Longer Operative Time Research Articles

Single-port non-lipolytic endoscopic surgery via the axillary approach for the treatment of benign breast tumors has better clinical outcomes: a case control study

BackgroundEndoscopic surgery provides good cosmetic results while ensuring therapeutic outcomes. This study aimed to evaluate the efficacy, safety, and cosmetic outcome of endoscopic surgery for benign breast tumors.MethodsIn total, 108 patients were enrolled and divided into endoscopic or open surgery groups based on the patients' voluntary decisions. Surgical information, complications, postoperative pain, and postoperative cosmetic scores were compared.ResultsThe endoscopic surgery group and open surgery group included 46 and 62 patients, respectively. Patients who underwent endoscopic surgery had longer operative times (p < 0.001) and postoperative hospital stays (p = 0.045), and there was no significant difference in intraoperative blood loss between the two groups (p = 0.501). The overall postoperative complication rate was 13% in the endoscopic group and 25.8% in the open group (p = 0.103). Postoperative pain scores were similar in both groups. Cosmetic scores were better in the endoscopic group (p = 0.002), especially regarding nipple shape and wound scarring.ConclusionsEndoscopic surgery is safe and effective for treating benign breast tumors and offers improved cosmetic results compared to open surgery.

The Learning Curve in Urogynecology and Functional Urology: A Systematic Review.

When adopting new methods, surgeons may experience a period of complexity and longer operation times because of their inexperience. This period is known as the "learning curve." This study was aimed at systematically reviewing the current literature on functional urology learning curves. A comprehensive search was conducted across multiple databases from inception to July 2023 with no language restrictions. All original studies on urogynecological and functional urological procedures, including cross-sectional, cohort, and clinical trials, were eligible for inclusion. Relevant data were extracted, and methodological quality was appraised using standardized Joanna Briggs Institute critical appraisal tools. To quantitatively investigate learning curves, a mixed-effects generalized linear regression analysis was conducted on studies employing cumulative summation methods. From the 7,104 records, 68 studies met the inclusion criteria. The majority of studies were observational and the most common outcome measures were surgical duration, blood loss, and hospital stay. The learning curves varied by procedure type-for incontinence surgeries, 15-80 cases were required; for pelvic organ prolapse surgeries, 18-47 cases; for laparoscopic procedures, 10-105 cases; and for robotic procedures, 5-84 cases. The analysis showed that the number of cases required to surpass the learning curve decreased over time, likely reflecting technological advancements and increased surgical experience. The learning curve for surgical procedures varies significantly. It varies between 5 cases for robotic supratrigonal cystectomy to 75 cases for robot-assisted ventral mesh rectopexy or robotic sacrocolpopexy surgery in 84 cases. These variable learning curves highlight the need for structured training programs and ongoing assessment.

The impact of kidney disease on peri-operative outcomes of novel BPH surgeries across the board: a propensity score matched analysis using the ACS-NSQIP database.

Pre-operative kidney disease was shown to impact peri-operative outcomes of endoscopic BPH surgeries. We aim to assess the effect of novel surgical techniques (Laser Enucleation of the Prostate (LEP) and Laser Vaporization of the Prostate (LVP)) compared to Transurethral Resection of Prostate (TURP), on post-operative outcomes stratified based on kidney function. The ACS-NSQIP database was reviewed from 2008 to 2021 for 83,020 patients that underwent TURP, LEP, and LVP. Pre-operative variables were compared across kidney function groups: G1(normal/high function); G2-G3(mild/moderate kidney disease); and G4-G5(severe kidney disease). Multivariate logistic regression was performed on 30-day peri-operative complications adjusting for pre-operative variables. Propensity score matching was done between LEP and LVP to TURP. LEP showed a protective effect against UTIs (p < 0.05) in the G1 and G2-G3 categories but lost that protective effect in the G4-G5 category when compared to TURP. It had longer operative time (p < 0.05) across all kidney function groups, and demonstrated shorter hospital stay (p < 0.05) in the G1 and G2-G3 categories compared to TURP. LVP had a persistent protective effect against bleeding (p < 0.05) across all kidney function groups and shorter hospital stay (p < 0.05) when compared to TURP. LVP had a protective effect against return to OR (p < 0.05) in the G1 and G2-G3 kidney function group but lost that protective effect in the G4-G5 category. LVP had significant protective effect against thromboembolic events (p < 0.05) in the G2-G3 category and against cardiac complications (p < 0.05) in the G4-G5 category. LEP and LVP are superior to TURP in terms of post-operative complications. The type of endoscopic surgery technique should be tailored according to patient's pre-operative kidney status and risk.

Clinical Reference Strategy for the Selection of Surgical Treatment for Nonsyndromic Sagittal Craniosynostosis: A Systematic Review and Network Meta-Analysis.

There is a lack of comprehensive comparative evidence regarding the effectiveness, intraoperative management, and safety of different surgical procedures for treating nonsyndromic sagittal synostosis. This study aims to evaluate existing clinical studies to provide evidence-based guidance for clinical practice. The authors performed a comprehensive search of 5 databases up to August 2024. Key outcomes included clinical effectiveness, measured by cephalic index (CI), and intraoperative management and safety indicators, such as intraoperative blood loss, operative time, and length of hospital stay. Direct and indirect effects, along with treatment rankings, were assessed using Bayesian pairwise and network meta-analysis models. Fifteen studies with 1436 patients were included, and 4 network meta-analysis models were used to compare 5 surgical techniques: open strip craniectomy (OSS), calvarial vault remodeling (CVR), spring-mediated cranioplasty (SMC), endoscopic strip craniectomy (ESC), and endoscopic spring-mediated cranioplasty (ESMC). No significant differences in postoperative CI were found between the surgical methods. However, CVR was associated with significantly greater blood loss, longer operative time, and longer hospital stays compared with OSS, SMC, and ESC. Current evidence does not demonstrate a clear superiority of one surgical method over another, with comparable treatment outcomes overall. However, CVR carries higher risks, and the choice of surgical approach should be individualized based on patient-specific factors and clinical judgment.

A comparative study of transforaminal and interlaminar approaches in percutaneous endoscopic lumbar discectomy for L5-S1 disc Herniation: Systematic review.

Percutaneous Endoscopic Lumbar Discectomy (PELD) is a leading minimally invasive technique for lumbar disc herniation (LDH). The two primary approaches, transforaminal (PETD) and interlaminar (PEID), each present distinct advantages and challenges in treating L5-S1 LDH. This study aims to compare the efficacy and safety of these two approaches. A systematic review was conducted using the PUBMED and Science Direct databases (2014 to 2024), following PRISMA guidelines. Major variables included operative time, fluoroscopy duration, blood loss, postoperative bed rest duration, length of hospital stay, MacNab criteria assessment, Oswestry Disability Index (ODI), visual analog scale (VAS) for pain, and complications. This study included eight comparative studies involving 784 patients with L5- S1 LDH, with 389 undergoing PETD and 395 undergoing PEID. The meta-analysis revealed that PETD was significantly associated with longer operative time (MD, 12.10min; 95% CI, 6.41-17.01; P < 0.01), extended fluoroscopy duration (MD, 8.68 times; 95% CI, 7.14-10.22; P < 0.01), and shorter postoperative bed rest duration (MD, -0.91days; 95% CI, -1.75 to -0.07; P = 0.03). No significant differences were observed in blood loss, length of hospital stay, Macnab criteria assessment, VAS scores, ODI scores, or complication rates. PETD demonstrates comparable clinical efficacy and safety to PEID; however, PEID is superior in terms of operative time and fluoroscopy duration, while PETD offers the advantage of reduced postoperative bed rest duration. Our study provides clear insights into the advantages and challenges of each PELD approach for L5-S1 LDH.

Correlation Between Relative Value Units and Operative Time for Peripheral Nerve Surgeries.

The work relative value unit (wRVU) system quantifies surgeons' effort and resources for procedures. Studies have shown its inaccuracy in capturing the complexity of certain plastic and upper extremity surgeries. Analysis for peripheral nerve surgery (PNS), a growing niche within hand and plastic surgery, has not been performed. The authors aim to evaluate the PNS wRVUs by correlation to their operative time. A retrospective analysis with current procedure terminology (CPT) codes for PNS (2005-2021) from the American College of Surgeons National Surgical Quality Improvement Program database was performed. Efficiency was determined by wRVU per operative time. Correlation was performed between operative time with wRVU and wRVU/minute. A total of 2402 procedures across 21 CPT Codes were included and categorized into neuroplasty, nerve repair, and nerve grafting/transfers with the median operative time being 63.75, 100, and 153.78 minutes respectively. Nerve graft/transfer generated the maximum wRVU (mean 16.35). Neuroplasty generated the minimum wRVU (mean 7.24). Nerve grafts/transfers generated the least wRVUs per minute (0.09). Longer operative times were associated with higher wRVUs. Neuroplasty (R = .86) and nerve repairs (R = .84) had a strong correlation to the operative time. Nerve grafts/transfer had a positive but moderate correlation with the operative time (R = .67). All procedures had a negative correlation between operative time and wRVU/minute. Nerve grafts/transfers had reduced compensation compared to neuroplasty or nerve repairs. Compensation did not reflect the procedure efficiency. This disparity in wRVU allocation for complex PNS underscores the need for remuneration reform.

Early outcomes of robotic vs open living donor right hepatectomy in a US Center.

Robotic living donor hepatectomy offers potential advantages but has been limited to high-volume centers, primarily in Asia and the Middle East. We report our experience establishing a robotic living donor right hepatectomy program in a U.S. center with low LDLT volume and no prior laparoscopic donor hepatectomy experience and analyze early outcomes. This retrospective cohort study analyzed 37 living donor right hepatectomies (13 robotic [including one open conversion], 24 open) performed between June 2022 and February 2024. The robotic group had longer operative times (median [range], 451 [374-568] minutes vs 368 [276-421] minutes; P < 0.001) but less blood loss (median [range], 200 [50-700] mL vs 900 [300-2500] mL; P < 0.001). One case required unplanned open conversion due to gas embolism. Two hematomas/bleeding (Clavien-Dindo grade IIIB) occurred in the robotic group, but no biliary complications. Comprehensive Complication Index, liver function tests, and hospital stays were similar between the two groups, with no 90-day graft failure/mortality. With extensive surgical experience in both open donor hepatectomy and robotic surgery, along with meticulous preparation as a team, U.S. centers with lower LDLT volume and no laparoscopic experience can safely implement robotic living donor right hepatectomy, achieving comparable short-term outcomes to the open approach. Further research on long-term outcomes and donor quality of life is necessary.

Deep Learning for Predicting Difficulty in Radical Prostatectomy: A Novel Evaluation Scheme.

To explore new metrics for assessing radical prostatectomy difficulty through a two-stage deep learning method from preoperative magnetic resonance imaging. The procedure and metrics were validated through 290 patients consisting of laparoscopic and robot-assisted radical prostatectomy procedures from two real cohorts. The nnUNet_v2 adaptive model was trained to perform accurate segmentation of the prostate and pelvis. A modified network PointNet was used for indirectly regressing 15 anatomical landmarks based on Gaussian heatmaps. Novel metrics proposed in this study that characterized the spatial relationship between the prostate and pelvis were included to evaluate the surgical difficulty. The two-stage process achieved decent segmentation and landmark localization results with the Mean Validation Dice of 0.8641 and millimeter-level accuracy. We found the coefficients of PV, ρ, PT, PAP, AG, PSD1, PSD2, πρ2/ISTA, AG+PG, AG×PG, PSD2×ρ, PAP/(AG+PG) with Estimated Blood Loss and PSD2, PSD2×ρ with Operation Time, respectively with statistic significant, which provides possibilities for assessing surgical difficulty evaluation. The entire pipeline had been validated on the external dataset, and the results were consistent. The two-stage anatomical landmark localization approach is feasible. Indicators describing pelvic-prostate spatial constraints significantly impact surgical difficulty in radical prostatectomy, leading to increased blood loss and longer operation times, while isolated pelvic measurements have minimal effect on surgical outcomes.

Infrainguinal bypass for limb salvage has comparable mortality and affords a better chance of home discharge than amputation among octogenarians.

Infrainguinal bypass for chronic limb-threatening ischemia (CTLI) in octogenarians is considered a high-risk procedure due to the presumed associated frailty of the patient population. However, the alternative which is major amputation may not be a better option. This study retrospectively compares the outcomes of bypass versus major amputation for functionally independent and partially dependent patients. Patients greater than and equal to 80 years old who underwent non-emergent infrainguinal bypasses for CTLI presenting with rest pain/tissue loss were selected from the targeted NSQIP database 2011-2022. Patients with major amputations (CPT codes 27880, 27882, 27590, 27592) for atherosclerosis by ICD9/10 codes were selected from the general database. We stratified the patients based on functional status (independent or partially dependent) and compared outcomes of bypass versus amputation within each group. Multivariable logistic regression was performed for 30-day mortality, major organ dysfunction, length of stay (LOS), and discharge destinations. There were 2,419 patients who underwent a bypass and 1,326 patients who underwent an amputation in the independent functional group. Patients with bypass were generally healthier. Multivariable analysis revealed that having a bypass was associated with significantly higher major adverse cardiac events (aOR: 1.7; p<0.01), bleeding requiring transfusion (aOR: 4.3; p<0.01), and wound complications (aOR: 1.7; p<0.01). There was no significant difference in mortality, renal complications, or sepsis. Additionally, bypass patients had longer operation time (p<0.01) and return to the operating room (aOR: 2.7; p<0.01). However, bypass patients were more likely to be discharged to home rather than to a facility (aOR: 4.2; p<0.01). Similar outcomes were observed for partially dependent patients, except that bypass patients had a longer LOS (12.40 ± 9.86 vs. 10.78 ± 9.94 days; p<0.01). Bypass for limb salvage for octogenarians does incur higher morbidities than amputation but does not increase mortality. The immediate higher morbidities of bypass should be weighed against a better chance of home discharge, which could potentially imply less functional decline.

Surgical outcomes of video-assisted neck surgery for papillary thyroid carcinoma.

New approaches to endoscopic thyroid surgery have been developed to improve cosmetic results, one of which is video-assisted neck surgery (VANS). The present study investigates the safety and effectiveness of thyroidectomy by VANS as oncologic surgery for papillary thyroid carcinoma (PTC). The subjects of this retrospective study were 121 patients with PTC, who underwent hemi-thyroid lobectomy and central lymph node dissection via open surgery (n = 102) or VANS (n = 19) at Tokushima University Hospital between 2011 and 2023. We performed 1:1 propensity score matching and then compared the surgical outcomes between the two matched groups. Propensity score matching generated 18 distinct examination pairs. The VANS group had significantly less blood loss (P = 0.003), but a longer operative time (P < 0.001) than the open thyroidectomy group. There were two cases of transient recurrent laryngeal nerve paralysis and one case of recurrence in the lateral regional lymph nodes in the VANS group. However, no significant differences were observed in the incidence of complications (P = 0.243) or recurrence (P = 0.500) between the two groups. VANS is a safe and effective surgical procedure for PTC, but longer follow-up is needed to assess tumor recurrence.

Semi-closed-circuit vacuum-assisted mini percutaneous cystolithotomy (vamPCL) in the pediatric population: Initial experience of a novel technique in native and augmented bladders.

Bladder stones (BS) in children are a rare condition and represent 1-5% of all urinary tract stones. With advances in miniaturized endoscopes and intracorporeal lithotripters, percutaneous cystolithotomy has been demonstrated to be an effective, safe and quick technique, despite the longer operative time. This limitation may be overcome by a semi-closed-circuit vacuum-assisted technology (vamPCL), characterized by a continuous inflow and a suction-controlled outflow (ClearPetra®). To assess the safety and efficacy of a vamPCL characterized by continuous inflow and suction-controlled outflow to treat bladder stones in pediatric patients with native or augmented bladder. From January 2021 up to December 2023, we prospectively collected variables on consecutive vamPCL procedures (Fig.) The stone-free rate (SFR) was defined as absence of stones or residual fragment <5mm diagnosed with ultrasound. Six patients with a median age of 139 months (55-212) were recruited for the study. Three patients (50%) with the initial diagnosis of extrophy-epispadia complex had an augmented bladder, whereas of the remaining three (50%) with an initial diagnosis of anorectal malformation two had an augmented bladder. All patients had a Mitrofanoff conduit opening on the right flank, except for one (16%) with umbilical access. The mean cumulative stone size was 24mm±14,2. The mean operating time was 78,3min±14,7. One procedure was interrupted after 90min due to the overall size (>50mm). Stone removal was achieved only via suction in all cases. All vamPCL procedures were completed without intraoperative complications. Fever for 24h (1/6; 16%) was the only post-operative complication. The mean stay of the suprapubic catheter was 3.4 days±1,5 and of the trans-Mitrofanoff catheter was 9.3 days±4,5. The SFR was confirmed in all the cases with US performed after 2 months. Only one male patient (16%) had recurrent stones after 8 months and he is waiting for second surgery. Mean follow-up was 7.2 months±9,4. In the present study we demonstrated that vamPCL is safe and feasible in selected cases especially in those with augmented bladder. To our knowledge, this manuscript is the first to present the use of the ClearPetra® for the treatment of bladder stones. To our knowledge, this manuscript is the first to present the use of the ClearPetra® for the treatment of bladder stones. The vamPCL seems to be sustainable, safe and feasible for bladder stones treatment in selected children.

Advances in Robotic and Laparoscopic Gastrectomy for Gastric Cancer: A Comparative Review of Surgical Outcomes and Techniques

The comparison between robotic and laparoscopic gastrectomy in gastric cancer treatment has sparked considerable interest due to the unique benefits and limitations of each technique. Both approaches aim to provide minimally invasive alternatives to open surgery to reduce morbidity and enhance recovery. Robotic surgery offers enhanced precision and three-dimensional visualization, potentially improving oncological outcomes, particularly in complex cases. However, it also incurs higher costs and longer operative times, which may impact accessibility and resource allocation, especially in lower-resource settings. In contrast, laparoscopic gastrectomy remains a widely adopted, cost-effective approach with established efficacy in early-stage tumors but may be limited in more advanced cases requiring extensive lymphadenectomy. This review evaluates critical factors such as operative duration, oncological radicality, cost-effectiveness and long-term survival while exploring the potential role of artificial intelligence in robotic surgery. We address the challenges of implementing robotic systems in low- and middle-income countries and examine the psychological impact of surgical choice on patient outcomes. Although both techniques have demonstrated favorable short-term outcomes, there remains a need for long-term, large-scale studies to determine their comparative effectiveness in survival and recurrence. Comprehensive guidelines tailored to tumor staging and patient characteristics are essential to optimize the surgical approach. This review highlights the current knowledge gaps and suggests directions for future research to advance minimally invasive surgical options for gastric cancer.

Comparing combined paravaginal repair with pubocervical fascia plication versus standard anterior colporrhaphy for the treatment of stress urinary incontinence in women with anterior vaginal wall prolapse: a randomised controlled trial.

Stress urinary incontinence (SUI) is prevalent among women, often occurring alongside anterior vaginal wall prolapse. This study compares the efficacy and safety of an improved vaginal wall repair technique with pubocervical fascia fixation versus standard anterior colporrhaphy for treating SUI in women with anterior vaginal wall prolapse. A single-centre, parallel-group, randomised controlled trial was conducted between September 2021 and June 2024. Women aged 40-70years with symptomatic SUI and stage 2-3 anterior vaginal wall prolapse were randomised to either the improved repair group or the standard repair group. The primary outcome was patient-reported success at 12months post-surgery, defined as 'very much improved' or 'much improved' on the Patient Global Impression of Improvement scale. Secondary outcomes included objective cure rates, quality of life scores, urodynamic parameters, anatomical outcomes, perioperative outcomes and adverse events. A total of 102 women were randomised (51 in each group). At 12months, the patient-reported success rate was significantly higher in the improved repair group (94.1% vs 78.4%, p = 0.019). The objective cure rate was also higher in the improved repair group (90.2% vs 74.5%, p = 0.038). Quality of life scores and urodynamic parameters showed greater improvements in the improved repair group. Anatomical success was achieved in 92.2% of the improved repair group compared with 80.4% in the standard repair group (p = 0.048). The improved repair technique was associated with longer operative time but lower estimated blood loss, shorter hospital stay and quicker return to normal activities. The overall complication rate was lower in the improved repair group (11.8% vs 23.5%, p = 0.043). The improved vaginal wall repair with pubocervical fascia fixation demonstrates superior outcomes compared with standard anterior colporrhaphy, with higher patient-reported success rates, improved quality of life and fewer complications.

Operative time and surgical efficiency in end-to-end versus side-to-end colorectal anastomosis for rectal cancer

Background: Side-to-end anastomosis (SEA) and end-to-end anastomosis (EEA) are widely used techniques in colorectal cancer surgery, yet their comparative outcomes remain a subject of debate. This study evaluates operative time, surgical efficiency, and functional outcomes of SEA versus EEA in patients undergoing low anterior resection for rectal cancer. Methods: A prospective observational study was conducted at Bangabandhu Sheikh Mujib Medical University, (BSMMU) Dhaka, from March to November 2023. Forty-four patients were purposively sampled and randomized into SEA and EEA groups. Intraoperative variables, postoperative outcomes, and functional results, including low anterior resection syndrome (LARS) scores, were evaluated at multiple intervals. Data were analyzed using SPSS version 25, with p&lt;0.05 considered significant. Results: The ASA PS classification and preoperative tumor stages were similar across groups. Splenic flexure mobilization was universally performed in SEA (100%) and in 90.9% of EEA patients (p=0.385). Blood loss was comparable between groups (&lt;100 mL in 90.9% of SEA and 95.5% of EEA, p=0.157). Operative time was significantly longer in SEA (183.0±10.2 minutes) compared to EEA (151.0±12.8 minutes, p&lt;0.05). Postoperative LARS scores revealed no significant differences, with major LARS observed in 39% of EEA patients and 61% of SEA patients (p&gt;0.05). Anastomotic line bleeding was infrequent in both groups, with no statistically significant differences. Conclusions: Both SEA and EEA demonstrated comparable safety and functional outcomes in rectal cancer surgery. SEA was associated with longer operative times but offered similar functional and surgical efficiency. The findings highlight the viability of both techniques, with the choice depending on patient-specific and surgical considerations.

Utility of a novel scoring system for difficulty of pure laparoscopic hepatectomy for intrahepatic cholangiocarcinoma

Despite the growing adoption of laparoscopic hepatectomy (LH) for intrahepatic cholangiocarcinoma (ICC), there is no scoring system available designed to evaluate its surgical complexity. This paper aims to introduce a novel difficulty scoring system (DSS), designated as the Wei-DSS, exclusively tailored to assess the surgical difficulty of pure LH for ICC. We retrospectively collected clinical data from ICC patients who underwent pure LH at our institution, spanning from November 2018 to May 2024. Patients were categorized into two levels of Wei-DSS scores (low-difficulty [5–6], and high-difficulty [7–10]) determined by tumor characteristics, liver texture, resection extent and tumor marker levels. A total of 104 patients were enrolled in this study including a low-difficulty (LD) group comprising 47 patients and a high-difficulty (HD) group comprising 57 patients. Perioperative comparisons indicated that the HD group was significantly associated with a longer operation time (318.14 ± 125.89 min vs. 222.83 ± 119.03 min, P < 0.001), higher rates of intraoperative blood transfusions (59.6% vs. 27.7%, P = 0.001), and increased rates of postoperative complications (84.2% vs. 48.9%, P < 0.001) compared to the LD group. The receiver operating characteristic (ROC) curve analysis indicated that the Wei-DSS demonstrated superior predictive accuracy over the Major/Minor Classification for predicting postoperative complication rates (area under the curve [AUC] 0.702 vs. 0.622) and operating time (AUC 0.720 vs. 0.604 ). The Wei-DSS score may have the potential to assist surgeons in categorizing ICC patients with varying levels of surgical difficulty of LH, though it warrants further validations across multiple centers to solidify its efficacy and reliability.

Laser technologies in treatment of arterial pathology

INTRODUCTION: Cardiovascular diseases hold a leading position in the structure of mortality in the world. Laser technologies permit to improve the outcomes of endovascular and surgical treatment of various forms of the coronary heart disease and diseases of peripheral arteries. Despite the development of technologies, laser angioplasty and endarterectomy are associated with a number of complications and often require additional intervention. AIM: To analyze currently available data on the use of lasers in treatment of arterial pathology. According to the results of analysis of the modern literature, the use of lasers confidently occupies its niche in endovascular treatment of acute coronary syndrome, chronic occlusions of the coronary and peripheral arteries, permits to optimize the results of stenting and balloon angioplasty. One main disadvantage of laser angioplasty is that in most cases the procedure combines with stenting and/or balloon angioplasty and requires more contrast agent and longer operation time. Large-scale studies on the open laser endarterectomy have not been conducted. CONCLUSION: Further study of the effect of laser on an atherosclerotic plaque and vessel wall in the open endarterectomy is a promising trend that may probably reduce the incidence of perioperative complications and improve long-term results of surgical treatment of diseases of peripheral arteries.

Robotic-assisted Kasai portoenterostomy for child biliary atresia.

The Kasai procedure (KPE) is an important treatment for biliary atresia (BA), the most common cause of neonatal obstructive jaundice. To investigate the efficacy of robotic-assisted Kasai portoenterostomy (RAKPE) in patients with BA. Clinical data of 10 patients with BA who underwent RAKPE at the Seventh Medical Center of the People's Liberation Army General Hospital between December 2018 and December 2021 were retrospectively analyzed. One patient underwent Open Kasai portoenterostomy (OKPE) due to intraoperative bleeding. Consequently, nine patients were included in this study. Fifty-two patients who underwent OKPE during the same period served as the control group. Preoperative and postoperative biochemical indexes, surgery-related indexes, and postoperative clearance of jaundice (CJ) were recorded and statistically analyzed. RAKPE was successfully completed in all nine patients, with an average total operative time of 352.2 minutes (including intraoperative cholangiography). Milk feeding resumed on an average 9.89 days postoperatively, and the average time of drainage tube removal was 18.11 days. All patients were followed up for 6 months to 2 years. The liver function indicators and bilirubin levels in 8 patients returned to normal within 3 months after surgery. Three patients developed recurrent cholangitis after discharge, with elevated white blood cell counts, liver function indicators, and bilirubin levels, requiring hospitalization for intravenous antibiotic treatment. The duration of cholangitis ranged from 5 to 8 months post-surgery. To date, no subsequent cases of cholangitis have occurred. All patients have normal liver function and bilirubin levels, with no intrahepatic bile duct dilatation on ultrasonography. Statistical analysis comparing these indicators with those of patients who underwent OKPE showed that the RAKPE group had longer operative times and postoperative drainage tube removal durations. However, there were no significant differences in intraoperative blood loss, postoperative oral milk intake resumption, postoperative hospital stay, or CJ at 3 months post-surgery. RAKPE is technically feasible, safe, and effective for treating BA. Once the technique is mastered, RAKPE may achieve CJ outcomes comparable to those of OKPE.

Robotic vs. laparoscopic gastrectomy for patients with locally advanced gastric cancer: a meta-analysis of randomized controlled trials and propensity-score-matched studies.

The role of robotic surgery for the treatment of locally advanced gastric cancer remains controversial. This meta-analysis aimed to compare the short-term outcomes between robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for patients with locally advanced gastric cancer using data collected from randomized controlled trials (RCTs) and propensity score-matched (PSM) studies. We searched PubMed, Cochrane Library, Embase, and Web of Science databases for RCTs and PSM studies comparing RG and LG. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Fifteen studies encompassing one RCT and 14 PSM studies were included, with a total of 5,079 patients (RG group: 2,279 patients; LG group: 2,800 patients). Although RG was associated with a longer operative time (MD, 19.82mins), patients may benefit from reduced blood loss (MD,-28.91mL), shorter length of stay (MD,-0.69days), lower morbidity (RR, 0.82), major complications (RR, 0.71), blood transfusion rate (RR, 0.60), conversion rate (RR, 0.38), and higher number of harvested lymph nodes (MD, 3.25). There were no significant differences observed in readmission (RR, 0.89), mortality (RR, 0.75), reoperation (RR, 0.71), and R0 resection (RR, 0.99) between the groups. In addition, RG shortened the time to to first flatus (MD,-0.38days), the time to first liquid intake (MD,-0.31days), and the time to first soft diet intake (MD,-0.20days). RG seem associated with improved short-term outcomes and enhanced postoperative recovery in locally advanced gastric cancer compared to LG. In the future, RG may become a safe and effective alternative to LG. Further research is needed to investigate long-term outcomes and confirm the promising advantages of RG in locally advanced gastric cancer.

Risk factors for mortality after 3-column osteotomy.

Three-column osteotomies (3COs), such as pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR), are used to surgically correct rigid adult spinal deformity (ASD). While extensive research exists about complications associated with 3COs, there remains a paucity of studies analyzing risk factors for mortality following 3CO. We believe the mortality rate after 3-column osteotomy will be low with specific identifiable demographic or medical risk factors. A retrospective analysis was conducted using the National Surgical Quality Improvement Program (NSQIP) database. Patients undergoing 3CO were identified via CPT codes. The primary outcome of interest was 30-day postoperative mortality. Univariate statistical analysis was performed, followed by multivariable logistic regression controlling for age, sex, and body mass index (BMI). The analysis included 1,441 patients. 446 patients had thoracic osteotomies, 996 patients had lumbar osteotomies, and 226 had multilevel osteotomies. The overall 30-day mortality rate was 1.2% (18 patients). On univariate analysis, mortality was more likely in patients with diabetes (2.8% vs. 1.2%, P = 0.029) and COPD (7.0% vs. 1.2%, P < 0.001). Mortality was associated with higher 5-factor modified frailty index (P = 0.004). After controlling for age, sex, and BMI, multivariable analysis revealed that mortality rates were independently associated with longer operative times (OR = 1.28, 95% CI:1.06-1.54, P = 0.010) and COPD (OR = 10.36, 95% CI: [2.17-49.47], P = 0.003). Thirty-day mortality after 3CO is 1.2% globally. The greatest univariate risk factors are diabetes, COPD, and frailty. Regardless of age, sex, or BMI, it was found that COPD and duration of surgery were independently associated with increased rates of mortality.

Transumbilical laparoendoscopic single-site surgery vs. multiport laparoscopic surgery for benign ovarian cysts: a retrospective cohort study

BackgroundTransumbilical laparoendoscopic single-site surgery (TU-LESS) has gained increasing attention due to the potential to maximize the benefits of laparoscopic surgery. This study aimed to compare outcomes of TU-LESS and multiport laparoscopic surgery (MLS) for the treatment of benign ovarian cysts.MethodsThis retrospective cohort study included patients with benign ovarian cysts that were admitted to the Second Hospital of Hebei Medical University between September 2010 and September 2022. Inverse probability of treatment weighting (IPTW) approach weighting were used to compare outcomes of TU-LESS and MLS for benign ovarian cysts. The primary outcome was the rate of cystic content spillage.ResultsA total of 528 patients with benign ovarian cysts were included and 236 (44.6%) patients underwent TU-LESS. The risk of cystic content spillage [relative risk (RR) = 4.37, 95% confidence interval (CI): 2.59–7.38), P < 0.001] and operation time (β = 4.94, 95% CI: 1.40–8.48, P = 0.017) during TU-LESS was significantly higher than that during MLS. While hospital stay (β=-0.10, 95% CI: -0.198 - -0.004, P = 0.043) during TU-LESS was significantly shorter. IPTW analyses yielded similar patterns of results. For ovarian cysts < 10 cm, the risk of cystic content spillage, operation time and EBL during TU-LESS was significantly higher than that during MLS (all P < 0.05). On the contrast, for ovarian cysts ≥ 10 cm, the risk of cystic content spillage, operation time and EBL during TU-LESS was significantly lower than that during MLS (all P < 0.05).ConclusionsTU-LESS had a significantly higher risk of cystic content spillage, longer operation time than MLS. While for ovarian cysts ≥ 10 cm, TU-LESS had a lower risk of cystic content spillage, shorter operation time, and less EBL than MLS. More experienced surgeons are needed to perform TU-LESS in benign ovarian cysts.