacryocystostomy and to establish a risk prediction model. We retrospectively analyzed the clinical data of chronic dacryocystitis patients (n = 101) treated between January 2022 and February 2024. They were divided into a training set (n = 71) and a validation set (n = 30). Patients were followed up for three months post-operation, and recurrence rates were assessed. Logistic regression analysis was used to identify risk factors for poor prognosis, and a nomogram model was developed utilizing these risk factors. Model validation involved the bootstrap method, calibration curves, receiver operator characteristic (ROC) curves, and the Hosmer-Lemeshow test. Out of the 101 patients, 27 (26.73%) experienced recurrence. The older age, longer operation time, and greater intraoperative bleeding were all associated with poor prognosis (all p < 0.05). Multivariate regression indicated that age (odds ratio (OR) = 2.18, 95% CI: 1.30-3.68), operation time (OR = 1.89, 95% confidence interval (CI): 1.13-3.17), and intraoperative bleeding (OR = 1.69, 95% CI: 1.06-2.69) were significant risk factors. The nomogram model incorporating these factors showed an area under the curve (AUC) of 0.666 for the training set and 0.585 for the validation set. Furthermore, for the training set, sensitivity and specificity were 0.654 and 0.621, and for the validation set, they were 0.598 and 0.548, respectively, with calibration curves indicating good agreement. Age, operation time, and intraoperative bleeding are significant factors affecting the prognosis of patients with chronic dacryocystitis.

Robotic Versus Laparoscopic Gastrectomy for Gastric Cancer: The Largest Systematic Reviews of 68,755 Patients and Meta-analysis.

This meta-analysis aimed to compare the efficacy of robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) in treating gastric cancer (GC). A comprehensive literature search across PubMed, MEDLINE, and Web of Science identified 86 eligible studies, including 68,755 patients (20,894 in the RG group and 47,861 in the LG group). The analysis revealed that RG was associated with superior outcomes in several areas: more lymph nodes were harvested, intraoperative blood loss was reduced, postoperative hospital stays were shorter, and the time to first flatus and oral intake was shortened (all p<0.001). Additionally, RG resulted in lower incidences of conversion to open surgery (OR=0.62, p=0.004), reoperation (OR=0.68, p=0.010), overall postoperative complications (OR=0.82, p<0.001), severe complications (OR=0.65, p<0.001), and pancreatic complications (OR=0.60, p=0.004). However, RG had longer operative times and higher costs (both p<0.001). No significant differences were found between RG and LG in terms of resection margin distance, mortality, anastomotic leakage, or recurrence rates. RG is a safe and effective surgical option for patients of GC, but further improvements in operative duration and costs are needed.

Using Machine Learning Algorithms to Predict Postoperative Anterior Bone Loss Following Anterior Cervical Disc Replacement.

Machine learning model. This study aimed to develop and validate a machine learning (ML) model to predict moderate-severe anterior bone loss (ABL) following anterior cervical disc replacement (ACDR). A retrospective review of patients undergoing ACDR or Hybrid surgery (HS) at a single center was performed. Patients diagnosed as C3-7 single- or multi-level cervical disc degenerative diseases (CDDD) with more than 2years of follow-up and complete pre- and postoperative radiological imaging were included. An ML-based algorithm was developed to predict moderate-severe ABL based on perioperative demographic, clinical, and radiographic parameters. Model performance was evaluated in terms of discrimination and overall performance. A total of 339 ACDR segments were included (61.65% female, mean age 45.65 ± 8.03years). During a follow-up period of 45.65 ± 8.03months, 103 (30.38%) segments developed moderate-severe ABL. The model demonstrated good discrimination and overall performance according to precision (moderate-severe ABL: 0.71 ± 0.07, none-mild ABL: 0.73 ± 0.08), recall (moderate-severe ABL: 0.69 ± 0.08, none-mild ABL: 0.75 ± 0.07), F1-score (moderate-severe ABL: 0.70 ± 0.08, none-mild ABL: 0.74 ± 0.07), and area under the curve (AUC) (0.74 ± 0.10). The most important predictive features were higher height change, higher post-segmental angle, and longer operation time. Utilizing a ML approach, this study successfully identified risk factors and accurately predicted the development of moderate-severe ABL following ACDR, demonstrating robust discrimination and overall performance. By overcoming the limitations of traditional statistical methods, ML can enhance discovery, clinical decision-making, and intraoperative techniques.

Intraoperative Factors Affecting Pain Management and Postoperative Narcotic Use in Cranial Vault Remodeling: A Retrospective Review

Perioperative pain control in open cranial vault reconstruction (CVR) poses significant challenges. Narcotic use may confound signs of neurological deterioration and cause medication-induced complications. Previous studies have shown improved health outcomes in CVR with reduced narcotic use. The purpose of this study was to investigate the relationship between modifiable intraoperative factors on postoperative narcotic use. A retrospective cohort study was performed on 237 patients with craniosynostosis who presented to a tertiary pediatric hospital over a 10-year period for open CVR. There was a statistically significant relationship between total fluid volume infused intraoperatively (mL/kg) and total morphine equivalents (MEs, mL/kg) given throughout hospitalization (P&lt; 0.001). Longer operative times were associated with greater total hospitalization ME (P ≤ 0.006) and total intraoperative blood products transfused (P ≤ 0.001). Patients who received drains were given significantly higher total hospitalization ME compared with those who did not (P&lt; 0.001). Patients who received postoperative nonsteroidal anti-inflammatory drugs required significantly fewer total ME compared with children who did not (P&lt; 0.005) and patients who received intraoperative tranexamic acid were less likely to require postoperative blood transfusion (P&lt; 0.001). Postoperative nonsteroidal anti-inflammatory drug use is associated with decreased narcotic requirements during the immediate postoperative period whereas increased fluid requirements intraoperatively, longer operative durations, and drain placement are associated with higher narcotic use. Modifying intraoperative factors like these may lead to decreased postoperative pain, thus limiting narcotic use for patients, and improving overall outcomes.

Determination of Quality Indicators for Microvascular Grafts in Cranio-Maxillofacial Surgery-A Retrospective Analysis of 251 Free Flaps.

The use of microvascular grafts is the gold standard in oral and maxillofacial surgery for the reconstruction of soft tissue and bony and combined defects. Graft loss is one of the most serious complications in the field of reconstructive surgery. A comprehensive analysis of factors influencing this is, therefore, essential. This hypothesis-generating study analyzed 251 patient cases of oral and maxillofacial surgery at the University Hospital Düsseldorf from 2016 to 2020 regarding patient- and therapy-specific parameters for their impact on graft survival. Statistically significant influencing factors were found among the 80 parameters examined: treatment with antiplatelet medication and a BMI ≥ 24.5 at the time of surgery had a positive influence on graft survival, while existing diabetes mellitus, atrial fibrillation, tracheostomy, and a longer operation time had a statistically relevant negative influence. This work demonstrates the relevance of patient-specific risk stratification and the need for further research to develop a valid risk profile. Identifying high-risk patients with medium-sized defects, where alternatives to microvascular reconstruction are available, appears to be crucial for the clinical outcome.

A prospective study of total hip arthroplasty for failed proximal femur fracture fixation

Background: Proximal femur fractures have been widely studied and there are several well-accepted management modalities for the same such as PFN A2, IMIL nails, and DHS. Despite several management options we do encounter significant failure rates which could be due to several factors such as post-operative time rehabilitate patients related comorbidity and differences in surgical techniques. Aim of the study was to assess the outcomes of total hip arthroplasty (THA) after failed surgical management in proximal femur fractures Methods: The 50 patients who underwent surgical management for proximal femur fractures at any given point in time and presented with non-union or malunion and inability to bear weight affecting their activities of daily living assessed with Harris hip score were enrolled in a prospective cohort study during 2015 and 2022 after obtaining IRB approval. All these patients underwent surgical management for proximal femur fractures within 3 weeks of sustaining a fracture. Results: A strong statistically significant difference is seen with pain, functional gait, functional activity, range of movement and total score in post-operative group of patients in comparison to patients of pre-operative group. THA had excellent outcomes in 42 patients (85.71%) of the study group. About 6 (14.29%) patients of the study group had good outcome. 2 patients that lost to follow up were removed from the study. Conclusions: THA is an effective procedure for failed proximal femur fracture fixation patients despite the challenges such as distorted anatomy of femoral head, poor bone quality, longer operative times, larger amounts of blood loss, high rates of intra-operativities and post operative complications.

Outcomes of robotic surgery for inflammatory bowel disease using the Medtronic Hugo™ Robotic-Assisted Surgical platform: a single center experience

PurposeThe aim of the study was to compare the perioperative outcomes of patients affected by inflammatory bowel disease (IBD) who underwent surgery performed through laparoscopy or using the Medtronic Hugo™ RAS.MethodsThis is a retrospective study from a prospectively maintained database comparing laparoscopic vs. robotic-assisted surgery for IBD from 01/11/2017 to 15/04/2024. All procedures were performed by a single surgeon robotic-naïve with a large experience in laparoscopic surgery for IBD. The robotic procedures were performed using the Medtronic Hugo™ RAS platform. Outcomes were 30-day postoperative complications, operative time, conversion rate, intraoperative complications, length of hospital stay, and readmission rate.ResultsAmong 121 consecutive patients, 80 underwent laparoscopic (LG) and 41 robotic-assisted surgery (RG). Baseline, preoperative and disease-specific characteristics were comparable except for older age (50 [38–56] vs. 38 [28–54] years; p = 0.05) and higher albumin level (42 [40–44] vs. 40 [38–42] g/L, p = 0.006) in the RG. The intracorporeal anastomosis was more frequent in the RG (80% vs. 6%; p < 0.001) with longer operative time (240 vs. 205 min; p = 0.006), while the conversion rate was not different (5% vs. 10%, p = 0.49). Surgical procedure types were equally distributed between the two groups, and the rate of intra-abdominal septic complication (IASC) was comparable across the different procedures. Postoperative complications were similar, including the rate of IASC (5% vs. 5%, p = 1), postoperative ileus (5% vs. 7.5%, p = 0.71), bleeding (2% vs. 5%, p = 0.66), and Clavien-Dindo > 2 complications (7% vs. 6%; p = 1).ConclusionIBD surgery performed using the Medtronic Hugo™ RAS is safe and feasible, with similar postoperative outcomes when compared to the laparoscopic approach.

Routine single-incision laparoscopic common bile duct exploration with concomitant cholecystectomy for elderly patients: a 6-year retrospective comparative study.

While single-incision laparoscopic cholecystectomy (SILC) has gained more popularity in recent years, its application to elderly patients needs further evaluation. Few SILC studies regarded this rapidly growing vulnerable population, and single-incision laparoscopic common bile duct exploration (SILCBDE) was never mentioned. We conducted an observational study of 146 routine SILCBDE to address this issue. One hundred forty-six consecutive patients underwent SILCBDE with concomitant cholecystectomies during a period of 6 years (July 2012-June 2016 and July 2018-July 2020). Forty patients with an age of 65years or older were the study target. Characteristics and operative outcomes were compared with the remaining 106 younger patients by retrospective chart review. The primary outcomes include complications and mortality, while the secondary outcomes contain intraoperative blood loss, operative time, procedural conversions, postoperative length of hospital stay, and bile duct stone recurrence. There was no mortality. The bile duct stone clearance rate was 98.6%. The elderly group had higher American Society of Anesthesiologists (ASA) scores, higher comorbidity rate, higher acute cholangitis rate, lower completion intraoperative cholangiography (IOC) rate, longer operative time, more blood loss, longer postoperative hospital stay (p < .001), longer total hospital stay (p < .001), higher procedural conversion rate (p < .05), higher complication rate (p < .001), and the exclusive open conversion (2.5%). The difference in complications derived from Clavien-Dindo grade I. Routine SILCBDE with concomitant cholecystectomy by experienced surgeons is safe and efficacious for elderly patients as for younger patients. Randomized controlled trials are anticipated.

Short-Term Outcomes Analysis Comparing Open, Lap-Assisted, Totally Laparoscopic, and Robotic Total Gastrectomy for Gastric Cancer: A Network Meta-Analysis.

Total gastrectomy (TG) is the cornerstone treatment for gastric cancer (GC). While open TG (OTG) with D2 lymphadenectomy remains the gold standard, alternative techniques such as lap-assisted TG (LATG), totally laparoscopic TG (TLTG), and robotic TG (RTG) have been reported with promising outcomes. The present analysis aimed to compare the short-term outcomes of different techniques for TG comprehensively in the setting of GC. A systematic review and network meta-analysis were performed. The primary outcomes were overall complications (OC), severe postoperative complications (SPCs), and anastomotic leak (AL). Pooled effect-size measures included risk ratio (RR), weighted mean difference (WMD), and 95% credible intervals (CrIs). Sixty-eight studies (44,689 patients) were included. Overall, 52.4% underwent OTG, 6.5% LATG, 39.2% TLTG, and 1.9% RTG. Both TLTG (RR 0.82; 95% CrI 0.73-0.92) and RTG (RR 0.75; 95% CrI 0.59-0.95) showed a reduced rate of postoperative OC compared to OTG. SPCs and AL RR were comparable across all techniques. Despite the longer operative time, LATG, TLTG, and RTG showed reduced intraoperative blood loss, time to first flatus, ambulation, liquid diet resumption, and hospital stay compared to OTG. Minimally invasive approaches seem to be associated with improved OC and functional outcomes compared to OTG.

Impact of patient age on outcome of minimally invasive versus open pancreatoduodenectomy: a propensity score matched study

BackgroundPancreatoduodenectomy in elderly patients may be associated with increased postoperative mortality, but studies in minimally invasive pancreatoduodenectomy (MIPD) are scarce. MethodsInternational multicenter retrospective study including patients aged >60 years undergoing MIPD (robot-assisted and laparoscopic) and open pancreatoduodenectomy (OPD), were categorized by age: 60-69, 70-79, and 80+ years. In each category, propensity score matching (PSM) was performed (1:1 ratio) between MIPD and OPD. Primary outcome was 30-day/in-hospital mortality. ResultsAmong 3820 patients, we matched 1468 patients aged 60-69, 1154 patients aged 70-79, and 196 patients aged 80+ years. In patients aged 60-69 and 70-79 years, MIPD was associated with longer operative time, less blood loss and a longer length of stay. Major morbidity was higher after MIPD with similar 30-day/in-hospital mortality. The R0 resection rate was higher after MIPD. In patients aged 80+ years, besides a longer operative time in MIPD, outcomes were comparable between both groups. ConclusionThis study found no evidence that increasing age worsens mortality of MIPD. MIPD was associated with longer operative time, higher rate of major morbidity, prolonged length of stay versus less blood loss and a higher R0 resection in patients aged 60-69 and 70-79 years. These differences continue in patients aged 80+ years, but became less evident.

Laparoscopic colectomy for patients with poor American Society of Anesthesiology classifications.

The American Society of Anesthesiologists (ASA) classification is used to assess the fitness of a patient for surgery. Whether laparoscopic surgery is appropriate for colorectal cancer patients with poor ASA performance status (PS) remains unclear. Among 4585 patients who underwent colorectal surgery between 2016 and 2023, this study retrospectively reviewed all 458 patients with ASA-PS ≥3. Patients were divided into two groups: patients treated by open surgery (O group, n = 80); and patients treated by laparoscopic surgery (L group, n = 378). We investigated the impact of surgical approach on postoperative complications in patients with colorectal cancer and ASA-PS ≥3. Operation time was longer (170 min vs. 233 min, p < .001), blood loss was less (156 mL vs. 23 mL, p < .001), postoperative complications were less frequent (40.0% vs. 25.1%, p = .008), and hospital stay was shorter (23 days vs. 14 days, p < .001) in L group. Univariate analysis revealed rectal cancer, open surgery, longer operation time, and blood loss as factors significantly associated with postoperative complications. Multivariate analysis revealed open surgery (odds ratio [OR] 2.100, 95% confidence interval [CI] 1.164-3.788; p = .013) and longer operation time (OR 1.747, 95% CI 1.098-2.778; p = .018) as independent predictors of postoperative complications. Laparoscopic surgery provides favorable outcomes for colorectal cancer patients with poor ASA-PS.

Lower blood loss with bi-cruciate retaining total knee arthroplasty compared with bi-cruciate stabilized total knee arthroplasty.

Introduction Total knee arthroplasty (TKA) is a common surgical procedure to treat end-stage knee osteoarthritis. This study compared blood loss volume and other clinical outcomes between bi-cruciate retaining (BCR) and bi-cruciate stabilized (BCS) TKA. Materials and Methods Ninety-seven participants who underwent unilateral TKA were enrolled. The BCS-TKA and BCR-TKA groups comprised 78 and 19 participants, respectively. Blood loss was calculated using preoperative and postoperative hematocrit values, height, weight, and sex. Measurements were taken immediately after surgery, on days 1 and 7, and total blood loss was calculated up to day 7. Operation time, range of motion at 7 and 14 days postoperatively, blood transfusion requirement, and postoperative complications such as infection, hematoma, and deep vein thrombosis were compared between the groups. Results Blood loss was comparable between groups at all time points (125.7 vs. 105.4 mL, 57.9 vs. 43.5 mL, and 68.2 vs. 41.7 mL for immediate, day 1, and day 7 postoperatively, respectively; all p>0.05) except for total blood loss, which was significantly lower in the BCR group compared with the BCS group (190.7 vs. 251.1 mL; p<0.05). The BCR group also had a longer operation time than the BCS group (131.2 vs. 112.4 min; p<0.05). No other significant differences were observed in other outcomes. Conclusion Total blood loss up to seven days postoperatively was significantly lower in the BCR group than in the BCS group despite a longer operation time. This may be attributed to the reduced bone resection and greater soft tissue preservation, including the anterior cruciate and posterior cruciate ligaments, in the BCR technique. Keywords: total knee arthroplasty, bi-cruciate retaining, bi-cruciate stabilized, blood loss volume, osteoarthritis.

Is robot-assisted appendicovesicostomy equivalent to the current gold standard open procedure? A comparative analysis

Robot-assisted Laparoscopic Appendicovesicostomy (RALAPV) is increasingly performed as a minimally invasive alternative to the open appendicovesicostomy (OPAV), but questions remain regarding the efficacy of the RALAPV compared to OPAV. To assess and compare outcomes for non-augmented RALAPV to the open surgical approach. An IRB approved prospective registry was retrospectively examined to abstract all patients who underwent APV without augment between 2012 and 2023. Baseline demographics, intra and post-operative characteristics, and long-term outcomes were aggregated and compared. P-values were two sided and a p-value <0.05 was considered statistically significant. 52 children were identified, 19 (36.5%) OAPV and 33 (63.5%) RALAPV. The median age at surgery was 8.5 years for OAPV and 9.3 years for RALAPV (p=0.29). Longer operative time was noted in the RALPAV group (346min vs 289min, p=0.04), with a lower estimated blood loss (5cc vs 30cc, p=0.003), shorter median length of hospital stay (4 days vs 5 days, p=0.07), and lower IV morphine administration (0.04mg/kg/d vs 0.09mg/kg/d, p=0.01). Similar surgical reintervention rate was seen in both cohorts (42% OAPV vs 36% RALAPV, p=0.77). At the end of follow-up, continence was achieved in 18 (95%) OAPV and 33 (100%) RALAPV patients (p=0.37) CONCLUSIONS: RALAPV shows comparable success to patients who underwent OPAV procedures. The longer follow-up interval for OPAV highlights minimally invasive surgery as a recent adoption.

Robotic versus open pancreaticoduodenectomy in octogenarians: a comparative propensity score analysis of perioperative outcomes

IntroductionCompared to open pancreaticoduodenectomies (OPD), the robotic (RPD) approach improves the rate of complication and the length of stay. However, it remains unknown if these benefits persist in octogenarians, who are at higher risk for perioperative morbidity and mortality. MethodsA retrospective analysis of the ACS-NSQIP database was performed to identify patients aged 80 years or older who underwent PD for pancreatic adenocarcinoma between 2015 and 2021. Patients who underwent RPD or OPD were compared using inversed probability weighting of the propensity score to control for known confounding variables. Outcomes assessed include operative time, length of stay (LOS), non-home discharge, major complications, unplanned readmission, return to the operating room (OR), mortality, and clinically relevant postoperative pancreatic fistula (CRPOPF). ResultsOf 30,751 patients undergoing PD, 1720 were 80 or older. One thousand six hundred twenty-five patients (94 %) underwent OPD, and 95 (6 %) underwent RPD. RPD was significantly associated with a reduced incidence of major complications (32.6 % vs. 45.6 % in OPD; p < 0.01) and a lower rate of non-home discharge (24.7 % vs. 34.3 % in OPD; p < 0.05). However, RPD was associated with a longer operative time (438 min vs. 342 min for OPD; p < 0.0001). There was no difference in other assessed outcomes between the two groups. ConclusionRPD may reduce major postoperative complications and non-home discharges compared to the open approach for octogenarians.

Feasibility of major hepatectomy following preoperative chemotherapy for advanced perihilar cholangiocarcinoma

BackgroundThe safety of major hepatectomy following preoperative chemotherapy for perihilar cholangiocarcinoma (PHCC) is underexplored. This study evaluates the impact of preoperative chemotherapy on surgical outcomes and assesses chemotherapy-induced liver injury in patients with advanced PHCC. MethodsThis retrospective study included 62 PHCC patients who underwent surgery between January 2019 and January 2024. Patients were divided into an upfront surgery group (UFS, n = 31) and a preoperative chemotherapy group (POC, n = 31). Preoperative chemotherapy was indicated when R0/R1 resection was unachievable, complex surgery was needed, or future liver reserve was insufficient. Baseline characteristics, surgical procedures, postoperative complications, and pathological findings were compared. ResultsPostoperative complications were comparable between groups, with Clavien-Dindo grade ≥3a rates of 30.7 % in the POC group and 24.3 % in the UFS group. Despite longer operative times and hospital stays in the POC group, no significant differences in hepatotoxicity or pathological findings, including Kleiner and Rubbia-Brandt scores, were observed. Notably, a pathological complete response was achieved in 12.9 % of the POC group. ConclusionMajor hepatectomy following preoperative chemotherapy for PHCC is safe and does not increase the risk of postoperative complications or hepatotoxicity. Further studies are warranted to refine resectability criteria and optimize patient selection.

Analysis of Initial Outcomes of Gas-insufflation One-step Single-port Transaxillary (GOSTA) Robotic Thyroidectomy for Thyroid Cancer.

This study compared the initial outcomes of gas-insufflation one-step single-port transaxillary (GOSTA) robotic thyroidectomy with traditional open thyroidectomy for thyroid cancer at a single institution. A retrospective analysis was conducted on 77 patients who underwent thyroidectomy for differentiated thyroid cancer from January to June 2024. Exclusion criteria included benign nodules, Graves' disease, and previous thyroid surgeries. Two surgeons performed the procedures, with one having no prior robotic surgery experience. Of the 77 patients, 48 underwent open thyroidectomy and 29 underwent GOSTA thyroidectomy. The GOSTA group had a significantly lower mean age (40.1 vs. 47.6 years, p=0.002) and a higher proportion of female patients (p=0.040). The open group patients had more harvested lymph nodes than the GOSTA group patients (7.9 vs. 2.4, p<0.001). The GOSTA group patients had longer operation time (156.4 vs. 80.6 min, p<0.001), and had extended hospital stay than the open group patients (5.9 vs. 3.4 days, p<0.001). Complication rates were similar between the groups. GOSTA robotic thyroidectomy provides comparable safety and effectiveness to open thyroidectomy, with improved cosmetic outcomes despite longer operation times and hospital stays. This technique is feasible for surgeons without prior robotic experience, offering a viable alternative for patients prioritizing cosmetic results.

Comparison of Surgical Outcomes of Autologous Mid-Urethral Fascia Slings and Retropubic Mid-Urethral Slings for Women Undergoing a Primary Surgery for Stress Urinary Incontinence: A Systematic Review and Meta-Analysis.

Current guidelines on surgical treatment of stress urinary incontinence (SUI) recommend an informed decision making process between the physicians and patients reviewing all available surgical options with and without mesh. However, there is a lack of synthesized clinical evidence on some of the comparisons that can feed into patient counseling processes. The aim of this study was to review the available studies comparing clinical outcomes of an autologous fascial sling (AFS) and a retropubic (RP) synthetic sling for women undergoing a primary surgery for SUI. We conducted a literature search from 1990 to 2024 following international guidelines. We have included studies reporting on comparative outcomes of AFS and RP synthetic sling surgeries as a primary procedure. Three randomized studies were included with follow-up durations ranging from 24 months to 10 years. The mean percentage change in symptom scores ranged from 27.7% to 44.9%, with no significant difference between the two sling types. There was no difference between groups with regard to objective cure rates, subjective cure rates and length of hospital stay between AFS and RP slings. AFS surgeries had longer operative times. There were concerns about bias, particularly related to allocation, blinding, and missing outcome data. Overall, both types of slings had similar cure rates but AFSs were associated with longer operative times. The study highlights the need for more research on the comparative effectiveness of AFS and synthetic slings for SUI surgery to guide decision-making for SUI surgical treatments.

Clinical features, surgical treatment strategy, and feasibility of minimally invasive surgery for synchronous and metachronous multiple colorectal cancers: A 14-year single-center experience.

Patients with a history of colorectal cancer (CRC) are at increased risk of developing secondary synchronous/metachronous CRCs. The role of minimally invasive surgery (MIS) for multiple CRCs remains unclear. This study aimed to evaluate the short-term outcomes of MIS in patients with multiple CRCs and elucidate their clinical characteristics. This retrospective study reviewed CRC patients who underwent MIS between 2010 and 2023. Multiple CRC cases were categorized into synchronous and metachronous cohorts. Demographics, pathological findings, and perioperative outcomes were analyzed. Propensity score matching (PSM) analysis was performed as appropriate. A total of 1,272 patients met the inclusion criteria, with 99 (7.8%) having multiple CRCs (75 synchronous and 24 metachronous). Multiple CRC patients had a higher prevalence of strong family history (8.1% vs. 1.0%, P < 0.001) and right-sided colon cancer (55.6% vs. 34.4%, P < 0.001) compared to solitary CRC patients. MSI-high/MMR-deficient status, including Lynch syndrome, was frequently observed among patients with multiple CRCs. Synchronous CRCs requiring double-anastomosis were associated with longer operation times (P = 0.03) and increased blood loss (P = 0.03) compared to those with a single-anastomosis. In the metachronous cohort, repeat operation patterns were categorized based on tumor location and sacrificed arteries. Preservation of the left-colic artery avoided extended colectomy in some patients. Patients with multiple CRC involving rectal cancer had a higher anastomotic leakage (AL) rate (17.6% vs. 5.7%, P < 0.01); however, this difference in AL rate disappeared after PSM (8.8% vs. 8.8%, P = 1.0). In patients with multiple CRCs, AL has not been observed ever since the indocyanine green fluorescence imaging was implemented. MIS is feasible for multiple CRCs, with perioperative outcomes comparable to those for solitary CRCs. Preservation of critical arteries may benefit patients at high risk of secondary CRCs, particularly those with a strong family history of CRC, right-sided tumors, or MSI-high/MMR-deficient profiles, including Lynch syndrome.